Hepatocellular Carcinoma - Opportune indication for novel therapies
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the Oncology pharmaceutical analysis team - page 2
- Andrew Paramore - Oncology Lead Analyst & Head of Product Development - page 2
- About the Oncology pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of analysis - page 3
- Datamonitor insight into the hepatocellular carcinoma market - page 4
- CHAPTER 2 HCC OVERVIEW - page 9
- Liver function - page 9
- The damaged liver and its implications - page 10
- Hepatocellular carcinoma - page 11
- Epidemiology - page 11
- Increasing incidence in the West - page 12
- Poor prognosis but improving - page 14
- Risk factors - page 15
- Increasing hepatitis infection attributed to rising HCC incidence - page 15
- Hepatitis B infection - page 16
- Hepatitis C infection - page 18
- Liver cirrhosis is a major risk factor for HCC - page 20
- Aflatoxin exposure increases HCC risk - page 20
- Increasing hepatitis infection attributed to rising HCC incidence - page 15
- Diagnosis and screening - page 20
- Diagnostic criteria - page 21
- Diagnostic procedures - page 22
- Biopsy - page 22
- Ultrasound - page 22
- Computerized tomography - page 22
- Magnetic resonance imaging - page 22
- Angiography - page 23
- Alpha-fetoprotein - page 23
- Staging - page 23
- AJCC TNM staging system - page 24
- Child-Pugh classification - page 25
- Okuda staging system - page 25
- The Cancer of the Liver Italian Program (CLIP) - page 26
- BCLC classification - page 27
- Liver function - page 9
- CHAPTER 3 CURRENT TREATMENT OPTIONS - page 29
- Introduction - page 29
- Treatment modalities - page 30
- Surgical resection remains the mainstay of treatment for HCC - page 30
- Liver transplantation is an option for patients with localized disease - page 32
- Radiofrequency ablation may be as effective as surgery in selected patient cohorts - page 35
- Opportunity for immunotherapy? - page 38
- Use of percutaneous ethanol injection remains marginal - page 38
- High complication rate of cryosurgery may limit its applicability - page 39
- Transcatheter arterial chemoembolization (TACE) offers a survival improvement - page 40
- Randomized study will be required to fully define role of hepatic arterial pumps - page 43
- CHAPTER 4 CHEMOTHERAPY REGIMENS IN UNRESECTABLE HCC - page 44
- Introduction - page 44
- Compromised liver function may restrict use of chemotherapy - page 45
- Single agents used in the management of HCC offer limited benefit - page 45
- Doxorubicin - page 46
- Doxil/Caelyx/Myocet (pegylated liposomal doxorubicin - Ortho Biotech/Schering-Plough/Cephalon/Sopherion) - page 47
- Cisplatin - page 47
- Gemzar (gemcitabine - Eli Lilly) - page 48
- Xeloda (capecitabine - Roche) - page 48
- Epirubicin - page 49
- Tamoxifen - page 49
- Intron A/Roferon A (interferon-alpha - Schering-Plough/Roche) - page 50
- Combination regimens fail to demonstrate any significant efficacy advantage - page 51
- Cisplatin and doxorubicin - page 52
- Cisplatin, interferon-alpha, doxorubicin and 5-FU (PIAF) - page 53
- Cisplatin, doxorubicin and Xeloda - page 54
- Cisplatin and Gemzar - page 54
- Cisplatin, epirubicin, UFT and leucovorin - page 54
- Cisplatin, mitoxantrone and 5-FU - page 54
- Gemzar and oxaliplatin - page 55
- Liposomal doxorubicin plus Gemzar - page 55
- Liposomal doxorubicin plus Xeloda or Gemzar - page 55
- Interferon combinations - page 56
- Single agents used in the management of HCC offer limited benefit - page 45
- CHAPTER 5 UNMET NEEDS - page 57
- Unmet needs - page 57
- Curbing the increasing incidence of HCC - page 57
- Lack of effective treatment - page 57
- Poor clinical trial designs - page 58
- Relatively modest R&D interest - page 58
- Unmet needs - page 57
- CHAPTER 6 HCC PIPELINE ANALYSIS - page 60
- Pipeline drugs for HCC - page 60
- Pipeline drugs by phase - page 62
- Pipeline drugs by drug class - page 63
- Pipeline drugs by phase and drug class - page 64
- Pipeline drugs in Phase III development - page 64
- Talaporfin (LS11) - Light Sciences Oncology - page 64
- Minimal toxicity is the key for talaporfin - page 65
- Nexavar (sorafenib) - Onyx Pharmaceuticals /Bayer Schering - page 66
- Phase III trial results indicate a 44% overall survival benefit associated with Nexavar - page 67
