ESMO 2026

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Palex80

Palex80

RAD ON
15+ Year Member
ESMO 2026 will be in Madrid, Spain this October.

Some abstract titles have already been announced. Here's some interesting RadOnc stuff.

1.
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We already know that Keynote-975 is negative, based on a company press release. I assume the French trial may also show similar results.


2.
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Since this "only" a rapid oral session, I have the feeling it's going to be negative. This would be very bad.


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5.
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Re Omission of RT after BCS for breast cancer: I’ll save everyone some time:

Like LUMINA, CALGB and Prime 2: omitting RT in older, lower risk ER+ patients doesn’t impact OS, but it does greatly reduce local recurrence.

Depending on what the authors were going for, they will either conclude that it’s indicated for LC or not indicated for lack of OS advantage.
 
Palex80 said:
ESMO 2026 will be in Madrid, Spain this October.

Some abstract titles have already been announced. Here's some interesting RadOnc stuff.

1.
View attachment 423139
View attachment 423135
We already know that Keynote-975 is negative, based on a company press release. I assume the French trial may also show similar results.


2.
View attachment 423137
Since this "only" a rapid oral session, I have the feeling it's going to be negative. This would be very bad.


3.
View attachment 423138


4.
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5.
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The TOP-1 study strikes me as cruel/sadistic
 
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thesauce said:
Re Omission of RT after BCS for breast cancer: I’ll save everyone some time:

Like LUMINA, CALGB and Prime 2: omitting RT in older, lower risk ER+ patients doesn’t impact OS, but it does greatly reduce local recurrence.

Depending on what the authors were going for, they will either conclude that it’s indicated for LC or not indicated for lack of OS advantage.
Click to expand...
It's an amazing conclusion. LR exceeded the prespecified threshold, but "RT omission is an option".
 
temujim said:
It's an amazing conclusion. LR exceeded the prespecified threshold, but "RT omission is an option".
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The Women’s Health Inititive study canceled hormone replacement therapy for nearly a generation of older women on account of excess breast cancer risk on the order of about 1 in 1000. HRT became a “never option” on account of that risk almost overnight.

But this new study looking at no therapy gives between 100 and 150 in 1000 women excess breast cancer and that non therapy becomes an option. Like literally we are OKing a treatment course that gives women 100x to 150x breast cancer risk relative to a treatment course that we freaked out about that gave them almost no excess breast cancer risk.

So folks medicine hates women, and it hates old women even more, but it hates radiation even more than that.
 
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RickyScott said:
Will be awaiting Volga trial with padcev and dual io. Will systemic therapy ultimately replace local therapy in solid malignancies?
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TMT for bladder cancer is likely dead (as we know it).

The future is clearly Enfortumab Vedotin + IO and then decide on how to proceed.

Patients with CR may go for surveillance.
Patients with superficial residual disease get TUR-B & intravesical treatment
Patients with muscle invasive disease get cystectomy (and a few may get RT)
 
Palex80 said:
TMT for bladder cancer is likely dead (as we know it).

The future is clearly Enfortumab Vedotin + IO and then decide on how to proceed.

Patients with CR may go for surveillance.
Patients with superficial residual disease get TUR-B & intravesical treatment
Patients with muscle invasive disease get cystectomy (and a few may get RT)
Click to expand...
Currently radiating someone who got padcev and io and refused cystectomy when the time came

It's a study question but from what the data is saying, clinical CR on cystoscopy can have up 50% positivity pathologically after radical cystectomy

I get the sense that, at least in my neck of the US, this hurt cystectomy more and the role of consolidative vs salvage bladder RT will need to be evaluated more
 
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medgator said:
Currently radiating someone who got padcev and io and refused cystectomy when the time came

It's a study question but from what the data is saying, clinical CR on cystectomy can have up 50% positivity pathologically after cystectomy

I get the sense that, at least in my neck of the US, this hurt cystectomy more and the role of consolidative vs salvage bladder RT will need to be evaluated more
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The big question in what you are doing is whether or not RT to the bladder now is going to kill off any immune response that may be happening in the bladder and the regional pelvic nodes. I presume your patient received IO on top of padcev and was/is scheduled to continue getting it?
 
medgator said:
Currently radiating someone who got padcev and io and refused cystectomy when the time came

It's a study question but from what the data is saying, clinical CR on cystectomy can have up 50% positivity pathologically after cystectomy

I get the sense that, at least in my neck of the US, this hurt cystectomy more and the role of consolidative vs salvage bladder RT will need to be evaluated more
Click to expand...

This is coming up a lot in my clinic recently and I am also currently doing the same. Is your patient getting chemo or pembro concurrent?

Im getting involved a little earlier now so at least I can tell patients EVP --> Radiation is not really a standard option people should pick up front. But maybe they can, what do I know.

Wish we had more data!

NRG Archer allows EVP induction then enroll, so theres that. But not a huge fan of the study question and it requires all this extra surveillance outside standard so I didnt open.
 
