This year’s European Society of Medical Oncology (ESMO) was the largest ever. Over 33,000 people attended ESMO Congress 2024 at Barcelona’s cavernous Fira Gran Via conference centre, where 5,000 abstracts were presented and 600 expert speakers took to the stage. The healthcare professionals and cancer drug developers in attendance were treated to five days of sessions covering the full gamut of oncology research, hundreds of pharma industry booths touting the industry’s latest innovations (and offering free coffees to those who stopped to chat), and an overall festival-like vibe replete with numerous food trucks. Read on for some of the key takeaways and what to look out for in oncology in 2025 and beyond.

 

Immunotherapy

Immunotherapies – which work by enabling the body’s immune system to recognise and destroy cancer cells – have been available for certain cancer types since the 1980s, while breakthrough immune checkpoint inhibitors – which prevent cancer cells from disabling immune cells’ response to tumours – have been on the scene since 2011. 13 years on from that milestone, ESMO 2024 represented a moment to present data on long-term survival rates for immunotherapy patients.

“There is increasing evidence that these types of therapies, when given in a pre-operative setting, and in combination with chemotherapy, can make a big difference in terms of improvement of long-term outcomes,” said Dr Rebecca Dent of the National Cancer Centre in Singapore and ESMO 2024’s Scientific Chair.

Promising data presented in Barcelona cut across several hard-to-treat cancers, including advanced melanoma – where immunotherapy appears to offer the potential for cure in patients who respond to this treatment. “When I used to treat melanoma 20 years ago there were very few options,” said Dent. “The clinics were very small because these patients did not do well. The introduction of immunotherapy and combination immunotherapy has dramatically changed outcomes for melanoma patients; we now have the luxury of being able to make choices about who gets what treatment at what point.”

For other hard-to-treat cancers, data was presented showing that MSD’s Keytruda was improving long-term survival rates of triple-negative breast cancer patients, while similarly positive results were seen for AstraZeneca’s Imfinzi in muscle-invasive bladder cancer.

“The main message from all of these studies is that immunotherapy continues to keep its promise and hope of long-term survival for many patients with different types of cancer,” said Dr Alessandra Curioni-Fontecedro of the Hospital of Fribourg in Switzerland.

Pushed on whether immunotherapies could be used for more patients (it is estimated that 40 percent of all cancers might benefit from some form of immunotherapy with response rates ranging from 20 to 60 percent), Dent was optimistic. She said that shifting immunotherapy into earlier lines of therapy, before tumours have had the chance to develop too much, would allow better harnessing of the body’s immune response to fight off cancer. She added, “can immunotherapy be combined with other therapies to improve the outcomes? The answer is absolutely yes, we just need better biomarkers so we can figure out which patients those are.”

 

ADCs

Antibody-drug conjugates (ADCs), which allow for the targeting of cancer cells with greater precision, were another hot topic at ESMO 2024, as they have been in the oncology community for the past few years. In 2023 for example, ADCs were involved in almost a quarter of pharma M&A deals, led by Pfizer’s USD 43 billion acquisition of Seagen.

“ADCs are a smart way of delivering chemotherapy as the antibodies it is bound to in a complex molecular structure deliver their payload directly inside the tumour cells they recognise. This preserves healthy tissue and thus offers reduced toxicity alongside potentially higher antitumour activity,” said Dr Andrés Cervantes of the University of Valencia, ESMO’s current president.

Over 100 ADC agents are currently under development with data presented at ESMO 2024 covering the entire spectrum of phase I, II, and III/IV trials. “Most of the current studies are exploratory and initial but complete, confirming that administering those ADCs is feasible and with no safety concerns,” explained Cervantes. “In the next few years we will see the impact.”

AstraZeneca, for its part, published phase 1 data on its in-house ADC candidates that it hopes will be able to compete with molecules from AbbVie and Pfizer. Although a mainstay of the ADC space, its successes thus far have come via deals with the Japanese firm Daiichi Sankyo rather than self-developed products.

Dent added that the newer generations of ADCs are showing better payloads, targeting harder to treat cancers and exploring previously unseen surface markers. Some of the new studies are exploring the little-understood effects of novel ADCs on the brain, for example, which she described as “a real unmet need for patients,” adding that obtaining more data on this issue “would be a big breakthrough.”

 

Artificial Intelligence

There is significant hype around artificial intelligence in healthcare – some of it overblown – but ESMO’s leadership feels that this technology has the potential to be truly transformational in oncology. From predictive analysis of large patient health record datasets to assisting clinical decision-making, the use of autonomous robots for surgery, and monitoring patient welfare via wearables, the use cases are numerous.

For Cervantes, however, “the most important thing [related to AI in oncology] is the digital analysis of images, whether radiological or pathological. By getting a digital analysis of those images, using techniques of deep learning, we can capture a lot of information that the human eye cannot. This may facilitate getting rid of complex molecular analysis.”

Understanding the huge potential of these technologies and the need for oncologists to rapidly upskill to make best use of it, ESMO is holding the first edition of a new dedicated conference on artificial intelligence and digital oncology in 2025. “We have the responsibility to let doctors know what is happening in those sectors of digital and computational oncology,” said Cervantes. “This is going to transform the way we receive cancer information and the way we take decisions.”

 

Burnout

Finally, ESMO is attempting to reduce burnout in the oncology profession amid concerns about losing young talent from the field. The primary causes of burnout include administrative burdens, such as paperwork and prior authorisation processes, which doctors say take time away from patient care. This is compounded by long hours which make striking a satisfying work-life balance challenging.

ESMO surveyed more than 4,000 doctors from over 104 countries on burnout and the results were sobering. More than 70 percent of young doctors were presenting some symptoms relating to burnout, while over a third of young doctors were considering abandoning the profession altogether.

“It’s important to underline that burnout may have consequences on mental health, causing anxiety, depression, and the inability to sleep properly,” explained Cervantes. He proposed a three-pronged strategy to dealing with this issue: helping individuals cope better with the problems they are facing; creating a healthier working environment at the institutional level; and raising awareness via professional societies of the dangers of burnout. “It is very important to take care of professionals so that these professionals can take proper care of their patients,” concluded Cervantes.

 

Photo Source: ESMO.org