This article is part of the Global Policy Lab: Decoding Cancer.
Researchers want to save the pharmaceutical industry time and money on clinical trials. But that means teaching companies to work together and convincing them to pool patient data, benefiting not just themselves but also their competitors.
Its not an easy sell.
“In the vast majority of cases, the company wants to be in control,” said Denis Lacombe, chief of the European Organisation for Research and Treatment of Cancer.
Lacombe is basically in a race against Big Pharma to build a public biological database before companies create their own private ones.
The stakes, for patients, are high.
Innovations in so-called precision medicine, in which treatments are tailored to individuals, has made patient data critically important. The more it is walled off in corporate troves, some cancer experts like Lacombe warn, the more the potential of using big data is undermined and the harder it becomes for patients to find relevant experimental treatments.
EORTCs SPECTA platform is a collection of genomic and other biological and clinical data. When a new treatment is available to be tested, the data can be searched to identify patients who could participate.
Thats something that will be increasingly important as personalized medicine drives pharmaceutical companies “to search for specific patients with specific [genetic] alterations,” Lacombe said.
That should be an opportunity for the pharma industry, said Lacombe. But it hasnt worked out that way.
There are signs the industry is slowly coming around | Daniel Mihailescu/AFP via Getty Images
The industrys been slow to engage with SPECTA. Lacombe is concerned that instead, companies are starting to collect peoples genomic data on their own, without having a particular treatment or trial in mind.
“There is a risk that the commercial sector will develop a … parallel route to access DNA,” he said. Its “suboptimal, if not unethical, that companies collect biological data and put it in a commercial silo.”
The EORTC isnt the only one trying to collect patient data.
A parallel effort with a more utopian vision is based in the neutral Alpine haven of Switzerland. MIDATA cites the philosopher John Rawls and his idea of “Property-Owning Democracy” in its promotional material. Its founder, Ernst Hafen, predicts that it could make even more money than Google or Facebook — though it would all be reinvested for the good of society.
People who contribute personal information to MIDATA — whether its their genome or smartphone steps log — would remain the owners of their personal info and get to sign off on how its used. Theyd also become shareholders in MIDATA, able to vote on how it conducts business and spends its profits — earned in part by pharma companies who pay to recruit study participants.
MIDATA is starting slowly, with some academic partnerships and some companies interested in how patients are faring with their migraine and multiple sclerosis drugs. But Hafen insists that MIDATA is the future, “a citizen-empowered way of changing the way science is done.”
Companies are deeply resistant to the idea of having their new idea compared (possibly unfavorably) to someone elses.
If patient data is to be collected in public data bases, citizens might have to do the powering. But there are signs the industry is slowly coming around.
Signs point to the pharma industry increasingly being open to sharing data and cooperating on trials, but theyre not eager to talk about it publicly yet. Requests for comment from both the European Federation of Pharmaceutical Industries, the sectors Brussels lobby, and individual companies yielded no one willing to discuss these new initiatives.
Collaboration has never been the pharmaceutical industrys strong suit. While industries like aviation and semiconductors have been working together for decades, “the pharmaceutical industry has been lagging,” said Dalvir Gill, CEO of TransCelerate BioPharma, a nonprofit initiative trying to change that.
Over the past seven years, TransCelerate has looked for ways to coordinate clinical trials. They have created a common set of forms for different companies trials. It also created a network for companies to procure comparable drugs from each other directly for use in trials, rather than having to buy the longer-standing treatment from third parties to test against a new drug.
Ten companies signed on to TransCelerate initially, up to 19 now. Its required companies to change their mindset, Gill said.
Vials containing biological samples at the Cancer Research U.K. Institute in Cambridge | Dan Kitwood via Getty Images
Theres a “vast amount of work that happens in the development of drugs that is not competitive,” Gill said. “The R&D people get it,” he added, but in the commercial divisions of a company, “theres a lot more convincing that needs to happen there.”
Regulators also need convincing, Gill noted — when companies cooperate, it raises a different set of eyebrows.
“Our biggest barriers are typically not running afoul of antitrust,” Gill said. “Whenever you have 19 companies in a room doing something,” its going to draw scrutiny.
With lots of new cancer drugs coming out for increasingly narrow subsets of cancer patients, so-called platform trials — in which multiple new drugs are tested at once — are seen as a key way to speed up the process and avoid duplication.
But companies are deeply resistant to the idea of having their new idea compared (possibly unfavorably) to someone elses.
Surgical oncologists treat a breast cancer patient in Marseille, southeastern France | Anne-Christine Poujoulat/AFP via Getty Images
The I-SPY 2 trial for breast cancer, a nonprofit platform trial that has resulted in three drugs winning approval, shows drugs can be tested at the same time without being pitted against each other. Instead theyre tested against the existing standard of care.
Brian Alexander, a Harvard radiation oncologist preparing to launch a platform trial for brain tumors called GBM AGILE, said that the precedent has made it easier for him to convince companies to let him test their drugs.
“They werent as worried anymore because once you see two New England Journal [of Medicine] papers in the same edition, both coming from arms from I-SPY 2, and theyre not compar[ed to] each other… then [drugmakers] were like, Oh, ok, that isnt that much of an issue,” Alexander said.
Hes expecting to announce the first drug to be tested in the new GBM AGILE trial next week, but he said that overcoming companies fear of sacrificing control remains a major challenge.
“To feel like theyre turning over the late stage development of an asset to this other entity — thats a bit of a tough sell,” Alexander said.