NON–SMALL-CELL LUNG CANCER: Shifting from Generic Chemotherapy Regimens to Complex Treatment Landscapes

GLOBAL MARKET FOR NSCLC TREATMENT POISED FOR GROWTH

Lung cancer continues to be the leading cause of cancer-related death worldwide. The American Cancer Society’s Facts and Figures 2015 indicated that lung cancer accounts for more deaths than any other cancer in both men and women, with 158,040 deaths in 2015. There are 2 main forms of the disease, non–small-cell lung cancer (NSCLC) and small-cell lung cancer. Approximately 85% to 90% of lung cancers are diagnosed as NSCLC, which is further classified into 3 main histologies: adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

NSCLC is most commonly associated with people who smoke, with at least 80% of deaths attributed to smoking. While smoking is the single biggest cause of lung cancer, other risk factors include exposure to radon gas, occupational or environmental exposure to secondhand smoke, asbestos, certain metals, air pollution, radiation therapy to the lungs, and family history of lung cancer. Lung cancer diagnosis at an early stage is usually asymptomatic. The majority of patients with NSCLC have locally advanced or metastatic disease at the time of diagnosis. Symptoms may include persistent cough, sputum streaked with blood, chest pain, voice change, worsening shortness of breath, and recurrent pneumonia or bronchitis.

Treatment options for NSCLC vary depending on the patient’s performance status, extent of disease, and histological subtype. Current treatment options include surgery, radiofrequency ablation, radiation therapy, chemotherapy, targeted therapy according to specific oncogenic drivers, and immunotherapy. Various organizations including the American Society of Clinical Oncology and National Comprehensive Cancer Network have published guidelines that outline treatment options and drug sequencing.

NSCLC MARKET LANDSCAPE

Over the last decade, efforts have been made regarding the understanding of cancer biology and molecular genetics of NSCLC. These advances have led to new FDA drug approvals and a growing pipeline of drugs in phase II and phase III clinical trials.

Managing and treating cancer comes with a hefty price tag. One of the fastest growing components of US health care costs is cancer care, the cost of which is estimated to increase from $125 billion in 2010 to $158 billion in 2020.6 One study reported that the cost of lung cancer is significant, with an estimated cost of $9 billion per year. NSCLC imposes a significant burden on patients, payers, formulary managers, and society due to increasing incidence, severity, poor survival rates, and rising costs. Therefore, it is becoming increasingly important to deliver high-quality, cost-effective care for NSCLC.

A report from GBI Research published in September 2015 found that the NSCLC market is undergoing a gradual change from a focus on generic chemotherapy regimens to complex treatment landscape based on different NSCLC subtypes and the presence of various molecular aberrations. The global market value for NSCLC treatment will rise from $6.9 billion in 2014 to $10.9 billion by 2021, representing a compound annual growth rate of 8.5%. This increase will occur across 8 major markets including the United States, driven primarily by the introduction of novel immune-checkpoint inhibitors.

“The majority of new drugs will target the second-line treatment of NSCLC in both squamous and non-squamous patient subsets, leading to a crowded treatment algorithm for these patient populations,” said Joshua Libberton, senior analyst, GBI Research. “Ultimately, due to their strong clinical performances, immunotherapies will have a greater uptake than other second-line market entrants.”—Eileen Koutnik-Fotopoulos