ABOUT DATAMONITOR HEALTHCARE 2
About the Oncology pharmaceutical analysis team 2

CHAPTER 1 EXECUTIVE SUMMARY 3
Strategic scoping and focus 3
Datamonitor insight into the cytotoxic therapies market 3
Related reports 4
Upcoming related reports 5

CHAPTER 2 MARKET DEFINITION 7
Market definition for this report 7
Cytotoxic therapies by ATC class 7
L1A - Alkylating agents 7
L1B - Antimetabolites 8
L1C - Vinca alkaloids and other plant-derived products 8
L1D - Antineoplastic antibiotics 8
L1X2 - Platinum compounds 8
L1X9 - All other antineoplastics 9

CHAPTER 3 MARKET OVERVIEW 10
Seven major markets 10
Current and future market overview 10
The cytotoxics therapies market will continue to grow through to 2018 despite several blockbuster products losing patent protection 10
Patent expiries on the leading cytotoxic brands are set to occur within the next 5 years 11
The US is due to lose nearly half its share of the seven major markets by 2018 due to generic erosion of key branded products 13
The antimetabolites are forecast to account for the largest proportion of market share through to 2018 14
The current leading cytotoxic brands are forecast to lose significant market share by 2018 due to patent expiry 16
The cytotoxics market will grow from $13.7 billion in 2008 to $18.7 billion in 2018 across the seven major pharmaceutical markets 17
Opportunities and threats 19
Opportunities 19
Threats 25
US 28
Current and future market assessment 28
The large impact that generic erosion has on sales of branded drugs will cause a decrease in the US cytotoxics market 28
The cytotoxics market will shrink from $6.8 billion in 2008 to $5.6 billion in 2018 in the US 30
Opportunities and threats 32
Opportunities 32
Threats 33
Japan 34
Current and future market assessment 34
The cytotoxics market in Japan is forecast to undergo strong growth due to new product launches and expansion of drugs into new indications 34
The cytotoxics market will grow from $2.1 billion in 2008 to $3.9 billion in 2018 in Japan 37
Opportunities and threats 39
Opportunities 39
Threats 40
Five major European markets (5EU) 42
Current and future market assessment 42
The cytotoxics therapies market in the five European countries will grow strongly through to 2018 as a result of several key product launches 42
The cytotoxics market will grow from $4.9 billion in 2008 to $9.2 billion in 2018 in the five major European markets 45
Opportunities and threats 47
Opportunities 47
Threats 50
France 53
Current and future market assessment 53
The cytotoxics market will grow from $1.8 billion in 2008 to $2.8 billion in 2018 in France 53
Germany 57
Current and future market assessment 57
The cytotoxics market will grow from $1.1 billion in 2008 to $2.3 billion in 2018 in Germany 57
Italy 60
Current and future market assessment 60
The cytotoxics market will grow from $0.8 billion in 2008 to $1.7 billion in 2018 in Italy 60
Spain 63
Current and future market assessment 63
The cytotoxics market will grow from $0.6 billion in 2008 to $1.4 billion in 2018 in Spain 63
UK 66
Current and future market assessment 66
The cytotoxics market will grow from $0.6 billion in 2008 to $1.1 billion in 2018 in the UK 66
Rest of the world snapshot 69
Current market assessment 69
Rest of the World sales represent 22% of the global cytotoxics market 69
Opportunities and threats 71
Opportunities 71
Threats 72

CHAPTER 4 BRAND DYNAMICS 73
Overview of competitive landscape 73
Taxotere and Eloxatin will be in the top 3 cytotoxic brands in 2008 and 2018 73
Drivers of brand choice 74
Efficacy and toxicity of a drug are the most important drivers of cytotoxic brand choice 74
Trends in marketing strategies 76
Marketing strategy for leading brands 76
Leading cytotoxic brands 77
Taxotere (docetaxel; Sanofi-Aventis) 77
Drug profile 77
Product positioning 78
SWOT analysis 79
Brand forecast to 2018 80
Eloxatin (oxaliplatin; Sanofi-Aventis) 81
Drug profile 81
Product positioning 82
SWOT analysis 83
Brand forecast to 2018 83
Gemzar (gemcitabine; Eli Lilly) 85
Drug profile 85
Product positioning 86
SWOT analysis 87
Brand forecast to 2018 88
Dacogen (decitabine; Eisai/Johnson & Johnson) 89
Drug profile 89
Development overview 90
Product positioning 92
SWOT analysis 92
Brand forecast to 2018 93

CHAPTER 5 KEY DEVELOPERS 96
Strategic overview 96
Trends in corporate strategy 97
Approval in multiple tumor types is most likely to result in significant sales 97
A mature and heavily genericized market means that the experience of large pharmaceutical companies is crucial 97
The current pipeline is relatively small and contains several reformulations of leading cytotoxic brands 98
Sanofi-Aventis 100
Corporate strategy 100
Oncology cytotoxics portfolio assessment 100
Eli Lilly 102
Corporate strategy 102
Oncology cytotoxics portfolio assessment 102
Portfolio assessment of other leading companies 103

