ESMO 2026 will bring the international oncology community together at a time of rapid change in oncology research, with new evidence continuing to shape how cancer is diagnosed, monitored and treated. The ESMO Congress 2026, taking place from 23 to 27 October, will provide an important opportunity for clinicians and researchers to examine emerging evidence across different cancer types and consider which developments could have meaningful implications for clinical practice.
The oncology landscape has become increasingly complex. Advances in precision medicine in oncology are allowing treatment decisions to be informed by a growing understanding of tumour biology, while developments in ctDNA testing and liquid biopsy in oncology are creating new possibilities for monitoring disease and identifying molecular changes over time. At the same time, antibody-drug conjugates and RAS-targeted therapy are expanding therapeutic possibilities across different tumour types. These advances are accompanied by practical questions about patient selection, treatment sequencing, resistance, toxicity and how emerging approaches should be integrated into existing care pathways.
The challenge is therefore no longer simply to develop more treatments or generate more molecular information. Clinicians increasingly need evidence showing how these advances can support better decisions for individual patients. A treatment may demonstrate activity in a clinical trial, but questions remain about who is most likely to benefit, when it should be used and how it should be sequenced alongside other available therapies. Similarly, a biomarker may identify residual disease or emerging resistance, but its clinical value depends on whether acting on that information improves patient outcomes.
These questions are reflected in the expectations of four physicians ahead of ESMO 2026. Dr Marco Filetti, Medical Oncologist at the Phase 1 Clinical Trials Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome, is particularly interested in the maturation of RAS-targeted therapy.
Dr Willem Lybaert, Medical Oncologist at VITAZ and UZA in Belgium, will be watching developments across neuroendocrine tumours, gastrointestinal cancers and head and neck cancer.
Dr Alexander Leißring, Chief Physician and Specialist in Internal Medicine, Gastroenterology, Endocrinology and Diabetology, is focusing on the relationship between molecular oncology and gastrointestinal and neuroendocrine malignancies.
Another physician (MD), Gastroenterology / Hepato-Gastroenterology, is particularly interested in multidisciplinary approaches to gastrointestinal cancers and evidence that can be translated into clinical practice.
Together, their perspectives highlight an important question ahead of the congress: as oncology gains more treatments, biomarkers and technologies, how can they be used more precisely and meaningfully for patients?
From New Treatments to Better Treatment Decisions
One of the major challenges accompanying advances in oncology research is determining how an expanding range of treatments should be used in practice. As targeted therapies, antibody-drug conjugates, immunotherapies and other approaches become available, evidence around patient selection, sequencing and resistance becomes increasingly important.
RAS-targeted therapy illustrates how quickly this landscape can evolve. Dr Filetti is particularly interested in seeing how this area is maturing. As he explains, “In a few years we have gone from the first KRAS G12C inhibitors to a broader family of RAS and SOS1 agents.” His daily work in early-phase trials sits within this area, and he hopes ESMO 2026 will provide greater insight into whether early signals hold up and how these treatments behave in combination.
His focus extends to G12D and pan-RAS approaches and to the question of how different agents should be combined and sequenced once several are active at the same time. If he could have one clinical question answered at ESMO 2026, it would concern the best way to combine and sequence new RAS-targeted agents in patients with KRAS-mutant tumours to delay resistance without creating toxicity that patients cannot live with.
Dr Leißring also identifies KRAS as an example of how rapidly thinking within oncology can change. For many years, KRAS was primarily regarded as a negative predictive biomarker and considered particularly difficult to target therapeutically. The field is now moving beyond KRAS G12C towards G12D, other mutations and broader RAS-directed strategies, particularly in pancreatic and colorectal cancers. For him, important questions concern whether newer agents can produce sufficiently deep and durable responses and how resistance should subsequently be managed.
Antibody-drug conjugates raise similar questions. As ADCs move further into solid tumours, the discussion is increasingly extending beyond whether they can demonstrate activity. Target expression, tumour heterogeneity, payload choice, resistance, cumulative toxicity and treatment sequencing all need consideration.
