T Kadota reports receiving honoraria from Olympus, and personal fees of advisory from Olympus out of this study. S Koyama reports grants from Merck & Co., Chugai Pharmaceutical Co., Ltd., and Otsuka Pharmaceutical and personal fees from Merck & Co. and Chugai Pharmaceutical Co., Ltd. outside the submitted work. D Kotani reports honoraria from Takeda, Chugai, Lilly, MSD, Ono, Seagen, Guardant Health, Eisai, Taiho, Bristol Myers Squibb, Daiichi-Sankyo, Pfizer, Merckbiopharma, and Sysmex: research funding from Ono, MSD, Novartis, Servier, Janssen, Sanofi, Hutchison MediPharma, Pierre Fabre Medicament, Isofol Medical, Sysmex, and Cimicshiftzero. M Wakabayashi reports receiving honoraria from Nihon Medi-Physics Co., Ltd. Y Nakamura reports advisory role from Guardant Health Pte Ltd., Natera,Inc., Roche Ltd., Seagen, Inc., Premo Partners, Inc., Daiichi Sankyo Co., Ltd., Takeda Pharmaceutical Co., Ltd., Exact Sciences Corporation, and Gilead Sciences, Inc.; speakers’ bureau from Guardant Health Pte Ltd., MSD K.K., Eisai Co., Ltd., Zeria Pharmaceutical Co., Ltd., Miyarisan Pharmaceutical Co., Ltd., Merck Biopharma Co., Ltd., CareNet,Inc., Hisamitsu Pharmaceutical Co., Inc., Taiho Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Chugai Pharmaceutical Co., Ltd., and Becton, Dickinson and Company, Guardant Health Japan Corp; research funding from Seagen Inc., Genomedia Inc., Guardant Health AMEA, Inc., Guardant Health, Inc., Tempus Labs, Inc., Roche Diagnostics K.K., Daiichi Sankyo Co., Ltd., and Chugai Pharmaceutical Co., Ltd.. A Kawazoe has received personal fees for advisory roles from GSK, Zymeworks, MSD and Abbvie; honoraria from Merck Biopharma, Lilly, Bristol-Myers Squibb, Ono Pharmaceutical, Taiho Pharmaceutical, and Daiichi-Sankyo; and research funding from MSD and AstraZeneca outside the submitted work. T Yano reports receiving research grants from Olympus, Fujifilm, HOYA, SHIMADZU, GURDANT HEALTH AMEA Inc., Craif, Astellas, Rakuten Medical, Daiichi Sankyo, Astellas Pharm Global Development, Surg storage out of this work; receiving honoraria from Olympus, Fujifilm, MeijiSeika Pharma and personal fees of advisory from Olympus, HOYA, PIOLAX Medical device out of this study. K Shitara reports receiving personal fees for consulting and advisory roles from Bristol Myers Squibb, Takeda, Ono Pharmaceutical, Novartis, Daiichi Sankyo, Amgen, Boehringer Ingelheim, Merck Pharmaceutical, Astellas, Guardant Health Japan, Janssen, AstraZeneca, Zymeworks Biopharmaceuticals, ALX Oncology Inc., Bayer, GlaxoSmithKline K.K., HEALIOS K.K., Moderna. Inc, Arcus Biosciences Inc.; receiving honoraria from Bristol-Myers Squibb, Janssen, AstraZeneca, Eli Lilly, Ono Pharmaceutical, and Astellas; and receiving research funding (all to institution) from Merck Pharmaceutical, Daiichi Sankyo, Taiho Pharmaceutical, Chugai Pharma, Ono Pharmaceutical, Astellas, Eisai, Amgen, PRA Health Sciences, AstraZeneca, PPD-SNBL K.K. and TORAY, outside the submitted work.