Chemotherapy induced diarrhea - Market Insight, Epidemiology And Market Forecast - 2032

This “Chemotherapy-induced Diarrhea (CID) - Market Insights, Epidemiology, and Market Forecast - 2032” report delivers an in-depth understanding of the CID, historical and forecasted epidemiology as well as the CID market trends in the United States, EU4 and the UK and Japan.

The Chemotherapy-induced Diarrhea (CID) market report provides current treatment practices, emerging drugs, CID market share of the individual therapies, and current and forecasted CID market Size from 2019 to 2032, segmented by seven major markets. The Report also covers current CID treatment practice/algorithm, and unmet medical needs to curate the best of the opportunities and assesses the underlying potential of the market.

Geography Covered

• The United States
• EU4 (Germany, France, Italy, and Spain) and the United Kingdom
• Japan

Study Period: 2019-2032

Chemotherapy-induced Diarrhea (CID) Understanding and Treatment Algorithm

This chemotherapy-induced diarrhea (CID) market report thoroughly explains the disease.

Most patients with cancer receive curative or palliative chemotherapeutic intervention throughout their treatment course. Gastrointestinal toxicities, including nausea, vomiting, ulceration, bleeding, constipation, and diarrhea, are often the major causes of treatment delays, dose adjustment, and treatment discontinuation during chemotherapy. Diarrhea is an unpleasant but common side effect in people receiving treatment for cancer, or cancer itself may cause it. The duration and severity of diarrhea may depend on the factors causing it; sometimes, it can signify something more serious. Diarrhea is a well-recognized side effect associated with various phases of a patient with cancer's treatment cycle. It is defined as the frequent passage of loose stools with urgency (or more frequent passage than is normal for the individual). Objectively defined, it is the passage of more than three unformed stools in 24 h.

Chemotherapy-induced diarrhea (CID), also called chemotherapy-related diarrhea, can be associated with various chemotherapy agents but is most commonly described with fluoropyrimidines (particularly fluorouracil [FU] and capecitabine) and irinotecan. Diarrhea is the dose-limiting and major toxicity of regimens containing a fluoropyrimidine with irinotecan. However, in addition to conventional cytotoxic drugs, many molecularly targeted agents (including tyrosine kinase inhibitors [TKIs] and monoclonal antibodies) are also associated with CID. Diarrhea affects chemotherapy's benefits by reducing the dose or delaying the schedule and decreasing patients' quality of life; it can even increase the life-threatening risk of dehydration. Despite the severity of CID, it is often not recognized by clinicians and is poorly managed.

The severity is often described using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) grades. Severity is determined by the number of stools per day or increased ostomy output compared with baseline, the need for hospitalization, and the effect on self-care activities. It is critical to ascertain the patient's baseline bowel pattern when grading the severity of CID. Although important, this grading system has limitations as it does not include either volume and duration or subjective complaints such as abdominal cramps and does not consider the patient's perception of the severity of this symptom.

Classification of CID uses grades established by the National Cancer Institute (NCI) to describe the severity of diarrhea. Grade 1 is an increase of fewer than four stools a day. Grade 2 is an increase of four to six stools a day. Grade 3 includes an increase of seven or more stools a day, an inability to control bowel movements, and a reduced ability to care for daily needs. Treating Grade 3 diarrhea usually requires a hospital stay. Grade 4 diarrhea is a life-threatening condition that requires immediate medical care.

Patients with mild-to-moderate (Grade 1 or 2) diarrhea and no moderate-to-severe abdominal cramping, Grade 2 or worse nausea/vomiting), decreased performance status, fever, frank bleeding, or suspected dehydration are classified as “uncomplicated.” Additionally, patients who present with Grade 3 or 4 diarrhea and those with Grade 1 or 2 diarrhea associated with moderate to severe abdominal cramping, Grade 2 or worse nausea/vomiting, declining performance status, fever, sepsis, neutropenia, frank bleeding, or dehydration are classified as “complicated.”

The diagnosis of CID starts with the doctor taking the patient's medical history, including exposure to possible causative agents. A careful physical examination may follow this to assess for signs of volume depletion (e.g., reduced skin turgor, hypotension, which may be primarily orthostatic, and low jugular venous pressure) and infection. Other than this, as per the patient's condition, various diagnostic tests may also be used to understand the patient's condition further. These tests include laboratory (stool cultures, blood cultures, etc.) and radiological exams (computed tomography [CT], endoscopy, ultrasound, etc.) in more compromised patients, microbiological examinations, etc.

