'Go­ing big': Mer­ck launch­es front­line PhI­II lung can­cer study for Keytru­da/Yer­voy com­bo

Mer­ck took a dom­i­nant po­si­tion in front­line lung can­cer with the ap­proval of a com­bi­na­tion of Keytru­da and chemo. And it isn’t just wait­ing around to see if any com­bi­na­tion of a PD-(L)1 with a CT­LA4 can come along and knock it off its mar­ket-lead­ing perch.

The phar­ma gi­ant has launched a Phase III study com­bin­ing its check­point star with the Bris­tol-My­ers drug. Re­searchers are re­cruit­ing 548 pa­tients at sites around the world, ac­cord­ing to the list­ing at clin­i­cal­tri­als.gov.

The ju­ry is still def­i­nite­ly out on how a PD-(L)1/CT­LA-4 com­bo will work. Yer­voy and its class has been ef­fec­tive in im­prov­ing sur­vival rates, but they’re al­so as­so­ci­at­ed with sig­nif­i­cant tox­i­c­i­ty, which makes their use prob­lem­at­ic.

Mer­ck al­so has its own CT­LA-4 (MK-1308), which it is com­bin­ing with Keytru­da. So why add Yer­voy to the mix?

The sim­plest ex­pla­na­tion may be that Mer­ck, which has hun­dreds of com­bo stud­ies un­der­way, is try­ing every­thing. It’s al­so been spurred on by Bern­stein’s Tim An­der­son.

Since 2016, we have ar­gued it would be wise for MRK to run com­bi­na­tion tri­als of Keytru­da+Yer­voy tri­al in 1L lung can­cer.  Even though MRK does not own Yer­voy, it could still eas­i­ly de­sign a study like this, and it would be a hedge against the pos­si­bil­i­ty that AZN’s MYS­TIC and BMY’s Check­mate-227 show that CT­LA4+PDx com­bi­na­tion ther­a­py is vi­able (its vi­a­bil­i­ty re­mains un­clear at the mo­ment).

MYS­TIC, of course, has proven to be some­thing of an em­bar­rass­ment to As­traZeneca so far, with dur­val­um­ab and treme­li­mum­ab miss­ing the first goal on pro­gres­sion-free sur­vival. They’re still shoot­ing for over­all sur­vival, though, and aren’t com­plete­ly count­ed out in a field that rou­tine­ly pro­vides ex­tra­or­di­nary sur­pris­es.

An­der­son has urged Mer­ck to “go big or go home” on this front. I have no idea what Mer­ck, which went big on Keytru­da sev­er­al years ago, thought of that. But An­der­son has some in­flu­ence here and is not to be ig­nored.

The tri­al will on­ly en­roll high PDL1 ex­pressers (>50%), and bold­ly, it will com­pare this com­bi­na­tion to Keytru­da monother­a­py (which has be­come stan­dard of care any­way; re­call that MYS­TIC and ‘227 don’t have a PDx as a com­para­tor, but on­ly con­ven­tion­al chemother­a­py). The pri­ma­ry end­points are PFS and OS, but re­sults won’t be in hand un­til 2022 per clin­i­cal­tri­als.gov (link); this time­line is ar­guably con­ser­v­a­tive.

Bris­tol-My­ers and Cy­tomX, mean­while, are work­ing on a new CT­LA-4 that they hope will prove just as ef­fi­ca­cious or more while sig­nif­i­cant­ly less tox­ic.

Has the mo­ment fi­nal­ly ar­rived for val­ue-based health­care?

RBC Capital Markets’ Healthcare Technology Analyst, Sean Dodge, spotlights a new breed of tech-enabled providers who are rapidly transforming the way clinicians deliver healthcare, and explores the key question: can this accelerating revolution overturn the US healthcare system?

Key points

Tech-enabled healthcare providers are poised to help the US transition to value, not volume, as the basis for reward.
The move to value-based care has policy momentum, but is risky and complex for clinicians.
Outsourced tech specialists are emerging to provide the required expertise, while healthcare and tech are also converging through M&A.
Value-based care remains in its early stages, but the transition is accelerating and represents a huge addressable market.

Clay Siegall, Morphimmune CEO

Up­dat­ed: Ex-Seagen chief Clay Sie­gall emerges as CEO of pri­vate biotech

Clay Siegall will be back in the CEO seat, taking the helm of a private startup working on targeted cancer therapies.

