Check­point ther­a­pies be­fore surgery? MD An­der­son team re­ports en­cour­ag­ing ef­fi­ca­cy but wor­ries about tox­i­c­i­ty

Days af­ter the No­bel com­mit­tee hon­ored im­munother­a­py in this year’s med­i­cine prize, MD An­der­son, where No­bel win­ner Jim Al­li­son cur­rent­ly works, has some new hu­man da­ta — and lessons — about a nov­el way to use check­point in­hibitors.

Rod­abe Amaria

While check­point drugs like Op­di­vo (nivolum­ab) and Yer­voy (ip­il­i­mum­ab) are of­ten giv­en to melanoma pa­tients af­ter surgery or when their can­cer is un­re­sectable, re­searchers want­ed to know if ad­min­is­ter­ing them be­fore surgery could be an ef­fec­tive ap­proach.

The short an­swer is yes — but with a big as­ter­isk.

In a Phase II study in­volv­ing pa­tients who have reached high-risk stage 3 of the dead­ly skin can­cer, MD An­der­son re­searchers gave 12 pa­tients the PD-1 in­hibitor nivolum­ab and an­oth­er 11 a com­bi­na­tion of nivolum­ab and ip­il­i­mum­ab, which tar­gets CT­LA-4.

Michael Tet­zlaff

In­ves­ti­ga­tors ob­served that com­bined check­point block­ade was “much more ef­fec­tive,” with 8 pa­tients in the arm see­ing their tu­mor shrink and 5 of them show­ing no ev­i­dence of dis­ease at surgery. It’s how­ev­er a re­sult marred by no­table tox­i­c­i­ty — 8 ex­pe­ri­enced grade 3 side ef­fects, caus­ing de­lays in dos­ing and surgery.

The sin­gle-agent an­ti-PD-1 group, mean­while, showed “mod­est re­sponse rates” at 25% tu­mor shrink­age or dis­ap­pear­ance. On­ly 1 pa­tient in the group had grade 3 side ef­fects, but 2 oth­ers pro­gressed to stage 4 metasta­t­ic melanoma be­fore they could get to surgery — a cause for con­cern.

“It is clear from this tri­al that we need to fur­ther op­ti­mize this treat­ment ap­proach,” said Rod­abe Amaria, co-first au­thor and as­sis­tant pro­fes­sor at MD An­der­son’s de­part­ment of melanoma med­ical on­col­o­gy.

Why does it mat­ter whether the check­point drugs are giv­en be­fore or af­ter surgery? Here Michael Tet­zlaff, a pathol­o­gy pro­fes­sor and se­nior au­thor on the study, ex­plains:

The ad­van­tage of a neoad­ju­vant ap­proach in this set­ting is that it en­ables an in­ter­val eval­u­a­tion of the tu­mor cells af­ter ther­a­py to de­ter­mine the ex­tent to which those tu­mor cells re­spond­ed to the ther­a­py in re­al time and pre­dict which pa­tients are like­ly to ex­pe­ri­ence durable re­spons­es go­ing for­ward. It al­so pro­vides us the tis­sue re­sources to de­ter­mine why tu­mors may not re­spond to ther­a­py and thus tai­lor ther­a­pies go­ing for­ward as we learn more about re­sis­tance.

The high oc­cur­rence of side ef­fects forced in­ves­ti­ga­tors to close the tri­al ear­ly, but they note that over­all sur­vival at 24 months was 100% in the com­bo arm and 75% in the nivolum­ab arm. In a re­designed study, they re­placed ip­il­i­mum­ab with re­latlimab (an LAG3 in­hibitor from Bris­tol-My­ers Squibb) an­tic­i­pat­ing a bet­ter safe­ty pro­file.

Ven­ture Cap­i­tal as a Strate­gic Part­ner: Fu­el­ing In­no­va­tion be­yond Fi­nance

The average level of investment required for a biotech start-up to succeed is increasing every year, elevating the pressure even further on venture capital to make smart financial investments. Financial investment alone, however, does not always guarantee that exciting innovations can be transformed into real businesses that make a meaningful difference to patients.

Beyond just capital

At Astellas Venture Management (AVM) – a wholly-owned venture capital organization within Astellas, headquartered in the San Francisco Bay Area – capital is just one of the ingredients we offer to add value to our biotechnology investments and partnerships. We generally take a strategic investor approach for companies in our invested portfolio, providing access to expertise, technology and/or resources in addition to the injection of finance. An equity investment from AVM can include access to Astellas’ research and development (R&D) capabilities and expertise, and a global network of partner academic institutions and biotechnology companies, to help advance and accelerate the start-up’s innovation.

