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Stakeholder Insight: Gastric Cancer Product Image

Stakeholder Insight: Gastric Cancer

  • Published: September 2010
  • 204 pages
  • Datamonitor

Introduction

Despite advances in surgery and the use of multimodality therapy, survival outcomes remain poor for gastric cancer patients. There is an urgent need for more effective therapies to improve survival rates in patients presenting with both localized and advanced disease. The recent approval of Herceptin (trastuzumab; Roche/Chugai) may pave the way for the introduction of more novel drugs

Scope

-Analysis of the gastric cancer market based on a survey of 180 oncologists and GI specialists, supported by interviews with key opinion leaders

-Epidemiologic forecast of the gastric cancer patient populations in the seven major pharmaceutical markets

-In-depth analysis of treatment patterns, regimens prescribed and treatment outcomes for gastric cancer patients

-Discussion of unmet needs and overview of late-stage pipeline drugs

Highlights

Despite a declining trend in incidence rates, the total incidence of gastric cancer in the seven major pharmaceutical markets is forecast to increase over the next decade, driven by the aging populations in these countries. The number of incident cases is forecast to reach over 250,000 cases READ MORE >

Overview
Catalyst
Summary
About Datamonitor healthcare
About the oncology pharmaceutical analysis team
Executive Summary
Scope of the analysis
Datamonitor insight into the gastric cancer market
Contributing experts
Related reports
Upcoming reports

