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jacosa 52 posts  |  Last Activity: Jul 11, 2016 12:47 PM Member since: Jan 24, 2000
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  • Reply to

    nice victory

    by netprophecy2 Jul 7, 2016 2:36 AM
    jacosa jacosa Jul 11, 2016 12:47 PM Flag

    And another one: http+:/+/finance.yahoo.com/news/myriad-announces-positive-results-endopredict-152513363.html (take out the + signs).

    Questions of adoption dynamics: it's hard to explain the benefit of testing someone who has a particular cancer for his genetic risk of getting that cancer, which has complicated the MyRisk business already; at least Myriad has been through that before. And oncologists have heard it before, even if urologists haven't. A prognostic test is simpler, although there is a patient population who will want "everything," even with a very good prognosis.

  • jacosa jacosa Jul 7, 2016 10:48 AM Flag

    I have to say that payday lenders did it to themselves. They just had to stay less abusive than banks and they'd have had political cover.

  • TMF ang4apples recently did a comprise of Incyte with Amylam. He didn't repeat any of the popular lies about ruxolitiib, and he gave a realistic number for potential impact of baricitinib. He tried to poke at the edge of the epac prospect; a single paragraph there is inevitably unenlightening, but he didn't get lost in it, and it can stand as a signpost marking the whole 'attractive nuisance' of drug couples.

  • CC coming up, and this is an anniversary of "The Bad Conference Call." Two special features this year: exaggerated "Show me the money" investment focus and a very threatening political season. Incyte is responding by becoming more closed-mouthed. As I've said before, this increases "event risk" to the stock price (it DOES save a lot of resources on the 355 days of the year when nothing much is new).

    So in general, there isn't much chance of NEW news, and essentially no chance of "6-month-cash" news. Since the study centered on 50465 (the delta drug) is open label, there may be updates from it. The need for a safe delta drug is great, so something might be said about seeking accelerated approval. That's the only own/own combination I can see being of interest to investors now. I'd love initiation of a trial of '110 against some sort of alopecia, and safety data might permit it, but it won't happen. Something related to ruxo + low dose interferon in MF might actually move the stock, but there's SOMETHING blocking IFN in the US (I'd appreciate a story)

    So the interesting things are Jaka[fv]i revenues, clinical trials budget and the remaining Novartis milestones. I expect another instance of near 60% YoY J..i revenue growth, driven by technically off-label expansion in PV (pts who have chart, but not health, improvement with HU), MF (lower risk active cases) and GVHD. This rate of growth can't continue forever, but this Q would be a particularly bad time [for us] for it to level off. 59% YoY might be acceptable, but I'd expect widespread disappointment with 57%. The phase 3 program won't change, and the big expansion of the phase 2 program was last year. So the big uncertainty is whether the "maybe" on atopic dermatitis is resolved. If Lilly goes with it, I'd expect Incyte to also, but the decision is still probably 6 mo off. Milestones? No reason to expect news.

  • jacosa jacosa Jul 1, 2016 10:31 AM Flag

    I mis-spoke about 5-year survival. The control groups in those trials generally crossed over to ruxolitinib. Survival is more than twice what was observed for patients receiving treatment matching the controls as of the time of the studies.

  • jacosa jacosa Jul 1, 2016 10:20 AM Flag

    He mentioned it in the SA article. He considers it a long-term threat to the business of Jakafi for MF.

    As for what actually happened in the Mayo Clinic demonstration series, you should read the full report in the Sept 3, 2015 issue of The New England Journal of Medicine, preferably along with the on-line appendix. (Many hospitals have back issues of NEJM available; I went to a university library to get the appendix. Tefferi ought to send you an offprint if you contact him.). A drug with the properties shown in the NEJM article (7 patients of 33 responded at all; there were more adverse events of grade 3 and 4 than total patients treated) would never be tried until after Jakafi had been tried and failed (that is, in fact, the subject population for the Janssen study).

    There have been 5-year follow-ups published recently on the 2 phase 3 clinical trials of ruxolitinib as treatment for MF. They're quite favorable; in particular, patients with intermediate-2 MF at time of enrollment have median survival more than twice as long as with placebo or prior best available treatment.

    There was an attempt in the NJM paper to confirm the proposed (anti-telomerase) mode of action of the drug. The Editors (M. Armanios and CW Greider) commented that it left other possibilities for mode of action open. What works, works, however it works, but in predicting generality and duration of activity, the mode of action is guidance. Anti-telomerase activity leads to more favorable predictions than most other possibilities.

  • Reply to

    They like us

    by jacosa Jun 29, 2016 10:17 AM
    jacosa jacosa Jun 30, 2016 1:05 PM Flag

    Couple more things: unenthusiastic reaction is likely because while the HRD-positive patients did a lot better than the HRD-negative patients, the all-comers response was pretty good. The full dataset contains stuff bearing on that. Myriad doesn't own the data so they can't comment much. For a few reasons, standard of care is likely to include the CD, even if the drug is approvable for all.

