As of 2020, unmet needs in immuno-oncology (IO) revolve around three main pillars: Cost, efficacy and toxicity. While a multitude of pipeline agents are poised to address needs related to toxicity and efficacy, with this level of industrial investment highlighting their importance for the future of IO, there is little incentive to optimize for issues related to cost of therapy and reimbursement and this need is unlikely to be addressed in the near future, says GlobalData, a leading data and analytics company.

Sakis Paliouras, PhD, Senior Oncology Analyst at GlobalData, comments: “The unprecedented progress in oncology brought about by immunotherapy agents over the past decade has led to regimens that frequently exceed $150,000/year. It is thus not surprising that high-prescribers in the seven major markets (*7MM) scored the high cost of therapy as the most important unmet need in IO, followed by reducing toxicity and by predictive biomarkers that can better guide treatment decisions.”

Examining individual themes of unmet needs, it was apparent that efficacy-related needs were related to various aspects such as low response rate, sustained response and resistance to IO, whereas the personalized medicine theme was dominated by the need for predictive biomarkers, followed by improving care in indications that are traditionally refractory to IO. In the toxicity theme, a large number of physicians are concerned about issues related to long-term management and quality of life.

Paliouras continues: “The ranking of unmet needs has been surprisingly uniform across the 7MM*. The only exception is Japan, where there is less concern about efficacy issues, but more concern about various needs such as clear guidelines and novel mechanisms of action. An important finding in the overarching theme of cost was that US-based physicians are mostly worried about the high cost of therapy per se, whereas physicians in the 5EU* and Japan were concerned about issues surrounding insurance coverage and reimbursement. A time lag of reimbursement/coverage for premium-priced IO agents in EU and Japan is a well-documented issue in the industry.”

High prescribers also ranked the level of attainment of these particular unmet needs. Cost and reimbursement scored very low, a view that is supported by the consistently high prices of IO therapies despite an ever-increasing number of competitors. Improved patient selection and new options for patients with poor performance score and rare cancers scored very highly in terms of the future level of attainment.

Paliouras concludes: “The call for biomarkers and real-time stratifying protocols that guide patient selection for IO therapy has been echoed by countless physicians over the years, and it seems that there is now optimism about its attainment.”

7MM* The US, Japan and the 5EU

5EU* The UK, Germany, France, Spain, and Italy