Chemotherapy-free regimen of targeted agent and immunotherapeutic superior to imatinib and chemotherapy among adult patients with Ph-positive ALL

 Findings from the phase III GIMENA ALL2820 study, focusing on "the superiority of a frontline chemotherapy-free targeted and immunotherapeutic approach over conventional treatment in adult patients with newly diagnosed Philadelphia-positive acute lymphoblastic leukemia" was recently published in the New England Journal of Medicine.  The authors of the study also acknowledged the challenges in obtaining marketing authorization for patients with newly diagnosed Philadelphia-positive acute lymphoblastic leukemia, "with overall costs of this new regimen [remaining] beyond the budget of many healthcare systems." 

Click here to read more about this study. 

Sources mentioned: 

• Chiaretti S, Piciocchi A, Skert C, et al. for the GIMEMA Investigators. Ponatinib–Blinatumomab or Imatinib–Chemotherapy for Adult Ph-Positive ALL . N Engl J Med 2026;395(15):1483-1494.  
• Fielding AK. Chemotherapy-free Treatment of Ph-Positive ALL . N Engl J Med 2026;395(15):1542-1544. 

How can oncologists keep up with the pace of cancer research

 A recent posting on the European Society for Medical Oncology (ESMO) website raises discussion of the numerous advances in understanding, diagnosis, and care in cancer over the past decades. New frameworks, classification methods, and guidelines have necessitated new training regimens for oncologists, with claims that "there is only so much time before what a clinician learns in their training is superseded by new findings."   ESMO has also been updating their living guidelines, "offering a complete and continuous updated overview of patient management for various types of cancer." 

Click here to learn more. 

Grey Horizon postings will resume week of September 21st

 To all Grey Horizon readers, 

Thank you for your continued support of this blog.  

Postings will resume the week of September 21, 2026. 

Potential role of an activated tumour immune microenvironment in predicting benefit from atezolizumab for triple-negative breast cancer

 Findings from a multicentre, multinational, double-blind, placebo-controlled phase III trial on the "addition of atezolizumab to a standard taxane-carboplatin-anthracycline-based neoadjuvant chemotherapy regimen" for patients with stage III triple-negative breast cancer was recently published in Nature Medicine.  According to trial results, atezolizumab significantly improved progression-free survival "when added to nab-paclitaxel for first-line treatment of metastatic, PD-L1-positive triple-negative breast cancer.  Further, progression-free survival also improved early-stage triple-negative breast cancer "with a trend for improved long-term outcomes when added to taxane-anthracycline-based neoadjuvant chemotherapy." 

Click here to learn more about this study. 

Study mentioned: 

Loibl S, Tang G, Nekljudova V, et al. Atezolizumab in early triple-negative breast cancer: the randomized phase 3 NSABP B-59/GeparDouze trial . Nature Medicine; Published online 1 September 2026. DOI: https://doi.org/10.1038/s41591-026-04565-6

No overall survival benefit from continuous as compared with fixed-duration maintenance therapy with lenalidomide in patients with newly diagnosed multiple myeloma

 Results from ENDURANCE, a randomized open-label phase III trial to determine duration of maintenance therapy in patients with newly diagnosed myeloma, has shown that "indefinite-duration maintenance with lenalidomide did not appear to have an overall survival benefit...compared to fixed-duration maintenance therapy for 2 years after induction therapy."  Further, progression-free survival after 7 years was 36.1% for the indefinite-duration group compared to 29.7% in the fixed-duration group. 

Click here to read more about the ENDURANCE study 

Sources mentioned: 

• Kumar S, Jacobus S, Cohen, A, et al. Continuous or Fixed-Duration Maintenance Therapy in Multiple Myeloma . N Engl J Med 2026;395(3):221-232.
• Mian H, Costa LJ. Time to Stop? Rethinking the Duration of Maintenance Treatment in Multiple Myeloma . N Engl J Med 2026;395(3):302-303.

