Ballparking future market share for a medicine is always tricky, so why not survey a few docs? In this case, the drug in question is Celegene’s Revlimid, which is used to treat mulitple myeloma, but only as a second-line treatment. Still, the med racked up $320 million in sales last year and Celgene hopes to win approval for first-line treatment in a couple of years.

MML is the second-most common form of blood cancer in the US, affecting about 50,000 people each year, with 14,000 new cases diagnosed and 12,000 deaths annually. Jim Reddoch, who tracks biotechs for Friedman Billings Ramsey, last month queried 20 oncologists and hematologists, each of whom sees an average of 45 patients annually. This is more of a snapshot than a scientific survey - 20 is a tiny group - but here are their replies:

Top three findings: most use of Revlimid is now second line, but on front-line approval, 70 percent plan to move Revlimid to front-line use; a third of the docs held back on Revlimid use in last year’s fourth quarter due to patient reimbursement issues; and 65 percent say they would use Revlimid more often given evidence that cutting the dose of dexamethasone, a steroid used with Revlimid, doesn’t sacrifice effectiveness.

About 80 percent of Revlimid use is currently as second-line treatment, and only 10 percent as front line. But after FDA approval for front-line use, 80 percent of the docs would go that route.
And 65 percent would use Revlimid more often if the low-dose Dex combo was as effective as the high-dose Dex regimen, since Dex has nasty side effects. A recent study showed that Revlimid plus low-dose Dex is more effective, so that could become the standard of care.

Reddoch sees a a possible late-2009 approval at the latest. Interestingly, 35 percent of the docs say they would use Revlimid off label as a front-line treatment, so there’s still sales growth likely before FDA approval as front-line therapy.

Revlimid product info.[tags]Celgene, Revlimid[/tags]