The state of the war on cancer, 2026

Generated from the OnCo corpus: what was approved, what read out, where the roadmaps stand, and what is still unsolved. Every figure below is a count over the objects on this site, so it is auditable and it is incomplete in exactly the ways the corpus is.

Three things defined 2026 in oncology as recorded here. First, antibody-drug conjugates moved from rescue therapy to first choice: two TROP2 ADCs were approved for first-line triple-negative breast cancer, trastuzumab deruxtecan reached early-stage HER2-positive disease, and the first bispecific ADC succeeded in phase 3. Second, immunotherapy grew a new limb: a personalised mRNA vaccine met its phase 3 endpoints in melanoma, an oncolytic virus was approved after an earlier rejection, and a blood test for residual disease decided, for the first time, who receives adjuvant immunotherapy. Third, targeted protein degradation arrived, with the first PROTAC approved for ESR1-mutant breast cancer.

The failures matter as much. TIGIT blockade did not add to PD-1 inhibition; a CD47 antibody was abandoned; a second TOP1-payload ADC given straight after a first works poorly. Pancreatic cancer and glioblastoma remain the deadliest common cancers, though the first pan-RAS inhibitor is in a pivotal trial and tumour treating fields earned the first pancreatic approval in decades.

The corpus at a glance

Approved 306Positive 296Standard of care 100Established 96Emerging 70Phase 3 54Phase 2 41Negative 40Mixed 30Recruiting 26Phase 1 20Withdrawn 14Preclinical 12Active 10Completed 6Concept 4Historic 3

Approvals recorded in 2026

34 label actions · 10 first-ever approvals

Product	Region	Indication
Acalabrutinib Calquence	US	Fixed-duration acalabrutinib + venetoclax, previously untreated CLL/SLL without del(17p)/TP53 (AMPLIFY)
ArteraAI Breast	US	Risk stratification in early-stage HR+/HER2- invasive breast cancer	first approval
Atezolizumab Tecentriq / Tecentriq Hybreza (SC)	US	Adjuvant muscle-invasive bladder cancer, ctDNA-positive after cystectomy
Belzutifan Welireg	US	Adjuvant clear-cell RCC with pembrolizumab
Camizestrant Etcamah	US	HR+/HER2- advanced breast cancer with an emergent ESR1 mutation on AI + CDK4/6, with a CDK4/6 inhibitor (accelerated, 4 Sep 2026)	first approval
Capivasertib Truqap	US	PTEN-deficient metastatic prostate cancer with abiraterone
Daratumumab Darzalex / Darzalex Faspro (SC)	US	With teclistamab after ≥1 line (MajesTEC-3); high-risk smouldering myeloma (AQUILA)
Daraxonrasib Rasonque	US	Metastatic pancreatic cancer (previously treated)	first approval
Datopotamab deruxtecan Datroway	US	First-line unresectable/metastatic TNBC, PD-1/PD-L1 inhibitor ineligible
Decitabine + cedazuridine (oral) Inqovi	US	Newly diagnosed AML, unfit for intensive induction, with venetoclax (ASCERTAIN-V)
Durvalumab Imfinzi	US	High-risk NMIBC with BCG
Encorafenib Braftovi	US	First-line BRAF V600E mCRC with cetuximab and chemotherapy
Gedatolisib Revtorpyk	US	HR+/HER2- advanced breast cancer after CDK4/6 inhibitor (July 2026)	first approval
Isatuximab Sarclisa / Sarclisa Escena (SC)	US	Subcutaneous formulation (Sarclisa Escena)
Lutetium-177 vipivotide tetraxetan Pluvicto	US	Label expansion (July 2026)
Nivolumab Opdivo / Opdivo Qvantig (SC)	US	Untreated advanced classical Hodgkin lymphoma with AVD, age ≥12
Optune / Optune Pax (TTFields) Optune	US	Locally advanced pancreatic cancer with chemotherapy
Palbociclib Ibrance	US	HR+/HER2+ advanced breast cancer maintenance with anti-HER2 and endocrine therapy
Pembrolizumab Keytruda / Keytruda Qlex (SC)	US	Platinum-resistant PD-L1+ ovarian cancer; adjuvant RCC with belzutifan; with sacituzumab govitecan in 1L TNBC
Piflufolastat F-18 / Pylarify TruVu Pylarify	US	Pylarify TruVu formulation
Pivekimab sunirine Decnupaz	US	Blastic plasmacytoid dendritic cell neoplasm	first approval
Relacorilant Lifyorli	US	Platinum-resistant ovarian, fallopian tube, or primary peritoneal cancer with nab-paclitaxel	first approval
Rusfertide Mimrylo	US	Erythrocytosis in adults with polycythaemia vera	first approval
Sacituzumab govitecan Trodelvy	US	First-line metastatic TNBC: monotherapy (PD-1 ineligible) or with pembrolizumab (PD-L1 CPS ≥10)
Selpercatinib Retevmo	US	Label update (July 2026)
Sonrotoclax Beqalzi	US	Relapsed/refractory mantle cell lymphoma after ≥2 lines including a BTK inhibitor (accelerated)
Teclistamab Tecvayli	US	Relapsed/refractory myeloma after ≥1 prior therapy
Tovorafenib Ojemda	EU	Relapsed/refractory paediatric low-grade glioma (conditional)
Trastuzumab deruxtecan Enhertu	US	Early-stage HER2+ breast cancer (neoadjuvant and post-neoadjuvant)
Vepdegestrant Veppanu	US	ESR1-mutated ER+/HER2- advanced or metastatic breast cancer after endocrine therapy	first approval
Vusolimogene oderparepvec Tudriqev	US	Unresectable/metastatic melanoma after anti-PD-1, with nivolumab (accelerated)	first approval
Zenocutuzumab Bizengri	US	NRG1-fusion cholangiocarcinoma
Zidesamtinib Jideytro	US	ROS1+ NSCLC (July 2026)	first approval
Zongertinib Hernexeos	US	First-line HER2-mutant non-squamous NSCLC

