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October is Breast Cancer Awareness
Month, during which charities around the world promote awareness
of breast cancer and raise vital funds for research. According
to the UK's Breast Cancer Campaign, one in nine British
women will be affected by breast cancer in their lifetime
and, although rare, it can also affect men, with approximately
210 cases diagnosed each year in the UK. Every year around
38,000 women are newly diagnosed with breast cancer and
although survival rates are improving, approximately 13,100
women die from breast cancer each year in the UK.
The survival rate with breast
cancer is relatively good compared to other cancers - although
it does vary between countries depending on factors such
as screening programmes, patient education, and quality
of services. In the UK, on average 74% of women are still
alive five years after diagnosis.
According to the World Health
Organization (WHO), the incidence
of breast cancer is
rising in most countries, with 50% of the world’s breast
cancer load being within the developing world.
Treatment
Treatment of breast cancer depends
on many factors, including the stage of disease, age, grade
of tumour, menopausal status, whether the patient is receptive
to certain hormones, and if there is any metastasis. There
are four main types of treatment for breast cancer:
- Surgery can range from
removal of the tumour and surrounding tissue, with lymph
nodes from under the arm, to a radical mastectomy where
the breast, chest muscles and all of the lymph nodes from
under the arm are removed
- Radiation therapy
uses high energy X-rays to kill the cancerous cells
- Chemotherapy is the
use of cytoxic drugs to destroy the tumour
- Hormonal therapy is
normally used as an adjuvant therapy and is given to patients
who have breast cancer cells that are oestrogen receptor-positive.
Luteinising hormone-releasing hormone (LHRH) reduces the
amount of oestrogen produced by the ovaries; progesterones
are believed to disrupt the process of cancer cell activation;
and aromatase inhibitors act by stopping the conversion
of hormones produced by the adrenal gland to oestrogen.
In addition, biological
therapy , bone marrow
transplantation, and peripheral blood stem cell transplantation
are being tested in clinical trials for the future treatment
of breast cancer. Perhaps the most significant new therapy
is Roche
and Genentech's monoclonal
antibody, Herceptin (trastuzumab), for HER2+ tumours.
Prostate cancer
Prostate cancer is one of the
most common cancers for men globally, with almost 550,000
cases worldwide in 2000 according to the International Association
of Cancer Registries (IARC). Around 75% of this load was
within developed countries, where the incidence of prostate
cancer is increasing by 10-15% every five years. Mortality,
however, has not increased as quickly and prevalence is
high, with survival rates improving over time.
Treatment of prostate cancer
depends on the stage and size of the tumour. The main treatments
are:
- Surgery, which can
involve the removal of the whole prostate gland, including
surrounding tissue, or a transurethal resection where
the cancer is cut out of the prostate via the urethra
- Radiation therapy and
chemotherapy, which work by killing or shrinking
the tumour
- Hormonal therapy, which
is generally given as palliative care to stop the tumour
from growing or in combination with radiotherapy. LHRH
analogues stop the production of the luteinising hormone
from the pituitary gland, which in turn leads to a reduction
in the levels of testosterone produced in the testes.
Cytostatic hormone therapy
forecast
Cytostatic hormone therapy is
used primarily in the treatment of breast and prostate cancer
but also, to a lesser extent, in endometriosis. The chart
below demonstrates global (aggregated sales from Canada,
France, Germany, Italy, Japan, Spain, UK and USA) sales
of cytostatic hormones between 1991 and 2000 with the evented
forecast to 2010, according to IMS HEALTH’s
Pharmacast
& Beyond
forecasting service.
Sales and forecast
for the cytostatic hormone market
1991 – 2010
Source: Pharmacast & Beyond
Pharmacast & Beyond is based
on historic trend data obtained from IMS HEALTH’s MIDAS
platform, and provides evented forecasts for over 40 therapeutic
classes in the eight major markets for a 10-year period.
The events are consolidated from over 600 interviews with
opinion leaders and medical practitioners in each country.
Main forecast influences
The main factors driving the
26% growth predicted in the cytostatic hormone (L2) market
are:
- The availability of aromatase
inhibitors, such as AstraZeneca's Arimidex (anastrozole)
and Novartis' Femara (letrozole), as first-line
therapy
- An increasing proportion of
the population being diagnosed due to breast screening
and increases in the population
- The approval of extended indications
for AstraZeneca's Casodex (bicalutamide) in the early
treatment of prostate cancer - granted in the UK in September
2001
- The patent expiries of AstraZeneca's
Nolvadex (tamoxifen) in the USA, and Zoladex
(goserelin), will lead to generic competition driving
revenue down.
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