Excitement around immuno-oncology treatments has been building for a little while now, and 2018 could be a pivotal year for the still relatively young sector.
It’s probably helpful to kick off with a little explainer about exactly what immuno-oncology, or I-O, treatments are.
What is immuno-oncology?
When a different (foreign) organism enters into the body, the immune system can normally tell that it’s harmful and will attack it, preventing it from causing any harm.
Cancer cells are pretty good at what essentially amounts to identity theft and can pass themselves off as healthy cells, evading detection.
I-O treatments lift the veil on these cells, allowing the immune system to better recognise and subsequently attack them.
One of the key features of I-O is that it uses the body’s own defence mechanism, limiting the damage to healthy cells. That compares with chemotherapy which attacks the tumour by poisoning the bad cells but which also leaves its mark on good ones.
Bristol-Myers top dog but for how long?
Bristol-Myers Squibb’s Opdivo I-O drug, which is used to treat lung cancer and metastatic melanoma as well as other strains of the disease, is currently the top dog and is estimated to have generated around US$4.8bn in 2017.
Merck isn’t too far behind and its flagship Keytruda immunotherapy, which has a wide range of applications including stomach cancer, is expected to rake in around US$3.7bn this year.
Just how long Opdivo and BMS remain on top is uncertain though.
Fresh from positive progression-free survival (PFS) data in one of its phase III I-O trials at the beginning of December, Swiss giant Roche is expected to report on two other late-stage lung cancer studies – IMpower 130 and IMpower 132 – in 2018 (maybe earlier in the case of 130).
Both of those are testing Tecentriq in combination with various chemotherapy drugs. That’s a similar technique to the one successfully adopted by Merck earlier in the year when the FDA approved its Keytruda drug in combination with chemo.
Elsewhere among the big players, overall survival data from AstraZeneca’s phase III MYSTIC lung cancer study will be keenly eyed.
MYSTIC missed it?
MYSTIC – which is looking at how two of Astra’s lead I-O drugs, Imfinzi and tremelimumab, work together in non-small-cell lung cancer patients – has long been seen as high-risk by the markets.
Billions were wiped from the company’s market cap over summer after the trial disappointed with its PFS readout, but chief medical officer Sean Bohen said at the time that overall survival was the real make-or-break data.
That’s due at some point in the first half of 2018 but analysts aren’t overly hopeful even though they agree that it could be a game-changer,
Bristol isn’t standing still though – it’s got its own phase III lung cancer trial on the go.
Its Checkmate 227 study of Opdivo and another checkpoint inhibitor Yervoy is also expected to read out in 2018.
The initial failure of Astra’s similar cocktail of immuno-oncology drugs in MYSTIC has heightened concerns that Bristol’s approach could share a similar fate.
Why the focus on lung cancer?
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.