And any specific disease and drug highlights?
Yes a few, in my opinion. In bladder cancer we have had some success with the PD-1s recently but there was a Phase II trial in bladder cancer with enfortumab vedotin, an antibody drug conjugate (ADC), which essentially is a clever way of getting the drug to where it should be. This drug acts on a substance called nectin-4 which is a cell-adhesion molecule present in almost all urothelial cancers. Following failed platinum chemotherapy and a PD-1 – i.e. at the end of the road, this single arm study showed an overall survival (OS) of 11.7 months, and the manufacturers are hoping for an accelerated approval based on these data. Almost a year’s survival at this stage of the disease and previous treatment bearing in mind that the best on offer is 13 months with first line chemo! This is effectively 3rd
line and getting almost 12 months…
Another very interesting read out, and one we highlighted in our ASCO predictions. Was from Amgen’s AMG 501, which is a KRAS targeted treatment. A Phase I, so very small, but with patients who had at least 2 lines of treatment and they achieved a 50% partial response in 10 lung cancer patients. This is an Amgen compound but the results caused the stock price of a tiny biotech called Mirati to soar, as they have a very similar compound called MRTX849.
There were 2 big, positive prostate cancer trials, both in the NEJM on the day showing benefits of apalutamide in one, and the addition of enzalutamide to existing, earlier treatment in another.
Although less glamorous, it’s important to recognise the failures too. Olaratumab failed to meet its endpoint in soft tissue sarcoma, and pembrolizumab in liver cancer – Keynote 240 – also didn’t quite make the grade. Keynote 62 - pembrolizumab in gastric cancer was a positive trial but only just, and the chatter afterwards confirmed my thinking that usage in this setting would be modest.
Finally from the data, and another area we highlighted prior to getting on the plane, was the racial disparity in time to treatment. Another interesting point was the impact that the expansion of Medicaid was having in the USA. Medicaid is essentially the government / tax funded system in the USA, which is liked and loathed along political party lines. This expansion was implemented in 33 states and where this was done the racial disparity virtually disappears.