15. Xtandi

Astellas and Medivation
Prostate cancer
2015 sales: $1.87 billion
2020 projection: $4.78 billion

Back when Xtandi was working its way through Medivation's ($MDVN) pipeline, market-watchers anticipated that the cancer pill could whiz ahead of Johnson & Johnson's ($JNJ) blockbuster Zytiga. So far, however, Zytiga has remained a step ahead of Xtandi, both in FDA approvals and in sales.

Medivation and marketing partner Astellas think that can change. In late 2014, the companies announced that Xtandi was FDA-approved to treat advanced prostate cancer in patients who hadn't yet received chemo. That first-line approval opened up a big new market to the drug, which had been OK'd only for patients who'd already failed on chemo.

Though Xtandi was second to this market, too--and Zytiga had already made big inroads--the drug has at least one advantage Astellas can use in its favor. Xtandi is a monotherapy, while Zytiga is used alongside the steroid prednisone. And then there's the combo approach, which could be a boon for both drugs: An ongoing Xtandi-plus-Zytiga trial, PLATO, reads out later in 2016.

The companies are also studying Xtandi in breast and ovarian cancers, which could obviously be big new markets for the med.

Leerink Partners analyst Geoffrey Porges sees Xtandi eventually hitting $4 billion to $5 billion in global sales--$6 billion, even, if it can expand into new indications as hoped. But in the next couple years, not so much. "The near-term outlook for [Medivation's] revenue trajectory and operating performance is unlikely to reflect this potential," Porges wrote in a recent investor note, "given the product's slower-than-expected uptake among the urologists who treat 85% of the eligible prostate cancer patients."

The overall prostate cancer marketplace is heating up with competition, including Bayer HealthCare's Xofigo and Dendreon's Provenge, recently bought out of bankruptcy by Valeant Pharmaceuticals ($VRX). Not surprisingly, an increase in market size is also expected, with Decision Resources estimating the market will double from $4.4 billion in 2013 to $9.3 billion by 2023. -- Tracy Staton (email | Twitter)

For more:
NIH and HHS get 'march-in' request for Astellas' Xtandi
NICE backs Astellas' Xtandi in pre-chemo patients, but J&J's Zytiga isn't so lucky
Astellas' Xtandi to challenge J&J's Zytiga in the EU with pre-chemo OK

15. Xtandi