Ipsos Healthcare

The Rising Tide of Next Generation Cancer Treatments

By Jackie Ilacqua & Valerie Wriede The Ipsos Healthcare Oncology Center of Excellence

August 2017 

IPSOSREAL WORLD EVIDENCE

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The Rising Tide of Next Generation Cancer Treatments

We’ve Come a Long Way…

Evidence of cancer has been found since the beginning of recorded history, with the oldest description of the disease dating

back to around 3000 BC. While various advances in the understanding of cancer have occurred throughout the ages, it was

in the mid-Eighteenth Century that Italian anatomist, Giovanni Morgagni, laid the first foundations for the scientific study of

oncology. He accomplished this by performing autopsies to relate the patient’s illness to their pathologic findings post-mortem,

thus allowing for the detection of cancer – albeit after death1.

It was not until World War 2, however, that exposure to mustard gas led to the study of nitrogen mustard as a cancer

treatment, ushering in the era of chemotherapy2.

The next four major milestones in the evolution of cancer treatment came roughly 20 years apart. 1960 saw the Philadelphia

Chromosome identified in CML patients; this was the first genetic defect to be associated with cancer. Next came the 1977

approval of tamoxifen (the first targeted cancer therapy, binding to ER receptors), followed by the 1997 approval of rituximab

(the first monoclonal antibody), and the approval of Provenge® (the first immunotherapy) in 20103.

Figure 1: Number of new cancer drugs approved by FDA per decade (as of Q1 2017)

1950s 1970s1960s 1980s 1990s 2000s 2010s0

10 13 16

28

51

84

59

40

20

60

80

# of

dru

gs

100

Source: Medications by Year of Approval (2017), HemOnc.org: https://hemonc.org/wiki/Drug_index#Medications_by_Year_of_Approval

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I P S O S H E A LT H C A R E

Today, however, advancements are coming thick and fast. According to HemOnc.org, we have gone from 10 new cancer

drug approvals in the 1950’s to over 50 in the 1990’s and 2000’siv (see figure 1 on page 3). As of March 2017, over 80 new

cancer drugs have been approved this decade, while 33 biomarker tests used for drug selection have been approved in the

USv. Also worthy of note, February 2017 saw the first approval, in Europe, of a monoclonal antibody biosimilar to treat cancer:

Truxima™, the biosimilar of rituximabvi.

But we have a long way to go…

The American Cancer Society estimates that, in the US alone, 2017 will see nearly 1,700,000 new cancer cases diagnosed

and 600,000+ cancer deathsvii. Yet, given the incredible complexity of cancer overall, there is considerable variation regarding

the specific cancer types contributing to these numbers. Fundamental differences exist in general incidence and survival rates

by cancer type, and these rates are continually evolving as advancements are made in cancer screening and treatment.

Ipsos Healthcare asked oncologists in the US (n=97), France (n=25) and Germany (n=25) what, in their opinion, were the

cancer types most in need of new drug treatment options. Although versus 2016 leukemia increased in perceived need in

both the US and EU countries (hereafter referred to as EU2), the main answer across regions was pancreatic cancer by a

large margin. Moreover, pancreatic cancer is seen as having the greatest discrepancy between need and likely advancement,

followed by brain cancer, HCC, sarcoma and gastric cancer (see Figure 2).

Figure 2: Cancer types most in need of - and most likely to see - treatment advances (physician perceptions)

Source: Ipsos Healthcare Oncology Monitor Panel: data collected online in EU (Jan 2017) and US (May 2017); Base = US: 97 physicians; EU: 50 physicians

* Asked on an unaided basis; major/multiple mentions

60%

50%

10%

0%

20%

40%

30%

60%

50%

10%

0%

20%

40%

30%

MOST IN NEED*:US

Likely to see advances in treatment*

MOST IN NEED*: EU2 (France & Germany only)

Likely to see advances in treatment*

Panc

reat

ic

Gast

ric

Brai

n

Colo

rect

al

Hepa

tobi

liary

Panc

reat

ic

Gast

ric

Leuk

emia

Sarc

oma

Hepa

tobi

liary

Brai

n

Blad

der

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And how are the anti-PD(L)-1s doing?

