Are emerging targeted therapies poised to fill the significant unmet need of patients in the second and subsequent lines of therapy?
Treatment decisions for non-small-cell lung cancer (NSCLC) patients are increasingly based on personalized tumor-specific characteristics. It is now standard practice for patients with advanced NSCLC of nonsquamous-cell—particularly adenocarcinoma—histology to undergo testing for epidermal growth factor receptor (EGFR) mutations. While the first-generation EGFR tyrosine kinase inhibitors (TKIs), erlotinib (Genentech/Roche/Chugai/Astellas’s Tarceva) and gefitinib (AstraZeneca’s Iressa) have revolutionized the first-line treatment of NSCLC (EGFR-mutation-positive; previously treated), no targeted agents are currently approved in the second or subsequent- lines. Consequently, the outcome for patients with NSCLC (EGFR-mutation-positive; previously treated) remains bleak. Going forward, the market is expected to become increasingly competitive following the approval of the targeted second-generation and third-generation EGFR TKIs for NSCLC (EGFR-mutation-positive; previously treated). Despite this development, significant clinical and commercial opportunity remains 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 NSCLC (EGFR-mutation-positive; previously treated):
- Median overall survival.
- Median progression-free survival.
- Overall response rate.
- Hematological toxicity: rate of grade 3/4 neutropenia.
- Dermatological toxicity: rate of all grades skin rash.
- Gastrointestinal toxicity: rate of all grades diarrhea.
- Price per 21-day cycle.
Attributes included in assessment of U.S. payers’ receptivity to new therapies for NSCLC (EGFR-mutation-positive; previously treated):
- Effect on median overall survival.
- Effect on progression-free survival.
- Incidence of grade 3/4 neutropenia.
- Incidence of all grades rash.
Physicians surveyed: 61 U.S. and 30 European oncologists.
Payers surveyed: 20 U.S. MCO PDs.
Comprehensive List of Therapies Included in Our Research and Modeling:
- Pemetrexed (Eli Lilly’s Alimta)
- Docetaxel (Sanofi’s Taxotere, generics)
- Gemcitabine (Eli Lilly’s Gemzar) + cisplatin (generics)
- Pemetrexed (Eli Lilly’s Alimta) + cisplatin (generics)
- Paclitaxel (Bristol-Myers Squibb’s Taxol, generics) + carboplatin (generics) + bevacizumab (Genentech/Roche/Chugai’s Avastin)
- Afatinib (Boehringer Ingelheim’s Gilotrif/Giotrif)
- Dacomitinib (Pfizer)
- CO-1686 (Clovis Oncology/Celgene)
- AP-26113 (Ariad Pharmaceuticals)
- Ganetespib (Synta Pharmaceuticals) + docetaxel (Sanofi’s Taxotere, generics)