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Beyond Medicine: Solving Disparities in Cancer Care · Making Medicine

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You're listening to Making Medicine Stories from the Early Stage Life Sciences Ecosystem, a
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podcast that explores the people and deals that have led to the medicines, devices,
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and technologies that keep us healthy. Let's get into the show. Hello,
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this is John Stanford, the host of the Making Medicine podcast. We're
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thrilled to have Mohit Monrau, the senior vice president of US Oncology at Astra
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Zeneca, one of the world's leading pharmaceutical companies, with us today to talk
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about his journey in the industry, his perspectives on developments and oncology, and
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insights on the future of the industry, particularly in a post inflation Reduction Act
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world. Mohit, thank you so much for being here today. Thank you
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John for having me. It's my pleasure to be on your podcast. Our
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listeners always like to sort of envision themselves and their roles in this industry,
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and they're intrigued by how our guests came to be where they are. You
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certainly have a critical role not just for industry but for pays leading US oncology
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at a company like Astra Zeneca. Can you tell us a little bit about
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your career leading up to where you are today. Yeah, sure, John,
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Let me go back to my days when I was growing up in northern
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part of India. You know, I was as a child always dreamed of
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becoming a doctor because in my family, I had one uncle who was a
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doctor and he used to run a hospital where I saw him taking care of
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people from different backgrounds, different socioeconomic status and those who were in need of
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medicine and care. That always inspired me. But also I came from a
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family of engineers, so as I grew up, my passion for cars and
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engines took me into mechanical engineering and from there I joined the industry and did
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different kinds of work in international business from Indian company before I went back to
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school for my MBA and that's where astra Zeneca was on campus, and I
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took that opportunity to come back to my original dream of wanting to help people,
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if not by being a physician, by at least being in pharmaceuticals and
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being focused on developing medicines and interventions for patients to have better outcomes. And
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since joining AstraZeneca in two thousand and twelve, I have lived and worked in
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Japan, in Europe, in our global operations as well as now in US
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across different therapy areas, and my global experience has furthered my appreciation for the
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fact that no two patient journeys are same and that what one person has access
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to another may not even know exists. So in my different roles, whether
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it was head of UK Oncology or head of our alliance with that Sancho in
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Europe, or even my global franchise head for lung cancer, and now this
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role, I take the opportunity to take the learnings across the globe and really
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put them channelize all of that into having patient impact. And this is something
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which I'm very passionate about. Well, I think that that patient centricity is
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something we talk a lot about. Even though this is sort of it.
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The voice of the investor community is as well as early stage biotechs all the
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way to companies like yours. Something that often comes through through our guests is
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that is that patient center journey. And it's clearly you bring that not just
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from your global role but now into leading US oncology. So this may come
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across as a dumb question, but you know it's a big title. Senior
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vice president for US oncology. What does that entail? What kind of roles
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and responsibilities is your day to day? Like, it's simple. I keep
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telling people that we go to multiple conferences, like we just came back from
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ASCO not that long ago, and we see some great advancements in science which
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brings the promise of transforming care for patients. But those are pennaries and standing
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ovations that do not change practice for a specific individual, you know, living
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in Nashville or living in Atlanta. Right, We've got to really ensure that
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we are able to transform that science into practice into care for every individual irrespective
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of where they are or what their zip code is. And to me,
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that's the work me and my team do here. We as we look at
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our us oncology business and are expansive oncology portfolio, our goal is to bring
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the science that are our scientists and innovators and our collaborations develop to every individual
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patient irrespective of their socioeconomic determinants as well as really personally, for me,
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another goal is to think about, while we push the boundaries of science,
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how are we and me personally developing the change makers of future that can help
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help take our patient centric goals to the next level. So though the title
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may sound too big, but our jobs are simple. We need to help
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patients and that's why we exist in this industry. Well, I think that
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title matches the excited audacity of a a goal. You recently announced that AstraZeneca
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announced a goal launching fifteen one five new drugs by twenty thirty and I think
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that is ambitious and exciting for patients. Can you tell us a little bit
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about that goal and what makes you excited about what it means for patients and
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if in particular cancer patients. It's very easy. I am most excited about
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delivering life saving treatments to patients and two people living with cancer giving more moments
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with their loved ones. And this is this goes hand in hand with what
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goals we have at AstraZeneca in oncology is to really aim big and ultimately eliminate
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cancer as a cause of death. With that, when at Astrozenica we think
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of launching fifteen new drugs, you know, it's not every day that we
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get to deliver a new treatment, but it's something we work towards tirelessly and
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we strive to stay at the forefront of science and innovation. I think in
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the last years since we committed to oncology as a priority, we've we've covered
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a lot of distance, and I'm excited about how this commitment will benefit people
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and they loved ones who are battling with cancer now. But at the same
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time, science alone doesn't make for healthy people. We've got to look beyond
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the medicine to ensure that people we're hoping to treat and health have access to
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medicines we're developing for patients with limited resources, you know, expanding access to
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existing treatments as the potential to improve quality of life and increase and support better
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health outcomes. And that's something that we are really working towards and passionate about.
