- Roche's immunotherapy Tecentriq looks set to become a more competitive option for the treatment of lung cancer, boosted by recent trial results that show the checkpoint inhibitor can help patients live longer when given in combination with older drugs like chemotherapy.
- The Swiss pharma on Tuesday announced a Phase 3 study, called IMpower-130, proved pairing Tecentriq with two chemo agents improved both overall survival and progression-free survival compared to chemo alone in patients with metastatic non-squamous non-small cell lung cancer (NSCLC).
- IMpower-130 is the third Phase 3 trial to show a survival or progression-free survival benefit to initial treatment with Tecentriq-based combinations in NSCLC, potentially giving Roche a shot at making inroads on the hold of rivals Merck & Co. and Bristol Myers Squibb on the lung cancer market.
Two previous Phase 3 studies — IMpower-150 and IMpower-131 — also found a benefit to first-line treatment with chemo combinations involving Tecentriq (atezolizumab) over chemo alone. Together, the clinical results reinforce evidence of Tecentriq's efficacy in both squamous and non-squamous NSCLC, a key market for the new cancer immunotherapies.
NSCLC is far and away the most common type of lung cancer. Squamous NSCLC, which develops from a type of flat cell that lines the inside of airways in the lungs, accounts for between 25% and 30% of all NSCLC cases.
Data released earlier this month from the IMpower-150 study showed adding Tecentriq to a regimen of Avastin (bevacizumab), carboplatin and paclitaxel reduced the risk of death by 22% in first-line treatment of non-squamous NSCLC. More detailed results from IMpower-131, which tested Tecentriq together with carboplatin and nab-paclitaxel in squamous NSCLC, are expected at the upcoming annual meeting of the American Society for Clinical Oncology (ASCO).
IMpower-130 also combined Tecentriq with carboplatin and nab-paclitaxel, but in non-squamous NSCLC. Roche only announced the topline result of the study, noting detailed data would be presented at an upcoming medical conference.
Tecentriq's clinical performance suggests Roche could compete more forcefully in the NSCLC market with Merck, which has secured a leading position for its PD-1 inhibitor Keytruda (pembrolizumab).
Roche's drug is currently approved in the U.S. to treat NSCLC after patients progress during or following platinum-based chemotherapy. The company expects to file for an OK in first-line NSCLC later this year.
Forecasts from Cowen, an investment firm, put sales of Tecentriq at $1.5 billion this year and predict the Roche drug will overtake Bristol-Myers' rival Opdivo (nivolumab) in share of the U.S. metastatic NSCLC market by 2019.
Those estimates, however, come with an acknowledgement of the major shifts which have played out in the cancer immunotherapy field over the past two years.
"Seismic activity is tough to predict, with convictions intact only until the next major data release," wrote Cowen analyst Steve Scala in a May 29 note to investors.
Despite Tecentriq's success, Roche will have a hard time eroding Merck's formidable lead.
Keytruda already holds U.S. approvals in first-line NSCLC, both as monotherapy and in combination. Results from a trial called KEYNOTE-189 widely impressed, showing Keytruda and chemotherapy together cut the risk of death by 51% versus chemo alone. An expected update from another study at the ASCO meeting could further extend Merck's edge.
Cowen estimates put Merck's share of the metatstatic NSCLC market in the U.S. rising to 50% by 2019, with global sales forecast to near $4 billion in that indication alone this year.
And while investors have cooled on Opdivo's competitiveness in NSCLC, Bristol-Myers could prove tougher to unseat in the indication than some expect.
The ASCO meeting, which kicks off this Friday, will give physicians and investors a clearer look at the profile of both Keytruda, Opdivo and Tecentriq. As Cowen's Scala suggests, surprises could still await.
Correction: A previous version of this article mischaracterized the benefit seen to treatment with Tecentriq in the IMpower-131 study.