#AACR: Mer­ck spot­lights piv­otal Keytru­da/chemo da­ta, hop­ing to break down skep­ti­cism to its front­line lung can­cer duo

CHICA­GO — Mer­ck wowed the im­muno-on­col­o­gy mar­ket ear­ly this year with the head­line news that its piv­otal KEYNOTE-189 study demon­strat­ed a clear suc­cess for Keytru­da com­bined with chemo in treat­ing front­line lung can­cer cas­es. And at AACR in Chica­go to­day, its in­ves­ti­ga­tors spelled out the promis­ing re­sults — demon­strat­ing that the com­bo re­duced the risk of death by half with a haz­ard ra­tio of 0.49 — as Mer­ck looks to hold back a wave of ma­jor league com­peti­tors as it carves out a big­ger share of the block­buster lung can­cer mar­ket.

In the first look at hard da­ta for non­squa­mous non-small cell lung can­cer — which will be care­ful­ly com­pared with the da­ta from Bris­tol-My­ers — re­searchers say that their com­bo clear­ly beat out chemo alone on over­all sur­vival, though the fi­nal OS rate for the com­bi­na­tion has not yet been reached. 

Leena Gand­hi

The great­est ben­e­fit among these pa­tients was among the high PD-L1 ex­pressers, but chief in­ves­ti­ga­tor Leena Gand­hi at the Perl­mut­ter Can­cer Cen­ter at NYU Lan­gone Health al­so says that the sur­vival ben­e­fit could be seen across the board on PD-L1 ex­pres­sion.

Mer­ck’s piv­otal da­ta from the -189 study are cru­cial to their cam­paign to be the leader in check­point in­hi­bi­tion. Ap­proved by the FDA for front­line cas­es on Phase II da­ta — but re­ject­ed in Eu­rope — Mer­ck says that physi­cians have been slow to change the way they treat lung can­cer. Now Mer­ck be­lieves this da­ta should re­solve any doubts as Keytru­da be­comes the stan­dard of care in this crit­i­cal­ly im­por­tant set­ting.

At 12 months, Gand­hi tells me, 69.2% of the com­bo arm was still alive, com­pared to 49.4% in the con­trol arm. 

Ac­cord­ing to Mer­ck, pa­tients in the drug arm were 51% less like­ly to die than the con­trol group, and those in the high­est PD-L1 score group were 58% less like­ly to die. The rates held up de­spite a high num­ber of pa­tients who crossed over to the com­bo af­ter their dis­ease pro­gressed.

“The great­est ben­e­fit was seen in those with high lev­els of PD-L1 ex­pres­sion, sug­gest­ing that PD-L1 does have some pre­dic­tive val­ue even in this com­bi­na­tion set­ting,” Gand­hi said. 

Me­di­an PFS was 8.8 months for the pem­brolizum­ab arm, ver­sus 4.9 months for the con­trol group.

Some an­a­lysts have been wait­ing to see if the ben­e­fits for the com­bo leaned pri­mar­i­ly to high PD-L1 ex­pressers, leav­ing ri­vals an open­ing in divvy­ing up the mar­ket on the rest. But Gand­hi says the sur­vival ad­van­tages are clear re­gard­less of PD-L1 sta­tus. That marks a trend that many are see­ing, where new ther­a­peu­tic ap­proach­es are de­liv­er­ing en­hanced re­sults for the high-PD-L1 group while re­tain­ing promis­ing re­sults for the full field.

“There was no group that didn’t get a sur­vival ben­e­fit in this study,” Gand­hi says, with the re­sults of­fer­ing a prac­tice-chang­ing set of re­sults. She al­so says she wants to ful­ly con­sid­er the fi­nal da­ta from Check­mate-227 (Bris­tol-My­ers) and IM­pow­er-150 (Roche) as she pon­ders the chang­ing scene for prac­ti­tion­ers.

Biotech Half­time Re­port: Af­ter a bumpy year, is biotech ready to re­bound?

The biotech sector has come down firmly from the highs of February as negative sentiment takes hold. The sector had a major boost of optimism from the success of the COVID-19 vaccines, making investors keenly aware of the potential of biopharma R&D engines. But from early this year, clinical trial, regulatory and access setbacks have reminded investors of the sector’s inherent risks.

RBC Capital Markets recently surveyed investors to take the temperature of the market, a mix of specialists/generalists and long-only/ long-short investment strategies. Heading into the second half of the year, investors mostly see the sector as undervalued (49%), a large change from the first half of the year when only 20% rated it as undervalued. Around 41% of investors now believe that biotech will underperform the S&P500 in the second half of 2021. Despite that view, 54% plan to maintain their position in the market and 41% still plan to increase their holdings.

Covid-19 vac­cine boost­ers earn big thumbs up, but Mod­er­na draws ire over world sup­ply; What's next for Mer­ck’s Covid pill?; The C-suite view on biotech; and more

Welcome back to Endpoints Weekly, your review of the week’s top biopharma headlines. Want this in your inbox every Saturday morning? Current Endpoints readers can visit their reader profile to add Endpoints Weekly. New to Endpoints? Sign up here.

