ABOUT DATAMONITOR HEALTHCARE
About the Oncology pharmaceutical analysis team
CHAPTER 1 EXECUTIVE SUMMARY
Strategic scoping and focus
Datamonitor insight into the supportive care in oncology market
Contributing experts
Related reports
Upcoming related reports
CHAPTER 2 MARKET OVERVIEW AND DYNAMICS
Overview
Market definition
Current and future dynamics
Seven major markets
Value of the supportive care market shrank between 2005 and 2008, and will continue to contract through to 2018 as the effect of generic and biosimilar erosion amplifies
The US accounts for 70% of the total supportive care in oncology market, although this share will contract slightly by 2018
The colony-stimulating factors class for neutropenia will account for over half of the supportive care market sales from 2008 through to 2018
Neulasta will remain the leading supportive care in oncology product throughout the forecast period of the report
The supportive care in oncology market will shrink from $10.3 billion in 2008 to $9.7 billion in 2018 across the seven major pharmaceutical markets
US
The US will experience the fastest rate of decline to 2018 of the seven major markets due to the large impact of patent expiry
The supportive care in oncology market in the US will shrink from $7.2 billion in 2008 to $6.2 billion in 2018
Japan
Japan is forecast to enjoy the highest rate of growth to 2018 of the seven major markets due to new product launches and expansion of drugs into new indications
The supportive care in oncology market in Japan will grow from $597m in 2008 to $702m in 2018
Five major European markets (5EU)
Generic/biosimilar erosion in the five major European markets will be offset by the launch of key pipeline products
The supportive care in oncology market in the five major European markets will grow from $2.5 billion in 2008 to $2.8 billion in 2018
Rest of the world snapshot
Rest of world sales represent 17% of the global supportive care in oncology market
Opportunities and threats
Opportunities
Aging population will result in increasing cancer incidence
New and emerging supportive care challenges will grow the market
Potential for chronic treatment of cancer expands the market for supportive care
Increasing co-operation between regulatory bodies
Threats
Restrictive pricing and reimbursement policies
Reduced periods of market exclusivity
Increasingly conservative regulatory environments
Ongoing cost-containment measures
Market entry of biosimilar biologics
Brand dynamics
Overview of the competitive landscape
Neulasta was the leading supportive care in oncology product in 2008, a position it will maintain through to 2018
Key developers
Strategic overview
Amgen
Corporate strategy
Supportive care in oncology portfolio assessment
Novartis
Corporate strategy
Supportive care in oncology portfolio assessment
CHAPTER 3 ANEMIA
Market potential
Introduction
Anemia is a major contributing factor to adverse effects suffered by patients, and may increase the relative risk of death
Anemia can be caused by a number of factors relating to underlying co-morbidities, the tumor itself, or treatment of the cancer
Four grades of anemia severity exist, with treatment usually initiated at moderate levels
Epidemiology
Current treatment options
Treatment of anemia should serve to correct the underlying cause
Red blood cell transfusions are an option for symptomatic, severely anemic patients
Erythropoiesis-stimulating agents are an option for certain patients with chemotherapy-induced anemia...
