Written by Steve Buckanavage, Operating Executive, Kineticos
It wasn’t that long ago that cancer was defined by the location in the body and histology. For example, lung cancer was broadly non-small cell or small cell cancer and depending on the size of the tumor at diagnosis, a rather limited toolkit was used to treat lung cancer. While significant advances were made in delaying disease progression or recurrence, hard-won battles ended up losing the war; cures were far and few in-between. A similar story can be said for other solid and hematological tumors. Progress was being made, but fell woefully short of significantly increasing cure rates.
Today, through years of research and drug discovery efforts, the biological basis of disease in many cancer types has been unraveled. This deeper understanding helps classify tumors by mechanism of growth, or ability to evade the immune system providing a range of new therapeutic targets. Cancer that is present in lung tissue is now known as EGFRmut+, PD/L-1 expressing, T790 mut, or ALK mut. Researchers can now describe a complex shield, called the tumor micro-environment (TME), which suppresses immune surveillance, and thereby enabling the tumor to resist therapy and grow unchecked.
Therefore, it is not surprising that investment has followed on the heels of clinical success from applying this new scientific knowledge. The prospect of curing certain cancers, such has been the case with B-cell lymphoma’s using CAR-T therapy using a CD19 antibody, has attracted billions of dollars in new business start-ups, hundreds of clinical programs, bioinformatics, and computational capability, as well as cell engineering and manufacturing investment. In addition, the ability to cure some cancers carries with it the prospect of significant return-on-investment. The market cap value of many start-up biotechs in this space indicate a very high expectation of return.
This is but one example where new technology is siphoning off investment, and making it more challenging for projects, not in immune-oncology, to attract investment. Rapid advances in gene therapy and proteomics are building investor confidence based on data that suggest we can manipulate these technologies specific to diseases for much higher cure rates.
The challenge then becomes to understand and manage the current trends, so as not to have standards of care change while your project is in mid-clinical development. Not easy for sure, but thoughtful bio-leaders who spend time to understand the chessboard, and able to think ahead, will have a better chance of success.