Healthy Skepticism Library item: 14513

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Publication type: news

Prounis C.
Bolder is Better
Pharmaceutical Executive 2008 Sep 1
http://pharmexec.findpharma.com/pharmexec/article/articleDetail.jsp?id=548884

Notes:

See Pharmaceutical Executive site for accompanying images

Full text:

In the last five years, more than 20 cancer-fighting products have been launched; the oncology pipeline is currently brimming, with 55 products in Phase III awaiting final results and approval; the Journal of Clinical Oncology is awash in product ads, and the exhibit floor at ASCO has never been so busy. The ranks of salespeople calling on cancer specialists have also swelled, with Genentech and Sanofi-Aventis fielding more than 500 oncology representatives each.

Meanwhile, as pipelines in other categories falter, marketers of oncology pharmaceuticals and biologics have moved to the forefront of companies’ portfolios. Their advertising campaigns show a new sophistication about branding and marketing.

Moving Beyond Traditions

Today, oncology therapeutics is big business: the market for cancer drugs is forecast to reach $55 billion in 2009, making it the largest sales volume category in the pharmaceuticals/biologicals industry. What’s more, the oncology pipeline is the richest in the industry by far, and IMS reports that by 2010, oncology will account for some 30 percent of all launches. With such a wealth of new products, successful positioning-first line vs. second line, etc.-could spell the difference between a blockbuster and an also-ran. To create that difference, advertisers must move beyond oncology’s traditions of mechanistic images and scientific themes, and develop innovative approaches to appeal to the US audience of more than 7,000 office-based medical oncology and hematology/oncology specialists.

To learn how companies are making that appeal, Flashpoint Medica examined a sample of 37 ad campaigns running in 2007 and 2008 to explore current trends in advertising and branding. The survey discovered five major approaches that dominate advertising and branding campaigns in oncology today. Some of the approaches that were once staples of oncology advertising-such as the use of scientific/mode-of-action visualization-seem to be on the way out, while others are being used more often. In aggregate, the data paint a picture of a category in transition. Let’s take a detailed look at these approaches and trends.

Trend #1: Data as branding

Market research typically shows oncologists to be data-driven pragmatists, often skeptical of advertising claims. While practically every cancer drug advertisement today features data prominently, some make it the focal point of the entire campaign.

For example, the campaign for Erbitux (cetuximab), Imclone/Bristol-Myers Squibb’s head and neck cancer drug, presents evidence of improvement in overall survival (OS, the “gold standard” in measuring efficacy in oncology). In addition, a Kaplan-Meier (K-M) curve (its double lines drifting downward over time) is perched atop a large pile of patient files and clinical publications, representing how many patients were still alive as the study continued. The headline reads: “Survival without Compromising Delivery of RT [radiation therapy].” Copy claims feature “survival” and “reduction in risk of death.” The tagline is “Strength in Data.”

With some tumor types, however, survival data won’t be available for many years (as in cancers with long survivorship, such as breast cancer), or is difficult to obtain methodologically. In these cases, other data take center stage. An Arimidex ad, in the form of an advertorial, features a graph showing that, on average, patients taking the drug had a greater duration of disease-free survival-a common end-point in adjuvant chemotherapy. Pfizer’s Aromasin (exemestane) ad outlines the letters “e” and “r” in the word “brighter”-referring to the patient’s future-to highlight the estrogen receptors that the product blocks. The rest of this all-copy ad describes disease-free survival data, delivered in bullet points rather than advertorial prose.

Some campaigns feature other key end points addressing patients’ aggregated experience, such as time to progression of disease (“progression-free survival”), as surrogates for true survival data. Others are limited to physical tumor characteristics, measured by response-such as if tumors disappeared (complete response) or shrank (partial response). (For a guide to cancer treatment claims, see “Sifting the data: Understanding oncology claims”.)

Unlike many campaigns for conventional pharmaceuticals, few oncology ads attempt to differentiate products based on subgroup analyses of specific patient populations, a practice sometimes disparaged as “data-dredging” by statisticians. This likely reflects the fact that smaller sample sizes, typical in oncology trials, often make subgroups too tiny for meaningful patterns to appear. More significant is the relative absence of claims of superiority based on an excellent tolerability, adverse events profile, or other quality-of-life data. In contrast to so many non-cancer drug ads, none of the advertising Flashpoint reviewed described a “balance” of efficacy and safety. To oncologists, it seems, efficacy nearly always comes first.

