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1、H E A L T H C A R E The Cancer Market Outlook to 2015 Competitive landscape, market size, pipeline analysis, and growth opportunities by Business Insights 2 About Business Insights Business Insights has a team of in-house pharmaceutical and regulatory analysts drawn from consulting, R ? Breast cance
2、r; ? Colorectal cancer; ? Prostate cancer; ? Pancreatic cancer; ? Ovarian cancer; ? Head and neck cancer; ? Leukemia; ? Lymphoma. This report also assesses: ? An overview and summary of significant developments and key R 20 ? Epidemiological analysis and forecast prevalence for cancer indications to
3、 2015; ? Sales forecasts and analysis of the key products over the period 200915 in the major indications to benchmark the forecast performance of the leading players. Methodology The report gives a strategic insight into the leading pharmaceutical players in the cancer market. The top 10 global pla
4、yers were selected from a pool of global US and European drug majors and were later rank- ordered and profiled based on revenues and market share presence in the cancer market space in 2009. IMS Health, company websites and Business Insights analysis were the sole source of data points for all the a
5、nalysis featured in this report. Where applicable, references were made to multiple secondary resources, in- house data, scientific journals and analyst reports during the course of the due-diligence on data-aggregation to derive strategic insights on currently marketed drugs and to build realistic
6、and robust sales projections in the outer years. 21 Chapter 2 Overview and epidemiology of cancer indications Summary ? Global cancer prevalence rates are on the rise owing to an aging population, changing lifestyle and increasing pollution. Prevalence data is significantly influenced by the increas
7、ing diagnosis and survival rates across the global market. ? Globally, lung cancer is one of the most common types of cancer, with an estimated 1.2m new cases being diagnosed every year. Among all lung cancer cases, around 42% survive after one year, yet the relative five-year survival rate for all
8、lung cancers combined is around 15% only. ? The last decade has seen a significant fall in mortality rates from breast cancer. Due to the lack of medical treatments for late-stage breast cancer, the long-term survival of patients still depends on early diagnosis, which has been improved through the
9、contentious use of large-scale screening and public awareness programs. ? Prostate cancer is one of the most commonly diagnosed cancers, and is the second leading cancer- related cause of deaths in men, surpassed only by lung cancer. The highest incidence of this disease is seen in the US, and studi
10、es have placed black men at a higher risk of prostate cancer than men from other ethnic origins. ? Globally, colorectal cancer (CRC) is the second most commonly diagnosed form of cancer. In 2009, approximately 1.6m individuals were affected by CRC in the seven major markets. The incidence of CRC inc
11、reases with age, generally occurring in the sixth or seventh decade of life. Mortality rates, particularly among men, look set to rise steadily over the next five years, despite the positive impact of screening on the early identification of the disease. ? Pancreatic cancer is most common in men and
12、 women between the ages of 60 and 75, making age the predominant risk factor for incidence of the disease. In the seven major markets, prevalence is 22 projected to grow modestly to 67m in 2015. Poor prognosis, late diagnosis and low survival can be attributed to the low prevalence of the disease. I
13、ntroduction This chapter provides a background to the cancer therapeutic area in terms of the major indications covered in this report, an overview of each of the indications, diagnosis, management and treatment, incidence and prevalence data, and forecast epidemiology data to 2015. The cancer types
14、 covered in this report are those that are highly prevalent and commonly treated through pharmacological therapy, namely lung cancer, colorectal cancer (CRC), lymphomas, leukemia, breast cancer, ovarian cancer, uterine cancer, prostate cancer, and pancreatic cancer. This chapter provides specific in
15、formation on these cancer types across the seven major markets, with current diagnosis and treatment techniques. The 10 types of cancer selected in this report are those that feature major drug dependent treatment regimens rather than those which entail surgery-based treatment regimens. Overview Can
16、cer is a group of diseases characterized by the uncontrolled growth and spread of abnormal cells. If the spread is not controlled, it can result in death. Cancer is caused by both external factors (tobacco, chemicals, radiation and infectious organisms) and internal factors (inherited mutations, imm
17、une conditions, hormones and random mutations). These causal factors may act together or in sequence to initiate or promote carcinogenesis. Depending on the stage of the disease, cancer can be treated by surgery, radiation, chemotherapy, hormone therapy, biological therapy and targeted therapy. Canc
18、er risk factors There are several risk factors which can lead to cancer. Some of the major ones include: Chemical carcinogens 23 A carcinogen is anything (chemical, radiation, etc.) which can damage a cell and make it more likely to turn cancerous. Examples of chemical carcinogens are inhaled asbest
19、os, certain dioxins; examples of radiation are gamma rays and alpha particles. Age The older you become, the more likely that you will develop cancer. This is probably due to an accumulation of damaged cells in the body over time. So, eventually one damaged cell may manage to survive and multiply, o
