Oncology — Weekly Evidence Brief

Recent studies underscore the growing role of immunotherapy in non-small cell lung cancer (NSCLC). All three approaches—neoadjuvant, perioperative, and adjuvant chemoimmunotherapy—have demonstrated event-free or disease-free survival benefits over chemotherapy alone in resectable early-stage NSCLC, and all are now approved standards of care 12. Furthermore, real-world data reinforces the significant clinical benefit of durvalumab consolidation following definitive chemoradiotherapy in patients with stage III NSCLC, particularly those with good performance status and low comorbidity, extending findings from pivotal trials into routine practice 3.

In colorectal cancer (CRC), precision strategies are evolving. A meta-analysis suggests a potential progression-free survival benefit from adding immune checkpoint inhibitors (ICIs) to chemotherapy plus bevacizumab in proficient mismatch repair (pMMR) metastatic CRC, though further validation is needed 4. Beyond treatment selection, novel circulating tumor DNA (ctDNA) methylation markers (ZNF671 and ZNF132) show promise in predicting recurrence and prognosis in stage III-IV CRC, potentially guiding immunotherapy decisions by correlating with Immunoscore 5. Moreover, a deep learning model combined with ctDNA molecular residual disease status significantly improves prognostic stratification for stage II/III CRC, suggesting that high-risk, MRD-negative patients may benefit from adjuvant chemotherapy 6.

Esophageal squamous cell carcinoma (ESCC) management has also seen progress. First-line chemoimmunotherapy combined with radiotherapy significantly prolongs overall and progression-free survival for patients with locally advanced or metastatic ESCC, especially those with regional lymph node metastasis, with manageable adverse effects 7. Additionally, oncogenic NFE2L2 mutations in ctDNA and tumors have been identified as predictors and prognosticators of chemoradiation therapy response in resectable ESCC, offering a means for earlier risk stratification 8. The general strategy of combining ICIs with anti-angiogenic therapy is also emerging as effective across multiple solid tumor types by modulating the tumor microenvironment to enhance anti-tumor immune responses 9.

Beyond specific cancers, the integration of precision oncology tools is transforming treatment paradigms. Genomic profiling guided by Molecular Tumor Boards (MTBs) in advanced breast cancer has expanded biomarker-matched treatment options, with approximately half of patients receiving such targeted therapies experiencing clinical benefit 10. This emphasis on personalized medicine extends to treatment de-escalation strategies across various cancer types, which aim to reduce toxicity and improve quality of life while maintaining oncologic control. Molecular diagnostics, including ctDNA analysis, are crucial for selecting appropriate candidates for these less aggressive, yet effective, approaches 11.