Cancer Awareness Day : Cost Matters

February 4, 2019 | Disease

Melanie senior

Imagine if, by 2034, three quarters of all cancer sufferers survive the disease. That is the aim of the Union for International Cancer Control (UICC), which leads World Cancer Day on February 4.

It’s an admirable goal. This most deadly and cunning disease is newly-diagnosed in 18 million people across the globe each year. It continues to devastate lives and families, even amid the extraordinary scientific progress driving new treatments.

These same new treatments, while often life-prolonging and sometimes life-saving, also contribute to the huge economic cost of cancer. This was estimated, in a 2014 IARC World Cancer Report, at over $1 trillion per year; it is now likely to be a lot higher.

Discussing the cost of saving lives is awkward, but necessary. This necessity is reflected in the ongoing pricing debate across pharma more broadly, as governments and payers seek sustainable ways to fund a growing range of more sophisticated medicines.

Disease prevention strategies provide part of the answer. Investing $11 billion in cancer prevention strategies in low- to middle-income countries could save ten times that in treatment costs, according to Knaul et al.’s 2012 book, “Investing in Cancer Care and Control.” And while prevention does not, at first glance, look like a great commercial model for pharmaceutical companies, investors have not shied away from supporting companies like GRAIL Inc., which is seeking a test to detect cancer early, when it can be more successfully treated.

GRAIL has raised over $1.5 billion in the last three years. The privately-owned company is about to begin a prospective longitudinal study of 50,000 people without cancer, to determine how well its next-generation sequencing-based blood test can detect cancer. About half of the participants will be considered ‘high-risk’ for lung and other cancer types, due to smoking history. The study will be conducted in partnership with the UK’s University College London and the UCL Hospitals National Health Service Foundation Trust, along with Lung Cancer Alliance, a non-profit based in Washington, DC.

Partnerships are key to combating cancer, at any stage. Industry, charities, governments, providers, patients and the public must work together, locally, nationally and internationally. This is true for prevention strategies – requiring governments and

communities to promote and support healthy lifestyles; for early detection – requiring companies and health systems to implement more widespread, effective screening; and for successful treatment.

Effective cancer treatment, increasingly, means more personalised treatment. Personalised or precision medicine is being enabled by new technologies and new kinds of data, allowing scientists to combine patients’ genomic and other molecular data with clinical and life-style information to create a fuller picture of their disease – and to choose the most appropriate treatment.

According to a 2018 paper by Marquart et al. in JAMA Oncology, just over 8% of US cancer patients are eligible for FDA-approved, genome-driven cancer therapies. About 5% would actually benefit from the treatment. Those numbers may not appear very high (and they also assume universal testing and access, which is far from reality). But the authors say the figures have increased linearly by 0.5% annually between 2006 and 2018.

Precision medicine will play a greater role in future, as tests become more accurate, cheaper and accessible. But practical and economic constraints make them difficult to scale. So investment must continue into broader therapeutic strategies like cytotoxic drugs and into non-personalised immuno-therapies. Indeed, amid the plethora of exciting new immuno-therapy approaches (such as cancer vaccines and oncolytic viruses) practical considerations such as cost and manufacturing are, increasingly, front of mind.

That’s in part because of the competition. Oncology is the hottest therapy area for deals and fundraising across the life sciences. Competition is forcing developers to think beyond the science in order to differentiate their offerings. It is forcing them to consider the economic costs of cancer.

That’s good news for everyone.