ESMO 2025 –
ensuring innovation isn’t lost in translation

Fifty years on, ESMO still feels like the world’s most hopeful laboratory – a living experiment in how science, collaboration and human ambition combine to advance cancer’s future.

In Berlin, that experiment reached full scale. More than 35,000 delegates packed into Messe Berlin for ESMO 2025, marking the congress’s 50th anniversary under the theme: ‘Many journeys. One global community.’ Over four days, 2,926 sessions charted oncology’s rapid progress – from paradigm-shifting data to the vital work of bringing innovation into everyday care.

This wasn’t a nostalgic celebration; it was a declaration that oncology’s next era is already here. The energy was electric, the conversations constant. Everywhere you turned, the message was the same: discovery is only the beginning – what matters is how we translate it into the real world.

ESMO’s dual identity was impossible to ignore. On one side, a flood of new data drew packed auditoriums. On the other, conversations about health equity, sustainability and communication reminded us that science only comes alive when it reaches people.

The crowds voted with their feet: blockbuster clinical data sessions filled every seat, while more novel sessions (like one on the impact of climate change) played to smaller audiences. It was a reminder that progress in oncology still tends to orbit the molecule – even as its future depends on systems, stories and shared responsibility.

If oncology had a headline act this year, it was breast cancer. The data deluge was relentless, with fifteen official sessions and almost as many industry symposia.

In the early breast cancer setting, MONARCH-E was the first trial to demonstrate OS data over 76 months with Lilly’s adjuvant Verzenio (abemaciclib), while NATALEE provided a five-year update with Novartis’ Kisqali (ribociclib). Both trials underscored the benefit of adjuvant CDK4/6 inhibition.

In metastatic HR+/HER2- breast cancer, one thing was clear: first-line therapy should pair a CDK4/6 inhibitor with endocrine treatment. The open question is whether aromatase inhibitors should give way to fulvestrant or oral SERDs like camizestrant or giredestrant, since AIs can drive ESR1 mutations. Possibly – but either way, new options are ready for second line. Orserdu and Inluriyo are already approved, while Roche’s giredestrant showed strong results with everolimus in the evERA study. Celcuity’s VICTORIA-1 trial added another layer: gedatolisib combined with fulvestrant and palbociclib achieved a hazard ratio of 0.24 versus fulvestrant alone, with low hyperglycaemia. Oral therapies are popular, but monotherapy is no longer enough. The key question now is whether second-line treatment will move towards triple combinations – as first-line HR+ mBC continues to evolve with camizestrant, giredestrant and, in HER2-, inavolisib entering the mix. How this shifting landscape will affect sequencing and rechallenge remains to be seen.

In triple-negative disease – one of the toughest frontiers – there were first-time positive studies: Gilead’s Trodelvy (sacituzumab govitecan) and AstraZeneca/Daiichi Sankyo’s Datroway (datopotamab deruxtecan) bring advances in a field that for the longest time was based on chemotherapy, with Trodelvy showing significant improvements in overall survival across HER2- MBC.

In HER2-positive disease, AstraZeneca/Daiichi Sankyo’s Enhertu (trastuzumab deruxtecan) presented results from its DESTINY-Breast09 study, but to mixed responses. When clinicians were surveyed on how they would use the drug, 34% said they would give it as a first-line treatment for all patients, while 37% would reserve it for those at high risk. Smaller numbers preferred it in the second line (7%) or only in selected individual cases (16%).  Around 6% said they were still undecided. Physicians also confirmed they would not use chemotherapy after Enhertu but would keep using Roche/Genentech’s Perjeta (pertuzumab), with one commenting that Enhertu isn’t suitable for long-term use. This was also the main takeaway when Enhertu was discussed in early stage (DESTINY-Breast05 and DESTINY-Breast11 neoadjuvant studies): use in high-risk patients only. Side effects that may be acceptable in advanced disease are simply too heavy a burden for patients with early-stage disease.

With so many new treatment options emerging, one question dominated: how do we match the right patient to the right therapy, faster and smarter? Biomarkers featured prominently.

Among the headlines: AI-assisted mammography can direct select women to supplemental MRI for early diagnosis – with data suggesting combined pathological markers and non-pathologic data can lead to improved prognostic outcomes. The challenge, however, is infrastructure: fewer than five US hospitals use AI routinely in pathology, mainly because full digitisation remains costly.

ctDNA – one of the most discussed biomarkers – reported mixed results. SERENA-6 showed ctDNA could detect ESR1 mutations in breast cancer up to six to nine months before clinical, radiographic progression, creating a new window for intervention. The INVIgor-011 study in muscle-invasive bladder cancer found that ctDNA status enhanced the risk determination: consistently ctDNA-negative patients had lower relapse risk and gained no benefit from atezolizumab. The AGIT-DYNAMIC study had similar conclusions, finding the effort to de-escalate oxaliplatin use in stage 3 colon cancer based on ctDNA was unsuccessful.

