Opportunities for Drug Development in Gastroesophageal Cancer

Does the future market value for gastroesophageal cancer reflect the effectiveness of emerging treatments?

Key findings: In a new report from Decision Resources Group, Gastroesophageal Cancer Disease Landscape & Forecast, we observed the market for gastroesophageal cancer treatment reached $1.7 billion in 2017 across the seven major markets, despite chemotherapies prescribed for this treatment consisting of largely low-cost generic drugs. The four approved high-cost biologics accounted for approximately half the sales in this year. Over the next decade, DRG forecasts numerous label expansions of current therapies and the approval of seven novel agents, which we predict will drive the market to a staggering $9.5 billion in 2027.

Despite the substantial 19% annual growth we predict, only incremental efficacy benefits are expected based on currently available clinical data. While drug approvals will be based on statistically significant efficacy improvements over the standard of care, these benefits could prove clinically modest. Today’s available data suggests many of the emerging therapies currently in development will provide patients with less than a three-month survival benefit. Still, while survival outcomes may not be numerically significant for the majority of patients, many of the emerging therapies provide better magnitudes of improvement in response rates compared with current standards of care. This means that larger proportions of patients will derive a benefit, but of course, ultimately, the most meaningful benefit is survival.

Although the launch of several high-cost novel therapies will add to the financial burden on already strained healthcare systems, factors other than efficacy should be taken into consideration when assessing the overall effectiveness of cancer therapies. For example, gastroesophageal cancer is a notoriously difficult-to-treat disease, with an extensive list of failed therapies, including:

  • The PD-1/PD-L1-targeting agents Bavencio (avelumab; third- and later-line) and Keytruda (pembrolizumab; second- and later-line);
  • The HER2-targeting agents, Perjeta (pertuzumab), Kadcyla (trastuzumab emtansine), and Tykerb/Tyverb (lapatinib);
  • The angiogenesis inhibitor Avastin (bevacizumab);
  • The PARP inhibitor Lynparza (olaparib);
  • And the c-Met inhibitor MetMab (onartuzumab).

Evidently, demonstrating statistically significant improvements over current standards of care in gastroesophageal cancer is no mean feat. Therefore, even numerically modest improvements in survival represent significant achievements.

Additionally, quality-of-life is an important factor in treatment value. In the first-line setting for gastroesophageal cancer, emerging agents are generally prescribed in combination with chemotherapy backbones, thereby adding to the toxicity and reducing tolerability of the treatment. However, in the pretreated settings, well-tolerated single agents (such as immune checkpoint inhibitors) are being evaluated with the expectation of replacing toxic chemotherapy, a vital consideration in a sick and often frail patient population.

Implications for decision makers: A sound understanding of the gastroesophageal cancer market is vital to devise a robust strategy to conquer this devastating disease. Despite the anticipated developments in the gastroesophageal cancer market over the next decade, the threshold for demonstrating a survival benefit will be only marginally raised, leaving a significant unmet need for more efficacious, safer, and better value-for-money treatments. So, there is a substantial opportunity for drug developers to gain a foothold on the market, and, although a challenging endeavor to undertake, it could prove commercially lucrative. The medical oncologists interviewed seek more clinically meaningful gains for gastroesophageal cancer patients, so small but statistically significant improvements in efficacy can lead to significant drug sales for biopharmaceutical companies. Moreover, cumulative efficacy gains over time should have a noteworthy impact on patients’ lives.

The full Gastroesophageal Cancer Disease Landscape & Forecast report answers:

  • How do current treatment practices differ between esophageal, gastric, and GEJ cancer, and which populations provide the greatest drug-treatment opportunities by geography?
  • What are interviewed thought leaders’ insights on Herceptin, Cyramza (ramucirumab), Keytruda (pembrolizumab), Opdivo (nivolumab), and chemotherapy? What clinical needs remain unfulfilled and what opportunities can developers capitalize on?
  • Which other immune checkpoint inhibitors (Bavencio [avelumab], Yervoy [ipilimumab], tislelizumab) are forecast for approval in which disease setting and how will they compete with currently marketed and established therapies?
  • What agents with novel mechanisms of actions are being assessed in Phase III trials, which populations are they targeting, and how will these impact the gastroesophageal cancer market?
  • What are the market drivers and constraints in the gastroesophageal market, and how will the market evolve over the forecast period?

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

Methodology: 20 country-specific interviews with thought-leading medical oncologists, supported by survey data collected from 210 medical oncologists across the G7

Key indications covered: Gastroesophageal cancer, gastric and gastroesophageal junction (GEJ) adenocarcinoma, esophageal adenocarcinoma, esophageal squamous cell carcinoma

Key drugs covered: andecaliximab, Bavencio (avelumab), Cyramza (ramucirumab), DS-8201, Herceptin (trastuzumab), Keytruda (pembrolizumab), Lonsurf (TAS-102), Opdivo (nivolumab), pamiparib, rivoceranib (apatinib), Stivarga (regorafenib), TAS-118, tislelizumab, zolbetuximab

Key companies mentioned: Astellas Pharma, Bayer HealthCare, BeiGene, Bristol-Myers Squibb, Celgene, Chugai Pharmaceutical, Daiichi Sankyo, Eli Lilly, Genentech, Gilead Sciences, LSK Biopharma, Merck & Co., Merck KGaA, Ono Pharmaceutical, Onyx Pharmaceuticals, Pfizer, Roche, Taiho Pharmaceutical

Discover how the gastroesophageal cancer market is expected to change over the next decade and where potential lucrative opportunities remain for drug development. Learn how to access this report:

 


Contributors: Paul Wilcock, Ph : Senior Business Insights Analyst
Published on: 31 October, 2018