Oncology marketing for the 21st century
Market access and non-prescribing decision-makers are the key to successful oncology marketing. Industry must wake up to this if it is to get its drugs used, reports Peter Mansell
By on Apr 24, 2008Market access and non-prescribing decision-makers are the key to successful oncology marketing. Industry must wake up to this if it is to get its drugs used, reports Peter Mansell
Cancer encompasses many different conditions and oncology worldwide is a giant tapestry of different stories, Sean McGrath, Managing Director of Succinct Healthcare Communications, revealed at the start of eyeforpharmas recent Oncology Summit Europe in London.
The challenge for marketers is to accommodate these stories within a framework that satisfies both local and global objectives, be they corporate, political or personal. And, in oncology, the personal really is the political. Too often assigned the mantle of victimhood, patients are making their voices heard with unprecedented force in an environment dominated by concerns about the price, cost and volume of new treatments.
Things have come a long way since the 1970s when people were not even told they had cancer, points out Professor Karol Sikora, Medical Director ofCancerPartnersUK. Yet there are still doctors who, when asked about a new oncology drug that is not on the local formulary, deny knowing anything about it.
These are the opposing currents into which oncology marketers must pitch their offerings: on the one hand are prescribers and other decision-makers whose choices are heavily circumscribed by budgetary pressure and pending or issued cost-effectiveness assessments; on the other are media-smart patients and advocacy groups who know what is out there and want the best available. Between them comes the awkward question of whose interests politicians or indeed pharmaceutical companies are serving when they talk about putting patients first.
At the same time, the very nature of innovation in todays oncology sector is to accentuate the patient. Targeted therapies, biomarkers, more sophisticated diagnostics, and heightened awareness leading to early intervention are leading towards that perhaps over-hyped concept, personalised medicine (see this months Therapeutic focus: Cancer on pages 44-47). In parallel, the whole treatment model is shifting, from palliative to chronic care, from a passive in-patient, towards a more active outpatient, setting.
All this has implications for the estimated 55 oncology projects now in Phase III trials and eight more in pre-registration, which are likely to face a substantially more crowded marketplace in years to come.
These competitive dynamics were outlined in London by Nader Naeymi-Rad, Senior Vice President, Brand Management Practice at Campbell Alliance, who believes niche therapies will not mean having the market to yourself. For example, there are at least two vascular endothelial growth factor inhibitors now in development for every major tumour type, he points out. Oncology marketers are placing their bets in the same squares and the noise level is getting incredible.
The perfect storm
Furthermore, while oncology salesforces are gearing up for a commercial arms race in the USA Genentech and Sanofi-Aventis have around 500 specialist representatives apiece the number of oncologists remains relatively static, with marked shortages in some European countries in particular. So an expanding patient population is being seen by the same volume of oncologists, who have less time for the increasing flow of representatives hammering at their door as Naeymi-Rad notes, a recipe for a perfect storm.
It is also a market shaped by higher expectations where, Naeymi-Rad believes, diagnostics and biomarkers will increasingly be regarded as standard; indeed oncology supremo Genentech, for one, has talked about combining drugs and diagnostics throughout its portfolio. But there has to be meaningful differentiation: the go broader strategy will no longer wash in the oncology sector, he stresses.
How that differentiation is achieved may be as much to do with service, administration and the wider healthcare context as it is about coming up with the right data to knock out the competition. In the USA, for instance, the new, more convenient oral therapies such as Roches Xeloda (capecitabine) have actually suffered because of the more attractive margins available to oncologists on infusions.
The category also demands an excellent logistical solution, Naeymi-Rad notes. These are complex products, often (still) infusion-based, generally part of a multidrug regimen and likely to raise significant issues of side-effect management. In many cases they will be launched into a niche indication without a full or country-specific data package.
Building a value proposition
This is why marketers need to have a value proposition built around the compound at a very early stage of the development cycle. And it needs to be validated early on with payers, who in a cost-constrained environment will increasingly demand predictable value, Naeymi-Rad says.
