- 2 years ago
16 May 2022
Prashant Nikam wants to put a sign on the wall at MSD’s Macquarie Park offices that simply says, ‘Patients can’t wait’.
For Nikam, who arrived in Australia in January to lead the company’s Australia and New Zealand operations, these three simple words are a rallying call for MSD employees to pull together and do everything possible to secure patient access and, for this scientist-turned-businessman with a passion for oncology, it is easy to understand his sense of urgency.
For Nikam, the lives of oncology patients are too often measured in months, not years, so every day, every week, and every month that patients are denied access to innovative medicines, some will die.
While his message may seem grim, Nikam himself is cheerful and easy-going, the recently arrived leader finding much to delight in, joking about the quirks of Aussie slang while marvelling at our insistence on English-style school uniforms, blazers and hats included.
Yet with a kaleidoscope of academic and career experiences gained across four continents, Nikam brings much to Australia and, as a leader who clearly embraces new experiences and makes the most of every opportunity, he is sure to leave an indelible mark on the local pharmaceutical scene.
From pharmacy to oncology
Born in a beautiful town in India’s northern region known for its vineyards, Nikam’s parents are college professors and he recalls an upbringing focused heavily on academic achievements, his father constantly reminding him that ‘continuous refinement should be your goal’ – a piece of advice that has stuck with him throughout his life.
Nikam earned a pharmacy degree and was intent on working for a local company when a chance meeting with a childhood friend studying in the US saw him secure a scholarship to study for a PhD in pharmaceuticals at Ohio State University.
“It was all in the lab and I found out quite quickly I was terrible at lab work,” he laughs. “I really messed up and my professor said, this is not your cup of tea – you’re breaking instruments in my lab but you’re really good at maths and statistics. Why don’t you try health economics?”
It turns out his professor was right – Nikam was highly suited to health economics, and after earning his PhD, the same professor encouraged him to look abroad for work, resulting in Nikam moving to the UK with GSK.
“I was working on a drug for restless leg syndrome, and the experience was really formative because it gave me a window into how decisions are made, how a body like NICE thinks about value, and how you create an honest dialogue between HTA bodies,” he says. “Those experiences really inform your long-term thinking.”
While Nikam relished the work, he had left his future wife behind to finish her own PhD and she gave him an ultimatum – if he wanted to marry her, they needed to live on the same continent.
“My boss agreed to send me back to the US but said I had to work in oncology,” he says. “GSK was a non-player in oncology at that time but my primary goal was to be closer to my future wife, so I said yes. Who knew I would stay in oncology for 18 years?”
A career following people
After working as global product lead on a new breast cancer drug for six years, Nikam realised marketing held the decision-making power and controlled the budget, so he asked to move across and was appointed Marketing Product Director.
“I actually loved it – it was an amazing experience,” says Nikam. “It was all about building a global strategy to launch a new drug.”
GSK also put him through an MBA – something for which Nikam says he will always be grateful.
“You need a business education as otherwise, because of the PhD, you’re always labelled a scientist. GSK thought about training and developing people in a different way, and the MBA helped shape the way I think about business.”
From GSK to Sanofi to Novartis
In 2009, Debasish Roychowdhury left GSK to head up Sanofi’s Oncology Division and in 2010, asked Nikam if he would join him.
“He was an incredible drug developer and a very humanistic leader,” recalls Nikam. “He asked me to lead the launch of the first PARP inhibitor for triple-negative breast cancer, which was amazing.
“Unfortunately, it failed, which was a watershed moment for me. I had moved my pregnant wife from Philadelphia to Boston for a drug that showed amazing survival in phase 2 but failed in phase 3. Luckily, people believed in me.
Sanofi had acquired Genzyme with a portfolio of old legacy haematology assets coming to the end of their life cycle, so Nikam was made franchise head.
“I went from launching a new, sexy, exciting drug to doing the grunt work on some older brands, but when I look back, those tough problems give you a much richer experience solving bigger business problems in the future,” he says.
An offer to move to Novartis Oncology as a global marketing lead for myelofibrosis drug Jakavi (ruxolitinib) followed and Nikam was considering moving to Europe when Joanne Monahan and Jill DeSimone from the Merck* Oncology Leadership called with a new offer.
Merck was building an oncology unit centred around a new drug immuno-oncology drug called Keytruda (pembrolizumab) and the pair wanted Nikam to join them as Executive Director.
Nikam went to Merck to discuss the opportunity and, upon walking into Merck’s US headquarters, a quote on the wall from founder George Merck saying, ‘Never forget, medicine is for the people, not for the profits’ sealed the deal.
“It’s a very idealistic statement, but a true one,” he says. “I was like, oh wow, and you could see the people at Merck are anchored in that philosophy – the idea percolates everywhere.”
The challenge of Keytruda
In the past six years, Nikam has gone from US commercial lead for the company’s growing precision medicine franchise followed by Vice President of Oncology Marketing for the US, riding the back of the Keytruda wave. Australia is his first Managing Director role and he continues to be inspired both by the words of George Merck and the incredible opportunities and outcomes of Keytruda.
“This drug is going beat penicillin in terms of the number of indications someday,” he says. “It is mind-boggling to see what it has achieved in melanoma and yet you repeat this tumour after tumour.
“We have 46 indications approved in the US, so this drug is not a fluke. It has touched one million patients, so there’s a lot of information out there but if you look at it through an outdated lens, you’re not going to see the same value.”
It is perhaps Australia’s ‘outdated lens’ in assessing drugs such as Keytruda that prompts Nikam’s desire to partner with the Australian Government and find a new path forward for Keytruda, with a minority of the 46 indications reimbursed here.
“There are very few times when science moves in leaps and bounds, so the government has to take into account that there’s genuine innovation here,” he says. “How can we make sure this innovation becomes available to all Australians who need it?
“Yes, we need a sustainable pharma industry. Yes, we need value for money as a government, but why not take into account the practical realities of science, the practical realities of the drug that you have?
“We might never have this opportunity again with a drug that is impacting hundreds of cancers. Why do we want to miss out on that opportunity? Let’s sit at the table and have a discussion around compromise, not just working around the edges.”
For Nikam, a life working on new drugs always comes back to the same three words – patients can’t wait.
“We have the clinical evidence, so let’s start walking towards each other,” he says. “I feel that any problem can be solved through conversations where both parties see each other’s side. There are sticky problems, but you can solve them through discussion – you just need the right kind of mindset.”
Nikam wants MSD to play its part by getting the whole company thinking about getting products to patients faster. He also wants to think differently.
“I would be very happy if we did something very innovative with the government to approve multiple rare cancers with Keytruda – if we had 30, 40 indications approved for Australians,” he says.
“It feels like there will never be another drug like Keytruda but the beauty is that the science is changing every day as the world learns more about tumour biology.
“If your innovation is coming that fast, do you have the health technology processes to evaluate that innovation at the same cutting edge level? Cutting edge drugs require cutting edge systems.”
*Merck is known as MSD outside the US.