ESMO 2025 wasn’t just another medical meeting. It was a milestone moment: a half-century celebration under the banner “Many journeys. One global community.” More than 35,000 delegates descended on Berlin’s sprawling Messe halls to navigate nearly 3,000 sessions – and, in true conference fashion, get lost trying to find them.
But beyond the maze of corridors and session maps, a glance at the programme prompted a bigger question: was the ESMO 2025 congress still the place to explore the broader healthcare ecosystem – policy, practice, and the human side of cancer care – or was it evolving into something closer to ASCO’s showcase for breakthrough innovation? Judging by the crowds packed into sessions unveiling the latest molecules, the centre of gravity has clearly shifted toward science. Meanwhile, smaller sessions on health equity, sustainability, and the wider ecosystem drew more intimate audiences – quieter, perhaps, but no less vital.
Amid the data and p-values, the threads of empathy and collaboration still held strong – a reminder that real progress in oncology happens where science and humanity stay connected.
Against that backdrop of data and dialogue, the key themes of ESMO 2025 came into focus.
Breast cancer: leading the charge
Few topics commanded more attention than breast cancer, with 15 official sessions and almost as many industry symposia. The data was dense, but the message was clear: precision is advancing, and treatment choices are multiplying fast.
In early-stage disease, MONARCH-E was the first trial to demonstrate overall survival over 76 months with Lilly’s adjuvant Verzenio (abemaciclib), while NATALEE delivered a five-year update with Novartis’ Kisqali (ribociclib). Together they reinforced the benefit of adjuvant CDK4/6 inhibition.
In HR+/HER2– metastatic disease, consensus pointed to CDK4/6 inhibitors plus endocrine therapy as the first-line go-to, though debate continues over whether aromatase inhibitors (AIs) should be replaced with fulvestrant or oral SERDs since AIs can drive ESR1 mutations. Either way, new second-line agents are already ready to play: Orserdu and Inluriyo are approved, while Roche’s giredestrant fared well with everolimus in the evERA study. Celcuity’s VICTORIA-1 trial added another layer, showing gedatolisib plus 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 toward 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.
ESMO 2025: When discovery meets humanity
From landmark breakthroughs to moments of humanity, ESMO’s golden anniversary showed progress in oncology is powered not just by discovery, but by connection.
In triple-negative disease, one of oncology’s toughest frontiers, there were long-awaited positive results. Gilead’s Trodelvy (sacituzumab govitecan) and AstraZeneca/Daiichi Sankyo’s Datroway (datopotamab deruxtecan) both demonstrated gains in a field that has long relied on chemotherapy, with Trodelvy showing improvement in overall survival across HER2– MBC.
In HER2-positive disease, AstraZeneca/Daiichi Sankyo’s Enhertu (trastuzumab deruxtecan) presented data from the DESTINY-Breast09 study, drawing both enthusiasm and caution. When clinicians were surveyed on its use, 34% said they would prescribe it first line for all patients, while 37% would reserve it for those at high risk. Smaller numbers preferred it second line (7%) or in selected cases (16%), with around 6% still undecided. Physicians confirmed they would not use chemotherapy after Enhertu but would retain Roche/Genentech’s Perjeta (pertuzumab). As Dr N. Turner noted, Enhertu’s transformative efficacy is tempered by its tolerability – it’s not suitable for long-term use. The same conclusion applied in early disease, where the DESTINY-Breast05 and DESTINY-Breast11 studies suggested its role is best limited to high-risk patients. Side effects that may be acceptable in advanced settings can be too heavy a burden in early-stage disease.
Biomarkers, AI and the precision puzzle
With so many new treatment options emerging, the next frontier isn’t just about discovering breakthrough therapies – it’s about discovering which patients truly benefit from them. As such, biomarkers featured prominently in debate, reflecting a growing desire among clinicians to match therapies faster, smarter, and more precisely.
One standout example came from AI-assisted mammography, now helping identify women who may benefit from supplemental MRI for earlier diagnosis. Data suggest that combining pathological markers and non-pathologic data could improve prognostic accuracy. The challenge, as Dr P. Siziopikou noted, is infrastructure. Fewer than five hospitals in the US currently use AI routinely in pathology, mainly because full digitisation remains costly and complex.
Another hot topic was circulating tumour DNA (ctDNA) – one of the most closely watched biomarkers of the moment. Results were mixed but thought-provoking. SERENA-6 showed that ctDNA could detect ESR1 mutations in breast cancer up to six to nine months before clinical or radiographic progression, opening a new window for intervention. In muscle-invasive bladder cancer, the INVIgor-011 study found that ctDNA status helped refine risk assessment: patients who remained consistently ctDNA-negative had lower relapse risk and derived no benefit from atezolizumab. Similarly, the AGIT-DYNAMIC study in stage III colon cancer showed that attempts to de-escalate oxaliplatin based on ctDNA alone were unsuccessful – reminding clinicians that the biomarker’s role is promising, but still evolving.
