What is Space Oncology?
​Space oncology (SO) is a rapidly emerging field that investigates how microgravity (MG) and cosmic radiation influence cancer progression and treatment. Space-based environments are being studied to accelerate tumour modelling and drug discovery, making space a unique laboratory for cancer biology.
Space oncology has already generated important conceptual and technological spin-offs, ranging from three-dimensional cell culture systems and protein crystal studies for cancer drug development to advances in radiation biology, tissue-response research and biomarker discovery.​

Effects of Microgravity on Cancer Cells
Reviews of both real-space and simulated microgravity experiments have demonstrated important effects on cell adhesion, migration, proliferation, gene expression and the formation of multicellular spheroids. Microgravity alters cytoskeletal organisation and promotes spheroid formation, creating more physiologically relevant tumour models that may accelerate drug discovery while reducing reliance on animal models.
The effects of microgravity on cancer cells, cancer stem cells and drug response may also help shape future therapeutic strategies. Microgravity enables the production of more uniform protein crystals, lower-viscosity biologics and more stable pharmaceutical formulations.
Microgravity also influences the formation of nanoparticles that deliver chemotherapy directly to tumours while enabling controlled drug release. It alters cancer cell morphology, membrane behaviour and gene expression, thereby influencing how cells take up therapeutic agents. When gravity is removed or substantially reduced, cells experience profound changes in fluid dynamics, mechanical loading and cell-to-cell interactions. For cancer cells, these changes are far from trivial. They also facilitate the production of drug crystals and biologic formulations that are difficult to manufacture under normal terrestrial conditions.

Graf et al. discussed in detail the effects of microgravity on multiple omics disciplines in their paper Omics Studies of Tumor Cells under Microgravity Conditions, summarising transcriptomic, proteomic, metabolomic and epigenetic findings across multiple tumour types exposed to both real and simulated microgravity.
Similarly, Grimm et al., in their paper Recent Studies of the Effects of Microgravity on Cancer Cells and the Development of 3D Multicellular Cancer Spheroids, demonstrated how microgravity alters cell adhesion, proliferation, survival, cytoskeletal organisation, extracellular matrix interactions and spheroid formation, with important implications for drug discovery and the reduction of animal experimentation.
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Mechanobiological Diversity of Cancer
Cancer is biologically diverse. Understanding the differing mechanobiological responses of tumour cells to microgravity may help identify signalling pathways that are fundamental to metastasis, tissue invasion and treatment resistance.
Studies have demonstrated cytoskeletal reorganisation, altered focal adhesion signalling, changes in extracellular matrix interactions and the spontaneous formation of multicellular spheroids, all of which are highly relevant to tumour progression and therapeutic response. Microgravity not only alters the biology of tumour cells targeted by drugs but may also improve the performance of advanced drug-delivery systems, including nanoparticles and three-dimensional formulations.
Studies conducted aboard the International Space Station have investigated both real-space and simulated microgravity across breast, lung, thyroid, prostate, melanoma, glioblastoma and haematological cancer models. Cancer cells exposed to microgravity and the unique radiation environment of space behave differently from those grown under conventional laboratory conditions. These differences continue to reveal biological mechanisms that are otherwise difficult to observe and may ultimately contribute to improved cancer therapies.

