Why we examined 15 years of oncology trial geography — and what the findings mean for American patients, sponsors, and providers who run trials
Having worked with clinical trial sponsors for more than a decade, I have watched China move from an important trial market to a center of gravity for early clinical development. That shift is now visible in the data, in the biggest oncology research stages, and in the choices patients make to reach new treatments. It reinforces the importance of building a resilient, accessible U.S. clinical research infrastructure so American patients can reach cutting-edge care sooner.
In order to understand the potential solutions, we need to sharpen the question.
Much of the public discussion blends together two observations: Chinese companies are inventing more oncology medicines that are either developed in-country or licensed to global pharmaceutical companies, and China can often launch globally-sponsored studies, recruit patients, and generate data faster and at lower cost than the United States. But discovery location does not dictate trial location. A medicine discovered in China can begin Phase 1 in the United States or Australia, just as a medicine discovered in Germany can.
The questions for our analysis were therefore more specific:
- Are assets discovered and owned by U.S. / western companies being moved to China for trials?
- After a China-origin oncology asset is licensed or partnered to a Western company, does early development move with the new sponsor, or does it remain in China?
The evidence is moving into plain sight
Recent evidence shows how quickly the landscape has changed. A March 2026 JAMA study found that China's share of global early-stage drug-development programs rose from 8.0 percent in 2015 to 32.3 percent in 2024, while the U.S. share moved from 48.2 percent to 37.4 percent. In cancer, China accounted for 37.4 percent of programs in 2024, slightly ahead of the United States at 36.5 percent.
At ASCO 2026, a China-only Phase 3 study of Akeso's ivonescimab became the first such dataset selected for the meeting's plenary session and reported a 34 percent reduction in the risk of death versus the comparator regimen; ASCO emphasized that global-population data are still pending. Other recent reporting has described patients traveling to China for cancer treatment and raised questions about how China's rise could reshape access, regulation, and pricing. These are different stories, but together they show that China's clinical-development advantage is already affecting science, markets, and patients.
About this analysis
We created this evidence brief to test that operational question and inform next steps for our industry. Our team used internal LLM tooling alongside public and licensed data sources, including ClinicalTrials.gov and a third-party commercial database, as well as Paradigm Health's curated knowledge and in-house clinical-development expertise. Our team framed the questions, curated asset lists, ran the analysis using our LLM tooling, iterated on the output, and documented the methodology and limitations.
We focused on interventional oncology drug and biologic trials, with particular attention to Phase 1 and Phase 2 studies. We asked where trials were being conducted, whether the geography changed with the origin of the medicine, and what happened after China-origin assets were licensed to Western companies.
What the data showed
The scale of the change is striking. Among industry-sponsored Phase 1 and Phase 2 oncology trials, the number with a China site grew from 183 in 2011–2015 to 2,347 in 2021–June 2026 — roughly thirteenfold. Over those five-year windows, the number with a U.S. site rose from 1,957 to 2,707, or about 38 percent.
Looking across all phases, China nearly reached the United States in industry-sponsored oncology trial volume in the 2021–2025 window: 3,176 China-sited trials versus 3,317 U.S.-sited trials. The share of industry-sponsored oncology studies that included at least one China site rose from about 10 percent to 43 percent.
That growth is not limited to Chinese sponsors. Among the large Western biopharma companies in our analysis, the share of oncology studies with a China site increased from roughly 9 percent to 34 percent over the same period. China's infrastructure was built over decades through regulatory reform, domestic investment, and sustained commitments from global drugmakers. For example, one top global company announced a $1.5 billion China R&D investment and a Beijing-based Asia R&D headquarters in 2011, including clinical development infrastructure. The result is a mature system with advantages in enrollment, cost, concentrated patient populations, site capacity, and development speed.
The clearest operational signal comes from assets that did not remain with Chinese companies. In our curated cohort of 24 China-origin oncology assets licensed or partnered to non-Chinese companies before Phase 1 or Phase 2 trials began, approximately 76 percent of post-licensing early-phase trials included a China site, while only about 11 percent included a U.S. site. A matched set of Western-origin assets showed nearly the inverse pattern: about 8 percent included China and 65 percent included the United States. Even after Western companies acquired development rights, early research largely stayed in China.
The companion analysis points to the same structural shift from another angle. Phase 1 oncology trial starts among a basket of major China-based biopharma companies increased from 27 in 2011–2015 to 454 in 2021–June 2026. Starts among a basket of Western-based major biopharmaceutical companies moved from 713 to 602. The analysis counts trials, not unique molecules, and the company baskets are illustrative rather than exhaustive. Even with those caveats, the trajectory deserves attention.
Why this matters beyond competition
The most important implication is not national ranking. It is patient access.
Early clinical development determines where physicians gain experience with new therapies, where research infrastructure compounds, and which patients can reach promising options before they become broadly available. Recent reporting on patients traveling to China for cancer treatment makes that access gap tangible. When China-origin medicines remain concentrated in Chinese early-phase trials even after Western licensing, American patients may wait until a later global program reaches the United States.
The opportunity in the United States
America has extraordinary scientific talent, leading academic centers, experienced investigators, community practices, integrated health systems, and a diverse patient population. What it often lacks is a connected clinical research model that makes participation predictable and scalable across all of those provider settings.
That is the gap Paradigm Health was created to help close. We work across academic, integrated health systems, and community providers to make research a more integrated part of care, and we build technology and operating capabilities intended to reduce the friction that slows study selection, activation, recruitment, and data flow.
The findings reinforce the work underway across protocol optimization, portfolio intelligence, and trial enrollment. Better protocol decisions can account for how care is actually delivered. Better portfolio intelligence can help match the right studies to the right provider environments. Better recruitment workflows can help identify and connect potentially eligible patients without asking already stretched clinical teams to shoulder more manual work.
No single platform or company will solve U.S. clinical-development efficiency. Sponsors, providers, regulators, technology companies, patient communities, and policymakers all have a role. Operation TrialBlazer and the FDA's real-time clinical-trials work show that concrete policy and operating changes are already underway. Progress will require designing trials around real-world care, widening access beyond a small group of research centers, modernizing data flow, and removing avoidable work without compromising rigor or patient protection.
Why we are sharing the work
We are sharing this work because the United States needs to invest in a resilient clinical-trials infrastructure. Investment means capital, but it also means regulatory modernization, clearer and faster decisions, leadership attention, interoperable data, stronger site capacity, and operating models that let more providers participate.
While this work has limitations — the analysis is a point-in-time evidence brief, not a definitive census; ClinicalTrials.gov likely undercounts purely domestic Chinese research; drug origin must be curated rather than pulled from a single registry field — the direction is nevertheless clear. China has built a system in which trial capacity attracts development and domestic innovation feeds more trials back into that capacity. The United States cannot answer that system with one program or one appropriation. It needs sustained policy changes and practical execution that make clinical research faster, more predictable, and more available across the places patients receive care.
The choice is not whether to engage with Chinese innovation. It is whether the United States will build the infrastructure required to remain a preferred place to develop new medicines, and to give American patients earlier access to them.
Read the full Paradigm Health analysis, China and the Geography of Oncology Trials, by downloading the report below.
