Targeted therapies and various biomarkers (e.g., RAS, BRAF, MSI-H,dMMR) play an important role in the treatment of colorectal cancer. Treatment is becoming increasingly segmented by the side on which the tumor is located, BRAF status, and MSI-H or dMMR status. Immune checkpoint inhibitors targeting MSI-H / dMMR metastatic colorectal cancer are experiencing uptake and influencing current treatment algorithms. Therapies targeting specific biomarker-defined populations, such as BRAF-mutant metastatic colorectal, contribute to more-personalized treatment. This report provides insight on how treatment options for colorectal cancer are likely to change over the 2019-2029 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:

  • Current treatment for metastatic colorectal cancer is dominated by chemotherapy regimens in combination with angiogenesis inhibitors and EGFR inhibitors. The launch of new, high-priced therapies for colorectal cancer will encounter competition from generic and biosimilar versions of older therapies. What are the key drivers of and constraints on the colorectal cancer therapy market, and how will the major markets evolve over the ten-year forecast period? What are the drug development activities of note? What challenges and opportunities remain?
  • The BRAF inhibitor combination of Braftovi plus Erbitux has shown promising efficacy in BRAF-mutant colorectal cancer patients. What is thought-leader opinion of this combination? For which lines of therapy will this combination be positioned? How will use of this combination affect prescribing of other agents for colorectal cancer?
  • Keytruda (Merck & Co.) was approved in the United States in 2020 and in Europe in 2021 for the first-line treatment of MSI-H/dMMR metastatic colorectal cancer. This agent and Opdivo—with or without low-dose Yervoy (Bristol-Myers Squibb)—have been available since 2017 in the United States and in Japan since 2020 for the second- and later-line treatment of MSI-H/dMMR colorectal cancer that is refractory to a fluoropyrimidine, irinotecan, and oxaliplatin.How do key opinion leaders perceive these therapies? Will these therapies receive label expansions? 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?

Scope:

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: 7 drugs; Phase I-II: 9 drugs.

