Breast Cancer - Changing Treatment Paradigms for Local and Locally Advanced Breast Cancer
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- About Datamonitor Healthcare - page 2
- About the Oncology pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- CHAPTER 2 EPIDEMIOLOGY - page 10
- US - page 12
- Japan - page 13
- France - page 14
- Germany - page 15
- Italy - page 16
- Spain - page 17
- UK - page 18
- CHAPTER 3 TUMOR CHARACTERISTICS - page 19
- Introduction - page 19
- Hormone-receptor status - page 19
- Almost all patients are checked for ER status... - page 21
- ... except in Italy - page 22
- Fewer patients are tested for PgR status - page 23
- HER2 status - page 25
- IHC and FISH - page 29
- Hormone-receptor status - page 19
- Introduction - page 19
- CHAPTER 4 NEOADJUVANT THERAPY IN LOCAL AND LOCALLY ADVANCED BREAST CANCER - page 31
- Introduction - page 31
- Randomized clinical trials of neoadjuvant therapy - page 31
- Neoadjuvant therapy - no survival advantage but decrease in mastectomy rates - page 31
- Sequential docetaxel adds a new dimension - page 33
- The Aberdeen trial - page 33
- NSABP B-27 - page 34
- The GEPAR-DUO study - page 34
- The Consensus Conference on Neoadjuvant Chemotherapy in Carcinoma of the Breast - page 35
- The use of neoadjuvant therapy in local and locally advanced breast cancer in the seven major markets - page 35
- Limited use of neoadjuvant therapy in local stage - page 36
- More common in locally advanced stage - page 36
- Minimal difference between stages in Japan - page 37
- Also low usage in Germany - page 37
- High in Spain - page 37
- Significant increase in neoadjuvant chemotherapy in recent years - page 37
- Neoadjuvant chemotherapy regimens - page 38
- Localized breast cancer - page 38
- Doxorubicin-based regimens is prominent in the US, Italy and Spain... - page 40
- Relatively low use of anthracyclines in Italy - page 42
- Taxane usage in the neoadjuvant setting - page 43
- Paclitaxel is more commonly used in the US and Japan - page 44
- Docetaxel-based regimens are more common in Europe - page 45
- Locally advanced breast cancer - page 46
- Drug regimens remain similar across the stages - page 47
- Localized breast cancer - page 38
- CHAPTER 5 ADJUVANT THERAPY IN LOCAL AND LOCALLY ADVANCED BREAST CANCER - page 51
- Introduction - page 51
- Clinical trials for adjuvant chemotherapy - page 51
- The advent of the taxanes - page 51
- Clinical trials for adjuvant chemotherapy - page 51
- The use of adjuvant therapy in local and locally advanced breast cancer in the seven major markets - page 53
- Fewer patients treated with adjuvant therapy in Japan - page 54
- Adjuvant chemotherapy regimens - page 54
- Localized breast cancer - page 54
- Adjuvant regimens remain similar to neoadjuvant regimens - page 55
- Doxorubicin-based regimens are also commonly used in Italy and Spain - page 56
- Epirubicin-based regimens are preferred in the other markets - page 57
- High taxane usage in the US and Spain - page 58
- Minimal usage in the UK - page 59
- Locally advanced breast cancer - page 60
- Anthracycline usage remains broadly similar between stages - page 61
- Increase in taxane usage in locally advanced stage - page 63
- Docetaxel to become the gold standard in France - page 64
- Localized breast cancer - page 54
- Fluorouracil-based regimens - page 65
- Varying usage of fluorouracil - page 65
- Taxanes over fluorouracil in the US - page 66
- 5-FU versus capecitabine - page 67
- Limited market penetration of capecitabine - page 68
- Varying usage of fluorouracil - page 65
- Taxanes' administration schedules - page 70
- Three-weekly regimens still predominantly used - page 71
- High usage of weekly taxane regimen in Japan - page 72
- Dose-dense regimen usage in the US and Spain is also high - page 72
- Introduction - page 51
- CHAPTER 6 HORMONAL THERAPY - page 73
- Introduction - page 73
- Hormone-receptor status - page 73
- Fewer HR-positive patients treated with antihormonals in Japan - page 74
- Some hormone-negative patients treated with antihormonals - page 74
- Menopausal status - page 75
- Premenopausal breast cancer patients - page 76
- Ovarian ablation - page 76
- LHRH agonists are mainly used as ovarian suppression - page 78
