The article discusses the updated illness trajectories for patients with incurable solid cancers, highlighting the challenges and advancements in treatment. New systemic anticancer treatments, such as targeted therapy and immunotherapy, have extended life expectancy but also introduced unpredictability. The trajectories include major temporary improvement, long-term ongoing response, and rapid decline due to adverse events. Supportive and palliative care are crucial to address physical, psychological, social, and spiritual challenges. The article emphasizes the importance of discussing patients' goals and preferences early, ideally at diagnosis, to manage expectations and plan end-of-life care effectively. It also addresses the limitations of using illness trajectories and the need for personalized care, especially in older patients or those with multiple comorbidities. The role of immunotherapy and targeted therapy in improving quality of life and survival is noted, along with the economic challenges and accessibility issues in low and middle-income countries. The article concludes by emphasizing the importance of early palliative care and supportive care to enhance patient well-being and quality of life.The article discusses the updated illness trajectories for patients with incurable solid cancers, highlighting the challenges and advancements in treatment. New systemic anticancer treatments, such as targeted therapy and immunotherapy, have extended life expectancy but also introduced unpredictability. The trajectories include major temporary improvement, long-term ongoing response, and rapid decline due to adverse events. Supportive and palliative care are crucial to address physical, psychological, social, and spiritual challenges. The article emphasizes the importance of discussing patients' goals and preferences early, ideally at diagnosis, to manage expectations and plan end-of-life care effectively. It also addresses the limitations of using illness trajectories and the need for personalized care, especially in older patients or those with multiple comorbidities. The role of immunotherapy and targeted therapy in improving quality of life and survival is noted, along with the economic challenges and accessibility issues in low and middle-income countries. The article concludes by emphasizing the importance of early palliative care and supportive care to enhance patient well-being and quality of life.