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For Treatment of Hepatocellular Carcinoma, at Least Half of Surveyed Oncologists View a Four-Month Improvement in Overall Survival or in Progression-Free Survival over Nexavar as Individually Sufficient to Prescribe a New Drug Ahead of Nexavar.

Emerging Small-Molecule Agents in Renal Cell Carcinoma/Hepatocellular Carcinoma That Fail to Garner Formulary Coverage Comparable to That of Current Therapies Will Have Difficulty Building Patient Share Among Some Surveyed Physicians

BURLINGTON, Mass. -- Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that surveyed U.S. oncologists prefer to use Bayer Healthcare/Onyx Pharmaceuticals' Nexavar as a front-line treatment for advanced hepatocellular carcinoma (HCC) patients, rather than reserving it for later lines, and their prescribing is aided by the 84 percent of surveyed managed care organizations (MCOs) that reimburse Nexavar on their commercial plans. The majority of surveyed oncologists view improvement in overall survival over that of Nexavar as the greatest unmet need to be addressed by an emerging therapy for HCC. At least half of surveyed oncologists view a four-month improvement in overall survival or a four-month improvement in progression-free survival over Nexavar as individually sufficient to prescribe a new drug ahead of Nexavar for the treatment of HCC. However, despite a strong focus on the efficacy of Nexavar, concerns about patient costs may make oncologists receptive to new therapies, if they have patient assistance programs that reduce copays.

The new U.S. Physician & Payer Forum report entitled Renal Cell Carcinoma and Hepatocellular Carcinoma: How Will U.S. Payer and Physician Attitudes Impact Prescribing of Small-Molecule Oral Therapies? also finds that although Pfizer's Sutent dominates surveyed oncologists' prescribing in the first-line setting for renal cell cancer (RCC), treatment of RCC in subsequent lines of therapy is highly fragmented and no single agent dominates patient share. Furthermore, 66 percent of surveyed commercial plans that reimburse for Sutent cover the agent on tier 1 or 2 of their formularies. Most surveyed oncologists say overall survival benefit is the factor that most strongly influences their selection of small-molecule agents for the first- and second-line treatment of RCC. Among all the angiogenesis inhibitors approved for advanced RCC, Sutent is the one with which the majority of surveyed oncologists are most familiar, and which physicians consider to have the best overall survival and progression-free survival data. In terms of performance on the majority of attributes profiled, most surveyed oncologists are unable to choose a clear winner from the two mTOR inhibitors approved to treat advanced RCC--Pfizer's Torisel and Novartis's Afinitor.

"An obstacle for emerging agents in the first-line setting for RCC is that they have not been trialed against Sutent, the current standard of care," said Decision Resources Analyst Gemma McConnell, Ph.D.

The report also finds that both office- and hospital-based surveyed oncologists acquire their small-molecule targeted agents for oncology overwhelmingly through specialty pharmacy. Greater convenience is the key driver of specialty pharmacy use for small-molecule targeted agents. Greater use of specialty pharmacy is expected by surveyed oncologists in two years' time, potentially eliminating the financial incentive to favor a specific drug because of its profit margin.

Emerging small-molecule agents in RCC/HCC that fail to garner formulary coverage that is at least comparable to that of current therapies will have difficulty building patient share among physicians who consider patient cost in their prescribing decisions.

"Surveyed MCO pharmacy directors are reluctant to reimburse for emerging therapies on a favorable tier without paying a discounted price relative to the comparator therapy," Dr. McConnell said.

About Decision Resources

Decision Resources ( is a world leader in market research publications, advisory services and consulting designed to help clients shape strategy, allocate resources and master their chosen markets. Decision Resources is a Decision Resources Group company.

About Decision Resources Group

Decision Resources Group is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Please visit Decision Resources Group at

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Publication:Business Wire
Date:Jun 26, 2012
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