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Pfizer is ready to move on from Covid.
Now, the company is betting on cancer drugs to help it regain its footing after a rocky year marked by the rapid decline of its Covid business. It just might take a while before that bet pays off.
Pfizer pitched its deeper push into oncology during a four-hour investor event last week. And it had a splashy 60-second Super Bowl ad that touted its initiative to “outdo cancer.”
The shift comes at a crucial time for Pfizer. The pharmaceutical giant has been trying to shore up investor sentiment after its shares fell more than 40% in 2023. That share drop erased more than $100 billion in Pfizer’s market value.
Along with plummeting demand for its Covid products, Pfizer disappointed Wall Street last year with the underwhelming launch of a new RSV shot, a twice-daily weight loss pill that fell short in clinical trials and a 2024 forecast that missed expectations. The company has launched a $4 billion cost-cutting program, laying off hundreds of employees and shaving down its research and development spending.
During the investor day, Pfizer laid out its priorities now that it has fully integrated with the targeted cancer drugmaker Seagen. That $43 billion Seagen acquisition doubled Pfizer’s oncology drug pipeline to 60 different experimental programs.
With Seagen under its belt, Pfizer says its drug pipeline could produce at least eight blockbuster medicines by 2030, up from just five today. But the company did not disclose which drugs it believes could offer that potential.
Some analysts noted that it might take a few years for some of Pfizer’s cancer drugs in mid-stage development to show pivotal clinical trial data and become less risky.
Pfizer’s existing oncology portfolio is also facing some competitive pressure. Revenue from the blockbuster breast cancer drug Ibrance and prostate cancer treatment Xtandi, which Pfizer shares with Astellas Pharma, has declined over the past year. Both drugs are expected to lose market exclusivity in 2027.
Still, some analysts came out of the investor day feeling encouraged.
“The company is facing a number of challenges, but we believe the event was a success in laying out a path for the oncology business to help offset upcoming patent losses, and drive growth in the future,” Guggenheim analysts wrote in a note Tuesday.
Long-term commercial strategy
Pfizer used the investor event to formally introduce its new business division dedicated to cancer research and to lay out a long-term strategy for it through the end of the decade.
That oncology unit hosts a sprawling portfolio of experimental medicines that Pfizer and Seagen discovered or acquired through deals, as well as the treatments both companies have long been selling.
The unit is led by Chris Boshoff, a longtime Pfizer executive who most recently served as the company’s head of cancer research and development.
“As a newly combined organization, our expertise and collective capabilities are now amplified to deliver even more impact for patients than each company could do by itself,” Boshoff said last week to kick off the event.
Boshoff highlighted the scale of Pfizer’s capabilities, noting it has 10 manufacturing sites producing cancer drugs on three continents, while Seagen had just one. He also pointed to Pfizer’s commercial presence in more than 100 countries and a customer-facing commercial team that is triple the size of Seagen’s.
Pfizer did not provide a specific sales projection for its oncology franchise by 2030. But the company said it expects roughly two-thirds of risk-adjusted oncology revenue to come from new drugs and new indications — or treatment uses — for existing products by the end of the decade.
Signage outside Seagen headquarters in Bothell, Washington, on Tuesday, March 14, 2023.
David Ryder | Bloomberg | Getty Images
Pfizer reiterated its expectation that the Seagen acquisition will bring in $10 billion in sales by 2030.
But the company provided little guidance on what Seagen’s growth will look like until the end of the decade, UBS analyst Trung Huynh said in a note Thursday.
A new focus
Pfizer also highlighted a huge shift in its drug pipeline strategy.
Boshoff said the oncology division plans to shift to biologic drugs as its main source of revenue, increasing the proportion of those treatments in its pipeline from 6% to 65% by 2030.
Biologics are treatments derived from living sources such as animals or humans, including vaccines, stem cell treatments and gene therapies. They are among the most expensive prescription drugs in the U.S.
