Lung cancer produced some of the most decisive survival data at the 2026 European Society for Medical Oncology (ESMO) Congress in Madrid. A bispecific T-cell engager moved into first-line maintenance, a head-to-head trial reordered KRAS G12C inhibitors, and TROP2-directed antibody-drug conjugates (ADCs) kept advancing. Each shift brings new monitoring and counseling work for pharmacists.
DeLLphi-305: Tarlatamab Moves Into Maintenance
In the phase 3 DeLLphi-305 trial (NCT06211036), adding tarlatamab (Imdelltra; Amgen) to durvalumab (Imfinzi; AstraZeneca) maintenance after first-line durvalumab plus platinum-etoposide nearly doubled median OS in extensive-stage small cell lung cancer (21.1 vs 12.7 months; HR, 0.42; 95% CI, 0.32-0.54). Median progression-free survival (PFS) was 7.4 vs 1.9 months (HR, 0.34), and the benefit held in patients with brain or liver metastases.1,2
Cytokine release syndrome (CRS) occurred in 49.6% of patients, with 1 grade 3 event, and immune effector cell–associated neurotoxicity syndrome occurred in 1.1%.2 Moving tarlatamab earlier means more patients on longer treatment, which makes step-up dosing protocols, CRS education, and outpatient monitoring plans core pharmacy work.
Krascendo 1: A New Leader Among KRAS G12C Inhibitors
The phase 3 Krascendo 1 trial (NCT06497556) compared divarasib (Genentech) with sotorasib (Lumakras; Amgen) or adagrasib (Krazati; Bristol Myers Squibb) in previously treated KRAS G12C–mutated non–small cell lung cancer (NSCLC). Divarasib improved median PFS (9.8 vs 5.7 months; HR, 0.58; 95% CI, 0.44-0.76) and OS (17.7 vs 12.0 months; HR, 0.56; 95% CI, 0.41-0.78), with a confirmed response rate of 58.4% vs 32.3%. Grade 3 or 4 treatment-related adverse events (AEs) were less frequent (24.6% vs 34.5%).3 Diarrhea, nausea, and vomiting were more common but mostly grade 1, so proactive antiemetic and antidiarrheal counseling will matter if divarasib reaches the market.4
