Merck exclusive: Oncology insight  

Doina Ionescu, General Manager for the UK & Ireland at Merck, talks with DDW’s Megan Thomas about Merck’s innovations in the oncology sector, her thoughts on the future opportunities in the sector, as well some trade secrets and more. 

MT: The company has expertise in the oncology space – what innovations can you share and can you talk me through some of the latest innovations and approvals in bladder cancer and kidney cancer? 

DI: It is clear that as clinical trials progress, we are learning more about the way that immunotherapy might be best used to treat different types of genitourinary cancers. In kidney cancer, there is mounting evidence from several studies now that immunotherapy combined with a tyrosine kinase inhibitors (TKIs) is a valuable option for many patients. For some kidney cancer patients, it may be that immunotherapy-only combinations play a part, but in my view the majority of kidney cancer patients should be considered for a first-line treatment that contains an immunotherapy.  

In bladder cancer, the use of immunotherapy as a first-line maintenance, for patients whose tumours have not progressed after platinum-based chemotherapy, seems to show where immunotherapy can have the biggest impact on patient outcomes. The data seems to be more clinically compelling than waiting to use immunotherapy in the second-line, after progression on first-line platinum-based chemotherapy, which is great news for advanced bladder cancer patients who have limited treatment options and a poor prognosis. 

MT: Where do you see the current opportunities and major developments in oncology in the future? 

DI: I think over the last 20 years we have seen more and more targeted therapies become available; therapies that can target specific mutations, for example, that are drivers of tumour growth. In the last few years, immunotherapy has become more commonplace and established in the treatment of many cancers. There are more and more combination studies emerging, which is very exciting. We are still searching for many new ways to tackle cancers where there has been little progress for many years.  

MT: Merck is rooted in science and innovative research – what is its secret to tackling disease and major illnesses?   

DI: At Merck we prioritise our focus and where we think there are areas of huge unmet need, where patient outcomes can be significantly improved. We have developed an expertise in the area of identifying cancers that have specific oncogenic drivers, as well as immuno-oncology. We have targeted areas of research where outcomes remain poor and treatment options are limited. If we can find ways to win in these areas, we are going to have a sustainable long-term business that also delivers maximum benefit to healthcare systems and patients. 

MT: What have been the most significant global improvements in this field of oncology in the last five years?  

DI: There are two areas that have impressed me. The first is the speed and breadth at which immunotherapy has become the standard of care in many difficult-to-treat cancers. We have seen huge improvements in survival for patients with melanoma, lung cancer, bladder cancer and many others, where survival used to be really poor. I am also excited about how other agents have changed outcomes across many difficult to treat cancers.  

MT: Has the pandemic had an impact on cancer research? If so, how? How has Merck overcome them?  

DI: I don’t think there is any area of life that the pandemic has not affected. Initially, we were all faced with the unknown, but we have learnt as it went on. Throughout the whole of the last two years, our priority has been the safety and well-being of the patients participating in our clinical trials and continuity in treatment and care, and that is a duty we took very seriously. 

With respect to opening new trial sites and ongoing enrolment, the situation was dynamic, as countries and investigational sites in many areas increased their containment measures and were affected by resource constraints. We managed this through a responsive strategy that is geographically orientated to minimise impact on our clinical trials and ensure the scientific integrity of our studies, adopting the guidance from health authorities and investigators. 

Our approach to the situation is focused at the study level, and together with our partners, are proactively working to take pragmatic actions. This includes proactively reviewing protocols to see where we could pursue avenues like virtual trial-related activities and leveraging alternative methods for procedures e.g. local clinical laboratories and imaging facilities. We are partnering closely with sites in regions that are beginning to recover from the pandemic and are less impacted to ensure continuity.  

MT: How does the business prepare itself to compete on a global scale / use its scientific resources to ensure success in this way?  

DI: Merck is a large and diverse company. At the same time, within our healthcare business, we have the ability to be flexible and agile, while still making a meaningful impact for patients. We have a long history in oncology discovery and development; as early innovators in immuno-oncology and precision medicine, we continue to take a biology-focused approach as we continue our work to develop new medicines for patients with cancer, and we learn from each and every experience. 

MT: How do you see the oncology landscape evolving in the next 10-20 years? 

DI: I hope that we see a move to more treatments in the earlier stage of cancer, as we all know that the earlier we detect and diagnose cancer, the better the outcomes are. There are some exciting trials underway to find new ways of detecting early-stage cancers, and I hope they will be positive and mean earlier intervention and treatment.  

I am also excited by new ways in which we can fight cancers. The PARP (poly adenosine diphosphate-ribose polymerase) inhibitors are the first agents that are DNA Damage Response (DDR) targeted agents and there are several therapies under investigation that can act in different parts of the DDR pathway. This could be the next way to target tumours and it would be great to see this class of drugs become another tool to help fight cancer and improve outcomes for patients. 

About the author 

Doina Ionescu has been Merck’s General Manager for the UK & Ireland since May 2020. Since joining Merck as a research scientist in 1998, she has held a diverse range of roles within the company including in Corporate Business Development, Corporate Mergers & Acquisitions and Commercial Operations. 

In June 2021, she was elected to the Board of Directors for the Association of British Pharmaceutical Industry (ABPI). She also represents Merck on the European Medicines Group, contributing towards the development of its policy positions and advocacy efforts. 

Ionescu is a physicist by background and holds a Master’s degree in nuclear physics from the University of Bucharest, a PhD in physics from the University of Southampton and an Executive MBA from Ashridge Business School. 

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