Ovarian reserve better indicator of adjuvant chemotherapy benefit than self-reported menopause status, age, or other hormone levels

 Findings from the RxPONDER trial, whereby adjuvant chemotherapy followed by endocrine therapy compared with endocrine therapy alone has shown that "women with low pretreatment serum anti-Mullerian hormone (AMH) were unlikely to benefit from chemotherapy, even if younger than 50 years." In addition, AMH, a known measure of ovarian reserve, found that "usage of ovarian function suppression was low in premenopausal participants, with only 6% and 19% in the chemotherapy followed by endocrine therapy and endocrine therapy arms" respectively, thus the unmet need to determine benefit from adjuvant chemotherapy in order to avoid overtreatment especially in younger women.

Click here to read more about this study. 

Sources mentioned: 

Kalinsky K, Barlow WE, Pathak HB, et al. Ovarian reserve as a measure of adjuvant chemotherapy benefit in hormone receptor positive (HR-positive), HER2-negative, node-positive breast cancer in SWOG S1007 (RxPONDER) . Annals of Oncology; Published online 24 July 2026. DOI: 10.1016/j.annonc.2026.05.697

Valenza C, Partridge AH. Measurement of ovarian reserve to tailor systemic therapy decisions: future potential or ready for primetime? Annals of Oncology; Published online 8 July 2026. DOI: 10.1016/j.annonc.2026.07.002

Benefit of adjuvant chemotherapy in patients with ctDNA-positive resected stage II colon cancer

 The CIRCULATE study, comprised of investigators from Arbeitsgemeinschaft Internistische Onkologie (AIO) and the Austrian Breast and Colorectal Cancer Study Group (ABCSG) "evaluated a treatment escalation strategy [to determine] whether patients with circulating tumour DNA (ctDNA)-positive status would benefit from capecitabine-based adjuvant chemotherapy after resection for stage II colon cancer".  While the study could not be fully completed due to lapse of funding, preliminary results indicated that time to recurrence and disease-free survival were improved with chemotherapy vs. observation: 3-year recurrence was 19% vs. 62%, while 3-year disease-free survival was 77% compared to 38%.  

Click here to read more. 

Sources mentioned: 

• Folprecht G, Stasik S, Reinacher-Schick, et al. Chemotherapy for patients with circulating tumour DNA-positive, stage II colon cancer (CIRCULATE)—an AIO/ABCSG trial . Annals of Oncology; Published online 31 May 2026. DOI: 10.1016/j.annonc.2026.05.001
• 
  
• Folprecht G, Stasik S, Christmann J, et al. Disease-free survival (DFS) and time to recurrence (TTR) with circulating tumor (ct) DNA–based decision for adjuvant treatment in colon cancer stage II (CIRCULATE): An AIO (KRK-0217)/ABCSG trial . J Clin Oncol 2026;44:(suppl 17; abstr LBA3500).
• 
  
• Tarazona N, Parikh A. ctDNA-guided adjuvant therapy in stage II colon cancer: a step forward, but not the final word . Annals of Oncology; Published online 11 June 2026. DOI: 10.1016/j.annonc.2026.06.002

Aiming to improve cancer prevention, ESMO calls for strong policy measures to fight the tobacco epidemic

 The European Society for Medical Oncology (ESMO) recently submitted its response to the European Union in regards to the Tobacco Products and Tobacco Advertising directives.  As per ESMO, "up to 40% of all cancers are preventable...robust tobacco cessation policies are among the most effective strategies for reducing the risk of cancer, improving human health, and reducing cancer cases."  According to the International Agency for Research on Cancer (IARC), 7 000 000 million people worldwide die from tobacco use each year (700,000 deaths in Europe alone), contributing to 25% of all cancer-related deaths.  

Click here to read the full ESMO report. 

Blood test may help identify which colorectal cancer patients with liver metastases are most likely to benefit from chemotherapy after surgery

Research recently present at the European Society for Medical Oncology (ESMO) Gastrointestinal Cancers Congress in Munich, Germany, indicates that a blood test may identify colorectal cancer patients which has metastasized to the liver and thus "most likely to benefit from chemotherapy after surgery."   Known as GALAXY, the joint phase II study between researchers and collaborations from Hyogo Medical University in Japan and the University of Oxford determined that "among patients with detectable ctDNA who underwent upfront surgery, those who received adjuvant chemotherapy had substantially better outcomes...[with] a markedly lower risk of cancer recurrence and death, including a 93% reduction in the risk of recurrence." 

To learn more about the GALAXY study, click here. 

