In the first part of this series, which you can find here, we explored why cancer has been such a stubborn foe - how it mutates, hides, and adapts - and how decades of research have steadily turned the tide. We looked at the breakthroughs that have reshaped treatment and prevention, from precision drugs to immune-based therapies, and how they’ve already saved millions of lives.

But science alone doesn’t win battles this big. Behind every new therapy lies an enormous ecosystem - the companies developing the drugs, the firms building the diagnostics, the startups turning data into insight, and the manufacturers making sure treatments reach patients worldwide. Together, they form one of the most complex and fast-moving industries on Earth: the business of curing cancer.

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The business of oncology is vast - and expanding fast. Global spending on cancer care, including drugs and diagnostics, is estimated at around $320 billion in 2024, with forecasts suggesting it could reach $800–900 billion by 2034, growing at roughly 10–11 percent a year. Within that, oncology drugs alone account for about $220 billion, making cancer the largest and fastest-growing segment of the entire pharmaceutical industry.

Growth is strongest in a few key areas. Immunotherapies continue to dominate global sales, but the fastest-rising fields include cell and gene therapies, radiopharmaceuticals, and AI-powered diagnostics. Precision medicine is also expanding rapidly as genomic testing becomes a routine part of treatment planning. Together, these innovations are shifting oncology from a one-size-fits-all approach to a more targeted and data-driven model that treats each patient’s cancer as unique.

Merck leads global oncology thanks to its immunotherapy Keytruda, now approved for more than twenty cancers and used in millions of patients. Its model centers on expanding that drug’s reach through combination trials and earlier-stage use while developing follow-ups that target similar immune pathways. Merck’s vast clinical network and regulatory credibility are unmatched, but its heavy reliance on Keytruda is a double-edged sword. The company’s long-term growth hinges on replacing that revenue before patents expire later this decade - something its pipeline of next-generation immunotherapies must prove it can do.

Roche remains the pioneer of targeted therapy, with Herceptin and Avastin laying the groundwork for precision oncology. Its advantage lies in owning both the treatment and the diagnostic, through Genentech and its diagnostics arm, allowing it to tailor drugs to specific patients. That integrated model keeps Roche central to personalized medicine, but many of its key drugs are aging, and competition in biologics is fierce. Future growth will depend on whether its new antibody-drug conjugates and immunotherapies can recapture the influence its early breakthroughs once held.

AstraZeneca has built one of the most balanced oncology portfolios in the world. Its targeted lung-cancer drug Tagrisso and its antibody-drug conjugate Enhertu, developed with Daiichi Sankyo, have become international blockbusters. The company’s strategy blends in-house R&D with strategic partnerships, letting it cover more ground across tumor types. Its strength is speed and breadth; its risk is spreading too thin in a crowded field. If AstraZeneca continues at its current pace, it’s on track to become the defining global leader in precision oncology over the decade ahead.

Novartis has carved out leadership in two cutting-edge areas: radiopharmaceuticals and cell therapy. Its drugs Pluvicto and Lutathera have made targeted radioactive treatments commercially viable, while its CAR-T therapy Kymriah broke ground in blood cancers. Novartis’s business model depends on mastering supply chains, from isotope production to complex cell handling, that few others can replicate. That vertical control is a clear moat, but also a logistical challenge. If it can scale those systems efficiently, Novartis could remain the defining player in radiopharma and a long-term leader in next-generation cell therapies - two markets set to grow exponentially this decade.

Pfizer has reasserted itself in oncology through its $43 billion acquisition of Seagen, a leader in antibody-drug conjugates. The deal gave Pfizer a deep pipeline of next-generation targeted therapies and the expertise to manufacture them at scale. Its global reach and resources make commercialization straightforward, but success depends on integrating Seagen’s fast-moving biotech culture without losing momentum. If the ADC category continues to grow as expected, Pfizer is positioned to capture a large share of that value.

