Targeted Cancer Therapy – Road to Precision Medicine
Achim Regenauer, Chief Medical Officer, Europe and Asia Pacific
Bryce Shepherd, Head of Capabilities Development, Life & Health, APAC
In this, the third of our 4-part series of insurance-focused articles on cancer, Dr. Achim Regenauer, Chief Medical Officer, presents a high-level overview of targeted cancer therapy – a catch-all term for a spectrum of innovative new cancer therapies that are improving the outlook for patients and moving us closer to precision medicine – and its impact on Life & Health insurers.
Dr. Regenauer’s content is presented in a concise bulleted format – so there’s no need for you to wade through complex medical descriptions or interpret sensationalised headlines.
Alongside the observations, Bryce Shepherd, Head of Capabilities Development, Life & Health APAC, adds valuable market insights and solutions relating to how the industry can adapt to these changes to ensure that our products and services stay relevant, valued and sustainable over the next decade.
What is targeted cancer therapy?
- Cancer cells have the ability to hide from the body’s immune system. Targeted cancer therapy has the potential, via different pathways, to remove these “brakes” on the immune system and induce an anti-tumour response so that the cancer can be defeated.
- Targeted cancer therapy is a catch-all term, encompassing smarter cancer therapy via immunotherapies, monoclonal antibodies, CAR-T-cell therapies, interferons, small molecules and cancer vaccines.
- There is no general definition of targeted cancer therapy – the term is often used interchangeably with “immunotherapy” or “biologic therapy of cancer”.
What’s new about this?
- For decades, the conventional anti-cancer treatment strategies have been surgery, chemotherapy and radiotherapy. Chemotherapy drugs are often poorly tolerated as they also kill healthy cells.
- In quite a number of different cancers, the response rate from targeted therapy was much higher than from chemotherapy, the toxicity much lower and survival outcomes shifted from several weeks to months, if not several years, depending on the specific treatment and cancer type.
- In some cancer types, even metastases1 could be eliminated by immunotherapeutics – a significant development as metastasis usually signifies inevitable death.
Expected further advances
- Next to surgery, chemotherapy and radiation, targeted cancer therapy will emerge as the fourth pillar of cancer treatment. For a number of cancers, it is already, next to surgery, the most successful treatment.
- A gradual extension of cancer subtypes treatable by immunotherapy – even as a first line therapy.
- The development of liquid biopsy tests (expected early diagnosis via a simple blood test2) is intertwined with the development of new targeted cancer therapeutics: the earlier cancers are detected, the better any drug will work. Currently, almost 80 targeted cancer therapeutics are being used after a predictive biomarker test, up from only 20 in 20113.
- After breakthrough mRNA COVID vaccines, much hope is laid upon development of mRNA vaccines for existing cancers. The first trials are already running.
Business solution: Challenges & opportunities for Life & Health insurers
The movement to precision medicine, and in this case precision oncology, is an exciting and significant development, offering cancer patients (expanding) additional medical options for improved treatment outcomes and even recovery. At the same time, the Life & Health industry is presented with both opportunities and challenges:
The opportunity lies in how Life & Health insurers incorporate product redesigns and proposition services to make targeted cancer therapy more accessible and affordable. If achieved, treatment success rates should correspondingly improve and fewer severe cancers develop, increasing the value of protection products to the customer and (through the right benefit payout design) reducing the cost to the insurer.
There are also challenges. These revolve around the uncertainty in the trend level caused by the availability of new drugs/therapies and their impact on existing product definitions. After a drug is approved, there are understandably ‘spikes’ in claiming due to the availability. Herein lies the challenge to design the benefit to incorporate a constantly changing available therapies list, whilst also ensuring product sustainability.
With the speed of advancements in targeted cancer therapies and their market regulatory approvals, a close eye should be kept on all developments to maintain alignment between medical advancement, product and pricing revisions. See more on this in the following sections.
Expected impact on Life & Health insurers
- With mortalities improving for many cancer types, close monitoring of underwriting revisions for cancers will be required. Furthermore, a much deeper differentiation will be necessary in order to depict the different prognoses of the increasing number of molecular based cancer subtypes.
- With significant mortality improvements, pricing of Critical Illness covers (in Asia) based on historical experience needs regular review.
- New opportunities for innovative products that more closely align to the exploding cost profile for patients able to benefit from targeted cancer therapy.
- High treatment costs for numerous cancer types and subtypes (impacting Health and Medical Reimbursement covers).
- Medical Reimbursement covers may become unsustainable without benefit limits.
- Terminal illness products will need to be reassessed.
Business solution: Designing products that lower the cost barrier to treatment
As new treatments take time to become more standard, their costs remain high, often leaving them out of financial reach for the majority.
Can we lower the barrier of cost by designing a new cancer benefit / cancer product? This is the role of (re)insurance, i.e. to collaborate, spread risk and ensure sustainability and affordability.
PartnerRe has made in-roads by developing an original definition to cover targeted therapy – please contact us to discover more about this solution.
State-of-the-art
- Targeted cancer therapy, and here particularly immunotherapy, has moved beyond the domain of basic science. The total number of new drugs in the R&D pipeline reached almost 3,500 in 2020, up 75% since 20153.
- Over the last 15 years, the FDA has approved more than 150 new cancer drugs4, mostly for cancers with a specific genetic mutation. However:
- Only a subset of patients (approximately 10-30%) respond to immunotherapies and there is no predictor available for who will and who won’t benefit.
- There may be a large group of cancer patients who will never respond to immunotherapy.
- Alongside the development of new cancer drugs, combination regimes with chemotherapies or other types of targeted cancer drugs are now widely being researched in clinical trials.
Prediction for the next 10 years
- Targeted cancer therapies have the potential to be a disruptive technology over the next 10 years, with a high potential for even greater mortality improvements than in the past – even heralding a systematic improvement in cancer therapy.
- Genomics is a big enabler, but with new dimensions of complexity. Insurers will correspondingly require professional expertise in medicine and oncology.
Business solution: Delivering affordable, attractive, sustainable and future-proofed products
Looking forward to an even more promising future, it’s important to recognise that it remains unknown as to when further new treatments will become available, to whom and at what cost, and to endeavour to create products that accommodate the unknowns (are future-proofed).
One of the key roles the insurance industry plays is to improve the accessibility of medical advancement to society. This is where an informed, ongoing redesign of treatment or severity benefits will allow products to become more relevant to the customer and maintain the alignment between event, financial outlay and benefits.
PartnerRe has a strong track record on product innovation. We have already made in-roads in product design for advances like this. We firmly believe that this approach to future-proofing products will be valued by customers.
We are excited by this challenge and are backed by our global medical experts on the latest available therapies.
There are solutions waiting to be created and we very much look forward to working with you on them.
We hope you found this overview helpful.
Don’t miss the next article in this series on cancer classification, “Part 4: Genomic Sequencing of Tumours – Driving all New Developments in Cancer Medicine”, find out how genomic sequencing is the key enabler for doctors to better diagnose and identify the appropriate drugs, therapies and/or clinical trials for patients – coming out soon.
Contact PartnerRe
Our approach is one of partnership, shared expertise and the creation of success for our clients.
We look forward to discussing these trends and concepts with you, and to turning them into concrete solutions for your business.
Bryce Shepherd, Head of Capabilities Development, Life & Health, APAC
This article is for general information, education and discussion purposes only and does not constitute legal or professional advice.
References:
1 The spread of cancer cells to other organs of the body.
2 PartnerRe 2021 Cancer Series. Part 2: Cancer Diagnostics – Earlier Detection & Impact on Incidence.