Biotech Strategy Blog

Commentary on Science, Innovation & New Products with a focus on Oncology, Hematology & Immunotherapy

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Controversies and pitfalls at ASCO24

Time for a pitstop to reflect on some ASCO24 data

Day 1 at ASCO is usual a nice easy glide into the clinical sessions with barely a moment of controversy to be seen.

Not this year, however.

If you’re going to buck the trend then you might as well do it with a splash – something which can be interpreted positively or negatively depending upon your perspective.

Talking of pitstops always reminds me of those colourful Hanna-Barbera Wacky Races cartoons so familiar from our childhood with their insanely odd vehicles and absurd plot developments.

Are some of the claims coming out of Chicago living up to these expectations one might well wonder?

In the first of our daily commentaries from the annual meeting, we take a look at four very different trial readouts and discuss the issues they raise because all is not what it seems in some cases…

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How to beat your competition

With new trial data being presented at the annual meeting of the American Society of Clinical Oncology (ASCO) today, a provocative question on the minds of many interested in hematologic malignancies is…

Do we really need yet another tyrosine kinase inhibitor (TKI) for chronic myeloid leukemia (CML)? Is it time to go in a new direction?

Instead I’m going to turn it around and suggest we consider the issue in an entirely different way:

What’s the best thing to do for people living with CML?

The solution lies not in the usual chestnut about having more choice or available options, but rather in how can they be helped more by having access to a different therapy?  What do they gain or lose from it?

When we look at the situation in this fashion then the answer quietly speaks for itself…

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A Renaissance in Biomarkers at ASCO24

Duomo, Firenze – a Renaissance masterpiece

This week I have been very much struck by the stark contrast between the neat, organised, and predictable nature of Renaissance architecture and the chaotic, complex, and interconnected challenge of developing robust cancer biomarkers.

While Renaissance architects could rely on established mathematical principles to create harmonious designs, scientists working on cancer biomarkers must navigate a much more unpredictable and intricate landscape, seeking patterns and reliable indicators in the midst of biological complexity.

While biomarkers are much harder to find amidst the chaos of tumour heterogeneity, this doesn’t mean the task is impossible or we should stop the attempt altogether.

In fact, it’s quite the opposite, as these intriguing examples we’ve selected for discussion from the ASCO abstracts this year illustrate…

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A new dawn or the sunsetting of cytokines?

Much has been written about cytokines over the last decade in terms of various ways of employing them systematically as cancer therapeutics.

There has been little success reported, however, beyond a small number of patients receiving high dose IL-2 in certain situations such as melanoma and renal cell carcinoma.

What if we take an orthoganal approach to the problem and explore different ways of delivering the desired effects?

Does this change the outcomes, and with it, our thinking?

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Choose wisely

In part two of our mini-series on tulip mania in Pharmaland, where oncology companies are switching their attention and focus from one niche to another, we take a look at how perceptions can change with time.

What looks a wide open landscape may not be all it first appears

Sometimes though, what initially looks like a less crowded space than the original one may rapidly turn out to be quite different than supposed in a very short space of time.

The moral of the story is be careful what you wish for because choosing wisely is just as important as executing, as we learn in this exercise…

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The hidden dangers of tulip mania

Dog Drug Heaven high in the hills above Edinburgh

With every new shiny or sparkly category coming through oncology pipelines, there’s nearly always a sense of fervent tulip mania once the niche reaches a certain threshold of new compounds moving into the clinic.

The latest such example is antibody-drug conjugates (ADCs).

It’s time to think about some of the practicalities and reality checks because few things in oncology R&D ought to be viewed from the perspective of rose tinted glasses.

Instead of breathless hype, we’re taking a common sense perspective deeply rooted in first principles around targeted therapies.

Look before you leap into the unknown – because there are plenty of clues regarding where this niche is headed for many early stage agents…

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Who’s showing a clean set of heels at ASCO24?

Who’s getting away from the competition this year?

One of the many challenges in early stage drug development is figuring out who’s showing the competition a clean set of heels…

Meaning to get ahead of the pack.

In the run-up between AACR and ASCO the chatter starts with ‘oh, but the response rate was 66%!’

Only you look at the small print and realise it was 4/6 responders, half of whom were unconfirmed – and may never be confirmed if the tumours have progressed. Ah.

If we look carefully beyond the breathless hype of press releases and curtain raisers, what stands out as trials worth looking at more carefully, for better or worse?  Here we offer 15 abstracts to watch out for at ASCO in three weeks time…

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Early stage cancers

There has been quite a movement of late in focusing on active treatment of early stage disease rather than watchful waiting under the basic premise the earlier we treat early stage cancers, the better the outcomes.

Is this hypothesis sound given the majority will be benign and can be left alone? Do we really need to over treat many in order to see benefit in just a few individuals?

First, do no harm.

Instead, what if we could select out many of the high risk patients for escalation and leave the rest alone?

Ah, now this is a much more selective strategy I could get on board with.  This then begs the provocative question of how on earth do we go about identifying them?

Last week something novel and intriguing cropped up and captured my attention on this very front…

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Is TGF-β making a comeback in cell therapy?

Will the new developments be the equivalent of walking down the steps rather than the steep climb up of late?

Targeting cytokines – once seen as the next big thing in immuno-oncology (IO) – has been falling by the wayside as researchers and companies alike found them much trickier than expected to incorporate into cancer therapeutics.

Part of the problem lies in their pleiotropic nature – they can have an inhibitory or a stimulatory effect depending on the situation they encounter.

In our latest post on this niche we focus on one particular cytokine, which has long frustrated oncology companies,  regardless of the modality deployed.

With the new round of early data reveals, we take a look at whether several different next generation approaches are harnessing the complicated nuances at play, and in the process changing things for the better…

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For whom the bell tolls

Yes, it really was sunny in England one fine day in April 2024!

“Each man’s death diminishes me,
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.”

~ John Donne (1572–1631), Dean of St Paul’s Cathedral in London and poet extraordinaire

Most writers quote the beginning of Donne’s poem and make some point around “No man is an island” and yet, in oncology the latter half of the first verse is a much more apt reminder for us all to ponder.

Few in R&D will forget how patients with advanced solid tumours have precious little time to find the right treatment or regimen to help them live another six months in comfort – in order to put their affairs in order or say goodbye to their loved ones.

It behooves us all to work smarter and find new solutions to move the needle while reducing the incidence of severe adverse events. There is also a responsibility inherent in the process to improve on what’s gone before.

While targeted protein degradation (TPD) is still in its infancy, there is quiet hope for the future versions that we may be on the right track to making a difference to the lives of people with cancer.

In our latest company interview, we chat with a thoughtful company researcher who is leading from the front in developing novel approaches to tackling advanced cancers…

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