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.

A new era of treat­ment: How bio­mark­ers are chang­ing the way we think about can­cer

AJ Patel was recovering from a complicated brain surgery when his oncologist burst into the hospital room yelling, “I’ve got some really great news for you!”

For two years, Patel had been going from doctor to doctor trying to diagnose his wheezing, only to be dealt the devastating news that he had stage IV lung cancer and only six months to live. And then they found the brain tumors.

“What are you talking about?” Patel asked. He had never seen an oncologist so happy.

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David Ricks, Eli Lilly CEO (David Paul Morris/Bloomberg via Getty Images)

Eli Lil­ly set to in­vest $2.1B in home state man­u­fac­tur­ing boost

Eli Lilly is looking to expand its footprint in its home Hoosier State by making a major investment in manufacturing.

The pharma is investing $2.1 billion in two new manufacturing sites at Indiana’s LEAP Lebanon Innovation and Research District in Boone County, northwest of Lilly’s headquarters in Indianapolis.

The two new facilities will expand Lilly’s manufacturing network for active ingredients and new therapeutic modalities, including genetic medicines, according to a press release.

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US sees spike in Paxlovid us­age as Mer­ck­'s mol­nupi­ravir and As­traZeneca's Evusheld are slow­er off the shelf

New data from HHS show that more than 162,000 courses of Pfizer’s Covid-19 antiviral Paxlovid were administered across the US over the past week, continuing a streak of increased usage of the pill, and signaling not only rising case numbers but more awareness of how to access it.

In comparison to this week, about 670,000 courses of the Pfizer pill have been administered across the first five months since Paxlovid has been on the US market, averaging about 33,000 courses administered per week in that time.

Almirall is tapping artificial intelligence on behalf of its sales force for insights and efficiencies. (via Shutterstock)

Almi­rall rolls out sales rep ar­ti­fi­cial in­tel­li­gence sys­tem, cut­ting pre-call prep and 'wind­shield time'

Dermatology specialty pharma Almirall is making its sales reps smarter. Not with extra training or educational courses, but instead with artificial intelligence tools.

It began a soft launch of a sales rep AI and machine learning platform it calls Polaris last August in one of its 7 US coverage regions. The platform from Aktana gathers information from across Almirall internal sources and external ones – such as claims and prescribing data – to generate insights for reps. Now, instead of spending hours prepping for a sales call, Polaris can generate details about a physician’s preferences, past behaviors and prescription habits for reps in minutes, said Almirall head of commercial operations Vincent Cerio.

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Pfiz­er and CD­MOs ramp up Paxlovid man­u­fac­tur­ing with Kala­ma­zoo plant ex­pan­sion lead­ing the way

As the Covid-19 pandemic continues to evolve, pharma companies and manufacturers are exploring how to step up production on antivirals.

Pfizer is planning to expand its Kalamazoo-area facility to increase manufacturing capabilities for the oral Covid-19 antiviral Paxlovid, according to a report from Michigan-based news site MLive. The expansion of the facility, which serves as Pfizer’s largest manufacturing location, is expected to create hundreds of “high-skilled” STEM jobs, MLive reported. No details about the project’s cost and timeline have been released, but according to MLive, Pfizer will announce the details of the expansion at some point in early June.

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FDA spells out the rules and re­stric­tions for states seek­ing to im­port drugs from Cana­da

The FDA is offering more of an explanation of the guardrails around its program that may soon allow states to import prescription drugs in some select circumstances from Canada, but only if such imports will result in significant cost reductions for consumers.

While the agency has yet to sign off on any of the 5 state plans in the works so far, and PhRMA’s suit to block the Trump-era rule allowing such imports is stalled, the new Q&A guidance spells out the various restrictions that states will have to abide by, potentially signaling that a state approval is coming.

Greg Mayes, Antios Therapeutics CEO

An­tios' HBV col­lab axed af­ter clin­i­cal hold, but biotech be­lieves safe­ty in­ci­dent is not treat­ment-re­lat­ed

The FDA has placed a clinical hold on a Phase IIa study of Antios Therapeutics’ investigational hepatitis B med, CEO Greg Mayes confirmed to Endpoints News in an emailed statement.

A safety report was delivered to the biotech on May 17 after a patient dosed in a triple combination cohort of the study had experienced bradycardia and hypotension. The triple combo included Antios’ ATI-2173, Assembly Biosciences’ vebicorvir and Viread, an approved antiviral for HIV and hepatitis B.

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Tim Schoen, BioMed Realty CEO

Life sci­ences de­vel­op­er Bio­Med Re­al­ty buys San Fran­cis­co ho­tel for $75M — re­port

In a somewhat unconventional deal, life sciences real estate developer BioMed Realty has bought a 169-room Hilton Garden Inn in South San Francisco for $75 million, the San Francisco Business Times reported.

BioMed Realty, an affiliate of Blackstone, has multiple life sciences and technology office projects in the Bay Area, including three sites within a five-minute drive of the hotel.

While the sale of the hotel property was announced earlier this month, the sellers, Summit and GIC, did not identify the buyer at the time.

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Pfizer CEO Albert Bourla at the World Economic Forum (Gian Ehrenzeller/Keystone via AP Images)

All about ac­cess: Pfiz­er moves to a non-prof­it mod­el for drug sales in 45 low­er-in­come coun­tries

Leading the way to increase access to cheaper drugs worldwide, Pfizer said Wednesday it will provide all current and future patent-protected medicines and vaccines available in the US or EU on a not-for-profit basis to about 1.2 billion people in 45 lower-income countries.

Rwanda, Ghana, Malawi, Senegal and Uganda are the first five countries to sign on to this accord, which will also seek to blaze new paths for quick and efficient regulatory and procurement processes to reduce the usual delays in making new medicines and vaccines available in these countries.