Keytru­da PhI­II fail­ure in gas­tric can­cer blights Mer­ck­'s quest for front­line dom­i­nance

A year and a half af­ter scor­ing an ap­proval to use Keytru­da in third-line gas­tric can­cer, Mer­ck has run in­to a wall try­ing to ap­ply the PD-1 star in the front­line set­ting.

In an up­date for the KEYNOTE-062, the com­pa­ny $MRK dis­closed that Keytru­da as a monother­a­py proved non-in­fe­ri­or to chemother­a­py — the cur­rent stan­dard of care for ad­vanced gas­tric or gas­troe­sophageal junc­tion ade­no­car­ci­no­ma — in over­all sur­vival. In com­bi­na­tion, though, Keytru­da plus chemo was not found to be su­pe­ri­or for ei­ther OS or pro­gres­sion-free sur­vival com­pared with chemo alone. That like­ly meant more miss­es than hits in the pri­ma­ry end­points, list­ed as PFS and OS on clin­i­cal­tri­als.gov.

As a spokesper­son ex­plained:

Based on the pre-spec­i­fied sta­tis­ti­cal analy­sis plan, su­pe­ri­or­i­ty test­ing for OS in the KEYTRU­DA monother­a­py group was con­duct­ed, how­ev­er as an­nounced, the fi­nal analy­sis showed that KEYTRU­DA monother­a­py was non-in­fe­ri­or, not su­pe­ri­or, to the chemother­a­py arm in pa­tients whose tu­mors were CPS ≥1. For KEYNOTE-062, it made sense to test for non­in­fe­ri­or­i­ty in the event that KEYTRU­DA monother­a­py had com­pa­ra­ble ef­fi­ca­cy as chemother­a­py with a po­ten­tial­ly fa­vor­able safe­ty and tol­er­a­bil­i­ty pro­file.

Roy Baynes

Mer­ck went ahead with the Phase III tri­al de­spite a flop in the sec­ond-line set­ting of the same in­di­ca­tion in 2017. Grant­ed, the drug had pos­i­tive third-line da­ta go­ing for it in a tough dis­ease where Pfiz­er and Mer­ck KGaA’s PD-L1 drug Baven­cio failed.

All pa­tients in the tri­al had tu­mors that ex­press PD-L1. In­ves­ti­ga­tors did not tease out any dif­fer­ences be­tween those with a high com­bined pos­i­tive score (CPS ≥10) and those with low CPS, of 1 or above.

“Gas­tric can­cer is his­tor­i­cal­ly dif­fi­cult to treat, and un­for­tu­nate­ly con­tin­ues to be as­so­ci­at­ed with high mor­tal­i­ty rates in many coun­tries, par­tic­u­lar­ly in the metasta­t­ic stage,” said Roy Baynes, Mer­ck’s head of glob­al de­vel­op­ment, in a state­ment.

The brief state­ment al­so didn’t cov­er any of the sec­ondary end­points, in­clud­ing over­all re­sponse rate, du­ra­tion of re­sponse, qual­i­ty of life and a gas­tric can­cer score.

Mer­ck says it plans to dis­cuss the fi­nal analy­sis with the FDA, as well as oth­er on­go­ing gas­tric stud­ies that might serve as con­fir­ma­to­ry tri­als, in­clud­ing KEYNOTE-811 and KEYNOTE-859. Then there’s the Phase III KEYNOTE-585 to watch, where Keytru­da in com­bi­na­tion with chemother­a­py is test­ed in a neoad­ju­vant/ad­ju­vant set­ting.

Brian Kaspar. AveXis via Twitter

AveX­is sci­en­tif­ic founder fires back at No­var­tis CEO Vas Narasimhan, 'cat­e­gor­i­cal­ly de­nies any wrong­do­ing'

Brian Kaspar’s head was among the first to roll at Novartis after company execs became aware of the fact that manipulated data had been included in its application for Zolgensma, now the world’s most expensive therapy.

But in his first public response, the scientific founder at AveXis — acquired by Novartis for $8.7 billion — is firing back. And he says that not only was he not involved in any wrongdoing, he’s ready to defend his name as needed.

I reached out to Brian Kaspar after Novartis put out word that he and his brother Allen had been axed in mid-May, two months after the company became aware of the allegations related to manipulated data. His response came back through his attorneys.

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We­bi­nar: Re­al World End­points — the brave new world com­ing in build­ing fran­chise ther­a­pies

Several biopharma companies have been working on expanding drug labels through the use of real world endpoints, combing through the data to find evidence of a drug’s efficacy for particular indications. But we’ve just begun. Real World Evidence is becoming an important part of every clinical development plan, in the soup-through-nuts approach used in building franchises.

