Oncology’s Next Decade: The Therapies And Players Reshaping A $400bn Future

This examination of global market trends and the overall structure of the oncology sector sets the stage. Oncology is the pharmaceutical industry’s largest therapeutic area, representing about 18% of global prescription and over-the-counter sales in 2024. At roughly $220bn, the market is forecast to almost double by 2032, growing at 5-9% annually, according to Evaluate consensus forecasts (see Exhibit 1).

Oncology drugs not only account for a large amount of sales but also attract vast R&D investment. Over the last five years, on average, 32% of annual registered clinical trial spend has been on cancer assets. Data from Citeline’s Pharmaprojects show just under 3,800 anti-cancer assets in clinical development, with an additional 900 already approved treatments also in ongoing clinical trials (see Exhibit 2).

This sales growth and industry investment is driven by a number of factors. Firstly, the expanding patient population. As Exhibit 3 demonstrates, there has been a rising incidence of cancer cases in the US over the last two decades with the American Cancer Society estimating 2.1 million new cases in the US in 2026. Much of this growth reflects demographic change, with aging populations meaning more people are living into cancer-prone age groups. Advances in diagnostics and, particularly in countries with robust healthcare systems, the wider implementation of screening programs have also increased detection. Together with global – though uneven – shifts in lifestyle and environmental risk factors, these dynamics have contributed to rising cancer incidence worldwide.

Mortality rates are, at a top-line level, falling in the US. Total cancer 5-year survival rates have climbed to ~70% for patients diagnosed between 2015 and 2021 in the US, a large improvement from the 49% recorded in the 1970s. This high overall survival rate, however, masks some stark differences between different cancer types and stagings. Breast, prostate and thyroid cancers have relatively high survival rates thanks, in part, to earlier detection rates and better treatment options. In comparison, lung and pancreatic cancers, have persistently poorer outcomes, despite being common cancer types (see Exhibit 4). This is largely due to biological challenges, such as tumor-type aggression and late symptom onset. Still, in some cases, this is reflective of the limited treatment options available.

Regional Dynamics

The global oncology drug market has traditionally been dominated by North America and Europe, which still account for the majority of spending. In 2024, the US was the largest region by oncology drug expenditure, accounting for 55% of sales, while Europe contributed 20% of global oncology revenues. This dominance reflects historically higher access to new cancer therapies and ability to pay premium prices in these regions.

The US market’s freedom in drug pricing, lacking direct price controls, and strong reimbursement environment mean that breakthrough cancer drugs – such as immunotherapies and targeted agents – see swift uptake and high revenues. However, the US is entering a new era of pricing reform with the 2022 Inflation Reduction Act empowering Medicare to negotiate prices on top-selling drugs starting in 2026, which could temper oncology spending growth. Despite this change, forecasts still expect the US to remain the world’s foremost oncology market.

Western Europe collectively is the second-largest region for oncology expenditures. The single-payer or social insurance healthcare systems ensure wide access to cancer care, but also impose strict cost containment measures. Most European countries use central health technology assessments and pricing negotiations to decide which new cancer drugs to reimburse and at what price. This often leads to slower and more selective uptake of expensive therapies. There have been a number of oncology drugs which have voluntarily withdrawn from the European market, including Dendreon’s Provenge (sipuleucel‑T ) for prostate cancer in 2015, due to sales expectations not being met. Furthermore, when European countries do reimburse new cancer drugs, it is frequently at significantly discounted prices. The result is that Europe’s contribution to global oncology sales is lower than its share of cancer cases.

Asian markets are rapidly expanding their share of the oncology market. China has seen a surge in both usage and domestic innovation, transforming from what had previously been a primarily generics-focused pharmaceutical market (see Exhibit 5).

Nearly 70% of oncology drug launches in 2024 were for assets developed by Chinese companies or in partnership with Chinese companies. Whilst there is a large development market in “me-too” drugs targeting known mechanisms, such programmed death-(ligand) 1 (PD-(L) 1) antibodies, (which the National Medical Products Administration (NMPA) has approved eight of from native companies) this has served to drive down prices for some historically expensive treatments. China’s expanding R&D ecosystem – supported by government initiatives and a vast patient pool – has also begun delivering innovative therapies.

