Colorectal Cancer: KOL Insight [2018]

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Publication Date:
September 2018
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Are immunotherapies set to revolutionise the treatment of colorectal cancer?

Available therapies for metastatic colorectal cancer (mCRC) prolong survival by nearly three years, but for most patients, treatment eventually fails due to resistance and other escape mechanisms. The recent approval of PD-1 inhibitors has improved the outlook for some patients, but will immunotherapy transform the treatment of mCRC like other cancers? Do new combinations hold the key to improving survival among broader groups of patients, or does a breakthrough exist among novel therapies such as TLR9 agonists, anti-LAG3 antibodies, or ‘stemness’ inhibitors? Which products and combinations are likely to prevail?

Learn what the KOLs think about these and other strategic questions facing developers and competitors in Therapy Trends KOL Insight: Colorectal Cancer. Ten of the world’s foremost KOLs from the US and Europe present essential insights on major developments in the field.

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Top takeaways

  • Will Merck & Co.’s Keytruda gain approval in the first-line setting? Early data from the KEYNOTE-177 trial are promising, but will the drug show superior efficacy compared with standard treatments?
  • Will novel PD-1 combinations provide benefit in a larger cohort of patients? Ongoing trials investigating various combinations hold the key and experts give their opinions.
  • What’s expected from the ongoing clinical trials for marketed immunotherapies? How will the outcome of these trials impact the competitiveness of BMS/Ono’s Opdivo and Merck & Co.’s Keytruda?
  • How do KOLs rate the potential of Array BioPharma/Pierre-Fabre/Merck KGaA’s MEK/BRAF/EGFR inhibitor combination? Will the early positive results from the BEACON trial be validated and lead to approval?
  • How have data concerning tumour ‘sidedness’ impacted therapy selection? What do the experts think about the impact on Roche’s Avastin and Lilly’s Erbitux?
  • How do KOLs view biosimilars and what impact will they have on the market leading originator products? Is approval in colorectal cancer based on extrapolated data an issue for oncologists?
  • What does the future hold for Taiho’s Lonsurf and Bayer’s Stivarga? Do the experts think either of these drugs will move up in the treatment paradigm?
  • Will Roche/Genentech’s Tecentriq offer any advantages over approved immunotherapies? What do the experts think will be key to Tecentriq gaining a foothold in the CRC market?
  • Which targeted agents in the late-stage pipeline are most likely to succeed? What is the potential of Boston Medical’s ‘stemness’ inhibitor napabucasin and Mologen’s lefitolimod and others?
  • How do KOLs rate the potential of early-stage pipeline candidates? Will Symphogen’s dual EGFR inhibitor futuximab/modotuximab or BMS/Ono’s anti-LAG3 antibody relatlimab provide a breakthrough?
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“If somebody comes up with the immune therapy combination then everything will move in that direction. It will be the basis for everything else to add on.”
US Key Opinion Leader

“We are moving towards an era of combining targeted therapies with antibodies, so I think we will probably be leaving the classical chemo-based therapeutic strategies with oxaliplatin and moving to the targeted therapies together with immunotherapy. This will make a big change.”
EU Key Opinion Leader

Sample of therapies covered

Marketed Products

  • Avastin (bevacizumab; Roche)
  • Zaltrap (ziv-aflibercept; Regeneron/Sanofi/Bayer)
  • Cyramza (ramucirumab; Lilly)
  • Erbitux (cetuximab; Lilly/Merck Group)
  • Vectibix (panitumumab; Amgen)
  • Stivarga (regorafenib; Bayer)
  • Keytruda (pembrolizumab; Merck & Co.)
  • Opdivo (nivolumab; BMS/Ono)
  • Lonsurf (trifluridine/tipiracil; Taiho/Servier)

Pipeline Programmes

  • Tecentriq (atezolizumab; Roche/Genentech)
  • Binimetinib/encorafenib/cetuximab (Array BioPharma/Pierre-Fabre/Merck Group)
  • Ofev/Vargatef (nintedanib; Boehringer Ingelheim)
  • Napabucasin (Boston Biomedical)
  • Lefitolimod (Mologen)
  • Masitinib (AB Science)
  • Teysuno (gimeracil/oteracil/tegafur; Taiho/Nordic Group)
  • Sym004 (futuximab/modotuximab; Symphogen)
  • ABT-888 (veliparib; AbbVie)
  • SNDX-275 (entinostat; Syndax)
  • Mekinist (trametinib; Novartis)
  • Relatlimab (BMS/Ono)

KOLs interviewed

KOLs from North America

  • Marwan G. Fakih. Professor, Medical Oncology and Therapeutics Research, Section Head, GI Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
  • Michael Aaron Morse. Professor of Medicine, Professor in the Department of Surgery, Member of the Duke Cancer Institute, Duke University School of Medicine, Durham, NC
  • Catherine Azar. Former principal investigator, Colorado Cancer Research Program, Clinical Associate Professor of Medicine, University of Arizona, Tucson, AZ
  • Anonymous US KOL. Professor of Medicine and expert in colon, gastric, pancreas, and rectal cancers
  • Anonymous US KOL. Professor of Clinical Medicine specialising in colon, esophageal, liver, and pancreatic cancers

KOLs from Europe

  • Khurum H Khan. Clinical Research Fellow in Gastrointestinal Oncology Research Unit at Royal Marsden Hospital, London, UK
  • Giuseppe Aprille. Head, Department of Oncology, San Bortolo General Hospital, Vinceza, Italy
  • Jaafar Bennouna. Professor of Oncology, University Hospital Centre, Nantes Saint-Herblain, France
  • Anonymous German KOL. Leading physician and head of internationally recognised clinic which specialises in urological and gastrointestinal tumours
  • Anonymous German KOL. Senior physician and expert in gastrointestinal tumours, including gastric cancer and colorectal cancer

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