Treatment Algorithms: Colon Cancer – Treatment dictated by stage, prior therapy, and reimbursement

The colon cancer pipeline has grown as pharmaceutical companies are attracted by the high incidence and success of other developers. Cytotoxics will remain an integral part of treatment, but with key brands expected to come off patent over the forecast period and the approval of new therapies, treatment of this growing market is set to evolve.

Features and benefits

• Disease overview assessing, etiology, risk factors, screening procedures, and patient segmentation
• In-depth analysis of most common treatment types according to stage at diagnosis and patient characteristics
• Analysis of physician prescribing trends in the seven major markets across all stages of disease
• Analysis of possible future treatment trends with regard to targeted therapies and companion diagnostics

Highlights

The standard of care for Stage I–III colon cancer is based around surgical resection. Advanced Stage II and Stage III tumors often require additional therapy in combination with surgery. FOLFOX accounts for 50% of the Stage IIIb market and is the preferred adjuvant chemotherapy regimen in all major pharmaceutical markets, except the UK.

First-line treatment of metastatic colon cancer is based on chemotherapy. Bevacizumab plus FOLFOX remains the most prescribed first-line regimen in less cost-conservative markets. However, in almost all pharmaceutical markets FOLFOX remains the chemotherapy of choice over FOLFIRI despite similar clinical efficacy in the metastatic setting.

Datamonitor’s survey indicated that the use of targeted therapies in the first- and second-line settings will increase. Increasing pressure to demonstrate cost-effectiveness of drugs and anticipated approval of new targeted therapies means the use of companion diagnostics will play an increasingly important role in the treatment of colon cancer.

Your key questions answered

• Gain insight into the treatment strategies and prescribing trends of 126 physicians treating colon cancer across the seven major markets
• Excel deliverable contains extensive treatment trees for each disease stage and country, including percentages and patient numbers
• Assess colon cancer market potential by identifying where treatment options are not fulfilling patient needs and how physicians select drugs

Table of Contents

OVERVIEW
Catalyst
Summary

EXECUTIVE SUMMARY
Strategic scoping and focus
Datamonitor key findings
Related reports

DISEASE DEFINITION AND DIAGNOSIS
Disease definition
Colorectal cancer is the third most common tumor type and cause of cancer-related death in both men and women
The only differentiator between colon cancer and rectal cancer is primary tumor location
Etiology
Adenomas are precursors to the majority of colorectal cancer cases
Inherited and environmental factors are instrumental in the etiology of colorectal cancer
Symptoms
Change in bowel habits is the principle symptom of colorectal cancer
Prognosis
Survival rates for colorectal cancer patients still lag behind those in other high-incidence indications
Presentation and diagnosis
Screening reduces colorectal cancer incidence and mortality
Influences on diagnosis and treatment rates
Screen for Life: National Colorectal Cancer Action Campaign
In 2012 the "Be clear on cancer" campaign was launched in the UK
Referral patterns
Referral is dictated by stage at diagnosis and treatment approach

PATIENT SEGMENTATION
Stage distribution
The American Joint Committee on Cancer TNM classification system has replaced the older Dukes' staging system

CURRENT TREATMENT OPTIONS
Overview of the available drug classes
Stage I–III
Treatment type
Prescribing trends
Stage IV
Treatment type
Prescribing trends: first-line
Prescribing trends: second line and third line
Local and distant relapse
Local and distant relapse rates
Treatment and prescribing trends: local relapse
Treatment and prescribing trends: distant relapse
Future changes in therapy
Targeted therapies and companion diagnostics

BIBLIOGRAPHY
Journal papers
Websites
Datamonitor reports
Other

APPENDIX A
Physician data

APPENDIX B
Contributing experts
Conferences attended
Report methodology

List of Tables

Table: Colon cancer 5-year survival rates, by stage at diagnosis, 2001–07
Table: Leading treatments for colon cancer across the seven major markets, 2011
Table: Survey respondents across the seven major markets, by country and physician type, 2011

List of Figures

Figure: Relative sensitivity and specificity of different colorectal cancer screening tests
Figure: Distribution of colon cancer patients across the seven major markets, by stage, 2011
Figure: Percentage and number of Stage III patients with Stage IIIa, IIIb, and IIIc colon cancer in the seven major markets, 2011
Figure: Percentage of Stage I–III patients receiving each treatment type in the seven major markets, 2011
Figure: Number of Stage II–III patients receiving adjuvant chemotherapy, by country, 2011
Figure: Top three chemotherapy regimens used in the adjuvant treatment of Stage IIIb in each of the seven major markets, 2011
Figure: Percentage of Stage IV patients receiving each type of treatment in the seven major markets, 2011
Figure: Top three regimens used in the first-line treatment of Stage IV colon cancer in each of the seven major markets, 2011
Figure: Number of Stage IV patients receiving chemotherapy neoadjuvant, adjuvant, or both, by country, 2011
Figure: Top three regimens used adjuvantly with surgery for first-line treatment of Stage IV colon cancer in each of the seven major markets, 2011
Figure: Number of Stage IV patients receiving additional lines of therapy across the seven major markets, 2011
Figure: Top three regimens used for second-line treatment of Stage IV colon cancer in each of the seven major markets, 2011
Figure: Top three regimens used for third-line treatment of Stage IV colon cancer in each of the seven major markets, 2011
Figure: Percentage of Stage I–III colon cancer patients experiencing local or distant relapse across the seven major markets, 2011
Figure: Top three regimens used for treatment of local relapse colon cancer patients in each of the seven major markets, 2011
Figure: Top three regimens used for treatment of first-line distant relapse colon cancer patients in each of the seven major markets, 2011
Figure: Top three regimens used for the treatment of second-line distant relapse colon cancer patients in each of the seven major markets, 2011
Figure: Top three regimens used for the treatment of third-line distant relapse colon cancer patients in each of the seven major markets, 2011
Figure: Physician opinion regarding the role of companion diagnostics in increasing the uptake of targeted therapies in colon cancer in the seven major markets, 2011