Examples include Legend Biotech’s BCMA-targeted CAR-T Carvykti (ciltacabtagene autoleucel), developed with Johnson & Johnson, and BeOne Medicine’s Brukinsa, which launched in the US eight months before its approval in China.

The Chinese government has paired faster approval schemes with aggressive policies to improve access to new cancer treatments for its population. The National Reimbursement Drug List negotiations have added dozens of high-cost cancer therapies to the NRDL in recent years in exchange for steep price cuts averaging 44%-61%. These negotiations have dramatically lowered prices of drugs making them more affordable for patients in China’s broad public insurance scheme and offering manufacturers vast volume expansion, if they accept lower margins than those seen in the West.

Other Asian countries such as Japan and South Korea are important centers of global oncology innovation and are swift adopters of new-generation therapeutics. However, they represent far smaller markets in terms of global expenditure.

Several other regions, including Brazil and India, offer large market potentials with growing cancer burdens. Their contribution to global oncology spending is, however, held back by variable healthcare infrastructure and insurance coverage.

Therapeutic Modalities: Traditional Vs. New Approaches

Over the past few decades, cancer therapy has expanded from a near-exclusive reliance on the “cut, burn, poison” approaches of surgery, radiation and broad-spectrum chemotherapy to a broad suite of highly specialized treatments.

Today’s oncology landscape features targeted small-molecule drugs, monoclonal antibodies, immune-based therapies, combination biologics and more (see Exhibit 6). For the purpose of this review cancer drugs have been split into four broad classes: cytotoxic chemotherapy, targeted therapies, immunotherapies, and cell/gene therapies.

Once the backbone of cancer treatment, chemotherapy accounted for about 15% of Rx and OTC oncology sales in 2012, but its share is projected to fall to ~4% by 2032, largely reflecting the shift toward newer therapies. Most agents are now generic. Although nearly all patients still receive chemotherapy at some stage, its role is gradually shrinking as targeted therapies and immunotherapies increasingly replace or complement it.

Targeted Therapies

Targeted therapies include hormonal treatments for endocrine-driven cancers and drugs designed to inhibit specific oncogenic pathways. They have driven the precision-medicine revolution by focusing on cancer-specific molecular targets and have represented the largest share of oncology spending over the past decade.

In 2024, the targeted-therapy landscape was dominated by small-molecule kinase inhibitors and monoclonal antibodies, including antibody-drug conjugates, which block cancer-driving proteins or pathways. Kinase inhibitors targeting EGFR, ALK and BRAF/MEK mutations have transformed treatment for lung cancer, melanoma and gastrointestinal tumors (see Exhibit 7). Meanwhile, therapies targeting DNA-repair mechanisms (PARP) and growth and survival pathways such as PI3K, mTOR, and BCL-2 continue to expand treatment options across tumor types.

In hematologic cancers, the rise of BTK, FLT3, IDH and menin inhibitors has enabled precision treatment of leukemias and lymphomas.

This diversity of targeted-therapy families underscores the shift towards precision oncology, where biomarker testing for gene mutations, protein overexpression, etc. guides drug matching for patients.

However, with the rise of other modalities, such as immunotherapies, targeted therapies’ share of the oncology market has been moderated. Still, targeted agents remain a cornerstone for many tumor-type treatments and are forecast to retain a 55% market share out until at least 2032 (see Exhibit 8).

Immune-based drugs, including checkpoint inhibitors, have transformed oncology in the last decade to become a core pillar of cancer treatment. Whilst the concept of enlisting a patient’s own immune system to recognize and destroy cancer cells is not new, with IL-2 cytokine therapies having been approved in the early ‘90s, only starting in the 2010s did immune-based treatments demonstrate broad, transformative impact across multiple cancers.

