The ESMO 2025 digest: Is oncology in fine condition? 

The European Society for Medical Oncology(ESMO) Congress 2025 in Berlin (17–21 October) delivered every week of consequential however not all the time uniform readouts. Antibody-drug conjugates (ADCs) stayed within the highlight, most notably with disitamab vedotin in first-line, HER2-expressing urothelial most cancers. 

Radiopharmaceuticals superior however with caveats: Novartis’ Pluvicto minimize the danger of radiographic development or loss of life by about 28% in metastatic hormone-sensitive prostate most cancers, whereas overall-survival knowledge are nonetheless maturing, and the scale-up query stays entrance and heart. 

Immunotherapy noticed a reset fairly than a surge: a number of SKYSCRAPER updates once more did not present a transparent profit for Roche’s anti-TIGIT technique, pointing consideration to various checkpoints and smarter affected person choice. 

The assembly additionally featured headline lung knowledge (HARMONi-6/ivonescimab) with a simultaneous publication that bolstered the development towards mixture regimens guided by biomarkers. 

On this article, we check out what got here out of ESMO 2025. 

Key ESMO 2025 highlights 

Prostate most cancers: EMBARK exhibits a survival edge, however questions stay 

Two main prostate most cancers trials offered at ESMO 2025 supplied contrasting messages on the usage of enzalutamide (Xtandi) in early illness. 

Within the EMBARK trial, sponsored by Pfizer and Astellas Pharma, including enzalutamide to leuprolide in males with high-risk, non-metastatic prostate most cancers whose illness had returned after native therapy led to fewer deaths and delayed metastases in contrast with hormone remedy alone. After virtually eight years of follow-up, sufferers on the mixture lived longer and stayed disease-free for longer, a significant advance on this setting. 

But, the optimism was tempered by outcomes from ENZARAD, a separate trial that examined the identical drug alongside radiotherapy in males with high-risk localized or domestically superior prostate most cancers. That examine didn’t present a transparent survival benefit, suggesting that enzalutamide’s profit could rely strongly on how and when it’s used. 

With imaging expertise reminiscent of PSMA-PET and salvage radiotherapy practices evolving quickly, translating these findings into customary care will take time. Nonetheless, EMBARK gives the clearest sign but that early, focused hormone remedy might change the administration of biochemical recurrence, even when the sphere is not fairly prepared for sweeping modifications throughout all non-metastatic illness levels. 

Radiopharmaceuticals – Pluvicto: sturdy sign, cautious learn 

At ESMO 2025, Novartis reported that including Pluvicto (lutetium-177 vipivotide tetraxetan) to plain remedy for metastatic hormone-sensitive prostate most cancers delayed illness development in contrast with customary remedy alone – roughly a 28% decrease threat of radiographic development or loss of life within the main evaluation. That’s a significant step for radioligand remedy earlier within the illness course. 

However the presentation additionally left open questions. Total-survival knowledge weren’t but mature and described as a constructive development fairly than a confirmed profit. A number of shops famous that the magnitude of profit, whereas statistically vital, was modest relative to some expectations and prior, later-line experiences with PSMA-targeted remedy. 

The sensible constraints had been flagged, from dose depth and variety of cycles nonetheless being debated, to xerostomia and different class-typical unwanted effects, to manufacturing and isotope provide that should scale if earlier-line use expands. 

Urothelial carcinoma: ADCs transfer up entrance 

A section 3 trial led by RemeGen and Jiangsu Hengrui Prescription drugs positioned disitamab vedotin firmly within the highlight at ESMO 2025. The mix of disitamab vedotin with the checkpoint inhibitor toripalimab in beforehand untreated, HER2-expressing superior bladder most cancers outperformed platinum chemotherapy on a number of endpoints, together with progression-free survival and response charge. 

The outcomes counsel that ADCs are starting to reshape first-line therapy in strong tumors, not simply in breast or lung most cancers. If confirmed by regulators, this routine might emerge as a brand new customary for chosen sufferers with HER2-positive urothelial carcinoma. 

Immunotherapy: TIGIT faces a reckoning 

Roche delivered updates from a number of SKYSCRAPER research evaluating the anti-TIGIT antibody tiragolumab alongside atezolizumab (Tecentriq). Throughout tumour sorts, not one of the mixtures met their main endpoints, together with the pivotal SKYSCRAPER-03 trial in non-small cell lung most cancers. 

The information marks a transparent setback for the TIGIT pathway, as soon as thought-about the subsequent frontier in checkpoint inhibition. With tiragolumab displaying no constant scientific profit, analysis efforts at the moment are turning towards various immune targets reminiscent of LAG-3 and novel bispecific antibodies, in addition to a renewed give attention to biomarker-driven affected person choice. 

Lung most cancers: HARMONi-6 earns the highlight at ESMO 2025

Akeso and Summit Therapeutics offered section 3 outcomes from HARMONi-6, testing ivonescimab, a twin PD-1/VEGF-blocking antibody, with chemotherapy in newly recognized squamous non-small cell lung most cancers. 

The trial demonstrated a progression-free survival enchancment of roughly 4 months in contrast with tislelizumab plus chemotherapy, in accordance with knowledge revealed concurrently in The Lancet. The result highlights the potential of mixing immune checkpoint blockade with anti-angiogenic mechanisms to boost efficacy in lung most cancers. 

How shortly ivonescimab strikes towards broader adoption will rely upon overall-survival follow-up and regulatory assessment exterior Asia, the place many of the knowledge had been generated. 

ESMO 2025: The larger image

Past particular person drug readouts, ESMO 2025 additionally pointed to broader modifications in how most cancers care is delivered and developed. 

Radiopharmaceuticals are transferring from remoted analysis applications towards integration inside hospital programs. Devoted periods targeted on how healthcare networks can scale radioligand remedy safely and effectively, from workforce coaching and radiation-safety protocols to patient-selection standards and treatment-flow optimization.  

On the commercial aspect, firms outlined next-generation isotope methods, reminiscent of increasing lead-212 capability for alpha-emitting brokers and growing accelerator-based actinium-225 manufacturing to beat power isotope shortages. 

Synthetic intelligence (AI), in the meantime, continued its regular integration into oncology apply. Shows confirmed how AI-driven pathology and imaging are narrowing the hole between analysis and scientific decision-making, utilizing algorithms educated to detect molecular signatures in customary histology slides. On the identical time, ESMO’s devoted AI & Digital Oncology periods highlighted that this area is transferring from experimental to operational, as regulatory frameworks and scientific validation start to catch up. 

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