918 days left
Lots of interesting things happening!
ICPT might be more commercially viable than the DOA pronouncement given. We’ll see! Will not be simple, for sure. But I wouldn’t figure in zero revenue, either.
When I spoke on the RDEB complex of KRYS ABEO and FCSC, I wanted to make a few things clear. 1) I have NEVER recommended any of these stocks and do not know them well at all. After two hours of research my (very) preliminary conclusion is buying the entire complex will probably achieve a positive return. FCSC is a strange company with a very bad capital structure and a partner I don’t trust (XON). If they dump XON it would be a more valuable company. KRYS only has reported two patients. ABEO is also a company in flux with tons of projects. It is very hard to tell which company will do well, FCSC may not even survive, after all. I don’t have any positions but I’m watching eagerly as this is really rough disease and the global opportunity is in the billions (value, if not revenue).
ACET filed and shocked with a sale of the chemical business for quite the price.
Papers I’ve Read
Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. von Minckwitz et al. NEJM 2019.
Roche hits it out of the park with Kadcyla in this trial. It’s still a bit unclear if you’d rather take Perjeta, Kadcyla or neratinib at this point, but it almost all benefits Roche’s attempt to transition away from Herceptin in any event. HR=0.50 for invasive disease or death is a bit shocking in such (relatively) well-controlled patients.
Residual Disease after Neoadjuvant Therapy – Developing Drugs for High-Risk Early Breast Cancer. Prowell, Beaver & Pazdur. NEJM 2019.
This whiny editorial bemoans the lack of a pathway to shortcut large phase 3s in relatively indolent early-stage cancers. One cannot have it both ways. A robust surrogate requires robust validation, in which case, you’ve so substantially improved the disease from hard outcomes, one cannot possibly be upset about requiring such large trials. At that point, you’re treating a different illness, akin to primary prevention vs. secondary prevention in CVD. If you don’t have a robust surrogate endpoint, then why risk the accelerated approval for a disease that is admittedly indolent and within striking distance for a surrogate?
In HRPC, PSA might become a viable endpoint due to the same circumstances. I just view this narrative as solutionless and fruitless. Pazdur’s suggestion of enriching for sick patients also misses the point that trials should reflect intended population and you’d be making serious errors in generalizing to broad populations if you did as suggested.
When I don’t post for some time, it is because I am very busy. What have I been doing? Mostly reading back issues of PLoS One, Nature Communications, Hum Mol Genet and other favorites. If you don’t hear from me, you should actually be HAPPY, as I am occupied and entertained. Daily posts would be a bad sign!
Good luck to Bernie Sanders, my old buddy! YOU CAN STILL WIN!