Pancreatic, lung, liver, breast, brain, prostate, colon; the list of potential cancers seems to forever be lengthening. But thanks to advancements in the pharmaceutical and drug development fields, the number of therapies being researched far outweighs the types of illness. With the "cancer cure" still proving elusive, just which of these treatments will prove successful?
This May industry leaders are meeting at ViB pharma's Next Generation Targeted Cancer Therapies event to attempt to answer that question. About 7.6 million people die from cancer each year, according to the American Cancer Society, with one in three people contracting the disease at some point in their lives. Finding the big blockbuster, therefore, is crucial for Big Pharma.
In only a week of research, therapy hopes are being promoted through a hormone therapy for colon cancer in older women, a drug that targets PKD molecules involved in tumour growth of pancreatic cancer has been discovered, and a cancer gene suppressor that researchers say can be "turned off" is being investigated.
Alongside these are countless other treatments that are causing excitement for some and concern for others, with competition as fierce as you'd expect. There is a great range of exciting, controversial and costly therapies being researched today.
Avastin – the big disappointment?
Seen as a key driver in Roche's buy-out of Genentech, Avastin was always going to be a big bet or, as Roche's head of pharmaceuticals Bill Burns says, "it was always the toss of the coin". But recent study results show that the toss may have fallen out of Roche's favour. On 22 April 2009 it was announced that Avastin failed to prevent the recurrence of colon cancer in patients who had undergone surgery – sending Roche stocks tumbling.
Roche's annual sales of Avastin total $4.4bn but before news broke about the failed C-08 study – evaluating the drug plus chemotherapy immediately after surgery – analysts predicted that this could rapidly double. Investors' eyes are now on rival medicine Erbitux, which is conducting similar trials.
Although quite open about Avastin's outlook, Burns is still looking on the bright side of the drug's future and the Genentech acquisition. "We always factored in the entire transaction," he says. "This study was never a binary event in the valuation of Genentech. It's a much broader, strategic deal than one study."
Perhaps he is right to do so. Researchers are still looking at Avastin for treating early-stage cancers in the breast and lung as well as its possible use as a medical imaging tool. The latter discovery broke towards the end of 2008, when it was announced that Avastin may help find tumours as well as treat them. After tagging the antibody drug with a radioactive tracer and injecting it into mice, it was discovered that it successfully highlighted cancer cells, from which high-quality images could be produced.
Sutent – the promised land?
Sutent, already approved for treatment of renal call carcinoma cancer and cancer of the digestive system, may prove to be Pfizer's ace when a series of its patents expire around 2012, leading to the company losing cherished revenue from popular drugs such as Lipitor, Caduet, Geodon and Viagra.
Frost & Sullivan programme leader of pharmaceuticals and biotechnology life sciences Shabeer Hussain says that Pfizer is conducting studies to look at the drug's success when it is used in single form, although to date combinational drugs have been more successful and have gained greater acceptance from industry bodies such as NICE.
"The 2008 market was very good, around $847bn according to Pfizer's financial report," says Hussian. "But heath policies in the US are going to take over and Pfizer is trying to put together a first line treatment."
As closed trials examine what affect the drug can have on early stage cancers, Sutent looks set to hold on to the lion's share of the US market.
But even golden drugs can't win every time and Pfizer recently announced that it was forced to halt a late-stage breast cancer trial between Sutent and Roche's Xeloda after the study failed to show significant improvement of progression-free survival in patients.
Pfizer senior vice-president of clinical development and medical affairs Dr Mace Rothenberg said that the discontinuation of the trial was a blow to the company. "We are disappointed with these results given the previous findings that suggested [Sutent] may provide benefit for patients with this difficult-to-treat cancer."
But the company remains positive and will continue with clinical trials using Sutent in the treatment of cancers of the liver, colon and prostate, as well as for non-small cell lung cancer.
Iressa – the comeback kid?
Having been largely discounted by analysts, the news that AstraZeneca's lung cancer treatment Iressa had gained approval from European regulators in April gave a boost to company morale. Although it may not prove to be an express lane to the bank, the sentiment that the approval signals remains strong for the company.
Using Iressa in a subset of patients with a certain gene mutation won't generate huge sales but the news has given investors renewed confidence, since the medicine was largely written off by analysts following a clinical trial failure in 2004.
Iressa is on sale in Japan but as marketing approval by the European agency Committee for Medicinal Products for Human Use are usually endorsed by the European Commission in just a few months, its widespread use throughout Europe is just a matter of time.
Now it appears the news hasn't just caused shockwaves within the AstraZeneca team but also stirred competitors into action.
After the Iressa approval was granted it took Roche just a matter of days to announce that it was considering expanding the use of its oncology agent Tarceva, which tackles the same form of gene mutation as the AstraZeneca drug.
Meanwhile, Roche has said it will partner with the Spanish Lung Cancer Group in a Phase III trial to study if Tarceva is a better option for initial treatment of patients with EGFR mutation positive disease than chemotherapy.
With cancer drugs proving to be costly research endeavours for Big Pharma, the progress of any of these medicines is dependent on cash, clinical trial success and more than a little bit of luck. But for those that manage to achieve the right combination, there is a healthy prize.