Oncology Summit Europe 30-31 Jan

A wet and windy London greeted pharma representatives from across Europe, along with key opinion leaders, physicians and media. On the agenda: Successful marketing in the upcoming oncology drugs explosion and chemotherapy in the next decade.

A good range of speakers was introduced by conference chairman Sean McGrath, MD of Succinct Healthcare Communications. He started by outlining topics set to become issues in the next few years, such as a much greater incidence of cancer, many more cancer drugs  and called for centrally managed market access across Europe.

First guest speaker, Karol Sikora, Medical Director of Patient Advocacy Group (PAG) Cancer Partners UK, kicked off proceedings by addressing the state of cancer care in Europe, highlighting the variations between not just countries, but areas of cities as well.

He pointed out that there was likely to be increased strain on public health services across Europe as the populations aged, more drugs came online and demand increased. These factors will be coupled with increasing patient knowledge, putting extra strain on already information-saturated doctors.

“[In the UK] tax would have to go up by 5 pence in the pound to cover the upcoming costs”, suggested Dr Sikora. “Patients will drive drug consumption as they purchase drugs over the internet”, he added. He went on to highlight the danger of the idea of ‘co-payment’, given the ‘free to all’ ethos of the NHS, but hinted that it may well be the only way forward given the huge costs looming.

Sikora looked at the UK’s poor cancer treatment record compared with the rest of Europe, as detailed in the 2007 Karolinska report, putting the discrepancy down to poor management rather than poor clinical practice.

Looking to the future, he predicted the restructuring of NICE (National Institute for Health and Clinical Excellence, UK equivalent of the FDA), given the current situation whereby patients can obtain some drugs in Scotland and France that they cannot obtain in England. He foresaw greater drug innovation, a boom in private cancer clinics in the EU, a bigger role for PAGs, and pharma lowering prices in poorer countries.

WHAT PATIENTS NEED TO DO

Next speaker, Jola Gore-Booth from charity Europacolon, echoed Karol Sikora’s emphasis of patient advocacy groups in pushing new drugs from trial, through NICE, to the patient. She called for greater interaction between pharmaceutical companies and charities, citing the recent high level of attention paid to cancer charities by NICE when deciding what drugs to clear.

“Our sector should join hands publicly together. We need to work together against the media, who are prone to hyping up a negative story to sell papers”, she added, referring to media outcry over pharma sponsoring charities. Ms Gore-Booth insisted that most charity workers are professionals and could be trusted not to succumb to pharma pressure to promote a certain drug.

She called for better coordination of PAG funding by pharma, with 2-3 year contracts as opposed to annual, as well as cheaper oncology drugs and ‘more responsible’ press releases. Addressing charities, she suggested a tough approach to wooing the media, and a minimum of 2 company sponsors at any one time to prevent suspicion.

WHAT PHARMAS NEED TO DO

First to represent the pharmaceutical companies, Eddie Gibson of Bristol Myers Squib (BMS) looked at how pharma could help the NHS better spend its money. He highlighted the financial waste within the NHS, which, if correctly estimated by the think tank Reform and Imperial College London, far outweighs the entire budget for oncology drugs.

He covered the difficulty establishing the price, given the lack of ‘price barometer’ predicting tomorrows market and demand, and emphasised selling the drugs as innovative, rather than just good value for money.

This new approach to marketing oncology drugs was built upon by Astra Zeneca’s representative Chris Teale who emphasised that new drugs should be marketed not just for their overall survival but also associated quality of life, clinical, humanistic, economic and pain relief attributes: “Pharma have often been blinkered in the past and have had a too regulatory focus” he suggested, adding that in the future “all levels in a pharmaceutical company will need to interact with all levels of the payer [drug buyer]”. Mr Teale called for closer and earlier collaboration between those buying the drugs and the pharmaceutical companies in order to get the right drug to the right patient, an approach which would run alongside continuous reassessment of emerging drugs to benefit patient, payer and pharma alike.

SUCCESSFULLY LAUNCHING A DRUG

Medical management consultant Nader Naeymi-Rad detailed what a successful oncology drug launch should entail, underlining the need for specialist marketing teams fully educated on the key science and able to talk to doctors on a peer to peer basis, as well as the use of PAGs and key opinion leaders (KOLs) to both promote and bolster doctor confidence in the drug.