1. Introduction and scope
Coverage of the Stakeholder Insight Survey
Epidemiology
Treatment options
Treatment trends
Key prescribing influences and brand assessment
Improving treatment outcomes
Assumptions and caveats
2. Country treatment trees
Introduction to treatment trees
US
Japan
France
Germany
Italy
Spain
UK
3. Epidemiology
Introduction and background
Key points
Disease definition and diagnosis criteria
Global variation and historical trends
Contemporary trends
Incidence
Prevalence
Risk factors
Dietary
Meat
Fruit and vegetables
Salt
Coffee and tea
Helicobacter pylori infection
Tobacco smoking
Family history
Epidemiologic forecasting of gastric cancer
Sources of epidemiologic data
Cancer registries: age- and sex-specific incidence rates
Population denominators
Description of methods
Statistical analysis
Categorization and stratification
Results
Current incident cases and future trends of gastric cancer
Segmentation of incident cases
Segmentation by sex
Segmentation by age group
Segmentation by stage
Discussion
US
Japan
Europe
Strengths of Datamonitor's epidemiologic projections
Conclusions
4. Patient Segmentation
Staging of gastric cancer patients
Segmentation of the gastric cancer population
Gastric adenocarcinoma
5. Treatment options and trends
Overview of gastric cancer treatment options
Surgery has a central role in the management of localized gastric cancer, but controversy remains regarding the extent of surgery
Neoadjuvant and adjuvant approaches are employed in localized disease, in an attempt to prevent recurrence
The treatment of advanced disease is based on best supportive care (BSC) and palliative chemotherapy
Treatment trends in resectable gastric cancer
Stage I gastric cancer
Treatment options
Neoadjuvant therapy alone
Adjuvant therapy alone
Both neoadjuvant and adjuvant therapy
Resectable Stage II gastric cancer
Treatment options
Neoadjuvant therapy alone
Adjuvant therapy alone
Neoadjuvant and adjuvant therapy together
Resectable Stage III gastric cancer
Treatment options
Neoadjuvant therapy alone
Adjuvant therapy alone
Both neoadjuvant and adjuvant therapy
Treatment trends in unresectable gastric cancer
Unresectable Stage II gastric cancer
Treatment options
First-line chemotherapy
First-line chemoradiotherapy
Unresectable Stage III gastric cancer
Treatment options
First-line chemotherapy
First-line chemoradiotherapy
Stage IV gastric cancer
Treatment options
First-line chemotherapy
Second-line chemotherapy
Further chemotherapy
6. Prescribing influences and brand assessment
Factors influencing prescribing decisions in gastric cancer
Overall survival is the most important prescribing influence for gastric cancer
Physician perception of selected branded drugs used in the treatment of gastric cancer
Physicians think highly of Taxotere in terms of its clinical efficacy and are familiar with its clinical profile
Xeloda scores highly in terms of convenience and physician familiarity
Herceptin is perceived as an effective and safe, but costly drug
7. Improving treatment outcomes
Treatment outcomes
Resectable gastric cancer
The rate of remission/cure decreases with increasing stage of disease
Significantly higher remission/cure rates and lower relapse rates are seen in Japan compared with Western markets
Neoadjuvant and/or adjuvant therapy improve survival in resectable disease
Unresectable gastric cancer
Survival is very poor for patients with unresectable gastric cancer
Survival time for metastatic disease appears to be lower in the US
Unmet needs
The treatment of localized disease needs to be refined
More effective therapies are needed for the treatment of advanced disease
Research efforts should be directed towards the development of predictive markers and molecular targeted therapy
New product development
Selected drugs in company-sponsored Phase III development for gastric cancer
Afinitor (everolimus; Novartis)
Avastin (bevacizumab; Roche/Chugai)
Erbitux (cetuximab; Bristol-Myers Squibb/ Eli Lilly/Merck KGaA)
Tykerb/Tyverb (lapatinib; GlaxoSmithKline)
Ramucirumab (Eli Lilly)
Physician perception of pipeline drugs
Physicians are optimistic about the future of Herceptin in gastric cancer, but less positive on the uptake of Tykerb
Despite the AVAGAST results, there is still optimism for Avastin in gastric cancer
Physicians see a higher potential for Erbitux than Afinitor
Physicians see limited potential for ramucirumab in gastric cancer
Bibliography
Journal papers and books
Websites
APPENDIX A
Physician research methodology
Physician sample breakdown
US
Japan
France
Germany
Italy
Spain
UK
Contributing experts
APPENDIX B
Datamonitor consulting
Disclaimer
List of Figures
Figure 1: Treatment of Stage I gastric cancer patients in the US (1 of 2), 2010
Figure 2: Treatment of Stage I gastric cancer patients in the US (2 of 2), 2010
Figure 3: Treatment of resectable Stage II gastric cancer patients in the US (1 of 2), 2010
Figure 4: Treatment of resectable Stage II gastric cancer patients in the US (2 of 2), 2010
Figure 5: Treatment of resectable Stage III gastric cancer patients in the US (1 of 2), 2010
Figure 6: Treatment of resectable Stage III gastric cancer patients in the US (2 of 2), 2010
Figure 7: Treatment of unresectable Stage II gastric cancer patients in the US, 2010
Figure 8: Treatment of unresectable Stage III gastric cancer patients in the US, 2010
Figure 9: Treatment of Stage IV gastric cancer patients in the US, 2010
Figure 10: Treatment of Stage I gastric cancer patients in Japan (1 of 2), 2010
Figure 11: Treatment of Stage I gastric cancer patients in Japan (2 of 2), 2010
Figure 12: Treatment of resectable Stage II gastric cancer patients in Japan (1 of 2), 2010
Figure 13: Treatment of resectable Stage II gastric cancer patients in Japan (2 of 2), 2010
Figure 14: Treatment of resectable Stage III gastric cancer patients in Japan (1 of 2), 2010
