Supportive Care in Cancer Treatment - Some first-generation products proving difficult to dislodge
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the Oncology pharmaceutical analysis team - page 2
- Nish Saini - Lead Analyst, Oncology - page 2
- About the Oncology pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the supportive market - page 4
- CHAPTER 2 INTRODUCTION - page 15
- Introduction - page 15
- Coverage of the Stakeholder Insight Survey - page 15
- Definition & treatment characteristics - page 15
- Supportive care guidelines - page 15
- Brand preference - page 15
- Unmet needs - page 16
- Future scenarios - page 16
- Coverage of the Stakeholder Insight Survey - page 15
- Introduction - page 15
- CHAPTER 3 COUNTRY TREATMENT TREES - page 17
- Introduction - page 17
- Country treatment trees - page 18
- US - page 18
- Japan - page 21
- France - page 24
- Germany - page 27
- Italy - page 30
- Spain - page 33
- UK - page 36
- CHAPTER 4 DEFINITION AND EPIDEMIOLOGY - page 39
- Definition of supportive care - page 39
- Classes of supportive care products - page 39
- Anti-emetics - page 39
- 5-HT3 receptor antagonists - page 40
- NK-receptor antagonists - page 41
- Corticosteroids - page 42
- Erythropoietin products - page 42
- Colony-stimulating factors for neutropenia - page 43
- Colony-stimulating factors for thrombocytopenia - page 44
- Bisphosphonates - page 45
- Anti-emetics - page 39
- Epidemiology of key tumor types - page 47
- CHAPTER 5 TREATMENT CHARACTERISTICS - page 56
- Introduction - page 56
- Association of supportive care with specific tumor types - page 56
- Solid tumors - page 56
- Supportive care use is highest for nausea and vomiting, due to a greater incidence - page 57
- Country differences may arise due to varying treatment guidelines and gold-standard therapies for specific tumor types and pharmacoeconomic challenges - page 59
- Supportive care use in the 'big four' solid tumors - page 62
- Use of anti-emetics is highest in breast cancer, due to reliance of treatment upon high emetic risk cytotoxics - page 63
- Reliance on platinum agents means incidence of cytopenias is highest among NSCLC patients - page 64
- The high rate of bone metastasis in prostate cancer correlates to greater use of pharmacotherapy for tumor-related skeletal events - page 64
- Hematological malignancies - page 64
- As with solid tumors, use of supportive care for hematological malignancies is dependent on incidence of toxicity - page 66
- Nature of malignancy translates into increased need for supportive care to treat cytopenias - page 66
- Country differences may arise due to varying treatment guidelines and gold-standard therapies for specific tumor types, as well as pharmacoeconomic issues - page 67
- Supportive care use in the main hematological malignancies - page 67
- Dose-intensive treatment of acute leukemia increases incidence of chemotherapy-induced nausea and vomiting - page 69
- The compromised immune system in lymphoma means use of supportive care to treat cytopenias is higher in this indication - page 69
- Proximity of primary tumor to the bone explains the high rate of skeletal events in myeloma patients - page 70
- Solid tumors - page 56
- Association of supportive care with specific drug regimens - page 71
- Regimen-induced nausea and vomiting - page 71
- Platinum-based compounds are associated with the highest risk of emesis - page 73
- A deceptively high ranking for paclitaxel and docetaxel, both low emetic risk cytotoxics - page 74
- The reduced emetogenicity associated with novel targeted therapies is reflected by a significantly lower need for supportive care pharmacotherapy - page 74
- Regimen-induced anemia - page 75
- Platinum-based compounds are widely recognized to cause anemia across a range of tumor types - page 76
- Other cytotoxics are only considered anemia inducing in certain tumor types - page 77
- Changing treatment modalities for anemia may cause confusion over extent of toxicity of cytotoxics - page 77
- Regimen-induced neutropenia - page 78
- The anthracyclines and taxanes are widely associated with chemotherapy-induced neutropenia - page 79
- Severity of neutropenia is directly correlated to aggressiveness of chemotherapy regimen - page 79
- Novelty of the targeted therapies means optimum growth factor support measures may not yet be fully developed - page 80
