In the fight against cancer

In the shadow of Corona, the large pharmaceutical companies have further expanded their oncology research through internal programs, biotech alliances and acquisitions. BMS is a pioneer in many ways. All in all, the group is now examining around 55 potential cancer therapies in clinical studies, many of them in Germany.

The need is huge. According to a recently published study by Washington University, the number of new cases worldwide rose from 2010 to 2019 by a good quarter to almost 24 million, and the number of deaths by around 20 percent to ten million. The market research company Iqvia predicts that sales in the oncology market will increase to a good 300 billion dollars by 2026.

Experts fear the catch-up effect in cancer

This corresponds to annual growth of nine to twelve percent. In the past decade, oncology sales in the industry increased significantly in double digits before the corona pandemic slowed growth from 2020.

In many countries, treatments have been postponed and preventive medical check-ups have been avoided by patients. According to Bristol-Myers Squibb, the number of diagnoses is currently still below the pre-crisis level.

Many experts therefore fear a catch-up effect with a wave of new, relatively advanced diseases. “This is likely to increase the need for drugs for the treatment of more advanced cancers and also place greater demands on resources in the health care system as a whole,” warns BMS boss Caforio.

Clinical research programs, especially in the biotech sector, were in some cases delayed by the pandemic, which, however, hardly affected the ambitions of large pharmaceutical companies such as BMS.

With its active ingredients Yervoy and Opdivo, the US company was already doing pioneering work in the early 2010s in the development of a new class of anti-cancer drugs, the so-called checkpoint inhibitors. At the end of 2019, BMS acquired US competitor Celgene, a blood cancer drug specialist, for almost $ 90 billion, making it the top-selling cancer drug provider. Oncology products accounted for around two-thirds of consolidated sales of approximately $ 46 billion last year.

After the Celgene takeover, the group broadened its clinical research program through additional therapeutic approaches and biotech collaborations. Most recently, he sealed a second alliance with the Tübingen-based biotech company Immatics, which had previously formed an alliance with Celgene for the development of cell therapies. In Germany, BMS sees itself as the second largest player in clinical research.

The BMS boss sees further progress primarily in the interaction of new, innovative approaches. “The last decade has been the decade of immuno-oncology. If you look into the future now, a multitude of new technologies are gaining in importance.

From immune to cell therapy as a new beacon of hope

Caforio counts cell therapies as one of the particularly promising concepts. Patients’ immune cells are genetically modified and thus activated against cancer cells in a targeted manner, which has so far shown unusually high response rates of up to 90 percent in some blood cancers in particular. “I believe cell therapies are the next step in treating advanced cancer,” said Caforio.

BMS itself has been represented in this area since 2021 with two approved products, the cell therapies Abecma and Breyanzi. Both are used against multiple myeloma, a tumor disease of the plasma cells, and B-cell lymphoma, a malignant disease of the lymphatic system – i.e. those vessels, organs and cells that are responsible for the specific defense against pathogens.

Four other cell therapy projects are in clinical development. For Breyanzi in particular, the group is aiming for a broader range of applications in the field of hematological cancers such as lymphoma and leukemia.

Another area in which some of the hopes of BMS cancer researchers rest is the relatively young research field of so-called protein degradation, in which companies such as Pfizer, Novartis and Bayer have recently become involved.

This involves novel active ingredients that can be used to control the breakdown of harmful proteins in the cells. BMS sees itself in a leading position here and tests several substances in both early and advanced phases of clinical development.

The latest alliance with Immatics is primarily aimed at the development of so-called bispecific antibodies, a class of active ingredients that can couple immune cells with cancer cells and thus trigger an immune reaction against tumors.

This concept is also currently gaining in importance in cancer research as an additional and complementary instrument in the field of immunotherapies. BMS boss Caforio speaks of an “exciting” technology with a very interesting mechanism of action with regard to the Tübingen company. “It is a very good addition to cell therapies and is exactly the type of drug that we can develop clinically very well,” he says.

Expiring patent protection as a challenge for BMS

Regardless of its broad development of new drugs, the US group is also facing operational challenges with its oncology business. The high-selling blood cancer drug Revlimid, which was acquired as part of the Celgene acquisition, and three other active ingredients from the current cancer drug range will lose their patent protection by the middle of the decade. More than a third of the current oncology business will therefore come under competitive pressure from generic companies in the foreseeable future – a perspective that has been holding back the group’s assessment for a long time.

Caforio also does not rule out a short-term dent in the oncology business due to the patent situation. Nevertheless, thanks to its diversification, he sees the company on a long-term growth path. “Even after Revlimid’s patent expires in 2025, we will have the ability to continue growing until the end of the decade,” says the BMS boss. In addition to the new developments in oncology, new drugs against cardiovascular diseases and autoimmune diseases are also to be developed.

Here, too, Bristol-Myers Squibb has recently stepped up its research through acquisitions and in-house developments. With its anticoagulant Eliquis, BMS is the main competitor for the Bayer pharmaceuticals division and its bestseller Xarelto. The US company also sees itself in a leading role in the development of a new type of anticoagulant, the so-called Factor XI inhibitor, as a successor product for these high-volume blood thinners.

A high free cash flow of around 15 billion dollars annually also offers scope for further acquisitions, both in the cancer area and in other fields. In the past year, Bristol-Myers Squibb had strengthened itself, among other things, through the takeover of the US company Myokardia, which was worth $ 13 billion and is working on new drugs for special, genetic heart diseases.

There were also a number of smaller, science-oriented transactions. Caforio wants to continue this strategy: “We will do a lot more such deals.” Between a third and a half of the drug candidates will possibly come from outside in the future

“In addition, we are principally interested in acquiring companies with advanced product developments, especially in areas where we already have extensive experience and expertise.”

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