R&D spending in the biotech industry has almost doubled2 in the five years leading up to 2022 and is forecast to grow twice as fast, at up to 8% per year. There is a record 65%3 out of approximately 6,000 clinical asset candidates currently in active development, including more than 2,000 cell and gene therapies. That means that the biotechnology sector remains the industry’s engine of innovation and expansion, driven by growing product pipelines. On the other hand, amid rising R&D costs, emerging and mid-size biotechs are looking for leaner solutions for their clinical trial strategies, which is closely tied with the CRO selection process. Historically, large pharmaceutical companies have been known to partner with global CROs, thus becoming the primary source of revenue for global vendors. For instance, CROs such as IQVIA have over 50% of their revenue4 coming from large pharmaceutical companies, while small and mid-sized CROs such as Europe-based OCT Clinical generate 70% to 85% of revenue from small-to mid-sized biotech companies. Therefore, one can conclude that global CROs have a larger presence, workforce and capacity, and so big clients would always remain the priority for them, which makes perfect sense. And here comes the question of where smaller biotechs should look for their perfect CRO match.