The start of a new year invites reflection on emerging trends likely to shape clinical oncology in 2026. These perspectives draw on clinical trials, regulatory activity, technological progress and real-world practice observed in 2025 and prioritize converging signals over speculation.
1. Artificial intelligence will become a meaningful clinical support for patients and oncologists.
AI is set to be widely integrated as a decision‑support and patient‑navigation tool, especially where access to experienced oncologists is limited. AI assistants will provide explanations of diagnoses, treatment options, adverse events and prognostic expectations in patients’ native languages and aligned with local care pathways. Early management guidance for common toxicities may reduce unnecessary treatment interruptions and delayed referrals, improving outcomes. Ongoing learning from hundreds of thousands of patient queries, integration with guidelines and validated sources, and Retrieval‑Augmented Generation will refine performance. Studies already show AI can match or exceed average human reproducibility in standardized tasks and can add prognostic value, for example in analysis of renal tumor CT scans that outperformed traditional staging in predicting outcomes. As AI’s informational role grows, oncologists’ clinical judgment, ethics and empathy will remain essential, and high‑quality clinician‑generated data will be critical for validation.
2. Molecular decision‑making after surgery or radiation will enter routine practice.
Circulating tumor DNA (ctDNA) and other molecular markers are moving from investigational tools to clinically actionable tests for guiding adjuvant therapy. Large randomized studies in colorectal cancer (DYNAMIC, CIRCULATE‑Japan, GALAXY, BESPOKE) and in urothelial carcinoma (IMvigor011) show ctDNA identifies patients at high recurrence risk while safely sparing ctDNA‑negative patients from unnecessary treatment. Evidence is also emerging for renal cell carcinoma and HPV‑associated oropharyngeal cancer. Given accumulating data and growing regulatory acceptance, molecularly guided escalation or de‑escalation of adjuvant therapy is likely to become standard in selected tumor types in 2026.
3. Expansion of theranostics and radioligand therapies.
New PET‑CT tracers will expand diagnostic applications and earlier treatment‑response assessment. Radioligand therapies are poised for broader adoption with anticipated new indications across metastatic prostate cancer, neuroendocrine tumors, breast, thyroid and gastrointestinal cancers. Trials are evaluating isotopes beyond iodine, lutetium and radium—including actinium, yttrium, rhenium and phosphorus—which could broaden therapeutic options.
4. The future belongs to deeply personalized therapy.
Regulatory approvals in 2025 reinforced a shift from organ‑based to biomarker‑driven indications, with many new drugs linked to companion diagnostics, broad NGS testing or tumor‑agnostic approaches. Analysis of 2025 FDA activity showed a large proportion of solid‑tumor approvals were personalized therapies, while purely non‑personalized approvals were rare. Personalization—guided by mutations, amplifications, receptor expression or microenvironmental signatures—is becoming a defining principle of oncology development despite ongoing challenges in testing access and data interpretation.
5. Continued rapid growth of antibody‑drug conjugates.
Development of ADCs continues to accelerate. Recent reviews counted 284 ADC trials launched globally in 2024–2025 and large numbers of early‑phase presentations at scientific meetings. Analytics platforms report hundreds of planned and ongoing ADC studies across multiple countries. Innovations in antibody carriers, linker chemistry and payload diversification are expanding the class. Increased regulatory filings, approvals and indication expansions—especially into earlier disease settings and combination regimens—are likely in 2026.
6. Cellular technologies will generate continued interest but face limits in solid tumors.
CAR‑T therapies remain transformative in hematologic malignancies but continue to face fundamental biological challenges in solid tumors, including microenvironmental barriers and toxicity. Cellular approaches such as therapeutic mRNA vaccines have shown strong immune responses and tolerability in Phase 1–2 trials, and several programs (including Moderna/Merck) are in Phase 3; however, registration‑ready data may not be available until 2027–2029. Progress in tumor‑infiltrating lymphocyte (TIL) and T‑cell receptor (TCR) therapies is incremental, and unexpected approvals for specific cellular products in 2026 remain possible but uncertain.
7. Continued search for new immunotherapy options, including bispecific antibodies.
Beyond PD‑1/PD‑L1 and CTLA‑4, many novel immune targets have yet to deliver consistent benefits, but active investigation continues. Established immunotherapies are moving into earlier disease settings and complex combination regimens are under study. Bispecific antibodies that redirect T cells toward tumors represent a promising front; recent approvals such as tarlatamab in advanced small‑cell lung cancer illustrate the approach’s potential. Additional bispecific approvals in solid tumors are plausible given multiple ongoing phase‑3 trials. Targeting the immunosuppressive tumor microenvironment is also advancing, with recent regulatory activity for CSF‑1R inhibitors and phase‑3 development of agents such as zanzalintinib.
8. PROTAC degraders may reach approval.
Proteolysis‑targeting chimeras (PROTACs) induce targeted protein degradation rather than inhibition. The first PROTAC, vepdegestant, showed estrogen‑receptor degradation in the Phase‑3 VERITAC‑2 trial and has been submitted for FDA review. Multiple mid‑stage trials of other degraders are underway, making a first PROTAC approval a realistic near‑term prospect.
9. Radiation therapy will emphasize personalization, precision and sequencing.
Stereotactic ablative radiotherapy (SABR/SBRT) continues to gain ground for primary tumors and metastases, offering high local control with low severe toxicity and expanding guideline indications. Positive prospective studies in 2025 support broader SABR use across tumor types and oligometastatic disease, including combinations with systemic therapy. Attention is shifting from the abscopal effect to recognizing potential adverse radiation‑induced systemic influences (the so‑called “badscopal effect”) and identifying mechanisms such as radiation‑induced amphiregulin expression that may promote immunosuppression. Evidence has accumulated that concurrent chemoimmunoradiation often increases toxicity and attenuates immunotherapy benefit; as a result, treatment paradigms are moving toward sequential strategies—induction chemoimmunotherapy followed by preoperative or definitive chemoradiation—a trend supported by trials including INCREASE, InTRist, MDT‑Bridge and APOLO.
10. Renewed interest and continued scrutiny for proton therapy.
Proton therapy has expanded globally and now features in more than 900 prospective studies, often combined with immunotherapy. However, comparative evidence against modern photon techniques remains inconsistent, with no clear, consistent clinical superiority demonstrated to date. Key randomized and comparative trials due to report in 2026 should help clarify its role and value.
Ilya Tsimafeyeu
Medical Oncologist
Member, Editorial Board, OncoDaily
Director, Bureau for Cancer Research – BUCARE, USA/Russia
Natalia Dengina
Radiation Oncologist
Editor‑in‑Chief, RUSSCO Newspaper
Head, Department of Radiation Therapy, Ulyanovsk Regional Cancer Center, Russia
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