Bristol Myers Squibb remains a key player in immunotherapy with Opdivo and Yervoy and has expanded into cell therapy through its Celgene acquisition, though it faces patent expirations and intense competition. Johnson & Johnson dominates in blood cancers with Darzalex and Carvykti and is working to extend that expertise into solid tumors. Eli Lilly is building steadily in targeted therapies such as Verzenio, focusing on incremental innovation rather than big swings. Each remains profitable and well-established, but none currently define the frontier in the way Merck or Novartis do.

Together, these pharmaceutical giants dominate today’s oncology market, generating tens of billions in annual revenue and driving much of the field’s clinical progress. Their focus now is on expansion rather than reinvention - pushing successful drugs into earlier use, refining delivery methods, and defending the franchises that built their empires. They’ll remain the foundation of global cancer care and continue to benefit as access and screening expand, but the most dramatic future gains, both scientific and financial, are likely to emerge from the smaller, more specialized players building on the groundwork these giants have laid.

While drug makers dominate the headlines, diagnostics companies quietly shape the future of cancer care. Their technologies determine who gets treated, which therapies are chosen, and how well those treatments work. As oncology moves toward ever more personalized medicine, the companies that can detect cancer earlier and predict how it will behave are becoming just as critical as those that make the drugs.

Exact Sciences built its reputation with Cologuard, a simple at-home stool test for detecting colorectal cancer. The company’s model is accessibility - making screening easier for patients who might otherwise avoid invasive tests. It has since expanded into genomic testing for treatment selection and recurrence monitoring. Exact’s strength lies in broad adoption and a strong brand, but its margins depend on insurance coverage and competition from newer liquid biopsy technologies. Continued growth will hinge on whether it can stay the most convenient and cost-effective option as blood-based tests mature.

Guardant Health is one of the leading names in liquid biopsy, using a simple blood draw to detect fragments of tumor DNA. Its tests help doctors both find cancer earlier and monitor whether a treatment is working. Guardant’s edge is its deep data pipeline and growing portfolio of tests spanning screening, diagnostics, and minimal residual disease tracking. However, limited insurance coverage and the high cost of scaling have slowed profitability. If liquid biopsies become the standard for early detection, Guardant stands to capture a significant share of that market.

Natera has carved out a strong position in monitoring cancer after treatment using its Signatera test, which detects tiny traces of tumor DNA left in the body - a sign cancer may return. This approach, known as minimal residual disease (MRD) testing, is becoming one of oncology’s most important tools for personalizing follow-up care. Natera’s business model focuses on recurring revenue from regular patient monitoring, giving it a steadier income stream than one-time diagnostic tests. Its growth depends on continued clinical validation and insurer acceptance, both of which are moving steadily in its favor.

Grail, owned by Illumina, aims to move beyond disease-specific tests to multi-cancer early detection (MCED) in people without symptoms. Its Galleri test searches for more than 50 cancer types by analyzing patterns of DNA fragments circulating in the bloodstream. The idea is simple but transformative: find cancers long before symptoms appear. Grail’s potential is enormous, but its science is still being validated, and questions remain about how such tests will fit into public health systems. If large trials confirm its accuracy and governments embrace population-level testing, Grail could make routine multi-cancer screening a standard part of preventive healthcare.

Foundation Medicine, now owned by Roche, was one of the first companies to offer comprehensive genomic profiling of tumors. Its tests identify mutations that can guide treatment decisions, making it an essential partner for oncologists using targeted therapies. Being part of Roche gives it the stability and scale to integrate directly into global drug development. The company’s main challenge is differentiation, many labs now offer similar sequencing tests, but its connection to Roche’s drug portfolio keeps it embedded in the clinical workflow.

Beyond these leaders, firms like Myriad Genetics, Qiagen, and Thermo Fisher Scientific provide the infrastructure behind precision testing, from genetic panels to reagent kits, ensuring that hospitals worldwide can perform advanced diagnostics. They may not capture headlines, but their tools underpin almost every step of modern oncology.

Taken together, these companies form the front line of early detection and personalized treatment. They are turning cancer diagnosis from a static event into a continuous process - one that starts earlier, adapts faster, and guides therapy more precisely than ever before. Their success will determine how soon “finding cancer early” becomes the global norm rather than the lucky exception.