Treatment

Treatment for CID includes nonpharmacologic and pharmacologic interventions to slow diarrhea and careful serial evaluation to assess therapy response and rule out significant volume depletion or other risk factors that would require targeted intervention or hospitalization. Initial management depends on the severity of diarrhea and whether or not additional “risk factors” are present. The management is recommended based on classifying patients with “uncomplicated” or “complicated.”

Uncomplicated CID patients can initially be managed conservatively at home with oral hydration, dietary modification, and antidiarrheal therapy (typically loperamide 4 mg to start, then 2 mg every 4 h or after each loose stool). If symptoms persist after 12-24 h, the loperamide dose can be increased to 2 mg every 2 h. If mild-to-moderate diarrhea persists 12-24 h later despite the higher dose of loperamide, patients should be evaluated in the office under observation for further evaluation. Outpatient octreotide is a reasonable next step without an added risk factor for complicated diarrhea, chest pain, or prior admission for CID.

Most complicated patients warrant admission for IV fluids, octreotide, monitoring of cardiovascular status, serial assessment of electrolytes, and antibiotics if needed. However, selected patients with Grade 3 diarrhea that have not yet been treated adequately with loperamide, who are well hydrated, and who have no worrisome signs or symptoms may be managed at home initially. Neutropenic patients are recommended to avoid surgery if possible.

For patients who develop severe symptoms (diarrhea, mucositis, myelosuppression) during a first chemotherapy cycle containing a fluoropyrimidine, in whom deficiency of one of the fluoropyrimidine metabolizing enzymes (i.e., DPD or thymidylate synthetase) is suspected, or who have had an unintentional overdose of FU or capecitabine, the need for uridine triacetate should be addressed. Uridine triacetate must be started within 96 h of the last exposure to be effective.

Chemotherapy-induced Diarrhea (CID) Epidemiology

Chemotherapy-induced diarrhea (CID) epidemiology division provides insights into the historical and current CID patient pool and forecasted trends for every seven major countries. It helps to recognize the causes of current and forecasted trends by exploring numerous studies and views of key opinion leaders. This report also provides the diagnosed patient pool, their trends, and assumptions undertaken.

Key Findings

The disease epidemiology covered in the report provides a historical and forecasted CID epidemiology scenario in the 7MM covering the United States, EU4 and the United Kingdom, and Japan from 2019 to 2032.

The disease epidemiology covered in the report provides historical and forecasted CID epidemiology (segmented as incident cases of selected cancer types, total patients on chemotherapies by cancer type, incident cases of CID by selected cancer* types, grade-specific incident cases of CID, and total treated cases of CID) in the 7MM covering the United States, EU4 countries and the United Kingdom, and Japan from 2019 to 2032.

*selected cancers include - colorectal cancer, breast cancer, bladder cancer, cervical cancer, esophageal cancer, head and neck, lung cancer, ovarian cancer, pancreatic cancer, testicular cancer, stomach cancer, endometrial cancer, and castration-resistant prostate cancer (CRPC)

In 2022, the total incident cases of CID were around 1,000,000 in the 7MM, which are expected to rise by 2032 at a significant CAGR. In the 7MM, the highest number of total incident cases of CID were observed in the US, with a significant market share in the total cases.

Country Wise Chemotherapy-induced Diarrhea (CID) Epidemiology

The epidemiology segment also provides the CID epidemiology data and findings across the United States, EU4 and the UK, and Japan.

As per The estimates, among the selected 13 major indications, lung cancer contributed to the highest number of CID cases in the US. The incidence cases of CID associated with lung cancer in the US were nearly 100,000 in 2022, projected to increase by 2032, with a significant CAGR. Apart from these, the incidence cases of CID associated with various cancers, including colorectal cancer, breast cancer, bladder cancer, cervical cancer, esophageal cancer, head and neck, ovarian cancer, pancreatic cancer, testicular cancer, stomach cancer, endometrial cancer, and CRPC were approximately 60,000, 80,000, 25,000, 3,500, 6,000, 25,000, 8,000, 10,000, 2,000, 10,000, 6,000, and 17,000, respectively in 2022. In 2022, the total number of incident cases of CID by selected cancer were ~360,000 cases in the US, which might rise by 2032.

