Key oncology trends to watch in 2025

Cancer has long been one of the most persistent and deadly diseases, and with its ability to evolve, resist treatment, and spread relentlessly, it has left scientists grappling for solutions. Yet, amid the uncertainty, the landscape of cancer treatments is shifting. Once limited to chemotherapy and radiation, treatment options have expanded since and continue to do so. Largely thanks to this, cancer death rates have fallen by 33% in the U.S. since 1991. As we observe World Cancer Day today, let us look at some of the trends in oncology expected to improve cancer care in 2025.

While the number of clinical trials for cancer has been growing, they have been moving towards “innovative designs and patient-centric approaches,” according to Stephan Schann, chief scientific officer of French biotech Domain Therapeutics.

“The industry has witnessed increased investment in platforms that address previously ‘undruggable’ targets and I expect this theme to continue into 2025. We can anticipate a year of meaningful innovation, smart growth, and significant patient impact,” said Schann.

Drugging the “undruggable”: cancer therapies to target new receptors in 2025

Recent advances in research are changing the landscape, making it possible to target molecules once considered beyond reach, or “undruggable”. One of the best examples of a former undruggable target is KRAS. Over the past few decades, KRAS mutations were deemed undruggable, meaning that these target sites lacked the ability to interact with other molecules, including drugs. But the problems faced with getting small molecules to bind to these targets have been addressed, making sotorasib the first KRAS inhibitor to be approved in 2021. Now, candidates like divarasib are in the clinic to beat sotorasib’s efficacy. 

And, Bristol Myers Squibb’s adagrasib, which was approved for patients with previously treated colorectal cancer (CRC) by the U.S. Food and Drug Administration (FDA) last year, just proved sustained efficacy in January 2025. This means that KRAS inhibitors could be making moves this year as more clinical data is to be churned out.

To add to that, more than 50% of G protein-coupled receptors – proteins that act as cell surface receptors – are considered undruggable. But biotechs like Schann’s Domain Therapeutics and Teon Therapeutics have candidates in early stages of development that target formerly undruggable and difficult-to-drug GPCRs to treat cancer.

Moreover, molecular glues are small molecules that came about to overcome the limitations of conventional small molecules. These drugs induce the proximity of two proteins and can lead to targeted protein degradation, explained Ryan Schoenfeld, chief executive officer of The Mark Foundation for Cancer Research.

“[Molecular glues] are at a key inflection point in preclinical research and early clinical development. While promising in targeting previously ‘undruggable’ proteins, most candidates remain in early-stage studies, with pharma investment accelerating discovery efforts,” said Schoenfeld. “In 2025, expect breakthroughs in understanding their mechanisms, optimizing drug design, and selecting the most viable targets – laying the groundwork for future clinical translation.”

Radiopharmaceuticals: A key trend in oncology expected to continue their success in 2025

Meanwhile, Patrick Amstutz, chief executive officer (CEO) of Molecular Partners, confirms that radiopharmaceuticals are still having their moment. These molecules are used in diagnostics as well as therapeutics. When an imaging radioactive isotope of an element – like fluorine-18, gallium-68, zirconium-89 and technetium-99m – is bound to a drug or monoclonal antibody, it attaches itself to cancer cells, much like a key to a lock. Then, with the help of nuclear imaging, the radioisotope can be spotted, therefore locating the tumor cells.

Once the target cells have been identified, a therapeutic radioisotope – actinium-225, iodine-131, yttrium-90 and astatine-211 – that is linked to the same kind of vector that was previously used in detecting the target enters the cancer cells. It then breaks down, destroying cancer cells.

“We see two major themes emerging in 2025 and beyond to transform cancer care, in terms of both quality of life and patient survival. These are radiopharmaceuticals and conditional immune cell engagers,” said Amstutz.

In the clinic, Canada-based Fusion Pharmaceuticals’ FPI-2265 – newly owned by AstraZeneca – is in phase 2/3 trials for metastatic castration-resistant prostate cancer, and so is BMS-acquired RYZ101 for neuroendocrine tumors.

Other candidates to look out for include Bayer’s BAY 3563254 in phase 1 for prostate cancer and Eli Lilly’s PNT 2001 in phase 2 for the same indication. 

Amstutz’s Swiss biotech Molecular Partners has come up with a new kind of radiopharmaceutical called Radio-DARPins. Designed Ankyrin Repeat Proteins, or DARPins, are small, customizable proteins that can be engineered to target specific tumors and are designed to not be heavily absorbed by the kidneys. The first of its kind will enter the clinic in 2025 to evaluate a preclinical candidate to treat neuroendocrine tumors and small cell lung cancers.

Cancers such as small cell lung cancer are highly aggressive and can quickly become treatment resistant. Germo Gericke, chief medical officer at Germany-based Ariceum Therapeutics, believes that radiopharmaceuticals can make standard treatment more effective for cancers like it.

“There is a considerable unmet need in small cell lung cancer, which tragically has an even worse prognosis than non-small cell lung cancer. We believe that radioligand therapy could offer a powerful new way to treat this disease by targeting the diseased tissue with radiation that can kill cancer cells and make them more susceptible to immunotherapy,” said Gericke, whose biotech is developing a 77Lu-based radiopharmaceutical in the clinic.

