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Lance Armstrong and the Future of Cancer Care

Lance Armstrong and the Future of Cancer Care

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Published by ogangurel
© Ogan Gurel (All Rights Reserved)

Lance Armstrong and the Future of Cancer Care
Posted by Ogan Gurel MD MPhil at 22 January 2007, 10:38 AM and is filed under Practice of Medicine,Personalized Medicine,Diagnostics,Cancer,Targeted Therapy,Biotech Business Models,MIS


Lance Armstrong is a unique phenomenon. He’s a talented athlete, a cancer survivor and a political activist. He is in a league by himself. Or is he? As many people know, survivors of cancer are much more common today. A recent National Center for Health Statistics report released by the American Cancer Society showed a drop in cancer deaths for the second year in a row. Cancer patients as political and even business activists are also increasingly common. In a Dec. 2006 column on MidwestBusiness.com, I wrote about this growing phenomenon:

Various disease-oriented non-profit groups, charities and government groups are actively providing venture financing to new biotech start-ups.

If the trend of socially driven popularization of biotech investment continues, investors would be looking not just at financial returns but also at social returns.

Ultimately, this is what most patients want. Though it is not yet clear whether or not this will require new legal frameworks, it is clear that it would involve new paradigms.
For example, it may imply regulations that make it easier for smaller companies to access the public or semi-public financial markets. Let’s first discuss more about the increasing numbers of cancer survivors, the reasons for that and the implications for future technologies.

http://www.linkedin.com/in/ogangurel
© Ogan Gurel (All Rights Reserved)

Lance Armstrong and the Future of Cancer Care
Posted by Ogan Gurel MD MPhil at 22 January 2007, 10:38 AM and is filed under Practice of Medicine,Personalized Medicine,Diagnostics,Cancer,Targeted Therapy,Biotech Business Models,MIS


Lance Armstrong is a unique phenomenon. He’s a talented athlete, a cancer survivor and a political activist. He is in a league by himself. Or is he? As many people know, survivors of cancer are much more common today. A recent National Center for Health Statistics report released by the American Cancer Society showed a drop in cancer deaths for the second year in a row. Cancer patients as political and even business activists are also increasingly common. In a Dec. 2006 column on MidwestBusiness.com, I wrote about this growing phenomenon:

Various disease-oriented non-profit groups, charities and government groups are actively providing venture financing to new biotech start-ups.

If the trend of socially driven popularization of biotech investment continues, investors would be looking not just at financial returns but also at social returns.

Ultimately, this is what most patients want. Though it is not yet clear whether or not this will require new legal frameworks, it is clear that it would involve new paradigms.
For example, it may imply regulations that make it easier for smaller companies to access the public or semi-public financial markets. Let’s first discuss more about the increasing numbers of cancer survivors, the reasons for that and the implications for future technologies.

http://www.linkedin.com/in/ogangurel

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Published by: ogangurel on Nov 17, 2008
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Thinking about Life Sciences
http://blog.aesisgroup.com
Monday, January 22, 2007
Lance Armstrong and the Future of Cancer Care
Lance Armstrongis a unique phenomenon. He’s a talented athlete, a cancer survivor and a political activist.He is in a league by himself. Or is he? As many people know, survivors of cancer are much more commontoday. A recentNational Center for Health StatisticsreportreleasedbytheAmerican Cancer Societyshowed a drop in cancer deaths for the second year in a row. Cancer patients as political and even business activistsare also increasingly common. In a Dec. 2006columnon MidwestBusiness.com, I wrote about this growingphenomenon:Various disease-oriented non-profit groups, charities and government groups are activelyprovidingventure financing to newbiotech start-ups.If the trend of sociallydriven popularization of biotech investment continues, investors would be lookingnot just at financial returns but also at social returns.Ultimately, this is what most patients want. Though it is not yet clear whether or not this will require newlegal frameworks,it is clear that it would involve newparadigms.For example, it may imply regulations that make it easier for smaller companies to access the public orsemi-public financial markets. Let’s first discuss more about the increasing numbers of cancer survivors, thereasons for that and the implications for future technologies.
Major Technology Trends
There are four major technology trends that have impacted cancer care over the past decade. I’ll discusseach with some implications for the industry.
1
. Earlier detection and diagnosis
2
. Targeted therapies
3
. Personalized medicine
4
. Minimallyinvasive surgery
Earlier Detection, Diagnosis
The explosive advances in imaging technologies (computerized tomography (CT), magnetic resonanceimaging (MRI), ultrasound (U/ S), mammography and others) have completely revolutionized cancer care.With most cancers, earlier detection and diagnosis means more localized disease.There are two implications to earlier and more localized disease: the disease has a higher chance of beingcured and surgical options generallyfigure more largelyin the treatment of earlydisease. The second pointalso relates in that advances in minimally invasive techniques have further contributed to growth in thesurgical management of cancer.There have been several industry implications of earlier detection including an increase in demand forradiology services. This has not only spurred growth in the sales of these complex machines but also in
Thinkingabout Life Sciences: Lance Armstrongand the Future of Cancer ... http://blog.aesisgroup.com//2007/01/22/lance-armstrong-and-the-future-of...1 of 3 11/17/2008 12:49 AM
 