Similarly, among the selected 13 major indications, lung cancer contributed to the highest number of CID cases in EU4 and the UK. The incident cases of CID by lung cancer in EU4 and the UK were nearly 100,000 in 2022, projected to rise by 2032, with a significant CAGR. Apart from these, the incidence cases of CID by colorectal cancer, breast cancer, bladder cancer, cervical cancer, esophageal cancer, head and neck, ovarian cancer, pancreatic cancer, testicular cancer, stomach cancer, endometrial cancer, and CRPC were approximately 95,000, 85,000, 35,000, 4,000, 9,000, 30,000, 10,000, 15,000, 3,000, 20,000, 5,000, and 16,000 in 2022, respectively. In 2022, the total number of incident cases of CID by selected cancer were ~430,000 cases in EU4 and the UK, which might rise by 2032.

Among selected 13 major indications, colorectal cancer contributed to the highest number of CID cases in Japan. The incident cases of CID by colorectal cancer in Japan were nearly 60,000 in 2022, projected to rise by 2032, with a moderate CAGR. Apart from these, the incidence cases of CID by lung cancer, breast cancer, bladder cancer, cervical cancer, esophageal cancer, head and neck, ovarian cancer, pancreatic cancer, testicular cancer, stomach cancer, endometrial cancer, and CRPC were approximately 60,000, 35,000, 12,000, 3,000, 8,000, 8,000, 4,000, 8,000, 200, 55,000, 2,000, and 4,000 in 2022, respectively. In 2022, the total number of incident cases of CID by selected cancer were ~250,000 cases in Japan, which might rise by 2032.

Chemotherapy-induced Diarrhea (CID) Drug Chapters

The drug chapter segment of the chemotherapy-induced diarrhea (CID) report encloses a detailed analysis of CID late-stage (Phase III and Phase II) pipeline drugs. It also helps to understand the CID clinical trial details, expressive pharmacological action, agreements and collaborations, approval and patent details, advantages and disadvantages of each included drug, and the latest news and press releases.

Chemotherapy-induced diarrhea (CID) emerging drugs

The report provides the details of the emerging therapies under the late and mid-stage of development for chemotherapy-induced diarrhea treatment.

MYTESI/crofelemer (Napo Pharmaceuticals [Jaguar Health])
Crofelemer is an investigational drug developed by Napo Pharmaceuticals, a wholly owned subsidiary of Jaguar Health in California, to treat secretory diarrhea from various causes. It is a novel, first-in-class antisecretory agent that normalizes electrolyte and fluid balance while acting locally in the gut. This mechanism of action can benefit multiple disorders that cause gastrointestinal distress, including diarrhea and abdominal discomfort. This antidiarrheal agent is an isolated and purified compound extracted from the red bark sap, also referred to as “dragon's blood,” of the Croton lechleri (Euphorbiaceae) tree found in South America and works through two separate channels associated with chloride and fluid secretion in the GI tract. Based on its mechanism of blocking chloride ion secretion through CFTR and CACC, crofelemer is being investigated in diarrhea (with multiple causative factors, including cancer therapy-related diarrhea) and has also been approved for the symptomatic relief of non-infectious diarrhea in adult patients with HIV/AIDS on anti-retroviral therapy. Currently, the company is investigating the drug in Phase III clinical trial, evaluating crofelemer for diarrhea prophylaxis in adult patients with solid tumors receiving targeted-cancer therapies with or without standard chemotherapy. Moreover, in February 2022, Jaguar Health and Napo Therapeutics announced that Napo Therapeutics has been granted Small and Medium Enterprise (SME) designation by the EMA.

Note: Detailed emerging therapies assessment will be provided in the final report.

Chemotherapy-induced Diarrhea (CID) Market Outlook

Chemotherapy-induced diarrhea (CID) market outlook of the report helps to build a detailed comprehension of the historic, current and forecasted CID market trends by analyzing the impact of current therapies on the market, unmet needs, and demand for better technology.

This segment gives a thorough detail of the CID market trend of late-stage pipeline therapy by evaluating their impact based on the annual cost of therapy, inclusion and exclusion criteria, mechanism of action, compliance rate, growing need of the market, increasing patient pool, covered patient segment, expected launch year, competition with other therapies, brand value, their impact on the market and view of the key opinion leaders. The calculated market data are presented with relevant tables and graphs to give a clear view of the market at first sight.

