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Institute Report
Global Oncology Trends 2023
Outlook to 2027
May 24, 2023
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Report Summary

The global oncology ecosystem continues to discover, develop, and deliver important novel treatments that are intended to bring improved outcomes for an increasing number of patients. While this is a strong testament to the ingenuity and innovative power of the stakeholders involved, at the same time global oncology is facing complex challenges reflected in the trends highlighted in this report.

The research of the IQVIA Institute profiles the current state of research and development in oncology, including key mechanisms, targets and cancer types being investigated as well as pointing to some novel areas which are only just emerging. We also look at metrics of clinical development productivity and the progress being made to improve representativeness of race and ethnicity in clinical trial populations.

As more novel cancer medicines are launched, patient access and use of those drugs vary widely around the world. Trends in the use of novel mechanisms in specific cancer types are reported here and intended to provide an evidence base that encourages stakeholder discussion.

Finally, the costs associated with treating more patients for longer and with more advanced therapies is bringing stress to healthcare budgets, even as the broader adoption of biosimilars provides some relief. How these spending dynamics will play out over the next five years globally is also examined in this report.

Key findings:

  • Oncology trial starts remained at historically high levels in 2022, up 22% from 2018
  • The global number of treated patients has increased annually by an average of 5% over the past five years
  • Spending on cancer medicines is expected to reach $375Bn globally by 2027, up from $196Bn in 2022
  • Oncology clinical trial representation for Black/African American and Hispanic patients was 80% and 61% below the 2019 U.S. cancer incidence respectively
  • Emerging biopharma companies led innovation in oncology in 2022 and account for 71% of the pipeline

Other findings:

  • The number of products under development in oncology has grown significantly over the last decade, with more than 2,000 products currently under development.
  • Emerging biopharma companies — defined as those with less than $500Mn in annual sales and R&D spending less than $200Mn per year — are responsible for 71% of products currently under development for cancers, an increase from 51% in 2017.
  • Large pharma companies — those with greater than $10Bn in annual sales — have seen a declining share of the oncology pipeline, responsible for 21% of products currently under development, down from 36% in 2017.
  • White patients are included in oncology trials at rates close to their U.S. cancer incidence and are experiencing cancer mortality at rates that are consistently close to the average mortality across all cancers and a selection of eight specific cancers.
  • In contrast, Black/African American patients have been included in clinical trials at only 45% the level of the average incidence across all cancers, and in only one of the cancer-specific cases analyzed are Black/African American patients included in clinical trials at more than 50% the expected rate based on cancer-specific incidence.
  • Hispanic trial inclusion across all oncology trials is only 53% of the U.S. Hispanic cancer incidence rate, and no individual specific cancer type analyzed had more than 60% of the incidence predicted Hispanic patients included in trials completing between 2013 and 2022.
  • Globally, 237 NASs have launched to treat cancers in the last 20 years, with nearly half of these (115) in the last five years.
  • The U.S. has seen 78 NAS launches for oncology in the last five years, with 189 over the last 20 years, and has consistently been first to launch the majority of new cancer medicines worldwide.
  • Notably, 40 global NASs launched in the last five years have not launched in the U.S., and all but four were first launched in China or Japan, suggesting the emergence of divergent sources and destinations of innovation.
  • Aging populations and robust access to care are driving steady levels of cancer treatment in developed markets.
  • Widening access to care in lower income markets, along with longer treatment durations, are resulting in higher numbers of patients receiving treatment each year, with treatment regimens growing globally an average of 5% annually over the last five years.
  • Per capita rates of treatment remain highest in developed countries, averaging more than five times the level in lower income and pharmerging countries.
  • Collectively, the top five tumor types (breast cancer, non-small cell lung cancer, prostate cancer, multiple myeloma, prostate cancer, and kidney cancer), account for 53% of all oncology sales.
  • The continued launch of innovative medicines is one of the key drivers fueling the growth across different tumors (Exhibits 29 and 30).
  • The high value growth observed in NSCLC, kidney cancer and SCLC can be attributed to the expansion of PD-1/PD-L1 Inhibitors in these patient groups. Prior to the launch of this class of products, targeted therapy options were limited in a few of these cancer types.
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