The emergence of immunotherapy has helped to redefine cancer treatment. Even though we are now several years out from

the initial launch of these agents, and expectations have been slightly tempered by real world experience, immunotherapy

continues to generate considerable excitement. In our research, we found not only that clinical experience with anti-PD(L)-

1s is virtually universal in both the US and EU2, but that over 8 in 10 of our oncologists in both regions still spontaneously

mention anti-PD(L)-1s as having “the greatest potential among new cancer treatments”.

There is definitely hope, however. As shown in Figure 3, as of 2015 there were more than 800 drugs in development for

cancer in the US alone. While many focus on lung and hematologic cancers, numerous drugs are being investigated for the

cancers perceived to have the greatest need for treatment options, including pancreas (49), brain (58), and liver/HCC (35)viii.

Figure 3: Number of drugs in development for cancer in the US in 2015

Source: PhRMA Medicines in Development for Cancer 2015 Report: http://www.phrma.org/report/medicines-in-development-for-cancer-2015-report

Solid tumors

Lung cancer

Leukemia

Lymphoma

Hematological malignancies

Breast cancer

Brain cancer

Skin cancer

Ovarian cancer

Prostate cancer

Pancreatic cancer

Multiple myeloma

Colorectal cancer

Liver cancer

Kidney cancer

Stomach cancer

Bladder cancer

Head/neck cancer

Sarcoma

Other cancers

Unspecified cancer

227

123

106

92

84

82

58

53

51

50

49

38

35

35

30

29

23

21

17

56

27

500 100 150 200 250

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I P S O S H E A LT H C A R E

This is certainly supported by data from the Ipsos Global Oncology Monitor, which show continued growth of the anti-PD(L)-1

market since these drugs were first approved for use (see figure 4). If any more evidence were needed, multiple outlets report

Q1 2017 Opdivo® sales of over $1.1 billion, with Keytruda® at $584 million.

So, what’s driving the ongoing growth of anti-PD(L)-1s? Simply put, it’s both new indications for existing products and

approval of new agents. Since initial approval, both Opdivo and Keytruda have been approved for use in multiple cancers in

both the US and EU (see figure 5) . Likewise, approvals within certain cancer types continue to increase as data becomes

available for use by biomarker status, for earlier treatment lines, and in combination with other agents.

Figure 4: Anti-PD(L)-1 market growth continues

Source: Ipsos Healthcare Global Oncology Monitor; data collected online from Sep 2014 – Apr 2017

Initial Approval

Initial Approval

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15-M

ar

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pr

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ay

16-M

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15-J

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15-J

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15-A

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16-A

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15-S

ep

16-S

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15-O

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16-O

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15-N

ov

16-N

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15-D

ec

16-D

ec

TOTAL OPDIVO® KEYTRUDA® TENCENTRIC® BAVENCIO®

Keytruda maintaining market growth and gaining swiftly on OpdivoUS data: Base: 25 - 1,884 patient records per R3M. Includes clinical trial patients

EU data: Base: 12 -1,336 patient records per R3M. Includes clinical trial patients

Opdivo and Keytruda mirroring US market in first 16 months since launch

R3

MA

PR

OJE

CT

ED

PA

TIE

NT

S

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The impact of newer anti-PD-L1s is still largely unknown; in fact, in the US, where both drug classes are available for use,

anti-PD-L1s are more often seen as distinct from anti-PD-1s. Interestingly, as seen in figure 6, oncologists who perceive a

distinction between the two drug classes and express a preference are more likely to prefer the newer anti-PD-L1s.

