Exelixis unlikely to move Bristol’s renal needle for now

Bristol Myers Squibb and Exelixis have shown that adding a small molecule to dual checkpoint blockade can delay disease progression in first-line kidney cancer, but this is unlikely to help them catch up with Merck & Co in this space. Interim analysis of the Cosmic-313 study showed that Cabometyx on top of the approved Opdivo plus Yervoy combo cut risk of progression or death by 27%. So far so good, but Bristol’s problem is that Opdivo plus Yervoy itself cuts risk by just 18% versus Sutent, Pfizer’s benchmark renal cancer drug against which Merck’s Keytruda plus Lenvima scored a stunning 61% reduction in Keynote-581. Thus – on a very rough cross-trial basis – the Cosmic-313 triplet seems to have beaten Sutent by something like 40%, which will not move the needle against Keytruda plus Lenvima. Exelixis fell 5% in early trade today. Overall survival remains an unknown quantity, and while it was not significant in Cosmix-313’s interim analysis this could be down to statistical allocation. For now Bristol/Exelixis would do better to stick with the approved Opdivo plus Cabometyx combo, as Yervoy will likely add toxicity – though how much remains unknown until we see the full data.

The first-line renal cancer battleground
  Keytruda + Lenvima Opdivo + Cabometyx Opdivo + Yervoy Opdivo + Yervoy + Cabometyx
Trial Clear/Keynote-581 Checkmate-9ER Checkmate-214* Cosmic-313*
Comparator Sutent Sutent Sutent Opdivo + Yervoy
mPFS 23.9mth vs 9.2mth 16.6mth vs 8.3mth 11.6mth vs 8.4mth Not given
HR=0.39 (p<0.0001) HR=0.51 (p<0.0001) HR=0.82 (not stat sig) HR=0.73 (p=0.01)**
mOS NR vs NR NR vs NR NR vs 25.9mth Not given
0.66 (p=0.0049) 0.60 (p=0.0010) 0.63 (p<0.0001) Not stat sig at interim
Note: *in intermediate/poor-prognosis patients; **on a cross-trial basis Opdivo + Yervoy + Cabometyx would be expected to yield an HR for PFS versus Sutent of 0.60 (0.82 times 0.73). Source: product labels and Exelixis press release.

Share This Article