The chemotherapy induced anemia market is estimated to be valued at USD 2.65 Bn in 2024 and is expected to reach USD 4.1 Bn by 2031, growing at a compound annual growth rate (CAGR) of 6.1% from 2024 to 2031. The high prevalence of cancer patients undergoing chemotherapy as the primary line of treatment is expected to drive the demand for chemotherapy induced anemia drugs and therapeutics.

Market Driver - Increasing Use of Chemotherapy in Cancer Treatment Causing a Rise in Cases of Chemotherapy-induced Anemia

As per estimates, nearly three quarters of all cancer patients receive chemotherapy during the course of their treatment. While chemotherapy is aimed at destroying cancer cells, the drugs used also tend to impact healthy cells including red blood cells. This can lead to reduced red blood cell count or hemoglobin levels manifesting as anemia. Anemia due to chemotherapy is quite common, occurring in over 90% of cancer patients receiving the drugs.

The primary driver of increased anemia risk is the growing number of chemotherapy regimens used for handling cancers. A wider array of chemotherapy agents is available today that target different signaling pathways and molecular targets within cancer cells. This allows oncologists to employ multi-drug combination therapies that are more effective against heterogeneous and drug-resistant malignancies.

However, such intensive chemotherapy comes at the cost of greater hematological toxicities including anemia that requires treatment. Another factor promoting the condition is improved survival rates of cancer allowing patients to receive more cycles of chemotherapy over their lifespan. This prolonged exposure to chemotherapy only elevates their anemia probability long term. Rise in elderly population diagnosed with cancer also heightens chemotherapy induced anemia due to age related decline in bone marrow reserve and function.

Market Driver - Development of Novel Therapies and Biosimilars Enhances Treatment Efficacy and Accessibility

The chemotherapy induced anemia market is witnessing entry of novel anemia treatment options which are aimed at improving patient outcomes and experience. Continuous drug innovation is expanding therapeutic choices available to physicians.

Coming years will see many pipeline drugs entering the commercial stage after gaining regulatory clearances. These next generation drugs hold promise of better targeting multiple pathways involved in anemia management like iron regulation, erythropoiesis stimulation and inflammation control. They may prove more effective at correcting anemia and reducing needs for blood transfusions or hospitalizations.

Biosimilars of blockbuster erythropoietic stimulating agents have also expanded the treatment universe. Their competitive pricing compared to reference biologics have made anemia medications more affordable and boosting adoption rates. Being equally safe and effective alternatives, biosimilars are assisting in lowering financial barriers to accessing anemia care, especially in developing world healthcare systems with limited budgets.

With rising focus on reducing costs of Specialty drug spending across the world, inclusion of biosimilars in insurance formularies and public health programs are expected to escalate. Their uptake will support in offsetting price inflation pressures owing to monopoly patents expiring on originator brands in the analyzed market over the next five years.

Market Challenge - Adverse Effects Associated with ESAs and Iron Supplements May Limit Their Usage

One of the major challenges faced by the chemotherapy induced anemia market is the adverse effects associated with the usage of ESAs (erythropoiesis-stimulating agents) and iron supplements. Both ESAs and intravenous iron supplements which are commonly used to treat chemotherapy induced anemia come with certain risks.

ESAs have been associated with increased risks of thromboembolic events like heart attacks and strokes in cancer patients. Several clinical studies in the past have linked ESAs usage to reduced survival and increased tumor progression in some cancer patients. This has led health regulators across countries to issue label changes and restrictions on the usage of ESAs.

Intravenous iron supplements, on the other hand, may cause severe allergic reactions and anaphylaxis in some patients. The risks of side effects and safety concerns amongst healthcare professionals as well as patients have resulted in more cautious approach towards the usage of ESAs and IV iron, especially when treating non-myeloid cancers.

This safety and efficacy profile of the current anemia management therapies can limit their usage in real-world clinical settings and discourage physicians from prescribing them. The adverse event risks can negatively impact the market potential of these drugs despite their therapeutic benefits.

Market Opportunity - Growing Healthcare Infrastructure in Developing Countries Presents New Market Opportunities

The chemotherapy induced anemia therapeutics market has strong prospects for growth in developing regions of the world due to improving healthcare infrastructure and rising focus on cancer care. Many countries in Asia Pacific, Latin America, Middle East and Africa are witnessing substantial investments in healthcare delivery systems and expansion of health insurance coverage in the recent years. This is enabling better access to advanced cancer treatments like chemotherapy for a greater number of patients in these countries.

Since anemia commonly occurs as a side effect of chemotherapy, the growing chemotherapy patient pool will directly translate to increasing demand for effective anemia management therapies. At the same time, developing nations offer much lower treatment costs compared to developed markets of North America and Western Europe, which makes these regions lucrative for manufacturers.

