CHICAGO The American Society of Clinical Oncologys annual meeting always features data with the potential to change clinical practice. This years meeting, though, was headlined by the kind of medical breakthrough cancer researchers have waited years for and progress for another class of medicine many believe to hold similarly standout potential.These two headlining presentations from Revolution Medicines in pancreatic cancer and Akeso and Summit Therapeutics in lung cancer dominated the discussion at McCormick Place on Sunday. But they were also just two of hundreds of studies that sparked debate that carried on outside presentation rooms and across convention center hallways, as well as at sales meetings, dinner tables and cocktail parties.Below are three storylines that emerged from ASCO.A bispecific vs. ADC clashBispecific antibodies and antibody-drug conjugates have exploded in popularity in recent years, in part, for their potential to upend more traditional methods of cancer treatment. Bispecifics, as their name suggests, can get after two troublesome targets instead of one. And antibody-drug conjugates, or ADCs, are a form of precision chemotherapy designed to squarely aim tumor-killing toxins at cancer cells while sparing healthy tissue.Both drug types have been approved for multiple malignancies. But at ASCO this year, a battle began brewing between them in one of oncologys most competitive landscapes.Over the weekend, Merck & Co. and Akeso presented dueling datasets testing a bispecific and an ADC, respectively, in non-small cell lung cancer. Both were from Phase 3 trials in China that, if replicated in global studies, could enable their therapies to become essential front-line treatments.Leading up to the meeting, analysts and investors parsed through the details from Merck and partner Kelun Biotechs study of the ADC sac-TMT, and the implications its progress might have for Akeso and collaborator Summits bispecific ivonescimab. But at ASCO, some attendees were more skeptical that an ADC like sac-TMT would measure up.Though ADCs are designed to be safer than traditional chemotherapy, theyre still associated with side effects. Those toxicities come from the chemotherapy payload, and their severity can depend on how well the ADC keeps it out of systemic circulation, where it can cause broader harm. In the case of sac-TMT, some of those side effects include lung inflammation as well as mouth sores known as stomatitis.Some argue that, by comparison, the side effects a bispecific like ivonescimab adds when paired with a Keytruda-like drug may not be as burdensome. “You're not adding a lot of toxicity, and youre increasing the efficacy fairly substantially, said John Heymach, chair of thoracic and head and neck cancer care at MD Anderson Cancer Center, in an interview. (Heymach is an investigator in a study involving ivonescimab.)But not all ADCs have these toxicities. And in those that do, the side effects can often be proactively managed by treating physicians. Patients can be given eye drops to manage swelling in ocular tissue, ice chips during infusions and steroid-based mouth washes to reduce mouth soreness. They can also be educated to look for signs of lung problems, such as shortness of breath.You have to know what the toxicities are going to be and how to get patients through that treatment safely, which can certainly be done with some foresight and planning, said Krushangi Patel, a City of Hope oncologist, speaking in an interview about a different ADC called Datroway. Jonathan GardnerThe RAS revolutionRAS, a family of genes that, when mutated, drive a constellation of tumors, has long been seen as an unattainable Holy Grail of cancer research. But a series of recent discoveries have shown RAS mutations can finally be successfully targeted with drugs.Revolution Medicines pancreatic cancer medicine daraxonrasib is at the forefront of this scientific progress, but many more RAS-targeting drugs are quickly following, prompting Rachna Shroff, the hematology and oncology chief at the University of Arizonas Cancer Center to declare to journalists that the RAS revolution is here.Revolutions results which showed daraxonrasib nearly doubled survival in patients with a notoriously fast-moving and deadly disease drew a rare and spontaneous standing ovation at ASCO on Sunday. Jennifer Knox of the University of Toronto, the oncology expert ASCO asked to provide outside commentary, called the slide depicting that finding an absolutely beautiful curve.This is the first glimpse at the real power of targeting RAS in pancreas cancer, Knox said.Knox lamented the fact that many people in the setting daraxonrasib could be approved for second-line treatment, following an initial round of chemotherapy may die or decline too quickly before theyre eligible. Still, the data provide hope for whats to come. Revolution is already testing daraxonrasib in newly diagnosed patients. And more than 20 companies, including Roche, Eli Lilly, Amgen, Boehringer Ingelheim and BeOne Medicines, are following with different, experimental RAS-targeting drugs.That all suggests the story is just beginning, said Brian Wolpin, a medical oncologist at Dana-Farber Cancer Institute and the daraxonrasib trials lead investigator.A RAS mutation is the founding event of pancreatic cancer, and now we've shown that you can drug that, and you can clearly benefit patients, he said.The next step will be science that lets us have long, durable responses and ultimately cure patients, Wolpin added, and I think it's here. Jonathan GardnerA paradigm shift in prostate cancerProstate cancer is often such a slow-growing tumor that it can be dealt with via active surveillance rather than any type of intervention. But in aggressive or high-risk cases, surgery to remove the prostate gland and some surrounding tissue can come next.For decades, that procedure has been the one way to effectively eliminate prostate cancer. But its not a cure-all; up to half of patients experience a recurrence within five years.Study results from Johnson &Johnson suggest there may be a new option ahead. In a Phase 3 trial called PROTEUS, the pill Erleada, when combined with a hormone therapy before and after prostate surgery, reduced the relative risk of disease progression and death by 20% compared to standard treatment. Patients who received it were nine-times more likely to have no cancer remaining at the time of their surgery. Treatment also helped lengthen the time before recipients needed additional treatment, according to findings presented at a plenary session on Sunday and simultaneously published in The New England Journal of Medicine.You have that moment where you could potentially give this patient curative-intent treatment, but once recurrence occurs, you've lost that opportunity, said Mark Wildgust, J&Js vice president of global medical affairs for oncology, in an interview. We had a conviction that Erleada was really different.Erleada is already approved for two different, advanced stages of prostate cancer and is now a blockbuster medicine for J&J. The drug brought in over $3.5 billion in revenue last year, a 19% jump from 2024, and generated $949 million in the first quarter of 2026.The latest data could drive those numbers much higher, making Erleada available to a much earlier, larger localized-disease population, wrote Leerink Partners David Risinger. Various sources estimate that about 50,000 people in the U.S. are diagnosed each year, he added in a Monday note to clients.Treatment does come with caveats. Rates of serious adverse events, as well as treatment-related discontinuations, were higher among Erleada recipients. Wildgust, however, said combining Erleada with existing care only added a little bit more rash.But he believes the biggest challenge ahead for J&J will be convincing physicians to change practice and just changing peoples minds.Theres going to be a lot of questions, and were ready to support them in answering those questions, he said. Delilah Alvarado '