ASCO 2026 was defined by one core theme: The beauty and complexity of abundance. Across nearly every tumor type and mechanism class, the meeting delivered more options. New ways to hit old targets, previously undruggable biology becoming actionable, and a rapidly expanding combination landscape. The excitement was plentiful, but so was the honest conversation about the gap between the promise of science and the reality of clinical decision-making.
With each new available option, new layers of complexity are added. More sequencing decisions, more toxicity management demands, and more complexity for clinicians, patients, and payers. Medical Affairs has a defining role to play in unraveling this complexity and paving the way for new options to reach the patients who can benefit from them.
So, what new layers emerged this year? Four key trends we spotted:
Toxicity management: A new layer of differentiation?
Alongside the groundbreaking data from daraxonrasib and a veritable explosion of ADCs, T-cell engagers, and IO combinations, there was a quiet but clear discourse around the substantial toxicities that can be associated with these agents. Many of them are moving into earlier lines of treatment, where the threshold of tolerance is far lower than in metastatic disease. This creates a clear need for sponsors to invest in supporting toxicity and combination management through evidence generation, education, and caregiver support. In crowded landscapes where efficacy improvements are mostly incremental, we predict that toxicity management will form a new foundation for differentiation.
Precision within precision
Precision medicine is nothing new. Biomarkers continue to be vital in enabling HCPs and payers to define patient populations who will benefit from a given treatment. But as combination approaches dominate treatment landscapes across multiple lines of therapy, a dynamic layer has been added to precision oncology. HCPs are increasingly seeking validated post-surgical risk-stratification criteria and temporal biomarkers such as ctDNA to enable them to decide when to escalate and when to de-escalate treatment, even within a given line of therapy. This brings challenges not only in ensuring HCPs have access to the algorithms and diagnostic platforms they need to make precise decisions, but in ensuring they can apply the results.
Both these layers demand field teams to shift from information delivery toward evidence-focused dialogue that helps clinicians interpret toxicity and risk data in context, and integrate them into their own decision frameworks, while carefully maintaining compliant scientific exchange that informs, but does not direct, clinical decision-making.
Old targets, new tricks?
As expected, the HARMONi-6 OS data made a splash at ASCO. But in contrast with ESMO, the conversation in Chicago had moved from excitement to measured skepticism. As the FDA PDUFA date for ivonescimab approaches, experts are questioning how confidently we can extrapolate the data from an exclusively Chinese patient population. It also raises a broader question around the reuse of mechanisms like anti-VEGF: Are we just re-buying VEGF baggage in a new format? At the same time, there were encouraging signs of more imaginative ADC design, including payloads and constructs that move beyond traditional cytotoxic “chemo delivery” and start to look more like true precision tools. Yet we still heard calls for drug developers to broaden ADC design beyond the same cytotoxic MMAE and TOPO1 payloads, with one speaker labeling ADCs as “chemo-delivery systems, not precision medicines.” What both these challenges reveal is that differentiation is more critical than ever. Medical Affairs needs to build strong evidence-based scientific narratives to show where a new construct offers a genuine incremental gain vs just simply another option in an already crowded space.
GLP-1s: An unexpected layer
One striking finding within the ASCO program was more than 20 studies on GLP-1 receptor agonists across more than 10 tumor types. Although these were all retrospective studies not powered to detect treatment effects, the consistency of association with improved outcomes across colorectal, endometrial, and pancreatic cancers was hard to dismiss. The mechanistic hypotheses are plausible, covering metabolic remodeling, reduced insulin resistance, and potential direct anti-tumor effects, and early signals have already prompted calls for prospective studies to test whether these associations are causal rather than happenstance. Although the data are early, against a backdrop of intense lay-press attention, we predict that the narrative around them will escalate rapidly. Medical Affairs teams will need to be ready to address HCPs’ questions about the potential implications of these findings, as well as supporting them to confidently address questions from their patients.
Looking ahead
As we move into the second half of 2026, we’ll be watching as several of the conversations ASCO set in motion take clearer shape. As these layers evolve, the differentiator will be confident decisions, by HCPs at the point of care, and by Medical Affairs teams shaping the evidence and dialogue that support them. If you’re looking to strengthen how your organization equips clinicians to navigate this new complexity, we’d be happy to explore how we can help.
