Soon-Shiong Envisions Better, Ultimately Cheaper Cancer Care
This article was originally published in Scrip
Describing biotech billionaire Patrick Soon-Shiong as a big thinker is an understatement given the goals that he and his web of businesses have for improving the way cancer patients are treated, and now he's enlisting the help of other biopharma companies to test immunotherapy hypotheses.
In fact, to find the best treatments for all the myriad types of cancer, it's essential that as many researchers and drug developers as possible get involved in the Cancer MoonShot 2020 initiative led by Soon-Shiong and other companies, to bring their therapeutic vaccines, immuno-oncology drugs and targeted therapies to the table. That's why Soon-Shiong has been on a roadshow recently to talk to oncologists, scientists and biopharma executives, including a stop on Feb. 25 at Biocom's Global Life Science Partnering Conference in San Diego.
When Scrip asked how many companies will be able to participate in Cancer MoonShot 2020, he said: "As many as want to get involved. We've had multiple inquiries from multiple multinationals and biotech companies that want to participate."
Cancer MoonShot 2020 is an effort that's separate from the cancer moon shot program that President Barrack Obama and Vice President Joe Biden also unveiled in January, despite Soon-Shiong's initial suggestion that cancer centers backed by the National Cancer Institute (NCI) were supporting the private moon shot effort.
The private sector initiative is backed by the newly formed National Immunotherapy Coalition (NIC) made up of two of Soon-Shiong's companies, NantWorks and NantKwest; well-known cancer drug developers Celgene Corp. and Amgen Inc.; and several other biotech firms, including Etubics, Altor Bioscience and Precision Biologics. Academic cancer centers, community oncology clinics, and health insurers also are involved in the NIC.
What's The Difference?
Soon-Shiong explained the difference between the two moon shot initiatives in an interview with Scrip during the partnering conference hosted by Biocom, a San Diego-based biotech industry association.
He said the Obama Administration moon shot initiative spearheaded by Biden and Cancer MoonShot 2020 have the same goal: to use genomics to identify the right combination of cancer treatments, including immunotherapies, to treat individual patients based on their very specific tumor mutations, which change over time.
Where the two ambitious programs are different is that Biden's initiative will focus on removing barriers that keep government agencies, researchers, private industry, doctors, patients and nonprofit groups from working together efficiently on clinical trials. Meanwhile, Cancer MoonShot 2020 already has trials under way and will initiate several more with the goal of running multiple studies to quickly and efficiently answer questions about immunotherapy combinations.
"What [Biden is] doing is harnessing the government in terms of freeing up bureaucracy," Soon-Shiong said. "We're focused on the trials and making them work. What he can do is something that I can't do; what I can do, he can't."
Cancer MoonShot 2020's goal is to conduct dozens of Phase I and II clinical trials in as many as 20 tumor types and at all stages of cancer by 2020 under a blanket program known as QUantitative Integrative Lifelong Trial (QUILT). The QUILT studies will test various therapeutic combinations that target different elements of the immune system, including cell therapies, checkpoint inhibitors, vaccines, chemotherapy, low-dose radiation and immunomodulators.
"There are some trials currently active, which we are amending as we speak to add [new immunotherapy] combinations," Soon-Shiong said, noting that many more clinical trial protocols will be submitted to the US FDA soon to get additional studies up and running.
Enrolling Patients, Bringing Payers on Board
With 1.2 million people diagnosed with cancer every year, he doesn't think it will be difficult to enroll 20,000 patients in the QUILT studies, since the Cancer MoonShot 2020 initiative has enlisted the help of smaller community oncology centers, where most patients are treated, in addition to large academic centers.
"Less than 4% of patients go into clinical trials, because they are in major academic centers," which are too far from home for many people, Soon-Shiong said. "These treatments are associated with low toxicity, so it can be done in the community. We can monitor vital signs remotely."
However, he said the "big breakthrough" for the Cancer MoonShot 2020 initiative is that private health insurers are beginning to pledge their support by agreeing to cover next-generation whole genome sequencing for cancer patients who participate in the QUILT clinical trials.
Independence Blue Shield, a health insurance company with 9 million customers on the East Coast, will pay for patients to undergo genomic proteomic sequencing (GPS) developed by Soon-Shiong's NantWorks. A handful of self-insured employers, including Bank of America, also have agreed to cover the tests, which scan patients' tumor DNA for genetic mutations and analyzes their RNA and proteome to determine the best treatment combinations for each individual.
Soon-Shiong said payers are supporting the GPS Cancer tests, because they saves lives and save money by identifying the right therapeutics for each patient. That means health plans won't pay for drugs and multiple rounds of therapies that won't actually help the patient, assuming that the QUILT studies provide the kind of results that the Cancer MoonShot 2020 participants are hoping for.
Soon-Shiong's Big Stake
Between the GPS Cancer tests that will be used in the QUILT studies and NantKwest's activated Natural Killer (aNK) cells, which also will be used in some of the trials, Soon-Shiong has a lot at stake. The founder and majority owner of Abraxane (nab-paclitaxel, albumin-bound) developer Abraxis Bioscience, which was sold to Celgene for $2.9bn in 2010, has invested a lot of his own money in NantWorks, NantKwest and their affiliated companies.
NantKwest had the largest biotech initial public offering of 2015, based on the company's market value, to fund Phase I/II clinical trials for the company's off-the-shelf cell therapies. NantKwest's stock price has fallen since the IPO, wiping out some of that value, due to a general decline in biotech stocks and probably some doubt about what the company's aNK cells can do – similar to doubt that's plagued other immuno-oncology firms.
"I don't think anyone is smart enough to make assumptions about what is immunotherapy and what’s not, but I think we know it's not just checkpoint inhibitors," Soon-Shiong said.
He said during his presentation at Biocom's partnering conference that cancer treatment is now "hand-to-hand combat" and the tumor microenvironment is the battleground where combinations of immunotherapies and other treatments will be needed to win the war.