Gastric Cancer: KOL Insight [2018]

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Publication Date:
June 2018
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All change in the gastric cancer treatment landscape? KOLs speak out…

The treatment of gastric cancer is rapidly evolving and the range of therapies is set to diversify with the approval and introduction of novel targeted treatment options. Mainstays of treatment look set to come under pressure from new treatment options. So how will the market evolve? Will Roche’s Herceptin maintain its dominance, even with trastuzumab biosimilars becoming available? What impact will data from the Phase III RAINFALL study have on Lilly’s Cyramza? And what has been the early experience with Keytruda, Merck & Co.’s most recently approved treatment for gastric cancer? Within the late-stage development pipeline, which programmes are KOLs most excited about? Can pipeline immunotherapies, including avelumab, nivolumab and ipilimumab, differentiate themselves sufficiently and carve out market share? Within the oral therapies space, what do KOLs think about napabucasin? And do any of the non-immunotherapy targeted biologics, such as claudiximab and andecaliximab, hold promise? Further ahead, what prospects do KOLs believe next-generation immunotherapy approaches, such as anti-LAG-3, Anti-CXCR4, Anti-CD40 and IDO1 inhibitors, are likely to have?

Twelve of the world’s leading KOLs from the US and Europe offer candid insights on four marketed therapies and 18 Phase II/III drugs. 

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Top takeaways

  • What clinical unmet needs remain in the treatment of gastric cancer? Beyond aspirational hopes of cure, what other unmet needs do KOLs identify as ‘must haves’ and are currently available therapies meeting these needs?
  • Is Herceptin’s place in the treatment paradigm under threat from biosimilars? With a number of companies developing trastuzumab biosimilars, is Roche’s flagship product about to get pushed aside, or do KOLs see another, more likely, scenario?
  • Has data from the Phase III RAINFALL study damaged Cyramza’s hopes of moving up the treatment paradigm? KOLs speak out on reasons for the negative result from the RAINFALL study, and offer some hope to Lilly in terms of what they should do next with Cyramza
  • How do KOLs view Keytruda as a 3L treatment option for gastric cancer? Are KOLs happy with the introduction of Merck & Co.s flagship anti-PD1 mAb, and what hope does the company have of moving Keytruda into other treatment settings?
  • How can pipeline immunotherapies differentiate themselves? A number of immuno-oncology (IO) programmes are progressing through the development pipeline (e.g. nivolumab, durvalumab, avelumab, atezolizumab), but what hope do they have of differentiating themselves versus already established incumbents?
  • What else in the development pipeline do KOLs find exciting? Several other pipeline programmes come under the microscope, including oral therapies (e.g. napabucasin), targeted biologics (e.g. claudiximab) and next-generation IO programmes (e.g. anti-LAG-3), but are KOLs optimistic about these programmes, or do they see more of the same?
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“I think it’s terrible. The response rate is very low, lower than reported. For most patients you treat based on PD-L1 they do very poorly, but there will be a small fraction of patients who seem to do well, so it’s not a great treatment. The problem is the biomarker – PD-L1 is not a good biomarker."
US Key Opinion Leader

“I was expecting it. It hasn’t been positive anywhere else. That’s been consistent with other studies, it’s not likely to be successful, so I don’t think it has a future.”
US Key Opinion Leader

“I think this is a good drug. It seems to have a good synchronicity with chemotherapy. It has got a good mechanism of action targeting the stromal underpinning of the cancer. It is well-tolerated – I know the side-effect profile is good. It is active. My understanding of it is that it will be something that can be used in the neoadjuvant setting. I know that Gilead are studying in that space. I think that that’s potentially where that’s going to fit in.”
EU Key Opinion Leader

Sample of therapies covered

Marketed Therapies

  • Teysuno (tegafur/gimeracil/oteracil, Taiho)
  • Herceptin (trastuzumab; Roche/Genentech)
  • Cyramza (ramucirumab; Lilly)
  • Keytruda (pembrolizumab; Merck & Co.)

Late Stage Pipeline Programmes

  • Avelumab (Bavencio; Merck Group/Pfizer)
  • Nivolumab (Opdivo; BMS/Ono)
  • Ipilimumab (Yervoy; BMS/Ono)
  • Napabucasin (Boston BioMedical)
  • Apatinib (LSK Biopharma)
  • Varlitinib (Array Biopharma/Aslan)
  • Claudiximab (Astellas/Ganymed)
  • Andecaliximab (Gilead)

Early Stage Pipeline Programmes

  • Durvalumab (Imfinzi; AstraZeneca)
  • Atezolizumab (Tecentriq; Roche/Genentech)
  • Tremelimumab (AstraZeneca)
  • Relatlimab (BMS/Ono)
  • BL 8040 (BioLineRx/Roche)
  • APX 005M (Apexigen)
  • Epacadostat (Incyte)
  • Olaparib (Lynparza; AstraZeneca)
  • AZD 6738 (AstraZeneca)
  • DKN 01 (Leap/Merck & Co.)

KOLs interviewed

KOLs from North America

  • Jaffer Ajani. Professor, Tenure Track, Department of Gastrointestinal (GI) Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
  • Igor Astsaturov. Associate Professor, Department of Hematology/Oncology, Fox Chase Cancer Center, Temple University Health System, Inc., Philadelphia, PA
  • Daniel Catenacci. Assistant Professor of Medicine, The University of Chicago Medical Center, Chicago, IL
  • Andrew Ko. Professor, Department of Medicine (Hematology/Oncology), UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
  • Michael A. Morse. Professor of Medicine, Professor in the Department of Surgery, Member of the Duke Cancer Institute, Department of Medicine, Duke University School of Medicine, Durham, NC
  • Benjamin Musher. Associate Professor, Medicine-Hematology & Oncology, Baylor College of Medicine, Houston, TX

KOLs from Europe

  • Tobias Arkenau. Medical Director of Sarah Cannon Research Institute (SCRI) UK, Executive Medical Director for SCRI UK, Clinical Lead for the Hospital Corporation of America International Cancer Service Line, London, UK
  • Eric Van Cutsem. Professor of Internal Medicine at the University of Leuven, Head of the Digestive Oncology Unit at the University Hospital Gasthuisberg in Leuven, Belgium
  • Michael Davidson. Research Fellow, The Royal Marsden NHS Foundation Trust, Sutton, UK
  • Elisabeth Smyth. Clinical Research Fellow, GI & Lymphoma Department, The Royal Marsden NHS Foundation Trust, Sutton, UK, and Lead Author on ESMO Gastric Cancer Treatment Guidelines
  • 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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