- Half of patients do not undergo ovarian ablation - page 79
- Ovarian ablation - page 76
- Postmenopausal breast cancer patients - page 81
- Tamoxifen still dominates... - page 82
- ...but anastrozole will become the gold standard - page 84
- Barriers to the uptake of anastrozole - page 86
- Other aromatase inhibitors only play a minor role - page 87
- Femara (letrozole) - page 87
- Aromasin (exemestane) - page 91
- Switch from tamoxifen - page 94
- Japanese physicians more readily switch to anastrozole - page 95
- Subsequent letrozole therapy common in the US and France - page 96
- Exemestane remains underused - page 96
- The majority of patients do not switch - page 96
- "Renaissance" of the antihormonals market - page 96
- CHAPTER 7 PIPELINE DRUGS - page 98
- Introduction - page 98
- Physician awareness of pipeline drugs - page 99
- Abraxane (albumin-bound paclitaxel) - page 99
- Physician awareness of Abraxane - page 100
- Physician rating of Abraxane - page 102
- RPR109881 (taxane) - page 104
- Physician awareness of RPR109881 - page 104
- Physician rating of RPR109881 - page 106
- Ixabepilone (epothilone B) - page 107
- Physician awareness of ixabepilone - page 108
- Physician rating of ixabepilone - page 109
- Evista (raloxifene) - page 111
- Physician awareness of Evista - page 111
- Physician rating of Evista - page 113
- Atamestane - page 114
- Physician awareness of atamestane - page 114
- Physician rating of atamestane - page 116
- Lapatinib (GW572016) - page 118
- Physician awareness of lapatinib - page 118
- Physician rating of lapatinib - page 119
- IGN-101 - page 121
- Physician awareness of IGN-101 - page 121
- Physician rating of IGN-101 - page 123
- Other drugs - page 124
- Physician awareness of other pipeline drugs - page 125
- Physician rating of other pipeline drugs - page 128
- Comparative ratings of key pipeline drugs - page 130
- Neoadjuvant setting - page 130
- Adjuvant setting - page 132
- Metastatic setting - page 134
- Abraxane (albumin-bound paclitaxel) - page 99
- CHAPTER 8 APPENDIX - page 136
- Supplementary data - page 136
- Questionnaire - page 144
- Respondent breakdown - page 159
- Opinion leader interview transcript - page 160
- Definition of breast cancer - page 169
- Types of breast cancer - page 169
- Ductal carcinoma in situ (DCIS) - page 169
- Lobular carcinoma in situ (LCIS) - page 169
- Paget's disease - page 170
- Male breast cancer - page 170
- Progression of breast cancer - page 170
- Genetics of breast cancer - page 170
- Diagnosis - page 171
- Major prognostic factors - page 172
- Hormone receptor status - page 172
- Lymph node involvement - page 172
- Histologic grade - page 172
- HER-2/neu status - page 172
- S-phase status - page 173
- Standard treatment options - page 173
- Stage I - page 173
- Stage II - page 173
- Stage III - page 174
- Stage IV - page 175
- Overview of current drug therapy options - page 176
- Chemotherapy - page 176
- Hormonal therapy - page 177
- Treatment of advanced disease - page 178
- Types of breast cancer - page 169
- References - page 180
- About Datamonitor - page 197
- About Datamonitor Healthcare - page 197
- About the Oncology analysis team - page 198
- Disclaimer - page 199
- List of Tables
- Table 1: TNM staging in breast cancer: stage groupings - page 11
- Table 2: Percentage of local and locally advanced breast cancer patients undergoing tests for hormone receptor status in the seven major markets - page 21
- Table 3: Percentage of 'reasons' for not testing ER status in local and locally advanced breast cancer patients in Italy - page 22
- Table 4: Percentage of local and locally advanced breast cancer patients undergoing tests for HER2 status - page 25
- Table 5: Percentage of 'reasons' for not using HER2 test in local and locally advanced breast cancer patients in the seven major markets - page 27
- Table 6: Percentage of local and locally advanced breast cancer patients undergoing IHC and FISH tests in the seven major markets - page 29
- Table 7: Summary of randomized clinical trials for neoadjuvant therapy in breast cancer which failed to show survival advantage - page 32
- Table 8: Summary results of sequential docetaxel as neoadjuvant therapy in locally advanced breast cancer - page 34
