The age of Precision Medicine

Douglas Morrison looks at the disruptive forces at work in the life sciences arena and the extraordinary research being carried out that will revolutionise medicine

These are heady days at the R&D end of healthcare with what seems like a constant drip-feed of news on breakthrough drugs.

Yet the latest buzz around this sector turns not so much on the underlying science but a new approach to delivery – precision medicine.

This is all about tailoring medicine to specific patient groups and consequently making healthcare more efficient, both medically and financially.

“The aim is to get personalised drugs and therapy to the patient faster and more cheaply. The patient becomes the centre of everything,” says John McKinley, CEO of Precision Medicine Catapult (PMC), a new agency established by the UK government to accelerate the introduction of products and services.

Precision medicine is essentially a refinement of the already established area of personalised medicine, harnessing the disruptive therapies and innovation from pioneers such as Roche (see sidebar) but with greater use of computer technology.

“It comes from big data in the first instance and what you are producing at the end, are new therapies, new vaccines, new drugs,” says McKinley.

And as he suggests, it is ‘a golden age’ of discovery, with all the advances in such areas as epigenetics and immunotherapy.

When PMC was launching a UK-wide network of innovation centres, Oxfordshire-based Immunocore raised £205 million (US$340 million) in the biggest private financing of a European life sciences company, reflecting the expectations around immuno-oncology.

With health services worldwide strapped for cash and resources, the stakes are high.

PMC estimates that precision medicine is already worth US $14 billion in annual sales worldwide, and it is forecast to reach US$50-60 billion by 2020.

“There’s a universal recognition that the healthcare models of the past 50 years will not be able to sustain the changes in the industry over the next 50 because of innovation, new technology, new diseases happening every day,” adds McKinley.

“Healthcare has to move more towards the individual.”

Roche

A small number of pharma companies account for the lion’s share of personalised medicine and one of the undoubted disruptors here is Roche with a total of almost US$20 billion in sales from its targeted drugs.

The Swiss group identified personalised healthcare as a key business strategy as long ago as the mid-1990s when its big corporate play was to have diagnostics and pharmaceuticals together under one roof.

According to Roland Diggelmann, Roche’s COO Diagnostics, this twin-track approach gives the group “a fundamental advantage” over its competitors in an area of healthcare that customises medicine for specific patient groups, if not yet for the individual.

“In simplified terms you’re looking for a genetic mutation or genetic status and then you can tailor the medicine, and then you know that the response rate for that particular group is going to be higher than for the general population,” he says.

“This is the approach of personalised healthcare and it’s a compelling approach.

The more you know the better you can treat.

The basis to that is, of course, the gathering of information and a big part of that is the diagnosis.” He continues: “In medical terms, we say the targets come from pharma and the diagnostics picks this up and sees where we can find the so-called bio-markers, anything in blood or tissue which would indicate the validity of this hypothesis.

So we work together very early and we have advantages because we work without boundaries.” One of Roche’s early breakthroughs was Herceptin, a drug that targets the HER2 genetic mutation in a particular form of breast cancer.

Global sales of Herceptin in 2014 alone totalled CHF6.3 billion (US$6.4 billion).

“Personalised healthcare is very much a reality,” he adds.

“It’s going to increase in importance as we continue to make scientific advances, we understand more about the individual patient make-up, about how biology works and all the molecular information.

And that ultimately leads to more and more tailored medicines.

This is exactly what modern and future medicine is all about – having the best possible understanding of a patient’s situation and then having the ability to select treatment.”immunocore

Immunocore

There is genuine excitement surrounding immunotherapy – drugs that harness the body’s immune system to fight cancerous cells – and one UK company is a leader in research and development in the field – Immunocore.

Oxford-based Immunocore is well known in the biotech world following high-level partnerships with the likes of Roche, AstraZeneca and GSK.

But in July this year the company’s profile soared to a new level of public consciousness after raising £205 million (US$340 million) in Europe’s largest private life sciences financing.

Leading institutional investors piled in because Immunocore’s main drug – IMCgp100 – has shown huge promise in trials on patients with melanoma.

In effect, the drug enables the immune system to recognise and kill cancerous cells it would not other wise recognise and, as a result, offers a nine-fold increase in success rates compared with conventional cancer therapies.

Immunocore’s so-called T-cell receptor technology, is described by Chief Executive Eliot Forster as a “potential game-changer” within the field of immuno-oncology – itself widely acknowledged as the biggest advance in cancer treatment for a generation.

“We don’t think that this will be the only way of treating cancer but it certainly, we believe, will be an important component in treating cancers,” he says.

“This technology is rather like the development of monoclonal antibodies in the ’80s and that started in a very narrow area and eventually has gone on to be the most widespread drug classes available today.

“We believe that this technology has many parallels to that.

We’ve started our work with oncology but we’ve already announced we have a collaboration with GSK in anti-virals and we’re also interested in auto-immune diseases.” Now in late-stage development, Immunocore’s breakthrough skin cancer drug could be just three years away from widespread usage following the fundraising.

Forster adds: “The sad fact is that though huge progress has been made in the treatment of cancer over the last 20 years, it really has only been baby steps and the quality of life of patients and the expectation of life still leave a lot to be desired.

There’s a real opportunity for these patients and we believe we can help.”