Many of us in the biopharmaceutical industry marvel at the tidal wave of new treatment options in oncology. This trend should only accelerate with literally hundreds of unique medicines in phase two and phase three trials across a variety of tumor types. But what are the commercial implications of this trend?
In our research with clients, we’ve observed that oncologists, particularly those in the community setting, feel increasingly overwhelmed. The goal of finding the right treatment choice remains constant, but there’s simply too much interesting science and new data to neatly compartmentalize. To help sort it all out, the biopharmaceutical industry must explain why our products deliver unique benefits for specific patients in specific settings. In other words, we must rediscover the art of storytelling.
- Competitive cornucopia:With the ongoing flood of approvals, competitive share of mind will only decrease. When considered in the context of declining rep access, it will be even more difficult to deliver a memorable story.
- MOA migraine:15 years ago, targeted agents for BCR/ABL, HER2/NEU, VEGF and CD20 lit our imaginations and became new standards of care. Today feels a bit like pea soup by comparison: It’s hard to get a clear sense of various products’ benefits. Most oncologists have limited patience for the intimate nuances of mechanism of action (MOA). They want a concise explanation of why the drug works with data to back it up. Furthermore, we now see multiple agents competing in the same MOA with limited clinical differentiation, such as ALK inhibitors, BRAF inhibitors and PD-1/PD-L1. Manufacturers must explain how their brands are different.
- Data don’t differentiate:With the proliferation of new MOAs, clinical trial data has become increasingly difficult to interpret. Physicians are often forced to extrapolate between studies or rely upon their own personal experiences. Positioning helps physicians cut through the clutter to differentiate when, how and for whom to prescribe the drug. Consider the example of chronic lymphocytic leukemia (CLL), where four new targeted therapies were approved in roughly 18 months—all of which had received the FDA’s breakthrough therapy designation. Ibrutinib has emerged as the clear winner and is now being used widely in CLL and beyond. No doubt this was driven by its data, but it was also driven by the powerful narrative that accompanied this molecule at launch.
- Frenemies forever:An unprecedented level of cooperation exists amongst manufacturers in oncology, yet these bonds of partnership remain fragile. Each manufacturer wants to control the conversation around the combination: Which agent is the backbone, which is the booster and which should be dropped after disease progression? Brands without strong positioning will be left behind—or worse, will be positioned by the market without the input of the manufacturer.
- Community consternation: The explosion of new treatment options has been wonderful for physicians, patients and patients’ families. However, with so many competing choices, community oncologists want more direction about what to use, with whom and when. Local key opinion leaders can and do provide this guidance, and maintaining relationships with these stakeholders is critical. Nevertheless, for these community oncologists, the power of positioning shouldn’t be ignored.
As a final reflection, consider the current buzz around immunotherapy. The concept of recruiting the immune system in the fight against cancer is hardly new. We’ve been harnessing the immune system for over a decade through therapies such as allo-SCT, MABs and IMiDs, yet somehow the checkpoint inhibitors have managed to position themselves as uniquely new and exciting in this field. The class has managed to capture the hearts and minds of many by activating our feelings of awe, scientific wonder and hope. This has been so powerful that it seems that almost no trial readout today is complete without some reference to immune stimulation and the effects on the microenvironment.
For those still pondering the role of positioning in oncology, the checkpoint inhibitors will serve as either a cautionary or an aspirational tale.