José M Peñaloza

The 3.5yr OS from EV302 continues to show transformative benefit (HR 0.53 (0.45-0.63)) #ASCO26 for EV/pembro. The landmark OS for the CR population (30%) is ~90%. Median time to CR is 4.5 months (responses mature over time). Response rates of platinum chemo after EVP is 21% (OS 11 months). This should be considered a 2nd line standard. Median duration of EV was 7 months - longer in responders. Optimal duration of EV trials are needed. @OncoAlert

@Martin_AngelMD @DrYukselUrun @ASCO 👏👏👏

Happy to start #ASCO26 with my friend @DrYukselUrun @ASCO

Clear cell RCC sheds low levels of ctDNA, but positivity and ctDNA dynamics are relevant in the adjuvant setting @DrChoueiri #ASCO26. This analysis is with an exome based personalised technique and shows a lack of sensitivity (5-8% ctDNA+ve rate vs 40% radiological relapse rate) but good specificity (almost all ctDNA +ves relapse). Whole genome ctDNA analysis should work work better. There is a future for ctDNA in renal cancer, we’re just not quite there yet IMO.

A really thought-provoking study at #ASCO26 (Abstr 4512, Clinical Science Symposium): decision regret after adjuvant pembrolizumab in RCC. 🔹 The question Do patients regret receiving adjuvant pembro — and if so, is it driven by long-term toxicity that CTCAE grading doesn't adequately reflect? They built a patient co-designed tool focused on long-term toxicity. 🔹 The study 104 RCC pts post-adjuvant pembro across 3 London centres, median f/u 30 mo. Pts completed the Ottawa Decision Regret Scale alongside their own rating of irAEs as life-changing, significant, or non-significant. 🔹 What they found 28% rated their toxicity as significant and 11% as life-changing — but these ratings did NOT correlate with CTCAE grade (a third of G1–2 events were rated significant), and regret was identical for G1–2 vs G3–4 irAEs. Regret was driven by patient-perceived long-term toxicity, especially permanent endocrine and MSK irAEs — and not by disease recurrence (only 1/14 who relapsed expressed regret). Lower baseline expectations of toxicity → more regret. 🔹 My take Striking that >1 in 4 reported significant and >1 in 10 life-changing toxicity. What concerns me most isn't that CTCAE missed these events — it's that the grade didn't correlate with how significant patients found them, nor with regret at all. That deviates from the very purpose of grading. The hard part: a regret analysis is tough to contextualize when the alternative, no treatment, risks recurrence — arguably worse than a long-term toxicity. Adjuvant therapy is challenging by nature: most patients are either cured already or destined to recur regardless — we expose everyone to toxicity to benefit a minority. We urgently need biomarkers to find the few who truly benefit. This slide from @Prof_IanD says it all 👇 Looking forward to seeing the presentation! 🔗 asco.org/abstracts-pres… #kcsm #ASCO26 @BethN01 @tompowles1

⚡️ Phase 3 LITESPARK-022 in high-risk ccRCC after nephrectomy: adjuvant pembrolizumab + belzutifan vs pembrolizumab alone (n=1,841). 24-month DFS: 80.7% vs 73.7% (HR 0.72; P=0.0003). First phase 3 adjuvant trial to demonstrate DFS benefit vs pembrolizumab monotherapy — a potential new standard of care. #KidneyCancer ascopubs.org/doi/10.1200/JC…

Finally published!!! 😃 The assessment of the Meet-URO score in a first-line mRCC international cohort. Thanks to @gbanna74 @amg120395 academic.oup.com/oncolo/advance…

⚡️ IMvigor011 at #ASCO26: ctDNA-guided adjuvant atezolizumab in MIBC improved DFS and OS in ctDNA+ patients — with no negative impact on patient-reported QoL. >90% of patients reported little or no treatment side-effect burden throughout therapy. Efficacy and tolerability together. Relevant for shared decision-making in the adjuvant setting. #BladderCancer @OncoBellmunt @ASCO asco.org/abstracts-pres…

Ab#5082 @ASCO #ASCO26 by @Soum_Roy_RadOnc👉bit.ly/4wKOPPj👉Baseline NADIR model predicts 6-mo PSA👉independently validated in Ph3 ARCHES in pts w/ enza-treated mHSPC #prostatecancer👇@DrSpratticus @oncoalert @urotoday @PCF_science @OpenMedicineHQ

🚨Hungry for a new α/β study?🚨 🧪📉 We often quote α/β ratios in clinic as if they’re fixed truths — but where do those numbers actually come from? This study compared in vitro vs. clinical α/β estimates across prostate, breast, and head & neck cancers and... ... they often do NOT match. Key findings: 📍Prostate: in vitro α/β ~3.8 Gy vs clinical ~2.3 Gy 🦀Breast: fairly similar (~3.6-3.9 Gy) 🗣️H&N: clinical estimates actually HIGHER than lab estimates (~14 vs 9 Gy) Why it matters for everyday radonc 👇 ⚠️ The “standard” α/β assumptions we use for BED/EQD2 calculations, hypofractionation discussions, and protocol design may oversimplify real tumors. 🧬 Tumor heterogeneity, hypoxia, stem-cell populations, ADT, and the tumor microenvironment likely make clinical tumors behave very differently from cell lines grown in a dish. 💡 Practical takeaway: When we debate fractionation schedules or compare regimens, remember that the radiobiology behind those BED calculations is probably messier than the spreadsheet suggests. The paper also reinforces that the classic “10 Gy for most tumors” assumption likely doesn’t hold true for many disease sites. 📚 advancesradonc.org/article/S2452-… @ASTRO_org