Dr Filetti is watching antibody-drug conjugates closely, placing “as much attention to their tolerability as to their efficacy”, because cumulative toxicity is becoming a real clinical problem. Dr Leißring similarly highlights questions around whether changing the antigen, payload or both might help overcome resistance as patients encounter multiple ADCs during the course of their disease.
Dr Lybaert is also interested in ADCs as they expand into solid tumours, particularly gastrointestinal and head and neck cancers where traditional options may have been exhausted. Another physician, meanwhile, hopes ESMO will provide greater clarity on patient-selection criteria for ADCs in gastrointestinal cancers.
These perspectives demonstrate why new treatment options are only one part of the picture. As oncology becomes more therapeutically diverse, understanding how treatments fit together may become just as important as establishing whether each individual treatment works.
ctDNA Testing, Liquid Biopsy and Precision Medicine in Oncology
Precision medicine in oncology is also moving beyond the concept of identifying a single molecular alteration and matching it with a particular treatment. Increasingly, the aim is to understand cancer as a disease that can change throughout the treatment pathway and to use molecular information to inform decisions as those changes occur.
ctDNA testing and liquid biopsy in oncology are central to this evolving approach. Serial blood-based testing has the potential to provide information about molecular changes over time, creating possibilities for identifying minimal residual disease, detecting emerging resistance and monitoring tumour evolution. The challenge is establishing when that information should lead to a change in clinical management.
For Dr Leißring, the crucial transition for ctDNA is “from prognostic information to actionable information”. Detecting molecular residual disease after potentially curative treatment or identifying a resistance mutation before radiological progression may provide valuable information, but the decisive question is what clinicians should do differently as a result.His central clinical question concerns patients with resected colorectal cancer who have no radiologically detectable disease but remain or become ctDNA-positive. Could a ctDNA-directed intervention increase their probability of cure and improve survival? Conversely, could patients who remain persistently ctDNA-negative safely receive less adjuvant treatment?
“We are becoming increasingly good at measuring microscopic disease, but measurement alone is not enough,” he explains. “We need to know whether acting on that information changes the natural history of the disease.”
Dr Lybaert is similarly interested in ctDNA and liquid biopsy for gastrointestinal cancers and head and neck oncology. Potential applications include detecting minimal residual disease after surgery, monitoring dynamic clonal evolution and guiding earlier treatment changes. However, he also describes clinical application in 2026 as challenging, reflecting the gap that can exist between technological capability and routine implementation.
For another physician, ctDNA testing is particularly relevant to colorectal cancer follow-up. He is interested in its potential for post-operative surveillance and the detection of minimal residual disease, including whether it could influence established endoscopic and radiological monitoring. One of his central questions is whether ctDNA surveillance can genuinely reduce the frequency of invasive endoscopic and radiological investigations without compromising the early detection of recurrence.
Dr Filetti also sees liquid biopsy as relevant to his work, particularly for patient selection in early-phase trials, while emphasising the broader need for better biomarkers to identify which patients are most likely to benefit from treatment.
Together, these perspectives illustrate the next challenge for precision medicine in oncology. Generating increasingly detailed molecular information is only the beginning. The more difficult question is whether clinicians can use that information to intervene earlier, avoid unnecessary treatment or select a more appropriate therapy in ways that ultimately improve outcomes.
Radioligand Therapy, Immunotherapy and AI: Other Areas to Watch
While targeted therapy, antibody-drug conjugates and liquid biopsy are prominent areas of interest, ESMO 2026 will also provide a setting for discussions around other evolving approaches, including radioligand therapy, immunotherapy and artificial intelligence. Each is at a different stage of development, but all raise questions about patient selection, implementation and clinical value.
Radioligand therapy is particularly relevant to the management of neuroendocrine tumours. Dr Lybaert is following expanding indications for peptide receptor radionuclide therapy, novel radioisotopes and sequencing challenges following progression on first-line somatostatin analogues. He is particularly interested in how alpha-PRRT may influence future treatment algorithms and hopes for greater clarity around toxicity management and patient selection when radioligands are combined with systemic agents.
