At the European Society for Medical Oncology (ESMO) Congress in Madrid in October 2026, one of the most discussed lung cancer studies was KRAScendo 1. For the first time, a newer targeted tablet called divarasib was compared directly with the two tablets already used for lung cancer with a KRAS G12C gene change, sotorasib and adagrasib. Divarasib came out ahead, both in how well it worked and in how well people tolerated it.
For patients and families, news from a medical congress can be exciting but also hard to interpret. What did the trial show, who does it apply to and can divarasib be prescribed today?
Dr Dionysis Papadatos-Pastos, a consultant medical oncologist in London specialising in lung cancer, mesothelioma and thymic tumours, explains the results and what they may mean in practice.
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Topics CoveredKRAS G12C Lung Cancer in Brief
KRAS is a gene that helps control how cells grow. A specific change in this gene, called KRAS G12C, keeps the KRAS protein switched on, so that it constantly tells the cancer to grow. This change is found in around one in eight people with the most common type of non-small cell lung cancer (adenocarcinoma).
For many years KRAS was thought to be impossible to target with medicines. That changed with the first KRAS G12C inhibitors, sotorasib and adagrasib, which are taken as tablets and are usually used after earlier treatment such as immunotherapy and chemotherapy. Our article on KRAS G12C lung cancer explains the gene change, how it is found and how treatment is planned.
What the KRAScendo 1 Trial Tested
KRAScendo 1 included 338 adults with advanced non-small cell lung cancer carrying the KRAS G12C change, whose cancer had grown after earlier treatment. Half received divarasib, a newer tablet taken once a day. The other half received one of the existing tablets, sotorasib or adagrasib, chosen by their doctor.
All three medicines work in the same way: they attach to the faulty KRAS protein and switch it off. Divarasib was designed to do this more strongly and more selectively. This made it important to see whether it would also help patients more, and this trial was the first to answer that question directly.
What the Trial Found
Divarasib did better than the existing tablets on every main measure. In simple terms:
- Living longer: people treated with divarasib lived for about 17.7 months on average, compared with about 12 months with sotorasib or adagrasib, an average difference of around five to six months.
- Keeping the cancer under control: the cancer was held in check for about 9.8 months on average with divarasib, compared with 5.7 months.
- Shrinking tumours: tumours shrank in about 6 in 10 people treated with divarasib, compared with about 3 in 10 with the existing tablets.
These figures are averages from a clinical trial and describe a whole group, not an individual. Some people do well for much longer, and others respond less. The results were presented at ESMO 2026 and published at the same time in the New England Journal of Medicine. Details of the trial design are listed on ClinicalTrials.gov (KRAScendo 1).
Side Effects and Quality of Life
A treatment that works better is only part of the story. For people living with advanced lung cancer, how a treatment feels day to day matters just as much.
In KRAScendo 1, divarasib caused fewer serious side effects than the existing tablets (about 8% compared with 15%), and fewer people had to stop treatment because of side effects (about 5% compared with 12%). As a result, people stayed on divarasib for longer.
The most common side effects were stomach upset, such as diarrhoea, nausea and vomiting, which was more frequent with divarasib but usually mild and manageable with simple medicines and advice. Changes in liver blood tests can also occur, so regular blood tests are part of treatment. Any new or troublesome symptom should be reported to the care team, as most side effects can be managed well when they are recognised early.
Is Divarasib Available in the UK?
Not yet. Divarasib is an investigational medicine: it is not licensed in the UK or elsewhere, and it can currently only be given within clinical trials. Its developer, Roche, has said it is working with regulators following these results. A licence from the Medicines and Healthcare products Regulatory Agency (MHRA), and then a decision by the National Institute for Health and Care Excellence (NICE) on NHS funding, would normally follow.
In the meantime, sotorasib and adagrasib are licensed in the UK for KRAS G12C lung cancer after earlier treatment. In England, sotorasib has been available through the Cancer Drugs Fund while NICE reviews it, and NICE did not recommend adagrasib for routine NHS use. Access can change, so it is worth asking your oncologist what is available to you now, on the NHS or privately.
What's Next: Divarasib After Surgery (KRASCENDO 3)
Following these results in advanced lung cancer, divarasib is now being studied at an earlier stage of the disease, to explore whether it has a role after surgery.
