Brad Lon­car­'s AS­CO18 pre­view: Past AS­COs point to the top drugs that will soon el­bow for the Os­cars of can­cer R&D

To pre­pare for the fu­ture, it helps to look back on what has hap­pened in the past. AS­CO is a great bench­mark for do­ing that. Drug de­vel­op­ment does not hap­pen overnight. A pat­tern of re­al progress emerges if you view things in the con­text of two “AS­COs” ago, or five, or ten. I al­ways try to ap­proach it from this macro per­spec­tive as I pre­pare for the con­fer­ence be­cause it helps set the stage for how to­day’s new de­vel­op­ments might fit in.

Con­sid­er the fol­low­ing:

  • One AS­CO ago we were wowed by the abil­i­ty of pre­ci­sion on­col­o­gy to treat pa­tients based on a spe­cif­ic ge­net­ic mu­ta­tion (NTRK) rather than where can­cer orig­i­nat­ed in the body. That drug (larotrec­tinib) is cur­rent­ly in front of FDA and an­oth­er (Keytru­da) has since been the first ap­proved for a non-tu­mor spe­cif­ic in­di­ca­tion. This trend will con­tin­ue. Roche was smart to buy Igny­ta, as these are small but po­tent in­di­ca­tions. They were al­so smart to in­vest in Foun­da­tion Med­i­cine a few AS­COs ago and their fore­sight on that is fi­nal­ly pay­ing off. Ex­pect to be hear­ing about pre­ci­sion strate­gies for many more AS­COs to come.
  • Four AS­COs ago, there were no PD-1s ap­proved. Can you be­lieve that? I know it feels more like a decade, but it is im­por­tant to know that this is still on­ly ear­ly days for the class. In those four years, we have learned what types of can­cers the drugs work for as monother­a­py, in what cas­es com­bi­na­tions are need­ed, how many pa­tients of var­i­ous can­cer types are re­spond­ing, and hints of bio­mark­er strate­gies are start­ing to emerge. No doubt there have been dis­ap­point­ments on the com­bo side of things, but as our un­der­stand­ing of these drugs and the tu­mor mi­croen­vi­ron­ment im­proves, so will the chances of some­thing break­ing through.
  • Cell ther­a­py? One AS­CO ago this was still just a con­cept and many doubt­ed it could cross the reg­u­la­to­ry fin­ish line. Since then we have seen land­mark ap­provals of CD19 CARs and a rush of in­vest­ment from all around the world. I don’t think it is an ex­ag­ger­a­tion to say this is the fastest mov­ing sci­ence in on­col­o­gy. What is on the mar­ket to­day could be ob­so­lete as soon as just a cou­ple AS­COs from now. The next ver­sions of these ther­a­pies are like­ly to be very dy­nam­ic and pow­er­ful.
  • Four AS­COs ago there were al­so no PARP in­hibitors ap­proved. While the first (Lyn­parza) was ahead of its time, it is on­ly now that PARPs are get­ting in­ter­est­ing with new­com­ers on the mar­ket and some com­pelling com­bo tri­als un­der­way. Com­bo da­ta has large­ly been dis­ap­point­ing so far, but I think this is on­ly a mat­ter of time. Mer­ck, a leader in on­col­o­gy, made a sig­nif­i­cant in­vest­ment in a PARP last year and you can bet it is be­cause they see sub­stan­tial util­i­ty in more can­cers to come. 2018 could fi­nal­ly be a break­out year for this class.

With that past his­to­ry in mind, here are things I am watch­ing for at AS­CO 2018 to build on the suc­cess. Note: these are things I’m per­son­al­ly in­ter­est­ed in and this is def­i­nite­ly not an ex­haus­tive list for the en­tire con­fer­ence.


