Novel mutation-targeting therapies in the horizon to relieve the global healthcare burden NSCLC poses

Non-small cell lung cancer market is anticipated to increase in the 7MM from USD 9,730 million in 2017 by 2030.

Worldwide, cancer claimed the lives of approximately 9.6 million people in 2018 as per WHO, with lung cancer being the most commonly diagnosed one and accounting for the highest number of deaths (1.76 million deaths in 2018). Attributed to the increasing healthcare burden that lung cancer poses, the epidemiological analysis is taken into careful monitoring.

Lung cancer, till date, remains the most leading cause of the deaths worldwide, however, the epidemiological analysis depicts varying NSCLC incidence all over the world. According to the American Cancer Society, out of the total lung cancer cases, approximately 80─85% of lung cancers are non-small cell lung cancer (NSCLC).

Non-small cell lung cancer Epidemiology

As per the DelveInsight analysis, the total NSCLC incident cases in the 7MM were observed to be 484,726 cases in the year 2017. Moreover, the NSCLC incidence is expected to increase on significantly for the study period 2017–2030.

Categorizing the sub-types of cancer on the basis of histology can play a potential role as a predictive factor in advanced NSCLC patients undergoing chemotherapy. On the basis of histology, NSCLC is categorized into Adenocarcinoma, Squamous cell carcinoma, Large cell carcinoma, and NSCLC not otherwise specified (NOS) – where the diagnosis does not confirm any particular subtype. Total cases of squamous cell carcinoma were observed to be 142,566 with adenocarcinoma following behind with 228,106 cases of total non-small cell lung cancer. Large cell carcinoma accounted for 57,027 and remaining 57,027 cases fell into the category of NOS in the 7MM.

NSCLC is further stratified on the basis of the location of the tumor, and it’s spread to the other parts of the body, non-small cell lung cancer is bifurcated into stages from zero to four. However, the rate of metastasizing in NSCLC to other organs is quite slower in comparison to Small cell lung cancer. As per the DelveInsight estimates, the total NSCLC diagnosed cases by stages in the 7MM were observed to be 86,590 for stage I, and 31,552 for stage II. Stage II further subcategorized into III A and III B accounted for 56,297 and 65,410 cases respectively, whereas Stage IV NSCLC cases were reported to be 244,876 approximately. These cases are expected to grow with a significant CAGR in the study period 2017–2030.

The pathophysiology of the NSCLC is very poorly understood so it becomes imperative to study and define treatment regimen that improved the disease course. Mutations in EGFR, KRAS, and ALK influence the targeted therapies to be administered, hence testing for these mutations and tailoring therapy accordingly are widely accepted as standard practice. As per the DelveInsight estimates, the total NSCLC cases of patients by genetic mutation/biomarkers are expected to increase in the 7MM due to rising cases of NSCLC. The total NSCLC cases of patients by genetic mutation/biomarkers in the United States were observed to be 89,597 cases of PD-L1; 37,370 of EGFR; and 50,393 of KRAS. The NSCLC cases due to mutations in ALK, PI3KCA, BRAF, MET, and ROS-1 were reported to be 8,449; 12,665; 8,979; 7,202; and 2,136 respectively in the year 2017. Moreover, DelveInsight estimates an increase in the NSCLC incidence cases by genetic mutations by 2030.

Non-small cell lung cancer Market: Diagnosis and current therapies

Early detection of the NSCLC offers favourable prognosis and high chances of eliminating tumor through surgical resection.  The diagnosis and staging of NSCLC are often done at the same time. The tests and procedures used in the diagnosis of NSCLC are Physical exam and history, Laboratory tests, Chest X-ray, CT scan, Sputum cytology, Thoracentesis, Fine-needle aspiration (FNA) biopsy of the Lung, Bronchoscopy, Thoracoscopy, Mediastinoscopy, Anterior Mediastinotomy, Lymph node biopsy, Molecular test, Immunohistochemistry, among others.

However, approximately 75% of NSCLC patients have advanced stages of cancer and the survival rate of patients at advanced stages of NSCLC remains unsatisfactory.

However, with the recent breakthroughs in the medical sector and an inclination towards targeted therapy from chemotherapy, there was a hope for the patients diagnosed at advanced stages of non-small cell lung cancer. Targeted therapies are one of the most exciting breakthroughs in cancer treatment, which unlike chemotherapy, is proficient in differentiating tumor cell from healthy normal cells. People who have advanced lung cancer with certain molecular biomarkers may receive treatment with a targeted drug alone or in combination with chemotherapy.

However, for developing successful targeted agents, an in-depth understanding of this disease, and awareness of its histologic subtypes, molecular subgroups harboring critical mutations becomes increasingly of significance to facilitate which, several institutes and pharmacological companies have indulged themselves into.

EGFR was the first one to be identified among the various types of mutations associated with the condition. Also, over time several other drivers have been identified that potentially leads to the development of lung cancer. The current scenario of Non-small cell lung cancer therapeutics is mainly based on the use of targeted therapies and immunotherapies. Especially the current paradigm is mainly associated with treatment specific to mutations that occur in NSCLC.

In the Pipeline

At present, therapies in the Non-small cell lung cancer market are Opdivo (Nivolumab), Imfinzi (Durvalumab), Keytruda (Pembrolizumab), Tecentriq (Atezolizumab), Tagrisso (osimertinib), and Vizimpro (dacomitinib) which target different types of mutations and form the major treatment option in the Non-small cell lung cancer market.

Several other novel targeted therapies are in the pipeline for Non-small cell lung cancer market that that shall drive the market size in the 7MM, and is anticipated to increase by 2030 from USD 9,730 million in 2017. Even though Non-small cell lung cancer market constitutes a robust pipeline, the cost-effectiveness of targeted therapies come out as a great dejecting factor which is a major barrier in the growth of non-small cell lung cancer market. Key players such as AstraZeneca, Bristol-Myers-Squibb, AbbVie, Roche, Merck, Novartis, Pfizer, Takeda Pharmaceuticals, Eli Lilly, Johnson & Johnson, Sanofi, GlaxoSmithKline, and others are involved in developing drugs for Non-small cell lung cancer (NSCLC) that are responsible for the change in dynamics of the Non-small cell lung cancer (NSCLC) market by 2030. In addition to the key companies, hike in healthcare spending, early diagnosis due to better understanding of the disease are other factors driving the NSCLC market forward.