The Changing Shape of Oncology Innovation
Author: Abby Kim, PharmD, BCOP
For those who follow oncology closely, the pace of therapeutic innovation has become both familiar and formidable. Each year brings a steady stream of new approvals, expanded indications, and evolving standards of care.¹ Against this backdrop, the 2026 Oncology Drug Report* offers a nuanced snapshot of how clinicians are engaging with innovation today, one that suggests oncology is not slowing down, but changing in how new therapies are introduced, selected, and applied in practice.² Rather than reading the report as a measure of momentum or restraint, its greatest value may lie in what it signals about the maturing complexity of oncology care.
A Snapshot of Selective Adoption
The 2026 report reinforces several themes familiar to oncology stakeholders. As shown in the tables below, while a growing proportion of oncologists report prescribing at least one newly approved therapy each year, prescribing patterns have shifted toward a smaller, more focused set of new drugs, most commonly one to three agents annually. This pattern reflects a maturing oncology landscape in which clinicians are increasingly selective about which innovations add meaningful value in routine practice. Clinicians most commonly cite high drug list prices, challenges with toxicity management and limited data at the time of adoption to be key drivers of these prescribing trends.¹
Have you prescribed new drugs or drugs with new indications during the past year? 1
| 2022 | 2023 | 2024 | 2025 | |
|---|---|---|---|---|
| Yes | 59% | 70% | 80% | 87% |
| No | 41% | 30% | 20% | 13% |
How many new drugs/indications have you prescribed in the past year? 1
| 2022 | 2023 | 2024 | 2025 | |
|---|---|---|---|---|
| 1-3 | 30% | 33% | 33% | 49% |
| 4-6 | 40% | 37% | 34% | 28% |
| 7-9 | 10% | 7% | 13% | 9% |
| 10+ | 20% | 22% | 20% | 13% |
Concerns about pricing remain prominent, reflecting the continued introduction of high‑cost agents and the expansion of existing therapies into earlier lines of treatment and longer durations of use. Toxicity management also features heavily, particularly as newer modalities introduce adverse event profiles that can be challenging to anticipate and manage consistently across diverse sites of care – academic to community and inpatient to outpatient. At the same time, clinicians cite limitations in the evidence base at the time of approval, noting that many newer oncology therapies enter practice supported by surrogate endpoints, with longer‑term outcomes and real‑world performance still evolving post‑approval.¹
Administrative considerations, including prior authorization, continue to factor into treatment decisions but appear to be less prominent than in prior years, based on comparisons between 2024 and 2025 responses.¹ This shift may reflect recent prior authorization reform efforts and greater alignment between coverage policies and evidence based‑ clinical guidelines, even as access and affordability remain central considerations.³
When clinicians were asked to identify drugs that have most changed practice in the last year, pembrolizumab again stood out, reflecting its broad use across multiple cancer types. Firmly embedded in oncology practice and top of mind for providers, pembrolizumab continues to exert a significant influence on oncology spend. While the anticipated loss of exclusivity later this decade is often cited as a potential inflection point for cost, that expectation is complicated by ongoing product evolution, including the recent approval of a subcutaneous formulation.⁴ In contrast, the remaining agents most frequently cited were concentrated in breast cancer, underscoring the rapid and sustained pace of innovation in this disease area.¹ Given that breast cancer already represents the highest oncology spend among all cancer types, this continued innovation suggests that utilization pressures in this category are likely to persist and likely increase making it one to watch closely.⁵
Top Drugs that Changed Practice in 2025 1
| Pembrolizumab (Keytruda) |
| Trastuzumab deruxtecan (Enhertu) |
| Ribociclib (Kisqali) |
| Datopotamab deruxtecan (Datroway) |
The Next 10 Years
Looking ahead, clinicians point to a 10-year outlook of the oncology landscape dominated by highly advanced and highly expensive therapies, including cell and gene therapies, bispecific antibodies, antibody–drug conjugates, and radiopharmaceuticals. These modalities are widely viewed as practicechanging, but they also carry substantial clinical and operational complexity alongside significant cost. The prominence of these therapies in clinicians’ long-term outlook reinforces that innovation in oncology is expected to intensify cost pressures.¹
Why This Matters for Managed Care
Taken together, these findings highlight why provider focused reports like the Oncology Drug Report are especially valuable for managed care audiences. They offer early insight into how innovation is being prioritized, operationalized, and challenged in real-world practice, often before changes are fully reflected in utilization or claims data. Understanding where clinicians see promise, friction, and unmet need creates an opportunity for ongoing collaboration between payers and providers to design oncology care models that are more aligned, efficient, and sustainable. As oncology continues to evolve toward greater complexity and cost, incorporating provider perspectives is essential to building systems that support access while navigating the realities of high cost, high impact care.
*The Oncology Drug Report is conducted via an online survey. Respondents were asked about their practice patterns and opinions during the past 12 months. There were 293 total respondents, with 77% being physicians, along with physician assistants, nurses/advanced practice nurses, and pharmacists. The majority of respondents reported being in practice for more than 10 years.¹
References
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U.S. Food and Drug Administration. Oncology (Cancer)/Hematologic Malignancies Approval Notifications. FDA website. Accessed April 8, 2026. https://www.fda.gov/drugs/resources-information-approved-drugs/oncology-cancerhematologic-malignancies-approval-notifications
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Oncology News Central Editorial Team. Oncology Drug Report 2026. Oncology News Central. Published January 23, 2026. Accessed April 8, 2026. https://www.oncologynewscentral.com/oncology/oncology-drug-report-2026
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Emerson J. Insurers have cut prior auth requirements by 11%: AHIP‑BCBS. Becker’s Hospital Review. Published April 7, 2026. Accessed April 8, 2026. https://www.beckershospitalreview.com/finance/insurers-have-cut-prior-auth-requirements-by-11-ahip-bcbsa/
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Manalac T. As exclusivity loss looms, Merck wins subcutaneous approval for Keytruda. BioSpace. Published September 22, 2025. Accessed April 8, 2026. https://www.biospace.com/fda/as-exclusivity-loss-looms-merck-wins-subcutaneous-approval-for-keytruda
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Prime Therapeutics LLC. Prime Therapeutics Medical Pharmacy Trend Report™. Fifteenth ed. Published 2025. https://www.primetherapeutics.com/mp-trends
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