Abstract
A Complex Market of Diverse Needs
Chronic pain in cancer patients can result from either the cancer pathology
itself or cancer treatment. Cancer pain can also be categorized by its
location (somatic versus visceral) or pathophysiology (nociceptive versus
neuropathic). Treatment-induced pain is found in 20% of cancer pain patients,
whereas up to 90% have pain resulting from the tumor pathology itself.
An Opportunity to Meet Unmet Need for Therapy
By 2018, there will be approximately 2.5 million individuals in US suffering
from some form of cancer pain.
Given this substantial patient population, cancer pain has received particular
attention in recent years. Usually, a combination of analgesic drugs and drugs
to combat the side effects of the analgesics is needed to bring the pain under
control. Patients vary in their ability to respond to drugs and the ways in
which they metabolize drugs. Thus, agents that are successful in some patients
will not work in others, and the doses of all the various pain and adjuvant
medications need to be customized for a given patient. Moreover, all of these
factors change over time as the patient' s health improves or worsens. Patients
often develop tolerance to their drugs and thus the choice of drugs and their
doses need constant reassessment by the treating physician. There is still a
great need to develop novel therapies that are safe and effective with fewer
side effects than currently marketed products.
Report Objectives & Methodology
In this report WWMR, Inc., provides an overview of cancer pain in the US
market.
This report also summarizes WWMR, Inc.' s current understanding of cancer pain
mechanisms, and highlights promising targets for drug development. Also
reviewed are new treatments already in development that offer the promise of
improved pain management of cancer pain in the near future.
Models representing patient populations and the commercial value (USD) of this
market in 2008, 2013, and 2018 are presented.
Expert analysis and commentary describing the future cancer pain market are based on:
- WWMR' s Pain Clinic Monitor, profiling cancer pain
- Comprehensive analysis of drug uses for cancer pain, including estimations
of prescription size, number of refills, and cost
- Interviews with Pain Clinicians and Oncologists
- Evaluation of drugs in the cancer pain drug pipeline as well as those
being studied for other conditions but have the potential to treat cancer
pain, with conclusions on the future directions in treatment
- In-depth analysis of the medical literature, including treatment review
articles, medical textbooks, epidemiology studies, and clinical studies
Market and patient population forecasts are based on a consensus developed
from industry experience, clinician input, and analysis of secondary sources.
WWMR' s US Cancer Pain report will allow pharmaceutical and biotechnology executives to:
- Compare the epidemiology of cancer pain by type of pain, including
projected growth rates
- Recognize the specific aspects of cancer pain that have high market
potential in the next 10 years
- Target specific patient populations who will benefit most from drugs in
the pain pipeline
- Identify drugs in development that have potential future utility in the
treatment of cancer pain
- Anticipate upcoming competitors and product licensing opportunities
- Understand the type and level of unmet need in the US cancer pain market
- Recognize the impact of special market dynamics, including potential
off-label usage, on product uptake forecasts
WWMR' s US Cancer Pain report also includes a PowerPoint presentation which
comprises perspectives from pain clinic specialists and oncologists with
expertise in treating cancer pain.
This presentation includes:
- An assessment of cancer pain treatment practices incorporating physician
verbatims.
- Physician' s views on the merits of various routes of administration of
cancer pain medications
- An analysis of physician satisfaction with current cancer pain treatments
- A review of physician-reported unmet needs in the cancer pain market
- Physician perspectives on recent advances in cancer pain treatment.
