SEELEY: With the advent of new oral therapies, we're going to have to take some lessons from the primary-care arena. And largely,
we already have. We're looking at pill burden, overall quality of life—even toxicities that previously wouldn't have been
considered a big factor, such as diarrhea—things like drug–drug interactions, compliance in the elderly population. Marketers
really need to evolve their thinking.
But when you're talking about chronic treatment of cancer, long-term tolerability is a key component. And I'm not sure we're
necessarily there in terms of finding tolerable regimens that patients can take for years at a time. One early sign we see
is Herceptin—FDA recently approved it in the adjuvant setting for early-stage HER2-poitive breast cancer patients.
CLINTON: Where are the areas of the biggest opportunity at the moment in cancer?
LACAZE: Pharmacogenomics. If you look at some of the pediatric cancers, it's not just about predicting efficacy, it's also about
predicting toxicity as well. To get there is very difficult to do, but that is where the science is leading the industry.
AYERS: I personally hope that the opportunity is to make cancer look a lot like HIV—and that we are going to learn how to keep people
alive. Some of them may be cured; others may need to take drugs for extended periods of time. But I hope that we can get smart
enough to have a large armamentarium of different therapeutic options and to know how to combine and sequence them so that
patients can really have extended survival.
NAEYMI-RAD: The biggest opportunity—and challenge—is for companies to be able to better predict the drugs their products will compete
against tomorrow. Just the number of possible permutations on a set of regimens in any of the more crowded tumor types is
mind-boggling. I mean, what [drugs] are you going to compare yourself with, knowing that that standard will almost certainly
change by the time your drug gets to launch?
LACAZE: As a country, we're not where we need to be in the war on cancer. But if you look back to when the US declared a war on cancer
in the mid-1970s, taking all cancers together, there was maybe a 50 percent survival rate. And if you look at the latest data,
from 1996 to 2002, it's about 66 percent—a 30 percent increase in overall survival rates. That's because of better diagnosis,
prevention, drug therapies, radiation, and surgeries.
We have a lot of new tools from a pharmaceutical perspective coming down, and what we're dealing with is how to incorporate
all of this together and grow that number from 66 percent to 75, 80 percent—or as close as you can get to cure rates or chronic