RE:RE:Investigators, very helpful - lots to digestI started PRRT (Lu177-Dotatate) in July 2017, so I made more than six years on it while I never met the criteria for partial response (30% overall tumor shrinkage). Some of my tumors shrinked by more than 30%, but overall, but it was never 305 overall, so it never qualified as a partial response per RECIST. And Lutathera, was approved based on PFS in a phase III.
All that to say that stable disease while maintaining a decent quality of life is a very meaningful outcome, especially if it can be for a long time. In my case, doctors told me that the best outcome for me would be to live up to 15 years with it, starting in 2017, and having it treated like a chronic disease, so impossible to cure, but that can be slowed down over a long period of time. If TH1902 can deliver a good PFS number, it will be approved.
SPCEO1 wrote: The stable disease element of today's presentation really stuck out to me. I have assumed that was nice but not good enough for approval or to move the trial along, thus the pause. After today, I suspect it might be enough (and should be enough if you ask me) to get the drug approved as those were some really impressive results. I imagine if I had cancer I would be happy to take a drug that stabilized the cancer as long as there were no better treatments available.
It was overall an encouraging call but we will need proof of concept and/or a partnership to move the stock in any meaningful fashion.
Wino115 wrote: Having the KOLs was highly beneficial --realistic, reminder of clinical benefit equation, placing actual results into the context of their practices and what they see. Fascinating that someone who has discontinued is still seeing stability --that is worth trying to understand and I can only think it has something to do with disrupting the CSC and VM part. There's a lot to unpack, but I don't think these KOLs thing the program is dead, it stumbled and they think there are answers given they saw PRs and lots of SDs. They seemed to also point that SDs of 3-6 months is a winner for these last stage patients where there appears to be no real solutions on offer from the ADC side.
Qwerty's right that the main issue for them is the neuropathy. They seemed to say that, while more data would be needed, they don't think it's because of the sort1 expression around the nervous system, but the accumulated amount of "free docetaxol" that is at issue. Yet they were very clear they think dosing and timing has worked in the past at "controling" this (Winer said it). I don't know enough, but are they saying the one huge dose may leave more "free" taxol buzzing around doing bad things and that if they do smaller doses it always be a lower dose, not accumulate in the body as much, allow the receptors to get occupied and then recycled to cell surface, and they hope that will lower it to a tolerable level? Clearly will be there, they just want to get it tolerable for what they see as the novel benefit -- allowing people to take this for a long, long time. Marsolais pointed to at least one patient where the neuropathy was likely because the surface area vs weight dosing gave the patient that 420+ type dose which caused the known problems they saw previously.
All in -- loads of information to digest, actually very good questions from the analysts and attendees, candid responses from KOLs. Need to rewatch and get the finer points. Look forward to other's views here, but I can see why they think this is a "way forward", but as the KOLs kept repeating, it must show that clinical benefit --the simple equation of confirmed benefits outweighing adverse events. I think they also dispelled the need to do Sort1 testing pre-treatment and pointed out no ADC did that, they all just picked cancers known to have a lot of the target. They did seem to place the overexpression of Sort1 as being high (Dr Winer) and it seemed he meant more prevalent than what he's seen in other targeted therapies.