...albeit with extensive restrictions on their use
Unmet needs
Drugs with increased safety is the greatest unmet need in cancer-related and chemotherapy-induced anemia
More cost-effective products are needed
Predicting which patients will respond to erythropoietin products will prevent unnecessary administration
Further clinical research could optimize adminstration of the erythropoietin products
Current and future market overview
Seven major markets
The chemotherapy-induced anemia market will undergo a significant decrease through to 2018 as the effect of restricted use continues and biosimilars enter the market
The US accounts for the vast majority of the chemotherapy-induced anemia market, making up nearly three-quarters of sales
Epogen/Procrit will remain the leading colony-stimulating factor throughout the forecast period of the report
The chemotherapy-induced anemia market will shrink from $2.3 billion in 2008 to $941m in 2018 across the seven major pharmaceutical markets
US
The chemotherapy-induced anemia market will shrink from $1.7 billion in 2008 to $717m in 2018 in the US
Japan
The chemotherapy-induced anemia market will shrink from $23m in 2008 to $11m in 2018 in Japan
Five major European markets (5EU)
The chemotherapy-induced anemia market will shrink from $598m in 2008 to $213m in 2018 in the five major European markets
Rest of the world snapshot
Rest of world sales represent 15% of the global chemotherapy-induced anemia market
Brand dynamics
Overview of competitive landscape
Epogen/Procrit was the leading erythropoietin product in 2008, a position set to be maintained through to 2018
Epogen/Procrit (epoetin alpha; Amgen/Kyowa Kirin/Johnson & Johnson)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
Aranesp (darbepoetin alpha; Amgen/Kyowa Kirin)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
Recormon (epoetin beta; Roche/Chugai)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
CHAPTER 4 BONE METASTASES
Market potential
Introduction
Bone metastases cause major debilitating complications in advanced cancer patients
Biomarkers of bone metabolism have been identified that often correlate with extent of bone metastases, however, current clinical utility is limited
Epidemiology
Current treatment options
Bisphosphonates are central to the management of bone metastases
Zometa is the bisphosphonate of choice in cancer patients
Careful monitoring of patients receiving bisphosphonates is required to prevent adverse side effects
Unmet needs
More effective and safer agents are needed with potential effects on survival
Predicting which patients will develop bone metastases could reduce the unnecessary administration of bisphosphonates
Further clinical research could optimize administration schedules and reduce cost of treatment
Current and future market overview
Seven major markets
The bone metastases market will nearly double in value between 2008 and 2018 due to the introduction of pipeline products
The US accounts for approximately half of the bone metastases market, indicating significant use in Japan and the five major European markets
Zometa will lose its place as the leading product for bone metastases by 2018
The bone metastases market will grow strongly from $1.3 billion in 2008 to $2.1 billion in 2018 across the seven major pharmaceutical markets
US
The bone metastases market will grow from $668m in 2008 to $968m in 2018 in the US
Japan
The bone metastases market will grow from $105m in 2008 to $200m in 2018 in Japan
Five major European markets (5EU)
The bone metastases market will grow from $526m in 2008 to $955m in 2018 in the five major European markets
Rest of the world snapshot
Rest of world sales represent 24% of the global bone metastases market
Brand dynamics
Overview of competitive landscape
Zometa was the leading bisphosphonate in 2008, however, it is forecast to lose this position to Prolia by 2018
Zometa (zoledronic acid; Novartis)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
Bondronat (ibandronic acid; Roche)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
Pipeline overview and dynamics
Drug assessment summary
Comparative forecasts
Late-phase pipeline analysis and forecasts
Alpharadin (ATI-BC-1/radium-223; Algeta/Bayer)
Drug overview
Drug profile
Key historical events
Clinical trial data
SWOT analysis
Datamonitor drug assessment summary
Clinical and commercial attractiveness
Satisfaction of unmet needs
Forecasts to 2018
Prolia (denosumab/AMG-162; Amgen)
Drug overview
Drug profile
Key historical events
Clinical trial data
SWOT analysis
Datamonitor drug assessment summary
Clinical and commercial attractiveness
Satisfaction of unmet needs
Forecasts to 2018
Acapodene (toremifene; Orion/GTx/Ipsen)
Drug overview
Drug profile
Key historical events
Clinical trial data
SWOT analysis
Clinical and commercial attractiveness
CHAPTER 5 NAUSEA AND VOMITING
Market potential
Introduction
Chemotherapy-induced nausea and vomiting has severe implications on patient qualtity of life
Chemotheray-induced nausea and vomiting is caused by activation of neuroreceptors in the vomiting center of the brain
Several cytotoxic- and patient-specific factors affect the severity of chemotherapy-induced nausea and vomiting
Emetic risk of different cytotoxics ranges from minimal to high
Epidemiology
Current treatment options
Preventing nausea and vomiting is the primary aim of CINV management
Anti-emetic mode of action is conferred by blocking the action of various neuroreceptors
Classes of anti-emetic
Prevention of chemotherapy-induced nausea and vomiting typically employs a combination of anti-emetic agents
Unmet needs
Improved treatment of breakthrough and refractory chemotherapy-induced nausea and vomiting
While vomiting is effectively prevented, many patients still suffer significant nausea
Need for anti-emetics that do not interact with other commonly used anticancer agents
Potential for a single agent that blocks multiple pathways?