Figure 15: Treatment of resectable Stage III gastric cancer patients in Japan (2 of 2), 2010
Figure 16: Treatment of unresectable Stage II gastric cancer patients in Japan, 2010
Figure 17: Treatment of unresectable Stage III gastric cancer patients in Japan, 2010
Figure 18: Treatment of Stage IV gastric cancer patients in Japan, 2010
Figure 19: Treatment of Stage I gastric cancer patients in France (1 of 2), 2010
Figure 20: Treatment of Stage I gastric cancer patients in France (2 of 2), 2010
Figure 21: Treatment of resectable Stage II gastric cancer patients in France (1 of 2), 2010
Figure 22: Treatment of resectable Stage II gastric cancer patients in France (2 of 2), 2010
Figure 23: Treatment of resectable Stage III gastric cancer patients in France (1 of 2), 2010
Figure 24: Treatment of resectable Stage III gastric cancer patients in France (2 of 2), 2010
Figure 25: Treatment of unresectable Stage II gastric cancer patients in France, 2010
Figure 26: Treatment of unresectable Stage III gastric cancer patients in France, 2010
Figure 27: Treatment of Stage IV gastric cancer patients in France, 2010
Figure 28: Treatment of Stage I gastric cancer patients in Germany (1 of 2), 2010
Figure 29: Treatment of Stage I gastric cancer patients in Germany (2 of 2), 2010
Figure 30: Treatment of resectable Stage II gastric cancer patients in Germany (1 of 2), 2010
Figure 31: Treatment of resectable Stage II gastric cancer patients in Germany (2 of 2), 2010
Figure 32: Treatment of resectable Stage III gastric cancer patients in Germany (1 of 2), 2010
Figure 33: Treatment of resectable Stage III gastric cancer patients in Germany (2 of 2), 2010
Figure 34: Treatment of unresectable Stage II gastric cancer patients in Germany, 2010
Figure 35: Treatment of unresectable Stage III gastric cancer patients in Germany, 2010
Figure 36: Treatment of Stage IV gastric cancer patients in Germany, 2010
Figure 37: Treatment of Stage I gastric cancer patients in Italy (1 of 2), 2010
Figure 38: Treatment of Stage I gastric cancer patients in Italy (2 of 2), 2010
Figure 39: Treatment of resectable Stage II gastric cancer patients in Italy (1 of 2), 2010
Figure 40: Treatment of resectable Stage II gastric cancer patients in Italy (2 of 2), 2010
Figure 41: Treatment of resectable Stage III gastric cancer patients in Italy (1 of 2), 2010
Figure 42: Treatment of resectable Stage III gastric cancer patients in Italy (2 of 2), 2010
Figure 43: Treatment of unresectable Stage II gastric cancer patients in Italy, 2010
Figure 44: Treatment of unresectable Stage III gastric cancer patients in Italy, 2010
Figure 45: Treatment of Stage IV gastric cancer patients in Italy, 2010
Figure 46: Treatment of Stage I gastric cancer patients in Spain (1 of 2), 2010
Figure 47: Treatment of Stage I gastric cancer patients in Spain (2 of 2), 2010
Figure 48: Treatment of resectable Stage II gastric cancer patients in Spain (1 of 2), 2010
Figure 49: Treatment of resectable Stage II gastric cancer patients in Spain (2 of 2), 2010
Figure 50: Treatment of resectable Stage III gastric cancer patients in Spain (1 of 2), 2010
Figure 51: Treatment of resectable Stage III gastric cancer patients in Spain (2 of 2), 2010
Figure 52: Treatment of unresectable Stage II gastric cancer patients in Spain, 2010
Figure 53: Treatment of unresectable Stage III gastric cancer patients in Spain, 2010
Figure 54: Treatment of Stage IV gastric cancer patients in Spain, 2010
Figure 55: Treatment of Stage I gastric cancer patients in the UK (1 of 2), 2010
Figure 56: Treatment of Stage I gastric cancer patients in the UK (2 of 2), 2010
Figure 57: Treatment of resectable Stage II gastric cancer patients in the UK (1 of 2), 2010
Figure 58: Treatment of resectable Stage II gastric cancer patients in the UK (2 of 2), 2010
Figure 59: Treatment of resectable Stage III gastric cancer patients in the UK (1 of 2), 2010
Figure 60: Treatment of resectable Stage III gastric cancer patients in the UK (2 of 2), 2010
Figure 61: Treatment of unresectable Stage II gastric cancer patients in the UK, 2010
Figure 62: Treatment of unresectable Stage III gastric cancer patients in the UK, 2010
Figure 63: Treatment of Stage IV gastric cancer patients in the UK, 2010
Figure 64: Age-adjusted gastric cancer incidence rates per 100,000 in the seven major pharmaceutical markets, 2008
Figure 65: Historical age-adjusted incidence rates in men in the seven major pharmaceutical markets, 1983-2002
Figure 66: Historical age-adjusted incidence rates in women in the seven major pharmaceutical markets, 1983-2002
Figure 67: Percentage of Stage I gastric cancer patients receiving each type of therapy (neoadjuvant, adjuvant, both neoadjuvant and adjuvant) and surgery alone in the US, five major European markets (5EU) and Japan, 2010
Figure 68: Percentage of Stage I gastric cancer patients receiving each type of neoadjuvant therapy in the US, five major European markets (5EU) and Japan, 2010
Figure 69: Percentage of Stage I gastric cancer patients receiving each type of adjuvant therapy in the US, five major European markets (5EU) and Japan, 2010
Figure 70: Percentage of Stage I gastric cancer patients receiving each type of perioperative therapy in the US, five major European markets (5EU) and Japan, 2010
Figure 71: Percentage of Stage II gastric cancer patients treated initially with surgery in the seven major pharmaceutical markets, 2010
Figure 72: Percentage of resectable Stage II gastric cancer patients receiving each type of therapy (neoadjuvant, adjuvant, both neoadjuvant and adjuvant) and surgery alone in the US, five major European markets (5EU) and Japan, 2010
Figure 73: Percentage of resectable Stage II gastric cancer patients receiving each type of neoadjuvant therapy in the US, five major European markets (5EU) and Japan, 2010
