5 Key Questions for Biopharmaceutical Innovation in Lung Cancer

Lung cancer accounted for approximately 2.1 million cases and 1.8 million deaths worldwide in 2020. Non-small cell lung cancer (NSCLC) represents 80-85% of patients, and small cell lung cancer (SCLC), the more aggressive and fast-growing cancer type, represents about 15% of lung cancer patients. The Lung Ambition Alliance – launched in 2019 – has identified three major challenges that limit long-term survival worldwide: late diagnosis, few treatment advances for early-stage cancer, and disparity in cancer care both worldwide and within countries. 

We are fortunate to work with organisations that are passionate about changing the trajectory of patients with lung cancer. One needs to care enough about something to get an idea about it. Informed by opportunities in the market, we are keen to pose five key questions for a plan to learn how to best address challenges in lung cancer.  

1. How can we achieve the prevention and early detection of lung cancer? 

The Lung Ambition Alliance has set a goal to eliminate lung cancer as a cause of death. The opportunity to diagnose asymptomatic people at a point when there is a potential for them to be cured is missing. Improving lung cancer diagnosis by raising awareness of the compelling evidence in favour of screening and addressing the barriers to early detection, in combination with continued improvements to the ease and reliability of diagnostics is paramount for all healthcare stakeholders and industry partners. 

2. What can we know about lung cancer tomorrow that we don’t already know today? 

At a fundamental level, the better we understand the disease, the better we can target it through treatment strategies. Lung cancer has the attention of thousands of incredibly motivated researchers, patient groups and HCPs (Healthcare Practitioners) who will stop at nothing to eliminate it. Global and local networks enable direct patient engagement, where patients can opt to contribute their tumour profile data to expand the knowledge base about which therapies work, which can unlock novel insights for improving lung cancer health outcomes. 

3. What does efficacy mean? 

Innovation in lung cancer treatment means achieving early intervention, when there is a greater likelihood for a cure, and when targeted treatments significantly improve outcomes for many patients. Progression‐free survival (PFS) and overall survival (OS) are two common endpoints in cancer trials. Post‐progression survival (PPS) is highly associated with OS after first and second‐line chemotherapy in patients with advanced non‐small cell lung cancer and small cell lung cancer, whereas PFS is only moderately associated with OS. The increasing impact of PPS on OS, a PFS‐related advantage does not necessarily indicate an OS‐related advantage. Using progression-free survival (PFS)2, time from randomisation to 2nd disease progression or death, as a surrogate for OS can be used to measure long-term clinical benefit in clinical trials. When the industry prioritises the validation and standardisation of surrogate endpoints and identifies predictive biomarkers, it accelerates the research of treatments that have the potential to cure rather than moderately extending survival. Innovations that link the molecular structure of cancer pathways to more effective drugs are, for instance, therapies that target the KRAS mutation. Investments in research to improve patients’ treatment options have resulted in 200+ key companies with lung cancer assets in their pipeline. However, excellence in delivering innovation is unevenly distributed across the industry: not every company is consistently able to realise the value in their pipeline. There’s a demand for targeted therapies to balance treatment efficacy, toxicities and cost. The Non-Small Cell Lung Cancer pipeline is rich with several novel therapeutic agents in different clinical development stages. Small molecules, gene therapies, CAR-T therapies, immunotherapies, and serum globulins are expected to transform the NSCLC market landscape dramatically. Whereas Small Cell Lung Cancer R&D focuses on chemotherapy combination treatments, human monoclonal antibodies, small molecules, and gene therapies.  

4. How can technology shape and advance clinical care in lung cancer? 

Innovative technologies are changing lung cancer research and treatment. Novel clinical trial designs will play a vital role in assessing the efficacy and safety of emerging therapies and diagnostics. Artificial intelligent platforms will globally optimise combination therapies from preclinical through clinical stages of validation. Evolving approaches to precision medicine will harness population-wide data to identify individualised treatment strategies. The widespread deployment of innovative technologies will merge several factors ranging from evolving education at policy and clinical care level, support of new clinical trial designs, interoperability of electronic medical records to drive clinical decision support, and companion diagnostics that accompany new anti-cancer drugs. 

5. How do we think globally and act locally to maximise impact? 

Specific local barriers to access quality care exist and must be considered when developing patient-centric solutions to address them. The variations in lung cancer management worldwide are significant and require initiatives that are developed not only for but together with local communities. Only through a collaborative approach, the industry will be able to get better results. 

As you can tell, our work at IDEA Pharma is never generic, and our project experience covers a wide range of therapeutic areas, including deep expertise in oncology. We are currently working with several of the most innovative biotech and pharma companies to improve the probability of success for their early-stage pipelines. There is much to look forward to in the coming months and years!  

References: 

• World Health Organization. Globocan 2020 Fact Sheet. Available at: https://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf. Accessed March 2021. 

• Oncology Central. Transformation in lung cancer: driving innovation where patients’ needs are greatest. Published on September 14, 2020. Available at: https://www.oncology-central.com/transformation-in-lung-cancer-driving-innovation-where-patients-needs-are-greatest/ Accessed March 2021.  

• American Cancer Society. What is Lung Cancer? Available at: http://www.cancer.org/cancer/lung-cancer/about/what-is.html. Accessed March 2021. 

• National Cancer Institute. NCI Dictionary - Small Cell Lung Cancer. Available at: https://www.cancer.gov/publications/dictionaries/cancer-terms/def/small-cell-lung-cancer. Accessed March 2021. 

• Patient Power. What’s Next for the Cancer Moonshot Initiative? Published on February 4, 2021 Available at: https://patientpower.info/whats-next-for-the-cancer-moonshot-initiative/ Accessed March 2021. 

• Thoracic Cancer. Clinical significance of post‐progression survival in lung cancer. Hisao Imai, Kyoichi Kaira, Koichi Minato. Available at: https://onlinelibrary.wiley.com/doi/epdf/10.1111/1759-7714.12463 Accessed March 2021.