The overall survival impact is questionable, unfortunately. But that's been discussed ad nauseam here, and we're left with the conclusion that there's a signal of survival benefit, particularly in the +5% long-term survival compared with an external comparator.
The second point you make here is more worth discussing. It's actually usually MORE difficult to show survival benefit in less aggressive cancers. The trials usually take more patients and very very long follow-up to resolve these modest signals.
You see it in diseases like breast cancer, taking many hundreds, if not thousands of patients just to see 5-year survival improve by a few percentage points (like 92% going to 96% 5-year survival). Examples include APHINITY (iDFS benefit of just 4.9%) and NATALEE (~5% improvement in 4-year OS rate among, and it took 5 THOUSAND patients).
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