Stakeholder Opinions: Cancer Cachexia - Higher profile needed to unlock market potential of neglected syndrome

Introduction

Cancer cachexia is a muscle and fat wasting syndrome that affects the majority of incurable cancer patients and adversely impacts treatment outcomes, survival and quality of life. Current treatment options for cancer cachexia are limited. The lack of a universal objective definition and the low profile of the condition among oncologists have restricted advances in treatment.

Scope

• About Datamonitor Healthcare
  • About The Oncology Pharmaceutical Analysis Team
• Chapter 1 Executive Summary
  • Scope Of Analysis
  • Datamonitor Insight Into The Cancer Cachexia Market
  • Contributing Experts
  • Related Reports
  • Upcoming Reports
• Chapter 2 Cancer Cachexia Overview
• Key Findings
• Introduction To Cancer Cachexia
  • Characteristics Of Cancer Cachexia
  • Cancer Cachexia Is A Syndrome Characterized By Progressive Weight Loss
  • Defining Cancer Cachexia
  • Cancer Cachexia Lacks A Universal Definition
  • ...Although Recent Progress Has Been Made Towards A Definition
  • Progression Of Cancer Cachexia
  • Cancer Cachexia Covers A Broad Spectrum Of Severity
  • Impact Of Cancer Cachexia
  • Survival Is Lower In Cancer Patients With Cachexia
  • Patients With Cancer Cachexia Show A Poorer Response To Chemotherapy
  • Cancer Cachexia Adversely Affects Quality Of Life
  • Pathophysiology Of Cancer Cachexia
  • Cancer Cachexia Results From A Combination Of Reduced Food Intake And Altered Metabolism Driven By Host-Tumor Interactions
  • Reduced Food Intake
  • Altered Metabolism
  • Additional Factors Contributing To The Cachexia Syndrome
  • Epidemiology Of Cancer Cachexia
• Introduction
  • Forecast Cancer Incidence In The Seven Major Markets
  • Forecast Cancer Mortality In The Seven Major Markets
  • Cancer Cachexia Forecasts
  • Weight Loss Is Most Common In Patients With Gastrointestinal Tumors And Lung Cancers
  • Over 1.3 Million Incurable Cancer Patients May Be Potential Candidates For Palliative Treatment For Cachexia In The Seven Major Markets In 2009
• Chapter 3 Current Treatment Options And Controversies
• Key Findings
  • Palliative Care In Oncology
  • Cachexia Is One Of Several Symptoms Experienced By Cancer Patients That Require Palliative Care
  • A Number Of Different Types Of Clinician Are Involved In Cancer Cachexia Management
  • Current Treatment Options
  • Drugs Used To Treat Cancer Cachexia
  • There Is A Lack Of Comprehensive Guidelines For The Treatment Of Cancer Cachexia
  • Progestational Agents Are Widely Used For Cancer Cachexia Therapy
  • Megestrol Acetate Is One Of The Most Extensively Studied Agents For Cancer Cachexia Treatment
  • Progestational Agents Improve Appetite But Have Several Limitations
  • Corticosteroids Were The First Therapy Option For Cancer Cachexia
  • Short-Term Corticosteroid Use Improves End-Stage Cancer Patients' Well Being
  • Nutritional Support Often Helps To Increase Food Intake But Does Not Reverse Loss Of Lean Body Mass
  • Eicosapentaenoic Acid Has Been Extensively Investigated But Has Not Shown Evidence Of Clinical Efficacy
  • Cannabinoids Show Lower Efficacy In Cachexia Treatment Compared To Megestrol Acetate
  • Advances In Cancer Cachexia Treatment Are Likely To Require A Multimodal Approach
• Chapter 4 Unmet Needs And Challenges Facing Drug Developers
• Key Findings
  • Unmet Needs
