For a second consecutive year, members of the oncology community recently descended on Spain to hear the practice-changing results and latest advances in clinical cancer research presented at the annual ESMO Congress. As in Madrid last year, this year’s meeting in Barcelona was attended in person or online by more than 30,000 delegates, from 149 countries.

Multiple phase III trials featured in the top-billing Presidential Sessions emphasized continuing efforts to expand the benefits of immunotherapy to patients with resectable early stage tumours or unresectable locally advanced cancers by integrating ICIs with standard-of-care chemotherapy and local treatments. An update from KEYNOTE-522 confirmed that the improved pathological response rates and event-free survival (EFS) previously reported with the addition of perioperative pembrolizumab to neoadjuvant chemotherapy for stage II–III triple-negative breast cancer translated into an OS benefit (86.6% versus 81.7% at 60 months; HR 0.66, 95% CI 0.50–0.87; P = 0.002). Similarly, adding perioperative durvalumab to neoadjuvant chemotherapy improved both EFS and OS in cisplatin-eligible patients with muscle-invasive bladder cancer in the NIAGARA trial (as covered in a dedicated article in the previous issue of this journal). In the ENGOT-cx11/GOG-3047/KEYNOTE-A18 trial involving patients with locally advanced cervical cancer, the addition of concurrent and maintenance pembrolizumab to chemoradiotherapy improved OS (82.6% versus 74.8% at 3 years; HR 0.67, 95% CI 0.50–0.90; P = 0.004). In the LEAP-012 trial involving patients with intermediate-stage hepatocellular carcinoma, the combination of pembrolizumab and lenvatinib with transarterial chemoembolization significantly improved PFS (median 14.6 versus 10.0 months; HR 0.66, 95% CI 0.51–0.84; P = 0.0002), with an early trend towards improved OS (HR 0.80; 95% CI, 0.57–1.11; P = 0.087). In addition, in POD1UM-303/InterAACT 2, patients with previously untreated locally recurrent or metastatic anal squamous cell carcinoma derived a significant PFS benefit from the addition of retifanlimab to chemotherapy (median 9.3 versus 7.4 months; HR 0.63, 95% CI 0.47–0.84; P = 0.0006), and immature data indicate a strong trend towards improved OS despite crossover being permitted (median 29.2 versus 23.0 months; HR 0.70, 95% CI 0.49–1.01; P = 0.027).