This Week in Oncology: New Approvals, Surgical Advances, and Biomarker Insights

This week's oncology research highlights significant therapeutic advances and practical management strategies. The FDA granted accelerated approval to adagrasib (Krazati) for KRAS G12C-mutated NSCLC as monotherapy and for colorectal cancer in combination with cetuximab, offering new targeted options for these historically difficult-to-treat mutations. In surgical oncology, a meta-analysis of 1,185 patients from three randomized trials provides strong evidence that VATS lobectomy improves overall survival compared to open surgery for early-stage NSCLC, with a 21% mortality risk reduction, supporting its prioritization when technically feasible.

Several studies offer refined approaches to existing treatments. In stage III dMMR colon cancer, the addition of atezolizumab to mFOLFOX6 chemotherapy improved 3-year disease-free survival by 10.1 percentage points (86.3% vs. 76.2%), suggesting a new standard for this biomarker-defined subgroup. For ER+/HER2- breast cancer, the SERENA-3 trial identified camizestrant 75 mg as a well-tolerated, maximally effective dose for ER degradation, achieving approximately 65% reduction in ER expression within 5-7 days. In multiple myeloma with extramedullary disease, a phase 2 trial of frontline selinexor-VRD (SVRD) showed promising activity, with an 89.7% overall response rate and complete EMD resolution in 79.3% of 29 patients.

Research also focused on supportive care and complication management. A randomized trial found that guided breathing virtual reality (VR) reduced post-PTBD opioid use by 64% compared to conventional VR, offering a non-pharmacologic adjunct for pain control. For venous thromboembolism, two studies provide nuanced guidance: a companion report from the ONCO PE trial suggests home treatment may be an option for active cancer patients with low-risk PE (sPESI=1), with a 4.6% major bleeding rate observed, while a prespecified analysis of the ONCO DVT study supports 12 months over 3 months of edoxaban for preventing recurrent VTE in cancer-associated isolated distal DVT, regardless of anemia status.

Biomarker studies offered prognostic insights. A meta-analysis of 963 patients with leptomeningeal metastases found that adverse baseline CSF ctDNA status was associated with worse overall survival (HR 2.40) and progression-free survival (HR 2.45), and longitudinal increases predicted poorer outcomes. In retinoblastoma, a meta-analysis of 521 patients linked higher TFF1 expression to a 43% reduced risk of bilateral disease, suggesting its potential as a diagnostic and prognostic biomarker.

Collectively, this week's findings underscore a continued trend toward personalized, biomarker-driven therapy, minimally invasive surgical techniques, and improved management of cancer-related complications. The new FDA approval for KRAS G12C inhibition, the survival benefit of VATS lobectomy, and the positive data for immunotherapy in dMMR colon cancer are particularly practice-informing. Future research will need to confirm these findings in larger, longer-term studies and further integrate novel biomarkers into routine clinical decision-making.