21 Apr The War Against Cancer Wages With Hope, U.S. Stimulus Fund
CHICAGO – The U.S. pharmaceutical industry took a quantum leap in growth during World War II when the U.S. government requested several key companies like Pfizer and Squibb to help in the development of the first major antibiotic (penicillin), which was used to help injured troops at the war front to combat infections.
With the development of this first major antibiotic, the pharmaceutical industry launched a spectacular age of development of many new families of antibiotics during the 1940s, 1950s, 1960s and 1970s including tetracyclines, macrolides, sulphas and new and improved forms of penicillin such as ampicillin.
Antibiotics established the pharma industry around the world and became the largest therapeutic class. While antibiotics continued to be important, in 1971 during the presidency of Richard Nixon the U.S. government declared another type of war to combat yet another threatening disease: cancer.
Nixon launched this campaign with $100 million in funding. That was a substantial amount of money back then. He enlisted the help of the U.S. Army and Fort Detrick became the first U.S. cancer research center. Nixon also signed the National Cancer Act into law that year.
If you fast forward 37 years, this war has broadened substantially with billions of research dollars to help the 1.4 million people who represent new cases of cancer every year in the U.S. with more than 4 million new cases in the major countries in the world. There are more than 5 million people living with cancer in the U.S.
More than 500,000 people die of cancer every year in the U.S. The stimulus plan alone will pump an additional $10 billion into the National Institutes of Health (NIH) for research in a wide spectrum of diseases (not just cancer).
Though cancer is not yet curable, there are a select few types of cancer that are treatable (among them testicular cancer and some forms of leukemia) with a favorable response. Within a few years, it’s believed that cancer might be converted from an acute mortal disease to a chronic manageable disease much like what HIV infection has become.
This situation might mean that a person could have cancer and live with the disease potentially for a long time with the cancer in check due to new medications. In the cancer world, the leading scientists of the world get together twice a year in two separate meetings to look at the latest discoveries and progress in the management of the disease:
1. The American Society of Clinical Oncology (ASCO) annual meeting is usually held in June.
2. The American Association of Cancer Research (AACR) annual meeting is usually held in April.
While both meetings are “American” meetings, in reality they are global meetings with oncologists coming from all over the world. The main difference between the two meetings is that the former focuses on new cancer therapies that are being tested in human trials while in the latter these new therapies are still concepts with perhaps initial results in a test tube or mice.
The AACR meeting more and more also focuses on new diagnostic techniques through the use of biomarkers. The AACR meeting is more academic and scientific in approach with large scientific poster sessions. The ASCO meeting is somewhat more commercial in tone as the technologies and products have progressed further in development.
The 2009 AACR meeting is taking place this week in Denver and oncologists will gather from around the world. There is more and more focus on preventing and diagnosing cancer. Earlier cancer detection and treatment is leading to longer survival.
Cancer is the leading cause of death in children from ages one to 14, according to the U.S. National Cancer Institute (NCI). By 2010, cancer will be the leading cause of death in the U.S. for all ages. One in five people will die from cancer in the U.S. According to the NIH, the overall cost of cancer in the U.S. was $180 billion in 2000.
With the expansion of biotechnology, new and improved cancer therapies have come to the market based on monoclonal antibodies. These have the benefit of being targeted therapy, they are more effective and come with less side effects than traditional chemotherapy.
According to the pharma publication Drug Discovery News in its April 2009 edition, the global cancer products market reached $66.2 billion in 2007. It grew more than 13 percent over the prior year or at about double the rate of the entire pharma market. Cancer products now have more than a 10 percent market share of the global pharma market.
