Improving survival among those with advanced cancer along with a high rate of cancer-related pain in this patient population will lead to steady growth in the prevalence of cancer pain in the seven major markets under study throughout the ten-year forecast period. However, treatment of cancer-related pain will not change dramatically over the next decade because of a dearth of new therapies. Indeed, strong opioid analgesics will continue to be the mainstay of treatment for severe types of cancer pain, accounting for more than 90% of major-market drug sales for cancer pain in 2014 and 2024. Overall, we expect only modest growth in the $2 billion cancer pain market throughout our ten-year forecast period.

Questions Answered:

  • The late-stage pain pipeline is dominated by several strong opioid reformulations in the United States that feature abuse-deterrent properties. What are the expected peak-year sales for these products in the treatment of cancer pain in the U.S. market? Will third-party payers reimburse these newer abuse-deterrent formulations in place of the older opioids? How will political and public pressure in the U.S. market to curb widespread opioid abuse affect uptake of these agents for cancer pain?
  • Several later-stage investigational analgesics, including Immune Pharmaceuticals’ AmiKet, GW Pharmaceutical’s and Otsuka’s Sativex, and Pfizer/Eli Lilly’s and Janssen/Takeda’s anti-nerve growth factor monoclonal antibodies (tanezumab and fulranumab, respectively) have had poor results in clinical trials for cancer pain in recent months. How will these disappointing data affect these agents’ prospects for cancer pain? How will the outlook for these drugs affect the overall cancer pain market going forward?
  • Several key cancer pain drugs will lose patent protection during the ten-year forecast period. How will these patent expiries affect the overall cancer pain market? Which particular products will see the greatest generic erosion, and when? To what extent will sales of new analgesics offset generic erosion of key products?

Scope:

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

Primary research: 51 country-specific interviews with thought-leading physicians, including pain specialists, palliative care specialists, anesthesiologists, oncologists, and neurologists.

Epidemiology: Prevalent cases of severe cancer pain, breakthrough cancer pain, neuropathic cancer pain, and metastatic bone pain.

Emerging therapies: Phase II: 7 drugs; Phase III or preregistration: 8 drugs.

Market forecast features: Top-down market features prescription drug treatment for severe, breakthrough, neuropathic, and metastatic bone pain in cancer patients in the seven major markets under study for 2014, with forecast drug sales for 2019 (mid-year) and 2024 (final forecast year).

