Oncology markets continue to rapidly evolve and grow.  New entrants with novel mechanisms of action and a wealth of new data mean patient outcome goals are more varied and treatment options more complex.  With so much for launch and brand teams to consider, we asked Cello Health's Hassan Choudhury, Managing Consultant and Jakub Kaczor, Principal, to give their thoughts on the challenge of navigating this complexity, making the right stakeholder impact and how teams should be focussing their efforts to differentiate their brands.

1. How are oncology markets evolving?

Targeted therapies growth, understanding of cancers, and technological advancements

Jakub: The area of oncology has changed significantly over last decade or so. The evolution is undeniable with a huge expansion of targeted therapies and notable progress in understanding the genetics of cancers. As a result, life expectancy has increased dramatically and cure is now an option for many cancers. Also, whereas in the past, surgery was the only option for a large proportion of solid tumour cancers, there are now a number of targeted therapies that can eliminate that need, positively impacting patients’ life quality.  

Technological advancements are also playing their part in shaping the oncology space. Genomic sequencing is a good example. Thinking back, completion of the Human Genome Project took more than 10 years and its cost can be counted in $ billions. Today, thanks to great advancements in technologies, genome sequencing can be done within days at a fraction of the original cost. There are multiple examples of precision medicine, often informed by genomic sequencing, making a real and significant difference to patient care, especially in oncology. Care of lung, breast or prostate cancer have been transformed by the departure from a “one-size-fits-all” approach and increased focus on precision medicine based on genomic variants.

Treatment personalisation in a more diverse and granular oncology space

Hassan: The increased depth of oncology disease understanding and number and range of treatment options available are of course a welcome trend leading to better results for all patients – but this exciting progress has created a far more diverse and complex oncology space compared to what we’ve experienced in the past. Sub-oncology categories continue to emerge, and the shift to more personalised treatments is accelerating. 

When we think about the treating physician, their big challenge is understanding the range and specifics of data available, and knowing precisely when and how to personalise a patient’s treatment for optimal results.  A given treatment used in the right way, for the right patient can alter their life expectancy and quality of life significantly – the alternative or lack of, may cost them precious time and eliminate future options.

2. What challenges are HCPs facing in order to make the best treatment decisions for oncology patients?

Balancing exciting new treatment options and data, versus urgency to treat

Hassan: The number of variables and relevant criteria for making treatment decisions can be overwhelming.  Physicians now have to consider the cancer origin, the genomic characteristic; prior treatments as well as a patient’s overall health.  Access restrictions and multiple layers of guidelines also play a significant role in informing treatment choice. Whilst data can be empowering, enabling access to newer treatments - urgency to treat is still paramount in many cases. Patient profiling to develop personalised plans takes time, which is why chemotherapy still plays its role as the go-to treatment that is effective in a large proportion of patients quickly. 

The importance of surrogate endpoints and increased complexity for physicians

Many newer therapies are locked into later lines of therapy due to weaker OS data than established therapies, due to the nature of OS data.  Consequently, there is a real need to establish surrogate endpoints for OS, with MRD, DMR or PFS representing exciting options across certain cancers. These surrogate endpoints all have potential to enable newer superior treatments to leapfrog older options if established.

Linked to this, if you compare lung cancer to CLL or even CML, there’s an important nuance that one cancer is more aggressive and the other more indolent. Aggressive cancers are often associated with shorter OS data –  enabling newer options to surpass them within a reasonable timeframe. However, generating superior OS data for indolent cancers requires a significant amount of time and investment that often postpones access to later treatment lines.  It’s with these cancers where surrogate endpoints are starting to have an impact. However, physician habits and familiarity with traditional treatments and data endpoints impede progress.  Chemotherapy in CLL is a case in point, where fewer patients should be treated with this option in first-line.

Jakub: In seeking to understand the available data, surrogate endpoints and different patient types, physicians are also required to embrace digital solutions to navigate and distil what really matters.  Across all of these challenges, pharmaceutical companies can play a more active role in differentiating their treatments for physicians and communicating clearly why and when to use a particular treatment.   

