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Pipeline Insight: Non-Small Cell Lung Cancer - Pipeline set to offer only modest improvements

Published by: Datamonitor

Published: Apr. 17, 2008 - 266 Pages


Table of Contents


ABOUT DATAMONITOR HEALTHCARE
About the Oncology pharmaceutical analysis team
CHAPTER 1 EXECUTIVE SUMMARY
Scope of the analysis
Datamonitor insight into the NSCLC market
Related reports
Upcoming reports
CHAPTER 2 PIPELINE OVERVIEW AND DYNAMICS
Pipeline overview
Drugs in late-phase development for NSCLC
Drugs in Phase II development for NSCLC
Drugs in Phase I development for NSCLC
Pipeline by development phase and therapy class
There are over 100 drugs in the NSCLC pipeline, more than half of which are molecular targeted therapies
Pipeline by mode of action
Pipeline drugs have diverse modes of action
Pipeline by indication
The majority of drugs are being investigated in the first-line treatment of advanced disease
Pipeline by company
Nearly 100 different companies or institutions are involved in the NSCLC pipeline
Merck Serono is the only company with two drugs in Phase III development for NSCLC
Top three companies in terms of the number of NSCLC pipeline candidates are Pfizer, Novartis and Bristol-Myers Squibb
Pfizer
Novartis
Bristol Myers Squibb
Key metrics
Datamonitor pipeline assessment summary
CHAPTER 3 NON-SMALL CELL LUNG CANCER - MARKET POTENTIAL
Definition of NSCLC
Non-small cell lung cancer accounts for about 80% of all lung cancers
Three major types of NSCLC exist
Staging of NSCLC is usually based on the AJCC Tumor Node Metastases (TNM) staging system
A revised staging system may have treatment implications in the future
The NSCLC market is segmented according to disease stage
Risk factors in the development of NSCLC
Overview of NSCLC treatment
The treatment of early-stage disease (Stages I-IIIA)
The management of early-stage disease is largely based on surgery
Adjuvant chemotherapy may benefit a subset of patients with early-stage disease
Radiotherapy has a central role in the treatment of unresectable early-stage disease
The treatment of advanced disease (Stages IIIB-IV)
Chemoradiotherapy is the standard of care in patients with unresectable Stage IIIB disease
A recent trial has generated controversy regarding the use of consolidation chemotherapy in unresectable Stage III disease
Systemic platinum-based chemotherapy has a central role in the management of advanced disease
The addition of Avastin may offer an added advantage for a subset of patients
A number of options are available for previously-treated patients
The role of targeted therapies in the treatment of NSCLC
Avastin is extensively used in the first-line setting, but only a subset of patients is eligible for treatment
Off-label use of Tarceva is taking place in the first-line setting
AstraZeneca will be seeking EU approval for Iressa in the second-line setting
Targeted therapies may find an application in a number of settings in NSCLC
The treatment of NSCLC is moving into an era of individualized medicine
The epidemiology of NSCLC
There will be more than 380,000 new cases of NSCLC in the seven major markets in 2017
Mortality from NSCLC is high
NSCLC is predominantly a disease of the elderly
Adenocarcinoma has become the most common histological subtype of NSCLC
Asia will face a major epidemic of lung cancer in the future
NSCLC incidence and mortality rates are still increasing in women
NSCLC in never-smokers may become more prevalent in the future
Increased detection by screening is unlikely to affect NSCLC incidence
NSCLC is an attractive market for new product development
Unmet need in NSCLC
Effective treatments are required for both advanced and early-stage disease
NSCLC needs to be recognized as a heterogeneous disease
Less toxic treatments for poor performance status patients are required
The treatment of NSCLC is in need of an overall refinement
CHAPTER 4 R&D APPROACH
Classification of pipeline products
Cytotoxic therapies
Molecular targeted therapies
Single-target signal transduction inhibitors
Angiogenesis inhibitors
Apoptosis inducers
Cell cycle inhibitors
Multi-targeted inhibitors
Epigenetic modulators
Immunotherapeutic agents
Evolution in NSCLC clinical trial design
The heterogeneity of NSCLC makes patient selection a critical issue
Targeted trial designs utilizing biomarkers are increasingly used
Early-phase clinical trials and endpoints may need redefining
Barriers may still exist to the accrual of patients to NSCLC trials
NSCLC trials may not be very representative of the clinical setting
CHAPTER 5 MOLECULAR TARGETED THERAPIES ANALYSIS AND FORECASTS
Overview of molecular targeted therapies
Pipeline summary
Late-phase pipeline of molecular targeted therapies
Phase II pipeline of molecular targeted therapies
Phase I pipeline of molecular targeted therapies
