Four years af­ter EU ap­proval, NICE fi­nal­ly backs Revlim­id use in cer­tain first-line mul­ti­ple myelo­ma pa­tients

Four years af­ter the Eu­ro­pean Com­mis­sion sanc­tioned the use of Cel­gene’s flag­ship Revlim­id to treat adults with pre­vi­ous­ly-un­treat­ed mul­ti­ple myelo­ma who are not el­i­gi­ble for trans­plant, Eng­land’s Na­tion­al Health Ser­vice (NHS) will adopt its use as the first or sec­ond line of de­fense — in cer­tain pa­tients. Al­though the block­buster drug is rou­tine­ly used as a back­bone treat­ment in much of the de­vel­oped world, un­til now, the drug was on­ly cleared for third-line use by NICE.

Revlim­id, which gen­er­at­ed rough­ly $9.7 bil­lion in glob­al 2018 sales, has long been Cel­gene’s key­stone treat­ment, but its use in Eng­land had been re­strained due to pric­ing dis­agree­ments. The drug is al­so cru­cial to Bris­tol-My­er’s $BMY $74 bil­lion bet on the big biotech (al­though the loss of patent pro­tec­tion is loom­ing).

Mul­ti­ple myelo­ma is a life-threat­en­ing form of blood can­cer, which orig­i­nates in the bone mar­row, and af­fects rough­ly 17,500 peo­ple in the UK at any giv­en time, ac­cord­ing to char­i­ty Myelo­ma UK, which es­ti­mates each year that about 5,700 new pa­tients are di­ag­nosed with the dis­ease.

NICE pub­lished two pieces of fi­nal draft guid­ance on Fri­day. In the first re­port, NICE rec­om­mend­ed the use of Revlim­id — known chem­i­cal­ly as lenalido­mide — in com­bi­na­tion with the cor­ti­cos­teroid dex­am­etha­sone as an op­tion for treat­ment-naive adults with mul­ti­ple myelo­ma who are not el­i­gi­ble for a stem cell trans­plant and can­not take thalido­mide. This new op­tion could ben­e­fit about 2,100 pa­tients, NICE said.

Thalido­mide (or borte­zomib, or Take­da’s $TAK Vel­cade, for those who can’t take thalido­mide) re­mains the first line of de­fense, al­though NICE ac­knowl­edged that se­vere side-ef­fects as­so­ci­at­ed with its use can rule out its adop­tion. How­ev­er, “(l)enalido­mide plus dex­am­etha­sone can­not be rec­om­mend­ed for un­treat­ed mul­ti­ple myelo­ma in peo­ple who could take thalido­mide be­cause this would not be cost ef­fec­tive,” NICE un­der­scored.

Lenalido­mide is avail­able as a 21‑cap­sule pack, and its cost varies per dose, up to £4,368 for the high­est 25 mg dose/pack. But, Cel­gene $CELG has now agreed to a (con­fi­den­tial) dis­count that has sat­is­fied NICE. 

In the sec­ond re­port, NICE backed the use of lenalido­mide as an op­tion for treat­ing mul­ti­ple myelo­ma in adults if they have had on­ly one pre­vi­ous ther­a­py, in­clud­ing borte­zomib. Par­tic­u­lar­ly for those that have been first treat­ed with borte­zomib, the on­ly next treat­ment in the doc­tor’s tool­box is chemother­a­py — how­ev­er, ev­i­dence in­di­cates that the lenalido­mide+dex­am­etha­sone is more ef­fec­tive than cy­to­tox­ic chemother­a­py. In one clin­i­cal study, pa­tients tak­ing lenalido­mide lived on av­er­age 7 months longer, NICE said.

About 320 pa­tients are ex­pect­ed to ben­e­fit, it added.

The most ‘plau­si­ble’ cost-ef­fec­tive­ness es­ti­mate for lenalido­mide plus dex­am­etha­sone may be above the range that NICE nor­mal­ly con­sid­ers be­ing a cost-ef­fec­tive use of NHS re­sources, re­searchers high­light­ed in the re­port, but con­ced­ed that since lenalido­mide has been rec­om­mend­ed for use as a first treat­ment (for which it is cost-ef­fec­tive) — the need for lenalido­mide as a sec­ond treat­ment will like­ly de­crease be­cause peo­ple are more like­ly to have it as a first treat­ment in the fu­ture.

Last month, NICE al­so backed the use of J&J’s $JNJ Darza­lex in com­bi­na­tion with Vel­cade as a sec­ond-line treat­ment for mul­ti­ple myelo­ma via the can­cer drugs fund.

Cel­gene, mean­while, is ad­vanc­ing the use of triplet mul­ti­ple myelo­ma ther­a­pies. On Thurs­day, the EU ap­proved 1) Revlim­id in com­bi­na­tion with Vel­cade and dex­am­etha­sone for adult pa­tients with pre­vi­ous­ly un­treat­ed mul­ti­ple myelo­ma who are not el­i­gi­ble for trans­plant; 2) Im­novid in com­bi­na­tion with Vel­cade and dex­am­etha­sone in adult pa­tients with mul­ti­ple myelo­ma, who have re­ceived at least one pri­or treat­ment reg­i­men in­clud­ing Revlim­id.


Im­age Source: As­so­ci­at­ed Press

Is a pow­er­house Mer­ck team prepar­ing to leap past Roche — and leave Gilead and Bris­tol My­ers be­hind — in the race to TIG­IT dom­i­na­tion?

