Jack O’Brien interviews Arun Krishna, head of the U.S. lung cancer franchise at AstraZeneca, about a Tagrisso-based combo that promises a new treatment option for patients. Lecia Bushak gives an update on the confirmation process for Monica Bertagnolli, President Biden’s pick for a new NIH director. And TikTok’s bed-rotting trend tops our Trends segment, along with items on hazardous energy drinks and how the “Ozempic effect” could impact corporate America. Music by Sixème Son.

Note: The MM+M Podcast uses speech-recognition software to generate transcripts, which may contain errors. Please use the transcript as a tool but check the corresponding audio before quoting the podcast.

Hey, it’s Marc.

There’s a faceoff brewing among prescription drugs to treat lung cancer, with billions of dollars at stake for the companies involved.

The cancer drug Tagrisso represents AstraZeneca’s most lucrative product, generating $5.4 billion last year . 

Tagrisso holds a commanding position as a first-line treatment for patients who have a positive EGFR mutation. [kind of cancer called EGFR-mutant non-small cell lung cancer.]

Pats whose tumors have this type of genetic mutation are a subset of the more than two million people diagnosed yearly with lung cancer, but thry’re a significant one

Around 15 to 20% of patients who are diagnosed in the metastatic phase have it.

And Tagrisso’s success in treating that population has not gone unnoticed by other drugsmakers.

Johnson & Johnson’s own drug cocktail pairing the bispecific drug Rybrevant with the T-K-I lazertinib led to a 30% reduction in risk of disease progression or death in a head-to-head trial against Tagrisso

But AstraZeneca isn’t standing still. It’s been testing Tagrisso along with chemotherapy in the same setting. And data from its FLAURA-2 trial demonstrated a roughly 9-month benefit in risk of disease progression or death for the Tagrisso-chemo combo versus Tagrisso alone. That’s about 2 months better than J&J’s combo. 

As analysts now debate whether Tagrisso can blunt the challenge from J&J for share of the first-line EGFR-mutant NSCLC market, 

Arun Krishna, VP and head of the US lung cancer franchise at AstraZeneca, joins us on the podcast this week to discuss how the FLAURA-2 data can help Tagrisso differentiate itself and – just maybe – hold onto its lead in lung cancer 

And Lecia’s here with a health policy update 

Hey Marc, today I’ll give an update on Monica Bertagnolli’s nomination to head the National Institutes of Health, following a Senate HELP committee hearing last week.

And Jack?

This week, we’re talking about hazardous drinking products, TikTok’s bed-rotting trend and the impact GLP-1 weight-loss drugs could have on the gambling industry. 

Hi, I’m please be welcome today by Arun Krishna the VPN head of the US lung cancer franchise at AstraZeneca Arun. How are you doing today? Excellent jack happy to be on board as well. I’m really pleased to have you on the show. Obviously some really interesting news that came out from astrozeneca Recently. Can you walk me through the phase three trial results for Ted grissow and chemotherapy and kind of give us a high level overview of some of the most meaningful results.

Yeah. Absolutely. Yeah, it’s great to see positive high level results of the study. We call Flora too. It’s a follow-on study, which is previously we have Flora which was a griso our Aussie merchantment as a mono therapy compared to Korean standard of care here, Florida too is combination of degrees. So our you call Aussie Merchant in combination with chemo, the high level results was presented at wclc the world long conference at Singapore and it was great to see the positive results and some of those meaningful endpoints which we were measuring actually

Hit so the first one was progression-free survival. What we were able to demonstrate was we were able to see a nine-month increase on progression free survival of the experiment arm which in this case, Aussie Martin versus schema, which is a compared around which is Aussie numertinib as a monotherapy. We also look to see whether they were any profound safety signals during this study and we was and we can say that it was very comparable to that of the standard of care arm as well.

Excellent. So I I appreciate you giving us the background there, I guess on the go forward. What does that look like in terms of next steps whether that is a phase, you know, I’m kind of curious where it goes from here in terms of any sort of regulatory steps or you know, what the next phase of this is.