Breast and Gastrointestinal Cancer in Outer Space
​Breast cancer cells demonstrate changes in gene expression, morphology, signal transduction and invasive behaviour under microgravity. Experimental studies suggest that, under microgravity conditions, some breast cancer cell lines adopt a less aggressive phenotype. Under normal gravity, breast cancer cells attach firmly to the surrounding extracellular matrix through focal adhesions. In space, however, these adhesion complexes fail to mature fully, reducing the cells' ability to migrate and metastasise.
Key proteins involved in cell-cycle regulation, including cyclin D1 and cyclin B1, are significantly downregulated, slowing cell division and reducing the rapid colony-forming capacity of tumour cells. Breast cancer spheroids grown in space have also shown increased susceptibility to certain targeted therapies.
Gastrointestinal and colorectal cancers, however, appear to respond differently to microgravity, with some studies suggesting accelerated tumour progression and a more aggressive phenotype. Reduced expression of drug-resistance genes, increased DNA and RNA damage markers, and reorganisation of F-actin have also been reported, making gastric cancer cells more sensitive to doxorubicin.
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FDA and Space Oncology
​The U.S. Food and Drug Administration (FDA) does not have a separate approval pathway for drugs developed using space-based research. Rather than focusing on where an experiment was performed, the FDA evaluates how well it was conducted. Space-derived evidence must therefore be scientifically rigorous, reproducible and generated in accordance with accepted preclinical standards. The FDA assesses whether the submitted data are credible, relevant and sufficient to support claims of safety and effectiveness within the existing regulatory framework.
In 2025, the FDA approved a subcutaneous formulation of pembrolizumab. NASA had contributed to the underlying protein crystal growth research performed aboard the International Space Station, targeting the ADAR1 gene. The resulting protein crystals were more uniform and better suited to formulation studies supporting this route of administration.
Similarly, rebecsinib became the first space-tested cancer drug to enter clinical trials. Following successful International Space Station-linked testing, it received U.S. FDA Investigational New Drug (IND) status. Tumour organoids grown in microgravity demonstrated sufficient antitumour activity to support further regulatory progression.
Together, the pembrolizumab and rebecsinib examples illustrate that space-based research is becoming a legitimate component of modern drug development rather than simply a scientific curiosity.
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New Regulations and Investment
​In 2026, UK regulators and the UK Space Agency publicly supported the development of a regulatory pathway for pharmaceutical research conducted in outer space. Investors and regulators alike have recognised the need for clear legal and quality standards governing commercial space-based biomanufacturing.
The Medicines and Healthcare products Regulatory Agency (MHRA), the Civil Aviation Authority (CAA) and the Regulatory Innovation Office (RIO) have worked together to streamline inter-agency regulation. In doing so, they have addressed many of the "dual-regulation" challenges that previously discouraged major commercial investment in space-based pharmaceutical manufacturing.
In microgravity, protein crystals and complex biologics form more slowly and uniformly because they are not affected by gravitational sedimentation. This allows companies such as BioOrbit to engineer highly stable, concentrated cancer therapies that may ultimately be administered as subcutaneous injections rather than lengthy intravenous infusions.
BioOrbit's BOX unit, launched in May 2026, is a microwave-sized autonomous orbital manufacturing platform designed to crystallise protein-based drugs under microgravity conditions. Following £9.8 million in seed funding, the company is using BOX to develop cancer therapies that can be delivered by self-injection at home rather than requiring prolonged hospital-based infusions.
Instead of launching entire manufacturing facilities into orbit, companies can now deploy compact autonomous production units capable of operating independently in space.
The UK is leveraging its £2 billion Life Sciences Sector Plan to position itself as a global centre for commercial space-enabled biomanufacturing.
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Economics of Space Oncology
With this background, it is essential that we begin planning for the future rather than focusing only on the low-hanging fruit. Despite a relatively modest US$13 billion space economy, ISRO has emerged as the world's third-largest space technology power and ranks among the five major government space agencies. As launch costs continue to fall and commercial space platforms become more widely available, space oncology is becoming an increasingly realistic proposition.
Launch costs have fallen dramatically, from approximately US$50,000 per kilogram in the early 2000s to less than US$2,500 per kilogram on the SpaceX Falcon 9 in 2025, making space-based pharmaceutical manufacturing significantly more viable. With the continued growth of successful commercial space companies in India, these costs may decrease further.
Space manufacturing is no longer confined to research. BioOrbit's BOX platform, Varda Space's manufacturing capsules and emerging UK regulatory frameworks demonstrate that the industry is moving from proof-of-concept towards commercial production.
Although space-based cancer drug development remains more expensive than conventional terrestrial research, the potential benefits are considerable. Improved disease models and more predictive preclinical testing may reduce drug-development failure rates by as much as 10%, potentially saving around US$100 million per successful drug. Space experiments currently cost approximately US$2 to 8 million on the International Space Station, or US$10 to 15 million using commercial re-entry capsules, compared with roughly US$10,000 to US$500,000 for comparable terrestrial preclinical studies.
The microgravity pharmaceutical manufacturing market, valued at approximately US$1.5 billion in 2025, is projected to reach US$9.8 billion by 2034, representing a compound annual growth rate of 23.7%. Commercial space stations and nano- and microsatellites (CubeSats) are rapidly becoming essential research platforms, while smaller, more frequent launches are making pharmaceutical payloads increasingly practical.