Sources mentioned: 

1. 8O“ctDNA status and adjuvant chemotherapy after resection of colorectal liver metastases: an overall survival analysis of the GALAXY study” will be presented by Koza Kataoka during Proffered Paper session on Friday, 3 July, 16:30-18:00 CEST, in Room 14
2. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians. 2024;74(3):229–263.
3. Folkerts AD, Janczewski LM, Merkow RP, et al. Liver-directed therapies for colorectal liver metastases. Cancer. 2025;e70097.
4. Kataoka K, Mori K, Nakamura Y, et al. Survival benefit of adjuvant chemotherapy based on molecular residual disease detection in resected colorectal liver metastases: subgroup analysis from CIRCULATE-Japan GALAXY. Annals of Oncology. 2024;35(11):1015–1025.

ESMO joins WHO global clinical trials forum to strengthen global oncology research ecosystems

 Earlier this month (June 5, 2026), the European Society for Medical Oncology (ESMO) joined the World Health Organization's Global Clinical Trials Forum, "reinforcing its long-standing collaboration...to advancing more equitable, high-quality clinical research worldwide." This new partnership further strengthens the mission of ESMO to provide equal access to best possible treatments for cancer patients worldwide. 

Click here to read more. 

Grey Horizon postings will resume week of June 22, 2026

  To all Grey Horizon readers, 

Thank you for your continued support of this blog.  Postings will resume the week of June 22, 2026. 

Metastasis-directed therapy for oligometastatic solid tumours in histology-specific context

 Findings from EXTEND, "a multicentre, open-label, parallel group, superiority-design phase II randomized study conducted among patients with oligometastatic solid tumours" was recently presented at the European Society of Radiotherapy and Oncology (ESTRO) Congress in Stockholm.  EXTEND is the first randomized study for oligometastatic kidney cancer, a phase II ASTROS trial "comparing metastasis-directed therapy followed by pembrolizumab or surveillance." The EXTEND trial thus emphasizes consideration of control arm with potential adaption to novel systemic therapies. 

Click here to learn more about the EXTEND trial. 

Source mentioned: 

Sherry AD, Haymaker C, Wang S, et al. Addition of Metastasis-Directed Therapy to Standard of Care for Oligometastatic Solid Tumors: Primary Analysis of All Tumor-Histology Baskets of the Phase II Randomized EXTEND Trial . JCO; Published online 16 May 2026. DOI: 10.1200/JCO-25-02856

A single colonoscopy reduces colorectal cancer risk, but not mortality

 Findings from the NordiCC (Nordic Colorectal Cancer) group, a 13-year follow-up study that "enrolled men and women aged 55-64 years, who were randomly allocated to colonoscopy screening or no screening" was recently published in The Lancet.  Study authors commented that they did not observe a clinically relevant cancer stage shift between the screening and non-screened groups of participants.  Further, "stage shift of cancer due to screening applies only to cancers detected at screening or surveillance after screening."  At 13 year follow-up, screening-detected colorectal cancer only occurred in 16% in the screening group; "cancers detected later were due to clinical symptoms, as there was no colonoscopy screening."  

Click here to read more about the NordiCC study. 

Sources mentioned: 

• Kaminski M, Kalager M, Løberg, et al. for the NordiCC Study Group. Long-term effects of colonoscopy screening on colorectal cancer incidence and mortality: a multicountry, population-based randomised controlled trial . The Lancet; Published online 4 May 2026. DOI: 10.1016/S0140-6736(26)00508-8
• 
  
• Shaukat A. Colonoscopy, cancer prevention, and the new arithmetic of benefit . The Lancet; Published online 4 May 2026. DOI: 10.1016/S0140-6736(26)00794-4

Towards a chemotherapy-free future in breast cancer?

 New research, set to be discussed at the European Society for Medical Oncology [ESMO] Breast Cancer Congress (May 6-8, 2026 in Berlin) purports that "a less intensive chemotherapy regimen is associated with improved quality of life for patients, without compromising clinical outcome."  Traditional approaches to treatment, with an intent to extend treatment for several years to maximize tumour control, may lead to "unnecessary toxicities and treatment burden."  Multimodal strategies are being explored to de-escalate treatments, such as removing carboplatin from chemotherapy in a neoadjuvant setting, or a positron emission tomography (PET)-guided strategy "associated with a high 3-year invasive disease-free survival rate in patients with HER-2 positive early breast cancer who omitted chemotherapy." 