Tar­get­ed Ther­a­pies

Loxo is look­ing like it might be the star of AS­CO two years in a row. Has such a small biotech com­pa­ny ever done that be­fore? Has any com­pa­ny pe­ri­od? Wel­come to 2018, where most of the in­no­va­tion in drug de­vel­op­ment is com­ing from the mid and small cap range of our sec­tor. As far as RET goes, this is clear­ly an ex­cel­lent tar­get. The on­ly ques­tion at this point is whether $LOXO or $BPMC is go­ing to come out on top.


Check­points

  • Mer­ck’s Keynote-042 pre­sen­ta­tion has a chance to be the biggest news com­ing out of AS­CO. This is Keytru­da monother­a­py in pa­tients with >1% PD-L1 ex­pres­sion. We al­ready know the tri­al suc­ceed­ed on OS but what we don’t know yet is if the suc­cess is large­ly due to strong re­spons­es from the high PD-1 pa­tients or if those clos­er to 1% al­so saw com­pelling re­sults. We’ll need to see dif­fer­ent cuts at the da­ta at AS­CO for the an­swer. “Chemo free” is a term that is sneak­ing in­to the ad­ver­tis­ing cam­paigns of these com­pa­nies late­ly. With stel­lar re­sults in low ex­pressers, it would be a big win for im­munother­a­py and the “chemo free” move­ment. Good da­ta here might make treat­ment choic­es (whether to go mono or com­bo) quite dif­fi­cult for some physi­cians and pa­tients in the fu­ture.
  • Bris­tol (does any­body re­mem­ber them?) is pre­sent­ing IO/chemo com­bo da­ta from Check­mate-227 in 1L NSCLC pa­tients with <1% tu­mor PD-L1 ex­pres­sion. The haz­ard ra­tio for PFS from the ab­stract looks com­pa­ra­ble to what Mer­ck has pre­sent­ed in the past and will lend some cre­dence to Bris­tol’s sug­ges­tion that these two drugs are in fact Coke and Pep­si. How­ev­er, we ul­ti­mate­ly have to wait for OS re­sults to make a fi­nal call on that. This is still an im­por­tant pre­sen­ta­tion be­cause Bris­tol could use some good news in 1L lung. AACR il­lus­trat­ed what a tough hill they have to climb to con­vince physi­cians on the va­lid­i­ty of TMB so any pre­sen­ta­tion like this that doesn’t nec­es­sar­i­ly re­ly on it is a wel­come event for them.
  • Roche’s IM­pow­er131 late break­er study­ing Tecen­triq in com­bi­na­tion with chemo in ad­vanced squa­mous NSCLC was set­ting up to be an in­ter­est­ing event (though on­ly PFS da­ta is avail­able). And then the king of lung can­cer Mer­ck an­nounced on Wednes­day that its Keynote-407 study in the squa­mous his­tol­ogy hit on both PFS and OS. When it comes to lung can­cer, all hail the king.

