From a small gathering in 2009 to progressively increasing numbers of 250 in 2016, 320 in 2017, 375 in 2018 to now over 500 in 2019. Interest and global participation continues to climb. This year included dozens of excellent posters and stimulating lectures ranging from the history of cardio-oncology as a discipline, to “The use of biomarkers for prediction of cardiotoxicity.” As in the past international friendships were renewed, practical experience was shared, and we were treated to outstanding Brazilian food and entertainment.