Figure 5: New indications for existing products & approval of new agents are driving growth

Figure 6: US Oncologists’ perceptions of anti-PD-1s vs anti-PD-L1s

OPDIVO®: 7 melanoma indications / 4 lung indications

KEYTRUDA®: 3 melanoma indications / 6 lung indications

Source: Ipsos Healthcare Oncology Monitor Panel: data collected online in US (May 2017); Base = 97 physicians

Pre-

14

14-S

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ct

14-N

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14-D

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16-A

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16-O

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16-N

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YERVOY®

Melanoma

NSCLC

RCC

Bladder

cHL

H&N

MSI-H Tumors

OPDIVO®

KEYTRUDA®

TECENTRIQ®

BAVENCIO®

IMFINZI®

US

EU

61% 75%

41%59%anti-PD-1s and anti-PD-L1s are distinct products

anti-PD-1s and anti-PD-L1s are similar products

Prefer anti-PD-1s

No preference for either

Prefer anti-PD-L1s

23%

2%25%

14%

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I P S O S H E A LT H C A R E

What comes next?

While anti-PD(L)-1s are the stars of today, there are yet more advancements on the horizon, with the most immediate

being the continuing evolution of anti-PD(L)-1s and the looming availability of CAR-T technology – which has the potential

to redefine the current treatment landscape. Looking even further ahead, we can see the advent of the new I-O therapies,

including anti-ICOS(R) drugs, BiTE (Bi-Specific T-cell Engagers), DART (Dual Affinity Re-Targeting), and NK -1 (Natural Killer

Cells) (see Figure 7).

Figure 7: Ongoing developments in anti-cancer drug therapy

CURRENT PLAYERS IN THE FUTURE BiTE FIELD INCLUDE

CURRENT PLAYERS IN THE ANTI-PD(L)-1 SPACE INCLUDE

- W I T H O T H E R S O N T H E H O R I Z O N -

Roche/ GenentechTODAY

it’s all about the checkpoint

inhibitors & their combinations with

other agents (anti-PD(L)-1s) AstraZeneca

Pfizer

Merck Serono

Regeneron

Bristol-Myers Squibb

Merck

CURRENT PLAYERS IN THE FUTURE CAR-T FIELD INCLUDE

TOMORROW it’s all about CAR-T therapy

(anticipated 2nd half of 2017)

Bellicum Juno Novartis Adicet Bio

Bluebird Bio Pfizer Kite Pharma

FUTURE I-O THERAPY Anti-ICOS(R) drugs

BiTE (Bi-Specific T-cell Engagers)

DART (Dual Affinity Re-Targeting)

NK -1 (Natural Killer Cells)

Jounce

NantKwest

Incyte

AstraZeneca

Janssen

Pfizer

Amgen

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Our research respondents in the US confirmed the buzz

surrounding anti-PD(L)-1 combinations, with nearly half (44%)

stating that they are most excited about these options (see

Figure 9). Enthusiasm for anti-PD(L)-1 combinations with

chemotherapy has only been heightened with the recent

US approval of Keytruda in combination with pemetrexed/

carboplatin for the frontline treatment of metastatic

nonsquamous NSCLC.

Meanwhile, CAR-T therapies are likewise generating

considerable interest, despite the onerous manufacturing

process, logistical limitations in securing facilities capable of

administering, and unknown reimbursement challenges. And

the first critical hurdle to bringing these therapies to market

has just been cleared with the recent unanimous FDA vote in

favor of Novartis’ offering.

Clearly, the next step in the evolution of anti-PD(L)-1 agents is combination use. According to Evaluate Ltd, there has been a

huge rise in the number of anti-PD(L)-1 combination studies (see figure 8). To put some numbers to this, combination studies

using Keytruda went from 70 in 2015 to 268 in 2017. For Opdivo, the figures were 73 and 242, respectivelyix.

