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Stakeholder Opinions: Gastric Cancer - Targeted therapies compete for first-to-market status

Datamonitor
April 6, 2009
76 Pages - SKU: DFMN2217998

Abstract Table of Contents Related Reports

Introduction

Gastric cancer incidence in 2009 is forecast to be 197,000 in the seven major pharmaceutical markets (US, Japan, Germany, France, Italy, Spain, and UK). Although, the global incidence has decreased in recent years, mortality remains high, particularly in the US and Europe. Therefore, predictably a high unmet need remains for effective therapies to improve mortality.

Scope

Gastric cancer overview, including definition, risk factors, epidemiology forecasts and discussion of unmet needs
Current diagnosis and treatment of gastric cancer, including drug regimens used by stage and ongoing controversies
Examination of the late-phase gastric cancer pipeline and market opportunities for drug developers
Stakeholder opinions based on qualitative interviews with key opinion leaders in the field of gastric cancer

Highlights

Surgery is the mainstay of gastric cancer treatment. Chemotherapyalone or in combination with radiotherapyhas a role in the treatment of both early-stage and locoregional disease. However, its main application is in the treatment of advanced disease, where it is used with palliative intent and only results in a poor median survival of 79 months.

The Phase III gastric cancer pipeline comprises six drugs, five of which are molecular targeted therapies. All the drugs in the pipeline are intended for use in the first-line treatment of advanced gastric cancer.

The gastric cancer market is currently attracting R&D interest from key pharmaceutical players. Drugs such as Avastin (bevacizumab; Genentech/Roche/Chugai), Herceptin (trastuzumab; Genentech/Roche/Chugai), and Tykerb (lapatinib; GlaxoSmithKline) are seeking line extensions. Approval of any agents will result in a very competitive market.

Reasons to Purchase

To estimate the number of treatable patients and understand where high unmet needs exist which may provide opportunity for pipeline agents
To gain insight into the current dynamics of gastric cancer management
To analyze the current gastric cancer pipeline drugs and understand effects of approval on market dynamics

