Developments in cancer treatments accelerating, and the market is expanding. Where does Europe stand?
Cancer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells. In 2014, the global oncology market reached €92.6B ($100B) and will represent €157.5B ($170 Bn) in 2021. After Asia, Europe has the largest number of new cancer cases and deaths, and the most common types are lung, prostate, breast, and colorectal cancer.
To treat cancer, physicians and patients have 5 main options, surgery, chemotherapy, radiation therapy, targeted therapy and immunotherapy. (You can read more about biotech’s innovations in some of these areas in our review!) Many companies have been investing heavily to find new drugs, and 70 new oncology treatments have been launched since 2011. Roche is undisputedly leading the pack with more than €23B ($25B) in worldwide sales in 2015; Celgene, BMS, Novartis and Pfizer are also competing.
Investment has driven innovation for patients with successful drugs like Opdivo and Keytruda, which will continue to shape the future of oncology market in combinations. Notably, two of these drugs, Opdivo and Keytruda, are checkpoint inhibitors, the vanguard of immunotherapy. Immunotherapy leverages the intrinsic ability of a person’s immune system to find and destroy tumor cells.
We have 4 types of immunotherapy used to treat cancer in addition to checkpoint inhibitors; they are monoclonal antibodies, photodynamic therapy, vaccines and ‘other’ non-specific immuno-therapies. Immune checkpoint inhibitors are leading the immuno-oncology market, accounting for 69% of treatments in 2014 and a projected 94% in 2021; they are followed by therapeutic vaccines (15% & 4%) and cytokines (16% & 2%) like Imbruvica. Immuno-oncology represents a €1.3B ($1.4B) market and will grow to more than €25.1B ($27.1B) in 2021.
In this space, Bristol-Myers Squibb will represent 34% of market share in 2021 with 2 important products, Yervoy and Opdivo. Merck & Co. will represent 29% in 2021 with Keytruda, which was originally developed by Dutch scientists.
From 2010 to 2014, 49 new oncology medicines were launched, but these new options are not available uniformly in all countries. The United States has access to the most, a total of 41. In Europe, Germany is first with 38, followed by the United Kingdom with 37, then Italy (31) and France (28). Oncology drugs are also more widely available in Western European countries than their counterparts in Eastern Europe.
Newly launched products have many indications, and manufacturers are working together to develop combinations of two molecules for one indication. While this expands access to a drug, it makes pricing difficult.
Despite the resultant fluctuations, the financial cost of treatments in oncology is substantial: the monthly price range is between €5550 ($6000) and €12040 ($13000). Globally, the cost of therapeutics and supportive care increased 11.5% in 2015 to hit €99B ($107B); it will likely reach €165B ($178B) in 2020. Following the US, the EU is the second largest region in term of cost, €20.3B ($21.9B) in 2015 and €28.8B ($31.1B) in 2020.
When treatments are commercially available, reimbursement can be an issue because countries driven by cost-effectiveness approach will likely take more time to cover a drug with public insurance. In France, only 57% of oncology medicines are reimbursed; in the United Kingdom, it’s even lower — 38% — a figure outdone by Germany at 29% and Spain at 5%.
Biosimilars will become more present in the oncology space as patents expire, opening up a market that will grow to €12B in 2020 (assuming the United States develops its own biosimilar market, which is also the largest). Though these drugs are expected to be cheaper than their originals, biosimilar production still comes with a hefty financial and temporal cost; fortunately, this is offset by increased diagnoses and demand for treatments.
Europe has one of the largest numbers of new cancer cases and deaths, and companies around the world are developing approaches based on three pillars, Prevention, Early Detection and Effective Treatment. In order to benefit patients, drugs will need to be available in all countries at affordable prices. While much work remains to be done on these two points, it is heartening that cancer treatments do exist!
Despite the bad news from Juno last year, CAR-T is still marching forward to bring a new treatment to market. A number of other European biotechs announced exciting results from their efforts to cure cancer at the American Society of Hematology‘s conference last fall. Also, the field of ADC‘s is taking off, bridging the gap between old-guard chemotherapy and the new generation of biologicals. Stay tuned for more developments!
Joseph Pategou is a consultant at Wavestone specializing in the pharmaceutical industry. He is fascinated by healthcare and the experience of many companies in the development of new types of drugs with the aim of saving lives around the world. His focus rests on strategy, digital, innovation and biosimilars.
Image from jannoon028 / shutterstock.com