Cell Ther­a­pies

  • CAR-T was right­ful­ly named AS­CO’s 2018 clin­i­cal Ad­vance of the Year. Will the da­ta con­tin­ue to live up to the ex­cite­ment? Un­for­tu­nate­ly there is on­ly one tru­ly enor­mous CAR-T pre­sen­ta­tion (BC­MA) I see on the sched­ule this year.
  • It was a big deal one AS­CO ago when blue­bird and Leg­end showed ear­ly promise with BC­MA CAR-T. To il­lus­trate that cell ther­a­pies like­ly have util­i­ty be­yond CD19 was a morale boost­er and I’m sure it was ma­jor fac­tor in con­vinc­ing Gilead and Cel­gene to do their big ac­qui­si­tions.
  • How­ev­er, BC­MA isn’t out of the woods yet. In­vestors are ner­vous about re­laps­es/dura­bil­i­ty. What will BC­MA da­ta look like with more time and more pa­tients treat­ed in tri­als? This could be Fri­day’s biggest sto­ry when blue­bird presents an up­date on their BC­MA CAR-T can­di­date bb2121. They al­so have a call sched­uled Fri­day af­ter­noon to dis­cuss the da­ta. We might have to broad­cast it on loud­speak­ers at the un­of­fi­cial tweet­up.
  • Speak­ing of dura­bil­i­ty, CD19 CARs have been de­vel­oped so quick­ly that we don’t ac­tu­al­ly know how durable the re­spons­es will be over the long-term. It has al­ways been a hy­poth­e­sis that dura­bil­i­ty will last for pa­tients who are out a con­sid­er­able amount of time, but com­pa­nies still need to prove it. Gilead had long-term da­ta from ZU­MA-1 in NHL that looked spec­tac­u­lar at ASH, and AS­CO da­ta will like­ly be sim­i­lar­ly good. The more proof these com­pa­nies can show at ma­jor med­ical meet­ings that pa­tients have last­ing re­spons­es, the eas­i­er it will be to over­come the pay­er and lo­gis­tic chal­lenges that have emerged in the ear­ly days of com­mer­cial launch. Gilead will al­so have some Man­tle cell lym­phoma and ALL da­ta.
  • To put it mild­ly, Cel­gene is hav­ing a bad year. Af­ter var­i­ous prob­lems have emerged from past BD deals, they des­per­ate­ly need the Juno ac­qui­si­tion to go smooth­ly. Or to say it in a glass-half-emp­ty kind of way, they can­not have this one blow up in their face too. For­tu­nate­ly, so far Juno da­ta has looked good. There will be a JCAR017 up­date at AS­CO in DL­B­CL and again at EHA. The key here is for it to con­tin­ue to look com­pet­i­tive with Gilead and No­var­tis and that no sur­pris­ing safe­ty is­sues arise.
  • There has al­so been talk this last week about an ab­stract from a Chi­nese group com­par­ing 4-1BB CAR-T (Kym­ri­ah) di­rect­ly to CD28 CAR-T (Yescar­ta) to see if one is bet­ter than the oth­er. Their con­clu­sion was that 4-1BB had en­hanced safe­ty, ef­fi­ca­cy, and ex­pan­sion. Per­son­al­ly, I think this study is flawed and I wouldn’t draw many con­clu­sions about U.S. prod­ucts from it.
  • We know a lot about CAR-T but still know lit­tle about TCRs. When will this ap­proach step up to the plate and have a break­out year? It is still too ear­ly for that, but look for da­ta from Adap­ti­m­mune tar­get­ing NY-ESO and MAGE-A10 and da­ta from NCI tar­get­ing HPV on­co­pro­teins to pro­vide some clues. The fact that Glaxo opt­ed to con­tin­ue their Adap­ti­m­mune col­lab­o­ra­tion is a pos­i­tive sign.

Cy­tokines

Mike Glad­stone

At­las Ven­ture’s Mike Glad­stone had the call of the year last De­cem­ber when he pre­dict­ed 2018 would be the Year of the Cy­tokine. We have since seen Bris­tol pay Nek­tar $1.85 bil­lion up­front to own es­sen­tial­ly 1/3 of its CD122 ag­o­nist and then last month Lil­ly came from out of nowhere to ac­quire Ar­mo for $1.6 bil­lion. The bi­ol­o­gy be­hind cy­tokines brings a fa­mil­iar­i­ty and com­fort fac­tor giv­en the decades it has been re­searched. Will to­day’s new ap­proach­es to har­ness­ing them be the first ma­jor break­through in the IO com­bo race? Al­ready this year $3B+ has been bet on it.

There is a ton rid­ing on the Nek­tar da­ta at AS­CO. Bris­tol is both in need of pos­i­tive news af­ter be­ing rout­ed by Mer­ck in 1L NSCLC at AACR and al­so must jus­ti­fy the cash they threw at Nek­tar to part­ner on this. Ear­ly da­ta at SITC looked stel­lar, but it was just that….ear­ly da­ta. How will the re­sponse rates hold up with more pa­tients on drug and in more types of can­cers? The ab­stract re­lease caused some ner­vous but­ter­flies and so we will have to look to the full AS­CO pre­sen­ta­tion for more com­fort. Nek­tar is host­ing a huge­ly im­por­tant an­a­lyst meet­ing on Sat­ur­day af­ter­noon that is not to be missed.

