There are four areas of innovation that are noticeable both in isolation and how they feed into each other for a transformation in cancer care

1. “Big data” and Bioinformatics – rapidly developing data management systems and analytics e.g. NGS that will enable us to collect, analyze and learn from vast amounts of real-world data – not just the 3% of patients that participate in clinical trials. Outcome –there will be an increasing slicing and dicing(cancer panomics) of an indication to identify a network of molecular and genomic drivers of tumors

2. Rational Drug Design & Delivery – increasing molecule selectivity, affinity and binding will be complimented with increasingly non-intrusive (not necessarily non-invasive) delivery devices AND regenerative medicine targeted towards DNA repair

3. Diagnostics – more and more markers of tumors will be collected via blood and other body parameters (e.g. urine, breath, saliva, mucous, skin inductance etc.)

4. Care Pathways – due to big data and increasingly sophisticated bioinformatics algorithms, there will be an increasing exchange of clinical care parameters (between leading hospitals) resulting in an ongoing optimization of clinical care pathways/algorithms resulting in highly nuanced clinical care

The interaction between the above can be visualized as a “loop” feeding into each other as shown below:

Based on this hypothesis, we believe there could be following waves of cancer care (5 year each)

1. Rapidly Evolving State of the Art: multiple I/O, Targeted and Genomic medicine combinations resulting in longer DoR, longer PFS, longer OS leading to increasing normalizationof 5 year OS
2. Preventing Progression: integrating RWE, NGS, longer PFS and constant monitoring, interventions (beyond the core tumor drugs) will move forward as the analysis of risk of progression will become a clear artifact of the care algorithm
3. Preventing Tumors: With the increasingly savvy risk analysis tools (predicting tumors 2-3 decades in advance), the screening and risk monitoring programs are implemented for younger populations leading to preventive medicine