Bristol's Abecma, Amgen's Lumakras headline record-setting oncology launch class as costs continue to balloon: IQVIA

A flurry of innovation in oncology has led to a record number of new cancer drugs launched globally in 2021. But spending on oncology medicines also reached a new high.

The world welcomed 30 novel oncology medicines in 2021, IQVIA found in its annual Global Oncology Trends report published Thursday. That’s compared to 104 new rollouts in the past five years.

But as more treatments become available, global spending on cancer drugs is also on the rise. Last year, global oncology spending jumped $20 billion to a record $185 billion. The number will continue to go up and is expected to reach $307 billion in 2030, IQVIA says.

Among the 2021 class of launches, 22 were from the U.S., including two diagnostic agents. These include the first BCMA-targeted CAR-T therapy, Bristol Myers Squibb’s Abecma; Amgen’s first-in-class KRAS inhibitor Lumakras; and Novartis’ novel STAMP inhibitor Scemblix, a follow-up to Gleevec for chronic myeloid leukemia. Among them, 14 drugs got their initial go-ahead under the FDA’s accelerated approval pathway.

By IQVIA’s tally, China had the second most new cancer drug launches during the last five years, surpassing the combination of five European countries, namely, France, Germany, Italy, Spain and the U.K. That trend was driven by a regulatory review reform by Chinese authorities.

Notably, 21 new oncology molecules launched in the last five years haven’t reached the U.S. These include several PD-1 inhibitors developed by Chinese companies, such as Innovent Biologics and Eli Lilly’s sintilimab, which was first cleared in China in 2018 but was rejected by the FDA earlier this year because of concerns over China-only data.

Since approvals for the first PD-1 inhibitors in 2014, the field has ballooned into arguably the largest oncology sub-area. In its report, IQVIA calculated 5,761 trials globally involving PD-1/L1 inhibitors. Nearly 90% of new trials of PD-1/L1 meds starting in 2021 are testing them in combination with other therapies.

Just as checkpoint inhibitors like Merck & Co.’s Keytruda are widely utilized across multiple tumor types, they have also driven up spending on cancer medicines overall. Last year, checkpoint inhibitors cost the world $35 billion, up from $5.6 billion in 2016. As PD-1/L1 inhibitors are used in combinations to reach more patients, the upward trend will continue, IQVIA projects.

But PD-1/L1s aren’t the only driving force behind increased cancer drug expenditure. In the U.S., the number of new cancer drugs that cost over $200,000 a year is on the rise, accounting for a third of launches in the past five years, up from 2% in the 2012 to 2016 timeframe.

Of the total $185 billion global spending on cancer drugs in 2021, $75.5 billion came from the U.S. The U.S. contributed $70.7 billion to the global tally in 2020 and $43.7 billion in 2016.

Moving forward, IQVIA expects U.S. spending growth to remain in the 9% to 12% range annually as the effect from the initial rollout of biosimilars to widely used therapies such as Roche’s blockbuster troika—Herceptin, Rituxan and Avastin—wanes.