Immuno-oncology: driving new marketing strategies

The latest advances in cancer therapy, coupled with the drive to bring new drugs to market via accelerated access programmes, means market researchers must keep pace to support optimum positioning.

The old adage 'the more things change, the more they stay the same' does not hold true in oncology. In this sphere, the more things change, the more they change, and quickly! Just as this is true on the therapy front, it's also true on the marketing front and, by extension, on the market research and positioning front.

Oncology has undergone a number of treatment advances in the last decade, the most recent of which – the advent of successful immuno-oncology options – is poised to upend how we position oncology products.

The phenomenon of changes in therapy impacting research is not new. We've seen it happen multiple times, most recently with the rise of the importance of patient voice. As a result, pharma companies have stepped up their strategies for patient communication, and patient insight is now a core capability of most qualitative market research firms.

In oncology, much of the change in market research has been led by changes in oncology treatment itself – the advancement of basic science, and how it's translated into new therapies that require different marketing strategies. Over the 15 years that I have been working in this field I've witnessed it change from one with few advances and little hope to one that now seems to be running at break-neck speed, and in which many pharma companies have pinned their financial hope. (Evaluatepharma's 2014 outlook predicts an unprecedented CAGR of 11.2 per cent for oncology through to 2020).

The rise of targeted therapy has meant tailoring of treatment to ever more select patient populations. Traditionally, oncology drugs – which largely subsisted of cytotoxic chemotherapies – were indicated broadly by tumour type, and marketed accordingly. Thus, with a drug like Taxol that might be used across a number of different tumour types, including breast, lung and ovarian, marketing rested largely on clinical benefit. There was little brand differentiation as there was hardly any competition.

The rise of targeted therapies – specifically tyrosine kinase inhibitors (TKIs) – saw the advent of the oncology version of the 'blockbuster' drug, and the branding power that came with it. Starting with Novartis's Glivec in 2001, these small molecule drugs attack specific tumour types' particular weaknesses. Glivec stops production of the protein driving Chronic Myeloid Leukaemia (CML), in effect putting the disease on 'pause' and offering patients the possibility of turning their disease into a chronic condition instead of a death sentence.

"This set a positioning standard that subsequent targeted therapies have been striving to equal since"

In its marketing, Novartis positioned Glivec as a 'present' to patients, utilising gift box imagery in the communications to physicians. This set a positioning standard that subsequent targeted therapies have been striving to equal since.

Interestingly, these small molecules, while certainly feats of engineering and risky to test (a high percentage of oncology trials fail in phase III), are relatively easy to produce, compared to monoclonal antibodies. As a result, as seen with blockbusters in other therapy areas – such as the statins in cardiology – there has been a veritable 'arms race' for companies to develop 'me too' TKIs for various tumour types once proof of efficacy with a novel mechanism of action has been established in a particular therapy area.

There are now a multitude of options for epidermal growth factor receptor (EGFR)/vascular endothelial growth factor (VEGF) TKIs in Renal Cell Carcinoma (RCC), including Sutent, Votrient, Inlyta, and Nexavar. The same situation now exists for the roughly 10-15 per cent of Non-Small Cell Lung Cancer (NSCLC) patients with a specific EGFR mutation; physicians now have the choice of Iressa, Tarceva, or Giotrif, with a host of potential 'third-generation' options in development.

So, the result of all of this innovation is a crowded market place for smaller patient populations, as products become more and more specific to individual mutations. The playing field has narrowed as the competition has increased, leading to ever-more emotional-based positioning as differences in clinical benefit have largely converged.

However, the latest oncology therapy is poised to upset – and possibly even reverse – this trend: immune-oncology (I-O).

In oncology, success has traditionally been defined as a matter of months – gaining months of life or, more commonly, months where the disease doesn't get worse. With the advent of monoclonal antibodies that appear to 'unmask' the tumour so that the patient's own immune system can find and attack it, suddenly the focus is on the 'long tail' that these therapies are capable of producing in a Kaplan Meyer curve. Those 'tails' represent patients still alive many months – even years – after therapy has stopped. For a select few patients, I-O represents the possibility of an actual cure.

As a result, all major companies are currently scrambling to develop their own versions of these antibodies, alone or in partnership. And it's easy to see why; Bristol-Myers Squibb's Opdivo, the first I-O product to make it to market and a star of this year's ASCO meeting, has a projected 2020 revenue upwards of $5 billion.

Cue another arms race – only this time, partially thanks to the new regulatory 'breakthrough' designation which can fast-track promising products (and these products are nothing if not promising), combined with the financial value at stake, competing development of these therapies is a marathon being run like a sprint. Marketing timelines are being cut in half if not more, and the knock-on effect on market research is that studies must often combine functions – positioning and message testing in one, for example – or sometimes even run in parallel. The spoils are going to market research agencies that are able to put together efficient programmes that can pack a year's worth of brand development research into mere months.

Also of note is how these therapies are likely to be positioned. This year's ASCO highlighted that combination immunotherapy (a checkpoint inhibitor such as Opdivo + a CTLA4 inhibitor like Yervoy) may obviate the need for biomarker testing in those patients who are fit enough to withstand the toxicity. As such, we are seeing the rise of combination positioning. Given the nature of I-O, these combinations are likely to be effective across a number of tumour types, as opposed to TKIs which are usually designed for one or two specific tumours.

As a result, oncology positioning is reversing a trend of contraction and is starting to expand again, with combination, umbrella, and even I-O portfolio positioning. Pharma companies are starting to compete on the franchise level as well as the product level. It remains to be seen how this is going to drive innovation in marketing research, but market research agencies that develop ways to help clients link breadth (of indications, products) and depth (one product/regimen within a single indication) into a cohesive positioning strategy – taking time pressures into account – will have a distinct advantage in this brave new I-O world.

About the author:

Kelly Price is head of the Oncology Specialist Group at THE PLANNING SHOP international. With a background in strategic consulting, she has over 13 years' experience in oncology-specific research across the vast spectrum of tumour types.

Contact Kelly on +1 215 680 8720 or at kelly.price@planningshopintl.com or on Twitter @theplanningshop