Before the Seagen deal, 94% of Pfizer’s cancer products were small-molecule drugs. Those medicines are made of chemicals and have low molecular weights.
Boshoff said biologics represent “a more durable revenue potential” based on several factors. That includes upcoming patent expirations and potential pressure from President Joe Biden’s Inflation Reduction Act.
A provision of that law allows Medicare to start negotiating the prices of biologics as early as 13 years after they receive Food and Drug Administration approval, compared with just nine years for small-molecule drugs. The pharmaceutical industry has argued that would deter drugmakers from investing in small molecules.
Pfizer’s decision to rely more on biologics may also offer “better protection” against competition from cheaper copycats, Guggenheim analysts said in their note. Those copycats, or biosimilars, have historically had trouble gaining market share from biologic treatments. That’s unlike with drugs called generics, which are exact copies of small-molecule treatments.
Small molecules will remain one of three core drug types of Pfizer’s oncology division. The other two are biologics, namely bispecific antibodies, and antibody-drug conjugates, or ADCs.
Pfizer’s three core oncology drug types
- Small-molecule drugs: Treatments with a low molecular weight made up of chemicals created in a lab.
- Bispecific antibodies: Treatments that can bind to two different antigens — or any substance that causes the body to have an immune response — at the same time. Those drugs are biologics because they are developed from living sources that produce antibodies.
- Antibody-drug conjugates: Medications that deliver a cancer-killing therapy to specifically target and kill cancer cells and minimize damage to healthy ones. The treatments represent a hybrid between biologics and small-molecule drugs, but the FDA classifies ADCs as biologics.
Notably, the company is developing a “next-generation” platform for ADCs that combines Pfizer’s protein engineering and antibody design capabilities with Seagen’s ADC technology. Together, the companies have 12 ADCs in development, six of which are in early clinical trials or studies on animals.
JPMorgan analyst Chris Schott wrote in a note last week that the firm walked away from the investor event encouraged by the breadth of Pfizer’s mid-stage oncology pipeline. But he noted that it will take time before a number of the treatments show “pivotal data.”
Four core cancer types
Pfizer plans to focus on four main types of cancer: breast cancer; genitourinary cancer, which impacts urinary and genital organs or functions; thoracic cancer, such as lung, head and neck cancer; and hematology-oncology, or cancers of the blood, such as multiple myeloma and lymphomas.
Pfizer expects breast cancer’s contribution to total oncology sales to drop to about 10% by 2030 from roughly 40% last year, the company’s oncology commercial chief Suneet Varma said during the event.
That decline accounts for the upcoming loss of exclusivity of top-seller Ibrance, which raked in $4.75 billion in sales in 2023.
But the company said it has a handful of breast cancer drugs in development that could become “potential growth drivers” as Ibrance sales fall. That includes a certain type of treatment called atirmociclib that could potentially be more effective and easier for patients to tolerate.
Pfizer is testing the medicine as a second-line treatment for a certain type of breast cancer in a phase three trial. A second-line therapy is given when an initial treatment doesn’t work or stops working.
The company also plans to start a separate late-stage trial on atirmociclib as a first treatment for the same condition in the second half of the year.
Pfizer expects genitourinary cancer to make up an estimated 35% of oncology sales by 2030, which would make it the largest franchise of the cancer business. That’s up from 20% in 2023.
Pfizer is testing an experimental ADC called disitamab vedotin — which Seagen licensed from Chinese firm RemeGe — as a treatment for certain bladder cancers, with data from mid-stage and late-stage trials expected in 2025 and 2026.
Notably, RemeGe already sells that drug in China. Pfizer is also examining the medicine’s potential to treat breast cancer and other tumor types.
Meanwhile, Padcev, an ADC Pfizer shares with Astellas Pharma, in combination with Merck‘s immunotherapy Keytruda is becoming a new first-line standard of care for bladder cancer. Pfizer executives last week said Padcev had “mega-blockbuster” potential, which the company defines as raking in annual sales of more than $3 billion.
