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Multiple Myeloma (Event Driven)
Description: The 2010 multiple myeloma (myeloma) market garnered impressive sales despite being a relatively small oncology indication in terms of incidence. Significant achievements in clinical practice over the last decade and the launches of efficacious, premium-priced agents drive market expansion, but untapped market potential remains for agents that can improve survival and reduce peripheral neuropathy and/or myelosuppression compared with currently available agents.
Contents: Executive Summary
What are the key parameters of the multiple myeloma market? What factors are driving the market for multiple myeloma therapies? What factors are constraining the market for multiple myeloma therapies? What are the drug development activities of note in multiple myeloma? What do the experts say?
What key challenges and opportunities remain? 1 Etiology and Pathophysiology
Overview
Disease Pathophysiology Normal Plasma Cells Monoclonal Gammopathies
Monoclonal Gammopathy of Undetermined Significance Asymptomatic Myeloma
Symptomatic Multiple Myeloma
Solitary Bone and Extramedullary Plasmacytomas Cytogenetic Changes
Early Events Late Events Epigenetic Changes Genetic Testing
Bone Marrow Microenvironment Myeloma Stem Cells
Risk Factors
Staging and Prognostic Factors Pathways and Drug Targets
Potential Therapeutic Targets for Myeloma Treatment Cell-Surface Molecules
Disruption of Aberrant Signaling Pathways Angiogenesis
Bone Metabolism Other Cellular Processes
2 Epidemiology and Patient Populations Overview
Disease Definition Methods
Newly Diagnosed Cases of Multiple Myeloma Subpopulations
Stage at Diagnosis
Diagnosed and Drug-Treated Populations Percentage Diagnosed
Drug-Treatable and Drug-Treated Populations First Line
Second Line Third Line
3 Current Therapy and Medical Practice Overview
Diagnosis
Treatment Guidelines Clinical Trial End Points Drug Treatment
Myeloma Treatment Overview
Treatment of Bone Complications Overview Commonly Prescribed Drugs
Regimen Dosing
Clinical Analysis of Therapies Used for Asymptomatic Multiple Myeloma Clinical Analysis of Therapies Used for First-Line, Transplant-Eligible Multiple Myeloma
Clinical Analysis of Therapies Used for First-Line Maintenance, Consolidation, and Tandem-Transplantation Treatments After Initial ASCT
Clinical Analysis of Therapies Used for First-Line Transplant-Ineligible Multiple Myeloma
Clinical Analysis of Therapies Used for Relapsed/Refractory Multiple Myeloma Clinical Development
General Treatment Algorithm Country-Specific Treatment Practices Reimbursement
4 Unmet Needs Overview
Effective Therapies That Lead to Cure/Long-Term Remission Therapies for Refractory Patients
Therapies That Target Myeloma Cells Tailoring of Novel Therapies
Well-Tolerated Therapies
Preventive Therapies for Patients with MGUS or Asymptomatic Myeloma 5 Emerging Therapies
Overview
Future Positioning of Key Competitors Early-Stage Therapies
Drug Development and Regulatory Hurdles Proteasome Inhibitors
Overview
Mechanism of Action Carfilzomib
Immunotherapies Overview
Mechanism of Action Pomalidomide Pegylated Interferon Elotuzumab
MAGE-A3/NY-ESO-1 Vaccine Therapy 160 mTOR/Akt/Interleukin-6 Inhibitors Overview
Mechanism of Action Perifosine
Enzastaurin Siltuximab Temsirolimus
Histone Deacetylase Inhibitors Overview
Mechanism of Action Panobinostat Vorinostat Romidepsin
Cytotoxic Chemotherapy Overview
Bendamustine Kinase Inhibitors Overview
Mechanism of Action Masitinib
Angiogenesis Inhibitors Overview
Mechanism of Action Bevacizumab Sorafenib
Heat-Shock-Protein Inhibitors Overview
Mechanism of Action Tanespimycin
Apoptosis Stimulators Overview
Plitidepsin
Mechanism of Action 6 Market Outlook Overview
Segment-Specific Trends First-Line Multiple Myeloma Immunomodulatory Agents Proteasome Inhibitors Cytotoxic Chemotherapy
Relapsed/Refractory Multiple Myeloma Immunomodulatory Agents
Proteasome Inhibitors Cytotoxic Chemotherapy Histone Deacetylase Inhibitors Akt Inhibitors
Alternative Market Scenario
Appendix A Bibliography—Multiple Myeloma Appendix B Market Forecast Methodology Bottom-Up Market Forecasting Overview Patient Populations