- Table 9: Percentage of local and locally advanced breast cancer patients undergoing neoadjuvant therapy in the seven major markets - page 35
- Table 10: Percentage use of top three neoadjuvant chemotherapy regimens in local stage in the seven major markets - page 38
- Table 11: Percentage use of doxorubicin- and epirubicin-based neoadjuvant regimens in local breast cancer in the seven major markets - page 40
- Table 12: Percentage use of paclitaxel- and docetaxel-based neoadjuvant regimens in local breast cancer in the seven major markets - page 43
- Table 13: Percentage use of top three neoadjuvant drug regimens in locally advanced stage in the seven major markets - page 46
- Table 14: Percentage use of doxorubicin- and epirubicin-based neoadjuvant regimens in locally advanced breast cancer in the seven major markets - page 48
- Table 15: Percentage use of paclitaxel- and docetaxel-based neoadjuvant regimens in locally advanced breast cancer in the seven major markets - page 49
- Table 16: Percentage of local and locally advanced breast cancer patients undergoing adjuvant therapy in the seven major markets - page 53
- Table 17: Percentage use of top three adjuvant chemotherapy regimens in local stage in the seven major markets - page 54
- Table 18: Percentage use of doxorubicin- and epirubicin-based adjuvant regimens in localized breast cancer in the seven major markets - page 56
- Table 19: Percentage use of paclitaxel- and docetaxel-based adjuvant regimens in localized breast cancer in the seven major markets - page 58
- Table 20: Percentage use of top three adjuvant drug regimens in locally advanced stage in the seven major markets - page 60
- Table 21: Percentage use of doxorubicin- and epirubicin-based adjuvant regimens in locally advanced breast cancer in the seven major markets - page 62
- Table 22: Percentage use of paclitaxel- and docetaxel-based adjuvant regimens in locally advanced breast cancer in the seven major markets - page 63
- Table 23: Percentage use of fluorouracil-based adjuvant regimens in localized and locally advanced breast cancer - page 65
- Table 24: Percentage of localized and locally advanced patients treated with fluorouracil-based adjuvant regimens receiving 5-FU and Xeloda - page 68
- Table 25: Percentage of adjuvant patients treated with weekly, bi-weekly or three-weekly taxane regimens in the seven major markets - page 70
- Table 26: Percentage of local and locally advanced breast cancer patients receiving antihormonal therapy depending on HR status - page 73
- Table 27: Percentage of local and locally advanced premenopausal patients undergoing ovarian ablation - page 77
- Table 28: Percentage of local and locally advanced postmenopausal patients treated with antihormonal drugs in the seven major markets - page 81
- Table 29: Percentage of patients undergoing tamoxifen treatment for less than two years, between two and five years, and more than five years, in the seven major markets - page 82
- Table 30: Percentage of patients undergoing anastrozole treatment for less than two years, between two and five years, and more than five years, in the seven major markets - page 85
- Table 31: Percentage of patients undergoing letrozole treatment for less than two years, between two and five years, and more than five years, in the seven major markets - page 89
- Table 32: Percentage of patients undergoing exemestane treatment for less than two years, between two and five years, and more than five years, in the seven major markets - page 92
- Table 33: Percentage of patients switching from tamoxifen to aromatase inhibitors in the seven major markets - page 94
- Table 34: Late-phase pipeline drug summary - page 98
- Table 35: Percentage of physicians aware of Abraxane - page 100
- Table 36: Physician rating of Abraxane - page 102
- Table 37: Percentage of physicians aware of RPR109881 - page 104
- Table 38: Physician rating of RPR109881 - page 106
- Table 39: Percentage of physicians aware of ixabepilone - page 108
- Table 40: Physician rating of ixabepilone - page 109
- Table 41: Percentage of physicians aware of Evista - page 111
- Table 42: Physician rating of Evista - page 113
