Bristol-Myers aims to become an oncology powerhouse in the next five years. Through M&A, alliances, and internal R&D, Bristol-Myers is building an armamentarium of oncology assets that allows it to take multiple "shots on goal." It is leveraging its past experiences in the field as it also adds new skill sets in biologics, market access, and biomarkers. But the market has become more competitive, as companies look to participate in one of the few growth areas of pharma. Bristol, like others, is carving out space in the Avastin-ineligible or -intolerant portion of the market, particularly in the gastrointestinal, colorectal, and head-and-neck cancer areas. Even if successful, current late-stage development projects aren't likely to contribute much to revenues before 2011-and oncology products have slow ramp-ups. With a patent cliff looming in 2012, the company needs new products now.

The repositioning of drugs for new clinical indications is becoming an increasingly prominent development strategy because it can reduce development risk as well as both the time and investment required to bring a product to market. Previously exclusive to pharmaceutical companies working to expand the applications of their marketed drugs, repositioning (also known as repurposing, reprofiling, therapeutic switching, or developing 'second use' indications) has emerged as an industry in its own right, encompassing both technology and drug companies. Today, companies involved in repositioning are charging for their services, establishing collaborative agreements and using the strategy to develop their own pipelines.

Acacia Pharma is focused on supportive care, primarily cancer supportive care. It has established a discovery approach generating product opportunities that have a high probability of success, based on known drugs--new indications, optimized formulations, and optimal isomers. Its lead product, for post-operative nausea and vomiting, has been widely marketed for another indication and can be differentiated through delivery.

Vicus Therapeutics reinterprets the medical literature to identify generic drugs that could be repurposed and reformulated into patentable combination products to treat disease, with a focus on those conditions that accompany cancer and its treatment.