A new JAMA study raised concerns that accelerated approval in oncology is being underutilized, potentially weakening the evidentiary “safety net” that requires confirmatory trials after surrogate-driven approvals. The paper, by Brian Shkabari and colleagues at the Sinclair Cancer Research Institute, analyzed 385 adult cancer drug approvals from 2006–2025. The authors reported that more approvals are increasingly based on response rate and other surrogate endpoints, while the proportion tied to overall survival and progression-free survival declined. They also observed an increase in regular approvals supported by weaker evidence compared with earlier eras. The paper notes that accelerated approval was designed to allow earlier access while confirmatory evidence is generated, and argues that offering up-front regular approval based on surrogate measures can remove the required follow-up that verifies clinical benefit and safety. Overall, the work suggests oncology regulators and sponsors face growing pressure to balance speed of access with the strength and completeness of clinical evidence, as regulators update guidance and survival assessments remain central to decision-making.