胃癌(gastric cancer)是全球癌症相关死亡的第3大常见病因,也是发病率排名第4的最常见恶性肿瘤。尽管罗氏赫赛汀(Herceptin)已获批用于HER2阳性胃癌的一线治疗,并为生物标志物(biomarker)驱动的个性化治疗铺平了道路,然而,礼来2014年4月获批的血管生成抑制剂Cyramza(ramucirumab)将满足临床治疗中对更加有效的二线疗法的巨大医疗需求。目前,胃癌后期研发管线依旧相当活跃,在预测期内,广泛药物类别中多种新颖疗法的预期上市,将使不可切除性或转移性胃癌的临床治疗方案进一步多元化。
根据全球领先的制药与医疗保健顾问公司Decision Resources日前发布的一份新报告,未来10年(2013-2023),不可切除性局部晚期和转移性胃癌临床治疗领域,5种靶向性治疗药物的上市,将帮助推动美国、日本、欧洲5大主要市场(法国、德国、意大利、西班牙、英国)胃癌市场高速发展,从2013年的11亿美元,增长至2023年的38亿美元,其中,日本的胃癌发病率最高,使该国成为最具商业吸引力和有利可图的市场。
礼来的血管生成抑制剂Cyramza(ramucirumab)于2014年4月获FDA批准,是FDA批准用于转移性胃癌二线治疗的首个靶向疗法,该药将部分满足晚期胃癌二线治疗中的巨大医疗需求。然而,胃癌市场中,更有效、更安全及耐受性更好的药物,仍存在相当多的市场机会。
——生物标志物助推个性化治疗:处于早期和晚期临床阶段的许多药物,均针对携带特定生物标志物的亚组患者群体,尤其是HER2和c-Met。罗氏HER2靶向性药物Perjeta和Kadcyla、安进处于III期临床的c-Met抑制剂rilotumumab的出现,将助推胃癌治疗超更加个性化的方向前进。
——罗氏将统治HER2阳性胃癌市场:Kadcyla和Perjeta将争夺HER2阳性胃癌市场份额,该市场将由罗氏的HER2专营权统治。
——HER2阴性胃癌存巨大医疗需求:接受采访的专家强调,胃癌临床治疗中,迫切需要能够延长患者生命的更有效的治疗方案,尤其是HER2阴性患者群体,该群体不适合罗氏赫赛汀(Herceptin)的治疗。
——Cyramza和Kadcyla竞争二线治疗:接受采访的专家预计,礼来Cyramza将迅速成为胃癌二线治疗的首选药物。然而,Decision Resources则认为,罗氏Kadcyla将成为胃癌二线治疗的重大突破,该药将成为经罗氏赫赛汀(Herceptin)治疗后病情复发的HER2阳性胃癌患者群体的标准治疗药物。
——c-Met临床前景存疑:罗氏单抗药物MetMab的失败,使业界对于c-Met抑制剂是否能在胃癌领域获得成功产生了相当大的疑问。然而,接受采访的专家指出,在这些临床试验中,c-Met的积极性(positivity)需要被更好的界定,这类药物也许能够使比原先预期更小的患者群体受益。
——胃癌治疗将多元化:未来几年内,随着更多药物的上市,胃癌临床治疗将多元化,尽管这些药物多数为化疗辅助药物。总体而言,在未来,胃癌临床治疗将逐渐摆脱当前单纯化疗为主的治疗方案,将朝更加个性化的治疗方法迈进。
英文原文:The Gastric Cancer Market is Expected to More Than Triple Over the Next Ten Years, Capturing Nearly $3.8 million by 2023
Several Emerging Therapies Will Expand Treatment Armamentarium for Unresectable Locally Advanced or metastatic Gastric Cancer, According to Findings from Decision Resources Group
September 18, 2014 - Burlington, Mass. – Decision Resources Group finds that the gastric cancer market will grow exponentially from over $1.1 billion in 2013 to nearly $3.8 billion by 2023. Fuelling this growth will be the launch of five targeted therapies for unresectable locally advanced and metastatic gastric cancer. Eli Lilly’s Cyramza, which was approved by the U.S. Food and Drug Administration in 2014, is the first targeted therapy to enter the second-line metastatic setting and thereby partially fulfills an unmet need. Nevertheless, considerable market opportunity remains for more effective, safe and tolerable therapies.
——Other key findings from the Pharmacor report entitled Gastric Cancer:
Use of predictive biomarkers: A number of drugs in early- and late-phase clinical development are targeting patient subpopulations that carry a specific biomarker – notably HER2 and c-Met. The emergence of Roche/Genentech/Chugai’s HER2-targeted agents, Perjeta and Kadcyla, and Amgen’s c-Met inhibitor rilotumumab will propel gastric cancer treatment toward more-personalized therapy.
——New market entrants for HER2-positive gastric cancer: Kadcyla and Perjeta will compete for a share of this small patient segment, making it a dynamic space dominated by the Roche HER2 franchise.
——Unmet needs: Interviewed experts stress that an urgent need remains for more-effective treatment options that can extend survival, especially for patients who are HER2-negative and thus not eligible for Herceptin.
——Second-line dynamics of Cyramza and Kadcyla: Interviewed experts expect that Cyramza will quickly become the treatment of choice in the second-line metastatic setting. However, Decision Resources Group expects that the launch of Kadcyla in this setting will be a major breakthrough in treatment, and that it will emerge as the second-line standard of care for HER2-positive gastric cancer patients who are refractory to Roche/Genentech/Chugai’s Herceptin.
Comments from Decision Resources Group Analyst Sehrish Rafique, M.Sc., Ph.D.:
——“The failure of Roche/Genentech’s MetMab has cast considerable doubt over whether or not c-Met inhibitors will be successful in gastric cancer. However, interviewed experts point out that c-Met positivity needs to be better defined in these trials and that perhaps these drugs benefit a smaller population of patients than originally anticipated.”
——“The gastric cancer treatment algorithm is going to diversify over the coming years with more options becoming available for patients with unresectable or metastatic disease. Whilst many of these agents are adjuncts to chemotherapy, overall we will see a move away from chemotherapy alone being the mainstay treatment for gastric cancer to a more individualized approach.”