20、ut of control, into a cancer. Tobacco smoke Tobacco smokers are more likely to develop cancer of the lungs, mouth, throat, esophagus, bladder or pancreas. Lifestyle factors Diet and other lifestyle factors may increase or decrease the risk of developing cancer. Radiation Radiation is carcinogenic. F
21、or example, exposure to radioactive materials and nuclear fallout can increase the risk of leukemia and other cancers. Too much sun exposure and sunburn (radiation from ultraviolet A or B rays) increases the risk of developing skin cancer. Immune system People with a poor immune system have an incre
22、ased risk of developing certain cancers: people with AIDS, for example, or people on immunosuppressive therapy. Genetic make-up Some cancers have a strong genetic link. For example, in certain childhood cancers, the abnormal gene or genes may trigger a cell to become abnormal and cancerous. However,
23、 regular screening examinations by a healthcare professional can result in the detection and removal of precancerous growths, as well as the diagnosis of cancers at an early stage. Such screening examinations also help to detect cancers of the colon, rectum, breast, prostate, skin, etc in early stag
24、es. 24 Lung cancer Overview Globally, lung cancer is one of the most common types of cancer, with an estimated 1.2m new cases being diagnosed every year across the world. The epidemic of lung cancer has been identified as a major health issue confronting both developed and developing countries, with
25、 the disease featuring high mortality rates across all countries. Lung cancer is one of the predominant causes of cancer-related deaths in the seven major markets, causing up to 3m deaths globally each year. Lung cancer is a malignant tumor that develops from the uncontrolled growth of lung cells, w
26、hich if left untreated can metastasize to the liver, brain, bones, and eventually throughout the body. There are two main types of lung cancer: small-cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). NSCLC is the third largest cancer market in terms of numbers of patients diagnosed. Th
27、ere are three main types of NSCLC, namely: Adenocarcinoma: This develops from the cells which produce mucus (phlegm) in the lining of the airways. This type of cancer is most common and represents 40% to 50% of the NSCLC patient population. It is characterized by originating near the gas exchange su
28、rface of the lung and is most commonly caused by smoking. Squamous cell carcinoma: This is the second most common type of lung cancer. It develops in the cells which line the airways. This type of lung cancer is often caused by smoking and accounts for approximately 20% to 25% of NSCLC cases. Large
29、cell carcinoma: The final NSCLC subtype is large cell carcinoma, which grows at an accelerated rate near the surface of the lung. It is sometimes known as undifferentiated carcinoma. SCLC, also known as oat cell carcinoma is a less common form of lung cancer. It has its origins in the larger breathi
30、ng tubes and grows rapidly, becomes large in size and metastasizes to other parts of the body at an early stage. NSCLC and SCLC grow and spread in different ways and therefore have different treatment procedures. 25 Diagnosis, treatment and management Usually symptoms of lung cancer do not appear un
31、til the disease is in its advanced stages. But some lung cancers are diagnosed early, and are often found as a result of tests for other medical conditions, mainly through chest X-rays. Clinical manifestations of lung cancer are dependent upon the location of the tumor and the extent of metastasis.
32、The most common symptoms of local-regional cancer include coughing, dyspnea, hemoptysis, wheezing, chest pain, and pneumonia. Figure 1 illustrates the treatment of lung cancer according to the growth stage. Figure 1: Treatment of lung cancer by stage Source: The New England Journal of Medicine (NEJM
33、), 2004 BUSINESS INSIGHTS 26 Treatment for lung cancer depends on a number of different factors, such as the stage at which the cancer is discovered, its form, and the age and general medical state of the patient. Typical treatments can involve some combination of surgery, chemotherapy, and radiatio
34、n therapy. When discovered early enough, surgery with adjuvant chemotherapy represents the best prognosis. The surgical procedures performed are lobectomy (removal of one lobe), bilobectomy (both lobes), and pneumectomy (removal of whole lung). Sometimes radical radiotherapy with curative intent is
35、used instead of surgery to treat local disease. Moreover, the use of continuous hyperfractionated accelerated radiation therapy (CHART) has been shown to improve survival (at one and two years) by 9% compared to conventional radical radiotherapy. For SCLC, etoposide or ifosfamide is typically added
36、to a platinum analog to comprise the standard chemotherapy treatment regimen. Radiotherapy represents another treatment option for patients and is given in conjunction with chemotherapy to patients who are not eligible for surgery. The standard first-line chemotherapy in NSCLC in the US is carboplat
37、in/paclitaxel, but in Europe oncologists favor cisplatin/Gemzar. The addition of Avastin to both of these regimens demonstrated an efficacy advantage when it was approved for first-line NSCLC in October 2006 in the US and August 2007 in the EU. Epidemiology NSCLC NSCLC is the most common type of lun
38、g cancer, accounting for approximately 80% of all lung cancers. Table 1details NSCLCs epidemiology. 27 Table 1: Estimated prevalence of NSCLC across the seven major markets, 2009 Country Prevalence (000s)Prevalence (%)Share (%) France 33.380.056.70 Germany 35.960.047.22 Italy 33.740.066.77 Spain 18.