    Explaining to a lay audience the value of hereditary cancer testing in patients with known cancer remains difficult.

  • Reply to

    They like us

    by jacosa Jun 29, 2016 10:17 AM
    jacosa jacosa Jun 30, 2016 12:47 PM Flag

    Very positive call. It may be possible to get around Myriad's patents, but definitely not easy (and they DO appear to be good patents).

    It isn't clear yet whether CD will be required by FDA, but payers will be a lot faster to reimburse the drug with CD.

    Adoption of a CD has more drug-like dynamics than test-like dynamics--the transition from the slow initial phase to the rapid-growth mid phase happens earlier.

    There are apparently about half a dozen other indications being looked at with anticipated topline (or better) in the next 12 months (of 22 total ongoing studies).

    A fairly full presentation on this study is anticipated at ESMO (in October). Since there are likely to be meetings among the companies and FDA in the interim, the presentation may well include the specific analyses that FDA was most interested in.

    There was a question about the delay in implementing the regulations to make reimbursement levels for devices and tests more predictable. Myriad doesn't expect major impact because the reference price determination phase is not being delayed, and much pricing is under contracts extending past the new implementation target.

  • jacosa by jacosa Jun 29, 2016 10:17 AM Flag

    Niraparib looks like a better drug than Lynparza, so there's some halo effect there. And it sounds so much better to say that HRD testing identifies 50% more patients who might benefit compared to previous CDs, compared to the story told with platinum drugs and Lynparza (we can spare patients these drugs would be futile for from the expense and side effects). Same thing of course, but better positioning.

    We learn something real on Thursday, but the drug looks approvable and a CD will probably be on the label. Frankly, the time to actual money is probably over a year, so I don't expect a huge effect soon.

    This year it's still mostly Vectra and Prolaris; be REAL nice to see 17% QoQ in both o them in the next CC.

  • jacosa by jacosa Jun 28, 2016 11:33 AM Flag

    That smarted. But looking back, I see Incyte has been making higher highs and higher lows for the last 4 months. That sort of thing tends to be a bit self-reinforcing. Whatever. We're in for 4 months of politics dominating everything. The only thing I can see in that with more than a brief effect would be a clear sign that Elizabeth Warren will or will not be errr "messing with" the drug industry. If she's VP or Treasury Secretary she'll be distracted. If she's Commerce Secretary, she might easily get involved. I don't think she'd take HHS. And if she's still in the Senate, all bets are off. (If Trump wins, I put most of my investable funds into canned food, but that's just me).

    Motley Fool had something about Agenus yesterday. Piece projected a need for [presumably dilutive] financing around EoY. Curiously, that's also estimated timing for bari approval milestone payments from Lilly to Incyte. If ongoing trials look good, Incyte might buy more. The theory has always been that for development of biologic / small molecule drug pairs, any on-target biologic is good in the early stages. And contrariwise, for a developmental biologic, early stage trials as part of a combo can pay for what would otherwise be substantial nuisance expenses.

    For all the Brexit-related talk about European bureaucracy, EMA may well approve bari a bit before FDA. EMA "showed their work" on Xeljanz, and protection of joint structure was most of the story. Lilly made sure that was well-addressed in trials.

  • Reply to

    Where we are

    by jacosa Mar 11, 2016 12:58 PM
    jacosa jacosa Jun 27, 2016 12:08 PM Flag

    Seems worth bumping on a bad day. Market cap up by a decent fraction of $1 bln. Peak market for ruxo looks higher by maybe $1/2 bln mostly because of GVHD excitement (again, it's not clear whether that has already shown up in sales, which would lower the ultimate market). Case for starting Jakafi in earlier stages of MF has strengthened, but I'm still not counting on it. Bari approval is now within investment time horizons. First p3 on epac has started. A European business organization has been bought relatively inexpensively (but in a way that could be undone in case of a merger). The diabetic nephropathy trial is definitely off, which is a big long-term negative, but almost as big a short-term positive. Capmatinib and the delta candidate are looking like more than just leads.

    ESMO, in October, looks like a real possibility for one of the "other combinations" with epac to report something, so I don't expect anything earlier. Merck, on the other hand, probably wants a journal publication of its combo results to help study recruitment; they may reiterate them at ESMO or wait until SITC.

    Net: I'd make the "no air" valuation about $68. Yeah, I have seen a good company (TSRA) sell for less than cash-on-hand (in '08), but buying generally comes in at some reasonable level. Main risk is political.

  • jacosa jacosa Jun 26, 2016 11:48 AM Flag

    Graft failure is less frequent but more devastating than GVHD. With the latter becoming more treatable, will SCT be used more, or will fear of the former prevent noticeable changes in practice? [for comparison, I'm strongly "Don't know"]

  • jacosa jacosa Jun 26, 2016 3:01 AM Flag

    I have at least as much trouble following responses on SA.

  • jacosa jacosa Jun 25, 2016 10:23 AM Flag

    Would you be wiling to participate here regularly (or at least occasionally)? We can use more intelligent discussion.

