PatBoone
1 year ago
Yes, Iβve read that book. And having worked in the Bay Area biotech industry for over 20 years, you canβt help but know many of the players. Duggan got into Pharmacyclic by dumb luck, driven by the death of his son from glioblastoma. Duggan was attracted to Pharmacyclic by the failed drug motexafin gadolinium, but he was smart enough (viciously) to pivot to supporting ibrutinib. Miller lost credibility with Wall Street and control of the company due to his decade long fixation on that failed drug, culminating with his writing of that nasty opinion piece of the FDA for The Wall Street Journal. Persistence can be a double-edged sword sometimes. Miller is academically brilliant, but he was too stubborn to adapt to changing conditions. So he missed out on the windfall for both rituximab and ibrutinib. Roche ate his lunch on the former, Duggan on the latter. Letβs hope he has learned his lessons and adapt to reap the windfall of CPI-818. Two strikes, and this point in his career, heβs at bat with full count. Letβs see if he can get a hit, or if someone needs to step in to make the first ITKi successful.
PatBoone
2 years ago
I don't know about accumulation. I've been buying this stock since 2018 when they announced the only ITKi in the clinic, CPI-818. I won't pretend to be able to predict stock price movement. Personally I assigned zero value to their A2A inhibitor or anti-CD73; but that's just me. I'm a molecule guy; I follow the molecule, and CPI-818 is shaping up to be one hell of a molecule, after almost 5 years of waiting and meandering in Phase 1a, finding the dose and understanding its mechanism of action. I'm also heartened that it appears that Richard has learned his lesson from his debacle at Pharmacyclics, where his stubbornness and refusal to let go of the failed motexafin gadolinium led him to lose control of the company and the first BtKi that was the mega blockbuster ibrutinib; it appears that he's now prioritizing CPI-818 over everything; about time.
IF it's true what Richard said regarding CPI-818 specificity regarding its ability to differentiate between ITK and RLK (the difference being only amino acid between these two related kinases), then this molecule will have a huge potential in autoimmune diseases that originate from Th2 dysfunction. That alone is a mega blockbuster, $20bil+.
IF the skewing of lymphocytes toward Th1 (the killer cells that eliminate cancer cells and viral infection) is the mechanism of action of CPI-818, and we see similar objective response rate in solid tumors for patients with ALC > 900 or who have normal ALC of 100-4000, then this molecule will be used with every approved drugs in solid tumors. That alone is a mega blockbuster. Potential value there is unprecedented, off the chart. Corvus is planning to start a Phase 1 study with CPI-818 (I'm assuming at the optimal dose of 200mg twice daily) as early as this year, so we won't get that glimpse of initial clinical data until late next year at the earliest, if not mid 2025.
PatBoone
2 years ago
Latest update from Jefferies Healthcare Conference
Alright, if you've been following, what has changed from April corporate update to yesterday update at Jefferies?
Before I post the latest update, for context, here are the registration studies for the two currently approved agents for relapse/refractory T-cell lymphoma (R/R TCL) and some common terminology: ORR or objective response rate means partial response + complete response (PR+CR); progression free survival (PFS); absolute lymphocyte count (ALC) per microliter. Remember that in this aggressive disease, many patients don't even make it to the first evaluation period (for CPI-181, that is 3-month of treatment) since they have about 3 prior treatments before taking CPI-818. So, it is critical to illustrate the activity of CPI-818 to include less sick patients, where their ALC is still normal (>1000).
-pralatrexate (in 111 patients): ORR of 29% (with CR of 11%), PFS of 3.5 months
-belinostat (in 129 patients): ORR of 25.6% (with CR of 10.6%), PFS of 8.4 months
April 2023, Corvus reported for CPI-818 (13 evaluable patients, with n = 8 patients meeting Corvus biomarker criterion of ALC>900, data cutoff as of February 20223): ORR of 4/8 or 50% (with 3/8 or 37.5% CR), PFS of 28.1 months; for patients not meeting their biomarker criterion or ALC<900): ORR of 0/5 or 0% (with 0/5 or 0% CR); PFS of 2.1 months
June 7, 2023 Jefferies conference, Corvus reported for CPI-818 (19 evaluable patients, with n = 13 patients meeting Corvus biomarker criterion of ALC>900, data cutoff as of May 1,2023): ORR of 6/13 or 46.2% (with 3/13 or 23% CR), PFS of 19.9 months; for patients not meeting their biomarker criterion or ALC<900): ORR of 0/6 or 0% (with 0/6 or 0% CR); PFS of 2.1 months
The data that will be presented next week June 13th at the iCML in Lugano, Switzerland won't be much different from the June 7, 2023 presentation; maybe a couple more evaluable patients will be included and some of the stable disease patients could convert into PR or PR into CR, but that's it. It won't materially change the ORR and PFS from yesterday's presentation.