Epilogue
​More than 700 peer-reviewed papers, 40 book chapters and 12 monographs have already been published in the field of space oncology. I am optimistic that, during my grandchildren's generation, cancer management on terra firma will increasingly benefit from research undertaken, and medicines developed, in outer space.
Confucius could well have been referring to space oncology when he observed more than 2,000 years ago:
"A journey of a thousand miles begins with a single step."
Humanity will continue to exploit the unique environment of outer space in its enduring quest to solve the cancer conundrum here on Earth.
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Further Reading
​Readers wishing to explore this rapidly developing field may find the following resources of interest:

• Graf et al. Omics Studies of Tumor Cells under Microgravity Conditions
• Grimm et al. Recent Studies of the Effects of Microgravity on Cancer Cells and the Development of 3D Multicellular Cancer Spheroids
• U.S. Food and Drug Administration (FDA): Oncology Drug Development
• BioOrbit
• UK Government Life Sciences Sector Plan

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Human activity on the Moon, Selene for the ancient Greeks, constitutes one of the most significant chapters in scientific history. Between 1968 and 1972, the Apollo program, conducted by NASA (National Aeronautics and Space Administration), took twelve astronauts to the lunar surface, beginning with the Apollo 8 mission, the first crewed mission to orbit the Moon, and culminating with Apollo 17. These missions not only demonstrated humanity's technological capabilities but also provided crucial scientific data on lunar geology, the formation of the Earth-Moon system, and the history of the Solar System itself.
However, after 1972, human exploration of the Moon came to an end, marking the beginning of a hiatus that has now lasted more than five decades.
This prolonged interval reflected geopolitical changes, shifting economic priorities, and technological challenges. Nevertheless, fascination with Selene remained alive, both as a scientific destination and as a strategic platform for future interplanetary missions. In the twenty-first century, with advances in technology and increasing international cooperation, NASA launched the Artemis program. With Artemis I and Artemis II now successfully completed, its objective is not only to return to the Moon, but also to establish a sustainable human presence there.

The Artemis I Mission: The Past
Conceived as the cornerstone of the Artemis Program, the Artemis I mission represented the first major integrated test of the systems designed to take humans back to the Moon. Launched on 16 November 2022 (Figure 1) aboard the Space Launch System (SLS) rocket, the mission carried no astronauts. Instead, Orion flew with the instrumented mannequins Commander Moonikin Campos, Helga, and Zohar, equipped with sensors capable of recording the radiation and acceleration conditions to which future astronauts would be exposed in the space environment.
During a journey of approximately 25.5 days, Orion travelled more than 2.25 million kilometres, entered a distant retrograde orbit around the Moon (Figure 2), and reached a maximum distance of 432,210 kilometres from Earth, the greatest ever achieved by a spacecraft designed for human transport, before returning and splashing down safely in the Pacific Ocean on 11 December 2022.

Throughout the mission, Orion's heat shield, life-support systems, the propulsion system of the European Service Module (ESM) developed by the European Space Agency (ESA), and its long-range communication systems were thoroughly tested and validated. The critical re-entry phase, during which the capsule reached speeds close to 40,000 km/h and temperatures of up to 2,760°C on the surface of its heat shield, was successfully completed, confirming the robustness of the AVCOAT ablative coating, one of the most critical elements for ensuring the safety of future crews.
Although post-mission analyses identified slightly higher-than-expected erosion in some regions of the heat shield, these findings proved invaluable for improving the system before the first crewed flight.

From a scientific perspective, Artemis I provided a valuable dataset on the radiation environment in deep space, essential for protecting future crews. The dosimeters installed on the mannequins showed that astronauts will be exposed to significantly higher radiation doses than those experienced during missions in low Earth orbit, reinforcing the need for mitigation strategies already incorporated into the planning of subsequent Artemis missions.
More than a technological demonstration, Artemis I established the benchmark against which the entire Artemis Program would be evaluated, proving that a human return to the Moon was not only desirable but also technically feasible, thereby laying the foundations for the first crewed mission that would follow.

