The ATOMIC trial has been widely celebrated as providing a positive result. However, when viewed with a lens of critical appraisal that considers issues related to overtreatment, treatment de-escalation, surrogacy, post-trial access to treatment and contributions of component, we argue that ATOMIC should not change clinical practice but rather form the basis for future trials that test de-escalation strategies.
Sinicrope, F. A.
et al. Atezolizumab plus FOLFOX for stage III mismatch repair-deficient colon cancer.
N. Engl.
J. Med.
394 , 1155–1166 (2026). Gyawali, B.
& West, H. J.
Lessons from ADAURA on adjuvant cancer drug trials: evidence, ethics, and economics. J.
Clin. Oncol.
39 , 175–177 (2021). André, T.
et al. Effect of duration of adjuvant chemotherapy for patients with stage III colon cancer (IDEA collaboration): final results from a prospective, pooled analysis of six randomised, phase 3 trials.
Lancet Oncol. 21 , 1620–1629 (2020).
Sargent, D. J.
et al. Disease-free survival versus overall survival as a primary end point for adjuvant colon cancer studies: individual patient data from 20,898 patients on 18 randomized trials.
J. Clin.
Oncol.
Nature Reviews Clinical Oncology published a clinical update in Oncology on 23 Apr 2026.
The item focuses on Did ATOMIC really improve on the standard of care for mismatch repair-deficient colon cancer?.
Review the original article for the full source wording and details.