Frontline Treatment Transformation: Interpretation of the 2026 CSCO and Other Major Oncology Guideline Updates — Chinese Innovative Drugs Lead a New E

By:DengYue International Business Division

In recent years, with the continuous updates of authoritative clinical guidelines from the Chinese Society of Clinical Oncology (CSCO), the National Comprehensive Cancer Network (NCCN), and the European Society for Medical Oncology (ESMO), oncology treatment has been rapidly evolving from the era of conventional chemotherapy toward precision medicine and immunotherapy.

Between 2025 and 2026, multiple landmark Phase III clinical trials were incorporated into the latest treatment guidelines, including antibody-drug conjugates (ADCs), bispecific antibodies, immune checkpoint inhibitors (PD-1/PD-L1), and novel targeted therapies. Notably, several Chinese-origin innovative drugs achieved historic breakthroughs by being incorporated into frontline treatment recommendations across multiple tumor types, marking China's transition from a follower to a global innovator—and in some areas, a leader—in oncology drug development.

This article reviews the most significant frontline treatment updates and emerging trends based on the latest 2026 CSCO guidelines, as well as updates from ASCO, ESMO, and NCCN.

Urothelial Carcinoma: DV + Toripalimab Becomes a Category I Recommendation, Reshaping the Treatment Landscape

The 2026 edition of the CSCO Guidelines for Urothelial Carcinoma was officially released during the CSCO Guideline Conference held in Harbin.

One of the most significant updates is the inclusion of the combination therapy consisting of:

● Disitamab Vedotin (DV, RC48)

● Toripalimab

developed by RemeGen, as a Category I recommendation (Level 1A evidence) for first-line treatment of:

● Metastatic bladder urothelial carcinoma

● Upper tract urothelial carcinoma (UTUC)

Importantly, this recommendation applies to both:

● Cisplatin-eligible patients

● Cisplatin-ineligible patients

thereby expanding therapeutic benefits to a broader patient population.

Key Findings from the RC48-C016 Trial

The study demonstrated that compared with standard platinum-based chemotherapy, the DV + Toripalimab regimen achieved:

● Nearly double the objective response rate (ORR)

● Significant improvement in progression-free survival (PFS)

● Markedly prolonged overall survival (OS)

According to Professor Jun Guo of Peking University Cancer Hospital, the DV + Toripalimab combination is redefining the global first-line treatment paradigm for urothelial carcinoma.

Furthermore, results from the international RC48-G001 study presented at the ASCO Genitourinary Cancers Symposium (ASCO GU) confirmed consistent efficacy in Western patient populations, supporting its global clinical adoption.

Growing International Recognition

Since 2025, multiple international expert consensus statements have increasingly recognized ADC-immunotherapy combinations as a future cornerstone of urothelial carcinoma management.

This shift signifies a transition away from chemotherapy-centered treatment approaches toward more precise, effective, and better-tolerated therapeutic strategies.

Lung Cancer: Chinese Innovative Therapies Challenge International Standards

Lung cancer remains the leading cause of cancer-related mortality worldwide.

One notable trend in the 2025–2026 guideline updates is the increasing incorporation of domestically developed PD-1 inhibitors and bispecific antibodies into frontline treatment recommendations.

Non-Small Cell Lung Cancer (NSCLC)

For patients harboring EGFR mutations, the following regimens continue to play a central role:

● Osimertinib

● Osimertinib plus chemotherapy

● Osimertinib combined with VEGF inhibitors

For patients with ALK rearrangements, the preferred frontline options include:

● Alectinib

● Lorlatinib

Patients with High PD-L1 Expression

The role of immunotherapy monotherapy has been further strengthened.

Highly recommended regimens include:

● Pembrolizumab

● Tislelizumab

● Sintilimab

Among the most closely watched developments in 2026 is Ivonescimab, a novel PD-1/VEGF bispecific antibody developed in China. Multiple Phase III studies have demonstrated its potential to outperform certain international standard-of-care therapies, positioning it as a possible future game-changer in the global lung cancer treatment landscape.

Breast Cancer Enters the ADC Era

A key theme of recent breast cancer guideline updates is the earlier use of ADCs.

Increasingly, ADC therapies are moving from later-line settings into frontline and early-stage treatment strategies.

Triple-Negative Breast Cancer (TNBC)

Sacituzumab Govitecan has received stronger recommendations and is particularly relevant for:

● PD-L1-positive patients

● Patients previously treated with taxane-based therapies

● Individuals at high risk of recurrence

The HER2-Low Revolution

With the widespread acceptance of the HER2-low classification, ADC therapies have expanded beyond traditional HER2-positive populations.

Agents such as:

● Trastuzumab Deruxtecan (T-DXd)

● Next-generation HER2-targeting ADCs

are transforming treatment algorithms and enabling more patients to benefit from precision oncology through refined molecular classification.