This market is expected to reach $104 billion by 2012. There are some estimates that 38 percent of all new drugs in the clinical trial stage of development are cancer drugs. The leading pharma and biotech companies in the cancer products market, according to Drug Discovery News, were:
|1) Amgen||$11.1 billion|
|2) Roche||$9.2 billion|
|3) Genetech||$6.3 billion|
|4) Sanofi-Aventis||$5.5 billion|
|5) AstraZeneca||$4.8 billion|
As Roche just acquired Genentech earlier in 2009, this acquisition would make Roche the new market leader of this category. Cancer therapy was traditionally based on a triad of approaches:
1. Surgery (to remove the tumor)
2. Radiation (to shrink the tumor)
3. Chemotherapy (to poison and kill the tumor)
The problem with these approaches has been the high secondary or side effects of both radiation and chemotherapy (as not just the cancer cells are affected but also healthy tissues) as well as the “escape” of smaller micrometastatic cancer cells to survive and migrate to other areas of the body and grow.
After the development of chemotherapy, another approach called hormonal therapy came into active use for specific, hormone-related types of cancer such as breast and prostate cancer. Some 20 to 30 years ago, a newer modality of cancer therapy called immunotherapy (or adjunctive therapy) also came to the forefront.
The idea here was that the this new class of anti-cancer drugs could help stimulate the body’s own immune system a powerful weapon to fight against cancer (and particularly these tiny micrometastic cells). The next wave of therapy, which is called monoclonal antibodies, allowed for specific targeting of therapies to the cancer cells to leave the healthy cells alone.
According to Drug Discovery News, this new wave of biotech drugs represent about 36 percent of sales of all cancer therapy with the “adjuncts” representing about 30 percent of the market followed by chemotherapy with 21 percent of the market and hormonal therapy with 13 percent of the market.
The limitation of the above medicinal approach to the treatment of cancer is the philosophy of “one size fits all” (i.e. one drug can help all patients with a particular type of cancer). There has been a substantial amount of research in the last five to 10 years to show that there are multiple genetic variants of a particular type of cancer and better diagnostics would predict which patient would respond to a specific type of therapy.
With the advent of the drug Herceptin for women with breast cancer (for which there was diagnostic evidence of the her2 neu gene in these women), this drug was found very effective for this subgroup of patients with breast cancer. Where this is leading to is a greater understanding of these genetic variants and a more personalized approach to the treatment of cancer.
This will most likely accelerate over the next 10 years.
Walking around the AACR meeting, one sees a high representation of university research scientists. The Midwest has a number of good research institutions and is well represented at this meeting. Northwestern University, the University of Chicago and the University of Illinois-Chicago in Chicago alone represent excellent cancer research institutions and cancer treatment centers.
They are joined by other Midwest institutions in nearby Madison, Wis. (the University of Wisconsin), Indiana (Indiana University), St. Louis (Washington University), Michigan (the University of Michigan), Minnesota (the University of Minnesota) and more. We also have great cancer treatment centers at the Mayo Clinic (in Minnesota) and the Cleveland Clinic.
Though a cure for cancer is not yet in evidence, coming to a meeting such as this one provides hope and a sense that progress is being made. You must realize, however, that any drug or other approach to cancer therapy coming out of this meeting is at least five to 10 years from coming to the marketplace.
The additional stimulus funding being provided by the Barack Obama government will hopefully provide the necessary impetus to come up with the next wave of cancer therapies (and other disease therapies) to have the kind of societal impact that the development of antibiotics had between the 1940s and 1970s. See you soon!
Recent columns by Michael Rosen
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- Michael Rosen: IBIO: A twelve year retrospective on biotechnology in Illinois
- Michael Rosen: Pharma transformers: Big Pharma into biotech or into bigger pharma?
- Michael Rosen: U.S. Venture Capital 2008: Strong Midwest growth albeit overall decline
- Michael Rosen: CleanTech VC investments on the rise during 2008 while life sciences lags
This article previously appeared in MidwestBusiness.com, and was reprinted with its permission. The article is not meant to be a stock recommendation.
The opinions expressed herein or statements made in the above column are solely those of the author, and do not necessarily reflect the views of Wisconsin Technology Network, LLC. WTN accepts no legal liability or responsibility for any claims made or opinions expressed herein.