Boil the pasta: Bring a large pot of salted water to a boil. Cook the pasta until just shy of al dente. Reserve 1 cup of pasta water, then drain.
Start the tomatoes: While the pasta cooks, heat olive oil in a large skillet over medium heat.
Add tomatoes and a pinch of salt. Cook, stirring occasionally, until some tomatoes split and release juices, 5–7 minutes.
Add garlic and heat: Stir in garlic and red pepper flakes. Cook 30–60 seconds until fragrant, being careful not to brown the garlic.
Create the sauce base: Lower the heat.
Add the pesto and cream, stirring to combine. Loosen with a splash of reserved pasta water until the sauce looks silky.
Toss with pasta: Add the drained pasta to the skillet. Sprinkle in Parmesan and toss, adding more pasta water a little at a time until the sauce coats the pasta and looks glossy.
Finish and season: Add lemon zest and a small squeeze of lemon juice.
Taste and adjust salt and pepper. If you want more richness, add another spoonful of Parmesan.
Serve: Top with torn basil, extra cheese, and a drizzle of olive oil. Serve hot.