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Owing to the complexity of cancer treatment and the needs of patients, the anti-cancer drugs market is promising.

The cost of medicines especially for cancer is under scrutiny by lawmakers around the world, and market watchers. Therefore, the drugmakers must now carefully select a price point for new meds—one that won’t encourage payers to restrict their use.

It has now become all the mpre important in the present as immuno-oncology moves toward combination cocktails. Using combinations of drugs is nothing new in oncology, but it’s particularly pertinent now as checkpoint inhibitors are tested alongside just about every other possible treatment, old and new.

As clinical data on those cocktails emerge in the coming years, the relative importance of individual drugs could fundamentally change, and their prices along with it.

To illustrate the fast pace of change in oncology, take a look at  top 10 best selling drugs, five years from now:

1. Revlimid

Generic name: lenalidomide
Company: Celgene
Sales (In billions): $4.28

Revlimid has been on the market for a decade, and it’s been the powerhouse behind Celgene’s growth since its launch. Already a megablockbuster, the drug is the linchpin of a hematology franchise that Celgene expects to exceed $15 billion in annual sales by 2020. It was approved by the FDA in 2005 for the treatment of myelodysplastic syndromes (MDS). In 2006, the FDA approved Revlimid’s new indication of treating multiple myeloma patients. In 2013, FDA approved Revlimid’s supplemental new drug application for the treatment of mantle cell lymphoma (MCL) patients. By 2022, it is expected that the composite annual growth of this drug partly owes to new indications, such as follicular lymphoma and non-Hodgkin’s lymphoma (NHL). With plenty of clinical trials looking at Revlimid’s use as a backbone of combination therapies, as well as patent protection in place out to 2022 in Europe and 2027 in the U.S., the drug should have plenty of years of growth in the tank.

2. Opdivo

Generic name: nivolumab
Companies: Bristol-Myers Squibb; Ono Pharmaceutical
Sales (In billions): $1.12

Opdivo was the first drug in the PD-1/PD-L1 inhibitor class to reach the market after its approval in Japan in 2014. In December 2014, the US FDA accelerated the approval of Opdivo for the treatment of advanced melanoma patients whose melanoma cannot be removed by operation or have already metastasized and fail to respond to other drugs. However, with the approval of Merck’s keytruda by the FDA, fierce competition appears between these two drugs. Although keytruda may be a stumbling block to Opdivo’s sales, Opdivo is still the best next-generation tumor immunotherapy drug. Its annual sales in 2022 is predicted to reach 12.6 billion US dollars.

3. Imbruvica

Generic name: ibrutinib
Companies: AbbVie (Pharmacyclics); Johnson & Johnson
Sales (In billions): $1.23

Imbruvica, a BTK inhibitor co-developed by AbbVie and Johnson & Johnson, was approved by the US FDA in 2013 for the treatment of MCL and Waldenström macroglobulinemia. Since its launch, first-in-class BTK inhibitor Imbruvica has grown quickly to cross the blockbuster sales threshold, showing that targeting rarer cancers is no impediment. The drug now leads the market in the second-line chronic lymphocytic leukemia (CLL) market, backed up by use in previously treated mantle cell lymphoma and Waldenström macroglobulinemia. Its annual sales in 2022 is expected to reach 8.3 billion US dollars.

4. Keytruda

Generic name: pembrolizumab
Company: Merck & Co.
Sales (In millions): $566

Although Keytruda is the first PD-1 / PD-L1 inhibitor launched in the US market, its sales are less than Opdivo. While Keytruda remains in direct competition with Opdivo in melanoma, second-line non-small cell lung cancer, and head and neck cancer, it got a chance to strike out on its own when it won an FDA approval to treat first-line NSCLC, while competitor Opdivo failed to meet its primary endpoint in that lucrative area. The current situation may be reversed in the next few years. The same as Opdivo, Keytruda is expanding its indications, including multiple myeloma, Hodgkin’s lymphoma, breast cancer, and the roles in combination therapy, which is the very place where cancer immunotherapy drugs can really show their functions. It is expected that Keytruda’s sales will reach $ 6.5 billion in 2022.

