New Drug Options for Advanced Prostate Cancer

Wednesday 6 February 2013, Amsterdam

Prostate cancer is becoming increasingly common due to globally growing numbers of elderly men, and scientists are fighting to create new treatment options for patients with advanced disease, states a new report by healthcare experts.

The new report* states that the prostate cancer market has historically been dominated by chemotherapies and hormone therapies, with major players including AstraZeneca, which market the hormone therapies Zoladex (goserelin acetate) and Casodex (bicalutamide), and Sanofi, which market the popular chemotherapies Taxotere (docetaxel) and Jevtana (cabazitaxel).

Hormone therapies will continue to be a mainstay of prostate cancer treatment, but the role of chemotherapies will be reduced as targeted therapies like Johnson & Johnson’s (J&J’s) Zytiga (abiraterone acetate) and Medivation/Astellas’ Xtandi (enzalutamide) become the most popular treatment options for metastatic Castration-Resistant Prostate Cancer (mCRPC).

mCRPC patients characterize the disease population with the greatest unmet need of all prostate cancer patients. While patients with early stage prostate cancer can often be cured with surgery and radiation therapy, the cancer suffered by mCRPC patients is incurable, and they often suffer from painful symptoms related to bone metastases.

However, recent market entrants J&J’s Zytiga and Medivation/Astellas’ Xtandi fulfill the unmet need for oral mCRPC therapies that extend overall survival and have positive safety and side effect profiles. Another promising pipeline drug, Bayer/Algeta’s Alpharadin (radium-223 chloride), also extends overall survival, has an excellent safety and side effects profile, lessens the likelihood of Skeletal-Related Events (SREs), and eases bone pain.

Following the expected European launch of Xtandi in 2013, Zytiga and Xtandi will globally become the favored mCRPC treatments due to their oral route of administration and good level of tolerance by patients. J&J, Medivation, and Astellas initially sought regulatory approval for their drugs in mCRPC patients who are refractory to chemotherapy drug docetaxel, the current gold standard medication. Ultimately, they will expand their brands to the more lucrative chemotherapy-naïve mCRPC patients. This reflects a trend of diversity in the pharmaceutical market, as successful companies sponsor clinical trials evaluating their drugs in multiple patient segments and in combinations with competing therapies, maximizing potential revenue from their products.

We predict that Zytiga and Xtandi will dominate the mCRPC space, expecting peak Zytiga sales of US$1.7 billion in 2018, and Xtandi sales increasing to US$2.05 billion by 2022. However, increasing pressures to prove cost-effectiveness could restrain growth in the prostate cancer market, particularly in Europe, as reimbursement hurdles and price cuts will limit the premium pricing and uptake of new drugs. Alpharadin and other promising pipeline drugs that will launch over the next decade are also anticipated to have a difficult time capturing significant market share, as the market becomes crowded with competitors.

The anticipated success of Zytiga and Xtandi, as well as the launch of a wealth of first-in-class pipeline products, will drive sales of prostate cancer therapeutics to increase from an estimated US$3.8 billion in 2012 to US$7.9 billion by 2022 in the US, the UK, France, Germany, Spain, Italy, Japan, Australia, and Canada.