Comparative forecasts
Definition of current comparator therapy
Avastin (bevacizumab Genentech/Roche/Chugai)
Erbitux (cetuximab; ImClone/Merck Serono/Bristol-Myers Squibb)
Drug overview
Key historical events
Clinical development in NSCLC
Phase III study of Erbitux with cisplatin and vinorelbine meets its primary endpoint of improved survival
Phase III study of Erbitux with carboplatin and a taxane fails to meet its primary endpoint
A number of other trials have evaluated Erbitux in NSCLC
A combination of chemotherapy, Erbitux, and Avastin is being evaluated
Erbitux may enhance the efficacy of chemoradiotherapy in the treatment of unresectable, locally advanced disease
Datamonitor comments
Erbitux may become the first EGFR inhibitor to show a survival improvement in combination with chemotherapy in the first-line setting
The extent to which US physicians will adopt the cisplatin/vinorelbine regimen may affect Erbitux's uptake
Erbitux may achieve a higher uptake in patients who are not eligible for Avastin treatment
Erbitux could find additional application in the treatment of locally advanced, unresectable NSCLC
Forecasts to 2017
Nexavar (sorafenib; Bayer Schering)
Drug overview
Key historical events
Clinical development in NSCLC
The combination of Nexavar with platinum-based chemotherapy fails to improve overall survival in a Phase III study
Nexavar monotherapy results in disease stabilization in the second and third-line settings
An additional study has evaluated Nexavar monotherapy in the second-line setting
Datamonitor comments
Nexavar's potential in NSCLC now significantly limited
Nexavar joins the growing number of TKIs that have failed in the first-line setting
Bayer Schering has adopted a 'conservative' strategy for Nexavar's Phase III trial with Gemzar and cisplatin
Forecasts to 2017
Recentin (cediranib; AstraZeneca)
Drug overview
Key historical events
Clinical development in NSCLC
Two Phase I trials have evaluated Recentin in the first-line treatment of advanced NSCLC
Datamonitor comments
Recentin fails to progress into Phase III in advanced NSCLC
Sutent (sunitinib; Pfizer)
Drug overview
Key historical events
Clinical development in NSCLC
Sutent monotherapy shows moderate clinical activity in the second- and third-line setting of advanced NSCLC
The combination of Sutent with Gemzar and cisplatin is safe and tolerable
Datamonitor comments
The toxicity and cost of adding Sutent to Tarceva will need to be justified
Targeting the second-line setting may be a successful strategy for Sutent
Forecasts to 2017
Zactima (vandetanib; AstraZeneca)
Drug overview
Key historical events
Clinical development in NSCLC
The addition of Zactima to platinum-based chemotherapy improves progression-free survival in the first-line setting
The combination of Zactima with Taxotere and with Iressa improves progression-free survival in the second-line setting
Datamonitor comments
Zactima's multi-targeted nature could offer a competitive advantage
Zactima is targeting a broad population of previously-treated, advanced NSCLC patients
The head-to-head trial against Tarceva is a high-risk strategy
AstraZeneca's strength in the oncology market will be key to Zactima's success
Forecasts to 2017
Zolinza (vorinostat; Merck & Co)
Drug overview
Key historical events
Clinical development in NSCLC
Zolinza shows moderate clinical activity as a second-line monotherapy in NSCLC
A Phase II trial of Zolinza with Tarceva in relapsed/refractory NSCLC was terminated
Zolinza shows preliminary evidence of clinical activity in combination with chemotherapy
Datamonitor comments
A different strategy may have improved Zolinza's chances of success in the NSCLC market
Forecasts to 2017
Aflibercept (VEGF-Trap; Sanofi Aventis/Regeneron)
Drug overview
Key historical events
Clinical development in NSCLC
Aflibercept shows manageable toxicity and some evidence of clinical activity in heavily pre-treated, advanced NSCLC patients
Datamonitor comments
The combination of aflibercept with Taxotere will have to demonstrate a favorable toxicity profile
Aflibercept's Phase III trial may not be accounting for the current standards of care
Aflibercept's Phase II trial results are interpreted using the modified RECIST criteria
Presence in oncology field will aid commercialization of aflibercept
Forecasts to 2017
BIBW 2992 (Boehringer Ingelheim)
Drug overview
Key historical events
Clinical development in NSCLC
Phase III study will evaluate BIBW 2992 in patients who have failed prior therapy with reversible EGFR inhibitors
BIBW 2992 shows preliminary evidence of activity in a Phase I study in solid malignancies
Datamonitor comments
Targeting patients who are Tarceva-refractory may be a successful entry strategy into the NSCLC market
Motesanib (AMG706; Amgen/Takeda Pharmaceutical)
Drug overview
Key historical events
Clinical development in NSCLC