  • Ar­mo’s peg IL10 looked very com­pelling in pan­cre­at­ic can­cer, NSCLC and RCC. This ap­pears to be a very smart pur­chase by Lil­ly even con­sid­er­ing the ear­ly stage AR­MO is at and the high price of the deal. Will an­oth­er suit­or step up and make things in­ter­est­ing be­fore the June 22 ten­der dead­line?

Oth­er IO

  • Pri­vate­ly held Check­mate Phar­ma pre­sent­ed com­pelling da­ta from its TLR9 ag­o­nist dur­ing a ple­nary at AACR, but none of the pub­licly trad­ed TLR9 com­pa­nies (Dy­navax, Idera) have been able to match the ex­cite­ment. Why? Dy­navax trad­ed sharply down when in­vestors re­ex­am­ined the 60% ORR pub­lished in its ab­stract (PD1 naïve melanoma) af­ter re­al­iz­ing that 5 non-evalu­able pa­tients had been left out of the analy­sis. Will the high­er 60%+ num­ber turn out to be true as more da­ta is re­port­ed at the con­fer­ence?
  • It is al­ways im­por­tant when you get a first glimpse at clin­i­cal da­ta from a com­pa­ny with a unique new plat­form. Cy­tomX and its pro­body plat­form is that com­pa­ny at AS­CO 2018. Can they main­tain com­pa­ra­ble ef­fi­ca­cy to check­points while low­er­ing the tox­i­c­i­ties?
  • One of the biggest dis­ap­point­ments from the ab­stract re­lease day was Jounce and its ICOS ag­o­nist. While most on Wall Street threw in the tow­el, there are still a few be­liev­ers in this con­cept who are hang­ing on. The im­munother­a­py su­per­star founders of the com­pa­ny will be giv­ing a talk at an an­a­lyst event on Mon­day night. Jounce (and their part­ner Cel­gene) needs to walk out of Chica­go with some kind of pos­i­tive be­cause they have no oth­er as­sets (be­sides a PD-1) any­where near the clin­ic.
  • Mer­ck KGaA’s PD-L1/TGF-β trap fu­sion pro­tein looks promis­ing in HPV as­so­ci­at­ed can­cers and will be a much-dis­cussed tri­al. The TGF-β path­way and how it con­tributes to im­muno­sup­pres­sion is a hot top­ic in gen­er­al and there are a cou­ple of ab­stracts ad­dress­ing this. Ex­pect to see a few new com­pa­nies IPO soon with TGF-β pro­grams in their pipeline. One just hap­pened on Thurs­day.
  • Re­gen­eron might be the on­ly com­pa­ny (out of dozens) de­vel­op­ing a new PD-1 that re­al­ly mat­ters from a com­pet­i­tive stand­point. This is be­cause 1) they are Re­gen­eron and there­fore con­duct ter­rif­ic sci­ence and 2) they have done a good job of rac­ing theirs through the clin­ic. How does Cemi­plimab stack up against Keytru­da and Op­di­vo? Can they ac­tu­al­ly com­pete com­mer­cial­ly in ex­ist­ing in­di­ca­tions or will they have to set­tle for us­ing this as a com­bo de­vel­op­ment tool like every­one else?
  • I pre­dict that one fu­ture AS­CO will be the Year of Bi-specifics. We are not there yet, but watch for a hand­ful of ear­ly stud­ies this year to be­gin to set the stage.

