At the 2026 ASCO Annual Meeting, Jian Zhang and colleagues from Fudan University Shanghai Cancer Center presented several impactful studies spanning supportive care, targeted therapy, and prognostic modeling.The Phase III DESCEND trial (Abstract #12000) demonstrated that reducing or omitting dexamethasone in combination with NEPA (netupitant/palonosetron) and olanzapine was non-inferior to the standard antiemetic regimen for highly emetogenic chemotherapy (HEC), providing high-level evidence for corticosteroid de-escalation in the era of immunotherapy. The study has also been accepted by the Journal of Clinical Oncology.
Meanwhile, the PANKU-Breast02 study (Abstract #LBA1003), co-led by Jiong Wu and Jian Zhang, showed significant improvements in both progression-free survival (PFS) and overall survival (OS) with the EGFR×HER3 bispecific ADC Iza-Bren in previously treated advanced triple-negative breast cancer (TNBC), with the potential to change clinical practice.
The team also developed the first data-driven Breast Cancer Leptomeningeal Graded Prognostic Assessment (BC-LGPA) model (Abstract #1114), providing a new framework for prognostic stratification of patients with breast cancer leptomeningeal metastases.
Oncology Frontier interviewed Jian Zhang during ASCO to discuss these studies and their clinical implications.
Oncology Frontier: Could you introduce the studies your team presented at this year’s ASCO meeting?
Jian Zhang:
Our team presented several important studies at this year’s ASCO meeting.
First, I delivered an oral presentation on the DESCEND study (Abstract #12000), a randomized Phase III trial evaluating whether corticosteroid reduction or omission could be safely implemented on top of standard triple antiemetic therapy. The study met its non-inferiority endpoint, and the manuscript has already been accepted by the Journal of Clinical Oncology. We believe the findings have the potential to change clinical practice.
Another highlight was the PANKU-Breast02 study (Abstract #LBA1003), jointly led by Professor Jiong Wu and myself. Professor Wu presented the results during the meeting. The trial compared the EGFR×HER3 bispecific ADC Iza-Bren with physician’s choice chemotherapy in patients with unresectable locally advanced or metastatic TNBC who had received one or two prior lines of systemic therapy.
The study demonstrated a median PFS of 8.5 months versus 3.1 months (HR 0.29, P<0.0001) and a median OS of 15.9 months versus 12.5 months (HR 0.60, P=0.0019). Importantly, the PFS benefit translated into a meaningful OS improvement, representing one of the longest PFS outcomes reported in this setting. I believe this study also has the potential to change clinical practice.
In addition, we collaborated with several institutions to establish the BC-LGPA prognostic model for breast cancer leptomeningeal metastasis (Abstract #1114). Using data from 403 patients across four centers collected between 2013 and 2025, we developed and externally validated the first data-driven prognostic model specifically for breast cancer leptomeningeal metastases.
Patients were stratified into high-, intermediate-, and low-risk groups with median overall survival of 4.7, 8.0, and 16.6 months, respectively, findings that were consistently validated in an independent cohort. We also proposed a new classification system based on cerebrospinal fluid cytology, clinical presentation, and imaging characteristics, providing an important foundation for future clinical trials.
Beyond these studies, our team also presented several poster abstracts, including investigations of a KAT6 inhibitor (Abstract #TPS1144) and the oral SERD TFX06 (Abstract #1062), both of which warrant further clinical evaluation.
Oncology Frontier: The DESCEND study demonstrated that reducing or eliminating dexamethasone remained non-inferior when combined with NEPA and olanzapine. How do you think these findings will influence clinical practice?
Jian Zhang:
The rationale for this study comes from the current immunotherapy era.
Highly emetogenic chemotherapy is now frequently combined with immunotherapy, as seen in studies such as KEYNOTE-522 and ASCENT-04. Current guidelines recommend a four-drug antiemetic regimen consisting of a 5-HT3 receptor antagonist, an NK1 receptor antagonist, dexamethasone, and olanzapine.
However, concerns have emerged regarding repeated corticosteroid exposure. Even short-term dexamethasone can suppress T-cell proliferation and antigen presentation, potentially weakening antitumor immunity. In addition, repeated use across treatment cycles contributes to adverse effects such as hyperglycemia, infections, and insomnia.
The DESCEND trial randomly assigned 644 patients receiving highly emetogenic chemotherapy into three groups:
- Standard four-day dexamethasone regimen.
- Reduced dexamethasone, with only 6 mg on Day 1.
- Complete omission of dexamethasone.
Overall complete response rates for chemotherapy-induced nausea and vomiting (0–120 hours) were 72.4%, 72.2%, and 70.1%, respectively. Both the reduced-dose and dexamethasone-free strategies were non-inferior to the standard regimen for the primary endpoint.
For complete nausea control, the reduced-dose regimen remained comparable to standard therapy throughout the observation period, whereas the dexamethasone-free regimen performed somewhat worse after the first 24 hours. Steroid-related adverse events, particularly insomnia, were mainly observed in the standard-treatment group.
These findings support corticosteroid de-escalation, especially as chemo-immunotherapy and ADC-immunotherapy combinations become increasingly common.
The study has already been accepted by the Journal of Clinical Oncology, and I believe it has the potential to influence future clinical guidelines.
Oncology Frontier: Your team also developed the BC-LGPA prognostic model for breast cancer leptomeningeal metastases. What are its most important clinical implications?
Jian Zhang:
The BC-LGPA model represents years of collaborative work involving four centers and more than 400 patients.
It provides an important framework for prognostic assessment and future treatment decision-making in patients with breast cancer leptomeningeal metastases.
Today, molecular classification plays an increasingly important role in breast cancer management. By integrating multiple clinical and biological factors, this model helps identify patients with more favorable prognoses who may benefit from more aggressive therapeutic strategies.
For patients with particularly poor prognoses, our team is actively conducting additional clinical research, including a Phase III trial and an exploratory study investigating intrathecal administration of novel therapeutic agents.
We hope that, by combining this prognostic model with prospective clinical studies, we can further improve outcomes for patients with breast cancer leptomeningeal metastases.
Professor
Jian Zhang
Fudan University Shanghai Cancer Center
