Cocktails Are Next For Cancer-Drug Makers

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Compared with targeted therapies, though, chemo can be a blunt instrument that wipes out a wide swath of cells, including healthy ones.

Cancer begins when a gene mutation triggers some cells to divide faster than normal. Aberrant cells multiply to form tumors with billions of units competing for blood nutrients. The competition and rapid reproduction yield additional mutations that help the cancer grow and eventually take root in new organs. Through similar adaptations, cancer develops resistance to medicines.

The first studies of targeted cocktails better able to prevent cancer from escaping will be released in 2012, says Harish Dave, global head of hematology and oncology at clinical trial firm Quintiles, which had a role in 48 of the 50 best-selling cancer drugs. "We may see something very interesting come out," he says. However, the risk of the therapy "is that you could be shutting down so many activities in the cell that it could be toxic."

Cancer drugs aren't cheap. Dendreon's (DNDN) Provenge treatment for prostate cancer, for instance, sells for $93,000 for the one-month, three-dose cycle. Total sales of cancer drugs have risen 10 percent to 20 percent a year for a decade, according to research firm IMS Health. And combinations of cutting-edge targeted drugs will likely drive costs for patients and insurers even higher, since each component is so expensive.

"Five years ago, you couldn't get companies to agree to combine their agents," says John J. Wright, a senior investigator at the National Cancer Institute's drug evaluation program. That led the NCI to broker a legal framework—assuring each company maintains rights to its components during cocktail trials—that's leading companies to collaborate.

The first combinations available to patients will be mash-ups of existing treatments, such as Roche's Avastin and Bayer's Nexavar. Yet Roche's Mellman says combinations of pre-approved treatments are "old school," and that the real potential for drugmakers will be in the next generation of targeted cocktails, "driven by scientific discovery that starts in the laboratory."

The bottom line: Taking a cue from the cocktails of drugs that have made AIDS survivable, drugmakers are pursuing combination therapies against cancer.

Randall is a reporter for Bloomberg News in New York.

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