This article discusses the illness trajectories of patients with incurable solid cancers, highlighting the impact of new systemic anticancer treatments such as immunotherapy and targeted therapy. These treatments have improved treatment outcomes but also introduced more complex and unpredictable disease courses. The article outlines three main illness trajectories: major temporary improvement, long-term ongoing response, and rapid decline due to adverse events. It emphasizes the importance of discussing patients' goals and preferences with their caregivers at diagnosis, as prognosis remains uncertain. Supportive and palliative care should be integrated with newer anticancer therapies to address physical, psychological, social, and spiritual challenges. Traditional illness trajectories for incurable solid cancers involved a steady decline from diagnosis to death, but newer treatments have led to more varied outcomes. Patients may experience temporary stabilization, long-term responses, or rapid deterioration. The article provides examples of these trajectories, including cases where targeted therapy led to significant improvement, immunotherapy resulted in long-term remission, and adverse events caused rapid decline. The article also addresses the challenges of managing incurable solid cancers, including psychological, social, and physical difficulties. It highlights the need for timely discussions about prognosis and treatment preferences, as well as the importance of supportive and palliative care in improving quality of life. The role of supportive and palliative care is emphasized, as it can enhance quality of life, reduce symptom burden, and potentially extend survival. The article concludes with recommendations for integrating these care approaches into clinical practice and highlights the importance of patient-centered care and advance care planning.This article discusses the illness trajectories of patients with incurable solid cancers, highlighting the impact of new systemic anticancer treatments such as immunotherapy and targeted therapy. These treatments have improved treatment outcomes but also introduced more complex and unpredictable disease courses. The article outlines three main illness trajectories: major temporary improvement, long-term ongoing response, and rapid decline due to adverse events. It emphasizes the importance of discussing patients' goals and preferences with their caregivers at diagnosis, as prognosis remains uncertain. Supportive and palliative care should be integrated with newer anticancer therapies to address physical, psychological, social, and spiritual challenges. Traditional illness trajectories for incurable solid cancers involved a steady decline from diagnosis to death, but newer treatments have led to more varied outcomes. Patients may experience temporary stabilization, long-term responses, or rapid deterioration. The article provides examples of these trajectories, including cases where targeted therapy led to significant improvement, immunotherapy resulted in long-term remission, and adverse events caused rapid decline. The article also addresses the challenges of managing incurable solid cancers, including psychological, social, and physical difficulties. It highlights the need for timely discussions about prognosis and treatment preferences, as well as the importance of supportive and palliative care in improving quality of life. The role of supportive and palliative care is emphasized, as it can enhance quality of life, reduce symptom burden, and potentially extend survival. The article concludes with recommendations for integrating these care approaches into clinical practice and highlights the importance of patient-centered care and advance care planning.