Title: SVP and Head of Oncology, IMED Biotech Unit
If you look for powerful engines that are fueling AstraZeneca’s growth, you can’t miss third-generation EGFR inhibitor Tagrisso or first-in-class PARP inhibitor Lynparza. The commercial team has kept the money rolling in, but you can’t have a successful business without good science. Susan Galbraith was the key person behind the science of those two drugs as the company’s IMED biotech unit’s head of oncology with stewardship of small-molecule oncology R&D.
Galbraith developed an interest in medicine at a very young age and fell in love with oncology while doing a rotation for her medical degree. It was the relationships she formed with patients, the complexity from a clinical medicine perspective, as well as the underlying science of the disease and treatments that got her “hooked emotionally and scientifically,” she said.
But the leap into the pharma industry was “serendipity” for Galbraith. An early-phase drug she worked on for her Ph.D. was licensed to Bristol-Myers Squibb, which then offered her a job. With support from her husband, she moved across the Atlantic and from academia to the industry.
The drug was later cancelled because of safety problems, but it was a blessing in disguise. She started working on cancer immunology, which at the time was not as fashionable as it is today. She was closely involved in the in-licensing of Yervoy and the early development of Opdivo, the acquisitions of Adnexus and Medarex, and research collaborations with Exelixis, as she held increasing responsibility to become VP for oncology and immunology early development.
Now, two decades have passed since she tapped into the drug world, and oncology research has been transformed by genomic technology and more knowledge of cancer immunology.
“I think we’re reaping the benefits of the genomic understanding,” she said. “Now we have the possibility to get genomic analyses [for] a lot less money much more rapidly, and the insight that we’re gaining from that is making a huge difference in understanding the disease and therefore designing new drugs.”
But as more mechanisms emerge and more drugs are developed, how to combine them wisely toward a potential cure poses a new challenge. What’s Galbraith’s secret of managing that?
In 2011, AZ adopted a new R&D strategy that centers its decision-making on “5Rs”—the right target, right tissue, right safety, right patient and right commercial potential. Galbraith referred to that as one key guideline for choosing combinations.
“Where does the science suggest that there’s likely to be more than ‘1 plus 1 equals 2’ when you put these two drugs together?” she said. “So, complimentary cell killing, different populations, ability to evade the emerging resistance, mechanisms in enhanced activity.”
The second pillar in Galbraith's eyes rests on the right clinical trial design “to enable effective evaluation early and signal seeking.” To do that, AZ is using circulating tumor DNA for both patient selection and outcome monitoring, so that it can get more precise answers at an earlier point in time, she said.
In addition to the traditional randomized controlled trial, Galbraith’s oncology department has also adopted “platform studies,” which enable simultaneous studying of multiple therapies—or combinations—for a given disease. One example of that is the ongoing Hudson trial, a phase 2 that enrolls non-small cell lung cancer patients who’ve progressed on an anti-PD-1/L1 and puts each of them on two different arms of combinations that use Imfinzi, Lynparza, AZD9150, AZD6738 or vistusertib.
Galbraith also attributed the success of Tagrisso and Lynparza to the “5R” framework. “I always said we have Tagrisso because we had Iressa, and what that speaks to the depth and duration of investment in a particular area of biology,” she said.
With Iressa, AZ already had a deep understanding of the science of EGFR and of the resistance mechanism to Iressa, and it put that back into the design of Tagrisso. The new EGFR inhibitor selectively hits the T790M mutation, which was attributed to about two-thirds of those whose disease progresses after an EGFR TKI. It can also reach the brain, an important feature because brain metastasis is a common progression in NSCLC. It also has a global relationship particularly in Asia, where the EGFR mutation impacts about 30-40% of all NSCLC patients, compared with only 10-15% in the Western world.
As the industry grows more interested in biologics, Galbraith views it as a strength rather than pressure on the small-molecule franchise she leads. Because there are multiple types of cancer, a diverse portfolio of drugs will be needed to address them—not just one type—through combinations, she explained.
Being at the top of what she does, Galbraith has earned a senior VP title at AZ, but she's noticed a “fall-off” in the proportion of women progressing to the more senior levels—even though the balance is there at the entry levels.
AZ first built a “Women as Leaders” program in IMED in 2015 and has now rolled it out companywide. It gives women a platform to come together to discuss their career progression and personal development. Women who’ve attended the program gain sponsors and mentors and have seen a 30% promotion rate, according to the company.
Galbraith has also been active in that program, giving back what she's benefited from from her mentor. She’s also involved in the American Association for Cancer Research’s Women in Cancer Research group, which aims to foster women’s career and cancer research development.
Besides gender, Galbraith is also an advocate for other aspects of diversity, including foreign background and sexual orientation in the life sciences industry. She pointed to the Asian markets, where AZ’s products are growing at a faster rate than they are in the Western world.
“I think this is a huge opportunity for us to increase the proportion of people in our senior executive level that have gotten the experience of living and working in those countries, because otherwise we’re missing out on a whole set of understanding of the needs of patients and thinking about medicines on the value that they represent,” she said. “It is critically important we have those aspects of diversity as well as gender.”
Of young talents who just started their career in life sciences, Galbraith said they’ll be able to make a “transformative difference.”
The suggestion she has for them is to build self-confidence through asking lots of questions. “Maintain your curiosity, willingness to learn and willingness to put in hard work, and you’ll gain a huge reward, because you’re making a difference in many patients' lives around the word,” she said. “And those kinds of stories will come back and continue to inspire you despite the challenges and difficulties that you might fight along the way.”