Download the Visual
Pharma oncology growth comes from owning a backbone and combining any modality around it
To grow in oncology, big pharma needs to own a backbone therapy that works across tumors and build combinations on top of it, in whatever modality fits. That is the playbook in Sleuth’s August 2025 analysis of 12 oncology-focused pharma companies, most of which ran their pipelines on one or two modalities about five years earlier. By 2025, ADCs, T-cell engagers, multispecifics, targeted therapies and radioligands sit in the same portfolio and are frequently combined.
Sell-side forecasts reshuffle the oncology revenue rankings by 2030
Johnson & Johnson rises from fifth in 2024 oncology revenue ($20.8 billion) to first in 2030 ($36.8 billion) on Darzalex, Carvykti, Tecvayli and ADC launches. AstraZeneca moves from fourth to second ($22.4 billion to $29.5 billion) on Tagrisso, Enhertu and new ADC and radiopharma launches, and Pfizer from seventh to fifth ($15.6 billion to $20.6 billion) on ADCs from Seagen. Daiichi Sankyo makes the biggest jump in rank, from twelfth to seventh ($4.5 billion to $17.8 billion), on Enhertu, Datroway and other ADCs.
Merck falls from first to third ($32.7 billion to $25.1 billion) as Keytruda faces loss of exclusivity (LOE) and Inflation Reduction Act (IRA) price negotiation, partly offset by subcutaneous Keytruda, which the FDA approved as Keytruda Qlex in September 2025, and by ADCs. Roche, BMS and Novartis slip on biosimilars and LOEs, and Astellas drops furthest in rank, from tenth to eighteenth ($7.3 billion to $4.3 billion), on Xtandi’s LOE. Amgen, Lilly and AbbVie grow oncology revenue but lose rank; the 2030 ranks include companies outside the 12.
Rank moves come down to two forces: when a company’s anchor franchise loses exclusivity, and how quickly it adds new modalities on top.
Each generation of cancer care has had a backbone, and pharma needs to own one
In Sleuth’s view, each generation of cancer treatment has had a backbone therapy that works across tumor types, most recently PD-(L)1 inhibitors. PD-(L)1 x VEGF bispecifics may be next, which helps explain the recent flurry of PD-(L)1 x VEGF deals. As of September 2026, that was still unproven: ivonescimab, the lead PD-(L)1 x VEGF bispecific, missed statistical significance on progression-free survival at a May 2026 interim analysis of HARMONi-3, its first-line NSCLC trial. Owning the backbone is table stakes for controlling clinical development: without one, a company depends on partners for every combination it wants to run.
That is why so many large pharma companies built their own PD-(L)1 inhibitor even as “another PD-1” became shorthand for inefficient R&D. The drug does not have to sell well; it has to give the company its own combination partner.
For pharma, the backbone is a strategic asset first and a revenue line second.
Modality flexibility plus tumor focus is the new playbook
The 2025 franchise profiles show the shift. Merck has diversified beyond Keytruda into ADCs, T-cell engagers from Harpoon, next-generation IO combinations and personalized cancer vaccines with Moderna, and AstraZeneca built out ADCs and entered radiopharma through Fusion.
Concentrating on one platform is too risky. Sleuth points to cell therapy as the cautionary case: big infrastructure bets can be leapfrogged by nimbler modalities such as bispecific antibodies that offer similar or better efficacy, cleaner manufacturing and modular combination potential.
The goal is first-line ownership in large patient populations, by any modality. Under the IRA, the Medicare negotiation clock starts at a drug’s first approval, so building up from late-line approvals in smaller indications burns time. Since a July 2025 change to the IRA, drugs approved only for rare diseases are exempt until their first non-orphan approval, when their clock starts. A franchise built around a large, specific tumor justifies several shots on goal, compounds relationships with key opinion leaders, investigators and providers, and leaves room to switch modalities.
For biotechs selling into pharma oncology, Sleuth sees three positioning strategies: lead with the combination rationale rather than a standalone asset, map to the tumor franchises each pharma company is investing in, and design around future backbones, where synergistic data can transform a business development process.
Oncology revenue is 2024 results and 2030 sell-side consensus as of August 2025. This page is a dated snapshot; the Keytruda Qlex, ivonescimab and IRA orphan-drug updates are current as of September 2026.
Frequently asked questions about pharma oncology backbone strategy
What is a backbone therapy in oncology?
A drug that works across many tumor types and anchors combination regimens, as PD-(L)1 inhibitors do today. In Sleuth’s August 2025 analysis, owning one is table stakes for controlling combination development.
Which pharma company will have the largest oncology revenue in 2030?
Johnson & Johnson, on sell-side consensus as of August 2025: $36.8 billion in 2030, up from $20.8 billion and fifth place in 2024. AstraZeneca ($29.5 billion) and Merck ($25.1 billion) follow.
Which 12 oncology pharma companies did Sleuth analyze?
Merck, Roche, BMS, AstraZeneca, Johnson & Johnson, Novartis, Pfizer, Amgen, Eli Lilly, Astellas, AbbVie and Daiichi Sankyo, listed by 2024 oncology revenue, in Sleuth’s August 2025 analysis.