- Japanese physicians consistently assign the highest likelihoods to anticancer drugs for requiring supportive care pharmacotherapy - page 81
- Cancer-related skeletal events - page 81
- Myeloma patients require the highest use of bisphosphonates for cancer-related skeletal events - page 83
- Use of bisphosphonates is mainly for the treatment of bone metastases secondary to malignancy - page 83
- Use of bisphosphonates for prevention/delay of bone metastases is lower because of the difficulty in identifying an optimal patient cohort - page 84
- To date no bisphosphonate has received regulatory approval for use in the adjuvant setting - page 84
- In the future, gene expression profiling may help identify patients most likely to benefit from prophylactic bisphosphonate treatment - page 85
- If bone metastases are treated adequately, then supportive care for hypercalcemia is negated - page 86
- Regimen-induced nausea and vomiting - page 71
- CHAPTER 6 SUPPORTIVE CARE GUIDELINES - page 87
- Introduction - page 87
- Supportive care treatment guidelines - page 87
- Guidelines for prevention and/or treatment of chemotherapy-induced nausea and vomiting - page 88
- Comparison of NCCN, ASCO and ESMO guidelines - page 88
- NCCN guidelines - page 88
- ASCO guidelines - page 89
- ESMO guidelines - page 90
- Guidelines for treatment of chemotherapy-induced anemia - page 91
- Comparison of NCCN, ASCO/ASH and EORTC guidelines - page 91
- NCCN guidelines - page 91
- ASCO/ASH guidelines - page 92
- EORTC guidelines - page 93
- Guidelines for treatment of chemotherapy-induced neutropenia - page 94
- NCCN guidelines - page 94
- ASCO guidelines - page 95
- ESMO guidelines - page 96
- Guidelines for the use of bisphosphonates in cancer - page 97
- ASCO guidelines for breast cancer - page 97
- ASCO guidelines for myeloma - page 98
- Guidelines for prevention and/or treatment of chemotherapy-induced nausea and vomiting - page 88
- Supportive care guidelines in practice - page 100
- Physician awareness of guidelines - page 100
- European and Japanese physicians have a surprisingly high awareness of NCCN and ASCO guidelines - page 101
- US physicians have a low awareness of guidelines outside those set by the NCCN and ASCO - page 102
- Use of supportive care guidelines - page 103
- NCCN guidelines appear to be the standard for use in the US - page 104
- ASCO guidelines enjoy a relatively high rate of use in the EU and Japan - page 105
- EORTC guidelines are used most by European physicians, while Japanese physicians favor those set by local hospitals/institutions - page 105
- Physician awareness of guidelines - page 100
- CHAPTER 7 BRAND PREFERENCE - page 107
- Introduction - page 107
- Anti-emetic products - page 107
- Prophylaxis of acute nausea and vomiting - page 107
- The general trend for prophylaxis of acute emesis is use of a two-drug regimen of 5-HT3 receptor antagonist and corticosteroid - page 108
- Use of an NK-receptor antagonist is unexpectedly high in Japan - page 108
- Small percentage use of NK-receptor antagonist plus a corticosteroid in France and Italy - page 109
- Prophylaxis of delayed nausea and vomiting - page 110
- Use of a 5-HT3 receptor antagonist and corticosteroid combination is high, despite a lack of recommendation in treatment guidelines - page 111
- Use of three-drug regimen is highest in the US, highlighting a lack of familiarity with treatment guidelines - page 111
- Use of an NK-receptor antagonist and corticosteroid combination is relatively frequent in most of the EU countries - page 112
- Treatment of acute nausea and vomiting - page 112
- Treatment requires administration of an additional agent in a different drug class, hence the increased use of NK-receptor antagonists - page 113
- Use of a two-drug combination of NK-receptor antagonist and corticosteroid is relatively higher in the EU countries and Japan in this indication - page 114
- Preferred brand of 5-HT3 receptor antagonist - page 114
- First-to-market Zofran is the preferred brand of 5-HT3 receptor antagonist - page 115
- High potency and longer-lasting protection conferred by Aloxi is reflected by strong physician preference in the US, Japan and Italy - page 116
- Use of Aloxi and Anzemet in Japan is surprising - page 117
- Anzemet and Navoban are used infrequently - page 117
- Key prescribing influences - page 118
- Efficacy and safety are the top two key prescribing influences - page 119