The Artemis II Mission: The Present
Building on the foundations established by Artemis I, the Artemis II mission was the second major step in the Artemis Program and the first with a crew on board. Conducted in April 2026 over approximately ten days, its central purpose was to validate, under real flight conditions, systems previously tested only in simulated or uncrewed environments: life support, navigation, communication, propulsion, and human performance in deep space. More than a journey around the Moon, Artemis II was a decisive and successful test of the viability of this new paradigm of human activity in space, delivering a rich set of physiological and operational data fundamental to the planning of subsequent missions.
The mission used the powerful Space Launch System (SLS) rocket to place the Orion spacecraft on a translunar trajectory (Figure 3). Named Integrity by the crew themselves, a name embodying the values of trust, respect, and humility that united the four astronauts and the thousands of professionals from many nations involved in the project, the spacecraft was powered by the European Service Module (ESM), developed by the European Space Agency (ESA) with significant participation from Airbus Defence and Space.

This European module, equipped with 33 engines and four large solar arrays, functioned as the "heart" of the spacecraft, providing propulsion, electrical power, and life support throughout the journey, a concrete example of the international cooperation that distinguishes the Artemis Program. At the controls of Integrity was a crew composed of Reid Wiseman (Commander), Victor Glover (Pilot), Christina Koch, and Jeremy Hansen (Mission Specialists), a historic team that, for the first time, included a woman, an African American astronaut, and a Canadian representative on a mission beyond low Earth orbit (Figure 4).

The trajectory followed the free-return trajectory, in which the Moon's orbital dynamics guarantee a safe return to Earth even in the event of a propulsion failure, the same strategy that safeguarded the most critical Apollo missions. After launching from the Kennedy Space Center on 1 April 2026, Orion completed its translunar injection on the second day and continued towards the Moon. On 6 April, it reached a record distance of 248,655 miles from Earth, surpassing the historic mark set by Apollo 13. On the same day, the crew also observed a spectacular solar eclipse (Figure 5). During the fly-by of the far side of the Moon, the astronauts experienced approximately three hours of communications blackout, a period used for autonomous observations, unprecedented photographic records of the Orientale Basin and Pierazzo Crater, and observations of unexpected shades of green and brown, suggesting mineralogical variations within the lunar crust.

In parallel, the crew conducted pioneering human health experiments, including ARCHeR, the immune biomarker protocol, Standard Measures, and AVATAR (organ chips derived from the crew members themselves). These investigations collected valuable data on sleep, stress, immunity, the microbiome, and the effects of cosmic radiation on living human tissues, information that will be crucial for planning future missions to Mars.
The mission culminated in splashdown in the Pacific Ocean on 10 April 2026, approximately 200 kilometres off the coast of San Diego. Atmospheric re-entry, performed at speeds exceeding 11 km/s and temperatures approaching 3,000°C, confirmed the robustness of Integrity's heat shield. Specialist teams from the United States Navy, operating from the recovery ship USS John P. Murtha, safely recovered the four astronauts, who emerged emotional and in excellent health. Hours later, after being transferred to the Johnson Space Center in Houston, they began the protocols for readaptation to Earth's gravity and the technical and scientific debriefing, bringing to a highly successful conclusion the first human flight beyond low Earth orbit in more than five decades.

The Artemis III and IV Missions: The Future
​Artemis II proved that humans can safely travel beyond Earth's atmosphere, while Artemis III (Figure 6) will have an equally crucial, yet distinct, mission. Scheduled for mid-2027 in low Earth orbit, it will be the first operational docking test between the Orion spacecraft and commercial lunar landing systems: SpaceX's Starship and Blue Origin's Blue Moon.
This demonstration mission is of extraordinary operational complexity. The Space Launch System (SLS) will launch Orion with four astronauts, using a structural spacer in place of the upper propulsion stage, while the commercial lunar vehicles will reach orbit through separate launches. The astronauts will spend longer aboard Orion than during Artemis II, validate Orion's docking system for the first time, and may also enter one of the lunar landing vehicles. In the words of Jeremy Parsons, Acting Deputy Associate Administrator for NASA's Moon to Mars Program, "Artemis III is one of the most complex missions ever undertaken by NASA," because the success of the subsequent lunar landing depends upon it.