Overall, ESMO 2025 reinforced the growing potential of biomarkers in cancer, with AI integration accelerating adoption.

As Fátima Al-Shahrour said: “We are witnessing a paradigm shift toward personalised medicine, where imaging and blood-based biomarkers help guide care more precisely and safely.”

The priority now is making it scalable.

Another resonant theme was the evolution of antibody–drug conjugates (ADC). Clearly here to stay, the focus is shifting to refining their performance. Lillian Siu’s session on ADC optimisation drew one of the largest crowds of the week. Her call to action was simple: there are opportunities to use them in combination with synergistic treatments that would allow ADC dose reductions, with the potential to reduce adverse events.

Meanwhile, bispecific antibodies (bsAbs) have been quietly expanding their territory. Once the preserve of multiple myeloma and B-cell lymphomas, they’re now moving into solid tumours like NSCLC and SCLC.

In addition to T-cell engagers, a novel biparatopic bispecific has arrived on the scene in Jazz Pharmaceutical’s Ziihera – a dual HER2-targeting bispecific for HER2+ biliary tract cancer. Summit Therapeutics hailed the start of a ‘new era’ presenting data on its PD-1/VEGF bispecific ivonescimab – a novel class of PDx-based bispecifics. It hopes for approval outside China for EGFR+ mNSCLC, with additional ongoing global phase 3 trials, while data presented for AstraZeneca’s rilvegostomig showed promise with dual PD-1 x TIGIT blockade in 1L mNSCLC.

For all the technical language, the story is simple: both ADCs and bispecifics are evolving – not just in mechanism, but in intent. The challenge now is to translate that innovation into tangible, accessible benefit for patients.

Not every breakthrough came from the lab. Some of the most striking moments showed us what cancer care looks like in the real world – messy, human, hopeful.

Presentation of the POSITIVE study stood out for its simplicity and emotional power. It showed that women with breast cancer who wish to become pregnant can safely pause adjuvant therapy for two years, resume treatment and achieve both high pregnancy success and low relapse rates. It was one of those rare sessions where science, empathy and patient autonomy meet – proof that progress isn’t just about longer survival, but fuller lives.

There was also a growing conversation about sustainability in oncology. Under the banner of ‘eco-friendly radiotherapy’, one presentation showed that patient travel to and from treatment centres is a major hidden contributor to healthcare-related CO₂ emissions.  Another confirmed that extreme weather disrupts treatment. The message: climate isn’t an abstract backdrop to cancer care – it’s part of the outcome equation.

Shared decision-making (SDM) also had its moment. One patient advocacy session showed that men with prostate cancer who engaged more deeply in SDM reported better quality of life and fewer regrets about treatment. Already embedded in urology and oncology guidelines, SDM is proving to be more than good ethics – it’s good medicine.

Together, these moments reminded delegates that cancer progress isn’t written only in hazard ratios and p-values, but in people, systems and the willingness to look beyond the molecule.

If ESMO’s scientific sessions are where oncology’s future is written, the exhibition hall is where it’s branded and brought to life. This year, creative ambition matched the data.

The congress theme, ‘Many journeys. One global community.’ echoed across the hall in a chorus of unity. ‘Togetherness’ wasn’t just a tagline – it was the creative currency every brand traded in. Astellas promised to be ‘Changing the course together’. BeOne declared that ‘Together we are how the world stops cancer’, while J&J pledged ‘Together, we’re working tirelessly to get in front of cancer’. It was a masterclass in messaging alignment – a collective effort to humanise the science and show that pharma’s competitive edge can coexist with shared purpose.

Visually, the hall told two stories. One was scale: the biggest names – AstraZeneca among them – occupied vast spaces impossible to miss. The other was craft: smaller booths that invested in smart, emotive storytelling over spectacle. Chinese biotechs made a strong showing – both in data and design – signalling a new maturity in how emerging players engage clinicians beyond the podium.

Curiously, gaming – once the darling of engagement strategy – was largely absent. Virtual reality, used mainly for education, took its place. Novartis invited visitors to ‘build your own antibody’, turning complex molecular biology into interactive play, while Regeneron used immersive experiences to help attendees ‘see’ how bispecifics target cancer cells. The technology felt purposeful rather than gimmicky – an encouraging sign that experiential storytelling in pharma is finally maturing.

But the real win wasn’t about screens or slogans – it was about intent. The best booths understood that scientific credibility and emotional resonance aren’t opposites; they’re partners. Delegates lingered where brand stories connected the human ‘why’ to the scientific ‘how’ – a reminder that in cancer care, data may start the conversation, but empathy keeps it going.

ESMO 2025 showed oncology at full strength – ambitious, connected and human. The message from Berlin is that progress isn’t just about data – it’s about translating discovery into understanding.

Fifty years on, ESMO still feels like the world’s most hopeful laboratory – and proof that progress, at its best, is deeply human.

Susanne Bobadilla is Executive Director, Global Medical Strategy and Costas Saratsis is Medical Strategy Director, both at VML Health