As Uday Bose, European Marketing Director for GlaxoSmithKline Oncology, observes, pharma should be approaching payers as customers and tailoring oncology products to their needs. That requires pre-emptive action from R&D and commercial departments, working together to designpharmacoeconomic studies and identify real points of differentiation.
By the time a drug is in Phase II development these teams need to be selecting the compound with the best reimbursement profile and price potential, Bose notes. And, by Phase III, they should be thinking about the specific benefits clinicians will want to see. As Gary Hendler, Associate Vice President, Global Oncology Marketing for Sanofi-Aventis, suggests, marketing now has to sit at the centre of R&D, business development and commercial operations.
Naeymi-Rad also emphasises the importance of assiduously preparing the ground ahead of marketing; key opinion leaders have an unparalleled influence in oncology and if they are not behind your product the blast radius can be extensive, he warns. The initial KOL launch will be critical to the eventual product introduction, although it has to be handled carefully and ethically, he adds.
Oncologists in general are a highly concentrated and specialised breed who are used to experimenting in a population with high unmet needs, but who are also strongly research- and data-driven, Naeymi-Rad points out. Quality trumps quantity in this market, so representatives must know the science inside out and have convincing medical information to back it up.
But they also have to be capable of dealing with the more practical elements of therapy delivery. Companies are hiring PhD level staff to detail their oncology products, but these representatives are reluctant to get their hands dirty when it comes to, say, discussing side-effect management with a nurse, Naeymi-Rad comments.
Patient power also plays an important part in the equation. Cancer patients are highly motivated to find alternative solutions, so engaging advocacy groups meaningfully and proactively is key. They can help in striking the right balance with compassionate use programmes, which may be a valuable access tool, but can also be disastrous.
Taking patient organisations seriously
Too often in the past, pharma has failed to take patient organisations seriously enough, notes Jola Gore-Booth, Chief Executive of not-for-profit organisation europacolon.
These are now extremely professional organisations run on a business model. Moreover, they share a common objective with the pharmaceutical industry: after all, our patients need what you are making for them.
Patient groups also wield considerable influence, Gore-Booth told the conference, citing their impact on the National Institute for Health and Clinical Excellences assessment of Roches breast cancer drug Herceptin (trastuzumab). It is unlikely any pharmaceutical company could have achieved this, she suggests. They are also an effective vehicle for raising awareness of cancers that have traditionally lacked political clout, such as colorectal cancer. Roche recognised this five years ago by making a substantial investment in the UKs first ever public roadshow (Dont Blush Look Before You Flush) on the disease, run by Colon Cancer Concern.
However, while relations between industry and patients groups are improving, there are still a number of sticking points, Gore-Booth notes. These include the need for coordination and standardisation of funding mechanisms and for a united front against media accusations of undue industry influence. The rebound effect of this has resulted in fear among patient groups of receiving money from pharmaceutical companies, and fear among companies of being pilloried for too much financial support, Gore-Booth claims.
She acknowledges that sole sponsorship of patient organisations is no longer a viable option, and that advocacy groups should not accept funding that might compromise their objectives. But requiring these groups to publish every last detail of sponsorship on their websites would be lethal, she believes.
Patient positioning is also making itself felt more in advertising for oncology products, observes Hendlers. This marks a shift away from data-driven adverts traditionally focused on survival messages towards either a hybrid of branding and scientific evidence or, more radically, adverts that relate to the patient experience and treat the doctor as a normal consumer.
In this respect, market research is absolutely vital to shape oncology launches, Hendler insists. And marketing and advertising strategies should remember that, even in a scientifically-driven arena, purchasing decisions tend to be made on an emotional basis, then rationalised in retrospect. In the end, he points out, marketing is about positioning the product in the mind of the consumer.
As cancer increasingly becomes a chronic disease, so the importance of talking about the patient rather than the competition will grow. It is up to pharmato adapt and change to this patient revolution.
The opinions expressed by the speakers are their own and not necessarily those of the companies they represent.
Author: Peter Mansell, PharmaTimes
This article has been reproduced with the express permission of PharmaTimes. To sign up to PharmaTimes Magazine and industry news elerts for free, go to: www.pharmatimes.com/subscribe