ESMO 2026 brought together important developments in oncology research, with precision medicine in oncology, antibody-drug conjugates and ctDNA testing featuring prominently in discussions about cancer treatment and monitoring. From personalised immunotherapy to emerging targeted therapies, the congress highlighted new approaches that could influence clinical decisions and improve patient outcomes.
Ahead of the congress, we invited four healthcare professionals to share their expectations, the research areas they were following and the questions they hoped would be addressed. Their perspectives were featured in our pre-event article, Ahead of ESMO 2026: Key Topics and Expectations. Following the event, we reached out to the same participants with a post-event questionnaire to understand which studies stood out, whether their expectations were met and what the findings could mean for clinical practice.
One recurring theme was the importance of moving beyond scientific advances to consider how new evidence can guide treatment decisions. Dr Alexander Leißring, Chief Physician and Specialist in Internal Medicine, Gastroenterology, Endocrinology and Diabetology, explained:
“My biggest takeaway was the growing importance of connecting biological information with a clearly defined clinical decision.”
Dr Alexander Leißring, Chief Physician, Specialist in Internal Medicine, Gastroenterology, Endocrinology and Diabetology
Immunotherapy and Precision Medicine: Key Developments at ESMO 2026
Immunotherapy remained a major focus of the congress, with developments in personalised cancer vaccines and gastrointestinal cancers attracting particular interest.
Dr Willem Lybaert, Medical Oncologist at VITAZ and UZA in Belgium, identified the phase III INTerpath-001 trial as his most significant takeaway. The study evaluated a personalised mRNA neoantigen therapy alongside pembrolizumab in patients with resected high-risk melanoma. For Dr Lybaert, the reported recurrence-free survival benefit represented an important development in personalised treatment. He described his biggest takeaway as:
“The definitive transition of personalized oncology from a theoretical concept into a clinically proven, standard-defining reality in the adjuvant setting.”
Dr Willem Lybaert, Medical Oncologist, VITAZ and UZA, Belgium
The findings strengthened his interest in using individual tumour characteristics to develop tailored immunotherapy. He also highlighted the possibility of investigating similar approaches in other cancers, including lung, pancreatic, kidney and head and neck malignancies.
However, delivering personalised vaccines involves several practical considerations. Tumour sequencing, vaccine manufacturing and treatment administration must be coordinated within appropriate clinical timelines. Identifying patients most likely to benefit also remains an important research priority.
Dr Leißring highlighted two developments in colorectal cancer. The final overall survival analysis from CheckMate 8HW strengthened his confidence in nivolumab plus ipilimumab for selected patients with MSI-H/dMMR metastatic colorectal cancer, while reinforcing the importance of balancing efficacy against immune-related toxicity.
He also discussed AZUR-1, which investigated dostarlimab in locally advanced MSI-H/dMMR rectal cancer. The possibility of sustained complete responses without major surgery was particularly meaningful because of its potential to preserve organ function and quality of life. However, longer follow-up, careful patient selection and reliable surveillance remain essential. Together, these developments demonstrate how precision medicine in oncology is expanding treatment possibilities while creating new questions about patient selection and long-term outcomes.
Antibody-Drug Conjugates and Targeted Therapy: Progress and Challenges
Advances in antibody-drug conjugates and targeted treatments were another important theme at ESMO 2026, particularly as newer agents move from early clinical investigation into larger trials.
Dr Marco Filetti, Medical Oncologist at the Phase 1 Clinical Trials Unit in Rome, highlighted the progress of therapies that were being investigated in phase I trials only a few years ago.
“Targeted agents and ADCs now deliver overall survival gains in settings where we had little to offer until recently.”
Dr Marco Filetti, Medical Oncologist, Phase 1 Clinical Trials Unit, Rome
One study that stood out to him was Krascendo 1, investigating divarasib in previously treated KRAS G12C-mutant non-small cell lung cancer. Dr Filetti highlighted the reported progression-free and overall survival advantages over other KRAS G12C inhibitors, noting the importance of differences between treatments targeting the same molecular alteration.
However, antibody-drug conjugates were his strongest area of interest. He pointed to TroFuse-005, which reported an overall survival benefit with sacituzumab tirumotecan in previously treated endometrial cancer.
For Dr Filetti, these developments raise important questions about treatment sequencing, cross-resistance between ADCs with similar payloads and managing toxicity during prolonged treatment.
Dr Leißring also highlighted CLARITY-Gastric01, which investigated the CLDN18.2-targeted ADC sonesitatug vedotin in gastric cancer. Although the reported overall survival results were encouraging, one co-primary endpoint did not reach statistical significance.
These findings underline the importance of interpreting new evidence carefully. As more targeted treatments become available, understanding which patients benefit and how therapies should be sequenced will become increasingly important.
ctDNA Testing and AI: Turning Molecular Data into Clinical Decisions
The growing role of ctDNA testing, liquid biopsy and artificial intelligence was another important discussion point. While these technologies offer opportunities to personalise treatment, participants emphasised the need to demonstrate their clinical value.