    I think ruxo is becoming / will become the standard of care for acute GVHD before breakthrough designation can have any effect...has a lot to do with physician personalities. The kinds of oncos who do a lot of SCTs are also fairly active in using available drugs off-label. Short-term / cash, I think the big effect of the designation is the couple $tens of millions it's likely to shave off the expense of getting the label expansion.

    I think the risk of transplant failure will be enough to prevent large expansion of the use of SCT soon, but better treatment for GVHD will tilt the choice between autologous and mixed autologous / heterologous SCTs where that choice is a live one. That may be a big deal for myeloma treatment. (A LITTLE anti-host reaction from the foreign-derived marrow helps control the cancer)

  • It was frustrating when N.I.C.E. gave the narrowest justifiable approval to sale of Jakavi. But with a couple years of limited English sales as a result of that, it partially insulates Incyte from Brexit (and I DO believe Britain is headed for the big exit--Scottish devolution soon, possibly with a less-than-friendly border; Northern Ireland next.) (Welsh participation in The UK has always been something you see if you look one way, and don't see if you look another)

    N.I.C.E. is going to have to change substantially to replace the overall approval function of EMA. Probably going to be delays for everything. Unfortunately, bari has very much the profile of a drug most likely to be hurt by the changeover (The case for it is SO strong that EMA might even beat FDA to approval; cost effectiveness likely to get it through N.I.C.E's existing functions quickly--even if it's the first thing English FDA approves, that's likely to be a few months of delay).

  • jacosa jacosa Jun 23, 2016 11:41 AM Flag

    I heard a noise from the Midwet about the rarity of GVHD. With about 5000 new cases a year and miserable prognosis, the market is comparable to active MF. Effective treatment could easily double the market size. The present mainstay of GVHD management is steroids. Since ruxo and steroids don't play well together (even alternated), if ruxo is adopted at all, it will likely be used first.

  • jacosa jacosa Jun 23, 2016 9:37 AM Flag

    I could be Sleepy, too.

    This may save a meaningful amount of money as Incyte brings GVHD on-label for ruxo. I don't know the reimbursement landscape for off-label use, but that ought to improve also. I think a large fraction of the sales possible for this indication are not waiting for the label expansion, though, so The direct benefit of accelerated approval is modest.

    The second-order benefits are unpredictable, and may be larger. It'll take at least until the p3 finishes for those to show clearly, because they are likely to involve more cautious oncologists. With improved prognosis for GVHD, more procedures that carry a risk of causing it will be done (particularly mixed autologous / heterologous stem cell transplants--I've said why I'm an avid spectator of myeloma developments, and mixed transplants have a large AVERAGE benefit there, but are limited because the worst case outcome is so bad). Other procedures that have a risk of causing marrow failure will look more attractive as rescue by transplant becomes less desperate.

  • Interesting MarketWatch article dated 6/20. Looks like drug pricing is going to figure in the Presidential election no matter what, because Trump thinks it can broaden his appeal, and frankly, Hillary is a bit scared to touch it after the reaction to her Turing tweet.

    ANYway, there's a suggestion in the article which might get us most of the benefit of UK's N.I.C.E. without the rigidity (which would hurt worse in the US than it does Over There, 'cause we don't have such a tradition of changing laws on-the-fly). A government agency might require cost::effectiveness reviews of selected already-approved [classes of?] drugs. It offers a hope of stopping the present trend for newest drugs to explore unheard-of price territory without intolerably disrupting markets.

    Something MUST give. The politics of hepatitis C could get unlimitedly bad (many, maybe most cases were a result of treatment of war wounds but VA can't afford CURATIVE drugs for all; by limiting number of cases cured, an outbreak that could be ended in a year or two can be stretched for decades).

    Trump's said to favor allowing re-importation of drugs sold overseas, and to want to free Mdiacare to negotiate drug prices any way they choose. Hillary is thought to favor something much closer to N.I.C.E. (Whose main tool is "You can't sell it for that price. Come back cheaper and we'll reconsider--from the beginning).

  • jacosa by jacosa Jun 17, 2016 12:11 PM Flag

    Most likely extended report on phase 1/2 of epac + pembo vs multiple tumor types. What we've heard about is longer follow-up on the same subjects from last SITC. I'm guessing a journal publication. "Other" PD-axis drugs + epac probably not until this year SITC.

    Trial of a combination of ruxo with low dose interferon could come any time. I don't know the politics here, but on a purely med-sci basis, this would have happened months ago.

    Also in the investing time frame, there may be an announcement related to that S,N oligonucleotide. A planned safety/tolerability review has perhaps 1 chance in 3 of causing the dosages being tested to be changed. Change would be announced; no change won't be.

  • Reply to

    Question

    by alexalekhine Jun 15, 2016 11:14 AM
    jacosa jacosa Jun 16, 2016 1:47 PM Flag

    Not just $6, but widely ignores. So yeah,almost certainly "Buy 100, sell 100, see if anything happens" programs.

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