Cancer may offer greater reassurance than any other disease area to pharmaceutical companies leery of using new pharmacogenomics technology in drug discovery, according to an AstraZeneca cancer specialist.
And why shouldn’t it? The global market for cancer drugs is poised to triple over the next seven years to more than $64 billion. Drugs like Gleevec and Herceptin have taken pioneering strides in personalized medicine, and the unique specter of cancer tends to encourage regulatory agencies to grant pharmas greater incentive to develop new drugs.
But on the whole, big pharma, and to some extent investors, have been lukewarm on pharmacogenomics. Tool companies selling genotyping instruments or services have fallen out of favor among customers and investors, and the majority of pharmas continue to rely on antiquated combi-chem methodologies.
One reason for this, many agree, is pharma’s reluctance to embrace a technology it believes can endanger the concept of the blockbuster. However, others contend the marketing mantras taken up by big pharma and Wall Street — that the blockbuster is king — do not apply to cancer.
“I think right now the difficulty is that for all of the [pharma] companies, their motivation is capitalism — we accept that because that’s the way the world works,” said Karol Sikora, a cancer specialist at AstraZeneca. For cancer, he said, pharmacogenomics will create a market for “hundreds of niche-marketed drugs.” But can pharma and its pharmacogenomics vendors endure the wait?
Massage the Machine
One factor experts attribute to the sluggish growth of pharmacogenomics is the pharma marketing machine. According to Sikora, big pharma has a track record of usurping what he called “normal therapeutic hierarchies” while hobbling personalized medicine.
Sikora, who also is a professor of cancer medicine at Imperial College School of Medicine in London, likes to compare his duties as chief of the World Health Organization’s cancer program with the modern pharma mentality. “When I was at the WHO, I told people they’ve got to put together a priorities ladder. At the top we had prevention — the boring stuff of public health. Then you’ve got palliative care, and so on,” he said. “Then, at the very bottom, you have bone-marrow transplantation, which is really not worth conceiving unless you’ve got the other rungs in place.”
This model seldom exists in big pharma today, Sikora said. The difficulty pharmacogenomics faces, he explained, is that pharma firms see a drug like Herceptin or Gleevec and they begin to hear a chorus of cash registers. “They want to start giving Herceptin to everyone with breast cancer,” he said. “The market drives you to take the latest, the newest, the most innovative, because that has the highest value” for big pharma. He spoke with SNPtech Reporter Tuesday following a session at a cancer-research meeting in Bethesda, MD.
“A marketing director I know — not one at AstraZeneca — once told me it's no fun marketing a drug that works. 'It's much more fun to take one that doesn't work or one that doesn't work very well,' he said. That's the challenge in marketing.” Reacting to a reporter's raised eyebrow, he added: “If you're a marketer that's what you do: You try to maximize the value of your drug.”
“Big pharma really don't know how to handle it: that's why everybody is doing it differently,” Sikora said. There are exceptions, of course. Roche and Abbott, for example, have their own diagnostics division so they can put together a kit and market it to certain patient populations. Sikora's firm, AstraZeneca, closed its diagnostics division in the late 1990s but still markets a number of popular cancer drugs: Arimidex, for acute refractory promyelocytic leukemia; Casodex, for prostate cancer; Zoladex, for prostate and breast cancer, and Tamoxifen, for breast cancer.
Sikora said his argument is likely only to work with cancer because other widespread diseases — hypercholesterolemia or gastric ulcers — already have attracted an abundance of therapeutics, like statins and proton-pump inhibitors, that work safely and well.
“The mantra in big pharma is 'Make a big drug or two as quickly as possible … and make a blockbuster,'” said Sikora. “Pharmacogenomics complicates [this] mentality.”
However, he speculates that cancer therapeutics will force pharmas to view the market in another way. “There will be hundreds of niche-marketed drugs, and I think we're beginning to see the whole market break into niche-marketed drugs that come with their own diagnostic.
“It will balance off,” he went on. “You will have drugs that are more effective — essentially more people will want them and will take them for longer — but there may never be another Taxol again. There will instead be a hundred compounds whose total value will be the same as [a single] billion-dollar drug.”
“To not have pharmacogenomics in cancer [research] is craziness,” said Sikora. “It would make nonsense of doing it.”