This would hopefully address what Mr Naeym-Rad saw as the “perfect storm” of doctors with more patients, more drugs, more sales reps and less time.

He further called for full operational transparency within the drugs marketing team, and a different flexible approach to each country.

NEGOTIATE ON PRICE

Uday Bose, European marketing director for GlaxoSmithKline (GSK), gave some insight into the complicated process of pricing oncology drugs, and defended the high costs demanded by pharma pointing out that 10,000 chemicals may end up as one single drug.

But, he accepted that pharma should be prepared to negotiate on price, pointing out that the situation where therapies were combined, for example using 3 types of drug at once, was untenable with high prices.

This change would need to be accompanied by ensuring that the overall innovation of drug development was seen by customers, not just the end result. “Small steps in innovation are often ignored so customers need to be educated on the dynamics of drug development. The magnitude of many small advances needs to be emphasised”.

Mr Bose also extolled the virtues of using research and development data, not just for proving the safety of a drug, but also for use in pricing negotiations; suggesting that further openness with data would benefit all parties.

Risk sharing with purchasing new drugs was put forward as a means of transferring drugs to patients, to prove drug efficacy in the real world, not just the laboratory.

He noted a clear trend in EU pricing and regulatory environment to prioritise innovation and suggested that pharma must respond by demonstrating this innovation and ensure pricing strategies reflect not only the brand positioning, but also the economic value. Mr Bose also put forward the idea that close collaboration between the marketing team and research and development personnel from phase I to post-launch is a critical success factor in marketing of a new drug.

Having covered these points, Mr Bose put the onus firmly on pharma to take action to meet the upcoming likely issues in pharmaceutical oncology treatment.

PUBLIC ACCEPTION

John de Wit, Business Unit director at Amgen, hinted that the public would have to expect to pay more for their treatment in the future, pointing out that the average person spends more per month on their mobile phone than on their health services; “we can’t have the crown without paying for it”.

He lamented the UK’s NICE authority, linking their high drug rejection rate with the UK’s poor performance in the Karolinska report, and noted that Amgen would likely be attempting to convince NICE to adjust its parameters in the future.

PRICE

Sanofi-Aventis oncology marketing VP Gary Hendler examined the different levels of oncology drug advertising employed to encourage doctors to invest; from basic factual, to more branded emotional, patient-orientated adverts. He highlighted the difficulties likely to be faced over the next ten years by pharma as numerous drugs come online, and competition between pharma becomes increasingly heated.

He emphasised strongly that prices will need to come down across the board in order to be realistic about selling large quantities of oncology drugs in emerging markets such as Brazil, Mexico, China, India and Eastern Europe.

Mr Hendler also criticised the idea that prices could be set high then ‘capped’, (i.e. sold at reduced cost after a certain amount or length of time) pointing out that patients were often already dead by the time the limit was reached: “Capping the amount of money is not practical, we just need to charge less”.

GREATER INTERACTION

There were further calls for greater interaction between pharma and the Department of Health and the NHS from Jackie Holding, consultant from Holding Associates.

TECHNOLOGY

Such calls were echoed by Crispin Simon of Biocompatibles International who covered the need for greater interaction between engineering companies involved in oncology such as his and pharmaceuticals. He detailed new cancer-fighting technologies such as drug eluting beads and more established ones such as pinpoint ablation. The drug eluting beads work by releasing the drug specifically to the tumour rather than the surrounding body. Mr Simon asked for the cooperation of pharma in providing new drugs that had failed phase II trials due to toxicity, to be tested in their beads. The concentrated delivery method means that toxicity is potentially less of an issue, so failed drugs may become viable. The beads had already been proved to be successful in treating Hepatocellular carcinoma (liver cancer) with the drug sorafenib.

ONCOLOGY TRENDS AND FUTURE CHALLENGES

A spokesman for IMS Health described what he saw as a “promising new future” for oncology drugs, given the ‘rich pipeline’ previously mentioned. He predicted that by 2011 there would be a $80 billion spend on oncology drugs worldwide, boosted by the new affluent middle classes in countries such as China and India.

