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Article History

Received: 9 December 2025

Accepted: 14 May 2026

First Online: 6 June 2026

Declarations

:

: Andrea Marcellusi has received honoraria as a speaker and adviser for MSD, Astra Zeneca, Eli Lilly and other pharma companies. He is an Editorial Board member of Clinical Drug Investigation , but was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Fabio Calabrò has received honoraria as speaker for MSD, Astra Zeneca, Pfizer, Novartis, Bayer, Ipsen, Johnson and Johnson, Recordati and Astellas. Anna Maria Di Giacomo has served as an advisor or board member for MSD, Bristol Myers Squibb, Incyte, Pierre Fabre, Sanofi, GSK, Novartis, SunPharma and Immunocore. She has also received honoraria for MSD, Roche, Bristol Myers Squibb, Sanofi, Pierre Fabre, GSP and Vyvamed. Fabio Puglisi has received honoraria for advisory boards, activities as a speaker, travel grants and research grants from Amgen, Astra Zeneca, Bayer, Daiichi Sankyo, Celgene, Eisai, Eli Lilly, Exact Sciences, Gilead, Ipsen, Italfarmaco, Menarini, MSD, Novartis, Pierre Fabre, Pfizer, Roche, Seagen, Takeda and Viatris. He has also received research funding from Astra Zeneca, Eisai and Roche. Alessio Cortellini received grants for consultancies/advisory boards: MSD, OncoC4, Roche, Regeneron, Bristol Myers Squibb, Amgen, Daiichi Sankyo, Astra Zeneca, Access Infinity, Ardelis Health, Alpha Sight, Capvision, Techspert, Alira Health, Atheneum, Lightening Health. He also received speaker fees from Astra Zeneca, Roche, Pierre-Fabre, MSD, Sanofi/Regeneron and Yuhan corporation, compensation for writing/editorial activity from Bristol Myers Squibb, MSD and travel support from Sanofi, MSD, Roche and funding (to institution) from the International Association for the Study of Lung Cancer. Isobel Thornton, Yan Zhi Tan, Alessandro Catanzaro and Catarina Neves are employees of Lumanity, which have been contracted by MSD for this study, and do not have any further financial or nonfinancial interests to disclose. Fabrizio Ascone, Matilde Franceschini and Mario Calandriello are employees of MSD, Italy. Raquel Aguiar-Ibáñez is an employee of Merck Canada Inc., Kirkland, QC, Canada. Yizhen Lai is an employee of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, USA.

: The data used in this study can be made available from the corresponding author on reasonable request.

: Not applicable; no coding was used for this study.

: All data used in this study were fully de-identified; ethics approval was not required and was not sought.

: Not applicable; this modelling study is exempt from informed consent.

: Not applicable.

: Study conceptualisation and design: all authors; study conduct: I.T., Y.Z.T., A.C., C.N. and Y.L.; analysis and interpretation of results: I.T., Y.Z.T., C.N. and Y.L.; draft manuscript preparation: I.T., Y.Z.T., C.N., R.A., M.F. and Y.L. All authors read and approved the final version and agree to be accountable for the research.