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Many pharma and biotech companies are unprepared to deal with the dramatic changes taking place in oncology. Manufacturers’ highly redundant oncology pipelines have created intense competition. Meanwhile, at the very time when oncology developers need to differentiate their products the most, traditional commercialization tools, such as access to therapy decision makers, are being swept away. To gain insight into the commercial changes occurring in the industry, Campbell Alliance initiated the Oncology National Commercial (ONC) study, which surveyed 75 key industry experts, physicians, payers, and opinion leaders. The study revealed that the oncology space is transforming in such a way that never-before-seen competition is now built into the fabric of the business of oncology, and few companies are prepared to operate in the face of this intense competition. These findings were confirmed by examining manufacturers’ oncology pipelines and commercialization efforts. In this article, Campbell Alliance outlines 10 specific transformative trends about which every oncology product marketer and developer should be informed. 