The Financial Future of Follicular Lymphoma

Every now and then, when I'm doing research on Follicular Lymphoma, I'll come across a report from a financial firm that discusses how a particular lymphoma treatment is going to have an effect on the company's stock price. Most FL treatments are offered by large pharmaceutical companies, and it seems like smaller companies that develop new treatments will partner with bigger ones or sell the rights to a treatment to a big one. Our health is a big business. There's no way around that.

I came across one of those articles this morning -- "B-Cell Non-Hodgkin’s Lymphoma Treatment Market Will Stutter to $5.45 Billion by 2024, says GlobalData" -- published by ETHealthWorld.com. I'm no finance expert, so I can't say how accurate the report is, but I think it raises some interesting questions for us as patients.

According to the report being discussed in the article, the value of the B-Cell Lymphoma treatment market in 2014 was $4.35 billion. It is expected to reach $5.45 billion by 2024. That represents a compound annual growth rate of just 1%.

In other words, if you were hoping to make some money by investing in companies that produce treatments for B-Cell lymphomas (including Follicular Lymphoma, but also including a bunch of other lymphomas), you probably aren't going to make much.

Now, I personally don't have any extra money to invest (that's what happens when you spend your free time researching and writing a blog but you're too dumb to attach sign up for Google Ads to make a little money off of it). I'm much more interested in what the analysis might mean for my health.

According to the report, the growth is going to be very slow in seven major markets: the US, France, Germany, Italy, Spain, the UK, and Japan. One big reason is because Rituxan's patent in the US will expire in September, and a biosimilar should be available in all seven countries by 2018. This means that biosimilar versions will be allowed to be sold -- stuff that isn't officially Rituxan, but that was made in the same way and that will (or should) act the same way, but for less money. (It will cost less because they companies making the biosimilar didn't have to spend all of that money researching and developing and marketing Rituxan.)

The article also points out that Bendamustine and Lenalidomide will have generic versions introduced in those countries at different times between now and 2024. (I don't have information about when that might happen.)

Finally, the report says that "no late-stage drugs in the NHL pipeline are expected to achieve blockbuster status, as rituximab-based chemotherapy regimens are gold-standard therapies that dominate the NHL treatment algorithms across both indolent and aggressive forms of the disease." To be clear, this doesn't mean that there are no new treatments becoming available soon -- there are lots of them. But there are no "blockbusters" -- no treatments that will overwhelm everyone and have oncologists insisting that everyone has to take them and make investors lots of money. That's not a big surprise -- we can't decide what the best first treatment is for Follicular Lymphoma, even with the ones we have.

So what does that all mean for us as patients?

Let me say again, I'm no financial expert. And I'm not a medical doctor, either, so this is just guessing.

In the US, anyway, there is still lots of disagreement over health care, and the best way to deliver it for the least amount of money. (I know other countries have this same disagreement -- it costs a lot to stay healthy.) So I would guess that insurance companies or governments or whoever pays for health care in different countries will push the cheapest possible treatments. If biosimilar or generic versions of Rituxan and Bendamustine become available, does that mean that we will see B + R being pushed more often? That's not necessarily a bad option -- it's an effective combination, with less toxicity than R-CHOP. And we've seen lots of good stuff about Lenalidomide in the last few months. If that also gets cheaper in the next few years, and we keep seeing strong results from clinical trials, maybe we'll see some kind of R-squared + Bendamustine combination getting more popular?

Of course, this doesn't mean that other treatments won't become available, or that doctors won't prescribe them. But it might mean that those other treatments will need some help in showing how effective they are, and that means more patients signing up for clinical trials. I actually spent a little time a few days ago looking up trials that were near where I live. I found about 8 really interesting ones that I would qualify for. I don't expect to need treatment any time soon, but every now and then, I like to know what my options are. I learned about a couple of new treatments in the pipeline. It was a fun night in the Lympho Bob household. Hot chocolate and cancer clinical trials. (If you want to join in the fun, Lymphomation has lots of information and links to easy tools for finding trials.)

Because, really, the only way for anyone to know how good certain treatments are is to have them tested in trials. We may not like to think about it, but our health depends on other peoples' money. Some people have to make money in order for a treatment to become available. Other people have to save money in order for treatments to get to us. We're stuck in the middle. The least we can do is help make more treatments available and give them something to fight about.

As I said, all of this is guessing, certainly from me, but really, also from the financial analysts who are trying to figure out how to make money off cancer. They can only guess about how well certain treatments will do in trials. Sometimes a trial surprises us and has results that are much, much better than anyone expected.

Maybe we'll get lucky and there really will be a blockbuster. It works on lots of patients, and economies of scale mean that it becomes cheaper because it is so popular. The investors win, the money savers win, and the patients win.

If that happens, I'll smarten up and start letting in advertisements. I'll need a little extra cash for investing.....