  • In The Absence Of Effective Therapies, Most Cancer Cachexia Patients Do Not Receive Any Treatment
  • Pharmaceutical And Biotech Companies Appear Reluctant To Invest In High-Risk Cachexia Clinical Trials
  • Patient Recruitment To Cancer Cachexia Clinical Trials Is Problematic
  • Cancer Cachexia Needs A Universally Accepted Definition
  • Progress In Cancer Cachexia Is Hindered By The Low Profile Of The Condition
  • The Visibility Of Cancer Cachexia Is Low In The Medical Oncology Community
  • The Syndrome Needs A Higher Profile In The Oncology Community In Order To Move Treatment Forward And Establish A Market
  • Improvement Is Needed In Approaches To Palliative Care For Cancer Patients
  • Earlier Integration Of Palliative Care Into Management Of Cancer Patients And Better Coordination Between Oncologists And Nutritionists Is Needed
  • Low Rate Of Hospice Admissions And Tendency To Administer Chemotherapy Late In The Course Of Cancer Patients' Lives Has Hindered Palliative Care
• Chapter 5 Drug Development
• Key Findings
• Overview Of The Cancer Cachexia Clinical Pipeline
  • Pipeline Drugs
  • Angiotensin Ii-Targeting Agents
  • Vitor (Imidapril Hydrochloride; Ark Therapeutics)
  • Hormone-Based Therapies/Hormone Mimetics
  • Ghrelin, A Circulating Appetite-Stimulating Hormone, Shows Potential In Cancer Cachexia Therapy
  • Anamorelin (Rc-1291; Sapphire Therapeutics/Ono)
  • Growth Hormone Releasing Peptide-2 Is Also Able To Directly Affect Appetite And Is In Development For Cancer Cachexia
  • Ostarine (Mk-2866; Gtx/Merck & Co)
  • Anti-Inflammatory Drugs
  • Thalomid (Thalidomide; Celgene)
  • Avr118 (Advanced Viral Research Corp)
  • Vt-122 (Vicus Therapeutics)
  • Drugs Targeting Neurotransmitter Receptors
  • Mirtazapine
  • Olanzapine
  • Cancer Cachexia Clinical Trial Design
  • Patient Selection
  • Variations In Entry Criteria Across Clinical Trials Reflect The Lack Of Consensus Over A Definition Of The Syndrome
  • The Choice Of Tumor Type Is Critical To Cancer Cachexia Clinical Trial Design
  • Endpoints
  • Change In Body Weight Does Not Give Robust Evidence Of Anti-Cachexia Activity
  • Lean Body Mass Is A More Suitable Surrogate Of Anti-Cachexia Activity Than Body Weight And Is Currently The Most Appropriate Primary Endpoint
  • Survival Is Rarely Used As An Endpoint In Cachexia Trials
  • Quality Of Life (Qol) Is An Important Endpoint In Cancer Cachexia Clinical Trials
  • Measuring Physical Function Potentially Provides Objective And Quantitative Evidence Of Qol Improvement
  • Cancer Cachexia Awaits A Validated Biomarker
  • Pharmacoeconomic Endpoints Could Be Considered In Clinical Trial Design
• Bibliography
  • Bibliography
  • Datamonitor Reports
• Appendix
• List Of Tables
• List Of Figures
  • About Datamonitor Healthcare
  • About The Oncology Analysis Team
  • Disclaimer
• List Of Tables
  • Table 1: Crude Incidence Rates Per 100,000 Persons For All Types Of Cancer (Excluding Non-Melanoma Skin Cancer) In The Seven Major Markets, 2002
  • Table 2: Forecast Total Incidence Of All Types Of Cancer (Excluding Non-Melanoma Skin Cancer ) In The Seven Major Markets, 2009-2018
  • Table 3: Crude Mortality Rates For All Types Of Cancer (Excluding Non-Melanoma Skin Cancer) In The Seven Major Markets, 2002
  • Table 4: Forecast Total Mortality From All Types Of Cancer (Excluding Non-Melanoma Skin Cancer ) In The Seven Major Markets, 2009-2018
