Daniel V. Araujo’s, Associate Professor at University of Florida and Medical Director for Biospecimen Resources at UF Health Cancer Center, shared a post on X:
“A really thought-provoking study at ASCO 2026 (Abstr 4512, Clinical Science Symposium): decision regret after adjuvant pembrolizumab in RCC.
The Question:
Do patients regret receiving adjuvant pembro – and if so, is it driven by long-term toxicity that CTCAE grading doesn’t adequately reflect? They built a patient co-designed tool focused on long-term toxicity.
The Study:
104 RCC pts post-adjuvant pembro across 3 London centres, median f/u 30 mo. Pts completed the Ottawa Decision Regret Scale alongside their own rating of irAEs as life-changing, significant, or non-significant.
What They Found:
28% rated their toxicity as significant and 11% as life-changing – but these ratings did not correlate with CTCAE grade (a third of G1–2 events were rated significant), and regret was identical for G1–2 vs G3–4 irAEs. Regret was driven by patient-perceived long-term toxicity, especially permanent endocrine and MSK irAEs – and not by disease recurrence (only 1/14 who relapsed expressed regret). Lower baseline expectations of toxicity – more regret.
My Take:
Striking that >1 in 4 reported significant and >1 in 10 life-changing toxicity. What concerns me most isn’t that CTCAE missed these events – it’s that the grade didn’t correlate with how significant patients found them, nor with regret at all.
That deviates from the very purpose of grading. The hard part: a regret analysis is tough to contextualize when the alternative, no treatment, risks recurrence – arguably worse than a long-term toxicity. Adjuvant therapy is challenging by nature: most patients are either cured already or destined to recur regardless – we expose everyone to toxicity to benefit a minority.
We urgently need biomarkers to find the few who truly benefit. This slide from Ian Davis says it all.
Looking forward to seeing the presentation!”
Title: Decision regret and toxicity perception following adjuvant pembrolizumab in renal cell carcinoma.
Author: Elizabeth Nally
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