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Article History

Received: 19 December 2025

Accepted: 22 April 2026

First Online: 28 April 2026

Declarations

:

: This study was conducted in accordance with the principles of the Declaration of Helsinki. The study protocol was reviewed and approved by the Institutional Review Board of Shizuoka cancer center (Approval No. J2023-165–2023-2).

: The requirement for written informed consent was waived due to the retrospective nature of the study. Instead, an opt-out consent process was implemented, and patients were provided with the opportunity to decline participation. Details of the study were made publicly available to allow patients to opt out of participating.

: Tateaki Naito has received research funding from Otsuka Pharmaceutical and the Japan Agency for Medical Research and Development (AMED) (to his institution) and honoraria from Ono Pharmaceutical and Helsinn SA. Hirotsugu Kenmotsu has received research grants from Ono Pharmaceutical Co., Ltd., Novartis Pharma K.K., Eli Lilly K.K., AstraZeneca K.K., and Loxo Oncology (to his institution). He has also received honoraria for lectures or presentations from Amgen, AstraZeneca K.K., Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Eli Lilly K.K., Kyowa Kirin Co., Ltd., Merck, MSD, Novartis Pharma K.K., Ono Pharmaceutical Co., Ltd., Pfizer, Taiho Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co., Ltd. Kazushige Wakuda has received research grants from Chugai Pharmaceutical Co., Ltd., AstraZeneca, Novartis, AbbVie, Amgen, MSD, Daiichi Sankyo, and Dizal Pharma (to his institution). He has received honoraria for lectures or presentations from several pharmaceutical companies including Chugai Pharmaceutical, Taiho Pharmaceutical, Boehringer Ingelheim, Eli Lilly, Ono Pharmaceutical, MSD, AstraZeneca, Daiichi Sankyo, Janssen Pharmaceutical, Takeda Pharmaceutical, and Nihon Kayaku. Keita Miura has received honoraria for lectures or presentations from AstraZeneca, Chugai Pharmaceutical, and Taiho Pharmaceutical. Nobuaki Mamesaya has received research funding from Boehringer Ingelheim (to his institution) and honoraria from Chugai Pharmaceutical, Boehringer Ingelheim, AstraZeneca, Taiho Pharmaceutical, MSD, and Ono Pharmaceutical. Ryo Ko has received research funding from MSD and AstraZeneca and honoraria from Taiho Pharmaceutical, Chugai Pharmaceutical, Eli Lilly, AstraZeneca, Ono Pharmaceutical, Daiichi Sankyo, Takeda, and MSD. Toshiaki Takahashi has received research funding from multiple pharmaceutical companies including AstraZeneca, Eli Lilly, Chugai Pharmaceutical, MSD, Pfizer, Amgen, Merck Biopharma, Janssen Pharmaceutical, and AnHeart Therapeutics (to his institution), and honoraria from AstraZeneca, Chugai Pharmaceutical, Eli Lilly, Ono Pharmaceutical, MSD, Pfizer, Takeda Pharmaceutical, Bristol-Myers Squibb, Amgen, and Novartis. Akira Ono has received honoraria from AstraZeneca, Chugai Pharmaceutical, Ono Pharmaceutical, and Indica Labs. Haruki Kobayashi has received honoraria from Eli Lilly, Novartis Pharma, Taiho Pharmaceutical, AstraZeneca, Chugai Pharmaceutical, Ono Pharmaceutical, Bristol-Myers Squibb, and Daiichi Sankyo. Haruyasu Murakami has received research funding from several pharmaceutical companies including Chugai Pharmaceutical, AstraZeneca, Takeda, Daiichi Sankyo, AbbVie, IQVIA, Taiho Pharmaceutical, and Bayer (to his institution), honoraria from multiple pharmaceutical companies, and has served on advisory boards for Chugai Pharmaceutical, GAIA BioMedicine, Daiichi Sankyo, and Amgen. All other authors declare that they have no competing interests.Hirotsugu Kenmotsu has received research grants from Ono Pharmaceutical Co., Ltd., Novartis Pharma K.K., Eli Lilly K.K., AstraZeneca K.K., and Loxo Oncology (to his institution). He has also received honoraria for lectures or presentations from Amgen, AstraZeneca K.K., Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Eli Lilly K.K., Kyowa Kirin Co., Ltd., Merck, MSD, Novartis Pharma K.K., Ono Pharmaceutical Co., Ltd., Pfizer, Taiho Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co., Ltd.Kazushige Wakuda has received research grants from Chugai Pharmaceutical Co., Ltd., AstraZeneca, Novartis, AbbVie, Amgen, MSD, Daiichi Sankyo, and Dizal Pharma (to his institution). He has received honoraria for lectures or presentations from several pharmaceutical companies including Chugai Pharmaceutical, Taiho Pharmaceutical, Boehringer Ingelheim, Eli Lilly, Ono Pharmaceutical, MSD, AstraZeneca, Daiichi Sankyo, Janssen Pharmaceutical, Takeda Pharmaceutical, and Nihon Kayaku.Keita Miura has received honoraria for lectures or presentations from AstraZeneca, Chugai Pharmaceutical, and Taiho Pharmaceutical.Nobuaki Mamesaya has received research funding from Boehringer Ingelheim (to his institution) and honoraria from Chugai Pharmaceutical, Boehringer Ingelheim, AstraZeneca, Taiho Pharmaceutical, MSD, and Ono Pharmaceutical.Ryo Ko has received research funding from MSD and AstraZeneca and honoraria from Taiho Pharmaceutical, Chugai Pharmaceutical, Eli Lilly, AstraZeneca, Ono Pharmaceutical, Daiichi Sankyo, Takeda, and MSD.Toshiaki Takahashi has received research funding from multiple pharmaceutical companies including AstraZeneca, Eli Lilly, Chugai Pharmaceutical, MSD, Pfizer, Amgen, Merck Biopharma, Janssen Pharmaceutical, and AnHeart Therapeutics (to his institution), and honoraria from AstraZeneca, Chugai Pharmaceutical, Eli Lilly, Ono Pharmaceutical, MSD, Pfizer, Takeda Pharmaceutical, Bristol-Myers Squibb, Amgen, and Novartis.Akira Ono has received honoraria from AstraZeneca, Chugai Pharmaceutical, Ono Pharmaceutical, and Indica Labs.Haruki Kobayashi has received honoraria from Eli Lilly, Novartis Pharma, Taiho Pharmaceutical, AstraZeneca, Chugai Pharmaceutical, Ono Pharmaceutical, Bristol-Myers Squibb, and Daiichi Sankyo.Haruyasu Murakami has received research funding from several pharmaceutical companies including Chugai Pharmaceutical, AstraZeneca, Takeda, Daiichi Sankyo, AbbVie, IQVIA, Taiho Pharmaceutical, and Bayer (to his institution), honoraria from multiple pharmaceutical companies, and has served on advisory boards for Chugai Pharmaceutical, GAIA BioMedicine, Daiichi Sankyo, and Amgen.All other authors declare that they have no competing interests.

: Not applicable.