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China's unique market for antineoplastic drugs in the era of precision medicine
   [China Pharmaceutical net market analysis] Antitumor drugs are rapidly moving towards the era of precision medicine and have their own unique market structure. In China, the market structure of antineoplastic drugs is different from that of the whole world.
  
Not long ago, the National Cancer Registry released its 2015 annual report. The annual report collected data on cancer in China in 2011. The results show that there are about 3 million 370 thousand cancer cases in China every year, with an incidence rate of 2.6 per thousand. Lung cancer, gastric cancer, liver cancer and colorectal cancer are the most common types of malignancies. Breast cancer, colorectal cancer, cervical cancer, prostate cancer and thyroid cancer are among the fastest growing categories.
  
Compared with China, the incidence of malignant tumors in the west is even higher. The incidence rate of cancer in the major countries of Europe and the United States is more than 4 per thousand. However, cancer is the leading cause of death in both China and the world.
  
The early diagnosis and new treatment methods bring about a high level of treatment, which greatly prolongs the survival time of malignant tumor patients in western countries, and also makes the global anti-tumor market maintain a rapid growth trend. According to the "GlobalOncology/CancerDrugsMarket (2013-2020)" released by AlliedMarketResearch in February 2015, the scale of the global antitumor drug market will still maintain a compound growth rate of 8.7%, and it is estimated that the scale will reach 111 billion 900 million US dollars in 2020. According to IMS data, as the largest drug category, the global antitumor drug market in 2014 has reached $74 billion 500 million, an increase of 8.8% over the same period last year.
  
Antitumor drugs are rapidly moving towards the era of precision medicine (PrecisionMedicine). According to the US version of the precision medical program, the key to precision medicine is gene sequencing, cancer and personalization.
  
Precision medicine is not just targeted at cancer, but for the time being, the most sophisticated area of precision medicine is antitumor drug therapy. At present, the global sales of targeted antitumor drugs have exceeded US $40 billion, and the share of the antitumor drug market has exceeded 50%. The world's best selling antitumor drugs, MabThera, An Weiting (Avastin), Hessaitin (Herceptin), Revlimid (Revlimid), Greve (Gleevec), Wan Ke (Velcade), and ITO (Erbitux), are all targeted drugs.

  
   "12th Five-Year" market tuning
  
Considering that China has added more than 3 million cancer patients every year, this has kept the Chinese antitumor drug market growing at a relatively fast pace, even in the context of the overall slowing down of the overall growth in the pharmaceutical market. From the data of the sample hospitals, the sales of antitumor drugs in the sample hospitals reached 15 billion 800 million yuan in 2014, up by 13.7% over the same period last year.
  
The cytotoxic drugs represented by alkaloids and anti metabolites are still the mainstream of clinical medication, while small molecule targeted drugs are growing rapidly.

  
   Cytotoxic drugs are still the mainstream.
  
Focus varieties: pemetrexed, gemcitabine, capecitabine, teggiol, paclitaxel, docetaxel
  
Antimetabolites and alkaloids are the most commonly used antitumor drugs in clinical practice.
  
Currently, the best selling drugs include pemetrexed, gemcitabine, capecitabine and teggio, the 4 drugs.
  
Pemetrexed is similar to methotrexate and belongs to folate resistant metabolites. Pemetrexed is the best selling anti metabolite drug. The sales volume of the sample hospital is 995 million yuan, an increase of 20% over the same period.
  
Sales are second only to pemetrexed's "teggio", the fastest growing anti metabolite. The drug is based on tegafur, and Jimei pyrimidine and ortetracil mainly play a synergistic and toxic role. In terms of efficacy and safety, the drug is superior to fluorouracil. The sales of teggio sample hospitals amounted to 707 million yuan, up 21% over the same period last year. Generic drugs account for 80% of the total, among which the most popular is the "new Kangda" in the new era of Lunan.
  
Capecitabine and teggio belong to oral fluorouracil drugs. The sales volume of the sample hospitals is 635 million yuan. The best seller is Roche's original research drug Xeloda. In 2014, a number of generic drugs were listed on the market, but the sales scale was limited.
  
The sales volume of gemcitabine sample hospital was 505 million yuan. The original drug "gemcitabine" and the generic drug "zefei" accounted for the majority of the shares. The antitumor mechanism of the drug was similar to that of cytarabine.
  