Trials reported in 2026

13 positive

NegativeAMPLIFY-7PPrimary DFS endpoint not met.
PositiveASCERTAIN-VCR 41.6%; median time to CR 2 months.
PositiveAZUR-1Primary endpoint (sustained cCR at 12 months) met; rates pending congress presentation.
PositiveBL-B01D1-307PFS and OS significantly improved at interim analysis (numbers presented ASCO 2026).
PositiveCLARITY-Gastric 01Co-primary endpoints including OS met (July 2026); numbers pending.
NegativeDREAM3RStopped early; primary endpoint not met.
PositiveEMERALD-3PFS HR ~0.70 (interim); OS immature.
MixedEPCORE DLBCL-1PFS HR 0.74; OS HR 0.96 (NS).
NegativeFianlimab + cemiplimab phase 3 (first-line melanoma)Primary PFS endpoint not met; numerical +5.1 months median PFS at the high dose.
PositiveFOURLIGHT-1PFS improved (HR not yet published in detail).
MixedHARMONi-3Interim PFS not statistically significant (May 2026); final readouts pending.
PositiveHERIZON-GEA-01PFS 12.4 vs 8.1 months (HR 0.63-0.65); OS significantly improved.
PositiveINSIGHTPFS favouring ripretinib in the ctDNA-defined subgroup (2026).
PositiveINTerpath-001 (V940-001)RFS and DMFS significantly improved (HRs pending presentation).
PositiveKrascendo 1Superior PFS and OS vs approved G12C inhibitors (topline, July 2026).
NegativeLITESPARK-012Primary endpoint not met (ASCO GU 2026).
PositiveLITESPARK-022DFS significantly improved vs pembrolizumab (interim; HR presented ASCO GU 2026).
PositivePANKU-Esophagus01 (BL-B01D1-305)OS and PFS significantly improved at interim analysis; numbers per ASCO 2026 presentation.
NegativepersevERAPFS 33.1 vs 28.2 months, not significant.
PositiveRASolute 302OS 13.2 vs 6.7 months, HR 0.40.
NegativeXPORT-EC-042 / ENGOT-EN20 / GOG-3083Primary PFS endpoint not met; mPFS 12.75 vs 7.43 months (mITT) not significant.

