Advancements in precision oncology have transformed the landscape of clinical trials. Whether it has been isolating genetic subpopulations, advanced targeted drug delivery, altering epigenetics, CAR-T therapies and beyond, we have seen an explosion of innovative technologies to address the consistently growing oncology treatment needs. Yet, alongside these breakthroughs come numerous risks and challenges. This keynote presentation delves into the complexities of today’s oncology trials, exploring strategies to overcome obstacles and maximize success, including the vital role of partnering with small/mid-sized CROs where we highlight how collaboration can mitigate risks and ensure focus on the efficacy of novel innovative treatments.