Is Merck’s Keytruda ahead of BMS Opdivo?


  • Both Keytruda and Opdivo are highly effective and commercially successful immunotherapies, yet Keytruda is at the forefront.
  • In newly diagnosed lung cancer, a commercial market opportunity that could reach $8 billion in sales annually, Merck’s Keytruda works and Bristol’s Opdivo does not.
  • With many failures in last 2-3 years for Nivolumab as monotherapy or as combination therapy, caused a fall flat, whereas consecutive accelerated approvals in past one year for Keytruda added to its market share and success.

We really don’t always get to see a head-on confrontation like the Merck’s Keytruda (pembrolizumab) and BMS Opdivo (nivolumab). These two have always been so much hyped immunotherapies along with other PD-1/L1 inhibitors.

But these two used to steal the show many a times in most of the international major conferences. Even though Opdivo has been approved earlier than Keytruda, yet, we feel that Keytruda was a better player. Both drugs are highly effective and commercially successful immunotherapies. Both are even effective in treating patients with lung cancer that no longer responds to prior therapies.

However, in newly diagnosed lung cancer, a commercial market opportunity that could reach $8 billion in sales annually, Merck’s Keytruda works and Bristol’s Opdivo does not. Keytruda, first approved for advanced melanoma in 2014, is Merck’s most important growth driver. It has overtaken Bristol’s Opdivo as the industry’s immuno-oncology leader with sales expected to top $10 billion this year and $20 billion in 2024, according to IBES data. Kidney cancer is the latest proving ground for IO in combination with other drugs.

While treatments like Keytruda (pembrolizumab) and Opdivo (nivolumab) have proved startlingly effective for a minority of patients — depending on the tumor type — most don’t experience a significant benefit. In response, biopharma companies have leaned on combinations, but only with modest success.

Bristol-Myers’ combo of Opdivo and Yervoy has been one of those successes, with approvals in metastatic melanoma, certain types of colorectal cancer and, most recently, advanced renal cell carcinoma. The pairing has also underpinned a good part of Bristol-Myers’ commercial success in immuno-oncology. As Keytruda has become the immunotherapy of choice in lung cancer, more of Opdivo’s growth has come in melanoma and renal cell carcinoma, according to Bristol-Myers’ executives.

However, the combination is also hampered by Yervoy’s side-effect profile, which includes severe and fatal immune-related adverse reactions like enterocolitis and neuropathy. With many failures in last 2-3 years for Nivolumab as monotherapy or as combination therapy, might be due to the kind of patient segments they recruited in the respective trials, caused a fall flat. On the contrary, consecutive accelerated approvals in past one year for Keytruda added-in Merck’s Kitty have made it a better player than Opdivo.