As Asian medical markets grow, so do bio opportunities
Expo: BioTaiwan Exhibition
The Asian medical market is booming. McKinsey predicts that Asia will become the second highest medical technology market in the world by 2020, and it could account for a third of global sales by 2025. The opportunity is great, and with good reason. Until the last decade, many Asian countries were largely underserved by pharmaceutical companies and medtech providers.
Carl Firth, CEO of Singapore-based ASLAN Pharmaceuticals, worked at AstraZeneca for 10 years before founding his biotech company. He said that until recently, it was very difficult to pitch drug development concepts for diseases that made relatively little impact in the West.“Back 10 or 12 years ago in Big Pharma, I remember if you were proposing a drug for a disease where there were 10,000 patients in the U.S., the commercial team would just laugh at you and it would be very difficult to get that investment required, which is unfortunate,” Firth said.
However, he said “there has been a sea change” in the pharmaceutical industry and that major pharmaceutical companies are now more interested in developing treatments for Asia-prevalent diseases. “We saw this huge unmet need,” he said of ASLAN Pharmaceuticals. “For many, many years, Big Pharma really just wanted to focus on diseases in the West,” particularly those impacting the U.S., Europe, and to a lesser extent, Japan. “Recently, that’s started to change and many companies now are pursuing diseases like gastric cancer, which is widely recognized to be a problem in Asia but also in the West.”
Targeting Asia-prevalent diseases
Fredrik Nyberg, CEO of the Asia Pacific Medical Technology Association (APACMed) witnessed a similar evolution in thinking about the region. “Asia-Pacific used to be very much about Japan, then China, but not much else,” he said. “Then about five years ago, Asia-Pacific started to represent 15-20% of global revenue for many of these [medtech] multinationals. Then all of a sudden, you hear discussions in boardrooms in the U.S. and Europe mention Indonesia and Vietnam and India.” The potential for growth in the region also garnered interest, along with indicators of rising need. Among the latter is the increase in non-communicable diseases, such as stroke, diabetes, and cancer, according to Nyberg.
Lung and breast cancers are among the most common cancers in Asia, as they are in the U.S. However, stomach, liver, and biliary tract cancers are also highly problematic here. Firth noted that the high rates of stomach and liver cancers in Asia are often due to diet and environmental factors. He offered the example of South Korea, which suffers the highest rate of stomach cancer in the world. Firth attributes this to frequent consumption of kimchi, a fermented dish served with most meals there. While he noted that consuming kimchi a few times a week is likely healthy, eating it several times a day repeatedly exposes the stomach to inflammation, which can cause cancer to develop over time.
High rates of liver cancer in China and Taiwan are often linked to Hepatitis B, he said, while some factors are purely biological. For instance, the bacteria helicobacter pylori (h. pylori), which can cause stomach cancer, tends to be a more aggressive strain in Asia than in the West, Firth said. He also said that cancers behave differently in patients throughout the world. “Often, the molecular pathology, the bits of molecular machinery that are dysfunctional and that causes the cancer, is different in Asia than it is in the West,” he said.
The market for drug treatments for Asia-specific cancers is vast, particularly in areas such as biliary cancer. The disease impacts only 8,000 U.S. patients each year but 220,000 in Asia. Firth said that although there are still “huge areas of unmet need” with regard to treating breast cancer and other globally prominent diseases, there are at least targeted treatments and life-extending options for many of the most common cancers.
However, there are currently no treatments on the market for biliary tract cancer. Patients may be eligible for a surgical resection if the cancer is found early enough but Firth said that in many cases, symptoms present at a very late stage, which means that’s not an option for most people. Patients who are not eligible for surgical resections can try standard chemotherapy, though most either opt out of a second round or are denied the option due to the grim prognosis.
ASLAN is attempting to address this problem by developing a drug treatment specifically for biliary tract cancer. The company launched a study earlier this year in partnership with an American cancer center after consulting with the FDA on what results would be needed to get the drug approved. The study includes 120 participants and will span two years. “We’re hoping at the end of our study to demonstrate that our drug can provide patients with benefits above what they would normally receive with biliary tract cancer,” Firth said.
