roadmaps

Twenty-five years of trying to make chemotherapy hit only cancer cells, from the unstable first ADC to today's third-generation blockbusters and the fourth generation now in trials.

Artificial intelligence in cancer started as software that flagged spots on a mammogram. It now designs molecules, reads slides better than any single pathologist for some tasks, and is beginning to match patients to trials and draft the tumour board summary; the question is which of it will be proven to help.

How AI is moving from single-task readers of scans and slides towards systems that weigh everything about a patient, and what regulators and evidence still require.

About four in ten cancers could be prevented with tools that already exist: vaccines against the viruses that cause them, tobacco and alcohol control, weight, aspirin for the right people, and finding the families who carry a high-risk gene. The roadmap is mostly about deployment, with interception vaccines as the long-range bet.

From a cure for some leukaemias in 2017 to the first solid-tumour CAR-T and the prospect of making CAR-T inside the body with an injection.

Chemotherapy went from a poison that sometimes worked to the backbone of most cures, and is now being given more precisely: to fewer people, at better doses, and increasingly delivered inside an antibody so that it reaches the tumour and not the whole body.

Bowel cancer grows from a polyp over years, so removing the polyp prevents it. This roadmap follows the evidence from that discovery through the stool tests and scopes that built the screening programmes, the operation that changed rectal cancer, the chemotherapy and antibody era, immunotherapy that dissolves some tumours without surgery, and the unexplained rise in young adults, to 2032.

Blood carries fragments of tumour DNA. This roadmap follows the tests that read them, from the first sighting in 1948 to blood tests that now choose a drug, spare chemotherapy, or screen for many cancers at once, and it lists the readouts to watch next.

Devices treat cancer with physics rather than chemistry: heat, cold, light, electric fields and sound. After decades at the margins, several now have randomised proof and approvals, and the next generation aims to prime the immune system as it destroys the tumour.

Cancer diagnosis moved from what a tumour looks like under a microscope to what is driving it, and now to reading it from a blood sample. The next step is tests that tell the doctor what to do, not only what is there.

What people eat, weigh and do shapes who gets cancer and how treatment goes. Decades of trials separated what is established (obesity, alcohol and inactivity cause cancer; exercise after treatment reduces recurrence) from what is hype, and the next questions are being asked with the rigour of a drug trial.

Finding the next cancer drug used to mean testing compounds on mice and cell lines and hoping. It now means mapping which genes each cancer cannot live without, growing a patient's tumour in a dish, and designing molecules on a computer; the job is making those tools predict what happens in people.

From mammograms and colonoscopies to a single blood draw that might screen for dozens of cancers, with the FDA's first decision imminent.

Epigenetic drugs change how genes are read rather than the genes themselves. They started as gentle chemotherapy for blood cancers and are becoming precise drugs against the enzymes and scaffolds that particular cancers depend on.

Gallbladder cancer is usually found by accident when a gallbladder is removed for stones, and for most of its history the only treatment was a bigger operation. This roadmap follows the disease from the first cholecystectomy in 1882, through staging by depth and the borrowed chemotherapy standards of 2010 and 2019, to immunotherapy and HER2 drugs, and lists the trial readouts to watch to 2030.

Seven in ten cancer deaths happen in countries with almost no cancer care, and even rich systems cannot afford every new drug. The roadmap is the set of levers that already work, from generics and biosimilars to trials that cut the dose, and the ones being built: regulators trusting each other's reviews, pooled purchasing, and drugs and cell therapies made where patients live.

Cutting off the hormones that breast and prostate cancers feed on has kept people alive for decades. The therapy is now moving from blocking the hormone to destroying its receptor, and from waiting for a scan to switching drugs when a blood test sees resistance coming.

The immunotherapy roadmap is a 130-year arc from injecting bacteria into tumours to releasing immune brakes, and now to designing the immune response itself with vaccines, engagers, and cells.

The most important cancer gene was declared undruggable for 40 years. Then a pocket was found, and now a pan-RAS drug is in phase 3 for pancreatic cancer.

