#AS­CO21: Mer­ck tacks on ar­mor in ear­ly-line can­cer fight with 2 Keytru­da wins set­ting the tone

With more and more PD-(L)1 check­point in­hibitors flood­ing the mar­ket, there has been a long-run­ning war over which of those drugs can se­cure a lead in ear­ly-line pa­tients. With Keytru­da on top of the world, Mer­ck is well-po­si­tioned to take the lead — and it’s rolling out a pair of stud­ies tar­get­ed di­rect­ly at that front.

As part of a broad plan of at­tack to bring I-O won­der drug Keytru­da in­to ear­li­er lines of metasta­t­ic can­cer, Mer­ck will un­veil win­ning re­sults at this year’s AS­CO from Phase II and Phase III tests as part of com­bi­na­tion ther­a­pies top­ping stan­dard of care in non-small cell lung and gas­tric can­cers.

First, a com­bi­na­tion ther­a­py of Keytru­da and stan­dard-of-care Her­ceptin plus chemother­a­py post­ed a con­firmed over­all re­sponse rate of 74% com­pared with 52% for place­bo+SOC in first-line pa­tients with HER2-pos­i­tive gas­tric or gas­troe­sophageal can­cer, ac­cord­ing to da­ta from the Phase III KEYNOTE-811 study.

It’s the first con­fer­ence pre­sen­ta­tion for KEYNOTE-811, worth point­ing out as the FDA al­ready grant­ed the com­bi­na­tion an ac­cel­er­at­ed ap­proval ear­li­er this month. The com­plete re­sponse rate for the com­bo was 11.3% com­pared with 3.1% with a me­di­an du­ra­tion of re­sponse of 10.3 months com­pared with 9.6 months, re­spec­tive­ly. Mean­while, the com­bo’s safe­ty re­sults were com­pa­ra­ble with stan­dard of care with no new safe­ty flags.

Roy Baynes

The da­ta are a bit af­ter the fact with the ap­proval in hand, but Mer­ck Re­search Labs CMO Roy Baynes told End­points News the re­sults are part of an es­ca­lat­ing bat­tle among drug­mak­ers to bring I-O med­i­cines in­to ear­li­er and ear­li­er lines of ther­a­py. For Mer­ck, that strat­e­gy hinges around the use of com­bi­na­tion ther­a­pies for Keytru­da, which have shown a lot more promise than sub­sti­tut­ing monother­a­py for es­tab­lished stan­dard of care in terms of tu­mor re­sponse.

“What you’re see­ing is of­ten­times in the com­bi­na­to­r­i­al set­ting, the bio­mark­er be­comes less im­por­tant, re­sponse rates are of­ten­times quite a lot high­er, and we’re of­ten able to ad­dress pop­u­la­tions that gen­er­al­ly were not nec­es­sar­i­ly ben­e­fit­ing max­i­mal­ly from monother­a­py,” he said.

At AS­CO, Mer­ck will al­so present da­ta from KEYNOTE-799, a Phase II study of Keytru­da plus plat­inum-based chemother­a­py and ra­dio­ther­a­py in first-line, lo­cal­ly ad­vanced stage III non-small cell lung can­cer pa­tients whose tu­mors can’t be sur­gi­cal­ly re­moved.

The cur­rent stan­dard of care in that set­ting is chemora­di­a­tion fol­lowed by a “con­sol­i­da­tion reg­i­men” of As­traZeneca’s Imfinzi. Up to 30% of those pa­tients can­not com­plete the Imfinzi reg­i­men, of­fer­ing a big un­met clin­i­cal need.

Ac­cord­ing to ear­ly re­sults, the Keytru­da com­bo post­ed a over­all re­sponse rate around 70% across two co­horts of pa­tients with ei­ther squa­mous or non-squa­mous NSCLC re­ceiv­ing two sep­a­rate chemora­di­a­tion reg­i­men plus Keytru­da or Keytru­da alone. The com­bined com­plete and par­tial re­spons­es in Co­hort A were 79 and 72 in Co­hort B. The du­ra­tion of re­sponse rate af­ter 12 months was 80% and 76%, re­spec­tive­ly.

