Why do some Pharma companies do well in oncology and other's don't?

A chance email yesterday from Matthew Herper of Forbes Health got me thinking.  He was interested in whether a company, who have been successful in other therapeutic areas, could do well in cancer.

A question like that can quietly sit in the back of your mind for days percolating and brewing until you sit down and really think about it.

I've had some great opportunities to work in several different therapy areas including cardiovascular, dermatology, immunology, CNS, hematology and oncology.  The last two have much in common, the others less so.  But what makes them different, what factors are important to take into consideration and how do make it work?

Two of the big differences are data and science.

Cancer is much more technically complex than many diseases and the understanding of how the biochemistry and the drug interact can make or break a product.  One of the first oncologists I ever met, a dour academic chap who did a lot of leukemia transplants and research in equal measure, memorably advised me in a most stern manner to "forget the fluff and puff, just show me the data!"  

Cardiologists and dermatologists always seemed to ask 'how' questions... how much does this cost, how soon will you have slides for a lecture series, how many papers do you have published so far etc.

Oncologists are a different breed.  They ask a lot of why and where questions... why should I use this drug, where is the evidence to show X or Y etc.

For me, it's about learning a completely different mindset and adjusting to a new customer focus.  If your drug isn't better than what an oncologist has already, especially in efficacy, no amount of hype is going to give you a hook or an advantage.  Risk-benefit trade-offs in a serious disease that may lead to deaths forces people to think about the treatments in another light. 

Think about it, the most common questions an oncologist is going to hear from people who visit are:

1. Will I be cured?
2. Will it make me live a little longer?
3. Will the treatment make me feel better?

Intuitively, people with cancer focus on the most important things and for doctors hearing that many times during the course of a week, they will subconsciously be thinking that way too.

Going back to Matt's broad question, I was thinking about all these things yesterday while interviewing an oncologist about how he treats a certain cancer, which in rare cases is curative but in most situations 2) and 3) more clearly applied.  My focus was a little sharper than usual because I found myself automatically asking why questions about a range of different regimens.    

Now, some of the companies for the treatments he mentioned have indulged in typical marketing hype, with fancy programs, e-details and branded campaigns that could well have applied to an anti-hypertensive or skin cream.  As the doctor walked through his treatment algorithm, I could almost imagine the critical survival charts on the wall in from of my desk.  Finally, it became clear that he ranked them by the survival curves, with one exception that was reserved for a small, rare subset that had aggressive disease because the consequences of managing the concomittant myelosuppression were too high. 

And there in is the rub.

Success in the oncology arena boils down to data and how well you stack up against the competition. Being first to market gives you a huge advantage too, since a hurdle is set and the ones afterwards are forced to demonstrate why they are better.

This is way many good marketers I've met avoid or dislike oncology: it's data driven, not marketing driven.

In oncology new products, the best thing you can do is focus on the data and find areas or niches where you can do well. It requires a more analytical approach to understand the science, work with the clinical and research teams and patiently build a blockbuster niche by niche.  If a drug fails in an indication, either find another one quick or ditch it.  Spend money wisely on more smaller phase I and II studies experimenting with different tumour types to match the biology of the disease with the drug's target. This is critical, but it also takes money and time with a high risk attached to it because more drugs fail than succeed.

Of course, once you get a drug to market, that's not the end.  You have to practice 'kaizen' and continually invest more dollars in new indications.  If you're too slow doing this, the second to market drug can be equivalent but have the advantage of a broader clinical program while you sat on your laurels for several years.  Life cycle management means planning ahead for the second and third indications before you finish the first cancer type.  If the first one fails, this also means you have a backup in advanced stages and that's a smarter strategy than everyone trying to get senior management's attention for resources and dollars if you put all your eggs in one basket.

Not every company has the scientific mindset and willingness to invest research dollars to succeed in cancer.  Management by consensus doesn't work very well either, that just drags things down to the lowest (and often slowest) common denominator.  You need passionate driven product champions who fight to the end and generate resources, focus and high priorities to get things moving by corralling the collective energy to get things moving at pace faster than the proverbial snail.

With regards to cancer pipelines, Roche/Genentech and Novartis probably have two of the most promising at the moment and are significantly ahead of the pack in my view.  They invest heavily in science and research, as well as broad clinical programs that creates a continuous buzz. The mindset is clearly to accept a few negatives that are easily over shadowed by the many successes. This creates a groundswell and positive energy.  Pfizer, Merck and BMS all have interesting pipelines, but also have to fight the internal entropy for execution as well.  

Data matters.  Execution matters.

Forget the hype in oncology and think about making a real difference to the lives of people with cancer and intelligent ideas around the concept of artisanal marketing, which my buddy Morgan Brown described in an intelligent and thought provoking post this week:

"Thoughtful, insightful, honest, embracing complexity and celebrating the craft of the product or products themselves."

Comments

[SBE]

Hey Sally,
Just found your blog a week ago, and am enjoying it.

You mentioned physician interest, and I would add that the mechanism of action is also important to them. I am sensing there is an interest in advancing a new Tyrosine Kinase Inhibitor (or some other newfangled awesome drug) rather than a new anthracycline or platinum agent. Much of this interest may be due to side effect profile, but I also think that physicians are scientists at heart, and enjoy finding new targets to exploit in order to further science.

[MaverickNY]

Yes and no... it all comes back to efficacy really so if a new targeted agent is approved but has less efficacy than existing chemotherapy then they get less excited.

MoA and science is only really interesting or compelling when it has real proof of concept that results in deep and lasting responses that make a difference.

Without a doubt though, academic researchers are driven by the concept of finding newer and better targets, but the average community oncologist wants more practical and effective treatment options.

[twitter.com/mikehartCXO]

Excellent post Sally.

Unfortunately, oncology is one big ongoing clinical trial. New targets and new therapies may change that one day, but no one single agent cures the disease and combination therapy is the norm.

Creative oncology drug development requires understanding where the drug should be positioned in the treatment paradigm. If the data supports its use then oncologists will use it. If not they won't.

Everyone would like to see more efficacy, but if you have better tox profile for equal efficacy or show patients respond better under a different dosing regimen then oncologists will use it.

A case in point to your comment about life cycle management. Doxorubicin dates back to the 1950s and has been generic for years, yet it is still used and approved for use in 12 different cancers.

[Pharma Conduct Guy]

This post gave some great insight into oncology, especially how the life-or-death nature of the disease influences market perceptions. After seeing a recent demonstration of the Cyberknife technology for treating tumors with radiation, I was impressed enough to post about it. I referenced this post because it provides a good rationale for longer term thinking by pharma in terms of delivering value to patients (see A Healthcare Innovation that Really Delivers - Cyberknife - http://bit.ly/a0vQOM).