Progress and Optimism in Oncology Today

Oncology is one of the most challenging and important areas of medicine—and we’re charting a new frontier. The recent explosion of scientific progress has brought new and advanced technology platforms to the fore, and a rising generation of leaders—from the lab to the clinic—have the opportunity to tackle historically intractable challenges as we work to overcome one of our greatest killers.

In drug development and as CEO, I’ve been fortunate to collaborate with teams working tirelessly to tackle different cancers. From being in the room for the historic FDA approval of the first CAR-T therapy for pediatric cancer to seeing remarkable advances in breast cancer, prostate cancer, and hematology, I’ve witnessed the kind of progress that reinforces my optimism that one day, we will beat cancer.

Oncology is an area that requires extraordinary resilience and determination. I’ve learned the effort requires scientists and leaders who listen and learn from their patients, and a mentality that takes failure in stride and prioritizes resiliency. As leaders in the industry and beyond continue working to make progress in oncology, I wanted to share some perspectives on the current moment and the challenges we can address together.?

Oncology’s long history

Humans have been wrangling with cancer for thousands of years. For most of human history, we didn't understand much about cancer biology or why tumors form. Over the last century, we began to understand that cells, through a variety of different mechanisms, including genetic mutations and external factors, can start to grow in an uncontrolled manner.

In the 1920s and 1930s, we began to understand that the immune system plays a role in cancer—and as the century progressed, we realized we could treat it. Taxol and other naturally occurring compounds that indigenous societies used for natural medicines were discovered for their anti-cancer and anti-tumor properties. Along the way, we discovered radiation could be useful, which was another powerful moment in the history of medicine.

However, many of those therapies are nonspecific. They kill both cancer cells and normal cells, resulting in the challenging side effects that accompany chemotherapy and radiation therapy, for example.

But exciting progress has been made over the last two decades. We've become more specific in how we treat cancer, and there are four essential areas in which we continue to make progress.?

• First is targeted therapies. We’ve learned that specific genes are altered through mutations that drive cancer behaviors or mechanisms that spur cancer cell growth. We can now target certain cancers with discrete genetic alterations. Decades ago, Novartis developed a drug that targeted a specific mutant protein to stop chronic myeloid leukemia from expanding, and that remarkable medicine started the targeted therapy revolution.
• Then we learned about immuno-oncology and how you can remove the “brake” in the body that stops immune cells from targeting cancers. When that brake is removed, immune cells can detect cancer cells and eliminate cells that are growing out of control.
• Later, we learned you could reprogram cells in the body to target cancer cells, and that effort kicked off the rapidly growing field of CAR-T therapy. Novartis became a pioneer on CAR-T therapy, working with the University of Pennsylvania.
• Lastly, one of the areas I'm excited about, is radioligand therapy and antibody drug conjugates. These tumor-targeting therapies deliver radiation or other cytotoxic payloads to certain cancer cells, damaging or destroying them more selectively.?

Progress like this has enabled patients with many cancers to live longer and healthier lives, but there's work still to be done. We need improved therapies for a range of cancers, such as glioblastomas and gastrointestinal cancers. I'm hopeful that one day, we'll get to the point where we can detect cancers very early, treat them, and prevent them from impacting people's lives.

Looking ahead—there are three areas of oncology we can continue to strengthen.?

1. The hard yards of oncology research

Cancer drug development is arguably the hardest, and success rates are the lowest of any therapeutic area. Some cancers, like blood cancers, emerge from a single type of cell that expands repeatedly, and while these are marginally simpler to target, they also can evade treatment. Other types of cancers, particularly solid tumors, involve many evolved biological processes, especially as they reach later lines of therapy. This requires a continued commitment to novel R&D approaches and innovative platforms.

One major scientific challenge is dealing with the tumor heterogeneity found in metastatic tumors. Another is detecting cancers earlier and discovering better treatments, because when you get to a cancer early and prevent it from progressing, you get much better outcomes. And lastly, one of the great challenges is being able to demonstrate in later lines of cancer treatment that you can meaningfully impact life expectancy and quality of life.

2. Improving cancer care

We must also continue improving cancer care for patients, including improving patients’ quality of life while treating cancer. Taking medicines that can extend life for months or years can often come with difficult side-effects and the high burden of taking certain therapies. We must keep working to create a patient experience in which patients live longer lives, with a high quality of life. Novartis is currently partnering with patients on drug development so we can discover therapies that are the most meaningful to patients and caregivers.

Additionally, we must increase access to supportive care. As patients move through therapy, they need a significant amount of supportive care—to receive the medicine, to receive nutritional support, to manage side effects, and to access psychosocial services. There is an entire health ecosystem that must be present, and it’s a collective effort governments, nonprofits, and industry must tackle together.

3. Strengthening systems to help people get the medicines they need

Access to cancer therapies, including the latest medical innovations, is a challenge we must continue working to overcome. It spans beyond pricing and supply and requires strengthened health systems.

When a cancer becomes metastatic or enters later stages of development, it's much harder to treat, so it’s essential to educate populations about the importance of routine screenings. Through various novel diagnostic technologies, such as circulating tumor DNA or other technologies, we continue to detect and find ways to intervene earlier.

In bringing our novel cancer therapies to patients in low- and middle-income countries, and to those in disadvantaged communities in wealthier countries, Novartis has seen the need for patients to have access to medical care through which they receive early and accurate diagnosis, so they can access early lines of therapy.?

While the challenges ahead can seem daunting, we can all find a sense of optimism in the progress being made in oncology today. When the challenge seems immense, I remember the stories of those I’ve met along the way—the doctor in Ghana who raised his hand in a crowded room to thank Novartis for our access efforts, the daughter of a cancer patient who emailed me a photo to let me know her dad was able to walk her down the aisle on her wedding day thanks to care he received.

If you have a loved one or a friend who has been impacted by cancer, we share your sense of urgency and desire to meaningfully improve the lives of cancer patients. It will require an unwavering, concerted effort, and I have deep admiration for the many scientists, oncologists, care workers, and patients who partner with Novartis on our clinical trials and are working to discover new medicines. Cancer is one of the most intractable areas of science, but progress is possible. And we keep at it because we know how important this work is. ?