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Physician Views: What is Reaction Among Urologists, Oncologists to the Xtandi PREVAIL Data – Can it Displace Zytiga in the Pre-chemotherapy Prostate Cancer Setting?

  • ID: 2693643
  • Report
  • October 2013
  • Region: Global
  • FirstWord Publishing
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The prostate cancer market looks poised to enter its next stage of evolution in 2014, with Medivation and Astellas expected to seek approval for their androgen receptor antagonist Xtandi (enzalutamide) for the treatment of castrate-resistant prostate cancer (CRPC) patients in the pre-chemotherapy setting.

Johnson & Johnson's Zytiga (abiraterone) – which was approved for pre-chemotherapy usage in December last year – has demonstrated that a notable commercial opportunity exists for treatment of prostate cancer at this stage. Indeed, some analysts believe that the pre-chemotherapy market could be worth up to $5 billion in the US alone.

Furthermore, initial key opinion leader (KOL) feedback in response to top-line data from Medivation's PREVAIL study – which was released last week – would appear to suggest that Xtandi may emerge as the therapy of choice in pre-chemotherapy patients.

Approval for the treatment of pre-chemotherapy patients is expected to significantly increase the use of Xtandi among urologists (in addition to oncologists). This population of physicians will be keen to use Xtandi, not only given its impressive overall survival (OS) and disease progression data, note KOLs, but its greater convenience; such as the lack of requirement to dose with steroids.

In addition, Xtandi's status as an androgen receptor antagonist (a familiar drug class among urologists) may prove to be useful in driving longer-term use in even earlier lines of therapy – a strategy that Johnson & Johnson is also pursuing for their next-generation prostate cancer treatment ARN-509, which was acquired from Aragon Pharmaceuticals earlier this year for a cost of up to $1 billion.

Thus, this week's Physician Views poll will look to assess whether initial KOL and analyst reaction to the top-line PREVAIL data is shared by the broader urologist and oncologist populations. The authors are polling urologists and oncologists based in both the US and EU5 with the following questions:

- What percentage of castrate-resistant prostate cancer patients do you currently treat in the pre-chemotherapy setting with abiraterone (Zytiga)?

- Based on top-line data from the PREVAIL study, and assuming enzalutamide (Xtandi) is approved for the treatment of castrate-resistant prostate cancer in the pre-chemotherapy setting, to what percentage of new pre-chemotherapy patients would you prescribe the drug once approved?

- Based on data from the PREVAIL study, to what percentage of new pre-chemotherapy patients do you expect to prescribe enzalutamide (Xtandi) to on an off-label basis prior to approval?

- What characteristic would most influence you to prescribe enzalutamide (Xtandi) in favour of abiraterone (Zytiga) in the pre-chemotherapy setting?

- Based on enzalutamide's mechanism of action (androgen receptor antagonist), how comfortable would you be in prescribing the drug on an off-label basis in the hormone ablation setting?
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