Table of contents

  • Colorectal Cancer - Landscape & Forecast - Disease Landscape & Forecast
    • Key Updates
      • Q1 2021
        • March 2021
        • February 2021
        • January 2021
      • Q4 2020
        • December 2020
      • Q3 2020
        • August 2020
      • Q2 2020
        • May 2020
    • Key Findings
      • Colorectal Cancer – Key Findings
        • May 2020
    • Market Outlook
      • Key Findings
        • Market Share of Drug Classes for Colorectal Cancer: 2019
        • Market Share of Drug Classes for Colorectal Cancer: 2029
        • Drug-Treatable Population Share and Major-Market Sales Share in Colorectal Cancer: 2019
        • Drug-Treatable Population Share and Major-Market Sales Share in Colorectal Cancer: 2029
        • Population Positioning of Therapies in Colorectal Cancer
        • Colorectal Cancer SWOT Analysis
      • COVID-19: Areas of Potential Forecast Impact
        • Market Drivers and Constraints
          • What Factors Are Driving the Market for Colorectal Cancer?
          • What Factors Are Constraining the Market for Colorectal Cancer?
          • Sales of Major Drug Classes, G7 (millions of U.S. dollars)
          • Major-Market Sales of Key Drugs by Brand/Biosimilar: 2019-2029
        • Segment-Specific Trends
          • Stage II/III Colorectal Cancer
          • Patient-Share Dynamics of Key Players in Stage III Colon Cancer, United States (2019-2029)
          • Patient-Share Dynamics of Key Players in Stage IV First-Line, Left-Sided, BRAF Wild-Type, RAS Wild-Type Colorectal Cancer, U.S. (2019-2029)
          • Patient-Share Dynamics of Key Players in Stage IV First-Line, Right-Sided, BRAF Wild-Type, RAS Wild-Type Colorectal Cancer, U.S. (2019-2029)
          • Patient-Share Dynamics of Key Players in Stage IV First-Line, BRAF Wild-Type, RAS-Mutant Colorectal Cancer, U.S. (2019-2029)
          • Patient-Share Dynamics of Key Players in Stage IV First-Line, BRAF-Mutant, RAS Wild-Type Colorectal Cancer, U.S. (2019-2029)
          • Second-Line Metastatic Colorectal Cancer
          • Patient-Share Dynamics of Key Players in Stage IV Second-Line, Left-Sided, BRAF Wild-Type, RAS Wild-Type Colorectal Cancer, U.S. (2019-2029)
          • Patient-Share Dynamics of Key Players in Stage IV Second-Line, Right-Sided, BRAF Wild-Type, RAS Wild-Type Colorectal Cancer, U.S. (2019-2029)
          • Patient-Share Dynamics of Key Players in Stage IV Second-Line, BRAF Wild-Type, RAS-Mutant Colorectal Cancer, U.S. (2019-2029)
          • Patient-Share Dynamics of Key Players in Stage IV Second-Line, BRAF-Mutant, RAS Wild-Type Colorectal Cancer, U.S. (2019-2029)
          • Third-Line Metastatic Colorectal Cancer
          • Patient-Share Dynamics of Key Players in Stage IV Third-Line, Left-Sided, BRAF Wild-Type, RAS Wild-Type Colorectal Cancer, United States: 2019-2029
          • Patient-Share Dynamics of Key Players in Stage IV Third-Line, Right-Sided, BRAF Wild-Type, RAS Wild-Type Colorectal Cancer, United States: 2019-2029
          • Patient-Share Dynamics of Key Players in Stage IV Third-Line, BRAF Wild-Type, RAS-Mutant Colorectal Cancer, United States: 2019-2029
          • Patient-Share Dynamics of Key Players in Stage IV Third-Line, BRAF-Mutant, RAS Wild-Type Colorectal Cancer, United States: 2019-2029
      • Forecast
        • Market Forecast Assumptions - Colorectal Cancer
        • Market Forecast Dashboard - Colorectal Cancer
      • Etiology & Pathophysiology
        • Disease Overview
          • Disease Pathophysiology
            • Etiology
            • Risk Factors for Developing Colorectal Cancer
            • Pathophysiology
            • Proposed Adenoma-Carcinoma Sequence Model for Colorectal Cancer with Chromosomal Instability
          • Staging and Classification
            • Staging of Colorectal Cancer
            • TNM Classification of Colorectal Cancer
            • Modified Astler-Coller Dukes Staging System vs. AJCC/UICC Colorectal Cancer (TNM) Staging System
            • Symptoms According to Tumor Location in Colorectal Cancer
            • Screening for Colorectal Cancer
            • Prognostic Factors in Colorectal Cancer
          • Key Pathways and Drug Targets
            • Drug Targets for Colorectal Cancer
            • Select Genes Reportedly Involved in Colorectal Cancer
        • Epidemiology
          • Key Findings
            • Key Updates
          • Epidemiology Populations
            • Disease Definition
            • Methods
            • Sources Used for Diagnosed Incidence of Colorectal Cancer
            • Diagnosed Incident Cases of Colorectal Cancer: 2019-2029
            • Disease Definition
            • Methods
            • Sources Used for Stage Distribution of Colorectal Cancer
            • Diagnosed Incident Cases of Colorectal Cancer by Stage Distribution: 2019-2029
            • Definition
            • Methods
            • Sources Used for Recurrent Incidence of Colorectal Cancer
            • Recurrent Incident Cases of Colorectal Cancer: 2019-2029
