The second- and
subsequent-line metastatic castrate-resistant prostate cancer (mCRPC) market is
becoming increasingly crowded. Since 2010, four new therapies have been
approved in the United States for this patient population based on Phase III
clinical data showing that these agents do offer a survival benefit. The launch
of these agents has significantly altered the treatment algorithm and improved
the outlook for patients; nevertheless, our research indicates that significant
clinical and commercial opportunity remains for therapies that can further
prolong overall survival. Several therapies are in late-stage development for
second- and subsequent-line mCRPC, and we anticipate that some of these agents
will be approved for this indication, and this lucrative market will become
even more dynamic and competitive.
Attributes included in conjoint analysis based assessment of target product profiles for second- and subsequent-line mCRPC:
- Median overall survival (months).
- Median radiographic progression-free survival (months).
- PSA response rate (% of patients) defined as a ≥ 50% decline in PSA levels (enzalutamide: 54%).
- Pain palliation rate (% of patients) (enzalutamide: 45%).
- Incidence of grade 3/4 hematological toxicity (neutropenia/anemia, % of patients) (cabazitaxel: 82%/11%).
- Incidence of grade 1-4 gastrointestinal toxicities (nausea/vomiting, % of patients) (cabazitaxel: 34%/23%).
Attributes included in assessment of U.S. payers’ receptivity to new therapies for second- and subsequent-line mCRPC:
- Effect on median overall survival.
- Effect on radiographic progression-free survival.
- Effect on pain palliation rate.
- Effect on grade 3/4 hematological toxicity.
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:
- Abiraterone (Johnson & Johnson/Janssen Biotech/Janssen-Cilag’s Zytiga)
- Docetaxel (Sanofi’s Taxotere, generics)
- Mitoxantrone (EMD Serono/Pfizer/Meda’s Novantrone, generics)
- Cabazitaxel (Sanofi’s Jevtana)
- Enzalutamide (Medivation/Astellas Pharma’s Xtandi)
- Orteronel (Takeda/Millennium)
- Cabozantinib (Exelixis’s Cometriq)
- Radium-223 (Algeta/Bayer HealthCare’s Xofigo)
- Ipilimumab (Bristol-Myers Squibb’s Yervoy)
- Custirsen (OncoGenex/Teva)