With the docking systems validated by Artemis III, the path opens for the most anticipated stage of the programme: Artemis IV, scheduled for early 2028, which will mark the first human landing on the lunar surface since Apollo 17 in 1972. Four astronauts will travel to lunar orbit aboard Orion. There, two of them will transfer to the commercial Human Landing System (HLS) and descend to the vicinity of the lunar south pole, a region never explored in situ, where uncrewed probes have identified evidence of water in permanently shadowed craters.
​The lunar south pole is of particular scientific interest because permanently shadowed craters are believed to contain water ice, a resource that could support future human exploration by providing drinking water, oxygen, and rocket propellant.
Over the course of approximately one week, the crew will conduct spacewalks using Axiom Space's advanced AxEMU spacesuits, collect unprecedented geological samples, and deploy scientific instruments on the surface, including DUSTER (DUst and plaSma environmenT survEyoR), which will characterise the dust and plasma environment around one of the nine candidate landing regions identified by NASA near the lunar south pole. The mission will also mark the historic moment when the first woman and the first non-white astronaut set foot on the Moon.
More than a return, Artemis IV will lay the foundations for a sustainable human presence on the Moon and represent the first concrete step on a journey that will eventually take humans to Mars.

Synthesis
The Artemis Program, encompassing Artemis I, II, III, IV and the missions that will follow, inaugurates a new era of human activity in space, demonstrating the viability of crewed missions beyond Earth's orbit after more than fifty years. Its achievements will be crucial to the success of the next stages of the Artemis Program, particularly Artemis III, which aims to enable humanity's return to the lunar surface. In addition, the programme establishes the technological and operational foundations required to build a sustainable presence on the Moon and, ultimately, to support future missions to Mars.
The public and inspirational impact of the missions, especially Artemis II, has also been remarkable. Millions of people around the world followed the first crewed flight beyond low Earth orbit in more than fifty years through television, the internet, and social media, rekindling a collective fascination with space and inspiring a new generation of students interested in science, engineering, and exploration.
The Artemis Program represents a remarkable synthesis of tradition and innovation in humanity's exploration of the cosmos. As the heir to the Apollo legacy, it goes beyond merely repeating history by embracing new technologies, unprecedented international cooperation, and ambitious scientific objectives. More than journeys to the Moon, these missions represent a full-scale rehearsal for the expansion of human presence beyond Earth.
May the deities whose names these missions bear, Apollo, Artemis, and Selene, herald not only new chapters in humanity's exploration of space, but also a renewed appreciation of the importance of caring for Earth (Figure 7), our shared home, whose shades of blue continue to cradle every known form of life.

Why Artemis Matters
Beyond its remarkable engineering achievements, Artemis is also transforming our understanding of human health in deep space. Each mission generates invaluable knowledge on radiation exposure, physiological adaptation, behavioural performance, and operational medicine, helping prepare astronauts not only for sustained exploration of the Moon but ultimately for human missions to Mars.
For the aerospace medicine community, Artemis represents one of the most important research opportunities since the Apollo era. The programme is advancing our understanding of how humans can live and work safely beyond Earth while driving innovations with potential benefits for healthcare on our own planet. As the Artemis missions continue, they will not only shape the future of space exploration but also deepen our understanding of the remarkable adaptability of the human body and mind.

Exploring a New Model for Future Space Missions
What happens when students and researchers on opposite sides of the world work together to operate a simulated lunar habitat?
In a recent multinational mission simulation, teams in China and Australia collaborated remotely to test the operation of the UMIC (Underwater Modular Interplanetary Community) Lunar Farm. The project explored how future lunar and Martian settlements might be managed through a combination of life support systems, robotics, and remote mission control.
The experiment formed part of the Space Mission Commons initiative, an effort to investigate how small, distributed research facilities can contribute to a global network of space mission simulations and educational opportunities.​

A Lunar Habitat in the Heart of a City
Most lunar and planetary analogue stations are located in remote deserts, volcanic regions, or polar environments. While these locations provide realistic terrain, they are often expensive to operate and difficult to access.The UMIC Underwater Lunar Farm takes a different approach.
Located within an urban environment in China, the facility is designed to support remote access and operation while simulating key aspects of a future extraterrestrial habitat. At its core is an intelligent biosphere system intended to explore how self-sustaining communities might function beyond Earth.
The project focuses on three primary research areas:

• Collaboration between life support systems and remote mission teams
• Distributed mission command and control
• Community-scale operational models for future space habitats

