Ipsen takes on BMS as kidney cancer pill launches in EU

Ipsen is hoping to make doctors think twice about prescribing an injected immunotherapy in kidney cancer, as its Cabometyx pill becomes available in most European markets.

A tyrosine kinase inhibitor, Cabometyx (cabozantinib) looks set to become the mainstay of Ipsen’s cancer franchise, despite only being readily available on the European market for a few months.

Although the drug was approved in 2016 in second line renal cell carcinoma after VEGF inhibitor treatment such as Novartis’ Afinitor, it’s taken about a year to get the drug reimbursed in most European countries.

But now that major EU health systems have agreed to fund it, Ipsen’s chief financial officer Aymeric le Chatelier told pharmaphorum the company can mount a challenge against Bristol-Myers Squibb’s blockbuster Opdivo (nivolumab) in the second line indication.

Cabometyx is also under review in untreated renal cell carcinoma in Europe, where Ipsen has rights, although Exelixis and Takeda market the drug in the US and Japanese markets respectively.

First quarter results show the drug is finally off the mark, with sales of 28.2 million euros ( £25 million) – but le Chatelier said this could grow to 300 million euros once Cabometyx gets established and approved in other indications including liver cancer, and first and third line RCC.

Le Chatelier told pharmaphorum: “Really the first quarter was where we had it launched in most EU countries after approval 18 months ago. It is now reimbursed in 18 countries and we expect some further countries in 2018.”

Exilixis’ experience in the US suggests Cabometyx could take as much as 50% market share in the second line RCC use from Opdivo.

While it’s not a simple case of one drug being better than the other – trial data suggest patients may find Cabometyx toxicity hard to tolerate compared with possible immune reactions to Opdivo – patients and doctors may opt for Ipsen’s drug because it is taken in a convenient pill form instead of an injection.

Patients are also more likely to respond to Cabometyx, according to Ipsen's analysis of trial evidence so far.

In the first-line use Cabometyx is also likely to come up against BMS’ combination of Opdivo and Yervoy (ipilimumab), – but le Chatelier said Ipsen is “confident” it will get approval and take further market share from BMS in the untreated patient group.

Further back in the pipeline Ipsen is also trialling Cabometyx in untreated kidney cancer patients with immunotherapy - potentially competing against Merck & Co and Eisai and their combination of Keytruda and Lenvima.