The Royal Marsden Drug development

Carbon copies

The Royal Marsden has led the drive to bring biosimilars – near-identical replicas of vital drugs that are just as effective as the originals, yet cost far less – to more cancer patients

20 September 2018

Jatinder Harchowal led the RM Partners biosimilars project

The healthcare and pharmaceutical industries are on the cusp of a revolution in the use of biosimilars – ‘copycat’ drugs that could save the NHS hundreds of millions of pounds while providing the same benefits for patients.

Biosimilars are copies of biological drugs – or biologics – such as monoclonal antibodies. These differ from common medicines, such as aspirin, which are relatively simple chemical structures. By contrast, biologics are large and extremely complex structures that are harvested directly from biological cells.

Due to their complexity, they are expensive and can take up to 10 years to develop. Biosimilars typically take up to eight years to produce and approve. Scientists develop them by isolating every bend and fold in a biologic’s primary structure before duplicating this ‘recipe’ in the laboratory, so that the molecular profile of the biosimilar matches the reference product.

Although biosimilars have been around for more than a decade, it is only now that patents are starting to expire on widely used biological treatments for cancer and other serious diseases, and this is when biosimilars can be introduced.

We are reaching a tipping point for biosimilars, with more on the way

Copy and save

Jatinder Harchowal, The Royal Marsden’s Chief Pharmacist, led a groundbreaking project to increase the adoption of a new generation of biosimilars across England in his role as Medicines Optimisation Lead of RM Partners, along with Tim McCarthy, Drug Resource Manager and NHS England Clinical Commissioning Pharmacist.

Hosted by The Royal Marsden, RM Partners is part of the NHS West London Cancer Alliance’s local delivery system across northwest and southwest London. Biosimilars are a key element of NHS England’s National Cancer Strategy to develop new models of care for cancer.

“Biosimilars offer a really rare opportunity to help manage rising costs in the NHS, while maintaining the same clinical impact for our patients,” says Jatinder.

This means we can treat more patients, and the money saved can be reinvested into the NHS

Explaining why biosimilars are so much cheaper than the original drug, he says: “For biosimilars, the pyramid of drug development is inverted. More work is done in early-phase trials to demonstrate a high similarity in safety and effectiveness between the copy version and the original drug, with less investment required in costly Phase III patient trials. As a result, we have seen the cost of biosimilars become 50-60 per cent cheaper.”

The Royal Marsden was one of the first UK trusts to switch to the biosimilar of rituximab (also known as Mabthera), an important drug for treating blood cancers.

Jatinder led a Cancer Vanguard programme to develop educational materials, policies and patient information with the Lymphoma Association, all of which supported the nationwide adoption of the biosimilar. Any cancer centre across the country could access these resources via a dedicated website, which “ensured a consistent approach and avoided duplication of effort”, he says.

Within months, 80 per cent of eligible patients across England had been switched to biosimilar rituximab. If used nationwide, this biosimilar alone could save the NHS up to £100 million a year.

Cancer and beyond

Consultant Haematologist Dr Sunil Iyengar is using biosimilar rituximab to treat patients with lymphomas, the fifth most common type of cancer in the UK.

Over the past 15 years, rituximab has been a game-changer in our field and clinicians see it as one of their most effective treatments

“When a biosimilar version comes along, there’s understandable concern about it having the same clinical impact for patients, which sometimes creates a barrier to adoption. That’s why the NHS West London Cancer Alliance is so important: raising awareness among patients and clinicians, as well as reassuring them about their effectiveness.”

However, the impact of biosimilars reaches far beyond cancer. The work of RM Partners and The Royal Marsden is now being used as a model to implement non-cancer biosimilar drugs across the country, including biosimilar adalimumab (Humira) for arthritis.

Jatinder says: “We are reaching a tipping point for biosimilars, with many more in the pipeline this year. Adalimumab is the biggest drug in the NHS, with a yearly spend of around £350 million, so the saving is potentially vast." 

Our work has shown that biosimilars can be incorporated into treatment plans quickly and without compromising the safety of our patients