Yeah. Absolutely. So when you think about any phase three study these as we saw this was a positive readout of Flora to phase three study at wclc the next steps, of course is for us to have ongoing discussions with FDA EMA and

Regulatory bodies across the world and hopefully go through the relevant timelines to make sure that we are then available for patients at the time of approval and that is the standard process that we follow as any pharmaceutical company would the impact so I think if I just rewind, you know, Aussie Martin about tigreso has been approved for patients who have a positive egfr mutation. This is a specific type of mutation which you know, a certain types of lung cancer patients could have and it’s around the prevalence that around 15 to 20% of patients who are diagnosed in the metastatic phase have an ego for mutations. It’s quite a significant population. So this drug is specifically for them the Florida to study as I said was in the late stage or in the metastatic stage with these were patients who are either locally Advanced which are stage 3B and C or stage 4 disease as well and I’m curious how these results help you differentiate yourself

in what is increasingly

Coming a very competitive space. I know that each drug maker kind of looks for their different angle to say, you know, this treatment may work. But this is one that you really want to go with. How does how do these results play into that Dynamic for you?

Oh, yes spot on so, you know a lot of times, you know when you think about lung cancer as a

A treatment option for patients who have lung cancer the first and foremost thing one should be doing is to be able to test for your biomarkers status. This is the most crucial and critical aspect of it because we feel able to test for your biomarker status. You are then able to provide the necessary treatment which which addresses the biomarker which in this case testing for an egfr positive mutation is critical because if you are positive egfr, then you have tki as an option for your treatment and to yourself is your third generation tki which is has the current which is the current standard of care in these patients. So first and foremost to your point is extremely important and relevant to test the biomarker status. If you’re able to test the biomarker status, then you’re able to tailor the necessary treatments and therapy to that patient So within that context to grow so as a mono therapy has always been the backbone for patients with eg of our positive results now we

Are coming up with another option with this study for patients within that space as well. So which is showing an additional benefit of around nine months. So

this is another alternative for patients who could be you could where this therapy could be potentially used particularly. We have seen some really promising results with Florida too with patients who have CNS our patients who have an l858r mutation and compared to the current standard of care. So when we we look forward to having further discussions with our external Community as well as regulatory bodies and then look at see how we can actually impact some of those for those specific types of patients, which I’ve mentioned.

So if we were to have a conversation say six months from an hour even at a year about where the lung cancer franchise stands for AstraZeneca, where would you see it, you know in your ideal world. What would it look like in terms of maybe products roll out or other developments down the line?

Yeah, really good point as you can see the trajectory in terms of oncology medicines and access Jennica has really accelerated over the past fight to eight years, right and especially in our lung cancer treatment and to Grisel was one of the first options for patients for from AstraZeneca in the lung cancer space and since then we have numerous indications and treatments within this space. Our ambition is around impacting the lives of every patient across every stage within the lung cancer treatment. And so we look to see whether we have the opportunity through our robust phase three trials and early pipeline to see if we can make an impact in that space and one of the things that we are quite excited about in the near term is a new top 2 ADC called Dad.

DxD we just announced positive high-level results for dado dxt. Within the lung space with the tlo1 study. And we look to share that results in an upcoming upcoming

Congress in the near future. I saw those results last week and obviously it’s it’s it’s exciting to hear your enthusiasm around it. I am curious though. Obviously coming here from a Layman. I don’t come from the oncology world per se but when you look at how oncology is discussed or lung cancer specifically what sort of misunderstandings, you know our audience our primarily Messengers and communicators. So they always want to have the best understanding to relate to the general public. But when you see it as it relates to your space in particular, we’re the ones that saniti where you’re like if we could just get this down in terms of messaging or communicating are there anything that come to mind Jack? That’s an excellent point

right? One of the things that we often seen in the US as well as globally that that early diagnosis is critical in terms of lung cancer patients overall survival because we are able to

Now move treatments up in that setting so the most important message is around patients to get our people or population to be screened.

