The Past, Present, and Future of Lung Cancer Treatments

Lung cancer, which accounts for 14% of all new cancers, remains one of the deadliest cancers in the United States, causing nearly 160,000 deaths in 2013.

Over the past few decades, lung cancer treatments have improved, and smoking rates have dropped from 42% in 1965 to 18% in 2012, but lung cancer and other respiratory diseases remain the third highest cause of death in the United States.

Therefore, let's take a closer look at how treatments from companies like Roche (NASDAQOTH: RHHBY  ) , Pfizer (NYSE: PFE  ) , Clovis Oncology (NASDAQ: CLVS  ) , and Inovio Pharmaceuticals (NASDAQ: INO  ) could shape the future of lung cancer treatments.

Understanding lung cancer
When we discuss lung cancer, two types are usually mentioned -- non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC).

NSCLC is far more common, accounting for 85% to 90% of all lung cancer cases, and is split into three main subtypes: adenocarcinomas (40% of NSCLC cases), squamous cell carcinomas (25% to 30%), and large cell carcinomas (10% to 15%).

Squamous cell carcinomas occurs more frequently in smokers, while adenocarcinomas occur more often in non-smokers, although they are not exclusive to either group. Large cell carcinomas can occur in either group, and it can be more aggressive and harder to treat than the other two types.

SCLC, which is far less common than NSCLC, mainly occurs in smokers and is characterized by smaller cancer cells that start spreading from the bronchi in the middle of the chest.

Standard treatments are Roche's territory
Since NSCLC is far more common than SCLC, there are more targeted treatment options for the former than the latter.

The most common first-line treatment for NSCLC is Roche's Avastin, which inhibits the growth of new blood vessels that can help cancer cells spread. Avastin is also approved as a treatment for colorectal cancer, renal, ovarian, and brain cancers.

Since Avastin is approved for such a wide variety of indications, it is also one of Roche's top-selling drugs, generating $3.45 billion in worldwide sales in the first half of fiscal 2013.

The market for second-line treatments for NSCLC is dominated by Roche's Tarceva, another top drug that generated $769 million in sales during the first half of 2013. However, Tarceva is only effective in NSCLC patients whose cancer cells have an overexpression or mutation of tyrosine kinase, an epidermal growth factor receptor (EGFR).

Both Avastin and Tarceva are administered alongside standard chemotherapy treatments such as Eli Lilly's (NYSE: LLY  ) Alimta and generic versions of Sanofi's (NYSE: SNY  ) Taxotere (docetaxel).

The growing market for targeted mutation treatments
Since Roche's footprint in NSCLC treatments is so large, other companies, such as Pfizer and Clovis Oncology, have tried to carve out new niche markets with treatments targeting specific mutations of NSCLC instead.

Pfizer's Xalkori targets a specific mutation of NSCLC cells known as ALK. ALK mutations only occur in NSCLC patients with adenocarcinomas, and account for approximately 5% of all lung cancer cases. Xalkori, which was approved by the FDA in 2011, was shown during clinical trials to shrink tumors by 50% to 60% in ALK-positive patients. It also exhibited a progression-free survival rate of 7.7 months versus three months on chemotherapy alone.

Clovis, on the other hand, is targeting another specific mutation known as T790M, which only occurs in 1% to 4% of all lung cancer cases. T790M is a resistance mutation to EGFR that renders Tarceva ineffective. Clovis' CO1686, which is currently in a phase 1/2 trial, could be the first targeted treatment for T790M mutations if approved. An earlier phase 1 trial showed that CO1686 was effective at shrinking tumors in 3 out of 4 patients.

Although the size of Pfizer and Clovis' prospective markets are smaller than Roche's, analysts predict that Xalkori and CO1686 (if approved) could respectively hit peak sales of $1.3 billion and $1.2 billion.

Will a lung cancer vaccine ever be approved?
Looking farther into the future, we should consider next-generation treatments such as therapeutic cancer vaccines. Therapeutic cancer vaccines, also known as immunotherapy treatments, are drugs that attempt to teach a patient's immune system to recognize cancer cells so they can be naturally destroyed.

One of the brightest hopes for a real NSCLC vaccine was Merck KGaA (NASDAQOTH: MKGAY  ) (not to be confused with the U.S. Merck (NYSE: MRK  ) ) and Oncothyreon's (NASDAQ: ONTY  ) Stimuvax, now known as tecemotide. Unfortunately, the drug failed phase 3 trials in December 2012.