Oth­er Ther­a­pies

  • There has been much an­tic­i­pa­tion for PARPs to shine in com­bi­na­tion with PD-1s, but the da­ta has been lack­ing so far. Why? Tesaro’s TNBC da­ta from TOPA­CIO doesn’t look much bet­ter than what we’d ex­pect to see with monother­a­py un­for­tu­nate­ly. Speak­ing of monother­a­py, QUADRA doesn’t seem to shake the ground in late stage ovar­i­an ei­ther. The com­pa­ny’s stock has prac­ti­cal­ly gone down every day for a year and many are wait­ing for it to get cheap enough to fi­nal­ly be ac­quired. That might not hap­pen at any price un­til they can demon­strate broad­er util­i­ty.
  • With Ro­va-T con­tin­u­ing its cold streak this year, we are look­ing to­wards oth­ers for pos­i­tive da­ta in SCLC. PD-1s, PARPs, and lur­binecte­din are pos­si­ble can­di­dates for this ter­ri­bly ag­gres­sive can­cer and huge un­met need.
  • An­ti­body-drug con­ju­gates are still a thing, though much less to­day than back in the glo­ry days when Roche was the dar­ling of AS­CO with T-DM1. Im­munomedics re­cent­ly filed its BLA for sac­i­tuzum­ab govite­can in triple-neg­a­tive breast can­cer. This us­es SN-38, the ac­tive metabo­lite of irinote­can, con­ju­gat­ed to Trop-2. Da­ta from their study pre­sent­ed at AS­CO will help us bet­ter un­der­stand the ap­prov­abil­i­ty and com­mer­cial vi­a­bil­i­ty of the drug.

Thanks a lot for your in­ter­est. These have been some of the things I am watch­ing and I hope it helps. Best of luck to all the com­pa­nies, re­searchers, physi­cians, and pa­tients who will no doubt make 2018 an­oth­er great AS­CO.


Brad Lon­car is an in­de­pen­dent in­vestor fo­cused on biotech­nol­o­gy. He can be reached on Twit­ter at @Brad­Lon­car.

Im­age: 2017 an­nu­al meet­ing. AS­CO

AUTHOR

Brad Loncar

CEO, Loncar Investments

Inside FDA HQ (File photo)

The FDA just ap­proved the third Duchenne MD drug. And reg­u­la­tors still don’t know if any of them work

Last year Sarepta hit center stage with the FDA’s controversial reversal of its CRL for the company’s second Duchenne muscular dystrophy drug — after the biotech was ambushed by agency insiders ready to reject a second pitch based on the same disease biomarker used for the first approval for eteplirsen, without actual data on the efficacy of the drug.

On Wednesday the FDA approved the third Duchenne MD drug, based on the same biomarker. And regulators were ready to act yet again despite the lack of efficacy data.

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Franz-Werner Haas, CureVac CEO

UP­DAT­ED: On the heels of a snap $1B raise, Cure­Vac out­lines plans to seek emer­gency OK for their Covid-19 vac­cine in a mat­ter of months

CureVac is going from being one of the quietest players in the race to develop a new vaccine to fight the worst public health crisis in a century to a challenger for the multibillion-dollar market that awaits the first vaccines to make it over the finish line. Typically low-key at a time of brash comments and incredibly ambitious development timelines from the leaders, CureVac now is jumping straight into the spotlight.

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Cell and Gene Con­tract Man­u­fac­tur­ers Must Em­brace Dig­i­ti­za­tion

The Cell and Gene Industry is growing at a staggering 30% CAGR and is estimated to reach $14B by 20251. A number of cell, gene and stem cell therapy sponsors currently have novel drug substances and products and many rely on Contract Development Manufacturing Organizations (CDMO) to produce them with adherence to stringent regulatory cGMP conditions. Cell and gene manufacturing for both autologous (one to one) and allogenic (one to many) treatments face difficult issues such as: a complex supply chain, variability on patient and cellular level, cell expansion count and a tight scheduling of lot disposition process. This complexity affects quality, compliance and accountability in the entire vein-to-vein process for critically ill patients.

Sanofi vet Kather­ine Bowdish named CEO of PIC Ther­a­peu­tics; As the world Terns: Liv­er dis­ease biotech makes ex­ec­u­tive changes

PIC Therapeutics hasn’t raised much money, yet. But the fledgling biotech has attracted a high-profile player to the helm.