Figure 8: Number of anti-PD(L)-1 combination studies: 2015 vs 2017

Figure 9: Cancer therapies US Oncologists are MOST excited about

Source: PD-1 / PD-L1 Combination Therapies, Evaluate Group: http://info.evaluategroup.com/rs/607-YGS-364/images/epv-pdct17.pdf

Other

BTK in

hibito

rs

CDK4

/6 in

hibi

tors

CAR-T 32%

... with chemo 19%

... with CTLA-4 inhibitor 17%

Anti-PD(L)-1 combinations: 44%

... with IDO1 inhibitor 8%ADCs

7%

4%

4%2%

PARP inhibitors 7%

Source: Ipsos Healthcare Oncology Monitor Panel: data collected online in US (May 2017); Base = 97 physicians

300

250

200

150

100

50

0

# of

com

bina

tion

stud

ies

2015

2017

70

Keytruda Opdivo Imfinzi Tecentriq Others

73

4226

4

123

83

49

268

242

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I P S O S H E A LT H C A R E

Figure 10: US Oncologists’ reasons for excitement about new cancer therapies* * Asked on an unaided basis; major/multiple mentions

Figure 11: US Oncologists’ perceived influence of factors on treatment decisions moving forward

And what drives this excitement? Regardless of the anticipated new cancer therapy, the reason is clear: efficacy, efficacy,

efficacy! It remains to be seen if these new options will live up to the hype, but trial data so far has been encouraging.

Following the mention of efficacy, physicians are also intrigued by the novel MOAs of these future options (see Figure 10).

Of course, how treatment is determined is also evolving, with new markers and metrics emerging. When asked which factors

will influence treatment decisions moving forward, nearly half of physicians (44%) cited MSI status as being ‘very influential’

(see figure 11) – an understandable perception given the recent and unprecedented tumor-agnostic approval for Keytruda in

the US, based on MSI result. Physicians additionally anticipate Tumor Mutation Burden to be ‘very influential’ (31%) and, to a

lesser extent, NTRK (Neurotrophic Tyrosine Receptor Kinases) Gene Fusions (18%).

On an unaided basis, physicians also mentioned the increasing influence of genomic profiling/specific mutations (24%) and

PD-L1 OE (23%). This ties into ASCO naming Immunotherapy 2.0 its ‘Advance of the Year 2017’. Now that immunotherapy

has been embraced as a standard option, the next step – 2.0 – involves not only expanding its use, but refining patient

selection in order to maximize benefitx.

CAR-T (n=31)

EFFICACY 77%

Good data / promising results 39%

Possible cure 19%

Effective in refractory/hard to treat pts 19%

NOVEL MOA 29%

Anti-PD(L)-1 combination with chemotherapy (n=18)

EFFICACY 78%

Broad activity/potential to help large number of pts

44%

Good data / promising results 33%

NOVEL MOA 28%

Anti-PD(L)-1 combination with CTLA-4 inhibitor (n=16)

EFFICACY 69%

Broad activity/potential to help large number of pts

25%

Durable response 25%

NOVEL MOA 13%

More supportive data 13%

Source: Ipsos Healthcare Oncology Monitor Panel: data collected online (May 2017); Base = US: physicians most excited about therapy

Source: Ipsos Healthcare Oncology Monitor Panel: data collected online (May 2017); Base = US: physicians familiar with factors

27% 24% 4% 44%

40%

25%

22%

32%

4%

15% 10%

3%

1%

31%

18%

MSI Status (n=93)

Not Influential at all Very Influential2 3 4

Tumor Mutation Burden (n=92)

On an unaided basis, physicians also mention increasing influence of:

• Genomic profiling/ specific mutations (24%)

• PD-L1 OE (23%)NTRK (Neurotrophic

Tyrosine Receptor Kinases) Gene

Fusions (n=68)

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Figure 12: US Oncologists testing MSI/dMMR in breast cancer

We are already seeing evidence of this occurring. In separate research conducted by Ipsos Healthcare in June 2017 among

US oncologists (n=75), nearly half (48%) indicated that they are already testing for MSI/dMMR in breast cancer. This allows

physicians another means of tailoring treatment to appropriate patients, especially those with hard to treat triple negative

breast cancer (see figure 12).

