DEVELOPMENT AND INNOVATION IN CANCER MEDICINE - Innovation in the Biopharmaceutical Industry - page 54

Healthcare payers will create sophisticated systems for evaluating the economic
benefits of innovative imaging and tissue analysis technology.

New Treatment Approaches

Future cancer care will be driven by the least invasive therapy that is consistent
with long-term survival. Eradication, although still desirable, will no longer be the
primary aim of treatment. Cancers will be identified earlier and the disease process
will be regulated in a similar way to chronic diseases such as diabetes. Surgery and
radiotherapy will still play a role, how great a role will depend on the type of cancer
a patient has, the stage at which the disease is identified, and how well the drugs
that are currently in development perform in the future.
Cancer treatment will be shaped by a new generation of drugs. What that gen-
eration will look like depends critically on the relative success of agents that are
currently in development, and on society's willingness to pay for innovation. Over
the next three to five years we will begin to understand better the benefits that com-
pounds such as kinase inhibitors are likely to provide. It is estimated that around
500 drugs are currently being tested in clinical trials. Around 300 of these drugs
inhibit specific molecular targets (Melzer, 2003), but that number is set to rise dra-
matically. By 2007, 2,000 compounds will be available to enter clinical trials, and
by 2010, that number will increase to 5,000. Many of these drug candidates will
be directed at the same molecular targets, so industry is racing to screen those that
are most likely to make it through the development process. By 2008, tremendous
pressures will come from the loss of patent protection for the majority of high-cost
chemotherapy drugs. Unless new premium-priced innovative drugs are made avail-
able, cancer drug provision will come from global generic manufacturers who are
currently gearing up for this change.
What will these drug candidates look like? The main focus of current research
is on small molecules which are designed to target the specific gene products that
control the biological processes associated with cancer. These include signal trans-
duction, angiogenesis, cell cycle control, apoptosis, inflammation, invasion and
differentiation. Treatment strategies that involve monoclonal antibodies, cancer vac-
cines, and gene therapy are also being explored. Although we do not know exactly
what these targeted agents will look like, there is growing confidence that they will
work. What is more uncertain is their overall efficacy at prolonging survival. Many
might be no more than expensive palliatives. In the future, advances will be driven
by a better biological understanding of the disease process (Fig. 2).
We are already seeing the emergence of drugs targeted at the molecular level:
Herceptin ® , directed at the HER2 protein, Glivec ® , which targets the Bcr-Abl tyro-
sine kinase, and Iressa ® and Tarceva ® , directed at EGFR tyrosine kinase. These