Just musing here about this ever increasingly crowded CRPC space, and sequencing of therapies.
As an oncologist I think the combination of these trials is quite intriguing, assuming they both end up being positive. Obviously I personally think that is likely which is why I am invested as a "long."
Imagine a patient with CRPC sitting in front of you, with family, and trying to decide upon numerous options. I have this encounter weekly. Imagine that the FDA label states, like Zytiga did initially, "okay for use post failure or intolerance of X."
I can recommend RA223 which I fear will cause bone marrow suppression an limit options for him in the future with Taxotere, Jevtana or any other new agent with that as a potential AE. I'll likely wait on using RA223 becasue of that, the ordeal of administering, and the fact their data doean't blow one out of the water. Patients are turned off by Provenge and its $93K pricetag, most of my patients refuse it.
Now...I have Cabo...which not only shoys PFS or OS benefit (assuming here again), AND has been shown to decrease pain, and has crazy benefit in bone disease (the major target area of prostate ca).
Which do think I am going to always puish for early on in the treatment sequence? (Nothing to do with investments here, speaking about any oncologist). If Cabo and Zytiga combo shows great activity and tolerability you just got the new first-line treatment in US and Europe for CRPC too.
Just some thoughts over coffee at my office desk...sorry for typos.
The current vague description of a breakthrough therapy is "something that can "treat a serious or life-threatening disease or condition and for which preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over existing therapies." If the Phase 1 combination of Cabo and Zytiga is as effective as the in vitro proliferation studies have demonstrated and presents no incremental AE implications, is it possible EXEL requests a breakthrough designation? The Dana Farber sponsored Phase 1 times out in April of 2014. Is it possible EXEL could be filing for a breakthrough designation with Cabo/ Zytiga for early line treatment of CRPC, before Comet 1 reads out?
if cabo and abi cocktail comes in as routine pre chemo treatment, we will cover 30,000 new patients per year. Most of them will have at least tow to three years' staying on Cabo. Can you see the mCRPC market alone for Cabo ?