The ISOP Bulletin
RAS finally blinks: daraxonrasib doubles survival in pancreatic cancer
On 26 August the FDA approved daraxonrasib (Rasonque), the first drug that targets RAS broadly, for metastatic pancreatic adenocarcinoma after at least one prior line of therapy. In the 500-patient RASolute 302 trial it roughly doubled median overall survival over chemotherapy; response rates were 30% vs 11% and median PFS 7.2 vs 3.6 months (HR 0.49).
"Welcome to the first ISOP Bulletin. This quarter has two sides for Pakistani oncologists. Abroad, RAS has been drugged in pancreatic cancer, and the ESR1 era has arrived in breast cancer. At home, newly priced immunotherapy waits for a notification, counterfeit vials keep turning up, and patients go without morphine. We will report both sides plainly, with links to every source, and invite your corrections and contributions."
01 · CLINICAL UPDATES
Practice-changing data, July–October 2026
SERENA-6 and EMBER-3: the ESR1 era arrives
Camizestrant is the first drug approved for switching treatment when an ESR1 mutation appears in ctDNA during first-line AI + CDK4/6 therapy, before scans show progression (SERENA-6, median PFS 16.8 vs 9.2 months, HR 0.45). Two weeks later, imlunestrant + abemaciclib was approved for ESR1-mutated disease after endocrine therapy.
DESTINY-Lung04: T-DXd beats chemo-IO first line in HER2-mutant NSCLC
In 454 untreated patients, trastuzumab deruxtecan improved median PFS over pembrolizumab + platinum-pemetrexed: 14.3 vs 8.3 months (HR 0.63). Early OS numerically favoured the control arm (HR 1.15), and drug-related ILD occurred in 20.8% vs 2.3%.
First phase III win for a personalised mRNA cancer vaccine
INTerpath-001 randomised 1,137 patients with resected stage IIB–IV melanoma to intismeran autogene plus pembrolizumab, or pembrolizumab alone. At a prespecified interim analysis it met both recurrence-free and distant-metastasis-free survival.
- Gedatolisib (14 Jul) for HR+/HER2- PIK3CA wild-type advanced breast cancer after endocrine therapy: VIKTORIA-1 median PFS 9.3 vs 2.0 months with the triplet (HR 0.24) [7].
- Lu-177 PSMA-617 (31 Jul) moves into PSMA-positive hormone-sensitive prostate cancer: progression risk fell (HR 0.67); OS not yet significant [8].
- NHS-Galleri (NEJM, Sep) missed its primary endpoint of fewer stage III–IV cancers, though stage IV diagnoses fell [9].
02 · RESEARCH FROM PAKISTAN
New work by Pakistan-based and diaspora authors
Patterns of cancer frequency in Balochistan: regional perspectives and implications for cancer control
Of 16,342 biopsies, 5,145 were malignant. Oesophageal cancer led in men (17.4%), unlike the national pattern; the authors call for province-level registration.
Pancreato-duodenal cancers in Pakistan: patterns of presentation, disease burden and outcomes at a tertiary cancer facility
A 20-year series (2000–2020): resected pancreatic NETs had 90% 5-year OS. Late presentation remains the main barrier.
Cancer care in Pakistan: a national survey of infrastructure, diagnostic capacity, therapeutic access, and workforce perspectives
Maps gaps in diagnostics, drug access and workforce — useful evidence for investment at institutional or provincial level.
Published recently? Send us your paper → 03 · REGULATORY WATCH
Approvals, alerts and withdrawals
04 · COMMENT & CONTROVERSY
Four arguments worth having
Each item gives the case for, the case against, and where the Bulletin's editors think the weight of evidence sits today.
An FDA panel says yes to Galleri. The trial said not yet.
The FDA advisory committee voted 6–4 that GRAIL's multi-cancer blood test is effective; the same week, NHS-Galleri missed its primary endpoint of fewer stage III–IV cancers. Most stage I cancers are missed.
Treating the blood test before the scan
ODAC voted 6–3 against camizestrant in April; the FDA approved it anyway in September. Supporters point to PFS2 (25.7 vs 19.1 months); sceptics note the control arm stayed on the AI until progression.
The accelerated-approval bill comes due
KRYSTAL-10 showed no PFS or OS gain for adagrasib + cetuximab despite response rates of 47% vs 16%; LAGOON did not improve survival. One analysis found 28% of surrogate-endpoint approvals later failed to show an OS benefit.
A PFS win with an OS hazard ratio of 1.15
DESTINY-Lung04 cut the risk of progression by 37% and lifted responses to 70%, but early survival leaned the other way, and one in five patients developed ILD.
05 · MEETING COVERAGE
From the conference halls
National Cancer Conference 2026, LUMHS Jamshoro (19–21 Oct)
Theme: "Improving Cancer Care through Innovation, Accessibility and Collaboration". 500+ delegates, nine workshops, 34 lectures and 55 research papers [22].
- Prof Abdul Majeed Chaudhry: a significant share of Pakistani breast cancers occur before 40 — never assume a lump in a young woman is harmless.
- Prof Muhammad Farooq Afzal made the case for weekly MDTs with recorded decisions and named follow-up owners.
Best of ASCO 2026, Lahore (28–30 Aug)
Hosted by the Society of Medical Oncology-Pakistan: equitable access, multidisciplinary care, immunisation in cancer patients, and a RECON ONCO-thon for early-career oncologists [23].
WCLC 2026, Seoul (12–15 Sep)
- DESTINY-Lung04: first-line T-DXd improved PFS in HER2-mutant NSCLC [5].
- TAISHAN-302: the B7-H3 ADC tambotatug pelitecan met all three endpoints in second-line SCLC [24].