And diagnosed early and if you’re screened in diagnosed earlier, you have a child you have a significant higher chance of having a bigger overall survival and potentially even a chance for cure in that setting so most patients are diagnosed late currently and if we can move that up through screening IP and detection, which is incidentally pulmonary nodule detection and Clinics we’re able to then get patients treated earlier and by getting patients treated earlier, we have that much chance of improving their survival, but potentially even cure so that to me is the number one message. The second message is every time you’re diagnosed with lung cancer ensure, you know, your biomarker status because if you know your biomarker status you’re then able to Target the therapies to that biomarker status as opposed to a one size fits all solution

and I can imagine that your point is so much more well-taken, especially as we’re coming out of the emergency phase of the pandemic. We’re a lot of people, you know, rightly or wrongly put off care put off doing a lot of these screeners and

You know, the the research is still ongoing but you know the fear among a lot of the people at least I speak to in the Healthcare Community. I’m sure it’s the same for you is that you know cancer is another things have gone on gone undetected and we’re you know do for maybe a surge or people that are so far down the line that they didn’t have these, you know chances to really intervene earlier in the process.

Yes, but on because what we have seen from the data is that daddy’s been a dip in terms of lung cancer diagnosis during the time of covid and it could and and I can see why because the symptoms sometimes can be quite misrepresented as covid symptoms. Right? But to your point as we come out of covid my urge is for people to go get checked to ensure especially if you have been a previous smoker when you follow certain things that that could put you potentially at high risk of lung cancer ensure you go and get green. It is an easy process in order to do that. So you’re able to then ensure that you know, you are diagnosed.

Earlier and you buy being diagnosed earlier. You have a significant higher chance of living longer and potentially cure as I said,

excellent. Well Arun, I’ve really appreciate you being on the show and being able to pass along these insights to our audience want to give you the final word in case there’s anything else as it relates to the lung cancer franchise after Xanax or anything else that the company is working on that you think is Meaningful for our audience to now,

you know, first up thank you Jack for having me over at the show as you can see, you know, lung cancer is a

rotating

disease and and there are a lot of patients who are being diagnosed late. So my number one message I would love to trade is if you are a high risk patient population, please get yourself screened. And secondly, if you are if you know somebody who’s been diagnosed with lung cancer or yourself diagnosed with lung cancer ensure, you know, your biomarker status because there are numerous number of treatments out there who can extend your survival and potentially cure. I think it’s a great time to be with AstraZeneca, especially in the oncology space. We are investing heavily not just in lung cancer, but across all like all Cancers and we’re looking to really move treatments up in the in the stage so we can so patients can truly benefit from these drugs and have a longer and a more meaningful life.

Thanks. Well again, everyone really appreciate you being on the show certainly wish you the best in terms of any advancements on the one cancer space and if they’re more results down the line, we’d love to be happy back on the show

to discuss them. Thank you Jack. I really appreciate it.

Health policy update with Lecia Bushak.

Cancer surgeon Monica Bertagnolli has been President Joe Biden’s pick for the director of the National Institutes of Health since May. But her confirmation process has taken months – compared to her predecessor Francis Collins’ confirmation, which took only four weeks.

The delay is mostly due to Senator Bernie Sanders, who heads the Senate Health, Education, Labor and Pensions or HELP committee – and who has refused to move forward with the process over drug prices.

Over the summer, Sanders vowed to, “oppose all NIH nominations until we have a very clear strategy on the part of the government… as to how we’re going to lower the outrageously high cost of prescription drugs.”

Last week, though, Sanders finally agreed to hold a HELP committee hearing on Bertagnolli’s nomination. That’s because the Biden administration has made one step toward Sanders’ wish.

The White House recently announced a new contract with Regeneron Pharmaceuticals for  COVID-19 monoclonal antibodies. That deal would require the list prices of any resulting drugs from the collaboration to be equal to or lower than the price in other countries.

During the hearing, Sanders grilled Bertagnolli on drug prices, as well as what her priorities would be as head of the NIH.

SANDERS: Will you commit to us that you will work to ensure that Americans do not pay higher prices for prescription drugs in this country than people around the world?

