Breast Cancer Drugs: Many Play, Few Will Win

This just makes me sad. Not that I didn't already know, but it's just hard to read in print sometimes. I suppose we should be grateful that vaccines are in the works....somehow that doesn't ease the pain though, of knowing if you have advanced disease, your f*cked.

My interpretation is very different and I think what they are saying is actually a good thing for patients.  

Reading the article and a couple that are linked to it, what I believe they are saying is that currently 62% of all treatments for advanced BC are given to women who developed advanced BC because they had a recurrence.  In the future, "due to the anticipated approval of novel agents that will improve outcomes for localized disease", they expect that fewer women will have recurrences and therefore fewer women will have advanced disease. Since advanced disease is where most of the drug money is currently spent (Herceptin costs a whole lot more than Tamoxifen, for example), with fewer women with advanced disease, the overall market for breast cancer drugs will decline.  As such, there will be few blockbuster drugs in the future, from a sales revenue standpoint.

They do say that "the number of women first presenting with advanced disease is expected to increase more quickly than the number of those presenting with recurrent disease." But this does not necessarily mean that they expect a greater percentage of women or more women to be diagnosed with advanced disease.  It's just the way the math works if fewer women develop recurrences. And in fact given that they are projecting a slowing of the drug market for advanced disease, one can conclude that they in fact expect fewer women to have advanced disease.  Here's an example of how the numbers could work:

2012: 400 women with BC; 100 of these women have advanced disease

• 25% have advanced disease
• 62 women had recurrences that led to the development of advanced disease; this represents 62% of those with advanced disease (as per the article) and 15.5% of those with BC
• 38 women were initially diagnosed with advanced disease; this represents 38% of those with advanced disease (as per the article) and 9.5% of those with BC

.

2021: 410 women with BC; 91 of these women have advanced disease Note that the reason I've assumed that more women are diagnosed with BC is because of population growth and an aging population. The rate BC development could be quite a bit lower than it is today and yet for those two reasons, in 10 years we'll still see more women being diagnosed (as an absolute number, not as a percentage of the population). 

• 22% have advanced disease
• 52 had recurrences that led to the development of advanced disease; this represents 57% of those with advanced disease (as per the projection in the article) and 12.7% of those with BC
• 39 were initially diagnosed with advanced disease; this represents 43% of those with advanced disease (as per the projection in the article) and 9.5% of those with BC

.

This example shows how the percent of women who are diagnosed with advanced disease could grow faster than those who develop advanced disease as a result of a recurrence, as the articles suggests will happen, and yet the number of women diagnosed with advanced disease still falls both as a percentage of the population and as a percentage of women diagnosed with BC. 

As for the question about the 250 companies and whether any other drugs will come onto the market, I think that part of the answer is what gracie said, which is that many of the drugs in development are biosimilars.  After all, Tamoxifen is not even marketed anymore; now it's all generics.  I think another part of the answer is that it takes a long time - more than 10 years in most cases - to get a drug to market. So there is no mystery about what might be coming to market over the next 10 years - it's all drugs that are currently in the pipeline. Looking at the pipeline, what the market analysis seems to have concluded is that there will be only 3 blockbuster drugs.  The other drugs in the pipeline likely are more targetted, drugs that they consider "novel agents that will improve outcomes for localized disease".  So I don't think at all that they are saying that only 3 drugs will make it to market. They are talking about the number of "big winners" from a revenue standpoint.  I think it's a good thing that much of the development is going against these types of more targetted "novel agents".  This means that in 10 years we will be able to refine and target treatment much more effectively.  

That's my interpretation.