2025 predictions: immunotherapies won’t cease to reign in cancer therapeutic R&D  

Other strong contenders to treat small cell lung cancer are monoclonal antibodies. Imfinzi is one such monoclonal antibody that was just recommended for approval in the European Union. It works by blocking the PD-L1 protein on cancer cells so that the immune system can go on to attack the cells. It is the first and only immunotherapy for limited-stage small cell lung cancer.

Immunotherapies will continue to be relevant in 2025. In fact, according to Jonathan Kagan, president of Massachusetts-based Corner Therapeutics, T cell immunotherapies will stay relevant in cancer therapeutics for years to come. 

“The last ten years revealed the T cell as the central immunotherapy player. The next ten years will be the age of innate immune cells, which are so important to control T cell functions naturally. In the next few years, breakthroughs in our understanding of the innate immune system will unveil a wave of next-generation vaccines that could eradicate many cancers and infectious diseases. We are rapidly moving towards a future in which patient-friendly, low-cost vaccines are possible and can broaden the spectrum of diseases treatable with immunotherapy.”

Although developing cancer vaccines can be challenging, especially as they have to be designed to beat the tumor microenvironment (TME) – as they often suppress immune responses and help tumor cells to evade immune detection – these are exciting times for immunotherapies. Cancer vaccines of various sorts are in the clinic, including cell-based vaccines, protein vaccines, mRNA vaccines, and DNA vaccines.

Integrating them with immune checkpoint inhibitor drugs like pembrolizumab has shown enhanced antitumor responses, suggesting that the combined approach might help conquer the limitations associated with them.   

Engaging the immune system: immune cell engagers in the clinic 

Besides, as Amstutz mentioned, immune cell engagers are also gaining traction. For instance, just in the past two months, newly launched Candid Therapeutics forged four partnerships with biotechs like Nona Biosciences and WuXi Biologics for T cell engagers. 

Immune cell engagers are a type of bispecific antibody that acts as a bridge between a patient’s immune cells and cancer cells, forcing the immune system to recognize and attack the tumor cells by helping them bind to each other. 

Amstutz’s Molecular Partners is also involved in developing this class of drugs.

“We develop next-gen immune cell engagers to activate the immune system while preferentially sparing healthy cells, allowing us to explore targets and dose levels that might otherwise be difficult for other therapeutic modalities,” said Amstutz. “This includes our tetraspecific CD3 T cell engager for the treatment of acute myeloid lymphoma (AML), which will continue to produce data this year from its ongoing phase 1 study.” 

Bispecific antibodies to be part of more oncology trials in 2025 

Most immune cell engagers belong to a group of drugs called bispecific antibodies. As multiple bispecific antibodies, namely Zenocutuzumab-zbco, Zanidatamab-hrii, and Epcoritamab-bysp, were greenlit by the FDA last year, Schoenfeld thinks that these drugs “are moving beyond proof-of-concept and into broader clinical development.”

“In 2025, expect to see expanded trials assessing their durability, safety, and efficacy across new indications, particularly in solid tumors. As researchers refine dosing strategies and combination approaches, bispecifics are poised to play a larger role in next-generation cancer treatment,” said Schoenfeld.

CAR-T for cancer in 2025: need to overcome toxicities

Besides, we can’t talk about cancer immunotherapies without getting into chimeric antigen receptor (CAR)-T therapies. The T cells of patients are engineered to express CAR, which recognizes proteins on cancer cells, after which the T cells are injected into the patient to kill cancer cells. However, CAR-T therapies have been flagged for safety concerns. 

While the prevention of cytokine release syndrome (CRS) is critical to enable their full potential, Liam Tremble, principal scientist of Poolbeg Pharma, explained that “further progress is expected from cell therapies in solid tumors in the coming years.”

“These therapies will grow massively, bringing enormous benefits to patients,” Tremble added.

This is a view shared by other scientists in the field too. 

John Maher, CSO at Leucid Bio, said: “Despite the FDA’s safety concerns, CAR T-cell therapies are now better established as a treatment option, and emerging long-term data from large centers, such as the University of Pennsylvania, continue to provide insights on safety and management concerns. However, there is a significant amount of work needed to further improve CAR-T’s and enhance efficacy against solid tumors.”

As with CAR-T therapies, all immunotherapies come with their hurdles. Mikkel Wandahl Pedersen, interim CEO of Commit Biologics, explained that while immunotherapies have raised the standard of care in many types of cancer, there are still issues with response rates and immunological side effects. That’s where novel medicines could be used in combination with immunotherapies to address cancer.

Pedersen said: “A new opportunity is to harness the power of the complement system to fight cancer, potentially allowing a powerful response that could be used as a standalone therapy or in combination with already available immunotherapies.”

Echoing Pedersen’s thoughts, João Ribas, principal at Novo Holdings Seed Investments, explained that “we need to improve response rates in immunotherapy” and pointed towards antibody-drug conjugates (ADCs) to improve outcomes for cancer.

