How are NSCLC Treatments Sequenced and What Factors Drive Prescribing?

Contributors : Rachel Webster : Principal Director, Oncology Lead

Publish date: 09 Jul, 2018

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Key Findings:

  • By drilling down into very specific patient subpopulations (such as Keytruda-treated in the first line, strongly PD-L1-positive [≥50% tumor expression] with EGFR and ALK wild-type/unknown metastatic nonsquamous disease), we reveal physicians’ most-frequently selected treatment sequences and uncover where brands are positioned in the treatment journey. For example, for first-line EGFR TKI-treated metastatic patients who are EGFR-T790M-mutation-positive in the second line, Tagrisso is most commonly used post-Tarceva and -Gilotrif, but single agent PD-1 inhibitors, Keytruda and Opdivo, are making inroads.
  • Approximately, 10% of EGFR-mutation-positive and ALK-translocation-positive patients receives Keytruda + Alimta + carboplatin in the first line, which is less than half the percentage in the EGFR or ALK wild-type/unknown setting. The strongest drivers for greater use of Keytruda in first-line EGFR-mutation-positive or ALK-translocation-positive patients include oncologists’ desire to initiate immunotherapy as soon as possible and their perception that this combination regimen is more likely to extend overall survival, delay disease progression, and produce longer-lasting responses compared with EGFR/ALK inhibitors.

The “so what” for decision makers: Given the complexity and fragmented nature of the fast-moving NSCLC market, it is challenging to get an accurate picture of the landscape and clinical journey, especially how treatments are sequenced. Treatment Sequencing enables pharma strategists to navigate the NSCLC treatment patterns in distinct clinical scenarios defined by molecular, histology, and disease status and devise a plan to improve asset positioning and facilitate forecasting.

Pharma companies also need to understand the drivers (and obstacles) behind treatment pathways, drug positioning, and uptake. Understanding the factors that influence oncologists’ prescribing of Keytruda + chemotherapy, or any other therapy in the NSCLC landscape, in distinct populations defined by molecular tumor markers can aid strategic planning. It is also important for developing specific messaging around treatment dynamics to effectively defend or strengthen competitive position.

Key questions answered in the analysis:

  • What are physicians’ most-frequent treatment sequences in market-relevant NSCLC treatment scenarios—who is benefiting and how can I defend my assets share and position?
  • How do the drug-treatment rates vary across key metastatic NSCLC patient populations?
  • What is the uptake of Keytruda plus chemotherapy in first-line metastatic NSCLC?
  • What are the main drivers (and obstacles) in prescribing Keytruda in first-line metastatic NSCLC?

Markets covered: United States.

Methodology: Survey of 100 medical oncologists.

Indication coverage: NSCLC

Key drugs covered: Keytruda, Opdivo, Tecentriq, Tarceva, Tagrisso, Xalkori, Alecensa, Alimta

Key companies mentioned: Merck & Co., Bristol-Myers Squibb, Roche, Genentech, AstraZeneca, Pfizer, Eli Lilly

Discover more about physicians’ prescribing in NSCLC and most-frequent treatment sequence in DRG’s latest research. Learn how to access these reports:





 

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