3. How should pharma focus or adapt their efforts to better address HCP challenges and at the same time, ensure success of their brands?

The need to be clear on precisely where a treatment should be used and why

Hassan: It’s critical right from the outset to ensure that the core strategy and value proposition is clear on where a treatment should be used and why.  It sounds obvious, but as a strategic consultancy working with launch and brand teams, we often see that this fundamental level of clarity is missing or lacks rich market and customer insights.

We also put emphasis on assessing the key market value drivers that help determine what physicians care about when deciding whether to treat with option A or B. This then needs to be evaluated versus the competition to understand the strengths and weaknesses of each asset across likely future scenarios. 

Simple, clear messaging, understood by all

When it comes to identifying and effectively communicating relevant data – it’s essential, particularly in the context of the challenges we’ve outlined, that the strategic narrative is aligned with the core strategy and the relevant insights; and that physicians know precisely when to use a newer treatment and for which patients. This is an important area where pharma needs to disrupt the playing field and where we frequently support our oncology clients.

Jakub: Now more than ever, it’s also critical to evaluate how to engage with HCPs and tailor the content and messages communicated so they resonate with stakeholders and address their needs. This need for clarity applies equally across digital engagement channels - holistically, it’s about understanding how to create a continuum of content and messaging and ‘surround sound’.

Hassan: Lastly, but equally important is to ensure the infield teams truly understand the overarching strategic narrative and key communication points that need conveying to customers.  In other words, where and why the brand should be used, what makes it unique and different to everything else available. If internal teams aren’t 100% clear it’s unlikely they can convince external stakeholders. 

4. How important is the synchronization of the clinical and commercial strategy early in the oncology development journey? 

Aligning evidence generation to the commercial challenges ahead

Hassan: There’s opportunity for significant gains by establishing the commercial objectives and understanding the potential future commercial challenges earlier in the development process than is typical. In oncology markets, we’re no longer thinking in terms of surgery, chemotherapy and palliative, or traditional endpoints such as OS.

In categories where there’s potential that all treatment options can offer cure, the clinical development stage of an asset needs to ask ‘what makes your path treatment better?’ and what evidence needs to be generated so this can be communicated.  This has to be unpicked and woven into the TPP and trial design – for example, showing correlation of surrogate endpoints and use of biomarkers.

Jakub: The combination of personalised approaches to therapy and increasing small multiple indication therapies also challenge the traditional go-to-market models implemented for large single indications brands. By considering the go-to-market approach earlier in the development lifecycle, you are able to ensure that appropriate infrastructure is in place to successfully market a product and ultimately that the physicians and patients can access the best treatments.

Hassan: Pharma also needs to consider the future interplay within their portfolio and how the disease treatment paradigm may change due to their assets and those of new entrants – it’s important to ensure a consistent approach and strategy, that negative risks are mitigated and the long-term ambition remains in focus.

5. How does Cello Health Consulting support oncology teams at different stages of development?

Hassan: Across these complex oncology markets, we focus on partnering with pharma and biotech clients to make the right stakeholder impact with their brands.  We can summarise our areas of expertise and regular client engagement as follows:

Go to market model and commercial strategy – with many new oncology assets targeting smaller more disparate populations, we support the development of an effective and nuanced plan that ensures treatment access. 

Message platform – developing a message platform that communicates complex data in a concise, clear way for the right audience; and in a way that challenges existing perceptions and drives treatment selection.

Scenario learning and competitor response – competitor intensity is increasing and the need for detailed forward thinking and planning is essential to understand the battles which must be won now, with core and contingent response plans developed.

Long-term disease, asset and portfolio strategy – with many new assets considering tumour agnostic approaches, combination trials or multiple assets within a disease, there’s a need to ensure proactive, long-term strategies support one another, mitigating potential risks of devaluing future needs.

Jakub: Our clients often tell us that working with Cello Health feels different – they appreciate the feeling of partnership and continual support.  Each client engagement team is constructed to deliver the right blend of scientific, industry and consulting experience, often drawing on a number of real world analogues which give an additional degree of confidence to the strategic thinking and choices that are being made.