All cancers are genomic diseases, and with the advent of time efficient and more widely affordable genome sequencing technology, the study into similarities between cancer specific gene mutations has snowballed. Personalised therapy using targeted treatment (based CDx (Companion Diagnostic) testing of cancer samples), such as PD-1 (Programmed Death Protein 1) and PD-L1 (Programmed Death Ligand 1) inhibitors, are rapidly becoming the most efficacious treatment options for a variety of cancers. The broad use of a single active substance is not a new idea in oncology, with crude platinum-based chemotherapies having indications across a multitude of cancers; though effective to a point, toxicity and indifferent somatic cell damage caused by these DNA synthesis inhibitors is a crucial limiting factor to their use.  

However, a possible future for the oncology market may not only be targeted therapies, but pan-cancer targeted therapy. A current in market example of this paradigm shift in cancer treatment is Merck’s Keytruda (pembrolizumab); first approved for Cervical cancer and B-Cell lymphoma in 2018, it has since gained indications for: Melanoma, NSCLC, Head and Neck Cancer, Urothelial Carcinoma, Microsatellite Instability and Gastric Cancer.

The basis of Keytruda’s mechanism of action, is the ability to block the PD-1 and PD-L1 surface protein-ligand interaction, found in multiple tumour types at varying proportions. PD-1 to PD-L1 binding is a key oncologic immune evasion mechanism, by preventing this process using a PD-1 inhibitor, any tumour with a high percentage of PD-L1 will no longer be able to efficiently evade immune response using this mechanism, thereby making the tumour much more susceptible to immune cells.    

The ability to treat multiple tumour types has the potential to create dramatic shifts in the oncology market; eligible patient populations for individual targeted therapies will span disease areas, expanding any previously conceived market size for a single product. Moreover, length of treatment on a targeted therapy will potentially be longer due to the more tolerable toxicity profiles (by comparison to previous platinum-based chemotherapies), leading to a shift from cyclic treatment to treatment to progression.

An overview of a potential future to the oncology market, based on targeted pan-cancer therapy can be summarised in a single sentence: more disease areas are treated with the same products, leading to fewer products in active use therefore, potentially fewer pharmaceutical companies holding large stakes in the oncology market.

Jai Bains

Oncology Market Forecasting Analyst