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As we arrive mid-term of my ESMO presidency, I find myself reflecting on the current state of oncology and the necessity to more successfully bridge existing gaps between expectations and today’s realities, for our patients as well as our profession. It really is a matter of two-way considerations and a delicate balancing act demanding reality and transparency in equal measure. Happily, in many areas we are delivering on expectations by translating them into proven realities. Other issues, however, require a lot more work or a rethink.At the research level, we have witnessed tremendous progress over the past decade driven by increased focus on prevention and early diagnosis, and an expanding portfolio of powerful anti-cancer therapies that are being more precisely matched to individual cancers. For example, from 2011 to 2016, 68 new cancer medicines were approved for 22 indications,1 including immune-based therapies that have significantly improved patient outcomes across many cancers, including melanoma and non-small cell lung cancer (NSCLC). The emergence of PD-1 inhibitors, with pembrolizumab and nivolumab taking centre stage back in 2014 for treating melanoma, has been followed by others, including CAR T-cell therapies and therapeutic antibodies, with a welcome expansion across many tumour types.They are most certainly here to stay as we investigate further how to empower and personalise this anti-cancer armoury to unleash the power of the immune system to attack disease.That said, the heightened expectations of our patients must be carefully managed as we seek to understand why some cancers do not respond or eventually become resistant to the treatments, as well as establish predictive markers of response to identify those individuals who would be most likely to benefit. The call to better manage expectations as we move this rapidly evolving field forward was recently highlighted in the specialised literature.2 …

Two-way traffic: aligning expectations with current realities in oncology. Mid-term ESMO Presidency considerations