According to surveyed oncologists in 5 major European Union countries (France, Germany, Italy, Spain and the United Kingdom) abiraterone acetate (Zytiga?,Johnson & Johnson/Janssen Biotech/Janssen Cilag) has heavily penetrated second-line treatment of metastatic castrate-resistant prostate cancer (mCRPC) and is displacing cabazitaxel (Jevtana?, Sanofi) to Later-Line treatment of mCRPC.

Options to treat patients have dramatically changed since 2011. Until that year there was a lack of effective treatment options for the treatment of patients with mCRPC who had previously received docetaxel (Taxotere?, Sanofi) in second- and subsequent-line settings.However, after a long period of stagnation and intense R&D, 2011 became a landmark year for drug approvals. The European Medicines Agency approved cabazitaxel (March 2011) and abiraterone acetate (September 2011) for the treatment of mCRPC previously treated with docetaxel-containing chemotherapy. Except for abiraterone acetate in Italy, both drugs have now launched across 5 major European markets. European first-line label extension for the use of abiraterone acetate in asymptomatic or minimally symptomatic chemotherapy-naive mCRPC followed in January 2013.

Since 2011, the wave of new drug development activity in the prostate cancer and multiple market authorization applications of novel mCRPC treatment options continued. Among the drugs approved was sipuleucel-T (Provenge?, Dendreon). As a result, the market for mCRPC drugs is expected to become increasingly crowded and competitive. As Europe continues to tighten their healthcare belt, payers are charged with balancing clinical need with diminishing budgets and physicians are challenged in making economical prescribing decisions and determining the optimal sequence of treatment for their patients.

Decision Resources, one of the world’s leading research and advisory firms for pharmaceutical and healthcare issues, compiled the results. Their reportis based on a survey of 250 medical oncologists in the 5 major European markets as well as 31 urologists in Germany only, and on interviews with 15 European payers.The researchers found that, despite its recent market entry, abiraterone acetate is changing oncologists’ second-line treatment of metastatic castrate-resistant prostate cancer (mCRPC) patients who have received prior treatment with docetaxel. Uptake of abiraterone acetate is especially high in France and the United Kingdom, where, on average, approximately half of respondents’ second-line patients are prescribed abiraterone acetate.

Among respondents in most countries, Sanofi’s cabazitaxel is more commonly used in the third-line than the second-line setting, suggesting that second-to-market abiraterone acetate is displacing Jevtana to later-line mCRPC. In support of this finding, most of those surveyed in all countries indicate that the recent launch of abiraterone acetate will influence a shift in prescribing of Jevtana toward later-line mCRPC treatment in the next 12 months.

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A shift in prescribing patterns
The report developed for the new European Physician & Payer Forum finds that more than one-third of respondents in Germany and Spain believe abiraterone acetate launch will significantly influence a shift in prescribing for cabazitaxel, while almost one-quarter of those in Italy agree. Abiraterone acetate’s more favorable side-effect profile, convenient oral administration, and mechanism of action likely explain why such a substantial percentage of physicians expect this trend. At the end of 2015, despite the anticipated approval of three new therapies including enzalutamide(Xtandi?,Medivation/Astellas Pharma), Radium-223 (Algta/Bayer; formerly known asAlpharadin), and orterone (TAK 700, Takeda/Millennium), abiraterone acetate is expected to maintain its position as the favored second-line mCRPC therapy among surveyed physicians in Europe.

Downstream cost savings
This report also finds that, in addition to robust efficacy, therapeutic innovation and demonstrable downstream cost savings are key market access levers that will encourage payers in the 5 European countries to think beyond an emerging agent’s proposed price tag. Pharmaceutical innovation is key to reimbursement decision making in Italy and Spain, and, in the former, inclusion on AIFA’s innovative drugs list ensures funding across regions.

“Savings in hospitalization and supportive care costs, as well as the societal benefits of improving quality of life, will help encourage uptake within countries following admission to reimbursement,” noted Decision Resources Senior Director Rachel Webster, Ph.D. “Costs associated with management of Jevtana’s side effects may well have contributed to NICE’s decision on its lack of cost-effectiveness. Furthermore, the United Kingdom’s value-based pricing system, set to be implemented at the end of this year, will pave the way for consideration of wider societal benefits and associated cost savings, and the principles of this concept are increasingly evident across the 5 European countries.”

For more information:
European Physician & Payer Forum report entitled The Dynamic Prostate Cancer Landscape: How Will European Payer and Prescriber Attitudes Shape This Competitive Market? [Report]

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