The introduction of the HER2-targeting agent trastuzumab (Roche/Genentech/Chugai’s Herceptin) in 2010 transformed the treatment algorithm for metastatic gastric cancer, segregating the population into those patients with HER2-positive disease (HER2 overexpressers) and therefore eligible for trastuzumab treatment, and those deemed HER2-negative. Despite the entrance of Herceptin, the outlook for patients with metastatic gastric cancer is bleak, notably for those with HER2-negative disease. Several emerging therapies including agents from novel drug classes are in development for metastatic gastric cancer; and owing to the high levels of unmet need, significant clinical and commercial opportunity exists for therapies that can provide greater survival benefits than current standards of care.
Attributes included in conjoint analysis-based assessment of target product profiles for metastatic gastric cancer:
- Median overall survival (months).
- Median progression-free survival (months).
- Objective response rate (% of patients).
- Incidence of cardiac dysfunction (% of patients).
- Incidence of neutropenia (grade 3/4) (% of patients).
- Incidence of peripheral edema (all grades) (% of patients).
- Price per 21-day cycle.
Attributes included in assessment of U.S. payers’ receptivity to new therapies for metastatic gastric cancer:
- Effect on median overall survival.
- Effect on progression-free survival.
- Effect on incidence of grade ≥ 3 diarrhea.
- Effect on incidence of grade ≥ 3 neutropenia.
Physicians surveyed: 60 U.S. and 30 European oncologists.
Payers surveyed: 20 U.S. MCO PDs.
Comprehensive List of Therapies Included in Our Research and Modeling:
- Trastuzumab (Roche/Genentech/Chugai’s Herceptin)
- Capecitabine (Roche/Chugai’s Xeloda, generics)
- Leucovorin (Pfizer/Takeda’s Elvorine, generics)
- Oxaliplatin (Sanofi’s Eloxatin/Eloxatine, Yakult Honsha’s Elplat, generics)
- Epirubicin (Pfizer’s Ellence/Pharmorubicin/Farmorubicin/Farmorubicina, generics)
- Docetaxel (Sanofi’s Taxotere, generics)
- Pertuzumab (Roche/Genentech/Chugai’s Perjeta)
- T-DM1 (Roche/Genentech/Chugai’s Kadcyla)
- Onartuzumab (Roche/Genentech/Chugai)
- Rilotumumab (Amgen/Astellas Pharma)
- Ramucirumab (Eli Lilly/ImClone Systems)