Stakeholder Insight: Lung Cancer - Third-Generation Cytotoxics Set to Dominate the Market

Table of Contents

CHAPTER 1 EXECUTIVE SUMMARY

Scope of the analysis

Datamonitor insight into the lung cancer market

Cisplatin plus Campto (irinotecan) is the gold-standard regimen for extensive SCLC in Japan, based on the results of a Japanese trial. Physicians in the US and Europe are generally skeptical of the regimen and it will not see a wide uptake until the results are replicated in a Western clinical trial

Third-generation cytotoxics, such as gemcitabine, vinorelbine and paclitaxel, commonly used for NSCLC, are increasingly being prescribed to SCLC patients. Having reached an efficacy plateau with cisplatin and etoposide regimen, Datamonitor believes that physicians will increasingly experiment with third-generation chemotherapy that have proven to be effective in NSCLC

Adjuvant chemotherapy for NSCLC remains controversial and opinions are divided on its benefit. There are ongoing clinical trials such as ANITA I and II that are investigating the survival benefit of adjuvant chemotherapy, but unless they show significant improvement in survival, the controversy is likely to continue and adjuvant chemotherapy is not expected to become a standard practice for NSCLC

Aventis'  Taxotere (docetaxel) has the potential to become the gold-standard first-line therapy for NSCLC in the US. However, Datamonitor believes that this is unlikely to be the case in the European markets, where Lilly' s Gemzar (gemcitabine) and Pierre Fabre/GSK' s Navelbine (vinorelbine) will continue to dominate the NSCLC market

Key metrics

CHAPTER 2 INTRODUCTION AND SCOPE

Coverage of the Stakeholder Insight Survey

CHAPTER 3 COUNTRY TREATMENT TREES

US

Japan

France

Germany

Italy

Spain

UK

CHAPTER 4 DEFINITION AND EPIDEMIOLOGY

Definition of lung cancer

Non-small cell lung cancer (NSCLC)

Small cell lung cancer (SCLC)