39、500.043.71 UK 22.950.044.60 EU5 144.520.0529.00 US 248.770.0849.91 Japan 105.090.0821.09 Total 498.390.07100.00 Source: IARC 2008, Business Insights analysis BUSINESS INSIGHTS SCLC SCLC generally has a more rapid growth and earlier development of widespread metastases accounting for about 20% of new
40、 lung cancer cases diagnosed per year. Because of its propensity to grow rapidly, SCLC is highly sensitive to initial chemotherapy and radiotherapy. Approximately 124,480 individuals were estimated to be suffering from SCLC across the seven major markets in 2009. Table 2 details SCLC epidemiology. 2
41、8 Table 2: Estimated prevalence of SCLC across the seven major markets, 2009 Country Prevalence (000s)Prevalence (%)Share (%) France 8.350.016.70 Germany 8.990.017.22 Italy 8.430.016.78 Spain 4.620.013.71 UK 5.740.014.61 EU5 36.130.0129.03 US 62.080.0249.87 Japan 26.270.0221.11 Total 124.480.02100.0
42、0 Source: IARC 2008; Business Insights analysis BUSINESS INSIGHTS Forecast epidemiology NSCLC In 2009, there were approximately 500,000 individuals affected with NSCLC, which is projected to grow modestly to around 513,000 by 2015. The primary risk factor for NSCLC is smoking, which is responsible f
43、or more than 85% of all lung cancer-related deaths. 29 Table 3: Forecast epidemiology of NSCLC across the seven major markets, 2009-15 Country 20092010201120122013 2014 2015 France Prevalence (000s) 33.3833.4833.5833.6733.77 33.87 33.97 Prevalence (%) 0.050.050.050.050.05 0.05 0.05 Germany Prevalenc
44、e (000s) 35.9635.9735.9735.9735.98 36.08 36.19 Prevalence (%) 0.040.040.040.040.04 0.04 0.04 Italy Prevalence (000s) 33.7433.7633.7833.8133.83 33.93 34.03 Prevalence (%) 0.060.060.060.060.06 0.06 0.06 Spain Prevalence (000s) 18.5018.5218.5518.5818.61 18.66 18.71 Prevalence (%) 0.040.040.040.040.04 0
45、.04 0.04 UK Prevalence (000s) 22.9523.0123.0823.1423.21 23.27 23.34 Prevalence (%) 0.040.040.040.040.04 0.04 0.04 EU5 Prevalence (000s) 144.52144.74144.96145.17145.39 145.82 146.24 Prevalence (%) 0.050.050.050.050.05 0.05 0.05 US Prevalence (000s) 248.77251.30253.86256.44259.05 259.80 260.56 Prevale
46、nce (%) 0.080.080.080.080.08 0.08 0.08 Japan Prevalence (000s) 105.09105.14105.19105.25105.30 105.61 105.92 Prevalence (%) 0.080.080.080.080.08 0.08 0.08 Total Total Prevalence (000s) 498.39501.18504.01506.86509.74 511.23 512.72 Total Prevalence (%) 0.070.070.070.070.07 0.07 0.07 Source: IARC/ Globo
47、can 2008; Business Insights analysis BUSINESS INSIGHTS SCLC According to Business Insights estimates, the 2009 prevalence population of approximately 124,400 in the seven major markets is projected to grow modestly through to 2015. Despite high initial responses to chemotherapy and radiotherapy, mos
48、t SCLC patients die from recurrent disease. 30 Table 4: Forecast epidemiology of SCLC across the seven major markets, 2009-15 Country 2009 20102011201220132014 2015 France Prevalence (000s) 8.35 8.378.398.428.448.47 8.49 Prevalence (%) 0.01 0.010.010.010.010.01 0.01 Germany Prevalence (000s) 8.99 8.
49、998.998.998.999.02 9.05 Prevalence (%) 0.01 0.010.010.010.010.01 0.01 Italy Prevalence (000s) 8.43 8.448.458.458.468.48 8.51 Prevalence (%) 0.01 0.010.010.010.010.01 0.01 Spain Prevalence (000s) 4.62 4.634.644.644.654.67 4.68 Prevalence (%) 0.01 0.010.010.010.010.01 0.01 UK Prevalence (000s) 5.74 5.755.775.795.805.82 5.84 Prevalence (%) 0.01 0.010.010.010.010.01 0.01 EU5 Prevalence (000s) 36.13 36.1836.2436.2936.3536.45 36.56 Prevalence (%) 0.01 0.010.010.010.010.01 0.01 US Prevalence (000s) 62.08 62.6663.2463.8264.4164.60 64.79 Prevalence (%) 0.02 0.020.020.020.020.
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