The big news today was the Thursday release of two papers, one from Science and one from the NEJM, from two teams who have done something that we in the drug industry have long been working on and expecting, with equal parts anticipation and fear.
AstraZeneca's drug Iressa, like many other chemotherapies, varies widely in its effectiveness. Some lung cancer patients have experienced dramatic, life-saving remissions, while others have shown no improvement at all. Everyone's suspected that there is some genetic difference responsible for this, and now it's been found. The responders tend to have a set of mutations in their version of Iressa's target protein, EGFR, as compared to the nonresponders. So here it is - the pharmacogenomic era has started for real.
I've written about this issue before. As I've said, this is going to mean, eventually, that we're going to need a lot more cancer drugs as the various forms of the disease are categorized. Of course, the best way to categorize them is for us in the drug industry to keep on delivering therapies that don't work as well as we'd hoped, which is a little nerve-wracking. There's no way we could have predicted these EGFR mutations from first principles, for example. But we're going to end up with a lot more discrete targets to work on.
And as we find drugs for them, the clinical effects are going to be dramatic. If we can keep it up, people are going to gradually, over the next decades, stop dying from cancer. It'll be one tumor line at a time, but I think it'll happen. In an aging population, that's going to be the next thing to a miracle.
But finding all these drug subtypes is going to be tough, and expensive - and the kicker is that we're no longer going to have as large a patient population to sell them to. The not-so-well-kept secret of cancer therapy is that everyone has, for a long time now, ended up prescribing every drug for almost everything. Because you never know, it might work, and what do you have to lose after a certain point? But that whole market regime is going to collapse eventually, and the first tremor just shook today.
This is going to be "creative destruction" in its purest form, because something's going to have to change drastically. We drug companies are going to have to deliver drugs that (at least as far as we can see now) are going to cost just as much to find and develop as the ones we have today - and maybe more. But we're only going to be able to sell them to a fraction of the market that we can now, and this in a world where people are already having rug-biting fits about the prices we charge.
There's celebrating going on in the drug industry tonight - we finally know why a compound really works in some people! We know exactly who to sell the drug to! But there a lot of nervousness, too, because now we also know exactly who we can't sell it to, either.