Yervoy (ipilimumab) was the first immune checkpoint inhibitor to gain US FDA approval in 2011. However, PD-1/PD-L1 checkpoint inhibitors, such as Merck’s Keytruda (pembrolizumab) and Bristol-Myers Squibb’s Opdivo (nivolumab), have been the major growth drivers in this class. First approved in 2014, they have quickly expanded to cover over 20 indications, generating $53bn collectively by 2024.

Although many of the first-generation PD(L)-1 checkpoint inhibitors are approaching the end of their patent protection, innovation in this space continues (see Exhibit 9). Many developers are shifting towards combinations with novel immunotherapies, bispecific antibodies and mRNA vaccines.

Investigation in major inhibitory checkpoints is not limited to PD-1/PD-L1 and CTLA-4, however. Lymphocyte-activation gene 3 (LAG-3), was the third immune checkpoint pathway target to receive regulatory approval, in the form of Opdualag (relatlimab+ nivolumab) in 2022, and its data from the RELATIVITY-047 trial was the first time a novel checkpoint inhibitor outperformed PD-1 monotherapy in this setting. Several other drugs targeting LAG-3, either as a combination or monotherapy, are in late-stage development with strong analyst sales forecasts.

Other checkpoint inhibitors have not had as much success. Mechanisms such as T-cell Immunoreceptor with Ig and ITIM Domains (TIGIT) and T-cell Immunoglobulin and Mucin-domain 3 (TIM-3) showed early promise and huge amount of investment but late-stage stumbles have caused many companies to withdraw from development in recent years.

For the treatment of blood cancers bispecific T-cell engagers (BiTE) have been gaining ground. Six of these engineered antibodies are currently approved by the FDA with a further five currently in Phase III trials. BiTEs offer the therapeutic benefit of targeted immune activation with off-the-shelf convenience, making them very appealing treatments. They have also shown to increase PD-L1 expression, and so are being studied in combination with the checkpoint inhibitors to try improve efficacy.

Overall, immunotherapy has transitioned from experimental to mainstream in a very short time (see Exhibit 10) – the number of FDA-approved immunotherapy indications has grown rapidly with more than 130 distinct immunotherapy approvals having been granted by the FDA between 2011 and 2024.

Cell And Gene Therapies

Representing a new frontier, cell and gene therapies made up less than 2% of oncology spend in 2023, but could approach ~7% by 2032 if current forecasts hold. The leading edge of this has been CAR T-cell therapies. A patient’s own T lymphocytes are extracted, genetically modified to carry a chimeric antigen receptor (CAR) that recognizes a cancer antigen, and then infused back to seek and destroy cancer cells. The first two CAR-T cell therapies, for blood cancers, launched in 2017 and a further five have been approved since (see Exhibit 11).

This grouping is not limited to CAR-T, other treatments including tumor-infiltrating lymphocyte (TIL), TCR-engineered cells and oncolytic viruses can also produce durable remissions, but are extremely expensive and complex to deliver. Yescarta and Abecma, each cost in the region of $400k per infusion, not taking into account supportive and hospitalization costs. It is this expense that will be one of the core challenges for market adoption, especially outside of aggressive disease settings.

By 2032, dozens of gene/cell therapies may be approved, with current Evaluate consensus forecasts estimating a combined revenue of $29bn.

Top Indications By Incidence And Treatment Landscape

The oncology market can also be viewed by cancer type. Certain malignancies contribute disproportionately to global disease burden and drug sales. Exhibit 12 shows a summary of several major cancer indications, their epidemiology, as well as current and forecast sales values.

Lung and breast cancers not only are the most commonly diagnosed cancers but also command the largest pharmaceutical market presence. Lung cancer, in particular, has seen an explosion of new drug approvals. There have been more than 25 FDA approvals in NSCLC alone between 2020 and 2025, making it the top revenue-generating cancer. Breast cancer is a close second in drug market size, with several therapeutic classes addressing different subtypes, hormone-positive, HER2-positive, triple-negative etc.

On the other hand, some very prevalent cancers like colorectal and bladder have more stagnant treatment paradigms and consequently smaller drug spends relative to their incidence. Meanwhile, certain less-common cancers have outsized drug markets: for example, multiple myeloma, thanks to many expensive lines of therapy such as Darzalex (daratumumab) and Revlimid (lenalidomide) .

