Surging Undercurrents: The Changing dynasties of the billion-dollar breast cancer market

Breast cancer, known as the pink killer, is the most common malignant tumor in women and the most dangerous cancer in the world.

According to data released by the World Health Organization (WHO), the number of new cases of breast cancer in the world reached 2.26 million in 2020, surpassing lung cancer for the first time.

Behind that cold number, there is a huge clinical unmet need, as well as a huge business world. Frost Sullivan predicts the global breast cancer drug market will reach $36.9 billion in 2022.

In this regard, many pharmaceutical companies eye covetously. In this supermarket, there is no fixed number of "medicine Kings". Roche, once the dominant firm, is now under siege from both the patent cliff and the innovation challengers.

As a challenger, Astrazeneca is poised to become the heir apparent with the slogan "redefine breast cancer treatment."

With billions of dollars in the market for breast cancer treatments flowing, a dynastic change seems to be under way.

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Roche says goodbye to breast cancer throne

Roche was once the king of breast cancer.

Targeted drugs for the treatment of breast cancer are mainly divided into antibody drugs and small molecule compounds. The former includes trastuzumab and Pertuzumab, while the latter includes lapatinib, olabaril and parbucylib.

Among them, the dominant position is antibody drugs, Roche is the dominant player in this field. Specifically, Roche's HER2 mab, Trastuzumab and Pertuzumab, as well as its HER2ADC, T-DM1, cover all aspects of HER2, the most important target in breast cancer.

At its peak in 2019, the combined sales volume of the three drugs reached 10.9 billion Swiss francs, accounting for more than 20% of the total revenue of Roche's pharmaceutical business, making it a worthy pillar of Roche.

With the help of three drugs, Roche has been the global drug king for years. However, flowers are not a hundred days red, people are not a thousand days good. After 2019, the situation changed.

On the one hand, trastuzumab and patozumab face the patent cliff. In the face of challenges from biosimilars, revenues for two drugs have plummeted: Trastuzumab and Rituximab sales fell 37% and 28%, respectively, in 2021.

On the other hand, with the advent of the DS-8201, T-DM1 was challenged. After beating TDM-1 head-to-head, DS-8201 was on a tear in HER-2 breast cancer, while T-DM1 was losing ground.

Although Roche has other businesses in breast cancer, its success seems to be fading as its core product position is being challenged.

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Astrazeneca is trying to take the throne

When the old king Luoshi abdicated, a new king took his place. As things stand, Astrazeneca is eyeing the throne.

Astrazeneca and Roche have something in common: they are targeting HER2, the natural enemy of breast cancer. The DS8201, which was developed by Daiichi Sankyo, is owned by Astrazeneca outside Japan.

After defeating T-DM1, DS-8201 went even further, winning more and more indications, especially targeting the Holy grail of breast cancer, low-expression breast cancer HER2. This is a territory T-DM1 has never conquered before.

In addition, DS-8201 is poised to become a first-line treatment for HER2-positive breast cancer, attempting to cover the full spectrum of breast cancer treatment.

With its strong record in HER-2 breast cancer, Astrazeneca is poised to take over. But Astrazeneca has more than its ace, the DS-8201.

In addition to HER2, Astrazeneca also has TROP2, HER3 and other potential targets in breast cancer.

In addition to large molecules, Astrazeneca's small-molecule drugs for breast cancer are also carefully designed to cover a wider range of targets.

Astrazeneca's oral SERDs, for example, target HER2-/HR+ breast cancer. HER2-/HR+ breast cancer is the most important group, accounting for about 70% of all breast cancer patients.

Serds are not the first choice in this field, but they are important and have a large market size. Jefferies analysts estimate the oral SERD market to be worth between $7 billion and $8 billion.

In HR+, Astrazeneca also has AKT inhibitors. Currently, no AKT inhibitor has been approved for sale in the world, and Astrazeneca is likely to be the first.

On October 26, a Phase III trial of Astrazeneca's Akt inhibitor capivasertib in combination with fluvestran in patients with breast cancer reached its primary endpoint.

In fact, the pipeline is only part of Astrazeneca's footprint in breast cancer. Astrazeneca has more than 40 new drugs in the pipeline in this area, according to the Insight database.

Clearly, Astrazeneca is playing the allin card. No wonder, then, that at this year's SABCS, Astrazeneca made an ambitious statement:

Redefining breast cancer care.

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There is no certain number of Kings of medicine

Fortunes turn with the same force, to the hero is not free.

After two decades of betting, Roche dominates breast cancer. But all of a sudden, Roche's breast cancer empire was in serious danger. Beyond the sigh, there is more revelation.

Roche's fall from the top of the breast cancer business is ostensibly due to the patent cliff, but the deeper reason is the "unpredictable situation" as new technologies continue to evolve. The challenger DS-8201 came out of nowhere and caught Roche by surprise.

This is the cruelty of innovative drug discovery. While innovation is not easy, in the process of continuous iteration, all victories are short periods of truce.

The winner of the moment is always on guard against the catch up. But the powerful may remain powerless in the face of the seismic changes that new technologies and new targets can bring.

Even if it is as strong as the DS-8201, it still has the potential to be surpassed by new technologies in the future. Neither Roche yesterday nor Astrazeneca today may be king of breast cancer forever.

That is why there is greater uncertainty in medicine. It's not just breast cancer. The same is true in other fields. "Medicine King" of the competition, always undercurrent surging, waves constantly.

Innovative drug research and development, there is no absolute center, the core depends on the efficacy of the product. And there are different principles and routes of technology that determine the efficacy, and these giants don't have a monopoly. Just as nucleic acid drugs are hot, gene therapies are emerging.

But that's the beauty of innovation. After all, the growth bottleneck for the big boys is the opportunity for newcomers to emerge.