1. Biosimilars - Can we do without them?
Dr Paul Cornes,
Consultant Oncologist,
Bristol Haematology & Oncology Centre
Comparative Outcomes Group

2. Pharmaceutical medicine moves fast!
1984 Nobel Prize for Medicine
"for the discovery of the principle for production of monoclonal antibodies".
awarded jointly to Niels K. Jerne, Georges J.F. Köhler and César Milstein
Yet only 27 years later

3. We have developed a whole range of new treatments - 1984 to 2012 Monoclonal antibody therapy
Head and Neck Cancer
Macular Degeneration
Multiple sclerosis
Breast Cancer
Asthma
Bowel Cancer
Heart disease
Leukaemia
Transplant rejection
Lymphoma
Inflammatory bowel disease
Ovary cancer
Secondary bone cancer
Psoriasis
Melanoma skin cancer
Arthritis
Yet only 27 years later

4. Monoclonals in Cancer - Lymphoma
Rituximab
Halves Lymphoma Relapse
Prima Trial reviewed at

5. Monoclonals in Breast Cancer
Trastuzumab
Halves the chance of relapse
Reduces death by 33%
Romond EH, et al. NEJM. 2005;353:

6. 71% reduction in disability in Multiple sclerosis
Campath-H1 vs interferon

7. Controlling type 1 diabetes
Anti-CD3 vs placebo

8. Controlling Rheumatoid Arthritis
Thermal imaging of hand and elbow joints before……
..and after Mab therapy

9. Controlling painful skin diseases – Efalizumab for psoriasis
Sylvia Marecki & Peter Kirkpatrick. Efalizumab. Nature Reviews Drug Discovery 2004;3:

10. All demonstrations of the power of “Biologic or Targeted therapy”

11. I am very fortunate to work with international colleagues
Comparative Outcomes Group

12. We know - there is a cost to cancer
cancer has the most devastating economic impact of any cause of death in the world.
Cancer causes the highest economic loss of all of the 15 leading causes of death worldwide
WHO: Cancer world's top killer since 2010
16.7 percent of all 'healthy' years lost in the European Union
The total economic impact of premature death and disability from cancer worldwide was $895 billion in 2008.
Cancer is the most important disease for the world – with more impact than HIV, Malaria and Tuberculosis combined
83 million years of “healthy life” lost due to death and disability from cancer in 2008.

13. We know - there is a cost to cancer care
…but “cost” may be the wrong word to use – try “investment” instead
“Think about health spending as not consumption but investment”
David E. Bloom,
professor of economics and demography at Harvard
File:David E. Bloom at the World Economic Forum Summit on the Global Agenda 2008.jpg

14. Payback on our “investment” is plain to see - Good news for cancer treatment
Cancer death rates are falling
Jemal A, Ward E, Thun M (2010). Declining death rates reflect progress against cancer. PLoS ONE 5(3): e doi: /journal.pone
Novel approaches dominate drug development
Timbs O, Cancer World, 2004; Sept-Oct p.12
Vaccines
Immunostimulants
Gene therapy
Supportive care
Novel approaches
Hormonals
Cytotoxics

15. Good news for cancer treatment
Drugs in development, 2010
900 drugs in development are for cancer
The costly war on cancer. The Economist May 26.

16. But it is not all good news – Bad news for cancer treatment
There will be more cancer to treat
World population growth and ageing imply a progressive increase in the cancer burden
15 million new cases,10 million new deaths are expected in 2020, even if current rates remain unchanged
D Maxwell Parkin. Global cancer statistics in the year Lancet. 2001;2(9) 01 September
New cancer cases will likely increase to 27 million annually by 2030, with deaths hitting 17 million

17. Bad news for cancer treatment
Innovative drug development is slow and expensive
From compounds in pre-clinical trials:
only 0.1% reach clinical trial stage
of these, only 10-20% are finally approved
It takes 15 years from the target discovery to the market at 800 million $/drug
Adams CP et al: Estimating the cost of new drug development: Is it really 802 million dollars? Health Aff (Millwood) 2006;25:

18. ASCO 2009 Meeting emphasis: individualised care and cost-effectiveness
USA Medical insurance costs are rising faster than earnings and general inflation
Medical care is becoming unaffordable
Ward E. CA Cancer J, 2008;58:9-31

19. Cost of USA cancer care 1963 to 2004
Cancer treatment spending, in billions
$72.1
Cancer is a key driver for increasing costs
US$
$27.5
$13.1
$1.3