The Cancer Industry and Pharmaceutical Policy in Germany

Prof. Dr. Karl Lauterbach MdB

Seite 1

The “Cancer Industry” and Pharmaceutical Policy in Germany

Dr. Karl Lauterbach, MD, ScD, MPH (HSPH ‘92)Professor of Health Economics and Clinical Epidemiology, University of

Cologne Member of the Deutscher Bundestag

Deputy Leader of the Social Democratic Parliamentary GroupAuthor of the new book The Cancer Industry


Seite 2

Probability of developing cancer in Germany in Percent

Male Female0

10

20

30

40

50

60

50.8

42.9

Birth to Death

Source: Robert Koch-Institut, Krebs in Deutschland, 2009/2010, Berlin 2013


Seite 3

Probability of dying of cancer in Germany in Percent


Male Female0

5

10

15

20

25

30

25.8

22.2

Birth to Death


Seite 4

Incidence rates for cancer in Germany, by gender and age (per 100,000 population)


Male

Female


Seite 5

Estimated cumulative risk of developing cancer in Great Britain for 1960 cohort

Source: A S Ahmad, N Ormiston-Smith and P D Sasieni,:Trends in the lifetime risk of developing cancer in Great Britain: comparison of risk for those born from 1930 to 1960.British Journal of Cancer (2015) 112, 943–947


Seite 6

Hallmarks of cancer

Source: Hanahan D., Weinberg R.A.: "The Hallmarks of Cancer". Cell 100 (1): 57–70. (2000) and Hanahan, D.; Weinberg, R. A.: "Hallmarks of Cancer: The Next Generation". Cell 144 (5): 646–674 (2011)https://en.wikipedia.org/wiki/The_Hallmarks_of_Cancer#Limitless_replicative_potential

Limitless replicative potentialNon-cancer cells die after a certain number of divisions. Cancer cells escape this limit and are apparently capable of indefinite growth and division (immortality). Insensitivity to anti-growth signals

Self-sufficiency in growth signals

Sustained angiogenesisAngiogenesis is the process by which new blood vessels are formed. Cancer cells appear to be able to kickstart this process, ensuring that such cells receive a continual supply of oxygen and other nutrients


Seite 7

Hallmarks of cancer

Source: Hanahan D., Weinberg R.A.: "The Hallmarks of Cancer". Cell 100 (1): 57–70. (2000) and Hanahan, D.; Weinberg, R. A.: "Hallmarks of Cancer: The Next Generation". Cell 144 (5): 646–674 (2011)https://en.wikipedia.org/wiki/The_Hallmarks_of_Cancer#Limitless_replicative_potential

Evading apoptosisApoptosis is a form of programmed cell death (cell suicide), the mechanism by which cells are programmed to die in the event they become damaged. Cancer cells are characteristically able to bypass this mechanism.Tissue invasion and metastasisCancer cells can break away from their site or organ of origin to invade surrounding tissue and spread (metastasize) to distant body parts.Evading the immune systemCancer cells appear to be invisible to the body’s immune system.Deregulated metabolismMost cancer cells use abnormal metabolic pathways to generate energy, a fact appreciated since the early twentieth century with the postulation of the Warburg hypothesis, but only now gaining renewed research interest.


Seite 8

New cancer drugs

Source: Traxler P.: Tyrosine kinases as targets in cancer therapy - successes and failures. Expert Opin Ther Targets 2003 Apr;7(2):215-34 andSebolt-Leopold J.S., English J.M.: Mechanisms of drug inhibition of signalling molecules. Nature 441, 457-462 (25 May 2006)

Tyrosine kinase inhibitorsProtein kinases play a crucial role in signal transduction and also in cellular proliferation, differentiation and various regulatory mechanisms. The inhibition of growth-related kinases, especially tyrosine kinases, might therefore provide new therapies for cancer.


Seite 9

New cancer drugs

Source: Shuptrine C.W., Surana R., Weiner L.M.: Monoclonal antibodies for the treatment of cancer. Semin Cancer Biol 2012 Feb;22(1):3-13. doi: 10.1016/j.semcancer.2011.12.009. Epub 2012 Jan 8

Monoclonal antibodiesAntibodies have the unique capacity to target and kill tumor cells while simultaneously activating immune effectors to kill tumor cells through the complement cascade or antibody-dependent cellular cytotoxicity (ADCC). This multifaceted mechanism of action combined with target specificity underlies the capacity of antibodies to elicit anti-tumor responses while minimizing the frequency and magnitude of adverse events.


Seite 10

New cancer drugs

Source: http://www.fightcancerwithimmunotherapy.com/ImmunotherapyAndCancer/TypesOfCancerImmunotherapy.aspx andSharma P., Wagner K., Wolchok J.D., Allison J.P.. Novel cancer immunotherapy agents with survival benefit: recent successes and next steps. Nature reviews Cancer. 2011;11(11):805-812. doi:10.1038/nrc3153.

Checkpoint inhibitorsThe immune system depends on multiple checkpoints or “immunological brakes” to avoid overactivation of the immune system on healthy cells. Tumor cells often take advantage of these checkpoints to escape detection by the immune system. CTLA-4 and PD-1 are checkpoints that have been studied as targets for cancer therapy. Inhibiting a checkpoint (ie, “releasing the brakes”) on the immune system may enhance the anti-tumor T-cell response. This class of therapy has shown efficacy in cancer and clinical trials are ongoing.

http://www.fightcancerwithimmunotherapy.com/ImmunotherapyAndCancer/TypesOfCancerImmunotherapy.aspx

http://www.fightcancerwithimmunotherapy.com/ImmunotherapyAndCancer/TypesOfCancerImmunotherapy.aspx


Seite 11

Number of active products in the pipeline to date = 6234

Source: IMS Institute: Global Oncology Trend Report, 2014


Seite 12

Top 10 pharmaceutical companies based on global oncology revenue in 2014 and 2020 (in million U.S. dollars)

Source:EvaluatePharma - World Preview 2015, Outlook to 2020

Roche

Celgene

Bristol-Myers Squibb

Novartis

Pfizer

Johnson & Johnson

Astra Zeneca

Astellas Pharma

Merck & Co

Eli Lilly

0 5000 10000 15000 20000 25000 30000

28,467

14,197

12,614

11,314

8,388

6,812

6,725

5,332

5,167

4,964

25,828

7,407

3,833

8,729

3,046

4,158

2,997

1,459

2,986

2,875

2014 2020

Revenue in million U.S. dollars


Seite 13

“In the United States, the average price of cancer drugs for about a year of therapy increased from $5000 to $10,000 before 2000 to more than $100,000 by 2012, while the average household income has decreased by about 8% in the past decade. Further, although 85% of cancer basic research is funded through taxpayers’ money, Americans with cancer pay 50% to 100% more for the same patented drug than patients in other countries.”Hagop Kantarjian, MD, and S. Vincent Rajkumar, MD

Source:Mayo Clin Proc. 2015;90(4):500-504


Seite 14

Five charges against drug companies

1:The high prices of cancer drugs don‘t correlate with their benefits.

2:The high prices don‘t result from research and development but serve only the profit interests of the companies.


Seite 15

Five charges against drug companies

3:The companies misuse their market power.

4:The pharmaceutical companies often obstruct research.

5:The high drug prices will burst the healthcare systems.


Seite 16

Pay for benefit-

the AMNOGin Germany

The Cancer Industry and Pharmaceutical Policy in Germany

Documents

Transcript of The Cancer Industry and Pharmaceutical Policy in Germany