‘Eyes to the Future’ of Oncology at ESMO 2024

In September 2024, PLOS ONE staff editor Jenny Tucker attended the European Society for Medical Oncology (ESMO) Congress, a large, well-organized and well-attended conference with approximately 34,000 attendees, hosted at Fira Gran Via Conference and Exhibition center in Barcelona. Over 2100 abstracts were presented at the event, which resulted in talks by almost 600 experts from 149 countries, and over a thousand poster presentations across a great variety of oncology themes.

Key themes through this year’s event included collaboration for improved oncology care, survivorship and quality of life considerations, novel treatment combinations for better patient prognosis, women’s health, care accessibility, and technological innovations. Threaded through every theme was reflection on recent developments and forward-thinking of how this work is likely to progress; both in the short and long term future.

A standout talk in the first presidential session from Dr Domenica Lorusso presented the results of the KEYNOTE-A18 trial, in which pembrolizumab plus concurrent chemoradiotherapy was shown to extend patient survival in locally advanced cervical cancer. As cervical cancer is the fourth most common cancer in women globally, with over 600,000 diagnoses and 350,000 deaths reported in 2022, advances in treatment options are critical to improve on the current survival rate of around 50%.

Women’s health themes were covered in a number of symposia throughout the event, with two particularly well attended sessions: the first focused on the menopause and oncology treatment, whilst the other challenged previous assumptions around breastfeeding after breast cancer. These sessions both demonstrated increasing awareness and consideration of women’s health, beyond fertility preservation, when developing guidance for cancer treatment.

Developments in oncology technologies, for both detection and treatment, were well explored through the talks and poster presentations. Antibody–drug conjugates (ADCs) and protein degraders were exciting new tools for treating a variety of cancers, including application in drug-resistant cancers. In ADC presentations, toxicity was a recurrent theme, highlighting the importance of balancing treatment benefits against the risks of unpleasant side effects, which impact long-term tolerability. Some protein degraders, such as proteolysis targeting chimeras (PROTACs) and molecular glues, may allow targeting of previously ‘undruggable’ targets to treat challenging cancers whilst reducing treatment resistance. Artificial intelligence (AI) was another part of this key theme, with a particular focus on the development of more complex multi-modal systems;  however, warnings were included regarding the need to improve infrastructure to monitor for model degradation, and clear advice to use AI tools as scientific reasoning engines rather than knowledge databases.

On the issue of care accessibility and challenges in oncology care, two impactful sessions really stood out. Drs Bente Mikkelsen and Jean-Yves Blay hosted a great symposium discussing the aim of tackling cancer worldwide, and the work of the World Health Organization (WHO) to support this endeavor. Cancer is a non-communicable disease priority for WHO, with which ESMO has a long-standing relationship. The focus is primarily on preventative interventions, including education around the risks of tobacco use, high body mass index (BMI), high blood pressure and air pollution, with a clear eye on the need to address service limitations, improve accessibility, consider care in adverse situations, social instability and barriers to care adherence. Low- and middle- income countries (LMICs) face 70% higher mortality rates due to poor health, and investment in preventative approaches such as human papillomavirus (HPV) vaccination, cancer screening and hepatitis B immunization can all reduce the downstream burden of cancer treatment on the limited resources in LMICs. The ESMO–WHO collaboration is working to shape the cancer agenda and provide guidance to an international network of clinicians and patients; however, government involvement will be a key part of success. Inclusion of cancer care in national budgets and investments to support a thinly stretched workforce was highlighted as crucial to avoid oncologist burnout and the loss of trained clinicians due to low quality of life, which will lead to limited quality of care.

Another powerful symposium covered the topic of cancer care during exceptional circumstances; Remziye Semerci shared her experiences as an oncology nurse in the aftermath of the February 2023 Turkey-Syria earthquake, and the ongoing challenges in providing care; Nataliia Hrad shared a patient perspective on the impact of the war in Ukraine on cancer treatment, including the loss of fertility-preserving care and increased risk of death due to drug shortages delaying treatments; and Tamer Jafar shared his reality providing palliative oncology care in Palestine, with limited resources, visa delays, and property destruction resulting in increased mortality rates and reduced care in this setting. The three speakers received a standing ovation from the audience, some of whom were moved to tears by the honest accounts of the challenges they face daily. This session really highlighted the forgotten impact of adversity on patients with cancer and professionals working in cancer settings.

Other session types included debates, such as the applicability of immunotherapy in patients and which healthcare provider should hold responsibility for overall cancer care; short abstract presentations, whose themes included improving quality of life by developing novel treatments for cancer-associated symptoms such as cachexia, nausea, delirium and pain management; oncology nursing and early career researcher development and training events; and over one thousand poster presentations.

ESMO 2024 also allowed our staff editor to meet with several academic editors from cancer-focused sections of the PLOS ONE Editorial Board, who were keen to share their experiences as editors for the journal, and discuss their research.

 It was good to see that important research across key themes promoted at the congress this year are reflected in studies published in PLOS ONE, including but not limited to article collections bringing together work on early detection, screening and diagnosis of cancer, and rare cancers.

Overall, ESMO 2024 presented a diverse and impactful program, providing insights into the important developments in cancer treatment, with inclusion of quality of life considerations. Next year’s ESMO Congress will be held in Berlin, Germany in October 2025.