- Availability on the formulary is key in allowing access to drugs - page 120
- Most 5-HT3 receptor antagonists are available in oral and intravenous formulations, therefore administration issues are unlikely to be problematic - page 120
- Payment issues and patient preference are not key in influencing prescription of 5-HT3 receptor antagonists - page 120
- Brand mapping - page 121
- Efficacy appears to be the most important attribute - page 123
- Even clustering of brands around key attributes indicates little perceived difference - page 123
- Kytril and Zofran are market leaders of the 5-HT3 receptor antagonists - page 123
- Anzamet and Navoban are perceived as being of least utility - page 124
- Given the novelty of Aloxi, physicians have yet to fully utilize the drug - page 124
- Little space exists in the 5-HT3 receptor antagonist market for new products - page 124
- Prophylaxis of acute nausea and vomiting - page 107
- Erythropoiesis-stimulating agents - page 125
- Preferred brand of erythropoiesis-stimulating agent - page 125
- Procrit is the leading erythropoiesis-stimulating agent across the seven major pharmaceutical markets - page 126
- Use of Epogen is off-label and restricted to the US - page 126
- Pharmacoeconomic constraints mean use of Aranesp is greatest in the US - page 126
- Use of Recormon restricted to the EU and Japan - page 127
- US launch of Roche's second-generation Mircera remains uncertain - page 128
- Key prescribing influences - page 129
- Efficacy and safety are the top two key prescribing influences - page 130
- Availability on the formulary and factors related to administration convenience are key influences - page 130
- Payment issues and patient preference are not key in influencing prescription of erythropoiesis-stimulating agents - page 131
- Brand mapping - page 132
- Preferred brand of erythropoiesis-stimulating agent - page 125
- Colony-stimulating factors - page 132
- Preferred brand of colony-stimulating factor - page 132
- Neupogen appears to be the colony-stimulating factor of choice across the seven major pharmaceutical markets - page 133
- Increased emphasis on cost-containment translates to greater use of Neupogen than Neulasta in the EU and Japan - page 133
- Use of Granocyte/Neutrogin restricted to the EU and Japan - page 134
- Key prescribing influences - page 134
- Efficacy and safety are the top two key prescribing influences - page 135
- Convenience of dosing and administration are surprisingly high, given physician preference for Neupogen - page 136
- Influence of formulary availability, payment issues and patient preference follow the pattern seen with erythropoiesis-stimulating agents - page 136
- Brand mapping - page 137
- As expected, efficacy is the most significant attribute on the brand map - page 138
- Little perceived differentiation exists between the various growth factors - page 139
- The preferred brands of growth factors appear to be market leaders - page 139
- Aranesp and Neulasta are characterized by a convenient dosing schedule - page 139
- The brand map must be interpreted with caution - page 139
- Preferred brand of colony-stimulating factor - page 132
- Bisphosphonates - page 140
- Preferred brand of bisphosphonate for prevention/delay of cancer-related skeletal events - page 140
- Preference for bisphosphonate to prevent/delay cancer-related skeletal events is fragmented across the seven major markets - page 141
- Use of third-generation Zometa is highest in the US, where cost is not as significant an issue - page 142
- High use of unapproved Bondronat in Japan - page 143
- Oral Bondronat favored for prevention of cancer-related skeletal events in France, Italy and the UK - page 143
- Unexpectedly high use of Fosamax in Spain - page 143
- Use of Didronel is limited to Italy only - page 144
- Preferred brand of bisphosphonate for treatment of bone metastases secondary to malignancy - page 144
- Zometa is the preferred bisphosphonate for treatment of bone metastases across the seven major markets... - page 145
- ...and the clear favorite for treatment of bone metastases in the US, France, Germany and Spain - page 146
- Oral Bondronat is used most frequently in Japan and France - page 147
- Highest use of Fosamax in Italy and the UK - page 147
- Preferred brand of bisphosphonate for treatment of hypercalcemia of malignancy - page 148
