On October 21, data presented at the European Society for Medical Oncology (ESMO) congress highlighted results from the STAMPEDE trial in metastatic hormone-naïve prostate cancer (mHNPCa). Although Zytiga (abiraterone) was recently approved for this subset of patients, the analysis further segmented patients into high- and low-risk subgroups, and found that all benefited from the addition of Zytiga to the standard of care. Thus, it is expected that these practice-changing results will help to combat declining revenues due to Zytiga’s impending generic erosion. The extended duration of therapy for mHNPCa makes this an expensive patient segment to treat.

According to GlobalData’s analysis, shown in Figure 1 below, the mHNPCa (represented in green) and non-metastatic castration-resistant prostate cancer (represented in pink) segments are the fastest-growing patient segments, growing at compound annual growth rates (CAGRs) of 25.7% and 21.1%, respectively, between 2016 and 2026 for the seven major markets (7MM: US, France, Germany, Italy, Spain, UK, and Japan).

Figure 1: Prostate Cancer Sales by Patient Segment, 7MM

Source: GlobalData

Growth is mostly driven by label expansions and drug launches within the second-generation hormonal therapy category in the early to mid-forecast. J&J’s Zytiga was approved for mHNPCa in November 2017 in the EU and February 2018 in the US. An additional four approvals are expected for this patient subset before the end of the forecast period: Takeda/Myovant’s relugolix, Astellas/Pfizer’s Xtandi (enzalutamide), J&J’s Erleada (apalutamide), and Bayer/Orion’s darolutamide.