BMS immunotherapy combination impresses at ASCO

Bristol-Myers Squibb has presented data showing that a combination of its immunotherapies Opdivo and Yervoy significantly increases survival in advanced melanoma, but also increases the chance of serious side effects.

Data presented via the cancer conference ASCO underway currently, shows its Phase III Checkmate-067 trial found that median progression-free survival was 11.5 months for the Opdivo (nivolumab) and Yervoy (ipilimumab) combination, compared to 6.9 months for Opdivo alone and 2.9 months with Yervoy alone.

Tumour shrinkage rates were at 58% in patients taking Opdivo and Yervoy compared to 19% for Yervoy monotherapy patients.

Michael Giordano, senior VP and head of oncology development at BMS, says: “Our development strategy has aimed to characterise the potential of Opdivo and Yervoy as part of a regimen to improve outcomes in patients with this disease. The findings of Checkmate -067 validate our strategy to combine immuno-oncology agents as the best approach to offer patients the potential for long-term survival.”

Opdivo and Yervoy are PD-L1 inhibitors, and notably the combination was as effective in patients with low PD-L1 expression as Opdivo alone was in patients with high PD-L1 expression.

However, the risk of serious adverse events was also higher in patients taking the combination therapy – 55% compared to 16% for Opdivo alone and 27% for Yervoy alone – and 36% of patients in the trial had to discontinue the treatment.

“This is the first time immunotherapies have topped the 50% mark [in response rates],” says Ana Nicholls, healthcare analyst at the Economist Intelligence Unit. “Although doubling up on drugs increase the risks of severe side-effects, the potential benefits for patients are extremely exciting.

“There may also be knock-on effects in terms of the cost-effectiveness of these extremely expensive drugs if more patients can benefit, and for longer.”

The EMA only recently recommended Opdivo for approval in advanced melanoma but it has also been recommended for non-squamous non-small cell lung cancer – a much larger market. Another study presented at ASCO found that the drug increased overall survival in this area by 27 per cent.

Opdivo and Yervoy have separately been strong performers for BMS, although Yervoy has been beaten in trials by its main rival – Keytruda (pembrolizumab) from Merck.

It is too early to tell whether the new combination treatment will be able to outdo Keytruda in the market, as the researchers are still awaiting data on the co-primary endpoint of overall survival.

George Underwood