Roche caused quite a stir at ASCO with its first look at some positive — but not so impressive — data for their combination of Tecentriq with their anti-TIGIT drug tiragolumab. But some analysts believe that Merck is positioned to make a bid — soon — for the lead in the race to a second-wave combo immuno-oncology approach with its own ambitious early-stage program tied to a dominant Keytruda.

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UP­DAT­ED: Leg­end fetch­es $424 mil­lion, emerges as biggest win­ner yet in pan­dem­ic IPO boom as shares soar

Amid a flurry of splashy pandemic IPOs, a J&J-partnered Chinese biotech has emerged with one of the largest public raises in biotech history.

Legend Biotech, the Nanjing-based CAR-T developer, has raised $424 million on NASDAQ. The biotech had originally filed for a still-hefty $350 million, based on a range of $18-$20, but managed to fetch $23 per share, allowing them to well-eclipse the massive raises from companies like Allogene, Juno, Galapagos, though they’ll still fall a few dollars short of Moderna’s record-setting $600 million raise from 2018.

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As it hap­pened: A bid­ding war for an an­tibi­ot­ic mak­er in a mar­ket that has rav­aged its peers

In a bewildering twist to the long-suffering market for antibiotics — there has actually been a bidding war for an antibiotic company: Tetraphase.

It all started back in March, when the maker of Xerava (an FDA approved therapy for complicated intra-abdominal infections) said it had received an offer from AcelRx for an all-stock deal valued at $14.4 million.

The offer was well-timed. Xerava was approved in 2018, four years after Tetraphase posted its first batch of pivotal trial data, and sales were nowhere near where they needed to be in order for the company to keep its head above water.

Drug man­u­fac­tur­ing gi­ant Lon­za taps Roche/phar­ma ‘rein­ven­tion’ vet as its new CEO

Lonza chairman Albert Baehny took his time headhunting a new CEO for the company, making it absolutely clear he wanted a Big Pharma or biotech CEO with a good long track record in the business for the top spot. In the end, he went with the gold standard, turning to Roche’s ranks to recruit Pierre-Alain Ruffieux for the job.

Ruffieux, a member of the pharma leadership team at Roche, spent close to 5 years at the company. But like a small army of manufacturing execs, he gained much of his experience at the other Big Pharma in Basel, remaining at Novartis for 12 years before expanding his horizons.

Covid-19 roundup: Ab­b­Vie jumps in­to Covid-19 an­ti­body hunt; As­traZeneca shoots for 2B dos­es of Ox­ford vac­cine — with $750M from CEPI, Gavi

Another Big Pharma is entering the Covid-19 antibody hunt.

AbbVie has announced a collaboration with the Netherlands’ Utrecht University and Erasmus Medical Center and the Chinese-Dutch biotech Harbour Biomed to develop a neutralizing antibody that can treat Covid-19. The antibody, called 47D11, was discovered by AbbVie’s three partners, and AbbVie will support early preclinical work, while preparing for later preclinical and clinical development. Researchers described the antibody in Nature Communications last month.

Pfiz­er’s Doug Gior­dano has $500M — and some ad­vice — to of­fer a cer­tain breed of 'break­through' biotech

So let’s say you’re running a cutting-edge, clinical-stage biotech, probably public, but not necessarily so, which could see some big advantages teaming up with some marquee researchers, picking up say $50 million to $75 million dollars in a non-threatening minority equity investment that could take you to the next level.

Doug Giordano might have some thoughts on how that could work out.

The SVP of business development at the pharma giant has helped forge a new fund called the Pfizer Breakthrough Growth Initiative. And he has $500 million of Pfizer’s money to put behind 7 to 10 — or so — biotech stocks that fit that general description.

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Bris­tol My­ers is clean­ing up the post-Cel­gene merg­er pipeline, and they’re sweep­ing out an ex­per­i­men­tal check­point in the process

Back during the lead up to the $74 billion buyout of Celgene, the big biotech’s leadership did a little housecleaning with a major pact it had forged with Jounce. Out went the $2.6 billion deal and a collaboration on ICOS and PD-1.

Celgene, though, also added a $530 million deal — $50 million up front — to get the worldwide rights to JTX-8064, a drug that targets the LILRB2 receptor on macrophages.

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GSK presents case to ex­pand use of its lu­pus drug in pa­tients with kid­ney dis­ease, but the field is evolv­ing. How long will the mo­nop­oly last?

In 2011, GlaxoSmithKline’s Benlysta became the first biologic to win approval for lupus patients. Nine years on, the British drugmaker has unveiled detailed positive results from a study testing the drug in lupus patients with associated kidney disease — a post-marketing requirement from the initial FDA approval.

Lupus is a drug developer’s nightmare. In the last six decades, there has been just one FDA approval (Benlysta), with the field resembling a graveyard in recent years with a string of failures including UCB and Biogen’s late-stage flop, as well as defeats in Xencor and Sanofi’s programs. One of the main reasons the success has eluded researchers is because lupus, akin to cancer, is not just one disease — it really is a disease of many diseases, noted Al Roy, executive director of Lupus Clinical Investigators Network, an initiative of New York-based Lupus Research Alliance that claims it is the world’s leading private funder of lupus research, in an interview.

UP­DAT­ED: Es­ti­mat­ing a US price tag of $5K per course, remde­sivir is set to make bil­lions for Gilead, says key an­a­lyst

Data on remdesivir — the first drug shown to benefit Covid-19 patients in a randomized, controlled trial setting — may be murky, but its maker Gilead could reap billions from the sales of the failed Ebola therapy, according to an estimate by a prominent Wall Street analyst. However, the forecast, which is based on a $5,000-per-course US price tag, triggered the ire of one top drug price expert.