Stakeholder Insight: Breast Cancer (Hormone Receptor-Negative) - Triple-negative breast cancer offers a significant opportunity to new market entrants while Herceptin dominates the HER-2-positive market

Introduction
While some triple-negative breast cancer (TNBC) patients now have an additional treatment option in the form of Avastin, unmet need remains high. Similarly, despite the availability of Herceptin and Tykerb there is also considerable pipeline activity in HER-2-positive breast cancer. At the same time, there is uncertainty over the optimal way of using Herceptin and Tykerb in this patient subset.

Features and benefits
Analysis of the hormone receptor-negative breast cancer market based on a survey of 180 specialists, supported by opinion leader interviews
Epidemiological forecasts of breast cancer incidence and prevalence for the period 2010–19 in the seven major pharmaceutical markets
Segmentation of incident cases by age group, menopausal status, stage of disease and subtype
In-depth analysis of treatment patterns and regimens prescribed for TNBC and HER-2-positive breast cancer by line of therapy and disease stage
Highlights
Herceptin (trastuzumab; Roche/Chugai) has established a formidable position in the HER-2-positive breast cancer market. At relapse, retreatment with an alternative Herceptin-based regimen is favored over switching to Tykerb (lapatinib; GlaxoSmithKline), reflecting the lack of clinical data showing that switching to Tykerb is beneficial.

Avastin (bevacizumab; Roche/Chugai) has captured considerable market share in first-line metastatic TNBC in the US; loss of this indication would therefore have a large impact on sales. Avastin is also vulnerable to competition from new market entrants (e.g. Sanofi Aventis’s iniparib), even if it retains its breast cancer indication.

The popularity of Xeloda (capecitabine; Roche/Chugai) shows that side-effect profile is an important driver of prescribing behavior in metastatic TNBC beyond the first-line of therapy. It is therefore critical that new market entrants in this setting are well tolerated if they are to achieve extensive uptake.

Your key questions answered
Validate new product forecasting based on epidemiology, patient segmentation and treatment rates, and the likely rate of uptake for new products
Understand prescribing trends and identify key factors that influence treatment choices in defined breast cancer populations
Enhance commercial positioning by increasing understanding of current dynamics within the breast cancer market
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TABLE OF CONTENTS
Overview 1
Catalyst 1
Summary 1
About Datamonitor Healthcare 3
About the Oncology pharmaceutical analysis team 3
Executive Summary 5
Scope of the analysis 5
Datamonitor insight into the hormone receptor-negative breast cancer market 5
Contributing experts 7
Related reports 7
Upcoming related reports 7
1. Introduction and Scope 10
Coverage of the Stakeholder Insight Survey 10
2. Epidemiology 11
Introduction and background 11
Key points 11
Disease definition and diagnosis criteria 12
Global variation and historical trends 12
Risk factors 15
Epidemiologic forecasting of breast cancer 17
Description of methods 21
Epidemiologic Forecast Results 23
Discussion 30
Conclusions 32
3. Disease overview 33
Introduction 33
Patient segmentation 35
4. Treatment options 39
Introduction 39
5. Treatment Trends: Stage I–III 45
Triple-negative breast cancer 45
HER-2-positive breast cancer 59
6. Treatment Trends: Stage IV and Relapse 80
Triple-negative breast cancer 80
HER-2-positive breast cancer 113
7. Future Treatment 144
Late-phase pipeline products overview 144
Future treatment scenarios 196
BIBLIOGRAPHY 201
Chapter 2. Epidemiology 201
Chapter 3. Disease Overview 207
Chapter 4. Treatment Options 209
Chapter 5. Treatment Trends: Stage I–III Breast Cancer 211
Chapter 6. Treatment Trends: Stage IV and Relapsed Breast Cancer 212
Chapter 7. Future Treatment 214
APPENDIX A 219
Abbreviations 219
Physician research methodology 219
Physician sample breakdown 220
Contributing experts 221
APPENDIX B 222
The survey questionnaire 222
Datamonitor consulting 276
Disclaimer 277



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