Breast Cancer | Disease Landscape and Forecast | G7 | 2016

The treatment of breast cancer has a rich and diverse product pipeline and continues to be one of the most lucrative and active areas of research in oncology. However, the barriers to entry are high, owing to the well-established and effective therapies already available. Treatment is based on hormone receptor and HER2 expression, and successful therapies are often tailored to specific subpopulations. Substantial unmet need remains in the treatment of triple-negative breast cancer, for which no targeted therapy is approved.

Questions Answered:

• We forecast the launch of a new drug class, the immune checkpoint inhibitors, for triple-negative advanced/metastatic breast cancer. How do physicians anticipate using these agents? How will the entry of these agents impact the use of other therapies in this setting?
• Increasing treatment options for HER2-positive breast cancer mean that the historical treatment algorithm for these patients is being overhauled. How have the approvals of Roche/Genentech/Chugai’s Perjeta and Kadcyla affected the HER2-positive treatment algorithm? How will future label extensions of Perjeta and Kadcyla influence treatment dynamics?
• We forecast the launch of new drugs in the CDK4/6 inhibitors drug class for hormone-receptor-positive breast cancer. How do physicians anticipate using these agents? How will the entry of these agents affect the use of other therapies in this setting?
• Novartis’s Afinitor is the only member of the PI3K/AKT/mTOR drug class approved to treat breast cancer, but further approvals are anticipated throughout our forecast period. Which other agents in this drug class show promise? How will agents in this class compete with one another? How do physicians rate drugs from this class versus drugs from other classes?
• Four PARP inhibitors have entered Phase III development for BRCA1/2-mutated breast cancer. What impact will PARP inhibitors have on the breast cancer market? How do interviewed experts anticipate prescribing PARP inhibitors in the future?

Scope:

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

Primary research: 19 country-specific interviews with experts.

Epidemiology: Incidence of stages I, IIa, IIb, IIIa, IIIb, IIIc, and IV breast cancer; incidence of hormonal breast cancer by stage at diagnosis; incidence of nonhormonal breast cancer by stage at diagnosis; incidence of HER2-positive breast cancer by stage at diagnosis; incidence of triple-negative breast cancer by stage at diagnosis; incidence of premenopausal breast cancer by stage at diagnosis; incidence of postmenopausal breast cancer by stage at diagnosis.

Population segments in market forecast: Adjuvant and neoadjuvant HR+/HER2- premenopausal, adjuvant and neoadjuvant HR+/HER2+ postmenopausal, adjuvant and neoadjuvant HR+/HER2+ premenopausal, adjuvant and neoadjuvant HR-/HER2+, adjuvant and neoadjuvant HR-/HER2- (triple-negative), first-line metastatic HR+/HER2-, second-line metastatic HR+/HER2-, third-line metastatic HR+/HER2-, fourth-line metastatic HR+/HER2-, fifth-line metastatic HR+/HER2-, sixth-line metastatic HR+/HER2-, first-line metastatic HER2+ (HR+ and HR-), second-line metastatic HER2+ (HR+ and HR-), third- and subsequent-line metastatic HER2+ (HR+ and HR-), first-line metastatic HR-/HER2- (triple-negative), second-line metastatic HR-/HER2- (triple-negative), third- and subsequent-line metastatic HR-/HER2- (triple-negative).

Emerging therapies: Phase II: 44 drugs; Phase III: 20 drugs; registered: 27 drugs.

Market forecast features: Using a proprietary patient-flow model incorporating mortality, we forecast drug-treatable population sizes and drug sales for all patient segments annually through 2025.

Alternative market scenarios: (1) Ibrance is approved for HR-positive/HER2-negative adjuvant breast cancer.