Adding Tecentriq to Lung Cancer Treatment Boosts PFS 38% in Trial

Roche's IMpower150 was the first to read out of multiple phase 3 Tecentriq-chemo studies the company has running in the front-line setting

Coupling Roche 's ( RHHBY ) Tecentriq with chemotherapy and Avastin doubled the percentage of advanced lung cancer patients surviving a year without their disease progressing - but shares sank as the benefit seemed to be driven by one segment of the patient population.

A combination drug regimen pairing Roche's checkpoint inhibitor Tecentriq with three older cancer therapies cut the risk of disease progression or death by almost two fifths in previously untreated patients with a type of advanced lung cancer, when compared to the other drugs alone. Merck scored its chemo-combo approval for Keytruda earlier this year after posting strong progression-free survival numbers in a phase 2 study, and it also boasts a monotherapy indication for Keytruda in the front-line setting for patients with high levels of PD-L1.

The answers to those questions have far-reaching consequences, as four drugmakers-Roche and rivals Merck, Bristol-Myers Squibb and AstraZeneca-are all gunning for prime combo positioning in the mammoth first-line lung cancer market. Its success to date gives Roche a chance at eventually challenging the formidable position now held by Merck's Keytruda (pembrolizumab) in previously untreated patients.

Investors and analysts are still waiting on several key pieces of information, though-some of which they're hoping to get tonight when full results of the study, dubbed IMpower150, are presented at the European Society for Medical Oncology's Immuno-Oncology Congress in Geneva, Switzerland.

She added: "This is very, very promising".

Previously untreated patients who received the two immunotherapies along with chemotherapy (carboplatin and paclitaxel) showed a 38% reduced risk of disease progression or death compared to patients treated with Avastin and the chemotherapy combo alone.

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Importantly, a doubling of the 12-month landmark PFS rate was observed with the combination of atezolizumab and bevacizumab plus chemotherapy (37%) compared with bevacizumab and chemotherapy (18%).

The analysis of the co-primary PFS endpoint in IMpower150 was assessed in two populations: all randomised people without an ALK or EGFR genetic mutation (intention-to-treat wild-type, ITT-WT) and in a subgroup of people who had a specific biomarker (T-effector "Teff" gene signature expression, Teff-WT). IMpower150 met its PFS co-primary endpoint per study protocol for both populations assessed.

Roche, which said no new safety problems cropped up, is still awaiting Impower 150's overall survival data in the first half of next year.

Patients in the first group received Tecentriq, patients in the second received a combination of Tecentriq and Avastin, while patients in the third received Avastin.

The rush to invest in combination therapies, however, masks a still-developing understanding of how immunotherapy works, and why only certain patients benefit. Results like Roche's suggest a way to improve response rates, but it's far from clear how different combinations might compare. "The challenge will then be to judge which strategy is the best".

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