Merck, however, continued pushing ahead with an Asian study in an attempt to salvage the drug. Last September, the company announced that it was doubling down on tecemotide in new trials.

Meanwhile, Inovio Pharmaceuticals' pipeline of synthetic DNA-based vaccines are also worth watching. Inovio uses electroporation, a proprietary delivery system that uses brief electric pulses to boost cellular intake of its vaccines. The addition of synthetic DNA makes the vaccine slightly different from native human proteins and triggers the desired immune system response.

Inovio is primarily focused on cervical dysplasia and cancer vaccines, but it also has vaccines for hepatitis B/C, prostate cancer, influenza, malaria, HIV, breast cancer, and lung cancer in its vast pipeline. Inovio's breast and lung cancer vaccine, INO-1400, is currently in preclinical trials, but it could gain a lot of attention if its other vaccines prove that the company's method of electroporation delivery of synthetic DNA is viable.

The Foolish takeaway
In conclusion, lung cancer treatments have come a long way, but there's still plenty of room for new treatments -- the overall five-year survival rate for all stages of lung cancer is still only 16%.

While it's unlikely that next-generation vaccines will displace chemotherapy, radiation therapy, surgery, and targeted treatments anytime soon, they could one day render those old treatments obsolete.

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Help us keep this a respectfully Foolish area! This is a place for our readers to discuss, debate, and learn more about the Foolish investing topic you read about above. Help us keep it clean and safe. If you believe a comment is abusive or otherwise violates our Fool's Rules, please report it via the Report this Comment Report this Comment icon found on every comment.

  • Report this Comment On January 26, 2014, at 3:58 PM, Kngrthr wrote:

    Have smoked for 40+ years and still do, guess when I go at least I'll go out in history, as a statistic.

  • Report this Comment On January 26, 2014, at 10:32 PM, entheogenius wrote:

    Here's an excerpt from my upcoming book Psychopathic Psychotronics: 2-28-09 My head sets off my wireless camera detector, So does my abdomen at times! The signal is coming from the Dairy Queen next door. Dairy Queen corporation is owned by Warren Buffet one time worlds wealthiest man. I'm pretty sure his dad was one of the 2 clowns that turned distar into project follow through and tried hiding their names by closing down the website with the real project follow through time line. https://www.sraonline.com/about_history.html

    Nice investment Warren. A great strategy, have an army of unwitting geniuses plugged into a mind reading toy.

  • Report this Comment On January 26, 2014, at 10:37 PM, entheogenius wrote:

    Here's an excerpt from my upcoming book Psychopathic Psychotronics :

    7-13-07 Here's another one of the ideas used against me. It was used as a basis for one of my psychiatric commitments and was made a part of my medical record.

    At age 17 I read about Laetrile and Trophoblasts. Trophoblasts are supposedly a type of cell that play a crucial role in fetal development. Once that jobs done they just lay around in your body like a time bomb. If something comes along and wakes them up, they become cancer. Laetrile also known as Vitamin B-17 is a chemical sandwich with a cyanide molecule in the middle. To a non trophoblast cell laetrile is harmless, but to a trophoblast it's deadly because they produce the enzyme Beta-Glucoranidase which is supposedly able to activate the cyanide in the leatrile delivering it right to the cancer cell or so that's the theory. It turned out to be b.s. Or so they say. But it got me thinking about how some cancers are formed by viral activity. Cervical cancer from Human Pappiloma Virus is a good example of this. It's my understanding that only a trophoblast can become cancerous.

    My idea was to make a virus that can only infect and replicate in a trophoblast by making them require the enzyme beta-glucoaronidase to initiate infection and replication. When a virus infects a cell it replaces its DNA with its RNA destroying the cell. Such a virus could theoretically cure cancer and vaccinate against it as well.

    I once told part of my theory to the resident psychiatrist at Hazelden rehab center in 1993. He wrote it down and bitched me out for keeping it a secret. About 18 months later in the news of the world of medicine section in the Readers Digest I read about a novel new cancer therapy involving injecting herpes viruses into brain tumors in rats and with promising results. By the way no one thought of me as having any mental illness at Hazelden.

    Cancer is expected to make around $160,000,000,000 per year by 2020 do you think anyone that's in on the profit wants to be replaced with an injection that may cost $20 to make per dose or less? How does that sound for being unable to differentiate between reality and fantasy?

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