More than 40,000 researchers, clinicians, and industry participants are expected in Chicago this May for the American Society of Clinical Oncology (ASCO) annual meeting, the world's largest oncology conference, and an important event for biotech investors. This is where pivotal clinical trial data gets presented and, occasionally, the standard of care for cancer changes overnight.
What is most important for investors is that it’s one of the few moments in the year when a large volume of clinically meaningful data emerges at once, and that concentration tends to carry more weight than any single readout.
What feels different this year is not just the pace of innovation, but where we are in that cycle. Notably, a significant portion of the most meaningful late-stage clinical data is coming from biotechnology companies rather than large pharmaceutical incumbents, a shift that underscores how innovation in oncology is increasingly being driven by smaller, more specialized players. Many of the approaches that have been developing over the past decade, including cell therapy, targeted therapies, ADCs, and newer pathway-driven approaches, are now moving into later-stage development, with more clinically meaningful data expected across multiple programs.
Progress in Oncology
The trajectory of cancer outcomes has improved substantially over the last three decades. According to the American Cancer Society, overall cancer mortality in the United States has declined by roughly one-third since its peak in 19911, a reduction that has accelerated in the immunotherapy era. By some estimates, treatment advances have prevented more than 4.8 million deaths in the U.S. alone over that period. Globally, the impact is even larger, though access to these treatments varies dramatically. At the same time, unmet need remains high in many cancers, such as pancreatic cancer, where overall 5-year survival rate remains only about 14% and is even lower in metastatic disease.2
The result is not just incremental improvement, but a shift toward more predictable and repeatable therapeutic progress.
Immunotherapy
The single most transformative development in oncology over the past decade has been the rise of immune checkpoint inhibitors, drugs that release the brakes on the immune system's ability to recognize and destroy cancer cells. Agents targeting the PD-1/PD-L1 and CTLA-4 pathways, such as pembrolizumab and nivolumab, are now approved across more than 20 cancer types3. This has transformed what were once terminal diagnoses, for instance advanced melanoma and lung cancer, into diseases where long-term survival is achievable for a meaningful subset of patients. A parallel and increasingly important frontier involves cellular therapies. CAR-T cell therapy, which involves engineering a patient's own T-cells to recognize and fight cancer, has produced remarkable and durable responses in certain blood cancers, including multiple myeloma, and some leukemias and lymphomas. The field is now expanding in two important directions: into solid tumors and toward approaches that aim to engineer T-cells directly inside the body, bypassing the costly and logistically complex manufacturing process that has limited CAR-T's scalability.
Bispecific antibodies, particularly T-cell engagers, are another exciting frontier in immuno-oncology. These therapies are engineered to bind both a tumor antigen and CD3 receptors on T-cells, redirecting these immune cells to malignant cells to enable targeted killing. They have shown meaningful efficacy in several blood cancers and are now being actively developed for solid tumors.
Genetically Targeted Therapies
As tumor genomics has matured, researchers and biotechnology companies are increasingly trying to make oncology a disease of specific molecular subtypes rather than organ sites. Drugs are now designed to target the precise genetic alterations driving a patient's cancer. That’s a big shift with major implications for how clinical trials are designed, how patients are selected, and how we think about drug development.
A prime example is RAS mutations, which will be a highlight of this year’s ASCO. They are among the most common oncogenic drivers, occurring in approximately 90% of pancreatic cancers, ~40% of colorectal cancers, and ~30% of non-small cell lung cancers.4,5,6 Long considered "undruggable" because of their structural properties, we are seeing early progress from inhibitors targeting the KRAS G12C mutation and a next generation of pan-RAS inhibitors in active development.
Targeted Drug Delivery
Chemotherapy, one of the oldest tools in oncology, is being reimagined through more precise delivery mechanisms. Antibody-drug conjugates (ADCs) link a highly potent chemotherapy payload to an antibody that homes in on a specific protein expressed on tumor cells. The result is a drug that delivers its toxic cargo with far greater selectivity than traditional systemic chemotherapy, improving efficacy while reducing collateral damage to healthy tissue. Enhertu®, which targets HER2-expressing tumors in breast and several other cancers, is among the most striking recent examples of this approach. The ADC field now encompasses dozens of targets and payloads in development. A distinct but conceptually related area involves the direct, localized delivery of therapeutic agents, for example, approaches for bladder cancer that concentrate drug activity at the tumor site. And radiopharmaceuticals, which use tumor-targeting molecules to deliver radiation precisely to cancer cells, have emerged as a powerful and fast-growing category, exemplified by the recent approval of lutetium-177 PSMA for metastatic prostate cancer.
The RTW Perspective
ASCO is where much of this comes together. It acts as a release point, concentrating new data across multiple modalities and companies into a short window. That’s why it tends to matter disproportionately for how investors think about the space.
For us, the challenge is not identifying innovation. There is a lot of it.
The more interesting question is which of these approaches will translate into the most meaningful clinical outcomes and commercial opportunities. That is where we spend our time. We focus on understanding the biology, the data, and where the market may be underestimating or overestimating what matters.
In the weeks ahead, we'll be going deeper on specific programs, trial readouts, and themes we're watching closely. This is a useful moment to take a close look, not just at individual results, but to the broader pattern they’re forming.
Statements reflect RTW's views and opinions as of the date hereof and not as of any future date. All expressions of opinion are subject to change without notice and are not intended to be a forecast of future events or results.
1 Siegel RL, Kratzer TB, Wagle NS, Sung H, Jemal A. Cancer statistics, 2026. CA Cancer J Clin. 2026;e70043. doi:10.3322/caac.70043
2 Pancreatic Cancer — Cancer Stat Facts, National Cancer Institute, Surveillance, Epidemiology and End Results Program
3 Guégan M, Bichon M, Chaput N ... Cancer immunotherapy in elderly patients: The concept of immune senescence challenged by clinical experience, European Journal of Cancer, 2024; 214
4 Abidoye, O., Hoyek, C., & Bekaii-Saab, T. (2025). Targeting RAS in gastrointestinal malignancies. Clinical Advances in Hematology & Oncology, 23(2), 111-122.
5 Pun, M., et al. (2024). RAS mutations in advanced colorectal cancer: Mechanisms, clinical implications, and novel therapeutic approaches. Medicina, 61(7), Article 1202.
6 Wang, X., et al. (2024). Emerging landscape of KRAS inhibitors in cancer treatment. Cancer Cell