ADCs offer a targeted approach for cancer treatment, but will they suffice?

Often used in combination with immunotherapies in the clinic, ADCs selectively target cancer cells by binding to specific antigens on them and delivering cytotoxic agents to destroy malignant cells while sparing healthy tissue.

“There is an expanding pipeline of ADCs in clinical trials, and this continues to be a promising area of research with more than 100 drug candidates in the clinic. As we refine the technology, particularly payload potency, we have the chance to offer even more effective therapies for a wide range of cancers,” said Andreas Pahl, CEO of Heidelberg Pharma.

Due to their specificity, ADCs are regarded as targeted or personalized therapies. These are medicines that target specific molecules in cancer cells, and because they attack cancer cells more precisely and minimize the damage to healthy cells, they therefore have fewer side effects compared to traditional drugs such as chemotherapies. Maina Bhaman, partner at Sofinnova, believes that these medicines could make significant progress in cancer care this year.

“Personalized medicine is revolutionizing cancer treatment, making therapies more precise and less invasive. Advances in early detection and targeted treatments offer real progress, though cancer’s complexity means continued innovation is key,” said Bhaman.

Leveraging B cells for personalized treatment for people with cancer

As improving response rates and efficacy and mitigating toxicities remain a challenge in many fields of cancer therapeutics, Giusy di Conza, head of research at iOnctura, maintains that this will drive research into more personalized treatments for people with cancer.

“By looking at patient experiences and working backwards to determine their molecular mechanisms, we can discover new and increasingly bespoke therapies and approaches,” said di Conza.

Particularly as cancers constantly mutate and develop resistance to therapies, Stefano Gulla, CSO of Netherlands-based Kling Biotherapeutics, believes that we need as many different oncology drugs in our arsenal as possible.

“What we have realized over the past few years is that B cells are producing antibodies that can recognize antigens on the surface of tumors and also coordinate the immune response against them,” said Gulla. “We think that B cells are going to play a key role in producing novel antibodies that recognize cancerous tissue, yet leave healthy tissue untouched, creating a new generation of personalized therapies.”

Targeted therapies: cyclic peptides regarded as the “next wave of drug discovery” in oncology

To add to that, cyclic peptide-like compounds are a form of targeted therapy that is showing promise in the clinic, noted Simon Kerry, CEO of U.K.-based Curve Therapeutics. These drugs form a loop that allows them to bind to receptors on cancer cells to disrupt tumor growth. Last year, Merck signed a $220 million macrocyclic peptide deal with Unnatural Products, claiming that it is the next wave of drug discovery. Curve is also currently advancing its cyclic peptide candidates through the preclinical stages.

Beating cancer drug resistance: novel mechanisms make attempts

However, resistance to these targeted therapies is still an issue. There is a need to find ways to treat cancers for which there are still few or no available options for patients, according to Carolyn Porter, CEO of British biotech Outrun Therapeutics, which has come up with a way to inhibit the signals that cancer cells use to degrade tumor suppressor proteins – proteins that prevent tumors from forming.

“Stabilization of these proteins enables us to switch back on normal cellular processes that eradicate malignant cells,” said Porter.

Oncology in 2025: building on anti-angiogenesis therapy research

Meanwhile, anti-angiogenesis therapies have long been a part of cancer care since the first of its kind, Avastin, was cleared by the FDA over two decades ago. These drugs work by blocking the formation of new blood vessels as a means of starving tumors of blood supply to grow.

“We have a big opportunity to build on the knowledge and success in immunotherapy and anti-angiogenesis medicines made over the last several decades. While we know how to activate the power of the immune system and stop new blood vessels from growing, we were limited by toxicity. We now have the possibility to ensure that new medicines target tumor cells preferentially, so more patients benefit from a wider therapeutic window, thus staying on drugs longer and living longer as a result. The next few years hold the promise of radical improvements in cancer therapy,” said David Epstein, CEO of U.K.-based Ottimo Pharma.

Can artificial intelligence boost cancer drug discovery in 2025?

Additionally, it is no surprise that artificial intelligence (AI) is bound to play a role in diagnosing cancer and in drug discovery. 

“In 2025, the adoption of AI across various sectors of healthcare and life sciences is expected to accelerate significantly,” said Ofer Sharon, CEO of OncoHost. “AI-powered diagnostic tools are anticipated to achieve broader adoption in clinical settings, enhancing diagnostic precision and enabling more personalized patient care.”

Combination therapies deemed a “financial strain”; need for cost-effective measures

However, this year, the growing approval of combination drug therapies is expected to place added financial strain on healthcare systems, Sharon pointed out.

“This trend will likely prompt the implementation of more restrictive reimbursement schemes as a countermeasure to rising costs. As a result, pricing pressures will intensify, driving the need for cost-effective solutions,” said Sharon.

This may lead to a stronger focus on the adoption of companion diagnostics to ensure that the right patients are enrolled in drug trials to best observe the efficacy of cancer medicines.

As more and more cancer therapies pave their way through the clinic and scientists seek to improve the safety and efficacy of existing medicines, it’s safe to say that oncology research and development (R&D) is busier than ever, and 2025 is hoped to beat that.

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