Introduction:

In an effort to provide you with timely market feedback from ASCO 2012, OBR and MDOutlook Oncology Intelligence are pleased to share results from MDOutlook’s 5th Annual post-ASCO survey fielded among its global network of more than 62,000 cancer providers.

This third Quick-Poll to be published in the OBR blog explores Colorectal Cancer (CRC) & Hepatocellular Carcinoma (HCC). Stay tuned to our blog in the coming weeks as we publish QuickPolls on the other tumor types as well.

Quick Poll Methodology and Respondents’ Geographic Distribution

• Primary research phase involved a global survey to medical oncologists and multi-disciplinary physicians with an identified clinical interest in gastro-intestinal cancer and colorectal cancer utilizing targeting parameters within the proprietary MDOUTLOOK global cancer treater database
• Timing: June 2012. One week after 2012 American Society of Clinical Oncology (ASCO) Annual Meeting, held in Chicago, IL., May 31-June 4, 2012
• Fielding via <10 minute long interactive internet survey utilizing proven effective methodology via the MDOUTLOOK survey tool
• Survey closed 4 days after fielding
• Reponse:108 on June 25th
• No financial incentives provided for participationn

Attendance at 2012 ASCO Annual Meeting

Key Conclusions:

• Nearly 2/3 of all survey respondents attended this year’s ASCO annual meeting
• Proportionally, equal attendance by US and Ex-US respondents

CRC Survey Results:

1) Usage of Maintenance Bevacizumab in mCRC Will Increase in the Upcoming Year

Key Conclusions:

• Maintenance treatment with bevacizumab is currently being used in select patients with metastatic colorectal cancer (mCRC)
  • 1/4 of oncologists currently never use this approach; < 5% always use this approach (data not shown)
• Usage of maintenance bevacizumab is expected to increase in the upcoming year
  • 2x as much growth in US than in Ex-US (38% vs. 17%)
  • Non-users will drop from 25% to 11% and 18%, US and Ex-US respectively

2) Most US Treaters Will Use Aflibercept or Bevacizumab in Selected mCRC Patients who Have Progressed on Anti-Angiogenesis Therapy

Key Conclusions:

• Continuing anti-angiogenic targeting after progression on bevacizumab will be widely used by US treaters of mCRC
• Most physicians will use both aflibercept and bevacizumab in a selected subset of patients
• Very few will not use either / both agents or will have a strong preference of 1 agent over the other

3) Most Ex-US Treaters Will Use Aflibercept or Bevacizumab in Selected mCRC Patients who Have Progressed on Anti-Angiogenesis Therapy

Key Conclusions:

• Continuing anti-angiogenic targeting after progression on bevacizumab will be widely used by treaters of mCRC outside of the US
• Most physicians will use both aflibercept and bevacizumab in a selected subset of patients
• Up to 1/4 will not use one or the other agent in this setting; very few have a strong preference of 1 agent over the other

4) Most Physicians Believe Regorafenib Will Have Some, Yet-to-be-Determined Impact on the Treatment of mCRC;

• Most mCRC treaters believe regorafenib will be a useful option for mCRC
• It is currently unclear exactly how much of an impact it will have on the treatment landscape and in how many patients it will be useful

5) Different Medical Specialties May be Used to Treat Liver-Only Colorectal Metastases

• Medical oncologists are the most common treaters of liver only mCRC
• Surgical resection of the liver only mets is the next most common approach
• An interventional radiologist is used to treat up to 20% of these cases
• Overall usage of these specialists are remarkably similar inside and outside of US

Hepatocellular Carcinoma (HCC) Survey Results:

1) Tivozanib, Cabozantinib, and Lenalidomide Are All Expected to Make Some Impact on the Treatment Landscape for HCC

• HCC treaters expect these 3 agents to each have some usefulness in the treatment of HCC
• US physicians see these three agents as having roughly the same level of impact
• Ex-US responders rated each of these agents slightly lower than their US counterparts
  • Ex-US respondents also gave a slightly higher rating to tivantinib over the other 2 drugs

Conclusions from the ASCO 2012 Quick Poll on Gastrointestinal Cancers

• The usage of bevacizumab maintenance therapy in mCRC is expected to rise in the next year
  • Twice as much gain in the US compared to the Ex-US respondents
• Continued targeting of angiogenesis after progression on bevacizumab, either with aflibercept or repeating bevacizumab, will be widely integrated into the 2nd line treatments for mCRC
  • US oncologists will have a slight preference for bevacizumab while Ex-US oncologists expect to use slightly more afibrercept
    • Slightly higher overall usage of continued angiogenesis targeting is expected in US compared to Ex-US
  • Few oncologists will either not use these agents or predominately use only one of these agents, implying that patient selection will play a key role
• Most oncologists expect regorafenib to have some impact in the clinical landscape for mCRC
  • Differing opinions on exactly how large of an impact it will have and for how many patients
• Treatment of liver-only CRC metastases is predominantly done by medical oncologists
  • Surgical oncologists and interventional radiologists are used in selected patients
• Tivozanib, cabozantinib, and lenalidomide are all expected to have some impact on the treatment landscape for HCC

Final Thoughts

Quick polls are a fast way of measuring expected acceptance of clinical data post major medical meetings, and perhaps can be used to make some assumptions about adoption amongst providers. In today’s information hungry environment, the speed at which these polls can be conducted and analyzed can be advantageous for market planning and “pressure testing” acceptance of data amongst key stakeholders.

Submitted by Jan Heybroek, President and Robert Stephan, Sr. Director Medical Services, The Arcas Group