Lung cancer is where modern cancer epidemiology began: two studies in 1950 tied it to cigarettes, and a fifty-year cohort proved it. This roadmap follows the evidence from there through chemotherapy that barely worked, the scans that find the disease early, the drugs for cancers that depend on one broken gene, immunotherapy, and small-cell disease, to 2032.

Lymphoma was the first cancer shown to be caused by a virus, the first common cancer sorted into subtypes by reading which genes were switched on, and the first in which a patient's own immune cells were reprogrammed to cure them. This roadmap follows the evidence from 1958 to the trials reading out in 2032.

From a sugar tracer that lights up most cancers to tracers that show a single protein, a stromal cell type, or the immune cells inside a tumour.

Children's cancers were made curable by decades of cooperative trials that refined chemotherapy dose by dose. The next gains come from immunotherapy and targeted drugs built for children's cancers, from laws that stop companies skipping children, and from protecting the child who is cured from the cost of the cure.

Pancreatic cancer has had one operation since 1935 and a handful of chemotherapy drugs since 1997. This roadmap follows the evidence through FOLFIRINOX, chemotherapy before and after surgery, the first inherited-gene drug, the first drugs against the KRAS protein that drives nearly every tumour, personalised vaccines, and the surveillance and blood tests that might catch it earlier, to 2031.

Three different ways a cancer stops killing someone: stop it before it starts, remove every last cell, or hold it in check for life. Each needs different technology.

Prostate cancer is where hormone therapy for cancer was invented, in 1941, and where a blood test created an epidemic of diagnoses forty-five years later. This roadmap follows the evidence from castration to the modern androgen receptor drugs, through the screening trials and the argument about overdiagnosis they started, to DNA repair, PSMA and the questions still open in 2032.

Radical oncology is a horizon map of the wilder ideas in cancer, sorted by how close they are to mattering, with the reason each one might never arrive.

The radiopharmaceutical roadmap runs eighty years from radioactive iodine for thyroid cancer to alpha-emitting drugs for prostate and neuroendocrine cancers, with isotope supply as the limiting factor.

Radiotherapy cures more people than any drug and has reinvented itself every decade: from crude X-ray fields to beams shaped by computer, delivered in days instead of weeks, and now in fractions of a second. Its future is precision, fewer visits, and combination with drugs that make radiation work better.

Recovery became a research subject because children started surviving cancer and someone wrote down what the cure had cost. Sixty years later the damage is well measured, exercise is the only thing proven to change a hard outcome, and the next decade turns on whether anyone funds the trials and the services the evidence already justifies.

Supportive care began as the drugs that let people get through chemotherapy. It is now a discipline with randomised proof that exercise, early palliative care and symptom monitoring lengthen life, and its next task is organised lifelong care for the growing population of people living after cancer.

Surgery cures more cancers than any other treatment. Its story for a century has been learning how much can safely be left in, and now whether the operation is needed at all once drugs and radiation have cleared the tumour.

Targeted drugs switch off the specific broken protein a cancer depends on. The first ones turned a leukaemia into a chronic condition; the field then learned that resistance is the rule, designed drugs around it, and has now reached the drivers that were called impossible to target.

How triple-negative breast cancer went from the subtype with no targeted therapy to one with immunotherapy, PARP inhibitors, three ADCs, and a positive bispecific ADC in six years.

The randomised trial is how oncology knows what works, and it is slow, expensive and enrols fewer than one in ten patients. The roadmap is the set of designs and tools that keep the rigour while cutting the time, cost and exclusions: platform trials that never close, blood-test endpoints, remote consent, real-world data used honestly, and doses chosen by evidence.

Triple-negative breast cancer was named for what it lacks, the three receptors other breast cancers are treated through. This roadmap follows it from the receptor discoveries and the basal-like signature of 2000, through chemotherapy, platinum, PARP inhibitors, immunotherapy and antibody-drug conjugates, to the trials asking who can have less and who needs more, with registry dates to 2030.

One target, three approved-or-nearly-approved drugs, and a fourth wave. How TROP2 went from an obscure trophoblast antigen to the centre of breast and lung cancer treatment.

The attempt to build a computer model of a cell good enough to predict what a drug or mutation will do before anyone runs the experiment.