More results may be out from a closely watched trial of Roche’s Tecentriq in lung cancer, but industry watchers still don’t have many of the answers they’re looking for.
A phase 3 study combining the med with chemo—both with and without fellow Roche product Avastin—in the front-line setting yielded “some mixed findings,” as Bernstein analyst Tim Anderson put it in a Thursday afternoon note to clients.
One point he found “troubling”? A Tecentriq-chemo combo produced median overall survival of 17.9 months, while that pair plus Avastin put up a 19.3-month mark. Both those groupings topped an Avastin-chemo pairing, which posted a 14.4-month figure, but Avastin’s addition to the Tecentriq-chemo cocktail—a 1.3-month addition—was “not impressive,” he wrote.
“Most clinicians would view this as too small of an efficacy benefit to justify what is arguably higher toxicity ... as well as a much higher cost,” he added. Adding Avastin to the Tecentriq-chemo duo increased the rate of adverse event-related discontinuations to 33% from 14%, Evercore ISI analyst Umer Raffat added in his own investor note.
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But while Roche’s aim with the trial was to “find a home” for the older Avastin as oncology shifts toward I-O—something Anderson isn’t sure it successfully did—investors had a different goal: “more broadly define Roche’s placement in the future pecking order of I-O” among leading companies Merck, Bristol-Myers Squibb and AstraZeneca.
Anderson, though, doesn’t think the trial, dubbed IMpower150, did that either. “Do IMpower150 results give us this clarity? Not really,” he wrote.
Still, both Anderson and Raffat did draw comparisons between IMpower150 and Keynote-021G, the much smaller phase 2 trial that earlier this year helped Merck snag its Keytruda-chemo combo approval, despite acknowledging the apples-to-oranges nature of the exercise.
“My conclusion: Roche’s I-O-chemo trends WORSE than MRK’s I-O-chemo on (progression-free survival). On (overall survival), Roche and MRK look roughly comparable,” Raffat wrote, with Anderson adding, “on its face, 021G undeniably looks better.”
The more fair comparisons will take place after Roche’s “more conventional ‘chemo combo’ trials” read out in the coming months, Anderson said.
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The afternoon’s results came hours after Roche touted findings showing that adding PD-L1 drug Tecentriq to a combination of Avastin and chemo reduced the risk of disease worsening or death by 38% compared with Avastin and chemo alone.
“IMpower150 is one important piece of a complex, still largely incomplete, puzzle,” Anderson wrote at the time.