Negative, mixed, and withdrawn

failures are data

Trials

ACT IV AMPLIFY-7P ANNOUNCE ASPREE (ASPirin in Reducing Events in the Elderly)ASTRA ATLANTIS BEAT-meso (ETOP 13-18)BELINDA BILCAP BWEL (Breast Cancer Weight Loss, Alliance A011401)CheckMate 548 & CheckMate 143 & CheckMate 498 CheckMate 577 CONTACT-03 CONVERT COSMIC-313 DREAM3R DUO-O / ENGOT-ov46 EMERALD-1 EPCORE DLBCL-1 ERGO2: ketogenic diet and fasting during re-irradiation of recurrent glioma Fianlimab + cemiplimab phase 3 (first-line melanoma)FORTITUDE-101 GOG-0218 & ICON7 (bevacizumab)HARMONi-3 HER2CLIMB-02 HERTHENA-Lung02 IMbrave050 IMpassion130 IMpassion131 Interfant-06 JAVELIN Head and Neck 100 LACC (Laparoscopic Approach to Cervical Cancer)LEAP-002 LEAP-012 LITESPARK-012 LUME-Meso MAGNITUDE MARS 2 NALIRICC (AIO)NRG-HN002 & NRG-HN005 (HPV+ de-escalation)OUTBACK / ANZGOG 0902 / GOG-0274 PALLAS & PENELOPE-B PALOMA-2 persevERA POLO PREOPANC-1 / PREOPANC-2 PRIMA / ENGOT-OV26 RELATIVITY-098 ROMANA 1 and ROMANA 2 SARAH and SIRveNIB SIOPEN HR-NBL1 SPLASH STARGLO TiNivo-2 TrilynX TROPION-Breast01 TROPION-Lung01 UKCTOCS VERITAC-2 VITAL (VITamin D and OmegA-3 TriaL)VOYAGER WHEL (Women's Healthy Eating and Living)XPORT-EC-042 / ENGOT-EN20 / GOG-3083

Programmes and targets

Where the roadmaps stand

Current (19 steps)

Third generation: TOP1 payloads and bystander killing
ADC roadmap · 2019-2022
Third generation matures: earlier lines, more targets, combinations
ADC roadmap · 2023-2026
Screening at scale and risk models
AI in the oncology clinic · 2022-2024
First predictive AI and foundation models in products
AI in the oncology clinic · 2025-2026
Solid tumours: TIL, TCR-T, CAR-T
Cell therapy roadmap · 2024-2026
Pivotal trials and first approvals
Early detection roadmap · 2021-2026
Earlier lines and combinations
Immunotherapy roadmap · 2018-2024
Beyond G12C
KRAS roadmap · 2023-2026
Stromal PET and total-body scanners
Molecular imaging roadmap · 2018-2026
Removing every cell, and knowing that you did
Paths to cures · Eradication: established
Living with cancer as a chronic disease
Paths to cures · Control: established
Ideas already being tested against a control arm
Radical oncology · Now (randomised data exists)
PSMA theranostics
Radiopharmaceutical roadmap · 2020-2022
Earlier lines, consolidation, and an M&A wave
Radiopharmaceutical roadmap · 2023-2026
ADCs move to first line; bispecific ADC succeeds
TNBC roadmap · 2024-2026
Second entrant: datopotamab deruxtecan
TROP2 ADC roadmap · 2023-2025
First line: three positive phase 3 trials
TROP2 ADC roadmap · 2025-2026
First single-cell foundation models
Virtual cell roadmap · 2023-2024
Data at scale and context-aware models
Virtual cell roadmap · 2025-2026

Emerging (19 steps)

Fourth generation, wave 1: bispecific ADCs
ADC roadmap · 2026-2028
Fourth generation, wave 2: new payload logic
ADC roadmap · 2026-2030
Prospective evidence and regulatory frameworks
AI in the oncology clinic · 2026-2028
Manufacturing revolution: allogeneic and in vivo
Cell therapy roadmap · 2025-2028
Decision and integration
Early detection roadmap · 2026-2030
Engineered immunity arrives
Immunotherapy roadmap · 2024-2027
Approval and combinations
KRAS roadmap · 2026-2029
Drug-target and immune PET
Molecular imaging roadmap · 2024-2028
Vaccinating and monitoring people who do not yet have cancer
Paths to cures · Interception: next
Killing the last cell, wherever it is hiding
Paths to cures · Eradication: next
Steering resistance instead of waiting for it
Paths to cures · Control: next
Living drugs, logic gates, and designed proteins reach decision points
Radical oncology · By 2027 (early clinical, readouts imminent)
Radiation and radiopharmaceuticals get a second act
Radical oncology · By 2030 (physics and chemistry maturing)
Monitoring becomes continuous and selection becomes spatial
Radical oncology · By 2030 (detection and decision-making)
Alpha emitters and new targets
Radiopharmaceutical roadmap · 2026-2029
Next: residual disease, de-escalation, selection
TNBC roadmap · 2026-2029
Third entrant: sacituzumab tirumotecan and the Merck programme
TROP2 ADC roadmap · 2024-2027
Unsolved: selection, sequencing, resistance
TROP2 ADC roadmap · 2026-2029
Patient-derived contexts and spatial niches
Virtual cell roadmap · 2027-2029