5. Ibrance

Generic name: palbociclib
Company: Pfizer
Sales (In millions): $723

Pfizer’s Ibrance is the first new CDK4/6 inhibitor, and was approved by the US FDA in 2015. CDK4/6 is a key regulator of cell cycle, which can trigger cell cycle progress. Combined with letrozole, it can be applied in hormone-receptor positive (HR+) and human epidermal growth factor receptor – 2 – negative (HER2 -) late menopausal breast cancer. It has romped away since Pfizer launched it as a combination therapy with letrozole for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer that has spread to another part of the body. Its sales are predicted to reach 6 billion US dollars in 2022.

6. Tecentriq

Generic name: atezolizumab
Company: Roche
Sales: N/A

Roche’s Tecentriq is a PD-1/PD-L1 inhibitor and ranks third among immunotherapeutic drugs. In May 2016, the US FDA accelerated the approval of Tecentriq for the treatment of the most common types of bladder cancer (BC). BC is the world’s ninth most common cancer. Male incidence rate is 3 times higher than that of female, which brings Tecentriq a promising market potential. The fact that it was approved first in bladder cancer—ahead of both its rivals—gives Roche an opportunity to build its position in that field as it battles for share in lung cancer and prepares for a follow-up filing in colorectal cancer. Its sales are expected to reach $ 5.53 billion in 2022.

7. Darzalex

Generic name: daratumumab
Company: Johnson & Johnson
Sales (In millions): $20

In November 2015, Johnson & Johnson’s Darzalex injection was approved by the US FDA. Darzalex is used to treat patients with multiple myeloma who have previously received at least three treatments. Darzalex is the first monoclonal antibody injection approved for the treatment of multiple myeloma. Multiple myeloma is a blood cancer. In the United States, there are about 10,000 people died of multiple myeloma each year. Because of Darzalex’s outstanding performance, FDA awarded Darzalex breakthrough therapy designation, priority approval and orphan drug identification. It knew it had its work cut out to carve out market share. Its drug was reserved for fourth-line use, setting it behind its closest competitors, Celgene’s Pomalyst (pomalidomide) and Amgen’s Kyprolis (carfilzomib), in the treatment sequence.  That wasn’t a disaster, as multiple myeloma patients generally go through multiple treatment rounds to try to keep their cancer at bay, and J&J has already started to move the drug to earlier use. It is estimated that Darzalex injection’s sales in 2022 will reach 4.91 billion US dollars.

8. Perjeta

Company: Roche
Generic name: pertuzumab
Sales (In billions): $1.50

Roche’s Perjeta was first introduced in 2012 and was approved by the US FDA in 2013. It is used as a dual strategy in reducing the volume of breast cancer cells combined with herceptin or docetaxel. The drug is also the first case approved by the FDA of reducing tumors’ volume rather than killing the tumors. Perjeta is one of the fastest-growing new products in Roche’s portfolio, thanks to approvals for use in early-stage HER2-positive breast cancer that expand its initial use in more advanced disease. Its sales are expected to reach $ 4.73 billion in 2022.

9. Xtandi

Generic name: enzalutamide
Companies: Astellas Pharma; Pfizer
Sales (In billions): $2.10

Xtandi, a drug for the treatment of prostate cancer, is acquired by Pfizer through the acquisition of Medivation which cost it $ 14 billion. Xtandi is a novel androgen receptor signaling inhibitor, which can be administered once a day. This drug can reduce the growth rate of cancer cells and induce the death of tumor cells. In September 2014, the US FDA approved Xtandi for the pre-chemotherapy treatment of prostate cancer, followed by its listing in the EU market. Its sales in 2022 are expected to reach $ 4.71 billion.

10. Avastin

Company: Roche
Generic name: bevacizumab
Sales (In billions): $6.95

Roche’s bevacizumab was approved by the FDA in 2004, and was the first drug to be approved for tumor angiogenesis in the United States as well as one of the first-line drugs for the treatment of colon cancer. The VEGF-targeting antibody claimed its first approval has steadily added new indications since then, most recently picking up a European approval for use alongside Tarceva for patients with EGFR-positive non-small cell lung cancer. Recently, it obtained European license for patients with EGFR-positive non-small cell lung cancer. Its sales in 2022 are expected to reach 4.68 billion US.