            • Colorectal Cancer Patient Flow
            • Drug-Treatable Cases of Colorectal Cancer: 2019-2029
            • Drug-Treated Cases of Colorectal Cancer: 2019-2029
        • Current Treatment
          • Key Findings
            • Treatment Goals
              • Key Endpoints Used in Clinical Trials for Colorectal Cancer
            • Key Current Therapies
              • Overview
              • Mechanism of Action of Key Current Drug Classes Used for Colorectal Cancer
              • Current Treatments Used for Colorectal Cancer
              • Market Events Impacting the Use of Key Current Therapies in Colorectal Cancer
              • Advantages and Disadvantages of Avastin (Bevacizumab)
              • Key Results from Select Clinical Trials Investigating Avastin (Bevacizumab) for the Treatment of Colorectal Cancer
              • Expert Insight: Avastin (Bevacizumab)
              • Advantages and Disadvantages of Zaltrap
              • Key Results from Select Clinical Trials Investigating Zaltrap for the Treatment of Colorectal Cancer
              • Expert Insight: Zaltrap
              • Advantages and Disadvantages of Cyramza
              • Key Results from Select Clinical Trials Investigating Cyramza for the Treatment of Colorectal Cancer
              • Ongoing Clinical Development of Cyramza
              • Key Ongoing Clinical Trials of Cyramza in the Treatment of Colorectal Cancer
              • Expert Insight: Cyramza
              • Advantages and Disadvantages of Stivarga
              • Key Results from Select Clinical Trials Investigating Stivarga for the Treatment of Colorectal Cancer
              • Expert Insight: Stivarga
              • Advantages and Disadvantages of Erbitux
              • Key Results from Select Clinical Trials Investigating Erbitux for the Treatment of Colorectal Cancer
              • Ongoing Clinical Development of Erbitux
              • Key Ongoing Clinical Trials of Erbitux in the Treatment of Colorectal Cancer
              • Expert Insight: Erbitux
              • Advantages and Disadvantages of Vectibix
              • Key Results from Select Clinical Trials Investigating Vectibix for the Treatment of Colorectal Cancer
              • Ongoing Clinical Development of Vectibix
              • Key Ongoing Clinical Trials of Vectibix in the Treatment of Colorectal Cancer
              • Expert Insight: Vectibix
              • Key Results from Select Clinical Trials Investigating Keytruda for the Treatment of Colorectal Cancer
              • Ongoing Clinical Development of Keytruda
              • Expert Insight: Keytruda
              • Key Results from Select Clinical Trials Investigating Opdivo for the Treatment of Colorectal Cancer
              • Ongoing Clinical Development of Opdivo
              • Key Ongoing Clinical Trials of Opdivo in the Treatment of Colorectal Cancer
              • Expert Insight: Opdivo
              • Key Results from Select Clinical Trials Investigating Braftovi for the Treatment of Colorectal Cancer
              • Ongoing Clinical Development of Braftovi
              • Key Ongoing Clinical Trials of Braftovi in the Treatment of Colorectal Cancer
              • Expert Insight: Braftovi
              • Advantages and Disadvantages of Lonsurf
              • Key Results from Select Clinical Trials Investigating Lonsurf for the Treatment of Colorectal Cancer
              • Ongoing Clinical Development of Lonsurf
              • Key Ongoing Clinical Trials of Lonsurf in the Treatment of Colorectal Cancer
              • Expert Insight: Lonsurf
            • Medical Practice
              • Stage II/III Colon Cancer
              • Stage II/III Rectal Cancer
              • Treatment of Colorectal Cancer with Resectable Liver Metastases
              • Second-Line Treatment of Metastatic Colorectal Cancer
              • Third- and Later-Line Treatment of Metastatic Colorectal Cancer
              • Country-Specific Colorectal Cancer Treatment Guidelines
              • Patient Characteristics Influencing Drug Selection in Colorectal Cancer
              • Treatment Decision Tree for Stage II/III Colon and Rectal Cancer: G7
              • Treatment Decision Tree for Stage IV Colorectal Cancer: United States
              • Treatment Decision Tree for Stage IV Colorectal Cancer: France, Germany, Italy, and Spain
              • Treatment Decision Tree for Stage IV Colorectal Cancer: United Kingdom
              • Treatment Decision Tree for Stage IV Colorectal Cancer: Japan
          • Unmet Need Overview
            • Current and Future Attainment of Unmet Needs in Colorectal Cancer
            • Top Unmet Needs in Colorectal Cancer: Current and Future Attainment
            • Expert Insights: Unmet Need in Colorectal Cancer
          • Emerging Therapies
            • Key Findings
              • Pipeline Trends in Colorectal Cancer
            • Key Emerging Therapies
              • Key Therapies in Development for Colorectal Cancer
