Lung Cancer Treatment Market Outlook to 2022
The global lung cancer drugs market was valued at $3.1bn in 2016 and is forecast to grow at a healthy 31.1% CAGR between 2016 and 2022, resulting in 2022 global sales of $20.2bn driven by targeted therapies & strong market uptake of a range of Immuno-Oncology (IO) treatments.
Lung Cancer Market Size – 2016-2022 ($m)
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Lung cancer is the 2nd most common cancer in both men (after prostate) and women (after breast cancer). It is one of the most aggressive cancers and the leading cause of cancer death in the world, more than colon, breast, and prostate cancers combined. According to estimates by the American Cancer Society, approximately 223,000 new cases will be diagnosed and approximately 156,000 people will die of this disease in 2017.
After initial diagnosis, only 16.8% of all lung cancer patients are alive for 5 years or more. However, as most cases are caused by cigarette smoking, with the decrease in smoking, the incidence rate is expected to be stable or decreasing over time.
According to the NCCN, 15% of patients are diagnosed at stage I where cancer is still confined to the primary site; 22% diagnosed at stage II/IIIA where cancer has spread to regional lymph nodes or directly beyond the primary site; and 57% at Stage IIIB/IV (advanced stage) where the cancer has already metastasized. The 5 year survival for advanced stage is less than 5%.
A persistent cough is the most common symptom, making early detection of lung cancer difficult. A minority of lung cancers are diagnosed when the disease is still localized, and therefore amenable to potentially curative therapy (surgery, radiation).
The majority of lung cancer patients present with either stage III locally advanced (22%) disease or stage IV metastatic (57%).
Lung Cancer Types:
Based on physiology, lung cancer is broadly split into 2 main types: Small Cell Lung Cancer (SCLC), and Non-Small Cell Lung Cancer (NSCLC).
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Major Types of NSCLC:
Adenocarcinoma accounts for 40% of all lung cancer, and it is the most common type of lung cancer in non-smokers. The cancer starts in early versions of the cells that would normally secrete substance such as mucus. Mutations of ALKS and EFGR are more commonly seen in this subtype.
Squamous cell carcinoma accounts for 30% of total lung cancer, and it is closely related with history of smoking. It usually starts in early versions of squamous cells which are flat cells that line the inside of the airways in the lungs.
Large cell carcinoma accounts for 15% of all lung cancer, and it is typically harder to treat as it grows and spreads quickly.
Exhibit 3: Major Types of NSCLC
Current Standard of Care:
Chemo is the treatment of choice in the 1st line setting for lung cancer. Of the patients that fail chemo, it is reported that only 30% are suitable to continue subsequent treatments. 2nd and 3rd line treatment options typically include single chemo, targeted therapies such as Roche's Tarceva (Erlotinib), and Eli Lilly's Cyramza (ramucirumab) plus docetaxel.
Approximately 10-15% of first-line patients harbor EGFR mutations and are best treated by Tarceva (erlotinib), Iressa (gefitinib) or Gilotrif (afatinib) while recently approved Tagrisso (osimertinib) is used for T790M-mutant patients who have failed frontline EGFR inhibition.
Xalkori (Crizotinib) is used for ALK+ patients (3-7%) upfront, with both Zykadia (ceritinib) and Alecensa (alectinib) options for Xalkori (crizotinib) failures.
Leading commercial immunotherapies (IO) include Bristol Myers’ Yervoy, and Opdivo, Merck’s Keytruda and Roche’s Tecentriq. Bristol, Merck and Roche have only approved therapies in 2nd and 3rd line setting at this stage and are expected to dominate based on their first mover advantage.
AstraZeneca, Pfizer/Merck KGaA have products in advanced stages of trials and pivotal data read out is expected in next 1-2 years. AstraZeneca is also working on co-formulating durva+treme into a single administration which is believed to provide significant benefits on pricing flexibility in the combo vs mono indications.
Future Market Size
Optima Insights estimate that the global immunotherapy market in non-small cell lung cancer (NSCLC) could reach $20bn in 2022. Immunotherapies are currently primarily used in 2nd and 3rd line setting. Going forward, we expect increased adoption of immunotherapies in in first line treatment of lung cancer (NSCLC). Our scenario assumes both immunotherapies and immunotherapy-chemo combos will demonstrate benefits over standard chemotherapies in the first-line NSCLC setting and become new standards of care in patients regardless of PD-L1 expression and I/O immunotherapies.
Future Treatment Paradigm
Lung cancer represents the biggest opportunity in Immunotherapy. There are countless ongoing studies across a wide variety of indications facing immunotherapy. The initial wave of IO mono and combo therapies have been a step forward in the war on cancer. However there still remain significant room for improvement on both efficacy and safety. We continue to see the development of a wide variety of IO mechanisms that could broaden the activity of the current PD-1/ Lung cancer fist line treatment approach. This should improve outcomes for patient and alter the competitive landscape and size of the opportunity as we move on.
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