#ES­MO20: Push­ing in­to front­line, Mer­ck and Bris­tol My­ers duke it out with new slate of GI can­cer da­ta

Hav­ing worked in par­al­lel for years to move their re­spec­tive PD-1 in­hibitors up to the first-line treat­ment of gas­troin­testi­nal can­cers, Mer­ck and Bris­tol My­ers Squibb fi­nal­ly have the da­ta at ES­MO for a show­down.

Com­par­ing KEYNOTE-590 and Check­Mate-649, of course, comes with the usu­al caveats. But a side-by-side look at the over­all sur­vival num­bers al­so of­fer some per­spec­tive on a new fron­tier for the reign­ing check­point ri­vals, both of whom are claim­ing to have achieved a first.

No­tably, Bris­tol test­ed Op­di­vo plus chemother­a­py for three types of metasta­t­ic can­cers — gas­tric, gas­troe­sophageal as well as esophageal ade­no­car­ci­no­ma, while Mer­ck en­rolled pa­tients with lo­cal­ly ad­vanced or metasta­t­ic esophageal can­cer and gas­troe­sophageal junc­tion can­cer.

Samit Hi­rawat

“So the pop­u­la­tion is much broad­er in Check­Mate-649,” Bris­tol CMO Samit Hi­rawat notes.

Nonethe­less Roy Baynes, his coun­ter­part at Mer­ck, con­sid­ers KEYNOTE-590 broad in its own way.

“This was a re­al­ly im­por­tant tri­al for us,” he says, which “pret­ty much ad­mit­ted all com­ers.” And Mer­ck counts it as a ma­jor suc­cess.

“Ba­si­cal­ly,” Baynes adds, “every sin­gle group that was pre-spec­i­fied hit at a high­ly sig­nif­i­cant lev­el.”

PD-L1 sta­tus, though, de­fines a broad­er group of pa­tients more like­ly to ben­e­fit.

Roy Baynes

In the ‘590 tri­al, in­ves­ti­ga­tors con­clud­ed that Keytru­da com­bined with chemo re­duced the risk of death com­pared to chemo alone by a sig­nif­i­cant mar­gin of 27% among all com­ers. Me­di­an over­all sur­vival was 12.4 months for the com­bo com­pared to 9.8 months in the chemo con­trol arm.

There was al­so a 35% re­duc­tion in the risk of dis­ease pro­gres­sion or death. Look­ing at PFS ver­sus chemother­a­py in all ran­dom­ized ES­CC pa­tients in the study, the com­bo hit a haz­ard ra­tio of 0.65, while those with tu­mors ex­press­ing PD-L1 fared bet­ter, with an HR of 0.51.

Nar­row it down to ES­CC pa­tients whose tu­mors ex­press PD-L1 (CPS ≥10) and the OS num­ber jumps to 13.9 months com­pared to 8.8 months.

With Op­di­vo, me­di­an OS among the all-ran­dom­ized pop­u­la­tion was 13.8 months ver­sus 11.6 months for those on chemo, trans­lat­ing to a haz­ard ra­tio of 0.80. In­ves­ti­ga­tors re­port­ed a PFS ben­e­fit for the broad group as well, al­though they didn’t spell out the num­bers

Zoom in­to the PD-L1 pos­i­tive group (CPS ≥5), and the HR is down to 0.71 with me­di­an OS of 14.4 months and 11.1 months, re­spec­tive­ly. With­in the co­hort, adding Op­di­vo to chemother­a­py re­duced the risk of pro­gres­sion or death by 32% (PFS 7.7 months vs. 6.0 months on chemo alone).

“That 3.4 month-im­prove­ment is cer­tain­ly very mean­ing­ful in a very hard, very chal­leng­ing dis­ease to treat,” Hi­rawat says.

The next step for both com­pa­nies will be to bring the da­ta to reg­u­la­tors. But while Bris­tol is like­ly seek­ing a la­bel ex­pan­sion that cov­ers all up­per GI can­cers, Hi­rawat high­lights that Mer­ck on­ly man­ages to prove that Keytru­da is non-in­fe­ri­or, but not su­pe­ri­or, to chemother­a­py in ad­vanced gas­tric or gas­troe­sophageal junc­tion can­cer with the pre­vi­ous­ly pre­sent­ed KEYNOTE-062 da­ta.

There’s still plen­ty to prove. And ul­ti­mate­ly physi­cians could have their own takes on the da­ta.

“I think we’ve al­ways tak­en the view that this is not a win­ner-take-all mar­ket,” Baynes says.

Michel Vounatsos, Biogen CEO (via YouTube)

UP­DAT­ED: Bio­gen spot­lights a pair of painful pipeline set­backs as ad­u­canum­ab show­down looms at the FDA

Biogen has flagged a pair of setbacks in the pipeline, spotlighting the final failure for a one-time top MS prospect while scrapping a gene therapy for SMA after the IND was put on hold due to toxicity.

Both failures will raise the stakes even higher on aducanumab, the Alzheimer’s drug that Biogen is betting the ranch on, determined to pursue an FDA OK despite significant skepticism they can make it with mixed results and a reliance on post hoc data mining. And the failures are being reported as Biogen was forced to cut its profit forecast for 2020 as a generic rival started to erode their big franchise drug.

Endpoints News

Keep reading Endpoints with a free subscription

Unlock this story instantly and join 92,100+ biopharma pros reading Endpoints daily — and it's free.

Stephen Hahn, FDA commissioner (AP Images)

As FDA sets the stage for the first Covid-19 vac­cine EUAs, some big play­ers are ask­ing for a tweak of the guide­lines

Setting the stage for an extraordinary one-day meeting of the Vaccines and Related Biological Products Advisory Committee this Thursday, the FDA has cleared 2 experts of financial conflicts to help beef up the committee. And regulators went on to specify the safety, efficacy and CMC input they’re looking for on EUAs, before they move on to the full BLA approval process.

