Despite the wide range of treatment options available, metastatic non-small-cell lung cancer (NSCLC) remains a major cause of cancer-related death. For patients with metastatic (EGFR- and ALK-negative/unknown) NSCLC, chemotherapy is still a mainstay of treatment. However, immune checkpoint inhibitors (Opdivo, Keytruda, and most recently Tecentriq) are revolutionizing the treatment algorithm for this subpopulation. As this market segment continues to evolve at a rapid pace, drug manufacturers must understand the unmet needs associated with the treatment of metastatic NSCLC to identify the opportunities for drug development. We focus on this commercially important subpopulation and assess how current therapies perform on key drug attributes and how these attributes affect medical oncologists’ prescribing decisions. We identify potential hidden opportunities and which emerging therapies (if any) could capitalize upon them. Furthermore, we use conjoint analysis to determine attribute and price trade-offs that surveyed medical oncologists are willing to make when considering treatment options for metastatic NSCLC and simulate the share of preference and likelihood to prescribe of different target product profiles.

Questions Answered:

  • What are the treatment drivers and goals for metastatic (EGFR- and ALK-negative/unknown) NSCLC?
  • What attributes are key influences, which have limited impact, and which are hidden opportunities?
  • How do current therapies perform on key treatment drivers and goals for metastatic (EGFR- and ALK-negative/unknown) NSCLC?
  • What are the prevailing areas of unmet need and opportunity in metastatic (EGFR- and ALK-negative/unknown) NSCLC?
  • What trade-offs across different clinical attributes and price are acceptable to U.S. and European medical oncologists for a hypothetical new metastatic (EGFR- and ALK-negative/unknown) NSCLC drug?

Markets covered: United States, France, Germany, United Kingdom

Primary research: Survey of 60 U.S. and 30 European medical oncologists fielded in December 2016.

Key companies: Bristol-Myers Squibb, Merck & Co., Eli Lilly & Co., Roche/Genentech

Key drugs: Opdivo, Keytruda, Alimta, Avastin

Table of contents

  • Non-Small-Cell Lung Cancer - Unmet Need - Detailed, Expanded Analysis: EGFR- And ALK-Negative Or Unknown NSCLC (US/EU)
    • Key Updates
      • December 2017
      • September 2017
    • Treatment Drivers and Goals
      • Overview
      • Rationale for Treatment Drivers and Goals Selection
        • Efficacy
        • Safety and Tolerability
        • Nonclinical Factors
      • Physician Rating of Treatment Drivers and Goals in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC
        • Importance of Efficacy Attributes to Prescribing Decisions in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: United States
        • Importance of Efficacy Attributes to Prescribing Decisions in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: Europe
        • Importance of Safety and Tolerability Attributes to Prescribing Decisions in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: United States
        • Importance of Safety and Tolerability Attributes to Prescribing Decisions in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: Europe
        • Importance of Nonclinical Factors to Prescribing Decisions in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: United States
        • Importance of Nonclinical Factors to Prescribing Decisions in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: Europe
      • Stated vs. Derived Importance of Treatment Drivers and Goals
        • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Prescribing Decisions in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: United States
        • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Prescribing Decisions in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: Europe
    • Product Performance Against Treatment Drivers and Goals
      • Overview
      • Rationale for Drug Selection
        • Products/Regimens for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC
      • Current Brand Performance on Key Treatment Drivers and Goals
        • Overall Performance of Key Therapies for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: United States
        • Overall Performance of Key Therapies for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: Europe
        • Relative Performance of Key Therapies for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Across Select Efficacy Attributes: United States
        • Relative Performance of Key Therapies for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Across Select Efficacy Attributes: Europe
        • Relative Performance of Key Therapies for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Across Select Safety and Tolerability Attributes: United States
        • Relative Performance of Key Therapies for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Across Select Safety and Tolerability Attributes: Europe
        • Relative Performance of Key Therapies for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Across Select Nonclinical Attributes: United States
        • Relative Performance of Key Therapies for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Across Select Nonclinical Attributes: Europe
    • Assessment of Unmet Need
      • Overview
      • Overall Satisfaction with Current Treatment
        • Surveyed Oncologists’ Satisfaction with the Performance of Key Therapies for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: United States
        • Surveyed Oncologists’ Satisfaction with the Performance of Key Therapies for Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: Europe
      • Physician Rating of Unmet Need in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC
        • Surveyed Oncologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: United States
        • Surveyed Oncologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: Europe
        • Surveyed Oncologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: United States
        • Surveyed Oncologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: Europe
        • Surveyed Oncologists' Ascribed Level of Unmet Need Across Key Nonclinical Factors in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: United States
        • Surveyed Oncologists' Ascribed Level of Unmet Need Across Key Nonclinical Factors in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC: Europe
      • Unmet Need in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC and Related Indications
        • Surveyed Oncologists' Ascribed Level of Unmet Need in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC and Related Indications: United States
        • Surveyed Oncologists' Ascribed Level of Unmet Need in Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC and Related Indications: Europe
    • Opportunity Analysis
      • Areas of Opportunity in the Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Market and Emerging Therapy Insights
        • Opportunity: A New Therapy That Offers Substantial Improvement in Overall Survival 
        • Opportunity: A New Therapy That Improves Progression-Free Survival
        • Opportunity: A New Therapy with Improved Duration of Response
        • Opportunity: A Novel Biomarker-Driven Therapy That Is Predictive of Response
    • Target Product Profiles
      • Assessing Drug Development Opportunities
      • Target Product Profile Methodology
        • Attributes and Attribute Levels
        • Assigned Prohibitions for the Conjoint Module
      • Attribute Importance and Part-Worth Utilities
        • Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Target Product Profile: Attribute Importance
        • Median Overall Survival (Months)
        • Median Progression-Free Survival (Months)
        • Objective Response Rate (% of Patients)
        • Median Duration of Response (Months)
        • Incidence of Grade 3/4 Hematological Toxicities (% of Patients)
        • Incidence of Grade 3/4 Immune-Mediated Toxicities (% of Patients)
        • Price per Cycle of Treatment
      • Conjoint Analysis-Based Simulations of Market Scenarios
        • Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Market Simulations: Share of Preference of Target Product Profiles Included in Scenario 1
        • Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Market Simulations: Likelihood to Prescribe Target Product Profiles Included in Scenario 1
        • Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Market Simulations: Target Product Profiles Included in Scenario 1
        • Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Market Simulations: Share of Preference of Target Product Profiles Included in Scenario 2
        • Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Market Simulations: Likelihood to Prescribe Target Product Profiles Included in Scenario 2
        • Metastatic (EGFR- and ALK-Negative/Unknown) NSCLC Market Simulations: Target Product Profiles Included in Scenario 2
    • Appendix
      • Key Abbreviations
      • Bibliography

Author(s): Joshua Dawkins, M.Pharmacol., PhD

Joshua Dawkins, M.Pharmacol., Ph.D., is a Business Insights Analyst in the oncology team at Decision Resources Group. Prior to joining DRG, Dr. Dawkins obtained his doctorate in molecular biology at the Barts Cancer Institute, Queen Mary University of London, where he investigated the roles of epigenetic histone modifiers in pancreatic ductal adenocarcinoma. Dr. Dawkins also holds a Master of Pharmacology degree awarded by the University of Bath, and completed a one-year professional placement within the oncology team at MedImmune.


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