Keytruda, a Merck cancer immunotherapy that has become the world’s top-selling medication, is administered as an intravenous infusion over the course of 30 minutes. The pharmaceutical giant now has results from a pivotal clinical trial showing an experimental injectable version of Keytruda dosed in minutes was roughly comparable to the IV-administered drug. Merck now plans to discuss these results with regulators, laying the groundwork for potential submissions seeking approvals of the more patient-friendly subcutaneous version.
Injectable Keytruda could improve access to the product with a version that’s less burdensome to both patients and clinicians. For Merck, an injectable formulation would help the company hold on to some market share and revenue that will be lost when biosimilar versions of the drug become available. In pursuing an injectable version of its blockbuster cancer drug, Merck is taking the same strategy as some other pharmaceutical companies that also face looming biosimilar competition.
Pembrolizumab, brand name Keytruda, belongs to a class of immunotherapies called checkpoint inhibitors. The drug is an antibody designed to block PD-1, a protein on immune cells that keep those cells from recognizing and targeting tumors. Antibodies drugs are typically administered as IV infusions. Merck developed the injectable version of Keytruda with enzyme technology that enables intravenous drugs to be administered as injections. This technology, called Hybrozyme, comes from South Korea-based Alteogen.
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The results announced Tuesday are from an open-label Phase 3 test enrolled about 378 adults with advanced non-small cell lung cancer. Keytruda was evaluated as a first-line treatment. Patients were randomly assigned to receive injectable Keytruda in combination with chemotherapy or IV-infused Keytruda and chemotherapy. Both drug regimens were administered every six weeks. The main goal was to assess pharmacokinetics (PK) — how the drug distributed in the body.
Without releasing specific figures, Merck said injectable Keytruda met the two main PK goals of the study, demonstrating exposure in the body that was no worse than the IV-infused formulation of the drug during the first dosing cycle and at the Keytruda’s trough concentration measured at the drug’s steady state. On secondary goals of efficacy and safety, Merck said the subcutaneous formulation was consistent with the IV formulation. Merck said these results, plus data from ongoing analyses, will be presented at an unspecified upcoming medical meeting and shared with regulatory authorities worldwide.
“It is very encouraging to see positive Phase 3 results evaluating this fixed-dose combination of subcutaneous pembrolizumab, which was administered, on average, in approximately two to three minutes and has the potential to improve the patient experience as well as increase access for patients and healthcare providers compared to intravenous administration,” Marjorie Green, senior vice president and head of oncology, global clinical development, Merck Research Laboratories, said in a prepared statement.
Keytruda accounted for $21.6 billion in revenue through the first three quarters of 2024, a 17.6% increase compared to the same period in the prior year. It’s far and away Merck’s largest product by revenue and also the top-selling medication in the world. Keytruda drug faces patent expiration in 2028.
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Merck isn’t the only company that has turned to Alteogen’s technology as a way to try to compete against biosimilars. Earlier this month, Daiichi Sankyo secured rights to use the technology to develop a subcutaneous version of Enhertu, a blockbuster antibody drug conjugate cancer therapy that is commercialized in partnership with AstraZeneca. But Alteogen also has alliances with companies that are developing biosimilars. Sandoz has global rights to use the Alteogen technology to develop a subcutaneous version of an unspecified biosimilar in its portfolio. That deal includes an option for Sandoz to license the technology for two additional products.
Roche has already received FDA approvals for new injectable formulations of two of its blockbuster products. In September, the FDA approved an injectable version of the pharma giant’s cancer immunotherapy Tecentriq. That approval was followed by a regulatory nod for an injectable formulation of multiple sclerosis drug Ocrevus. Both Roche products were developed with Enhanze, a Halozyme drug delivery technology that enables biologic drugs to be administered as injections.