Epidemiology of lung cancer

CHAPTER 5 DIAGNOSIS AND REFERRAL

Diagnosis

Physician types responsible for diagnosis

Referral

Stage distribution of diagnosed SCLC patients

Stage distribution of diagnosed NSCLC patients

Issues in elderly patients

Diagnosis of elderly patients

CHAPTER 6 TREATMENT POPULATION

Multi-disciplinary approach to lung cancer

Physician types responsible for treatment

Patient characteristics

Stage distribution of treated SCLC patients

Stage distribution of treated NSCLC patients

Issues in the treatment of elderly patients

Treatment of elderly patients with chemotherapy

Increase in use of chemotherapy in elderly patients

Reasons for increase in use of chemotherapy for elderly patients

CHAPTER 7 TREATMENT MODALITIES FOR SCLC

Limited stage SCLC

Physician data

Extensive stage SCLC

Physician data

CHAPTER 8 TREATMENT MODALITIES FOR NSCLC

Stage I NSCLC

Physician data

Stage II NSCLC

Physician data

Stage IIIA NSCLC

Physician data

Stage IIIB NSCLC

Physician data

Stage IV NSCLC

Physician data

CHAPTER 9 FIRST-LINE DRUG REGIMENS

Small cell lung cancer

Limited stage SCLC

Extensive stage SCLC

Non-small cell lung cancer

Stage I

Stage II

Stage IIIA

Stage IIIB

Stage IV

CHAPTER 10 SECOND-LINE DRUG REGIMENS

SCLC patients progressing to second-line treatment

Second-line drug regimens for SCLC

NSCLC patients progressing to second-line treatment

Second-line drug regimens for NSCLC

CHAPTER 11 PRESCRIBING FACTORS & DRUG PROFILES

Prescribing factors

SCLC

NSCLC

Drug profiles

Cisplatin versus carboplatin

Paclitaxel versus docetaxel

Gemcitabine versus IV vinorelbine versus oral vinorelbine

Etoposide versus topotecan

Iressa

Comparative physician ratings

CHAPTER 12 TREATMENT OUTCOMES

Median survival for SCLC

Median survival for NSCLC

CHAPTER 13 FUTURE ISSUES

Future gold-standard regimens for SCLC

Reasons

Future gold-standard regimens for NSCLC

Reasons

CHAPTER 14 POPULATION DATA

US

Japan

France

Germany

Italy

Spain

UK

List of tables

List of figures

Physician research methodology

Introduction

Our research partners

Research objectives

Questionnaire development

Research methodology

Data processing

Quality control

Physician Sample breakdown

Contributing experts

The survey questionnaire

Disclaimer

List of Tables

Table 1: Incidence of SCLC and NSCLC in the seven major markets to 2011

Table 2: Stages of NSCLC

Table 3: Stages of SCLC

Table 4: Incidence of SCLC and NSCLC in the seven major markets to 2011

Table 5: Percentage breakdown of physician types responsible for the diagnosis of lung cancer

Table 6: Percentage of lung cancer patients referred to physicians interviewed by Datamonitor

Table 7: Percentage of SCLC patients diagnosed in each stage

Table 8: Percentage of NSCLC patients diagnosed in each stage

Table 9: Percentage of lung cancer patients who are elderly

Table 10: Percentage of physicians responsible for the treatment of lung cancer

Table 11: Percentage of SCLC patients treated in each stage

Table 12: Percentage of NSCLC patients treated in each stage

Table 13: Percentage of elderly lung cancer patients receiving chemotherapy

Table 14: Increase in use of chemotherapy in elderly patients

Table 15: Reasons for increase in use of chemotherapy for elderly patients

Table 16: Treatment modalities of limited stage SCLC

Table 17: Treatment modalities of extensive stage SCLC

Table 18: Treatment modalities of stage I NSCLC

Table 19: Percentage of patients receiving surgery alone or in combination with other modalities in stage I

Table 20: Treatment modalities of stage II NSCLC

Table 21: Treatment modalities of stage IIIA NSCLC

Table 22: Percentage of stage IIIA NSCLC patients receiving surgery in combination with other modalities

Table 23: Treatment modalities of stage IIIB NSCLC

Table 24: Treatment modalities of stage IV NSCLC

Table 25: Percentage use of drug regimens for limited SCLC

Table 26: Percentage use of drug regimens for extensive SCLC

Table 27: Percentage use of drug regimens for stage I NSCLC

Table 28: Percentage use of drug regimens for stage II NSCLC

Table 29: Percentage use of drug regimens for stage IIIA NSCLC

Table 30: Percentage use of drug regimens for stage IIIB NSCLC

Table 31: Percentage use of drug regimens for stage IV NSCLC

Table 32: Percentage of SCLC patients progressing to second-line

Table 33: Percentage use of second-line regimens for SCLC

Table 34: Percentage of NSCLC patients progressing to second-line

Table 35: Percentage use of second-line regimens for NSCLC

Table 36: Physician rating of prescribing factors for SCLC

Table 37: Physician rating of prescribing factors for NSCLC

Table 38: Physician ratings of cisplatin versus carboplatin

Table 39: Physician ratings of paclitaxel versus docetaxel

Table 40: Physician ratings of gemcitabine versus IV vinorelbine versus oral vinorelbine

Table 41: Physician ratings of etoposide versus topotecan

Table 42: Physician rating of Iressa

Table 43: Comparative physician ratings of commonly used lung cancer drugs

Table 44: Median survival of SCLC patients

Table 45: Median survival of NSCLC patients

Table 46: Physicians'  opinion of future gold standard regimens for SCLC (%)

Table 47: Physician ranking of reasons for choosing the above regimens as the future gold standard for SCLC

Table 48: Physicians'  opinion of future gold standard regimens for NSCLC (%)

Table 49: Physician ranking of reasons for choosing the above regimens as the future gold standard for NSCLC

