Data-driven insights into cancer treatment and care
The Credit Suisse Healthcare Database offers unique insights into the treatment of various diseases. It shows that immuno-oncology as a treatment for cancer has rapidly emerged as a $30 billion+ global market, with the potential for significant growth.
Therapeutic journeys followed by Credit Suisse
The CS Healthcare Database contains anonymized prescription claims data from around 122 million US citizens, with additional medical claims data for up to half of this population. The database allows real-world drug use to be tracked by indication (tumor type), something not currently available from other data sources. It captures typical therapeutic journeys and gives an overview of persistence and compliance on a therapy, common treatment cocktails, and transitions onto and off specific drugs.
Cancer insights are of particular importance given the widespread nature of the disease, the rate of growth in the market, and the lack of information on new commercially important treatments in available audit services.
Immuno-oncology and PD-(L)1 treatments
Immuno-oncology (I-O) harnesses a patient’s own immune system to fight cancer. Immunotherapy drugs were first assessed in "metastatic" cancer (when cancer has spread from the primary tumor site), where the unmet need was highest. Insights from the CS Healthcare Database illustrate the potential offered by earlier-stage and sequential use of I-O treatments to enhance initial responses.
PD-1 or PD-L1 inhibitors are a group of checkpoint inhibitor drugs that first came to the market in 2017. They work by blocking the activity of the PD-1 and PD-L1 immune checkpoint proteins that are present on the surface of cells. Blocking the binding allows T-cells to kill tumor cells, harnessing the body’s own immune system to fight cancer.
There are seven PD-1 or PD-L1 therapies with US regulatory approval for various different tumor types today. Global sales for these drugs are expected to increase by more than 50% by 2026 (from 2021), according to Evaluate consensus data. Notably, the CS Healthcare Database indicates that 20-30% of PD-(L)1 drug use occurs in tumor types for which the drugs are not currently approved by the Food and Drug Administration (FDA). This is known as “off-label” use.
Immuno-oncology market share by disease area
Immunotherapy agents are used for multiple tumor types. By looking at the number of claims by “indication”, an implied market share by disease can be calculated. Lung cancer is the most common cancer worldwide; patients are often diagnosed late, with around 75% as metastatic diagnoses. For most indications, Keytruda, the top-selling I-O drug, is seen as the dominant brand of choice.
Keytruda is gaining share of new patient starts, with lung, gastrointestinal and breast cancers contributing the most to patient growth.
The future of immuno-oncology
Global I-O sales between 2021 and 2027 are expected to have a compound annual growth rate (CAGR) of around 10%i. The therapies are seen as the backbone of future cancer care, with many companies exploring novel combinations to enhance responses and studying the drugs in earlier settings such as adjuvant use (where tumors are more localized and patients have a better likelihood of survival).
i Credit Suisse estimates