The rise of pan-tumor therapies: Striking a balance for commercial success

The last decade has seen tremendous expansion in the number of drugs approved across multiple tumor types in oncology. As of February 2023, nearly half of oncology blockbusters—defined as the top 20 oncology drugs by sales—were approved for more than three different therapeutic areas, according to Evaluate Pharma. In the last five years, 37 new molecular entities have launched indication expansions into additional tumor types, with more than half approved across three-plus tumor types. These products are responsible for nearly 150 new approvals since 2019 (Figure 1).

More companies are now initiating clinical trials studying multiple indications. The number of phase 1 and phase 2 pan-tumor trials, as a percentage of total oncology trials, increased from 4% in 2017 to 10% in 2021. We see no indication this will slow down in the coming decade.

Healthcare professionals (HCPs) are increasingly interested in products approved for multiple tumor types or that demonstrate pan-tumor potential. In a survey of more than 300 oncologists, the most frequently mentioned drugs are either pan-tumor or expected to have pan-tumor potential.

The surge of pan-tumor products is partly due to the development of new platforms that are applicable to multiple tumors, such as Keytruda in immuno-oncology or Enhertu in antibody-drug conjugates (ADCs). As manufacturers continue to develop targeted platforms like ADCs, targeted radiopharmaceuticals and T-cell engagers that span indications, these companies will need to create a unified asset story, or the development of a “pan-tumor identity” that transcends individual indications. This will require striking a balance between a tumor-agnostic approach to their brand across indications versus a strategy that is specific to each approved indication or tumor.

Building a pan-tumor identity can improve customer engagement, create a halo effect of excitement and grow customer reach. But leaning too heavily into this strategy has potential drawbacks, including the loss of asset-specific opportunities as the team prioritizes efforts across brands. There is also potential for companies to complicate team dynamics as they implement the expansive strategy, especially if the team is familiar with a more siloed approach. Here are some of the potential opportunities and challenges for companies considering this approach.

Customer engagement. As part of an asset’s pan-tumor brand strategy, manufacturers can consolidate efforts to support the product at the brand level and infuse a unifying identity into cross-functional teams, including patient support programs, research programs, marketing strategy or contracting with payers and providers. The association of these programs into overarching themes can strengthen awareness and lead to more powerful brand recognition. For example, AstraZeneca provides broad resources at the asset level, agnostic of indications, across Imfinzi’s HCP and patient resource portal. This one-stop-shop provides a clear central destination for any prescriber hoping to better understand Imfinzi above indication.

Halo effect. HCPs may also begin to associate positive clinical evidence in one indication with others. This leads to increased utilization and excitement for an asset across therapeutic areas. The KEYNOTE-021 trial provided a clear example, with Keytruda + Alimta + carboplatin’s superior efficacy prompting industrywide response and renewed excitement around Keytruda’s potential to enhance efficacy across indications.

Broad unbranded reach. Although each indication an asset is approved for may have its own nuances, such as suitability for different unmet needs, patient populations and demographics, a pan-tumor team can effectively focus on drivers between customers and concentrate on a centralized message in an effective “shotgun” approach. Companies may even leverage teams of medical oncologists or surgical oncologists that can vary their tone and messaging across indications and by HCP type. For assets with a few similar indications or similar prescriber bases, manufacturers should strongly consider a pan-tumor strategy to highlight benefits of the brand holistically in a cost-efficient manner.

Varying unmet needs. Pan-tumor strategies prioritize overarching asset strengths versus the unique considerations potentially required in individual therapy areas, like addressing unique unmet needs, treatment approach and HCP concerns. Accordingly, HCPs may not fully understand an asset’s unique strengths in each therapeutic area if they only hear or receive pan-tumor messaging. When leveraging a pan-tumor strategy, it’s important that customers also receive unique information highlighting the individual benefits of the asset by tumor type without losing sight of how the asset addresses each therapeutic area’s specific unmet needs. For example, Genentech maintains dedicated websites for each indication for Tecentriq, showcasing distinct content and resources tailored to the specific needs of each tumor type, for example, melanoma versus hepatocellular carcinoma (HCC), solidifying the perception of addressing needs in each tumor type.

Core team dynamics. While a unified brand identity can help organizations allocate resources across indications, it also requires the collaboration and coordination of stakeholders across various functional teams. This can create team inefficiencies from overlapping roles and responsibilities, increasing decision-making times. Depending on a manufacturer’s size and resource allocation, changing or adapting working models may cause a decrease in brand strategy effectiveness. If a team decides to move forward with a pan-tumor strategy, their ability to clearly articulate roles and responsibilities that are distinct and synergistic will be important to their success. 