UP­DAT­ED: Ver­tex joins Mer­ck, Pfiz­er — re­vamp­ing multi­bil­lion-dol­lar tri­al strat­e­gy as biotech R&D crum­bles

You can add Pfizer, Merck and — as we found out Friday morning — Vertex to the growing list of pharma giants hitting the pause button on a range of clinical trials. But not everyone in R&D is getting a red light.

Vertex says that it’s doing its best to keep working its pipeline strategy, coming up with a plan “to enable virtual clinic visits and home delivery of study drug to ensure study continuity and medical monitoring, and to facilitate study procedures.”

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Covid-19 roundup: In­ter­cept, blue­bird and a grow­ing list of biotechs feel the pain as pan­dem­ic man­gles FDA, R&D sched­ules

Around 100 staffers at Boston area hospitals have now tested positive for Covid-19, spotlighting the growing risk that the pandemic will sideline many of the most essential workers in healthcare as caseloads peak in the US and around the globe. With more than 3,400 deaths, Spain has become the latest country to surpass the official death count attributed to the new coronavirus in China, where the outbreak originated. As of Thursday morning, confirmed global cases had crossed 470,000 and the death count eclipsed 21,000.

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Af­ter crit­ics lam­bast­ed Gilead for grab­bing the FDA's spe­cial rare drug sta­tus on remde­sivir, they're giv­ing it back

Two days after Gilead won orphan drug status for remdesivir as a potential treatment for Covid-19, they’re handing it back.

The company was slammed from several sides after Gilead reported that the FDA had come through with the special status, which comes with 7 years of market exclusivity, the waiver of FDA fees and some tax credits as well. Typically, everyone who can get orphan status lands it without much of a fuss, but Democratic presidential candidate Bernie Sanders, Public Citizen and other consumer groups were outraged.

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Mod­er­na CEO Stéphane Ban­cel out­lines a short path for emer­gency use of a coro­n­avirus vac­cine

NIAID director Anthony Fauci has left no doubts that it takes 12 to 18 months to get a new vaccine tested and in commercial use, in the best of circumstances. But in times of a global emergency — like these — maybe there’s another, faster route to follow.

In an SEC filing on Tuesday, Moderna $MRNA staked out a record-setting pathway to getting their mRNA vaccine into the frontline of the healthcare response as early as this fall. The SEC filing notes that CEO Stéphane Bancel told Goldman Sachs that an emergency use approval could allow the vaccine to go to healthcare workers and certain individuals in a matter of months — presumably provided the NIH sees the safety and efficacy data they would need from the Phase I.

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Caught in a Covid-19 mael­strom, Eli Lil­ly locks down clin­i­cal tri­als as multi­bil­lion-dol­lar R&D ops de­rail

The Covid-19 pandemic has derailed Eli Lilly’s $6 billion R&D operations.

The pharma giant reported Monday morning that it has decided to hit the brakes on most new study starts and pause enrollment for most ongoing studies. Lilly adds that it is continuing dosing for ongoing studies, “but with study-by-study consideration.”

The pandemic has severely disrupted healthcare systems around the globe, says Lilly, making it difficult or impossible to conduct studies at many research sites. And there’s no timeline for when it expects to get back on track.

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As share buy­backs come un­der scruti­ny, what's in store for the bio­phar­ma in­dus­try?

Stock buybacks are not to be permitted for companies that will be bailed out in the coronavirus stimulus package, Congressional leaders have signaled. To what degree the biopharma industry has relied on buybacks for earnings growth in recent years, and if the trend continues, are the big questions as scrutiny into the practice heightens and balance sheets weaken with the coronavirus pandemic wreaking havoc on global economies.

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A Sin­ga­pore VC rais­es $200M for a new round, but will Covid-19 pre­vent it from rais­ing the rest?

A top Singaporean biotech venture fund is nearly halfway toward its largest ever fund, but in a sign of what could be in store for VCs amid a global economic freeze, said they could face headwinds raising the other half.

Vickers Venture Partners has secured $200 million out of a targeted $500 million for its 6th fund, first announced in early 2018. They’ve given themselves 13 months to complete the financing, Vickers founder Finian Tan told Deal Street Asia, but the financial frost settling amid the Covid-19 pandemic could slow efforts.

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Strug­gling Unum ex­ecs are ready to con­sid­er a sale, merg­er or any deal that comes its way

Unum $UMRX is working its way through a survival plan of sorts.

After getting hit with a trio of FDA holds in its brief public history and triggering its second pivot to a new lead drug program while laying off 60% of the staff, the troubled penny stock biotech Unum Therapeutics has hatched new plans to secure financial backing while lining up a go-forward strategy for the company.

First, Lincoln Park Capital Fund has agreed to buy up to $25 million of the long-suffering stock, as Unum directs. And the executive team — led by CEO Chuck Wilson — has put everything on the table for consideration: a sale, acquisition, merger, licensing deal, you name it. The ACTR707 program, meanwhile, is being formally wrapped up — their second failed lead program.