Mer­ck­'s Keytru­da nets an­oth­er ap­proval, this time in triple neg­a­tive breast can­cer. Can it catch up to Tecen­triq?

An­oth­er day, an­oth­er win for Mer­ck’s block­buster Keytru­da.

The FDA has grant­ed ac­cel­er­at­ed ap­proval for the cash cow com­bined with chemother­a­py in triple neg­a­tive breast can­cer, giv­ing the drug the green light in its 18th dif­fer­ent can­cer. Mon­day’s new in­di­ca­tion comes for pa­tients with PD-L1-ex­press­ing tu­mors with a Com­bined Pos­i­tive Score of at least 10.

Mer­ck not­ed that due to the na­ture of the ac­cel­er­at­ed ap­proval, the thumbs up is con­tin­gent up­on con­fir­ma­to­ry tri­als.

Da­ta for the ap­proval first came back in Feb­ru­ary, when the Keynote-355 tri­al demon­strat­ed Keytru­da plus chemo sig­nif­i­cant­ly im­proved pro­gres­sion-free sur­vival com­pared to chemo by it­self. The study showed that, in the tar­get pop­u­la­tion with a CPS of at least 10, the com­bi­na­tion re­duced the risk of dis­ease pro­gres­sion or death by 35% with a me­di­an PFS of 9.7 months, against 5.6 months in the place­bo arm.

On safe­ty, the Feb­ru­ary da­ta showed 2.5% of all pa­tients in the drug arm saw fa­tal ad­verse events, in­clud­ing car­diac ar­rest and sep­tic shock, with se­ri­ous side ef­fects ap­pear­ing in 30% of pa­tients. Keytru­da was dis­con­tin­ued due to ad­verse events in 11% of pa­tients.

Front­line triple neg­a­tive breast can­cer is a par­tic­u­lar­ly dif­fi­cult in­di­ca­tion to treat, as the growth of the can­cer is not fu­eled by the hor­mones es­tro­gen and prog­es­terone, or by the HER2 pro­tein. It’s one of the rare fields in which Roche’s PD-L1 Tecen­triq has en­joyed a head start over Keytru­da and Op­di­vo, the lead­ers in the check­point race, as Tecen­triq is ap­proved in com­bi­na­tion with Abrax­ane for this in­di­ca­tion.

Back in May 2019, Mer­ck con­ced­ed a fail­ure in the are­na af­ter a Phase III study flopped on over­all sur­vival. But a few months lat­er, the phar­ma turned things around af­ter dis­cov­er­ing a neoad­ju­vant reg­i­men of Keytru­da and chemo — fol­lowed by Keytru­da monother­a­py af­ter surgery — in­duced a high­er patho­log­i­cal com­plete re­sponse rate.

Though ex­ecs pre­sent­ed that as a pos­i­tive, some an­a­lysts didn’t paint as sun­ny a pic­ture. This past Feb­ru­ary, when the Keynote-355 topline da­ta was first pub­lished, SVB Leerink’s Daina Gray­bosch point­ed out that be­cause on­ly pa­tients with a CPS of at least 10 ap­peared to ben­e­fit, in­stead of a score of at least 1, it won’t be able to treat as broad a pop­u­la­tion as Tecen­triq. Roche, she not­ed, al­so has about a two-year head start.

A Mer­ck spokesper­son al­so had this to say about the CPS and IC per­cent­ages:

In TNBC, we mea­sure PD-L1 with a com­bined pos­i­tive score (CPS). The CPS in­cludes stain­ing for tu­mor cells, as well as tu­mor-in­fil­trat­ing im­mune cells and it is not a per­cent­age. We be­lieve CPS ≥10 is rough­ly equiv­a­lent to how Roche scores PD-L1+ pa­tients (IC>=1% based on the SP142 as­say) on tu­mor-in­fil­trat­ing im­mune cells (IC). The preva­lence of the PD-L1 pos­i­tive pop­u­la­tion in TNBC whether by CPS of greater than or equal to 10 or IC of 1% is both about 40%.

Keytru­da is al­ready one of the best-sell­ing drugs in the world, hav­ing notched rough­ly $3.9 bil­lion in the first half of 2020 alone. Some have pre­dict­ed the drug may over­take Ab­b­Vie’s Hu­mi­ra as the top sell­er with­in the next few years, with the most op­ti­mistic es­ti­mate pegged for $22.2 bil­lion in sales by 2025.

Pi­o­neer­ing Click Chem­istry in Hu­mans

Reimagining cancer treatments

Cancer is a leading cause of death worldwide, accounting for nearly 10 million deaths in 2020, which is nearly one in six deaths. Recently, we have seen incredible advances in novel cancer therapies such as immune checkpoint inhibitors, cell therapies, and antibody-drug conjugates that have revamped cancer care and improved survival rates for patients.

Despite this significant progress in therapeutic targeting, why are we still seeing such a high mortality rate? The reason is that promising therapies are often limited by their therapeutic index, which is a measure of the effective dose of a drug, relative to its safety. If we could broaden the therapeutic indices of currently available medicines, it would revolutionize cancer treatments. We are still on the quest to find the ultimate cancer medicine – highly effective in several cancer types, safe, and precisely targeted to the tumor site.

