FiercePharma: Trendlines In Immuno-Oncology Juggernauts -- 2016 through 2018

FiercePharma -- under the keyboard of Tracy Staton -- has delivered a very nicely thought-out summary of what to expect between these two gangbusters best-selling oncology meds, in the back half of 2016 -- and projecting out, to the end of 2018. That is, I expect her take will hold true, at least until then -- even though she doesn't specifically say so.

BMS is on-record as seeing between ten and fifteen per cent of all its sales coming from off-label (i.e., doctors choosing -- on their own -- to prescribe it, as essentially an experiment, with patient consent) via Opdivo, at this point. It seems clear that Merck's numbers (off-label) are lower. This is so, because BMS is available for so many more cancers, overall. And when writing off-label, the oncologist need not jump through the diagnostic test hoop, in order to win reimbursement (if it is not a private pay patient). So, it is reasonable to expect that through 2018, BMS will keep and perhaps extend its lead over Merck, here. Do go read it all:

. . . .Opdivo recorded $840 million in second quarter sales, more than twice Keytruda’s $314 million. For the first quarter, Opdivo posted $704 million, while Keytruda managed $249 million. That brings the drugs’ first-half tallies to $1.58 billion and $563 million, respectively. . . .

BMS admits that, as both drugs win their coveted first-line lung-cancer approvals, Opdivo’s advantage there could wane. In that field, up-front PD-L1 diagnostic testing will apply to both meds--and that means both companies will be pushing doctors to run those diagnostics.

More testing means more opportunity for Keytruda to win scripts, [Merck's Adam] Schechter said, and right now, doctors seem to be enthusiastic about Keytruda in PD-L1-positive patients.

"[W]hat’s important is we're seeing PD-L1 testing start to occur more and more often," he said on the call, adding that two-thirds of physicians are now testing. "And what we see is when physicians test, they tend to use Keytruda, and that's where we see the utilization of Keytruda for lung right now."

Unfortunately for Merck, however, Bristol-Myers is moving toward another first-line lung-cancer approval--this time for Opdivo alongside its other immunotherapy, Yervoy. In data rolled out at the American Society of Clinical Oncology meeting in June, the two meds together boosted response rates in lung cancer patients, compared with Opdivo alone. . . .

And so it goes. Onward. Ever onward.