The treatment paradigm for second- and subsequent-line advanced or metastatic colorectal cancer revolves around targeted agents (such as Erbitux, Vectibix, and Avastin) with or without chemotherapy regimens. The 2017 FDA approvals of Keytruda and Opdivo have expanded treatment options for the minority of patients with MSI-H or dMMR metastatic colorectal cancer. Although the market landscape is evolving at a rapid pace, significant unmet need exists for the development of well-tolerated agents that can improve overall survival and progression-free survival outcomes.

Questions Answered

  • What are the treatment drivers that are most likely to influence a therapy’s uptake for second- and subsequent-line advanced or metastatic colorectal cancer?
  • How do current therapies perform on key treatment drivers and goals for second- and subsequent-line advanced or metastatic colorectal cancer?
  • What are the prevailing areas of unmet need and hidden opportunities in this patient population?
  • What trade-offs are surveyed medical oncologists willing to make across different key clinical attributes and price, when considering hypothetical new treatment options in the second-line setting?

Product Description

Unmet Need provides quantitative insight into U.S. and European physician perceptions of key treatment drivers and goals and the current level of unmet need for a specific disease. Commercial opportunities are analyzed, and the extent to which emerging therapies may capitalize on these opportunities is evaluated.

Markets covered: United States, France, Germany, and the United Kingdom.

Primary research: Survey of 62 U.S. and 30 European medical oncologists fielded in March 2018.

Key companies: Roche/Genentech, Eli Lilly/Merck KGaA, Amgen, Taiho Pharmaceutical, Merck & Co., and Bristol-Myers Squibb.

Key drugs: Avastin, Erbitux, Vectibix, Lonsurf, Keytruda, and Opdivo.

Table of contents

  • Colorectal Cancer - Unmet Need - Detailed, Expanded Analysis (US/EU)
    • Introduction
      • Overview
      • Methodology
      • Rationale for Treatment Drivers and Goals Selection
        • Efficacy
        • Safety and Tolerability
        • Nonclinical Factors
      • Rationale for Drug Selection
        • Regimens for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer
    • Treatment Drivers and Goals
      • Key Findings: Attribute Importance
      • Relative Importance of Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Attributes to Surveyed Medical Oncologists' Prescribing Decisions in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer
      • Importance of Efficacy Attributes to Prescribing Decisions in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: United States
      • Importance of Efficacy Attributes to Prescribing Decisions in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: Europe
      • Importance of Safety and Tolerability Attributes to Prescribing Decisions in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: United States
      • Importance of Safety and Tolerability Attributes to Prescribing Decisions in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: Europe
      • Importance of Nonclinical Factors to Prescribing Decisions in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: United States
      • Importance of Nonclinical Factors to Prescribing Decisions in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: Europe
      • Key Findings: Stated vs. Derived Importance
      • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, and Nonclinical Attributes to Prescribing Decisions in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: United States
      • Stated vs. Derived Importance of Key Efficacy, Safety and Tolerability, and Nonclinical Attributes to Prescribing Decisions in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: Europe
    • Product Performance Against Treatment Drivers and Goals
      • Key Findings
      • Overall Performance of Key Therapies for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: United States
      • Overall Performance of Key Therapies for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: Europe
      • Relative Performance of Key Therapies for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer Across Select Efficacy Attributes: United States
      • Relative Performance of Key Therapies for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer Across Select Efficacy Attributes: Europe
      • Relative Performance of Key Therapies for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer Across Select Safety and Tolerability Attributes: United States
      • Relative Performance of Key Therapies for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer Across Select Safety and Tolerability Attributes: Europe
      • Relative Performance of Key Therapies for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer Across Select Nonclinical Attributes: United States
      • Relative Performance of Key Therapies for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer Across Select Nonclinical Attributes: Europe
    • Assessment of Unmet Need
      • Key Findings: Unmet Need in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer
      • Surveyed Medical Oncologists’ Satisfaction with Key Therapies' Performance for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: United States
      • Surveyed Medical Oncologists’ Satisfaction with the Performance of Key Therapies for Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer on Efficacy, Safety and Tolerability, Convenience of Administration, and Nonclinical Factors: Europe
      • Surveyed Medical Oncologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: United States
      • Surveyed Medical Oncologists' Ascribed Level of Unmet Need Across Key Efficacy Attributes in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: Europe
      • Surveyed Medical Oncologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: United States
      • Surveyed Medical Oncologists' Ascribed Level of Unmet Need Across Key Safety and Tolerability Attributes in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: Europe
      • Surveyed Medical Oncologists' Ascribed Level of Unmet Need Across Key Nonclinical Factors in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: United States
      • Surveyed Medical Oncologists' Ascribed Level of Unmet Need Across Key Nonclinical Factors in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer: Europe
      • Key Findings: Unmet Need in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer and Related Indications
      • Surveyed Medical Oncologists' Ascribed Level of Unmet Need in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer and Related Indications: United States
      • Surveyed Medical Oncologists' Ascribed Level of Unmet Need in Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer and Related Indications: Europe
    • Opportunity Analysis
      • Areas of Opportunity in the Second- and Subsequent-Line Advanced or Metastatic Colorectal Cancer Market and Emerging Therapy Insights
        • Opportunity: A Novel Therapy with a Substantial Survival Benefit
        • Opportunity: A New Therapy with Improved Progression-Free Survival
        • Opportunity: A Novel Therapy with More Durable Response
        • Opportunity: A Novel Agent with a Better Safety and Tolerability Profile
    • 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
        • Second-Line Advanced or Metastatic Colorectal Cancer Target Product Profile: Attribute Importance
        • Median Overall Survival
        • Median Progression-Free Survival
        • Objective Response Rate
        • Incidence of Grade 3/4 Hematological Toxicities
        • Incidence of Grade 3/4 Gastrointestinal Toxicities
        • Incidence of Grade 3/4 Dermatological Toxicities
        • Price Per 14-Day Cycle
      • Conjoint Analysis-Based Simulations of Market Scenarios
        • Second-Line Advanced or Metastatic Colorectal Cancer Market Simulations: Share of Preference of Target Product Profiles Included in Scenario 1
        • Second-Line Advanced or Metastatic Colorectal Cancer Market Simulations: Likelihood to Prescribe Target Product Profiles Included in Scenario 1
        • Second-Line Advanced or Metastatic Colorectal Cancer Market Simulations: Target Product Profiles Included in Scenario 1
        • Second-Line Advanced or Metastatic Colorectal Cancer Market Simulations: Share of Preference of Target Product Profiles Included in Scenario 2
        • Second-Line Advanced or Metastatic Colorectal Cancer Market Simulations: Likelihood to Prescribe Target Product Profiles Included in Scenario 2
        • Second-Line Advanced or Metastatic Colorectal Cancer Market Simulations: Target Product Profiles Included in Scenario 2
    • Appendix
      • Key Abbreviations
      • Bibliography

Author(s): Priti Girotra, M.Pharm., Ph.D

Priti Girotra, M.Pharm., Ph.D., is an analyst in the oncology team at Decision Resources Group and has authored insightful content on multiple indications including Non-Small-Cell Lung Cancer, Colorectal Cancer, Gastroesophageal Cancer, Malignant Melanoma, and Multiple Myeloma. Prior to joining DRG, Dr. Girotra conducted her Ph.D. research on formulation optimization of nanoparticles containing triptan derivatives for effective brain targeting and therapeutic management of migraine, under a DST-INSPIRE Fellowship at G.J. University of Science & Technology, Hisar, India.


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