Merck cements its position as dominant developer of immunotherapy

Source: Merck cements its position as dominant developer of immunotherapy

Merck cemented its position as the dominant developer of immunotherapy after a large clinical trial showed lung cancer patients taking its drug lived for longer than those on chemotherapy. 

Immunotherapy drugs, which work by encouraging the body’s immune system to attack cancer, have dramatically altered the odds for some of the sickest patients since they were introduced in 2014. 

On Sunday, US-based Merck unveiled a late-stage study of almost 1,300 patients that showed its immunotherapy, Keytruda, boosted survival in patients with an advanced form of the most common type of lung cancer. 

Patients taking Keytruda lived for an average of 16.7 months versus 12.1 months on chemotherapy, although people whose tumours contained higher levels of a certain protein did substantially better. 

Those whose cancers had very high levels of this protein, known as programmed death-ligand 1 or PDL1, survived for 20 months on average when taking Keytruda — almost twice as long as those on chemotherapy. 

The data from the study were unveiled at the annual meeting of the American Society of Clinical Oncology in Chicago — the world’s largest cancer conference — where doctors hailed immunotherapies as the biggest advance in tackling the disease for decades. 

“The main message is that immunotherapy has truly changed the way we manage lung cancer, which is remarkable for something that did not exist four years ago,” said Gilberto Lopes, an oncologist at the University of Miami, who led the study. 

In a sign of how quickly the field was advancing, the trial results were in effect out of date by the time they appeared on Sunday, owing to even more impressive results from another Merck study that had already been unveiled at a medical meeting in April. 

The earlier trial showed that combining Keytruda and chemotherapy — rather than using one or the other — substantially increased the amount of time a person could survive with lung cancer. 

Doctors and experts have described the results from the combination study as “practice changing”, putting the immuno-chemotherapy cocktail on course to become the standard treatment for the vast majority of sufferers.

However, Dr Lopes said Keytruda could still be given as a standalone drug to those patients who were unable to tolerate the brutal side effects associated with chemotherapy. 

“My personal impression is that patients do better with the combination, but that for those who do not want chemotherapy, then it is reasonable to use immunotherapy alone,” he said. 

Roger Perlmutter, Merck’s most senior scientist, agreed, pointing out that doctors would prefer not to use chemotherapy on some patients, such as the elderly or people with illnesses besides cancer.

“This provides a range of personalised options for those individuals,” he said. 

Drugmakers including Merck, Bristol-Myers Squibb, Roche and AstraZeneca have been racing to carve up the market for immunotherapies, and last year their drugs generated almost $10bn in sales. 

But the market for untreated lung cancer patients, where Merck now dominates, is the most lucrative because it is among the most prevalent forms of the disease as well as being the deadliest. 

The trial results published on Sunday were a blow for Bristol-Myers, Merck’s closest competitor in lung cancer, which shocked its investors in 2016 when a similar study of its rival medicine, Opdivo, failed to beat chemotherapy. 

Most doctors and investors have been working on the assumption that the Merck and Bristol-Myers drugs are indistinguishable from one another — the pharmaceutical equivalent of Coke and Pepsi — although that could start to change.

Dr Perlmutter said there was a “stronger set of data” behind Keytruda, which could be a reflection of the fact that the two companies had designed their clinical trials differently. 

But he added: “At this point, it’s impossible to know — you can’t exclude the possibility that they might be different.” 

Fouad Namouni, head of oncology at Bristol-Myers, disagreed: “There have been some positive studies here and negative studies there, but to conclude that this one is better than the other would not be scientifically accurate.”

Published at Sun, 03 Jun 2018 11:31:20 +0000