One Idea Worth Sharing:

A team celebrates a successful $30 million manufacturing validation campaign.

Three weeks later, the drug fails its Phase 3 trial.

This wasn’t a failure of science. It was a failure of alignment.

The manufacturing team did exactly what they were incentivized to do: hit their milestone. But they were operating without visibility into emerging clinical realities. The result was a perfectly executed investment in a product already at risk.

Silos in oncology drug development are not created by org charts. They are created by how organizations define and reward success.

This Isn’t a Structural Problem

In oncology, we constantly talk about silos as if they are organizational problems.

So companies reorganize. They redraw reporting lines. They create new matrices.

And then they wonder why nothing changes.

The reality is simpler and harder to fix.

Cross functional teams do not operate in silos because they want to. They operate in silos because they are measured that way. When functions are rewarded only for their own milestones, they optimize only for their own milestones.

Collaboration becomes optional.

And the broader mission, getting therapies to patients efficiently and effectively, gets buried beneath departmental success metrics.

What’s Actually Happening

Across the industry, functions are still incentivized independently:

• Phase 1 teams are rewarded for advancing assets through stage gates, not for long term program viability. • Research and Development is rewarded for approval, not for access or implementation. • Commercial and Market Access are often brought in too late to meaningfully shape strategy. • Medical insights are generated continuously but rarely integrated fast enough to influence enterprise level decisions.

Each function does its job perfectly.

The system fails anyway.

This is not a communication problem. It is an incentive design problem.

Why This Matters

Oncology drug development is too complex and too high stakes for fragmented execution.

Drug development is not a relay race where teams blindly hand off responsibility from one function to the next. It is a highly interdependent system where decisions made early ripple across every downstream function.

When those functions are misaligned:

• resources get wasted • timelines get delayed • evidence gaps emerge late • access strategies fail • and patients wait longer for therapies they may never receive

A drug can achieve regulatory approval and still fail patients because reimbursement, access, operational feasibility, and real world implementation were never integrated into the strategy early enough.

Incentive misalignment doesn’t just slow progress.

It shapes outcomes.

Where It Breaks in the Real World

We see this most clearly at major inflection points.

Take the $30 million Chemistry, Manufacturing, and Controls (CMC) campaign mentioned earlier. The CMC organization executed flawlessly. But they were intentionally kept out of

the loop regarding an upcoming Phase 3 readout because clinical colleagues wanted to protect material information.

Technically, every team followed the rules.

Strategically, the system failed.

If cross functional alignment and shared incentives had existed earlier, the manufacturing campaign could have been delayed until the clinical data were known. Instead, the organization optimized for isolated functional execution rather than coordinated enterprise decision making.

The result was not just wasted capital.

It was lost opportunity, resources that could have been redirected toward other potentially lifesaving innovations.

What Needs to Change

Breaking silos does not start with another reorganization.

It starts with redesigning incentives.

Cross functional collaboration must be measured, expected, and rewarded, not simply encouraged rhetorically.

That means:

• establishing shared objectives across functions • integrating downstream stakeholders earlier • aligning metrics around patient and program outcomes • and rewarding enterprise success, not isolated departmental wins

When teams are accountable to the same outcome, behavior changes naturally.

The Bottom Line

Silos persist because organizations continue rewarding them.

You cannot solve an incentive problem with an org chart.

As long as companies celebrate isolated functional victories, teams will continue operating in isolation, even while claiming to be collaborative.

In oncology, the cost of that fragmentation is measured in time, access, wasted investment, and patient outcomes.

Real progress requires a different model: one where success is shared, alignment happens early, and every function is accountable to coordinated execution.