An erstwhile anonymous commenter remarked last week that perhaps the FDA nod to Opdivo® would not mean too, too much to Merck’s Keytruda® in NSCLC, longer term. I suppose it may be that the world is changing underfoot (wouldn’t be the first time that’s happened to me!), but it had always been my perception that — in oncology at least — it tends to be “winner take all“. The below reiterates that view.
Of course, I do think there will be perhaps $5 to $7 billion in Keytruda market proceeds for Merck (per year), working into 2018 and beyond. However, I do think in the near term, BMS has scored a vast win, here — by nailing an inroad to NSCLC first — by as much as 9 to 12 months, over Kenilworth.
And I do think — as the below Bloomberg article intones, oncology is. . . different. Both as to price points — and as to prescribing patterns — where (as here) there is a clear survival benefit. A bit, then — from the Bloomberg story of this afternoon:
. . . .That’s because the FDA’s practice of approving drugs by each cancer type and stage of disease. So even if two cancer drugs are similar on paper, they may still not compete directly because they are approved for slightly different uses.
Another factor that helps keeps pricing up is that cancer doctors tend to exclusively prescribe the drug that is perceived to have the most efficacy for each particular cancer type, even if the advantage is narrow.
“In oncology, it tends to be winner take all,” Evans said. “Whoever has the best efficacy will get all the sales, and that really preserves the pricing power. . . .”
I still think the commenter has a fine longer term (circa 2018 and beyond) point. And, as much as I hate to say it, once Opdivo starts posting results in lung cancer, inside the oncology wards, day by day — those docs are reasonably likely to write off label for it — and second line vs. third line will become a blurred line, at best. In sum, I just think it is hard to overestimate the significance of Opdivo’s FDA NSCLC nod, last week. For what it is worth.