The company is running a study on a potential treatment for hepatocellular carcinoma as well, a type of cancer often associated with liver disease and which also typically doesn’t show symptoms until it’s reached an advanced stage. ASLAN is also developing a drug for cholangiocarcinoma, a subset of biliary tract cancer that is often associated with parasitic infections and is most common in Asia. In northern Thailand, which has the world’s highest rate of cholangiocarcinoma, people often contract liver fluke parasites from eating undercooked fish. The parasite finds its way to the biliary tract and can live there for decades, causing chronic inflammation that eventually leads to cancer. However, the causes for cholangiocarcinoma also vary by region, Firth said. He noted that rates are also high in Japan, though the disease does not seem to be linked to parasitic infection there. There are currently no targeted treatments on the market for the disease.
Regulatory challenges persist, but also need and opportunities
As the APAC market grows, both biotech and medtech companies face unique challenges given the vast range of socio-economic circumstances in this part of the world. “Part of the challenge is that it’s such a diverse region,” Nyberg said. “Of course, you have some of the richest markets in the world with the most sophisticated healthcare systems, in Singapore, Japan, and Australia. And of course you have some of the world’s poorest economies with the most undeveloped healthcare systems, like Myanmar and Laos and Cambodia, and then you’ve got the whole spectrum in between. And that creates challenges as well as opportunities.”
One of the major challenges is navigating regulatory standards across such a diverse collection of countries. Both Firth and Nyberg noted that China has traditionally been a particularly complex country for drug development due to its strict regulatory policies and its reticence to approve drug trials without a strong body of evidence that the drugs would work for its population.
Firth said that approvals to begin trials in China have taken up to 18 months, but he noted that the situation is improving. ASLAN Pharmaceuticals recently received approval within six months, and there’s talk of the timeline dropping to two months, he said. “The regulatory environment is still a moving piece, but it’s definitely moving in the right direction,” he added.
Nyberg said APACMed has worked with medical tech companies and government regulators throughout Asia to create and improve regulations that will allow more people access to needed medical devices. He said that inconsistency among legal standards has presented problems for medtech companies in the past, but that there have been increasing moves toward collaboration and standardization among regional countries. An example is the ASEAN Medical Device Directive, which seeks to harmonize legislation among the member states.
Another consideration both biotech and medtech companies must make is developing products that serve not just wealthy patients in wealthy countries, but a broad range of patients who can afford little more than generic drugs and low-cost supplies and therapies. “Large groups, hundreds of millions of people in say, India, China, and Indonesia haven’t had access to quality healthcare,” Nyberg said. That’s changing as new healthcare systems and policies come into effect, he said. But many of those previously underserved people still aren’t going to buy top-of-the-line, cutting-edge products. Therefore, some companies are tailoring their offerings according to different populations and the types of products they’re likely to buy. Firth noted that because ASLAN is developing oncology drugs for Asia-prevalent tumors, it will be able to adjust its pricing according to different Asian markets more easily than large pharmaceutical companies selling widely used drugs throughout the world. A company selling a common breast cancer treatment will have a difficult time selling at one price in China and another in the U.S., he said. But ASLAN will have more flexibility because the diseases its targeting are especially common in Asia.
Nyberg said APACMed hopes to reduce the timeline for regulatory approval by better leveraging clinical data and working with regulators to bring affordable devices and treatments to patients that much faster. He anticipates ongoing growth in the region, including increased interest from medtech and biotech companies, as well as the evolution of the regional medtech industry.
"Growth rates in this part of the world are going to continue to be far greater than growth rates that you'll see in any other part of the world, whether the U.S., or Europe or Latin American," he said. "So I think companies will continue to focus on Asia-Pacific, and that's of course exciting."
- Forbes / Asia / Biotech -
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