BERTAGNOLLI: Chairman Sanders, It would be a great honor to work with you to make sure that the American people have access to the care they need to live long and healthy lives.

Other hotspot issues that arose during the hearing included Republican questions around how Bertagnolli would restore public trust in the beleaguered agency, since its struggles during COVID-19; as well as issues like gain-of-function research and transgender youth care.

The committee will vote Wednesday to decide whether they will send Bertagnolli’s nomination to be approved by the Senate. I’m Lecia Bushak, Senior Reporter at MM+M.

And this is the part of the broadcast when we welcome Jack O’Brien to tell us what’s trending on healthcare social media. Hey, Jack.

Hey Marc, I want our listeners to beware of what they drink.

We have two recent headlines here about ingesting products that may be hazardous to your health or the health of your loved ones.

Late last week, the American Academy of Pediatrics (AAP) warned that powdered drink mixes that are widely promoted as “toddler milks” for older babies and children up to the age of three are unregulated, unnecessary and “nutritionally incomplete.”

The drinks are often advertised towards parents on social media platforms like TikTok and often contain added sugar and salt. The AAP criticized manufacturers, who often produce the top brands of infant formulas, and package them with similar labels and sell them in the same store aisles, for making unproven claims about how the drinks can boost kids’ brains or immune systems.

Also, earlier this week, parents alleged in a wrongful death suit against Panera Bread that a 21-year-old with a heart condition died after consuming a heavily caffeinated energy drink at the fast-casual restaurant chain that she may have believed was regular lemonade.

The suit alleges that Sarah Katz, who was diagnosed long QT syndrome (LQTS), experienced cardiac arrest after drinking a “Charged Lemonde.”

The lawsuit says Katz was “reasonably confident it was a traditional lemonade and/or electrolyte sports drink containing a reasonable amount of caffeine safe for her to drink” and charges that Panera misled consumers by not properly labeling “Charged Lemonade” as an energy drink in stores.

 

Yeah, you know the the cat’s story. I I looked up the charge lemonades because I’ve also never come across them a Panera and apparently a regular size of one of these lemonades contains around 260 milligrams of caffeine which to put into context is equivalent to about four shots of espresso. And when you look this up on Panera’s website, you know, they’re kind of marketed as being these refreshing clean green plant-based, you know drinks with different flavors and it’s not really clear how much caffeine is in them. So it appears it’s been sort of misleading customers, but it’s interesting because a tiktok actually went viral about this drink about a year ago or a girl said she was you know doing some work at Panera regularly and was drinking these lemonades and starting to feel like the Hulk and not knowing why until she realized how much caffeine they had in them. So I think they are maybe a little

gentle some of their marketing around this product

Yeah, Mark. I want to bring you into the conversation because I also saw that lesson the stories that were writing about this that that clean comment kept coming up and I don’t even know what that really means when it comes to a drink or plant-based. I think a lot of drinks are ultimately plant-based. I don’t know is interesting but Mark, what’s your take on all this in my kids

and I always laugh when we see that eat clean bro. Yeah, you know billboard on the turnpike, but you know to add to that little context, you know over the summer we had spoken about Logan Paul’s energy drink in the context of Senator Chuck Schumer is calling on the FDA to investigate the beverages as he put it absurd caffeine content in his letter to the to the agency as well as it’s marketing targeting kids on social. Well Prime energy as Jack pointed at you pointed out then has about 200 milligrams of caffeine, which is the equivalent of one to two eight ounce cups of brewed black coffee and the Mayo Clinic says on average 400 milligrams of caffeine per day is safe for adults though. Obviously, the drug effects people differently is in the case of

Cats she had this pre-existing condition and Paul’s drink also comes with a warning label, which doesn’t seem to have been the case here with cats as lawsuit. So important differences there. And obviously we see the need for being really clear and how you Market this stuff.

Absolutely, no it for certainly for Consumer safety. If nothing else Les. I want to throw it to you for this next story because you’ve gone down the tiktok rabbit hole again and come up with something that I guess a number of people wouldn’t have an issue with but some people also see it. It’s kind of a slippery slope to the opposite of self-care.

