Trends in the Oncology Pipeline

Global spending on cancer medications in 2022 was $196 billion, and that number is expected to jump to $375 billion by 2027, according to a keynote presentation at AMCP Nexus 2023. With many more oncologic agents in the pipeline, and the high costs often associated with these medications, managed care professionals need to understand the trends and areas of greatest growth.

Among current trends, next-generation biotherapeutics are a significant portion of the hematological cancer pipeline. Also growing are bispecific T-cell engager therapy (also known as BiTE therapy), antibody-drug conjugates, chimeric antigen receptor T-cell therapy, and cancer vaccines. However, growth of immuno-oncology treatments is beginning to taper, said the speakers, Kaelyn C. Boss, PharmD, a clinical consultant pharmacist at forHealth Consulting at the University of Massachusetts Chan Medical School, and Bhavesh H. Shah, RPh, BCOP, chief pharmacy officer for hematology/oncology and specialty pharmacy at Boston Medical Center Health System. Another important trend involves biosimilars, which saved $5.5 billion in 2022.

When examining the number of medications in the pipeline by cancer type, unspecified solid tumors is the area with the most medications under development, followed by leukemia, lung cancer, lymphoma, hematologic malignancies, and breast cancer.

The speakers then reviewed some of the most recent approvals and the important drugs in the pipeline, including several facing FDA review.

Areas that have the most promise with novel agents are:

  • Multiple myeloma, including several novel supportive care regimens.
  • Leukemia and lymphoma, which are seeing advancements in refractory disease.
  • Melanoma, now being treated with first-in-class tumor-infiltrating lymphocyte therapy.
  • Lung cancer, experiencing second- and third-in-class small-molecule therapies as well as improved administration of existing agents.
  • Hepatocellular carcinoma, where first-line treatment options are expanding with checkpoint inhibitor combination therapies.
  • Rare cancers (such as uveal melanoma with liver metastases and desmoid tumors), an area that is seeing more treatments aimed at metastases.


Boss KC, Shah B. Oncology Pipeline: Shaping 2023 and Beyond. Session K3. Presented at AMCP Nexus 2023; Oct. 16‒19, 2023; Orlando, Fla.