Defining the right level of pan-tumor focus is an important decision for the functional teams supporting an asset. Due to the unique nature of each team and their respective stakeholders, teams should make pan-tumor choices carefully and with a holistic consideration of factors such as marketing, evidence generation, value and access, organizational structures and more.

Marketing teams should weigh pan-tumor approaches by evaluating customer and product characteristics. For example, they should assess the extent of overlap between tumor types treated by customers and the tumor types approved for the product. If the overlap is extensive—for example if there are approvals in HCC, renal cell carcinoma or colorectal cancer—a pan-tumor campaign and branding may provide synergistic messaging for HCPs. If overlap is minimal, such as in glioblastoma and advanced pancreatic cancer, promotional efforts may be better allocated to unique campaigns highlighting the complexities of each therapeutic area.

It is also important for marketing teams to understand product characteristics such as the number of indications, composition of indications and mechanisms of action.

• A product with many indications may benefit more from adopting a pan-tumor approach, which may lower the cost of managing the complexity and variation in campaigning and messaging.
• For example, BeiGene’s approach with Brukinsa fosters a perception of pan-tumor potential among HCPs, conveying broadly applicable messaging across hematologic-oncology indications in one unified location. 

Integrated evidence and support planning (IESP) teams that consider a pan-tumor approach promote alignment and a unified vision across diverse functional teams when evaluating multiple indications. This situation will change in more complex indications with more in-line competitors, such as non-small-cell lung cancer, breast cancer and multiple myeloma. In these areas, deeper insights and data will be necessary with more focus on individual indications. Manufacturers should consider their asset’s core therapeutic areas to understand which approach would provide the greatest cost-benefit ratio.

For value and access teams, today’s access environment is challenging for therapeutics with multiple indications, as payers are increasingly scrutinizing the relative value provided by assets, by disease. When assets consider any indication beyond their first two indications, market access and health economics and outcomes research (HEOR) teams must make difficult choices about indication level valuation, dosing considerations and launch sequencing:

Indication level valuation

• Traditionally, HEOR teams focus on the health economics of pan-tumor products at the individual therapy area (TA) level rather than pan-tumor level. The economic value of products from a pan-tumor lens is easier to distill at the TA level due to a defined patient population, unmet needs and existing treatment options.
• Pan-tumor shift: If manufacturers want to ensure payers begin to consider pan-tumor value, access teams should focus efforts on pan-tumor evidence generation, such as through pooled analysis of tumor types.

Dosing considerations

• When assets launch with an anchor indication, their price is fixed according to the first launch. But companies can be forced to launch a drug at a discount when indications require lower doses.
• Pan-tumor shift: As access and HEOR teams consider the totality of an asset’s opportunities across indications, they need to ensure that subsequent launches are taken into consideration early on to enable optimal revenue generation across all therapeutic areas.

Launch sequencing

• The Inflation Reduction Act has shortened the exclusivity window for manufacturers in the U.S. to launch multiple indications—to nine years for small-molecule treatments and 13 years for biologics—so teams are under pressure to launch more indications as early in the product life cycle as possible.
• Pan-tumor shift: In this new environment, manufacturers may need to conduct bottom-up analyses to assess the optimal sequence and bundle of indication launches to maximize revenue and minimize price inversion.

Current organizational structures may require transformation to equip manufacturers with the capabilities for pan-tumor product brand planning. Manufacturers can establish teams that specifically coordinate across TAs and provide a united vision and branding. Considering existing team structures and how to efficiently introduce new teams will be critical to reduce friction and improve cross-indication considerations.

Global teams often have the resources and desire to develop cross-indication strategies, building strategic imperatives and objectives that help drive a pan-tumor identity. Affiliates, however, are often resourced with more lean teams and depend on their global counterparts to help provide strategies executable at a local level. These affiliates, depending on the size of the portfolio, may be resourced by disease area or brand across indications. Global teams should consider how executional pull-through of pan-tumor messaging can best be adapted to affiliate capabilities, matching the level of resources available.

The oncology community, including oncologists, patients, researchers and other stakeholders, have embraced pan-tumor products with enthusiasm, signaling that this approach is likely to transform the oncology treatment landscape for the next decade. As manufacturers build out their commercial strategies for these treatments, it is essential that they carefully evaluate internal factors—brand perception, impact on customer engagement and external factors—including resource allocation and functional team considerations. Finding the right balance between pan-tumor and tumor-specific approaches is crucial to maximize commercial success for pan-tumor products.