A final ASCO15 roundup: Docs slam prices for meds, ImmunoGen eyes redemption, Puma gets hammered
The marathon meeting of oncology professionals and pharma companies at ASCO15 in Chicago is finally coming to a close today. According to the group, attendance this year shattered records, with well over 35,000 doctors, researchers, investors, and biopharma executives in attendance.
Here's what you need to know out of the closing days of meeting:
1) The chorus of cancer med price critics is only getting louder
Immuno-oncology has been the obvious star and center of focus during ASCO15. But a recurring refrain among even the therapies' most enthusiastic supporters in the medical field has been the need to moderate prices, which are sky-high for cancer treatments in general and for immuno-oncology in particular. On Monday, ASCO (the group itself) and various speakers shone a light on this burgeoning problem and called for change.
Earlier during the conference, Dr. Peter B. Bach of the Memorial Sloan Kettering Cancer Center pointedly asked, "Why treat prices as immutable? Would we really pay an infinite amount for a microscopic benefit?"
Biopharma would likely take offense to that characterization, arguing that, to a cancer patient and his or her family, even two or three more months of additional progression-free survival provides a near-immeasurable benefit. But increasingly, oncologists have been pushing back against that notion—and some even named names.
Dr. Deborah Schrag of the Dana-Farber Cancer Institute explained during one session that she and her colleagues had analyzed data from colorectal cancer patients regarding treatments with Roche's Avastin versus Bristol-Myers Squibb's Erbitux. The survival and quality of life outcomes were almost the same for both medications—but there was a big difference in their prices.
"Because survival and quality of life are similar but cost is less, and because patients have significant out-of-pocket costs, I think there’s a good argument to be made that [Avastin] should be the first-line treatment. It’s certainly what I use in my practice," she said.
Dr. Bach said that government payers and ASCO should work together to determine the cost-benefits of various drugs, while still allowing patients to opt for pricier medications if they were willing to shell out the extra money.
This is a reality that the industry is going to have to grapple with in the coming months and years. Private payers and benefit managers, such as Express Scripts, have already started pushes for "pay-for-performance" metrics for drugs, meaning that cost is going to be a bigger and bigger part of the conversation.
2) ImmunoGen soars on ovarian cancer data
In a phase I study whose primary endpoint was safety, ImmunoGen's mirvetuximab soravtansine for treatment of ovarian cancer elicited an impressive 53% response rate. What makes that particularly impressive is the fact that the patients in the trial had become resistant to other ovarian cancer treatments, yet still responded to mirvetuximab soravtansine.
About 14% to 20% of the more than 14,000 women who die from ovarian cancer in the U.S. every year become resistant to platinum-based regimens.
"Based on these findings, we are implementing a development plan designed to advance mirvetuximab soravtansine as quickly as possible while also recognizing the potential to benefit the greatest number of patients," said ImmunoGen EVP and chief development officer Charles Morris in a statement.
ImmunoGen plans to initiate a phase II study of the drug later this year. The company's stock was up more than 70% at one point on the data (it's fallen a bit back down to earth in Tuesday trading).
3) Puma gets positively slammed on breast cancer data
Puma Biotechnology's breast cancer candidate neratinib did not impress investors and clinical oncologists at ASCO.
The drug, aimed at treatment of patients with HER-2+ breast cancer, saw a statistically significant but inarguably modest disease-free survival effect in patients (93.9% versus 91.6% with placebo). And the drug came with some serious side effects that would likely overwhelm that small level of survival benefit.
The adverse effect? Severe, grade 3 diarrhea—meaning diarrhea severe enough to require hospitalization. A staggering 40% of patients in the trial experienced this side effect, raising eyebrows at the conference and sending Puma's stock plummeting 9%.
4) Roche's Perjeta may have pre-surgery potential in breast cancer
The breast cancer medication Perjeta is already one of Roche/Genentech's biggest sellers. And mid-stage data presented at ASCO on Monday indicated that it may have the potential to further extend its market reach.
In a phase II study, HER-2+ early breast cancer patients who were given a regimen of Perjeta, Herceptin, and chemotherapy prior to undergoing surgery were 31% less likely to see their disease worsen, recur, or to die compared to those who only received Herceptin and chemotherapy.
Furthermore, patients on the three-drug cocktail were 40% less likely to experience disease recurrence or death.
"Treating breast cancer early, before it has spread, may help prevent the disease from returning or reaching an advanced stage," said Dr. Sandra Horning chief medical officer and head of Global Product Development at Genentech, in a statement. "These new results add to the body of data for Perjeta in the neoadjuvant setting, and we look forward to the Phase III APHINITY study results to better understand the broader impact of Perjeta in the adjuvant treatment of HER2-positive early breast cancer."
5) Merck KGaA says it can elbow its way into the immuno-oncology market
German pharma Merck KGaA is taking an aggressive stance when it comes to its own immuno-oncology candidate avelumab (being developed in conjunction with Pfizer), which has yet to win an indication but is currently in trials for cancers ranging from lung cancer to Merkel cell carcinoma.
The company's head of healthcare, Belen Garijo, believes that the drug can actually be among the first to market across several cancers, joining the ranks of Bristol-Myers Squibb's Opdivo and Merck's Keytruda.
"There are indications where we believe we can be part of the first two or first three immunotherapies, like ovarian, gastric, head and neck, bladder and renal cancer, for example," Garijo told Reuters, arguing that the candidate could make its way to the market as early as 2017.
Avelumab is currently in phase III trials for lung cancer, phase II trials for Merkel cell carcinoma, and phase I trials for seven other cancers including bladder and gastric cancer.