As­traZeneca chief is bet­ting the com­pa­ny’s fu­ture on a sin­gle roll of the dice

The view from End­points
As­traZeneca CEO Pas­cal So­ri­ot

Near­ly five years in­to his stint at the helm of As­traZeneca, CEO Pas­cal So­ri­ot has now reached his year of liv­ing dan­ger­ous­ly.

This morn­ing the phar­ma chief out­lined a steadi­ly de­clin­ing rate of rev­enue. Core EPS is ex­pect­ed to slide in the low to mid teens as gener­ics con­tin­ue to chop away at their Crestor fran­chise. All their old block­busters are be­ing dis­en­fran­chised, in a man­ner of speak­ing.

So­ri­ot, not known to wa­ver in times of a cri­sis, wasn’t about to break down now. He an­nounced: “It is an ex­cit­ing time as we rapid­ly ap­proach the in­flec­tion point for our an­tic­i­pat­ed re­turn to long-term growth, built on the sol­id foun­da­tions of a sci­ence-led pipeline.”

In­vestors weren’t very ex­cit­ed by the num­bers, though, send­ing the com­pa­ny’s shares down by close to 3% this morn­ing.

Af­ter a whole slate of clin­i­cal set­backs in 2016, the fi­nan­cial ero­sion at As­traZeneca has fo­cused an un­wa­ver­ing spot­light on the com­pa­ny’s com­bi­na­tion study for the PD-L1 check­point dur­val­um­ab and treme­li­mum­ab, a CT­LA-4, dubbed MYS­TIC.

A late­com­er to the check­point in­hi­bi­tion field, As­traZeneca is mak­ing a high-risk at­tempt at cut­ting in­to the line of heavy­weights com­pet­ing on lung can­cer, look­ing for ev­i­dence that they have a com­bo that can ri­val the ad­vanc­ing for­tunes of Mer­ck’s Keytru­da/chemo com­bi­na­tion, now un­der re­view.

As­traZeneca re­cent­ly tweaked MYS­TIC, adding months to the time­line as the phar­ma com­pa­ny awaits pro­gres­sion-free sur­vival da­ta this year and over­all sur­vival da­ta in 2018. And the move was wide­ly viewed as sig­nal­ing some un­der­ly­ing con­cerns about how the fi­nal da­ta read­out will look.

De­lays of any kind, though, are poi­son to As­traZeneca, as faster com­pa­nies con­tin­ue to cap­i­tal­ize on the first wave of check­points and more com­pa­nies mus­cle in along­side them. Pfiz­er, al­lied with Mer­ck KGaA, al­so has a check­point now un­der re­view at the FDA. Mer­ck, Bris­tol-My­ers and Roche are al­ready well in­to the mar­ket, with their own fol­low-up plans. And Bris­tol-My­ers’ de­ci­sion not to pur­sue an ac­cel­er­at­ed ap­proval for Op­di­vo (PD-1)/Yer­voy (CT­LA-4) in lung can­cer raised even more doubts about the ap­proach at As­traZeneca.

The stakes for As­traZeneca keep get­ting high­er, cre­at­ing a re­mark­able high-wire act for a Big Phar­ma play­er.

Not on­ly does As­traZeneca have to gain an ap­proval now, the com­pa­ny al­so has to be rec­og­nized as a leader in the field, po­si­tioned to grab bil­lions of dol­lars in new sales. Just falling short of ex­pec­ta­tions will be enough to quash hopes for the near-term turn­around that As­traZeneca needs.

“Rarely has a sin­gle tri­al re­sult been so cru­cial to a com­pa­ny the size of As­traZeneca,” said Mick Coop­er of Trin­i­ty Delta.

And how.

Rev­enue in 2016 hit $23 bil­lion in 2016, down from $24.7 bil­lion. But So­ri­ot promised $45 bil­lion in rev­enue by 2023, now just six years away. The com­pa­ny has al­ready start­ed back­ing away from that num­ber, blam­ing cur­ren­cy val­u­a­tions. But even their new goals will rapid­ly evap­o­rate with­out a big score on the I/O front.

It’s fi­nal­ly over: Bio­gen, Ei­sai scrap big Alzheimer’s PhI­I­Is af­ter a pre­dictable BACE cat­a­stro­phe rais­es safe­ty fears

Months after analysts and investors called on Biogen and Eisai to scrap their BACE drug for Alzheimer’s and move on in the wake of a string of late-stage failures and rising safety fears, the partners have called it quits. And they said they were dropping the drug — elenbecestat — after the independent monitoring board raised concerns about…safety.

We don’t know exactly what researchers found in this latest catastrophe, but the companies noted in their release that investigators had determined that the drug was flunking the risk/benefit analysis.

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It's not per­fect, but it's a good start: FDA pan­elists large­ly en­dorse Aim­mune's peanut al­ler­gy ther­a­py

Two days after a fairly benign review from FDA staff, an independent panel of experts largely endorsed the efficacy and safety of Aimmune’s peanut allergy therapy, laying the groundwork for approval with a risk evaluation and mitigation strategy (REMS).

