By: David Crow
Originally published on June 1, 2016
More than 30,000 doctors and scientists will gather in Chicago this weekend for the biggest annual meeting of cancer experts, organised by the American Society of Clinical Oncologists (Asco). They will be joined by healthcare investors and pharmaceuticals executives from the largest companies — such as Johnson & Johnson and Pfizer — to smaller biotech groups, to hear the results from more than 5,000 clinical trials.
The sheer amount of research on display this year underscores a recent renaissance in developing drugs for cancer, after pharmaceuticals companies and their investors poured billions of dollars into finding new ways to tackle the disease.
At last year’s event, a new generation of drugs that turn the body’s immune system into a weapon against tumours established themselves as the most important advance in cancer treatment in decades.
These “immunotherapies” have radically altered the odds of surviving cancer for some patients. About 40 per cent of melanoma sufferers taking Keytruda, made by American group Merck, are still alive after three years, according to data from a large trial that will be presented in full at Asco this weekend.
That is a remarkable turnround for an illness that has tended to result in a swift death for almost all of its victims.
But for all the excitement, the immunotherapies on the market only work in a minority of patients and tumour types.
This year, delegates will have to confront some difficult questions: can the benefits of these drugs be extended to help more sufferers, including those with the deadliest types of cancer?
And, if so, will cash-strapped healthcare systems be able to afford the medicines, which command price tags well in excess of $100,000 per patient per year.
Scientists hope that adding existing immunotherapies to more established treatments such as chemotherapy could result in a higher success rate, and several companies have been testing this approach in clinical trials.
Investors are awaiting the results of a study that combined Johnson & Johnson’s Daratumumab with chemotherapy in patients suffering from multiple myeloma, a cancer of the plasma cells. Ganymed Pharmaceuticals, a private German group, is also trialling a drug with chemo in patients with gastric cancer.
Data from both studies have been held back by Asco’s organisers to be discussed in “late breaker” sessions this weekend, in a sign they deem the results to be promising.
Other companies are trying to combine two novel immunotherapies, such as Pfizer, which will unveil data from a trial of Merck’s Keytruda with its own drug, known as 4-1BB. The former is designed to remove brakes in the immune system that stop it from attacking tumours, while the latter aims to speed up the body’s response.
“Last year, immunotherapies established themselves as having real promise, but now we are asking how you can mix and match them,” says Dr Alan Worsley of Cancer Research UK.
Some scientists warn that too much manipulation of the immune system could lead to intolerable and harmful side effects.
“When you’re dealing with agents that are going to stimulate the body, you have to be careful,” says Dr Steven Stein, chief medical officer at Incyte, a biotech focused on cancer drugs. “You do not want to get to a point where there is an ‘autoimmune response’,” he adds, referring to a condition where the body’s immune system attacks healthy cells.
HARD TO TREAT CANCERS
Some cancers are worse than others, and doctors will be looking for data that show progress in tackling the deadliest forms of the disease.
Investors are watching for data from a trial of a drug made by Immunomedics, a New Jersey-based biotech. The drug is designed to carry chemotherapy directly into the tumour cells of patients with triple negative breast cancer — one of the hardest cancers to treat — enabling them to take a type of chemo that would prove too toxic if delivered normally.
Small cell lung cancer, which tends to affect smokers, is also notoriously difficult to tackle and can spread very quickly. Stemcentrx, recently acquired by AbbVie for $5.8bn, will present data from a study of its drug, Rova-T. In a smaller clinical trial, 44 per cent of patients with high levels of a certain protein saw their cancer disappear completely after taking Rova-T.
PRICE AND VALUE
Delegates at Asco have traditionally paid little attention to the price of drugs, preferring to focus on science. But that position has become untenable as concerns grow that the cost of the latest generation of medicines will cause patients and healthcare systems to buckle under the strain.
“We have to think about fairness,” says Dr Julie Vose, president of Asco. “We’re trying wherever it’s suitable to talk about value and cost.”
A study comparing the price of 23 major cancer drugs in different countries could spark a debate when it is published at the conference, she says.
One of the problems with the latest generation of cancer drugs is that they are biologic medicines made from living cells rather than chemical compounds, making it harder for generic manufacturers to make cheaper copycat versions.
Instead, generic manufacturers must try to make biosimilar versions of the drug that are not direct copies, and some big pharma companies are warning these might not be as good as the “real thing”.
Mylan, one of the largest generic drugmakers, is publishing data from a large study of its biosimilar version of Roche’s Herceptin, a breast cancer drug with annual sales of $6.6bn. If the medicine works as well as the branded version, it could offer a much cheaper alternative for patients.