Who won big at #AACR18? Merck surges on Keytruda/chemo combo while Bristol-Myers shares tumble on comparison

Merck and Bristol-Myers Squibb both came to AACR looking to score points in their long-running slugfest over the lung cancer market. Both had promising results, but Merck’s KEYNOTE-189 was clearly the big winner this morning.

Merck shares $MRK gained close to 3% on its case that a combination of Keytruda with chemo offered solid, across-the-board benefits for a large segment of frontline cases, which will go a long way to winning over physicians and patents with its 0.49 hazard ration.

Bristol-Myers $BMY was pumped about its own pivotal data from Checkmate-227, which you can review below along with our story on Merck. But its shares dropped a painful 7.5%, despite the positive data. Merck has clearly pushed out front in this big market segment, with its combination already approved by the FDA. And Bristol-Myers still has considerable catching up to do if it hopes to compete for newly-diagnosed patients.

“MRK appears to be clear winner so far,” summed up Credit Suisse. “MRK data better than expected across all patient subgroups. BMY combo data shows early signs of a survival benefit, but questions remain until we see full data.”

Tim Anderson at Bernstein was more effusive, cheering Merck’s results and pointing to some weak spots in Bristol-Myers’ argument that will pose an ongoing challenge.

Opdivo+Yervoy showed a favorable impact on PFS, with a respectable hazard ratio, but this was only in one segment of patients, namely those with “high TMB” patients (an emerging, but still highly unconventional, biomarker).  In “low TMB” patients, the combination did worse than chemotherapy by itself.  This is in stark contrast to MRK’s ‘189 data, whose combination did better than chemotherapy in all segments, and the magnitude of the benefit in all of these segments was impressive.

Opdivo also failed in the mono therapy challenge here, leaving Anderson scoring the fight for Merck’s Keytruda.

Opdivo by itself just doesn’t seem to look as good as Keytruda, but the assessment here admittedly is apples-to-oranges (missing is Opdivo monotherapy efficacy in high expressers), and it is a bit confusing.

Umer Raffat also scored it for Merck.

On MRK hazard ratio on survival is better than expectations – that’s GOOD.

On BMY, the hazard ratio on TMB+ met the expectations.  However, the investor focus will inevitably turn to this line:

There was no significant difference in progression-free survival between the two treatment groups in this patient population; the median progression-free survival was 4.2 months with nivolumab and 5.6 months with chemotherapy (hazard ratio = 0.95)

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Research Scientist - Immunology
Recursion Pharmaceuticals Salt Lake City, UT
Director of Operations
Atlas Venture Cambridge, MA

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