Sure.

For Baby Boomers, turning your brain off after work might have involved sitting in front of the television with a TV dinner and a beer. For Gen Z and millennials, turning your brain off after work could mean participating in the latest TikTok trend: bed rotting.

Across the app, people have hopped on a trending hashtag dubbed #bedrotting to show how they “rot” — or stay in bed — all day. 

Bed rotting usually entails snuggling or camping out under the covers, often in pajamas, with Netflix streaming on a laptop or TV for hours. People are often bed rotting while mindlessly scrolling on the phone. 

The activity refers to shutting yourself off from doing any work or chores, as well as avoiding any form of socializing — all in the name of rest and self-care. However, bed rotting can become a slippery slope away from self-care and into self-destruction. 

“I’ve reached a stage in my life where rotting has become habitual,” one TikToker explained in a video. “It seems like the most natural thing to do for me, but it doesn’t feel good anymore. It doesn’t feel good to never leave my apartment… or scroll for hours on TikTok, feeling my anxiety build up and not taking any steps to relieve that. I don’t know how to address it, but I’m acutely aware of it. I need to change. Because I can’t keep living like that — it’s literally eating up my brain.”

This is an area that can be grey, as it’s quite a fine line between self-care and exacerbating mental health issues. Thoughts?

Yeah. I’ll hop in first and then Mark I’m curious to hear your thoughts. I as with anything, you know, I’m always good for a lazy day. I think that my fiance can attest that there’s nothing I love more than just the time where I can turn my brain off and not have to

Lies and not Beyond as we were talking about off-air, but when you get into the habit of doing it every day or for these prolonged periods of time. Yeah, it’s no it’s no question that it’s only goes from self-care to self-destruction some sort of way and can feed into these other mental health or behavioral issues that people have Mark. I’m I’m curious what you think about bedroding. Have you ever betrotted? I have not although

I have spent, you know my time in bed, but I have not crossed over to bed riding Trend per se but it reminds me of a piece that I read in time over the summer that kind of pointed at an interesting Trend as the article put it we’ve reached Peak therapy. So to speak, you know, where we have all these athletes celebrities politicians obviously people on tiktok talking about their mental health struggles. Not only that but people are talking correctly or not in the language of therapy as the article put it using terms like self care and but do they, you know, are they kind of you know,

Diagnosing themselves in the wrong way here, you know and so the article was kind of trying to figure out what’s at the same time. We have all of this, you know, increased awareness of mental health. The trends are going in the wrong direction, you know, one in eight us adults now takes an antidepressant one in five has recently received some kind of mental health care and increase of almost 15 million people in treatment since 2002. So the trends are not going in the right direction this kind of bedroding trend. I feel like it’s kind of like a symptom of that that people are just not you know, they’re kind of interpreting the self-care need in the in the wrong way self-care means taking care of yourself in a healthy way getting outside getting out towards doing more exercise leading a healthy lifestyle staying in bed, you know, you know under the covers doing scrolling through social media or watching binge watching. Okay, that might be okay to do, you know here and there but to turn to that as quote unquote self-care, there’s just like a disconnect there and perhaps, you know, the article didn’t necessarily come to a conclusion as to why there’s a gap there between the

Rising awareness of mental health issues and the trends going in the wrong direction, but it could be that there aren’t enough mental health professionals therapists to alleviate this crisis, but just seems to be another another symptom then that was my take.

Yeah, I don’t think that’s far off that was kind of the indication I got is that oh, yeah. This is obviously people who may you know with all good intentions say I’m doing something that’s gonna reclaim my own self-care and mental health and all the stuff that I think has been focused of decentization over the years. But if you lack the accessibility to medications to treatment to a mental health provider, you know, you can go into these real like, oh, I’m just gonna I’m gonna take it on my own terms. I’m gonna self-medicate if you will through bed rotting and then you song against the point where you’re actually doing yourself. No favors. You’re actually being a detriment to yourself. So definitely an interesting trend for sure in terms of you know, how people are talking about it online and you know, again people kind of making fun of it, but then also people saying hey I’ve been doing this and it’s not making my life any.