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ABOUT DATAMONITOR HEALTHCARE: About the Oncology pharmaceutical analysis team
CHAPTER 1 EXECUTIVE SUMMARY: Scope of analysis; Datamonitor insight into the gastric cancer market; Contributing experts; Related reports; Upcoming reports
CHAPTER 2 DISEASE OVERVIEW: Introduction; Disease overview; Anatomy of the stomach; Gastric cancer; Definition; Pathology/histology; Gastric adenocarcinoma is the most common type of gastric cancer; The heterogeneity of gastric adenocarcinoma requires several classification methods; Epidemiology; Gastric cancer incidence varies geographically; Mortality rates are relatively high across the seven major markets; Risk factors; Infection; Pre-malignant lesions; Genetics; Lifestyle; Symptoms; Non-specific nature of symptoms results in frequent late diagnosis in Western countries; Screening; Japanese laws enforce a population-based screening program; Diagnosis; Endoscopies are the most common procedure for gastric cancer detection; Endoscopic techniques may also serve as a means of treating early gastric cancer; Staging; Different staging systems are used in the US/EU and Japan; The gastric cancer market is segmented according to disease stage; Tumor staging is essential after diagnosis to aid therapy selection; Prognosis and survival; Disease stage determines survival
CHAPTER 3 CURRENT TREATMENT OPTIONS AND CONTROVERSIES: Introduction; Treatment guidelines overview; Gastric cancer treatment by disease stage; Treatment of early-stage disease; The treatment of early-stage disease is based on surgery; Treatment of locoregional disease; Treatment is based on surgery with lymph node dissection; The extent of lymph node dissection remains a matter of debate; Adjuvant chemoradiation is the standard of care in the US; Chemoradiation can be used in medically fit, unresectable patients; Perioperative chemotherapy seems to be the most favored approach in the five major EU markets; Radiotherapy reduces locoregional tumor recurrence but is not widely used; Treatment of advanced disease; The treatment of advanced gastric cancer is mainly palliative
CHAPTER 4 UNMET NEEDS
Key findings: Unmet needs; Effective systemic therapy for advanced disease; Second-line treatment options are required across all stages of gastric cancer; Education of US and EU surgeons on D2 dissection; Early diagnosis and treatment of H. pylori infections and other premalignant lesions may reduce the incidence of gastric cancer; Markers for asymptomatic disease
CHAPTER 5 PIPELINE ANALYSIS: Summary; The gastric cancer pipeline overview; Phase III pipeline; Phase II pipeline; Early-stage pipeline; Phase III drug profiles; Avastin (bevacizumab; Genentech/Roche/Chugai); Drug overview
Key historical events: Clinical development in gastric cancer; Datamonitor comments; Erbitux (cetuximab; ImClone/Merck KGaA/Bristol-Myers Squibb); Drug overview
Key Historical Events: Clinical development in gastric cancer; Datamonitor comments; Herceptin (trastuzumab; Genentech/Roche/Chugai); Drug overview
Key historical events: Clinical development in gastric cancer; Datamonitor comments; Tykerb (lapatinib; GlaxoSmithKline); Drug overview
Key historical events: Clinical development in gastric cancer; Datamonitor comments; Vectibix (panitumumab; Amgen); Drug overview
Key historical events: Clinical development in gastric cancer; Datamonitor comments
BIBLIOGRAPHY
Bibliography
APPENDIX
List of tables: List of figures; About Datamonitor; About Datamonitor Healthcare; About the Oncology analysis team; Disclaimer
List of Tables: Table 1: Lauren classification system for gastric adenocarcinoma; Table 2: Crude incidence rates of gastric cancer in the seven major pharmaceutical markets, 2002; Table 3: Forecast incidence of gastric cancer in the seven major pharmaceutical markets, 2009-2019; Table 4: Crude mortality rates of gastric cancer in the seven major pharmaceutical markets, 2002; Table 5: Forecast mortality of gastric cancer in the seven major pharmaceutical markets, 2009-2019; Table 6: Risk factors associated with gastric cancer; Table 7: Screening methods used in gastric cancer; Table 8: TNM classification system for gastric cancer; Table 9: US TNM stage grouping system for gastric cancer; Table 10: R (residual tumor) classification system for gastric cancer; Table 11: Dissection classification for gastric cancer; Table 12: Japanese Surgical Classification System for gastric cancer (1 of 2); Table 13: Japanese Surgical Classification System for gastric cancer (2 of 2); Table 14: Japanese Surgical Staging System for gastric cancer; Table 15: Type 0 classification of early gastric tumors; Table 16: 5-year survival rates by stage for gastric cancer in the US and Japan; Table 17: Currently approved drugs in gastric cancer, 2009; Table 18: 5-year survival rates of patients treated with D2 dissection in Japan; Table 19: Chemotherapy study results in the treatment of advanced gastric cancer; Table 20: Phase III gastric cancer pipeline, 2009; Table 21: Phase II gastric cancer pipeline, 2009; Table 22: Early-phase gastric cancer pipeline, 2009; Table 23: Avastin: key historical events, 2004-09; Table 24: Clinical development of Avastin in gastric cancer, 2009; Table 25: Erbitux: key historical events, 2001-09; Table 26: Clinical development of Erbitux in gastric cancer, 2009; Table 27: Herceptin: key historical events, 1998-2009; Table 28: Clinical development of Herceptin in gastric cancer, 2009; Table 29: Tykerb: key historical events, 2003-09; Table 30: Clinical development of Tykerb in gastric cancer, 2009; Table 31: Vectibix: key historical events, 2005-09; Table 32: Clinical development of Vectibix in gastric cancer, 2009
List of Figures: Figure 1: Anatomy of the stomach; Figure 2: Percentage distribution of gastric tumors worldwide, 2008; Figure 3: Forecast total incidence versus total mortality in the seven major pharmaceutical markets, 2009; Figure 4: Progression rates for premalignant lesions to gastric cancer; Figure 5: Gastric cancer stage at presentation in the US, five major EU markets and Japan, 2008; Figure 6: Gastric cancer treatment guidelines by stage of disease in the US, EU, and Japan, 2009; Figure 7: Phase III trial of chemoradiation in non-metastatic gastroesophageal cancer; Figure 8: Phase II trial of adjuvant chemoradiation coupled with D2 node dissection in Asian patients; Figure 9: Phase III study of perioperative chemotherapy in gastric and gastroesophageal cancer; Figure 10: Summary of unmet needs in gastric cancer; Figure 11: Phase II trial of Avastin with modified DCF in metastatic gastric cancer; Figure 12: Phase II study of Avastin, irinotecan and cisplatin in patients with metastatic gastric or gastroesophageal cancers; Figure 13: Phase II study of Erbitux plus modified FOLFOX6 in metastatic gastric cancer; Figure 14: Phase II study of Erbitux and FUFOX in metastatic gastric cancer; Figure 15: Phase II study of Tykerb monotherapy in advanced or metastatic gastric cancer

Stakeholder Opinions: Gastric Cancer - Targeted therapies compete for first-to-market status

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