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Comparing the TLR-9 players It's not always easy comparing data among companies in the same space since the data is often reported differently (creatively) and the patient populations often vary. In the TLR-9 field some areas of comparison can be made in the little raw data available. First off, the 3 main players, Idera, Dynavax, and Checkmate have all focused on melanoma mostly due to the need for better agents, the ease of access to lesions both for treatment and biopsy, the rapidity of obtaining results and the relative ease of evaluating results. Idera: Chose to study the sickest patients. Not only are they anti-PD-1 refractory but they also had multiple previous treatments. Agents: IMO-2125 and Ipilimumab Checkmate: Chose to study patients that were anti-PD-1 resistant and had a median of 2 prior treatments. Agents: CMP-001 and Pembrolizumab Dynavax: Chose to study patients that were both anti-PD-1 naive and those that were anti-PD-1 refractory. It has been popular to say that their patients had received less treatments and therefore were less sick but that really only applies to the anti-PD-1 naive patients. The anti-PD-1 refractory group actually had 2 or more prior treatment lines in 12 of the 13 patients studied. Agents: SD-101 and Pembrolizumab. So there are no directly comparable groups since IDRA used ipi and the other 2 players used pembro. Neither Idera or Checkmate studied anti-PD-1 naive patients. However, if you look at the Intention to Treat (ITT) groups in the anti-PD-1 refractory patient populations the result are as follows: ORR ITT population anti-PD-1 refractory only Idera: 6 of 18 (33%) Checkmate: 15 of 69 (22%) Dynavax 2 of 13 (15%) Furthermore from the available data IMO-2125 clearly wins in the durability of response. All 3 companies showed the abscopal effect and biopsy data showed similar mechanisms of action. It should be noted that the ITT group for IDRA was based on 4,8,16,32 mg patients. Once you hone down to the RP2D cohort using the 8 mg dose the ORR is 50% with an additional PR patient out greater than 1 year in the 4 mg cohort. I do not know the background of either Dynavax or Checkmate to comment on RP2D or caveats that may make the ITT group appear less impressive. It would appear that IMO-2125 is in the hunt for best in class. ASCO should shed more light on the field. |
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