Over the Pill
Welcome to “Over the Pill”, the Berenberg podcast where Kerry Holford & Luisa Hector lift the curtain on the messy reality of analysing pharma share prices. With over 30 years of friendship, Kerry & Luisa invite listeners into their regular debates on pharma strategy, drug pipeline prospects and commercial power.
Over the Pill
Episode 14
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As the June medical conference season comes to an end, Luisa and Kerry discuss key takes from ADA and ASCO. The team weave in feedback from their recent discussions with lung cancer and obesity key opinion leaders.
Hi, I'm Louisa Hector.
SPEAKER_01And I'm Gary Holford.
SPEAKER_00Welcome to Over the Pill, the weekly podcast on the latest hot topics in pharma investing. Morning. Good morning. So I feel like we're emerging from conference season. Can barely remember ASCO, although we've had a couple of lung cancer docs since.
SPEAKER_01Yeah.
SPEAKER_00And then most recently.
SPEAKER_01Well, our colleague attended. We had plenty of feedback over the course of the weekend. We've also had some discussions with doctors.
SPEAKER_00And a few company calls, right? They were all quite busy with those as well. So should we start with ADA then? Hopefully that's fresher in our minds. Okay. And you did your doc calls. For me, a key take-home actually was the sheer commitment, and I heard it from Lily, from Pfizer, from Roche, from Astra, but the extent to which they're ploughing money into these phase three programs, really. Yeah, what 10 phase threes in some cases? Maybe I'm exaggerating.
SPEAKER_01No, no, you're not. It's Pfizer's very proud to quote that number. That's their intention, and that's what they believe is required to compete in the market. And I guess the debate is also whether it's another way of blocking others from entering the market if you are willing and able to spend an amount of money. So, yeah, I mean, those we've definitely got this second wave of innovation forming now Pfizer, Roche, Astra, we saw data from all at ADA. And of course, we had the Lily Ratadratide phase three data, the triagonist at ADA that looked very impressive. Not so much from NOVO this year as expected, a little bit on CAG with Semer diabetes. But really, when we spoke with the doctors who attended the event, in addition to our colleague who attended, for us the most exciting elements, it was that phase three were tadrotide data showing really quite impressive weight loss, 20% or so, even at the lowest four-mig maintenance dose. So the feedback there being perhaps this is not just for the patients with super high BMI because the tolerability was surprisingly good with a low dropout rate. So is this a product that could be used more broadly in obesity to give, you know, really quite impressive weight loss with only one titration step. So that I think is intriguing. We have to think now how we model that product. And obviously, if retagotide is used earlier, then perhaps there is more cannibalization of some of the existing injectables.
SPEAKER_00Okay, and then on the Roche call we tackled this subject of the placebo-controlled trials. Yes. And the fact that in some cases patients on placebo are during the course of the trial adding on weight loss medicines. So that's sort of impacting that placebo response. Rosh, we're very clear. The FDA wants placebo-controlled trials. This is to then compare the drug versus placebo and the safety profile of placebo, so to get that safety element within the trial. But obviously, this is going to be harder and harder.
SPEAKER_01Agreed. And this was really a key factor. The sort of disappointing data presented for servadutide, which is the dual agonist from Bering Ingolheim, where we saw significant dropout rates, primarily relating to that heavy GI toxicity tolerability issues for servo, which probably lies with the glucagon component of that product. But yeah, within the data we saw presented on servo, they showed us 17% of the patients on the trial broke the rules in that they went away and took other incredients. Even 3% of the people did that on the drug arm, i.e., taking a combination. So I think it's increasingly difficult to control that. Ultimately, what physicians tell us they want is to look at more comparative data head-to-head. But that's not supported at this point, solely supported by the regulator who wants placebo controls. It's a tricky environment.
SPEAKER_00And then Pfizer, maybe a word on that. You spoke to the docs on their data, right?
SPEAKER_01And we saw the phase two data for the injectable formulation, monthly formulation for berabenitide. So this is their ultra-long acting GLP1 that they inherited through the Metcera acquisition. And the feedback from ADA was actually more positive than we thought, I would say. Doctors were quite enthusiastic about the proposition of monthly. They had patients who they could envisage absolutely wanting to be on a monthly therapy, and they were positively surprised by the tolerability data that was presented by Pfizer. So heading into phase three now, we've got a little while to wait, but I think that one was a, you know, more surprising positive than we had anticipated.
SPEAKER_00Okay, so maybe just a short recap on ASCO. We did a couple of lung cancer calls last week, which was quite timely with the GSK deal. And I would say there's definitely excitement around Merck's SAC TMT. So this is another Trop 2, ADC. The docs are very happy with that safety profile. You're starting to see increased efficacy with a slightly better safety profile. We just need to look out now for the phase threes and think about exactly where Merck is heading. They have a very broad program. The next readouts we get in lung cancer will be more in these slightly kind of niche subgroups. These are areas of unmet need where actually SAC TMT is probably going to look very striking. So I think the docs were talking about bringing a nice kind of shine to the product before some of those other trials where the hazard ratios might not be quite so spectacular, but it will already be a drug that's very well regarded by the community. So we're sort of mapping out exactly where SAC TMT could go, but clearly investors already very enamoured with Merck's efforts to replace K Truder in the long term. So that was probably the main topic of debate, you know, because you have Astra Daiichi with the readouts coming through this year, Avanzar, and then TL0708 next year. So we did get the comment that Datrowway being used in the EGFR mutants for long is actually performing very nicely. The doctor's very favorable comments on Dachway in that setting. So that's a positive towards Astra, and really that's the next card to turn is Avanzar by the end of this year. So we look forward to that. And then we have a lull now, really. So we've had conferences. We're about to head into Q2. We'll start the prep calls. I think got a few lined up for this week, right? And then meanwhile, we're very fortunate to have a few roadshows next week. The Teva CEO, looking forward to that. We have Merck head of RD, Dean Lee, in London. So that's super exciting. And then you've got GSK, right?
SPEAKER_01Yeah, it's a couple of weeks. Early July, we have the head of oncology RD, Hershem Abdullah. So yeah. Excellent. So we to focus on prepare for those as well.
SPEAKER_00And now we need to go back and speak to our Bloomberg guy about AI.
SPEAKER_01Yes, indeed. So we would love to hear your feedback as ever. Please do email us with any comments or requests, Kerry.com. Thank you for listening.