Table 50: Patient population data for treatment modalities of SCLC in the US

Table 51: Patient population data for SCLC drug regimens in the US

Table 52: Population data for second-line drug regimens for SCLC in the US

Table 53: Patient population data for treatment modalities of NSCLC in the US

Table 54: Patient population data for NSCLC drug regimens in the US

Table 55: Population data for second-line drug regimens for NSCLC in the US

Table 56: Patient population data for treatment modalities of SCLC in Japan

Table 57: Patient population data for SCLC drug regimens in Japan

Table 58: Population data for second-line drug regimens for SCLC in Japan

Table 59: Patient population data for treatment modalities of NSCLC in Japan

Table 60: Patient population data for NSCLC drug regimens in Japan

Table 61: Population data for second-line drug regimens for NSCLC in Japan

Table 62: Patient population data for treatment modalities of SCLC in France

Table 63: Patient population data for SCLC drug regimens in France

Table 64: Population data for second-line drug regimens for SCLC in France

Table 65: Patient population data for treatment modalities of NSCLC in France

Table 66: Patient population data for NSCLC drug regimens in France

Table 67: Population data for second-line drug regimens for NSCLC in France

Table 68: Patient population data for treatment modalities of SCLC in Germany

Table 69: Patient population data for SCLC drug regimens in Germany

Table 70: Population data for second-line drug regimens for SCLC in Germany

Table 71: Patient population data for treatment modalities of NSCLC in Germany

Table 72: Patient population data for NSCLC drug regimens in Germany

Table 73: Population data for second-line drug regimens for NSCLC in Germany

Table 74: Patient population data for treatment modalities of SCLC in Italy

Table 75: Patient population data for SCLC drug regimens in Italy

Table 76: Population data for second-line drug regimens for SCLC in Italy

Table 77: Patient population data for treatment modalities of NSCLC in Italy

Table 78: Patient population data for NSCLC drug regimens in Italy

Table 79: Population data for second-line drug regimens for NSCLC in Italy

Table 80: Patient population data for treatment modalities of SCLC in Spain

Table 81: Patient population data for SCLC drug regimens in Spain

Table 82: Population data for second-line drug regimens for SCLC in Spain

Table 83: Patient population data for treatment modalities of NSCLC in Spain

Table 84: Patient population data for NSCLC drug regimens in Spain

Table 85: Population data for second-line drug regimens for NSCLC in Spain

Table 86: Patient population data for treatment modalities of SCLC in the UK

Table 87: Patient population data for SCLC drug regimens in the UK

Table 88: Population data for second-line drug regimens for SCLC in the UK

Table 89: Patient population data for treatment modalities of NSCLC in the UK

Table 90: Patient population data for NSCLC drug regimens in the UK

Table 91: Population data for second-line drug regimens for NSCLC in the UK

Table 92: Stakeholder and Multiclient Insight Studies by Therapy Area, 2003

Table 93: Physician sample breakdown

List of Figures

Figure 1: Incidence of SCLC and NSCLC in the seven major markets to 2011

Figure 2: Comparative physician ratings of commonly used lung cancer drugs

Figure 3: Diagrammatic overview of the coverage of the Stakeholder Insight Lung Cancer survey, 2003

Figure 4: Population data of first- and second-line drug regimens for SCLC in the US in 2003

Figure 5: Population data of first- and second-line drug regimens for NSCLC in the US in 2003

Figure 6: Population data of first- and second-line drug regimens for SCLC in Japan in 2003

Figure 7: Population data of first- and second-line drug regimens for NSCLC in Japan in 2003

Population data of first- and second-line drug regimens for NSCLC in Japan in 2003 (cont' d)

Population data of first- and second-line drug regimens for NSCLC in Japan in 2003 (cont' d)

Figure 8: Population data of first- and second-line drug regimens for SCLC in France in 2003

Population data of first- and second-line drug regimens for SCLC in France in 2003 (cont' d)

Figure 9: Population data of first- and second-line drug regimens for NSCLC in France in 2003

Population data of first- and second-line drug regimens for NSCLC in France in 2003 (cont' d)

Population data of first- and second-line drug regimens for NSCLC in France in 2003 (cont' d)

Figure 10: Population data of first- and second-line drug regimens for SCLC in Germany in 2003

Population data of first- and second-line drug regimens for SCLC in Germany in 2003 (cont' d)

Figure 11: Population data of first- and second-line drug regimens for NSCLC in Germany in 2003

Population data of first- and second-line drug regimens for NSCLC in Germany in 2003 (cont' d)

Figure 12: Population data of first- and second-line drug regimens for SCLC in Italy in 2003