You may remember that at the beginning of this year, Endpoints News set a goal to go broader and deeper. We are still working towards that, and are excited to share that Beth Snyder Bulik will be joining us on Monday to cover all things pharma marketing. You can sign up for her weekly Endpoints MarketingRx newsletter in your reader profile.

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No­var­tis de­vel­op­ment chief John Tsai: 'We go deep in the new plat­form­s'

During our recent European Biopharma Summit, I talked with Novartis development chief John Tsai about his experiences over the 3-plus years he’s been at the pharma giant. You can read the transcript below or listen to the exchange in the link above.

John Carroll: I followed your career for quite some time. You’ve had more than 20 years in big pharma R&D and you’ve obviously seen quite a lot. I really was curious about what it was like for you three and a half years ago when you took over as R&D chief at Novartis. Obviously a big move, a lot of changes. You went to work for the former R&D chief of Novartis, Vas Narasimhan, who had his own track record there. So what was the biggest adjustment when you went into this position?

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Susan Galbraith, Executive VP, Oncology R&D, AstraZeneca

As­traZeneca on­col­o­gy R&D chief Su­san Gal­braith: 'Y­ou're go­ing to need or­thog­o­nal com­bi­na­tion­s'

 

Earlier in the week we broadcast our 4th annual European Biopharma Summit with a great lineup of top execs. One of the one-on-one conversations I set up was with Susan Galbraith, the oncology research chief at AstraZeneca. In a wide-ranging discussion, Galbraith reviewed the cancer drug pipeline and key trends influencing development work at the pharma giant. You can watch the video, above, or stick with the script below. — JC

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Amit Etkin, Alto Neuroscience CEO (Alto via Vimeo)

A star Stan­ford pro­fes­sor leaves his lab for a start­up out to re­make psy­chi­a­try

About five years ago, Amit Etkin had a breakthrough.

The Stanford neurologist, a soft-spoken demi-prodigy who became a professor while still a resident, had been obsessed for a decade with how to better define psychiatric disorders. Drugs for depression or bipolar disorder didn’t work for many patients with the conditions, and he suspected the reason was how traditional diagnoses didn’t actually get at the heart of what was going on in a patient’s brain.

Roche's Tecen­triq cross­es the fin­ish line first in ad­ju­vant lung can­cer, po­ten­tial­ly kick­ing off gold rush

While falling behind the biggest PD-(L)1 drugs in terms of sales, Roche has looked to carve out a space for its Tecentriq with a growing expertise in lung cancer. The drug will now take an early lead in the sought-after adjuvant setting — but competitors are on the way.

The FDA on Friday approved Tecentriq as an adjuvant therapy for patients with Stage II-IIIA non small cell lung cancer with PD-(L)1 scores greater than or equal to 1, making it the first drug of its kind approved in an early setting that covers around 40% of all NSCLC patients.

Susan Galbraith speaking at Endpoints News' virtual EUBIO21 summit

Imfinzi/treme­li­mum­ab com­bo scores As­traZeneca an­oth­er OS win — this time in liv­er can­cer

Is the tide turning on AstraZeneca’s battered PD-L1/CTLA4 combo?

A single priming dose of the experimental tremelimumab, followed by Imfinzi every four weeks, beat Nexavar (sorafenib) in helping a group of liver cancer patients live longer in a Phase III study, the company reported, meeting the primary endpoint.

Specifically, the two drugs extended overall survival for patients with unresectable hepatocellular carcinoma who had not received prior systemic therapy and were not eligible for localized treatment.

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FDA ad­comm votes unan­i­mous­ly in sup­port of a J&J Covid-19 boost­er two months af­ter one-dose shot

The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) on Friday voted 19-0 in favor of authorizing a second shot of J&J’s Covid-19 vaccine to follow at least two months after the initial dose.

Regulators don’t have to follow VRBPAC’s recommendation, but they almost always do. Considering that the CDC’s advisory committee has already been set to review the expanded EUA, VRBPAC’s recommendation is likely to be adopted.

FDA+ roundup: Marks on Wood­cock­'s tenure as act­ing com­mis­sion­er; FDA lead­ers of­fer per­spec­tive on bar­ri­ers to di­ver­si­ty in re­search

CBER director Peter Marks praised Janet Woodcock’s work as acting FDA commissioner, and while noting that Biden needs to nominate someone to fill the role permanently by Nov. 16, he said he has “no idea” when that actually might occur.

“Dr. Woodcock has been at the agency for over three decades and she, during that time, has proven herself to be a remarkably capable manager,” Marks said at the Alliance for Regenerative Medicine’s meeting Tuesday. “And she’s been managing as if she’s commissioner, unlike some previous acting [commissioners] who are afraid to actually do things. She doesn’t appear to be afraid to do things. I have not felt any different now from when we had a commissioner in place,” he added.

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