• Cancer incidence is expected to rise significantly through 2050, particularly in lower-income countries, to 32 million new cases annually – a potential increase of more than 12 million new annual cases
• Global spending on cancer medicine increased to $223 billion in 2023, $25 billion more than in 2022, and is projected to reach $409 billion by 2028
• In 2023, 25 oncology novel active substances (NASs) were launched globally, reaching a total of 193 since 2014 – however, large geographic variations exist in availability of these medicines
• More than 2,000 new oncology clinical trials started in 2023 with novel modalities and significant promise for cancer treatment, including cell and gene therapies, antibody-drug conjugates, multispecific antibodies, and radioligand therapies
• Cancer treatments have increased 9% annually since 2019 but the pace of bringing novel therapies to patients is uneven due to differences in biomarker testing rates, adoption of novel therapies and lack of infrastructure capacity to deliver some of the most advanced therapies

-As cancer incidence continues to rise, it’s being met by wider use of innovative therapies and a robust pipeline of new drugs, according to a new report from the IQVIA Institute for Human Data Science titled, “Global Oncology Trends 2024: Outlook to 2028.”

“The global oncology ecosystem is operating near peak levels to address increasing challenges. New therapies for advanced cancers, including some of the most advanced novel science in the industry, are under development or have been recently launched,” said Murray Aitken, Executive Director, the IQVIA Institute for Human Data Science. “These therapies represent the largest area of collective research and drug spending across all of healthcare. Yet despite significant advances in treatment and better access to care, the global oncology community and patients continue to struggle with disparities in access and care.”

A few key highlights in the report include:

• Trends in cancer incidence and mortality: Cancer incidence is expected to rise significantly through 2050, particularly in lower-income countries, to 32 million new cases annually – a potential increase of more than 12 million new annual cases. The growing disease burden underscores the urgent need for new treatments to enhance survival and quality of life. Disparities in five-year cancer survival across countries with similar GDP levels indicate that different healthcare strategies may lead to better outcomes for certain cancers. The variability in cancer severity and progression, along with healthcare system differences, suggests that tailored strategies, such as focusing on early detection or enhancing survivorship and quality of life, could be more effective for certain cancers.

• Oncology research and development activities: In 2023, more than 2,000 oncology trials started, fewer than the past two years of rebounding from the COVID-19 pandemic and 11% higher than in 2019. Emerging biopharma companies accounted for 60% of these trials, a significant increase from 33% in 2013. Novel modalities, including cell and gene therapies, antibody-drug conjugates (ADCs) and multispecific antibodies, show significant promise for cancer treatment and represent a growing share of clinical research. Trials involving PD-1/PD-L1 inhibitors grew 29% over the last five years, investigating across more tumors and in earlier lines of therapy. More than 250 trials testing CAR T-cell therapies in oncology started in 2023 and while the majority investigated for hematological cancers, the therapies were increasingly viewed across a range of solid tumors. Fifteen ADCs have been approved globally and the number of ADC trials grew 26% from 2022 to 2023 as more companies invested in these targeted chemotherapeutics. Development of these novel treatments is being accelerated by regulator and industry initiatives, including the use of artificial intelligence to advance new therapies.

• Oncology clinical development productivity: The oncology composite success rate increased to 10% in 2023 from 4% the year prior, with improvements across all phases, especially in rare oncology and solid tumor research. While oncology trials remain complex, their level of complexity – a comparison of a number of factors, including the number of countries, sites, patients, eligibility criteria, and clinical endpoints – has decreased by 8% since 2019, in contrast to a 2% increase in complexity for other disease areas. The number of subjects enrolled in oncology trials is down 11% in 2023 from the peak in 2021. Western European countries are included in trials the most often, although China and North American country inclusion has increased significantly in recent years. Despite a reduction in trial durations, the overall length of all oncology programs was only shortened by an average of five months due to an increase in the time between trial completion and starting the next phase. Improved success and declining complexity resulted in a 23% improvement in productivity in oncology clinical development in 2023.

• Novel active substances (NASs) in oncology: In 2023, 25 oncology NASs were launched globally, reaching a total of 193 since 2014 – however, large geographic variations exist in the availability of these medicines. The number of NAS launches in China over the last five years exceeded those in the U.S. While many of these new medicines in China are driven by domestic innovation, most have previously launched globally. New medicine launches in Europe have slowed, resulting in delays in the availability of innovative medicines compared to the U.S. – 38% of U.S. oncology NASs in the past 10 years are not yet available in Europe. Eighteen new cancer medicines were introduced in the U.S. in 2023 and these new drugs are largely targeting rare cancers, are recombinant and are often approved based on a single clinical trial. The European Medicines Agency approved eight NASs for hematological cancers and five for solid tumors in 2023, fewer than the 14 approved in 2022.

• Cancer patient access and use of scientific advances: The total number of cancer treatment regimens provided globally – defined as the number of patients treated with a regimen in a time period, whether one cycle or multiple – has increased by an average of 9% annually since 2019 due to higher cancer rates and better access to care. Despite this growth, the pace of novel cancer therapies arriving to patients is uneven across countries, with differences in biomarker testing rates, adoption of novel therapies, and the lack of infrastructure capacity to deliver some of the most advanced therapies. Treatment of women’s cancers, prostate cancer and late-stage multiple myeloma has advanced in recent years as novel modalities, including antibody-drug conjugates, radiopharmaceuticals, bispecifc antibodies and CAR T-cell therapies have been introduced – providing better outcomes for patients.

• Spending on oncology medicines: Global spending on cancer medicine increased to $223 billion in 2023, $25 billion more than in 2022, and is projected to rise to $409 billion by 2028. This growth is attributed to the volume of protected brands and the introduction of new products in the past five years, despite losses of exclusivity for some treatments. Biosimilars have been widely adopted in major markets, leading to significant cost savings. Notably, six major tumor categories experienced double-digit growth in spending due to breakthrough medicines and improved patient access. PD-1/PD-L1 inhibitors, which are widely used in solid tumor treatments, accounted for $52 billion in spending in 2023, with expectations to increase to more than $90 billion by 2028. The future of next-generation biotherapeutics in oncology is marked by clinical and commercial uncertainties, yet annual spending could still potentially rise from $4 billion to $23 billion by 2028.