The pharmaceutical companies can tap into this emerging chemotherapy induced anemia markets through partnerships with local distributors, pragmatic pricing of drugs and physician/patient awareness campaigns. The healthcare sector developments in Asia Pacific and other developing economies present significant commercial opportunities for market players over the coming years.

Chemotherapy-induced anemia is commonly treated with erythropoiesis-stimulating agents (ESAs). For mild cases (hemoglobin 10-11g/dL), prescribers typically start with a first-line ESA such as epoetin alfa (brand name: Procrit) or darbepoetin alfa (brand name: Aranesp). These agents are administered by subcutaneous injection on a weekly or biweekly basis.

For more severe anemia (hemoglobin <10 g/dL), prescribers may opt for intravenous iron supplementation in addition to an ESA. Commonly prescribed intravenous iron products include ferric carboxymaltose (brand name: Ferinject) and iron sucrose (brand name: Venofer). Prescribers often reserve intravenous iron for patients who are unable to maintain hemoglobin levels on ESA treatment alone or who have inadequate iron stores.

If anemia fails to respond to first-line ESA therapy or becomes dependent on high ESA doses to maintain hemoglobin, prescribers will switch to a second-line long-acting ESA such as methoxy polyethylene glycol-epoetin beta (brand name: Mircera). This second-line option allows for less frequent dosing.

Beyond medications, prescribers also consider factors like cancer type/stage, performance status, symptoms, and tolerability of side effects when choosing a treatment approach. Younger, fit patients receiving chemotherapy for curative intent are more likely to receive aggressive anemia management versus older, frail patients receiving palliative treatment.

Chemotherapy-induced anemia can range from mild to severe depending on the type and duration of chemotherapy. Treatment options vary based on the severity of anemia and line of treatment.

For mild CIA (hemoglobin 10-11.9 g/dL), erythropoiesis-stimulating agents (ESAs) like epoetin alfa (Procrit) or darbepoetin alfa (Aranesp) are preferred. They stimulate the bone marrow to produce more red blood cells. ESAs are administered by subcutaneous injection once or twice weekly.

For moderate CIA (hemoglobin 8-10 g/dL), ESAs are still the standard first-line treatment but intravenous iron supplementation may be added. Intravenous iron, such as ferric carboxymaltose (Injectafer), corrects iron deficiency and works synergistically with ESAs to produce a faster hematopoietic response.

In cases of severe CIA (hemoglobin <8 g/dL) requiring red blood cell transfusions, ESAs plus intravenous iron remain first-line. However, if the underlying cancer has a poor prognosis or the patient is transfusion-dependent, erythrocyte transfusions combined with ESA therapy provide more rapid and effective relief from anemia symptoms.

For later-line CIA treatment, biosimilar ESAs and inexpensive intravenous iron preparations are preferred to minimize costs. Overall, a personalized approach considering disease status and symptom severity guides the most suitable CIA treatment options in each line of therapy.

Market players have adopted strategic acquisitions and partnerships as a key part of their growth strategy over the past decade.

For instance, in 2011, Amgen acquired Pharmacia to strengthen its presence in cancer treatment. This gave Amgen access to several pipeline drugs and biosimilars to treat chemotherapy induced anemia. Epogen (Epoetin alfa) and Aranesp (darbepoetin alfa) were some of the blockbuster drugs in Amgen's portfolio to treat anemia resulting from chemotherapy.

Similarly, in 2015, Johnson & Johnson partnered with Shanghai Fosun Pharmaceutical to commercialize its anti-anemia drug, DARZALEX (daratumumab), in China. Through this partnership, J&J was able to leverage Fosun's strong regional expertise and network of over 1,300 hospitals to penetrate the fast-growing Chinese market. By 2018, DARZALEX sales in China exceeded $100 million, accounting for over 15% of its global revenues.

Another winning strategy has been expanding indications for existing drugs through continued clinical investments. For example, 3SBio Inc. conducted multiple phase III trials of Qilu (recombinant human erythropoietin) between 2010-2015 to expand its approved usage in chemotherapy induced anemia. This allowed 3SBio to maintain patent exclusivity and negotiate higher reimbursement prices from China's public insurance programs.

Insights, By Drug: High Efficacy and Safety drives Erythropoiesis-Stimulating Agents (ESAs) Segment Dominance

In terms of drug, erythropoiesis-stimulating agents (ESAs) is likely to hold 55.4% of the market owning to their well-established safety and efficacy profiles. ESAs work by stimulating the body's natural production of red blood cells, helping to reduce anemia symptoms and decrease the need for blood transfusions in chemotherapy patients. Short-acting ESAs provide a rapid response but require frequent dosing. Meanwhile, long-acting ESAs only need to be administered weekly or bi-weekly, improving convenience.

