Colorectal cancer is the third-most-common cancer globally, and metastatic disease is associated with poor five-year overall survival rates. Current treatment for metastatic colorectal cancer is dominated by chemotherapy regimens in combination with angiogenesis inhibitors and EGFR inhibitors. Several areas of high unmet need—notably, RAS-mutant patient populations—offer significant commercial opportunity for innovative agents. Although sales of immune checkpoint inhibitors and emerging BRAF/MEK inhibitor combinations will increase over the 2018-2028 forecast period, generic and biosimilar competition will also have a major impact on therapy sales. This report provides insight on how treatment options for colorectal cancer are likely to change over the 2018-2028 forecast period. It also analyzes the current and future earnings potential of drugs already in the market and those expected to be approved for colorectal cancer.

Questions answered:

  • The launch of new, high-priced therapies for colorectal cancer will encounter generic erosion of older therapies. .What will be the major constraints on therapy sales? What are the key drivers of growth over this period? What are the drug development activities of note? What challenges and opportunities remain?
  • TheBRAF/MEK inhibitor combination of Mektovi/Braftovi/Erbitux has shown promising efficacy in BRAF-mutant colorectal cancer patients. What is thought-leader opinion of these agents? For which lines of therapy will these agents be positioned? Will these agents receive approval in the markets under study? How will use of these agents affect prescribing of other agents for colorectal cancer?
  • In 2017, the FDA approved Keytruda (Merck) and Opdivo (Bristol-Myers Squibb) for second- and later-line treatment of MSI-H/dMMR colorectal cancer that is refractory to a fluoropyrimidine, irinotecan, and oxaliplatin. In 2018, Opdivo plus low-dose Yervoy received FDA approval in the same setting. How do key opinion leaders perceive these therapies? Will these therapies receive label expansions across the G7? Which other immune checkpoint inhibitors are being developed and for which patient populations?
  • Retrospective analyses of clinical trials with Avastin and EGFR inhibitors have shown that the side on which the tumor is located could be a prognostic factor for response to these agents. How do key opinion leaders view these data? Will“sidedness” influence the treatment of metastatic colorectal cancer during the forecast period?


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

Primary research: 20 country-specific interviews with thought leaders.

Epidemiology: Diagnosed incident cases of stage I, II, III, and IV colorectal cancer.

Population segments in market forecast:Stage II colon cancer;stage II rectal cancer;stage III colon cancer;stage III rectal cancer;stage IV colorectal cancer wild-type BRAF and RAS, first-line (left-sided);stage IV colorectal cancer wild-type BRAF and RAS, first-line (right-sided);stage IV colorectal cancer mutant RAS, first-line;stage IV colorectal cancer mutant BRAF, first-line;stage IV colorectal cancer wild-type BRAF and RAS,second-line (left-sided); stage IV colorectal cancer wild-type BRAF and RAS,second-line (right-sided); stage IV colorectal cancer mutant RAS, second-line; stage IV colorectal cancer mutant BRAF, second-line; stage IV colorectal cancer wild-type BRAF and RAS, third-line (left-sided); stage IV colorectal cancer wild-type BRAF and RAS, third-line (right-sided); stage IV colorectal cancer mutant RAS, third-line; stage IV colorectal cancer mutant BRAF.

Emerging therapies: Phase III: 10 drugs; Phase I-II: 7 drugs.

Table of contents

  • Disease Landscape & Forecast
    • Key Findings
      • Colorectal Cancer - Key Findings - December 2019
    • Key Updates
      • December 2019
      • September 2019
      • May 2019
      • February 2019
      • October 2018
    • Market Outlook
      • Key Findings
      • Market Drivers and Constraints
        • What Factors Are Driving the Market for Colorectal Cancer?
        • What Factors Are Constraining the Market for Colorectal Cancer?
      • Segment-Specific Trends
        • Stage II/III Colorectal Cancer
        • First-Line Metastatic Colorectal Cancer
        • Second-Line Metastatic Colorectal Cancer
        • Third-Line Metastatic Colorectal Cancer
    • Forecast
      • Market Forecast Assumptions - Colorectal Cancer (November 2019)
      • Market Forecast Dashboard - Colorectal Cancer (November 2019)
    • Etiology & Pathophysiology
      • Disease Overview
      • Disease Pathophysiology
        • Etiology
        • Pathophysiology
      • Staging and Classification
        • Staging of Colorectal Cancer
        • Screening of Colorectal Cancer
      • Key Pathways and Drug Targets
    • Epidemiology
      • Key Findings
      • Epidemiology Populations
        • Diagnosed Incident Cases
        • Stage Distribution of Colorectal Cancer
        • Recurrent Incident Cases of Colorectal Cancer
        • Drug-Treatable Populations
        • Drug-Treated Populations
    • Current Treatment
      • Key Findings
      • Treatment Goals
      • Key Current Therapies
        • Overview
        • Immune Checkpoint Inhibitors
        • Angiogenesis Inhibitors
        • EGFR Inhibitors
        • Chemotherapy
      • Medical Practice
        • Stage II/III Colon Cancer
        • Stage II/III Rectal Cancer
        • Treatment of Colorectal Cancer with Resectable Liver Metastases
        • First-Line Treatment of Metastatic Colorectal Cancer
        • Second-Line Treatment of Metastatic Colorectal Cancer
        • Third- and Later-Line Treatment of Metastatic Colorectal Cancer
        • Region-Specific Treatment Practices
    • Unmet Need Overview
      • Current and Future Attainment of Unmet Needs in Colorectal Cancer
    • Emerging Therapies
      • Key Findings
        • Key Findings
      • Key Emerging Therapies
        • BRAF/MEK Inhibitors
        • Tyrosine Kinase Inhibitors
        • Immune Checkpoint Inhibitors
        • Therapeutic Vaccines
        • Immunomodulators
        • Cancer Stem-Cell Pathway Inhibitors
        • Chemotherapy
      • Early-Phase Pipeline Analysis
    • Access & Reimbursement Overview
      • Region-Specific Reimbursement Practices
        • United States
        • EU5
        • Japan
      • Looking for More?
    • Methodology
      • Bottom-Up Forecasting Overview
        • Patient Populations
        • Drug- and Regimen-Specific Assumptions
      • Bottom-Up Forecast Assumptions
        • General Sources of Data
        • General Statements About Pricing
        • Dosing, Cycles of Therapy, and Compliance
        • Generic Erosion
        • Biosimilar Erosion
        • Out-Year Forecasting
        • Emerging Therapy Prices
      • Primary Market Research
        • Experts Interviewed
    • Appendix
      • Colorectal Cancer Bibliography

Author(s): Jorrit Schafer, M.Sc.,Ph.D; Narendra Parihar

Jorrit Schäfer, , is a business insights analyst at Decision Resources Group. Prior to joining DRG, Dr. Schäfer worked as a postdoctoral research associate at Imperial College London, where he studied the impact of antibiotic stress on RNA repair in bacteria. Dr. Schäfer holds a in molecular medicine and a in molecular cell biology from Imperial College London.

Narendra is an associate epidemiologist within the epidemiology team at Decision Resources Group. Narendra specializes in developing epidemiological forecasts for multiple indications within the DRG syndicated portfolio. His qualifications include an MPH with specialization in Health Policy, Economics and Finance from the Tata Institute of Social Sciences, Mumbai, and a Bachelor’s degree in Dentistry from the Rajasthan University of Health Sciences.

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