CHAPTER 6 CASE STUDIES 106
Introduction 106
Case study 107
Supergeneric cytotoxics...not so super? 107
Approval of Taxol in a variety of solid tumors resulted in blockbuster sales... 107
...however, sales were quickly eroded when generic paclitaxel was launched 109
Taxol achieved blockbuster status despite being associated with significant administration and toxicity issues... 109
...although this spurred on generics manufacturers to develop 'supergeneric' paclitaxel to eliminate toxicities 109
Abraxane was the first of the 'supergeneric' paclitaxel reformulations to reach the market with many theoretical advantages over Taxol... 110
...however, in reality, uptake of Abraxane has been modest compared with Taxol's previous dominance of the market 110
While advantages of a supergeneric cytotoxic are obvious, reality means that only modest sales are likely to be achieved 111
BIBLIOGRAPHY 112
Journal papers 112
Websites 113
Datamonitor reports 118
Other 119

APPENDIX A - MARKET ASSUMPTIONS 121
New product launches 121
Patent expiries 121
Rest of class definition 122
Data definitions, limitations and assumptions 123
Standard units 123
Japanese market data 123
Rest of the World 123
Derivation of sales forecasts and pricing trends 124
Forecast methodology 124
Report methodology 124

APPENDIX B 125
About Datamonitor 125
About Datamonitor Healthcare 125
About the Oncology analysis team 126
Disclaimer 127

List of Tables
Table 1: Definition of the cytotoxic therapies market, 2009 7
Table 2: Sales and growth of cytotoxic therapy drug classes in the seven major markets, 2008-2018 11
Table 3: Key events impacting the cytotoxic therapies market, 2008-2018 12
Table 4: Cytotoxic therapy sales forecasts in the seven major markets ($m), 2008-2018 17
Table 5: Summary of opportunities and threats to impact the cytotoxics market across the seven major markets, 2009-2018 19
Table 6: Sales and growth of cytotoxic therapy drug classes in the US, 2008-2018 28
Table 7: Top 5 branded cytotoxics in the US in 2008 and 2018 30
Table 8: Cytotoxic therapy sales forecasts in the US ($m), 2008-2018 30
Table 9: Summary of opportunities and threats to impact the cytotoxics market in the US, 2009-2018 32
Table 10: Sales and growth of cytotoxic therapy drug classes in Japan, 2008-2018 35
Table 11: Top 5 branded cytotoxics in Japan in 2008 and 2018 37
Table 12: Cytotoxic therapy sales forecasts in Japan ($m), 2008-2018 37
Table 13: Summary of opportunities and threats to impact the cytotoxics market in Japan, 2009 39
Table 14: Sales and growth of cytotoxic therapy drug classes in the five major European markets, 2008-2018 43
Table 15: Top 5 branded cytotoxics in the five major European markets in 2008 and 2018 45
Table 16: Cytotoxic therapy sales forecasts in the five major European markets ($m), 2008-2018 45
Table 17: Summary of opportunities and threats to impact the cytotoxics market in the five major European markets, 2009 47
Table 18: Top 5 branded cytotoxics in France in 2008 and 2018 55
Table 19: Cytotoxic therapy sales forecasts in France ($m), 2008-2018 55
Table 20: Top 5 branded cytotoxics in Germany in 2008 and 2018 58
Table 21: Cytotoxic therapy sales forecasts in Germany ($m), 2008-2018 58
Table 22: Top 5 branded cytotoxics in Italy in 2008 and 2018 61
Table 23: Cytotoxic therapy sales forecasts in Italy ($m), 2008-2018 61
Table 24: Top 5 branded cytotoxics in Spain in 2008 and 2018 64
Table 25: Cytotoxic therapy sales forecasts in Spain ($m), 2008-2018 64
Table 26: Top 5 branded cytotoxics in the UK in 2008 and 2018 67
Table 27: Cytotoxic therapy sales forecasts in the UK ($m), 2008-2018 67
Table 28: Comparison of cytotoxic drug class sales ($m) in the seven major markets and Rest of the World, 2008 70
Table 29: Comparison of cytotoxic drug class sales ($m) in the BRIC countries, Australia and Canada, 2008 71
Table 30: Leading branded cytotoxic drug sales in the seven major markets ($m), 2008-2018 73
Table 31: Marketing strategies employed by the companies behind the top three cytotoxic brands, 2009 76
Table 32: Taxotere - drug profile, 2009 78
Table 33: Impacting factors on the revenues of Taxotere, 2008-2018 81
Table 34: Eloxatin - drug profile, 2009 82
Table 35: Impacting factors on the revenues of Eloxatin, 2008-2018 85
Table 36: Gemzar - drug profile, 2009 86
Table 37: Impacting factors on the revenues of Gemzar, 2008-2018 89
Table 38: Dacogen - drug profile, 2009 90
Table 39: Ongoing Phase III trial investigating Dacogen in acute