Bristol lung-cancer
setback puts rival Merck drug in driver seat
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[October 11, 2016]
By Ransdell Pierson and Bill Berkrot
(Reuters) - New data is likely to prompt
doctors to abandon Bristol-Myers Squibb's immunotherapy Opdivo in favor
of Merck & Co's rival Keytruda in a large segment of the lucrative lung
cancer market, analysts said on Monday. The results of a closely watched
clinical trial sent Bristol's shares plunging 10 percent. The data,
presented at a medical meeting on Sunday, showed that lung cancer
patients fared worse on Opdivo than those on chemotherapy. Merck shares
rose nearly 2 percent on strong benefits shown by Keytruda in a similar
late-stage lung cancer study.
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Both trials tested the drugs that help the immune system to
recognize and fight cancer as an initial treatment for advanced lung
cancer. They are already approved for patients whose disease had
progressed following chemotherapy, but approval as a so called
first-line therapy could greatly increase the number of patients
taking them.
Opdivo had been considered the leader among the new class of
medicines. It generated $840 million of sales in the second quarter,
more than double those of Keytruda.
The view of the rival drugs began to change in August, with the
surprise announcement by Bristol-Myers that Opdivo had failed to
best older chemotherapies in the Phase III trial.
Details of the trial unveiled at the European Society for Medical
Oncology meeting in Copenhagen only heightened those concerns.
Patients on Opdivo went 4.2 months before their disease worsened
versus 5.9 months for those on chemo, although the difference was
not deemed statistically significant.
"This data represented a worst-case scenario for Opdivo," Sanford
Bernstein analyst Tim Anderson said in a research note.
The Opdivo trial enrolled patients regardless of their tumor's level
of PD-L1 expression, a protein targeted by the drug whose presence
may help identify those most likely to benefit from treatment with
the new medicines.
Meanwhile, researchers reported that Keytruda halved the risk of
disease progression in previously untreated patients, and cut
overall deaths by 40 percent compared to chemotherapy.
Patients in the Merck trial were only enrolled if they were shown to
have high levels of PD-L1, a narrower segment of the lung cancer
population than those in the Bristol-Myers study.
"Merck will completely 'own' the segment of first-line lung cancer
patients who have high PD-L1 expression levels, and Bristol Myers
will capture nothing really," Anderson said.
Doctors are allowed to prescribe medicines for not yet approved
uses, but analysts said they expect current off-label prescribing of
Opdivo in first-line lung cancer to dry up now.
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In addition, competition in second-line lung cancer is soon expected
to intensify with the anticipated approval of Roche's immunotherapy
Tecentriq, which is now approved to treat bladder cancer. Both
Keytruda and Tecentriq are given every three weeks, while Opdivo is
administered every two weeks, which is seen as a convenience
disadvantage.
"The nearly inexplicable failure of (Opdivo) at every level of PD-L1
expression ... puts Merck in the driver's seat in first-line lung
cancer for at least the next 12-18 months," said Leerink Partners
analyst Seamus Fernandez.
Calling the Keytruda data "stunning,” Fernandez said, "We fully
expect Merck to retain a significant place at the table long term."
Bristol shares, which had already lost one quarter of their value
since the initial trial data was disclosed in August, fell 10
percent $49.85, while Merck shares were up 1.7 percent at $63.84
after earlier rising more than 3 percent to a near 15-year high.
Opdivo is also approved for advanced melanoma, kidney cancer and a
type of Hodgkin lymphoma, while Keytruda is also approved for
advanced melanoma, plus head and neck cancer. But lung cancer is
considered by far the biggest market for cancer drugs.
(Reporting by Ransdell Pierson and Bill Berkrot; Editing by
Bernadette Baum and Cynthia Osterman)
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