The ASCO Annual Meeting is oncology’s Super Bowl. In 2025, the game was delivered—and then some. The plenary boards weren’t just crowded; they were clinically actionable, with results that will rewrite guidelines, reshape procurement, and redirect biopharma pipelines. Beyond the headlines, what matters is how these trials change Monday morning in clinics and what they imply for startups building diagnostics, decision support, and next‑gen therapeutics.
Five results that moved the field
1) ATOMIC (stage III dMMR colon cancer): Adding atezolizumab to adjuvant FOLFOX significantly improved disease‑free survival (DFS) vs chemotherapy alone, with a double‑digit absolute improvement at three years in dMMR tumors. Translation: IO moves into the adjuvant colon for the right biology, and ctDNA‑guided escalation/de‑escalation frameworks just got momentum.
2) SERENA‑6 (HR+, HER2‑ breast cancer): A ctDNA‑guided switch to the oral SERD camizestrant at the earliest sign of ESR1 mutation (while radiology still looks stable) cut the risk of progression by ~56% vs staying the course on an AI + CDK4/6 inhibitor. Translation: molecular MRD monitoring is not a boutique hobby; it’s a scheduling tool for when to pivot therapy.
3) MATTERHORN (resectable gastric/GEJ): Durvalumab + FLOT delivered a significant EFS benefit and higher pCR vs placebo + FLOT. Translation: perioperative immunotherapy is maturing beyond single‑center enthusiasm, with event‑free survival now a board‑room metric for access committees.
4) VERIFY (polycythemia vera): Weekly rusfertide (a hepcidin mimetic) reduced phlebotomy burden and improved hematocrit control in PV patients in a phase 3 setting. Translation: physiology‑native drugs can reset standards in classic hematology if they simplify life for both patient and clinic.
5) NIVOPOSTOP (high‑risk HNSCC): Adjuvant nivolumab layered on top of post‑op chemoradiation improved DFS in PD‑L1 all‑comers. Translation: the H&N space finally gets a broadly applicable adjuvant IO win, with workflow questions (timing, toxicity management) now worth solving at scale.
What changes on Monday
- Colon cancer (dMMR stage III): Expect guideline bodies to move quickly; hospital P&T committees will plan IO infusion slots in adjuvant schedules and budget for additional toxicity clinics. ctDNA becomes the tie‑breaker for adjuvant tailoring.
- HR+ breast (metastatic): Oncology practices will operationalize ESR1 surveillance (liquid biopsy every 2–3 months), with pre‑authorized switches to camizestrant pathways. Payers will push for testing compliance as a condition of coverage.
- Gastric/GEJ peri‑op: Multidisciplinary boards will tighten timelines between neoadj chemo, surgery, and adjuvant IO, with navigation teams managing steroid use and infection risk.
- PV clinics: Infusion centers rethink capacity; fewer phlebotomies, more nursing time for injection education and iron monitoring.
- Head & neck programs: Speech/swallow teams and survivorship clinics get baked into adjuvant IO pathways; toxicity tracking moves earlier.
The diagnostics and data ripple
ctDNA platforms are the quiet winners. SERENA‑6 validates mutation‑triggered therapy switches ahead of radiologic progression—a new clinical decision category. Lab vendors that can guarantee turnaround, sensitivity, and payer‑friendly reports will capture share. On the software side, expect pathway engines to embed trial‑validated triggers (e.g., ESR1 emergence → SERD switch) and push real‑time prior auth packets so clinicians don’t spend Fridays on hold.
Payer math to watch
- Total cost of care vs line‑of‑therapy churn: payers will accept higher drug costs if hospitalizations and ineffective cycles drop. Value‑based contracts tied to ctDNA adherence will proliferate.
- Site of care shifts: oral SERDs bring dispensing logistics; watch for specialty pharmacy plays and adherence monitoring bundled into contracts.
- Real‑world evidence (RWE): coverage committees will demand post‑launch registries proving that trial‑grade benefits translate outside academic centers.
Startup playbook for the ASCO afterglow
- Build to the new triggers. Codify ATOMIC/SERENA‑6/MATTERHORN/NIVOPOSTOP logic into workflow tools so clinics don’t rely on memory.
- Shave administrative friction. Automate prior authority and financial counseling tied to the new standards.
- Integrate with labs. APIs for ctDNA results that drive order sets and EHR nudges.
- Measure what payers care about. Time‑to‑switch, avoided chemo cycles, infusion chair utilization—you know, the cash flow.
The cultural shift at McCormick
ASCO has seen many hype cycles. 2025 felt different: less moonshot rhetoric, more operational detail. Every plenary talk was followed by panels on who to test, when to switch, how to document, and how to pay for it. That’s what progress looks like when science is ready for scale.
