ASCO 2014 - The emergence of non-specific immunotherapies for cancer

Several times now I have heard the phrase ‘we need a more holistic approach for treating cancer’ being used by specialist respondents during market research studies. These respondents often say that cancer requires a whole-body approach rather than the more targeted therapies available. Therefore, one of the key questions that researchers have been asking of late is: why does the immune system hold back against cancer cells? At ASCO last week, where our team went to present a workshop on brand immersion, it is clear that this holistic approach is starting to take the oncology field by storm.

Immune-therapy refers to a group of treatments called biologics. Biologics have two main modes of action: flagging and blocking. Antibodies that constitute immune therapy can work by flagging the hidden cancer cells to the immune system, for example Campath attaching to CD52 on T-cell leukaemia. Alternatively they can physically block a receptor, negating proliferation signals in cancer cells. For example, Herceptin binds Her2 receptor on mammary cancer cells and blocks epithelial growth factor (EGF) from activating a proliferation signal. These type of biologics have been designed to target specific molecules on cancer cells and this approach is now being replaced by more holistic approach which utilises the immune system.

Naturally, the immune system fights cancer. It is only when the immune system does not detect developing tumours that cancer prevails. For example, some of the side effects immune suppressants have are malignancies, or the incidence of non-Hodgkin’s lymphoma in (immunosuppressed) HIV patients. All of these indicate the role of the immune system in defending against cancers.

But the immune system has a complex status quo to keep. It has to attack pathogens, intrusions, and cancers, whilst at the same time avoid attacking the body.  To that end, the immune system has to train itself through life to give rise to immune cells that defend the body against pathogens and at the same time to rid itself of immune cells that may attack healthy organs (which is what happens in autoimmune diseases). The immune system has a complex mechanism with a lot of stops and guards to assure its efficient and safe operation. Some cancers evolve to find ways to utilise the stops and guards which provide immune tolerance to healthy tissues in order to evade detection.

Now Scientists in several pharmaceutical companies have chosen to try and kick start the immune system to fight cancer. Initial research even involved using a bacterial infection to activate an immune response that will kill the bacteria and then move on to the cancer.  In the last ASCO meeting a more clever way to ‘switch-on’ the immune system has taken over with several products in late development. All these new products target one or another of three molecules in the immune cycle pathway. PD-1 (Programme Death-1), PD-1L (Programme Death-1 Ligand) and (Cytotoxic T-lymphocyte associated protein 4 (CTLA-4). In this new approach, the treatments target the immune cells and their inhibitory markers, instead of attacking the tumour directly, once the immune system switches-on, it starts fighting the tumours. These revolutionary class of treatments could be used in various indications, because they are not cancer specific.

The main players in this field are BMS who have already launched Yervoy, an anti CTLA-4 antibody, and has an anti-PD-1 product in late stages (Nivolumab), which is currently being tested as a combination therapy with Yervoy in phase III trials. Additional competitors to enter the immune-cycle market are Merck (who received a breakthrough designation for their MK-3475), Teva/Curetech, GSK/Amplimmune and Roche who also received a breakthrough designation for their product.

The fact that so many companies chose to develop treatments to target the immune cycle indicate its importance, as this means that these treatments could be used to help in a wide variety of indications. It also means that late stage cancers that were previously untreatable because of a lack of specific therapies, can now be treated. Moreover, the healthy competition that is likely to arise through the introduction of several biologic treatments in this class, will certainly have an effect on price, market access, and the uptake of each product that will be licensed. We wait with baited breath for future developments.

But with the potential for broad indications, devising the right marketing strategy will become all the more vital to product success. 

We leave you with this question: How can these pharmaceutical companies create brand stories for their broadly licensed biologics that resonate with their key customers in each of the specific therapy areas?

 

In case you want to follow up

Merck’s MK-3475

Roche’s drug MPDL3280A

BMS’ Nivolumab and Ipilimumab (Yervoy)

GSK/Amplimmune’s Amp-224

Teva/Curetech’s CT-011

 

This article was written by Shai Senderovich, Research Executive at Branding Science

What's in a name: To what extent are new efforts to unbrand cigarettes going to reduce the number of smokers?

This article was written by Sofia Fionda and Alex Zaleski, both Research Executives at Branding Science, whose keen interest in blogging keeps them extra busy in between projects.

As people who work in branding and the healthcare industry, we at Branding Science found it interesting to hear that the UK Government is moving towards a ban on branded cigarette packets.

Why?

A few statistics:

If you are smoking 20 a day premium cigarettes, you are spending £2900 a year.

The total cost of treating diseases caused by smoking is £2.7 billion a year, while the total cost to society is £13.74 billion (this includes cleaning up the cigarette butts; the loss of productivity from cigarette breaks as well as increased sick time taken).

The treasury actually makes £9.5 billion from UK sales of cigarettes. Doing some simple math you can easily see that it costs more to deal with the problems associated with smoking than the government earns in tax from the tobacco industry. Clearly it is a financial imperative for the government to find a way to cut smoking rates.

But is there any evidence that de-branding cigarettes reduces the number of smokers?

Studies from Australia, where the ban has been in place since last year, have worrying results. Findings show that the amount of tobacco delivered to retailers has actually gone up since the ban because of a higher demand for roll up cigarettes due to ‘generic’ manufacturers producing cheaper tobacco. This means that the market now has a hole being filled with cheaper tobacco, and it may actually be increasing accessibility to cigarettes.

However, these studies should be taken with a pinch of salt for two main reasons. First, the data is short term. Second, according to how they’re presented in the British media, the studies appear to be sponsored by the tobacco industry.

But why would branding have any influence on cigarette usage in the first place, if all people want to do is smoke and get their nicotine hit?

Let’s look at Johnny, our hypothetical smoker. He had his first cigarette the day after his sixteenth birthday. His father was a smoker. He’d grown up handing the Marlboro man over to him and watching as his father puffed away. He was the youngest of three brothers who also smoked. Smoking was normal to Johnny. He knew from health classes that cigarettes were bad for you and even cringed over the blackened lungs his science teacher brought into class. But Johnny didn’t believe that could ever actually happen to him.

Why do kids like Johnny take up smoking, even though they are taught the risks associated with cigarettes? Why do adults who are also aware of the risks continue to smoke up to two packs a day?

While there are many socioeconomic reasons behind smoking, for the purposes of this article we will be examining the psychological theories behind why people choose to take up smoking, and how important brands are in driving people to start the habit.

Branding is one of the core forces that drives sales of any product. A branded product is immeasurably more valuable to a company than an unbranded one because it adds an emotional element to its physical and functional benefits.

So why do we like brands?

One theory is that brands help convey our own self-conceptions. For example, when you use your Apple laptop over a traditional PC computer, you feel innovative and forward thinking, almost like a Steve Jobs 2.0.

You might not actively praise yourself with these traits, but the undercurrent of meaning is nonetheless present. Interestingly, positive associations with brands is associated with psychological wellbeing.

Brands are not only important for perception of the self, but also to see how you belong in the larger social sphere. If you are the only one in your friendship group with a Samsung smartphone while everyone else has iPhones, you naturally feel like an outsider. If your aspiration is to belong to the group, then switching to an iPhone is going to meet those aspirations.

In Johnny’s case, the pack of Marlboro lights in his hand means that his aspiration of belonging to his family and friends is validated.

With this in mind, however, we ask you to open the discussion on the implications of unbranded cigarettes on smoking behaviour.

We’d love to hear your thoughts on this post!