A phase 3 study in China gave sacituzumab tirumotecan (sac-TMT) a randomized edge over Keytruda (pembrolizumab) in treatment-naïve, PD-L1–positive non-small cell lung cancer. In the OptiTROP-Lung05 abstract ahead of ASCO 2026, the TROP2-directed ADC plus Keytruda cut the risk of disease progression or death by 65% versus Keytruda alone. The progression-free survival results were reported as statistically significant (p<0.0001) with median PFS not reached in the combination arm after a median follow-up of 10.5 months, compared with 5.7 months for Keytruda monotherapy. A preliminary survival signal also favored the combo, though overall survival data were not mature at the stated cutoff. The readout increases pressure on alternative frontline strategies, including PD-(L)1xVEGF bispecifics, as developers race to define a new standard in a lucrative immuno-oncology segment. Keytruda’s baseline performance appears consistent across studies, sharpening attention on the ADC’s incremental effect size as the field heads deeper into ASCO 2026.