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A room where nobody worried about the drug
István Borbíró · 4 September 2026 · 4 min read
Another global advisory meeting, and the experts in the room were not worried about the drug.
They knew what it did, and it did it well. What they turned over, again and again, was what the treatment would look like on a Tuesday in a hospital giving it for the first time. Who would teach it. What the label and the protocol had to carry so that it was used well outside an academic centre. Which specialties needed to be in the conversation before the first dose rather than after the first problem. Whether a community clinic had what it needed to give the drug at all, or would have to refer the patient on.
I spent years in rooms like that, working alongside leading oncology and haematology experts across Europe. The clinical questions were answered with enormous care. P values were critiqued. The question of how the specialties would join up around the answer sat outside everyone's remit. Some brought up their own experience from the first exploratory trials, when they wrote the first protocol, and the years it took to make it work for anyone else.
Watch one therapy area across thirty years and the pattern becomes hard to miss. In the mid-1990s, HER2-positive breast cancer carried the worst outlook of any breast cancer subtype. When it first became treatable, the drug arrived with cardiac monitoring attached. Treatment evolved. The combination regimens that became standard demanded more precision in planning. The antibody-drug conjugates in use today require genetic confirmation, toxicity protocols and monitoring for brain involvement, across several specialists at once. A diagnosis that once measured survival in months now leaves room for years of living, and for the quality of those years.
Each advance was written down as a clinical act. Each one also placed a new demand on how the team held together, and that part was written down nowhere.
Every therapy specified the treatment. None of them specified the joining.
Multidisciplinary teams are the reality everywhere in European cancer care. Holding the meeting is not the same as holding the team together between meetings. Someone chases the report that went missing last time. Someone notices that the imaging slot moved. Someone carries the decision to the person who can act on it. That work happens in every centre and appears in no plan.
Corina Richter arrived at the same layer from outside oncology. Her ground is complex systems and where they fail, which is rarely at the centre and usually at the joins. She saw what the accumulated demand does to the individuals absorbing it. She also saw the way through. Complex systems do not answer to the large redesigns and fresh starts that leadership reaches for. They answer to small experiments placed at leverage points, where the load actually falls. Keep what works, tweak what nearly works, pivot away from what does not.
Two readings of the same layer, arriving from two directions.
The work was already being done. It had no name, no measure and no place in any plan.
Nexus Recognita was established on 1 October 2025.
Later that month we went to ESMO in Berlin. Not to present a method. To ask cancer care professionals what they see, what they carry, and whether they would want it looked at properly. Over four days we had more than thirty conversations. One young oncologist put her whole wish in a sentence: that people learn early on that oncology is not about personal decisions, it is about picking up the phone and solving the case together.
That is the whole beginning. Someone was already holding it together. We went to find out how many.