Global Spending on Cancer Drugs to Increase to $409 Billion

Global spending on cancer medications increased to $223 billion in 2023 and is projected to rise to $409 billion by 2028, according to the Global Oncology Trends report from IQVIA Institute for Human Data Science.

In the United States, spending on oncology therapies rose to $99 billion in 2023, and is expected to grow to nearly $180 billion in 2028. The growth was driven by brand volume and new products.

In the report, IQVIA researchers outlined several trends in spending on oncology drugs, as well as drug development. They found that global spending on next-generation products to treat cancer could rise from $4 billion in 2023 to $23 billion by 2028. Novel therapies, including cell and gene therapies, antibody-drug conjugates (ADCs), and multispecific antibodies, represent a growing share of clinical research.

Murray Aitken

“As more novel cancer medicines are launched, patient access and use of those drugs vary widely around the world and by some measures the gaps between the science and patients is expanding. Trends in the use of novel mechanisms in specific cancer types are reported here as well as current expectations for how spending dynamics will play out over the next five years,” Murray Aitken, executive director of IQVIA Institute for Human Data Science, wrote in the introduction of the report.

More than 250 trials testing CAR-T cell therapies in oncology started in 2023, with most being studied to treat patients with hematological cancers. The first CAR T-cell therapy, Novartis’s Kymriah (tisagenlecleucel) was approved and launched for treatment of acute lymphoblastic leukemia (ALL) in 2017. Globally, there are currently eight approved CAR-T therapies, six in the United States. There are currently 913 ongoing CAR T trials, with 80% of these for hematological cancers.

Another area of novel therapies, antibody drug conjugates, a class of targeted therapies. There are currently 15 approved globally and the number of trials grew 26% in 2023, according to IQVIA. The first ADC approved was Mylotarg (gemtuzumab ozogamicin), received accelerated approval in 2000 but was later withdrawn from the market following serious safety concerns. It was reintroduced in 2017. These now account for 25% of oncology trials, according to IQVIA.

Another novel area of research is bispecific antibodies, which are designed to bind to two different antigens. Globally, there are10 bispecific antibodies are marketed. In the United States in 2023, the FDA approved four bispecific antibodies – Epkinly (epcoritamab), Elrexfio (elranatamab), Columvi (glofitamab), and Talvey (talquetamab) –for hematological cancers. More recently, the FDA granted accelerated approval in May to Amgen’s Imdelltra (tarlatamab-dlle) to treat adult patients with extensive-stage small cell lung cancer, making it the first bispecific antibody for solid tumor.

More than 150 bispecific antibodies trials are ongoing for cancer treatment, with 82% being conducted in solid tumor cancers, according to IQVIA. More of the bispecifics in development are in late-stage development.

Many of these breakthroughs are designed to be used in earlier lines of treatment or are being developed to be used in combination to address drug resistance. The FDA, IQVIA said, is taking the lead with several newer projects that are part of the Oncology Center of Excellence. One is Project FrontRunner, which began in November 2022. FDA officials have identified treating early metastatic disease as a priority and are collaborating with sponsors to development treatments that improve quantity and quality of life.

Another regulatory program focused on oncology drug development is Project Endpoint, which began in 2022 and aims to collaborate with sponsors on endpoint development in clinicals. Project Optimus is an initiative to reform dose optimization in cancer drug development.

Many of the therapies approved to treat cancer have been approved with a single-arm study and limited data, finds IQVIA. The FDA’s Project Confirm aims to provide transparency of outcomes related to accelerated approval of oncology therapies.

IQVIA highlights recent research that showed oncology drugs often little or no added benefits. Published in February 2024 in the British Medical Journal, this research looked at oncology drugs approved by the European Medicines Agency from 1995 to 2020. his finding They found this was especially true for drugs approved through expedited pathways. Researchers in this study also found that no correlation between drug prices and company R&D expenses.