NotMattSpraker said:
This is coming up a lot in my clinic recently and I am also currently doing the same. Is your patient getting chemo or pembro concurrent?

Im getting involved a little earlier now so at least I can tell patients EVP --> Radiation is not really a standard option people should pick up front. But maybe they can, what do I know.

Wish we had more data!

NRG Archer allows EVP induction then enroll, so theres that. But not a huge fan of the study question and it requires all this extra surveillance outside standard so I didnt open.
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Holding everything. How are you treating? 55/20 whole bladder?
 
So, after years of hearing from Dr. Cercek on every single conference that 100% of patients with MSI-high rectal cancer on dostarlimab achieve cCR based on the MSKCC data...

Surprise, it's "only" 71%

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Don't get me wrong. 71% is great. But why did it take 4 years to (June 2022 NEJM publication - October 2026) to acknowledge that?

Thank you.
 
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I assume this larger study was accruing during that time and is now being reported for the first time? Is there an earlier time they would have been able to report this study? Am I missing something @Palex80
 
Palex80 said:
So, after years of hearing from Dr. Cercek on every single conference that 100% of patients with MSI-high rectal cancer on dostarlimab achieve cCR based on the MSKCC data...

Surprise, it's "only" 71%

View attachment 426037

View attachment 426038

Lying Kandi Burruss GIF


Don't get me wrong. 71% is great. But why did it take 4 years to (June 2022 NEJM publication - October 2026) to acknowledge that?

Thank you.
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I think there was something like 11 people in the original report, all with 100% LC

Flip a 71/29 coin and get 71 eleven times in a row, about a 2% chance of that happening.

So, interesting.
 
NotMattSpraker said:
Varies, I use both that and RTOG. Practice probably does mostly RTOG. We dont have a super high volume.

I tend to favor longer fractionation on very symptomatic/elderly, current smokers. Unless shorter treatment is the top priority.
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Even without chemo? I wasn't sure what the right answer was. This pt had a CR on repeat cysto and refused the completion radical cystectomy so I figured 20 fx to the entire bladder would be the analogous non surgical treatment.

This protocol is also doing 4 wks

bcan.org

Consolidative Therapy After EV + Pembrolizumab in Muscle Invasive Bladder Cancer, REINFORCE Trial

bcan.org bcan.org
 
medgator said:
Even without chemo? I wasn't sure what the right answer was. This pt had a CR on repeat cysto and refused the completion radical cystectomy so I figured 20 fx to the entire bladder would be the analogous non surgical treatment.

This protocol is also doing 4 wks

bcan.org

Consolidative Therapy After EV + Pembrolizumab in Muscle Invasive Bladder Cancer, REINFORCE Trial

bcan.org bcan.org
Click to expand...

I dont think there is a right answer right now unless you have a trial open, then thats the right answer haha

Thats a good point on using 20 for these patients.
 
drowsy12 said:
I assume this larger study was accruing during that time and is now being reported for the first time? Is there an earlier time they would have been able to report this study? Am I missing something @Palex80
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Well, one year ago @ESMO2025, during this session
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Dr. Cercek adamantly argued, that the cCR rate is 100% at her institution.

Given, that MSKCC sees alot of rectal cancer patients, and that the overall rate of cCR among various institutions now is 71%, how likely is it that the cCR rate at MSKCC is 100%?
 
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TheWallnerus said:
I think there was something like 11 people in the original report, all with 100% LC

Flip a 71/29 coin and get 71 eleven times in a row, about a 2% chance of that happening.

So, interesting.
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It's worse. In 2025 they published this
Cohort 1 was 49 rectal cancer patients on dostarlimab.

In cohort 1, all 49 patients who completed treatment had a clinical complete response and elected to proceed with nonoperative management. A total of 37 patients had a sustained clinical complete response at 12 months, a finding that met the criterion for efficacy.
 
I’m confused on what you are alleging here. One small trial showed one thing. Then a larger multi center study showed something different, as one would expect, that was the point of the larger study
 
Palex80 said:
It's worse. In 2025 they published this
Cohort 1 was 49 rectal cancer patients on dostarlimab.

In cohort 1, all 49 patients who completed treatment had a clinical complete response and elected to proceed with nonoperative management. A total of 37 patients had a sustained clinical complete response at 12 months, a finding that met the criterion for efficacy.
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Are you sure she is not just presenting lower GI cancers from cohort ii of the study?? I think this is the simple explanation and is consistent with the labeling of her presentation. Rectal cancers disappear, other MSI high cancers do very well but some likelihood of resistance.

The 100% number was in reference to rectal cancers only.
 
communitydoc13 said:
Are you sure she is not just presenting lower GI cancers from cohort ii of the study?? I think this is the simple explanation and is consistent with the labeling of her presentation. Rectal cancers disappear, other MSI high cancers do very well but some likelihood of resistance.

The 100% number was in reference to rectal cancers only.
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AZUR-1 is rectal cancer only, this is what she presented.


 
drowsy12 said:
I’m confused on what you are alleging here. One small trial showed one thing. Then a larger multi center study showed something different, as one would expect, that was the point of the larger study
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Let me break it down for you.