The Boston-based biotech has handed the reins to Katherine Bowdish as its president and CEO. Bowdish will also join the board of directors of PIC. Bowdish joins from Sanofi where she served as VP and head of R&D strategy, as well as helping launch and lead Sanofi Sunrise, a venture investment and partnering vehicle at Sanofi. Before that, Bowdish held several exec roles at Permeon Biologics, Anaphore, Alexion Pharmaceuticals and Prolifaron (acquired by Alexion).

Martin Shkreli (Shutterstock)

Mar­tin Shkre­li con­tin­ued to or­ches­trate an­ti-com­pet­i­tive schemes for Dara­prim be­hind bars — FTC

Martin Shkreli didn’t just blog, read up on drug development news and run his biotech business with a contraband cell phone in prison. According to the FTC, he was also coordinating the anticompetitive scheme to shield Daraprim — the drug at the center of a price-gouging controversy that earned him the “Pharma Bro” nickname — from generic rivals.

Back in January the FTC, together with New York’s attorney general, launched a federal lawsuit against Shkreli, who’s now serving a 7-year sentence for defrauding investors in his hedge fund, alleging that he effectively created a drug monopoly. While Shkreli’s notorious move to raise the per tablet price of Daraprim from $17.50 to $750 was perfectly legal, the tactics he allegedly deployed to box out competitors weren’t.

NIH director Francis Collins at a Senate Appropriations subcommittee hearing for Operation Warp Speed (Graeme Jennings/Pool via AP Images)

Covid-19 roundup: 'No­vem­ber or De­cem­ber' Collins' best bet on a vac­cine OK; First plas­ma tri­al sug­gests mor­tal­i­ty re­duc­tion

Count NIH director Francis Collins out for any wager that the FDA would authorize a Covid-19 vaccine in October.

The discussion came up during a call with reporters because some states and local governments have been told by the CDC to have vaccination plans ready to go by Oct. 1. Pharma execs, most notably from Pfizer and BioNTech, have raised hopes about a licensure during that month; President Donald Trump last week sounded an optimistic note about having a vaccine on the market “right around” Election Day on Nov. 3 — or possibly before.

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Charlie Silver (Mission Bio)

'We want to be every­where.' Mis­sion Bio rais­es $70M be­hind re­sis­tance-hunt­ing se­quenc­ing plat­form

Charlie Silver wants to look really, really closely at a lot of your cells. And he just got a lot of money to do so.

Silver’s startup, Mission Bio, raised $70 million in a Series C round Thursday led by Novo Holdings. The money, which brings Mission Bio to $120 million raised since its 2012 founding, will be used to advance the single-cell sequencing platform they built to detect early response or resistance to new cancer therapies.

Cal­lid­i­tas bets up to $102M on a biotech buy­out, snag­ging a once-failed PBC drug

After spending years developing its oral formulation of the corticosteroid budesonide, Sweden’s Calliditas now has its sights set on the primary biliary cholangitis field.

The company will buy out France-based Genkyotex, and it’s willing to bet up to €87 million ($102 million) that Genkyotex’s failed Phase II drug, GKT831, will do better in late-stage trials.

Under the current agreement, Calliditas $CALT will initially pay €20.3 million in cash for 62.7% of Genkyotex (or €2.80 a piece for 7,236,515 shares) in early October, then circle back for the rest of Genkyotex’s shares under the same terms. If nothing changes, the whole buyout will cost Calliditas €32.3 million, plus up to  €55 million in contingent rights.

Qi­a­gen in­vestors spurn Ther­mo Fish­er’s takeover of­fer, de­rail­ing a $12B+ deal

Thermo Fisher Scientific had announced an $11.5 billion takeover of Dutch diagnostics company Qiagen back in March, but the deal apparently did not sit well with Qiagen investors.

After getting hammered by critics who contended that Qiagen $QGEN was worth a lot more than what Thermo Fisher wanted to spend, investors turned thumbs down on the offer — derailing the buyout even after Thermo Fisher increased its offer to $12.6 billion in July. Qiagen’s share price has been boosted considerably by Covid-19 as demand for its testing kits surged.

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