- Resistance is not an issue with bisphosphonates, therefore Zometa is the preferred agent once again - page 149
- As before, Zometa is used most in the US, France and Spain, while Fosamax is used most in Italy and the UK - page 150
- Key prescribing influences - page 150
- Keeping to the trend, efficacy and safety are the top two prescribing influences for bisphosphonates - page 152
- Convenient dosing schedule and route of administration is of greater priority in bisphosphonates than other supportive care products - page 152
- Availability on the formulary is of slightly less significance in the prescription of bisphosphonates than other supportive care classes - page 153
- Payment issues and patient preference are not key in influencing prescription of bisphosphonates - page 153
- Brand mapping - page 154
- Percevied effficacy and toxicity are the most important attributes - page 155
- Aredia is most closely associated with perceived efficacy and reduced toxicity - page 156
- Zometa is associated with the greatest number of attributes - page 156
- Actonel is the major outlier bisphosphonate - page 156
- Space exists in the market for greater potency bisphosphonates - page 156
- An opportunity for Amgen's denosumab? - page 157
- Preferred brand of bisphosphonate for prevention/delay of cancer-related skeletal events - page 140
- CHAPTER 8 UNMET NEEDS - page 158
- Introduction - page 158
- Greatest areas of unmet need - page 158
- Levels of unmet need for the prophylaxis and/or treatment of cancer-related side effects are more or less equivalent - page 159
- Opportunity still exists for effective therapies to prevent delayed chemotherapy-induced nausea and vomiting - page 159
- A lack of approved agents for thrombocytopenia evidenced by highest physician rating of unmet need - page 160
- Prevention of cancer-related skeletal events is most difficult to achieve, therefore level of unmet need is relatively high in this indication - page 161
- Issues of cost and pricing are common across all areas of supportive care - page 162
- Areas of improvement per unmet need - page 162
- Prophylaxis and treatment of chemotherapy-induced nausea and vomiting - page 162
- Not all patients respond to anti-emetic therapy, therefore improved efficacy is the single most desirable improvement in the prophylaxis and treatment of chemotherapy-induced nausea and vomiting - page 164
- A more convenient administration schedule is desired most for prophylaxis of delayed chemotherapy-induced nausea and vomiting - page 164
- Increased cost effectiveness is desired in those regimens where Emend is typically used - page 165
- Monitoring requirements are of the least concern in the administration of anti-emetics - page 165
- Prophylaxis and treatment of cancer and cancer treatment-related cytopenias - page 165
- Improvements to unmet needs for prophylaxis and/or treatment of cytopenias is relatively fragmented - page 167
- Improved efficacy is key in pharmacotherapy for anemia and thrombocytopenia - page 167
- Cost effectiveness is key in pharmacotherapy for neutropenia and anemia - page 167
- More convenient dosing of greater priority than route of administration - page 168
- Monitoring requirements are not of great significance - page 168
- Prevention and treatment of cancer-related skeletal events - page 169
- Improved efficacy is key, although in prevention of skeletal events physicians have assigned a surprisingly low rating - page 170
- More convenient administration schedule was ranked surprisingly high - page 171
- Cost effectiveness and monitoring requirements were ranked relatively low - page 171
- Prophylaxis and treatment of chemotherapy-induced nausea and vomiting - page 162
- CHAPTER 9 FUTURE SCENARIOS - page 173
- Introduction - page 173
- Likelihood of future scenarios - page 173
- On average, each future scenario has around a 50% chance of occuring - page 174
- The increased use of targeted therapies will introduce new supportive care challenges - page 175
- The greater use of bisphosphonates by 2010 in the adjuvant setting to prevent skeletal events may result in increased survival - page 177
- Use of biosimilar products may become a reality sooner rather than later - page 177
- Use of erythropoiesis-stimulating products and colony-stimulating factors might not necessarily be greater in the future - page 179
- Use of keratinocyte growth factors may lose out to relatively cheaper products for the prevention and/or treatment of oral mucositis - page 180
