In the often cosy world of patented drug development all-out price wars are rare. Yet working on similarly acting versions of some of biopharma’s most expensive treatments, and then launching them at a discount, is precisely the aim of EQRX, a private biotech founded in January.
Yesterday the company trained its guns on the first targets of this strategy: Pfizer’s CDK4/6 inhibitor Ibrance for breast cancer, and Astrazeneca’s EGFR-targeting lung cancer drug Tagrisso. To this end EQRX has licensed two early-stage projects with the same mechanisms: G1’s lerociclib and Jiangsu Hansoh’s almonertinib respectively.
Still, the leaders should probably not panic just yet. It will take EQRX years to develop its assets, and the fast-follower plan depends on stellar clinical data; without a big-hitting sales machine behind it EQRX will have little chance of dislodging the entrenched products, even with a cut-price approach.
The lerociclib deal has cost EQRX $20m on signing, and gives the company rights to the CDK4/6 inhibitor globally including Japan, but excluding the rest of the Asia-Pacific region, where G1 earlier struck a deal with Genor Biopharma.
Lerociclib is one of G1’s two CDK4/6 inhibitors, so it might at first seem strange that the originator is willing to cut its own throat with the threat of discounted pricing. But G1 has positioned the other project, trilaciclib, in a niche of its own, to make chemotherapy more tolerable by reducing myelosuppression, so it faces little immediate threat.
EQRX aims to develop lerociclib for CDK4/6 inhibitors’ traditional indication of hormone receptor-positive, Her2-negative breast cancer. Three drugs with this mechanism are marketed today, but it is Pfizer’s Ibrance that is the most entrenched, with sales of nearly $5bn last year.
|Selected CDK4/6 inhibitors|
|Trilaciclib||G1 Therapeutics||Apr 2033||0||980||Phase II|
|SHR6390||Jiangsu Hengrui||NA||0||259||Phase III|
|Lerociclib||EQRX||Dec 2036||0||77||Phase II|
|Source: EvaluatePharma sellside consensus.|
Ibrance’s current US list price is around $13,000 a month, though of course this excludes discounting, and the cost to patients depends on their insurance plans.
At last year’s San Antonio Breast Cancer Symposium G1 presented phase I/II data in which it said lerociclib’s median progression-free survival of 15 months was “consistent with other CDK4/6 inhibitors used in combination with fulvestrant” in this breast cancer setting.
In the case of EQRX’s second deal, the lung cancer space Jiangsu Hansoh’s almonertinib targets – the downstream T790M mutation – is entirely controlled by Astrazeneca’s Tagrisso, whose US wholesale acquisition price is around $15,000 a month. There is also clinical evidence backing almonertinib, and in fact the drug is already approved in China, under the trade name Ameile.
That green light came in March, and was backed by the single-arm Apollo trial, results from which were presented at this year's virtual AACR meeting. These showed an overall remission rate of 68.9% in 244 patients, with median progression-free survival of 12.3 months, and no grade 3 rash or QT interval prolongation.
Beyond Tagrisso the industry pipeline has plenty of clinical projects targeting downstream mutations after initial EGFR inhibitor therapy. Specifically in T790M mutations almonertinib could face competition from another third-generation EGFR inhibitor, Novartis’s EGF816, though Clovis’s rociletinib, Hanmi’s HM61713, Astellas’s ASP8273 and Pfizer’s PF-06747775 have all been discontinued.
The up-front value of the Jiangsu Hansoh deal has not been revealed. EQRX says it has other, as yet undisclosed, projects in its pipeline, and no doubt the $200m of series A funding it raised in January gives it plenty of firepower to bring in more assets to develop to undercut the competition.