The first report was the NEJM paper back in 2022. The 11 patient report, which led to the FDA granting approval. All MSKCC, all rectal, 100% cCR.

Then in 2025, the expanded cohort of MSKCC was reported. Still 100% cCR in the rectal cancer subgroup (n=49).

And now, the "global" rectal cancer trial (n=154) is being presented. And, suddenly CCR is 71%.

Important: The 49 patients from MSKCC are not included in the AZUR-1 trial.
AZUR-1 was basically requested from the FDA, because the FDA wanted more than just the MSKCC report to uphold the approval of dostarlimab for this indication.


So, why the discrepancy?
- Are sites testing differently for MSI?
- Is investigator-assessed response review @MSKCC different than independent-assessed central response review?
- Is it inclusion / reporting bias?
 
Palex80 said:
Let me break it down for you.

The first report was the NEJM paper back in 2022. The 11 patient report, which led to the FDA granting approval. All MSKCC, all rectal, 100% cCR.

Then in 2025, the expanded cohort of MSKCC was reported. Still 100% cCR in the rectal cancer subgroup (n=49).

And now, the "global" rectal cancer trial (n=154) is being presented. And, suddenly CCR it's 71%.

Important: The 49 patients from MSKCC are not included in the AZUR-1 trial.
So, why the discrepancy?
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I mean the explanation is simple right? The non MSK sites are reporting a lower clinical CR rate, because this is also somewhat of a subjective site specific finding

None of this is in conflict with each other either regardless of the explanation
 
It is, but I don’t think any lies were told. The MSK assessment of ccr seems good in their longer term FU.

It would be interesting to see how the patients without a ccr in the intl data does long term as someone of them may have had what MSK would call a clinical CR

At any rate how things are assessed in a multi center study is important and will be more reflective of broad practice across academic centers at least. Important to have this data and also seems like a registrational trial to get approval
 
Palex80 said:
Perhaps. But that's quite a considerable difference, isn't it?

72% vs. 100%?
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There are lots of single institution data that doesn't parse out as well in the real world (or perhaps, since this is a 'trial' as well, just any treatments outside MSKCC). See 60Gy definitive RT for P16+ OPhx cancer. I personally wonder if th eMSKCC p16+ 30Gy ENI --> sequential boost to 70Gy wouldn't experience the same outcomes if formally evaluated outside MSKCC....

De-escalation of a very curable disease is a problem that should be addressed very cautiously, not with reckless abandon.

I wonder if the colorectal surgeons (or whoever is doing the post-treatment scopes) are blinded to who gets dostarlimab vs who don't as MSKCC. May be hard to call anything not a cCR if the PI whose career is predicated on a 100% cCR rate (at time of completion of treatment) is at your same institution.... Maybe you call the post-treatment scope cCR and then get a repeat scope in 6-12 weeks that shows 'recurrent' disease. If you say 12/49 patients had recurrent disease within 1 year and compare that to 72% cCR then it doesn't seem so far off....

That being said, 72% in a multi-institutional cohort is still, overall, pretty impressive. Probably won't get FDA to pull the indication.
 
drowsy12 said:
It is, but I don’t think any lies were told. The MSK assessment of ccr seems good in their longer term FU.

It would be interesting to see how the patients without a ccr in the intl data does long term as someone of them may have had what MSK would call a clinical CR

At any rate how things are assessed in a multi center study is important and will be more reflective of broad practice across academic centers at least. Important to have this data and also seems like a registrational trial to get approval
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This is the composite endpoint of pCR and cCR at 12 months. 76%

1793027341149.png
 
Palex80 said:
Given, that MSKCC sees alot of rectal cancer patients, and that the overall rate of cCR among various institutions now is 71%, how likely is it that the cCR rate at MSKCC is 100%?
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Was there any analysis by specific genetic profile? Ashkenazi Jews have a well-known founder mutation driving Lynch syndrome, where the rest of Lynch folks have a more diverse profile. The genetic profiles of the patients at MSKCC may have been different than the overall cohort?

I would need a lot of convincing that there was intent to overestimate cCR at MSKCC or that their assessment of response was somehow less sensitive than at other places, although the latter is a possibility.
 
I also think surgeons are more likely to want to ‘salvage’ we all know this well so I’m not sure if the MSK ones would have been rounding up to a CR. They’re used to non operative management in rectal cancer after TNT though so perhaps they have more experience in assessing it mucosally

At any rate the 70 percent number is what we should have in our heads now for patient counseling and clinical practice
 
communitydoc13 said:
Was there any analysis by specific genetic profile?
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Nope, did not see one. And a lot of centers were involved in multiple countries.

communitydoc13 said:
Ashkenazi Jews have a well-known founder mutation driving Lynch syndrome, where the rest of Lynch folks have a more diverse profile. The genetic profiles of the patients at MSKCC may have been different than the overall cohort?
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This is quite possible.
 
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