Click here to read more: 

Sources mentioned (conference abstracts) 

Llombart Cussac A, et al. Chemotherapy-free, pathological complete response (pCR)-guided strategy with trastuzumab-pertuzumab (HP) and T-DM1 in HER2+ early breast cancer (EBC): PHERGain-2. ESMO Breast Cancer 2026. Abstract 214O

Rapesta G, et al. Health policy and real-world strategies in early-stage HER2-positive breast cancer: results from an international survey within the DEFINITIVE project. ESMO Breast Cancer 2026. Abstract 223P

Clinical activity of elraglusib with gemcitabine and nab-paclitaxel in first-line treatment of patients with metastatic pancreatic ductal adenocarcinoma

Results of an open-label phase II randomized study, conducted at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago has unveiled "a 2.9-month improvement in overall survival in elraglusib with gemcitabine plus nab-paclitaxel arm and a 1-year survival rate of 44.1% vs. 22.3% with gemcitabine plus nab-paclitaxel in patients with previously untreated metastatic pancreatic ductal adenocarcinoma."   Due to these findings, additional studies are currently underway investigating the effects of elraglusib together with immune checkpoint inhibitors. 

To learn more about this study, click here. 

Source mentioned: 

Mahalingam D, Shroff RT, Carneiro BA, et al. Elraglusib and chemotherapy in metastatic pancreatic ductal adenocarcinoma: a randomized controlled phase 2 trial . Nature Medicine; Published online 14 April 2026. DOI: https://doi.org/10.1038/s41591-026-04327-4

Phenotypic profiling in pancreatic cancer: promise meets practical limits

Findings from the COMPASS trial, aimed at establishing "the feasibility of a comprehensive real-time genomic analysis of pancreatic ductal adenocarcinoma (PDAC) using whole genome sequencing and RNA sequencing".  While phenotypic profiling has been shown to be effective in treatment-based outcomes, a significant challenge is the 1.5-2 months of time required to receive whole genome sequencing results. 

Click here to learn more. 

Rare cancer patients still have limited access to personalized care in Europe

 Findings from a recent study presented at the ESMO Sarcoma and Rare Cancer Congress indicate a substantial gap between precision oncology and real-world access to high-quality cancer treatments, with "only one in five patients with advanced rare cancers able to access treatment matched through individual molecular profiling."   In addition, the study found very limited patient enrollment in clinical trials for rare cancer care; out of 304 patients recommended for clinical trials, only 6 were enrolled." 

Click here to learn more. 

Program details: Morfouace M, et al.Final analysis of the pan-European Arcagen study for molecular profiling and access to treatment for rare cancers: A joint EORTC-EURACAN initiative. ESMO Sarcoma and Rare Cancers Congress 2026 - Abstract 81MO

European Parliament (EP) draft report on Psychosocial Risks at Work (PSR) as a critical opportunity to protect the wellbeing of the cancer workforce

The European Society for Medical Oncology (ESMO) recently unveiled a draft report on "preventing work-related psychosocial risks that can lead to burnout in oncologists."  Targeted measures mentioned in the report include adequate staffing levels, worker control over workload, flexible scheduling, limits on overtime, and enhanced job security.   

Click here to read the draft report. 

Redesigning oncology clinical trials with agentic AI

 

Over the past few years, artificial intelligence (AI) has placed an increasing role in cancer research. AI tools "can be used to help improve the next generation of treatment options for patients in key tumour areas, leveraging real-life data...to combine new and existing therapies."   At the recent European Society of Medical Oncology (ESMO) Targeted Anticancer Therapies Congress, the following notion was brought forth: "AI is not the future - it is the present.  By learning how to best harness its power, we can help increased the speed and efficiency of personalized care delivery."  

Click here to learn more. 

