Global Oncology Trends Highlight Rising Cancer Costs, Access Disparities, and Treatment Innovations

Despite advances in diagnostics, screenings, and treatment, cancer remains a life-altering and fatal disease. According to IQVIA’s Global Oncology Trends 2024 report, cancer incidence is projected to rise significantly through 2050, especially in lower-income countries. In 2023, global spending on cancer medicines reached $223 billion, with projections indicating it could grow to $409 billion by 2028. At the NCODA Fall Summit in Orlando, Florida, Doug Long, Vice President of Industry Relations at IQVIA, provided insight into the expansion of the US oncology market, emphasizing cancer-related costs, incidence and mortality trends, research and development, the emergence of targeted therapies, cell and gene therapies, AI, and equity issues.^1,2

Novel oncology mechanisms, such as cell and gene therapies, have seen notable growth, now comprising 25% of all oncology trials. Image Credit: © aicandy - stock.adobe.com

The oncology market can be divided into 4 main segments: total oncology, cytotoxic, hormonal, and targeted therapies, each with unique growth rates. The total oncology market is experiencing a growth rate of approximately 20%, with high growth in cytotoxic and hormonal therapies compared with targeted therapies. Additionally, radiopharmaceuticals are showing signs of market recovery and rising sales. The adoption of biosimilars in oncology has been substantial, with over 50% uptake across major markets, leading to sales declines for other products. According to Long, biosimilars saved payers $7 billion in 2023 alone, amounting to $19 billion since 2017.

“Generally, when you have a loss, there is a biosimilar or generic involved. So, as you go down the list, you’d expect which ones have seen losses: Avastin [bevacizumab; Genentech], Herceptin [trastuzumab; Roche], Zytiga [abiraterone acetate; Janssen Biotech, Inc], things of that sort,” he noted. “Losses often result from patent expirations or biosimilars.”

Cancer incidence and mortality trends are rising, with an estimated 12 million new cases per year projected over the next 25 years, particularly in Asia-Pacific and Africa. Data show significant disparities in 5-year survival rates across countries with similar gross domestic products. Since the COVID-19 pandemic, screenings have decreased across cancer types, causing missed opportunities for early detection.

“Early detection is critical. But if people aren’t getting screened, it’s hard to detect that they have cancer,” Long said. “Many cancers are now much more survivable, and real-time benchmarking is becoming more important, particularly for melanoma, prostate, cervical, and brain cancers.”

Survivorship rates have improved overall, with testicular cancer and melanoma having higher rates than gastrointestinal, esophageal, liver, mesothelioma, and lung cancers. Pancreatic cancer survival rates, for example, have increased by 160%, with patients’ survival rising from 6.15% to 16%, despite a typical life expectancy of around 6 months from diagnosis.

These increases in survivorship are largely due to persistent advancements in oncology research and clinical trials. However, the number of oncology trials has declined in 2023 across various phases, although solid tumor trials are increasing. Rare disease oncology trials are decreasing, while hematologic trial levels remain stable. According to Long, China has now surpassed the US in the number of oncology trials, which may pose challenges due to the lack of FDA inspections of Chinese manufacturing facilities. Biopharma companies have taken a more active role in conducting oncology trials, supplementing efforts by established pharmaceutical companies and increasing trial availability in the US.

Novel oncology mechanisms, such as cell and gene therapies, antibody-drug conjugates, and multispecific antibodies, have seen notable growth, now comprising 25% of all oncology trials. This shift is particularly pronounced in solid tumor research rather than hematologic cancers, marking a new direction in the research landscape.

“These are the new things. You see a big increase in novel oncology mechanisms like cell and gene therapy, with more happening in solid tumor categories than in hematology cancers,” Long said. “There’s a lot of movement here.”

AI is also on the rise and is already being used in drug design, target identification, and precision medicine. It holds promise for drug discovery by helping to identify which cancers may be targeted by new therapies and can assist with transition planning. Additionally, AI could help overcome the “oncology crowd mentality,” where numerous companies and researchers focus on the same popular targets, by identifying less-explored cancer types worth investigating.

Despite these advancements, barriers to treatment remain, including financial toxicity, inadequate health care infrastructure, and drug shortages. Cancer medications are highly expensive, as seen in oncology spending projections, and many patients cannot afford them or lack adequate insurance. This issue is particularly acute for advanced therapies such as CAR T-cell therapy, where reimbursement remains a barrier to access.

Inadequate health care infrastructure also impacts patients. For instance, the limited number of treatment centers for CAR T-cell therapy—only 522 worldwide—restricts patient access to this advanced care. Long also highlighted the issue of “pharmacy deserts,” which further limit access to cancer medications and supportive care.

“The new issue I’m focusing on is pharmacy deserts, especially retail pharmacy deserts,” Long said. “With Walgreens recently announcing the closure of 1200 stores, more pharmacy deserts will likely emerge, particularly in urban and rural areas.”

Drug shortages are another growing concern. Following Hurricane Helene, critical facilities for IV fluids and other essential medications were damaged, causing widespread shortages in hospitals across the country. This situation underscores a growing concern that climate change, through increasingly severe and frequent storms, could disrupt health care supply chains and threaten patient access to life-saving treatments. As climate events escalate, ensuring the resilience of pharmaceutical manufacturing and distribution systems is crucial for protecting public health.^3,4

While breakthroughs in cancer treatments and technology bring new hope to patients, significant challenges persist. Rising cancer incidence, disparities in access to care, and obstacles like high costs and infrastructure limitations affect low-income and underserved populations disproportionately. Although innovations such as biosimilars and targeted therapies help reduce costs and improve accessibility, ongoing issues such as pharmacy deserts, drug shortages, and financial toxicity hinder equitable cancer care. Addressing these challenges requires collaboration across health care systems, policymakers, and communities to ensure that advances in oncology benefit patients everywhere, regardless of socioeconomic status or location.

REFERENCES

1. Global oncology trends 2024: outlook to 2028. Iqvia. May 28, 2024. Accessed October 25, 2024. https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/global-oncology-trends-2024

2. Long D. New options for patients: latest oncology drug trends. NCODA Fall Summit. October 25, 2024. Orlando, Florida.

3. Iv shortage update: baxter facility damage after hurricane in north carolina 2024. American Medical Association. October 23, 2024. Accessed October 25, 2024. https://www.ama-assn.org/delivering-care/public-health/iv-shortage-update-baxter-facility-damage-after-hurricane-north

4. Long before helene, iv fluid shortages plagued hospitals. NBC News. October 18, 2024. Accessed October 25, 2024. https://www.nbcnews.com/health/health-news/long-helene-iv-fluid-shortages-plagued-hospitals-rcna175563