Table of contents

  • Cancer Pain - Landscape & Forecast - Disease Landscape & Forecast
    • Executive Summary
      • Introduction
        • Key Findings
        • Market Share of Cancer Pain Drug Classes in 2014
        • Market Share of Cancer Pain Drug Classes in 2024
        • Cancer Pain SWOT Analysis
      • Note About Our Epidemiology Estimates
    • Market Outlook
      • Market Drivers and Constraints
        • What Factors Are Driving the Market for Cancer Pain?
        • What Factors Are Constraining the Market for Cancer Pain?
        • Key Market Events for Cancer Pain
        • Regional Cancer Pain Drug Market, 2014-2024
      • Drug Class-Specific Trends
        • Major-Market Share of Strong Opioid Analgesics for Cancer Pain, 2014-2024
        • Regional Sales of Strong Opioid Analgesics for Cancer Pain, 2014 - 2024
        • Major Market Sales of Transmucosal Fentanyl Formulations for Cancer Pain, 2014-2024
        • Major-Market Share of Dual-Acting Opioid Analgesics for Cancer Pain, 2014 - 2024
        • Regional Sales of Dual-Acting Opioid Analgesics for Cancer Pain, 2014 - 2024
        • Major-Market Share of Antiepileptic Drugs for Cancer Pain, 2014 - 2024
        • Regional Sales of Antiepileptic Drugs for Cancer Pain, 2014 - 2024
        • Major-Market Share of Antidepressants for Cancer Pain, 2014 - 2024
        • Regional Sales of Antidepressants for Cancer Pain, 2014 - 2024
    • Forecast
      • Sales of Drugs to Treat Cancer Pain in the Major Pharmaceutical Markets, 2014-2024
    • Etiology and Pathophysiology
      • Key Types of Cancer Pain
        • Severe Cancer Pain
        • Breakthrough Cancer Pain
        • Neuropathic Cancer Pain
        • Neuropathic Pain Syndromes Resulting from Direct Tumor Involvement
        • Neuropathic Pain Syndromes Secondary to Cancer Treatment
        • Metastatic Bone Pain
      • Pathophysiology of Pain Perception
        • Ascending and Descending Pain Pathways
        • Detailed Schematic of Nociceptive and Antinociceptive Molecular Pathways in the Dorsal Horn
      • Key Pathways and Drug Targets
        • Novel Drug Targets Under Investigation for Pain
    • Epidemiology Overview
      • Introduction
        • Key Findings
        • Expert Insight
        • Epidemiology Overview
      • Epidemiology Populations
        • Disease Definition
        • Studies Included in the Analysis of Cancer Pain
        • Studies Excluded from the Analysis of Cancer Pain
        • Cancer Pain Population and Forecast Parameters
        • Risk/Protective Factors for Cancer Pain
        • Key Sources for Cancer Pain Epidemiology and Model Parameters
        • Severe Cancer Pain
        • Breakthrough Cancer Pain
        • Neuropathic Cancer Pain
        • Metastatic Bone Pain
        • Number of Total Prevalent Cases by Subtype of Cancer Pain in the Major Pharmaceutical Markets, 2014-2024 (thousands)
        • Neuropathic Cancer Pain by Cause
        • Number of Total Prevalent Cases of Neuropathic Cancer Pain by Cause in the Major Pharmaceutical Markets, 2014-2024 (thousands)
        • Percentage Diagnosed
        • Percentage Drug-Treated
        • Number of Total, Diagnosed, and Drug-Treated Prevalent Cases of Severe Cancer Pain in the Major Pharmaceutical Markets, 2014-2024 (thousands)
        • Number of Total, Diagnosed, and Drug-Treated Prevalent Cases of Breatkthrough Cancer Pain in the Major Pharmaceutical Markets, 2014-2024 (thousands)
        • Number of Total, Diagnosed, and Drug-Treated Prevalent Cases of Neuropathic Cancer Pain in the Major Pharmaceutical Markets, 2014-2024 (thousands)
        • Number of Total, Diagnosed, and Drug-Treated Prevalent Cases of Metastatic Bone Pain in the Major Pharmaceutical Markets, 2014-2024 (thousands)
        • Note About Our Epidemiology Estimates
    • Current Treatment Overview
      • Introduction
        • Key Findings
        • Expert Insight
        • Treatment Overview
      • Treatment Goals
        • Key End Points Used in Clinical Trials for Pain
        • Key Physician Insights on Clinical End Points
      • Key Current Therapies
        • Overview
        • Mechanism of Action of Key Current Drug Classes Used for Cancer Pain
        • Current Treatments Used for Cancer Pain
        • Market Events Impacting the Use of Key Current Therapies in Cancer Pain
        • Major Market Opioid Analgesic Share for Cancer Pain, 2014
        • Advantages and Disadvantages of Opioid Analgesics
        • Expert Opinion on Rapid-Acting Fentanyl Formulations
        • Strong Opioid Analgesics With Abuse-Deterrent Properties Available in the U.S. Market
        • U.S. Expert Opinion on Abuse-Deterrent Opioid Analgesics
        • Major Market Dual-Acting Opioid Analgesic Share for Cancer Pain, 2014
        • Advantages and Disadvantages of Tapentadol
        • Expert Opinion on Tapentadol
        • Major Market Antiepileptic Drug Share for Cancer Pain, 2014
        • Advantages and Disadvantages of Gabapentin and Pregabalin
        • Expert Opinion on Gabapentin and Pregabalin
        • Major Market Antidepressant Drug Share for Cancer Pain, 2014
        • Advantages and Disadvantages of Antidepressant Drugs
        • Expert Opinion on Antidepressant Drugs
        • Advantages and Disadvantages of Ketamine
        • Expert Opinion on Ketamine
        • Advantages and Disadvantages of Ziconotide
        • Expert Opinion on Ziconotide
        • Advantages and Disadvantages of Bone-Specific Agents
        • Expert Opinion on Bone-Specific Agents
      • Medical Practice
        • Overview
        • Treatment Guidelines
        • Cancer Pain Treatment Guidelines, by Market
        • WHO Pain Ladder
        • Factors Influencing Drug Selection in Cancer Pain
        • Treatment Algorithm for Severe Cancer Pain
        • Treatment Algorithm for Breakthrough Cancer Pain
        • Treatment Algorithm for Neuropathic Cancer Pain
        • Treatment Algorithm for Cancer-Related Bone Pain
        • Regional Cancer Pain Market, by Drug Class, 2014
        • United States
        • Europe
        • Japan
    • Unmet Need Overview
      • Attainment of Unmet Needs
        • Current Attainment of Unmet Needs in Cancer Pain
        • Top Unmet Needs in Cancer Pain: Current Attainment
        • Future Attainment of Unmet Needs
        • Top Unmet Needs in Cancer Pain—Future Attainment
    • Emerging Therapies Overview
      • Introduction
        • Key Findings
        • Expert Insight
      • Pipeline Overview
        • Pipeline Trends for Cancer Pain
      • Late-Phase Pipeline Analysis
        • Notable Developments in the Late-Phase Pipeline for Cancer Pain
        • Therapies in Late-Phase Development Pipeline with Potential in Cancer Pain
        • Estimated Launch Dates of Key Emerging Therapies for the Treatment of Cancer Pain
      • Key Emerging Therapies
        • Abuse-Deterrent Opioid Analgesics Profile
        • Expert Insight: Use of Abuse-Deterrent Opioids in the Treatment of Cancer Pain
        • Expectations for Launch and Sales Opportunity of Abuse-Deterrent Opioid Analgesics in Cancer Pain
        • Cebranopadol Profile
        • Cebranopadol Clinical Development
        • Expert Insight: Use of Cebranopadol in the Treatment of Cancer Pain
        • Expectations for Launch and Sales Opportunity of Cebranopadol in Cancer Pain
        • Sativex Profile
        • Sativex Clinical Development
        • Expert Insight: Use of Sativex in the Treatment of Cancer Pain
        • Expectations for Launch and Sales Opportunity of Sativex in Cancer Pain
        • Tetrodotoxin Profile
        • Tetrodotoxin Clinical Development
        • Expert Insight: Use of Tetrodotoxin in the Treatment of Cancer Pain
        • Expectations for Launch and Sales Opportunity of Tetrodotoxin in Cancer Pain
        • Anti-NGF Therapies Profile
        • Anti-NGF Therapies Clinical Development
        • Expert Insight: Use of Anti-NGF Therapies in the Treatment of Cancer Pain
        • Expectations for Launch and Sales Opportunity of Anti-NGF Therapies in Cancer Pain
      • Early-Stage Pipeline Analysis
        • Notable Developments in the Early-Stage Pipeline for Cancer Pain
        • Select Phase II Therapies with Potential for Cancer Pain
        • Select Phase I Therapies with Potential for Cancer Pain
    • Access and Reimbursement Overview
      • Region-Specific Reimbursement Practices
        • Reimbursement Environment for Cancer Pain Therapies in the United States
        • Reimbursement Environment for Cancer Pain Therapies in Europe
        • Reimbursement Environment for Cancer Pain Therapies in Japan
      • U.S. Reimbursement Dynamics
        • Reimbursement Dynamics in Cancer Pain in the United States: Current and Future
        • Current Commercial MCO Coverage in the United States
        • Future Commercial MCO Coverage in Next 12 Months in the United States
      • U.S. Access & Reimbursement Considerations for Emerging Therapies
        • Access & Reimbursement Considerations for Emerging Cancer Pain Therapies in the United States
        • Anticipated Formulary Placement of Emerging Long-Acting Opioid ADFs and Cebranopadol at Price Points Similar to Closest Marketed Comparators
    • Appendix
      • Key Abbreviations Related to Cancer Pain
      • Brands, Marketers, and Generic Availability of Current Therapies Used for Cancer Pain, by Market
      • Experts Interviewed
      • Cancer Pain Bibliography

