A Survey of Medical Oncologists and Managed Care Organization Pharmacy and Medical Directors

The hepatocellular carcinoma (HCC) and renal cell carcinoma (RCC) markets differ with respect to small-molecule targeted therapies. Nexavar (Bayer/Amgen/Onyx’s sorafenib) is the only approved agent for HCC and, as a consequence, enjoys widespread uptake. However, challenges in the ability of HCC patients, who are frequently severely compromised by comorbidities, to tolerate Nexavar mean that substantial unmet need in this market remains. In contrast, the treatment of RCC is highly competitive as six small-molecule targeted therapies vie for patient share and strive to differentiate themselves on efficacy, tolerability, and delivery attributes. In this competitive environment, market access factors such as tier placement, preferred brand status, and levels of copayment and coinsurance are important factors in therapy selection. Although surveyed medical oncologists rank immune checkpoint inhibitors highly as showing promise in both HCC and RCC, they also express interest in emerging novel small-molecule targeted therapies directed at C-MET and MEK. We investigate surveyed physician perceptions and their prescribing of these agents in both first-line and pretreated settings and explore their receptivity to introducing biomarker testing to these indications. We also explore payer receptivity to price points of emerging novel small-molecule agents and their tier positioning.

Questions Answered in This Report:

  • There are six small molecule targeted therapies approved for use in advanced RCC patients. What are surveyed medical oncologists’ perceptions of Sutent (Pfizer’s sunitinib), Nexavar, Votrient (Novartis’s pazopanib), Inlyta (Pfizer’s axitinib), Torisel (Pfizer’s temsirolimus), and Afinitor (Novartis’s everolimus)? What factors influence medical oncologists’ choice of small molecule agents in each line of treatment? What factors influence MCO formulary decisions about agents for RCC?

  • Assess current prescribing of Nexavar for unresectable HCC patients. How do the side effects of Nexavar impact compliance? How do surveyed payers restrict access to these therapies?

  • Explore payer attitudes toward novel emerging targeted small-molecule agents for HCC and RCC. What factors will most influence formulary inclusion of targeted small-molecule agents? What will their tier placement be? What is the average out-of-pocket cost for targeted small-molecule agents?

  • Which emerging drug classes most interest surveyed medical oncologists? Will surveyed medical oncologists embrace C-MET inhibitors and MEK inhibitors as new market entrants? How will medical oncologists prescribe these novel agents? What constraints do they envisage they will encounter from payers?


Markets covered: United States.

Primary research: 101 medical oncologists; 30 MCO PDs/MDs.

Indication coverage: HCC and RCC.

Emerging therapies covered: 2 Phase III; 7 Phase II.

Author(s): Karen Pomeranz, M.Sc., Ph.D.

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