I’ve recruited a panel of 3 top experts in the field — the first in a series of premium webinars — to look at the practical realities governing what can be done today, and where this is headed over the next few years, at the prodding of the FDA.


ZHEN SU — Merck Serono’s Senior Vice President and Global Head of Oncology


ELLIOTT LEVY — Amgen’s Senior Vice President of Global Development


CHRIS BOSHOFF — Pfizer Oncology’s Chief Development Officer

A premium subscription to Endpoints News is required to attend this webinar. Please upgrade to either an Insider or Enterprise plan for access. Already have Endpoints Premium? Please sign-in below. You can contact our Subscriptions team at help@endpointsnews.com with any issues.

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Video: Putting the AI in R&D — with Badhri Srini­vasan, Tony Wood, Rosana Kapeller, Hugo Ceule­mans, Saurabh Sa­ha and Shoibal Dat­ta

During BIO this year, I had a chance to moderate a panel among some of the top tech experts in biopharma on their real-world use of artificial intelligence in R&D. There’s been a lot said about the potential of AI, but I wanted to explore more about what some of the larger players are actually doing with this technology today, and how they see it advancing in the future. It was a fascinating exchange, which you can see here. The transcript has been edited for brevity and clarity. — John Carroll

UP­DAT­ED: As­traZeneca’s Imfinzi/treme com­bo strikes out — again — in lung can­cer. Is it time for last rites?

AstraZeneca bet big on the future of their PD-L1 Imfinzi combined with the experimental CTLA-4 drug tremelimumab. But once again it’s gone down to defeat in a major Phase III study — while adding damage to the theory involving targeting cancer with a high tumor mutational burden.

Early Wednesday the pharma giant announced that their NEPTUNE study had failed, with the combination unable to beat standard chemo at overall survival in high TMB cases of advanced non-small cell lung cancer. We won’t get hard data until later in the year, but the drumbeat of failures will call into question what — if any — future this combination can have left.

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Ted Ashburn. Oncorus

Cowen, Per­cep­tive lead $79.5M Se­ries B for 's­tand­out' biotech shep­herd­ing on­colyt­ic virus to clin­ic

As several Big Pharma players secure biotech partners in the oncolytic virus space for new immuno-oncology combos, Cowen and Perceptive Advisors have come out with their own bet on a startup that promises to shine.

The marquee investors are joining MPM, Deerfield, Celgene, Astellas, Arkin and UBS in backing the drug developer, Oncorus, which will now deploy the $79.5 million in Series B cash toward clinical development of its lead program. Other new investors include Surveyor Capital, Sphera Funds, IMM Investment, QUAD Investment Management, UTC Investment, SV Investment Corp and Shinhan Investment-Private Equity, the last five of which are Korean-based funds.

Fu­til­i­ty analy­sis au­gurs de­feat in piv­otal tri­al test­ing of Nu­Cana's lead drug in metasta­t­ic pan­cre­at­ic can­cer

Nearly two years after making its public debut, UK-based NuCana’s mission to make chemotherapies more potent and safer was dealt a blow, after a pivotal study testing its lead experimental drug halted enrollment in a hard-to-treat advanced form of cancer, following a futility analysis.

The drug, Acelarin, is being evaluated for use in metastatic pancreatic cancer patients who were not considered suitable for combination chemotherapy. In the late-stage ACELARATE study — which compared the experimental drug against the chemotherapy gemcitabine — 200 patients had been enrolled by the sponsor, Clatterbridge Cancer Centre, before an analysis from an independent safety and data monitoring panel suggested the study’s main goal would not be met.

UP­DAT­ED: Pay­back? An­a­lysts say Sarep­ta was blind­sided by an FDA re­jec­tion dri­ven by reg­u­la­to­ry re­venge

In one of the least anticipated moves of the year, the FDA has rejected Sarepta’s application for an accelerated approval of its Duchenne MD drug golodirsen after fretting over safety issues.

In a statement that arrived after the bell on Monday, Sarepta explained the CRL, saying:

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Levi Garraway. Broad Institute via Youtube

Roche raids Eli Lil­ly for its next chief med­ical of­fi­cer as San­dra Horn­ing plans to step down

We found out Monday morning where Levi Garraway was headed after he left Eli Lilly as head of oncology R&D a few days ago. Roche named Garraway as their new chief medical officer, replacing Sandra Horning, who they say is retiring from the company.

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Af­ter a posse of Wall Street an­a­lysts pre­dict a like­ly new win for Sarep­ta, we're down to the wire on a crit­i­cal FDA de­ci­sion

As Bloomberg notes, most of the Wall Street analysts that cover Sarepta $SRPT are an upbeat bunch, ready to cheer on the team when it comes to their Duchenne MD drugs, or offer explanations when an odd setback occurs — as happened recently with a safety signal that was ‘erroneously’ reported last week.

Ritu Baral Cowen
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