Mer­ck high­lights cru­cial hit for Keytru­da in sec­ond-line esophageal car­ci­no­ma — but there are al­so 2 miss­es

Mer­ck has un­veiled a Phase III da­ta pack­age back­ing Keytru­da’s case as a sec­ond-line treat­ment for the tough in­di­ca­tions of esophageal and esoph­a­gogas­tric junc­tion car­ci­no­ma, un­der­scor­ing its ear­li­er con­fi­dence that the PD-1 in­hibitor rep­re­sents a sig­nif­i­cant ad­vance in this field de­spite on­ly hit­ting one of three pri­ma­ry end­points.

The key num­ber the com­pa­ny wants to fo­cus on is 31% — the de­gree by which Keytru­da re­duced the risk of death com­pared to chemother­a­py in pa­tients with squa­mous cell car­ci­no­ma or ade­no­car­ci­no­ma, who had pro­gressed af­ter stan­dard ther­a­py and whose tu­mors ex­pressed PD-L1 (as quan­ti­fied by a com­bined pos­i­tive score, or CPS, of 10 or above).

That sub­group, which con­sti­tutes 222 out of 628 to­tal pa­tients in the KEYNOTE-181 study, reached a me­di­an OS of 9.3 months ver­sus 6.7 months for the chemo group. They al­so had a 12-month OS rate of 43% while the chemo arm ex­pe­ri­enced 20%.

These are pa­tients whose can­cer — in the esoph­a­gus or the esoph­a­gogas­tric junc­tion — pro­gressed af­ter ini­tial treat­ment, fol­low­ing a poor prog­no­sis to be­gin with, re­searchers added.

For the en­tire in­ten­tion-to-treat pop­u­la­tion, though, the dif­fer­ence in OS be­tween two arms was not sta­tis­ti­cal­ly sig­nif­i­cant with a me­di­an OS of 7.1 months for both treat­ment groups. Same goes for the oth­er sub­group an­a­lyzed for the study — the 401 pa­tients with squa­mous cell car­ci­no­ma — with the Keytru­da group see­ing a me­di­an OS of 8.2 months com­pared to 7.1 months in those re­ceiv­ing chemo.

These fail­ures kept in­ves­ti­ga­tors from for­mal­ly test­ing the sec­ondary end­points, mean­ing that we won’t know the pro­gres­sion-free sur­vival and ob­jec­tive re­sponse rate.

Mean­while, a sep­a­rate Phase III study — dubbed KEYNOTE-590 — is putting the block­buster check­point in­hibitor to first-line use in com­bi­na­tion with chemother­a­py for pa­tients with esophageal car­ci­no­ma.

Ri­vals are lin­ing up their own shots at esophageal and esoph­a­gogas­tric can­cers, with late-stage of­fer­ings from chief ri­val Bris­tol-My­ers Squibb. Cel­gene and BeiGene, which were slat­ed to notch the 7th PD-1 ap­proval in the US, were al­so in the game, though the pro­gram’s fate re­mains un­clear as Bris­tol-My­ers com­pletes its $74 bil­lion ac­qui­si­tion of Cel­gene.

Up­dat­ed: FDA re­mains silent on or­phan drug ex­clu­siv­i­ty af­ter last year's court loss

Since losing a controversial court case over orphan drug exclusivity last year, the FDA’s Office of Orphan Products Development has remained entirely silent on orphan exclusivity for any product approved since last November, leaving many sponsors in limbo on what to expect.

That silence means that for more than 70 orphan-designated indications for more than 60 products, OOPD has issued no public determination on the seven-year orphan exclusivity in the Orange Book, and no new listings of orphan exclusivity appear in OOPD’s searchable database, as highlighted recently by George O’Brien, a partner in Mayer Brown’s Washington, DC office.

Illustration: Assistant Editor Kathy Wong for Endpoints News

As mon­ey pours in­to dig­i­tal ther­a­peu­tics, in­sur­ance cov­er­age crawls



Talk therapy didn’t help Lily with attention deficit hyperactivity disorder, or ADHD. But a video game did.

As the 10-year-old zooms through icy waters and targets flying creatures on the snow-capped planet Frigidus, she builds attention skills, thanks to Akili Interactive Labs’ video game EndeavorRx. She’s now less anxious and scattered, allowing her to stay on a low dose of ADHD medication, according to her mom Violet Vu.

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Eli Lil­ly’s Alzheimer’s drug clears more amy­loid ear­ly than Aduhelm in first-ever head-to-head. Will it mat­ter?

Ahead of the FDA’s decision on Eli Lilly’s Alzheimer’s drug donanemab in February, the Big Pharma is dropping a first cut of data from one of the more interesting trials — but less important in a regulatory sense — at an Alzheimer’s conference in San Francisco.