Current and future market overview
Seven major markets
Sales for the chemotherapy-induced nausea and vomiting market fell between 2005 and 2008, but will pick up marginally through to 2018
The US accounts for the largest proportion of the chemotherapy-induced nausea and vomiting market, despite being the only country to suffer a decrease in share through to 2018
The leading anti-emetic brands have already started to lose market share and sales value due to generic erosion
The chemotherapy-induced nausea and vomiting market will grow from $1.5 billion in 2008 to $1.7 billion in 2018 across the seven major pharmaceutical markets
US
The chemotherapy-induced nausea and vomiting market will shrink from $998m in 2008 to $975m in 2018 in the US
Japan
The chemotherapy-induced nausea and vomiting market will grow from $186m in 2008 to $209m in 2018 in Japan
Five major European markets (5EU)
The chemotherapy-induced nausea and vomiting market will grow from $365m in 2008 to $486m in 2018 in the five major European markets
Rest of the world snapshot
Rest of world sales represent 25% of the global chemotherapy-induced nausea and vomiting market
Brand dynamics
Overview of competitive landscape
Aloxi was the leading anti-emetic in terms of sales in 2008, although Emend will claim this position by 2018
Zofran (ondansetron; GlaxoSmithKline)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
Aloxi (palonosetron; Helsinn Pharma/Eisai/Taiho)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
Emend (aprepitant; Merck & Co)/Ivemend (fosaprepitant; Merck & Co)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
Pipeline overview and dynamics
Rezonic (casopitant; GlaxoSmithKline)
Drug overview
Drug profile
Key historical events
Clinical trial data
Clinical and commercial attractiveness
CHAPTER 6 NEUTROPENIA
Market potential
Introduction
Infections as a result of chemotherapy-induced neutropenia were potentially fatal prior to the development of current supportive care measures
Resulting febrile neutropenia is associated with a considerable economic burden from hospitalization costs
Several cytotoxic- and patient-specific factors affect the risk of chemotherapy-induced neutropenia
Risk of neutropenia varies from low to high depending on the chemotherapy regimen used
Epidemiology
Current treatment options
Preventing neutropenia is the primary aim of management to reduce risk to patients and decrease overall cost of cancer treatment
Colony-stimulating factors stimulate the production of white blood cells to prevent neutropenia
Colony-stimulating factors are adminstered in the prophylactic setting to prevent neutropenia
Unmet needs
Increased cost-effectiveness is the greatest unmet need in chemotherapy-induced neutropenia
Predicting which patients really require colony-stimulating factors will further drive down cost and prevent unnecessary administration
Further clinical research could optimize administration schedules and serve to cut overall cost of treatment
Current and future market overview
Seven major markets
The chemotherapy-induced neutropenia market will dip slightly through to 2018 as biosimilars take effect
The US accounts for the vast majority of the chemotherapy-induced neutropenia market, with three-quarters of sales
Neulasta will remain the leading colony-stimulating factor throughout the forecast period of the report
The chemotherapy-induced neutropenia market will shrink from $5.1 billion in 2008 to $5.0 billion in 2018 across the seven major pharmaceutical markets
US
The chemotherapy-induced neutropenia market will contract from $3.9 billion in 2008 to $3.6 billion in 2018 in the US
Japan
The chemotherapy-induced neutropenia market in Japan will remain fairly constant at $283m in 2008 and $282m in 2018, with a peak of $296m in the interim
Five major European markets (5EU)