All of this has already been spelled out to the developers. But the devil is in the details, and it’s clear from the first round of posted responses that some of the top players — including J&J and Pfizer — would like some adjustments and added feedback. And on Thursday, the experts can offer their own thoughts on shaping the first OKs.

Endpoints News

Keep reading Endpoints with a free subscription

Unlock this story instantly and join 92,100+ biopharma pros reading Endpoints daily — and it's free.

A new chap­ter in the de­cen­tral­ized clin­i­cal tri­al ap­proach

Despite the promised decentralized trial revolution, we haven’t yet moved the needle in a significant way, although we are seeing far bolder commitments to this as we continue to experience the pandemic restrictions for some time to come. The vision of grandeur is one thing, but operationalizing and execution are another and recognising that change, particularly mid-flight on studies, is worthy of thorough evaluation and consideration in order to achieve success. Here we will discuss one of the critical building blocks of a Decentralized and Remote Trial strategy: TeleConsent; more than paper under glass, it is a paradigm change and key digital enabler.

Years af­ter a ma­jor tri­al set­back, No­var­tis switch­es gears with SMA drug. This time they're try­ing it for Hunt­ing­ton's

Four years after a Phase I/II setback in spinal muscular atrophy (SMA), Novartis is hoping its drug branaplam will find more success in a new neurological indication: Huntington’s disease.

The decision was announced a year after the head of research, Jay Bradner, said he did not see a “big opportunity” in SMA, according to Reuters. Novartis says it has preclinical data showing that branaplam reduces levels of mutant huntingtin protein, and SMA data showing patients on the drug had reductions in huntingtin mRNA. The FDA gave branaplam their orphan drug designation, and Novartis plans to move forth with a Phase IIb trial next year.

Glax­o­SmithK­line's vac­cines group aims for a first as it kicks off PhI­II RSV stud­ies

One of GlaxoSmithKline’s big projects at its global vaccine R&D center in Rockville, MD is set to enter Phase III after passing early-stage tests with flying colors.

Eyeing the wide-open respiratory syncytial virus (RSV) space, GSK is pushing two different vaccine candidates: GSK3888550A is designed to confer protection to infants via maternal immunization, while GSK3844766A is meant for the elderly.

Pur­due Phar­ma signs guilty plea, preps $8B+ set­tle­ment on Oxy con­tro­ver­sy — re­port; Flag­ship brings in a comms chief

Purdue Pharma may soon be signing off on a guilty plea and an $8 million-plus settlement to wrap up its controversial role distributing OxyContin.

The AP has the breaking story this morning.

Purdue filed for bankruptcy last year, along with Insys and followed by Mallinckrodt, as it navigated its way through a blizzard of litigation surrounding Oxy, which triggered an epidemic of abuse around the country.

UP­DAT­ED: CRISPR Ther­a­peu­tics gets a snap­shot of off-the-shelf CAR-T suc­cess in B-cell ma­lig­nan­cies — marred by the death of a pa­tient

Just days after scientific founder Emmanuelle Charpentier shared the Nobel prize for her work on CRISPR/Cas9, CRISPR Therapeutics $CRSP is showing off a snapshot of success in their early-stage study for an off-the-shelf CAR-T approach to CD19+ B cell malignancies — a snapshot marred by the death of a patient who had been given a high dose of the treatment.

Using their gene editing tech, researchers for CRISPR engineered cells from healthy donors into an attack vehicle aimed at cancer, something that has been achieved with great success using patients’ own cells — the autologous approach. But autologous CAR-T is hampered by the more complex vein-to-vein requirement that delays treatment, and now CRISPR Therapeutics along with other players like Allogene are determined to replace the pioneers with CAR-T 2.0.

Endpoints News

Keep reading Endpoints with a free subscription

Unlock this story instantly and join 92,100+ biopharma pros reading Endpoints daily — and it's free.

Lit­tle Zosano takes an­oth­er beat­ing as the FDA slaps down their ap­pli­ca­tion for a mi­graine patch

Zosano $ZSAN has officially come up short in its bid to develop a migraine patch.

The FDA rejected the company’s application to repurpose the triptan zolmitriptan in a new delivery system as Qtrypta, Zosano said Wednesday morning, issuing a CRL for the microneedle patch. Regulators cited inconsistent exposure levels across multiple clinical trials as the main reason for the thumbs down.

Investors did not take too kindly to the news, with Zosano shares plunking down around 25%. The company is requesting a Type A meeting to “provide clarity on the next steps for the program,” CEO Steven Lo said in a statement.

Pfizer CEO Albert Bourla (Drew Angerer/Getty Images)

Pfiz­er is on the verge of claim­ing a multi­bil­lion-dol­lar first-mover ad­van­tage with their Covid-19 vac­cine — an­a­lyst

From the beginning, Pfizer CEO Albert Bourla eschewed government funding for his Covid-19 vaccine work with BioNTech, willing to take all the $2 billion-plus risk of a lightning-fast development campaign in exchange for all the rewards that could fall its way with success. And now that the pharma giant has seized a solid lead in the race to the market, those rewards loom large.

SVB Leerink’s Geoff Porges has been running the numbers on Pfizer’s vaccine, the mRNA BNT162b2 program that the German biotech partnered on. And he sees a $3.5 billion peak in windfall revenue next year alone. Even after the pandemic is brought to heel, though, Porges sees a continuing blockbuster role for this vaccine as people around the world look to guard against a new, thoroughly endemic virus that will pose a permanent threat.

Endpoints News

Keep reading Endpoints with a free subscription

Unlock this story instantly and join 92,100+ biopharma pros reading Endpoints daily — and it's free.