Myelodysplastic Syndrome - An underserved population offers commercial opportunity
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the Oncology pharmaceutical analysis team - page 2
- Richard Faint, Director of Oncology - page 2
- About the Oncology pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 5
- Introduction - page 5
- Scope and coverage of the brief - page 5
- Key findings - page 6
- MDS epidemiology is poorly monitored - page 6
- Curative therapy is elusive and supportive care remains the mainstay of treatment for the majority of patients - page 6
- The adverse effect profile of Pharmion's Vidaza is a key barrier to its widespread use - page 6
- SuperGen/MGI Pharma's Dacogen fails to improve upon Vidaza's efficacy and is associated with a more cumbersome administration schedule - page 7
- Sales between Vidaza and Dacogen will narrow following the latters' launch but Vidaza is still predicted to maintain a market lead - page 7
- Celgene's Revlimid can expect rapid uptake, both on- and off-label, following its predicted US launch in 2006 - page 7
- Further opportunities exist for developers wanting to join this niche market - page 7
- CHAPTER 2 DISEASE OVERVIEW - page 9
- MDS is a clonal hematopoietic stem cell disorder - page 9
- MDS diagnosis, classification and staging: unresolved controversies remain - page 9
- The French-American-British (FAB) system involves five subgroups - page 10
- The World Health Organization (WHO) system incorprates new diagnostic information to stratify MDS patients - page 11
- The International Prognostic Scoring System (IPSS) provides the most accurate prognostic assessment - page 13
- MDS epidemiology: a poorly monitored disease on the rise - page 15
- Range of risk factors linked to MDS - page 18
- MDS prognosis is particularly poor for Int-2/high-risk patients - page 19
- CHAPTER 3 CURRENT TREATMENT CONTROVERSIES - page 21
- Bone marrow transplantation: potentially curative MDS treatment only available to small patient subgroup - page 21
- MDS treatment goals highlight major unmet needs - page 22
- The three treatment approaches to MDS - page 22
- Supportive care therapies address MDS symptoms only - page 22
- Low-intensity therapies may improve hematological status - page 23
- High-intensity therapies are associated with increased morbidity and mortality - page 24
- Supportive care alone is the standard treatment for the majority of MDS patients - page 24
- Review of supportive care treatments used by surveyed physicians - page 25
- Blood transfusions prove problematic - page 25
- Cytokines improve hematological status - page 26
- Management of anemia with erythropoietin-stimulating factors is key - page 26
- Amgen's Aranesp (darbepoietin alfa) may improve patient compliance with more convenient administration schedule - page 27
- EPO and G-CSF combination therapy improves response rate but is economically-challenging - page 28
- Management of neutropenia and thrombocytopenia is a major unmet need - page 28
- Review of supportive care treatments used by surveyed physicians - page 25
- Pharmion's Vidaza (azacitadine): the first FDA approved MDS therapeutic - page 29
- Vidaza demonstrates response rate of 16% across all FAB subtypes in Phase III study - page 30
- Phase III study shows Vidaza improves time to AML progression or death for intermediate and high-risk patients - page 31
- Vidaza's early activity in MDS emerges from Phase II data - page 31
- Vidaza's adverse-effect profile limits treatment to high-risk patients - page 33
- Confusion regarding Vidaza's duration of treatment exists - page 34
- Vidaza's administration schedule unappealling to patients and physicians - page 35
- Despite Vidaza's launch significant market opportunites still exist in Int-2/high-risk patient population - page 37
- Vidaza demonstrates response rate of 16% across all FAB subtypes in Phase III study - page 30
- Toxicity of Celgene/Pharmion's Thalomid (thalidomide) limits it's utility in refractory low or Int-1MDS treatment - page 38
- Efficacy demonstration limited to low or Int-1 MDS - page 38
- Thalomid may have a role in growth-factor refractory patients who seek an orally administered alternative to Vidaza - page 39
- Cephalon's Trisonex (arsenic trioxide) may confer improved hematological improvement over Thalomid in refractory high-risk MDS - page 39
- Trisenox yields transfusion independence in low- and high-risk MDS, but few complete or partial remissions - page 40
- Grade III and IV adverse effects necessitate close patient monitoring - page 40
- CHAPTER 4 THE TWO NEWCOMERS: SUPERGEN/MGI PHARMA'S DACOGEN AND CELEGENE'S REVLIMID - page 42
- FDA approval of SuperGen/MGI Pharma's Dacogen (decitabine) deferred pending analysis of transfusion data - page 42
- Dacogen is a pro-drug that incorporates into DNA to inhibit DNA methyltransferase - page 42
- Dacogen misses Phase III trial endpoint of time to AML progression, while demonstrating similar response rate to Vidaza - page 43
