Physician Views: Can Roche's Tecentriq defend its lead in bladder cancer?

Bladder cancer may represent a relatively small proportion of the overall commercial opportunity for PD-(L)1 inhibitors, but until recently Roche enjoyed a monopoly position in the US market as the only approved therapy in second-line patients. Tecentriq was approved in this setting last May, but has subsequently been joined by Bristol-Myers Squibb's Opdivo (in February) and AstraZeneca's Imfinzi (last week). Each product has been approved on the basis of tumour response rate and duration of response, delivering broadly comparable data.

Roche has, at least, recently secured an expanded label for Tecentriq in bladder cancer, which permits use in first-line patients who are ineligible for treatment with chemotherapy. However, next month, Merck & Co.'s Keytruda could be approved for the treatment of both relapsed and treatment-naïve patients.

Furthermore, in second-line patients, Keytruda has demonstrated an overall survival advantage versus chemotherapy, which, assuming inclusion in its label, could prove advantageous versus competitors. In the first-line setting, Keytruda may also benefit from its momentum in other tumour types – notably in treatment-naïve non-small-cell lung cancer – while Merck's data in first-line bladder cancer patients who are higher PD-L1 expressers (10 percent expression or above) is impressive. 

To get a better understanding of potential near-term dynamics in the US bladder cancer market, we are snap-polling US oncologists with the following questions…

Roche's Tecentriq (atezolizumab) is approved for the treatment of first and second-line bladder cancer. Based on your experience with Tecentriq to date, how satisfied are you with this product in a real-world setting?

Very unsatisfied

Moderately unsatisfied

Slightly unsatisfied

Neutral

Slightly satisfied

Moderately satisfied

Very satisfied

Do you expect the more recent approvals of Opdivo (nivolumab) and Imfinzi (durvalumab) to reduce utilisation of Tecentriq in second-line bladder cancer patients over the next 12-18 months; like Tecentriq, approval of Opdivo and Imfinzi in this setting is based on tumour response rate and duration of response. Opdivo's ORR was 19.6% (rising to 28.4% in PD-L1 patients with 5% or greater expression), while Imfinzi's ORR was 17% (rising to 26.3% in PD-L1 patients with 25% or greater expression). By comparison Tecentriq's ORR was 14.8% (rising to 26% in PD-L1 patients with 5% or greater expression). Furthermore, Tecentriq is administered via a 30 minute infusion every three weeks, while Opdivo and Imfinzi require a 60 minute infusion every two weeks.

No impact on Tecentriq utilisation

Minimal impact on Tecentriq utilisation

Moderate impact on Tecentriq utilisation

Significant impact on Tecentriq utilisation

Very significant impact on Tecentriq utilisation

Keytruda (pembrolizumab) is also awaiting approval in both the first and second-line bladder cancer settings (it has a June 14 PDUFA date). In second-line patients, it has demonstrated an overall survival benefit versus chemotherapy; median OS of 10.3 months versus 7.4 months for chemotherapy (8.0 months versus 5.2 months in PD-L1 patients with 10% or greater expression). Keytruda also demonstrated an ORR of 21.1% versus 11.4% for chemotherapy (21.6% versus 6.7% in PD-L1 patients with 10% or greater expression). Assuming the OS benefit is included in labelling, do you think availability of Keytruda will reduce utilisation of Tecentriq in second-line bladder cancer patients over the next 12-18 months?

No impact on Tecentriq utilisation

Minimal impact on Tecentriq utilisation

Moderate impact on Tecentriq utilisation

Significant impact on Tecentriq utilisation

Very significant impact on Tecentriq utilisation

Recent first-line approval of Tecentriq in bladder cancer patients ineligible for chemotherapy is based on an ORR of 23.5% (rising to 28.1% in PD-L1 patients with 5% or greater expression). Potential approval of Keytruda next month is based on an ORR of 24% (rising to 37% in PD-L1 patients with 10% or greater expression).

Which of these two products would you expect to be utilised more frequently in first-line, chemotherapy-ineligible patients 18 months from now?

Keytruda – significantly more

Keytruda – moderately more

Keytruda – slightly more

Equal utilisation

Tecentriq – slightly more

Tecentriq – moderately more

Tecentriq – significantly more

Do you agree that Keytruda's broader labelling in other oncology indications will also support adoption in first and second-line bladder cancer?

Completely disagree

Disagree

Somewhat disagree

Neither agree or disagree

Somewhat agree

Agree

Completely agree

Results and related analysis will shortly be published for FirstWord Pharma PLUS subscribers to read, with the opportunity for non-FirstWord Pharma PLUS subscribers to purchase these findings. To be notified when poll results and analysis become available, please click here.

As always, FirstWord would very much like to receive your feedback and suggestions. Note: FirstWord Polls are powered by MedePolls, a fast-turnaround service to conduct instant polls of up to five questions with guaranteed samples that include physicians from dozens of specialties and over 100 markets. To conduct this poll with a different audience, or an entirely different poll, contact us at info@firstwordpharma.com

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