For decades, cancer care has been built around escalation.
More chemotherapy. More surgery. More combinations. More treatment lines. More intensity.
ASCO 2026 showed a different side of progress.
Some of the most important discussions in Chicago focused not on adding treatment, but on safely removing it.
That may sound less dramatic than a new drug approval. In policy terms, it may be just as important.
IPM Take
Personalised medicine is often presented as a way to match patients with the most advanced therapies. But its real value is broader than that. It is also about knowing when treatment can safely be reduced or avoided. At ASCO 2026, several studies pointed to a more mature model of cancer care, where biology, risk, patient preference, and long-term quality of life guide treatment intensity. In practice, this means giving more treatment to patients who truly need it, while sparing others unnecessary chemotherapy, surgery, toxicity, cost, and anxiety. This is not undertreatment. It is precision.
The old model: high risk means more treatment
For many years, cancer treatment decisions were shaped mainly by visible clinical risk: tumour size, nodal involvement, stage, location, age, and overall fitness. These factors still matter, but they do not always tell the full story. A patient may appear high risk by traditional measures, yet have tumour biology suggesting a lower chance of recurrence. Another may look lower risk on paper, but carry molecular features that justify more intensive treatment.
ASCO 2026 showed how oncology is moving beyond risk as something defined only by scans, pathology reports, or anatomy. Increasingly, risk is becoming biological. Early breast cancer offered one of the clearest examples, with genomic testing helping to identify patients who may safely avoid chemotherapy, even when they appear clinically high risk. For patients, this can mean avoiding months of physical and emotional burden. For health systems, it means fewer unnecessary treatments, fewer avoidable toxicities, and better use of limited oncology capacity.
This is where personalised medicine becomes very practical. It is not only about access to expensive innovation, but about using better information to avoid the wrong intervention.
Surgery is also being questioned
The same logic is now reshaping local treatment.
ASCO 2026 also reinforced the move toward surgical de-escalation in selected breast cancer patients, including evidence supporting omission of completion axillary lymph node dissection in some patients with limited sentinel node involvement.
The policy message is simple: more invasive care is not always better care.
If survival can be maintained while reducing long-term arm morbidity, lymphoedema risk, pain, and functional limitation, then de-escalation is not a compromise.
It is a better outcome.
Cancer systems often measure success in survival curves. Patients also measure success in whether they can move, work, sleep, care for family, and live without permanent treatment-related damage.
Less treatment requires more system intelligence
De-escalation is not about doing less for everyone.
It requires more intelligence, not less.
To safely reduce treatment, health systems need:
- access to validated genomic and molecular tests
- clear clinical guidelines
- trained multidisciplinary teams
- shared decision-making with patients
- reimbursement for diagnostics, not only medicines
- real-world monitoring to confirm outcomes
- trust that less treatment can still be high-quality care
This is why de-escalation is a policy issue.
A health system cannot safely avoid unnecessary treatment if it cannot identify who is unlikely to benefit.
Without diagnostic access, de-escalation becomes guesswork.
With diagnostic access, it becomes personalised care.
What ASCO 2026 really showed
ASCO 2026 showed that the future of oncology is not only about having more treatment options, but about making better decisions. New medicines and combinations are expensive, but overtreatment also carries a cost: avoidable toxicity, pressure on hospital capacity, greater supportive care needs, and disruption to patients’ lives. For many patients, the most personalised question is not only “what else can we add?” but “what can I safely avoid?” Knowing when chemotherapy is unnecessary, when surgery can be reduced, and when biology should guide treatment intensity is not undertreatment. It is smarter, more precise cancer care.
