How Will Physician and Payer Attitudes and Decisions Shape this Market? The treatment of metastatic colorectal cancer (mCRC) is increasingly driven by patients’ RAS mutational status of their disease: a mutation in RAS markedly reduces sensitivity to EGFR monoclonal antibody inhibitors, making them ineligible for treatment with either Erbitux or Vectibix. In the fiercely competitive RAS wild-type patient segment, Avastin competes for share against the EGFR inhibitors. While strength of clinical data and patient characteristics and preferences play an important part in treatment selection, price, reimbursement, and market access restrictions to mCRC biologics and other high-cost agents are increasingly influential in the EU5 markets. Indeed, in particularly cost-constrained, budget-restricted markets, non-clinical factors can tip the balance towards prescribing of either antiangiogenics, biomarker-driven EGFR inhibitors, or, indeed, chemotherapy alone.
Recently approved agents for mCRC have failed to impress payers in terms of differentiation and/or efficacy gains over standard of care, creating a stringent pricing landscape for new therapies. Furthermore, regional variations in drug access in some EU5 markets, and delays between EMA drug approval and the completion of country-specific pricing and reimbursement negotiations, may impact uptake. Developers of emerging therapies for mCRC should be mindful of the barriers and levers to market access for such therapies in their communications and negotiations with payers in the cost-constrained EU5.