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ASCO Highlights: Top stories from this year's meeting

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By John Carroll and Ryan McBride

Bristol-Myers claims ASCO spotlight with promising PD-1 drug data

Bristol-Myers Squibb ($BMY) was out early Saturday with positive data on BMS-936558, its anti-PD-1 drug obtained in its buyout of Medarex. The treatment spurred tumor shrinkage in three of five cancer groups studied, including 18% of 72 lung cancer patients, close to a third of 98 melanoma patients and 27% of 33 patients with kidney cancer. 

BMS already gained an approval for the pioneering Yervoy in melanoma, also snagged in the Medarex buyout. The significance here is that BMS-936558--which disarms PD-1, preventing it from stopping an attack by the immune system's T cells--appears less toxic and more effective than Yervoy. This is a very early-stage program, but the treatment has emerged as one of the most closely-watched drugs to come out of ASCO. Some analysts believe the treatment may be on track to emerge as a possible blockbuster therapy with multiple uses in oncology.

Bristol-Myers also reports that some patients "experienced stable disease for six months or more, including five of 76 (7 percent) lung cancer patients, six of 94 (6 percent) melanoma patients and 9 of 33 (27 percent) kidney cancer patients." And based in part on the data offered at ASCO, an aggressive Bristol plans to push into a late-stage, pivotal study.

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T-DM1 results push Genentech's armed antibody tech into ASCO's center stage

T-DM1 lived up to its star billing at ASCO. The "armed antibody" from Roche's Genentech subsidiary was in the center ring at ASCO as the wraps came off Phase III data, delaying disease progression in metastatic breast cancer patients by several months while reducing the risk of adverse events. And in the process investigators highlighted antibody-drug conjugates as the hot new technology in cancer drug development. 

T-DM1 delayed tumor progression by an average of 3.2 months. Median progression-free survival was 9.6 months for the T-DM1 arm while standard therapy delivered a median PFS rate of 6.4 months. Close to two thirds of the patients taking T-DM1--which was designed with ADC technology provided by ImmunoGen--were alive after two years, while slightly fewer than half of the patients receiving a Tykerb/Xeloda combo survived the same period.

T-DM1 is an elegantly crafted weapon that relies on technology in-licensed from ImmunoGen, which stands to gain mid-single digit royalties on the product. An antibody linked to a highly toxic drug delivers the payload right in the target. That may sound simple, but it's taken 30 years to get the technology right. And now it's a must-have approach for every big pharma company in oncology.

Genentech has eight other ADCs in the clinic, says Dietmar Berger, vice president in product development oncology at Genentech. And it has a total of 25 ADCs in the pipeline, with a number of programs built with technology provided by Seattle Genetics, a pioneer in the field.

"Genentech is a company which is really built on the program," Berger tells FierceBiotech. "Personally, I believe it's going to revolutionize therapy." And a combo study of pertuzumab and T-DM1 is in the works.

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GSK aces pivotal studies for pair of melanoma drugs

Look out Roche. Because here comes GlaxoSmithKline ($GSK) touting upbeat results of two Phase III studies of the targeted drugs dabrafenib and trametinib in patients with metastatic melanoma. And the London-based drugmaker is now out to see how the pair of drugs taken together compares with Roche's ($RHHBY) approved Zelboraf in combating the deadly skin cancer.

GSK plans to submit applications for approval of each of the targeted drugs for treating the skin cancer. Yet investigators and company officials are most jazzed about the prospects of using a combo of the two drugs to treat melanoma, after a Phase I/II study showed that the tandem of treatments reduced the risk of a common side effect of therapy with BRAF inhibitors--the development of non-melanoma skin tumors. A new Phase III study compares the combo with Roche's BRAF inhibitor Zelboraf, which was approved last year, and another late-stage trial puts the combo of experimental drugs head-to-head with GSK's dabrafenib.

For GSK, the rapid development of the two programs underscores the changing landscape of R&D in oncology.

"It has been the fastest experience of my entire career," Paolo Paoletti, the president of GSK Oncology, tells FierceBiotech.

