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Article History

Received: 8 January 2026

Accepted: 21 March 2026

First Online: 28 April 2026

Declarations

:

: Ken Kato has received honoraria from Ono Pharmaceutical, Bristol Myers Squibb, and MSD; has served as an advisor/consultant for Ono Pharmaceutical, Bristol Myers Squibb, MSD, BeOne Medicines, Roche, AstraZeneca, and Bayer; has served on speaker bureaus for Ono Pharmaceutical, Bristol Myers Squibb, MSD, and Taiho Pharmaceutical; and has received institutional research funding from Ono Pharmaceutical, Bristol Myers Squibb, MSD, BeOne Medicines, AstraZeneca, Daiichi-Sankyo, Merck Biopharma, and Boehringer Ingelheim. Takashi Kojima has received honoraria from Ono Pharmaceutical, MSD, Bristol Myers Squibb, TFBS Bioscience, Inc., Japanese Society of Pharmaceutical Health Care and Sciences, and The Japan Esophageal Society; has served as an advisor/consultant for Nippon Boehringer Ingelheim Co., Ltd.; and has received institutional research funding from BeOne Medicines, AstraZeneca, Chugai Pharmaceutical, Taiho Pharmaceutical, Astellas Amgen BioPharma, MSD, and Ono Pharmaceutical. Hiroki Hara has received honoraria from Asahi Kasei, Astellas, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Lilly, Merck Biopharma, Miyarisan, MSD, Nippon Kayaku, Ono, Otsuka, Taiho, Takeda, and Yakult; has served as an advisor/consultant for Boehringer Ingelheim, Chugai, and Daiichi Sankyo; and has received institutional research funding from AbbVie, ALX oncology, Amgen, Astellas, AstraZeneca, Bayer, Chugai, Daiichi Sankyo, Henlius, Janssen, Jazz Pharmaceuticals, Merck Biopharma, MSD, Ono, and Taiho. Akihito Tsuji has received institutional research funding from Taiho Pharmaceutical Co., Ltd., and Chugai Pharmaceutical Co., Ltd., and personal fees from Merck Biopharma Japan, Bristol Myers Squibb, Daiichi Sankyo, Toray Medical Co., Ltd., MSD Corporation, Eli Lilly Japan, Ono Pharmaceutical Co., Ltd., Taiho Pharmaceutical Co., Ltd. and Chugai Pharmaceutical Co., Ltd. Hisateru Yasui has received honoraria and institutional research funding from MSD. Kei Muro has received honoraria from MSD, Bristol-Myers Squibb, Ono, Eli Lilly, Takeda, Daiichi Sankyo, and Taiho; has served as an advisor/consultant for Amgen, AstraZeneca, Ono, Astellas, Takeda, Roche Diagnostics, and Chugai; and has received institutional research funding from Astellas, Amgen, Sanofi, Novartis, Parexel International, PRA Health Sciences, Taiho, MSD, Chugai, and Ono. Taroh Satoh has received honoraria from Daiichi Sankyo, Ono Pharmaceutical. Bristol Myers Squibb, Merck Serono, Merck, and Eli Lilly; and has received institutional research funding from Daiichi Sankyo, Ono Pharmaceutical, Bristol Myers Squibb, Shionogi, MSD Janssen, Taiho Pharmaceutical, and Eli Lilly. Naoyoshi Yatsuzuka and Tomoko Sakata are full-time employees of MSD K.K., Tokyo, Japan and own stock in Merck & Co., Inc., Rahway, NJ, USA. Shirong Han has no conflicts to declare. Toshihiko Doi has received honoraria from Daiichi Sankyo; has served as an advisor/consultant for Takeda, Rakuten Medical, Kyowa Kirin, Shionogi, Kaken Pharma, Sumitomo Pharma, Noil-Immune Biotech, Oncolys Biopharma, Boehringer Ingelheim, Chugai Pharma, A2 Healthcare, Mitsubishi Tanabe Pharma, Janssen Pharma, Taiho Pharma, and Amgen; and has received institutional research funding from MSD, Taiho, Boehringer Ingelheim, Daiichi Sankyo, Pfizer, BMS, AbbVie, Janssen Pharma, Chugai, PRA Health Science, Ono Pharma, Shionogi, Amgen, GSK, Rin Institute, and Bayer.

: The study was conducted in accordance with the Declaration of Helsinki 1964 and later versions and was approved by the appropriate institutional review boards and regulatory agencies. All participants provided written informed consent.