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Cancer: an old problem

Posted on: 29 Jul 03


Although elderly people have a higher incidence of the four major cancers than any other age group, there is a fundamental lack of knowledge regarding the treatment of this demographic, resulting in their under-treatment. Commercial opportunity therefore awaits any pharmaceutical company able to target the development of strategies aimed specifically at elderly patients.

Although elderly people have a higher incidence of the four major cancers than any other age group, there is a fundamental lack of knowledge regarding the treatment of this demographic, resulting in their under-treatment. Commercial opportunity therefore awaits any pharmaceutical company able to target the development of strategies aimed specifically at elderly patients.


Therefore in the Market Brief 'Treatment of Elderly Cancer Patients: An untapped market opportunity,' Datamonitor examines the reasons why the elderly cancer population has been neglected for so long by physicians and pharmaceutical developers alike, together with some of the potential avenues for best exploiting this market.


An aging population


Cancer is an age-related disease, with over 60% of new cancer cases and two-thirds of all cancer deaths occurring in elderly people. The incidence of the four main cancers (namely breast, lung, colorectal and prostate) increases with age, and all the data suggests that the incidence of these conditions amongst the aged will reach one million individuals this year alone.


In spite of the increase in numbers of elderly people suffering from cancer, many do not receive the most effective treatment. In the UK, for example, around 40% of cancer patients over the age of 75 are placed on palliative regimens, and it has been suggested that this is so because of a "persistent uncertainty" among clinicians as to whether the benefits outweigh the risks of treating the very old and very frail.


One of the primary reasons for this uncertainty is that there is a lack of reliable data on how elderly patients respond to cancer treatment. This lack of data in turn stems from an under-representation of the elderly in clinical trials, as well as a lack of investment and research by drugmakers into what is surely one of their key patient groups


A number of barriers prevent elderly patients from participating in most clinical trials. In addition to "protocol exclusions," whereby patients in trials are required to be free from other health problems, many clinical investigations have upper age limits which eliminate the elderly, while the impact of psychological and socioeconomic barriers also cannot be discounted.


Lack of data


The net effect is that there are very few older patients participating in trials for new anticancer agents, which translates into an uncertainty about how new drugs will be tolerated and how effective they will be when tested in larger groups of elderly cancer patients.


With such an absence of data on how the various cancer treatments affect the elderly, the general tendency amongst physicians has been to assume that older patients have poor tolerance to chemotherapy. The upshot of this is that many elderly patients with cancer have been under-treated for fear of excessive toxicity and related morbidity and mortality.


However, the lack of a comprehensive treatment strategy for elderly cancer patients is an issue that needs to be addressed, as it is predicted that 30 years from now, elderly people will comprise 70% of all those diagnosed with cancer.


This means that there is an ever-growing market for cancer treatment strategies aimed specifically at the elderly; hence it would be highly beneficial for pharmaceutical manufacturers to increase their research into this area. And indeed, this effort becomes even more important when one realizes that certain tumor types are actually more effectively treated in the elderly than in the young


Market opportunity


Currently, 44% of breast cancer cases occur in women aged 65 or over, and breast cancer is the most common cause of death in women of this age in developed countries. Furthermore, the prevalence and incidence of breast cancer in older women is expected to increase by 30% over the next decade.


In general, breast tumors in elderly patients tend to show a greater differentiation of tumor cells, a lower proliferative rate and a higher estrogen receptor content than in younger patients. With the vast majority (80%) of cancers in this group being indolent and rich in hormone receptors, Datamonitor recommends that manufacturers of hormonal breast cancer therapies target elderly patients in order to drive uptake of their products among this group.


Meanwhile, in non small-cell lung cancer (NSCLC), a number of non-platinum drugs have been tested in the elderly population, and Datamonitor believes this may be a profitable area of research for manufacturers of well tolerated agents, such as GlaxoSmithKline’s / Pierre Fabre’s Navelbine (vinorelbine).


Clinical trials have shown that vinorelbine can give a response rate of 20% in NSCLC, with only mild toxicity. The trials have also shown that vinorelbine can improve quality of life in comparison to best supportive care and improves survival to the same extent as cisplatin-based chemotherapy in adult patients.


Two to watch


On the basis of these results, Datamonitor recommends the promotion of this drug, in addition to Eli Lilly’s Gemzar (gemcitabine), in the elderly NSCLC population.


The pharmaceutical companies may also consider targeting oral formulations of these drugs at the elderly population since. An oral form will be easier to administer, and may improve quality of life and compliance. Should oral vinorelbine prove as effective as intravenous dosing in elderly patients, other pharmaceutical manufacturers would be well advised to consider developing their own non-platinum based agents that could be targeted toward elderly patients.


GSK and Pierre Fabre should look to conduct US-based supportive trials aimed specifically at the elderly, in order to further determine and promote the use of vinorelbine and other non-platinum based drugs in this population. The possibility of having active and well-tolerated chemotherapy while preserving quality of life is an attractive option for elderly patients with NSCLC, and marketing to physicians treating this large patient group could provide a significant return on investment.


With a population that is aging as a whole, elderly people represent a significant market opportunity for manufacturers of oncology drugs. Those pharmaceutical companies willing to invest in researching and developing cancer products specifically with the older population in mind should end up reaping the benefit.



If you found this week's Expert View useful, you may be interested in Datamonitor's reports:


  • Treatment of Elderly Cancer Patients - An Untapped Market Opportunity priced $1,600
  • Pipeline Insight: Angiogenesis Inhibitors - Diversification and expansion of the innovatives class driving the evolution of cancer treatment priced $3,200


For a free Datamonitor healthcare report please click here

Michael Randle

Last updated on: 27/08/2010 11:40:18

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