It is very easy. The marketing and sales forces required to successfully sell a drug are huge, unless it is a very small orphan indication only dealt with by a few hospitals. To sell something like efti you are talking about every cancer hospital in the world. If you don't have the economies of scale that the big boys have it is just too expensive. Place you need a history to gain trust. This isn't a secret lots of studies have been done to show this.
Imagine it this way, BMS roles up at an oncologist's office and says well we have, this, this, this, this, this, this and this you might be interested in. Here are all of the papers supporting them. There are "educational" dinners on here, here and here. Oh, you would like to run a study using one of our drugs? We'll supply the drug for free and here is a bit of funding to get you on you way.
Immutep roles up at an oncologist's office. They are greeted with "who" by the receptionist? Oh we have a new drug that can be used in breast cancer patients and in combination with Keytruda. Receptionist: Anything thing else? Immutep: No mam. Receptionist: I'll check with the doctor (feigns a phone call). Receptionist: I'm sorry, the doctor is just too busy today to see you, but thanks for stopping by. Immutep: But,..... Receptionist: I really am sorry.
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