<10%10-19%

25%

20%

15%

10%

5%

0%20-29% 30-39% 40-49% 50-59% >60%

% P

HY

SIC

IAN

S

% PAT I E N T S T E S T E D

MEAN: 30% OF PATIENTS TESTED

MEAN: 19% OF TESTED PATIENTS RESULT IN MSI-H

Stage at which Breast Cancer Patients Typically Tested*

CURRENTLY TEST BREAST CANCER

PATIENTS FOR MSI/dMMR

More Likely to Test a Specific Breast Cancer Subset

* Asked on an unaided basis: select mentions

STAGE IV - 47%

AFTER PROGRESSING THROUGH MULTIPLE LINES - 18%

AT DIAGNOSIS - 6%

YES: 58%YES: 58%

NO: 42%

(n=21) TNBC 81%HER2+ 19%

MOST LIKELY TESTED

% OF BREAST CANCER PATIENTS TESTED FOR MSI/DMMR IN PAST MONTH

Which oncology companies are leading the way?

In both the US and EU2, our oncology panel physicians consider Roche/Genentech to be the leader in oncology research and

development. Although its anti-PD-L1, Tecentriq®, launched substantially later than Opdivo and Keytruda, Roche/Genentech’s

considerable oncology portfolio and strong pipeline keep it at the forefront of perceived innovators. BMS follows, based on the

early success of its anti-PD-1, Opdivo. Although perceptions of MSD/Merck lagged behind BMS at the time the research was

conducted, a recent series of rapid approvals for its anti-PD-1, Keytruda, are likely to enhance perceptions. Novartis rounds

out the top four companies mentioned for its ongoing dedication to cancer treatment (see Figure 13, over).

Source: Ipsos Healthcare Oncology Monitor Panel: data collected online in US (June 2017); Base = 75 physicians

YES: 48%NO:

52%YES: 48%

(n=36)

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I P S O S H E A LT H C A R E

Figure 13: Perceived leaders of Oncology R&D

Figure 14: Top companies with FDA breakthrough designated therapies as of March 2017

As of the end of March 2017, data from Friends of Cancer Research reveal that the FDA has designated 170 drugs as

breakthrough therapies since the program’s inception in 2012xi. Of these, 32 cancer drugs have achieved FDA approval.

Unsurprisingly, the companies perceived to be leaders in oncology R&D have secured the greatest number of breakthrough

therapy designations, as seen in figure 14.

RANK COMPANY # of Breakthrough Therapy Designated Products Overall

# of Breakthrough Therapy Designated Products in CANCER

1 Roche/Genentech 15 8

2 Novartis 11 6

3 BMS 10 7

4 MSD/Merck 9 7

5 Pfizer 7 5

6 AbbVie 7 3

Roche/Genentech

Bristol-Myers Squibb

MSD/Merck

Novartis

Pfizer

Amgen

Janssen

75%

62%

57%

44%

33%

16%

28%

24%

14%

15%

16%

16%

4%

38%

Source: Ipsos Healthcare Oncology Monitor Panel: Data collected online in EU (Jan 2017) and US (May 2017); Base = US: 97 physicians EU: 50 physicians

Source: Breakthrough Therapies, Friends of Cancer Research https://www.focr.org/breakthrough-therapies

% O F P H Y S I C I A N S

US 2017

EU 2017

Asked on an unaided basis; major/multiple mentions

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13

What does the future hold in store?

The global oncology market exceeded $100 billion in 2015, with sales potentially reaching $150 billion by 2020xii. Yet, there

are many unknowns looming on the horizon, including:

• Ability of facilities to take on ever more complex manufacturing processes, as well as equipping hospitals to administer

these new therapies

• Skyrocketing drug prices, potentially limiting access to life-saving medications

• A paradigm shift in treating metastatic cancer more as a chronic condition as many patients are living far longer

• The impact of biosimilars

• Appropriately screening for the multitude of known biomarkers, and those to be identified

Yet, despite all the answers we are still seeking, we’ve come so far since the initial discovery of anti-cancer drugs, and in

a relatively short space of time. The pace of advancement has never been more rapid than it is today. The future is very

exciting – will the next generation treatments finally enable us to triumph in the fight against cancer…?