According to an international, cross-sectional survey among European oncologists by Kordes and Gerling (2019), the recommended initial approach to the patient with severe CID generally includes hospital admission, IV fluids, and the opioid-receptor agonist, loperamide, to regulate gut motility. However, evidence from randomized controlled trials for the use and dosage of loperamide is limited, and recommendations are largely based on expert opinion and clinical experience, as well as extrapolated from data from the treatment of diarrhea in other clinical settings, such as irritable bowel disease. In therapy-refractory cases, the somatostatin analog, octreotide, has been recommended based on a Phase I trial and a small study conducted in the 1990s comparing octreotide to loperamide. Beyond these evidence-based recommendations, data on CID management are sparse, reflected in the limited overall strength of guideline recommendations.

Results from the survey among European oncologists on the management of CID revealed a broad consensus on the drugs and the type of IV fluid used to treat patients with CID. Most oncologists considered loperamide as the drug of choice for severe CID, followed by deodorized tincture of opium, octreotide, and oral antibiotics. Some variations in treatment approaches became evident when analyzing results from countries with more than eight answers separately; however, most respondents used loperamide.

Napo Pharmaceuticals, a wholly owned subsidiary of Jaguar Health, has initiated clinical trials investigating new treatment options. The company is investigating their candidate, MYTESI (crofelemer), to manage CID in Phase III clinical trial. Other than this, few companies are also investigating their candidate in the pre-clinical development stage, such as OnQuality Pharmaceuticals (OQL105).

According to the publisher, the CID market in the 7MM is expected to witness a major change in the study period 2019-2032.

Key Findings

Chemotherapy-induced diarrhea (CID) market size in the 7MM is expected to change during 2019-2032. The total market size of CID in the 7MM accounted for ~USD 80 million in 2022, which is expected to rise with a significant CAGR during the study period (2019-2032).

The United States market outlook

The total market size of CID in the United States accounted for ~USD 40 million in 2022, which is expected to rise with a significant CAGR during the study period (2019-2032).

EU4 Countries and the UK: market outlook

In EU4 and the UK, the total market size of CID was found to be ~USD 25 million in 2022, which is expected to rise with a significant CAGR during the study period (2019-2032).

Japan market outlook

The total market size of CID in Japan accounted for ~USD 15 million in 2022, which is expected to rise with a significant CAGR during the study period (2019-2032).

Chemotherapy-induced Diarrhea (CID) Uptake

This section focuses on the uptake rate of potential drugs recently launched in the CID market or expected to be launched during 2019-2032. The analysis covers CID market uptake by drugs, patient uptake by therapies, and sales of each drug.

This helps in understanding the drugs with the most rapid uptake and reasons behind the maximal use of new drugs and allows the comparison of the drugs based on market share and size, which again will be useful in investigating factors important in market uptake and in making financial and regulatory decisions.

Chemotherapy-induced Diarrhea (CID) Development Activities

The report provides insights into therapeutic candidates in the Phase II and III stages. It also analyses chemotherapy-induced diarrhea key players involved in developing targeted therapeutics.

Pipeline development activities

The report covers detailed information on collaborations, acquisitions, and mergers, licensing patent details, and other information for CID emerging therapies.

KOL Views

To keep up with current market trends, we take KOLs and SMEs' opinions working in chemotherapy-induced diarrhea (CID) domain through primary research to fill the data gaps and validate our secondary research. Their opinion helps to understand and validate current and emerging therapies, treatment patterns, or CID market trends. This will support the clients in potential upcoming novel treatments by identifying the overall scenario of the market and the unmet needs.

Competitive Intelligence Analysis

The publisher performs competitive and market intelligence analysis of the chemotherapy-induced diarrhea (CID) market using various competitive intelligence tools, including SWOT analysis, PESTLE analysis, Porter's five forces, BCG Matrix, Market entry strategies, etc. The inclusion of the analysis entirely depends upon the data availability.

Scope of the Report

• The report covers the descriptive overview of chemotherapy-induced diarrhea (CID), explaining its causes, signs and symptoms, pathophysiology, diagnosis, and currently available therapies.
• Comprehensive insight has been provided into the CID epidemiology and treatment in the 7MM.
• Additionally, an all-inclusive account of emerging therapies for CID are provided, along with the assessment of new therapies that will impact the current treatment landscape.
• A detailed review of the CID market, historical and forecasted, is included in the report, covering drug outreach in the 7MM.
• The report provides an edge while developing business strategies by understanding trends shaping and driving the global CID market.