Ivan Cheung, Eisai US chairman and CEO

Bio­gen, Ei­sai re­fresh amy­loid hy­poth­e­sis with PhI­II show­ing Alzheimer's med slows cog­ni­tive de­cline

In the first look at Phase III data for lecanemab, Eisai and Biogen’s follow-up Alzheimer’s drug to the embattled Aduhelm launch, results show the drug passed with flying colors on a test looking at memory, problem solving and other dementia metrics.

One of the most-watched Alzheimer’s therapies in the clinic, lecanemab met the study’s primary goal on the CDR-SB — Clinical Dementia Rating-Sum of Boxes — giving the biotech the confidence to ask for full approval in the US, EU and Japan by next March 31. The experimental drug reduced clinical decline on the scale by 27% compared to placebo at 18 months, the companies said Tuesday night Eastern time and Wednesday morning in Japan.

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Gilead names 'k­ing­pin­s' in coun­ter­feit HIV med law­suit

Gilead is mounting its counterfeit drug lawsuit, naming two “kingpins” and a complex network of conspirators who allegedly sold imitation bottles of its HIV meds, some of which ended up in US pharmacies.

The pharma giant on Wednesday provided an update on what it called a “large-scale, sophisticated counterfeiting conspiracy,” accusing two new defendants of “leading and orchestrating” a scheme to sell hundreds of millions of dollars in illegitimate drugs posing as meds such as Biktarvy and Descovy.

Nooman Haque, head of life sciences and healthcare at Silicon Valley Bank, and John Carroll

I’m head­ed to Lon­don soon for #EU­BIO22. Care to join me?

It was great getting back to a live ESMO conference/webinar in Paris followed by a live pop-up event for the Endpoints 11 in Boston. We’re staying on the road in October with our return for a live/streaming EUBIO22 in London.

Silicon Valley Bank’s Nooman Haque and I are once again jumping back into the thick of it with a slate of virtual and live events on October 12. I’ll get the ball rolling with a virtual fireside chat with Novo Nordisk R&D chief Marcus Schindler, covering their pipeline plans and BD work.

Vlad Coric, Biohaven CEO (Photo Credit: Andrew Venditti)

As Amy­lyx de­ci­sion waits in the wings, Bio­haven’s ALS drug sinks (again) in plat­form tri­al

The FDA’s decision on Amylyx’s ALS drug is set to come out sometime Thursday. In a space with few drugs, any approval would be a major landmark.

But elsewhere in the ALS field, things are a bit more tepid.

Thursday morning, Biohaven announced that its drug verdiperstat failed its arm of an ALS platform trial led by Massachusetts General Hospital. According to a press release, the drug did not meet its primary endpoint — improvement on an ALS functional status test — or any key secondary endpoints at 24 weeks. The trial had enrolled 167 patients, giving them either verdiperstat or placebo twice a day.

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Work taking place in the clean rooms at Vor (Credit: Vor)

Vor Bio opts to keep man­u­fac­tur­ing op­er­a­tions in-house for de­vel­op­ing stem cell, CAR-T ther­a­pies

While it is not uncommon for a biotech to go down the route of having the product manufactured by a contract organization, one small biotech is looking to keep its card close to its chest.

Vor Biopharma has started manufacturing operations at an in-house facility at its HQ in Cambridge, MA after beginning construction last summer.

According to the biotech, the facility aims to develop Vor’s hematopoietic stem cells (eHSCs) and CAR-T therapies for patients with blood cancers. The site will initially manufacture a clinical supply of its candidate VCAR33allo to support its IND, which is slated to be submitted in the first half of next year. It also plans to transfer the production of VOR33 to the facility. Vor is getting to work quickly as engineering runs for VCAR33allo has started this week.

Aim­ing for fourth nod, Sarep­ta files an­oth­er DMD gene ther­a­py to FDA; Ax­some head­ed to­ward mi­graine re­sub­mis­sion

Sarepta Therapeutics has filed the data needed for an FDA accelerated approval, which would be the biotech’s fourth if granted by the agency.

The biotech has yet to complete confirmatory trials for those first three conditional nods. The filing for its fourth Duchenne muscular dystrophy treatment, disclosed Thursday, is not a surprise. Sarepta said in late-July it would do so after releasing positive results for the Roche-partnered gene therapy.

Phillip Gomez, Siga Technologies CEO

Siga nabs $10.7M from the US gov­ern­ment in deal for its mon­key­pox an­tivi­ral

The US government is all set to buy $10.7 million worth of Siga Technologies’ monkeypox oral antiviral, the company announced Thursday.

Of the total doses, $5.1 million worth of oral antivirals called Tpoxx (tecovirimat) will be delivered this year, with the US Department of Defense having the option of buying the rest at a later point.

The new contract follows an earlier one in which the government had purchased $7.4 million worth of Tpoxx from the company.

Tar­sus looks to raise aware­ness of eye­lid mite dis­ease in cam­paign aimed at eye­care spe­cial­ists

Eyelid mite disease may be “gross” but it’s also fairly common, affecting about 25 million people in the US.

Called demodex blepharitis, it’s a well-known condition among eyecare professionals, but they often don’t always realize how common it is. Tarsus Pharmaceuticals wants to change that with a new awareness campaign called “Look at the Lids.”

The campaign and website debut Thursday — just three weeks after Tarsus filed for FDA approval for a drug that treats the disease.

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