A new batch of data on Monday showed how immunotherapy, a new kind of cancer treatment that harnesses the body’s immune system, works in lung cancer patients.
The data looked at how combinations of two rival immunotherapy drugs — made by Merck and Bristol-Myers Squibb — worked in treating a common form of lung cancer compared to traditional chemotherapy. While the trials looked at two different combinations — Merck with chemotherapy and BMS with another immunotherapy — the markets picked Merck as the winner, finishing the day up 2.6%.
BMS was down 7.7% for the day, despite posting positive data and an FDA approval for its immunotherapy combination of Opdivo and Yervoy to treat certain kinds of kidney cancer.
Its late-stage trial, published in the New England Journal of Medicine, found that its immunotherapy drug in combination with another managed to keep lung cancers that had a certain number of mutations from getting worse for a longer period than those treated with chemotherapy.
Merck, on the other hand, showed that its drug Keytruda in combination with chemotherapy cut the risk of death in lung cancer patients in half. That was the case for all patients with advanced or metastatic nonsquamous non-small-cell lung cancer.
Bernstein analyst Tim Anderson said that the results Monday confirm Merck “will remain in the driver’s seat.” Even so, BMS is optimistic about its approach to immunotherapy-only combinations that treat a more specific patient population.
“Today is an important day from a scientific standpoint, from a medical standpoint, and also from a patient standpoint, that there are multiple options for patients, or more than we had in the past,” Dr. Fouad Namouni, oncology development head at BMS, told Business Insider Monday afternoon.
Getting precise
BMS’s trial looked at how the combination of its immunotherapy drugs, Opdivo and Yervoy, compared with chemotherapy in a group of people with lung cancer. It was the only company coming out with a treatment based strictly on immunotherapy.
In addition to being the only trial based strictly on immunotherapy, BMS’s also was the only one to use a biomarker called tumor mutation burden. The idea is that the more mutations a tumor has, the more likely the immune system will be able to recognize and go after it.
The trial found that of the patients with a high TMB — 45% of the patients in the trial qualified — the combination managed to prevent progression longer than for people treated with chemotherapy. The median progression-free survival in the 139 patients treated with the immunotherapy combination was 7.2 months, while in the 160 treated with chemotherapy it was 5.5 months.
“It’s a journey. What you’re seeing today is the tip of the iceberg,” Namouni said. “More work is needed to better understand this disease and continue to bring combinations like Opdivo and Yervoy to patients. But not every patient’s the right patient in our case.”
Namouni said the reason for going more precise, as opposed to taking the broader route that other cancer drugmakers have taken, stems from the way we’ve learned about infectious disease.
Before doctors understood the particular bugs that were leading to a disease, they treated the infection on an organ-by-organ basis. Once they learned about bacteria and viruses, they could go after them to treat the infection. Namouni said the same thing’s happening in cancer.
“I don’t think we’re going to go backwards,” he said. “I think we can only go forward by being very precise and understanding the drivers of a given disease, not just to the organ where the disease belongs, but the real driver of cancer and then target that with some medicine.”
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