ancillaryservices such as free-standing diagnostic centers and even teleradiology.As cancers are detected earlier, there is an inverse pattern between increasing surgical care and decreasing(in relative terms) chemotherapy. In addition, as disease is caught at earlier and at less-symptomatic stages,the importance of drug safetywill also increase. All of these trends will continue.
Targeted Therapies
Even back in the days of Richard Nixon and his “war on cancer” (and even before then), there have beendreams of a magic bullet that will kill onlycancer cells and preserve normal cells. For most people, cancerchemotherapy is associated with dreadful side effects from relatively benign but certainly concerning hairloss to severe bone-marrow suppression and fatal infections. A recent CNN article on Lance Armstrong’scancer crusade showed a galleryof cancer patients. All of them were bald from undergoing their respectivechemotherapies. Ironically, this picture is becoming less common with the new generation of targetedtherapiessuch asHerceptin,GleevecandErbitux. The mechanism of action of these newer, more targeted drugs is not on inhibiting cell growth in general(with moderate levels of differentiation between cancerous and normal cells) but rather on affectingspecific functions and pathways unique to cancer cells. Even though these targeted drugs are darlings of the media and Wall Street and theystill onlyrepresent a small proportion of overall cancer chemotherapy,the industry implications have been profound. These new drugs have impacted longer survival and hencehave contributed to the concept of cancer in many cases now being a chronic disease. Another importanttrend has included a marked decrease in the level of in-patient cancer care (much of which is often relatedto the serious side effects of chemotherapy).
Personalized Medicine
Personalized medicineis not specific to cancer as it represents a new paradigm in medicine in whichindividual genetic variations become relevant in fine-tuning the diagnosis and treatment. While people had“high cholesterol” just 20 years ago, theynow have various syndromes relating to subtypes of blood-bornecholesterol such as HDL, LDL and VLDL. Even more finely-tuned genetic subtypes are available forwhat was once a simple and monolithically defined syndrome. To some extent, the phenomenon of personalized medicine overlaps with the targeted therapies above. These targeted therapies are in somecases not just directed more effectively toward cancer cells but are also targeted by virtue of patient-specific genetic factors. Women with certain mutations in the BRCA1 gene, for example, have an 80percent lifetime risk of breast cancer. For these women, radical mastectomy is not such an extremetherapeutic (preventative) option. To a lesser extent than early detection and targeted therapies, thisnascent era of personalized medicine has likelyalso reduced death rates from cancer.The wider implicationss of personalized medicine for cancer care are still being explored and understood.Apart from the improvements in survival as suggested above, one absolutely critical impact is on howclinical trials for cancer are designed and constructed. As therapies become more personalized, the patientpool correspondinglygets smaller. This means the statistical power of large population-based clinical trialsis less or even not available for these highly personalized and targeted drugs. This is a problem that theFDAis addressing now. It will impact drug development and drug pipelines for years to come.
Minimally Invasive Surgery
In addition to earlier detection, the remarkable advances inminimally invasive surgical techniques– not just traditional “cuttingsurgery but other approaches such as interventional radiology, endovascularmethods, lasers and radio-frequency ablation – have also raised the profile of surgery as a part of the careof many cancers. New minimally invasive techniques have caused a complete paradigm shift in theunderstanding of surgeryparticularlyas applied to cancer. In the traditional paradigm, surgerywas a “last-resort treatment” in which (generally speaking) only one, definitive operation was possible. t was literally“do or die”.Incremental surgeries can now be performed along with combination diagnostic/ therapeutic surgeries,second-look diagnostic procedures, drug-delivery system implants and repeat surgeries. A host of other
Thinkingabout Life Sciences: Lance Armstrongand the Future of Cancer ... http://blog.aesisgroup.com//2007/01/22/lance-armstrong-and-the-future-of...2 of 3 11/17/2008 12:49 AM

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