New biomarkers are constantly being identified; this rapidly changing field of biomarkers poses some challenges for clinical practice. Hisham Mehanna, PhD, BMedSc, MBChB, FRCS, FRCS(ORL-HNS), of the University of Birmingham, Birmingham, UK, discusses one of the most significant challenges for biomakers at the European Society for Medical Oncology (ESMO) 2018 Congress, in Munich, Germany; validation and transition into clinical practice, and suggests improvements. A prospective combination therapy currently being investigated in clinical trials, coupling immunotherapy and metabolic modulators, is also discussed.