ADCs get smarter, bispecifics get bolder
We know that antibody–drug conjugates (ADCs) are here to stay – but as ESMO showed us, they’re not standing still. In one of the most highly attended sessions, Dr Lillian L. Sin described how the next wave will focus on refinement; improved linkers, dual payloads, smarter dosing, and combinations that reduce toxicity without compromising efficacy. In a related session, the key point was shown to be the therapeutic index of the ADC (number of cancer cells killed vs healthy cells killed). This has led to a plethora of combinations and variations of ADCs; Bispecific antibodies (bsAbs); and Bispecific antibody drug conjugates (bsADCs), among others.
Bispecific antibodies, once a staple in multiple myeloma and B-cell lymphoma, are now branching into solid tumours such as NSCLC and SCLC. Beyond T-cell engagers, a new biparatopic bispecific has arrived with Ziihera, a dual HER2-targeting therapy for HER2-positive biliary tract cancer. Summit Therapeutics hailed “the start of a new era” as it presented data on ivonescimab, a PD-1 × VEGF bispecific from the HARMONi trial – part of a novel class of PDx-based agents. The therapy is now in global Phase 3 trials and seeking approval outside China for EGFR-mutant metastatic NSCLC. Meanwhile, data from AstraZeneca’s rilvegostomig, another PDx bispecific targeting PD-1 × TIGIT, also showed encouraging results in the ARTEMIDE-01 study, reinforcing interest in dual-checkpoint blockade as a way to enhance efficacy without adding toxicity.
Where data meets the day-to-day
Not every headline was molecular. The POSITIVE study offered reassurance to women with breast cancer hoping to start a family: pausing adjuvant therapy for up to two years to allow pregnancy was safe, with high rates of pregnancy success and no added relapse risk.
Sustainability also found a voice on the main stage. R. Chuter’s ‘ecofriendly radiotherapy’ session revealed that the biggest contributor to treatment-related CO₂ isn’t the machinery – it’s patient travel. And Seamus O’Reily connected the dots between extreme weather and treatment disruptions, showing that climate and healthcare are now inseparable conversations.
In patient advocacy, shared decision-making (SDM) got the spotlight it deserves. Already included in the guidelines of EAU, UAU, and NCCN, it was shown that men with prostate cancer who engaged more fully in treatment choices reported better quality of life and fewer regrets. Data proving that empathy works – it doesn’t get more human than that!
Oncology without borders
The congress spotlighted how oncology is becoming truly global. China introduced two new KRAS inhibitors – HRS7058 (G12C) and HRS4642 (G12D) – while Australia entered the field with INCB161734 (G12D). In mesothelioma, early studies of IAG933 and VT3989 (both TEAD inhibitors) hinted at new hope for a notoriously resistant cancer.
Perhaps the most striking moment came from the IMA203 trial of anzutresgene autoleucel, a PRAME-directed cell therapy in metastatic uveal melanoma. Sixteen patients, sixteen tumor reductions, and an 88% disease control rate. A small cohort, yes – but a big idea: could targeting a single antigen turn a ‘cold’ tumor ‘hot’?
Experience design, cancer edition
If the scientific sessions were about precision, the exhibition floor was about presence. ESMO’s 50th-anniversary theme – “From progress to global impact. Let’s move forward together” – echoed across the booths, as brands leaned hard into language of unity and shared purpose. Astellas invited delegates to “Change the course together,” BeOne promised “Together we are how the world stops cancer,” and Johnson & Johnson reinforced, “Together, we’re working tirelessly to get in front of cancer.” Different brands, one collective narrative: partnership as proof of progress.
What stood out this year was how storytelling trumped spectacle. Gone were the competitive gaming setups of past congresses; this time, technology served education rather than entertainment. Novartis used virtual reality to let visitors build their own radioligand, a tactile way to demystify complex science. Regeneron’s immersive bispecific explorer offered a hands-on understanding of how dual-targeted antibodies locate and attack cancer cells – proof that engagement doesn’t need fireworks when the science itself inspires curiosity.
Physical space still made a statement. AstraZeneca’s stand dominated by sheer scale – an architectural anchor point in a maze of multi-hall layouts – while smaller companies opted for intimacy and interaction. Most notably, Chinese biotechs took a clear step forward from ASCO. Their booths went beyond data displays, adopting design and storytelling to express identity, intent, and belonging on the global oncology stage.
Through an agency lens, it was a reminder that healthcare experience design is shifting. The most effective booths didn’t just show science; they staged connection – translating complex innovation into something people could feel, not just read.
Next stop: Madrid
As the dust settles on ESMO 2025, what lingers isn’t just the data, but the human stories behind it – the conversations, collaborations, and shared purpose that drive discovery forward. By ESMO 2026 in Madrid, many of these studies may have transitioned into approvals, turning data points into real-world outcomes and strengthening the connections that give progress its meaning. The enduring lesson is clear: fifty years on, ESMO’s annual gathering continues to prove that oncology’s greatest strength lies where discovery meets humanity.
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