There are reasons to select a specific drug to use in a
There are reasons to select a specific drug to use in a trial with your own, but it doesn't necessarily mean said drug would be limited to use with only the specific drug once approved. There are drug classes that are considered first line, and then there are favored drugs within that class that rise to the top for different reasons, including insurance formularies that might pick and choose to make one easier and cheaper to get over the rest. So with checkpoint inhibitors, we'd likely end up with an indication that said something like "in combination with a PD-1 or PD-L1 inhibitor for MSS colorectal cancer" and all would be fair game to be prescribed by the treating oncologist. But let's say a trial was run where they drilled down and saw that while overall it was a success, the subgroup of patients who were on Keytruda did amazing but the group on Roche's drug didn't. You could then argue that a more specific indication could come as a result of the phase 3 being narrowed further to only include the drug they had success with, Keytruda. But overall, class effect is often assumed even if the indication gets written to a specific drug in the class a doctor might very easily choose to use a different drug from the class. Could be that the patient had Keytruda already and suffered a side effect they didn't like, but with Roche's drug they don't have the same problem. Or drug to drug interactions limit one versus another. Who knows. But there's little reason to believe we'll be pigeonholed.
That being said, if we prove LL works and it's a specific checkpoint that was used along the way, that drug would likely be used more often than the rest of the class by doctors and insurance companies. The caveat to that is if the consensus is that Keytruda is the best and then we use a lesser known drug, the idea of class effect might cause more doctors to choose Keytruda in place of the other drug because they believe it's the best of the class. Leronlimab (and the patient) wins either way.
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