Programme details

Reis-Filho J. Transforming R&D with AI. ESMO Targeted Anticancer Therapies Congress 2026 - Educational Session: The agentic AI advantage: Optimising oncology clinical trials

New survey highlights the role of clinical practice guidelines to improve care for patients with rare cancers

 Results from a recent ESMO (European Society for Medical Oncology) and EURACAN (European Reference Network to Cancers) had led to a "call for policy action to standardize care pathways for rare cancers after analysis links guidance adherence to patient survival").  According to the survey, conducted between September - October 2025, patients with rare malignancies equate to 650,000 new cases per year, representing 24% if all cancer diagnoses across Europe.  

ESMO and EURACAN thus propose the following actions: 

• Centralize rare cancer surgeries in accredited centres  
• Enforce mandatory multidisciplinary decision-making and time-critical standards throughout patient diagnosis, treatment, and follow-up
• Track adherence to established Clinical Practice Guidelines via national dashboards

Click here to learn more

Overall survival not substantially improved with CDK4/6 inhibitors used in first- compared with second-line treatment in Patients with HR-positive, HER2-negative advanced breast cancer

 Findings from SONIA, a phase III Dutch study comparing "the sequence of an aromatase inhibitor plus CDK4/6 inhibitor as first-line treatment followed by fulvestrant as second-line treatment (CDK4/6 inhibitor first-line group") did not improve overall survival compared with second-line treatment. Rather, this treatment regimen increased treatment-related and financial toxic effects in patients with HR-positive HER-2 negative advanced breast cancer.  Following an analysis of 1050 patients enrolled in SONIA, median overall survival was 47.9 months with first-line CDK4/6 inhibitor and 48.1 months with second-line CDK4/6 inhibitor  

To learn more about the SONIA study, click here. 

Sources mentioned: 

• Wortelboer N, van Ommen-Nijhof A, Konings IR, et al. Overall Survival With First-Line vs Second-Line CDK4/6 Inhibitor Use in Advanced Breast Cancer A Randomized Clinical Trial  JAMA Oncology; Published online 19 February 2026. doi: 10.1001/jamaoncol.2025.6585
• 
  
• Valenza C, Burstein HJ. Lessons From the SONIA Trial on Timing of CDK4/6 Inhibitors in Advanced Breast Cancer—The Sooner, the Better? JAMA Oncology; Published online 19 February 2026. doi: 10.1001/jamaoncol.2025.6345

Research unlocks insights into lung cancer evolution from electronic medical records

 A recently completed study at the University Hospital of Toulouse, France emphasized the benefits of a "domain-specific natural language processing (NLP) pipeline...in extracting clinically meaningful information from diverse clinical documents of patients with non-small cell lung cancer."  Following an analysis of 1,028 discharge summaries and external consultation letters from 120 non-small cell lung cancer patients undergoing oral targeted therapy, "the domain-adapted NLP solution achieved an F1 score of 79.7% for tumor evolution concept extraction and 62.0% for temporality alignment." 

To read more about this study, click here. 

Source mentioned: 

Vinot, C., et al. "Automated extraction of temporalized tumor evolution from oncology EMRs using natural language processing." ESMO Real World Data and Digital Oncology 11 (2026): 100660.

Worse survival among patients diagnosed with cancer during first 2 years of the COVID-19 pandemic

A recently published U.S. population-based cohort study found "significant reductions in 1-year cause-specific survival rates among patients diagnosed with both early-stage and late-stage cancer in 2020 and 2021."   Compared to cancer patients diagnosed between 2015-2019, patients with a diagnosis of esophageal cancer (early-stage, 3.67%-3.89%), colorectal cancer (0.78%-1.08%) and prostate cancer (late-stage, 0.64%-0.77%)), were noted to have the largest site-specific survival reductions during the first 2 years of the COVID-19 pandemic.  The authors of this cohort study thus propose that "swift action should be taken to increase cancer screening, rebuild healthcare capacity, and improve patient communication." 

Source mentioned:

Burus T, Damgacioglu H, Huang B, et al. Survival of Patients Diagnosed With Cancer During the COVID-19 Pandemic . JAMA Oncology; Published online 5 February 2026. doi:10.1001/jamaoncol.2025.6332

Trustworthy and explainable AI – a key to equitable oncology

Trustworthiness of artificial intelligence (AI) applications and validating data analysis in cancer care was recently discussed at the ESMO Women for Oncology Forum.  

Click here to read about an interview with Alessandra Pedrocchi, founder of the laboratory for oncology at the National Cancer Institute in Milan.  