In a recent Bank of America report to clients, analysts laid out the pros and cons of more people asking their doctors for GLP-1 agonists, a class of weight-loss drugs we have covered significantly on this show.

Many have speculated about how the widespread emergence and use of these weight-loss drugs could impact traditional food and beverage producers and retailers as well as fast food chains.

Now the gambling industry is taking notice.

One analyst highlighted the link between obesity and problem wagering, noting that casino customers who display problematic betting patterns account for between 10% to 30% of industry revenue.

This caught the attention of Casino.com, which reported that the analyst added that the implication is the usage of GLP-1 could create a “0-4% revenue headwind” for U.S. commercial gaming with higher risk for slot machines or regional gaming.

The site also said that while two of the largest operators on the Las Vegas Strip, MGM and Caesars, could benefit as weight loss encourages more people to travel, regional operators could be pinched by a move toward healthier living.

I have my own thoughts on gambling and betting and all of that and that’s obviously not where we’re gonna take the conversation but interesting Mark that there is this kind of angle where it’s saying like, hey, we’ve had this widespread discussion about the impact of weight loss drugs, but here’s how it could affect this one industry in particular. That’s maybe outside of

the the mainstream Focus, right? It’s also interesting Jack that I think the jury is still out even in the gaming industry as you pointed out there could be an offset in terms of more people traveling, you know to to places and destinations.

Of Las Vegas, but in addition to its effects on the gaming and tourism that so called ozemic effect is hitting a wide breadth of industries from food and beverage makers to manufacturers of glucose monitors Reuters had an interesting report on this I think was based on investor calls and some of the more interesting ones I noted were food company ConAgra saying they might consider changing portion sizes if the rising use of weight loss drugs leads to a shift in consumption patterns for senius and DaVita are so far monitoring if the effects on their dialysis products and J&J’s third quarter sales for devices used and abdomin surgeries was hit by slow down in demand for weight loss and other procedures then again Abbott Labs, which makes glucose monitoring products that the market was overestimated the impact to its sales from growing popularity these drugs and J&J CFO and so far as to say the use of the drugs could eventually make patients eligible for procedures like hip and knee Replacements or other

orthopedic surgery, so it’s seems to be cutting both ways.

It’s interesting you bring up that point about the Abbot that was on their investor call last week after they released their earnings. I know that made quite a few ripples in the history with people saying like, huh Abbott’s taking that stance on it given where their business is. I wonder how they’re reading the tea leaves Lesh. I’m curious. I mean we were just in Vegas. So the idea that we’re talking about gambling is kind of on the nose, but just your thoughts on kind of the the effect we could be seeing on weight loss drugs maybe outside of the main category that we’ve been focusing on.

Yeah. I mean, I think it’s really interesting that they’ve been starting to see Elise initial evidence that you know, these drugs might potentially also be able to curb other forms of addiction drug alcohol and tobacco use disorders. For example, the science isn’t quite there yet. There was a 2022 study published in the British Journal of pharmacology that noted that initial studies and rodents and non-human primates have demonstrated a reduction in intake of alcohol and drugs of abuse and clinical trials have been

Created to investigate whether those preclinical findings can be translated to patients. So we’re still ways a way to from knowing with certainty that they could work for other issues as they we know they do work for weight loss and curbing appetite. But I do think this it’s definitely fascinating to see how that rolls out and how that impact will be felt in those areas.

Yeah. I think it’s something that you kind of touch on there where there’s so much other research that shows promise and tackling other aspects of the brain and human behavioral certainly be interesting to see how that all shakes out as we get the results in the future. But as for right now, I guess, you know gaming industry beware Lillian Novo are coming for you.

Thanks for joining us on this week’s episode of the MM+M Podcast. Be sure to listen to next week’s episode when we’ll be joined by Justin Steinman, chief marketing officer at Definitive Healthcare.