The combination of motesanib with chemotherapy is safe and shows preliminary evidence of clinical activity
Datamonitor comments
Can motesanib succeed where other tyrosine kinase inhibitors have failed?
Amgen runs a high risk with the inclusion of squamous cell patients in motesanib's Phase III trial
Forecasts to 2017
CHAPTER 6 CYTOTOXIC THERAPIES ANALYSIS AND FORECASTS
Overview of cytotoxic therapies
Pipeline summary
Late-phase pipeline of cytotoxic therapies
Phase II pipeline of cytotoxic therapies
Phase I pipeline of cytotoxic therapies
Comparative forecasts
Definition of current comparator therapy
Taxotere (docetaxel; Sanofi-Aventis)
Abraxane (albumin-bound paclitaxel; Abraxis)
Drug overview
Key historical events
Clinical development in NSCLC
The combination of Abraxane with carboplatin and Avastin is well-tolerated
Abraxane shows clinical activity and a favorable toxicity profile as a first-line monotherapy in metastatic NSCLC
Datamonitor comments
A novel taxane with an improved toxicity profile could gain a share of the NSCLC market
There is a high chance of approval for Abraxane in NSCLC
Abraxane's sales growth in the breast cancer market may be indicative of an uptake in NSCLC
Forecasts to 2017
Glutoxim (NOV-002; Novelos)
Drug overview
Key historical events
Clinical development in NSCLC
Glutoxim has been evaluated in the first-line treatment of advanced NSCLC
Datamonitor comments
Glutoxim's clinical and commercial potential cannot be evaluated
Forecasts to 2017
Javlor (vinflunine; Pierre Fabre)
Drug overview
Key historical events
Clinical development in NSCLC
Javlor shows efficacy equivalent to that of Taxotere in a Phase III trial in advanced NSCLC
Datamonitor comments
Pierre Fabre's intentions for Javlor in NSCLC are unclear
Javlor will face intense competition in the second-line setting
Javlor could increase its uptake with use in combination with radiotherapy
Forecasts to 2017
Lipoplatin (liposomal cisplatin; Regulon)
Drug overview
Key historical events
Clinical development in NSCLC
The combination of Lipoplatin with Gemzar is safe and shows evidence of clinical activity
Lipoplatin shows a better toxicity profile than cisplatin as part of a combination regimen with paclitaxel
Datamonitor comments
Favorable market conditions exist for novel cytotoxic agents such as Lipoplatin
A more experienced oncology player could improve Lipoplatin's chances of success in the market
Forecasts to 2017
Taxoprexin (DHA paclitaxel; Luitpold)
Drug overview
Key historical events
Clinical development in NSCLC
Taxoprexin shows moderate clinical efficacy and an unfavorable toxicity profile in a Phase II trial
Datamonitor comments
Taxoprexin's clinical results to date raise concerns regarding its future in the NSCLC market
Forecasts to 2017
Xyotax (paclitaxel polyglumex; Cell Therapeutics/Novartis)
Drug overview
Key historical events
Clinical development in NSCLC
Three Phase III trials failed to meet their primary endpoints of improved overall survival
Combined analysis of STELLAR 3 and STELLAR 4 showed a survival benefit in women
Datamonitor comments
Non-inferiority may grant Xyotax approval in an underserved patient population with poor prognosis
It is unclear whether Cell Therapeutics will achieve a return on Xyotax's development costs
The use of a prognostic biomarker for the selection of patients could enhance Xyotax's clinical results
Forecasts to 2017
CHAPTER 7 IMMUNOTHERAPIES ANALYSIS AND FORECASTS
Overview of immunotherapies
Pipeline summary
Late-phase pipeline of immunotherapies
Phase II pipeline of immunotherapies
Phase I pipeline of immunotherapies
Comparative forecasts
Definition of current comparator therapy
Stimuvax (BLP-25; Merck Serono)
Drug overview
Key historical events
Clinical development in NSCLC
Stimuvax shows evidence of a survival benefit in patients with Stage IIIB locoregional disease
Datamonitor comments
The need for a minimally toxic maintenance therapy may drive Stimuvax's uptake
Stimuvax may have to overcome regulatory hurdles...
Forecasts to 2017
MAGE-A3 ASCI (GSK1572932A; GlaxoSmithKline)
Drug overview
Key historical events
Clinical development in NSCLC
MAGE-A3 ASCI decreases the risk of cancer recurrence after surgery in a Phase II trial
Datamonitor comments
An adjuvant therapy with a favorable toxicity profile would be welcome in the NSCLC market
Recruitment to the large Phase III trial may present challenges
MAGE-A3 needs to overcome regulatory and pharmacoeconomic obstacles
Forecasts to 2017
APPENDIX
Bibliography
List of tables
List of figures
List of abbreviations
Contributing experts
Methodology
Datamonitor forecast methodology
Epidemiology forecasts
Product forecasts
Datamonitor drug assessment summary
About Datamonitor
About Datamonitor Healthcare
Datamonitor Healthcare's therapy area capabilities
About the Disease Analysis Team
Disclaimer