Richard Miller (Corvus' CEO) also further clarified on their planned registrational phase 3 study for CPI-818 in R/R TCL (Richard expects to meet and conclude meeting with the FDA before August 2023) that will also enroll less sick patients (with one and three treatments; to take advantage of CPI-818 mechanism of action of skewing toward Th1). The trial will be 1 to 1 randomized study with 75 patients in CPI-818 and 75 patients with the physician's choice of either pralatrexate, belinostat or gemcitabine (which is not an approved drug, but it's an old drug and oncologists used it more than pralatrexate plus belinostat combined), with PFS as the primary endpoint; with PFS in the comparator arm (pralatrexate, belinostat or gemcitabine) expecting to be about 3 months, the trial will be completed and NDA filed in 2.5 years from end of this year.
flatlander_60048
2 years ago
Crescendo and Biontech appear to be targeting the development of novel, targeted T cell enhancing therapeutics for treatment of cancer. BionTech looks to be exploring several approaches " mRNA-based therapies, innovative chimeric antigen receptor T cells, bi-specific checkpoint immuno-modulators, targeted cancer antibodies and small molecules".. They are in early clinical trial for prostate cancer..
I wonder to what extent CRVS has crossed BionTech's radar. Looking at the links it looks like Biontech has collaborations with Genmab, so monoclonal antibody approaches to T cell modulation have to be high on their list.
FL
https://finance.yahoo.com/news/angle-plc-announces-pharma-services-060000021.html
https://investors.biontech.de/news-releases/news-release-details/biontech-and-crescendo-biologics-announce-global-collaboration
flatlander_60048
2 years ago
Good conversation you two are having. Most of it well above my pay grade. However, without the same grasp of details, I was also arriving at a similar big picture scenario. Continue IB with patients with ACL>900 and update results in Lugano in June and then hopefully the data lines up for the Phase 3 registration trial mtg with FDA with fast track Orphan drug status.
CAR-T Gene therapy was mentioned in the prior posts as a possible competing treatment for PTCL. I believe Miller really took a few shots at this line of treatment in one of his previous presentations. If CAR-T does show promise and make it to market, I doubt that this treatment would be priced less than $500,000.
Given the difficulties treating PTCL and the relative rare occurrence rate. I agree w the 8K annual estimate in the US based on the following:
https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21589
Given this limited US market, I can see the FDA-Orphan drug pathway as reasonable shot. I have no idea how it would be priced. $150K is certainly consistent w other life saving treatments. If trials are successful, I would also assume that the emphasis would shift to front line treatment or combo in order to reach patients before their immune response is degraded by Chemo.
Thanks for the discussion.
FL
PatBoone
2 years ago
Top line data for the 7 patients with ALC > 900 should be available and presented at the ICML conference mid June. Until then, there will be lots of volatility in CRVS. Hold on to your panty hoses. And shortly thereafter they should have that meeting with the FDA to discuss the registrational randomized Phase 3 study; if the data confirm the blocking of Th2/Th17 and skewing toward Th1 hypothesis, which requires patients to have ALC > 900 to be responsive and beneficial on treatment with CPI-818, then the share price should appreciate to the $10βs by end of the year for them to raise much needed fund to complete the registrational Phase 3 study. Partnership with a big partner could also work, if the financials make sense. With the kind of data in refractory PTCL that would be competitive with CHOP in frontline, hedge funds will jump into CRVS. That should be fun for all CRVS longs. Any potential application in autoimmune like atopic dermatitis can be pursued once CRVS has a far better financial health.
PatBoone
2 years ago
If what Richard is saying is verified with the 7 remaining patients currently on study, who were selected based on the additional criterion of their ALC having to be above 900, if the response rate in patients with ALC > 900 is about 80%, and the CRs rate is 40%, which also indicated that SD/PR patients have a chance of converting into CRs on treatment for refractory PTCL, then yeah, CPI-818 might very well be competitive with CHOP in the frontline setting as well. CHOP is brutal on your immune system. If you have a normal ALC level (around 4000), I would opt to take CPI-818 first, especially if youβre positive for Th2/GATA3, which has poor prognosis for survival, and the hypothesized mechanism of action of CPI-818 seems to be blocking Th2 and Th17 and skewing toward Th1. After refractory PTCL, maybe the fastest path to frontline PTCL is through subset of patients with positive Th2/GATA3. And then position CPI-818 as second line behind CHOP for patients who progress or become lymphopenic (ALC level dropping below 1000). And then do the CPI-818/CHOP combo for all front line study.
kenyonn2000
2 years ago
I think the frontline setting is a lot tougher. From what I can tell, CHOP and BV-CHP approaches have 80%+ response rates and 40%+ complete remission rates lasting for years, and even some cures, at least in certain subtypes of PTCL. Then there's CAR-T therapies in trials right now--while more risky in terms of side effects, they have very high response rates. All this means I think 818 would have to have eye-popping responses as a mono therapy in a frontline setting.
I wonder if 818 might carve out a market in frontline combo therapy. If it's very well tolerated and it's mechanism of action is in fact doing what Corvus thinks it is, it might make existing treatments even better. CHOP-818?