I have had 40 years experience at a tertiary teaching hospital. Early on I was long INCY. I am now short for the following reasons:
1. In my experience and that of my colleagues JAKAFI can be helpful in a selected subgroup of MF patients(including prolongation of survival), but for the bulk of MF patients it is no great shakes, particularly when taking the great expense of the medicine into account.
2. It is widely quoted that the polycythemia vera study is in patients who became "refractory" to the standard therapy for PV in patients over 60 which is hydroxyurea(HU). However, the information I find is that Jakafi is simply being compared to HU in patients who have not been recently treated with phlebotomy or HU. I agree that Jakafi will show reduction of nite sweats, itching, bone pain, etc vs HU in the relatively small group of PV patients who have significant symptoms, but very few hematologists will prescribe such an expensive drug except for the most extreme cases, particularly since there are inexpensive alternatives such as low dose steroid, ibuprofen, benadryl, etc.. Hence, I see the PV market as MUCH smaller then advertised.
3. Sanofi, Gilead and Geron have competing JAK-2 inhibiors in advanced development for MF; competition is not that far away. The Gilead drug in particular looks good with much less tendency to cause low platelets.
4.The recent 35% jump in stock price is totally out of proportion to the long term significance of a phase1 study involving a small number of patients. Bulls are acting like this is a slam dunk to help all solid cancers. The market cap is now up to 5.5 billion!
Happy to hear responses to my arguments.
Yes, if you follow his posts you could deduce that this guy really is a hematologist at Mass General, He probably has some emeritus teaching position and, I have decided from reading past posts, is an expatriate Brit. One of the amusing features of these boards is how quickly any dissenting opinions are discounted, Everyone is looking for opinions which support their own opinion. I am long INCY, but part of wisdom is recognizing when someone knows more about a subject than you do.
GERON??! Geron? I wouldn't let them take care of a Chia-pet. Those idiots took 7 years to advance imtelstat to p2. Fleeced shareholders, lined their pockets and then jettisoned an ill-conceived stem-cell program. What a bunch of dolts. Incyte should WISH their competition was GERN.
Well yeah, the obvious--other JAK inhibitors appropriate for MF aren't close at all and that was a p2 study, a mistake natural enough in a less frantic specialty than oncology. In oncology, p2-s are sometimes even accepted for registration (I wouldn't count on it, though)
I agree that managements present 30% of prevalence estimate of market size for PV seems exaggerated, but so, I think, do all analysts. Price predictions are mostly based on about 10% of prevalence. A hemato can tell us how frequently phlebotomy can be done before patients resist, and whether the proportion of malformed blood cells puts a firmer limit on that treatment than compliance does. By accounts I have seen, HU is a lousy drug (frequent minor side effects, noticeable rate of major ones, improves charts much more than patients' self-reported health) with low cost as its greatest recommendation. The fact that HU is used at all suggests that the symptomatic treatments listed are perceived as inadequate.
We outside the medical profession should keep in mind the fact that in the trenches, the typical case of MF is MUCH milder than what we mostly think of. There is often an indolent phase that can last for years, and was never traditionally named aloud (why tell a patient that he has a fatal disease for which there is no treatment, at least while it's indolent). That is strong motivation behind the "early treatment extends life the most" research push.
Yeah, if the company wants to capture the largest market, the drug price will have to come down. There are consultants who figure out optima for those things. It never COSTS money to add another indication (although it may not make as much as simple counting suggests).
Look at my thought question topic. Last possibility. Yeah, lots of us fully expect Ruxo to be thrown at all toxic cancers SOON, and at least sometimes it'll stick.
"Life is short, and the art long; opportunity fleeting and experiment perilous. Decision is difficult."