Chemotherapy is a long-standing systemic treatment approach to multiple oncology indications. Historically, patients diagnosed with cancer received surgical and radiological interventions before chemotherapy options were discovered, introduced, and optimized for each indication.

However, chemotherapy lacks cancer-specific targets. With the increasing arrival of novel therapies, improved understanding of pathology, and discovery of biomarkers, chemotherapy could cease to be to the standard of care therapy option in many indications. The rate at which chemotherapy will become displaced will vary by indication. For example, hematological malignancies are more likely to retain chemotherapy as a key treatment strategy, while solid tumors are less chemotherapy-sensitive. Furthermore, cost-effectiveness remains an important issue for the use of chemotherapy, since chemotherapeutic agents are mostly generic and therefore cost less than the premium pricing of novel therapies entering the market. GlobalData expects that as premium-priced therapies lose patent protection, the resulting generics and biosimilars will usher in a new era where chemotherapy use may nearly cease to exist.

A review of GlobalData’s most recent syndicated oncology reports, of which six are hematological and eight cover solid tumors, served to highlight key trends on how the general oncology treatment paradigm is changing. For each report, a sum of all drug class sales in the base year was compared to the end of forecast year sales to determine these trends. Non-chemotherapeutic drug classes currently represent a larger market share than chemotherapy agents, and this gap is expected to widen over the forecast period. Furthermore, growth of these non-chemotherapeutic drug classes is more predominant in the five major European markets (5EU) (France, Germany, Italy, Spain, and UK) than in the US, though only by a small margin. One main reason for the current gap between the US and 5EU sales of premium agents is the privatization of the US healthcare system versus the common use of public healthcare in the 5EU. Scrutiny of cost-effectiveness is higher in the 5EU as governments are mostly responsible for the costs of healthcare in those countries. Therefore, decision-makers are more likely to opt for chemotherapy when possible, thus delaying the approval and uptake of premium-priced agents.

Two fundamental trends were identified when looking specifically at the chemotherapy drug class. First, the US market is projected to have a decline in chemotherapy sales in both hematological and solid tumors, while the 5EU is forecast to have an increase in sales for both types of indications. Similarly, in both the US and 5EU, these trends are greater in hematological malignancies, which rely more heavily on chemotherapy-based treatments.

Although multiple factors influence the key trends described above, chemotherapy is a “one size fits all” drug class that is highly cost-effective due to its lower price, and has the current advantage of having undergone extensive research into optimizing combinations for each indication. However, targeted and immune therapies continue to enter the market and prove their cost-effectiveness, despite significantly higher costs of therapy and the need for more research. Furthermore, the current 10-year forecasts are just beginning to project the rise of the biosimilar era, and are likely to peak during the next decade as blockbuster drugs lose their patents. GlobalData expects that chemotherapy will fall further behind in terms of preference, since indication-specific drugs will continue to decline in price and maintain a higher efficacy and safety profile versus chemotherapy.