Oncology

Cancer is emerging as a major public health concern in India. According to reports published in 2020 by the National Cancer Registry Programme, cancer cases in our country are likely to rise by 12% in comparison to current estimated cases. Here are some alarming statistics:

• Breast Cancer: 1 in every 22 women are affected by breast cancer in India.

• Lung Cancer: The most common & deadliest cancer in the world, accounting for 1 in 5 of all cancer deaths.

• Blood Cancer: India ranks 3rd highest in reported blood cancer cases globally.

We have made great strides in our understanding of cancer, but more remains to be done. If detected early enough, many forms of the disease can be effectively treated. We have been at the forefront of cancer research and treatment for over 50 years. At Roche, our goal is to be at the leading edge of finding cures for cancer. In recent years, progress has been made in developing cancer immunotherapies that target specific aspects of an individual’s tumor. As our understanding of the immune system and tumor biology expands, so does our hope for developing treatments that may change people’s lives.

DLBCL (diffuse large b cell lymphoma) is the most common form of non-Hodgkin lymphoma. Since 40% of people with DLBCL relapse after initial therapy, achieving meaningful treatment effects in the front-line setting has the potential to be transformative. Polivy is already approved in previously treated DLBCL, but this new Polivy regimen is the first in two decades to improve progression-free survival in DLBCL compared to the standard of care, and has the potential to reduce the burden on patients and healthcare systems, associated with disease progression. Polivy is a first-in-class CD79b-directed ADC (antibody drug conjugate) engineered for targeted activity against dividing B cells. Polivy is approved in over 80 countries and has treated 10,000+ 1L DLBCL patients till date.

Perjeta is an absolutely essential treatment in HER2+ cancers, setting a new standard for more life and bringing patients one step closer to cure. Perjeta and Herceptin bind to different sides of HER2 receptors and complement each other’s mode of action, providing a more comprehensive HER2 blockade. Perjeta is administered together with Herceptin to increase the efficacy. The mechanisms of action of Perjeta and Herceptin (trastuzumab) are believed to complement each other, as both bind to the HER2 receptor, but to different locations. The combination of Perjeta and Herceptin is thought to provide a more comprehensive, dual blockade of HER signaling pathways, thus preventing tumor cell growth and survival. Perjeta is also approved in over 80 countries.

Cancer Immunotherapy (CIT) fundamentally changes the treatment paradigm for people with cancer. Its goal is to enable a person’s immune system to recognize and destroy cancer cells. Prevents the tumor cell from deactivating the patient’s natural immune response, allowing it to recognize and attack the tumor by itself. Tecentriq is a monoclonal antibody designed to target PD-L1 proteins of tumor cells and tumor-infiltrating lymphocytes. Approved indications for Tecentriq:

• Metastatic non-small cell lung cancer (NSCLC)

• Extensive-stage small cell lung cancer (SCLC)

• Advanced or metastatic triple-negative (TNBC)

• Unresectable or metastatic hepatocellular carcinoma (HCC)

• Metastatic urothelial carcinoma (mUC)
  

Role of Tecentriq in Unresectable or metastatic HCC & rationale for combining with Bevacizumab (Avastin)

Bevacizumab (Avastin) normalizes the blood supply in the liver, starving the tumor, as well as making the tumor microenvironment more permissive to the immune system. Tecentriq®️, through checkpoint inhibition, then boosts T-cell mediated cancer cell killing.

PHESGO is the world’s first ready to use, fixed dose, subcutaneous (SC) injection, combining two monoclonal antibodies - Perjeta® (pertuzumab) and Herceptin® (trastuzumab) with hyaluronidase - in the history of cancer care. PHESGO is a SC injection that is administered over minutes compared to hours with Perjeta and Herceptin given intravenously and can reduce a patient’s time in hospital by up to 90%. Faster administration through PHESGO frees up time for everyone (patients, caregivers, doctors and paramedical staff), shorter appointments, allowing more time for HCPs to treat more patients. From launch to December 2021, PHESGO has impacted the lives of over 16,000 patients globally with HER2+ve breast cancer.

Roche and Genentech have led the research and transformed the lives of patients with HER2+ Breast Cancer for more than 35 years now. Kadcyla (ado-trastuzumab emtansine) was born with the 1st US FDA approval in 2013 but the history and extensive research behind this unique concept of an antibody-drug conjugate (ADC) started well before 2013. 

Kadcyla is an antibody drug conjugate, a unique combination of a target-specific monoclonal antibody, a stable linker and a potent cytotoxic agent. It takes real ingenuity and the mind of the inventor to replicate exactly the molecular structure of the product, which yields the benefit to the product. A mild change in linkage or molecular weight or site of linkage, can not only render re-engineered products ineffective but toxic. Kadcyla is the first FDA approved ADC for treating HER2-positive metastatic breast cancer (mBC), an aggressive form of the disease and from February 2019 onwards for Adjuvant early breast cancer (eBC).

Kadcyla has been approved and marketed in more than 100 countries worldwide. From February 2013 until February 2021, over 1.70 lakh patients have been treated with Kadcyla. A very strong real world evidence is available for >3500 patients from 12 countries across 3 continents. With an ESMO-MCBS score of 4, Kadcyla has been recommended by all major global guidelines including ESMO, NCCN and ASCO.

Follicular Lymphoma (FL) is the most common type of slow-growing blood cancer, considered an incurable disease, with most patients relapsing repeatedly. The body produces abnormal B-cells that build up in lymph nodes (called follicles), bone marrow and spleen. Over time, these abnormal cells multiply too quickly and replace the normal cells, mostly in the lymph nodes, causing worsening of the disease. Most often, people above the age of 50 are impacted. 2022 marks the launch of Gazyva in India for usage in people with previously untreated Follicular Lymphoma. 

Gazyva is the first -engineered type II anti-CD20 monoclonal antibody which is designed to attack and destroy targeted B-cells both directly and indirectly by making the B-cells a target for the body’s immune system. It binds to CD20 on abnormal B-cells so they can be identified and destroyed by the immune system. It  is designed to deliver superior efficacy and become the best-in-disease foundation for patients with B-cell malignancies.

Gazyva is currently approved in more than 90 countries in combination with chlorambucil for people with previously untreated chronic lymphocytic leukemia, in more than 80 countries in combination with Bendamustine for people with certain types of previously treated follicular lymphoma, and in more than 70 countries in combination with chemotherapy for previously untreated Follicular Lymphoma. It is also approved as a shorter duration infusion, meaning the treatment can be administered to the patient over a shorter time period and can result in potential time savings for patients, as the standard rate of infusion can take approximately three to five hours.

Alecensa is a tyrosine kinase inhibitor (TKI) that selectively targets ALK (Anaplastic lymphoma kinase). By inhibiting the ALK phosphorylation and ALK-mediated activation of downstream signaling proteins, it blocks cell signaling pathways and induces death (apoptosis) of tumor cells.