RAS inhibition in pancreatic cancer

 The Experimental Oncology Group at the National Research Centre (CNIO) in Madrid has recently unveiled findings from genetically engineered mice afflicted with pancreatic ductal adenocarcinoma.  The mice "underwent rapid apoptotic cell death that resulted in complete tumour regressions and remained tumour-free for over 200 days post-treatment."  While results of these animal studies are promising towards determining therapeutic vulnerabilities of pancreatic cancer, Dr. Ben Westphalen, chair of the European Society of Medical Oncology (ESMO) Precision Oncology Task Force cautions that these results cannot yet be applied to patient care. More work is needed to determine side effects of the triple combination therapy in humans. 

Click here to learn more about this news story. 

Structured exercise enters ESMO guidelines for colon cancer as recommended treatment

 The European Society of Medical Oncology (ESMO) has released an update to their colon cancer guidelines, whereby "physical activity, when personalized and delivered as a structured program" is now recommended...for patients with resected stage III or high-risk stage II colon cancer." Over a period of 3 years, 889 stage III or stage II high-risk colon cancer patients enrolled in the CHALLENGE study saw significant improvements in disease-free survival over 5 years (80.3%) compared to 73.9% of patients who received health education materials and standard surveillance with no structured exercise program. 

Click here to learn more about the CHALLENGE study. 

European parliament adopts its position on the Critical Medicines Act, strengthening security of cancer care in Europe

 The European Parliament recently adopted first-reading of the Critical Medicines Act, expanding "collaborative procurement and solidarity mechanisms, explicitly acknowledging their relevance to specialized treatments, including in oncology."  Now entering interinstitutional negotiations, the Critical Medicines Act ensures that continuity of care for cancer patients will remain a key focus area for European Union health policy. 

To read more about the Critical Medicines Act, click here. 

Biological mechanism enabling breast cancer to spread to the brain uncovered

Researchers from the Gray Faculty of Medical and Health Sciences in Tel Aviv, in partnership with researchers in 14 laboratories in Israel, USA, Italy, Germany, Poland, and Austria, have uncovered "a mechanism that allows breast cancer to send metastases to the brain - a highly lethal occurrence for which there is currently no effective treatment."   Following injection of cancer cells with or without functional gene P53, results indicated that "cells with disrupted P53 activity thrived much more." These findings are crucial towards developing new drugs and personalized monitoring for early detection and treatment of brain metastases. 

Click here to learn more. 

Source: 

Laue K, Pozzi S, Zerbib J, et al. p53 inactivation drives breast cancer metastasis to the brain through SCD1 upregulation and increased fatty acid metabolism. Nat Genet. Published online December 29, 2025. doi:10.1038/s41588-025-02446-1

Grey Horizon postings will resume week of January 5, 2026.

 To all Grey Horizon readers, 

Thank you for your continued support of this blog.  Postings will resume the week of January 5, 2026. 

Season's Greetings and all the best for the new year.  

Neoadjuvant immunotherapy and understanding anticancer immunity

 Study results currently being presented at the ESMO Immuno-Oncology Congress (held in London, England, December 10-12, 2025) showcase the rise of neoadjuvant immunotherapy studies "from small investigator-led window-of-opportunity...to standard of care paradigms across various tumour types."  Using triple-negative breast cancer and early-stage non-small cell lung cancer as examples, treating patients before surgery provides "access to living tumour ecosystems responding - or not- to immunotherapy." 

Click here to read more and note the Immuno-Oncology Congress program details below: 

Mulder K, et al. Residual tumour immune microenvironment shapes relapse risk in early TNBC following immunotherapy. ESMO Immuno-Oncology Congress 2025 - Abstract 328MO

Nijman H, et al. Neoadjuvant immune checkpoint inhibition skews the B cell response in mismatch repair deficient endometrial cancer. ESMO Immuno-Oncology Congress 2025 - Abstract 329MO

Pircher A, et al. Neoadjuvant induction with pembrolizumab (Pembro) plus lenvatinib (Len) in resectable early-stage NSCLC impacts the tumor microenvironment (TME): Clinical results including multi-omic deconvolution of the TME from the INNWOP01 study. ESMO Immuno-Oncology Congress 2025 - LBA1