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Ariad's ponatinib scores well in key leukemia study

Ariad Pharmaceuticals' ($ARIA) key cancer drug ponatinib didn't disappoint at the ASCO meeting, with new data from the company's pivotal "PACE" trial trumping those revealed late last year. And now the Cambridge, MA-based drug developer is on track to turn in applications for U.S. and European approvals in the third quarter.

Cambridge, MA-based Ariad reported that 54% of leukemia patients on the targeted drug had a major cytogenetic response, besting the figure released during the ASH meeting in December. The pivotal trial involves more than 400 patients with chronic myeloid leukemia (CML) or Philadelphia-positive acute lymphoblastic leukemia (Ph+ ALL), who have built up resistance or have intolerance to the marketed kinase inhibitors dasatinib, sold as Sprycel by Bristol-Myers Squibb ($BMY), or Novartis' ($NVS) nilotinib (Tasigna) or who have the T315I mutation.

Seventy percent of patients on ponatinib with the T315I mutation had a major cytogenetic response, meaning that a certain percentage of patients' bone marrow tissue tested normal, up from 65% revealed in December, TheStreet's Adam Feuerstein reported. (Ariad aims to advance a genetic test to spot patients with the mutation via a partnership with a diagnostics company.)

"Clinical responses to ponatinib were observed in patients regardless of their mutation status or disease stage," Dr. Jorge Cortes, of the University of Texas M.D. Anderson Cancer Center, said in Ariad's press release. "Of particular importance, responses to ponatinib appear to be durable, with 93 percent of chronic-phase CML patients projected to remain in major cytogenetic response at one year, clearly highlighting the potency of ponatinib."

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Bayer's regorafenib delays stomach cancer in last-ditch study

Bayer has taken another step forward in its quest to make regorafenib into a blockbuster drug, offering new late-stage data which show the drug put the brakes on stomach cancer among a group of patients who had failed two standards of care. The median progression-free survival time for the regorafenib arm of the study was 4.8 months compared to only 0.9 months in the placebo arm. The study did not demonstrate added overall survival time.

"We do believe that this is very important data," Dirk Laurent, head of global clinical development for Bayer, tells FierceBiotech. All the patients in the study had been heavily pretreated with Gleevec and Sutent, with no remaining options.

For Bayer, which has had only one big cancer drug--Nexavar--on the market, the regorafenib data represents a major success in its long campaign to create a cancer franchise. Company execs at ASCO reiterated that the drug can emerge as a blockbuster if it goes on to win approval for several cancers. Regorafenib has already been filed for metastatic colorectal cancer and the company says it will now file for gastrointestinal stromal tumors in the second half of this year. 

The news is also a plus for Onyx Pharmaceuticals ($ONXX), which wrested a 20% royalty stream on the drug after learning how closely regorafenib resembles Nexavar.  

- here's the press release

Zytiga impresses in prostate cancer

Johnson & Johnson ($JNJ) was out early in the ASCO meeting with data demonstrating some impressive results among pre-chemo prostate cancer patients. Already approved in the post-chemo crowd, investigators said that patients in the control arm achieved an average progression-free survival rate of 8.3 months while investigators had yet to establish PFS for the Zytiga arm as their cancer was progressing more slowly.

J&J stopped its study early--and with great fanfare--so that the steroid-only arm of the study could get Zytiga.  As a result, the stats fell shy of statistical significance on overall survival, a fact that the pro-Provenge crowd at ASCO jumped on. But J&J is confident that it has the data needed to expand the label to include a much larger population of patients. Investigators estimated a 33% improvement in overall survival for the drug arm.

"These results are very promising for abiraterone acetate in the treatment of patients with metastatic castration-resistant prostate cancer who are asymptomatic or mildly symptomatic and have not received chemotherapy. The results also advance our understanding of the role of androgen biosynthesis inhibition in this patient population," said Charles J. Ryan, M.D., lead investigator of the study.

J&J's team says that the company will file for expanded approval in the second half of this year. And given the way cancer meds are prescribed, where more than half of all scrips are provided off-label, a shift in the market is likely already underway. 

