2026 ASCO Supportive Oncology Updates

I attended the ASCO Annual meeting this month and thought I would share the updates in the area of Supportive/ Palliative care. Before I do that, I’d like to start off by congratulating a 2026 ASCO award-winner and supportive oncology pioneer, Dr. Frank Ferris. Dr. Ferris is the recipient of the 2026 ASCO Walther Cancer Foundation Supportive Oncology Award. He is known globally as a trailblazer, visionary, and innovator in palliative medicine, research, and education. Since 2010, Frank has directed many in-person and virtual ASCO palliative care courses through the ASCO Center for Global Impact. These courses and many of his videos, podcasts, and lectures are available in a free online Palliative Care Interdisciplinary curriculum at https://pallmed.net.

Now, let’s look at what Supportive Oncology researchers reported works and what doesn’t.

Chemotherapy-Induced Nausea and Vomiting (CINV). Does dexamethasone-sparing for patients receiving Highly Emetogenic Chemotherapy (HEC) work? YES

Many patients receiving HEC find it very difficult to tolerate the 4 days of dexamethasone included in the “standard” anti-emetic regimen. Zhang et al (Abstract 12000) in a Phase III trial, studied several dexamethasone-sparing regimens to determine whether the full 4 days were needed. All patients received NEPA (a fixed oral combination of netupitant and palonosetron) but were randomized to (1) a standard regimen (NEPA day 1, olanzapine 5 mg days 1-4, and dexamethasone 12 mg day 1 and 8 mg days 2-4), (2) the standard regimen except that the patients received 6 mg of dexamethasone on day 1 and no further dexamethasone, or (3) no dexamethasone at all. They found that 6 mg of dexamethasone on day 1 produced control of nausea and vomiting that was equivalent to a full four days of dexamethasone. The dexamethasone-free regimen, however, was not as effective. Their findings support a steroid-sparing regimen for patients receiving HEC, such as breast cancer patients receiving Adriamycin and Cytoxan. Dr. Hegseth, one of the pioneers in research in CINV, who was not involved with the study, cautioned that while this may work for patients receiving carboplatin or oxaliplatin, one day of dexamethasone may not be adequate for those receiving cis-platin.

Can chemotherapy-Induced Peripheral Neuropathy (CIPN) be prevented by Vit D repletion? Maybe.
Is CIPN ameliorated by exercise? Possibly, in patients with prostate cancer

Vitamin D: Other than the somewhat controversial and rather cumbersome wearing of ice-cold mittens and socks, there are no reliable preventive measures to reduce CIPN. Authors have advised avoiding CIPN-producing agents, when possible, in patients who are obese, sedentary, or have diabetes. Nguyen-Hoang et al (Abstract 12012), in a prospective cohort study (SWOGS1714) found that patients with Vitamin D deficiency had a significantly increased risk and severity of taxane-induced peripheral neuropathy (TIPN). Of the 22% of patients who had low vitamin D levels at the start of therapy, 63% developed TIPN. The Vitamin D-deficient patients had a higher risk of TIPN than those who had normal Vitamin D levels (p.= .013) and more severe worsening of neuropathy (p=.013). Repletion of Vitamin D is recommended for patients with cancer for a variety of reasons, and further studies may show that prevention or amelioration of TIPN and CIPN in general may be another.

Exercise: In a Phase II RCT (Abstract 12014), Kleckner et al found that a virtually delivered regimen of walking and resistance exercise (Virtual delivered Exercise of Cancer Patients (vEXCAP) decreased sensory symptoms in patients with CIPN, though tactile and motor function were unchanged. Sensory symptoms are often the most troubling, so I look forward to the results of future Phase III trials of this intervention.

Mucositis Prevention. Does topical betamethasone ointment work? Probably

For patients with cancer of the head and neck on combination chemotherapy and radiation therapy, oral mucositis is an expected and very painful side effect. Many patients require enteral feeding to maintain adequate nutrition. Soutome et al (Abstract 12015) found in a multicenter randomized phase II trial that topical betamethasone ointment, applied 3 times a day after the onset of Grade 1 mucositis was very effective in decreasing the cumulative incidence of Grade 3 mucositis without an increase in oral candidiasis (14.3% in the study population vs 48.5% in those receiving standard care). The study was small, only 35 pts in the intervention and 33 in the standard care group. I’ll be looking forward to results of a subsequent Phase III trial.

Cancer-related Fatigue. Do Exercise/Yoga help ameliorate fatigue: Yes

Does adding Methylphenidate to exercise or using methylphenidate alone ameliorate fatigue? No

The YOGAS team (Choi et al, Abstract 12004) extended their study of yoga for insomnia, studying the same program to decrease anxiety and fatigue in breast cancer survivors. YOCAS includes “breathing exercises, 18 gentle Hatha and Restorative yoga postures, and meditation.” In their Phase III randomized controlled trial with women (96% female participants) who had completed adjuvant therapy for non-metastatic breast cancer 2-24 months before enrolling, patients in the YOGAS group had less mood disturbance, anxiety, fatigue, or insomnia (p <.05). They postulated that the improvement in insomnia might be related to the improvement in mood and fatigue. These findings are of importance in the care of these survivors who suffer from the late side effects of adjuvant chemotherapy as they attempt to return to their pre-therapy state of health and function.

Methylphenidate, however, was again shown not to improve cancer-related fatigue. In a Phase III randomized, placebo-controlled trial (Yennu at al, Abstract 12005), exercise improved fatigue in patients with prostate cancer receiving either ADT and/or XRT who had cancer-related fatigue. The Exercise + methylphenidate (5 mg bid up to 20 mg/d) arm was not superior to the Exercise + placebo arm. And a separate study in patients with advanced cancer (Stone et al. J Clin Oncol 42:2382-92) confirmed that after 6±2 weeks of methylphenidate titrated weekly x 6 weeks up to a maximum of 20 mg po tid, methylphenidate did not reduce fatigue more than placebo.

Does THRIVE-MM decrease fatigue and depression in patients with multiple myeloma? Probably

A psychosocial digital application (THRIVE-MM) did decrease fatigue and depression symptoms in patients living with multiple myeloma (El-Jawahri et al. Rapid Oral Abstract 1513). THRIVE-MM has five modules which include interactive activities, educational games and videos which provide “psychoeducation and evidenced-based self-management skills training for behavioral change and coping.” In a single center, randomized trial, patients could use the THRIVE-MM application for up to 8 weeks after enrollment; the control arm patients received usual care. Patients were stratified by line of therapy (1^st vs 2^nd /3^rd vs maintenance). THRIVE-MM participants reported lower fatigue (p =.012) and lower depression symptoms p=.044) at week 8.

So overall, more successes than failures, but in most cases, we must await the results of Phase III trials. For additional resources in any of these and many other areas, visit the Pain and Symptom Management Resource section of my website.

In next month’s newsletter I’ll be offering a recap of a variety of resources we have not yet featured in Communication, Special Topics, and End of Life and Bereavement so stay tuned.