Printer Friendly Printed from http://www.researchandmarkets.com/reports/310447 Prostate Cancer - A Prostrate Market Waiting For Innovations Description: Introduction The prostate cancer market is reaching maturity, and major players sales have been eroded by the launch of various LHRH agonist depot formulations. Safety concerns with AstraZenecas Casodex (bicalutamide) have also seen a significant proportion of physicians switching to alternatives. Establishing the optimal timing of antihormonal therapy will provide the key to market growth. Scope - Current treatment practices for hormone-sensitive and hormone-refractory prostate cancer based on 180 physician interviews in the seven major markets - Changes in prescribing habits for prostate cancer between 2003 and 2005 Physician awareness and ratings of late-stage pipeline drugs for prostate cancer, including Abbotts Xinlay and Dendreons Provenge - Potential drug regimens for prostate cancer in 2010 based on physicians opinion Highlights The use of bicalutamide has significantly decreased in localized stage between 2003 and 2005 since the EPC trial demonstrated increased mortality with bicalutamide 150mg. This has not only undermined physicians confidence in the drug in localized stage but it has also affected the uptake of the drug in locally advanced and advanced stage disease. TAB has failed to conclusively establish survival benefit in clinical trials and remains used in a minority of patients in advanced stage. Cost is also a problem for TAB, even in the US. However, oral drugs are expected to be reimbursable under Medicare from 2006 and that should increase the uptake of anti-androgens as well as that of TAB regimens. Although physicians are hopeful of molecular-targeted agents for HRPC, primary research suggests that its use will remain relatively low in 2010 and they are not expected to be used in a level similar to that seen in other tumors. However, opinion leaders have identified angiogenesis inhibitors to be the most promising for prostate cancer. Reasons to Purchase - Quantify the size and scope of the antihormonals market for prostate cancer by examining the uptake of LHRH agonists and anti-androgens - Examine the potential of late-stage pipeline drugs for prostate cancer through physician awareness and ratings. - Develop commercial strategies by analyzing physicians opinion on the potential drug regimens for prostate cancer in 2010 Contents: bout the Oncology pharmaceutical analysis team 2 CHAPTER 1 3. CHAPTER 2 INTRODUCTION 13. Scope 13 The prostate 14 Prostate cancer 14 Histology 15 Etiology 15 Age and race 16 Family history 16 Hormones 17 Dietary fat 17 CHAPTER 3 TREATMENT TREES 19. US 20 Japan 23 France 26 Germany 29 Italy 32 Spain 35 UK 38 CHAPTER 4 ANTIHORMONAL THERAPIES 41. Stages of diagnosis 41 Mis-staging may be common in some markets 43 Antihormonal therapy 44 Localized stage 45 Locally advanced stage 49 Advanced stage 50 CHAPTER 5 ANTIHORMONAL DRUGS 54. Localized stage 54 LHRH agonist monotherapy is the standard of care in localized stage 55 Bicalutamide is the leading anti-androgen 63 The lack of clinical evidence for TAB in localized stage 67 Locally advanced stage 75 More aggressive therapy in locally advanced stage 77 Bicalutamide remains dominant 81 TAB has yet to gain a wider uptake 85 Advanced stage 89 LHRH agonist monotherapy remains the standard therapy in advanced stage 94 Bicalutamide remains in the driving seat 97 The use of TAB is surprisingly low 100 CHAPTER 6 THE USE OF ANTIHORMONALS BETWEEN 2003 AND 2005 103. Changes in the use of drug classes 103 Significant increase in the use of LHRH agonist monotherapy at the expense of TAB 104 Decline in the use of anti-androgen in localized stage 106 Market differences 107 Percentage of patients treated with LHRH agonists between 2003 and 2005 109 Market differences 112 Percentage of patients receiving anti-androgens between 2003 and 2005 114 Market differences 