Further misalignment between incidence and drug sales is illustrated by prostate and pancreatic cancers: prostate cancer is far more common, but most patients are cured or managed with old therapies, so global drug spending is moderate – whereas pancreatic cancer, with a grim prognosis, has few drug options to spend on despite its high mortality.

Leading Oncology Drugs And Companies

The oncology revenue tables are headed by a few strong players with the top five companies accounting for over 55% of all oncology sales in 2024.

The dominance of PD-(L)1 drugs made Merck and BMS the top oncology revenue companies in recent years, accounting for 14% and 13% of 2024 oncology sales, respectively. However, they sit at opposite ends of the asset count spectrum, both in terms of marketed oncology drugs as well as pipeline assets. Roche also has a broad oncology portfolio, however much of it is made up of legacy drugs such as Avastin (bevacizumab) , Herceptin (trastuzumab) and Rituxan (rituximab).

Novartis and AstraZeneca have grown their oncology franchises rapidly – AZ with Tagrisso, Imfinzi, Lynparza, Enhertu (co-developed) – and Pfizer is making a big play by acquiring Seagen for $43bn in 2023 to become a leader in antibody-drug conjugates. Johnson & Johnson (with Darzalex, Imbruvica from its Pharmacyclics deal) and AbbVie (which co-markets Imbruvica and has acquired Pharmacyclics) are also key players.

There has also been a shift in rankings as some portfolios mature and new therapies emerge: . AbbVie’s Humira (immunology) waned and it looked to oncology (via acquisitions) for growth; meanwhile, companies strong in immuno-oncology are bulking up in new tech (Merck’s $22bn ADC deal, BMS’s string of cell therapy and protein degrader deals). By 2030, oncolytic viruses, personalized cancer vaccines (like the Moderna mRNA vaccine in trials with Keytruda), and next-gen T-cell engagers could create new winners.

Merck & Co.

Merck’s oncology business revolves around Keytruda (pembrolizumab). The PD-1 inhibitor accounted for roughly 55% of the company’s sales in 2024 and is approved across melanoma, lung, kidney, head-and-neck, breast and other tumours. The subcutaneous formulation of pembrolizumab, Keytruda Qlex, was approved by the FDA in September 2025 and should offset some of the inevitable losses when Keytruda faces patent expirations in 2028. Current forecasts predict Qlex will capture around a third of Keytruda’s sales in 2030.

Outside of pembrolizumab, Merck’s marketed offering in oncology is very small when compared to the other leaders in the space, although it has several licensing deals in place for cancer assets - including co-marketing for AstraZeneca’s PARP inhibitor Lynparza (olaparib). Merck also has one of the smaller oncology pipeline portfolios where its lead prospect, according to current consensus forecast, is the cytotoxic T-lymphocyte (CTL) stimulant intismeran autogene, which Merck has access to via a deal with RNA therapeutic developer Moderna.

Bristol Myers Squibb

Similar to Merck, BMS’s revenue stability in recent years was anchored by the PD-1 inhibitor Opdivo, which achieved $9.3bn in 2024. However, BMS has a broader checkpoint inhibitor franchise including Yervoy (ipilimumab), the CTLA-4 antagonist, and Opdualag (nivolumab + relatlimab) – the former of which lost its market exclusivity in 2025. The issue of an aging portfolio also extends into BMS’s multiple myeloma offerings. In 2024, the company pulled in around $7bn in sales in the indication, primarily due to its oral immunomodulatory drugs - Revlimid (lenalidomide) and Pomalyst (pomalidomide) – both of which are now off-patent.

BMS is a leader in CAR-T therapy with Breyanzi (lisocabtagene maraleucel), marketed in large B-cell lymphomas, being the second best-selling therapy in this emerging mechanism. The company also has a robust and expansive pipeline of clinical-stage assets to try and fill the large gaps in its oncology revenue left by patent expirations.

