From practice-changing data to future innovation, and doctors’ wellbeing

The European Society for Medical Oncology (ESMO) Congress 2024, which took place from 13-17 September in Barcelona, Spain, offered a comprehensive view of the current oncology drug development landscape, with existing medicines demonstrating benefit in additional applications and new agents emerging in large numbers as the range of potential molecular targets for therapy continues to expand. At the opening press conference of ESMO’s flagship annual event, wide-sweeping progress made with novel immunotherapy combinations was highlighted alongside results that prefigure how cancer diagnosis and treatment could be transformed in the future.

ESMO 2024 Scientific Chair Dr Rebecca Dent underlined the importance of the overall survival data presented from the KEYNOTE-522 study in this difficult-to-treat breast cancer subtype, as the therapy is not yet approved everywhere in the world. Dr Dent similarly highlighted that for bladder cancer, where treatment options were limited in the past, the positive phase 3 NIAGARA trial marks another milestone in a recent surge of research advances already reported at the ESMO Congress 2023.

In anal cancer, a disease usually diagnosed in the advanced stages and where rates of relapse on standard treatment with chemoradiotherapy are high, a combination of immunotherapy and chemo is opening up new, much-needed possibilities for patients. As ESMO President Dr Andrés Cervantes explained: “POD1UM-303/InterAACT 2 is the first phase 3 randomised controlled trial not just of immunotherapy, but overall in this tumour type. Though uncommon in the developed world, anal cancer is more prevalent in low- and middle-income countries and, alongside HPV vaccination as an effective means of prevention, this is an important step in treating a disease that is currently still managed with medicines developed 50 years ago.”

Important data was also presented on the long-term outcomes of the first melanoma patients treated with immunotherapy, providing novel insights into its survival benefits and toxicities. “The arrival of immune checkpoint inhibitors and combination therapies dramatically changed the situation for melanoma patients, who previously had few treatment options and poor life expectancy. Talking about 10-year survival outcomes is outstanding in and of itself, but as clinicians we also need to understand what happens to these patients over time to be able to better differentiate whom to give which treatment to based on the expected benefits,” Dr Dent explained.

With several phase 3 trials reporting positive results, patients with metastatic castration-resistant prostate cancer will benefit from new options to treat this fatal condition going forward, the Congress heard.

“Prostate cancer is very common, so it is exciting to see research producing a multitude of therapies to help patients beyond castration resistance, including a novel combination of the androgen receptor antagonist enzalutamide with radium 22, combination immunotherapy, and several new compounds,” said Dr Dent.

Research introducing antibody-drug conjugates (ADCs) is equally prolific, with over 100 agents currently under development and data presented at the ESMO Congress 2024 covered the entire spectrum of phase 1, phase 2, and phase 3/4 trials. “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, preserving healthy tissue and thus offering reduced toxicity alongside potentially higher antitumour activity,” said Dr Cervantes.

While many research results presented over the five days of the Congress will change clinical practice in the short-term, the event also provided a perspective on the directions in which oncology will evolve in the future during a dedicated Presidential Symposium. Dr Cervantes highlighted artificial intelligence (AI) for its potential to be applied to medical images not just from radiology devices, but also from pathology slides, to capture information that the human eye cannot and eventually facilitate better diagnosis, treatment, and follow-up.

The ESMO President took the opportunity to announce the launch of a new ESMO AI and Digital Oncology Congress in 2025. “ESMO has a responsibility to keep doctors updated on what is happening in these areas, which are going to transform the way we receive information about cancer and the way we make decisions in oncology,” he said, explaining the rationale for the new event.

The ESMO Congress 2024 also addressed current issues affecting the profession. Among these, ensuring the resilience and wellbeing of the cancer workforce in the face of increasing pressures from staff shortages and rising workloads was the subject of a dedicated session. A vital message in this regard was conveyed in the recently published ESMO Resilience Taskforce recommendations to manage psychosocial risks, optimise wellbeing, and reduce burnout in oncology, a proposal for multi-tiered, concerted action to support and retain oncologists in the field.

“Burnout is a situation in which a professional feels overwhelmed by their responsibilities and is no longer able to cope with the difficulties of performing their day-to-day activities, with possible knock-on effects on the individual’s mental health, such as anxiety, depression, or insomnia,” said Dr Cervantes.

“We cannot afford to lose our workforce, so we must raise awareness and tackle burnout as the common problem that it has become.”

With a wealth of high-quality data selected from over 5,000 submitted abstracts and 600 experts onsite who presented and discussed the latest research results with 33,000 registered attendees, the ESMO Congress 2024 was a record-breaking edition.

“These unprecedented figures illustrate the strength and the global reach of this meeting in delivering new science to the oncology community,” Dr Cervantes concluded.