CRC – a crowded space with strong market leaders

CRC – a crowded space with strong market leaders
Colorectal cancer (CRC) is the third most common cancer in men and the second in women worldwide, making it the third largest cancer type in the world (based on annual cases). Based on the pure market size, CRC is a lucrative opportunity, which attracts many new pharmaceutical companies and candidates. However, CRC is a crowded market and the established branded drugs – primarily Avastin and Erbitux – have established a dominance that is hard to challenge. Biosimilar approvals are expected to create some competition – and possibly some price pressure – for these two market leaders, but their dominant positions are expected to maintain sales at blockbuster levels for at least 5-8 more years. Avastin is heavily prescribed in both first- and second-line treatment settings and Avastin plus FOLFOX (leucovorin + 5-FU + oxaliplatin) is currently the most prescribed first-line regimen for metastatic CRC in less cost-conservative markets. This combination regimen is expected to protect much of the big seller’s revenue also after the introduction of biosimilars.

 

Because of these barriers, the three leading late-stage CRC pipeline candidates (Cyramza, Ofev and Imprime PGG) are not expected to dramatically alter the prescription landscape. Cyramza (Lilly), a gastric- and non small cell lung cancer drug, was recently approved in the US as a second-line treatment for metastatic CRC for use in combination with FOLFIRI. Although, Cyramza may reach combined sales exceeding a billion dollar from its other indications – sales in CRC may not even reach the $100m-mark. Even lower sales have been predicted for recently approved IPF drug, Ofev (Boehringer Ingelheim) and phase III candidate Imprime PGG (Biothera) – if they reach the CRC market. Ofev is currently being developed in a clinical phase III study as a third-line treatment for metastatic CRC and is predicted to reach an approval in 2017, while Imprime PGG is currently in phase III tests in combination with cetuximab targeting patients with metastatic CRC with wild-type KRAS. Imprime PGG is hoping for moderate uptake in patients who otherwise would receive cetuximab as a monotherapy, but the addition of Imprime PGG to the expensive cetuximab could also limit its use in this patient population.

 

Is there a way to challenge Avastin’s dominant position or is later line treatments the only market entry for new pipeline candidates…?

CXO and Co-founder of Monocl Software