Indoximod vs Epacadostat
People saying that indoximod has had disappointing results vs INCY Epacadostat simply do not understand what is a double blinded trial and how immunotherapy works.
The only similar trial they had was for Naive Advanced Melanoma patients in combination with PD1 inhibitors.
Provided that comparing efficacy results in different trial is bad science, since patient populations are different in each trial, INCY Epacadostat had trials with both Nivolumab and Pembrolizumab, Indoximod only with Pembrolizumab.
The results are reported below (for non ocular melanoma):
1) EPA plus PEMBRO n. 19 patients ORR 58% (CR 26% PR 36%)
2) EPA plus NIVO n. 40 patients ORR 63% (CR 5% PR 58%)
2) INDO plus PEMBRO n. 51 patients ORR 59% (CR 12% PR 47%)
Pembro and Nivo have shown to be equivalent PD1 inhibitors as monotherapy in many melanoma trials, with a slight advantage for Nivo , if any.
This is also evident to me looking at the two EPA combinations where ORR was quite similar and the same was also for Indomixod trial.
I would not put too much weight on the higher CR for EPA plus Pembro since it is a smaller and older trial and I am sure that more PR with other two trials will become CR with time. This is normal with immunotherapies that need time to show efficacy and have long duration of response.
So all in all, in the only almost comparable trials i have seen so far I do not think that Indoximod is an inferior product to Epacadostat at all.
With the only difference that INCY is a $24B market cap company (at least half of which due to Epacadostat potential) and NLNK is less than $200M company (with $100M plus in cash).
This without even considering the other IDO inhibitor ROCHE has today declined to develop further and on which NLNK has regained its global rights (after getting $150M cash btw).
In any case IDO inibition has a future with PD1 inhibitors in many cancers with or without chemotherapy or as an alternative to PD1 inhibitor with chemotherapy and it is far too early to write off NLNK Indoximod, this could be as big as Epacadostat fetching many billions in annual revenue each.
