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Highlights From The 2026 American Society of Clinical Oncology (ASCO) Annual Meeting |
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| Clinico-Transcriptomic Risk Stratification to Guide Abiraterone Treatment Intensification in High-Risk Prostate Cancer: A Combined Analysis of NRG/RTOG 9202, 9413, 9902, and 0521
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| Krishnan Patel, MD
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| Krishnan Patel presented a combined analysis showing that a 22-gene genomic classifier adds prognostic value beyond standard clinical risk factors in high-risk prostate cancer and can identify a meaningful subgroup of patients with discordant clinical and biomarker risk. A simple clinical-transcriptomic model may help guide abiraterone intensification, with the highest-risk patients appearing most likely to benefit from adding abiraterone to radiation plus ADT.
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| Assessment of the Ability of Decipher Prostate Genomic Classifier >0.85 to Identify Patients Who Benefit from Adding Docetaxel to ADT + Enzalutamide: Level 1B Evidence from the ENZAMET Study
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| Christopher Sweeney, MBBS
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| Chris Sweeney presented ENZAMET biomarker analysis data suggesting that the Decipher Prostate Metastatic Classifier can help identify which men with mHSPC are most likely to benefit from adding docetaxel to ADT plus enzalutamide. Patients with DPMC scores >0.85 appeared to benefit from triplet therapy, while those with lower scores did not clearly benefit and may even do better without docetaxel.
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| Al-Inferred Spatial Gene Expression from H&E Predicts Docetaxel Benefit in Metastatic Hormone-Sensitive Prostate Cancer (CHAARTED / E3805)
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| Sebastian Medina, MSc
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| Sebastian Medina presented a retrospective CHAARTED biomarker analysis showing that a virtual spatial transcriptomic classifier, inferred from routine H&E slides, can identify mHSPC patients who benefit from adding docetaxel to ADT. Biomarker-positive patients had a significant overall survival benefit with docetaxel, while biomarker-negative patients did not, suggesting this approach could spare some men from unnecessary toxicity.
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| Precision Oncology: How to Apply New Biomarkers in Clinical Practice
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| Joshua Lang, MD, MS
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| Joshua Lang presented a discussant overview of three recent ASCO 2026 biomarker studies in prostate and germ cell cancers, emphasizing that while genomic classifiers and circulating miRNAs show strong prognostic value, their predictive utility for guiding treatment intensification remains uncertain. Integrated clinical-transcriptomic models and AI-inferred spatial gene expression may help identify patients most likely to benefit from therapies like abiraterone or docetaxel, but prospective randomized trials (e.g., NRG-GU009/PREDICT-RT) are still needed to validate clinical utility before routine adoption.
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| A Phase 2 Trial of ADT Interruption in Patients Responding Exceptionally to Androgen Receptor Pathway Inhibitor in mHSPC (A-DREAM / Alliance A032101)
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| Atish Choudhury, MD, PhD
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| Atish Choudhury presented results from the phase 2 A-DREAM trial showing that in men with mHSPC who achieved an exceptional response, interrupting both ADT and ARPI was feasible and safe for a substantial subset. The data showed that 41% remained treatment-free with testosterone recovery at 18 months, 38.5% stayed off therapy at a median 26.9-month follow-up, and outcomes were favorable—though high-volume disease predicted earlier need to restart treatment.
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| Cognitive Effects of Darolutamide vs Enzalutamide: Results of ARACOG (AFT-47), a Randomized Clinical Trial from the Alliance for Clinical Trials in Oncology
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| Alicia Morgans, MD, MPH
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| Alicia Morgans presented the ARACOG randomized trial showing that enzalutamide caused significantly greater decline in objective cognitive function than darolutamide over 24 weeks, particularly in working memory, visual memory, executive function, and attention. Darolutamide preserved cognitive performance (with expected learning effects) while enzalutamide did not, and that only patients on enzalutamide crossed over to the other drug due to cognitive/neurologic changes, supporting darolutamide’s more favorable CNS safety profile.
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| Minimizing Toxicity and Maximizing Patient Benefit in Prostate Cancer
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| Catherine Marshall, MD, MPH
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| Catherine Marshall presented a discussant overview emphasizing how to balance efficacy and toxicity when selecting upfront therapy for metastatic hormone-sensitive prostate cancer, including whether to use docetaxel, choose abiraterone versus an ARPI, and pick among ARPIs based on side-effect profiles. Darolutamide appears to have a more favorable cognitive toxicity profile than enzalutamide (supported by ARACOG). While continuous ADT remains standard, the A-DREAM trial reopening the question of safe treatment interruption in exceptional responders warrants prospective validation before changing practice.
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