- Table 43: Percentage of physicians aware of atamestane - page 115
- Table 44: Physician rating of atamestane - page 116
- Table 45: Percentage of physicians aware of lapatinib - page 118
- Table 46: Physician rating of lapatinib - page 120
- Table 47: Physician awareness of IGN-101 - page 122
- Table 48: Physician rating of IGN-101 - page 123
- Table 49: Percentage of responses for other pipeline drugs - page 125
- Table 50: Physician rating of other pipeline drugs - page 128
- Table 51: Comparative ratings of key pipeline drugs in the neoadjuvant setting - page 130
- Table 52: Comparative ratings of key pipeline drugs in the adjuvant setting - page 132
- Table 53: Comparative ratings of key pipeline drugs in the metastatic setting - page 134
- Table 54: Percentage of localized patients receiving drug regimens in the neoadjuvant setting - page 136
- Table 55: Percentage of locally advanced patients receiving drug regimens in the neoadjuvant setting - page 138
- Table 56: Percentage of localized patients receiving drug regimens in the adjuvant setting - page 140
- Table 57: Percentage of locally advanced patients receiving drug regimens in the adjuvant setting - page 142
- Table 58: Respondent breakdown - page 159
- Table 59: Adjuvant therapy guidelines for breast cancer - page 176
- Table 60: Dosing schedules for adjuvant and first-line breast cancer chemotherapy regimens - page 177
- Table 61: Dosing schedules for breast cancer antihormonal therapies - page 178
- Table 62: Second-line treatment dosing schedules for breast cancer - page 179
- Table 63: Dosing schedules for Herceptin regimens - page 179
- List of Figures
- Figure 1: Number of local and locally advanced breast cancer patients diagnosed, tested and treated in the US - page 12
- Figure 2: Number of local and locally advanced breast cancer patients diagnosed, tested and treated in Japan - page 13
- Figure 3: Number of local and locally advanced breast cancer patients diagnosed, tested and treated in France - page 14
- Figure 4: Number of local and locally advanced breast cancer patients diagnosed, tested and treated in Germany - page 15
- Figure 5: Number of local and locally advanced breast cancer patients diagnosed, tested and treated in Italy - page 16
- Figure 6: Number of local and locally advanced breast cancer patients diagnosed, tested and treated in Spain - page 17
- Figure 7: Number of local and locally advanced breast cancer patients diagnosed, tested and treated in the UK - page 18
- Figure 8: Clinical outcomes according to hormone-receptor status - page 20
- Figure 9: Percentage of local and locally advanced breast cancer patients undergoing tests for hormone receptor status in the seven major markets - page 21
- Figure 10: Percentage of 'reasons' for not testing ER status in local and locally advanced breast cancer patients in Italy - page 23
- Figure 11: Percentage of 'reasons' for not testing PgR status in local and locally advanced breast cancer patients in the UK - page 24
- Figure 12: Percentage of local and locally advanced breast cancer patients undergoing tests for HER2 status - page 26
- Figure 13: Percentage of 'reasons' for not using HER2 test in local and locally advanced breast cancer patients - page 28
- Figure 14: Percentage of local and locally advanced breast cancer patients undergoing IHC and FISH tests in the seven major markets - page 30
- Figure 15: Percentage of local and locally advanced breast cancer patients undergoing neoadjuvant therapy in the seven major markets - page 36
- Figure 16: Percentage use of top three neoadjuvant chemotherapy regimens in local stage in the seven major markets - page 39
- Figure 17: Percentage use of doxorubicin- and epirubicin-based neoadjuvant regimens in local breast cancer in the seven major markets - page 40
- Figure 18: Percentage use of paclitaxel- and docetaxel-based neoadjuvant regimens in local breast cancer in the seven major markets - page 43
- Figure 19: Percentage use of top three neoadjuvant drug regimens in locally advanced stage in the seven major markets - page 47
- Figure 20: Percentage use of doxorubicin- and epirubicin-based neoadjuvant regimens in locally advanced breast cancer in the seven major markets - page 48