Traditionally, peanut allergies are managed by avoidance, but the threat of accidental exposure cannot be nullified. Some allergists have devised a way to dose patients off-label with peanut protein derived from supermarket products to wean them off their allergies. But the idea behind Aimmune’s product was to standardize the peanut protein, and track the process of desensitization — so when accidental exposure in the real world invariably occurs, patients are less likely to experience a life-threatening allergic reaction.

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Rit­ter bombs fi­nal PhI­II for sole lac­tose in­tol­er­ance drug — shares plum­met

More than two years ago Ritter Pharmaceuticals managed to find enough silver lining in its Phase IIb/III study — after missing the top-line mark — to propel its lactose intolerance toward a confirmatory trial. But as it turned out, the enthusiasm only set the biotech and its investors up to be sorely disappointed.

This time around there’s little left to salvage. Not only did RP-G28 fail to beat placebo in reducing lactose intolerance symptoms, patients in the treatment group actually averaged a smaller improvement. On a composite score measuring symptoms like abdominal pain, cramping, bloating and gas, patients given the drug had a mean reduction of 3.159 while the placebo cohort saw a 3.420 drop on average (one-sided p-value = 0.0106).

Ear­ly snap­shot of Ad­verum's eye gene ther­a­py sparks con­cern about vi­sion loss

An early-stage update on Adverum Biotechnologies’ intravitreal gene therapy has triggered investor concern, after patients with wet age-related macular degeneration (AMD) saw their vision deteriorate, despite signs that the treatment is improving retinal anatomy.

Adverum, on Wednesday, unveiled 24-week data from the OPTIC trial of its experimental therapy, ADVM-022, in six patients who have been administered with one dose of the therapy. On average, patients in the trial had severe disease with an average of 6.2 anti-VEGF injections in the eight months prior to screening and an average annualized injection frequency of 9.3 injections.

Alex Ar­faei trades his an­a­lyst's post for a new role as biotech VC; Sanofi vet heads to Vi­for

Too often, Alex Arfaei arrived too late. 

An analyst at BMO Capital Markets, he’d meet with biotech or pharmaceutical heads for their IPO or secondary funding and his brain, trained on a biology degree and six years at Merck and Endo, would spring with questions: Why this biomarker? Why this design? Why not this endpoint? Not that he could do anything about it. These execs were coming for clinical money; their decisions had been made and finalized long ago.

Arde­lyx bags its first FDA OK for IBS, set­ting up a show­down with Al­ler­gan, Iron­wood

In the first of what it hopes will be a couple of major regulatory milestones for its new drug, Ardelyx has bagged an FDA approval to market Ibsrela (tenapanor) for irritable bowel syndrome.

The drug’s first application will be for IBS with constipation (IBS-C), inhibiting sodium-hydrogen exchanger NHE3 in the GI tract in such a way as to increase bowel movements and decrease abdominal pain. This comes on the heels of two successful Phase III trials.

Lisa M. DeAngelis, MSKCC

MSK picks brain can­cer ex­pert Lisa DeAn­ge­lis as its next CMO — fol­low­ing José Basel­ga’s con­tro­ver­sial ex­it

It’s official. Memorial Sloan Kettering has picked a brain cancer expert as its new physician-in-chief and CMO, replacing José Baselga, who left under a cloud after being singled out by The New York Times and ProPublica for failing to properly air his lucrative industry ties.

His replacement, who now will be in charge of MSK’s cutting-edge research work as well as the cancer care delivered by hundreds of practitioners, is Lisa M. DeAngelis. DeAngelis had been chair of the neurology department and co-founder of MSK’s brain tumor center and was moved in to the acting CMO role in the wake of Baselga’s departure.

Penn team adapts CAR-T tech, reengi­neer­ing mouse cells to treat car­diac fi­bro­sis

After establishing itself as one of the pioneer research centers in the world for CAR-T cancer therapies, creating new attack vehicles to eradicate cancer cells, a team at Penn Medicine has begun the tricky transition of using the basic technology for heart repair work.

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Tal Zaks. Moderna

The mR­NA uni­corn Mod­er­na has more ear­ly-stage hu­man da­ta it wants to show off — reach­ing new peaks in prov­ing the po­ten­tial

The whole messenger RNA field has attracted billions of dollars in public and private investor cash gambled on the prospect of getting in on the ground floor. And this morning Boston-based Moderna, one of the leaders in the field, wants to show off a few more of the cards it has to play to prove to you that they’re really in the game.

The whole hand, of course, has yet to be dealt. And there’s no telling who gets to walk with a share of the pot. But any cards on display at this point — especially after being accused of keeping its deck under lock and key — will attract plenty of attention from some very wary, and wired, observers.

“In terms of the complexity and unmet need,” says Tal Zaks, the chief medical officer, “this is peak for what we’ve accomplished.”

Moderna has two Phase I studies it wants to talk about now.

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