Merck and Bristol-Myers Squibb aren’t the only big players looking to make a splash in frontline lung cancer. Roche is also looking to elbow in, and it’s offered up a look at some additional IMpower150 data at AACR to back up their shot.
We already know that Roche execs gave a preliminary thumbs up for its pivotal IMpower150 trial, studying a combination of Tecentriq, Avastin and chemo in frontline nonsquamous non-small cell lung cancer and hitting a hazard ratio of 0.62 for the full group of patients in the study. Progression Free Survival in the main group was a median 8.3 months compared to 6.8 months in the control, a marginal gain which isn’t likely to stir much excitement.
We’re finding out at AACR, though, that the lineup of therapies also stood out in some key subgroups with particularly encouraging progression-free survival data.
Looking at one EGFR/ALK+c subgroup, Roche is reporting a median progression-free survival rate of 9.7 months — and a hazard ration of 0.59 — compared to the control arm with a 6.1 month PFS rate. Among 59 patients in the EGFR exon 19 deletion of L858R group the hazard ratio hit 0.42, with a 10.2 month PFS compared to 6.1 months. And in patients with liver metastases the PFS was 8.2 months compared to 5.4 months, with an HR of 0.40. In patients without liver metastases, the HR jumps to 0.64.
Those kinds of numbers in these particular subgroups are hugely important, says Alan Sandler, global head of the lung cancer franchise at Genentech, as this is the first time investigators are getting a close look at these patients’ response.
Sandler also noted that they saw positive results for both low and high PD-L1 expressers, underscoring a trend where the high expressers are likely to see an enhanced benefit from lung cancer combos, with low expressers still gaining a significant response as well.
I talked to Sandler ahead of the posting at AACR. One objection that’s been raised to the three-drug regimen is that it adds a costly therapy to the mix. But he doesn’t think that price will be a barrier to future use.
“If there’s a clinical benefit,” says Sandler, “there will be usage.”
There are also plenty of ways that a price on a particular combination can be worked so that there isn’t necessarily a cost hurdle to overcome, he adds.
Roche still has further to go in collecting more mature survival data from the study. That will arrive at a future conference. But they’re in the mix today, even as Merck steals the show with its Keytruda/chemo combo.
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