AstraZeneca miss on OS in the phase 3 MYSTIC trial – what next?
Getting there… in 1L NSCLC
At one point we were posting almost quarterly updates on the runners and riders in the 1L NSCLC niche and what a roller coaster it has turned out to be!
There have been some successes, failures, and even mixed results so far, suggesting that there’s no room for complacency here.
Previously, AstraZeneca were the first to readout out on PFS in the MYSTIC trial and missed, meaning they had to go to the back of the queue and patiently await the OS data. Since then, we’ve seen several phase 3 trials from Merck, Genentech/Roche and BMS all readout without any real rhyme, reason or consistency between them.
Now AstraZeneca are back in the spotlight with a not altogether unexpected miss on median OS.
It’s easy for people to kick a dog when it’s down rather than take a moment to reflect on the deeper meaning – what does the result mean both for the company and other key players in this highly competitive landscape? What can we learn from this experience and other recent results?
To answer that, we put some insights and analysis together in our latest update on the space…
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At AACR last week we had the long awaited initial readouts for three key phase 3 studies in lung cancer, namely CheckMate–227, IMpower150, and KEYNOTE–189 in the same session on the same day.
This had me thinking about how it might end up being, “a killer and a chiller and a thriller when I get the (PD–1) gorilla in Manila,” with sincere apologies to Muhammed Ali and Dr Jean-Charles Soria for (mis)appropriating their past themes 😉
Chicago River Bridge at #AACR18
For those attending the event, you might well be forgiven for thinking from the first two adjectives that I’m referring to the weather, as it was certainly cold enough (!), or even the results this week from AstraZeneca’s unfortunately named ARCTIC study exploring the IO-IO combo of durvalumab plus tremelimumab in the third line setting with a miss in both PFS and OS endpoints.
In reality, we should be warmed and heartened to see three positive immunotheraopy trials appear at once and presented in the same session at the same meeting. It isn’t always the case as regular attendees at ASCO well know.
When all is said and done, what do thought leaders specialising in lung cancer really think about the data that was presented in Chicago, and what were the convergence and discord on the various key issues under consideration? There is, after all, a lot of subtlety and nuance to consider in 1L NSCLC.
To find out more, we interviewed not one, but four, lung cancer specialists in Chicago for their personal perspectives. What they had to say as a group was both candid and absolutely fascinating, so it made sense to curate their insights around various key topics together into one detailed post for easy reading…
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After yesterday’s notes on the exciting lung cancer clinical trials plenary, I received a bunch of questions from readers following yesterday’s analysis of the 1L NSCLC market.
This is a good opportunity to take some time out to answer some of them, as they highlight some important points worth discussing, clarifying and reviewing.
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After writing about the 1L NSCLC landscape every quarter last year, I was thinking the other day that we were due another update and discussion on this riveting topic again soon and added it to the editorial calendar of topics to write about on BSB.
It was therefore no surprise to hear Merck’s announcement this morning that their phase 3 trial KEYNOTE-189 exploring pembrolizumab plus chemotherapy hit its co-primary endpoints and is now the second study to do so after Genentech/Roche’s announcement for atezolizumab plus chemo plus the VEGF inhibitor, bevacizumab was a success.
Are we at a crossroad for lung cancer? With many more readouts yet to come competition in this space is certainly heating up dramatically!
Meanwhile, there are a few important implications to consider here, so we sat down and penned an update based on the emerging data and highlight some key insights to consider…
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Periodically, we post an analysis and look at a particular landscape and the leading competitors within. One area of rather intense interest that we have been following is the progress (or march might be more precise) of checkpoint blockade in previously untreated metastatic non-small cell lung cancer (1L NSCLC).
Our extensive reviews and discussions in this area have included a look at:
In addition, I last posted my recent predictions on this space in July this year and already quite a bit has happened since then!
With a bunch of other phase 3 trial readouts coming up over the next couple of months, it’s now time for another update on what to watch out for, what to expect and why some studies can be handicapped differently.
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Back in January this year, we posted an early look on what to expect from the evolving 1L NSCLC landscape following the controversial FDA submission of Merck’s pembrolizumab with chemotherapy. This lead to subsequent approval in May.
Checkpoint Charlie, Berlin July 2017
At that time, quite a few people were shocked and surprised that the phase 2 KEYNOTE–021 Cohort G data presented ESMO was neatly parlayed into accelerated approval in the US.
Since then, a lot has happened and now many readers are on tenterhooks as we await the next round of lung cancer trial results in the upfront setting.
First up is AstraZeneca’s MYSTIC trial exploring an IO-IO combination with durvalumab plus tremelimumab. Merck’s confirmatory trial for pembrolizumab plus chemo is also expected in the fall – will it support the accelarated approval – or not? Meanwhile, we also await Roche/Genentech’s IMpower150 study evaluating their checkpoint inhibitor, atezolizumab, in combination with chemotherapy by the year end.
These are quite different strategies with diverse endpoints so following them closely will be key to understanding what happens next. Based on what we’ve seen in lung cancer to date, the roller coaster looks set to continue. The C-suite shenanigans have only added to the intrigue and mystique – do they mean anything? Who knows, but we’re focusing on the hard data i.e. science and the clinical clues that are available.
It’s all to play for and many readers wrote in asking for an update on the landscape and what to expect now that we’re much nearer to the shoes actually dropping.
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