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Article History

Received: 6 March 2025

Accepted: 9 December 2025

First Online: 12 January 2026

Competing interests

: J.H.S. reported being in a consultant or advisory role for Abbvie, Astellas, AstraZeneca, Bayer, Beigene, Daiichi-Sankyo, Eli Lilly, GE Healthcare, GSK, Johnson & Johnson, Jazz Pharmaceuticals, Merck, Natera, Pfizer, Roche/Genentech, Regeneron, Sanofi, Taiho, Takeda, Xilio Therapeutics; stock options from Triumvira Immunologics; research funding/contracted research from Abbvie, Amgen, AStar D3, Bayer, Beigene, Curegenix, Daiichi-Sankyo, Eli Lilly, Erasca, GSK, Leap Therapeutics, Novartis, Pfizer, Quanta Therapeutics, Revolution Medicines, and Roche/Genentech. A.C. reported grants paid to their institution by Seagen, GlaxoSmithKline, Inspira (previously RGenix); receiving consultancy and advisory fees from Bayer, Merck, Seagen, GlaxoSmithKline, Janssen, and G1 Therapeutics. S.S. reported participating on advisory boards for Agenus, AstraZeneca, Bayer, Bristol Myers Squibb, CheckmAb, Daiichi-Sankyo, Guardant Health, Menarini, Merck, Novartis, Pierre-Fabre, Roche-Genentech, and Seagen. T.A. reported receiving honoraria from Bristol Myers Squibb, GlaxoSmithKline, Merck & Co. Inc., Merck Serono, Roche, Sanofi, Seagen, and Servier; being in a consultant or advisory role for Abbvie, Aptitude Health, Bristol Myers Squibb, Gritstone Oncology, Gilead, GlaxoSmithKline, Merck & Co. Inc., Nordic Oncology, Seagen, Servier, and Takeda; serving on Speaker Bureaus for Merck & Co. Inc and Bristol Myers Squibb; a leadership role being president of the ARCAD foundation since 2022 (Aide et Recherche en Cancérologie Digestive); receiving travel and expenses from Merck & Co. Inc and Bristol Myers Squibb; full/part-time employment from Sorbonne University and APHP; other: DMC member role for Inspirna. K.N. reported receiving grants from Pharmavite, Revolution Medicines, Evergrande Group, and Janssen; receiving consultancy fees from Bayer, Seagen, X-Biotix Therapeutics, Array Biopharma, BiomX, Bicara Therapeutics, GlaxoSmithKline, Pfizer, Redesign Health, CytomX, Jazz Pharmaceuticals, Revolution Medicines, AbbVie, Etiome, and CRICO. E.V.C. reported participating on advisory boards for Abbvie, Agenus, ALX, Amgen, Arcus Biosciences, Astellas, AstraZeneca, Bayer, Beigene, Bexon Clinical, Biontech, Boehringer Ingelheim, Bristol-Myers Squibb, Canfour, Daiichi-Sankyo, Debiopharma, Elmedix, Eisai, Galapagos, GSK, Hookipa Biotech, Incyte, Ipsen, Lilly, Merck Sharp & Dohme, Merck KGaA, Mirati, Novartis, Nordic, Pierre Fabre, Pfizer, Roche, Seattle Genetics, Servier, Simcere, Takeda, Taiho, and Terumo. C.W. reported grants paid to their institution by Boston Biomedical, Bristol Myers Squibb, Lycera, RAPT Therapeutics, Seagen, Symphogan, Vaccinex, INHBRX, and Pfizer; receiving honoraria from Array Biopharma, Signatera, Pfizer, and Daiichi-Sankyo; receiving travel support from Array Biopharma; former employment at Winship Cancer Institute of Emory University, Atlanta, GA, USA (at the time of study conduct). A.S.P. reported receiving support for the present work from Seagen to provide medical writing assistance, institutional funding, study materials, processing charges; funding paid to their institution for clinical research trials from Ipsen, Bristol Myers Squibb, Exelixis, HutchMed, Seagen, Taiho, Lilly, AstraZeneca, Incyte, Deciphera, G1 Therapeutics, Zentalis, Tempus, Camurus, Relay Therapeutics, Nucana, Merck, and Bayer; receiving honoraria from Ideo Oncology and MJH Life Sciences (both educational event companies); participating on advisory boards for Amgen, Bristol Myers Squibb, Eisai, Ipsen, AAA, Exelixis, Pfizer, QED, Lilly, Mirati, HutchMed, Astellas, and Aadi; receiving travel support from Pfizer; owning stock or stock options from Aptose, Actinium, and Alexion; receiving medical writing services from Bayer, Ipsen, HutchMed, Exelixis, and Seagen. J.E.H. reported grants paid to their institution by Merck, Boston Biomedical, Senhwa Pharmaceuticals, Bayer, Incyte, TriOncology, Seattle Genetics, Hutchison MediPharma, Pionyr Immunotherapeutics, Trovogene, G1 Therapeutics, Roche, and Treos Bio; participating on advisory boards with honoraria to the institution by Bayer, Merck, BeiGene, and Incyte. A.L.C. reported receiving grants from Nucana, Seagen, Abgenomics, Novocure, Actuate, Medimmune/AstraZeneca, PanCan, Amgen, and Nextrast. C.F. reported grant funding all paid to their institution from the NIH/NCI, National Comprehensive Cancer Network (NCCN) Oncology Research Program and NCCN Foundation, Pfizer Inc., Taiho Oncology, and Merck (all unrelated to the current study). A.K. reported no conflict of interest. P.M.K. reported grants paid to their institution by Advanced Accelerator Applications, Tersera, Boston Scientific/BTG, Merck, Agenus, and