Small biotechs versus large pharma: Who drives first-in-class innovation in oncology?

There is a narrative that large pharma relies on biotech and academia for drug innovation. We tested this thesis by identifying the originators of all 50 first-in-class (FIC) oncology drugs that were approved by the FDA from 2010 through 2020. Overall, the numbers support the narrative: large pharma was the sole originator of only 14% of FIC cancer drugs, whereas small biotechs originated 46%, and academic labs 14%. However, origins tell an incomplete story: large pharma companies launched or were involved in launching 76% of FIC cancer drugs. Moreover, three of the five top-selling FIC oncology drugs had large pharma origins. Thus, although biotechs and academia do originate more drugs, large pharma remains important in shepherding drugs through clinical development and approval, and in originating high-impact novel therapies.