The Cancer Drug Dark Ages Are Coming to an End
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well-defined patient populations, not the broad-brush, organ-based classifications of the past like “breast cancer,” which made everybody’s disease sound the same. As any biologist will tell you, cancer is nefarious in its complexity. But by homing in on biologically distinct malignancies, these drugs were able to offer excellent benefits to people who otherwise had been given a death sentence. And while all these drugs are expensive, I would argue these prices are more defensible than many cancer drugs for a couple reasons. One, these treatment offer major benefits to people without other options. And two, there are diagnostics that can help weed out most of the waste by ensuring the drugs go exclusively to people most likely to benefit.
The results are starting to change the way people in biotech and pharma think.
This week at the BIO Investor Forum in San Francisco, Alan Wahl of Abbott Laboratories said his company won’t advance a biotech drug in development anymore unless it has a diagnostic to push in parallel. “Companies that get personalized medicine will win” because they will have the data that can truly justify high prices when insurance companies start pushing back, said Rollie Carlson, the CEO of Austin, TX-based Asuragen, on the same panel. And later in the conference, Bryan Roberts of Venrock related a story about how one senior Genentech executive is so pumped about cancer drug development that he said it is getting to the point where scientists can basically move down a checklist, knocking out aberrant cancer pathways one-by-one.
There will be losers in the push toward more personalized cancer medicine. Cancer drugmakers (think Dendreon, and in some instances Genentech) are going to continue to have a hard time justifying high-priced medicines that have no real way of predicting who will respond, and who won’t. The diagnostic companies are going to have to fight tooth and nail for every dollar they get on reimbursement, because society still puts most of the value on drugs. Some patients are going to struggle with denial when they get the bad news that there’s a lifesaving new drug out there for their form of cancer, but they can’t have it because there’s something in their genes that says it won’t do them any good.
But there’s no other way to put it, the rules of the cancer drug development game are changing for the better. Companies who base their work on great science will have a shot at running leaner, meaner, shorter, and cheaper clinical trials that have a good chance at satisfying the FDA. It’s great news for insurers, who can now show their shareholders that when they pay six-figure sums for cancer drugs, they are no longer flushing two-thirds of the money down the toilet on patients who see no benefit.
This switch toward personalized cancer drugs won’t happen overnight, and FDA official Janet Woodcock recently said it will be a “long slog.” Personally, I loved hearing her say that. I love climbing mountains in my spare time, so I can appreciate that some of the very best things in life come at the end of a long slog. Personalized cancer medicines like the ones being approved today are worth every ounce of effort and every penny of investment, even if it takes a long time for us to see the summit.