The physician-assisted suicide law went into effect last year.
Photograph by Richard Lautens — Toronto Star via Getty Images
By Sy Mukherjee
March 14, 2016

Bristol-Myers Squibb’s (bmy) cancer treatment Opdivo has been lapping its rivals in the red-hot immunotherapy space, the Wall Street Journal reports. The reason? A distinct marketing advantage which doesn’t force doctors to order time-consuming diagnostic tests before prescribing the drug.

Bristol-Myers’ main competitor in this field is Merck (mrk), whose immuno-oncology drug Keytruda was approved more than three months before the BMS therapy in 2014.

Since then, the companies have been scrambling to rack up indications for the rival drugs, which are both approved for treating melanoma and lung cancer. But Opdivo was the clear winner in 2015 sales, raking in $942 million globally to Keytruda’s $566 million.

One setback for these therapies which use the body’s immune system to fight cancers is that they are, at times, more effective in certain patient pools than others.

Merck took a precision approach and targeted its medication towards patients whose tumors express the PD-L1 protein, enrolling these individuals in clinical trials. The FDA subsequently decided to approve the therapy contingent on physicians administering a diagnostic checking for the protein since Keytruda is more likely to work for them.

Bristol-Myers decided to enroll a wider swath of patients in trials even though Opdivo is also an anti-PD-L1 drug. That seems to have paid off—the FDA approved the medication without requiring a diagnostic and the company claims that 60% of new, treatment-eligible lung cancer patients are prescribed Opdivo.

The tradeoff here is cost versus time. Merck says it’s working with doctors to acclimate them to the diagnostic, which could prevent wasteful spending on a costly drug which may not benefit all patients.

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