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Merck’s Keytruda sets up Opdivo showdown with esophageal cancer victory

After archrival Opdivo from Bristol Myers Squibb posted a pair of esophageal cancer wins last week, Merck & Co.’s Keytruda is determined not to be left behind.

The New Jersey drugmaker Wednesday said a combination of its PD-1 blockbuster plus chemo had topped chemo at keeping cancer at bay and extending patients’ lives in a trial of those with previously untreated advanced or metastatic disease.

Full results are still under wraps, but the company is hoping to present them at next month’s European Society for Medical Oncology (ESMO) Virtual Congress.

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Esophageal cancer isn’t as common as some other cancers—but it is deadly. This year, the U.S. will see an estimated 18,500 new cases and record more than 16,000 deaths, Merck said.

“Esophageal cancer is a devastating malignancy with a high mortality rate and few treatment options in the first-line setting beyond chemotherapy,” Roy Baynes, M.D., Ph.D., Merck SVP and head of global clinical development, said in a statement.

But options may not be that limited for long. Earlier this month, Keytruda’s PD-1 nemesis Opdivo showed it could significantly stall the time to disease worsening and prolong lives among certain patients with previously untreated gastric and esophageal cancers—specifically, those with levels of biomarker PD-L1 at or above a combined positive score of 5.

The two trial populations aren’t the same, but they’re overlapping, and Merck could have the advantage in esophageal cancer patients thanks to Bristol’s PD-L1 requirement.

But Bristol has its own advantages in the wider gastric cancer space. Its trial enrolled those with gastric or gastroesophageal junction cancer, a population where Keytruda failed a phase 3 study last year.

And the same day it touted those top-line results, BMS also pulled back the veil on top-line data from a separate phase 3 study earlier in treatment, which showed Opdivo could beat placebo at keeping tumors from returning in postsurgery patients with removed esophageal or gastroesophageal junction cancer.