Spread around the big table, the players make their bets. The game calls for some cards showing, others hidden, and with each round more of the players’ cards lie face up. One contestant in particular seems to have the hot hand, so it is almost unsurprising when the next card that player lays down, along with a hefty ante to the pot, causes a stir among all the others. To stay in this game, everyone will have to ante up. This imagined scene fairly represents the situation in the immuno-oncology (IO) space right now — and it’s an accurate metaphor for this, our annual immuno-oncology update for 2018.