Beyond the pharmaceutical giants, a new generation of biotech companies is reshaping what cancer treatment looks like. These are the innovators taking the biggest scientific risks - experimenting with entirely new ways to kill tumors, reprogram immune cells, or even train the body to vaccinate itself against cancer. Their therapies are complex and expensive, but when they work, they can completely redefine what’s possible in oncology.

Both BioNTech and Moderna are building on the same idea that made them household names during the pandemic: using mRNA to program the body’s cells. Instead of fighting viruses, their goal now is to help the immune system recognize and attack cancer. Each is developing personalized cancer vaccines that teach the body to identify the unique mutations within an individual’s tumor. Early results in melanoma have been encouraging, especially when combined with immunotherapies like Merck’s Keytruda. Their strength lies in speed, mRNA allows for rapid customization and production, but the challenge is scale. Manufacturing personalized vaccines for thousands of patients is far more complex than making one for a virus. If they can solve that, BioNTech and Moderna could pioneer a new era of individualized cancer prevention and post-treatment protection.

Iovance Biotherapeutics is leading the push into tumor-infiltrating lymphocyte (TIL) therapy - extracting a patient’s own immune cells, growing them in large numbers, and reinfusing them to fight cancer. Its first treatment, lifileucel, was recently approved for advanced melanoma, marking a breakthrough for a therapy once thought too complicated to commercialize. Iovance’s edge is being first to market, but its challenge is scaling production efficiently enough to meet demand. If it can automate parts of the process, TIL therapy could extend to other solid tumors and become a major new treatment class.

Allogene Therapeutics takes a different approach to cell therapy. Instead of using each patient’s own cells, it engineers immune cells from healthy donors - creating an “off-the-shelf” product that could be ready immediately rather than custom-made for every individual. This model could make powerful cell therapies faster, cheaper, and more accessible, but safety remains an open question. Preventing immune rejection is difficult, and regulators will move cautiously. If Allogene can prove its therapies are both safe and effective, it could transform cancer immunotherapy from a bespoke service into scalable medicine.

Immunocore is exploring an entirely new type of immune engineering known as T-cell receptor (TCR) therapy. Its first approved drug, Kimmtrak, extends survival in a rare eye cancer and shows how TCRs can reach targets other drugs can’t. The company’s strength lies in the precision of its science, it can see molecular “flags” on cancer cells that antibodies miss, but its commercial challenge is market size. Rare cancers limit revenue potential in the short term, though the same technology could apply to more common tumors in time.

China’s BeiGene has grown into one of the world’s most ambitious oncology biotechs, combining low-cost development with global reach. It already markets successful drugs for blood and solid cancers and is investing heavily in AI-guided research. BeiGene’s speed, scale, and willingness to tackle global markets make it stand out, though its exposure to Chinese regulation and geopolitics remains a risk. If it continues to execute, it could become the first truly global biotech from Asia to rival Western incumbents.

Legend Biotech, based between the U.S. and China, co-developed the multiple-myeloma therapy Carvykti with Johnson & Johnson - one of the most successful CAR-T launches to date. The company’s pipeline focuses on improving these therapies to make them faster and cheaper to produce. The model is proven, but the economics are still tough: each treatment costs hundreds of thousands of dollars and requires complex logistics. If Legend can industrialize that process, it could help make cell therapy a realistic option for many more patients.

Australia’s Telix Pharmaceuticals is one of the strongest emerging players in the radiopharma space. Its imaging agent Illuccix helps doctors identify prostate cancer that has spread, and its therapy pipeline targets kidney, brain, and blood cancers. Telix’s model combines diagnostic and therapeutic use, a “theranostic” approach, that allows doctors to both see and treat cancer using the same molecule. The company’s strength is agility and focus on accessibility, offering radiopharmaceuticals designed for use in ordinary hospitals rather than specialized centers. Its challenge will be scaling global production and competing with giants like Novartis as more radioligand therapies enter the market.