Population data of first- and second-line drug regimens for SCLC in Italy in 2003 (cont' d)

Figure 13: Population data of first- and second-line drug regimens for NSCLC in Italy in 2003

Population data of first- and second-line drug regimens for NSCLC in Italy in 2003 (cont' d)

Figure 14: Population data of first- and second-line drug regimens for SCLC in Spain in 2003

Figure 15: Population data of first- and second-line drug regimens for NSCLC in Spain in 2003

Population data of first- and second-line drug regimens for NSCLC in Spain in 2003 (cont' d)

Figure 16: Population data of first- and second-line drug regimens for SCLC in the UK in 2003

Figure 17: Population data of first- and second-line drug regimens for NSCLC in the UK in 2003

Figure 18: The lung

Figure 19: Incidence of SCLC and NSCLC in the seven major markets to 2011

Figure 20: Percentage breakdown of physician types responsible for the diagnosis of lung cancer

Figure 21: Percentage of lung cancer patients referred to physicians interviewed by Datamonitor

Figure 22: Percentage of SCLC patients diagnosed in each stage

Figure 23: Percentage of NSCLC patients diagnosed in each stage

Figure 24: Stage distribution of diagnosed NSCLC patients in Japan

Figure 25: Stage distribution of diagnosed NSCLC patients in the UK

Figure 26: Percentage of lung cancer patients who are elderly

Figure 27: Percentages of physicians responsible for the treatment of lung cancer

Figure 28: Percentage of SCLC patients treated in each stage

Figure 29: Percentage of NSCLC patients treated in each stage

Figure 30: Percentage of elderly lung cancer patients receiving chemotherapy

Figure 31: Increase in use of chemotherapy in elderly patients

Figure 32: Reasons for increase in use of chemotherapy for elderly patients

Figure 33: Treatment modalities of limited stage SCLC

Figure 34: Treatment modalities of extensive stage SCLC

Figure 35: Treatment modalities of stage I NSCLC

Figure 36: Percentage of patients receiving surgery alone or in combination with other modalities in stage I

Figure 37: Treatment modalities of stage II NSCLC

Figure 38: Treatment modalities of stage IIIA NSCLC

Figure 39: Percentage of stage IIIA NSCLC patients receiving surgery in combination with other modalities

Figure 40: Treatment modalities of stage IIIB NSCLC

Figure 41: Treatment modalities of stage IV NSCLC

Figure 42: Top five regimens for limited SCLC in the seven major markets

Figure 43: Top five regimens for extensive SCLC in the seven major markets

Figure 44: Percentage use of drug regimens for Stage I NSCLC

Figure 45: Percentage use of drug regimens for stage II NSCLC

Figure 46: Percentage use of drug regimens for stage IIIA NSCLC

Figure 47: Percentage use of drug regimens for stage IIIB NSCLC

Figure 48: Percentage use of drug regimens for stage IV NSCLC

Figure 49: Percentage of SCLC patients progressing to second-line

Figure 50: Percentage use of second-line regimens for SCLC

Figure 51: Percentage of NSCLC patients progressing to second-line

Figure 52: Percentage use of second-line regimens for NSCLC

Figure 53: Physician rating of prescribing factors for SCLC

Figure 54: Physician rating of prescribing factors for NSCLC

Figure 55: Physician ratings of cisplatin versus carboplatin

Figure 56: Physician ratings of paclitaxel versus docetaxel

Figure 57: Physician ratings of gemcitabine versus IV vinorelbine versus oral vinorelbine

Figure 58: Physician ratings of etoposide versus topotecan

Figure 59: Physician rating of Iressa

Figure 60: Comparative physician ratings of commonly used lung cancer drugs

Figure 61: Median survival of SCLC patients

Figure 62: Median survival of NSCLC patients

Figure 63: Physicians'  opinion of future gold standard regimens for SCLC

Figure 64: Physician ranking of reasons for choosing the above regimens as the future gold standard for SCLC

Figure 65: Physicians'  opinion of future gold standard regimens for NSCLC

Figure 66: Physician ranking of reasons for choosing the above regimens as the future gold standard for NSCLC

Figure 67: Primary Research Process