The edition · Oncology
In BRCA non-mutated ovarian cancer, the olaparib did the work and the pembrolizumab did not
KEYLYNK-001 randomised 1,367 patients three ways and found pembrolizumab alone no better than chemotherapy, while adding olaparib maintenance improved progression-free survival at the cost of a great deal more toxicity. Plus a pan-RAS inhibitor in lung cancer, SGLT2 inhibitors and gastrointestinal cancer risk, a nab-sirolimus supplement, and consensus on a second breast cancer in the same breast.
The edition in brief
KEYLYNK-001 randomised 1,367 patients with stage III–IV BRCA non-mutated epithelial ovarian cancer at 224 centres to pembrolizumab plus chemotherapy followed by pembrolizumab-olaparib maintenance, pembrolizumab plus chemotherapy followed by pembrolizumab alone, or chemotherapy with placebo. At final analysis, the pembrolizumab-olaparib arm improved progression-free survival — HR 0.66 (95% CI 0.53 to 0.83) at PD-L1 combined positive score of 10 or more, and 0.71 (0.61 to 0.84) in the intention-to-treat population. Pembrolizumab without olaparib did not, HR 0.95 (0.77 to 1.19, p = 0.33), which places the benefit with the PARP inhibitor. Grade 3 or higher treatment-related events rose from 51% to 66%, serious events from 9% to 24%, and four patients died of treatment-related causes. Overall survival is not reported here. Daraxonrasib, an oral multiselective RAS(ON) inhibitor, gave objective responses in 31% to 37% of 136 previously treated patients with RAS-mutant non-small-cell lung cancer across dose bands in a phase 1–2 study, with grade 3 or higher adverse events in 54% and four grade 5 events — activity worth following, in an uncontrolled trial whose primary endpoint was safety. A meta-analysis of 48 randomised trials and 48,765 patients found no association between SGLT2 inhibitors and gastrointestinal neoplasm risk overall (OR 1.10, 0.84 to 1.44, I² 0%) or at any single site, though half the trials ran a year or less and cancers were captured as adverse events rather than adjudicated. The FDA approved a supplement to the nab-sirolimus application on 2 September 2026. And a 36-panellist international Delphi consensus reached agreement on 78 of 97 items about a second ipsilateral breast cancer, supporting repeat breast-conserving therapy in selected patients.
KEYLYNK-001: the three-arm design is what makes this result readable
In BRCA non-mutated advanced ovarian cancer, pembrolizumab added nothing to chemotherapy; olaparib maintenance improved progression-free survival, with serious treatment-related events rising from 9% to 24% and no survival benefit shown.
A pan-RAS inhibitor produces responses in RAS-mutant lung cancer, at a real toxicity price
Daraxonrasib produced responses in 31% to 37% of previously treated RAS-mutant lung cancer, with grade 3 or higher toxicity in 54% — a genuine signal against a hard target, from an uncontrolled phase 1–2 study.
SGLT2 inhibitors and gastrointestinal cancer: reassuring, and not the same as safe
Pooled randomised data on 48,765 patients show no increase in gastrointestinal cancer with SGLT2 inhibitors — reassuring for the short term, with too little follow-up to settle long-term risk.
A supplement approved to the nab-sirolimus application
A supplement to the nab-sirolimus application was approved on 2 September 2026; the record does not state what changed, and nothing about current use follows until the label is read.
A normal creatinine in a wasted patient will overdose the carboplatin
In a cachectic or sarcopenic patient a normal creatinine overestimates filtration and so overdoses carboplatin — cap the estimate, recalculate every cycle, and reweigh.
A second cancer in the same breast no longer means an automatic mastectomy
A second breast-conserving therapy with tumour bed reirradiation is a reasonable option for selected patients with a second ipsilateral breast cancer — offer it rather than defaulting to mastectomy.
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