Oncology

Routine tumor–normal whole-genome sequencing quickly yields actionable findings and impacts outcomes in solid tumors

In this real-world series of 888 solid-tumor patients, paired tumor–normal whole-genome sequencing (WGS) succeeded in 89% with a median 6 working-day turnaround. Actionable biomarkers were identified in 73% of patients, including markers for reimbursed therapies in 27% and for experimental options in 63%. Within one year, 40% started reimbursed and 19% experimental biomarker-informed therapies, associated with a 31% longer median overall survival than non–biomarker-informed care. Among previously untreated patients, biomarker-informed treatment produced significantly longer overall survival than either non–biomarker-informed systemic therapy or no systemic therapy. 1

Sequential, rather than concurrent, radio-immunotherapy associates with better survival in advanced NSCLC

This territory-wide Hong Kong cohort included 335 NSCLC patients receiving radiotherapy plus immune checkpoint inhibitors within a system covering over 90% of the population. In newly diagnosed advanced NSCLC, sequential radiotherapy followed by immunotherapy achieved longer overall survival than concurrent radio-immunotherapy, 20.3 versus 16.0 months, adjusted hazard ratio 0.68. Chemotherapy receipt was also associated with improved survival in this newly diagnosed iRT cohort, highlighting the importance of systemic backbone selection. In refractory NSCLC, radiotherapy with ICI maintenance showed numerically longer survival than radiotherapy without maintenance, though the difference was not statistically significant. 2

ctDNA-guided adjuvant atezolizumab in MIBC is cost-saving and improves quality-adjusted survival

Using IMvigor011 outcomes, a three-state Markov model compared ctDNA-guided adjuvant atezolizumab with standard care for postoperative muscle-invasive bladder cancer from a US payer perspective. Over five years, the ctDNA-guided strategy yielded 3.05 QALYs at $78,796 versus 2.92 QALYs at $131,601 with standard care. This produced an incremental cost-effectiveness ratio of −$397,163 per QALY gained, indicating greater benefit at substantially lower cost. Sensitivity analyses showed ctDNA guidance remained cost-effective across willingness-to-pay thresholds from $50,000 to $150,000 per QALY. 3

FOLFOXIRI/bevacizumab plus nivolumab delivers high responses in first-line RAS/BRAF-mutant MSS mCRC

The phase II NIVACOR trial evaluated first-line FOLFOXIRI/bevacizumab plus nivolumab in 73 patients with RAS/BRAF-mutated metastatic colorectal cancer, predominantly pMMR/MSS. Objective response rate was 76.7% and disease control rate 97.3%, meeting the primary endpoint in this typically IO-resistant population. Median progression-free survival was 10.1 months, and median overall survival was not reached at the time of reporting. Grade 3 or higher treatment-related adverse events occurred in 65.8% of patients, reflecting substantial toxicity with this intensified regimen. 4