One of the standout talks of #ESTRO2026 👏 'A lot to be proud of' @alison_tree brilliantly highlighted how modern #RadOnc in #PCa is evolving beyond technology alone , with increasing focus on continenze, sexual function and QoL alongside outstanding cancer control!

ICI rechallenge in metastatic clear-cell RCC (real-world, n=288): median OS 33.2 months, PFS 8.5 months. Rechallenge ≥6 months after prior ICI was associated with improved OS (34.9 vs 19.4 months; P=0.014) and PFS, independent of prior ICI type or sequencing strategy. Timing — not agent selection — may be the key determinant of benefit. 📄 ESMO Open 2026 esmoopen.com/article/S2059-… #KidneyCancer #Immunotherapy

Conclusion: Pelvic RT is NOT SOC in #prostatecancer pts, even at high risk of nodal disease, staged with CI. We need to improve risk stratification to escalate/deescalate according to individual risk. But the notion of vHR prostate cancer may need to be redefined. 5/5

Day THREE of #ESTRO26 Coverage by OncoAlert 🚨 Salvage Hypofractionated Accelerated versus Standard Radiotherapy for Biochemical Recurrence after Radical Prostatectomy (SHARE): A Phase 3 Randomized Clinical Trial Presented by Youngju Song 🇰🇷 #RadOnc ☢️ The 4-year biochemical progression-free survival rates were similar (80.1% in the hypofractionated arm and 78.1% in the conventional arm). Although late gastrointestinal toxicities were more frequent in the hypofractionated arm, they were not severe and self-limiting. Considering that there was no significant difference in patient-reported outcomes, hypofractionated radiotherapy could be considered a viable alternative treatment option in the salvage setting. @ESTRO_RT @yasemin09896924 @LindaMrissa @christian_roenn @Valeriadionisi @gerryhanna @clchiang_hk @mtugceyilmaz @B_Tomasik @gmpetrianni @CiroFranzese1 @Atem84 @piet_ost @brachyexpert @BlanceS90 @The_PT_Explorer @BarbaraJereczek @Mat_Guc @ZilliThomas @AnnaKirby17 @PBlanchardMD @achoud72 Pinging OA faculty @MKnoll_MD @_ShankarSiva @Icro_Meattini @seanmmcbride @NiuSanford @nataliagandur @acampsmalea @to_be_elizabeth

PACE-NODES PACE-NODES (n=1166): Pelvic nodal SBRT adds modest acute GI AEs vs prostate-only SBRT, resolving by 12 weeks, confirmed in the patient-reported QoL. #ESTRO26

Testosterone suppression and recovery in patients with advanced #ProstateCancer treated with relugolix: an interim analysis of the OPTYX study. Presentation by @UroDrBen @ChesUrology. #AUA26 written coverage by @chavarriagaj @PSH_Urology > bit.ly/4fwZYwO @AmerUrological

That’s interesting to observe @DrSpratticus , a RadioOnco, give criticism to some Urology panel guidelines #AUA26 To Urology community, most of what he is saying comes from not fully understanding how guideline methodology actually works, which then leads to unsupported accusations about “bias” or “industry influence.” The bellow long post will help all of you understand why To Daniel, you are always to academic debate with ME.

Association of a computational histology AI (CHAI) prognostic biomarker with high-grade recurrence independent of traditional risk factors in low-grade #NMIBC. Presented by @UrogerliMD @MoffittNews. #AUA26 written coverage by @chavarriagaj @PSH_Urology > bit.ly/3PsDgLU #BladderCancer #AUA2026 @AmerUrological

Nice plenary on extended #PLND in #ProstateCancer at #AUA26 from Dr Jean Lestingl. Phase 3 study in press @TheLancetOncol •n=300, limited vs extended •node count: 3 vs 17 (unlike Touijer) •⬇️BCR for GG3-5 but no diff in mets/survival (my)THM: await results of #ElIPSE_Trial!!

The FDA approves the signatera ctDNA assay for muscle invasive bladder cancer patients post surgery. This is based on the results of Imvigor011 study (atezo vs placebo in ctDNA positives, surveillance for the ctDNA negatives). It opens a new chapter for personalised therapy in urothelial cancer. Focusing on early treatment for those patients that need it and sparing those at lower risk potentially harmful treatment makes sense. ‘It is the first companion diagnostic approval in the field of blood-based MRD.’ natera.com/company/news/s…