Dr Leißring also plans to follow radioligand therapy closely because of its relevance to neuroendocrine tumours. For him, the theranostic concept offers an interesting approach: using molecular imaging to identify and quantify a therapeutically relevant target and then using the same biological target to deliver radiation selectively to tumour tissue. However, practical questions remain around patient selection, dosimetry, sequencing with systemic therapies and potential long-term bone marrow or renal toxicity.
Immunotherapy presents a different challenge. In some molecularly defined cancers, it has already changed treatment substantially. Attention is therefore increasingly turning towards optimisation, including treatment duration, timing and whether selected patients could safely receive less therapy.
Dr Leißring highlights these questions in MSI-high or dMMR gastrointestinal cancers, while noting that microsatellite-stable colorectal cancer continues to represent an important unmet need. Dr Lybaert is following developments in head and neck cancer, including biomarker-driven treatment de-intensification in HPV-positive disease and the integration of new immunotherapies or antibody-drug conjugates to overcome resistance in recurrent or metastatic disease.
Artificial intelligence adds another dimension. AI could potentially assist with diagnostic interpretation, prognostic assessment, treatment selection and the integration of increasingly complex clinical and molecular information. However, the oncologists’ expectations also demonstrate a degree of caution.
Dr Filetti follows AI in oncology “with a more critical eye”, as he believes clinical evidence still lags behind enthusiasm. Dr Leißring similarly argues that impressive algorithms are not enough. The important question is whether AI improves diagnostic accuracy, treatment selection, efficiency or patient outcomes when evaluated prospectively in routine care.
Another participant physician is particularly interested in AI for lesion detection in endoscopy and prognostic stratification, while Dr Lybaert raises a broader possibility: whether AI could eventually help integrate multi-omic profiling, ctDNA and functional imaging into clinical decision-making. Across these different areas, the underlying question remains consistent. New technology has to demonstrate not only what is technically possible, but what is clinically useful.
What Could Make ESMO 2026 Meaningful for Clinical Practice?
The expectations surrounding the ESMO Congress 2026 show that progress in oncology research is increasingly being judged by more than the introduction of new treatments or technologies. For clinicians, the significance of an advance ultimately depends on whether it can support better decisions and produce meaningful benefits for patients.
Dr Filetti hopes for greater clarity around the sequencing of targeted agents and the long-term tolerability of antibody-drug conjugates. Better biomarkers are also important to him, particularly those that can help identify patients who will genuinely benefit. At the same time, he highlights the need to understand “what treatment costs patients in time and quality of life”.
This broader view of clinical benefit is also central to Dr Leißring’s expectations. As oncology treatments become more complex, he argues that improvements in progression-free survival should not be viewed in isolation from toxicity, patient-reported outcomes, treatment burden and the feasibility of implementation in real healthcare systems.
Dr Lybaert’s key question reflects another challenge: how to bring different sources of information together. He asks how multi-omic profiling, liquid biopsies and functional imaging could be incorporated into a unified, dynamic decision-making approach that predicts individual resistance patterns and treatment responses ahead of clinical progression. He also asks whether artificial intelligence could help clinicians achieve this in everyday practice.
One participant mentioned, meaningful progress also involves multidisciplinary care. He is looking for updated evidence on the management of gastrointestinal cancers, particularly therapeutic sequencing in metastatic colorectal cancer and hepatocellular carcinoma. As a practitioner involved in endoscopic diagnosis and hepatological follow-up, he is interested in information that can translate directly into clinical practice, including how gastroenterologists and oncologists work together across patient pathways.
As ESMO 2026 approaches, these perspectives demonstrate that some of the most important questions in oncology are no longer simply about what comes next. They are about how new evidence should be used.
The ESMO Congress 2026 may provide new evidence across several of these areas. For clinicians following the meeting, the most meaningful advances may be those that help turn increasingly sophisticated oncology research into clearer decisions, more individualised treatment and better-informed patient care.
Looking forward to the event, which research areas, presentations or unanswered questions are you hoping to see addressed? Share your perspective in the comments section.
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