Most im­por­tant­ly on the safe­ty front, the com­bi­na­tion of chemora­di­a­tion and Keytru­da didn’t spur a high rate of pneu­moni­tis — or lung in­flam­ma­tion — in the pa­tient pop­u­la­tion, Baynes said. Both ther­a­pies tak­en alone have been tied to pneu­moni­tis, and in­ves­ti­ga­tors close­ly mon­i­tored pa­tients to see how that safe­ty flag would progress.

With proof-of-con­cept se­cured, Mer­ck is al­so chas­ing a Phase III study for Keytru­da on top of chemora­di­a­tion fol­lowed by ei­ther Keytru­da alone or in com­bi­na­tion with PARP in­hibitor Lyn­parza as part of the KEY­LYNK-012 study.

ZS Per­spec­tive: 3 Pre­dic­tions on the Fu­ture of Cell & Gene Ther­a­pies

The field of cell and gene therapies (C&GTs) has seen a renaissance, with first generation commercial therapies such as Kymriah, Yescarta, and Luxturna laying the groundwork for an incoming wave of potentially transformative C&GTs that aim to address diverse disease areas. With this renaissance comes several potential opportunities, of which we discuss three predictions below.

Allogenic Natural Killer (NK) Cells have the potential to displace current Cell Therapies in oncology if proven durable.

Despite being early in development, Allogenic NKs are proving to be an attractive new treatment paradigm in oncology. The question of durability of response with allogenic therapies is still an unknown. Fate Therapeutics’ recent phase 1 data for FT516 showed relatively quicker relapses vs already approved autologous CAR-Ts. However, other manufacturers, like Allogene for their allogenic CAR-T therapy ALLO-501A, are exploring novel lymphodepletion approaches to improve persistence of allogenic cells. Nevertheless, allogenic NKs demonstrate a strong value proposition relative to their T cell counterparts due to comparable response rates (so far) combined with the added advantage of a significantly safer AE profile. Specifically, little to no risk of graft versus host disease (GvHD), cytotoxic release syndrome (CRS), and neurotoxicity (NT) have been seen so far with allogenic NK cells (Fig. 1). In addition, being able to harness an allogenic cell source gives way to operational advantages as “off-the-shelf” products provide improved turnaround time (TAT), scalability, and potentially reduced cost. NKs are currently in development for a variety of overlapping hematological indications with chimeric antigen receptor T cells (CAR-Ts) today, and the question remains to what extent they will disrupt the current cell therapy landscape. Click for more details.

Susan Galbraith, AstraZeneca EVP, Oncology R&D

Can­cer pow­er­house As­traZeneca rolls the dice on a $75M cash bet on a buzzy up­start in the on­col­o­gy field

After establishing itself in the front ranks of cancer drug developers and marketers, AstraZeneca is putting its scientific shoulder — and a significant amount of cash — behind the wheel of a brash new upstart in the biotech world.

The pharma giant trumpeted news this morning that it is handing over $75 million upfront to ally itself with Scorpion Therapeutics, one of those biotechs that was newly birthed by some top scientific, venture and executive talent and bequeathed with a fortune by way of a bankroll to advance an only hazily explained drug platform. And they are still very much in the discovery and preclinical phase.

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Lat­est news on Pfiz­er's $3B+ JAK1 win; Pacts over M&A at #JPM22; 2021 by the num­bers; Bio­gen's Aduhelm reck­on­ing; The sto­ry of sotro­vimab; and more

Welcome back to Endpoints Weekly, your review of the week’s top biopharma headlines. Want this in your inbox every Saturday morning? Current Endpoints readers can visit their reader profile to add Endpoints Weekly. New to Endpoints? Sign up here.

For those of you who attended #JPM22 in any shape or form, we hope you had a fruitful time. Regardless of how you spent the past hectic week, may your weekend be just what you need it to be.

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A $3B+ peak sales win? Pfiz­er thinks so, as FDA of­fers a tardy green light to its JAK1 drug abroc­i­tinib

Back in the fall of 2020, newly crowned Pfizer chief Albert Bourla confidently put their JAK1 inhibitor abrocitinib at the top of the list of blockbuster drugs in the late-stage pipeline with a $3 billion-plus peak sales estimate.