- Enhancing the future uptake of current pipeline products - page 182
- Likelihood of future scenarios - page 173
- Introduction - page 173
- APPENDIX A - page 184
- Physician research methodology - page 184
- Physician sample breakdown - page 184
- US - page 184
- Japan - page 185
- France - page 185
- Germany - page 186
- Italy - page 186
- Spain - page 187
- UK - page 187
- Brand map interpretation - page 188
- Contributing experts - page 193
- Key opinion leader transcripts - page 193
- APPENDIX B - page 194
- The survey questionnaire - page 194
- 1. DISEASE AND TREATMENT CHARACTERISTICS - page 194
- 2. SUPPORTIVE CARE GUIDELINES - page 200
- 3. BRAND PREFERENCE - page 202
- 4. UNMET NEEDS - page 211
- 5. FUTURE SCENARIOS - page 214
- The survey questionnaire - page 194
- APPENDIX C - page 216
- Bibliography - page 216
- List of tables - page 223
- List of figures - page 227
- About Datamonitor - page 231
- About Datamonitor Healthcare - page 231
- About the Oncology analysis team - page 232
- Disclaimer - page 233
- List of Tables
- Table 1: Key commercially available 5-HT3 receptor antagonists, 2006 - page 40
- Table 2: Key commercially available bisphosphonates, 2006 - page 46
- Table 3: Relative potencies of bisphosphonates - page 46
- Table 4: Crude incidence rates by gender per 100,000 across the seven major pharmaceutical markets (solid tumors) - page 48
- Table 5: Crude incidence rates by gender per 100,000 across the seven major pharmaceutical markets (hematological malignancies) - page 49
- Table 6: Frequency of leukemia subtypes - page 50
- Table 7: Estimated incidence of cancer across the seven major pharmaceutical markets, 2000-14 - page 50
- Table 8: Estimated incidence of breast cancer across the seven major pharmaceutical markets, 2000-14 - page 51
- Table 9: Estimated incidence of prostate cancer across the seven major pharmaceutical markets, 2000-14 - page 51
- Table 10: Estimated incidence of colorectal cancer across the seven major pharmaceutical markets, 2000-14 - page 52
- Table 11: Estimated incidence of NSCLC across the seven major pharmaceutical markets, 2000-14 - page 52
- Table 12: Estimated incidence of acute leukemia across the seven major pharmaceutical markets, 2000-14 - page 53
- Table 13: Estimated incidence of chronic leukemia across the seven major pharmaceutical markets, 2000-14 - page 53
- Table 14: Estimated incidence of lymphoma across the seven major pharmaceutical markets, 2000-14 - page 54
- Table 15: Estimated incidence of myeloma across the seven major pharmaceutical markets, 2000-14 - page 54
- Table 16: Percentage of solid tumor patients receiving supportive care - page 56
- Table 17: Percentage of patients per tumor type who develop bone metastases - page 58
- Table 18: Percentage of patients per tumor type who develop hypercalcemia - page 59
- Table 19: Percentage of the 'big four' solid tumor types receiving supportive care - page 62
- Table 20: Percentage of hematological malignancy patients receiving supportive care - page 65
- Table 21: Percentage of the main hematological malignancies receiving supportive care - page 68
- Table 22: Likelihood of initiating pharmacotherapy for therapy-induced nausea and vomiting - page 71
- Table 23: Emetic risk of commonly used anticancer agents - page 73
- Table 24: Likelihood of initiating growth factor support for therapy-induced anemia - page 75
- Table 25: Likelihood of initiating growth factor support for the prevention and/or treatment of therapy-induced neutropenia - page 78
- Table 26: Cytotoxic score to reflect expected severity of neutropenia - page 80
- Table 27: Percentage of patients receiving bisphosphonates for cancer-related skeletal events - page 82
- Table 28: Comparison of guidelines for prevention and/or treatment of chemotherapy-induced nausea and vomiting - page 88
- Table 29: NCCN guidelines for the prevention of chemotherapy-induced nausea and vomiting - page 89
- Table 30: Guidelines for prophylaxis of acute nausea and vomiting - page 91
- Table 31: Guidelines for prophylaxis of delayed nausea and vomiting - page 91
- Table 32: Scales of anemia severity - page 92
- Table 33: Chemotherapy regimen risk of febrile neutropenia - page 95
- Table 34: Bisphosphonates in the treatment of breast cancer-related skeletal events - page 98