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I P S O S H E A LT H C A R E

About the Research

This paper incorporates data and information from the Ipsos Global Oncology Monitor, the Ipsos annual ASCO perceptual

questionnaire*, the Ipsos MSI assessment** and other third party sources.

* 97 completes from Ipsos US Oncology Monitor Panel in May 2017

* 50 completes from Ipsos EU Oncology Monitor Panel in Jan 2017

** 75 completes from Ipsos US Oncology Monitor Panel in June 2017

All data was collected online. © Ipsos 2017, all rights reserved.

References

i Rare Cancer Alliance. 2011. Cancer History. [ONLINE] Available at: http://www.rare-cancer.org/history-of-cancer.php. [Accessed 27 July 2017].

ii American Cancer Society. 2014. Evolution of Cancer Treatments: Chemotherapy. [ONLINE] Available at: https://www.cancer.org/cancer/cancer-basics/

history-of-cancer/cancer-treatment-chemo.html. [Accessed 27 July 2017].

iii National Cancer Institute. 2015. Milestones in Cancer Research and Discovery. [ONLINE] Available at: https://www.cancer.gov/about-cancer/treatment/

research/first-treatment-vaccine-approved. [Accessed 27 July 2017].

iv HemOnc.org. 2017. Medications by Year of Approval. [ONLINE] Available at: https://hemonc.org/wiki/Drug_index#Medications_by_Year_of_Approval.

[Accessed 27 July 2017].

v FDA. 2017. List of Cleared or Approved Companion Diagnostic Devices (In Vitro and Imaging Tools). [ONLINE] Available at: https://www.fda.gov/

MedicalDevices/ProductsandMedicalProcedures/InVitroDiagnostics/ucm301431.htm. [Accessed 27 July 2017].

vi The Centre for Biosimilars. 2017. Truxima Receives Approval in EU for Autoimmune, Oncology Indications. [ONLINE] Available at: http://www.

centerforbiosimilars.com/news/truxima-receives-approval-in-eu-for-autoimmune-oncology-indications. [Accessed 27 July 2017].

vii American Cancer Society. 2017. Cancer Facts & Figures 2017. [ONLINE] Available at: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-

facts-figures/cancer-facts-figures-2017.html. [Accessed 27 July 2017].

viii PhRMA. 2015. Medicines in Development for Cancer 2015 Report. [ONLINE] Available at: http://www.phrma.org/report/medicines-in-development-for-

cancer-2015-report. [Accessed 27 July 2017].

ix Jacob Plieth & Edwin Elmhirst, Evaluate Group. 2017. PD-1 / PD-L1 Combination Therapies (PDF). [ONLINE] Available at: https://www.evaluategroup.com

x American Society of Clinical Oncology. 2017. Advance of the Year: Immunotherapy 2.0. [ONLINE] Available at: https://www.asco.org/research-progress/

reports-studies/clinical-cancer-advances/advance-year-immunotherapy-20. [Accessed 27 July 2017].

xi Friends of Cancer Research. 2017. Breakthrough Therapies. [ONLINE] Available at: https://www.focr.org/breakthrough-therapies. [Accessed 27 July 2017].

xii QuintilesIMS. 2016. IMS Health Study: Global Market for Cancer Treatments Grows to $107 Billion in 2015, Fueled by Record Level of Innovation.

[ONLINE] Available at: http://www.imshealth.com/en/about-us/news/ims-health-study-global-market-for-cancer-treatments-grows-to-107-billion-in-

2015-fueled-by-record-level-of-innovation#. [Accessed 27 July 2017].

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