Late-stage pipeline

41 products in phase 3 · 36 trials recruiting or active

Frontier technologies

ADC payload neutralisers AI-driven drug & target discovery Alpha-emitter nanogenerators and daughter trapping Antibody-oligonucleotide conjugates Armoured, logic-gated & next-gen CARs Auger-electron therapy Bacteriophage-based tumour delivery Bispecific ADC Breath and volatile-organic-compound detection Cachexia-directed therapy (GDF-15 blockade)Cancer interception vaccines Cancer neuroscience: cutting the nerve supply CAR-NK & CAR-macrophage CAR-T against stroma: fibroblasts and myeloid cells cfDNA fragmentomics Chronotherapy: timing treatment to the body clock Continuous and near-continuous ctDNA monitoring De novo designed protein binders Degrader-antibody conjugate (DAC)Digital twins and virtual control arms DNA origami nanorobots Dual-payload ADC Engineered bacteria as living cancer drugs Engineered exosomes as drug carriers Epigenetic editing (durable gene silencing)FLASH radiotherapy Histotripsy as an immune primer Hypoxia-activated prodrugs Immune-stimulating antibody conjugate (ISAC)In situ vaccination In vivo base and prime editing for cancer In vivo CAR-T Intratumoural gene electrotransfer (IL-12 plasmid)Lattice and GRID radiotherapy Logic-gated therapeutics (AND, NOT gates)Magnetic nanoparticle hyperthermia Masked / conditionally active ADC Metabolic therapy: starving the tumour of a nutrient Microbiome modulation to unlock immunotherapy Molecular glue discovery platforms N-of-1 and rapid platform trials Oligonucleotide therapeutics Organoid-guided therapy at scale Pathology & radiology foundation models Photothermal (plasmonic) nanoparticle ablation Programmable DNA-targeting therapeutics Proton arc therapy Quantum-dot and molecular ultrasound imaging agents Radio-antibody & radio-ADC Radiodynamic therapy and radiosensitising nanoparticles Radioligand plus DNA-repair inhibitor combinations Self-amplifying and circular RNA therapeutics Senolytics and senescence-directed therapy Sonodynamic therapy Spatial-omics-guided treatment selection STING & innate immune agonists Systematic drug repurposing Targeted alpha therapy Targeting the tumour's own microbes Targeting tumour mechanics and pressure Total-body PET for screening and ultra-low-dose imaging Trained innate immunity TROP2 PET Very-high-energy electron therapy

