Cell and gene therapies are finally becoming a reality, with hundreds of clinical trials underway and some major therapeutic breakthroughs already reaching the market. In the past year alone, the FDA approved its first gene therapy, Spark’s Luxturna for the treatment of a rare form of vision loss, as well as the first two CAR T-cell therapies, Novartis’s Kymriah and Gilead’s Yescarta, for certain forms of blood cancer. While this certainly marks the beginning of an exciting period in the development of cell and gene therapies — the culmination of decades of development — the future impact of cell and gene therapies is uncertain.

Will their use become ubiquitous, changing the landscape forever as many have promised they would? Or will applications be confined to rare diseases as they have been thus far? The answer largely hinges on the advancement of science and whether or not we are able to uncover the genetic causes for some of today’s greatest medical challenges. However, challenges also remain around how willingly payers, providers, and patients will adopt these therapies, either due to their safety, efficacy, and/or long-term costs.

Working through these uncertainties, we explore four very different scenarios that could unfold over the next decade. Based on extremes, these scenarios will expand traditional thinking and help life science companies determine the appropriate position and strategy.