Researchers, investors and analysts continue to pore over clinical results reported over the weekend at the annual meeting of the European Society for Medical Oncology, which kicked off Friday and runs through Tuesday.
Europe's answer to the American Society of Clinical Oncology's yearly conference, ESMO brought notable updates from immunotherapy leaders like Merck & Co. and Roche, as well as from targeted specialists like Loxo Oncology and PARP inhibitor developer AstraZeneca.
With hundreds of studies read out, here are three more data sets to pay attention to:
Bavencio plus Inlyta post strong results in kidney cancer
Despite owning partial rights to an approved checkpoint inhibitor, Pfizer's has remained an also-ran in cancer immunotherapy behind leaders Merck & Co, Bristol-Myers Squibb and Roche.
Bavencio (avelumab), which Merck KGaA developed and later partnered with Pfizer on, is currently approved for a rare type of skin cancer and previously treated bladder cancer.
Strong results from a Phase 3 study of the drug plus Pfizer's Inlyta (axitinib) point to potential in renal cell carcinoma (RCC) as well. Pfizer previously disclosed the trial had succeeded, but did not release detailed data.
Together, the two drugs reduced the risk of disease worsening or death in patients with untreated RCC by 39% versus Sutent (sunitinib). Median progression-free survival reached 13.8 months in all patients given combination treatment, compared to only 8.4 months for the Sutent arm.
Overall survival data was not yet mature — information that will be key to fully characterize the combination's benefit.
But the results make Bavencio a challenger in first-line RCC, where Bristol-Myers Squibb currently owns an approval for its Opdivo (nivolumab) plus Yerycoy (ipilimumab). Exelixis also markets Cabometyx (cabozantinib) for advanced RCC.
"It appears [Bristol-Myers Squibb's] market share in RCC is at risk," wrote Cowen analyst Steve Scala in an Oct. 22 note to investors.
The study success also puts Pfizer in an interesting position. Another study combining Merck's Keytruda (pembrolizumab) plus Inlyta recently read out positive as well, marking a potential challenger to a Bavencio plus Inlyta regimen, given Keytruda's more dominant position. Pfizer, with ownership of Inlyta, could be in a position to drive a competitive bargain with payers to support Bavencio's use.
IDO redux? STING data spurs combo questions for Merck
Having secured a leading position in immuno-oncology with Keytruda, Merck has advanced a broad clinical program testing various combinations of immunotherapy drugs.
All told, the pharma is investigating about 20 experimental agents designed to work by modulating the body's immune defenses to attack tumors.
Merck previously highlighted one of those drugs, known internally as MK-1454, as particularly intriguing. But early results from ESMO raise questions about how well it might work.
MK-1454 is designed to activate a signaling molecule called STING, spurring production of inflammatory proteins that can attract T cells. In theory, this could help amplify an immune-mediated response to cancer cells — particularly if paired with an immunotherapy like Keytruda that helps to unleash an immune attack.
At ESMO, results from a Phase 1 study of MK-1454 were presented, but the data likely won't do much to spur enthusiasm for the asset.
Given as monotherapy, treatment with MK-1454 led to zero complete or partial responses among 20 patients evaluated. Six of 25 patients who received the drug in addition to Keytruda experienced a partial response, with all still ongoing at time of analysis.
"We are somewhat disappointed with a ORR [less than] 30% and it is difficult to identify the benefit coming from the STING asset," wrote analysts from Credit Suisse's European pharma team in a Oct. 20 client note.
The absence of a treatment signal from MK-1454 monotherapy is also noteworthy. Since the setback of Incyte's IDO inhibitor this spring, investors (and researchers) have been more cautious about touting the promise of combination assets without demonstrated efficacy as a monotherapy.
"Similar to IDO as a monotherapy, we highlight no monotherapy effect," the analysts continued.
For its part, Merck looks set to push on. "We are encouraged by these early findings with our STING agonist, most notably the observations of several robust anti-tumor responses in patients receiving MK-1454 in combination with Keytruda," said Eric Rubin, head of early-stage development at Merck Research Laboratories, in a statement.
Novartis finds (some) success where Roche fell flat
In August, Novartis announced its SOLAR-1 study of an experimental breast cancer drug called alpelisib succeeded. The news was notable because of recent struggles from drugs that work in a similar way to Novartis' candidate.
Now, data presented over the weekend give investors and analysts a better sense of how well alpelisib performed.
When combined with fulvestrant, alpelisib led to a 5.3 month improvement in median progression-free survival compared to fulvestrant alone in postmenopausal women with previously treated HR+/HER2- metastatic breast cancer. That translated to a relative risk reduction of 35% versus fulvestrant.
Safety data showed the combination led to significant occurrence of hyperglycemia, diarrhea and nausea, although Novartis noted most adverse events were manageable through dose modifications or medical management.
Alpelisib targets a specific mutation known as PI3KA, estimated to affect about 40% of patients whose cancers progress following treatment with an aromatase inhibitor.
"We have had HER2-targeted drugs — targeting the HER2 protein — but, until now, the use of tumour genomics has not really entered the practical care of breast cancer, unlike melanoma or lung cancer," said lead study author Fabrice André, a professor of medical oncology at the Institut Gustave Roussy, Villejuif, France, in a statement from ESMO.
This summer, Roche discontinued development of its PI3K inhibitor taselisib after reporting disappointing results showing a 30% risk reduction and a less manageable safety profile. About a fifth of patients given taselisib discontinued treatment during Roche's study, compared to the 5% who discontinued from the alpelisib cohort in Novartis'.
Elsewhere, Novartis also reported positive results for an experimental lung cancer treatment called capmatinib. Data showed the drug led to a 72% overall response rate in treatment-naive patients with MET exon 14-mutated non-small cell lung cancer.
"This data is promising in our view but we did not see any durability data, which has been a problem for Met inhibitors in the past," noted Credit Suisse's European pharma team in a note.