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And one of the things I get very inspired and excited with is the
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deeper focus that not only us at EASY have, but now are you the
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industry is having on solving for disparities in care, solving for health equity,
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and bringing everybody along irrespective of as I was saying, their zip code.
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Is something that is very sighting. As we enter this next chapter of launching
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fifteen new drugs plan that we have for AstraZeneca by twenty thirty, well,
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I think realizing that goal. You know, there was a piece just recently
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in the New York Times magazine about this golden era of drug development. We're
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living in new modalities, whether they came out of COVID or otherwise. And
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I'm sure that plays that new science plays a role in this idea of bringing
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those drugs to market. And so you know, the winds that are back,
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to be sure from an R and D standpoint, But what headwinds are
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there? What's keeping you up at night that you might not reach that goal
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and you might not be able to make that meaningful difference in patients lives.
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Yeah, there are always multiple challenges when you go on a board journey.
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Amongst a few I would highlight is like we go to focus on sustainability as
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an industry and as a company. We are absolutely putting sustainability at the heart
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of it. We believe and from our end, sustainability is around three key
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priorities. Ensuring healthy people, ensuring we support a healthy planet, and we
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are having a healthy society. So working on to improve health of people is
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our business. But at the same time, if we aren't reducing our environmental
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impact and not solving for the climate change then we are perpetuating a negative impact
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on health outcomes. So that sustainability and focus on healthy people, planet and
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society is an integral part of it, which is a challenge as we think
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of the industry and the world we are going towards. So we've got to
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make that a priority in the industry and asset. As xenecame, I think
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the second thing to your point that keeps me awake at heights as I've worked
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in different parts of the world. As I was alluding to on the gaps
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in care as well as disparities in care and access that exists, the access
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to innovation at the pace at which different countries got access to innovation was very
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broad. Right where American patient could actually quickly get access to innovation because of
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the right incentives and systems in place, there were many countries where it took
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quite a while for those things to happen because of the systemic barriers that existed.
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And with IRA and I'm sure you guys have covered that topic in depth.
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There are some great things within that that would help patients get the right
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care, but then there are things that would get the unintended consequences that would
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get in the way of innovation and potentially to that big goal, get in
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the way of innovating in some of the therapy areas that could have lead to
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poor or outcomes for patients in the longer run because lack of innovation happening.
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So there are those spaces that keep me awake in night and ensuring how do
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we put the patient perspective, the science perspective, the innovation perspective front and
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center in front of policymakers so that we are having that conducive environment for science
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to make constantly make progress and for the environment to constantly ke based with that.
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Well, you're certainly right that the IRA or the Inflation Reduction Act is
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something that we've talked about with a number of folks, patient advocates, small
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drug developers, now a large company like yours, and it is those unintended
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consequences that seem to keep us all up at night. You know. Astra
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Zeneca recently had data presented at ASCO, the American Society of Clinical Oncology meeting,
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and most of us know as ASCO, and you know, there's been
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talk about some of the post approval studies on an existing small molecule therapy can
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you talk a little bit about you know, small molecules have been in the
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spotlight a little bit with this disincentive to some extent that comes out of the
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Inflation Reduction Act. How does the life cycle for a small molecule cancer drug,
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how's it upended potentially by the provisions of the IRA. Yeah, I
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think there are multiple aspects to it, and let me let me take one
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at a time. So starting with you talked about small molecules. The rule
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of when you become eligible for price setting on nine verses for a biologics at
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thirteen years is kind of putting a barrier in for what you would want to
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do as you uncover and bring the small molecules with the first indication and understand
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where the science goes, because you know, you may be at year three
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of a small molecule as you uncover, yes it works in a specific area
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in a late line cancer setting, and you're moving it into earlier setting.
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But if you are having an uncertainty on what happens at year nine for your
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drug, you've got competing priorities for that investment of you know, a few
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hundred million dollars of a phase three investment going into that small molecule for that
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specific versus a different place. So you know that that's the reality, and
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that's a rational question to ask, as this nine versus thirteen rule brings in
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different dynamics, and I would kind of put two more lengths to this one
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is you know, small molecules in many ways are also helping solve for inequalities
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because when I'm out in the field and I'm meeting patients and I'm meeting physicians,
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I end up so many times listening to physicians about patients adherence challenges,
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patients affordability challenges, not only from drug and insurance perspective, but also because
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coming in for infusion every two weeks or even every four weeks when they live
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in outskirts and they don't even have, you know, care for their children,
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but also to look for when they aren't spending half a day in the
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hospital or for example, of old rights to come in and go back to
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their homes. You know, you're putting more burden versus small molecules tablets that
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actually could be taken at home and do not have that kind of intensive visit,
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Thus improving adherents and affordability and removing different barriers and thus better outcomes.
