The race among Big Pharma to develop a successful lung cancer treatment is hotting up, with AstraZeneca PLC (LON:AZN), Merck & Co Inc (NYSE:MRK) and Bristol Myers Squibb Co (NYSE:BMY) all vying for dominance.
Earlier this week, American group Merck got a massive boost when the US Food and Drug Administration (FDA) approved its flagship Keytruda immunotherapy in combination with chemotherapy.
Merck got initial approval back in October but various restrictions meant it could only target a subset of patients. Analysts reckon this new approval opens up its Keytruda-chemo combo to more than 90% of newly diagnosed non-small-cell lung-cancer patients.
Merck’s success has come at the expense of both AstraZeneca and Bristol-Myers and it’s certainly in pole position at the moment, but the race to be the long-term undisputed leader in the market is far from over.
Things can change quickly at the top, just ask Bristol. The group was comfortably ahead of the chasing pack this time last year but its flagship Opdivo drug failed a trial in newly-diagnosed lung cancer patients last summer.
Astra and Bristol bet that two is better than one
This is where it gets interesting, with both Astra and Bristol going down a different route to Merck to develop what they hope will be a better, and therefore more lucrative, treatment.
The drugs giants are betting that a combination of two immuno-oncology drugs can work together to boost the effectiveness of the overall treatment.
Astra is currently running its highly-anticipated MYSTIC phase III trial which is looking at how two of its lead IO drugs, Imfinzi and tremelimumab, work together in lung cancer patients. Bristol too is exploring if Opdivo is more effective when partnered up with another of its drugs.
There’s some support in the pharma industry that putting two drugs together to create one ‘super treatment’ will work, although not all analysts are convinced.
We’ll only find out for sure once the two report data from the trials, which is expected to be any time over the next month or two for Astra and later in the year or early 2018 for Bristol.
Recent data bodes well for Astra’s MYSTIC trial
AstraZeneca reported “positive results” from its phase III PACIFIC lung cancer trial on Friday. The study showed that Imfinzi reduced the risk of a patient’s lung cancer worsening or causing death.
We won’t know about overall survival until that data is analysed in more detail, but it bodes well for Astra given that Imfinzi is one half of the key MYSTIC trial.
MYSTIC is seen as high-risk by the markets, but with Imfinzi coming up trumps on Friday, it would seem AstraZeneca’s chances of getting it across the line have improved slightly.
“In terms of impact, we think this will significantly increase confidence in AZ's overall I-O franchise given this is a positive phase III readout,” said Liberum analyst Roger Franklin.
“The fact the success was 'clinically meaningful' and in all-comers suggests meaningful commercial potential.”
Is Roche a contender as well?
Aside from Astra and Bristol, Roche is another player in the market which could challenge Merck at the top.
It is testing its lead IO drug Tecentriq alongside chemotherapy and its well-stablished blockbuster, Avastin.
The data from the trial is expected at some point in the next quarter of this year, and should it be positive, then a direct rival for Keytruda might not be too far away.
The signs don’t look too promising at the moment though, given that Tecentriq failed in a bladder cancer study earlier this month.
Lung cancer treatment is a huge potential market
Given the significant competition in the lung cancer treatment space, you’d be forgiven for asking why at least one of them hasn’t considered shifting its focus elsewhere.
The cold truth is that the treatment of lung cancer is an extremely lucrative business, potentially worth tens of billions of dollars to these companies in the not too distant future.
Lung cancer is the leading cause of cancer death among both men in women, and it is expected that around 155,000 people will die from the disease this year in the US alone.
Around the globe it accounts for roughly one-third of all cancer deaths – that’s more than breast, prostate and colorectal cancers combined.
Given how big the problem is then, it’s easy to see that an improved solution could be very profitable.
Only recently analysts tipped Merck’s Keytruda to generate the best part of US$7bn in sales by 2020. Even Astra’s currently less-developed tremelimumab drug is tipped to hit the US$500mln annual sales mark over the same period while Bristol’s Yervoy could surpass US$1.5bn.
With today’s update, there’s a chance that those figures for treme might get a bump, as well.