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The European Society for Medical Oncology(ESMO) Congress 2025 in Berlin (17–21 October) delivered a week of consequential but not always uniform readouts. Antibody-drug conjugates (ADCs) stayed in the spotlight, most notably with disitamab vedotin in first-line, HER2-expressing urothelial cancer.
Radiopharmaceuticals advanced but with caveats: Novartis’ Pluvicto cut the risk of radiographic progression or death by about 28% in metastatic hormone-sensitive prostate cancer, while overall-survival data are still maturing, and the scale-up question remains front and center.
Immunotherapy saw a reset rather than a surge: multiple SKYSCRAPER updates again failed to show a clear benefit for Roche’s anti-TIGIT strategy, pointing attention to alternative checkpoints and smarter patient selection.
The meeting also featured headline lung data (HARMONi-6/ivonescimab) with a simultaneous publication that reinforced the trend toward combination regimens guided by biomarkers.
In this article, we take a look at what came out of ESMO 2025.
Key ESMO 2025 highlights
Prostate cancer: EMBARK shows a survival edge, but questions remain
Two major prostate cancer trials presented at ESMO 2025 offered contrasting messages on the use of enzalutamide (Xtandi) in early disease.
In the EMBARK trial, sponsored by Pfizer and Astellas Pharma, adding enzalutamide to leuprolide in men with high-risk, non-metastatic prostate cancer whose disease had returned after local treatment led to fewer deaths and delayed metastases compared with hormone therapy alone. After almost eight years of follow-up, patients on the combination lived longer and stayed disease-free for longer, a meaningful advance in this setting.
Yet, the optimism was tempered by results from ENZARAD, a separate trial that tested the same drug alongside radiotherapy in men with high-risk localized or locally advanced prostate cancer. That study did not show a clear survival advantage, suggesting that enzalutamide’s benefit may depend strongly on how and when it’s used.
With imaging technology such as PSMA-PET and salvage radiotherapy practices evolving rapidly, translating these findings into standard care will take time. Still, EMBARK provides the clearest signal yet that early, targeted hormone therapy could change the management of biochemical recurrence, even if the field is not quite ready for sweeping changes across all non-metastatic disease stages.
Radiopharmaceuticals – Pluvicto: strong signal, cautious read
At ESMO 2025, Novartis reported that adding Pluvicto (lutetium-177 vipivotide tetraxetan) to standard therapy for metastatic hormone-sensitive prostate cancer delayed disease progression compared with standard therapy alone – roughly a 28% lower risk of radiographic progression or death in the primary analysis. That’s a meaningful step for radioligand therapy earlier in the disease course.
But the presentation also left open questions. Overall-survival data were not yet mature and described as a positive trend rather than a confirmed benefit. Several outlets noted that the magnitude of benefit, while statistically significant, was modest relative to some expectations and prior, later-line experiences with PSMA-targeted therapy.
The practical constraints were flagged, from dose intensity and number of cycles still being debated, to xerostomia and other class-typical side effects, to manufacturing and isotope supply that must scale if earlier-line use expands.
Urothelial carcinoma: ADCs move up front
A phase 3 trial led by RemeGen and Jiangsu Hengrui Pharmaceuticals placed disitamab vedotin firmly in the spotlight at ESMO 2025. The combination of disitamab vedotin with the checkpoint inhibitor toripalimab in previously untreated, HER2-expressing advanced bladder cancer outperformed platinum chemotherapy on multiple endpoints, including progression-free survival and response rate.
The results suggest that ADCs are beginning to reshape first-line treatment in solid tumors, not just in breast or lung cancer. If confirmed by regulators, this regimen could emerge as a new standard for selected patients with HER2-positive urothelial carcinoma.
Immunotherapy: TIGIT faces a reckoning
Roche delivered updates from several SKYSCRAPER studies evaluating the anti-TIGIT antibody tiragolumab alongside atezolizumab (Tecentriq). Across tumour types, none of the combinations met their primary endpoints, including the pivotal SKYSCRAPER-03 trial in non-small cell lung cancer.
The data marks a clear setback for the TIGIT pathway, once considered the next frontier in checkpoint inhibition. With tiragolumab showing no consistent clinical benefit, research efforts are now turning toward alternative immune targets such as LAG-3 and novel bispecific antibodies, as well as a renewed focus on biomarker-driven patient selection.
Lung cancer: HARMONi-6 earns the spotlight at ESMO 2025
Akeso and Summit Therapeutics presented phase 3 results from HARMONi-6, testing ivonescimab, a dual PD-1/VEGF-blocking antibody, with chemotherapy in newly diagnosed squamous non-small cell lung cancer.
The trial demonstrated a progression-free survival improvement of roughly four months compared with tislelizumab plus chemotherapy, according to data published concurrently in The Lancet. The outcome highlights the potential of combining immune checkpoint blockade with anti-angiogenic mechanisms to enhance efficacy in lung cancer.
How quickly ivonescimab moves toward broader adoption will depend on overall-survival follow-up and regulatory review outside Asia, where most of the data were generated.
ESMO 2025: The bigger picture
Beyond individual drug readouts, ESMO 2025 also pointed to broader changes in how cancer care is delivered and developed.
Radiopharmaceuticals are moving from isolated research programs toward integration within hospital systems. Dedicated sessions focused on how healthcare networks can scale radioligand therapy safely and efficiently, from workforce training and radiation-safety protocols to patient-selection criteria and treatment-flow optimization.
On the industrial side, companies outlined next-generation isotope strategies, such as expanding lead-212 capacity for alpha-emitting agents and developing accelerator-based actinium-225 production to overcome chronic isotope shortages.
Artificial intelligence (AI), meanwhile, continued its steady integration into oncology practice. Presentations showed how AI-driven pathology and imaging are narrowing the gap between research and clinical decision-making, using algorithms trained to detect molecular signatures in standard histology slides. At the same time, ESMO’s dedicated AI & Digital Oncology sessions highlighted that this field is moving from experimental to operational, as regulatory frameworks and clinical validation begin to catch up.
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