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Article History

Received: 23 May 2025

Accepted: 30 April 2026

First Online: 16 May 2026

Competing interests

: A.C.G.-C. reports research funding (to Institution) from AstraZeneca, Bicycle Therapeutics, Biovica, BioNTech, Bristol-Myers Squibb, Case45, Daiichi Sankyo, Foundation Medicine, Gilead Sciences, Merck & Co., Novartis, Precede Biosciences, Reveal Genomics, Zenith Epigenetics, 4D Path; compensated service for consulting and service on scientific advisory boards and/or steering committee for AstraZeneca, BioNTech, Bristol-Myers Squibb, Daiichi Sankyo, Gilead Sciences, Merck & Co., Novartis, TD Cowen, and Pfizer; speaker honoraria from AstraZeneca, Daiichi Sankyo, Gilead Sciences, Bicycle Therapeutics, and Roche/Genentech; travel/other financial support from Roche/Genentech, Gilead Sciences, AstraZeneca, Daiichi Sankyo, Merck & Co., Novartis, Stemline Therapeutics, and Pfizer. S.M.T. reports consulting or advisory roles at Novartis, Pfizer/SeaGen, Merck, Eli Lilly, AstraZeneca, Genentech/Roche, Eisai, Bristol Myers Squibb/Systimmune, Daiichi Sankyo, Gilead, Blueprint Medicines, Reveal Genomics, Sumitovant Biopharma, Artios Pharma, Menarini/Stemline, Aadi Bio, Bayer, Jazz Pharmaceuticals, Natera, Tango Therapeutics, eFFECTOR, Hengrui USA, Cullinan Oncology, Circle Pharma, Arvinas, BioNTech, Launch Therapeutics, Zuellig Pharma, Johnson&Johnson/Ambrx, Bicycle Therapeutics, BeiGene Therapeutics, Mersana, Summit Therapeutics, Avenzo Therapeutics, Aktis Oncology, Celcuity, Boehringer Ingelheim, Samsung Bioepis, Olema Pharmaceuticals, Tempus, Boundless Bio, Denali Therapeutics, Relay Therapeutics; research funding (to Institution) from Genentech/Roche, Merck, Exelixis, Pfizer, Lilly, Novartis, Bristol Myers Squibb, AstraZeneca, NanoString Technologies, Gilead, SeaGen, OncoPep, Daiichi Sankyo, Menarini/Stemline, Jazz Pharmaceuticals, Olema Pharmaceuticals; and travel support from Eli Lilly, Gilead, Jazz Pharmaceuticals, Pfizer, Arvinas, Roche. K.W.W. serves on the scientific advisory boards of DEM BioPharma, Solu Therapeutics, D2M Biotherapeutics, DoriNano, Inc., and Nextechinvest. He is a co-founder of Immunitas Therapeutics and receives sponsored research funding from Fate Therapeutics. He holds equity in TScan Therapeutics. These activities are not related to the research reported in this publication. A.D.C. reports he receives research funding from Bayer and consults for KaryoVerse. E.M.V. reports advisory/consulting roles for Enara Bio, Manifold Bio, Monte Rosa, Novartis Institute for Biomedical Research, Serinus Bio, TracerBio; research support from Novartis, BMS, Sanofi, NextPoint; equity in Tango Therapeutics, Genome Medical, Genomic Life, Enara Bio, Manifold Bio, Microsoft, Monte Rosa, Riva Therapeutics, Serinus Bio, Syapse, TracerDx; speaking fees from TD Cowen; institutional patents filed on chromatin mutations and immunotherapy response, and methods for clinical interpretation; intermittent legal consulting on patents for Foaley & Hoag; and an editorial board role at Science Advances. N.U.L. reports institutional research support from Genentech, Pfizer, Merck, Seattle Genetics, Zion Pharmaceuticals (as part of Roche/GNE), Olema Pharmaceuticals, AstraZeneca, Iksuda, Stemline, consulting honoraria from Pfizer/SeaGen, Daiichi Sankyo, AstraZeneca, Olema Pharmaceuticals, Stemline/Menarini, Artera Inc., Eisai, Shorla Oncology, Denali Therapeutics, royalties from UptoDate and travel support from Olema, AstraZeneca, Daiichi Sankyo. R.Pe., L.W.P., and M.A.C. are full-time employees of Foundation Medicine, Inc, and hold stock in Roche Holdings AG. S.M. and T.D. are employees at 4D Path. A.J.W. is an employee of Biovica Inc. All remaining authors report no competing interests.