Inside the UMIC Lunar Farm
The facility is surrounded by approximately 800 litres of water and incorporates several interconnected systems designed to simulate aspects of a lunar settlement.
These include:

• A plant cultivation chamber designed to emulate a controlled life support environment
• A robotic patrol corridor
• Human living and working spaces

Together, these components support research into autonomous biosphere operations, robotic control strategies, and human factors in environments where communication delays and remote supervision play important roles.
Unlike traditional analogue habitats, UMIC's urban location allows researchers and students to participate remotely, creating opportunities for international collaboration without requiring travel to isolated locations.​

Cardiovascular diseases remain one of the leading causes of mortality worldwide, demanding diagnostic and therapeutic strategies that are not only accurate but also personalised. As healthcare shifts toward precision medicine, aptamer-based technologies are emerging as powerful tools with the potential to revolutionise how cardiac diseases are detected, monitored, and treated.

​Aptamers, short single-stranded DNA or RNA molecules, are engineered to bind specific targets such as proteins, cells, or biomarkers with high affinity and selectivity. Often described as synthetic alternatives to antibodies, aptamers offer several advantages, including low immunogenicity, high stability, cost-effective synthesis, and ease of chemical modification. These features make them particularly suitable for integration into next-generation diagnostic and therapeutic platforms.

In the context of cardiac diseases, early detection is critical. Conditions such as myocardial infarction, heart failure, and atherosclerosis rely on timely identification of biomarkers like troponins, C-reactive protein (CRP), and B-type natriuretic peptide (BNP). Aptamer-based biosensors enable highly sensitive and rapid detection of these biomarkers, even at very low concentrations, offering the potential for earlier diagnosis compared with some conventional approaches. When integrated with portable platforms such as paper-based assays or smartphone-assisted devices, these systems can deliver point-of-care diagnostics, reducing the need for centralised laboratory infrastructure. These innovations maybe particularly valuable in remote or resource-constrained environments, including spaceflight medicine, where rapid point-of-care cardiovascular monitoring is essential.

​Beyond diagnostics, aptamers are also gaining attention in targeted therapy. Their ability to specifically bind disease-related molecules allows them to act as drug delivery agents or therapeutic inhibitors. Although not a cardiovascular therapy, Pegaptanib, an RNA-based aptamer approved by the FDA in 2004, demonstrates the therapeutic viability of aptamer technologies and supports exploration of similar cardiovascular applications. For example, aptamers may be designed to block clot formation pathways or target inflammatory mediators involved in cardiovascular disease progression.

That tension is exactly what motivated our recent study, published in Acta Astronautica. Rather than asking only what additive manufacturing can technically do, we asked a broader and perhaps more important question: what actually enables or constrains its adoption within spacecraft organisations?

​In many public discussions, additive manufacturing is framed as an inevitable next step for aerospace and space production. But in reality, the transition is more complex. Space is a high-stakes sector. Components must meet extremely demanding standards, qualification processes are rigorous, and the cost of failure is exceptionally high. Under these conditions, even highly promising technologies face barriers that go beyond engineering performance.

​Our study explores these barriers and drivers in a structured way. It shows that implementation depends on the interaction of three broad dimensions: technological characteristics, organisational readiness, and environmental pressures. In other words, even when additive manufacturing offers clear technical advantages, adoption may stall if organisations do not yet have the right skills, culture, processes, validation pathways, or strategic alignment to support it. Likewise, external pressures such as supply-chain demands, industrial competition, regulatory expectations, and ecosystem maturity also shape whether AM moves from experimentation to routine use.

This matters because it shifts the conversation. The question is no longer simply whether additive manufacturing is useful for spacecraft production, but how it can be usable, scalable and trusted. This approach highlights that adoption is also about organisational capability, industrial context, and the ability to connect technical potential with the realities of spacecraft development. In that sense, the challenge is not only to improve additive manufacturing, but also to understand what space-sector requirements need to be met for additive manufacturing to become part of everyday practice in the space sector.

​This is perhaps the key message of our work. If additive manufacturing is to truly “lift off” in spacecraft production, the challenge is not only to improve the technology, but also to prepare the organisations that will use it. The future of space manufacturing will not be shaped by technical capability alone. It will be shaped by the alignment between innovation potential and the organisational capacity to absorb, validate and deploy it.

​And that may be where the real transformation begins.