Pfizer’s key cancer drugs on the U.S. market
- Ibrance: treatment for certain breast cancers.
- Xtandi: treatment for four types of advanced prostate cancer.
- Adcetris: treatment for certain lymphomas from Seagen.
- Padcev: treatment for some types of advanced bladder cancer, either alone or in combination with Keytruda.
- Elrexfio: treatment for certain adults with multiple myeloma.
- Talzenna: treatment for some breast cancers.
- Lorbrena: treatment for a type of non-small cell lung cancer.
Pfizer executives expect thoracic cancer to double its revenue contributions by 2030.
Seagen brings an ADC called sigvotatug vedotin to this franchise. The drug recently entered a late-stage trial as a second-line treatment for a certain type of lung cancer, with data expected around 2026 to 2027. Pfizer also plans to test the ADC as a first-line treatment.
Guggenheim analysts said they expect the treatment to be one of Pfizer’s blockbuster oncology drugs by the end of the decade. Those analysts also expect a bispecific drug called Elrexfio, which falls under Pfizer’s hematology-oncology portfolio, to eventually become a top seller.
The hematology-oncology franchise is expected to account for 25% of the cancer unit’s sales by 2030, up from just 10% in 2023.
The FDA has approved Elrexfio for patients with multiple myeloma who have tried at least four prior types of therapy. But Pfizer is conducting two late-stage clinical trials on Elrexfio as a second-line treatment, with data not expected until around 2025 and 2026.
Drugs outside of cancer
Pfizer is splitting the rest of its business outside of oncology into two divisions: a U.S. commercial unit and an international commercial unit. Those divisions are focusing on vaccines, along with metabolic and inflammatory conditions.
This fall, Pfizer plans to roll out another updated version of its Covid vaccine that will target a new strain of the virus.
The company previously outlined plans to develop “next-generation” versions of its Covid shot, which aim to broaden and extend the protection people get to a full year.
But Pfizer hasn’t decided whether to move forward with those plans because the company needs to be convinced that there is still an “eagerness to embrace Covid intervention,” Dr. Mikael Dolsten, the company’s chief scientific officer, told CNBC in an interview last week.
The new vaccine COMIRNATY® (Covid-19 vaccine, mRNA) by Pfizer, available at CVS Pharmacy in Eagle Rock, California.
Irfan Khan | Los Angeles Times | Getty Images
Dolsten pointed to two other “strong pillars” in the company’s vaccine portfolio: bacterial and viral shots. The company is testing a “fourth-generation” version of its vaccine to prevent pneumococcal disease, which is caused by a bacteria that can attack different parts of the body.
Pfizer is also working to expand the use of its shot against respiratory syncytial virus, commonly called RSV, to high-risk patients ages 18 to 59. It’s currently approved in the U.S. for expectant mothers and adults age 60 and above.
The company is also testing combination vaccines targeting multiple respiratory viruses, including a shot for Covid and the flu in late-stage development.
Outside of vaccines, the company is developing an oral treatment for sickle cell disease called GBT601. Pfizer views that drug as a potentially more effective successor to its drug Oxbryta, which is already approved for the condition.
Pfizer also expects to release mid-stage trial data on its experimental treatment for cancer cachexia, or what Dolsten called “the opposite of obesity.” It refers to the loss of body weight and muscle mass, along with weakness that may occur in patients with cancer, AIDS or other chronic diseases.
Another area that’s top of mind for investors is obesity. Pfizer expects to release early-stage trial data on a once-daily version of its experimental weight loss pill, danuglipron, in the first half of the year. The company is also working on a second drug for obesity, but has not disclosed how it will work.
Dolsten touted the potential of a weight-loss drug pill, which could help meet the soaring demand for obesity treatments. Much of the existing injectable drugs for the condition are in shortage in the U.S. He also noted that a pill would likely be priced differently than injections, which cost around $1,000 per month before insurance.
