Colorectal Cancer | Disease Landscape and Forecast | G7 | 2018

Colorectal cancer is the third-most-common cancer globally and is associated with a five-year overall survival of 65.1%. Current treatment for metastatic colorectal cancer is dominated by chemotherapy regimens in combination with angiogenesis inhibitors and EGFR inhibitors. Several areas of high unmet need—notably, RAS-mutant patient populations—offer significant commercial opportunity for innovative agents. Although sales of immune checkpoint inhibitors and emerging BRAF/MEK inhibitor combinations will increase over the 2017-2027 forecast period, generic and biosimilar competition will also have a major impact on therapy sales. This report provides insight on how treatment options for colorectal cancer are likely to change over the 2017-2027 forecast period. It also analyzes the current and future earnings potential of drugs already in the market and those expected to be approved for colorectal cancer.

Questions answered:

We forecast that sales of colorectal cancer therapies will decline over the 2017-2027 study period. What will be the major constraints on therapy sales? What are the key drivers of growth over this period? What are the drug development activities of note? What challenges and opportunities remain?

Two BRAF/MEK inhibitors combinations—Mektovi/Braftovi/Erbitux and Zelboraf/Erbitux/irinotecan—have shown promising efficacy in BRAF-mutant colorectal cancer patients. What is thought-leader opinion of these agents and of this drug class? For which patient populations will these agents be positioned? Will these agents receive approval in the markets under study? How will use of these agents affect prescribing of other agents for colorectal cancer?

In 2017, the FDA approved Keytruda (Merck) and Opdivo (Bristol-Myers Squibb) for second- and later-line treatment of MSI-H/dMMR colorectal cancer that is refractory to a fluoropyrimidine, irinotecan, and oxaliplatin. In 2018, Opdivo plus low-dose Yervoy received FDA approval in the same setting. How do key opinion leaders perceive these therapies? Will these therapies receive label expansions across the G7? Which other immune checkpoint inhibitors are being developed and in which patient populations?

Retrospective analyses of clinical trials with Avastin and EGFR inhibitors have shown that the side on which the tumor is located could be a prognostic factor for response to these agents. How do key opinion leaders view these data? Will “sidedness” have an impact on the treatment of metastatic colorectal cancer over the forecast period?

Scope:

Markets covered: United States, France, Germany, Italy, Spain, United Kingdom, and Japan.

Primary research: 20 country-specific interviews with thought leaders.

Epidemiology: Diagnosed incident cases of stage I, II, III , and IV colorectal cancer.

Population segments in market forecast:Stage II colon cancer;stage II rectal cancer;stage III colon cancer;stage III rectal cancer;stage IV colorectal cancer wild-type BRAF and RAS,first-line (left-sided);stage IV colorectal cancer wild-type BRAF and RAS, first-line (right-sided);stage IV colorectal cancer mutant RAS, first-line;stage IV colorectal cancer mutant BRAF, first-line;stage IV colorectal cancer wild-type BRAF and RAS,second-line (left-sided); stage IV colorectal cancer wild-type BRAF and RAS,second-line (right-sided); stage IVcolorectal cancer mutant RAS, second-line; stage IV colorectal cancer mutant BRAF, second-line; stage IV colorectal cancer wild-type BRAF and RAS, third-line (left-sided); stage IV colorectal cancer wild-type BRAF and RAS, third-line (right-sided); stage IVcolorectal cancer mutant RAS, third-line; stage IV colorectal cancer mutant BRAF.

Emerging therapies: Phase III: 12 drugs; Phase II: 26 drugs; Phase I: 14 drugs.