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So there are there's going to be a knock on effect on health equity but
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also on life cycle development of those drugs. As we talk about it at
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the same time, you know there are and I talk about cancer and this
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is how it is within the IRA. It's framed, even if it's for
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a small moleculate nine years those which are orphan drug And if we go back
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to when Orphan Drug Act was put out, it was to create the right
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incentives to solve for rare diseases, right, and if you think from where
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out of from thirty eight approvals, that act led to six fifty plus approvals,
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many of them were in rare cancers. Actually, fifty percent of orphan
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drug designations came there, which means it was a huge progress made when the
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right incentives were put in to really support patients with those rare diseases. Now,
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what the IRA lays out is if you are a orphan drug in one
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disease, even with multiple indications for that disease, then you are not into
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that price setting at whatever x years religible. Now the question is the life
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cycle doesn't work like that. You develop a drug in a third line setting
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or late line setting. Then you you know, you understand it works,
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you move it into you earlier line setting and potentially into curative line settings,
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and it takes years. Now, if your clock is running against you,
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what is the incentive to keep going there into different orphan diseases as you learn
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more? So again there may be there may be rare diseases for which there
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could be potentially a drug that should be tried out, but it would compete
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for investment selfware. So those would be the knock on effects again on rare
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diseases an orphan way, we know so many of themselves do not have an
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appropriate treatment or the right treatment to move the outcomes forward. So I think
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those are real areas of concern as it relates to patient outcomes, as it
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relates to innovation. And one last thing I'd like to mention, which is
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which is really interesting because the more we talk about or go to eliminate cancer
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as a cause of death, the more we talk about going into curative settings,
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the more longer the trials take. So I'm giving you an example for
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a pop inhibitors of ours laperev. We started a breast cancer early stage trial
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that took eight years to read or the data we presented for tigristo at asco
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with overall survival in early stage adduans setting for the first time for lung cancer
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egf OUR patients, it took eight years to come through. And again you
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imagine these are small molecules. You're making that investment when you don't even know
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these drugs work in late lines or they would be able to move the needle.
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And in future these readouts are going to take longer and longer. So
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all these do not stack up to create the right incentives in view of where
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we want to go with cancer moon shot or driving cures in this disease.
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So I think we need to pause and relook at whether over the next decade
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this will just save costs per se, and again there's a huge debate on
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it, or it will also get in the way of innovation. So again,
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yes, there are elements which are really good in IRA, which is
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all about patient out of pocket caps and this is great and we need to
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also support in ensuring that that is pulled through well. But then there are
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challenges of unintended consequences on innovation and investment behind life cycles as well as small
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molecules and curative treatments that would be challenging over the next ticcade. That was
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an incredible answer, to be quite honest, I hope that especially our policymaker
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listening audience, so play just that section back a couple of times, because
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there's a lot to unpack there. But I think you said it very eloquently
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because you actually really brought a third piece to this table. We have this
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traditional debate in Washington over innovation versus access, and I think those camps are
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well defined, and I think that the merits of ensuring people can access their
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medicine. You know, Incubate strongly supported the pro patient reforms there but also
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hinted at or shouted from the rooftops that this is going to come at a
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cost. But what I think came through while I was listening to you there
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is there's an additional element, and that's a practical one. And when you
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look at something like small molecules and their ability to address populations that don't have
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a clinic, that don't have a hospital right around the corner, you know,
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and it's not really a zero sum game. We're going to now have
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to think about things like adherents of a tablet versus missing one of those infusions
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because your kid was sick at school or because you couldn't get a ride to
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the clinic. And I don't think it's been fully appreciated by policymakers just how
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amazing small molecule products are and what they allow us to do to stay out
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of a clinical setting, and what that does mean for affordability. I also
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really appreciate it almost completely separate Vein, but it makes complete sense now that
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you've said it, for us to tackle that incredible goal of eliminating cancer as
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a cause of death, it is going to get harder and harder and harder,
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and these trials are going to take longer and longer and longer. And
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that's just working in the complete opposite of the new environment, which says if
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you can sort of rush to market, you'll be okay, but if you've
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got a longer tailwind, it might not be as beneficial from a financial standpoint,
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which of course leads to worse outcomes for patients. So I just want
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to really thank you. I'm half of all of our listeners for unpacking what
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is three or four different aspects of the inflation Reduction Act what it means for
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orphan drugs as well. Yeah, and Joan, this is and I just
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relate back what I see challenges not only from our side, but from patient
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perspective. And we would at ASCO and we had a patient advocacy event maybe
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had seventy plus representatives from you know, forty plus patient advocacy groups. And
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one thing that was said there which actually I'll talk about two, which was
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you know, which when you put in that context, really gives you,
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you know, chills that oh my gosh, that these are the unintended consequences,
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and why it is so important for us to work together with all the
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stakeholders, especially CMASS as they implement these things, that those are not overlooked.