“There will be $11 billion worth of oncology drugs in the next 5 years” he said, hinting that those purchasing (payers) will “need much more help from industry to access the cost-effectiveness of these drugs”. He admitted that there would be “headroom” created as major oncology drugs came off patent, and could be produced much more cheaply, but insisted that this would not cover the boom.

2020 VISION

Final speaker Professor Gordon McVie, of the European Institute of Oncology (IEO), joined the IMS Health representative in his look to the future, presenting a picture of what he thought cancer treatment would look like in 12 years time. He started with a slight grounding for the pharma noting that chemotherapy was by far the least productive field of cancer treatment, with most successful treatment being surgery or radiotherapy.

He suggested that by 2020 there would be 3 million cancer cases a year in Europe alone. “Oncotourism will be the norm”, he added looking to a future where patients with enough money will frequently travel across Europe, even worldwide, to seek out the best cancer care.

Professor McVie saw a great future in preventative medicine; for example vaccinating against viruses likely to cause cancer, egg HPV vaccination for cervical cancer.

Widespread screening for high risk genetic profiles also has the potential to save many lives: Expansion of the Guthrie test, currently employed in the UK to test new born babies for congenital diseases, to include testing for a specific high risk cancer gene, could, McVie suggested, give a head start to cancer treatment.

Both diagnostics and scanning would improve, with earlier, clearer diagnostics and more intelligent imaging. Such intelligent imaging has the potential to allow for widespread use of ‘virtual biopsies’ where extremely detailed scans are combined to allow a 3D image of part of a patient’s body, from which a section can then be ‘cut’ or removed.

Radiotherapy is set to develop at a similar rate with ‘targeted shape radiation’ becoming the norm; greatly reducing side effects which cause added stress to the patient.

Drugs are set to become for more targeted and patient-specific and smarter in their delivery; orally becoming more frequent.

But it is likely that not only drugs will become more intelligent; new surgery techniques using robots such as the ‘Da Vinci’ machine will mean faster, safer more efficient operations, with knock-on benefits:

“Budgets will be freed up for drugs by changes in surgery techniques and elsewhere saving patient time in hospital beds, a huge cost for institutes” said Prof McVie. He was also optimistic about the overall battle against cancer stating that “progress over the next 12-15 years will be much faster than the last 20”.

He agreed with Crispin Simon’s message that pharma objectives needed to be more aligned with machinery companies and also added that he would like to see “pharma funding biomarker assessment so that they can then push their drugs for a certain, specified patient; giving them a very strong selling position”.

SUMMARY

The meeting certainly raised a few key recurrent points: The issue of the upcoming ‘perfect storm’ faced by pharma and doctors alike as new oncology drugs flood the market, was covered many times, along with a need to lower drug prices or at least price accordingly depending on location and situation. Though there was much concern over the upcoming problems, as they were seen, there was still an overwhelming feeling of optimism at all the new drugs coming to market, and varied rapidly developing approaches to cancer treatment.

The strain on public health services, especially In the UK will be felt more acutely in the next few years, with difficult issues such as drug co-payment having to be tackled.

Specialised marketing teams look set to be the future for pharmaceuticals, taking over from generalised reps, and providing a better informed peer-to-peer dialogue with doctors, suggesting the need for greater scientific training of drug reps, or at least more in-depth.

There was also a nod to the new technology offered by the internet where marketing may be carried out in ‘virtual life’ environments such as Second Life, which gives the potential for meetings between doctors, drug reps and patients online.

Bioinformatics - using maths to solve biological problems, in this case analysing genetic mutations which cause cancer - was agreed to hold further promise for the future of cancer research. This type of innovation was deemed important to stress when marketing such cancer drugs, to encourage greater appreciation from the public of pharma achievements.

Overall the conference achieved a great deal, the wide range of speakers covered all angles of the oncology drugs topic. The only thing lacking, perhaps, was a NICE presence. Given the criticism frequently levelled at NICE by several speakers, some sort of defence, or explanation of their actions would have benefited the whole debate. Some idea of NICE’s plans for the future would also have been informative when hypothesising about the flux of oncology drugs coming to the market.