The promise of Immunotherapy as a game-changer for cancer treatment has been evident since its advent in the space. However, 2016 was the year where it really came to the fore. We examine the leading immunotherapies in the market and their development as we move further into 2017.
From the moment of the first indication for a first-line treatment, immunotherapy became the go-to treatment for a select group of patients, and the results it demonstrated were more than encouraging – even if they were only available to specific candidates for treatment.
Immunotherapy is still in its early days, with news breaking on an almost daily basis indicating where the future of this treatment may lie and with new indications appearing regularly. Two of the major medicines in the field are Keytruda, developed by MSD (known as Merck in the United States and Canada) and Opdivo, developed Bristol-Myers Squibb – both of these medicines were given approval for the treatment of certain cancer indications in 2014, in the US – Keytruda on 4 September and Opdivo on 22 December.
Opdivo is the global market leader in terms of revenue; it raced to an early lead with indications in melanoma, second-line non-small cell lung cancer (NSCLC), renal cell carcinoma, classical Hodgkin lymphoma, and squamous cell carcinoma of the head and neck. This raft of indications sent its global sales beyond that of Keytruda, despite MSD’s product being the first to gain approval in advanced melanoma. Opdivo’s future had looked secure, with Keytruda and a further rival, Roche’s Tecentriq, not having the same market impact.
Opdivo initially brought in close to $1 billion in global sales in 2015, and moving into 2016 this figure jumped to $3.8 billion. MSD’s Keytruda, by comparison, had global sales reaching $566 million in 2015 and $1.4 billion by 2016. Tecentriq, released only last year, brought in $157 million.
However, the reality is rarely as simple as sales figures suggest, and there are some big movements behind the scenes. Most notably and against all industry expectation, Opdivo took a huge hit last August when it failed in Phase 3 trials to improve progression-free survival when used as first-line treatment for Non-Small Cell Lung Carcinoma (NSCLC). This is significant because, months later, Keytruda was awarded first-line approval for metastatic NSCLC in October 2016.
This was the point when the battle between the top three medicines began to take off. Keytruda now has the potential to increase first-line NSCLC treatment options in those that express high levels of PD-L1. Meanwhile, in its annual financial report, BMS conceded that Tecentriq has begun eating into its market share.
With regards to Keytruda there is now a debate as to whether Opdivo can any longer be considered the market leader. Keytruda is expected to rapidly gain ground on Opdivo in terms of global sales, having gained regulatory approval as monotherapy for the first-line treatment of metastatic NSCLC in adults with appropriate tumour types. It is notable how quickly MSD has moved within the UK market, now commanding a leading position – an achievement which Ben Lucas discusses with us here at Pharmafocus.
Tecentriq, meanwhile, managed to race to the indication of the treatment of bladder cancer, in the US, and established itself as the leader in this particular field whilst expanding its own indication to include NSCLC - an important indication given the size of the global market, with it expected to grow from $5.1 billion in 2013 to $7.9 billion by 2020.
In light of these recent developments, we approached figures from Roche and MSD to offer commentary on where their upcoming immunotherapies treatments stand and how they view the developing field of immunotherapy.
Dr Maxwell Summerhayes, Senior Medical Manager, Roche
"We believe that, based on two approaches developed by Roche scientists, the future treatment landscape will be a much more personalised one that will likely include both monotherapy and combination treatments (targeted agents, chemotherapies and other immune molecules) assigned to a person’s own immune profile, allowing us to tailor the treatment to an individual’s own immune biology.
Roche has a major commitment to researching and developing cancer immun...
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