Consider This a Warning on Cancer-Drug Combos

The pharmaceutical industry believes that the lucrative future of cancer treatment lies in combining immune-boosting medicines with other drugs to boost their effectiveness. But that future is still a ways off, and the present is pretty ugly.

It’s something to keep in mind as one of the year’s biggest cancer conferences gets underway in Chicago.

The backbones of most cancer combo trials are a group of successful drugs called PD1/L1 inhibitors — led by Merck & Co.’s Keytruda and Bristol-Myers Squibb & Co’s Opdivo — that help unleash the human immune system against cancer. While these medicines can have a dramatic impact on some patients, they don’t work for most. The hope is that combining them with other treatments might make them work better and enable further expansion into more cancers. 

20 by 20

Analysts expect annual sales of currently approved PD1/L1 drugs to pass $20 billion by 2020, and everyone wants a piece

Source: Bloomberg

The appeal of combos is clear and there are already five of these medicines on the market, with more are on the way. As drugmakers fight to get an edge, they are running an incredible number of combination trials. Merck and Bristol-Myers alone are involved in more than 500, according to Bloomberg Intelligence. No wonder, then, that new data on these treatments will be a highlight at this year’s annual meeting of the American Society of Clinical Oncology (ASCO), which began Friday and runs through June 5.

Investors need to remember, though, that up to now the hype over combos has dramatically outpaced delivery.  Just last month, Genmab A/S revealed that its partner Johnson & Johnson was halting trials combining its drug Darzalex with PD1/L1s due to safety and efficacy issues. Genmab’s shares went on to drop more than 20 percent. And that’s only the latest disappointment.

Bristol got the combination of Opdivo and its older immune-boosting drug Yervoy approved for melanoma back in 2015, but uptake has been sluggish, in part because the second drug adds side effects. A kidney cancer approval may boost sales, but the combo has badly disappointed in lung cancer – the biggest market available. AstraZeneca PLC’s heavy investment in a similar approach has yielded little so far. 

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