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Apoptosis is regarded as the major mode of cell death in cancer and should therefore be considered as a potential target when developing new antineoplastic drugs. An increasing number of companies are doing so, and we anticipate that this approach will pay substantial dividends, both therapeutically and commercially. This report reviews 370 apoptosis-modulating drug candidates (9% in Phase 3 or later) developed by 233 companies and having 148 molecular targets. The report reveals a transforming market offering growth potential in cancer and other indications. Apoptosis (programmed cell death) is a natural phenomenon and occurs via a tightly regulated complex signaling cascade. Several major classes of drugs on the market - cancer chemotherapeutics, anti-TNF therapies, glucocorticoids - are now known to work, at least partly and/or indirectly, via apoptosis modulation. In cancer and in other diseases, elements of the apoptotic process become dysregulated, offering many direct targets for drug discovery. This report reveals that many drugs have been reported to induce cancer cell apoptosis in preclinical studies. Traditional chemotherapeutic agents impair cell division and induce apoptosis indirectly. Many of the second generation indirect apoptogens (IAs) in development are biotherapies. They include: monoclonal antibodies, peptides, oligonucleotides, oncolytic viruses, and immunotherapies. The prevalence of indirect apoptotic effects emphasises the importance of screening for apoptotic potential in new anticancer drugs. This is being enabled by the increasing availability of biomarker-based assays of apoptosis. Cancer is characterized by the (at least) partial suppression of apoptosis, which in turn causes chemotherapy resistance. Of particular interest therefore are direct apoptogens (DAs) designed to overcome treatment resistance due to overexpression of anti-apoptotic genes or downregulation of pro-apoptotic genes. Over one hundred first-in-class DAs directed at one or more of over 40 genes with a direct involvement in apoptosis (identified using the Stanford Research Institute's PANTHER database) are analyzed in this report. The targets include caspases, BCL2 family members, and TP53 (p53). Other targets which are gaining recognition are the proteasome and heat shock proteins (HSPs). Millenium Pharmaceuticals' Velcade is the first proteasome inhibitor (PI) on the US market, and represents the most cancer cell-selective apoptogen approved to date. We forecast that the market for specific, direct, modulators of apoptosis in oncology will grow from $0.6 billion in 2008 to $12 billion in 2013, an average annual growth rate (AGR) of 64%, when it will represent about 22% of all oncology drug sales. This is well in excess of the AGR for oncology as a whole (which is expected to be almost 14% over the same period). Oncology will itself be the best performing major segment of the overall pharmaceutical market, which will grow at around 6% over the forecast period. Individual forecasts are presented for PIs and other DAs targeting caspases, BCL2 proteins, TP53, and HSPs. We estimate that indirect modulators of apoptosis (which have varying apoptotic effects, but do not target known apoptotic pathways) comprise around half the oncology market by sales volume and will perform similarly to it, rising from $28 billion in 2008 to $57 billion in 2013, an average AGR of 12%. This corresponds to a fairly constant market share (51% of the oncology market in 2008, falling slightly to 48% by 2013). Forecasts are presented for first generation IAs and for the two main groups of second generation IAs (biologics and small moecules such as kinase inhibitors and hormone antagonists). Various agents known or suspected to have apoptosis-modulating properties are also in development for indications other than cancer. The two main areas are: CNS disorders (in particular neurodegenerative diseases) and chronic inflammation/autoimmunity (in particular rheumatoid arthritis). Depending on cells being targeted, therapies seek to either promote or interfere with apoptosis. Some of the DAs currently in development for cancer may also find application in the treatment of other diseases. This report also examines apoptosis-related patents and patent applications filed during the current decade to identify the most prolific filers of patents, technology trends and potential therapeutic applications of apoptosis research.
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