Trend #2: Patients are people too

Data alone can be cold and dispassionate; it’s hard own a space in physicians’ hearts with numbers alone. As oncology marketing matures, it is tapping the power of emotion to drive brand choices. Today, marketers recognize that when oncologists have multiple options, the brand with emotional power is most often remembered-and selected. One way to make strong data personal is by using imagery of real people in advertising campaigns. Judging by the numbers of campaigns using this approach, it’s a trend that’s growing.

Genentech’s Herceptin (trastuzumab) shows photographs of actual breast cancer patients who are happy and healthy enough to exercise. (All the patients are dressed in shades of pink and black, and bold bands of magenta echo similarly colored headline type to ensure that the drug name, Herceptin, stands out.) Copy links the drug’s “landmark studies” to “perseverance,” and a K-M curve shows how much delay in disease recurrence specialists and their patients can expect when the product is used as an adjuvant to surgery in appropriate patients.

Indeed, emotionality figures prominently in many of today’s oncology ads, even when data take a back seat. The challenge for marketers is to ensure these depictions are distinctive and memorable for their brand and don’t fall into the clichés of patient walking on a beach or in a field of flowers-or other picturesque scenery typical of direct-to-consumer advertising. In the campaigns for BMS’ Sprycel (dasatinib) and GlaxoSmithKline’s Tykerb (lapatinib), ad headlines voice the patient’s “thoughts.” “I am turning to SPRYCEL” thinks a greying gentleman, while in the Tykerb ad we see the profile of a grey-haired woman with the text “I want more.”

Are these patients’ images rendered or photographed in a sufficiently attention-getting way to help their brand stand out? Is the device of the patient’s intentions or pleas likely to make an impact on an oncologist’s decision-making? Consistency in execution doesn’t necessarily guarantee memorability if the consistently repeated idea lacks a compelling core.

Even more of a standout is the ad for AstraZeneca/Abraxis’ Abraxane (paclitaxel) featuring a hairless young woman whose decision to go turban-less both helps to identify the side effects at issue (we know to expect alopecia with paclitaxel) and suggests a willingness to confront the conventional.

Similarly, the Enzon ad showing young patients taking Oncaspar (pegaspargase) in black-and-white (but wearing headgear) helps them stand apart from the more common full-color images.

Trend #3: Metaphors and borrowed interest campaigns

One of the fastest growing trends is to move away from pictures of people and toward the use of visual metaphors to convey key messages. Some of these metaphors, by virtue of their simplicity and clarity, stand out boldly, delivering an emotional appeal as well as a rational one. Novartis has consistently branded Gleevec (imatinib) as a “gift” by using a Tiffany-style box wrapped in orange paper and tied with a cloth ribbon. This signifies the gift of survival that a doctor gives a patient via the drug. Some Gleevec ads even weave graphs and data graphics into the gift box’s ribbon-using it as survival curve, for example. A Camptosar (irinotecan) ad from Pfizer/Daiichi breaks with the convention of using Kaplan-Meier plots to show mixed overall survival and progression-free survival data, using the annular rings of a tree as a metaphor life lived longer (in metastatic colorectal cancer) and as a data graphic showing the results of the drug.

For many years, Sanofi-Aventis used the metaphor of a long pier extending into the water (overlaid with a Kaplan-Meier curve) to express the survival advantage provided by Taxotere (docetaxel). A Kaplan-Meier curve is similarly, and effectively, displayed on a man’s palm in a Genentech ad for Tarceva (erlotinib) to suggest extended life. Roche’s Xeloda (capecitabine) ad borrows from nature with a couple walking out of a desert landscape into a verdant, arcadian vista of farmlands and trees conveying the idea of a return to health and hope. Wyeth’s Torisel (temsirolimus) shows two halves of a tree, one part denuded of leaves and the other green and richly alive (with roots that form the molecular structure of the product).

