Case Study 1 – Medialis built the Breakthrough Cancer Pain (BTcP) market

The Breakthrough Cancer Pain market is dwarfed by other pain markets, such as chronic pain.

The concept of BTcP was a relatively new one in that:

It was a specific type of cancer pain that was characterized by high insensity, short onset, short duration pain.

Traditionally, these types of symptoms were treated with oral morphine. There was concern in the palliative care speciality that oral morphine’s pharmacokinetics were incongruent with an optimal treatment for this type of pain. Given that Oral morphine’s onset of action was around 40mins, the feeling was that the BTcP would have subsided on its own well before the oral morphine had begun to exert its effect.

Rapid onset opioids were a new class of pain medicines whose pharmacokinetic profile matched the profile of BTcP well, and was postulated to be a more efficacious option for this particular pain.

BTcP studies were difficult to complete given that high attrition rates of patients with cancer and primary research was ruled out at an early stage.


The need here was to build the BTcP market by highlighting the benefits of the ROO class. The approach adopted was to conduct a systematic review and meta analysis identifying studies where ROOs were compared to oral morphine directly, and to model expected performances of the class in a head-to-head scenario.



Strategic Asset Generation

Medialis generated the systematic review and published it in a high impact factor journal.

The article continues to be cited to this day and supports the argument to move away from oral morphine for the treatment of BTcP and to a product such as Fentanyl Buccal Tablet.

Efficacy of Rapid-Onset Oral Fentanyl Formulations vs. Oral Morphine for Cancer-Related Breakthrough Pain: A Meta-Analysis of Comparative Trials.

Jandhyala R, Fullarton JR, Bennett MI.

J Pain Symptom Manage. 2013 Feb 1. doi:pii: S0885-3924(12)00815-9. 10.1016/j.jpainsymman.2012.09.009. [Epub ahead of print]


Medialis carried out full training for the sales force and implemented 1:1 online briefings for key customers. An electronic and paper leave pieces were also produced.

The following claims were generated:

  • ~2:1 (66%) likelihood that Effentora will produce better pain relief than Abstral*

  • ~2:1 (68%) likelihood that Effentora will produce better pain relief than Actiq*

  • 2:1 (68%) likelihood that Effentora will produce better pain relief than OM*