              • Estimated Market Authorization Dates of Key Emerging Therapies for the Treatment of Colorectal Cancer
              • Key Results from Select Clinical Trials Investigating Fruquintinib for the Treatment of Colorectal Cancer
              • Key Ongoing Clinical Trials of Fruquintinib in the Treatment of Colorectal Cancer
              • Analysis of the Clinical Development Program for Fruquintinib
              • Expert Insight: Fruquintinib
              • Expectations for Market Authorization and Sales Opportunity of Fruquintinib in Colorectal Cancer
              • Key Results from Select Clinical Trials Investigating Tecentriq for the Treatment of Colorectal Cancer
              • Key Ongoing Clinical Trials of Tecentriq in the Treatment of Colorectal Cancer
              • Analysis of the Clinical Development Program for Tecentriq
              • Expert Insight: Tecentriq
              • Expectations for Market Authorization and Sales Opportunity of Tecentriq in Colorectal Cancer
              • Key Ongoing Clinical Trials of Bavencio in the Treatment of Colorectal Cancer
              • Analysis of the Clinical Development Program for Bavencio
              • Expert Insight: Bavencio
              • Expectations for Market Authorization and Sales Opportunity for Bavencio in Colorectal Cancer
              • Key Results from Select Clinical Trials Investigating Imfinzi for the Treatment of Colorectal Cancer
              • Key Ongoing Clinical Trials of Imfinzi in the Treatment of Colorectal Cancer
              • Analysis of the Clinical Development Program for Imfinzi
              • Expert Insight: Imfinzi
              • Expectations for Market Authorization and Sales Opportunity for Imfinzi in Colorectal Cancer
              • Key Results from Select Clinical Trials Investigating OncoVax for the Treatment of Colorectal Cancer
              • Key Ongoing Clinical Trials of OncoVax in the Treatment of Colorectal Cancer
              • Analysis of the Clinical Development Program for OncoVax
              • Expert Insight: OncoVax
              • Expectations for Market Authorization and Sales Opportunity for OncoVax in Colorectal Cancer
              • Key Results from Select Clinical Trials Investigating Napabucasin for the Treatment of Colorectal Cancer
              • Key Ongoing Clinical Trials of Napabucasin in the Treatment of Colorectal Cancer
              • Analysis of the Clinical Development Program for Napabucasin
              • Expectations for Launch and Sales Opportunity of Napabucasin in Colorectal Cancer
              • Key Results from Select Clinical Trials Investigating Modufolin for the Treatment of Colorectal Cancer
              • Key Ongoing Clinical Trials of Modufolin in the Treatment of Colorectal Cancer
              • Analysis of the Clinical Development Program for Modufolin
              • Expectations for Market Authorization and Sales Opportunity of Modufolin in Colorectal Cancer
              • Key Results from Select Clinical Trials Investigating Lynparza for the Treatment of Colorectal Cancer
              • Key Ongoing Clinical Trials of Lynparza in the Treatment of Colorectal Cancer
              • Analysis of the Clinical Development Program for Lynparza
              • Expert Insight: Lynparza
              • Expectations for Market Authorization and Sales Opportunity of Lynparza in Colorectal Cancer
            • Early-Phase Pipeline Analysis
              • Select Compounds in Early-Phase Development for Colorectal Cancer
          • Access & Reimbursement Overview
            • Region-Specific Reimbursement Practices
              • Key Market Access Considerations in Colorectal Cancer: United States
              • General Reimbursement Environment: United States
              • Key Market Access Considerations in Colorectal Cancer: EU5
              • General Reimbursement Environment: EU5
              • Key Market Access Considerations in Colorectal Cancer: Japan
              • General Reimbursement Environment: Japan
          • Appendix
            • Key Abbreviations Related to Colorectal Cancer
            • Brands, Marketers, and Generic Availability of Key Therapies for Colorectal Cancer by Market
            • Colorectal Cancer Bibliography

        Author(s): Fiona Wiegert; Mudasir Khan, M.P.H.

        Fiona Wiegert, M.Sc., is a business insights analyst on the Oncology team at DRG, part of Clarivate. She has a background in market research and analysis within the pharmaceutical industry and experience in several oncology indications. Prior to joining DRG, she worked on product-specific business cases and forecast models at Accord Healthcare. She earned a master’s degree in cognitive neuroscience from the University of Sussex and was awarded the prize for best performance on this course.

        Mudasir Khan, M.P.H., is a senior epidemiologist at DRG, part of Clarivate. He received his M.P.H. from the Tata Institute of Social Sciences in Mumbai.


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