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Space oncology is an emerging discipline exploring how microgravity and the space environment can deepen our understanding of cancer biology, accelerate drug discovery and inspire new approaches to cancer treatment. Once considered largely experimental, this rapidly developing field is beginning to generate discoveries with the potential to benefit patients on Earth. Author: Dr K GanapathyMCh (Neurosurgery) FACS FICS FAMS PhD; Hon.Distinguished Professor, IIM Jammu; Distinguished Professor, The Tamilnadu Dr MGR Medical University; Emeritus Professor, National Academy of Medical Sciences; Guest Adjunct Professor, Columbia University; Formerly Distinguished Visiting Professor, IIT Kanpur. Email: [email protected] Introduction Cancer is a group of diseases characterised by the uncontrolled growth of abnormal cells that invade surrounding tissues and may spread to distant organs. In India, an estimated 1.87 million new cases are expected to be diagnosed in 2026, and approximately one in nine people face a lifetime risk of developing cancer. Patients may incur out-of-pocket healthcare expenses of up to approximately US$350, in addition to income loss, debt, asset depletion and caregiver burden. Cancer remains one of the most economically disruptive illnesses affecting families. 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.  Figure 1: The International Space Station provides a unique microgravity laboratory for cancer research, drug discovery and protein crystallisation. 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. 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.  Figure 2: Microgravity alters cancer cell behaviour, including cell adhesion, gene expression and multicellular spheroid formation. 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. 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. 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. 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.  Figure 3: Microgravity is enabling new approaches to pharmaceutical manufacturing for future cancer therapies. 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. Further Reading Readers wishing to explore this rapidly developing field may find the following resources of interest:
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