Since then it’s been subjected to serious criticism for the safety warnings associated with the class, held back by a cautious FDA and questioned when researchers rolled out a top-line boast that their heavyweight contender had beaten the champ in the field of atopic dermatitis — Dupixent — in a head-to-head study.

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Robert Califf, FDA commissioner nominee (Graeme Sloan/Sipa USA/Sipa via AP Images)

Rob Califf ad­vances as Biden's FDA nom­i­nee, with a close com­mit­tee vote

Rob Califf’s second confirmation process as FDA commissioner is already much more difficult than his near unanimous confirmation under the Obama administration.

The Senate Health Committee on Thursday voted 13-8 in favor of advancing Califf’s nomination to a full Senate vote. Several Democrats voted against Califf, including Sen. Bernie Sanders and Sen. Maggie Hassan. Several other Democrats who aren’t on the committee, like West Virginia’s Joe Manchin and Ed Markey of Massachusetts, also said Thursday that they would not vote for Califf. Markey, Hassan and Manchin all previously expressed reservations about the prospect of Janet Woodcock as an FDA commissioner nominee too.

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Michel Vounatsos, Biogen CEO (World Economic Forum/Ciaran McCrickard)

Bio­gen vows to fight CM­S' draft cov­er­age de­ci­sion for Aduhelm be­fore April fi­nal­iza­tion

Biogen executives made clear in an investor call Thursday they are not preparing to run a new CMS-approved clinical trial for their controversial Alzheimer’s drug anytime soon.

As requested in a draft national coverage decision from CMS earlier this week, Biogen and other anti-amyloid drugs will need to show “a meaningful improvement in health outcomes” for Alzheimer’s patients in a randomized, placebo-controlled trial to get paid for their drugs, rather than just the reduction in amyloid plaques that won Aduhelm its accelerated approval in June.

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CRO own­er pleads guilty to ob­struct­ing FDA in­ves­ti­ga­tion in­to fal­si­fied clin­i­cal tri­al da­ta

The co-owner of a Florida-based clinical research site pleaded guilty to lying to an FDA investigator during a 2017 inspection, revealing that she falsely portrayed part of a GlaxoSmithKline pediatric asthma study as legitimate, when in fact she knew that certain data had been falsified, the Department of Justice said Wednesday.

Three other employees — Yvelice Villaman Bencosme, Lisett Raventos and Maytee Lledo — previously pleaded guilty and were sentenced in connection with falsifying data associated with the trial at the CRO Unlimited Medical Research.

‘Skin­ny la­bels’ on gener­ics can save pa­tients mon­ey, re­search shows, but re­cent court de­ci­sions cloud fu­ture

New research shows how generic drug companies can successfully market a limited number of approved indications for a brand name drug, prior to coming to market for all of the indications. But several recent court decisions have created a layer of uncertainty around these so-called “skinny” labels.

While courts have generally allowed generic manufacturers to use their statutorily permitted skinny-label approvals, last summer, a federal circuit court found that Teva Pharmaceuticals was liable for inducing prescribers and patients to infringe GlaxoSmithKline’s patents through advertising and marketing practices that suggested Teva’s generic, with its skinny label, could be employed for the patented uses.

A patient in Alaska receiving an antibody infusion to prevent Covid hospitalizations in September. All but one of these treatments has been rendered useless by Omicron (Rick Bowmer/AP Images)

How a tiny Swiss lab and two old blood sam­ples cre­at­ed one of the on­ly ef­fec­tive drugs against Omi­cron (and why we have so lit­tle of it)

Exactly a decade before a novel coronavirus broke out in Wuhan, Davide Corti — a newly-minted immunologist with frameless glasses and a quick laugh — walked into a cramped lab on the top floor of an office building two hours outside Zurich. He had only enough money for two technicians and the ceiling was so low in parts that short stature was a job requirement, but Corti believed it’d be enough to test an idea he thought could change medicine.

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