Novartis; a consultancy and advisory board relationship with Elicio (scientific advisory board member/shares/stock ownership); being co-founder of Precision Biosensors Inc; receiving consulting fees from Natera, Guardant Health, Foundation Medicine, Illumina, BostonGene, Merck/MSD Oncology, Tempus, Bayer, Lilly, Delcath Systems, IPBA, QED Therapeutics, Boston Healthcare Associates, Servier, Taiho Oncology, Exact Sciences, Daiichi-Sankyo/AstraZeneca, Eisai, Seattle Genetics, Beigene, Astellas, Illumina, SAGA diagnostics, Neogenomics, Bostongene, Regeneron, Agenus, Bexion Pharmaceuticals, and Xilio; former employment at University of Iowa Hospitals and Clinics, Iowa City, IA, USA (at the time of study conduct). H.J.L. reported grants from NCI (P30, U01, U2c, UG1, and UM1), US Department of Defense, and Southwest Oncology Group; receiving consulting fees from Merck, Bayer, Merck KG, Roche, Fulgent, Oncocyte, G1 Therapeutics, Jazz Therapeutics, 3 T bioscience, and Adagene; receiving honoraria from Bayer, Roche, and Pfizer; participating in unpaid leadership roles with Wunderglo Foundation, Debbie Dream Foundation, and Cancer Support Group; owning stock options in Fulgent. K.C. reported grants paid to their institution by Bristol Myers Squibb, Array, Incyte, Daiichi-Sankyo, Nucana, Merck, Pfizer, Calithera, Genentech, and Seagen; participating on advisory boards and receiving consulting fees from Merck, Lilly/Loxo, Pfizer, Replimune, Personalis, Exelixis, and Array; receiving travel or hotel support for attending advisory board meeting from Array; participating on the Board of Directors for Academic and Community Cancer Research United. E.E. reported grants, receiving consulting fees, and payment for expert testimony, receiving honoraria, receiving travel support, and participating on advisory boards from Amgen, Bayer, Hoffmann-La Roche, Merck Serono, Sanofi, Pierre Fabre, MSD, Organon, Novartis, and Servier; financial support for clinical trials or contracted research paid to their institution from Amgen Inc, Array Biopharma Inc, AstraZeneca Pharmaceuticals LP, BeiGene, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Debiopharm International SA, F Hoffmann-La Roche, Genentech, HalioDX SAS, Hutchison MediPharma International, Janssen-Cilag SA, MedImmune, Menarini, Merck Health KGAA, Merck Sharp & Dohme, Merus NV, Mirati, Novartis Farmaceutica SA, Pfizer, Pharma Mar, Sanofi Aventis Recherche & Developpement, Servier, and Taiho Pharma USA. D.L.B. reported a grant for trial support of the present study paid to their institution by Seagen; grants paid to their institution by Seagen, Rafael/Cornerstone, and Abbvie; receiving honoraria for speakers bureau from Natera; receiving salary support for participating on the local data safety monitoring board for University Hospitals; receiving no payment for participating on the advisory board for Rafael pharmaceuticals; receiving study drug from Novartis and Epizyme. C.C. reported being in a consultant or advisory role for AstraZeneca, Merck Serono, MSD, Nordic Pharma, Roche, Pierre Fabre, Takeda, and Tempus; an invited speaker with compensation from Amgen, Bayer, Merck Serono, MSD, Pierre Fabre Servier, and Takeda; research grants from Amgen, Merck, Pierre Fabre, Roche, Seagen (Pfizer), Servier, and Tempus. F.S. reported no conflict of interest. M.N. reported being employed by and owning stock in Seagen Inc., which was acquired by Pfizer in December 2023. W.F. reports being employed by and owning stock in Seagen Inc., which was acquired by Pfizer in December 2023. M.B. reported being employed by and owning stock in Seagen Inc., which was acquired by Pfizer in December 2023. T.S.B.-S. reported research funding paid to their institution by Agios, Arys, Arcus, Atreca, Boston Biomedical, Bayer, Eisai, Celgene, Lilly, Ipsen, Clovis, Seattle Genetics, Genentech, Novartis, Mirati, Merus, Abgenomics, Incyte, Pfizer, and Bristol Myers Squibb; consulting fees paid to their institution by Ipsen, Arcus, Pfizer, Seattle Genetics, Bayer, Genentech, Incyte, Eisai, and Merck; receiving consulting fees from Stemline, AbbVie, Boehringer Ingelheim, Janssen, Daichii Sankyo, Natera, TreosBio, Celularity, Exact Science, Sobi, Beigene, Kanaph, AstraZeneca, Deciphera, MJH Life Sciences, Aptitude Health, Illumina, and Foundation Medicine; participating on independent data monitoring committees or data safety monitoring boards for Fibrogen, Suzhou Kintor, AstraZeneca, Exelixis, Merck/Eisai, PanCan, and 1Globe; participating on scientific advisory boards for Imugene, Immuneering, Xilis, Replimune Artiva, and Sun Biopharma; receiving royalties from Uptodate; and inventions or patents—WO/2018/183488: HUMAN PD1 PEPTIDE VACCINES AND USES THEREOF (licensed to Imugene) and WO/2019/055687: METHODS AND COMPOSITIONS FOR THE TREATMENT OF CANCER CACHEXIA (licensed to Recursion).