Roche

Roche’s oncology offering is led by its HER2 monoclonal antibody franchise led by the quad of Herceptin (trastuzumab), Perjeta (pertuzumab), Kadcyla (ado-trastuzumab emtansine), and combination drug Phesgo. The first three of these drugs are already out-of-patent with Phesgo set to go generic in 2027. The HER2 franchise is also under competitive pressure from AstraZeneca and Daiichi Sankyo’s antibody-drug conjugate Enhertu, causing Roche to shift its pipeline investment which now focuses heavily on antibody drug conjugates and T-cell engagers.

Roche’s single best-selling cancer drug in 2024 was the PD(L)-1 antibody Tecentriq. Although its patent expiration date is further out than many of its competitors, Tecentriq is facing the same problems of pricing pressures and market maturity as the rest of the PD(L)-1 market.

In addition to its solid tumour portfolio Roche also owns several blockbuster blood-cancer treatments including the aging NHL treatment Rituxan (rituximab) and its successors Gazyva (obinutuzumab), and Polivy (polatuzumab vedotin). Roche also has US sales rights for the oral BCL-2 inhibitor Venclexta (venetoclax) which it jointly develops and markets with AbbVie.

AstraZeneca

AstraZeneca’s portfolio shows a high emphasis on targeted therapies and precision medicine. Tagrisso (osimertinib), Astra’s top oncology asset, is the market leading EGFR inhibitor for EGFR-mutated NSCLC and continues to expand into adjuvant and combination settings. Lynparza (olaparib, co-developed with Merck) is used in BRCA-mutated ovarian, breast, pancreatic and prostate cancers. Calquence (acalabrutinib) is a Bruton’s tyrosine kinase inhibitor for chronic lymphocytic leukaemia and mantle-cell lymphoma. Enhertu (fam-trastuzumab deruxtecan), an ADC partnered with Daiichi Sankyo, is approved for HER2-positive and HER2-low breast cancer and has entered lung and gastric cancer indications.

Imfinzi (durvalumab) is Astra’s contribution to the PD-(L)1 inhibitor market and the company’s second best-seller in cancer. In the face of this maturing market Astra has been moving into combination therapies with the CTLA-4 antibodies such as Imjudo (tremelimumab). AstraZeneca is also exploring PD-1/CTLA-4 bispecifics such as volrustomig.

The company’s late-stage candidates reinforce the strategy of layering targeted therapies, immunotherapies, ADCs and bispecifics. With its best-forecast assets including the oral selective oestrogen-receptor degrader camizestrant, PD-1/CTLA-4 bispecific volrustomig, and the highly selective PARP1 inhibitor saruparib.

Johnson & Johnson (J&J)

Johnson & Johnson’s anti-CD38 monoclonal antibody Darzalex is the standard-of-care therapy for multiple myeloma and is the backbone of the company’s oncology portfolio. Darzalex (daratumumab) and its subcutaneous formulation, Darzalex Faspro, earned over $11bn. Although Darzalex has protection from generics out until 2029 J&J has rapidly introduced a string of next-generation therapies for multiple myeloma over the last few years: the BCMA-directed CAR-T therapy Carvykti, the BCMA/CD3 bispecific Tecvayli, and the GPRC5D/CD3 bispecific Talvey.

Outside of myeloma J&J also has a presence in prostate. Erleada (apalutamide), an androgen-receptor inhibitor for metastatic and non-metastatic castration-resistant prostate cancers, is a strong contributor to J&J’s oncology revenue alongside its predecessor, Zytiga (abiraterone acetate). J&J also commercializes the multiblockbuster tyrosine kinase inhibitor (TKI) Imbruvica in a joint partnership with AbbVie across several B-cell malignancies.

In Summary

Recent and impending patent expirations are set to reshape the competitive landscape among the leading oncology players. The pressure is particularly acute for those whose pipelines lack late-stage assets ready to fill the gaps left by aging blockbusters.

Evaluate forecasts for 2032 show both Bristol-Myers Squibb and Merck dropping out of the top five, with Merck tumbling down the sales rankings to 10th spot. Potentially, the oncology stalwarts will be replaced by the likes of Daiichi Sankyo and Novartis.