Drug-Specific Assumptions General Sources of Data
Pricing, Dosing, Days of Therapy, and Compliance Assumptions General Statements about Pricing
Dosing, Cycles and Compliance Generics Erosion
Emerging Therapy Prices
Appendix C Experts Interviewed—Multiple Myeloma Tables and Figures
Table 1-1 Conditions Related to Multiple Myeloma Table 1-2 Molecular Biology of Multiple Myeloma Table 1-3 Durie-Salmon Staging of Multiple Myeloma Table 1-4 International Staging System for Multiple Myeloma Table 1-5 Novel Prognostic and Diagnostic Biomarkers
Table 2-1 Number of Diagnosed Incident Cases of Multiple Myeloma in the Major Pharmaceutical Markets, by Stage at Diagnosis, 2010-2020
Table 2-2 Key Sources for Multiple Myeloma Epidemiology
Table 3-1 Treatment Providers and Diagnostic Patterns in the Major Markets for Multiple Myeloma Table 3-2 Expert Insight on Diagnosis of Multiple Myeloma
Table 3-3 Multiple Myeloma Treatment Guidelines by Market Table 3-4 Key End Points Used in Clinical Trials for Multiple Myeloma Table 3-5 Expert Insight on End Points for Multiple Myeloma
Table 3-6 Brand and Manufacturer of Current Therapies to Treat Multiple Myeloma Table 3-7 Current Drug Classes Used for Multiple Myeloma—Mechanism of Action Table 3-8 Current Regimen Dosing for Multiple Myeloma
Table 3-9 Efficacy Achievements of First-Line Multiple Myeloma Treatment
Table 3-10 Most Frequent Toxicities Encountered During First-Line Induction Therapy Table 3-11 Efficacy Achievements in the Relapsed/Refractory Setting for Multiple Myeloma Table 3-12 Most Frequent Toxicities Encountered During Relapsed/Refractory Treatment
Table 3-13 Select Phase III Trials Investigating New Combinations of Bortezomib, Thalidomide, and Lenalidomide in the Treatment of Multiple Myeloma
Table 3-14 Select Results from Novel Combination Regimens Emerging into Clinical Practice and Currently in Development
Table 3-15 Most Commonly Prescribed Regimens for Multiple Myeloma, by Line
Table 3-16 Expert Insight: Therapies Used to Treat First-Line, Transplant-Eligible Multiple Myeloma Patients Table 3-17 Expert Insight: Therapies Used to Treat First-Line, Transplant-Ineligible Multiple Myeloma Patients Table 3-18 Expert Insight: Therapies Used to Treat Relapsed/Refractory Multiple Myeloma Patients
Table 3-19 Reimbursement Environment for Multiple Myeloma, by Market Table 5-1 Emerging Therapies in Development for Multiple Myeloma
Table 5-2 Estimated Launch Dates for Key Emerging Therapies for the Treatment of Multiple Myeloma Table 5-3 Therapies in Early-Stage Development for Multiple Myeloma
Table 6-1 Sales of Drugs to Treat Multiple Myeloma (all populations) in the Major Pharmaceutical Markets, 2010-2020
Table 6-2 Timeline of Key Market Events for Multiple Myeloma
Table 6-3 Alternative Market Scenario for the Multiple Myeloma Market Through 2020 Table B-1 Sources for Drug Prices
Table B-2 Dosing Assumptions
Figure 1-1 Clinical Manifestations of Multiple Myeloma Figure 1-2 Plasma Cell and Myeloma Cell Process
Figure 1-3 The Bone Marrow Microenvironment
Figure 1-4 Pathways Involved in Cytokine-Mediated Tumor Cell Proliferation, Survival, and Migration Figure 1-5 Cell-Surface Molecules on Myeloma Cells and Bone Marrow Stromal Cells
Figure 1-6 Mechanism of Bone Destruction in Multiple Myeloma
Figure 2-1 Diagnosed Indicence of Multiple Myeloma in the Major Pharmaceutical Markets,2010-2020 Figure 2-2 Multiple Myeloma, Stage at Diagnosis, 2010
Figure 2-3 Diagnosed Incident Cases of Multiple Myeloma, by Gender, 2010 Figure 2-4 Multiple Myeloma Patient Flow
Figure 3-1 General Treatment Algorithm for Multiple Myeloma
Figure 4-1 Unmet Needs: Attainment and Remaining Opportunity in Multiple Myeloma Figure 6-1 Multiple Myeloma Therapies, 2010-2020: Market Share
Figure 6-2 Timeline of Near-Term Events in Multiple Myeloma
Figure 6-3 Sales of Leading Therapies in the Multiple Myeloma Market, by Setting, 2010-2020 Figure 6-4 Immunomodulatory Drugs' Share of the Multiple Myeloma Market, 2010-2020 Figure 6-5 Leading Therapies in the Multiple Myeloma Market, 2010-2020
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