- Phase II trial suggests Nexavar's potential to significantly improve median survival offered by doxorubicin - page 68
- Ongoing Phase II combination trial will give better indication of Nexavar's worth - page 68
- Nexavar does not have overlapping toxicities with doxorubicin - page 68
- First-to-market status and collaboration will ensure Nexavar is the leading multi-kinase inhibitor in HCC - page 69
- Thado (thalidomide) - TTY BioPharm - page 69
- Phase II trial results do not support the use of thalidomide in HCC - page 70
- Additional Phase II trial does not support use of thalidomide in HCC - page 71
- Response in some patients may be due to etiology - page 71
- Thalidomide unlikely to make its mark on the HCC market - page 72
- AMT-2003 - Auron Healthcare - page 73
- Dearth of data for AMT-2003 - page 73
- Talaporfin (LS11) - Light Sciences Oncology - page 64
- Key pipeline drugs in Phase II development - page 73
- Avastin (bevacizumab) - Genentech/Roche/Chugai - page 73
- Erbitux (cetuximab) - ImClone/Bristol-Myers Squibb/Merck Serono - page 75
- Tarceva (erlotinib) - OSI Pharmaceuticals/Genentech/Roche/Chugai - page 77
- Iressa (gefitinib) - AstraZeneca - page 78
- Recentin (AZD2171/cediranib) - AstraZeneca - page 80
- Velcade (bortezomib) - Millennium Pharmaceuticals/Ortho Biotech - page 80
- Tykerb/Tycerb (lapatinib) - GlaxoSmithKline - page 81
- Sutent (sunitinib) - Pfizer - page 82
- Pipeline drugs for HCC - page 60
- APPENDIX - page 87
- Contributing experts - page 87
- UN Population Data - page 87
- Bibliography - page 88
- List of tables - page 106
- List of figures - page 107
- About Datamonitor - page 108
- About Datamonitor Healthcare - page 108
- About the Oncology analysis team - page 109
- Disclaimer - page 110
- List of Tables
- Table 1: Incidence of HCC in the seven major markets, 2007-2016 - page 13
- Table 2: Prevalence of HBV in various areas worldwide - page 17
- Table 3: AJCC TNM staging for liver tumors (including intrahepatic bile ducts) - page 24
- Table 4: Child-Pugh classification - page 25
- Table 5: Okuda staging system - page 26
- Table 6: CLIP scoring for HCC - page 27
- Table 7: Barcelona Clinic Liver Cancer classification - page 28
- Table 8: Reported outcomes of surgical resection for HCC - page 32
- Table 9: Improvement in five-year survival rates in HCC patients undergoing liver transplantation - page 33
- Table 10: Comparison of RFA and surgical resection in terms of recurrence rates and overall survival - page 36
- Table 11: Comparison of RFA in HCC patients with Child-Pugh class A and class B - page 37
- Table 12: Arterial embolization or chemoembolization compared to systemic treatment for HCC - page 41
- Table 13: Summary results of commonly used cytotoxic monotherapy in first-line unresectable HCC - page 45
- Table 14: Summary results of commonly used cytotoxic combinations in first-line unresectable HCC - page 51
- Table 15: Combining doxorubicin with cisplatin does not increase response rate - page 53
- Table 16: Drugs in clinical development for HCC, 2007 - page 60
- Table 17: Ongoing clinical trials of Avastin in HCC - page 74
- Table 18: Results of Phase II studies for unresectable HCC, 2007 - page 84
- Table 19: UN Population Data, 2002-2016 - page 87
- List of Figures
- Figure 1: Liver anatomy - page 9
- Figure 2: Incidence of HCC in the seven major markets, 2007-2016 - page 13
- Figure 3: Five-year survival rates for liver and intrahepatic bile duct cancer, 1975-1998 - page 14
- Figure 4: Association between HBV/HCV prevalence and HCC incidence - page 16
- Figure 5: HCV disease progression leading to HCC - page 19
- Figure 6: Treatment algorithm for HCC - page 30
- Figure 7: Summary results of commonly used cytotoxic monotherapy in first-line unresectable HCC - page 46
- Figure 8: Summary results of commonly used cytotoxic combinations in first-line unresectable HCC - page 52
- Figure 9: Pipeline drugs for HCC by phase, 2007 - page 62
- Figure 10: Pipeline drugs for HCC by class, 2007 - page 63
- Figure 11: Pipeline drugs for HCC by phase and class, 2007 - page 64
- Figure 12: Results of Phase II studies for unresectable HCC, 2007 - page 85
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