Marking IBT’s 30-year anniversary with a look at the transformation of cancer therapy
International Biotechnology Trust (IBT) recently celebrated its 30-year anniversary, having launched as a pioneering investment trust dedicated to the nascent opportunity in biotech back in 1994. In this article, we explore the key developments in cancer treatment during this time and the outlook for future breakthroughs, which are collectively profoundly changing the prospects for many patients.
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International Biotechnology Trust (IBT) recently celebrated its 30-year anniversary, having launched as a pioneering investment trust dedicated to what was then a nascent opportunity in the biotech industry, back in 1994. One key therapeutic area which has consistently been a focus of interest for the trust is oncology. In this article, we explore the key developments in the treatment of cancer over the last 30 years, which have profoundly changed perceptions of – and, ultimately, the survival rates of patients with – what was once seen as an insurmountable disease.
The foundations of modern cancer therapy
When IBT launched back in 1994, cancer therapy relied heavily on well-established methods of treatment such as surgery, chemotherapy and radiation therapy. While these treatments were effective to an extent, they lacked the ability to be targeted with precision, and often caused significant damage to healthy cells in the process.
However, in the late 1990s, we saw pivotal advancements that have ultimately paved the way for the more targeted approaches to cancer treatment that we see today. Drugs such as ICI/AstraZeneca’s Tamoxifen (approved in 1977), targeting oestrogen receptors in breast cancer cells, and Novartis’ Imatinib (approved in 2001), targeting the genetic mutation behind chronic myeloid leukaemia, were early examples that showcased the future promise of targeted therapies in achieving better outcomes for patients, with fewer side effects.
Unlocking the secrets of the human genome
As the understanding of the science of cancer deepened, so too did the ability to develop more targeted and personalised treatment strategies. The decoding of the human genome in 2000 was a key breakthrough in this regard and was followed in the mid-to-late 2000s by the approval of a range of targeted therapies designed to exploit specific genetic mutations or molecular pathways driving cancer growth.
Drugs like Genentech/Roche’s Herceptin (approved in 1998), which targets a protein in certain breast cancer cells, and Plexxikon/Roche’s Zelboraf (approved in 2011), which inhibits a mutated protein in melanoma, exemplified the promise of targeted therapy in improving treatment outcomes. By specifically targeting cancer cells while sparing healthy tissue, these drugs offered much greater precision and limited the damaging side effects that came with more traditional treatments.
Furthermore, the advent of molecular profiling and genetic testing allowed clinicians to identify specific mutations in cancer cells, enabling more personalised treatment approaches. By tailoring treatment regimens based on the unique genetic makeup of a specific patient's cancer, precision medicine has revolutionised cancer care, leading to better outcomes and improved quality of life for patients.
The rise of immunotherapy
The 2010s witnessed a flurry of ground-breaking developments that continue to reshape the landscape of cancer therapy. Among the most notable advancements were the introduction of CAR-T cell therapy and checkpoint inhibitors, which represented significant leaps forward in the field of immunotherapy.
CAR-T cell therapy involves reprogramming a patient's own immune cells to recognise and destroy cancer cells. This approach has shown remarkable success in treating certain types of leukaemia and lymphoma, offering the potential for long-term remission and even cure. For example, IBT is invested in Legend Biotech, a CAR-T cell therapy company that has launched Carvykti in multiple myeloma, following its regulatory approval in 2022. It also has a range of other exciting opportunities in its pipeline, focusing on cancers that have hitherto been considered intractable and incurable. IBT previously had holdings in Kite Therapeutics (acquired by Gilead for $11.9bn in 2017) and Juno Therapeutics, (acquired by Celgene in 2018 for $9bn) both of which were CAR-T cell therapy companies.
Checkpoint inhibitors, meanwhile, work by blocking the cancer cell’s ability to protect itself against the host’s immune system, thereby releasing the brakes on the immune system and allowing it to mount a more effective attack against cancer cells. An example from within the IBT portfolio is the Chinese company Beigene’s Brukinsa, which is a best-in-class Bruton’s tyrosine kinase (BTK) inhibitor which has been approved for use in certain blood cancers. Ongoing clinical trials could expand Brukinsa’s application across a broader range of haematologic conditions and BeiGene's broader pipeline contains other innovative therapies targeting different key cancer pathways. IBT previously owned Pharmacyclics which was acquired by Abbvie in 2015 for $21bn, which was the first successful BTK inhibitor on the market.
Current landscape and future directions
As IBT passes its 30-year anniversary, the speed of progress in cancer therapy shows no sign of slowing down. Indeed, as we regularly report, the pace of innovation in biotechnology more broadly continues to accelerate.
Recent progress in targeted therapies, immunotherapy and early cancer detection technologies continue to hold promise for further improving outcomes and transforming the way we approach cancer treatment.
Cell therapies like CAR-T still rely on harvesting a patient’s own cells and modifying them, which has side effects for the patients meaning that it is only available to the sickest patients for whom other treatments have failed. Sadly the complexity and time it takes to prepare the treatment from their own cells can mean that the patient often fails to survive long enough to benefit. Biotech companies are now working on allogenic cell therapies which use “off the shelf” donated cells, but have yet to find a way of creating a durable response in patients to this type of therapy. This next generation of cell therapies could radically simplify the treatment of advanced cancer, making it more readily available to these very sick patients.
While biotech companies have been reasonably successful in developing targeting therapies for certain cancers such as blood, lung and breast cancer, other solid tumour cancers such as liver and pancreatic are still treated in the same way they have been for decades. Finding a targeted treatment that is effective in solid tumours would represent a huge breakthrough for our sector and many companies are working on potential solutions. In IBT’s portfolio Immatics and Immunocore are both seeking to develop an “off the shelf” cell therapy and Immatics is focussing particularly on the harder to treat solid tumours.
The future, therefore, looks encouraging for cancer patients, and for investors in biotechnology. Patent protection allows the developers of genuinely life-enhancing therapies to be ultimately well-rewarded for the risks involved with developing their technology through to commercialisation.
The expiry of patents means more patients can access generic drugs globally and makes them cheaper for society as a whole. Patent expiries fuel pharmaceutical companies’ hunger to replace lost revenues by investing in new drugs either by buying or licensing in individual projects or acquiring biotech companies. This ecosystem ensures the flow of pharmaceutical revenues into biotech companies which ensures access to funding for the next generation of innovation. Investors in biotech companies also benefit from the premium paid by pharmaceutical companies eager to add exciting new treatments to their pipelines.
Conclusion
Over the last thirty years, significant medical breakthroughs have transformed the landscape of cancer treatment, offering many patients the possibility of managing cancer as a chronic condition rather than a terminal illness. Clearly, the many complexities of cancer in all its forms, mean not all patients have yet seen such an improvement in treatment outcomes, survival rates or quality of life. On balance, however, the progress in oncology has been – and indeed continues to be – overwhelmingly positive.
Looking ahead, the accelerating pace of innovation in oncology, and biotechnology more broadly, holds great promise for patients and investors alike. With continued investment in oncological research and development, we should hope to see even greater breakthroughs in cancer therapy in the years to come. IBT’s long experience in this sector has shown that investing in this area requires a nimble approach to ensure that we invest only in those companies which we believe hold the greatest potential for success. This requires careful monitoring of all companies in this space as incumbent drugs or even drugs still in development can quickly be outclassed by a newer drug with better potential.
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International Biotechnology Trust plc
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