Dr Lybaert highlighted the potential of ctDNA to detect minimal residual disease and help identify patients who may benefit from treatment intensification or closer monitoring. He also discussed how AI could support the analysis of complex molecular profiles and the development of personalised cancer vaccines.
Dr Leißring approached these developments from the perspective of clinical implementation. He highlighted the BRICKET study, in which no objective responses were observed among 16 patients receiving a ctDNA-selected rechallenge strategy for BRAF V600E-mutant metastatic colorectal cancer.
For him, the findings illustrate an important distinction between identifying a molecular characteristic and knowing how to act on it. A promising biomarker does not automatically establish that a particular treatment strategy will improve outcomes.
He also discussed practical AI applications, including extracting longitudinal treatment histories from electronic medical records. Such tools could make complex information easier to review during multidisciplinary discussions, provided their accuracy and reliability are demonstrated.
Dr Filetti acknowledged interesting developments in ctDNA, AI and radioligand therapy but did not consider the findings sufficient to change his immediate clinical practice.
These different perspectives highlight a central question for oncology research: how can increasingly detailed molecular information be translated into treatment decisions that provide measurable benefits for patients?
How ESMO 2026 Could Influence Everyday Clinical Practice
The potential impact of ESMO 2026 extends beyond individual treatments. Participants also highlighted the importance of diagnostic pathways, multidisciplinary coordination and reducing the practical burden of cancer care.
Dr Leißring emphasised timely molecular testing, adequate tissue sampling and ensuring that relevant results are available before major treatment decisions. He also highlighted the need for coordinated surveillance when considering organ-preserving approaches in rectal cancer.
Reflecting on how new findings should be evaluated, he identified three questions:
“How convincing is the evidence, how relevant is it to the patient in front of us, and what would we need to change in our clinical pathway to deliver the benefit?”
Dr Alexander Leißring, Chief Physician, Specialist in Internal Medicine, Gastroenterology, Endocrinology and Diabetology
Dr Lybaert similarly highlighted the organisational changes that personalised mRNA therapies may require, including next-generation sequencing, centralised manufacturing and timely treatment delivery.
Dr Filetti identified the MOIO trial as particularly relevant to everyday practice because it investigated reducing immunotherapy frequency in responding patients. Such approaches could potentially reduce toxicity, healthcare costs and the time patients spend receiving treatment.
Together, these perspectives suggest that implementing new therapies requires more than strong clinical trial results. Healthcare teams must also consider accessibility, diagnostic capacity, follow-up requirements and how treatment affects patients’ daily lives.
Beyond ESMO 2026: What Questions Remain?
Although ESMO 2026 addressed several important questions, the participants identified areas where further research is needed.
For Dr Lybaert, a major question is whether personalised mRNA vaccines will demonstrate similar benefits in metastatic disease. He also wants to understand how treatment manufacturing can be scaled and which biomarkers could identify patients who may not require additional therapy.
Dr Leißring remains interested in the clinical utility of ctDNA-guided treatment decisions, long-term organ preservation and optimal treatment sequencing. He also highlighted early findings involving SSTR2-targeted alpha-radioligand therapy in neuroendocrine tumours, while emphasising the need for comparative evidence and longer-term safety data.
Dr Filetti’s remaining questions focus on how newer treatments can be used effectively without increasing the burden on patients. As he explained:
“What remains open is how to sequence several ADCs in the same patient, which biomarkers truly predict benefit beyond target expression, and how to reduce the time and financial burden that these treatments place on patients.”
Dr Marco Filetti, Medical Oncologist, Phase 1 Clinical Trials Unit, Rome
A further perspective came from a participant specialising in gastroenterology and hepato-gastroenterology, who highlighted the growing integration of biomarker-guided treatment in gastrointestinal cancers. Their reflections focused on advances in immunotherapy, targeted treatments and post-operative ctDNA monitoring in colorectal cancer. They also emphasised broader molecular profiling to identify actionable alterations, alongside the potential of AI-assisted pathology and imaging. Important unanswered questions included resistance to KRAS inhibitors, optimal ADC sequencing and the cost of accessing molecular testing and innovative therapies in routine care.
Key Takeaways from ESMO 2026: What Comes Next for Oncology?
ESMO 2026 highlighted how oncology research is moving towards more personalised treatment approaches, supported by advances in immunotherapy, targeted therapies and molecular testing. The congress also demonstrated that promising clinical findings must be considered alongside treatment safety, patient selection and their practical application in healthcare settings.
The participants’ reflections point to several important developments. Antibody-drug conjugates and targeted therapies are expanding treatment possibilities, while ctDNA testing and artificial intelligence may help guide more informed clinical decisions. Advances in personalised cancer vaccines and organ-preserving approaches also offer opportunities to improve care for selected patients.
However, important questions remain about treatment sequencing, long-term outcomes, access to molecular testing and the burden of treatment on patients.
Ultimately, the value of these developments will depend on how effectively they translate into everyday clinical practice. As further evidence emerges, the focus will remain on delivering treatments that improve patient outcomes while preserving quality of life and reducing unnecessary treatment burden.
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