Open problems, two per cancer

Acute lymphoblastic leukaemia — Adult ALL outcomes.
Acute lymphoblastic leukaemia — CD19-negative relapse.
Acute myeloid leukaemia — TP53-mutant AML remains lethal.
Acute myeloid leukaemia — Older patients.
Adrenocortical carcinoma — No targeted therapy despite defined genomic subgroups.
Adrenocortical carcinoma — Mitotane toxicity and narrow therapeutic window.
Anal cancer — Screening programmes for high-risk groups exist almost nowhere despite ANCHOR.
Anal cancer — Late toxicity of pelvic chemoradiation (bowel, sexual, bone).
Appendiceal cancer and pseudomyxoma peritonei — No effective systemic therapy for high-grade or signet-ring disease.
Appendiceal cancer and pseudomyxoma peritonei — Selection for CRS-HIPEC and management of recurrence after maximal surgery.
Basal cell carcinoma — Hedgehog-inhibitor tolerability leads most patients to stop within a year.
Basal cell carcinoma — Resistance via SMO mutations has no approved next-in-class agent.
Biliary tract cancer — FGFR inhibitor resistance.
Biliary tract cancer — Late diagnosis.
Bladder & urothelial cancer — BCG supply.
Bladder & urothelial cancer — Bladder preservation strategies.
Blastic plasmacytoid dendritic cell neoplasm — No randomised trials; sequencing of CD123 agents unknown.
Blastic plasmacytoid dendritic cell neoplasm — Capillary leak syndrome with tagraxofusp.
Cancer of unknown primary — Whether finding the primary matters, or only finding the target.
Cancer of unknown primary — Median survival under a year for unfavourable CUP despite decades of trials.
Cervical cancer — Vaccine and screening access in LMICs.
Cervical cancer — Brachytherapy capacity.
Chronic lymphocytic leukaemia — Double-refractory disease.
Chronic lymphocytic leukaemia — Richter transformation.
Chronic myeloid leukaemia — Blast-phase CML: median survival still under a year.
Chronic myeloid leukaemia — Predicting who can stop TKI safely; second TFR attempts.
Colorectal cancer — MSS metastatic disease is immunotherapy-resistant.
Colorectal cancer — Early-onset CRC causes unknown.
Cutaneous squamous cell carcinoma — Organ-transplant recipients: high incidence, no safe immunotherapy.
Cutaneous squamous cell carcinoma — Who needs adjuvant therapy: gene-expression tests vs clinicopathologic staging.
Diffuse large B-cell lymphoma — Primary refractory disease.
Diffuse large B-cell lymphoma — CAR-T access and cost.
Endometrial cancer — p53-abnormal disease behaves like serous ovarian.
Endometrial cancer — Obesity-driven incidence rising.
Ewing sarcoma — Metastatic-to-bone and relapsed disease: survival under 20-30%.
Ewing sarcoma — EWSR1-FLI1 remains undrugged after 30 years.
Follicular lymphoma — Transformation to DLBCL cannot be predicted or prevented.
Follicular lymphoma — Sequencing bispecifics vs CAR-T.
Gastric & gastro-oesophageal junction cancer — Peritoneal metastasis.
Gastric & gastro-oesophageal junction cancer — Heterogeneous CLDN18.2/HER2 expression.
Gastrointestinal stromal tumour — Polyclonal resistance: different lesions carry different secondary KIT mutations.
Gastrointestinal stromal tumour — SDH-deficient and other wild-type GIST have no effective TKI.
Gestational trophoblastic neoplasia — Late diagnosis where hCG surveillance after molar pregnancy is absent (much of the world).
Gestational trophoblastic neoplasia — Fertility and psychological burden of a pregnancy-related cancer.
Glioma & glioblastoma — Blood-brain barrier.
Glioma & glioblastoma — Immunologically cold, heterogeneous, infiltrative.
Hairy cell leukaemia — Variant HCL and IGHV4-34 disease respond poorly to purine analogues.
Hairy cell leukaemia — Infection risk during induction neutropenia.
Head and neck squamous cell carcinoma — Functional toxicity of chemoradiation.
Head and neck squamous cell carcinoma — Few targets beyond EGFR/PD-1.
Hepatoblastoma — Metastatic and low-AFP disease.
Hepatoblastoma — Long-term effects of cisplatin (hearing, kidney) and doxorubicin (heart).
Hepatocellular carcinoma — Liver function limits therapy.
Hepatocellular carcinoma — Surveillance uptake in cirrhosis is poor.
HER2-positive breast cancer — Brain metastases in ~50% of metastatic patients.
HER2-positive breast cancer — Which patients can skip chemotherapy entirely.
Hodgkin lymphoma — Late toxicity in survivors.
Hodgkin lymphoma — Older patients.
HR-positive / HER2-negative breast cancer — Late recurrence (up to 20+ years) with no predictive test.
HR-positive / HER2-negative breast cancer — CDK4/6 resistance mechanisms and sequencing.
Kaposi sarcoma — Access to effective chemotherapy and ART-linked cancer care in sub-Saharan Africa.
Kaposi sarcoma — KS in people with suppressed HIV and normal CD4 counts (unexplained).
Mantle cell lymphoma — TP53-mutant and blastoid MCL fail chemo-immunotherapy; need CAR-T or bispecific-based first-line trials.
Mantle cell lymphoma — MRD-guided treatment duration.
Medulloblastoma — Group 3 MYC-amplified and SHH TP53-mutant tumours: survival under 50%.
Medulloblastoma — Relapse is almost always fatal after craniospinal irradiation.
