Roche’s PD L1 inhibitor Tecentriq: a new contender in non small cell lung cancer

Cancer remains among the leading causes of death worldwide. According to the World Health Organization (WHO ), there were approximately 14 million new cases and 8.2 million cancer-related deaths worldwide in 2012. Moreover, the number of new cases is expected to increase by approximately 70% over the next 20 years, highlighting the urgent need for more effective treatments. One of the most promising recent breakthroughs in cancer therapy is the development of immune-oncology agents that enhance the immune system’s ability to fight cancer, yielding unprecedented response rates in certain cancers. Roche’s Tecentriq (atezolizumab), an anti-programmed cell death ligand 1 (PD-L1) monoclonal antibody, entered the immune-oncology space in June 2016, following its accelerated approval in bladder cancer to become first-in-class PD-L1 inhibitor in this setting. However, Tecentriq is the third agent within the programmed cell death 1 (PD-1)/PD-L1 inhibitor class behind Bristol-Myers Squibb’s (BMS ’s) Opdivo (nivolumab), the current market-leader, and Merck & Co’s Keytruda (pembrolizumab). Furthermore, competition in the immune-oncology space is intensifying across all targeted cancer indications as the role of the PD-1/PD-L1 pathway has become one of the hottest topics in oncology.

Nonetheless, despite its late entry, Tecentriq may soon close the gap in the market-share race: it became the first and only anti-PDL1 cancer immunotherapy for second-line metastatic non-small-cell lung cancer (NSC LC) in October 2016, having demonstrated significantly improved overall survival (OS ) regardless of PD-L1 status, which could give Tecentriq an edge over its rivals. According to Consensus sales forecasts from Clarivate Analytics Cortellis, Opdivo is expected to remain the overall market leader, with 2021 forecasts for Tecentriq, Opdivo and Keytruda of $3.824 billion, $11.919 billion and $7.914 billion, respectively.

Tecentriq: a challenge to the status quo

Tecentriq gained accelerated approval in locally advanced or metastatic urothelial cancer in May 2016, making it the first FDA-approved treatment for patients with a specific type of bladder cancer in more than 30 years and the first agent in the PD-1/PD-L1 class to gain approval in this indication. Although bladder cancer represents a sizable market – it is the fifth most common cancer in adults in the US and an estimated 77,000 people in the US will be diagnosed with bladder cancer this year – it is the bigger NSC LC market that could prove more lucrative for Tecentriq. Lung cancer is the second most common cancer in both men and women, and NSC LC accounts for 80 to 85% of these cases. Tecentriq could now become a major player within the PD-1/PD-L1 class following its recent approval and release of top-line data from the phase III OA K study in second-line NSC LC patients whose disease had progressed on or after treatment with platinum-based chemotherapy. Patients receiving Tecentriq lived a median of 13.8 months, which was 4.2 months longer than those treated with docetaxel, regardless of their PD-L1 status.

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