What's Hot and What's Not in Oncology

Biotechs have long dominated the stage at the American Society of Clinical Oncology (ASCO), unveiling their latest innovations like magicians pulling rabbits out of hats. But last week's annual ASCO bash in Chicago showed that Big Pharma wants in on the $34 billion-a-year market--and already has a few tricks up its sleeve to show for it.

Bayer and Onyx Pharmaceutical's liver-cancer-fighting Nexavar (sorafenib), for instance, looks to be the biggest threat to biotech stalwarts like Genentech. The Nexavar presentation sent Onyx's stock soaring to a two-year high and Bayer's to an all-time high.

Nexavar is already approved for advanced kidney cancer, but promising new data suggest that it could be an option for people with late-stage liver cancer. Patients on Nexavar lived an average of 2.8 months longer, buoying survival time from eight months to 11. About 19,000 Americans a year are diagnosed with liver cancer, and more than half a million worldwide suffer from it, providing an ample global market. ''The results for Nexavar were fantastic,'' said Fleur Pijpers, senior oncology analyst at Datamonitor. ''It's going to be the new standard reference therapy for liver cancer.''

In stark contrast to Nexavar's smashing success, biotech Telik's Phase-III ovarian cancer drug Telcyta (Canfosfamide) crashed and burned, with FDA calling for the company to shutter the trial ASAP. ''Everyone expected their data to be bad, but this was unbelievably bad,'' said Morningstar biotechnology analyst Karen Andersen. ''This was harmful to everyone involved, and brought up a lot of safety issues.''

Pfizer's Sutent (sunitinib) got major ASCO play this year, with the pharma dynamo's signature cancer drug--approved for advanced forms of kidney and gastrointestinal cancers--appearing in 33 abstracts, up from 17 last year.

Pfizer also made headlines with its signal inhibitor axitinib, raising hopes in a slew of tests for advanced pancreatic cancer patients, thyroid cancer, metastatic breast cancer, and advanced renal cell carcinoma. Andersen noted that after anti-angiogenics, the class of inhibitors is the fastest-growing group of oncology drugs. Pfizer also announced that 20 percent of its '07 budget will be dedicated to cancer drug development, up from 12 percent last year. That adds up to a total of $1.9 billion, and Andersen predicted that that percentage will only grow in the coming years.

Sanofi-Aventis jumped on the blood-vessel bandwagon with its anti-angiogenic aflibercept, currently in late-stage breast cancer and lung cancer studies.

With the cancer market set to top $55 billion in 2009, Pijper noted that there's no ceiling for companies to hit--at least not until a safe, side-effect-free cure makes its ASCO debut. But she warned that the rush to oncology is likely to result in some overcrowded niches. ''If you have 12 drugs for liver cancer, one of them is going to be the best, and there'll be no use for the others,'' she said.

But Andersen noted that there is hope for finding new uses for "old" treatments. ''Even drugs that have already been approved can be used in combination studies,'' she said. ''Many of the data at ASCO were from combination studies with drugs like Avastin''--Genetech's all-points blockbuster.

These combo studies will play a major role in the next few years. ''Anytime you have a drug that's that effective, you're going to have a lot of piggy-backing,'' Andersen said.