FDA approval of Roche MEK inhibitor cotellic

The FDA approved cotellic, Roche's MEK inhibitor, and vemurafenib, BRAF inhibitor, for the treatment of BRAF V600E or v600k variant advanced melanoma This is the second BRAF / MEK inhibitor combination after Glaxo's TAF / MEK combination About half of the patients with melanoma are BRAF variant, and 70000 new patients and 10000 people die of the disease every year in the United States The combination sells for as much as $210000 a year, with experts predicting a peak of $800 million Glaxo's TAF / MEK and all of its anti-cancer pipelines were sold to Novartis last year, with sales of more than $100 million in the third quarter, so it seems convincing that the cotellic / zelboraf portfolio peaked at $800 million Before 2011, advanced melanoma can only be treated with chemotherapy, and the response rate is only about 10% The launch of vemurafenib is an important breakthrough The response rate of vemurafenib was 50%, which was 3 months longer than that of chemotherapy Cotellic is another node in Raf / MEK / ERK pathway, and PFS of inhibiting RAF and MEK is 5 months longer than that of inhibiting RAF alone Only 4 years later, there is almost no drug available for advanced melanoma Now, RAF, MEK, PD-1, CTLA4 inhibitors and t-vec are competing It can be seen that the high-speed progress of anticancer drugs and the high unpredictability of market changes are now obvious Targeted therapy is only suitable for the subtype of oncogene mutation, while immunotherapy does not require mutation In melanoma, PD-1 inhibitors do not even require the expression of PD-L1 In addition, immunotherapy response is more durable, so immunotherapy is theoretically more competitive However, immunotherapy response is slow, and targeted therapy is quick, and there are still follow-up means of immunotherapy after the progress, so now for BRAF variant targeted therapy is a first-line therapy Tumors are resistant to these targeted inhibitors for about a year, so patients will eventually have to use immunotherapy Targeted inhibitors may injure immune cells by mistake and have adverse effects on immunotherapy, but killing tumor cells will increase immunogenicity and may make tumor more sensitive to immunotherapy A combination of appropriate immunotherapy and targeted therapy may respond quickly and persistently Now there are such combinations in clinical trials Cotellic was first discovered by exelixis Exelixis mainly develops kinase inhibitors using fragment design as the technology platform, but in recent years, another kinase inhibitor, cabozantinib, lost 70% of its staff on the day of failure of prostate cancer experiment last year Now Roche and exelixis are developing a tripartite combination of zelboraf, cotellic, and xl888, an Hsp90 inhibitor, which achieves 92% response in phase I clinical trials The combination of anticancer drugs obviously increased the response, but the high drug price has become an important problem The Quartet of MEK / Raf / PD-1 / CTLA4 inhibitors will sell for more than $500000 a year, even if the patient's body can't stand a bank account Of course, 10 years later, the problem of overdue drug prices of these drug patents will be solved naturally For today's patients, this is the best and the worst (BIOON Com)