The breast cancer drug market will remain largely static over the next decade, increasing from $10.2 billion in 2009 to $10.4 billion in 2019 in seven major world markets, according to a new study.

Significant declines in sales, resulting from generic erosion of key products and a substantial reduction in prescribing of Roche/Genentech/Chugai's Avastin (bevacizumab) due to its withdrawal from the US market, will be offset by an annual increase in the incidence of breast cancer and also by the uptake of premium-priced emerging agents, according to the report, from Decision Resources.

By 2019, combined sales of emerging therapies will account for more than one-quarter of the overall market for breast cancer drug treatments, according to the study, which looks at the market over the next decade in the US, France, Germany, Italy, Spain, the UK and Japan.

Decision Resources notes that, at the time it undertook the study, oncologists were aware that the US Oncologic Drug Advisory Committee had recommended the removal of Avastin's label for the treatment of breast cancer. Nevertheless, 63% of oncologists surveyed for the report selected Avastin plus paclitaxel (Bristol-Myers Squibb's Taxol, plus generics) as the most efficacious treatment for metastatic triple-negative breast cancer when compared to other currently-available therapies, it notes. Moreover, given Avastin's dominance in metastatic triple-negative breast cancer, few of the physicians selected Celgene's Abraxane (nanoparticle paclitaxel), paclitaxel or Sanofi-Aventis' Taxotere (docetaxel) as the most efficacious therapy for the indication, it adds.

Based on clinical data and the opinions of thought leaders interviewed for the study, Decision Resources reports that Abraxane is currently considered the gold-standard therapy, as a result of having the strongest clinical profile among key marketed products used in the treatment of metastatic triple-negative breast cancer. However, it adds that the use of ramucirumab (Eli Lilly's IMC-1121b) plus Taxotere has competitive advantages in efficacy, which means this combination is expected to displace Abraxane and become the gold standard for metastatic triple-negative breast cancer following its launch for this indication in 2016.

Surveyed US oncologists and the pharmacy directors of managed care organisations (MCOs) indicate that efficacy, including improvement in time to disease progression, is one of the greatest unmet needs in metastatic triple-negative breast cancer, comments Decision Resources analyst Amy Duval. "The opinions of interviewed thought leaders indicate that ramucirumab plus Taxotere has the potential to partially fulfill this unmet need," she adds.

The report's survey of US oncologists also reveals that the clinicians would prescribe ramucirumab to 13% of their metastatic triple-negative patients, and Decision Resources comments that, as a result of its favourable efficacy profile, the compound is expected to earn an 11% patient share of the US market for drugs used in the treatment of metastatic triple-negative breast cancer by 2019.