What Is the Best-Selling Cancer Drug?

Zosia Chustecka

January 15, 2018

Surprisingly, a drug used for multiple myeloma generated the biggest sales for most of 2017, more than sales of drugs that are used across many different cancer types.

Top of the list is lenalidomide (Revlimid, Celgene), which is used mainly for multiple myeloma, although it is also indicated for certain myelodysplastic syndromes and mantle cell lymphoma

The list of cancer drug bestsellers appears in an article published online in Genetic Engineering & Biotech News.

Noting that cancer is the largest therapeutic area on the basis of sales, the report lists the top 10 bestselling cancer drugs, ranked by sales figures (for the first three quarters of 2017) provided by the manufacturers in various public statements. 

Table. Top-Selling Cancer Drugs

Drug Sales 1st to 3rd Quartile 2017 ($ billion) Sales 1st to 3rd Quartile 2016 ($ billion) Change (%)
Lenalidomide 5.999 5.166 16.1
Rituximab 5.760 5.620 2.5
Trastuzumab 5.363 5.252 2.1
Bevacizumab 5.121 5.241 –2.3
Filgrastim 3.864 4.151 –6.9
Nivolumab 3.587 2.464 45.6
Ibrutinib 3.236 2.226 45.4
Pembrolizumab 2.512 0.919 173.3
Palbociclib 2.410 1.492 61.5
Bortezomib 1.780 1.876 –5.1


After lenalidomide in the top spot, the next three positions are all held by monoclonal antibody products, all from the same manufacturer. 

In second place is rituximab (Rituxan, MabThera, Roche/Genentech & Biogen), which is a mainstay in the treatment of non-Hodgkin's lymphoma and chronic lymphocytic leukemia but is also used in the treatment of rheumatoid arthritis as well as granulomatosis with polyangiitis and microscopic polyangiitis.

Next is trastuzumab (Herceptin, Roche/Genentech), which is a mainstay in the treatment of human epidermal growth factor receptor 2–positive (HER-2) breast cancer and can also be used for HER-2–expressing gastric cancer..  

In fourth place is bevacizumab (Avastin, Roche/Genentech), an antiangiogenic agent that blocks vascular endothelial growth factor and is indicated for use in many cancer types, including colorectal, lung, kidney, and cervical cancers and glioblastoma. 

These latter three products are now starting to face competition from biosimilar versions, which have been approved in the last year in the United States and have already been available for a while in Europe. Indeed, it looks as if bevacizumab sales have already taken a hit and are showing a decrease when compared with the same period last year, whereas the other two products are holding on to small sales increases — for now. 

Falling Sales of Colony-Stimulating Factors 

Next in the table are filgrastim (Neupogen, Amgen & Gran, Kyowa Hakko Kirin) and the newer related product, a pegylated version of the same product, pegfilgrastim  (Neulasta/Peglasta). This granulocyte colony-stimulating factor is used in patients with various cancers to reduce neutropenia and infection.

The $3.864 billion sales figure for  2017 first through third quarters consists of $3.420 billion for Neulasta, $423 million for Neupogen, and ¥2.4 billion ($21.203 million) for the agents combined.  Nevertheless, even combined, these sales were lower compared with the same period last year, suggesting that competition from biosimilars is making its mark.

Filgrastim was the first bioengineered product to face competition from biosimilar versions. Biosimilar filgrastim has been marketed in Europe since 2008, and a biosimilar product was recommended for approval in the United States in January 2015.

Huge Growth for Immunotherapy

Showing a huge growth in sales are immunotherapies.

Pembrolizumab (Keytruda, Merck & Co) showed a staggering 173.3% increase in sales, while nivolumab (Opdivo, Bristol-Myers Squibb) grew by 45.6%. Both of these drugs are checkpoint inhibitors, acting on the programmed cell death pathways, and are now indicated for use in the treatment of many cancer types, building on the initial approvals in melanoma and lung cancer.  

Sandwiched in between these two immunotherapies in seventh place is ibrutinib (Imbruvica, Johnson & Johnson and AbbVie [Pharmacyclics]), which is indicated for several hematologic malignancies, including chronic lymphocytic leukemia, as well as mantle cell and marginal zone lymphomas, and use in chronic host-vs-graft disease. 

But another drug used in hematologic malignancies, bortezomib (Velcade, Johnson & Johnson and Takeda Pharmaceuticals), used in multiple myeloma and mantle cell lymphoma, is showing a decrease in sales and is at number 10 on the list.

In between is the new breast cancer drug palbociclib (Ibrance, Pfizer), the first of a new  class of agents, cyclin-dependent kinase (CDK) 4/6 inhibitors, indicated for use together with endocrine-based therapies in hormone receptor–positive breast cancer. These drugs used with antiestrogens have been hailed as the "new standard of care" for patients with advanced hormone-positive breast cancer, and the growing sales figures suggest that physicians have welcomed this one into the therapeutic armamentarium. 

Genet Engineer Biotechnol News. Published online January 15, 2018. Full text

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