The chemotherapy-induced neutropenia market will grow from $988m in 2008 to $1.1 billion in 2018 in the five major European markets
Rest of the world snapshot
Rest of world sales represent 13% of the global chemotherapy-induced neutropenia market
Brand dynamics
Overview of competitive landscape
Neulasta and Neupogen were the leading colony-stimulating factors in 2008, a position set to be maintained through to 2018
Neupogen (filgrastim; Amgen/Kyowa Kirin)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
Neulasta (pegfilgrastim; Amgen/Kyowa Kirin)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
CHAPTER 7 THROMBOCYTOPENIA
Market potential
Introduction
Chemotherapy is a common cause of thrombocytopenia, and often results in treatment delays or dose reductions
Several treatment- and patient-specific factors affect the risk of chemotherapy-induced thrombocytopenia
A lack of data makes it difficult to assess the true significance of chemotherapy-induced thrombocytopenia
Epidemiology
Current treatment options
No definitive treatment guidelines exist for thrombocytopenia, however, it is most frequently resolved via chemotherapy dose reductions or delays, or platelet transfusions for more severe cases
Dose reductions or delays, and platelet transfusions carry high inherent risk
One approved growth factor exists for treatment of thrombocytopenia, however, it use is very restricted
Unmet needs
Educating physicians and patients on the potential negative implications of thrombocytopenia could increase the need for an effective, tolerable and cost-effective treatment option
Further clinical research could optimize the definition of chemotherapy-induced thrombocytopenia
Current and future market overview
Seven major markets
Use of Neumega will continue to decrease through to 2018, although the eventual launch of pipeline products will help the overall chemotherapy-induced thrombocytopenia market to grow
Sales of Neumega will slump from $14m in 2008 to $3m in 2018 across the seven major pharmaceutical markets
Potential size of the chemotherapy-related thrombocytopenia market
Rest of the world snapshot
Rest of world sales represent 8% of the global chemotherapy-induced thrombocytopenia market
Brand dynamics
Overview of competitive landscape
Neumega is currently the only commercially available drug for chemotherapy-induced thrombocytopenia, however, the launch of pipeline products will transform the market through to 2018
Neumega (oprelvekin; Wyeth)
Drug profile
Product positioning
SWOT analysis
Brand forecast to 2018
Pipeline overview & dynamics
Key pipeline candidates
Nplate (romiplostim/AMG-531; Amgen)
Drug overview
Drug profile
Key historical events
Clinical trial data
SWOT analysis
Clinical and commercial attractiveness
Promacta (eltrombopag/SB-497115; Ligand Pharmaceuticals/ GlaxoSmithKline)
Drug overview
Drug profile
Key historical events
Clinical trial data
SWOT analysis
Clinical and commercial attractiveness
CHAPTER 8 EMERGING SUPPORTIVE CARE CHALLENGES
Introduction
Other established supportive care challenges
Cancer cachexia
Cancer pain
Mucositis
Other supportive care challenges
New emerging supportive care challenges
EGFR-related skin rash
Herceptin-related cardiotoxicity
Future of supportive care
BIBLIOGRAPHY
References
APPENDIX A - MARKET ASSUMPTIONS
New product launches
Patent expiries
Epidemiology of solid tumors and hematological malignancies
Data definitions, limitations and assumptions
Standard units
Japanese market data
Country group definitions
Rest of European Union
Rest of World
Derivation of sales forecasts and pricing trends
Forecast methodology
Pipeline product forecasts
Datamonitor drug assessment scorecard
Report methodology
APPENDIX B
About Datamonitor
About Datamonitor Healthcare
About the Oncology analysis team
Disclaimer