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So one was around the orphan drug as you as you talked about like
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if you're negocy or it's not negocy, it's a price setting happens at year
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nine, right, and you start in again a very small I'll give you
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an example again of la perev. The first indication was orphan drug with only
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two hundred three hundred patients eligible for so many years till the next one came
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in. It's rational to pause and thing do you want to launch and start
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your time at that versus actually develop further and get to a substantial because your
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clock is starting right. And one of a patient advocacy groups individuals said,
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just imagine that you had American patients had to go to Japan to get that
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treatment because rationally speaking, farmer decided not to launch it here just because the
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incentives were laid differently, And that's alarming. And second thing was all around
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like if we're all in for out of pocket medicare caps to two thousand dollars
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and smoothening of it, but if you go deeper and read through, you
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got to opt in and then if you miss out one single payment, you
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could be kicked out right for life. Now that that is, you know,
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these are patients who we're trying to help affordability and there is a chance
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that they may miss out on a payment because of where they belong in the
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in the federal party, you know limits. So from that perspective, those
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things need to be pulled up. And those things are realities that hit patients
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but cant get lost in thousands of pages of you know, stature and guidance.
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So it's very important for us all to collaborate and work with stake does
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to ensure that innovation, patient centric city patient outcomes do not get lost in
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the broader scheme of things where there are unintended ones agun system Well, I
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think that point at the end there. Look, Congress put in this legislation,
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this fast forward button on implementation. But I think you said something that
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I don't think a lot of people are talking about we all. I mean,
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I have to look hard for someone who's opposed to patient smoothing. You
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know, it makes so much sense and it does hopefully solve an access issue
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and affordability issue. But like you said, the devil's in the details here
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and with these rushed ones. When I talk with patient advocates, it seems
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like this is all moving very very fast, and we haven't thought this through,
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and that someone could be kicked out of the program that was designed to
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benefit them. It's concerning to be sure that even the pieces of this legislation
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that could have beneficial impact, we got to still put them together in the
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right way. You know you mentioned can we even imagine going to Japan?
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I had the pleasure of touring some bio manufacturing sites in Japan as they hope
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to emulate, you know, America's successful life sciences industry. And right next
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to their airport Hanada, they have built a huge hospital and what they're for
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medical tourism. And just now you sang that almost gave me chills because when
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they told me they were building it, of course they were building it for
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populations coming out of Asia that would come to Japan. But can we even
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envision putting ourselves in a place where Americans would have to go do medical tourism
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in Japan in order to access things because of these incredible disincentives to launch across
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different populations. Now now you've got the wheels of my brain really turning on
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this one. Yeah, but these are realities, and these are rational things
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that will take a pause. And this is something which I mean, I
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was at the hill yesterday as well. We are working closely in putting our
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our views and our comments into CMSs, you know, input their vast for
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we all got to hold hands and work around this so that we are able
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to really protect innovation, patients, access and outcome that that would get affected.
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And as you said, devil is in the detail, and I can
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tell you amongst those seventy or you know people that we spoke to at ASCO
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with patient advocacy leads, they do not have the resources and time and being
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able to go into depth of these things because they are already stretched too thin
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on other things they are serving for patients. So again we've got our work
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to be, you know, to do in this space. Well, I
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think we can add advocate then just as much to that title of yours.
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I think that's a great place to leave it. His Mohit man Rau.
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He is the senior vice president of US Oncology Astra Zeneca. We are so
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grateful to him and the team at Astra ZENECAI. You know I'm taking away
24:06
from this eliminate cancer as a cause of death. What an incredible goal to
24:10
work towards. We're so grateful that you took a little time out of the
24:12
day to join Incubate for our Making Medicine podcast. As always, you can
24:18
get more from Incubate and keep pace with things like the small molecule penalty and
24:22
some of these disincentives coming out of the Inflation Reduction Act and how you can
24:26
get involved at www dot Incubate Coalition dot org. As always a special thanks
24:33
to my colleagues Ashton Roberts and Grace Monster in making of today's podcast. As
24:38
always, keep innovating you've been listening to Making Medicine. To ensure that you
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