e-book: Cancer Immunotherapy

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IMMUNOTHERAPY: THE LATEST WEAPON TO FIGHT CANCER

ENTER

Immunotherapy is a new type of cancer treatment. Conventional chemotherapy drugs attack tumors with toxic chemicals. Immunotherapies work by enhancing our naturalimmune system to allow it to seek and destroy cancerous cells.1

There are now two kinds of FDA-approved cancer immunotherapy drugs:• Checkpoint inhibitors• CAR T therapy

Cancer immunotherapy may offer new hope for patients who previously had few, if any, options. We can expect additional treatments using these technologies in the short-to-mid-range future. Together, CAR-T and checkpoint inhibitor drugs join the leading edge of an onrushing revolution in medicine.

In this e-book, we will explore some of the basics about the two kinds of immunology now in use.

e-book: Cancer Immunotherapy

3Checkpoint inhibitors

4Market characteristics: Checkpoint inhibitors

5CAR-T therapy

6Market characteristics:CAR-T therapy

IMMUNOTHERAPY:THE LATEST WEAPON IN THE FIGHT AGAINST CANCER

TABLE OF CONTENTS

How they work: Some forms of cancer can “hide” from the immune system by secreting immune-suppressing proteins. Checkpoint inhibitor immunotherapies work by blocking, or, inhibiting the chemical signals cancer uses to hide.2

3

When immunotherapy works, the results can be outstanding. However, not every cancer is the same. Some checkpoint inhibitor drugs appear to work best for genetically specific patients, or they may work better in combination with other drugs. In other words, they’re not a simple solution, a single way to treat cancer.

Read the article below for an in-depth analysis of how checkpoint inhibitor immunotherapies work — or don’t work — and who can benefit.

e-book: Cancer Immunotherapy

CHECKPOINT INHIBITORSExamples: Keytruda® (pembrolizumab) and Opdivo® (nivolumab)

Unblocked immune cells attack tumor

Immune cellT-cells

Attack

Checkpoint inhibitor drugs prevent cancer cells from blocking T-cells

Source: Adapted from Nikkei Asian Review. New drugs harness the body’s own cancer-fighting abilities. Dec. 8, 2016.

Cancer cell

Here are some key facts and figures that highlight the size and shape of the checkpoint inhibitor market:

4 MARKET CHARACTERISTICS: CHECKPOINT INHIBITORS

e-book: Cancer Immunotherapy

Big price tags: Cost of treatment per year

• Alone: $100,000• In combination with other drugs: up to $200,0004

Highly selective targets: Approved to treat approximately

30% of all cancer types5

BUT

92% of patients do not respondto treatment — drugs work best in patients with specific genetic traits, or biomarkers (PD-L1)5

Big spenders: Keytruda and Opdivo ranked

#2 and #3 in February 2017in pharma TV ad spending3

5B

4B

3B

2B

1B

0

Source: BioPharma Dive. How biomarkers cost Bristol-Myers the lung cancer market. Feb. 13, 2017.

2015 2016 2017 (Q1 & Q2)

$ Billion

$2.4 billion

Checkpoint inhibitor sales

$4.4 billion

$3.8 billion

How they work: CAR T is short for chimeric antigen receptor T-cell therapy. CAR T treatment is different from the checkpoint inhibitor type of immunotherapy on the previous pages. CAR T takes naturally occurring infection-fighting cells, called T-cells, re-engineers them, and puts the altered T-cells back in the body where they can attack cancer cells.6

The point of CAR T is to produce super-potent T-cells that are far more effective at fighting cancer than ordinary T-cells.7

A single engineered T-cell can destroy up to 100,000 cancerous cells.7

5

e-book: Cancer Immunotherapy

The CAR T class is just getting started. Researchers hope to use CAR T therapy in a larger number of cancers that represent far larger patient populations. Find out more about this powerful new cancer-fighting tool, and what it means for the future:

CAR T THERAPYExamples: Kymriah™ (tisagenlecleucel), Yescarta™ (axicabtagene ciloleucel)

T-cells are engineered toallow the T-cells to recognizeand attach to a specificprotein on cancer cells.

T-cells are isolatedfrom patient.

Modified T-cells are grown and expanded in culture.

Modified T-cells are infused into patient.

National Cancer Institute. CAR T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers. Updated: Aug. 7, 2017.

6 MARKET CHARACTERISTICS:CAR T THERAPY

e-book: Cancer Immunotherapy

4.0

3.5

3.0

2.5

2.0

1.5

1.0

0.5

0.0

Source: Coherent Market Insights Analysis. 2017.

2015 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028

72.0

3348.0

Market value

Strong trial results Overall remission rates up to 83% (Kymriah) and 51% (Yescarta).8, 9

Very expensiveKymriah priced at $475,000 per one-time treatment.10

Yescarta is expected to cost $373,000 per patient.11

Serious immune reactionsUp to 81% of patients have serious side effects. These require costly additional treatments that can drive total care spending up to $1.5 million.12

Growing populations Kymriah’s initial approval affects ~600 patients per year.9

Yescarta approved for cancers affecting ~24,000 Americans per year.11

While the CAR T market is still too new to show actual sales results, analysts project strong sales growth as it gains approval for additional kinds of cancer.

North America CAR T cell therapy market size and forecast

$ Billion

2300 Main Street, Irvine, CA 92614

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1. National Cancer Institute. NCI Dictionary of Cancer Terms: immunotherapy.

2. Technology Review. Immunotherapy Pioneer James Allison Has Unfinished Business with Cancer. April 24, 2017.3. Fierce Pharma. Keytruda’s head-to-head against Opdivo rockets meds to Nos. 2 and 3 in ad spending. March 15, 2017. 4. Healthline News. The Value and Cost of Immunotherapy Cancer Treatments. Oct. 12, 2016.5. STATNews. Experimental cancer therapy holds great promise — but at great cost. Aug. 23, 2016.6. National Cancer Institute. CAR-T Cells: Engineering Patients’ Immune Cells to Treat Their Cancers. Updated: Aug. 7, 2017.7. Business Insider. A cancer treatment that one expert called the 'most exciting thing I’ve seen in my lifetime' just got closer to approval. July 12, 2017.8. FDA News Release. FDA approval brings first gene therapy to the United States. Aug. 30, 2017.9. FDA News Release: FDA approves CAR-T cell therapy to treat adults with certain types of large B-cell lymphoma. Oct. 18, 2017.

10. Fortune. The Way We Treat Cancer Will Be Revolutionized As Gene Therapy Comes To The U.S. Aug. 30, 2017.11. Forbes. FDA Approves Another Amazing And Costly Cancer-Killing Gene Therapy. Oct. 18, 2017.12. Kaiser Health News. Cascade of Costs Could Push New Gene Therapy Above $1 Million Per Patient. Oct. 17, 2017.

STATEMENT REGARDING FINANCIAL INFLUENCEThis article is directed solely to its intended audience about important developments affecting the pharmacy benefits business. It is not intended to promote the use of any drug mentioned in the article and neither the author nor OptumRx® has accepted any form of compensation for the preparation or distribution of this article.

About OptumRxOptumRx is a pharmacy care services company helping clients and more than 65 million members achieve better health outcomes and lower overall costs through innovative prescription drug benefits services. OptumRx is part of Optum®, a leading information and technology-enabled health services business dedicated to making the health system work better better for everyone. For more information, visit optum.com/optumrx.

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