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Article History

Received: 3 February 2026

Accepted: 15 May 2026

First Online: 15 June 2026

Competing interests

: GN reports travel, accommodation, and expenses for scientific meetings from Eli Lilly, Sanofi, and MSD. GV reports support for travel from Eli Lilly, Pfizer, and AstraZeneca; advisory board participation for Pfizer and Novartis; and speaker fees from Daiichi Sankyo and Eli Lilly. MMN reports travel, accommodation, and expenses for scientific meetings from Eli Lilly and Daiichi Sankyo. CB reports grants from the American-Italian Cancer Foundation during the conduct of the study, as well as other support from Gilead Sciences, Daiichi Sankyo, and Eli Lilly and Company, and personal fees from MSD outside the submitted work. LL reports personal fees for consultancy, advisory board participation, and speaker bureau activities from AstraZeneca, Daiichi Sankyo, Eli Lilly, Novartis, Pfizer, Gilead, Exact Sciences, Helsinn, Roche, Italfarmaco, Accord, Eisai, and Takeda; and support for attending meetings from Gilead, Accord, Helsinn, Roche, and Daiichi Sankyo. MM reports travel grants from Gilead and Eli Lilly. MP reports travel, accommodation, and expenses from Novartis and Eli Lilly. CC reports consultancy, advisory roles, and speaker bureau participation for Pfizer, Novartis, Eli Lilly, Roche, MSD, Daiichi Sankyo, AstraZeneca, Gilead, and Menarini Stemline. CZ reports travel, accommodation, and expenses for scientific meetings from Gilead. FP reports support for attending meetings from Menarini, Gilead, Pfizer, and Eli Lilly. AC reports support for attending meetings from Pfizer, Eli Lilly, and Novartis. JP reports advisory roles for Eli Lilly, Roche, Eisai, MSD, Daiichi Sankyo, AstraZeneca, Seattle Genetics, and Gilead; and travel expenses from Roche and Daiichi Sankyo. JC reports consultancy, advisory board participation, and honoraria from Roche, AstraZeneca, Daiichi Sankyo, Eli Lilly, Novartis, Pfizer, Merck Sharp & Dohme, Gilead, Eisai, Seattle Genetics, Menarini, Boehringer Ingelheim, Clovis Oncology, Jazz Pharmaceuticals, AbbVie, BioNTech, Zymeworks, Biocon, Circle Pharma, Delcath Systems, Hexagon Bio, Hibercell, BioInvent, Gemoab, Leuko, Bioasis, Ellipses, Reveal Genomics, Scorpion Therapeutics, Expres2ion Biotechnologies, BridgeBio, Bliss Biopharmaceutical, Stemline Therapeutics, and Zuellig Pharma.Research funding to the institution has been received from Roche, F. Hoffmann–La Roche, AstraZeneca, Ariad Pharmaceuticals, Baxalta GmbH/Servier Affaires, Bayer Healthcare, Eisai, Guardant Health, Merck Sharp & Dohme, Pfizer, Piqur Therapeutics, IQVIA, and Queen Mary University of London.Support for travel, accommodation, and meeting expenses has been received from Roche, Novartis, Eisai, Pfizer, Daiichi Sankyo, AstraZeneca, Gilead, Merck Sharp & Dohme, and Stemline Therapeutics.Stock ownership is reported in MAJ3 Capital and Leuko (relative).JC is a co-inventor on patents related to pharmaceutical combinations of a PI3K inhibitor and a microtubule-destabilizing agent (WO 2014/199294 A; issued) and HER2 as a predictor of response to dual HER2 blockade in the absence of cytotoxic therapy (US 2019/0338368 A1; licensed). LP reports consultancy, advisory board participation, and honoraria from Merck & Co., AstraZeneca, Bristol Myers Squibb, Agendia, Radionetics, Natera, and Personalis. Research funding to the institution has been received from Merck & Co., AstraZeneca, Bristol Myers Squibb, Pfizer, Menarini, Natera, Exact Sciences, Personalis, and Agendia. Stock ownership is reported in Ataraxis. LG reports advisory board participation and consultancy for AstraZeneca, Roche, Synaffix, Zymeworks, Daiichi Sankyo, BeiGene, Revolution Medicines, Menarini Ricerche, and Denali Therapeutics Inc; and is a co-inventor of European Patent Applications No. 12195182.6 and 12196177.5 titled “PD-L1 expression in anti-HER2 therapy” (Roche; no compensation provided). GB reports personal fees for consultancy, honoraria, and advisory roles from AstraZeneca, Daiichi Sankyo, Eli Lilly, Novartis, Pfizer, Roche, MSD, Gilead, Menarini, Exact Sciences, Seagen, Helsinn, Takeda, and Amgen. MD reports travel expenses from Insight Molecular Diagnostics. The other authors declare no competing financial or non-financial interests.