Immuno-oncology . . . the new frontier
As we have learned throughout many successes (and failures) in preclinical, translational, and clinical research, there always has been a very intriguing interface between immunology and oncology, especially with regards to the development of immunotherapeutic drugs. According to GlobalData, a research and consulting firm, the immune-oncology (I/O) market will be worth $14 billion by 2019 and this amount will increase to $34 billion by 2024.
Why is this market so promising?
Before answering that question, let’s take a step back to understand the importance of the immune system in relation to oncology. If you can image the human body as a garden, we have some key players: the soil = the immune system; “good” cells = nice pretty flowers; and weeds = cancer cells. Using this analogy, cancer cells (the weeds) will begin to overtake the good cells (the pretty flower) by competing for space and nutrients. Current treatments (surgery, chemotherapy, and radiation) attempt to kill the weeds but often times the good flowers are harmed and the roots for the weeds remain. Targeted therapies block the growth and spread of these weeds by interacting with these weeds. Some examples of FDA approved targeted therapies include: cetuximbab (Erbitux®; colorectal cancer and squamous cell carcinoma of the head and neck), bevacizumab (Avastin®; cervical cancer, colorectal cancer, and renal cell cancer), and sorafenib tosylate (Nexavar®; hepatocellular carcinoma, renal cell carcinoma, and thyroid cancer). Although these therapies attack the weeds, the good plants may still be damaged. I/O therapy activates the immune system in hopes that only the tumor cells/weeds will be destroyed. In our garden analogy, rather than directly attacking the weeds, I/O therapy is like adding weed-control fertilizer to the soil, although a small number of the flowers may be harmed.
Programmed cell death protein (PD-1) inhibitors, a major player in the IO field, have seen exception sales. Bristol-Myers Squibb’s Opdivo® (nivolumab) and Merck’s Keytruda® (pembrolizumab), being the first generation of I/O pharmaceutical to market, are estimated to generate over $7+ billion in sales by 2024.
In 2016, Opdivo®, Keytruda®, and Yervoy® racked up $3.8, $1.4, and $1.1 billion dollars in sales, respectively. While targets against PD-1/PD-L1 and CTLA-4 represent the first generation of I/O therapies, other pharmaceutic agents against other immunotargets (TIM3, LAG3, and OX40) are quickly competing for market share within this field. Also, there will come a point when these therapies will saturate the market; however, as scientists have learned – two therapies combined often times will make one GREAT therapy. It seems now the race is on for not only finding the best I/O therapy but also for finding the best combination of I/O drugs. This combined approach (with other I/O and/or non-I/O treatments) will lead to some interesting alliances in the I/O field.
Additionally, the emergence of I/O therapies has allowed very lucrative partnerships between various pharmaceutical companies. In 2016, GEN reported the top 15 I/O collaborations (***), ranked on dollar value and press announcements/releases. Below, is a quick list of the top 5 collaborations.
- Merck & Co. and Ablynx – $6.4 billion, July 2015
- Pfizer and Cellectis – $2.9 billion, June 2014
- Merck KGaA and Pfizer – $2.9 billion, November 2014
- Celgene and Jounce Therapeutics – $2.6 billion, July 2016
- Sanofi and Regeneron – $2.2 billion, July 2015
Time will only tell how well the I/O field with its current and potential Biopharm collaborations will pan out regarding treatment of various cancers. Although we cannot predict the future of this growing field, the general consensus is a positive one.