Stakeholder Opinions: Ovarian Cancer Growing importance as secondary indication for targeted therapies

Table of Contents

• ABOUT DATAMONITOR HEALTHCARE
  • About the Oncology pharmaceutical analysis team
    • Richard Faint - Director of Oncology
• CHAPTER 1 EXECUTIVE SUMMARY
  • Scope
  • Datamonitor insight
• CHAPTER 2 DISEASE OVERVIEW
  • Introduction
  • Types of ovarian cancer
    • Epithelial tumors
    • Stromal tumors
    • Germ cell tumors
    • Subtypes
  • Staging
  • Grading
  • Epidemiology
    • Incidence at diagnosis
    • Stage at diagnosis
    • Incidence by stage
    • Prevalence
  • Key risk factors
  • Prognosis
  • Improving survival for ovarian cancer
• CHAPTER 3 TREATMENT OPTIONS
  • Surgery
  • Radiotherapy
  • Drug therapy
• CHAPTER 4 DRUG REGIMENS
  • First-line drug regimens
    • Platinum + taxane
    • Cisplatin versus carboplatin
      • Carboplatin in the US, cisplatin in the EU for NSCLC
      • Is the pattern replicated for ovarian cancer?
      • Dose intensity of platinum drugs
      • Platinum monotherapy?
    • Carboplatin + paclitaxel is the standard of care in most markets
    • Potential for other platinums?
    • Paclitaxel versus docetaxel
      • Similar efficacy, better QOL with docetaxel
      • Paclitaxel dominates in the EU
      • Paclitaxel still expected to dominate in the US
    • Chemotherapy triplet
    • Intraperitoneal chemotherapy
      • Increased survival but also increased toxicity
  • Second-line drug regimens
    • Platinum combination versus platinum monotherapy
      • Carboplatin + paclitaxel
      • Optimal regimen not yet determined
    • Docetaxel
    • Topotecan
    • Tamoxifen
    • More than half of second-line patients are platinum sensitive
    • Fragmented second-line market in the EU
    • Drug regimens in first and second line in the five EU markets
  • Third-line drug regimens
    • Topotecan
    • Liposomal doxorubicin
    • Gemcitabine
    • Limited use of platinum agents in third line
    • Gemcitabine is the leading third-line regimen in the EU
      • Nevertheless Gemzar's sales are low
    • Topotecan is the second most commonly used agent
    • Platinum still used in a proportion of patients
  • Beyond third-line therapy
• CHAPTER 5 PIPELINE DRUGS
  • Cell Therapeutics - Xyotax (polyglutamate paclitaxel)
    • Impressive results but need to replicate in Phase III trial
    • Effect on QoL
    • Sufficient advantages for reformulated paclitaxel?
  • Novartis - Patupilone (epothilone B)
    • Limited potential for patupilone
    • More epothilone agents on the horizon
  • Unither Therapeutics/ViRexx - OvaRex (oregovomab)
    • Primary endpoint failure will hurt the drug
    • Insufficient marketing capacity and capability
  • Telik - Telcyta (TLK286)
    • Penetrating the second- and third-line market
    • Partner needed
  • Celgene - Thalomid (thalidomide)
    • Lack of Celgene support?
    • Stigma of thalidomide
  • Genentech/Roche - Avastin (bevacizumab)
    • Confidence transferred to ovarian cancer
    • Cost will be a problem for Avastin
  • Genentech/Roche/OSI - Tarceva (erlotinib)
    • Winning streak for Genentech/Roche?
  • Pharmamar - Yondelis (trabectedin)
    • Unlikely to change the treatment paradigm
    • More potential with combination therapy?
  • Marshall Edwards - phenoxodiol
    • Toxicity will be the key factor for phenoxodiol
    • Sanofi-Aventis as a marketing partner?
  • Recently discontinued Phase III pipeline drug
    • InterMune - Actimune (gamma interferon-1b)
  • Phase II drugs in development for ovarian cancer
• CHAPTER 6 APPENDIX A
  • Participating opinion leaders
  • Opinion leader interview transcripts
    • Opinion leader 1
    • Opinion leader 2
    • Opinion leader 3
  • Reference
• CHAPTER 7 APPENDIX B
  • About Datamonitor
    • About Datamonitor Healthcare
    • About the Oncology analysis team
  • Disclaimer
  • List of Tables
    • Table 1: Subtypes of epithelial, stromal and germ cell tumors
    • Table 2: Ovarian cancer staging
    • Table 3: Grading of ovarian cancer
    • Table 4: Incidence of ovarian cancer between 2002 and 2015 in the seven major markets
    • Table 5: Stage distribution at diagnosis
    • Table 6: Incidence of ovarian cancer by stage in the seven major markets in 2005
    • Table 7: Prevalence of ovarian cancer in the seven major markets
    • Table 8: Ovarian cancer five-year relative survival rate by stage
    • Table 9: Cisplatin-paclitaxel trial results
    • Table 10: Summary of key clinical trials for carboplatin-based regimens in ovarian cancer
    • Table 11: Top two regimens for first-line therapy of ovarian cancer in the 5 EU markets
    • Table 12: Summary results of Phase III trial of docetaxel versus paclitaxel
    • Table 13: Diagnosis and relapse rate of ovarian cancer by stage
    • Table 14: Top three regimens for second-line therapy of ovarian cancer in the 5 EU markets
    • Table 15: Sales of gemcitabine by indication in the five EU markets in 2005
    • Table 16: Key Phase III drugs in development for ovarian cancer
    • Table 17: Key Phase III trials of Telcyta for ovarian cancer
    • Table 18: Phase II drugs in development for ovarian cancer
  • List of Figures
    • Figure 1: The female reproductive organs
    • Figure 2: Incidence of ovarian cancer between 2002 and 2015 in the seven major markets
    • Figure 3: Stage distribution at diagnosis
    • Figure 4: Incidence of ovarian cancer by stage in the seven major markets in 2005
    • Figure 5: Prevalence of ovarian cancer in the seven major markets
    • Figure 6: Ovarian cancer five-year relative survival rate by stage
    • Figure 7: Five-year survival rates for ovarian cancer between 1975 and 1997 in the US
    • Figure 8: Percentage of first-line ovarian cancer patients treated with carboplatin- and cisplatin-based regimens in the 5 EU markets
    • Figure 9: Price of Paraplatin in the five EU markets
    • Figure 10: Percentage of first-line ovarian cancer patients treated with taxanes in the 5 EU markets
    • Figure 11: Diagnosis and relapse rate of ovarian cancer by stage
    • Figure 12: Percentage of second-line patients treated with platinum and non-platinum regimens in the five EU markets
    • Figure 13: Percentage of second-line ovarian cancer patients treated with carboplatin-based regimens in the five EU markets
    • Figure 14: Drug regimens in first and second line in the five EU markets
    • Figure 15: Platinum versus non-platinum regimens in third line in the five EU markets
    • Figure 16: Percentage of third-line patients treated with drug regimens in the five EU markets
    • Figure 17: Sales of Gemzar by indication in the five EU markets