The KRASCENDO 3 trial (ClinicalTrials.gov: NCT07541170; EU CT number 2025-524263-21-00), sponsored by Roche, is for people with stage II to IIIB non-small cell lung cancer that carries a KRAS G12C mutation. To take part, people must have had chemotherapy with immunotherapy before surgery and then had their cancer removed. The trial is testing whether divarasib, given after surgery, can lower the chance of the cancer coming back. It is being compared with current standard options, which are immunotherapy or careful monitoring.
Divarasib is an investigational medicine. It is not licensed in the UK, and its benefits and risks after surgery are not yet known. Taking part in a trial does not guarantee benefit, and not everyone will be eligible. Whether a trial is suitable for you depends on your individual circumstances and should be discussed with your own specialist.
What This Means for You
If you have been diagnosed with advanced non-small cell lung cancer, the most important first step is to know whether your cancer carries a KRAS G12C change or another targetable gene change. This is found through molecular profiling, a test on a tissue sample or sometimes on a blood sample.
If your cancer has the KRAS G12C change, you may wish to ask your oncologist:
- whether a KRAS G12C tablet is part of my treatment plan, now or later
- whether a clinical trial, including trials of divarasib, may be suitable for me
- how my treatment options might change if divarasib becomes available in the UK
Our guide to questions to ask your oncologist can help you prepare for these conversations. A specialist consultation offers time to review your test results, a second opinion on your treatment plan and input from a multidisciplinary team, and it can work alongside NHS care.
Conclusion
KRAScendo 1 is the first trial to compare KRAS G12C tablets head to head, and divarasib helped people live longer, kept the cancer under control for longer and caused fewer serious side effects than sotorasib or adagrasib. It is not yet approved, but it is a clear sign of progress for people with this gene change, and research is now exploring its use after surgery.
If you or someone close to you has KRAS G12C lung cancer and would like to discuss treatment options or clinical trials, Dr Papadatos-Pastos sees patients privately at several London clinics and offers both in-person and virtual consultations.
Disclosure: Dr Papadatos-Pastos is UK Chief Investigator for KRASCENDO 3. This information is provided for general education only and is not medical advice or a recommendation of any treatment.
Support and Follow-Up Care
Dr Papadatos-Pastos and his team provide ongoing support beyond medical treatment.
Patients receive clear communication, psychological care and access to nutrition, physiotherapy and symptom-management services.
Regular follow-up ensures early detection of recurrence and long-term wellbeing.
Book a Consultation
If you or someone close to you has been diagnosed with lung cancer, early consultation with a specialist can make a real difference. Appointments are available at several London clinics.
Faq
Answers to Common Questions
Patients and families often have questions after hearing about divarasib. Here are short answers to the questions we hear most often.
Divarasib is an investigational targeted tablet for lung cancer with a KRAS G12C gene change. Like sotorasib and adagrasib, it attaches to the faulty KRAS protein and switches it off, but it was designed to do this more strongly and selectively.
In the KRAScendo 1 trial, presented at ESMO 2026, people treated with divarasib lived about five to six months longer on average than people treated with sotorasib or adagrasib. Their cancer was also controlled for longer, tumours shrank more often and serious side effects were less common.
No. Divarasib is not licensed in the UK or elsewhere and is currently available only within clinical trials. Sotorasib and adagrasib are the KRAS G12C tablets licensed in the UK today.
The most common side effects were diarrhoea, nausea and vomiting, which were usually mild. Changes in liver blood tests can also occur. Serious side effects were less common than with sotorasib or adagrasib, and fewer people had to stop treatment.
KRASCENDO 3 is a clinical trial for people with stage II to IIIB KRAS G12C lung cancer who have had chemotherapy with immunotherapy and then surgery. It tests whether divarasib after surgery can lower the chance of the cancer coming back, compared with immunotherapy or careful monitoring.
KRAS G12C is found through molecular profiling, a test on a tumour tissue sample or sometimes a blood sample (liquid biopsy). In the UK, this testing is recommended for people with advanced non-small cell lung cancer. You can ask your oncologist whether it has been done and what it showed.
