Esmo event analyser – Tesaro tops the risers while Bristol-Myers is battered

Esmo proved itself the must-attend cancer conference this year, with hugely important data in lung cancer stealing the show. The meeting also demonstrated its ability to move share prices, with clear winners and losers emerging.

EP Vantage’s Esmo event analyser, which tracks stock market movements from the release of abstracts back in September to the close of the conference, finds that Tesaro and Incyte got the biggest boost. Exelixis and Myriad Genetics suffered the steepest declines – although in terms of lost value the $10bn wiped from Bristol-Myers Squibb’s market cap over the period is the most dramatic fallout by far (see table below).

All change in lung cancer

The Checkmate-026 trial of Opdivo in first-line lung cancer is of course to blame for the US pharma giant’s drop – even before considering the advantage it handed to its direct rival Merck & Co in this tumour type, the study in and of itself has to be considered a massive calamity.

Its failure to show any benefit for Opdivo over chemotherapy, regardless of PD-L1 expression, came as a massive surprise to the immuno-oncology field, which has become accustomed to unequivocal success. Still, the game is far from over as few believe that in the long term the PD-L1 antibodies and other checkpoint inhibitors will be used as monotherapies; data in the coming months on their use in combination with chemotherapy and other immuno-oncology agents could quickly change the game once again.

For example Bristol’s own Checkpoint-227 study, testing Opdivo and Yervoy in first-line lung cancer, could yield results towards the end of 2017. AstraZeneca’s Mystic study, which is due to read out early next year, will give much earlier insight into this combination approach – the study tests its own PD-L1 and CTLA-4 combination in first-line lung cancer.

Expectations of even more upheaval in lung cancer could perhaps explain Merck’s relatively muted share price response to Esmo. The almost unprecedented improvement in progression-free survival generated by the Keynote-024 study pretty much guarantees that Keytruda will own first-line lung cancer for the time being – yet the stock only climbed 2% over the period. Even so, this represents $3.7bn in added value, and the stock was already up 7% in the wake of the top-line results, released in early August.

Still, the Checkmate-026 disaster and lack of plausible explanation of why a seemingly equivalent compound could generate such a different result proves that the immuno-oncology space remains unpredictable. For Merck, Bristol and other contenders, there is still a lot to play for.

Elsewhere at Esmo, Tesaro’s gain was Myriad’s loss. Full data from the Nova study of niraparib were very impressive, showing the Parp inhibitor to have a clinically relevant benefit in all subgroups examined – including so-called HRD-negative patients, in whom the project was not expected to work. Thus this raises the question of whether a test to identify these patients is necessary – not great news for the maker of the test, Myriad.

Clovis, whose rucaparib is a Parp inhibitor like niraparib, suffered from the perception of being left behind in Tesaro’s wake. It was also probably not helped by incremental data at Esmo which, while far from negative, did not point to any distinction from class rivals.

Also moving in opposite directions were Ipsen and Exelixis, for less obvious reasons. The Cabosun trial of Cabometyx looks good enough to prompt a change in the standard of care in front-line renal cell carcinoma, although concerns that a large pivotal study would be needed to confirm the phase II result rattled investors.

Holders of Ipsen, which owns marketing rights outside the US, Canada and Japan, were less concerned by this detail. However, the French drug developer is far less dependent on the project than its US partner, which had enjoyed a strong run-up in the months ahead of Esmo.

Elsewhere among the risers, Incyte benefited from early data on epacadostat, the most advanced IDO inhibitor in development and one of the most closely watched novel immuno-oncology targets. Data from a phase I trial in advanced melanoma in combination with Opdivo pointed to strong efficacy and a better side-effect profile than the current standard of care.

Lilly presumably benefited from the prospect of future chemotherapy/Immuno-oncology combinations – its Alimta is involved in several lung cancer trials, for example – although with limited patent life remaining its window of opportunity is short.

Finally, Peregrine presented an analysis of the failed Sunrise study of bavituximab that claimed to have found a biomarker correlated with a survival benefit; this was not enough to reinvigorate interest in the project, however.

Esmo might not be physically as large as its US equivalent Asco, but this year it punched above its weight. 

To contact the writer of this story email Amy Brown in London at [email protected] or follow @AmyEPVantage on Twitter