“A pill would allow you also to have more access,” Dolsten said. “If you have 300 million patients per year, it will be one of the biggest medications ever.”
In a move that blends innovation with philanthropy, the American Cancer Society (ACS) has embraced web3 technology by partnering with Gitcoin, a leading figure in open-source funding, according to a statement shared with CryptoSlate.
This strategic collaboration signifies a milestone for the ACS as it steps into the decentralized world of web3, leveraging Gitcoin’s expertise to drive its ACS Cares program and the Crisis Response Fund.
The ACS round, distinct and independent from the regular seasonal Gitcoin Grants program, is designed to benefit the ACS Cares program and the Crisis Response Fund directly. This initiative is crucial, as donations will be channeled towards groundbreaking cancer research, advancing health equity initiatives, and bolstering patient support programs.
Additionally, it will aid in providing essential lodging for cancer patients undergoing treatment. This venture represents a crucial intersection of technology and philanthropy, where blockchain’s potential is harnessed for impactful healthcare outcomes.
The initiative represents a continued interest in decentralized open-source funding by a renowned non-profit organization utilizing Gitcoin technology. The first instance was a significant QF collaboration pilot with UNICEF in 2022.
Gitcoin and decentralized funding.
The significance of Gitcoin in the realm of open-source funding cannot be overstated. Since its inception, Gitcoin has played a pivotal role in the web3 ecosystem, mainly through its utilization of Quadratic Funding (QF). This innovative funding mechanism has enabled Gitcoin to disperse over $50 million across more than 100 rounds, empowering organizations like UNICEF and now the ACS in their mission-driven endeavors.
QF is central to Gitcoin’s strategy, a crowdfunding approach that values the number of contributors over the total donation amount. This method fosters widespread community involvement and ensures equitable allocation of funds to projects that resonate most with the public. In the case of the ACS round, this methodology promises to channel resources efficiently towards breakthrough cancer research, health equity initiatives, and patient support programs, all pivotal in the fight against cancer.
Azeem Khan, Head of Impact at Gitcoin, commented,
“By using Gitcoin, the American Cancer Society gains access to a vibrant community of technologists and crypto enthusiasts who are passionate about driving positive change.
This partnership combines Gitcoin’s expertise in blockchain with the American Cancer Society’s commitment to cancer research and prevention, creating a powerful synergistic effect in the fight against cancer.”
Azeem Khan added, “Participating in the ACS round powered by Grants Stack is a unique opportunity for individuals and organizations to contribute to the fight against cancer with blockchain technology.”
Kyle Weiss, Executive Director at the Gitcoin Foundation, and Nicole d’Avis, Protocol Lead at the Public Goods Network (PGN), have both expressed enthusiasm for these collaborative efforts. The PGN, an innovative project in the Gitcoin ecosystem, operates as a low-cost Layer 2 OP Chain, directing most of its net sequencer fees towards public goods. This initiative presents a cost-effective alternative to the Ethereum mainnet for users and developers, simultaneously generating funds for public goods through transactions.
While open-source funding may not have captured mainstream media attention, entities like Gitcoin and PGN have quietly revolutionized how public goods are supported. Their efforts are instrumental in creating sustainable and reliable funding sources for initiatives that serve the greater good.
The American Cancer Society’s venture into web3 with Gitcoin is more than a fundraising initiative; it is a beacon of innovation in the philanthropic world. By adopting blockchain technology and leveraging the power of community-driven funding, the ACS is furthering its mission to combat cancer and setting a precedent for other non-profits to explore the transformative potential of web3.
Prenuvo MRI machine
Courtesy of Prenuvo
While celebrating the July Fourth holiday last year on a boat in Tyler, Texas, Dr. Julianne Santarosa received the results from her full-body MRI scan. What she saw put a damper on the festivities.