That all amounts to more bad news for Provenge, which has suffered by comparison with Zytiga. Medivation, meanwhile, has its own prostate cancer pill in studies. And the company used ASCO to highlight some new secondary endpoint data demonstrating that enzalutamide (formerly MDV3100) improved quality of life and delayed the time to first skeletal-related events in men with a castration-resistant form of the disease. The Medivation drug appears well positioned and is a favorite with some analysts who have been deeply impressed with the drug's efficacy profile.

- here's the press release

Aveo makes a PhIII case for tivozanib, plots head-to-head with Sutent

Aveo CEO Tuan Ha-Ngoc and CMO Bill Slichenmyer were in Chicago to raise the flag for tivozanib, a new drug slated to head to the FDA in the near future in search of an approval for kidney cancer. Aveo put its best foot forward in advance of ASCO, highlighting data that demonstrated a better safety profile and tolerability compared to Nexavar. And Monday morning the company announced that it is planning a head-to-head study with Sutent as it positions the drug against heavy competition.

Aveo ($AVEO) has already posted a significant, though overall modest, edge over Nexavar on efficacy. And headed into a crowded market with its first prospective commercial launch, the biotech will work overtime to avoid some of the pitfalls that have befallen other companies which transitioned to commercial operations. 

Investigators for Aveo and its partner Astellas will now recruit 160 patients for the head-to-head with Sutent. "The primary objective of the study," the company says, "is to compare patient preference after receiving both tivozanib and sunitinib in sequence. Secondary objectives are to evaluate the incidence of treatment-emergent Grade 3/4 adverse events and serious adverse events; frequency of dose modifications; and quality of life in patients treated with tivozanib versus sunitinib."

The CEO says he was encouraged by the T-DM1 presentation, which also focused on the quality of life of patients. "This is the theme and future of cancer," Ha-Ngoc tells FierceBiotech, making the case that the single daily pill was easier for patients to take, triggering far fewer instances where doctors were required to reduce dosage compared to sorafenib. Given the totality of the efficacy, safety and tolerability presentation, Slichenmyer says he feels confident that Aveo can offer a convincing case to regulators. 

Failure is not an option. Aveo is already ramping up its sales efforts in anticipation of debuting the drug next year. Aveo and Astellas are partnered on the drug, with Aveo taking the lead in the U.S. market and Astellas taking the lead role in Europe.

- here's the press release on the trial announcement

Seattle Genetics expands its CD-30 horizons

"You can't do drug development in quarters," says Clay Siegall, the effusive chief at Seattle Genetics ($SGEN).

That's what he tells himself when his company's stock dips every time the revenue numbers at Seattle Genetics don't jibe with Wall Street's expectations--as it did, momentarily, just days ago.

So it's steady as he goes at the tiller of Seattle Genetics, which has two approvals for Adcetris and bragging rights for a stream of antibody-drug conjugate technology deals with Genentech and the like.

Adcetris is an ADC which is aimed right at CD-30 positive malignancies, a targeted approach that has broad applicability across a range of cancer types. Not only does the biotech have its own studies under way, a number of academics have been carrying out CD-30 investigations of their own. And the company plans to steadily chip away at new indications.

At ASCO, Siegall was manning the big company exhibit, happy to chat about new data. In a Phase II study, 70% of evaluable patients who had started treatment with Adcetris and then discontinued therapy achieved an objective response to their disease after restarting therapy. And in a separate mid-stage study of patients with relapsed or refractory CD30-positive non-Hodgkin lymphomas, including diffuse large B-cell lymphoma, a third of the 14 evaluable patients achieved an objective response, including two complete responses and two partial responses.

- here's the press release

ASCO spotlight: Antibody-drug conjugates arrive

The past year has been one worth celebrating for developers of antibody-drug conjugates (ADCs), which are drugs that marry an anti-cancer toxin to a targeted antibody to kill tumors with fewer side effects than traditional treatments. In a New York Times article, veteran reporter Andrew Pollack features this emerging class of therapies and the long haul required to advance some of the drugs.

"I don't think there is a major pharma or a midsized pharma with interest in cancer that doesn't have a program or isn't scrambling to put one together," Stephen Evans-Freke, a managing general partner at Celtic, told the Times.

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