14. AstraZeneca

While AstraZeneca's oncology unit posted notable wins in 2018, other areas of its business struggled. (AstraZeneca)

2018 revenue: $21.05 billion
2017 revenue: $22.50 billion
Headquarters: London

AstraZeneca may have finally returned to growth in the second two quarters of 2018, but for the year, the patent-cliff-stricken pharma still saw its revenue haul drop. The decline dropped it to No. 14 on this year’s list from the No. 13 spot last year, with Opdivo-driven Bristol-Myers Squibb jumping ahead to sink it in the rankings.

Still, the year marked a big turning point for AstraZeneca and its executives, who have been promising a pivot for the last few years as generics ate into blockbusters Nexium and Crestor. And the company has its oncology unit to thank.

For 2018, AZ’s cancer portfolio brought in $6.03 billion, a big jump over the $4.02 billion it tallied in 2017 and the $3.38 billion it mustered the year before that. Two treatments cracked the blockbuster barrier: Tagrisso and Faslodex, which churned out $1.86 billion and $1.03 billion, respectively.

Tagrisso, whose sales potential executives have been quick to tout, got an especially big $905 million boost after snagging a key FDA approval last April. The agency greenlighted the drug in previously untreated EGFR mutated lung cancer, an indication executives have said could eventually help grow sales to $3 billion.

RELATED: AstraZeneca gets back to growth, but can it hit $40B by 2023? CEO says yes—again

The go-ahead was a welcome one, especially in light of first-line failures for another big AstraZeneca cancer prospect, Imfinzi. The British drugmaker’s entrant in the PD-1/PD-L1 category flunked across the board in front-line non-small cell lung cancer, both on its own and in tandem with CTLA4 candidate tremelimumab.

On the other side of the coin, though, the immuno-oncology drug did bag a $1 billion lung cancer approval early in the year—and it did so in a setting where it’ll be a while before its rivals show up. The drug was first in its class to net an FDA blessing in stage 3 lung cancer, setting it up for some competition-free time in the market.

AstraZeneca also has Lynparza, the leading member of the red-hot PARP class, contributing to the sales mix, and that therapy brought in $647 million in 2018. It was helped by a first-in-class breast cancer approval last January, and another positive regulatory decision from December—which set the drug up for blockbuster sales in ovarian cancer maintenance—should keep the momentum going in 2019.

RELATED: AstraZeneca's Imfinzi breaks new I-O ground with landmark $1B lung cancer nod

Unfortunately for AZ, things didn’t look too hot outside the cancer arena. Respiratory sales managed to hold their ground thanks in part to a strong start for eosinophilic asthma newcomer Fasenra, with the unit eking out $4.91 billion in 2018 sales after posting $4.71 billion the year before. But sales of AstraZeneca’s cardiometabolic portfolio slipped to $6.71 billion from $7.27 billion in 2017.

AstraZeneca is going to need more out of those divisions if it hopes to hit a growth target CEO Pascal Soriot has outlined time and time again: $40 billion by 2023. If it can hit that lofty mark, it’ll join the ranks of GlaxoSmithKline and Sanofi in the sales department.

14. AstraZeneca