Rethinking Innovation: Why the Future of Oncology Depends on Delivery, Not New Molecules

Executive Summary

For more than two decades, oncology innovation has been defined by the pursuit of new targets, new pathways, and new molecular entities. This model has delivered extraordinary breakthroughs — but it has also created diminishing returns, escalating costs, and widening gaps between scientific promise and real-world patient benefit.

The next wave of oncology progress is unlikely to come from discovering ever more complex molecules. Instead, it will come from reimagining how we deliver the therapies we already know work. Reformulation, targeted delivery, and modality innovation represent the most underexplored, highest-yield opportunities in cancer care today. This article outlines why the industry must widen its definition of innovation and why delivery science, not target discovery, will shape the next decade of progress.

The Current Model: Brilliant Science, Limited Reach

Over the past 20 years, oncology has witnessed the rise of immunotherapies, targeted inhibitors, and next-generation biologics. These advances have transformed outcomes for many patients. Yet the innovation model built around “new molecules for new targets” now shows several limitations:

1. Rising Costs and Increased Development Time

Bringing a new oncology drug to market can exceed $2–3 billion and require over a decade of development (DiMasi et al., J Health Econ, 2016). Complexity increases risk.

2. Plateauing Impact Across Common Cancers

While novel agents drive dramatic responses in small molecularly defined groups, the majority of patients with lung, colorectal, and pancreatic cancer still experience modest gains (Prasad & Mailankody, Nature Reviews Clin Oncol, 2017).

3. Limited Benefit for Older or Comorbid Patients

Many modern therapies are too toxic, too immunosuppressive, or too burdensome for real-world patients — a major issue in lung cancer, where the median age at diagnosis is 70 (SEER Database, 2023).

4. A Narrow Focus That Overlooks Foundational Challenges

Tumor accessibility, local toxicity, delivery inefficiency, and dose limitations often constrain outcomes far more than target biology.

In other words, we have reached a point where molecules are advancing faster than the methods used to deliver them.

Why Delivery Matters More Than Ever

Increasingly, it is not what we give patients that limits oncology outcomes — it is how we give it.

1. Many Effective Agents Fail Because They Cannot Reach the Tumor

Drug distribution barriers — vascular, structural, metabolic, and anatomical — limit the true therapeutic exposure that tumors receive (Jain, Cancer Research, 2005). Delivery inefficiency often requires higher systemic doses, increasing toxicity without improving efficacy.

2. Toxicity Is Usually a Delivery Problem, Not a Molecule Problem

A chemotherapy or targeted agent may be highly potent against tumor cells, but toxicity to normal tissue constrains its use. Reformulating or localizing delivery can dramatically change the therapeutic index, as repeatedly demonstrated in pulmonary, intratumoral, and CNS therapies (Hersh et al., Clin Cancer Res, 2018).

3. Older and Frail Patients Need Lower-Burden Therapeutic Approaches

Half of cancer patients are over 65. Many are not candidates for high-dose systemic therapy or combination regimens (Hurria et al., JCO, 2014). Delivery optimization enables treatment that is effective, tolerable, and realistic for real-world populations.

4. Radiotherapy Is Underutilized as a Platform for Localized Innovation

Radiotherapy is used in 50% of all cancer patients (Delaney et al., Lancet Oncology, 2005), yet pharmacologic innovation around RT has stagnated. Delivery-enabled radiosensitizing or radioprotective strategies represent an enormous opportunity largely overlooked by molecule-centric innovation models.

5. Reformulation Can Unlock New Uses for Known Agents

Validated pharmacology comes with decades of safety data — but often with outdated modes of delivery. Modern preclinical and clinical tools allow us to revisit these agents with fresh eyes, enabling:

• new indications

• new routes

• new dosing paradigms

• new combination strategies

without the risk profile of de novo drug discovery.

A Shift Already Underway: Delivery as the Real Frontier of Innovation

Across the industry, the innovation spotlight is shifting — subtly but decisively.

The rise of drug–device combinations

Nebulizers, implants, depots, targeted release systems, and intranasal technologies are enabling therapies that would be infeasible systemically (Garg & Mathur, Adv Drug Deliv Rev, 2023).

The emergence of spatial precision in therapeutics

The future of oncology will involve tissue-specific, region-specific, and dose-shaped delivery — rather than body-wide exposure.

Regulatory momentum supporting reformulation

505(b)(2) pathways in the US and hybrid applications in the EU create favorable development routes for reformulated agents.

The shift toward real-world effectiveness

Clinicians and payers increasingly prioritize therapies that deliver meaningful benefit with manageable burden — an area where delivery innovation shines.

The industry is beginning to recognize that impactful innovation does not always require discovering a new molecule. Sometimes it simply requires delivering a known one more intelligently.

Why Delivery Innovation Is the Future of Oncology

1. It Directly Addresses the Two Biggest Barriers in Cancer Care: Toxicity and Access

If a therapy is too toxic or too complex, it fails — no matter how elegant the biology.

2. It Enables High-Impact Adjunct Therapies

Enhancing radiotherapy, supporting surgery, targeting sanctuary sites (such as the brain), or optimizing tumor exposure all depend more on delivery than on discovery.

3. It Unlocks Value in Proven Pharmacology

Reformulation allows biotech companies to leverage existing validation while creating new, differentiated assets.

4. It Aligns With Global Health Economics

Safer, simpler, more targeted administration models reduce hospital load, treatment discontinuation, and supportive care costs.

5. It Is Where the Greatest Untapped Potential Lies

New molecules will always remain essential. But the next decade’s most meaningful improvements in cancer outcomes are likely to come from therapies that reach the right place, at the right time, in the right amount.

Conclusion: The Industry Must Redefine What “Innovation” Means

The future of oncology will not be defined solely by new molecular entities. It will be defined by how effectively we can make therapies work for real people in real clinical settings.

Better delivery is not incremental — it is transformational.It expands who can be treated, how they can be treated, and how well they can tolerate treatment. It creates new therapeutic possibilities from known pharmacology. And it focuses innovation where it matters most: improving outcomes without increasing burden.

To meet the needs of modern oncology, we must rethink innovation itself.The next breakthrough won’t necessarily be a new molecule — but a smarter way to deliver the ones we already have.

References

• Delaney G. et al., Lancet Oncology, 2005

• DiMasi J. et al., Journal of Health Economics, 2016

• Prasad V., Mailankody S., Nature Reviews Clinical Oncology, 2017

• Jain R., Cancer Research, 2005

• Hersh A. et al., Clinical Cancer Research, 2018

• Hurria A. et al., Journal of Clinical Oncology, 2014

• Garg N., Mathur S., Advanced Drug Delivery Reviews, 2023

• SEER Cancer Statistics Review, 2023