For most of modern cancer drug development, the United States was the center of gravity. It still has the world’s leading universities and cancer centers, scientific talent, capital, biotechnology companies, Big Pharma, and an ecosystem for turning discoveries into medicines.
I have spent more than 15 years in oncology research and development, including a decade in senior leadership in global oncology R&D in Big Pharma.
What has changed is not that the U.S. stopped innovating. It is that the rest of the world started innovating at scale.
A 2026 analysis in the Journal of the American Medical Association illustrates the magnitude of that change. The annual number of drug development programs worldwide increased from 10,417 in 2015 to 18,999 in 2024, an 82.4% increase. During that period, U.S. programs increased from 5,024 to 7,107, but the U.S. share fell from 48.2% to 37.4%. China’s share rose from 8.0% to 32.3%.
In cancer, the shift is even more striking. In 2015, the U.S. accounted for 48.7% of cancer drug-development programs, compared with 10.2% in China. By 2024, the U.S. share had fallen to 36.5%, while China’s had risen to 37.4%. China had 4,152 cancer drug-development programs, slightly more than the U.S.’s 4,051.
But pipeline volume is not the same thing as innovation leadership. The more important question is who is producing breakthroughs that open new therapeutic possibilities and turning them into medicines that improve patients’ lives.
One useful measure is whether a drug is first-in-class, meaning it is the first approved therapy to introduce a new mechanism of action. It is not a perfect measure of clinical impact, but it indicates whether a drug-development system is generating genuinely new therapeutic approaches.
The U.S. still has a striking lead.
A recent Health Affairs Scholar study examined novel oncology drug approvals by the Food and Drug Administration and China’s National Medical Products Administration from 2020 through 2025. China approved more novel oncology drugs overall, 94 compared with 87 by the FDA. But among 36 therapies classified as global first-in-class, the FDA approved 30 first, compared with six for the NMPA. The FDA therefore accounted for 83% of these first global approvals, compared with about 17% for the NMPA.
The numbers tell a more complicated story than either American decline or Chinese dominance. China is no longer a peripheral player in biomedical innovation. In cancer, its pipeline has reached the scale of the U.S. At the same time, the U.S. continues to lead by a wide margin in first approvals of genuinely new therapeutic approaches.
America may not be getting worse. The rest of the world may simply be getting better faster.
America’s goal should not be to preserve its share of global drug development simply because it was once larger. Nor should it try to prevent other countries from becoming better at discovering and developing medicines.
The goal should be to remain one of the world’s best places to create genuinely innovative cancer therapies and turn those discoveries into medicines that have the greatest impact on patients. That means identifying the best scientific ideas early, developing them intelligently, and testing them against clinical reality. It means rewarding therapies that establish new therapeutic approaches, not simply adding another option to a crowded market. And it means measuring success not only by how many programs enter development or drugs are approved, but by whether those medicines improve survival, quality of life, and the way cancer is treated.
The U.S. does not need to be the only country capable of producing important cancer innovations. It needs to remain one of the best places in the world to produce them.
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China’s rise does not prove that America has lost its lead. It proves that America can no longer assume that its lead will be uncontested.
America is no longer competing against a world that is waiting for it to lead. It is competing against a world that has learned how to lead too.
Professor David Adler is a senior pharmaceutical leader in oncology clinical drug development and translational medicine with more than 15 years of industry and academic leadership experience. He spent a decade in senior leadership at Bayer AG’s Global Oncology Clinical Development organization and currently serves as chief scientific and medical officer of the PATHORA Institute of Pathology & Tissue Medicine. He also holds academic appointments at the Hebrew University of Jerusalem, Ben-Gurion University of the Negev, and the University of Bonn.