Across 150 Phase III lung cancer trials authorized from 2024 to 2026, 94 trials used at least one CRO or CRO-like operational vendor, equal to 62.7% of the cohort. CRO use increased from 59 of 99 trials in 2024 (59.6%) to 26 of 38 in 2025 (68.4%) and 9 of 13 in 2026 (69.2%). IQVIA was the most recurrent CRO group, appearing in 39 trials, followed by Clario/Bioclinica/ERT in 37 and PPD/Thermo Fisher in 31.
CRO support appeared in 94 of 150 Phase III lung cancer trials (62.7%). The share increased from 59.6% in 2024 to 68.4% in 2025 and 69.2% in 2026, showing that CRO-supported execution became the dominant model across recent CTIS-authorized lung cancer Phase III studies.
For lung cancer Phase III trial managers, CRO involvement is not occasional support; it is the default execution model in nearly two-thirds of recent European CTIS trial records.
IQVIA appeared in 39 of 150 trials (26.0%), followed by Clario/Bioclinica/ERT in 37 (24.7%), PPD/Thermo Fisher in 31 (20.7%), ICON in 24 (16.0%), and Parexel in 22 (14.7%). Among CRO-supported trials only, IQVIA appeared in 41.5% and Clario/Bioclinica/ERT in 39.4%.
| CRO / vendor group | Trials | Share |
|---|---|---|
| IQVIA | 39 | 26.0% |
| Clario / Bioclinica / ERT | 37 | 24.7% |
| PPD / Thermo Fisher | 31 | 20.7% |
| ICON | 24 | 16.0% |
| Parexel | 22 | 14.7% |
| Almac | 21 | 14.0% |
| Labcorp / Covance | 20 | 13.3% |
| Fortrea | 15 | 10.0% |
The leading names are not only full-service CROs. The top layer also includes imaging, ERT/eCOA, data-platform and trial-technology vendors, reflecting the operational complexity of late-stage lung cancer development.
The most consistent multi-year CRO groups were IQVIA, Clario/Bioclinica/ERT, PPD/Thermo Fisher, ICON, Parexel, Almac, Labcorp/Covance, Fortrea, Medidata and Signant Health. IQVIA appeared in 21 trials in 2024, 12 in 2025 and 6 in 2026; Clario/Bioclinica/ERT appeared in 24, 6 and 7 respectively.
| CRO / vendor group | 2024 | 2025 | 2026 | Total |
|---|---|---|---|---|
| IQVIA | 21 | 12 | 6 | 39 |
| Clario / Bioclinica / ERT | 24 | 6 | 7 | 37 |
| PPD / Thermo Fisher | 18 | 9 | 4 | 31 |
| ICON | 12 | 9 | 3 | 24 |
| Parexel | 16 | 3 | 3 | 22 |
For sponsors benchmarking CRO experience in European lung cancer trials, IQVIA, Clario/Bioclinica/ERT and PPD/Thermo Fisher show the broadest continuity across the 2024–2026 cohort.
CRO-supported trials accounted for 4,627 of 6,081 country-level sites (76.1%) and 16,292 of 26,902 country-level participants (60.6%). They also had a median of 8 countries per trial compared with 2 countries for non-CRO-supported trials. Median planned sample size was 333 participants in CRO-supported trials versus 290 in trials without CRO support.
CROs are disproportionately attached to geographically broader and site-heavier trials. The strongest operational difference is country spread: CRO-supported trials had a fourfold higher median country footprint.
Spain led CRO-supported site activity with 880 country-level sites and 3,245 country-level participants, followed by Italy with 668 sites and France with 626 sites. The top five countries by CRO-supported sites — Spain, Italy, France, Germany and Poland — accounted for 3,127 of 4,627 CRO-supported country-level sites (67.6%).
CRO-supported Phase III lung cancer work is highly concentrated in the major Western and Central European oncology trial markets, with Spain clearly leading the site-count footprint.
United States-based sponsors accounted for 47 of 94 CRO-supported trials (50.0%). Switzerland and Germany each accounted for 10 CRO-supported trials (10.6% each), followed by Ireland with 7 trials (7.4%) and Sweden with 6 trials (6.4%).
| Sponsor country | Trials | Share |
|---|---|---|
| United States | 47 | 50.0% |
| Switzerland | 10 | 10.6% |
| Germany | 10 | 10.6% |
| Ireland | 7 | 7.4% |
| Sweden | 6 | 6.4% |
Half of CRO-supported Phase III lung cancer trials came from US-based sponsors, reinforcing the role of CROs as the bridge between global sponsor headquarters and European country execution.
Across all 150 trials, the median number of third parties was 6 per trial, with an average of 6.1 and a maximum of 33. Vendor load peaked in 2025, where the median number of third parties reached 8 per trial and the average reached 8.4.
The CRO question is also a vendor-orchestration question. Phase III lung cancer trials commonly require multiple operational partners beyond the lead CRO, especially in imaging-heavy and digitally enabled oncology studies.
CRO means contract research organization. CTIS means Clinical Trials Information System. CRO-supported means the trial sponsor record listed CRO presence as “Yes.” Country-level sites and participants are summed from trial geography records by participating country.
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