The one thing I'd fix

2. When I was a young and idealistic doctor, I wanted to change the world. I was fascinated
by research and by the challenge of discovering new drugs. Today, some 25 years later the
one thing I’d like to fix is STOP CANCER!

3. The greatest challenge is to stop cancer cells from growing, dividing uncontrollably
and spreading- causing great suffering. Understanding how healthy cells divide and how
the process can go wrong - is the foundation on which efforts to beat cancer are built.

4. Cancer is one of the most complex
problems in modern medicine.
There is no one way to stop it, as it
manifests in more than a 100 ways and
can arise from numerous causes.
Thousands of cancer-causing gene
problems have already been identified,
but there may be many more yet to be
discovered.
Cancer results from an accumulation of
mistakes or abnormalities in genes that
normally control cell survival, growth
and migration. The resulting mass of
new cells forms the primary tumour.
Tumour cells can then spread (or
metastasize) from the primary to other
parts of the body.

5. Why do cells proliferate too much?
Genes are the instruction manual for our cells, mutations are like errors in the base
sequence. When these instructions are altered cells may begin to multiply
uncontrollably.

6. What can cause gene mutations?
Environmental factors may also be a factor in causing gene mutations. Some chemicals
in tobacco smoke, viruses or bacteria, some chemicals or radiation. They disrupt the
growth signalling pathway.

7. How can we reduce the risk of cancer?
Stop smoking! Eat lots of fruits and vegetables. Protect yourself from too much sunlight.
Don’t drink a lot of alcohol and smoke. Vaccines as advised by the doctor.

8. High Failure Rate
The number of new drugs making the journey all the way to market is reducing. In Phase II
clinical trials, typically around 70% of new molecules fail to progress further and a
remarkable 50% more fail at Phase III.

9. Learning more and more about genes and cancer.
The frame of reference for the field is continually changing. Each gene participates not in
one pathway, but in many – possibly dozens. A disease may have many different
pathways that take a wrong turn-A tangled knot rather than a straight road.

10. Turmoil and transition in Drug Development. Unprecedented challenges.
*Time for products from competitors is falling.
*Generic alternatives to existing drugs are commanding a growing share
*Costs are rising but less than one drug in ten recovers this cost.
*Drug development is very risky as the failure rate is high.
*Knowledge is growing exponentially.
*The regulatory bar is rising higher and higher.
*Oncology’s overall success rate is so low 6.7%relative to other
therapeutic areas 12%. Many fail in Phase III

11. So what is the answer? We still need to find a cure for cancer!
 innovative collaborations will be the new model
 Multidisciplinary and multi-sector collaborations,
 pathway to patient benefit will be a collective effort
Reaching out from national boundaries into a new approach of emerging collaborative
global networks for drug discovery and development

12. Profit Together
No pharmaceutical company will be able to “profit alone”. It will, rather, have to “profit
together” by joining forces with a wide range of organisations, from academic
institutions, hospitals and technology providers to companies new technologies to look
deeper.
Bill Gates urges Stanford grads to focus on progress, not profit alone

13. The dinosaur becomes obsolete and is replaced by a fast nimble cheetah.
The model of Big companies
retaining all the knowledge
within has become obsolete.
Managing partnerships in
parts of the drug
development cycle while
retaining core assets and
knowledge will be the
challenge.
Good communication skills
will be needed as the
industry moves from
internal to external focus.
Companies need to be
nimble and quick .
.

14. Building an asset light- drug development company.
It started with outsourcing to contract research organisations but has now
gone much further into a virtual world. Making smaller super specialized
teams that work across international borders. The best people in the field
are chosen to become members of the team. Outside expertise can be
brought in whenever needed.

15. Changing the game.
Being Patient centric-work
closer with patients- making them the focus. Collaborating with doctors even before
the search for new drug and integrating them early Scientists need to have collaborative
ability.
Changing the mind-set on intellectual property rights
An enabling Intellectual Property framework has become one of the prerequisites for
global prosperity.
Continuing engagement with the public and government policymakers to better
understand the challenges which drug discovery faces globally.

17. India Advantage
India can make drugs for the 6 billion people in the world who cannot
afford Western prices. India pharmaceuticals can reduce the burden of
disease not just in India but globally. The Biotechnology and life science
sector can follow the IT sector and India can become the center of
innovation and be the drug maker for the whole world. India can make
drugs for a tenth of the cost in the West.
(India’s successful Mars Mission was a tenth of the cost compared to
Western countries.)

18. The Early Cancer Detection is Key
0.13 mm3
= 500-3,000 cells
10 mm
103 mm3
= 0.5-3 billion cells
1 mm
13 mm3
= 0.5-3 million cells
Courtesy by Dr. Gambhir, Stanford University

19. Using new technology – Molecular Imaging to Stop Cancer
• detecting relevant disease at the earliest possible stage
and methods to predict and monitor therapies
• Molecular imaging using suitable probes is able to
localize site(s) and characterize tumor status at an
earlier stage
• Future cancer patient management will have
implemented Molecular Imaging for:
– Improved tumor detection and characterization
– Better understanding of tumor heterogeneity /
biology
– Tailored pathway-based therapies, individualized
therapeutic combinations / schedule variations,
optimized external beam radiotherapy
– Early assessment of response
An example- from Piramal Imaging.
18F-labeled derivative of the natural
amino acid glutamate
Specific transport via amino acid
exchanger system xC-Strong
accumulation in various tumor
types
Rapid blood clearance, low background
in healthy tissues
Potentially guiding therapy decisions for
improved outcome
Currently in clinical development

20. Can this idea work?
Here is an example -Piramal Enterprises acquired the Molecular Imaging assets of
Bayer in 2012. A small team of highly committed scientists working across
international borders was formed to complete the trials and shepherd the science
towards regulatory approval. FDA Approves Piramal Imaging’s NeuraceqTM
(florbetaben F18 injection) for PET Imaging of Beta-Amyloid Neuritic Plaques in
the Brain. The group is trying to replicate the success with cancer diagnosis.

21. Credits
DRG- Decision Resources Group USA Oncology Team
Merron, Andrew AMerron@dresourcesgroup.com
Piramal Imaging Germany
Dr Ludger Dinkelborg ludger.dinkelborg@piramal.com
Dr Andrew Stephens andrew.stephens@piramal.com
-Molecular Imaging Society of India.
Graphics- Anju Tikekar