  • Table 5: Percentage Of Cancer Patients With Weight Loss Across Different Tumor Types
  • Table 6: Number Of Patients Diagnosed With Cancer Experiencing Weight Loss By Tumor Type In The Seven Major Markets, 2009
  • Table 7: Forecast Number Of Patients Diagnosed With Cancer Who Will Experience Weight Loss During The Course Of Their Disease In The Seven Major Markets, 2009-2018
  • Table 8: Forecast Number Of Cancer Patients Experiencing Weight Loss In The Last 1-2 Weeks Of Life In The Seven Major Markets, 2009-2018
  • Table 9: Current Treatment Options For Cancer Cachexia, 2009
  • Table 10: Pipeline Drugs In Clinical Development For Cancer Cachexia, 2009
  • Table 11: Vitor: Key Historical Events, 1993-2008
  • Table 12: Anamorelin: Key Historical Events, 2001-07
  • Table 13: Ostarine: Key Historical Events, 2006-08
  • Table 14: Thalomid: Key Historical Events, 1996-2008
  • Table 15: Avr118: Key Historical Events, 2003-08
  • Table 16: Ongoing Trials In Cancer Cachexia, 2009
  • Table 17: Vt-122: Key Historical Events, 2007-08
• List Of Figures
  • Figure 1: Characteristics Associated With Cancer Cachexia
  • Figure 2: Spectrum Of Cancer Cachexia Severity And Approximate Associated Survival
  • Figure 3: Schematic Overview Of Cancer Cachexia Pathophysiology
  • Figure 4: Number Of Patients Diagnosed With Cancer Experiencing Weight Loss By Tumor Type In The Seven Major Markets, 2009
  • Figure 5: Forecast Number Of Patients Diagnosed With Cancer Who Will Experience Weight Loss During The Course Of Their Disease In The Seven Major Markets, 2009-2018
  • Figure 6: Forecast Number Of Cancer Patients Experiencing Weight Loss In The Last 1-2 Weeks Of Life In The Seven Major Markets, 2009-2018
  • Figure 7: Cancer Patient Treatment Flow Chart
  • Figure 8: National Comprehensive Cancer Network (Nccn) Guidelines For Cancer Cachexia Patients With Long Life Expectancy
  • Figure 9: National Comprehensive Cancer Network (Nccn) Guidelines For Cancer Cachexia Patients With Short Life Expectancy
  • Figure 10: Placebo-Controlled Study Of Megestrol Acetate In Cancer Cachexia Patients
  • Figure 11: Phase Iii Study Of Megestrol Acetate Versus Dexamethasone And Fluoxymesterone
  • Figure 12: Phase Iii Of Eicosapentaenoic Acid (Epa) In Gastrointestinal Or Lung Cancer Patients With Cachexia
  • Figure 13: Phase Iii Trial Of Dronabinol Versus Megestrol Acetate In Advanced Cancer Patients
  • Figure 14: Phase Iii Study Of Eicosapentaenoic Acid (Epa) With Or Without Megestrol Acetate In Cancer Cachexia
  • Figure 15: Study Of Megestrol Acetate And Ibuprofen Combination In Gastrointestinal Cancer Patients With Cachexia
  • Figure 16: Phase Iii Trial Comparing Various Treatment Options In Advanced Cancer Patients With Cachexia
  • Figure 17: Summary Of Unmet Needs In Cancer Cachexia, 2009
  • Figure 18: Pilot Phase Iii Trial Of Vitor In Cachectic Non-Small Cell Lung Cancer Patients
  • Figure 19: Phase Ii/Iii Trial Of Vitor In Advanced Cancer Patients With Cachexia Symptoms
  • Figure 20: Phase Ii Study Of Anamorelin In Cachectic Patients With Advanced Solid Tumor Cancers
  • Figure 21: Phase Ii Study Of Ostarine In Cancer Cachexia
  • Figure 22: Phase Ii Trial Of Thalomid In Advanced Cancer Patients
  • Figure 23: Randomized Trial Of Thalomid In Pancreatic Cancer Patients With Cachexia
  • Figure 24: Results Of Phase I/Ii Study Of Avr118 In Cancer And Aids Cachexia
  • Figure 25: Phase Ii Trial Of Mirtazapine In Advanced Cancer Patients