These biotechs represent the creative edge of oncology - the frontier where the biggest risks and the biggest breakthroughs coexist. Most will face setbacks, but a few could redefine how we think about cancer entirely. Their progress is what keeps the field moving forward, pushing the boundaries that even the largest pharmaceutical companies can’t reach.

Cancer care today generates vast amounts of information - from genetic sequences and biopsy slides to clinical notes and imaging scans. The companies turning that raw data into usable insight are becoming some of the most influential forces in modern oncology. Artificial intelligence isn’t replacing doctors or scientists, but it is helping them see patterns that would otherwise take years to uncover, accelerating everything from drug discovery to diagnosis.

Tempus sits at the center of the data revolution in oncology. Its platform combines genomic sequencing with real-world clinical data to help doctors match patients to the most effective treatments. By integrating AI, genomic testing, and real-world evidence into a single ecosystem used by hospitals and research centers worldwide, Tempus turns complex datasets into personalized reports that guide real decisions. Its business model blends testing revenue with enterprise software and research partnerships, giving it a rare mix of clinical and commercial reach. The challenge, as with any data-heavy company, is turning information into profit fast enough. Still, if personalized treatment continues to expand, Tempus could become one of the most valuable infrastructure players in cancer care.

Flatiron Health, now owned by Roche, was one of the first companies to organize and analyze real-world oncology data at scale. Its software helps cancer centers track patient outcomes and supports regulators in evaluating new treatments. Flatiron’s data are now used by the FDA and by dozens of drug companies in trial design, making it a quiet but critical part of how modern cancer drugs reach the market. Its strength is credibility and access to enormous patient datasets; its limitation is that much of its growth depends on continued trust and regulatory collaboration. With Roche’s backing, Flatiron looks likely to remain a cornerstone of evidence generation in oncology.

PathAI applies deep learning to one of medicine’s oldest tools: the microscope. By training algorithms to read tissue slides more consistently than humans, it helps pathologists detect subtle features that predict how a tumor will behave. The model improves diagnostic accuracy and speeds up workflows in hospitals and labs. PathAI’s challenge is adoption, medical systems change slowly, but partnerships with major pharma companies and lab networks are helping it scale. If AI pathology becomes standard practice, PathAI could become the default platform behind it.

Paige takes a similar approach to PathAI but with a focus on integrating digital pathology into clinical decision-making. Its FDA-cleared system uses AI to assist in diagnosing prostate and breast cancers and is expanding into biomarker detection. Backed by strong clinical validation, Paige’s advantage lies in being one of the first AI companies cleared for direct use in diagnosis rather than research. The risk is competition and the time it takes to roll out across hospitals, but the foundation is strong - especially as healthcare moves toward digitizing pathology slides at scale.

Exscientia, based in the U.K., and Insilico Medicine, based in Hong Kong, use AI to accelerate drug discovery itself. Both have designed and advanced drug candidates to clinical trials in a fraction of the traditional timeline. Their business model relies on partnerships with major pharma companies, who pay for faster target identification and molecule design. The key question is validation - whether AI-designed drugs can deliver real clinical success. If they can, these firms could permanently shorten the time and cost of developing new oncology medicines.

Smaller but equally interesting, ArteraAI uses AI to analyze scans and pathology data to predict which prostate cancer patients will benefit most from radiation or hormone therapy, reducing unnecessary treatment. Oncora Medical builds software that helps radiation oncologists plan therapy more precisely based on patient data. Both companies operate in the quieter end of oncology AI, decision support rather than discovery, but their tools directly improve day-to-day care, making them strong candidates for steady growth as hospitals digitize their workflows.

Together, these companies are building the invisible infrastructure of modern oncology - a data layer that connects diagnostics, treatment, and research. Their tools make medicine faster, smarter, and more individualized, turning the mountain of information produced by every cancer case into knowledge that can guide the next one. The better that data becomes, the closer oncology moves toward truly personalized care.

While new drugs and diagnostics attract most of the attention, much of oncology’s progress depends on the less visible infrastructure behind them - the suppliers, manufacturers, and technology providers that make it all possible.

