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President Trump, the Cancer Moonshot and the new war on drug pricing

What could the new US administration mean for drug discovery and development – in the US and the UK? Dr Angela Kukula, the ICR's Director of Enterprise, reports back from the world’s biggest life sciences conference, BioWeek SF.

San Francisco skyline 16x9

San Francisco, California. Photo by Don McCullough. Licensed under a Creative Commons Attribution-NonCommercial 2.0 Generic license (CC BY-NC 2.0).

A few weeks ago I was in San Francisco for what has become known as BioWeek SF. This is a gathering of many of the leading players in life sciences from around the world, centred on the JP Morgan Healthcare investors’ conference and the Biotech Showcase that both take place in San Francisco that week.

And what an interesting week it was to be in the US – in the last days of the Obama presidency, just ahead of the inauguration of President Trump.

There was certainly much speculation on what a Trump presidency would mean for the life science industry, drug development and cancer research.

Obamacare and the 21st Century Cures Act

While there was much focus on the pledge by the incoming president to reform the Affordable Care Act – also known as Obamacare – there was also some discussion about whether the 21st Century Cures Act (21CC) would be revisited.

21CC, passed by the US Congress in December last year, set out a number of measures aiming to speed the discovery, development and delivery of new treatments and cures. Amongst other things, 21CC provided $500m of new funding to the Food and Drug Administration (FDA) to allow it to support initiatives such as more collaborative development, qualification, use of biomarkers and incentivizing the development of drugs for paediatric diseases. It also promised $1.8bn of investment into Vice President Joe Biden’s Cancer Moonshot programme.

At The Institute of Cancer Research, we certainly hope that these initiatives within the FDA will continue under the new Trump regime. Producing smarter, kinder treatments and ensuring that they reach the right patient populations through use of biomarkers is one of the pillars of the ICR’s new research strategy. The more we learn about biology, the less attractive it is to give everyone the same thing. And we have long campaigned for better treatments for paediatric cancers.

It seems that no news is good news, in this respect. At the time of writing, the Trump administration has not made any mention of cutting them – so it seems likely they will continue, although they may begin to suffer from benign neglect if the focus of the FDA moves.

The Trump regime and drug pricing

And unfortunately it looks like that focus will move – towards how medicines are priced.

President Trump has already tweeted his views on drug company pricing strategies, and so it should perhaps not have come as a surprise that in his first press conference for several months – which also came in the middle of BioWeek – he accused drug companies of “getting away with murder”, a reference perhaps to the much reported, repeated list price increases on certain life-saving drugs.

There is certainly a need to review a system where how much something costs can depend as much on who is paying as what the product is. And this is as true in the UK as in the US, where the costs of providing cancer drugs to those that need them is likely to continue to challenge a cash-strapped NHS. But these kind of statements also affect those with more ethical pricing policies, and the comments sent share prices of 18 of the top 19 US listed pharmaceutical companies tumbling.

Cancer Moonshot – and how the ICR is ahead of the field

And what of the Cancer Moonshot Programme? This was the subject of an address by Joe Biden to the JP Morgan conference, during which the now former Vice President pledged to continue the work, if not under a White House programme, then under a new banner which he termed the Biden Cancer Initiative. President Trump has made no mention of the programme, so the assumption is that it is unlikely to continue to have an office in the White House

One of the things the Vice President Biden declared as an aim of the programme was to speed the initiation of trials for combinations of drugs. He said that it can take years to get permissions from the companies developing drugs to allow them to be used in combination with those from another company.

At the ICR, we are ahead of the field on discovering drug combinations. Along with our partner the Royal Marsden NHS Foundation Trust, we run a great many trials where drugs are used in combinations – and whilst it can sometimes be tricky to get all of the companies involved to agree on all of the details of a trial, it certainly does not take us years to get to these agreements.

Vice President Biden also mentioned that cancer research was typically an individual endeavour, and that an aim of his programme was to breakdown silos and get people working together. Again this is something of a strength for the ICR.

'Show up, dive in, and keep at it'

We are proud of our collegiate environment and our emphasis on team working – indeed we have even won awards for it. And we are committed to continue working in this way, bringing oncologists, biologists, chemists, engineers and data scientists together to understand and predict how cancers work and bring a sense of urgency to finding new treatments.

In any case change tends to happen slowly in government – it is built for stability not agility.  So for drug development and cancer research, there may not be any immediate change under the Trump administration. Bringing medicines to the market faster and more importantly, cheaper, is going to continue to be a focus. The challenge is going to be in maintaining momentum and ensuring that we don’t get distracted by the next shiny object. To borrow from President Obama’s farewell address, we are just going to have to continue to ‘show up, dive in and keep at it’.

Can we maintain our focus? Are we making a real difference to the lives of cancer patients? Can we really make the discoveries that defeat cancer? Yes we can. Yes we did. And yes we can.

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