It’s been almost a year since Siegall resigned from Seagen, the biotech he co-founded and led for more than 20 years, in the wake of domestic violence allegations by his then-wife. His eventual successor, David Epstein, sold the company to Pfizer in a $43 billion deal unveiled last week.

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No­vo Nordisk oral semaglu­tide tri­al shows re­duc­tion in blood sug­ar, plus weight loss

Novo Nordisk is testing higher levels of its oral version of its GLP-1, semaglutide, and its type 2 diabetes trial results released today show reductions in blood sugar as well as weight loss.

In the Phase IIIb trial, Novo compared its oral semaglutide in 25 mg and 50 mg doses with the 14 mg version that’s currently the maximum approved dose. The trial looked at how the doses compared when added to a stable dose of one to three oral antidiabetic medicines in people with type 2 diabetes who were in need of an intensified treatment.

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Ly­me vac­cine test com­ple­tion is pushed back by a year as Pfiz­er, Val­ne­va say they'll ad­just tri­al

Valneva and Pfizer have adjusted the end date for the Phase III study of their investigational Lyme disease vaccine, pushing it back by a year after issues at a contract researcher led to thousands of US patients being dropped from the test.

In a March 20 update to clinicaltrials.gov, Valneva and Pfizer moved the primary completion date on the trial, called VALOR, from the end of 2024 to the end of 2025.

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FDA spells out how can­cer drug de­vel­op­ers can use one tri­al for both ac­cel­er­at­ed and full ap­provals

The FDA’s Oncology Center of Excellence has been a bright spot within the agency in terms of speeding new treatments to patients. That flexibility was on full display this morning as FDA released new draft guidance spelling out exactly how oncology drug developers can fulfill both the accelerated and full approval’s requirements with just a single randomized controlled trial.

While Congress recently passed legislation that will allow FDA to require confirmatory trials to be recruiting and ongoing prior to granting an accelerated approval, the agency is now making clear that the initial trial used to win the AA, if designed appropriately, can also serve as the trial for converting the accelerated approval into a full approval.

Zhi Hong, Brii Biosciences CEO

Brii Bio­sciences stops man­u­fac­tur­ing Covid-19 an­ti­body com­bo, plans to with­draw EUA re­quest

Brii Biosciences said it will stop manufacturing its Covid-19 antibody combination, sold in China, and is working to withdraw its emergency use authorization request in the US, which it started in October 2021.

The Beijing and North Carolina biotech commercially launched the treatment in China last July but is now axing the work and reverting resources to other “high-priority programs,” per a Friday update. The focus now is namely hepatitis B viral infection, postpartum depression and major depressive disorders.

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Sijmen de Vries, Pharming CEO

FDA ap­proves Pharm­ing drug for ul­tra-rare im­mun­od­e­fi­cien­cy dis­ease

US regulators cleared an ultra-rare drug from Pharming Group, by way of Novartis, on Friday afternoon.

The Dutch biotech said the FDA greenlit leniolisib for an immunodeficiency disease known as activated phosphoinositide 3-kinase delta (PI3Kδ) syndrome, or APDS. People 12 years and older can receive the oral drug, to be marketed as Joenja, beginning early next month, Pharming said, five days ahead of the decision deadline set by the FDA as part of a priority review.

Stuart Peltz, former PTC Therapeutics CEO

Stu­art Peltz re­signs as PTC Ther­a­peu­tics CEO af­ter 25 years

Stuart Peltz, the longtime CEO of PTC Therapeutics who’s led the rare disease drug developer since its founding 25 years ago, is stepping down.

Succeeding him in the top job is Matthew Klein, who joined PTC in 2019 and was promoted to chief operating officer in 2022. In a call with analysts, he said the CEO transition has been planned for “quite some time” — in fact, as part of it, he gave the company’s presentation at the JP Morgan healthcare conference earlier this year.

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Bet­ter Ther­a­peu­tics cuts 35% of staff while await­ing dig­i­tal ther­a­peu­tic ap­proval

Digital therapeutics company Better Therapeutics announced on Thursday that it’s cutting 35% of its staff as it awaits FDA clearance for its first product.

The company, which launched eight years ago, is one of a growing group of companies seeking a digital alternative to traditional medicine. The space saw a record $7.5 billion in investments in 2021, according to Chris Dokomajilar at DealForma, with uses spanning ADHD, PTSD and other indications. However, private insurers have been slow to hop on board.