By 2020, the value of the market for bladder cancer therapies in the US and Europe will have increased dramatically, due in part to the arrival of emerging therapies that will carve out niche roles, according to new forecasts.

The current standard of care for non-muscle-invasive bladder cancer (NMIBC) includes chemotherapy within the bladder and Bacillus Calmette-Guerin (BCG) immunotherapy, both of which are associated with significant side effects. Approximately 50% of patients either fail to respond to treatment or suffer disease recurrence within 10 years, according to the study, from Decision Resources.

BCG dominates the NMIBC setting, and while none of the emerging therapies will overcome BCG in treating NMIBC, they will be used as alternatives to older chemotherapies - and, in the instance of Allergan/Spectrum Pharmaceuticals' EOquin (apaziquone), as treatment in the immediate postoperative setting within NMIBC, it says.

EOquin is expected to be the first novel agent to launch for the treatment of bladder cancer, and will be the only one to launch before 2015, according to Decision Resources, which forecasts that EOquin will be approved for single immediate postoperative use in 2013, in the US and in 2014 in France, Germany, Italy, Spain and the UK. The study also forecasts approval for the drug in multiple instillations in 2017 in the US, Germany and the UK, and in 2018 in France, Italy and Spain.

In addition to EOquin, experts believe that Celgene's Abraxane (paclitaxel injection) will benefit NMIBC patients, says the study, and it forecasts that this drug will launch in the US in 2018 for the treatment of bladder cancer.

"Marketers of bladder cancer therapies will find that NMIBC is the most lucrative setting because it encompasses about three-quarters of all bladder cancer patients," comments Decision Resources analyst Mary Argent-Katwala. 

"Within the treatment algorithm for NMIBC, the most feasible opportunity for multiple therapies are single immediate postoperative instillation and multiple adjuvant instillations for low- and intermediate-risk NMIBC," she says.

"Unless other tumour types - such as breast cancer, colorectal cancer, lung cancer - there have been few new agents approved for bladder cancer within the last 20 years, so there are low competitive barriers to entry for bladder cancer compared with some other cancer markets," adds Dr Argent-Katwala.