Lantheus Holdings sits between radiopharma and diagnostics. It supplies key imaging agents used in cancer detection and has partnered with POINT Biopharma to expand into therapeutic isotopes. Its business model is built on reliability, supplying essential medical isotopes to hospitals worldwide, and its edge lies in an established distribution network. Lantheus may not have the glamour of a biotech startup, but its steady role in imaging gives it durable revenue and a critical position in the transition from diagnosis to treatment.

Germany’s ITM Isotope Technologies is among the world’s leading suppliers of medical isotopes, including lutetium-177, the radioactive element used in many new radiopharmaceuticals. The company’s growth reflects one of oncology’s quietest bottlenecks: isotope supply. Without companies like ITM, even approved drugs can’t reach patients. ITM’s vertically integrated model - producing, processing, and distributing isotopes globally - gives it a powerful position in a niche with few competitors. Its challenge is scaling fast enough to meet surging demand as more radioligand drugs gain approval.

Eckert & Ziegler, based in Germany, and NorthStar Medical Radioisotopes, based in the U.S., play similar roles to ITM in ensuring a stable isotope supply. Eckert & Ziegler provides materials and manufacturing equipment used across radiopharma research, while NorthStar focuses on safer, more sustainable isotope production methods. Both benefit from the growing number of clinical trials relying on radioligands, positioning them as indispensable enablers rather than competitors.

At the hardware level, companies like Siemens Healthineers and Elekta are redefining radiotherapy. Their advanced imaging and precision-targeting systems allow doctors to deliver radiation with millimeter accuracy, reducing damage to healthy tissue and shortening treatment times. Their business model depends on large, long-term equipment contracts with hospitals, giving them stability and predictable revenue. As AI and automation make radiotherapy even more precise, these companies will continue to sit at the intersection of engineering and medicine.

Finally, the broader “picks and shovels” group - Thermo Fisher Scientific, Danaher, Lonza, and IQVIA - underpins almost every aspect of oncology innovation. Thermo Fisher and Danaher supply the lab tools, reagents, and sequencing systems that power cancer research. Lonza manufactures complex biologic drugs for companies that lack their own facilities, while IQVIA runs clinical trials and manages data for nearly every major pharma company. Their strength is stability: regardless of which therapy wins, they profit from the industry’s growth. Their weakness is exposure to general biotech spending cycles rather than any single breakthrough.

Together, these companies make the global oncology ecosystem function. They mine the isotopes, manufacture the biologics, build the machines, and manage the data that allow every new discovery to reach patients. They may not always grab attention, but without them, the fight against cancer would quite literally grind to a halt.

If you want a more qualified opinion on which companies are truly positioned to capture value from oncology’s rapid growth, I highly recommend checking out Nanalyze. Their team of MBA analysts goes far beyond headlines to uncover how these businesses actually make money - breaking down revenue streams, valuation drivers, and competitive risks across the oncology value chain.

They’ve published detailed reports on many of the companies mentioned here, including Tempus, Natera, Guardant Health, Grail, and Exact Sciences - along with analyses of the broader themes shaping the future of healthcare innovation. If you want expert financial insight to complement the science and strategy covered here, start with Nanalyze’s research on those firms.

Note: You may need to sign up for Nanalyze’s free newsletter to access the above pieces, but it’s well worth it for the quality of insight.

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The first part of this deep dive showed how science has learned to outsmart cancer; the second reveals the vast network turning that science into reality. Together, they tell one story - of a global effort that is as human as it is technological. Progress may not come from a single cure, but from thousands of breakthroughs steadily converging toward one goal: transforming cancer from something we fear into something we can live through, treat, and ultimately prevent.

This concludes our two-part Curing Cancer Deep Dive - and I’d love to hear your feedback on both editions.

Did Part One give you a clear picture of why cancer has been such a difficult enemy to defeat - and how science is finally turning the tide? And for this second part, did you enjoy the shift toward the business and investing side - exploring who’s driving progress across the oncology ecosystem?

Your thoughts help shape every future deep dive, so just hit reply and let me know what you think. I read every message.

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Thanks for reading and for being part of this journey.

See you soon,
Max

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