Among ESAs, epoetin alfa and darbepoetin alfa are commonly prescribed. Epoetin alfa was one of the first ESAs developed specifically for treating chemotherapy-induced anemia. It has a well-established safety record from decades of use. Darbepoetin alfa is a long-acting ESA that only needs to be dosed once every two or three weeks, providing an even more convenient option for patients. Both drugs significantly reduce the risk of blood transfusions compared to placebo or standard of care. Their strong efficacy at managing anemia allows patients to complete cancer treatment on schedule without interruptions.

Insights, By Route of Administration: Route of Administration Influences Choice of Therapy

In terms of route of administration, injectable ESAs and iron supplements are projected to hold 68.7% of the market share in 2024. While oral therapies may seem more convenient, factors like bioavailability, dose control and side effects make injectables the mainstream choice.

ESAs must be carefully dosed to be effective while avoiding serious side effects like thrombosis. Injectable administration allows for precise dosing according to patient factors like weight and hemoglobin levels. It also bypasses potential issues with oral bioavailability. Many chemotherapy patients already receive other intravenous medications as part of cancer treatment, so adding injectable anemia therapies does not burden them further.

For iron supplements, oral bioavailability is low and levels are difficult to regulate. Intravenous supplementation ensures better iron availability and faster hematologic response compared to oral routes. It is more effective at rapidly increasing iron stores and elevating hemoglobin levels, which is crucial during intensive chemotherapy cycles. Additionally, intravenous iron avoids potential gastrointestinal intolerance issues associated with oral supplements.

Insights, By Distribution Channel: Hospital Pharmacies are Preferred due to Complex Needs

Among distribution channels, hospital pharmacies contribute the highest share. Patients receiving chemotherapy tend to have complex medical needs requiring close monitoring and guidance from clinicians. Cancer care often involves long hospital visits and admissions for chemotherapy administration and management of side effects.

Being located within hospitals, pharmacies are well-positioned to address the specialized needs of this vulnerable patient population. They can efficiently provide injectable ESAs, intravenous iron and blood transfusions if required. Pharmacists also offer counseling on proper medication administration and side effect management. Same-day turnaround for medications ensures seamless continuation of cancer treatment without delays.

Close collaboration between oncologists, nurses and hospital pharmacists further optimizes anemia management. Any issues can be promptly addressed through convenient in-person discussions. This level of coordinated, integrated care is difficult for retail or online pharmacies to match. For chemotherapy patients dealing with significant illness impacts, the convenience and personalized support of hospital pharmacies remains invaluable.

• Prevalence of Anemia in Chemotherapy Patients: Approximately 70% of chemotherapy patients experience anemia, underscoring the significant need for effective management strategies.
• Impact on Quality of Life: Effective treatment of chemotherapy-induced anemia has been shown to improve patients' quality of life by reducing fatigue and enhancing physical functioning.
• The collaboration between Johnson & Johnson and Teva Pharmaceutical Industries led to the development of biosimilar ESAs, making treatments more affordable and accessible.
• Pfizer Inc. invested in research focusing on minimizing the side effects of iron supplements, improving patient tolerance and adherence to therapy.

The major players operating in the Chemotherapy Induced Anemia Market include Amgen Inc., Johnson & Johnson, Pfizer Inc., Hoffmann-La Roche Ltd., Teva Pharmaceutical Industries Ltd., Mylan N.V., Vifor Pharma, Akebia Therapeutics, Pharmacosmos A/S, and Sandoz International GmbH (a Novartis division).

• In September 2023, Vifor Pharma partnered with Pharmacosmos A/S to expand the distribution of intravenous iron supplements in Asia Pacific, aiming to address the unmet needs in emerging markets. However, recent news highlights that Vifor Pharma is under investigation by the European Commission for potentially anticompetitive behavior involving disparagement of Pharmacosmos, its main competitor in the intravenous iron treatment market.
• In July 2023, Akebia Therapeutics received FDA approval for Vafseo (vadadustat), an oral hypoxia-inducible factor prolyl hydroxylase inhibitor (HIF-PHI). This approval was specifically for the treatment of anemia due to chronic kidney disease (CKD) in adults who have been on dialysis for at least three months. Vafseo offers a convenient oral alternative to traditional injectable therapies and helps increase hemoglobin and red blood cell production by simulating the body’s response to hypoxia​.
• In March 2023, Amgen Inc. announced positive results from a Phase III trial of a long-acting ESA, demonstrating improved efficacy in managing chemotherapy-induced anemia. This advancement may enhance patient compliance and outcomes.

• By Drug
  • Erythropoiesis-Stimulating Agents (ESAs)
    • Short-acting ESAs
    • Long-acting ESAs
  • Iron Supplements
    • Oral Iron Supplements
    • Intravenous Iron Supplements
  • Others
    • Blood Transfusions
    • Nutritional Supplements
• By Route of Administration
  • Injectable
  • Oral
• By Distribution Channel
  • Hospital Pharmacies
  • Retail Pharmacies
  • Online Pharmacies