Astra extends its big pivotal TIGIT plan
Despite the numerous setbacks that TIGIT-targeting assets have faced in the past few years, AstraZeneca is continuing to bet on rilvegostomig. According to a new listing on clinicaltrials.gov, the company is preparing to launch another phase 3 study. Artemide-Biliary-02, to start in December, will evaluate the anti-TIGIT x PD-1 bispecific antibody plus chemo versus the current standard of care, Imfinzi plus chemo, in first-line biliary tract cancer. Interestingly, while the trial does not restrict enrolment to PD-(L)1-positive patients, the primary endpoint, overall survival, will be assessed only in that subgroup, with overall survival in the intent-to-treat population serving as a secondary endpoint. This will mark rilvegostomig’s 11th phase 3 trial, with the programme set to enrol more than 9,000 patients, almost double the roughly 5,000 patients Roche treated before discontinuing its anti-TIGIT MAb tiragolumab. This is an ambitious effort for a target that has yet to deliver convincing pivotal data. Still, AstraZeneca believes that its Fc-reduced approach could offer a meaningful advantage. Arcus, the other contender still standing, is pursuing a similar, Fc-silent, approach with the Gilead-partnered domvanalimab. However, its programme is more limited, with only three phase 3 trials under way.
Rilvegostomig phase 3 trials
| Trial | Setting | Regimen | Number of patients | Timing |
|---|---|---|---|---|
| Artemide-Biliary01 | Adjuvant biliary tract cancer | Rilvegostomig + chemo, vs chemo | 750 | Started Dec 2023; primary completion Jan 2029 |
| Tropion-Lung10 | 1st-line non-squam NSCLC (PD-L1 ≥50%) | Rilvegostomig +/- Datroway, vs Keytruda | 675 | Started Apr 2024; primary completion Apr 2028 |
| Destiny-BTC01 | 1st-line HER2+ve biliary tract cancer | Enhertu +/- rilvegostomig, vs chemo | 620 | Started Aug 2024; primary completion Jun 2028 |
| Tropion-Lung12 | Adjuvant ctDNA+ve stage I adenocarcinoma NSCLC | Rilvegostomig +/- Datroway, vs chemo | 660 | Started Oct 2024; primary completion May 2033 |
| Artemide-Lung02 | 1st-line squam NSCLC (PD-L1 ≥1%) | Rilvegostomig + chemo, vs Keytruda + chemo | 880 | Started Nov 2024; primary completion Feb 2029 |
| Artemide-Lung03 | 1st-line non-squam NSCLC (PD-L1 ≥1%) | Rilvegostomig + chemo, vs Keytruda + chemo | 878 | Started Nov 2024; primary completion May 2029 |
| Artemide-Gastric01 | 1st-line HER2+ve gastric cancer (PD-L1 ≥1%) | Rilvegostomig + Enhertu + chemo, vs Keytruda + Herceptin + chemo | 840 | Started Mar 2025; primary completion Apr 2029 |
| Destiny-Endometrial01 | 1st-line HER2+ve pMMR endometrial cancer | Enhertu + rilvegostomig or Keytruda, vs Keytruda + chemo | 600 | Started Mar 2025; primary completion Jan 2029 |
| Artemide-Lung04 | 1st-line NSCLC (PD-L1-high) | Rilvegostomig, vs Keytruda | 830 | Started Apr 2025; primary completion Jan 2030 |
| Artemide-HCC01 | 1st-line hepatocellular carcinoma | Rilvegostomig + Avastin +/- Imjudo, vs Avastin + Tecentriq | 1,220 | Started May 2025; primary completion Mar 2029 |
| Artemide-Biliary02 | 1st-line biliary tract cancer | Rilvegostomig + chemo, vs Imfinzi + chemo | 1,100 | To start Dec 2025; primary completion Jul 2029 |
Source: OncologyPipeline.
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