Report Highlights

• In the coming years, chemotherapy-induced diarrhea (CID) market is set to change due to the upcoming therapies with the novel route of administrations under investigation and ongoing research in CID; which would expand the market size to enable the drug manufacturers to penetrate more into the market.
• The companies and academics are working to assess challenges and seek opportunities that could influence CID R&D. The therapies under development are focused on novel approaches to treat/improve the disease condition.
• Major players are involved in developing therapies for CID. The launch of emerging therapies will significantly impact the CID market.
• A better understanding of disease pathogenesis will also contribute to developing novel therapeutics for CID.
• Our in-depth analysis of the pipeline assets across different stages of development (Phase III and Phase II), different emerging trends, and comparative analysis of pipeline products with detailed clinical profiles, key cross-competition, launch date along with product development activities will support the clients in the decision-making process regarding their therapeutic portfolio by identifying the overall scenario of the research and development activities.

Chemotherapy-induced Diarrhea (CID) Report Insights

• Patient population
• Therapeutic approaches
• Chemotherapy-induced diarrhea pipeline analysis
• Chemotherapy-induced diarrhea market size and trends
• Market opportunities
• Impact of upcoming therapies

Chemotherapy-induced Diarrhea (CID) Report Key Strengths

• 10 Years forecast
• The 7MM coverage
• Chemotherapy-induced diarrhea epidemiology segmentation
• Key cross competition
• Highly analyzed market

Chemotherapy-induced Diarrhea (CID) Report Assessment

• Current treatment practices
• Unmet needs
• Pipeline product profiles
• Market attractiveness

Key Questions Answered

Market Insights:

• What was chemotherapy-induced diarrhea (CID) drug class share (%) distribution in 2019, and how would it look in 2032?
• What would be the total CID market size and market size by therapies across the 7MM forecast period (2019-2032)?
• What are the key findings of the market across 7MM, and which country will have the largest CID market size during the forecast period (2019-2032)?
• At what CAGR the CID market is expected to grow by 7MM during the forecast period (2019-2032)?
• What would be the CID market outlook across the 7MM forecast period (2019-2032)?
• What would be the chemotherapy-induced diarrhea market growth till 2032, and what will be the resultant market size by 2032?
• How would the unmet needs affect the market dynamics and subsequent analysis of the associated trends?

Epidemiology Insights:

• What are the disease risk, burden, and regional/ethnic differences of chemotherapy-induced diarrhea (CID)?
• What are the key factors driving the epidemiology trend for seven major markets covering the United States, EU4 and the UK, and Japan?
• What is the historical CID patient pool in seven major markets covering the United States, EU4 and the UK, and Japan?
• What would be the forecasted patient pool of CID in seven major markets covering the United States, EU4 and the UK, and Japan?
• Where will be the growth opportunities in the 7MM concerning the patient population about CID?
• Out of all the 7MM countries, which country would have the highest incident population of CID during the forecast period (2019-2032)?
• At what CAGR the patient population is expected to grow by 7MM during the forecast period (2019-2032)?

Epidemiology Insights:

• What are the current options for chemotherapy-induced diarrhea (CID) treatment in addition to the approved therapies?
• What are the current treatment guidelines for CID in the USA, Europe, and Japan?
• How many companies are developing therapies for CID?
• How many therapies are in development by each company for CID?
• How many emerging therapies are in the mid-stage and late stage of development for CID treatment?
• What are the key collaborations (Industry - Industry, Industry - Academia), mergers and acquisitions, and licensing activities related to the CID therapies?
• What are the recent novel therapies, targets, mechanisms of action, and technologies being developed to overcome the limitation of existing therapies?
• What are the clinical studies going on for CID and their status?
• What are the current challenges faced in drug development?
• What are the key designations that have been granted for the emerging therapies for CID?
• What are the global historical and forecasted markets of CID?

Reasons to Buy

• The report will help develop business strategies by understanding trends shaping and driving the chemotherapy-induced diarrhea (CID) market.
• To understand the future market competition in the CID market and insightful review of the market.
• Organize sales and marketing efforts by identifying the best opportunities for CID in the US, EU4 and the UK, and Japan.
• Identifying strong upcoming players in the market will help devise strategies to help get ahead of competitors.
• Organize sales and marketing efforts by identifying the best opportunities for the CID market.
• To understand the future market competition in the CID market.