Radiologists at Prenuvo, which performed the scan, had identified a nodule in her lungs. Santarosa, who works as a spinal access surgeon in Dallas, could see the spot circled as she looked at the images from the patient portal on her phone.
“I was like, unless I swallowed a taco chip, that something should not be there,” she told CNBC in an interview.
Before paying $2,500 for the Prenuvo scan, Santarosa, who was 41 at the time, hadn’t felt any pain in and around her lungs and had no reason to suspect anything specific was wrong. Rather, she’d felt generally off since going through in vitro fertilization and had a gut feeling she should do the scan after seeing a Prenuvo ad on Facebook.
The day after seeing her Prenuvo results, Santarosa had a follow-up CT scan at a local hospital. The nodule was cancerous. She had it removed the following week.
Curious and concerned patients like Santarosa are flooding Prenuvo’s nine clinics in the U.S. and Canada. There’s so much demand that the 5-year-old Silicon Valley-based company has announced 11 more locations opening by 2024, including one in London and another in Sydney.
Kim Kardashian called Prenuvo a “life saving machine” in an August post on Instagram that’s generated more than 3.4 million likes. Actress and model Cindy Crawford is an investor, alongside Google ex-Chairman Eric Schmidt, 23andMe co-founder Anne Wojcicki and Nest Labs founder Tony Fadell. The company raised $70 million late last year in a funding round led by Felicis Ventures.
Prenuvo CEO Andrew Lacy said he wants to help customers understand what’s going on beneath their skin, which his company’s technology can do by identifying more than 500 conditions like cancer, multiple sclerosis and brain aneurysms. As of now, the scans have a limited audience because they aren’t covered by insurers, requiring patients to pay out of pocket.
For Santarosa, the imaging was worth every penny and more. Her cancer was detected early enough that she didn’t need to undergo treatments like chemotherapy or radiation. More importantly, it hadn’t spread to the point that it was life threatening.
“There’s no screening test for this,” Santarosa said. “I would’ve been stage 4. I would’ve figured this out when I was coughing up blood.”
Prenuvo CEO Andrew Lacy
Courtesy of Prenuvo
An MRI, which stands for magnetic resonance imaging, is traditionally used when ordered by a doctor. Interpreting the images is a complex science, and the scan alone can take more than an hour, even if it covers just part of the body.
Prenuvo’s custom MRI machines, which received clearance from the U.S. Food and Drug Administration in 2018, can scan a person’s entire body in about an hour. Once a scan is complete, the images are reviewed by one of the company’s 30 licensed radiologists. Customers usually receive their results back within five to 10 business days.
Waitlists are long. According to Prenuvo’s website, the next available slot for a full-body scan in New York is in March. The same is true for the Los Angeles clinic. In the Dallas suburb of Irving, there’s availability starting in mid-December.
Lacy said the business has spiked as awareness in the past 12 months has grown “incredibly.”
“These days, when people ask me what I do, and I say I work at Prenuvo, it’s ‘Oh, I heard that on this podcast,’ or ‘That influencer talked about it,'” he said.
In addition to full-body scans, Prenuvo offers a head and torso scan for $1,800 and a scan of just the torso for $1,000.
‘Old-fashioned scaling’
Lacy said Prenuvo is working to bring prices down through “old-fashioned scaling.”
Some companies have started offering Prenuvo scans as a perk for employees, which has helped increase access to the technology. Lacy said it works for companies with self-funded insurance plans, because they’re able to customize their offerings while assuming the risks.
Traditional insurance companies are paying attention.
“Over time, that data helps inform insurance companies about whether this should be something that would be covered across the insurance plans that they offer,” Lacy said.
Prenuvo is looking for other ways to lower costs through artificial intelligence and by potentially reducing the durations of the scans even further. Lacy said the cost is directly correlated to the amount of time customers spend in the expensive machines.