117 Percentage of patients treated with TAB between 2003 and 2005 120 Market differences 122 CHAPTER 7 DURATION OF TREATMENT 125. Treatment duration 125 LHRH agonists 125 Anti-androgens 127 Total androgen blockade 129 Overall average treatment duration 132 Intermittent hormonal therapy 133 IHT is used most commonly in localized stage 135 Reduced usage of IHT in more advanced stages 136 The use of IHT between 2003 and 2005 136 CHAPTER 8 RECURRENT PROSTATE CANCER 140. Remission rate 140 The chronic nature of prostate cancer 141 Aggressive TAB therapy benefiting localized patients in Japan 141 Recurrence rate 142 Poor disease control in France? 143 Treatment of recurrent prostate cancer 144 Leuprolide remains the dominant LHRH agonist 146 Increase in the use of bicalutamide 150 Leuprolide- and bicalutamide-based regimens are the mainstay of TAB regimens 152 CHAPTER 9 HORMONE-REFRACTORY PROSTATE CANCER 155. Progression to HRPC 155 High progression rate in localized stage in France, Germany and Spain 156 Discrepancy in advanced stages across the markets 157 Time to HRPC progression 157 Long time to progression in the UK in localized stage 158 Asymptomatic versus symptomatic HRPC 159 Nearly equal split 160 Active treatment of HRPC 161 Higher proportion of symptomatic patients are actively treated 162 Drug regimens for asymptomatic HRPC 162 Top three drug regimens for asymptomatic HRPC 164 Drug regimens for symptomatic HRPC 174 Top three drug regimens for symptomatic HRPC 176 Drug regimens for HRPC in 2003 and 2005 185 Estramustine monotherapy increases in use between 2003 and 2005 187 Increase in taxane-based regimens 187 No increase for vinorelbine 187 Decreasing use of ‘older’ drugs 188 CHAPTER 10 DRUGS IN DEVELOPMENT FOR PROSTATE CANCER 189. Xinlay (atrasentan) [Abbott] 190 Physician awareness of Xinlay 190 Physician rating of Xinlay 192 Satraplatin [GPC Biotech] 194 Physician awareness of satraplatin 194 Physician rating of satraplatin 195 Provenge [Dendreon] 197 Physician awareness of Provenge 198 Physician rating of Provenge 200 DN-101 (calcitriol) [Novacea] 202 Physician awareness of DN-101 202 Physician rating of DN-101 203 Thalomid (thalidomide) [Celgene] 205 Physician awareness of Thalomid 206 Physician rating of Thalomid 207 GVAX [Cell Genesys] 208 Physician awareness of GVAX 208 Physician rating of GVAX 210 Comparative awareness and physician ratings of pipeline drugs for prostate cancer 212 CHAPTER 11 FUTURE PRESCRIBING 214. Drug regimens for hormone-sensitive prostate cancer in 2010 214 LHRH agonist monotherapy will still be the standard of care especially in France, Italy and the UK 215 Physicians will remain skeptical of TAB 216 Chemotherapy plus antihormonals will gain support 216 Molecular-targeted agents will be minimally used 217 Trends in prescribing for hormone-sensitive prostate cancer 219 Drug regimens for HRPC in 2010 222 Taxane-based regimens will be the most commonly used drug therapies for HRPC 223 Novel agents are not expected to make a significant impact 224 Trends in prescribing for HRPC 225 CHAPTER 12 APPENDIX 227. Supplementary data 227 Respondent breakdown 241 Opinion leader interview transcripts 242 Dr Judd W Moul, Professor and Chief, Division of Urologic Surgery, Duke University Medical Center, NC, US 242 Dr Daniel Petrylak, Director of Genitourinary Oncology Program, Columbia Presbyterian Medical Center, NY, US 250 Dr Alessandro Sciarra, Department of Urology, University La Sapienza, Rome, Italy 258 Dr Marcos Lujan, Urology Department, Hospital Universitario de Getafe, Madrid, Spain 264 Study questionnaire 270 References 290 LIST OF TABLES 298 LIST OF FIGURES 304 Ordering: Order Online - visit http://www.researchandmarkets.com/reports/310447 Order by Fax - using the order form below Order By Post - print the order form below and send to Research and Markets, Guinness Centre, Taylors Lane, Dublin 8, Ireland. 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