Author(s): Bethany A. Kiernan, PhD; Andrea Witt, PhD

Bethany A. Kiernan, Ph.D., is a senior director in the central nervous system/ophthalmology disorders unit of Decision Resources Group. While at Decision Resources Group, Dr. Kiernan has covered the market dynamics of numerous indications, including schizophrenia, depression, migraine, multiple sclerosis, epilepsy, and other disorders.

Dr. Kiernan’s previous experience includes eight years of scientific research conducted at Tufts University School of Medicine, Case Western Reserve University, and the College of the Holy Cross. Dr. Kiernan earned her Ph.D. degree from Case Western Reserve University.

Andrea S. Witt, Ph.D., is Therapy Leader of the Central Nervous System and Ophthalmology Disorders Portfolio at Decision Resources Group where she oversees a team of 14 Business Insights Analysts and Senior Directors responsible for market research encompassing Neurology, Psychiatry, Pain, and Ophthalmology.

 Dr. Witt has been with Decision Resources Group for over 12 years, following CNS markets and trends. Her interests beyond specific CNS indications included the market potential for neuroprotectants and the impact of biomarkers on CNS markets. Dr. Witt’s research, analysis, and commentaries have appeared in Barron’s, Pharmaceutical Executive, PharmaVoice, Nature Medicine, and CNBC. Dr. Witt’s previous experience includes 10 years of scientific research conducted on neurodegenerative disorders at Harvard Medical School/Brigham and Women’s Hospital, Duke University, and the University of Texas-Southwestern Medical Center, where she earned her Ph.D. degree.


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