All you need to know about the rapidly evolving cancer treatment landscape and its economic impact. All the recent launches, highly anticipated new immuno-therapies and future trends. A complete review of the oncology pharmaceutical market in 2018
Cancer is the second most common cause of death in the US and it accounts for 1 in every 4 deaths. However, cancer incidence and mortality have been declining in recent times. In the past three decades, survival rates have increased. Over 15million in the US are survivors of cancer. Survival rate is growing steadily and numbers of survivors is expected to reach 26million by 2010 with 73% of the survivors of 65years or older. Decreased incidence and improved survival rate have been attributed to reductions in smoking as well as advances in early detection and treatments.
Advancements in Cancer Treatments
In the past decade, oncology treatments options have been expanding. The Food Drug Administration (FDA) has approved 63 new cancer agents for 78 cancer indications in the last five years. Currently there are more than 200 cancer treatment agents. In 2016, FDA approved 5 new active substances and in 2017, 14 new targeted medicines were approved. Of the 14 new active substances, 11 were designated Breakthrough Therapies, indicating that the drug may demonstrate a substantial improvement over available therapies on one or more clinically significant endpoint.
A significant milestone marked in 2017 is the approval of precision oncology medicine. Precision oncology, a directing therapy based on genomic biomarkers and independent of cancer type, has demonstrated promising treatment outcomes and can significantly impact treatment of cancer. As an additional indication, the immune checkpoint inhibitor pembrolizumab which was first approved in 2014 became the first cancer treatment approved to treat a tumor-agnostic indication. Based on the tumor response rate and durability of response observed across all cancer types in a clinical trial of 149 patients, pembrolizumab was approved for adult and pediatric patients with unresectable or metastatic, microsatellite instability-high (MSI-H) or mismatch repair deficient cancer.
In total, 7 out of the 14 new active substances were associated with predictive biomarkers. Precision oncology medicines provide patients with a wide range of different cancers an effective way to control the disease.
Immuno-oncology therapies have proven to be promising treatments since their launch in 2014 and have been used to treat a wide range of cancers. Every year more effort is channelled towards the development of immune-oncology therapies. In 2017, 5 immuno-oncology new active substances were approved and all received Breakthrough Therapy designation. Another significant milestone in 2017 is the first adoptive cell immunotherapy approval. In August 2017, the FDA approved the first chimeric antigen receptor (CAR) T-cell therapy, and the first gene therapy for cancer, tisagenlecleucel for the treatment of recurrent pediatric acute lymphoblastic leukemia (ALL). Later in October, the second CAR T-cell therapy, axicabtagene ciloleucel, to treat adults with certain types of lymphoma was approved. Both CAR T-cell therapies performed remarkably in clinical trials, bringing remission to cancer patients after treatment.
With the emergence of next-generation therapies, not only are patients gaining access to more treatment options, the composition of combination therapies is extending to include immune-oncology therapies thereby causing a shift in treatment paradigm of cancer.
This year, 2018, the oncology pipeline is off with a slow start with only two new active substances approved in the first half of the year. However, there are quite a number of launches to look forward to later in the year.
Economic Impact of Cancer
The global economic cost of cancer is significant and is increasing. Globally the costs associated with oncology care are higher than the treatment costs for any other disease. Costs incurred by oncology care encompass cost of individual treatments, diagnosis, surgery, hospitalization, and palliative and end-of-life care. The total global cost of oncology care was estimated at approximately $106.5billion in 2015 and is expected to rise by 53% by 2020.
Oncology treatments remain one of the biggest revenue sources for many pharmaceutical companies. Currently, oncology drugs represent 5 of the top 15 best selling drugs globally and the market for oncology drugs has been forecasted to grow at a CAGR of 10.9% to 2030. The oncology drugs market is driven by the growing prevalence of various types of cancer, aging population, lifestyle changes and an increasing demand of biological and targeted drug therapies. Global costs of oncology therapeutics and supportive care drugs increased from $96billion in 2013 to $133billion in 2017. Developed markets, United States, Europe and Japan, account for up to 74% of the total spending on oncology treatments. Compared to a spending growth rate of 14.8% in 2016, spending growth slowed to 12.5% in 2017 majorly offset by slower spending growth in the US, Japan and the five major European markets.
Newer medicines especially immunotherapies accrue higher costs than older medicines. On average, the yearly cost of new oncology medicines is now above $160,000 up from $79,000 in 2013. Use of oncology products also seems to differ in the different markets. While the developed markets spend more on new medicines that have been on the market for less than eight quarters for any quarterly period in the year , the pharmerging markets spend more on low cost branded and generic products which were first introduced globally over 20 years ago. The disparity in the trend of oncology treatment use can be attributed to limited access to new medicines in Pharmerging regions and slower forecast economic growth.
The high cost of oncology treatments is a pressing societal issue. Payers globally are of the opinion that the cost of cancer drugs is not parallel to the clinical benefits associated with their use. The high cost of oncology treatments has compelled payers globally to demand for concrete evidence of treatment success to get good value for the cost. As a result, many countries require effectiveness assessment or health technology assessments of new medicines and payers are demanding for outcomes- based contracts to determine discounted reimbursement levels for oncology drugs.
Oncology Pipeline 2017
The oncology pipeline is growing continuously. In 2017, over 700 molecules were in late stage development with almost 90% of the therapies being targeted treatments. Pipeline assets include small molecules, radiotherapies, hormonals, cytotoxics and targeted therapies.
In a bid to deliver more precision medicines to the market, the use of genomic biomarkers for patient selection in clinical trials is gradually spreading. Other oncology research interests include research on tumor targets and clinical studies to assess efficacy of multiple regimens.
- American Cancer Society (2017). Cancer Facts & Figures 2017. Atlanta: American Cancer Society; 2017.
- gov. (2018). Hematology/Oncology (Cancer) Approvals & Safety Notifications. [online] Available at: https://www.fda.gov/Drugs/InformationOnDrugs/ApprovedDrugs/ucm279174.htm [Accessed 13 Jun. 2018].
- IQVIA Institute for Human Data Science (2018). Global Oncology Trends 2018 Innovation, Expansion and Disruption. [online] New Jersey. Available at: https://www.iqvia.com/institute/reports/global-oncology-trends-2018 [Accessed 28 May 2018].
- The American Society of Clinical Oncolgy (2018). Clinical Cancer Advances 2018. [online] Journal of Clinical Oncology, pp.5-7. Available at: https://www.asco.org/research-progress/reports-studies/clinical-cancer-advances-2018 [Accessed 12 Jun. 2018].
- The American Society of Clinical Oncology (2017). The State of Cancer Care in America, 2017: A Report by the American Society of Clinical Oncology. Journal of Oncology Practice, 13(4), pp.e353-e394.