Table of Contents
I. EXECUTIVE SUMMARY
II. INTRODUCTION AND METHODOLOGY
III. PHYSIOLOGY OF CANCER PAIN
- A. Definition of Cancer Pain
- 1. Nociceptive Cancer Pain
- 1.1 Nociceptive Cancer Pain Mechanisms
- 2. Neuropathic Cancer Pain
- 2.1 Characteristics of Neuropathic Cancer Pain
- 2.2 Cellular Mechanisms of Neuropathic Pain
- 2.3 Cheomtherapy-Induced Neuropathy
- 2.4 Other Sources of Neuropathic Cancer Pain
- 3. Breakthrough Cancer Pain
- 3.1 Breakthrough Cancer Pain Mechanisms
- 4. Malignant Bone Pain
- 4.1 Malignant Bone Pain Mechanisms
- 5. Visceral Cancer Pain
- 5.1 Visceral Cancer Pain Mechanisms
IV. CLINICAL ASSESSMENT OF CANCER PAIN
- 1. Qualitative Description of Pain
- 2. Standard Quantitative Pain Measurement Scales
- 2.1 McGill Pain Questionnaire (MPQ)
- 2.2 MD Anderson Symptom Inventory (MDASI)
- 2.3 Brief Pain Inventory (BPI)
- 2.4 Visual Analog Scale (VAS)
- 2.5 The Neuropathic Pain Scale (NPS)
- 2.6 Pain Assessment by Functional Scales
- 3. Physical examination of the Cancer Pain Patient
- 3.1 Characterizing Underlying Systemic Illness
- 3.2 Regional Pain Physical Examination
V. EPIDEMIOLOGY - CURRENT AND FUTURE
- 1. Cancer Pain
- 1.1 Incidence of Cancer Pain
- 1.2 Prevalence of Cancer Pain
- 2. Incidence and Prevalence by Type of Cancer Pain
- 2.1 Tumor-Related Cancer Pain
- 2.2 Treatment-Related Cancer Pain
- 2.3 Neuropathic Cancer Pain
- 2.4 Breakthrough Cancer Pain
- 2.5 Malignant Bone Pain
- 2.6 Visceral Cancer Pain
- 2.7 Soft-Tissue Cancer Pain
- 3. Basis for Target Population
- 4. US Cancer Pain Population Forecasts
VI. APPROACHES TO TREATMENT OF CANCER PAIN
- A. Actual Clinical Practice
- 1. Opioids and Semi-Synthetic Narcotics
- 1.1 Categorization of Opioids
- 1.2 Opioid Treatment Design
- 1.3 Management of Opioid Side Effects
- 1.4 Specific Opioids used in the Treatment of Cancer Pain
- 2. Anti-Inflammatory Pain Medications
- 3. Corticosteroids
- 4. Anesthetics
- 5. Anticonvulsants
- 6. Antidepressants
- 7. Other Drugs
- 8. Surgery and Radiation
- 9. Alternative Therapies
- B. Clinical Practice Guidelines
- 1. World Health Organization Guidelines
- 2. National Comprehensive Cancer Network Guidelines
- C. Limitations of Current Treatment
- 1. Limitations in Patient Access to Treatments
- 2. Limitations in Current Products' Performance
- D. Promising New Approaches
- E. Future Trends
VII. DRUGS IN CLINICAL DEVELOPMENT TO TREAT CANCER PAIN
- 1. Introduction
- 2. Recent Lunches/Approvals
- 3. Current pipeline
- 3.1 Phase III, Preregistration, and Registration
- 3.2 Phase II
- 3.3 Phase I
- 4. New Formulations and Combinations of Previously Approved Pain Drugs
VIII. MARKET FORECASTS AND ESTIMATES - CURRENT AND FUTURE
- A. Current Sales of Pharmaceutical Products, By Drug Class
- 1. 2008 US Market: Summary by Drug Class
- 1.1 Opioids
- 1.2 Corticosteroids/Other
- 1.3 Anesthetics
- 1.4 Anti-Inflammatories
- 1.5 Anticonvulsants
- 1.6 Muscle Relaxants
- 1.7 Antidepressants
- 1.8 Methodology
- B. Market Forecast for Cancer Pain, 2008-1018
- 1. 2008 - 2018 US Market: Summary by Drug Class
- 1.1 Opioids
- 1.2 Corticosteroids/Other
- 1.3 Anesthetics
- 1.4 Anti-Inflammatories
- 1.5 Anticonvulsants
- 1.6 Muscle Relaxants
- 1.7 Antidepressants