In terms of alkaloids, the two best selling drugs are paclitaxel and docetaxel. Paclitaxel has been growing at CISCO's paclitaxel liposomes (paclitaxel) and Abraxis's paclitaxel albumin binding type (Abraxane), two innovative dosage forms. The sales volume of paclitaxel sample hospitals reached 1 billion 390 million yuan, an increase of 15% over the same period, of which the sales of Abraxane and TOCOM reached 830 million yuan, up 30% over the same period last year. Although the sales volume of docetaxel reached 1 billion 30 million yuan, the market growth was weak.

  
  Target drug growth is fast.
  
Focus varieties: rituximab, trastuzumab, imatinib, bortezomib, and ecuitinib.
  
After years of development, the market size of targeted preparations has been gradually expanded. According to the sample hospital database, sales of targeted antitumor drugs reached 3 billion 640 million yuan in 2014, accounting for 23% of the antitumor drug market. Among them, rituximab and trastuzumab in small molecule targeted drugs and monoclonal antibodies have maintained a rapid growth trend.
  
Among the targeted antibody drugs, rituximab and trastuzumab are specific drugs for lymphoma and breast cancer, and are currently the two most popular target cancer drugs. Because the curative effect is better than that of the conventional treatment, although the cost of the two drugs is high, it has maintained a rapid growth. The sales volume of Roche's "rituximab" and "Herceptin" sample hospitals reached 710 million yuan and 580 million yuan respectively, up 14% and 20% compared with the same period last year. The sales volume of two products will keep increasing after the approval of two varieties of generic drugs.
  
Imatinib is the best selling small molecule targeting anticancer drug. In 2014, the sample hospital's sales volume reached 530 million yuan, an increase of 17% over the same period last year. Bortezomib (Wan Ke) as a myeloma specific drug sales amounted to 180 million yuan, an increase of 42% over the same period. As the first self-developed tyrosine kinase inhibitor in China, the sales volume of eatinib sample hospital in Zhejiang was 153 million yuan, an increase of 113% over the same period last year.
  
   R & D prospects for 13th Five-Year
  
Traditional pattern is stable, target drug leading period is not yet reached, hormone share increases.
  
In Europe and America, antineoplastic drugs have entered the era of precision medicine. According to FDA data, 24 antitumor drugs have been approved by FDA since 2013, of which 17 are targeted drugs.
  
Not only in Europe and the United States, China is also planning the Chinese version of the precise medical plan. China's precision medicine, on the one hand, should strengthen genetic screening and sequencing, as well as the establishment of databases. On the other hand, it will also strengthen the research and development of targeted anticancer drugs.
  
However, considering the high expenditure of targeted drugs, the target drug in the next five years will not be able to take the place of traditional drugs in China. The traditional antitumor drug pattern will be stable. On the other hand, taking into account the high incidence of hormone related malignancies such as breast cancer, cervical cancer and prostate cancer, the market share of hormone antitumor drugs will gradually expand.
  
   Targeting drug
  
Targeted drugs, there are 20 listed drugs in the domestic market, of which 6 belong to independent research and development varieties. Considering that the state will give more support to innovative drugs developed in China, we expect that independent research and development of targeted anticancer drugs, including Camry, Ai Heng and endou, will still have good opportunities during the "13th Five-Year" period.
  
On the other hand, those salable drugs, including rituximab, Herceptin and Gleevec, are expected to continue to grow at a relatively fast pace, especially after serious illness coverage. In terms of new drugs, katzinib and lenalidomide have achieved good sales in the global pharmaceutical market as a specific drug, and are expected to perform well in the next five years in China.
  
In addition, it is worth mentioning that biosimilars, including a series of rituximab and trastuzumab, have been declared in China, which are expected to be approved in five years and will change the market structure of antibody targeted drugs.
  
  Cytotoxic products
  
Cytotoxic drugs will remain the first line of treatment for most cancers in the next five years, including paclitaxel, oxaliplatin, pemetrexed, Tizio, capecitabine and gemcitabine. It is expected that it will continue to grow steadily, and the new market of leitrexed and teritabine will have a good performance in the next five years.
  
   Hormones
  
The growth rate of hormone drugs reached 18% in 2014, and the growth rate in the next five years is expected to remain. Because in China, the incidence of hormone related tumors, including breast cancer, cervical cancer and prostate cancer, has increased significantly. The first-line drugs for these malignant tumors generally need hormone drugs. Table hormone drugs have good market opportunities.

(source: Medical Economics)

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