ernie, what's your guess regarding market potential of Cabo in 2nd/3rd line RCC in the US? What peak potential is there?
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great analysis duck -as usual. But it's more than just a chess game between two players - management and debt holders - which makes it impossible to predict outcome.
EXEL management understands this and is one of the reasons they are so defensive in their CCs. That along with the huge amounts of shares they keep giving themselves.
"Nivolumab hasn't preempted Cabo by so much time that all RCC practitioners are comfortable with managing IO related AEs."
Nivo was approved for 2nd line RCC last November. What would you think of an oncologist who in 2016 prescribed Everolimus for Sunitinib refractory RCC instead of Nivo? I'm sure there were some, but they are definitely not the guys I would want to see. Oncologists have to come to grips with incorporating Nivo into their practice. I'm repeating myself, but it should not be a choice between Nivo and Cabo. The real choice should be Nivo first or Cabo first. Not every patient will live long enough to get both, but hopefully that is what the treating oncologist is planning.
You seem to have the best read on this animal, let me know the moment you get back in
why converse. I bought more at 4.46 thank you. your pea sized brain is focused on very short term mkt movements. nothing but positive signals moving forward with exel. good luck with shorting. you want to scalp here and there probably could make some money. ...keep shorting. just make sure you come back to the board when this is trading 6+ and admit that you were an idiot. i'll do the same if it goes to $3.
I agree with all you mentioned. I would be surprised, however, if the number of shorts goes up anytime soon, including now after the run up with the RCC approval. I think most of the heavy volume is computer flash trading on up and down moves, profit taking, and day trading. That said, if I'm wrong, it won't be the first time.
"Duck, I think the next report will show that rather than a reduction is short position, there was a significant increase"
Interestingly the report was due out yesterday after 4 pm eastern and as of yet is still not published. I suspect the period up to 4/15 will show a continued trend of covering, but agree the next report that includes this week will show a reversal and increase in short interest.
"Did anyone really expect the FDA to not approve Cabo in RCC?"
No, the bigger question was the OS data. Cabo's stellar results were obvious in the solid deal struck with Ipsen, missed by those who questioned the partner.
The big question when it comes to a potential buyout besides total valuation is obviously the converts. Since with conversion in a buyout a significant number of new shares are created, wouldn't it seem more beneficial to both EXEL and an acquirer to resolve or retire that debt beforehand? Isn't this the PPS battle and why the converts could be using every tactic to keep it down. They want to be part of the negotiation. If EXEL through natural valuation exceeds the exercise price of $6.90 by August, couldn't they purchase for cash the shares at that prevailing price? Wouldn't that potentially mean hundreds of millions in savings to EXEL in a buyout? Is what we are witnessing right now more of a chess game than a valuation based upon the prospects of Cabozantinib? As we got closer to August, I expect the moves will become more and more obvious. The fact that we didn't even approach the post METEOR top line PPS of $6.81 after FDA approval and the stellar OS data release could be a huge tell that those in the game are playing it with much more intensity as August approaches.
Sentiment: Strong Buy
"OK. So here we are...And, we can agree upon a few things - those being that toxic financing has a stranglehold on shareholder value, and perhaps also that - given the competitive strength of METEOR results - EXEL fundamentals are more derisked than ever before. Anyone disagree with these statements?"
I'll take issue with the death spiral nature of the converts. Death spiral financing refers to an arrangement in which a company borrows and promises to repay with shares in lieu of stock. In a few instances this has set up situations in which questionable lenders have an incentive to drive the share price of a company so low, that they literally gain ownership of a viable enterprise through manipulation. To work, repayment has to be in shares and the company so illiquid that strategic shorting has a large effect on the underlying share price. EXEL has the option of repaying the converts at par (100 cents on the dollar) in cash on maturity. That takes the death spiral part out of the equation. The same is true for the Deerfield note.
