Cancer drug development notched several notable wins last year with the FDA approving more than 50 oncology drugs. And more candidates comprise a robust pipeline.
“We're seeing tremendous innovation across this space now, just an embarrassment of riches,” said Tim Heffernan, vice president and division head of the therapeutics discovery division at MD Anderson Cancer Center.
In 2026, the spotlight will be on a handful of therapeutic strategies that could change cancer care for patients by offering more durability, higher precision and fewer side effects.
The most promising drugs fall into two categories: tumor-intrinsic targeting drugs, which tamper with a tumor’s internal wiring to halt its growth; and immune-modulating drugs that weaponize the patient’s immune system against malignancies, Heffernan said. These approaches target not only common cancers, such as lung and breast cancer, but new areas like prostate cancer.
Here are two key oncology development areas to watch this year.
Weakening tumors from within
Antibody-drug conjugates and radioligand therapies command the most attention in the tumor-intrinsic targeting drug category, Heffernan said.
ADCs, dubbed “smart chemo” drugs for their precise delivery of powerful anti-cancer therapeutics, are taking on once “undruggable” targets such as KRAS gene mutations, which underlie many cancers.
“ADCs have shown dramatic efficacy,” Heffernan said. That promise has ramped up competition in the market, which analysts predict could reach $40 billion by 2029.
Serious side effects gave ADCs a rocky start, but scientists have learned to overcome many of the challenges that plagued earlier iterations. Blockbusters like Daiichi Sankyo’s Enhertu, most recently approved for a challenging type of HER2-positive breast cancer, have helped accelerate interest.
Merck & Co. has also put a lot of energy into ADC development. Among its candidates are sac-TMT, licensed from Sichuan Kelun-Biotech, which is in phase 3 for six indications. Merck is also co-developing another ADC, raludotatug deruxtecan, with Daiichi Sankyo, which is moving into a phase 3 trial in ovarian cancer and mid-stage studies in 10 other indications.
But there’s still a lot to learn to harness ADCs’ full potential, Heffernan said.
“Now the question is: How do we expand the efficacy of ADCs to other disease indications to benefit more patients?” Heffernan said.
Eyes are also on radioligands, which have vast market potential and bring targeted radiation into cancer cells while sparing surrounding tissue. The treatments have been around since the 1950s when the FDA approved radioactive iodine for thyroid conditions, but earlier progress was also stymied by side effects.
Newer versions have improved safety, reigniting interest in the field. The emerging crop of contenders are better at targeting specific receptors inside tumors, enabling them to deliver a precision blast while limiting off-target harm.
This growing interest has attracted substantial investment from major pharma companies, including Bristol Myers Squibb, which spent $4.1 billion to acquire RayzeBio in 2024, and Eli Lilly with its $1.4 billion purchase of Point Biopharma the year before.
Immune system drugs
The other oncology innovation category seeing substantial momentum includes drugs that target the immune system to help unmask cancers and dispatch the patient’s internal defenders.
“There's been significant investment in the immune cell engager space,” Heffernan said.
Investment has been high in particular for bispecific antibody drugs, with several bispecific drug developers delivering key clinical readouts in 2026.
One particular bispecific antibody drug, ivonescimab, turned heads when it beat Keytruda in an early-stage Chinese lung cancer trial. The therapy, developed by China-based Akeso and licensed to Summit Therapeutics, targets PD-1 and vascular endothelial growth factor, a protein that feeds blood vessel growth in tumors and helps hide them from the immune system. This dual-targeting approach provides a cancer-fighting advantage over either strategy alone.
But as companies work to validate bispecifics in the clinic, they’re already facing potential competition from newer multispecific options tackling three or more diverse targets.
As the field progresses, pharma researchers are working to overcome safety challenges and prove the treatments can be effective over time.
“Advances in protein engineering have enhanced our ability to direct the therapeutic to have its most impressive efficacy to the tumor by engaging and rewiring the tumor micro environment,” Heffernan said. “Over the last several years, the innovation across therapeutic modalities has enhanced the armamentarium. Now, as we go into 2026 and beyond, how do we combine these therapeutics to enhance efficacy, but more importantly, durability?”