In the unblinded 148-person study, Eli Lilly pitted its drug against Aduhelm, Biogen’s drug that won FDA approval but lost Medicare coverage outside of clinical trials. Notably, the study didn’t look at clinical outcomes, but rather the clearance of amyloid, a protein whose buildup is associated with Alzheimer’s disease, in the brain.

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Matt Gline, Roivant Sciences CEO (Photo by John Sciulli/Getty Images for GLG)

Pfiz­er and Roivant team up again for an­oth­er 'Van­t', set­ting up an­ti-in­flam­ma­to­ry show­down with Prometheus

Pfizer and Roivant are teaming up to launch a new ‘Vant’ aimed at bringing a mid-stage anti-inflammatory drug to market, the pair announced Thursday.

There’s no name for the startup yet, nor are there any employees. Thus far, the new company and Roivant can be considered “one and the same,” Roivant CEO Matt Gline tells Endpoints News. But Pfizer is so enthusiastic about the target that it elected to keep 25% of equity in the drug rather than take upfront cash from Roivant, Gline said.

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Roche HQ in Basel, Switzerland. (Image credit: Kyle LaHucik/Endpoints News)

As com­peti­tors near FDA goal­post, Roche spells out its re­peat Alzheimer's set­back

Before Roche can turn all eyes on a new version of its more-than-once-failed Alzheimer’s drug gantenerumab, the Big Pharma had to flesh out data on the November topline failure at an annual conference buzzier than in years past thanks to hotly watched rivals in the field: Eisai and Biogen’s lecanemab, and Eli Lilly’s donanemab.

There was less than a 10% difference between Roche’s drug and placebo at slowing cognitive decline across two Phase III trials, which combined enrolled nearly 2,000 Alzheimer’s patients. In its presentation at the conference Wednesday, Roche said it saw less sweeping away of toxic proteins than it had anticipated. For years, researchers and investors have put their resources behind the idea that more amyloid removal would equate to reduced cognitive decline.

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SQZ Biotech slash­es head­count by 60% as founder/CEO hits ex­it — while Syn­log­ic lays off 25%

It’s a tough time for early-stage companies developing highly promising, but largely unproven, new technologies.

Just ask SQZ Biotechnologies and Synlogic. The former is bidding farewell to its founder and CEO and slashing the headcount by 60% as it pivots from its original cell therapy platform to a next-gen approach; the latter — a synthetic biology play founded by MIT’s Jim Collins and Tim Lu — is similarly “optimizing” the company to focus on lead programs. The resulting realignment means 25% of the staffers will be laid off.

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Ei­sai’s ex­pand­ed Alzheimer’s da­ta leave open ques­tions about safe­ty and clin­i­cal ben­e­fit

Researchers still have key questions about Eisai’s investigational Alzheimer’s drug lecanemab following the publication of more Phase III data in the New England Journal of Medicine Tuesday night.

In the paper, which was released in conjunction with presentations at an Alzheimer’s conference, trial investigators write that a definition of clinical meaningfulness “has not been established.” And the relative lack of new information, following topline data unveiled in September, left experts asking for more — setting up a potential showdown to precisely define how big a difference the drug makes in patients’ lives.

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Paul Hudson, Sanofi CEO (Romuald Meigneux/Sipa via AP Images)

Sanofi and DN­Di aim to elim­i­nate sleep­ing sick­ness in Africa with promis­ing Ph II/III re­sults for new drug

The Drugs for Neglected Diseases initiative (DNDi) and Sanofi today said that their potential sleeping sickness treatment saw success rates of up to 95% from a Phase II/III study investigating the safety and efficacy of single-dose acoziborole.

The potentially transformative treatment for sleeping sickness would mainly be targeted at African countries, according to data published today in The Lancet Infectious Diseases medical journal. The clinical trial was led by DNDi and its partners in the Democratic Republic of the Congo (DRC) and Guinea, with the authors noting:

Lynn Baxter, Viiv Healthcare's head of North America

Vi­iV dri­ves new cor­po­rate coali­tion in­clud­ing Uber, Tin­der and Wal­mart, aimed at end­ing HIV

ViiV Healthcare is pulling together an eclectic coalition of consumer businesses in a new White House-endorsed effort to end HIV by the end of the decade.

The new US Business Action to End HIV includes pharma and health companies — Gilead Sciences, CVS Health and Walgreens — but extends to a wide range of consumer companies that includes Tinder, Uber and Walmart.

ViiV is the catalyst for the group, plunking down more than half a million dollars in seed money and taking on ringmaster duties for launch today on World AIDS Day, but co-creator Health Action Alliance will organize joint activities going forward. ViiV and the alliance want and expect more companies to not only join the effort, but also pitch in funding.

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