- Figure 21: Percentage use of paclitaxel- and docetaxel-based neoadjuvant regimens in locally advanced breast cancer in the seven major markets - page 50
- Figure 22: Percentage of local and locally advanced breast cancer patients undergoing adjuvant therapy in the seven major markets - page 53
- Figure 23: Percentage use of top three adjuvant chemotherapy regimens in local stage in the seven major markets - page 55
- Figure 24: Percentage use of doxorubicin- and epirubicin-based adjuvant regimens in localized breast cancer in the seven major markets - page 56
- Figure 25: Percentage use of paclitaxel- and docetaxel-based adjuvant regimens in localized breast cancer in the seven major markets - page 58
- Figure 26: Percentage use of top three adjuvant drug regimens in locally advanced stage in the seven major markets - page 61
- Figure 27: Percentage use of doxorubicin- and epirubicin-based adjuvant regimens in locally advanced breast cancer in the seven major markets - page 62
- Figure 28: Percentage use of paclitaxel- and docetaxel-based adjuvant regimens in locally advanced breast cancer in the seven major markets - page 64
- Figure 29: Percentage use of fluorouracil-based adjuvant regimens in localized and locally advanced breast cancer - page 66
- Figure 30: Percentage of localized and locally advanced patients treated with fluorouracil-based adjuvant regimens receiving 5-FU and Xeloda - page 69
- Figure 31: Percentage of adjuvant patients treated with weekly, two-weekly or three-weekly taxane regimens in the seven major markets - page 71
- Figure 32: Percentage of local and locally advanced breast cancer patients receiving antihormonal therapy depending on HR status - page 74
- Figure 33: Summary of treatment strategy for pre- and postmenopausal breast cancer patients - page 76
- Figure 34: Percentage of local and locally advanced premenopausal patients undergoing ovarian ablation - page 78
- Figure 35: Percentage of local and locally advanced postmenopausal patients treated with antihormonal drugs in the seven major markets - page 81
- Figure 36: Percentage of patients undergoing tamoxifen treatment for less than two years, between two and five years, and more than five years, in the seven major markets - page 83
- Figure 37: Percentage of patients undergoing anastrozole treatment for less than two years, between two and five years, and more than five years, in the seven major markets - page 86
- Figure 38: Percentage of patients undergoing letrozole treatment for less than two years, between two and five years, and more than five years, in the seven major markets - page 90
- Figure 39: Percentage of patients undergoing exemestane treatment for less than two years, between two and five years, and more than five years, in the seven major markets - page 93
- Figure 40: Percentage of patients switching from tamoxifen to aromatase inhibitors in the seven major markets - page 95
- Figure 41: Percentage of physicians aware of Abraxane - page 100
- Figure 42: Physician rating of Abraxane - page 103
- Figure 43: Percentage of physicians aware of RPR109881 - page 105
- Figure 44: Physician rating of RPR109881 - page 107
- Figure 45: Percentage of physicians aware of ixabepilone - page 108
- Figure 46: Physician rating of ixabepilone - page 110
- Figure 47: Percentage of physicians aware of Evista - page 112
- Figure 48: Physician rating of Evista - page 114
- Figure 49: Percentage of physicians aware of atamestane - page 115
- Figure 50: Physician rating of atamestane - page 117
- Figure 51: Percentage of physicians aware of lapatinib - page 119
- Figure 52: Physician rating of lapatinib - page 120
- Figure 53: Physician awareness of IGN-101 - page 122
- Figure 54: Physician rating of IGN-101 - page 124
- Figure 55: Percentage of responses for other pipeline drugs - page 126
- Figure 56: Physician rating of other pipeline drugs - page 129
- Figure 57: Comparative ratings of key pipeline drugs in the neoadjuvant setting - page 131
- Figure 58: Comparative ratings of key pipeline drugs in the adjuvant setting - page 133
- Figure 59: Comparative ratings of key pipeline drugs in the metastatic setting - page 135
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