ESMO 2026, Madrid (23–27 Oct): what to watch
- MC10: checkpoint inhibitors only every three months? The most important trial for cost-constrained systems [25, 26].
- KRAScendo-1, CLARITY-Gastric 01, and breast data from NATALEE and postMONARCH [24, 27, 28].
- Full ESMO coverage follows in the November issue.
06 · TRAINING, FELLOWSHIPS & GRANTS
Open now and coming up
Deadlines as published by each funder at the time of writing. Check the funder's page before applying.
| Opportunity | Type | Eligible | Deadline |
|---|---|---|---|
| AACR-QuadW Sarcoma Research Fellowship 2027 | Fellowship, $60,000 | Postdoctoral researchers, mentor anywhere; AACR membership required | LOI 12 Nov 2026 |
| CRI Irvington Postdoctoral Fellowship | Fellowship, 3 years | Immunology postdocs at non-profit institutions worldwide | 1 Mar 2027 |
| UICC Technical Fellowships 2027 | 2–8 week visit | Cancer professionals with 5+ years' experience | Call expected 2027 |
| Conquer Cancer IDEA (ASCO) | Travel + mentorship | Oncologists in LMICs within 10 years of training | 2027 cycle closed 30 Sep |
07 · ISOP CONNECT & SOCIETY NEWS
ISOP Connect: inaugural virtual MDT in preparation
ISOP Connect will bring oncologists in Pakistan together with the diaspora for case-based virtual tumour boards, masterclasses and mentorship. The first session's date and faculty will be announced to members by email. We welcome difficult, de-identified cases now.
08 · CAREERS
Hiring watch
Three large new cancer services are being staffed. Watch these employers' official channels.
Shaukat Khanum Hospital, Karachi
Opens 29 Dec 2026The network's third and largest hospital is due to open on 29 December 2026; linacs and a cyclotron are being installed and recruitment is under way [32].
Nawaz Sharif Institute of Cancer Treatment & Research, Lahore
Under constructionA planned 915-bed public cancer hospital; 219 posts advertised and 415 more approved. Posts on health.punjab.gov.pk [33, 34].
Nishtar Hospital Cancer Centre, Multan
Inaugurated Sep 2026A new 100-bed centre with a linear accelerator, PET-CT cyclotron and cryoablation unit, inaugurated in September [35].
09 · EDITORIAL
Priced is not the same as available
"A molecule that has a price in Islamabad but no stock in Peshawar has not reached our patients."
On 25 July a cabinet committee approved prices for 52 new medicines, including pembrolizumab and nivolumab. By late August the industry was still waiting for a notification it said could take one to two months more. Meanwhile, without legal stock, patients have turned to grey markets, and DRAP's own alerts confirmed counterfeit daratumumab, ruxolitinib and nine other cancer drugs in circulation. In July, major cancer centres ran out of injectable morphine and fentanyl.
These failures can be fixed. Pricing approval and notification should run on a fixed, published timetable. Narcotic import quotas should be renewed before they expire. Every oncology pharmacy needs an easy way to check batch numbers. ISOP offers its members' experience to DRAP and the Ministry of National Health Services, and will report on progress in every issue.
10 · TUMOUR BOARD PEARL
ESR1 found on a blood test. Switch now?
Illustrative case: A 52-year-old woman is in month 14 of letrozole + ribociclib for ER+/HER2- bone-predominant metastatic disease. Scans are stable and CA 15-3 is flat. Her family abroad arranges a ctDNA test, which shows an ESR1 mutation.
SERENA-6 supports switching to camizestrant, which is not available here. PADA-1 showed a PFS benefit from switching early to fulvestrant + palbociclib. Neither has shown an OS gain.
11 · HONOURS & ACCOLADES
Congratulations
Dr Abdul Bari Khan
Founder and President of the Indus Hospital & Health Network, and the only Pakistani recipient of the 2026 Eisenhower Fellowships Impact Award, to be presented in Philadelphia on 11 November [39].
The late Prof Tahir Shamsi
Sitara-i-Imtiaz (posthumous) for bone marrow transplantation. He founded the National Institute of Blood Diseases and performed Pakistan's first bone marrow transplant [40, 41].
Prof Faisal Saud Dar
Hilal-i-Imtiaz for medicine, among 15 doctors and health professionals recognised in the 2026 civil awards [40].
12 · YOUNG ONCOLOGISTS
Trainee corner
A 61-year-old with metastatic pancreatic adenocarcinoma progresses on first-line FOLFIRINOX. Her NGS shows KRAS G12D. Under the August 2026 FDA label, which statement about daraxonrasib is correct?
Mentorship: ISOP is building a scheme pairing trainees with senior oncologists at home and abroad — write to us to register as a mentor or mentee.
Spotlight: Did a trainee present at LUMHS, Best of ASCO or SKCS? Send us the abstract.
13 · OFF THE RECORD
A glossary for the modern oncologist
Entirely unofficial. No patients were harmed in the writing of these definitions.
14 · CALENDAR
Upcoming meetings
15 · IN MEMORIAM
Dr Rachna Shroff
GI oncologist at the University of Arizona Cancer Center and earlier at MD Anderson. She led trials in biliary tract cancer, co-chaired SWOG's hepatobiliary subcommittee and chaired ASCO GI 2024. Facing her own cancer, she raised more than $1.35 million within weeks to endow a permanent Conquer Cancer Young Investigator Award in biliary cancers. Her death, at 47, was reported in October [44].
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The ISOP Bulletin
Integrated Society of Oncologists from Pakistan · ISOP.global. Editorial team: [Editor-in-Chief] · [Section editors]
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Editorial note
Summaries are curated from published sources with links to the originals. Content is for professional education and is not a substitute for clinical judgement. Listings are not endorsements.