An interview with Dr. Noelia Tarazona, researcher and oncologist 

Ahead of ESMO 2025, we spoke with Dr. Noelia Tarazona, research fellow at Mass General Brigham Cancer Center (Boston, USA) and Medical Oncologist at INCLIVA BIomedical Research Institute (Valencia, Spain), about how translational research is driving a new era in gastrointestinal oncology. She reflects on how liquid biopsy, immunotherapy, and radiomics are shaping precision medicine, and how system-level strategies can make innovation more equitable and sustainable across Europe.

 

Turning Points: Liquid Biopsy and Immunotherapy

What advances in translational research have marked a turning point in gastrointestinal oncology in recent years?

Two major breakthroughs have transformed gastrointestinal (GI) oncology in recent years: liquid biopsy and immunotherapy. Both are moving us closer to truly personalized cancer treatment.

Circulating tumor DNA (ctDNA) has evolved from being merely a prognostic marker to a tool that can directly guide adjuvant therapy decisions. The DYNAMIC trial in stage II colon cancer demonstrated that a ctDNA-guided approach can safely reduce the use of chemotherapy without compromising long-term outcomes. Moreover, ctDNA clearance has been shown to correlate strongly with treatment benefit.

At the same time, biomarker-driven immunotherapy and targeted therapy have matured across GI tumors. Examples include MSI-H/dMMR for immunotherapy, BRAF_V600E combinations in metastatic colorectal cancer, CLDN18.2 in gastric cancer, and FGFR2 fusions in cholangiocarcinoma — all now part of clinical guidelines.

Looking forward, radiomics could become an essential, non-invasive layer in precision oncology, helping refine risk assessment, predict treatment response, and identify which patients should undergo deeper molecular testing.

 

Balancing Patient Care and Research in Modern Oncology

From a clinical researcher’s perspective, how can time and resources be balanced between patient care and research into new treatments?

To optimize both clinical care and research, we must integrate research into the routine workflow. It should not feel like an extra burden for clinicians.

This integration starts with standardized operating procedures, core datasets embedded in electronic health records, and the inclusion of ctDNA results and radiomics parameters directly within clinical notes. Molecular Tumor Boards (MTBs) should act as efficient decision filters, discussing only cases with plausible actionability and a defined clinical pathway.

By linking prospective registries to multidisciplinary team (MDT) decisions, we can transform routine practice into real-world evidence generation without adding extra workload — fully aligned with ESMO’s structured, guideline-based approach.

 

Liquid Biopsy in Practice: Interpreting and Applying ctDNA Data

Liquid biopsy has become key in detecting minimal residual disease and drug resistance. How can this data be interpreted and applied more effectively in daily clinical practice?

Liquid biopsy, particularly ctDNA analysis, is now central to detecting minimal residual disease (MRD) and treatment resistance in gastrointestinal cancers.

To improve clinical implementation, ctDNA reports should remain simple but informative — distinguishing detectable versus undetectable ctDNA, with an additional category for results “below the analytical range” to preserve sensitivity while clarifying limitations.

The timing of ctDNA testing is crucial: post-operative and end-of-adjuvant windows provide the most actionable prognostic information. Changes in ctDNA status (positive to negative or vice versa) should trigger predefined clinical actions.

For responsible large-scale adoption, we need two key elements:

1. Transparent assay performance data — including sensitivity, specificity, PPV, and NPV under well-defined pre-analytical conditions.
2. Robust cost-effectiveness analyses, showing that ctDNA-guided strategies can be budget-saving for public health systems.

Here, radiomics can add value by identifying imaging phenotypes associated with higher relapse risk, helping tailor surveillance and guide clinical trial enrollment alongside ctDNA dynamics.

 

Emerging Molecular Targets in Gastrointestinal Tumors

What are the most promising emerging targets in gastrointestinal tumours?

In colorectal cancer, BRAF_V600E remains a critical target, with encorafenib–cetuximab combinations now established as standard therapy. KRAS_G12C inhibition is also opening new options for pretreated patients, supported by adagrasib–cetuximab recently receiving FDA recognition.

In gastric and gastroesophageal junction (GEJ) tumors, CLDN18.2 has evolved from an emerging biomarker to a validated target, complementing HER2-directed therapy.

In biliary tract cancer, FGFR2 fusions and IDH1 mutations are now clinically relevant, with pemigatinib marking a significant therapeutic advance.

Once again, radiomics could help identify which patients deserve full molecular profiling by linking imaging signatures with aggressive or targetable phenotypes.

 

Equity and Access: Bringing Precision Oncology to all Patients

Within the framework of ESMO, there is much talk of personalized medicine. What challenges remain in bringing precision oncology to all patients in a real and equitable way, beyond the large referral centers?

Equitable access remains the central challenge. Availability of molecular testing, MTBs, and clinical trials still varies widely across regions and hospital systems.

We also need prospective evidence and health-economic studies to support reimbursement and sustainability. Standardizing pre-analytics for blood, tissue, and imaging will be key to ensuring that ctDNA and radiomics deliver consistent, reproducible results across institutions.

National registries linked to MTBs, using common data models and simplified consent workflows, represent a practical way to expand access to precision oncology across Europe — fully aligned with ESMO’s mission.

 

The Future of Oncology in Europe: Collaboration and Sustainability

What do you see as the most urgent priorities for the future of oncology in Europe?

The future of oncology in Europe depends on ensuring that every patient, regardless of location, benefits from scientific progress.

We need coordinated, cross-border programs guaranteeing molecular testing, MTB access, and shared registries that feed real-world evidence back into clinical care.

Every new innovation — from ctDNA and targeted therapies to AI and radiomics — should be introduced with built-in evaluation of clinical value and sustainability, so that precision oncology continues to expand without compromising fairness.