Figure 74: Percentage of resectable Stage II gastric cancer patients receiving each type of adjuvant therapy in the US, five major European markets (5EU) and Japan, 2010
Figure 75: Percentage of resectable Stage II gastric cancer patients receiving each type of perioperative therapy in the US, five major European markets (5EU) and Japan, 2010
Figure 76: Percentage of Stage III gastric cancer patients treated initially with surgery in the seven major pharmaceutical markets, 2010
Figure 77: Percentage of resectable Stage III gastric cancer patients receiving each type of therapy (neoadjuvant, adjuvant, both neoadjuvant and adjuvant) and surgery alone in the US, five major European markets (5EU) and Japan, 2010
Figure 78: Percentage of resectable Stage III gastric cancer patients receiving each type of neoadjuvant therapy in the US, five major European markets (5EU) and Japan, 2010
Figure 79: Percentage of resectable Stage III gastric cancer patients receiving each type of adjuvant therapy in the US, five major European markets (5EU) and Japan, 2010
Figure 80: Percentage of resectable Stage III gastric cancer patients receiving each type of perioperative therapy in the US, five major European markets (5EU) and Japan, 2010
Figure 81: Percentage of unresectable Stage II gastric cancer patients receiving chemotherapy, radiotherapy, chemoradiotherapy, and best supportive care as first-line treatment in the US, five major European markets (5EU) and Japan, 2010
Figure 82: Percentage of unresectable Stage III gastric cancer patients receiving chemotherapy, radiotherapy, chemoradiotherapy, and best supportive care as first-line treatment in the US, five major European markets (5EU) and Japan, 2010
Figure 83: Percentage of unresectable Stage III gastric cancer patients receiving 5-fluorouracil and Xeloda-based regimens as first-line therapies in the US, five major European markets (5EU) and Japan, 2010
Figure 84: Percentage of Stage IV gastric cancer patients receiving chemotherapy, radiotherapy and best supportive care as first-line treatment in the US, five major European markets (5EU) and Japan, 2010
Figure 85: Percentage of Stage IV gastric cancer patients receiving 5-fluorouracil- and Xeloda-based regimens as first-line therapies in the US, five major European markets (5EU) and Japan, 2010
Figure 86: HER2 status by stage of disease for gastric cancer patients who are tested for HER2 status in the seven major pharmaceutical markets, 2010
Figure 87: Percentage of Stage IV gastric cancer patients receiving second-line chemotherapy (CT) in the seven major pharmaceutical markets, 2010
Figure 88: Percentage of Stage IV gastric cancer patients treated with second-line chemotherapy (CT) who receive further lines of CT in the seven major pharmaceutical markets, 2010
Figure 89: Mean points allocated to each drug attribute (out of 100 points), indicating their degree of influence on treatment decisions for gastric cancer, 2010
Figure 90: Average percentage of Stage I gastric cancer patients who achieve remission/cure and average percentage of patients who, following remission/cure, suffer a relapse in the US, five major European markets (5EU) and Japan, 2010
Figure 91: Average percentage of resectable Stage II gastric cancer patients who achieve remission/cure and average percentage of patients who, following remission/cure, suffer a relapse in the US, five major European markets (5EU) and Japan, 2010
Figure 92: Average percentage of resectable Stage III gastric cancer patients who achieve remission/cure and average percentage of patients who, following remission/cure, suffer a relapse in the US, five major European markets (5EU) and Japan, 2010
Figure 93: Average duration between curative treatment and relapse for Stage I, resectable Stage II and resectable Stage III gastric cancer in the seven major pharmaceutical markets, 2010
Figure 94: Japan's percentage increase in the rate of remission/cure and percentage decrease in the rate of relapse compared with the corresponding US rates for Stage I, resectable Stage II and resectable Stage III gastric cancer, 2010
Figure 95: Average survival time in months for Stage I gastric cancer patients who receive neoadjuvant and/or adjuvant therapy versus no therapy in addition to surgery in the US, five major European markets (5EU) and Japan, 2010
Figure 96: Average survival time in months for resectable Stage II gastric cancer patients who receive neoadjuvant and/or adjuvant therapy versus no therapy in addition to surgery in the US, five major European markets (5EU) and Japan, 2010
Figure 97: Average survival time in months for resectable Stage III gastric cancer patients who receive neoadjuvant and/or adjuvant therapy versus no therapy in addition to surgery in the US, five major European markets (5EU) and Japan, 2010
Figure 98: Japan's percentage increase in survival time compared with the US for Stage I, resectable Stage II, and resectable Stage III gastric cancer patients who receive neoadjuvant and/or adjuvant therapy, 2010
Figure 99: Average survival time in months for unresectable Stage II gastric cancer patients who receive first-line therapy plus best supportive care (BSC) versus BSC alone in the US, five major European markets (5EU) and Japan , 2010
Figure 100: Average survival time in months for unresectable Stage III gastric cancer patients who receive first-line therapy plus best supportive care (BSC) versus BSC alone in the US, five major European markets (5EU) and Japan, 2010
Figure 101: Average survival time in months for unresectable Stage IV gastric cancer patients who receive first-line therapy plus best supportive care (BSC) versus BSC alone in the US, five major European markets (5EU) and Japan, 2010
Figure 102: Mean ranking of each attribute for a pipeline drug for gastric cancer (scale 1-7), indicating their relative importance, 2010

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