Download the Report
ESMO 2026 kicks off later this week - we analyzed thousands of abstracts and pulled out 8 themes that stood out to us heading into the conference.
- Something fundamental about oncology is that every time a drug moves earlier in treatment, it changes the downstream patient population (and the competitive landscape), creating new opportunities for differentiation.
We see that theme coming up in a few areas this year, with EV + pembro in bladder cancer and HER2-directed ADCs in breast cancer moving earlier. Frontline treatments tend to be more durable in holding their position in the treatment sequence, so being able to anticipate these shifts as pivotal data emerges is a huge advantage.
- One of the best parts of ESMO is getting to peer into the future - there's often a big disconnect between current late-stage trials and where early-stage efforts are accumulating. For example in KRAS, ~76% of clinical KRAS abstracts involve combinations, versus just 1 in 4 ongoing Ph3 programs.
Development competition is split between two approaches: selectively target the dominant mutant (G12D) vs. inhibit a broader set of RAS-driven tumors (daraxonrasib). All things equal, the latter is a better opportunity, so the debate is where precision might beat breadth.
- China is dominating ADC innovation, with ~86% of Ph3 readouts at ESMO coming from China-originated assets. Some are quite novel too, such as bispecific architectures (i.e. EGFR x HER3)
Broadly, as ADCs have moved into earlier treatment settings, they've been benchmarked against non-ADC standards. As some settle in as frontline treatment, it's creating a resistance problem for next-gen assets: if payload resistance cuts across targets, then the Topo I concentration may 'poison the well' for ADCs still competing in later-line settings.
The 12-page preview below gets into the details behind these and other themes, including key programs, data and references. Hope it's helpful for everyone heading to Madrid or following along remotely.
