Crossing the Canyon in Prostate Cancer

Cancer drugs are hot. Sales of cancer therapies rose from $2.1 billion to $2.9 billion between 1992 and 1996, and even those figures may understate the market. Moreover, the number of cancer drugs in development has also risen dramatically. Perhaps the most fertile area of opportunity: prostate cancer, which is being boosted by an increase in consumer support, leading to faster FDA approvals, and renewed investment from Big Pharma and biotechs.

Judging by the statistics, cancer is hot. US sales of cancer therapeutics, according to IMS, rose from $2.1 billion in 1992 to $2.9 billion in 1996. But Boston-based Jeremy Goldberg of JPG Healthcare notes that these numbers significantly understate both the current market and the opportunity: first, these sales don't include drugs, like the billion-dollar Neupogen, which are merely adjuncts to cancer therapy. Second, they don't reveal the inadequacies of the current offerings: four of the top eight anticancers—Lupron, Zoladex, Eulexin, and Casodex, with combined worldwide sales of over $1.7 billion, are simply palliative for metastatic prostate disease.

The good news is that cancer drugs in development have reached record numbers. Speaking at the CaPCure 4th annual scientific retreat in Lake Tahoe on September 6, Goldberg quoted PhRMA data showing that the number of cancer drugs in development jumped 73% from 1993 to 1995 and another 47% from 1995 to 1997. Within prostate cancer alone, Goldberg identified over 180 drugs in development, representing 28 different drug classes; more than 90 of the drugs are in trials, not including the hundreds of combination therapies in testing.

Among the reasons for the corporate cancer research renaissance: FDA's accelerated approval process, which has taken the average time for NDA approval for life-threatening cancer products down to 12.4 months vs. industry average of 29 months. Biotechs have always loved the cancer business; more than 25% of their drugs in development are for cancer. But for one of the reasons biotechs embraced cancer research—an accessible, small population of prescribers—drug firms kept away, preferring the larger, chronic care markets like cardiovascular therapy. Today, however, says Goldberg, cancer is a priority at many large companies—including Johnson & Johnson , Novartis AG and Hoechst Marion Roussel. Like biotechs, they've been encouraged not only by a more responsive FDA but by the burgeoning science of molecular oncology, which hints at focused treatments as opposed to the non-selective chemotherapeutics which have been the staple drugs of the cancer armamentarium.

Goldberg thinks prostate cancer, where—unlike other cancer areas—the vast majority of drugs are in the earliest stages of development, is likely to be the break-out therapeutic area in terms of treatment advances—to cross the canyon from early-stage development to commercialization, as he puts it. He analogizes its situation to AIDS: in 1992 doctors had eight drugs for treating AIDS and AIDS-related conditions. By 1997, there were 34 drugs—thanks to many of the same conditions coalescing around prostate cancer: increasing consumer and public support which smooths the way at the FDA while encouraging significant investment from both Big Pharma and biotechs.