Oncology ABCs (part three) – thinking outside the box in women’s cancer

Thinking outside the box in women’s cancer

Major breakthroughs in the treatment of metastatic breast cancer (mBC) and metastatic ovarian cancer (mOC) are relatively recent, with the success of new drug classes driving increased R&D investment in these areas. First-in-class approvals have been quickly followed by an increase in the late-stage development of competitor drugs vying for market share. While these competitors may be able to offer incremental improvements in safety and/or efficacy, we believe the next big advances in the treatment of mBC and mOC will likely come from outside existing treatment modalities. Hence, in this edition of Oncology ABCs, we focus on the most innovative areas for the treatment of women’s cancer.  

First-in-class: Better follow suit

Recent breakthroughs in the treatment of metastatic breast and ovarian cancers have come through major innovations in our understanding of tumor biology, leading to the discovery of new classes of drugs. These have been met with considerable commercial success resulting in the late-stage pipeline for breast cancer (BC) and ovarian cancer (OC) being filled with competitors targeting the same mechanisms. For example, c 50% of Phase III assets for BC treatment are focused on just five mechanisms, with c 60% in OC focusing on just three (Exhibit 1). However, we believe that in the medium to long term, innovation will likely come through the exploitation of novel cancer survival and proliferation mechanisms by smaller biotechs with notable expertise and focus outside of these norms.  

Exhibit 1: Assets in Phase III trials by mechanism of action (%)

Source: Edison Investment Research, EvaluatePharma

Expect innovation from the expert and nimble

Despite the successes of modern women’s cancer therapies to date, there remain significant unmet medical needs, such as a lack of effective therapeutics targets in some tumors (triple negative breast cancer, high grade serous ovarian cancer), therapeutic resistance (anti-estrogen resistance) and toxicity issues. The required knowledge needed to address these issues is often concentrated in highly specialized biotechnology companies that have invested time and resources to pursue the science. Given the widespread presence of BC and OC development programs in large pharmaceutical companies, we expect important breakthroughs from smaller and nimbler biotech companies could quickly become the subject of licensing/partnership/acquisition deals.   

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