In Cancer Diagnostics, The Profit Is In Test Services
Article Date: 12 Mar 2010 - 8:00 PST
The majority of new cancer tests coming to market are proprietary assays with the test services being provided by certified labs opened by the IVD companies that developed the tests. All the major reference labs in North America and Europe are also offering a slew of in-house developed diagnostic tests. This shift is leading to greater profits for those companies offering test services, notes healthcare market research publisher Kalorama Information in its new report "The Worldwide Market for Cancer Diagnostics, 4th Edition."
Test services are not a new business model. Myriad Genetics was the first company, in the mid 1990s, to offer its patented and proprietary cancer assays as a service in its own laboratory. The first generation of these tests targeted small markets where the financial investment for FDA market clearance would be difficult to recuperate with a commercial test kit.
However, in the past few years many IVD companies have begun to establish cGMP and CLIA-certified labs by which they offer their proprietary tests to physicians, hospitals and reference labs. Nowhere is this trend more evident than in the commercialization of cancer diagnostics.
In 2007 there were at least 40 company and lab developed cancer tests either already available or very near market. In 2008 and 2009 another 70 or so have been or are in development. The market for these tests is getting very competitive. Reference labs such as LabCorp, Quest Diagnostics, Specialty Labs and ARUP, as well as numerous private pathology labs, now offer sophisticated genetic and proteomic tests that they have developed alone and in collaboration with IVD companies.
Growth rates demonstrate the results of this strategy, according to Kalorama. Average annual revenue growth from 2005 to 2009 for the major cancer test service companies, including Clarient, Genomic Health, Genoptix, and Myriad Genetics, was 60%; while average annual revenue growth was 14% for the major cancer diagnostics companies during the same period.
"Success in this new test commercialization model may appear like serendipity and a function of being in the right place at the right time," notes Shara Rosen, Kalorama Information's diagnostic analyst. "While there is an element of this in success, it is more a question of successful product development; success is built on a test that fulfills a perceived unmet need, fulfills good test practices of sensitivity and specificity (good science) and has an element of proprietary technology (cannot be performed easily in a routine laboratory)."
Molecular biology is expected to lead to an exponential growth in the number of cancer tests available. Some 25,000 to 30,000 molecular and protein biomarkers may someday become part of the medical toolbox. The mix and match of molecular and protein markers opens the door to a whole new generation of tests. It is as part of this new generation of tests that company developed and in-lab developed cancer tests are aiming to make their mark.
Kalorama's newly updated report, "The Worldwide Market for Cancer Diagnostics, 4th Edition," contains detailed market data and forecasts of every significant area of cancer diagnostics, a discussion of industry trends, and extensive profiles of companies in the market. It is available here.
Source
Kalorama Information
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Cancer Diagnostics
posted by Gregory D. Pawelski on 25 Mar 2010 at 6:42 pmThe headlong rush to develop companion diagnostics to identify molecular predisposing mechanisms does not guarantee that a cancer drug will be effective for an "individual" patient. Nor can they, for any patient or even large group of patients, discriminate the potential for clinical activity among different cancer agents of the same class.
The drug discovery model over the last number of years has been limited to one gene/protein, one target, one drug. The "cell" is a system, an integrated, interacting network of genes, proteins and other cellular constituents that produce functions. You need to analyse the systems' response to drug treatments, not just one target or pathway.
The decoding of the human genome in 2000, sparked hopes that a new era of tailored medicine was just around the corner. However, uncovering the genetic differences that determine how a person responds to a drug, and developing tests, or biomarkers, for those differences, is proving more challenging than ever. As a result, patients with cancer are still being prescribed medicines on a trial-and-error basis or one-size-fits-all.
The key to understanding the genome is understanding how cells work. The ultimate driver is "functional" profiling (is the cell being killed regardless of the mechanism) as opposed to "target" profiling (does the cell express a particular target that the drug is supposed to be attacking). While "target" profiling tells you whether or not to give "one" drug, "functional" profiling can find other compounds and combinations and can recommend them from the one test.
The core of "functional" profiling is the cell, composed of hundreds of complex molecules that regulate the pathways necessary for vital cellular functions. If a "targeted" drug could perturb any one of these pathways, it is important to examine the effects of the drug within the context of the cell. Both genomics and proteomics can identify potential new thereapeutic targets, but these targets require the determination of cellular endpoints.
Cell-based "functional" profiling is being used for screening compounds for efficacy and biosafety. The ability to track the behavior of cancer cells permits data gathering on functional behavior not available in any other kind of testing.
The cell-based "function" methodology, which has existed for the last twenty years and is not hampered by the problems associated with gene/protein expression tests. That is because they measure the net effect of all processes within the cancer, acting with and against each other in real-time, and it tests "living" cells actually exposed to drugs and drug combinations of interest.
It would be more advantageous to sort out what's the best "profile" in terms of which patients benefit from this drug or that drug. Can they be combined? What's the proper way to work with all the new drugs? If a drug works extremely well for a certain percentage of cancer patients, identify which ones and 'personalize' their treatment. If one drug or another is working for some patients then obviously there are others who would also benefit.
Patients would certainly have a better chance of success had their cancer been "chemo-sensitive" rather than "chemo-resistant," where it is more apparent that chemotherapy improves the survival of patients, and where identifying the most effective chemotherapy would be more likely to improve survival above that achieved with "best guess" empiric chemotherapy through clinical trials.
It may be very important to zero in on different genes and proteins. All the validations of this gene or that protein provides us with a variety of sophisticated techniques to provide new insights into the tumorigenic process, but if the "targeted" drug either won't 'get in' in the first place or if it gets pumped out/extruded or if it gets immediately metabolized inside the cell, it just isn't going to work.
To overcome the problems of heterogeneity in cancer and prevent rapid cellular adaptation, oncologists are able to tailor chemotherapy in individual patients. This can be done by testing "live" tumor cells to see if they are susceptible to particular drugs, before giving them to the patient. DNA microarray work will prove to be highly complementary to the parellel breakthrough efforts in targeted therapy through cell "function" analysis.
As we enter the era of personalized medicine, it is time to take a fresh look at how we evaluate new medicines and treatments for cancer. More emphasis should be put on matching treatment to the patient, through the use of individualized cell-based profiling.
Upgrading clinical therapy by using drug sensitivity assays measuring cell-death (apoptosis) of three dimensional microclusters of "live" fresh tumor cell, can improve the situation by allowing more drugs to be considered. The more drug types there are in the selective arsenal, the more likely the system is to prove beneficial.
Literature Citation:
BMJ 2007;334(suppl 1):s18 (6 January), doi:10.1136/bmj.39034.719942.94
Functional profiling with cell culture-based assays for kinase and anti-angiogenic agents Eur J Clin Invest 37 (suppl. 1):60, 2007
Functional Profiling of Human Tumors in Primary Culture: A Platform for Drug Discovery and Therapy Selection (AACR: Apr 2008-AB-1546)
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