Page 2 precisely targeted radiopharmaceuticals are experiencing a renaissance . With supply chains key , a handful of well organised first movers look set to dominate . Immune checkpoint inhibitors have had a remarkable impact since introduction a decade ago . We are at last seeing products emerge that can add to or extend these benefits ; particularly drugs targeting the LAG-3 immune pathway . We also see the potential for mRNA-based cancer vaccines and ADC therapies to come to fruition .
Cancer Care
Over-diagnosis is currently a major impediment to early diagnosis , but real progress is being made with more accurate molecular markers
Figure 2 : Impact of early diagnosis
Survival 1 after early detection
Survival after late detection
[ 1 ] 5-year survival Source : OECD , goetzpartners Research
90 %
10 %
PT will slowly become adopted as the new SoC in RT
Earlier and more accurate diagnosis should facilitate minimally invasive treatment investment
Early diagnosis will be improved with liquid biopsy Early diagnosis of cancer decreases the incidence of metastases and often requires less invasive and cheaper treatment . However , existing screening programs are less accurate than patients realise and tests such as the PSA test for prostate cancer have low specificity . False positives lead to unnecessary invasive follow ups which are expensive to economies . While there have been substantial advances in imaging technology , specificity remains insufficient , and many techniques are too cumbersome or invasive for large-scale implementation . Screening tests are focusing on liquid biopsies to become less invasive and cheaper such as the multi cancer test by Grail which could detect early cancers population-wide using a single blood test . Liquid biopsies have the potential to be used throughout the cancer journey ; guiding treatment decisions , monitoring the cancer disease status and providing a vital early indication of the development of resistance to specific therapies .
Companion diagnostics to guide precison medicine There are now approaching 50 complementary / companion diagnostics with FDA approval for specific targeted cancer therapies . The use of these and associated biomarkers in clinical trials is increasing to up to 40 % of oncology trials in 2018 . Additionally , the quantity and diversity of information each molecular test can provide has increased , ensuring patients most likely to respond to drugs such as ICI ’ s are selected for clinical trials and treatment decreasing the likelihood of drug resistance . The move towards liquid biopsy tests should allow longitudinal monitoring and the opportunity for small service providers to undercut big pharma and offer repeated generic testing .
RT : Improved precision technology and proton therapy awaiting adoption RT remains one of the key cornerstones of cancer treatment . Constant improvements in technology have allowed intensity-modulated radiation therapy (“ IMRT ”) to become the standard of care (“ SoC ”), with machine learning providing further advancements for patient benefit . Proton therapy (“ PT ”) remains promising , but adoption is slow . It should allow increasing numbers of early-stage cancers to be treated with RT while reducing damage to surrounding healthy tissues . With a renewed focus on a smaller installation footprint , companies such as Varian ( acquired by Siemens Healthineers group in 2020 ) and IBA have developed systems that will result in PT becoming a feasible RT option for more patients . FLASH RT is a promising future technique to further improve clinical outcomes and new systems can now perform this , continued research in this field has established that RT will remain an effective cancer therapy .
Global adoption of robotic surgery As diagnoses of earlier stage cancers increase , this will drive a requirement for more minimally invasive surgery (“ MIS ”) and increased adoption of targeted RT . Robotic surgery has continued to grow with installations of the dominant market player Intuitive Surgical ’ s da Vinci system increasing worldwide every year . This has been fuelled by a recognition of faster recovery and shorter hospital stays in specialties outside of the traditionally robot-dominated urology and gynaecology surgery , alongside Asia and European expansion . Despite patents expiring , competitors are finding it difficult to gain a foothold in the robotic surgery market .
Radiopharmaceuticals ; introducing the radiation internally Conjugation of a radionuclide to an antibody or targeting moiety has significant potential to be a hugely effective weapon against heterogenous cancers as seen with similarly constructed antibody-drug conjugates (“ ADC ”), in addition to accurate radiation-emitting diagnostics . Telix Pharmaceuticals and ITM lead this sector , with Novartis also a key player regarding molecular-targeted radiation (“ MTR ”) therapy . The key predictors of success for radiopharmaceuticals are a company ’ s ability to manage complex supply chain logistics regarding radioactive materials and integration of both beta and alphaemitting radionuclide molecules .
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