Immuno-oncology (IO) agents will be the dominant class in the hepatocellular carcinoma (HCC) market by 2029 due to the launch of pipeline drugs targeting programmed cell death protein 1 (PD-1) or programmed death-ligand 1 (PD-L1) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), which will constitute a large proportion of prescriptions as they will be used as monotherapy or in combinations through all stages and lines of therapy for HCC, says GlobalData. Class-wide sales of IO are expected to grow to 72.2 per cent of the market, contributing $3.8 billion to global sales in 2029 and growing at a compound annual growth rate (CAGR) of 28 per cent.

Kinase inhibitors, such as Bayer’s Nexavar (sorafenib) and Eisai’s Lenvima (lenvatinib), have dominated the HCC market for more than a decade and were the standard of care (SOC) in first-line advanced HCC until recently. GlobalData’s forecast shows this class of drugs capturing 65.9 per cent or $679.6 million of the total market sales in 2019, followed by immunotherapy at 31.5 per cent or $324.9 million, and angiogenesis inhibitors at 2.5 per cent or $26.2 million.

In 2020, Roche’s Avastin (bevacizumab), an angiogenesis inhibitor, plus Tecentriq (atezolizumab), an IO therapy, a first-in-class combination approved for first-line advanced HCC, was approved in the eight major markets (*8MM). The combination showed better safety and efficacy compared to kinase inhibitors and immediately replaced the SOC. GlobalData anticipates that the combination will remain the market leader by sales through 2029. Combined sales of these drugs are expected to be $1.9 billion, including biosimilar sales, with $1.3 billion (68.4%) of those sales coming from the combination in the first-line advanced HCC setting, and the remainder from sales of those drugs in other combinations and other lines of therapy.

Mandana Emamzadeh, Pharma Analyst at GlobalData, comments, “Angiogenesis inhibitors—including Avastin, which will be found across all lines of therapy, and Lilly’s Cyramza, in the second-line advanced setting, along with their biosimilars— are expected to grow to 18.2 per cent of market share by sales. This class is forecast to contribute $965.7 million to global sales in 2029 and represents the highest CAGR of 43.4 per cent by 2029. While impressive growth is expected due to the fast uptake of Avastin + Tecentriq, and due to the additional label expansions for Avastin, this is in part due to the low base-year sales in 2019 when the drug was considered off-label for HCC.

“Kinase inhibitors will mostly be the treatment of choice in second-line advanced HCC. In general, kinase inhibitors will see a downward trend in usage, resulting in a decline in market sales to 9.5 per cent or $505.5 million and posting a negative CAGR of 2.9 per cent by 2029.”

*8MM: US, France, Germany, Italy, Spain, UK, Japan, and China