Stakeholder Insight: Supportive Care in Cancer Treatment

Introduction

Supportive care is used to prevent or treat the adverse effects that arise as a result of cancer treatment, particularly chemotherapy. While newer molecular targeted therapies do not exist without some toxicity, this is not as severe as that associated with traditional cytotoxics. A rising incidence of cancer worldwide will mean that supportive care market will increase both size and relevance.

Scope

• Treatment trends in the use of supportive care pharmacotherapy, including its association with major tumor types and therapy regimens
• Analysis of brand preference within four supportive care pharmacotherapy drug classes based on a survey of 180 physicians across the seven markets
• Physician awareness and use of various supportive care guidelines, including those from the NCCN, ASCO and EORTC
• Ranking of the greatest areas of unmet need within the supportive care market and the likelihood of key future scenarios occurring

Highlights

Approximately 7080% of all cancer patients who receive cytotoxics suffer nausea and/or vomiting, which has led to widespread acceptance of anti-emetic strategies as an integral component of chemotherapy treatment. In particular, the ubiquitous use of serotonin antagonists is evidenced by the number of products in this drug class.

Incidence of cytopenias is dependent on the use of chemotherapy and the nature of the disease, with hematological malignancies requiring greater supportive care measures. The biologic nature of growth factors used in treatment has translated into high therapy costs, which has somewhat restricted their use in the EU and surprisingly, in the US.

A major focus of current clinical research is the viability of bisphosphonates in the adjuvant setting, to prevent bone metastases prior to their formation. If trial results prove encouraging, a major commercial opportunity exists for those drug developers willing to become involved, particularly if one of the 'big four' tumor types is targeted.

Reasons to Purchase

• Identify key factors that influence prescribing patterns for supportive care pharmacotherapy
• Examine the significant unmet needs in the supportive care market and identify opportunities for new product development
• Enhance commercial positioning by increasing understanding of current dynamics within the supportive care market

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