Advancing pancreatic cancer therapies: A market access perspective

By Ali Farhat, Consultant, IPG Health Global Market Access

Pancreatic cancer is often detected late and is unique to every patient, resulting in an alarmingly low five-year survival rate of 7.3%.¹ There were an estimated 503,300 incident cases worldwide in 2022, and this is expected to increase to 511,000 cases by 2025.² The conventional treatments for pancreatic cancer offer limited success, leaving patients and their families grasping for hope. The search to find better treatment options for pancreatic cancer continues, and here we will explore the late-phase pipeline for pancreatic cancer treatments.
 

Current treatment landscape
 

Treatments for pancreatic cancer depend on size, location, and stage of the cancer.³ Earlier detection of pancreatic cancer increases the chances of treatment success. Standard of care (SOC) treatments include surgery, chemotherapy, and radiation, but these treatments have shown limited success in advanced stages. Cytotoxic chemotherapy remains the backbone for the treatment of advanced pancreatic cancer, whereas radiation and chemoradiation are reserved for resectable and adjuvant settings.⁴ Patients face significant challenges due to aggressive disease progression and limited treatment options, highlighting the critical unmet medical needs in this field.

In the current treatment landscape, targeted therapies and immunotherapies have emerged as promising avenues to augment traditional approaches.⁵ Targeted therapies, such as tyrosine kinase inhibitors, poly-ADP ribose polymerase (PARP), and epidermal growth factor receptor (EGFR) inhibitors, aim to disrupt specific molecular pathways implicated in pancreatic cancer’s growth and progression, offering more personalized treatment options. Concurrently, immune checkpoint inhibitors seek to tackle the body’s immune system to recognize and attack pancreatic cancer cells. While challenges such as the immunosuppressive tumor microenvironment in pancreatic cancer persist, ongoing research and clinical trials hold great potential for enhancing the efficacy of these innovative treatments, providing new hope for patients facing this formidable disease. ⁵
 

Advancements in the late-phase pipeline of pancreatic cancer therapies
 

The late-phase pipeline for pancreatic cancer therapeutics is marked by a promising array of investigational drugs and treatments focusing on a wide variety of targets that offer hope for improving patient outcomes. Figure 1, below, summarizes the list of pipeline drugs by classification. In total, there are currently 62 phase II and 7 phase III drugs in mid- to late-stage clinical trials.²

Figure 1: Number of pipeline pancreatic cancer drugs by classification as of August 2023²

Ipsen’s recent positive results from its NAPOLI 3 trial investigating Onivyde in combination with Eloxatin and 5FU/LV compared to the SOC regimen, Gemzar in combination with Abraxane, extended lives of front-line patients with metastatic pancreatic ductal adenocarcinoma.² Several novel targeted therapies, including drugs targeting specific genetic mutations and signaling pathways, are also advancing through rigorous clinical trials. AstraZeneca and Daiichi Sankyo’s HER2-targeting antibody-drug conjugate Enhertu has shown improved response rates in heavily pretreated patients with a range of tumor types in its phase II trial. Research is currently collecting additional progression-free and overall survival outcomes in the DESTINY-PanTumor02 study. Additionally, immunotherapies continue to garner significant attention, with ongoing research focused on refining immune checkpoint inhibitors, personalized vaccine-based approaches, and combination strategies to overcome the immunosuppressive microenvironment of pancreatic tumours.² Furthermore, precision medicine approaches, like molecular profiling, are aiding in patient stratification, allowing for more tailored and effective treatments.⁶ Although challenges persist in tackling this aggressive cancer, the late-phase pipeline signifies a growing commitment to advancing the field and expanding treatment options for patients with pancreatic cancer.
 

Market access challenges
 

As with any innovative therapy, immunotherapy in pancreatic cancer faces market access challenges. Addressing these challenges requires a collaborative effort among pharmaceutical companies, healthcare providers, payers, patient advocacy groups, and regulatory bodies to ensure that the latest pancreatic cancer drugs reach the patients who can benefit from them while maintaining a sustainable and unbiased healthcare system.

High development costs

Developing and introducing a new cancer drug to market is a costly process involving extensive clinical trials and research. The high costs can result in pricing challenges, as manufacturers need to recoup their investments while ensuring affordability for patients. Furthermore, these high costs will be closely scrutinized by healthcare payers and health technology assessment bodies upon assessing whether the health benefit of the new drug justifies its proposed price tag, which can lead to pricing negotiations and access restrictions.

Reimbursement challenges

Reimbursement policies and negotiations may be complicated, especially if the drug’s cost is high relative to its perceived benefits. Pharmaceutical companies may need to negotiate prices with payers to ensure that the drug is affordable while still meeting revenue targets. These negotiations can cause delays to market. Regardless, approval does not ensure top-tier formulary placement, which is prone to factors such as drug pricing and comparator availability.

Competitive landscape

Overcoming competition and differentiating a new drug can be challenging. New entrants must demonstrate clear advantages over existing dominating treatments to gain market acceptance. Nurturing relationships with thought leaders and key stakeholders in pancreatic cancer is paramount to support and endorse new pancreatic cancer treatments. Collaboration between stakeholders, including pharmaceutical companies, healthcare providers, and payers, is essential to navigate these barriers effectively.

If you have any questions or would like to discuss market access opportunities in oncology, please reach out to Ali.Farhat@ipghealth.com.

References

¹ Pancreatic cancer prognosis and survival

² Market spotlight: Pancreatic cancer

³ Treatment for pancreatic cancer

⁴ Current treatment landscape and emerging therapies for pancreatic cancer

⁵ Combining immunotherapy and targeted therapies in cancer treatment

⁶ Pancreatic cancer: challenges and opportunities