There’s a fine line, of course, between metaphors and “borrowed interest,” the age-old advertiser’s device of catching readers’ eyes with intriguing imagery related distantly, if at all, to the product. Finding a unique image that will stand out from the metaphors used by other campaigns is another challenge. BMS’ Ixempra (ixabepilone) uses the familiar lock-and-key metaphor to address tumor resistance-Ixempra is the key, of course. Will oncologists remember this unlocking among the many keys they’ve seen in campaigns over the years? The question is particularly germane as Pfizer’s Sutent (sunitinib) also uses a lock-albeit a combination lock-in its campaign. Additionally, incandescent light bulbs, another common approach, appear in campaigns for both Campath (alemtuzumab) and Zolinza (vorinostat).

Just as familiar to ad readers is the ring-shaped life preserver used by Novartis to embody the concept of “complete response” in malignant melanoma or metastatic renal cell carcinoma (RCC) for Proleukin (aldesleukin). Pharmion borrows from county fairgrounds and the he-man sledgehammer test to suggest the “power and performance” of Vidaza (azacitidine) in treament of myelodysplastic syndrome subtypes. And Lilly borrows interest from the famous dog sledding race, the Iditarod, for Gemzar (gemcitabine), suggesting ideas such as a changed landscape and a long haul.

Trend #4: Logos and icons as hero

Aiming to make their logos and icons stand apart, some marketers are using such branding as the centerpiece of their campaigns’. Millennium’s Velcade (bortezomid) arrays combat-ready sci-fi soldiers in a distinctive V (for Velcade) formation, blasting a path through malignant cells. Similarly, a recent Rituxan (rituximab) campaign for non-Hodgkin’s lymphoma turns a gigantic letter R on its side to form a bridge over a gaping crevasse; a hiker, presumably a patient, crosses the chasm. “Take the essential path toward improved survival” reads the headline, in case readers miss the visual’s point.

This icon-centered approach helps ensure logo recognition through repetition. Presumably, such branding hallmarks are the result of a thoughtful development process aimed at delivering a memorable, meaningful set of images to potential users. However, some of these logo-driven campaigns seem a bit a force-fit to their task. Celgene’s Revlimid (lenalidomide) campaign, for example, twists its unique yellow-and-teal symbol into various shapes-a butterfly, sails on a sailboat, the center of a globe-to keep the brand centered in readers’ attentions. The transformations surprise the reader with their unexpectedness-but possibly at the cost of clarity and relevance.

Trend #5: Fewer scientific ‘star wars’

One staple of oncology advertising campaigns has been the scientific graphic-a visual celebration of the product’s mode of action, rendered in a vivid and imaginative way by illustrators inspired by Hollywood’s finest special effects. We’re seeing less of this type of ad than in past years, perhaps because the approach substitutes pizzazz and “wow” factor for emotional connection. Still, examples abound. For Genentech’s Avastin (bevacizumab), angiogenesis inhibition is a key message, so a huge snarl of blood vessels dominates the pages of the campaign. For Vectibix (panitumumab), Amgen suspends a giant wire-frame illustration mirrored by a pair of hands, each forming the distinctive Y conventionally used to symbolize a monoclonal antibody. Temodar (temozolomide), indicated for the brain malignancy astrocytoma, depicts a network of lines and lights within the outline of a human form.

Lessons for oncology marketers

The bottom line: bolder is better. Oncology marketing is converging with the marketing of mainstream medications, where how you illustrate your brand’s benefits is as important as what those benefits actually are. Success in oncology increasingly means success in branding; strong data and technology, by themselves, will only get oncology marketers so far. And in today’s oncology world, it’s clear that strong emotion is the branding formula that gets prescribers’ attention and ensures memorability.

We can expect to see more and more branding-savvy marketers evoke emotion through humanistic imagery, with admirable people photographed heroically or stoically engaged in the challenge of living with cancer-putting a human face on the data to command the attention of audiences. And we’ll see these marketers tap the rich storytelling power of metaphors, which help brands stand for worthwhile, emotion-evoking values and stand apart from one another. We’ll see fewer ads with oncology’s traditional, mechanistic images and scientific themes. And we’ll see more and more oncology advertising overall-as a flood of new products grabs for the fleeting attention of oncologists surrounded by cascades of clinical trials, swarms of specialty reps, and increasing patient caseloads.