- Table 35: Bisphosphonates in the treatment of myeloma-related skeletal events - page 99
- Table 36: Percentage of physicians aware of guidelines for supportive care in cancer - page 100
- Table 37: Percentage use of guidelines for supportive care in cancer - page 103
- Table 38: Preferred anti-emetic regimen for the prophylaxis of patients at a high or intermediate risk of acute nausea and vomiting (%) - page 107
- Table 39: Preferred anti-emetic regimen for the prophylaxis of patients at a high or intermediate risk of delayed nausea and vomiting (%) - page 110
- Table 40: Preferred anti-emetic regimen for the treatment of patients at a high or intermediate risk of acute nausea and vomiting (%) - page 112
- Table 41: Preferred brand of 5-HT3 receptor antagonist (%) - page 114
- Table 42: Key prescribing influences affecting physician choice of 5-HT3 receptor antagonist - page 118
- Table 43: Scores for each brand with attribute weighting* applied - page 121
- Table 44: Preferred brand of erythropoiesis-stimulating agents (%) - page 125
- Table 45: Key prescribing influences affecting physician choice of erythropoiesis-stimulating agent - page 129
- Table 46: Preferred brand of colony-stimulating factor (%) - page 132
- Table 47: Key prescribing influences affecting physician choice of colony-stimulating factor - page 134
- Table 48: Scores for each brand with attribute weighting* applied - page 137
- Table 49: Preferred brand of bisphosphonate for prevention/delay of cancer-related skeletal events (%) - page 140
- Table 50: Preferred brand of bisphosphonate for treatment of bone metastases secondary to malignancy (%) - page 144
- Table 51: Preferred brand of bisphosphonate for treatment of hypercalcemia of malignancy (%) - page 148
- Table 52: Key prescribing influences affecting physician choice of bisphosphonate - page 151
- Table 53: Scores for each brand with attribute weighting* applied - page 154
- Table 54: Areas of unmet need in the supportive care market - page 158
- Table 55: Key improvements to pharmacotherapy for the prophylaxis and treatment of acute and delayed chemotherapy-induced nausea and vomiting - page 163
- Table 56: Key improvements to pharmacotherapy for the prophylaxis and treatment of cancer and treatment-related cytopenias - page 166
- Table 57: Key improvements to pharmacotherapy for the prophylaxis and treatment of cancer-related skeletal events - page 169
- Table 58: Likelihood of key future scenarios occurring in the supportive care market - page 173
- Table 59: US physician sample breakdown, 2006 - page 184
- Table 60: Japan physician sample breakdown, 2006 - page 185
- Table 61: France physician sample breakdown, 2006 - page 185
- Table 62: Germany physician sample breakdown, 2006 - page 186
- Table 63: Italy physician sample breakdown, 2006 - page 186
- Table 64: Spain physician sample breakdown, 2006 - page 187
- Table 65: UK physician sample breakdown, 2006 - page 187
- List of Figures
- Figure 1: Potential for the use of specific supportive care measures in the US - page 18
- Figure 2: Potential use of supportive care measures in solid tumor patients in the US - page 19
- Figure 3: Potential use of supportive care measures in hematological malignancy patients in the US - page 20
- Figure 4: Potential for the use of specific supportive care measures in Japan - page 21
- Figure 5: Potential use of supportive care measures in solid tumor patients in Japan - page 22
- Figure 6: Potential use of supportive care measures in hematological malignancy patients in Japan - page 23
- Figure 7: Potential for the use of specific supportive care measures in France - page 24
- Figure 8: Potential use of supportive care measures in solid tumor patients in France - page 25
- Figure 9: Potential use of supportive care measures in hematological malignancy patients in France - page 26
- Figure 10: Potential for the use of specific supportive care measures in Germany - page 27
- Figure 11: Potential use of supportive care measures in solid tumor patients in Germany - page 28
- Figure 12: Potential use of supportive care measures in hematological malignancy patients in Germany - page 29
- Figure 13: Potential for the use of specific supportive care measures in Italy - page 30
- Figure 14: Potential use of supportive care measures in solid tumor patients in Italy - page 31
- Figure 15: Potential use of supportive care measures in hematological malignancy patients in Italy - page 32
