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Article History

Received: 6 September 2025

Accepted: 26 February 2026

First Online: 13 March 2026

Competing interests

: The authors declare the following competing interests: P.T. reports consulting fees from AstraZeneca, BioNTech, Daiichi Sankyo, Gilead, Genentech/Roche, Novartis, Menarini/Stemline, Merck, Eli Lilly and Sanofi. J.G.T.Z. reports ownership of stocks in the biotechnology exchange-traded funds CNCR, IDNA, IBB, and XBI; owns stocks in Novo Nordisk and GRAIL; and previously owned stocks in Adaptive Biotechnologies, 2seventy bio, and bluebird bio. N.U.L. reports institutional research support from Genentech, Pfizer, Merck, Seattle Genetics, Zion Pharmaceuticals, Olema Pharmaceuticals, and AstraZeneca; consulting honoraria from Seattle Genetics, Daiichi Sankyo, AstraZeneca, Olema Pharmaceuticals, Stemline/Menarini, Artera Inc., Eisai, Shorla Oncology, Pfizer, and Denali Therapeutics; royalties from Up to date (book); and travel support from Olema, AstraZeneca, and Daiichi Sankyo. S.M.T. reports consulting or advisory roles for 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, and Denali Therapeutics; research funding from Genentech/Roche, Merck, Exelixis, Pfizer, Lilly, Novartis, Bristol Myers Squibb, AstraZeneca, NanoString Technologies, Gilead, Seagen, OncoPep, Daiichi Sankyo, Menarini/Stemline, Jazz Pharmaceuticals, and Olema Pharmaceuticals; and travel support from Lilly, Gilead, Jazz Pharmaceuticals, Pfizer, Arvinas, and Roche. A.D.C. receives research support from Bayer and consults for KaryoVerse. E.F.P. reports consulting for Ignite Proteomics, Perthera, DAiNA, Ceres Nanosciences, Equity for Perthera and Ceres Nanosciencesm Board of Director for Ceres Nanosciences, and royalty/licensing distribution from Ignite Proteomics for GMU assigned patents. C.K.A. reports research funding from PUMA, Lilly, Merck, Seattle Genetics, Nektar, Tesaro, G1-Therapeutics, ZION, Novartis, Pfizer, Astra Zeneca, Elucida, Caris, Incyclix, Beigene; honoraria from Genentech, Eisai, IPSEN, Seattle Genetics, Astra Zeneca, Novartis, Immunomedics, Elucida, Athenex, Roche; and royalties from UpToDate and Jones and Bartlett. D.L.R. has served as an advisor for AstraZeneca, Cell Signaling Technology, Cepheid, Daiichi Sankyo, Danaher, Halda Therapeutics, Incendia, Nucleai, PAIGE.AI, and Sanofi. AstraZeneca, Cepheid, Konica Minolta, Leica, NavigateBP, NextCure, Nanostring, and Lilly, have funded or currently fund research in DLR’s lab. H.M. reports consulting fees from AstraZeneca, Lilly, Novartis, Gilead, and Genentech. GC reports honoraria from AstraZeneca, Celcuity, Daiichi Sankyo, Exact Sciences, Lilly, Merck, Novartis, Pfizer, Roche, Veracyte, Ellipsis, Astellas, Blueprint Medicine, BMS, Kymab, Merck, Novartis, Philogen, Relay Therapeutics, Sanofi; and non-financial interests with the Italian National Health Council as Advisor for Ministry of Health ESMO, ESMO as Clinical Practice Guidelines Chair, Europa Donna as Member of the Scientific Council, EUSOMA as member of the Advisory Council, Fondazione Beretta, Lega Italiana Lotta ai Tumori as member of Board of Directors. A.P. reports grants and owns shares from Reveal Genomics during the conduct of the study, other from Reveal Genomics, personal fees from Roche, grants and personal fees from AstraZeneca, Daiichi-Sankyo, Novartis, and Ona Therapeutics, outside the submitted work; in addition, A.P. has a patent HER2DX and DNADX licensed to Reveal Genomics. F.B.M. reports part-time employment by Reveal Genomics and has the HER2DX and DNADX patents licensed to Reveal Genomics. The other authors declare no competing interests.