Oncology: The Big Picture and Key Dynamics Shaping the Market
Dr. Andrew Merron, Executive Director, DRG Oncology
For the introductory episode of the DRG Oncology Pulse video series, Dr. Andrew Merron provides a big picture overview of the oncology market and the dynamics that are shaping its future:
Oncology market overview (:40)
Key dynamics in the oncology market (2:36)
- Dominance of immunotherapy (2:43)
- Evolution of personalized medicine (4:31)
- Treatment optimization (5:30)
- New classes and innovation (6:08)
Future of the oncology market (6:58)
Visit DRGOncology.com for more insights from Andrew and other oncology experts.
Hello. My name is Andrew Merron. I'm the Executive Director of the Oncology team here at Decision Resources Group. I'm delighted to welcome you to DRG's oncology video series. This series will give you bite-size information to understand the oncology market better.
We will be describing some key events in oncology, breaking news, and our interpretation of that together with our analysis of key questions affecting the pharmaceutical industry today.
In today's presentation, I'm going to be really describing the current assessment of the oncology landscape from a 30,000-foot perspective. I've only got a short amount of time so it's going to be quite an ambitious goal to look at the entire oncology market, so I'm going to touch on some key themes and trends that we're seeing and then we can drill down into those topics in future episodes of this series. So let's go ahead and get started.
For anyone working in the oncology industry today, it's pretty clear that the last decade and last five years, in particular, have shown some really transformational advances in cancer care. Sometimes, improvements are incremental in nature but those incremental improvements do add up to a significant improvement overall. Other times, there are really big milestone leaps forward in cancer treatment in cancer care. Nevertheless, there is still a high unmet need of cancer treatment today. There will be 1.7 million new cases of cancer diagnosed in the U.S. this year. This corresponds to nearly 600,000 deaths this year alone in the United States meaning that cancer is the second most common cause of death only behind heart disease.
Clearly, there's a big unmet need here to improve care not only for pharmaceutical companies to make money but also clearly for societal benefit. So we have made enormous strides in cancer care but there's still a lot more to be done. Nevertheless, we shouldn't lose heart. Since the 1970s, it's been a near 50% increase in the five-year relative survival of cancer from diagnosis through to five years. This improvement is a result of increased developments in surgical practices, better diagnosis, but importantly, of course, better treatments.
The first thing I'd like to mention is the importance of immunotherapies. Clearly, everyone talks about immunotherapies in oncology. There's no escaping the importance of immunotherapies. But I wanted to mention that ASCO really focused the importance of immunotherapies in combination with other drug classes and immunotherapies in combination with other immunotherapies. That's really where the future is. It's really important that pharmaceutical companies understand what is the optimal combination to use for an immunotherapy agent. Immune checkpoint inhibitors are not without flaws, and that's why we need these combinations to improve the overall efficacy and to make them applicable for indications where they're not currently suitable as monotherapies.
When we're thinking about immunotherapies, it's not just checkpoint inhibitors of course. The other really exciting class are CAR T-cell therapies. At the moment, the two approved CAR T-cell therapies had made great efficacy improvements in select hematological malignancies. But I think the real excitement for CAR T will come in the future at least hopefully, once we can generate CAR T-cells for novel targets on solid shipments. That's when they'll really start to come into their own and that's where clearly most commercial opportunity lies.
But of course, there's a big competitive barrier to gain access into these indications especially those which are well served with current treatments. We mustn't ignore the logistical challenges associated with CAR T-cells. I remember the days when we were forecasting Provenge, and Provenge was of course associated with many logistical hurdles which hindered its uptake in prostate cancer. Now clearly CAR T-cells and Provenge are different, but some of the logistical barriers are there nonetheless.
The other key theme or trends that I'd like to mention and it was also discussed at ASCO is biomarkers. Now obviously oncology is the poster child of personalized medicine or precision medicine. Well, what's the future? Currently, everybody knows that specific biomarkers in specific patient populations can lend themselves amenable to particular targeted therapies. That's what biomarkers in personalized medicines can do. But the future, I think, lies in identifying biomarkers which are applicable across multiple different chemotypes and therefore we can gain approval of new biomarker-driven therapies across many indications and clearly, this is more commercially lucrative. If you was one of the first to do this with approval in MSI-High and mismatch repair deficient patients, but I think there's future drugs which are going to gain the same success.
The other trend that I wanted to highlight was treatment optimization. So over the last five years, there's been a wealth of new oncology treatments entering the clinic. The FDA has kept very busy through approvals of many new drugs. But what we still don't really have a good handle on is, what is the optimal sequence of some of these treatments? How should they be used in real clinical practice?
Because we know, of course, clinical trials are not truly representative of what happens in the real clinical setting. We need better data to understand in which order these drugs should be given and also what's the optimal dose and which patients will really benefit best from particular types of treatment. Pharma is also focused on innovation. What are the new mechanisms of action which are coming down the pipeline?
We're keeping track of the pipeline but we really need to understand which of those drugs are going to be successful. We're monitoring the efficacy and the safety of those drugs but until we get to phase III trials, it's very difficult to predict which ones will actually be successful. That's why we need randomized phase II drugs of new therapies. It's a bit dangerous to jump from phase I or even preclinical data straight into phase III. We've seen some high profile failures recently for novel drugs in combination with checkpoint inhibitors and we really need robust data before we launch into a costly and potentially risky phase III trial.
But all of this investigation and analysis is paying off. We are improving cancer care. As I mentioned, the relative five-year survival is improving over time and that's wonderful news for patients but also for pharma of course. But there's a lot more to be done.
Where does that leave the future of cancer care? I believe immune checkpoint inhibitors are here to stay. I think that's pretty clear. They've demonstrated some really robust data in multiple chemo types and are gaining new approvals and additional indications almost on a monthly basis.
But the future as I've mentioned really lies in effective combination treatment and those combination treatments need to be very carefully analyzed before getting to phase III. Novel therapies in the pipeline need to be critically assessed. We're analyzing all therapies in oncology development and we're analyzing not only those in development but how those trials are structured. What is the clinical trial design? Clinical trial design can make or break a new therapy. Deciding the optimal endpoint, the duration, the patient population, and of course, the combination and comparator arms are critical in order to make our trial successful but also appealing to physician and payers alike.
But the big question is, will we ever get a cure for cancer? I think that's a very difficult question to answer. But if I had to, I would say no, we won't get a cure for cancer. Cancer is not one indication. It's obviously an umbrella term for more than 250 separate patient populations and indeed, that number of patient populations is increasing on a regular basis as we are identifying new biomarkers which can carve out new discrete patient groups.
So there's not going to be one magic silver bullet which will cure cancer. And even if there were, cure is a very difficult word to use in oncology. Not only is it an emotive topic, but also cure suggests that every single cancer cell or clone has been completely eradicated and this is very difficult to prove especially in late-stage metastatic disease. Instead, what I think we'll see is a trend from acute disease to chronic disease and we've seen that already happen in some hematological malignancies.
We will go forward from very short life expectancies to gradually longer and longer and this will mean that some patients will remain on treatment for a very long period of time. Therefore, new issues in oncology become more relevant, issues such as patient compliance and persistency to medication. And of course, related to that is tolerability.
So today, I've described some very top level key themes and trends that we're seeing in oncology today and provided an overview of this video series. Please do let us know if you have any topics that you'd like us to cover in upcoming video series and let us know what you think of this one. Thank you so much. I hope you enjoyed today's session.
Visit DRGOncology.com for more insights from Andrew and other oncology experts.