- Figure 16: Potential for the use of specific supportive care measures in Spain - page 33
- Figure 17: Potential use of supportive care measures in solid tumor patients in Spain - page 34
- Figure 18: Potential use of supportive care measures in hematological malignancy patients in Spain - page 35
- Figure 19: Potential for the use of specific supportive care measures in the UK - page 36
- Figure 20: Potential use of supportive care measures in solid tumor patients in the UK - page 37
- Figure 21: Potential use of supportive care measures in hematological malignancy patients in the UK - page 38
- Figure 22: Estimated incidence of cancer across the seven major pharmaceutical markets, 2000-14 - page 55
- Figure 23: Percentage of solid tumor patients receiving supportive care - page 57
- Figure 24: Percentage of the 'big four' solid tumor types receiving supportive care - page 62
- Figure 25: Percentage of hematological malignancy patients receiving supportive care - page 65
- Figure 26: Percentage of the main hematological malignancies receiving supportive care - page 68
- Figure 27: Likelihood of initiating pharmacotherapy for therapy-induced nausea and vomiting - page 72
- Figure 28: Likelihood of initiating growth factor support for therapy-induced anemia - page 76
- Figure 29: Likelihood of initiating growth factor support for the prevention and/or treatment of therapy-induced neutropenia - page 79
- Figure 30: Percentage of patients receiving bisphosphonates for cancer-related skeletal events - page 82
- Figure 31: Percentage of physicians aware of guidelines for supportive care in cancer - page 101
- Figure 32: Percentage use of guidelines for supportive care in cancer - page 104
- Figure 33: Preferred anti-emetic regimen for the prophylaxis of patients at a high or intermediate risk of acute nausea and vomiting (%) - page 108
- Figure 34: Preferred anti-emetic regimen for the prophylaxis of patients at a high or intermediate risk of delayed nausea and vomiting (%) - page 110
- Figure 35: Preferred anti-emetic regimen for the treatment of patients at a high or intermediate risk of acute nausea and vomiting (%) - page 113
- Figure 36: Preferred brand of 5-HT3 receptor antagonist (%) - page 115
- Figure 37: Mean key prescribing influences affecting physician choice of 5-HT3 antagonist - page 119
- Figure 38: Brand map of the 5-HT3 receptor antagonists - page 122
- Figure 39: Preferred brand of erythropoiesis-stimulating agents (%) - page 125
- Figure 40: Key prescribing influences affecting physician choice of erythropoiesis-stimulating agents - page 129
- Figure 41: Preferred brand of colony-stimulating factor (%) - page 133
- Figure 42: Key prescribing influences affecting physician choice of colony-stimulating factor - page 135
- Figure 43: Brand map of the erythropoietin-stimulating and colony-stimulating factors - page 138
- Figure 44: Preferred brand of bisphosphonate for prevention/delay of cancer-related skeletal events (%) - page 141
- Figure 45: Preferred brand of bisphosphonate for treatment of bone metastases secondary to malignancy (%) - page 145
- Figure 46: Preferred brand of bisphosphonate for treatment of hypercalcemia of malignancy (%) - page 149
- Figure 47: Key prescribing influences affecting physician choice of bisphosphonate - page 151
- Figure 48: Brand map of the bisphosphonates for the treatment of bone metastases - page 155
- Figure 49: Areas of unmet need in the supportive care market - page 159
- Figure 50: Key improvements to pharmacotherapy for the prophylaxis and treatment of acute and delayed chemotherapy-induced nausea and vomiting - page 163
- Figure 51: Key improvements to pharmacotherapy for the prophylaxis and treatment of cancer and treatment-related cytopenias - page 166
- Figure 52: Key improvements to pharmacotherapy for the prophylaxis and treatment of cancer-related skeletal events - page 170
- Figure 53: Likelihood of key future scenarios occurring in the supportive care market - page 174
- Figure 54: Brand map raw data for the 5-HT3 receptor antagonists - page 189
- Figure 55: Brand map raw data for the erythropoietin-stimulating products and colony-stimulating factors - page 190
- Figure 56: Brand map raw data for the bisphosphonates in the treatment of bone metastases - page 191
- Figure 57: Angles in the brand map - page 192
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