Gastric Cancer and Gastrointestinal Malignancies: The Rise of Multi-Biomarker-Driven Therapy

One of the most important changes in the 2026 gastric cancer guidelines is the establishment of biomarker-driven treatment as the standard of care.

Treatment decisions are no longer based solely on histopathological classification but increasingly guided by molecular biomarkers, including:

● HER2

● PD-L1 Combined Positive Score (CPS)

● Claudin 18.2

● FGFR2b

● MSI-H/dMMR

Claudin 18.2 Emerges as a Key Therapeutic Target

As global approvals of Claudin 18.2-targeted therapies continue to expand, this biomarker has become one of the most promising new targets in gastric cancer treatment.

For patients with CLDN18.2-positive tumors, combining targeted therapies with immunotherapy may further improve survival outcomes.

Expanding Role of Chinese PD-1 Inhibitors

Several domestically developed immune checkpoint inhibitors have been incorporated into frontline recommendations across gastrointestinal malignancies, including:

● Sintilimab

● Tislelizumab

● Cadonilimab

● Toripalimab

Four Major Trends in the 2026 Oncology Guideline Updates

1. ADCs Move Earlier in the Treatment Paradigm

ADCs are no longer confined to salvage therapy settings.

Clinical research increasingly supports their use in:

● First-line treatment

● Perioperative therapy

● Neoadjuvant treatment

Many experts believe ADCs will represent one of the fastest-growing sectors in oncology over the next decade.

2. Rapid Rise of Bispecific Antibodies

Following the success of the PD-1 era, bispecific antibodies have emerged as one of the most active areas of oncology research and development.

Numerous bispecific candidates are currently undergoing pivotal Phase III clinical trials and may reshape treatment paradigms for:

● Lung cancer

● Gastric cancer

● Colorectal cancer

● Breast cancer

3. Precision Diagnostics Become the Gateway to Precision Therapy

Technologies including:

● Next-generation sequencing (NGS)

● Immunohistochemistry (IHC)

● Liquid biopsy

● Circulating tumor DNA (ctDNA) testing

have become essential tools for selecting optimal frontline treatment strategies.

Precision diagnosis is increasingly recognized as the foundation of precision medicine.

4. Accelerating Globalization of Chinese Innovative Drugs

Throughout 2025 and 2026, licensing and partnership deals involving Chinese innovative therapies continued to reach record levels.

ADCs, bispecific antibodies, CAR-T therapies, and targeted small molecules have attracted substantial international interest.

An increasing number of Chinese-developed therapies are entering:

● U.S. FDA review pathways

● European Medicines Agency (EMA) regulatory processes

● NCCN evidence and guideline discussions

demonstrating the growing international influence of China's biopharmaceutical innovation ecosystem.

Clinical Implications of the Guideline Updates

Key recommendations for clinical practice include:

● Early implementation of molecular testing and biomarker profiling

● Establishment of multidisciplinary team (MDT) management models

● Individualized treatment planning based on patient age, performance status, and treatment accessibility

● Proactive management of ADC-related toxicities and immune-related adverse events

● Dynamic monitoring of measurable residual disease (MRD) and resistance mechanisms throughout the treatment journey

For oncologists, treatment decisions will increasingly be driven by molecular biomarkers rather than tumor histology alone.

DengYue Med: Connecting Global Innovative Therapies with Precision Treatment Decision-Making

As CSCO, NCCN, and ESMO guidelines continue to evolve, both clinicians and patients face an ever-expanding volume of medical information. From interpreting clinical evidence and tracking global regulatory developments to evaluating precision medicine options and accessing international treatment resources, reliable medical intelligence has become increasingly important.

As a platform dedicated to precision medicine and global innovative therapies, DengYue Med continuously monitors the latest oncology guideline updates, novel drug development trends, and international clinical trial progress. By providing timely access to cutting-edge treatment information, DengYue supports healthcare professionals and patients in making more informed, personalized treatment decisions.

Conclusion

The 2026 updates to CSCO and other international oncology guidelines send a clear message:

Cancer treatment is transitioning from empirical medicine to precision medicine.

ADCs, immunotherapies, bispecific antibodies, and biomarker-driven treatment strategies are reshaping the global oncology landscape.

Perhaps most notably, Chinese innovative drugs are no longer merely participants in this transformation—they are increasingly becoming contributors to global treatment standards. From Disitamab Vedotin to Ivonescimab, and from domestically developed PD-1 inhibitors to next-generation ADCs, Chinese innovation continues to expand treatment options and improve survival outcomes for patients worldwide.

For patients, staying informed about the latest guidelines and clinical trial developments, undergoing timely molecular testing, and working closely with oncology specialists to develop personalized treatment strategies may provide the best opportunity for longer survival and improved quality of life.