Re-evaluating adjuvant systemic therapy in cancer treatment: Scientific rigour to guide policy and practice

The landscape of adjuvant treatment in cancer care is rapidly changing. Recent randomised trials have led to regulatory approvals for neoadjuvant and adjuvant hormonal agents, targeted therapies and immune checkpoint inhibitors. This has brought about increasing complexity in this space, challenging previously established paradigms of adjuvant treatment. As these treatments are increasingly implemented, healthcare systesms around the world face the challenge of critically appraising these studies and determining whether the treatments proposed provide clinically meaningful benefit. This article considers the validity of these data in the context of fundamental principles of adjuvant therapy, as well as the scientific rigour of the relevant registration trials. We propose a greater role for practising oncologists in the regulatory and reimbursement process, using the Singaporean context as an example.