Precision therapeutics have improved outcomes in gynecologic oncology, but their population-level impact depends on both biological efficacy and reliable treatment delivery. Randomized controlled trials establish causal effects under defined conditions; real-world evidence characterizes implementation and transportability while introducing distinct confounding and measurement challenges. This contextual narrative review integrates pivotal and updated therapeutic studies with clinical, social and translational evidence available through September 2026. Progression-free survival and overall survival are distinct endpoints, whereas effectiveness concerns benefit in routine care; cross-study interpretation requires aligned populations, treatment strategies, follow-up and estimands. The benefits of poly(ADP-ribose) polymerase inhibitors and immunotherapy are examined separately by molecular subgroup and treatment setting. Financial hardship, geographic access, caregiving and health-system constraints can affect initiation, tolerable exposure and continuity. We use the proposed term "social discontinuation" for treatment disruption with a material social contribution, while distinguishing clinical reasons and patient preference. Biological weathering provides plausible links between cumulative adversity and inflammatory, neuroendocrine, epigenetic and immune phenotypes. Human epidemiological associations, translational findings and experimental mechanisms support different inferences; mediation through treatment delivery remains distinct from biological modification of treatment effect. Priorities include justified broader eligibility, prospective social-needs and exposure measurement, responsive symptom management, navigation and hybrid care. Automated extraction and prediction tools require external validation, fairness assessment and prospective clinical-impact evaluation. Integrating randomized and real-world evidence can identify remediable barriers without diminishing the clinical value of effective therapies.

Circulating tumor DNA (ctDNA) is an emerging tool in precision oncology that enables noninvasive tumor profiling, detection of minimal residual disease, and treatment monitoring. Furthermore, routine ctDNA analyses offer the potential to support more personalized and dynamic cancer care. In advanced breast cancer (aBC), ctDNA-based monitoring has been investigated across multiple studies as a tool for detecting emerging resistance mechanisms, predicting treatment responses and informing biomarker-guided treatment decisions. One example, investigated in the phase III PADA-1 and SERENA-6 trials, is monitoring for emergent estrogen receptor alpha mutations (ESR1m) during first-line endocrine therapy in estrogen-receptor positive, human epidermal growth factor receptor 2-negative (ER+, HER2-) aBC. While not yet widely adopted in clinical practice, broader implementation of routine ctDNA-based monitoring for ESR1m is anticipated and will require standardized diagnostic workflows, encompassing both institutional operational processes and patient-centered scheduling pathways. Insights and recommendations were gathered from multidisciplinary experts across academic and community practices in the US regarding the feasibility, barriers, and operational requirements for implementing ESR1m monitoring during first-line treatment of aBC. Here, we present practical, experience-informed considerations, supplemented by an opinion-based consensus workflow model designed to provide clinicians with a flexible framework for implementing ctDNA-based ESR1m monitoring during first-line care for ER+, HER2- aBC.

Psychedelic-assisted therapy (PAT) is increasingly discussed as a potential intervention for anxiety, depression, and existential distress among patients with advanced cancer. Yet the ethical challenges of PAT for patients approaching the end of life remain underdeveloped, particularly for oncologists who may be asked to counsel patients or consider referral to clinical trials. This article uses 3 deidentified clinical vignettes from a clinical trial of psilocybin-assisted therapy in a palliative oncology context to examine what it means for PAT to "work." We argue that PAT should not be evaluated only by symptom reduction or the production of mystical experiences, but also by whether it helps patients move toward valued forms of self-understanding, connection, courage, acceptance, or reconciliation. Drawing on the concept of "aspirational autonomy," we propose that meaningful consent to PAT need not depend on full foreknowledge of an unpredictable experience. Rather, consent may be understood as a patient's endorsement of a supported process of moral and existential aspiration. We then identify practical ethical challenges for oncology, including expectation management, therapeutic ambiguity, somatic amplification, limited time for integration, and family dynamics. We conclude by offering candidate-selection considerations for oncologists, emphasizing aspirational clarity, cognitive and psychological stability, temporal feasibility, relational support, and realistic expectations.