For Merck & Co’s Keytruda, the immunotherapy golden child that can apparently do no wrong, to get a regulatory knock-back is a rarity. So today’s US complete response letter for its use in combination with Eisai’s Lenvima for first-line liver cancer will come as shock. Still, the move is perfectly rational, even if it does show the US FDA taking an unusually hard line. The point is that on June 2 Roche’s Tecentriq plus Avastin had gained a front-line liver cancer label, based on the Imbrave-150 trial, which showed a 42% reduction in risk of death versus Nexavar. This undermined Merck’s case, because Keytruda had been filed on the basis of remission rates in the Keynote-524 study, which later yielded overall survival data but did not have a control arm (Asco 2020 – after Tecentriq’s liver win the spotlight falls on Merck and Astra, June 2, 2020). Keytruda retains its second-line liver cancer accelerated approval even though it failed a confirmatory trial, and Merck’s first-line hopes now rest on the Leap-002 trial, which pits Keytruda plus Lenvima versus Lenvima alone, and ends in 2022.
|Immunotherapy in front-line hepatocellular carcinoma|
|Company||Product||Clinical trial detail|
|Roche||Tecentriq + Avastin||Approved: HR for OS 0.58 (p=0.0006) vs Nexavar in Imbrave-150 study|
|Merck & Co||Keytruda + Lenvima||CRL based on Keynote-524 study: mOS 22.0mth, 36% ORR||Leap-002 study vs Lenvima ends 2022|
|Astrazeneca||Imfinzi +/- tremelimumab||Himalaya study vs Nexavar ends 2020|
|Bristol Myers Squibb||Opdivo||Failed Checkmate-459 study vs Nexavar|
|Source: company presentations.|
This story has been corrected to reflect the data on which Keytruda had been filed.