Prenuvo MRI machine
Courtesy of Prenuvo
Radiologists are at the core of Prenuvo’s business. That brings its own challenges.
Many radiologists are fighting burnout as an aging population has led to mounting caseloads. Emerging technologies like AI have also discouraged some young physicians from pursuing the practice. By 2034, the U.S. could see an estimated shortage of up to 35,600 radiologists and other specialists, according to a report from the Association of American Medical Colleges.
So far, it’s a problem Prenuvo has managed to avoid.
Lacy said Prenuvo has a backlog of radiologists who want to work for the company. In traditional medicine, radiologists are often diagnosing patients with serious and advanced diseases, so identifying conditions early can be a welcome change, he said.
“When you’re catching stage 1 cancer, what you’re doing will save lives,” Lacy said.
Prenuvo is still in its early days. Medical experts caution that, in addition to the steep price, full-body MRI scans won’t catch everything and aren’t meant to replace targeted screenings like colonoscopies and mammograms.
“It is a tool that your physician and you can use, but it does not replace a full diagnostic examination,” said Dr. Jasnit Makkar, an assistant professor of radiology at Columbia University Medical Center, in an interview. “It is a work in progress.”
Dr. Kimberly Amrami, vice chair of the department of radiology at Mayo Clinic Rochester, said that because of the limitations, patients’ expectations have to be set accordingly. She said it can be challenging to identify lesions in the lungs, for instance, and scanning different body parts like the knee, the pelvis, the breasts and the prostate all require different techniques.
“There’s always a wish to do an exam that’s going to answer every question,” Amrami said in an interview. “It’s just not really the way that it works with MRI in particular, because the way that you evaluate different body parts in different disease states is quite different.”
Prenuvo doesn’t use contrast, a heavy metal that’s injected into the blood vessels, when conducting its scans. Contrast can help radiologists visualize certain conditions better, but there’s controversy surrounding its use, and the company doesn’t want to deter people.
Lacy said Prenuvo’s hardware was designed to do “almost as good a job” as contrast by using other techniques.
“We believe that that’s the best possible solution for screening patients who are at normal risk and asymptomatic,” he said. “If we find something that’s very concerning, oftentimes, we will suggest that the patient gets some type of follow-up dedicated imaging that might involve contrast.”
Amrami said people should consult with their physicians to determine what kind of imaging works best for them.
“There is no one-size-fits-all for MRI,” Amrami said.
A look inside a Prenuvo clinic
Prenuvo’s clinic in New York City, New York.
Courtesy of Prenuvo
Lacy said he was inspired to create Prenuvo after he started to wonder about how his high-stress lifestyle was affecting his body. He previously started an internet search company and helped found a gaming company, among other ventures.
He found a radiologist who was offering an early version of a full-body MRI scan. Lacy said he learned a lot from that experience.
“Although my lifestyle was impacting my health, there was nothing crazy going on,” Lacy said. “I remember just this incredible feeling of peace of mind.”
Prenuvo designed its experience for relaxation. Its New York location has the feel of a cross between a spa and a doctor’s office.
Upon arrival at the clinic, patients are led from a cozy waiting room to a private area where they can change into scrubs and remove their jewelry.
While lying down in the machine, patients are given a pair of headphones and can choose to listen to music or watch TV during the scan.
Dr. Eduardo Dolhun, a family physician in San Francisco, decided to get his first Prenuvo scan more than five years ago after Lacy stopped by his office. He said he was skeptical but intrigued by the technology, so he decided to fly to Vancouver, British Columbia, to try an early version of it.
After going through his results with a Prenuvo radiologist, Dolhun called one of his medical school peers at the Mayo Clinic.
“I think this is going to change medicine,'” Dolhun said, recalling the conversation.
Dolhun said he gets a scan every 18 months or so and recommends it to some of his patients. He still advises them to get screening exams like physicals and mammograms as well.
“Good science takes time,” he said.
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