The Reluctant Symbiosis of Companion Diagnostics

In nature, the rhinoceros and oxpecker have a perfectly symbiotic relationship. The rhino provides ticks for the bird to eat and the bird chatters loudly at the approach of danger. In Swahili, the oxpecker is known as "askari wa kifaru," the rhinoceros guard.

In healthcare, a symbiotic relationship between diagnostic and pharmaceutical companies makes perfect sense. Pharmacogenetic tests can guide the development and application of new drug therapies. But the relationship doesn't come naturally.

The pursuit of personalized medicine should be driving new relationships, but a recent report by PricewaterhouseCoopers (PWC) found that partnerships around companion diagnostics are slow to develop. Between 2004 and 2008, only 45 such partnerships were formed, with 21 of them relating to cancer.

Big Pharma is the greatest collaborator to date, mostly focusing on cancer. Funding remains strong for cancer research and resulting drug therapies are high-ticket items. Companion diagnostics can help prove effectiveness and guide treatment, especially given the role of genetics in cancer progression.

Why aren't more relationships progressing?

Diagnostics companies are hesitant to devote the resources required to develop companion diagnostics. Often their focus remains on clinical laboratories, their customary target and proven source of revenue. If they do pursue companion diagnostics, the preference is to go it alone and retain the value of the diagnostic within their own company.

According to Ted Snelgrove, who guided the development of the highly successful Oncotype Dx® breast cancer assay, development is difficult and expensive. Success for a test that costs more than $3,000 requires a strong value proposition and persistence. It is especially challenging when pharma partners prefer to keep more than 90 percent of revenue generated from companion diagnostics, leaving a small remainder for innovative diagnostic companies.

Will diagnostics and pharma become more like the rhino and oxpecker? I believe so. But the dynamics governing the relationship promise to be complex. Considering the trend toward FDA oversight, healthcare reform and continuing advances in technology, it will be difficult to determine who provides the ticks and who protects from danger.

— Tom DeSanto

PWC study available online at www.pwc.com/us/en/healthcare/publications/diagnostics-2009-moving-towards-personalized-medicine.jhtml. Recent webcast by Ted Snelgrove available at www.dxma.org.

Additional source: Clinical Laboratory News, October 2009. Image: www.flikr.com