Transcript Part 1
Biosimilars - Can we do without them?
Dr Paul Cornes, Consultant Oncologist, Bristol Haematology & Oncology Centre
Comparative Outcomes Group
Pharmaceutical medicine moves fast!
1984 Nobel Prize for Medicine awarded jointly to Niels K. Jerne, Georges J.F. Köhler and César Milstein
"for the discovery of the principle for production of monoclonal antibodies".
Yet only 27 years later
We have developed a whole range of new treatments 1984 to 2012 Monoclonal antibody therapy
Head and Neck Cancer Macular Degeneration Multiple sclerosis Breast Cancer Bowel Cancer Leukaemia Lymphoma Ovary cancer Secondary bone cancer Melanoma skin cancer Asthma Heart disease Transplant rejection Inflammatory bowel disease Psoriasis Arthritis
Yet only 27 years later
http://en.wikipedia.org/wiki/File:Da_Vinci_Vitruve_Luc_Viatour.jpg
Monoclonals in Cancer - Lymphoma • Rituximab – Halves Lymphoma Relapse – Prima Trial reviewed at http://www.medscape.c
om/viewarticle/722470 http://www.jnccn.org/content/8/Suppl_6/S-1/F3.large.jpg
Monoclonals in Breast Cancer • Trastuzumab – Halves the chance of relapse – Reduces death by 33% Romond EH, et al. NEJM. 2005;353:1673-1684
71% reduction in disability in Multiple sclerosis
Campath-H1 vs interferon
http://users.ox.ac.uk/~path0116/tig/new1/mstrialfig.jpg
Controlling type 1 diabetes
Anti-CD3 vs placebo
http://users.ox.ac.uk/~path0116/tig/new1/t1dtrial.jpg
Controlling Rheumatoid Arthritis
Thermal imaging of hand and elbow joints before……
http://users.ox.ac.uk/~path0116/tig/new1/thefg.gif
..and after Mab therapy
Controlling painful skin diseases – Efalizumab for psoriasis 1.
2.
Sylvia Marecki & Peter Kirkpatrick. Efalizumab. Nature Reviews Drug Discovery 2004;3:473-474 http://www.epgpatientdirect.org/send_article.cfm/page/355/title/Biologicals
All demonstrations of the power of “Biologic or Targeted therapy”
I am very fortunate to work with international colleagues
Comparative Outcomes Group
We know - there is a cost to cancer
cancer has the most devastating economic impact of any cause of death in the world.
Cancer causes the highest economic loss of all of the 15 leading causes of death worldwide WHO: Cancer world's top killer since 2010 The total economic impact of premature death and disability from cancer worldwide was $895 billion in 2008.
16.7 percent of all 'healthy' years lost in the European Union 83 million years of “healthy life” lost due to death and disability from cancer in 2008.
www.usatoday.com/news/health/2008-12-09-cancer_N.htm
http://www.cancer.org/acs/groups/content/@internationalaffairs/documents/document/acspc-026203.pdf
We know - there is a cost to cancer care
…but “cost” may be the wrong word to use – try “investment” instead “Think about health spending as not consumption but investment” David E. Bloom, professor of economics and demography at Harvard http://www.bloomberg.com/news/2011-06-20/global-rise-in-cancer-cost-300-billion-in-2010-harvard-economist-says.html
File:David E. Bloom at the World Economic Forum Summit on the Global Agenda 2008.jpg
• • Payback on our “investment” is plain to see - Good news for cancer treatment Cancer death rates are falling – Jemal A, Ward E, Thun M (2010). Declining death rates reflect progress against cancer. PLoS ONE 5(3): e9584. doi:10.1371/journal.pone.0009584
Novel approaches dominate drug
Vaccines
development –
Supportive care Novel approaches Hormonals Cytotoxics
Good news for cancer treatment
Drugs in development, 2010 900 drugs in development are for cancer
The costly war on cancer. The Economist. 2011 May 26. http://www.economist.com/node/18743951
But it is not all good news – Bad news for cancer treatment • There will be more cancer to treat • World population growth and ageing imply a progressive increase in the cancer burden – 15 million new cases,10 million new deaths are expected in 2020, even if current rates remain unchanged • D Maxwell Parkin. Global cancer statistics in the year 2000. Lancet. 2001;2(9) 01 September – New cancer cases will likely increase to 27 million annually by 2030, with deaths hitting 17 million
Bad news for cancer treatment • Innovative drug development is slow and expensive • From 5000 - 10000 compounds in pre-clinical trials: – only 0.1% reach clinical trial stage – of these, only 10-20% are finally approved • It takes 15 years from the target discovery to the market at 800
ASCO 2009 Meeting emphasis: individualised care and cost-
Medical care is becoming unaffordable Ward E. CA Cancer J, 2008;58:9-31
Cost of USA cancer care 1963 to 2004
Cancer treatment spending, in billions $72.1
US$ $1.3
Cancer is a key driver for increasing costs $13.1
$27.5