Oncology trial starts hit record levels as COVID disruptions ease: report

Oncology trial starts reached record levels in 2021—particularly in rare indications—as disruptions in cancer care brought on by the COVID-19 pandemic began to ease, according to the IQVIA Institute for Human Data Science.

The return to pace after a disruptive two years, when patients stayed home and missed crucial checkups, is certainly good news. But the IQVIA Institute’s new report did show that oncologists reported more new patients presenting with cancer that had spread due to delays in diagnosis and screenings.

“Global oncology is a bifurcated tale of two very different worlds,” said Murray Aitken, executive director of the IQVIA Institute. “On the one hand, we are witnessing a remarkable surge in R&D and innovation, potentially leading to new therapies for unresolved cancers. On the other hand, the global oncology community and patients continue to struggle with the impact from delays in screenings, diagnoses and cancer care. Even with the bright outlook for R&D and innovation, it will take a while for the oncology community to work its way through these challenges.”

The new report, "Global Oncology Trends 2022," found that cancer trial starts were up 56% in 2021 compared to 2016, with a focus on rare indications. Meanwhile, a record 30 novel active substances for cancer launched around the world, bringing to 159 the total number of therapies that have hit the market since 2012.

Oncologists reported a continued decline in caseloads for the year, about 20% to 29% below what they saw pre-COVID. But cancer screenings in the U.S. have returned to normal levels. More than 30 million screenings for four common tumors were disrupted during the pandemic, which means delayed or missed diagnoses for an estimated 58,000 patients.

But spending on oncology R&D has nevertheless continued to accelerate and is expected to exceed $300 billion by 2026, the IQVIA Institute said. Spending rose to $185 billion globally in 2021. Major markets including the U.S., Europe and China are seeing growth spurred by innovation, with new products and brand volume offsetting new competition brought by the loss of exclusivity on older meds and biosimilars.

R&D is happening faster and faster, with many therapies going from patent filing to product launch in less than five years.

While the focus in oncology tends to be on metastatic or advanced cancers, the report noted that more research is focusing on early cancer and vaccines, with this field doubling in the past 10 years. The composite success rate for oncology trials has been overall trending downward since 2015, hitting 5.2% in 2021, while rare tumors saw a higher success rate at an average of 15.6%.

Another trend is that emerging biopharma companies are becoming more prominent in cancer research. The IQVIA Institute found that 68% of the oncology pipeline came from these companies compared to 45% a decade ago.

The report also noted some concerning trends in the rollout of new therapies across countries. Differences in biomarker testing, adoption of novel therapies and infrastructure capacity means that some new treatments haven’t reached patients. For instance, checkpoint inhibitors are being used at rates two to three times higher in developed nations compared to lower income nations. Cell and gene therapies similarly are not being offered to all patients, although the number of centers with CAR-T offerings is growing.

The IQVIA Institute for Human Data Science provides research and analysis collected from life sciences analytics company IQVIA’s non-identified patient-level data.