Pharmacor

Introduction:

Last Updated 29 July 2010
Gastric cancer (GC) is the fourth-most common malignancy in terms of incidence and is the second-most common cause of cancer-related death worldwide. Japan has the highest incidence of GC among the markets under study, presenting a potentially high commercial reward. The approval of trastuzumab (Roche/Genentech/Chugai’s Herceptin) for the first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive GC is a significant milestone that marks the beginning of a new era for targeted therapy treatment in GC. However, there is a high unmet need for more therapeutic options. The launch of four premium-priced targeted agents by 2019 will address this need, almost doubling sales and dramatically impacting the GC market.

Questions Answered in This Report:

  *   Trastuzumab, in combination with chemotherapy for the treatment HER2-positive advanced and metastatic GC, was approved in January 2010 in Europe—the first targeted agent to be approved for GC. How do interviewed key opinion leaders expect trastuzumab to impact current medical practice in the G7?

  *   Therapeutic options for advanced and metastatic GC are still severely limited; docetaxel (Sanofi-Aventis’s Taxotere), capecitabine (Roche/Genentech/Chugai’s Xeloda), and trastuzumab have improved the survival of patients, but overall survival remains dismally low. Which targeted therapies in clinical development will launch for this population? How will the launch of targeted therapies impact the therapies currently used to treat GC?

  *   The vascular endothelial growth factor (VEGF) inhibitor bevacizumab (Roche/Genentech/Chugai’s Avastin) held promise of becoming the first angiogenic inhibitor to enter the GC market, but it failed to meet its primary end point of overall survival (OS) in a pivotal Phase III trial. What is the impact of bevacizumab’s failure on other angiogenic inhibitors in development for GC? Is there still a role for angiogenic inhibitors in GC?

  *   We forecast an annual growth rate of 7.7% in the GC market over the 2009-2019 forecast period. What are the key drivers of this market growth?

  *   Two second-line targeted therapies, everolimus (Novartis’s Afinitor) and ramucirumab (Eli Lilly/ImClone Systems’ IMC-1121B), have begun Phase III trials. What is the therapeutic potential of these novel targeted agents?

Scope:

Markets covered: United States, France, Germany, Italy, Spain, United Kingdom, Japan.

Primary research: 23 country-specific interviews with key opinion leaders.

Epidemiology: Diagnosed incidence of GC—specifically gastric adenocarcinoma—with AJCC stage IA, IB, II, IIIA, IIIB, IVA, and IVB. Diagnosed incidence of HER2-positive GC by AJCC stage (I-IV). Diagnosed prevalence of GC segmented by drug-treatable status.

Population segments in market forecast: Resectable (stage I-IIIB; localized and resectable locally advanced), unresectable first-line HER2-negative (stage IVA/B; unresectable locally advanced and metastatic), unresectable first-line HER2-positive (stage IVA/B; unresectable locally advanced and metastatic), second-line HER2-negative (after failure of first-line treatment), and second-line HER2-positive (after failure of first-line treatment).

Emerging therapies: Phase II: 21 drugs; Phase III: 6 drugs.

Alternative market scenarios: (1) Trastuzumab penetrates the resectable market segment during our forecast period, (2) ramucirumab moves into the first-line setting by the end of the forecast period, and (3) everolimus does not receive regulatory approval for second-line GC patients.