Drug development for cancer prevention: opportunities and challenges

Despite some notable successes, there are still relatively few medicines approved for cancer prevention in healthy individuals. Here we review progress thus far in the development of medicines for cancer prevention and summarise the challenges faced in this space. Furthermore, we outline some key concepts that could further enable or accelerate drug development for cancer prevention in the future. These are summarized under six key themes: (i) unmet clinical need, (ii) patient identification, (iii) risk stratification, (iv) pharmacological intervention, (v) clinical trials, and (vi) health care policy. These concepts, if successfully realised, may help to increase the number of medicines available for cancer prevention.

Comments from chat:

David Colquhoun: What you need is an acceptably low false positive risk. For conditions with low prevalence (as when screening people who aren't ill) that requires VERY high sensitivity and specificity
John Mellnik: It begs the question how the prevalence of nonmalignant cancers compares to malignant. Two orders of magnitude?
Jack Scannell: I need to head off, but this was a really interesting and thoughtful talk. Thanks so much. It reminds me of the more general problem around investing to optimize the use of cheap old generic drugs. It may be that prevention economics could only work with drugs that are old and off patent, in which case private sector R&D investment will be hard to attract. Maybe NIH, NIHR, etc., are the natural sponsors of this kind or work?
John Hickman: HPVvaccines cost $250 per dose
David Colquhoun: Surely the thinking behind pricing is this: people will pay anything if they think that it may prolong their lives