James Larkin, MD, PhD, of the Royal Marsden NHS Foundation Trust, London, UK, discusses the session ‘Clinical problems in oncology’ that he was involved in at the 2016 Annual Meeting of the American Society of Oncology (ASCO), held in Chicago, IL. He believes that this session provided a good opportunity to discuss some of the problems faced in the day-to-day practice. Clinical trials have not been able to provide excessive insights into how to deal with such problems that may arise with patients, such as dealing with patients with brain metastases, who are often excluded from clinical trials. This is a similar situation to that of patients with more aggressive diseases, since the status of their condition is progressing too quick for them to be included into clinical trials. Since these patients are underrepresented in clinical trials, when it comes to real world practice, questions regarding whether or not a drug will work with, for example, brain metastases will arise. Finally, he highlights that as we move forward, we learn more about the management of such patients. Recorded at the American Society of Oncology (ASCO) 2016 Annual Meeting held in Chicago, IL.