Abstract

Introduction

Non-small cell lung cancer accounts for about 80% of all lung cancers. In 2008, the incidence of NSCLC is forecast to exceed 367,000 new cases in the seven major pharmaceutical markets. The high incidence of the disease and the large unmet need make NSCLC an attractive market for new drug development.

Scope

Research and analysis of the NSCLC pipeline with in-depth clinical and commercial assessment of Phase III candidates

Seven major pharmaceutical market sales forecasts to 2017 for key pipeline candidates incorporating product specific assumptions and events

Segmentation and analysis of the current NSCLC pipeline by developmental phase, drug class and developer

Analysis of the NSCLC market potential, including identification of unmet needs, commercial opportunities, and key trends in development

Report Highlights

Datamonitor has identified 104 drugs in the NSCLC pipeline, 15% of which are in late-phase development. Collectively, these late-phase products have a forecast sales potential of up to $4,056m by 2017 in the seven major pharmaceutical markets.

Molecular targeted therapies are the focus of R&D in NSCLC, accounting for 60% of the entire pipeline. Of the molecular targeted therapies in late-phase development, Erbitux (cetuximab; ImClone/Merck Serono/Bristol-Myers Squibb) is forecast to achieve the highest level of sales, with $473m by 2017.

The current late-phase pipeline is unlikely to satisfy the high level of unmet need in the treatment of NSCLC. However, pipeline drugs are still likely to realize notable uptake, despite offering only incremental improvements in efficacy or toxicity.

Reasons to Purchase

Acquire a detailed appreciation and impartial perspective of the NSCLC pipeline

Identify the key products in late-phase development based on sales forecasts to 2017 and Datamonitor’s drug assessment methodology

Identify opportunities and risks influencing R&D in NSCLC, unmet needs in the treatment of the disease, and trends in current development


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