- Dacogen demonstrates promising Phase II results, especially in high-grade MDS - page 45
- What does Dacogen offer over Vidaza? - page 46
- Dacogen has similar efficacy and safety profile to Vidaza - page 46
- Dacogen fails to improve on inconvenience of Vidaza's administration schedule - page 46
- Physicians believe Dacogen may be preferred to Vidaza in Int-2 and high-risk MDS patients - page 48
- Celgene's Revlimid (lenalidomide) NDA under review for 5q- MDS - page 49
- Revimid is a novel immunomodulatory analogue of thalidomide - page 50
- Revlimid demonstrates impressive transfusion-independence Phase II data but toxicity concerns exist - page 50
- Upto 80% of patients in the MDS-003 trial required the doses of Revlimid to be held or reduced - page 50
- Physicians view Revlimid's toxicity as manageable - page 51
- With convenient oral delivery, Revlimid uptake will be quick in low-risk/Int-1 groups - page 52
- Lack of treatment options for advanced MDS may lead to off-label Revlimid use for Int-2/high-risk patients - page 52
- The market impact of Revlimid and Dacogen upon Vidaza sales - page 53
- Vidaza to remain US market leader for Int-2/high-risk MDS following Dacogen's launch, though EU market more evenly matched - page 53
- Revlimid to achieve significant on- and off-label market penetration in low-risk/Int-1 MDS - page 53
- FDA approval of SuperGen/MGI Pharma's Dacogen (decitabine) deferred pending analysis of transfusion data - page 42
- CHAPTER 5 MDS PIPELINE FOCUSED ON HEMATOLOGICAL IMPROVEMENT RATHER THAN AML PROGRESSION - page 58
- Review of MDS pipeline drugs in Phase III development - page 60
- Vion Pharmaceutical's Cloretazine (VNP-40101M) requires more explicit demonstration of MDS activity - page 60
- Phase III clinical trials focus on AML - page 60
- No breakdown of response in MDS sub-group provided in Phase II study - page 60
- Johnson & Johnson's Zarnestra (tipifarnib) holds promise with further MDS development eagerly anticipated - page 61
- Zarnestra demonstrates impressive MDS Phase II results, though whether J&J will enter Phase III MDS trials remains unclear - page 62
- Pfizer's Atgam (Antithymocyte Globulin (ATG) has potent immunosuppressive activity - page 63
- Phase III study open to recruitment - page 63
- Phase II results demonstrate statistically significant clinical benefit compared with historic cohorts - page 63
- Schering Plough's Sarasar (lonafarnib) to challenge Johnson and Johnson's Zarnestra - page 64
- Clinical trials: main focus of Sarasar development is MDS, where greatest antitumor activity is shown - page 64
- Sarasar and Zarnestra race to commercialization - page 65
- Vion Pharmaceutical's Cloretazine (VNP-40101M) requires more explicit demonstration of MDS activity - page 60
- Opportunities exist for developers wanting to join this niche market - page 65
- Review of MDS pipeline drugs in Phase III development - page 60
- APPENDIX - page 66
- Bibliography - page 66
- Disclaimer - page 73
- List of Tables
- Table 1: French-American-British (FAB) MDS classification system - page 10
- Table 2: WHO classification and criteria for MDS - page 12
- Table 3: International Prognostic Scoring System: derivation of patient score - page 14
- Table 4: MDS patient subtype breakdown by IPSS score - page 14
- Table 5: Population forecast of under and over 65 year olds in the seven major markets, 2005-2010 - page 16
- Table 6: MDS incidence forecast in the seven major markets, 2005-2010 - page 17
- Table 7: Median survival, interval & risk to AML by IPSS category - page 20
- Table 8: NCCN MDS supportive care recommended drugs - page 23
- Table 9: NCCN MDS low-intensity guidelines - page 24
- Table 10: Current treatment of MDS by severity - page 25
- Table 11: EPO clinical studies of erythroid response - page 27
- Table 12: Response rates in Vidaza-treated patients in Phase II and III studies - page 33
- Table 13: Dacogen's Phase III (0007) response rates - page 44
- Table 14: Dacogen's Phase III results of median time to AML or death (days) - page 45
- Table 15: Dacogen's Phase II trial response rates (CR +PR) - page 45
- Table 16: Revlimid Phase II response rate data - page 51
- Table 17: MDS market forecast ($m), 2005-10 - page 54
- Table 18: MDS Prevalence Forecast, 2005-2010 - page 55
- Table 19: Product market penetration forecast 2005-2010 (EU and US) - page 56
- Table 20: Product price, US and EU ($) - page 57
- Table 21: MDS pipeline, September 2005 - page 58
- List of Figures
- Figure 1: MDS incidence forecast in the seven major markets, 2005-2010 - page 17
- Figure 2: Median survival & interval to AML by IPSS category - page 19
- Figure 3: National Comprehensive Cancer Network MDS Treatment Guidelines - page 21
- Figure 4: Barriers to use of Vidaza in low/Int-1 risk MDS (1 = low barrier, 6 = high barrier) - page 36
- Figure 5: Barriers to use of Vidaza in Int-2/high risk MDS (1=low barrier 6=high barrier) - page 37
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