Melanoma — Primary IO resistance in ~40%.
Melanoma — Uveal and mucosal subtypes.
Merkel cell carcinoma — Half of patients do not respond to PD-1 blockade and have no effective second line.
Merkel cell carcinoma — Immunosuppressed patients: high incidence, poor outcomes, contraindications to immunotherapy.
Mesothelioma — Sarcomatoid subtype.
Mesothelioma — No early detection despite known exposure.
Multiple myeloma — High-risk cytogenetics.
Multiple myeloma — Infections with T-cell redirecting therapy.
Myelodysplastic syndromes / neoplasms — No drug has beaten azacitidine in higher-risk MDS.
Myelodysplastic syndromes / neoplasms — TP53-mutant and complex-karyotype disease: median survival about a year even after transplant.
Myeloproliferative neoplasms — No disease-modifying therapy in myelofibrosis short of transplant.
Myeloproliferative neoplasms — MPN in blast phase: outcomes as poor as secondary AML.
Nasopharyngeal carcinoma — Radiation late effects in a disease cured young.
Nasopharyngeal carcinoma — Western access to PD-1 inhibitors studied in Asia; regulatory lag.
Neuroblastoma — Relapsed high-risk disease.
Neuroblastoma — Long-term toxicity of intensive therapy.
Neuroendocrine tumours — Neuroendocrine carcinoma (high grade) behaves like SCLC.
Neuroendocrine tumours — Sequencing of PRRT vs targeted therapy.
Non-small-cell lung cancer — Resistance to every TKI.
Non-small-cell lung cancer — Squamous histology has few targets.
Oesophageal cancer — Late presentation.
Oesophageal cancer — Squamous cell carcinoma lacks targets beyond EGFR/HER3.
Osteosarcoma — No survival improvement since the 1980s; metastatic and relapsed disease ~20-30% survival.
Osteosarcoma — No recurrent druggable driver; genomic chaos.
Ovarian cancer — No effective screening.
Ovarian cancer — PARP resistance via BRCA reversion.
Pancreatic ductal adenocarcinoma — Late diagnosis; no screening.
Pancreatic ductal adenocarcinoma — Dense stroma blocks drug delivery.
Peripheral T-cell lymphomas — Five-year survival under 40% for PTCL-NOS with no new first-line regimen for non-CD30 disease.
Peripheral T-cell lymphomas — Randomised evidence for transplant consolidation is lacking.
Primary CNS lymphoma — Most patients are over 65 and cannot tolerate curative-intent therapy.
Primary CNS lymphoma — Neurocognitive decline from disease and therapy.
Prostate cancer — Overdiagnosis vs. underdiagnosis in screening.
Prostate cancer — Neuroendocrine transformation.
Renal cell carcinoma — Non-clear-cell histologies understudied.
Renal cell carcinoma — No validated predictive biomarker for IO.
Retinoblastoma — Late diagnosis and death in low-income countries; paediatric ophthalmology access.
Retinoblastoma — Second primary cancers in RB1 carriers across life.
Rhabdomyosarcoma — Metastatic alveolar RMS: survival <30% for 30 years.
Rhabdomyosarcoma — PAX3-FOXO1 is an undrugged fusion transcription factor.
Salivary gland cancers — Adenoid cystic carcinoma: no drug induces meaningful shrinkage; 20-year survival remains poor.
Salivary gland cancers — Trials are tiny; most evidence is phase 2 or retrospective.
Sarcomas — Rarity limits trials.
Sarcomas — Chemoresistance of most subtypes.
Small-cell lung cancer — Rapid chemoresistance.
Small-cell lung cancer — Brain metastases.
Testicular germ cell tumours — Platinum-refractory disease has no effective therapy; checkpoint inhibitors were inactive.
Testicular germ cell tumours — Late effects of cisplatin (cardiovascular disease, second cancers, hearing loss) in men cured in their 20s.
Thymoma and thymic carcinoma — No randomised trials have ever been completed in thymic epithelial tumours.
Thymoma and thymic carcinoma — Immunotherapy safety in a tumour that disturbs central tolerance.
Thyroid cancer — Overdiagnosis of microcarcinoma.
Thyroid cancer — Anaplastic thyroid cancer remains lethal.
Triple-negative breast cancer — Residual disease after KEYNOTE-522: no approved escalation beyond capecitabine/olaparib; ctDNA-guided trials needed.
Triple-negative breast cancer — ADC sequencing: does a second TOP1-payload ADC work after the first? SATEEN/BRE-354 suggest limited efficacy; chemotherapy interposition debated.
Uveal melanoma — Half of patients metastasise with no adjuvant therapy despite accurate prediction.
Uveal melanoma — Tebentafusp only for HLA-A*02:01 (about 45% of white patients, fewer elsewhere) and gives few objective responses despite OS benefit.
Vulvar cancer — HPV-independent p53-mutant disease recurs often and has no targeted therapy.
Vulvar cancer — Lichen sclerosus surveillance and prevention of malignant transformation.
Waldenström macroglobulinaemia — Indefinite BTKi therapy: cost, toxicity and resistance (BTK C481S).
Waldenström macroglobulinaemia — CXCR4-mutant disease responds slower and shallower.
Wilms tumour — Diffuse anaplastic and relapsed disease: survival ~50% or lower.
Wilms tumour — Global inequity: Wilms is curable, yet most children with it worldwide die.

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