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GI Cancers: Immediate Impact of 2015 ASCO Presentations on Clinical Practice

Introduction

OBR and MDoutlook are pleased to share excerpts from the most recent MDoutlook’s OncoPolls™ from ASCO 2015. This report highlights certain presentations concerning the anti-PD-1 / PD-L1 antibody-based Immune Checkpoint Inhibitors and other new agents in Gastrointestinal cancers. This research is based on separate surveys in non-Colorectal Gastrointestinal cancer and Colorectal cancer. The full complimentary report is available through MDoutlook per details below.

OncoPoll™ Methodology

  • Primary research phase involved global surveys to verified and validated medical oncologists and multi-disciplinary physicians with an identified clinical interest in GI cancers utilizing targeting parameters within the proprietary MDoutlook® global cancer treater panel
  • Timing: June 2015. Launched shortly after close of 2015 American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago, IL., May 29-June 2, 2015
  • Fielding via interactive web-based survey instrument, utilizing proven MDoutlook methodology and proprietary technology
  • Links to discussed abstracts on the ASCO website were provided within the survey
  • Responses: 86 global physicians in non-CRC GI Cancer survey and 82 US physicians in CRC survey

Expected Impact of Immune Checkpoint Blockade Antibodies in Non-CRC GI Cancer

Key Conclusions

  • Anti-PD-1 / PD-L1 antibodies are mainly expected to have a large impact for small patient groups
    • 27% of the respondents expect large patient collectives to be impacted
    • Only 2% of the respondents expect no impact at all
  • Impact on therapy was estimated marginally higher for Gastric compared to Esophageal and HCC

Perceived Value of Immune Checkpoint Blockade Antibodies in Non-CRC GI Cancer

Key Conclusions

  • Overall calculated average of 4.05 (for comparison: NSCLC 4.74 [data: 2015 OncoPoll NSCLC])
  • 15% of physicians perceive the value of these antibodies, at current prices, as being high / very high (for comparison: NSCLC 27% [data: 2015 OncoPoll NSCLC])
  • Two thirds (67%) perceive the value in the medium range (3-5 on a 7-point scale)


Multi-Factorial Impact of Targeted Agents as a Therapeutic Strategy for BRAF-Mutated mCRC

Key Conclusions

  • The therapeutic strategy of combining BRAF (+/-MEK) inhibition with EGFR inhibitors is seen to have limited potential for BRAF-mutated mCRC
  • Nearly half of physicians think this approach will have only small impact on a selected few number of these patients
    • A third of respondents think the clinical impact will be larger, but still restricted in the patient subset benefiting from this approach

Perceived Value of Immune Checkpoint Blockade Antibodies in mCRC

Key Conclusions

  • Overall calculated average of 4.56
    • Compares with average of 4.74 seen in NSCLC [data: 2015 OncoPoll NSCLC]
  • Over ¼ of physicians (27%) perceive the value of these antibodies, at current prices, as being high / very high


Expected Impact of PEGH20 on Pancreatic Cancer Treatment Landscape

Expected Clinical Impact of PEGH20

Key Conclusions

  • Overall impact rated as 5.56 (1 to 10-point scale)
  • 75% of the respondents expect PEGH20 to make intermediate or high clinical impact


Regorafenib in Advanced Gastric and Gastric Esophageal Junction Cancer: Expected to be Widely Used

Expected use of regorafenib in advanced G/GEJ cancer

Key Conclusions

  • Main usage of regorafenib is expected to be in 3rd and 4th lines of therapy
  • 99% of physicians would use regorafenib in G/GEJ cancers if granted regulatory approval (data not shown)
  • 80% of the respondents expect to use regorafenib in 2 or more lines (data not shown)

Impact of Abstract# LBA100: Expected Usage of Testing for MMR Deficiency and Treatment with Immune Checkpoint Blockade Antibodies in MMR-Deficient mCRC

Key Conclusions

  • Physicians expect to test two-thirds of their mCRC patients for mismatch repair (MMR) deficiency over the next 6 months; 45% growth from current levels
    • Almost half of physicians (47%) will test all of their mCRC patients for MMR deficiency (data not shown)
  • Treatment of MMR-deficient mCRC with anti-PD-1/PD-L1 antibodies is expected to nearly double (182%) over the next 6 months
    • 28% of this patient subset is expected to receive this therapeutic approach

Conclusions: Immediate Impact of 2015 ASCO Presentations on Clinical Practice

Non-CRC GI Cancers

  • Anti-PD-1/PD-L1 antibodies are expected to have a large impact for selected patients with Gastric, Esophageal and Hepatocellular Cancers
  • At current drug costs, only average value is placed on these agents in GI cancers (lower than what is seen for NSCLC)
  • 75% of the respondents expect the PEGH20 addition to have intermediate or high clinical impact on the treatment of pancreatic cancer
  • Regorafenib will be widely used in advanced G/GEJ cancers upon regulatory approval

Metastatic Colorectal Cancer

  • The immune checkpoint inhibitors (anti-PD-1/PD-L1) are going to have a very significant impact on the treatment landscape for MMR-deficient mCRC
    • Over a quarter of mCRC patients with this deficiency are expected to receive this treatment almost immediately
    • Most mCRC patients will now be tested for an MMR deficiency
  • At today’s prices, physicians see good value in using the anti-PD-1/PD-L1 antibodies for mCRC
  • Combining BRAF+/-MEK inhibitors with anti-EGFR antibodies is initially seen to have only a limited impact on the treatment of BRAF-mutated CRC

For a more detailed analysis report, please click here to download the full report.

Submitted by Robert Stephan, Sr. Director Medical Services and Strategy, and Jan Heybroek, President MDoutlook.

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