This Week in Oncology — Aug 5, 2026

Welcome to This Week in Oncology. This week we're covering 7 notable papers spanning supportive care and de-escalation, biomarker-driven treatment selection across solid tumours, and rare cancers with long-term outcome data. Let's dive in.

We start with two trials that ask whether adding or removing a drug actually changes anything. In the Journal of Clinical Oncology, the CIVIC POD trial tackled a problem every paediatric oncologist knows well — corticosteroid toxicity in children receiving antiemetic prophylaxis [1]. This multicentre, open-label phase three noninferiority trial randomised 310 children and adolescents aged four to eighteen receiving highly emetogenic chemotherapy to either dexamethasone, palonosetron and fosaprepitant, or a dexamethasone-free regimen substituting olanzapine. Complete response to vomiting over the full five-day window was 57 percent with dexamethasone and 63 and a half percent with olanzapine, an absolute difference of about six and a half points favouring olanzapine, comfortably meeting the prespecified noninferiority margin of minus fifteen percent. Acute and delayed period control, and nausea control, were essentially superimposable. The trade-off is sedation: any-grade somnolence occurred in roughly half of olanzapine patients versus about one in six on dexamethasone. For a child on a steroid-sensitive protocol, or one in whom hyperglycaemia, behavioural change or infection risk is a real concern, this gives you a defensible corticosteroid-sparing option — provided you counsel families about drowsiness. Contrast that with SOLARIS, Alliance A021703, published in JAMA, which asked whether more of a good thing helps [2]. A promising phase two signal had suggested high-dose vitamin D3 improved progression-free survival in metastatic colorectal cancer. In this double-blind phase three trial of 455 previously untreated patients receiving modified FOLFOX6 or FOLFIRI plus bevacizumab, high-dose vitamin D3 — 8,000 international units daily as loading, then 4,000 daily — did not improve progression-free survival compared with 400 units daily. Median progression-free survival was 11.8 versus 10.3 months, not statistically significant. Response rates and overall survival showed no significant difference either, and overall survival numerically favoured the standard-dose arm at 27 versus about 25 and a half months. Toxicity was similar. This is a clean negative trial, and it should end routine high-dose vitamin D supplementation as an anticancer strategy in metastatic colorectal cancer — a useful thing to be able to say to the patient who arrives with a bottle of 5,000-unit capsules.

Our second theme is biomarkers — where they work, and where they disappoint. Also in the Journal of Clinical Oncology, a correlative analysis of the PRODIGE-24 and CCTG PA6 adjuvant pancreatic trial sequenced tumour DNA from 317 resected pancreatic adenocarcinomas and applied the PurIST transcriptomic classifier [3]. Among patients treated with modified FOLFIRINOX, classical tumours had substantially better disease-free survival than basal-like tumours, with roughly a halving of the hazard. More provocatively, the disease-free survival advantage of modified FOLFIRINOX over gemcitabine was confined to driver-mutated tumours, with a significant interaction test, and was not apparent in wild-type tumours. Homologous recombination repair gene status was not predictive, and neither were mutational signatures. The authors are appropriately restrained: this is hypothesis-generating, and modified FOLFIRINOX remains the standard adjuvant regimen. Nothing here should change what you offer a fit patient after resection. A biomarker with more immediate practical appeal comes from Clinical Cancer Research, where investigators measured serum thymidine kinase activity — a simple blood marker of cell proliferation — in patients from the randomised phase two SECOMBIT trial in BRAF V600-mutated metastatic melanoma [7]. Splitting 81 patients at the median baseline value, low thymidine kinase activity was associated with markedly better five-year total progression-free survival, about 61 versus 35 percent, and overall survival, about 71 versus 37 percent. First progression-free survival differed in the same direction but did not reach significance. The intriguing signal is in sequencing: patients with high thymidine kinase activity appeared to do better with the sandwich strategy of short-term targeted therapy induction before immunotherapy than with either straightforward sequence. This is a post hoc analysis of a phase two trial with small subgroups, so it is not ready to direct therapy, but it does offer a cheap blood test worth watching for the perennial question of who needs targeted therapy first.

Finally, rare diseases and the value of long-term data. The Japanese phase two DISCOVARY trial in the Journal of Clinical Oncology tested darolutamide in androgen receptor-positive salivary gland carcinoma, a malignancy with no standard systemic therapy [5]. In 24 patients on darolutamide monotherapy, the confirmed response rate was only 8 percent with median progression-free survival of 5.7 months. In the 33-patient combination cohort adding goserelin, response rate was 45 percent and median progression-free survival 13.1 months. Toxicity was mostly grade one or two with no treatment-related deaths and preserved quality of life. These were sequential, non-randomised cohorts, so the comparison is indirect, but the message is that full androgen deprivation, not receptor blockade alone, appears necessary — and this offers a chemotherapy-sparing option in a disease with few. Also in JCO, the Euro-EWING99 study reports long-term outcomes on 3,395 patients with Ewing sarcoma enrolled between 1999 and 2015, the largest such series published [4]. At a median follow-up of 7.2 years, five-year progression-free survival was 55 percent and overall survival about 65 percent. Beyond metastatic status, age, tumour volume and histologic response to neoadjuvant chemotherapy were independent prognostic factors — reaffirming that complete histologic response after induction remains one of your most informative pieces of data. Rounding out the theme, a JCO review revisits high-risk smouldering myeloma after the AQUILA trial, in which daratumumab monotherapy roughly halved the risk of progression versus observation and showed a trend toward better overall survival [6]. The authors caution that with modern imaging most progression events are asymptomatic, irreversible end-organ damage is uncommon, and the survival benefit remains inconclusive in an era of quadruplet therapy at progression — so management should be risk-adapted, with observation still appropriate for many.

If you only have time for one paper this week, make it the CIVIC POD trial in the Journal of Clinical Oncology [1]. It is a properly powered, practice-ready de-escalation study that lets you drop corticosteroids from paediatric antiemetic prophylaxis in the children who most need to avoid them.

Here are the key takeaways from this week in Oncology. First, olanzapine can replace dexamethasone in paediatric antiemetic prophylaxis for highly emetogenic chemotherapy without losing vomiting control, at the cost of substantially more somnolence. Second, high-dose vitamin D3 does not improve progression-free survival in untreated metastatic colorectal cancer — the phase two signal did not replicate, so stop recommending it as therapy. Third, modified FOLFIRINOX remains the standard adjuvant regimen in resected pancreatic cancer; molecular subtyping is prognostic but not yet a treatment selector. Fourth, in androgen receptor-positive salivary gland carcinoma, darolutamide needs goserelin to deliver meaningful activity. And fifth, in high-risk smouldering myeloma, early daratumumab delays progression but the overall survival case is unproven — shared decision-making, not reflex treatment.

That's your roundup for This Week in Oncology. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

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