Summary
GBI Research, has released its latest pharma report, 'Acute Myeloid Leukemia Therapeutics Market to 2020 - Novel Therapies to Offer Clinical Benefit in Small Patient Cohorts'
Treatment and prognosis in AML is strongly influenced by a patients age, and their cytogenetic profile. In the majority of cases these two prognostic influences are linked, with a higher frequency of unfavorable cytogenetic abnormalities observed in the elderly. Survival in this cohort of elderly patients is very poor, with a five year overall survival of 38% (Luger, 2010). Despite a relatively advanced understanding of genetic abnormalities associated with AML, the introduction of targeted therapies is lagging in this indication in comparison to other cancers such as breast and lung cancer, with no approved targeted therapies. Such slow development may be a reflection of AMLs status as an orphan indication.
Intensive treatment in eligible patients (younger patients, and approximately 50% of diagnosed elderly patients) is typically the combination of the two chemotherapeutic agents cytarabine and daunorubicin, both of which were approved in the 1960s. In patients ineligible for intensive first-line chemotherapy, options are very poor, with the more recently approved Vidaza and Dacogen as the treatment options, which both offer unsatisfactory survival. Across all newly diagnosed patients that obtain complete remission, a stem cell transplant offers the highest chance of long-term survival. However, this procedure is risky, with a higher rate of treatment related mortality in the absence of better techniques to reduce the risk of graft-versus-host disease.
The majority of patients experience disease relapse, which is almost always fatal. Treatment options in these patients typically involve the off-label use of chemotherapeutic agents, whether in combination or as monotherapies.
There are clear gaps in the market for therapies to meet several unmet needs by increasing the initial length of remission; improving treatment options for newly-diagnosed patients, ineligible for relapsed disease treatments; improving the success of and reducing the side effects of stem cell transplantation; and improving survival, safety and quality of life in patients with relapsed disease. The current developmental pipeline addresses these gaps in the market, along with the significant lack of targeted therapies. Five of the eight pipeline products are under development as non-intensive therapies for the elderly, and six of the eight products are being investigated in relapsed disease.
Results so far have been mixed, with several drugs offering no overwhelming clinical benefit in Phase I and II clinical trials. Some drugs have demonstrated encouraging results namely CPX-351, quizartinib, StemEx, treosulfan and midostaurin. All of these drugs are forecast to be approved within the forecast period, a result of clinical trial data that suggest these drugs can offer improved survival in comparison to the currently marketed products. It is important to note however, that these improvements and the subsequent approval of these products is restricted to small patient cohorts including patients with secondary AML, those with internal tandem repeats in Fms-like tyrosine kinase, and patients eligible for a stem cell transplant, but for whom a matched donor cannot be found. This fragmentation in the treatment algorithm is a reflection of the heterogeneity of AML, with continued fractionation likely to be essential for further effective treatments to be developed. This is reflected in the current developmental pipeline, with drugs targeting a high variety of molecule types and molecular targets currently under investigation in this disease.
The small patient cohorts the pipeline drugs are expected to be approved in will result i