If between now and 2019 EXEL is unable to raise the cash or borrow on less drastic terms to pay off the converts, then it is a failed enterprise and from a stockholder's perspective a failure is a failure. The converts provide an umbrella for the noteholders to hold a protected (hedged) short position, collect a coupon, and enjoy a preferred position in the event of a bankruptcy. The short hedge is a musket, not a sixshooter. Once you short up to your full equity position represented by the convert, any additional short is no longer hedged and fully exposed to market risk. The only way to continue holding down share price is to continually keep adding to the size of the overall short position. The short position has been trending down, although my guess is we will see a spike related to the post approval rally.
I'll also add Pal's quote:
“This is an unfair comparison, because adverse events were all-cause in METEOR and only treatment-related in CheckMate 025. If you just looked at 19% vs 68%, it would not be an accurate picture. If you look at the package insert for nivolumab, the rate of all-cause adverse events is 56%, which begins to approach the 68% reported with cabozantinib. The difference has shrunk,” he said.
A better comparison for my second would be physicians continuing to BRAF/MEK inhibitors after Nivo/Ipi were approved for wt BRAF patients. You're even seeing an uptick in Vemurafenib/Cobi usage despite this superior option from an efficacy perspective and a modest downtick in Dabrafenib/Trametinib usage (rather than a decimation). I suspect the familiar profile or marketing relations is what drives this and this is likely an advantage of Cabo.
The AE advantage of nivolumab is definite, but the size of its AE benefit is exaggerated due to trial reporting protocol and its qualitative profile is notably different from TKIs.
As Pal noted: "Negative observations for nivolumab include primary progressive disease in 38% of second-line recipients compared to about 15% for cabozantinib. Anecdotally, investigators have said that nivolumab is less toxic than cabozantinib, but if you compare the tables of all-cause adverse events from trials side-by-side, the differences in toxicity become attenuated. In CheckMate 025, the rates of grade 3 and 4 adverse events were 37% with everolimus vs 19% with nivolumab. In METEOR, the rates of grade 3 and 4 adverse events were 58% with everolimus vs 68% with cabozantinib."
Nivolumab hasn't preempted Cabo by so much time that all RCC practitioners are comfortable with managing IO related AEs. You'll note that even in melanoma, there were holdouts using Vemurafenib long after Dabrafenib and Trametinib's advantages were established. I think it will take some time for RCC oncologists to give up their now 8 or 9 years of experience w/ TKIs
Cool, I guess J & J told dad not to be a d-bag on the MB's.
Hate to go beyond a finger wagging like this, but people like you are a drag on a boards karma, harmony & mental well-being.
On this board we want to channel Lakshmi, the goddess of good fortune, wealth, and well-being.
You're bringing Shiva & Kali, the destructive forces.
Channel the good energy Harry and you'll be rewarded, don't spread the Sacred animal manure, huh?
Sentiment: Strong Buy
That's a fair point, there's substantial negotiations behind the scenes as well and it maybe unclear what a company ultimately pays for a dose of Nivolumab. That said, Cabo is still much cheaper for a month of therapy. You also have to count the auxiliary cost of a nurse who needs to monitor a nivolumab infusion and the time / space needed at the clinic. Cabo will require additional medications to manage AEs and will potentially result in some hospitalized patients, but these are likely generics and end cost will end up less than Nivolumab the mandatory costs for administering nivolumab.
I'm not sure where Dave and Patriot are, but I can tell you that loudtalker is very, very close to you right now.
"....Celestial trial.", If you have to predict timing again, will it be 2017 or 2018?"
I have no idea as there is no information available on which to base a guess. The only thing I can say is that their reluctance to provide any update leads me to believe that they view their own progress in this regard negatively.
"If I were the insurance company, I'd wince at the likely 1/3 of a vial wasted of Nivolumab."
The insurance companies pay for a "dose." Currently that dose includes a excess amount. BMS could package differently to remove the excess, but that will not change what they charge. It's like the unpopped kernels in the bottom of your popcorn box at the theatre. It's a waste, but not very relevant to the transaction.
"I'd dispense Cometriq capsules (not the higher priced Cabometyx tablets) instead which have a much better dosing granularity."
That's what I would do as a patient or provider, but we'll see if the reimbursement agencies adopt it as a published policy. It may be subtly encouraged, but it's something we will have to wait and see on. I think MTC will eventually move to a 60mg dose and that would largely "fix" the inequity issue as it stands.