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 The latest research shared with 23,000 experts at Europe's top
oncology meeting shows how medicines that have already delivered
durable benefits in metastatic disease can also work well at an
earlier stage.
The findings promise to expand the market for established immuno-oncology
(I-O) drugs from companies like Merck, Bristol-Myers Squibb and
Roche, while opening up a window for relative latecomers such as
AstraZeneca.
AstraZeneca stole much of the limelight at the European Society for
Medical Oncology (ESMO) congress in Madrid after clinical trial
results showed its I-O drug Imfinzi helped lung cancer patients with
mid-stage disease.
Bristol-Myers, meanwhile, proved that Opdivo, which is already used
widely in advanced cancer, can prevent relapses in melanoma patients
if given straight after surgery. This earlier setting is known as
adjuvant therapy.
The data on both drugs highlight how so-called PD-1 and PD-L1 drugs
are moving down the treatment curve to earlier-stage disease.
"The aim is to help more and more patients in earlier phases of the
disease, like in adjuvant therapy," ESMO President Fortunato
Ciardiello told Reuters.
"I think this will be a trend that will increase over the next few
years, though we have to cautious because we have to do the proper
clinical trials to prove this in each case."
I-O drugs are now being investigated in the adjuvant setting in a
range of cancers, including lung, kidney and bladder - and some
trials are even underway in the neoadjuvant or pre-surgery setting
in the case of breast and head and neck cancers.
BRAKES OFF
By taking the brakes off the immune system and allowing the body's
natural killer cells to home in on tumors, immunotherapy offers a
different approach to toxic chemotherapy, which causes collateral
damage to healthy tissue.
It is not without side effects, some of which can be serious, but it
is generally a kinder option - especially when PD-1 and PD-L1 drugs
are given on their own.
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"There is now a potential to use immunotherapy to change the course
of early disease. I think that is one of the most important pieces
of news for patients at this ESMO meeting," said Fouad Namouni,
Bristol-Myers's head of medical oncology development.
By giving immunotherapy earlier, when immune systems are healthier,
the hope is that more patients will be lifted into long-term
remission.
"Earlier treatment does seem to produce higher responses, although
I'm not sure that is going to be true all of the time," said Roy
Baynes, who heads clinical development at Merck.
Some analysts forecast potential sales of immunotherapy drugs at as
much as $50 billion a year. However, significant challenges remain,
including deciding which patients will benefit most from infused
medicines with typical list prices of near $150,000 a year.
The possibility of early intervention also raises questions about
screening to spot cancer early on - something that becomes more
relevant once potentially curative options are available.
AstraZeneca's chief executive, Pascal Soriot, who expects
multibillion-dollar sales of Imfinzi in non-metastatic stage III
lung cancer, is hopeful screening will pick up in future.
"If you have a good early treatment then the incentive for screening
is massive," he said in an interview.
(Reporting by Ben Hirschler#; Editing by Greg Mahlich)
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