Liquid BiopsyWhat lies ahead for the insurance industry?

Paul Murray, Chief Pricing Officer, Life & Health 18th November 2017

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Our desire for longer healthier

lives

Increasing technological

advances

New discoveries from research

Size of the prize

Threats and opportunities for

life and health

Early detection of cancer has transformative power

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Progress is being made

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Liquid biopsyA new approach to diagnose cancer?

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How is cancer diagnosed today?

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Routine examsSymptoms investigation

Imaging determines

location

Biopsy confirms diagnosis

Staging & grading

CI event

What is liquid biopsy?

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http://egfrmutationtestv2.roche.com/liquid-biopsy/

Liquid biopsy is a fast and easy test which allows for the frequent monitoring of an evolving cancer

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Liquid biopsyThere are a few things to iron out

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• Need for perspective – how much do we really know?

• Let the immune system get on with it?

• ‘do no harm’

• Nice idea, lets go find the cancer cells!

• OK so we found some, now what?

• Regulation …. and cost

There are a few things to iron out…

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• Relapse or recurrence

• High risk groups

• What about the general population?

Looks promising for…

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Heitzer, Perakis, Geigl, Speicher, “Precision Oncology Potential of liquid biopsies for the early detection of cancer”, Nature Partner Journals 2017 36Bettegowda, et al, "Detection of circulating tumor DNA in early- and late-stage human malignancies", Science Translational Medicine, Feb 2014.

Liquid biopsyWhats next?

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Large scale trials are underway

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• Circulating Tumor Cells in Lung Cancer Screening (AIR)

– Estimated Study Completion Date: December 2019

– Preliminary result: CT-scan screening detected lung nodules 1 to 4 years after CTC detection, leading to prompt surgical resection and histopathological diagnosis of early-stage lung cancer.

• Detection of Circulating Tumor Cells for the Diagnosis of Pancreatic Adenocarcinoma

– Estimated Study Completion Date: September 2021

• A Potential Screening Test for Clinically Undetectable Breast Carcinoma

– Estimated Study Completion Date: January 2023

• Pasteur Hospital (Department of Pulmonary Medicine, CHU of Nice, France)

• 245 subjects, no detectable malignancies at the time of enrollment

• 168 of them were COPD patients, and CTCs were detected in 5 of the 168 patients

• The annual surveillance of the CTC-positive COPD patients detected lung nodules 1–4 years after CTC detection.

• Surgical resection and histopathological diagnosis confirmed all were stage 1a lung cancer.

• All CTC-negative patients had no CT detectable lung cancer after 4 years.

CTCs were detected in COPD* patients without clinically detectable lung cancer

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* Chronic Obstructive Pulmonary Disease

Commercial interest : pipedream or $200bn market?

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Grail’s mission is to detect caner

early, when it can be cured

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• Attracted over 3,500 professionals from over 40 countries in 2016, 500 speakers

• Focusing on Molecular Medicine, specifically on Discovery, Genomics, Diagnostics and Information Technology.

Academic interest is also intense

Liquid biopsyPotential impact on the insurance industry

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Cancer is the leading cause of CI claims

Liquid biopsy impacts …..

1. the number and timing of claims

2. cancer definitions

3. product design, pricing and long term guarantees

4. anti-selection risk, how we underwrite

i.e., pretty much everything

Mortality improvements may also be observed in the future

What does this mean for the insurance industry?

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How can the insurance industry respond?

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Know your exposure

Strong defence

Active engagement

Early warning systems

Above all maintain discipline, keep directors informed

With careful proactive management, we can

maintain the important role of cancer products in

meeting real needs and helping society respond to

adversity

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• Long term clinical trials are needed to establish liquid biopsy as an acceptable screening tool and as a substitute or adjunct for conventional cancer diagnosis

• A "negative" liquid biopsy test does not rule out the presence of cancer

• A "positive" liquid biopsy test does not meet today's clinical standard for cancer diagnosis, and therefore any critical illness claims should continue to require histopathological proof

• For the foreseeable future, histopathology will remain the standard for cancer diagnosis and staging

• All life and health companies should be actively monitoring this space for developments

Summary

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Ongoing activity Swiss Re activity

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Legal notice

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©2017 Swiss Re. All rights reserved. You are not permitted to create any modifications or derivative works of this presentation or to use it for commercial or other public purposes without the prior written permission of Swiss Re.

The information and opinions contained in the presentation are provided as at the date of the presentation and are subject to change without notice. Although the information used was taken from reliable sources, Swiss Re does not accept any responsibility for the accuracy or comprehensiveness of the details given. All liability for the accuracy and completeness thereof or for any damage or loss resulting from the use of the information contained in this presentation is expressly excluded. Under no circumstances shall Swiss Re or its Group companies be liable for any financial or consequential loss relating to this presentation.