Breast Cancer - Decision Resources

Will emerging targeted therapies such as bevacizumab and lapatanib significantly expand the breast cancer (CaB) market? How will increased adjuvant treatment rates for CaB affect drug sales? What clinical needs will remain after the launch of emerging therapies such as novel anti-tubulins and VEGF-directed agents?

The treatment of breast cancer is changing as physicians incorporate more intense regimens in the adjuvant setting in the hope of achieving a higher cure rate of early-stage disease. The incorporation of agents traditionally used in the metastatic setting--taxanes, trastuzumab (Roche/Genentech's Herceptin) for HER2-overexpressing patients, and aromatase inhibitors for post-menopausal hormone-receptor-positive patients--into the adjuvant population (a much larger population) is driving the robust growth of the CaB pharmaceutical market. For this report, we interviewed expert clinicians who tell us that the most urgent need in this market is for more active, less toxic therapies that are able to penetrate the blood-brain barrier for the treatment of metastatic disease; they suggest that emerging small-molecule targeted agents hold promise to meet this need.

In 2004, the number of diagnosed incident cases of CaB in the seven major markets exceeded 400,000; that population will grow modestly over the study period, primarily as a result of an increase in the average age of the population in all seven markets under study. Sales growth will be much more robust, particularly over the first half of the forecast period, as clinicians begin to treat the operable population (the largest CaB population) with more-aggressive neoadjuvant and adjuvant drug therapies.

The most significant unmet need in CaB treatment is for drugs that will prolong the survival of patients with hormone-refractory and/or drug-resistant advanced CaB. Patients whose disease recurs after resection of an early-stage tumor and patients diagnosed with advanced disease seldom achieve a cure.

Endocrine treatment of hormone receptor-positive CaB will be dominated by aromatase inhibitors, a class that will experience significant growth over the next five years. Taxanes will also enjoy increased uptake into adjuvant treatment, driving sales of this therapy class. Emerging agents are unlikely to make a major impact on the adjuvant market during our forecast period; however, new drugs will have an effect as they enter the metastatic market.

The recent advent of commercially available gene expression-profiling tests may enable accurate selection of patients at high risk of relapse. Assessment of relapse by expression of certain genes will enable drug therapy to be targeted to those most likely to benefit, potentially reducing treatment rates in future.

Uncover the clinical and commercial impact of the growth in the CaB population.

Discover the market dynamics of increasing use of aromatase inhibitors in the adjuvant population.

Explore whether the approval of small-molecule HER2-directed agents will steal share from the highly successful and lucrative antibody market created by trastuzumab.