When it comes to health breakthroughs, COVID-19 vaccines have received the lion’s share of recent attention — and rightly so, as they are key to ending a global pandemic that has killed millions and disrupted the lives of almost everyone on the planet. But there have also been big advancements in the field of cancer treatments. The American Society of Clinical Oncology held its annual meeting earlier this month, giving drugmakers and researchers the chance to share their findings on the latest developments in cancer research and drug research. There was much to celebrate. Here are four particularly promising takeaways:
Immuno-oncology (IO) drugs, which awaken patient immune cells to hunt down tumors, have proved capable of fighting multiple types of cancers and are among the industry’s biggest blockbusters. They’ve been mostly used in late-stage cancers, limiting their potential. Earlier use as so-called adjuvant therapy after surgery to catch stray tumor cells and prevent cancer from coming back has been seen as a huge opportunity because the body-spanning immune system is the perfect tool. Until now, it had only worked in melanoma, a relatively low bar because skin cancer has proved especially vulnerable to IO drugs. New data presented at ASCO finally confirmed the theory in other types of cancer. A year’s adjuvant treatment of lung cancer patients with Roche Holding AG’s IO flagship Tecentriq cut the risk of death by 21% relative to a placebo and left a higher proportion of patients disease-free after three years compared with the regular standard of care. There are many other adjuvant trials in progress, which will hopefully generate similar results.
Expanding immuno-oncology drugs
The revolution in treating cancer with IO drugs has faced one big obstacle: tumor cells use multiple mechanisms to evade the immune system. The most successful IO drugs, such as Merck & Co.’s Keytruda and Bristol Myers Squibb Co.’s Opdivo interfere with the action of PD-1, an “off switch” on immune T-cells. This is the part of the mechanism that the body uses to stop the immune system from attacking normal cells. But many cancers don’t respond, so the holy grail of IO has been to deactivate these other immune-evading defenses to help more patients. Bristol’s Yervoy is partnered with Opdivo to treat melanoma and some lung cancers, but it has high toxicity. At ASCO we saw data for Opdivo plus relatlimab, an antibody that blocks Lag-3, another T-cell off switch. The trial showed very similar efficacy to Opdivo and Yervoy, but with far fewer side effects, which should help more patients use the combo.
Better ‘me-too’ drugs
In the 1980s and 1990s, the pharmaceutical industry spent a lot of effort and money developing “me-too” knockoffs of rivals’ successful treatments with little differentiation on efficacy or tolerability. What we are seeing now is a more sophisticated approach to developing better versions of exciting drugs. The best example of this is AstraZeneca’s Calquence for a form of leukemia called CLL. Competing with AbbVie Inc. and Johnson & Johnson’s $9.4 billion-a-year blockbuster Imbruvica, Calquence was just as effective, but with a much better side-effect profile, data at the ASCO conference showed.
Tackling costs, with Chinese help
While the above advances are excellent news, there is of course the problem of cost. Just treating lung-cancer patients with IO drugs after surgery could cost $8 billion a year for the medicines alone. This is where biotechnology startup EQRx comes in. Launched in January, the company aims to address the high cost of drugs by leveraging innovation in China, which has experienced a surge in its biotech sector. EQRx has licensed cancer drugs from Chinese companies that have developed and conducted cheaper clinical trials at home. An example is the drug aumolertinib, with data at ASCO that suggested it may be as good as Astra’s blockbuster lung cancer drug Tagrisso. EQRx’s ultimate aim is to bring the drug to the U.S. and European markets at a substantial discount to Astra’s treatment.
The cancer treatment revolution rolls on. The key to getting the most out of breakthroughs is getting costs low enough that people can actually afford to benefit from them without damaging the incentive for drugmakers to spend heavily to develop even more effective treatments. It’s a tricky balance that we haven’t yet achieved with our current imperfect system. But there is still progress, and that’s worth cheering.