Differentiating immunotherapy truths vs opinion
Personalised treatment continues to be a major theme observed at the annual American Society of Clinical Oncology (ASCO) meeting, much overshadowing the exciting clinical potential of biotech derived ‘off-the-shelf’ assets, in our view. The conference follows on the heels of the American Association for Cancer Research (AACR) meeting 2023, where Merck and Moderna reported further data from their personalised mRNA vaccine (mRNA-4157 (V940))/Keytruda Phase II combination study in melanoma patients as they now look towards Phase III studies in 2023. Johnson and Johnson (J&J) and Gilead were also provided updates at ASCO with new survival data for their marketed patient-derived CAR-T treatments, Carvykti and Yescarta, in multiple myeloma and B-cell lymphoma respectively. Big pharma often dominate the headlines at events such as ASCO despite the potential shortcomings associated with some of their own technologies. In this report we want to shine a spotlight on non-patient derived, ‘off-the-shelf’ therapies that we believe could provide distinct competitive advantages compared to their individualised counterparts.
Patient access continues to be a thorn in the side
While we acknowledge the notable clinical advances that have been made in recent years with personalised (autologous) cell-based therapies, notably CAR-T in the treatment of haematological malignancies, these patient-specific treatments continue to suffer from significant logistical drawbacks. Notably, extended manufacturing lead times continue to be a major bottleneck for personalised treatments, a potentially serious issue for patients with highly aggressive cancers. Additionally, today’s CAR-T therapies can only be administered at specialised treatment centres, of which there are only c 100 in the US, and new hospitals that wish to offer CAR-T require significant upskilling. As such, we believe more universal immunotherapy approaches looking to provide quicker, upfront access to treatment for patients offer significant potential to differentiate themselves in the market.
An ongoing battle against the health economics
One of the major sticking points that many healthcare providers face with personalized treatment approaches is pricing pressures, not only with the high prices of the treatments themselves but also, in the case of CAR-T, costs associated with hospitalisation and patient aftercare. While hospitals may be able to estimate some expenses associated with treatments, they cannot anticipate how each individual will react to treatment and whether patients may need to stay for extended durations in hospitals to monitor potentially dangerous side effects. Health providers therefore run the risk of not being fully reimbursed and dealing with potential financial losses, raising question marks over the health economics of embracing such treatment protocols. Reimbursement strategies are evolving; however, personalised treatments are unlikely to benefit in our view from the same economies of scale as ‘off-the-shelf’ products, a key feature when attempting to alleviate pricing concerns and health equity concerns.
