Colorectal Cancer | Disease Landscape and Forecast | G7 | 2020

Targeted therapies and various biomarkers (e.g., RAS, BRAF, MSI-H,dMMR) play an important role in the treatment of colorectal cancer. Treatment is becoming increasingly segmented by the side on which the tumor is located, BRAF status, and MSI-H or dMMR status. Immune checkpoint inhibitors targeting MSI-H / dMMR metastatic colorectal cancer are experiencing uptake and influencing current treatment algorithms. Therapies targeting specific biomarker-defined populations, such as BRAF-mutant metastatic colorectal, contribute to more-personalized treatment. This report provides insight on how treatment options for colorectal cancer are likely to change over the 2019-2029 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:

• Current treatment for metastatic colorectal cancer is dominated by chemotherapy regimens in combination with angiogenesis inhibitors and EGFR inhibitors. The launch of new, high-priced therapies for colorectal cancer will encounter competition from generic and biosimilar versions of older therapies. What are the key drivers of and constraints on the colorectal cancer therapy market, and how will the major markets evolve over the 10-year forecast period? What are the drug development activities of note? What challenges and opportunities remain?
• The BRAF inhibitor combination of Braftovi plus Erbitux has shown promising efficacy in BRAF-mutant colorectal cancer patients. What is thought-leader opinion of this combination? For which lines of therapy will this combination be positioned? How will use of this combination affect prescribing of other agents for colorectal cancer?
• Keytruda (Merck & Co.) was approved in the United States in 2020 and in Europe in 2021 for the first-line treatment of MSI-H/dMMR metastatic colorectal cancer. This agent and Opdivo—with or without low-dose Yervoy (Bristol Myers Squibb)—have been available since 2017 in the United States and in Japan since 2020 for the second- and later-line treatment of MSI-H/dMMR colorectal cancer refractory to a fluoropyrimidine, irinotecan, and oxaliplatin. How do key opinion leaders perceive these therapies? Will these therapies receive label expansions? Which other immune checkpoint inhibitors are being developed and for 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” influence the treatment of metastatic colorectal cancer during 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 IV colorectal 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 IV colorectal cancer mutant RAS, third-line; stage IV colorectal cancer mutant BRAF.

Emerging therapies: Phase III: 7 drugs; Phase I-II: 9 drugs.