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Roche’s Xeloda (capecitabine) shows comparable efficacy rates to fluorouracil, but it is orally administered and treatment is cheaper. During the last half-decade a number of new agents, notably irinotecan (Pfizer) and oxaliplatin (Sanofi-Synthélabo), have entered the colorectal cancer market. These treatments are now used both alone and in combination with fluorouracil in the treatment of advanced colorectal cancer. Unmet needs Colorectal cancer presents a reasonable five-year overall survival rate of 61% (SEER Cancer Statistics 1998), but less than 10% of patients diagnosed with metastatic disease can expect to survive for five years.

There is also currently a need for consensus opinion on second-line treatments, and a need for increased randomized clinical trials to provide evidence for the various second-line approaches now in use. Furthermore, current hormonal treatments are expensive because of their long-term administration in prostate cancer, and there is a need for inexpensive, psychologically acceptable alternatives. Improvements in screening and diagnosis have led to increased early-stage diagnosis, but there remains a need for more expansive screening programs and increasing patient awareness, particularly in older men who are more at risk.

Traditionally this has been achieved by using an anti-androgen, but it is likely that many US urologists may now switch to Plenaxis. As such, Plenaxis may further reduce Lupron usage in prostate cancer. Third, the most immediate threat is expected from Zoladex (goserelin). After overtaking Lupron’s dominant position during in 2003, it will continue to eat into the older drug’s market share. The loss will become more pronounced on the expiry of Lupron’s patent in 2004, which will most likely result in more attractive pricing for Zoladex.

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