Submit a Comment

Colorectal, Pancreatic and Other Gastrointestinal Cancers: Integrating Latest Research Results into Clinical Practices

Introduction

In an effort to provide you with timely market feedback from ASCO 2013, OBR and MDoutlook are pleased to share results from MDoutlook’s second OncoPoll from the meeting exploring Colorectal, Pancreatic and other Gastrointestinal cancers.

Stay tuned to our blog in the coming weeks as we publish more survey results in other tumor types as well.

OncoPoll™ Methodology

  • Primary research phase involved a global survey to verified and validated medical oncologists and multi-disciplinary physicians with an identified clinical interest in gastrointestinal cancers utilizing targeting parameters within the proprietary MDoutlook® global cancer treater database
  • Timing: June 2013. Launched three days after close of 2013 American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago, IL., May 31-June 4, 2013
  • Fielding via <10 minute long interactive internet survey utilizing proven effective methodology via the MDoutlook survey tool
  • Links to discussed abstracts on the ASCO website were provided within the survey
  • Reponses at data collection: 97 on June 20th
  • No financial incentives provided for participation

Geographic Distribution of Respondents

Attendance at 2013 ASCO Annual Meeting

Key Conclusions

  • About half of all survey respondents attended this year’s ASCO annual meeting
  • Proportionally, Ex-US respondents had slightly more attendees than US respondents
  • This is in-line with results from previous years

Survey Participants’ GI Cancer Patient Flow: Average Nearly 40 Cases of GI Cancer Each Month

Key Conclusions

  • Participants averaged 20-25 cases of colorectal cancer (CRC) last month
    • Ex-US participants reported  treating 21% more colorectal cancer patients than US participants
  • Eight to nine cases of pancreatic cancer was the average monthly volume for survey participants
  • HCC case volume was the lowest at ~ 5 cases / month
  • Patient flow is roughly similar between US and Ex-US respondents

Survey Participants’ GI Cancer Patient Flow: Majority of Patients Have Metastatic Disease

Key Conclusions

  • ~1/2 of the CRC and HCC patients seen by survey participants have metastatic disease
  • Nearly 3/4 of the pancreatic cases involve metastatic disease
  • Prevalence of metastatic disease is roughly similar between US and Ex-US respondents

FOLFIRI + Biologic as 1st Line Treatment for mCRC: Expected Significant Shift Towards Cetuximab Preference

Key Conclusions

  • Increased use of cetuximab (Cetux) with FOLFIRI as 1st line treatment for KRAS wild-type metastatic CRC is expected due to the results of the FIRE-3 trial
    • About a 40% increase in cetuximab usage is expected – Significant impact
    • ~50% of the increase comes at  the expense of bevacizumab (Bev) usage in the 1st line
    • Ex-US respondents have and will continue to use more biologics with FOLFIRI than US respondents

Bevacizumab Usage in Maintenance Setting for mCRC: New Data Will Cause >25% of Oncologists to Increase Usage

Key Conclusions

  • In the US, the majority of oncologists will not change their usage of bevacizumab in the maintenance setting due to the results from the CAIRO-3 and SAKK 41/06 trials
    • For those who will change their usage, most will increase bevacizumab usage somewhat
  • Outside of the US, those who will somewhat increase usage of bevacizumab in maintenance setting is nearly equal to those who will not change their current usage
  • Very few will reduce their usage due to this new information

Abraxane Usage in Metastatic Pancreatic Cancer: Expect Half of Patients to Receive Abraxane as Treatment

Key Conclusions

  • Worldwide, 44% of metastatic pancreatic cancer patients are expected to receive Abraxane as treatment
    • Ex-US respondents are more aggressive in their expected increase due to lower previous levels of usage
  • Due to the results of the MPACT trial, 50% of US patients with metastatic pancreatic cancer are expected to receive Abraxane as treatment
    • 22% of oncologists will use Abraxane + gemcitabine in 76-100% of their patients (data not shown)
    • Significant 2.4 fold increase in Abraxane usage is expected: 50% expected usage vs. 20% previous usage

Expectations for Regulatory Approval for Abraxane in Metastatic Pancreatic Cancer: Oncologists Believe Approval is Very Likely

Key Conclusions

  • Oncologists agree with notion that Abraxane will receive regulatory approval for use in pancreatic cancer
    • 20-25% are absolutely certain of it
  • Slightly higher expectations from US oncologists

2nd Line Treatment for HCC: Only a Limited Subset of Patients Receive Post-Sorafenib Treatment

Key Conclusions

  • Fewer than a 1/3 of US HCC patients receive a 2nd line treatment following sorafenib treatment
    • 20% of US oncologists will use a 2nd line approach in a majority of their patients (data not shown)
  • Only 20% of HCC patients outside of the US receive a post-sorafenib treatment
    • 6% of Ex-US oncologists will use a 2nd line approach in a majority of their patients (data not shown)
  • No consensus for 2nd line approach, but Xeloda (capecitabine) was most commonly mentioned

Conclusions: Impact of ASCO 2013 on Clinical Practices for Gastrointestinal Cancers

  • Colorectal cancers (CRC) are the main type of gastrointestinal cancers seen in clinical practices
    • Oncologists’ patient flow in CRC is ~2-3x greater than in pancreatic cancer and ~4-5x greater than in HCC
    • Most of oncologists’ gastrointestinal cancer practice involves metastatic disease, especially concerning pancreatic cancer
  • In the front-line setting for mCRC, a significant increase of 40% in the usage of cetuximab in combination with FOLFIRI is expected due to the FIRE-3 results
    • ~50% of this increase will be at the expense of bevacizumab
    • FOLFIRI without either of these biologics will still be used in 30-40% of the 1st line cases
  • Some increase in the use of bevacizumab in the maintenance setting is expected due to the results of the CAIRO-3 and SAKK 41/06 trials
    • 25% (US) and 40% (Ex-US) respondents will increase their usage in this setting
    • Most or the remaining will not change their current practices due to this new information
  • Abraxane is expected to be used in 50% of US patients and 44% of global patients with metastatic pancreatic cancer
    • Increased usage represents a 2.4 fold increase from current usage levels
    • Outside of the US, a 5.2 fold increase is expected (from 7%of patients to 38%)
    • Most agree with notion that Abraxane will receive regulatory approval for metastatic pancreatic cancer
  • Post-sorafenib treatments for metastatic HCC are rarely used
    • More 2nd line treatments in the US (29%) than outside of the US (20%)
    • Few try 2nd line treatments in most of these patients
Submitted by Jan Heybroek, President and Robert Stephan, Sr. Director Medical Services, MDoutlook

You must be logged in to post a comment