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Exact Sciences Corporation Message Board

marsala1234 15 posts  |  Last Activity: Feb 27, 2015 5:46 PM Member since: Jan 31, 2003
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  • Reply to

    10,000 seems like a good number to me

    by bioimmunomabman Feb 27, 2015 5:03 PM
    marsala1234 marsala1234 Feb 27, 2015 5:46 PM Flag

    Agree BIO- the 2 related key points are USPSTF and Private insurer uptake. With Exacts strategy the test will sell itself once there is coverage.

  • Reply to

    advice please

    by go_wings383 Feb 19, 2015 2:08 PM
    marsala1234 marsala1234 Feb 19, 2015 5:05 PM Flag

    Oldguy - sorry to hear about your friend. As a doc I have more stories of bad prostate cancer outcomes than I can count - including operative deaths in 50 year olds. I know it a very controversial topic but I've never been convinced of the evidence. My own father had an elevated PSA 17 years ago. I convince him to not go to a Urologist and observe over time. He's 84 now with no problems.
    I'm waiting to hear about Exact 's Urine DNA test in 5 years to detect only aggressive prostate cancers! - that will make Cologuard sales look like a drop in the bucket.

  • Reply to

    advice please

    by go_wings383 Feb 19, 2015 2:08 PM
    marsala1234 marsala1234 Feb 19, 2015 3:40 PM Flag

    Like many things in medicine it comes down to statistics. If you are high risk do a colonoscopy.
    If you are average or low risk then its tougher. MAYBE you miss 1-2% more cancers doing Cologuard, which likely approaches 0-1% after your 2nd or 3rd. In exchange for that margin of safety you pay more $, do a lousy prep, take off a day of work, risk a small chance of scope related complications, likely get biopsies of insignificant polyps that may require you to then have more frequent colonoscopies the rest of your life. It's all about risk reward. I personally am willing to accept the small risk of missing something to avoid the risk of testing and complications. So I'll use cologuard. Remember, many CRC are found in people who have had a colonoscopy in the previous 3-5 years so if you really want to reduce your risk to 0 you should have one every 3 years. NO screening test is perfect so you have to decide what fits your comfort level. For example, I'll never have a PSA test because I think the risk of testing is worse than my risk of dying from prostate cancer. Good luck!

  • Reply to

    Insurance coverage

    by biotechinvestornow Feb 14, 2015 3:59 PM
    marsala1234 marsala1234 Feb 14, 2015 5:50 PM Flag

    That's great - I didn't think they would get any non Medicare reimbursement until contracts were agreed upon.
    Nice to know these 8 states may pay up due to the mandate. Interesting that they denied the claim until you appealed. I'm sure Exas is aware of this but it might be good for you to share your experience with them - great info.

  • Reply to

    Insurance coverage

    by biotechinvestornow Feb 14, 2015 3:59 PM
    marsala1234 marsala1234 Feb 14, 2015 5:24 PM Flag

    Biotech - thanks for the info! Do you have medicare or non medicare commercial insurance? Thanks

  • Reply to

    Earnings Predictions

    by keith_barshinger Feb 13, 2015 11:46 AM
    marsala1234 marsala1234 Feb 13, 2015 5:09 PM Flag

    Wow- that is pretty cynical Old Guy! I'm not "that old" yet but aren't these commercial payers the same ones that cover all the Mcare Advantage members and will be paying for the advanced CRC treatment anyway?

  • Reply to

    Earnings Predictions

    by keith_barshinger Feb 13, 2015 11:46 AM
    marsala1234 marsala1234 Feb 13, 2015 4:32 PM Flag

    bioimmunomabman- None of the big boys are covering it yet. If they were it would be announced. It's only a matter of time. KC said 12-24 months to get contracts in place. USPSTF will drive this. Anyone know how much time Insurers have after USPSTF A or B to cover the test based on the ACA guidelines and at what price they are mandated to pay at?

    I trust KC and the crew but I wonder whether it's better to offer the test to commercial payers for $493 instead of $599 and potentially get faster coverage and utilization (possibly now) vs. holding strong on the $599 and waiting for mandatory coverage to force their hands? I'd love to know the thought process behind the negotiations.

    Sentiment: Strong Buy

  • Reply to

    New 'hit' piece, this time from Potomac Research

    by trader_am Feb 11, 2015 10:01 AM
    marsala1234 marsala1234 Feb 11, 2015 11:29 AM Flag

    Read the piece. I would be SHOCKED if USPSTF gave it an "I". FDA approval, CMS approval, ACS recommendation, GI org recommendations, largest study ever, NEJM article, FOBT has an "A" rating and Cologuard is vastly superior to FOBT, colonoscopy has always been on without any evidence of benefit (until recently), Barium enema is on with no evidence of benefit. USPTF does not look at cost, only evidence. It's a slam dunk in my opinion.

  • Reply to

    Competition for EXAS?

    by joethius Feb 7, 2015 9:01 AM
    marsala1234 marsala1234 Feb 7, 2015 11:04 AM Flag

    They haven't even started a clinical trial yet. That would start in 2016 or 2017 and take years after that if the it has any promise. Maybe I'm missing something but I see NO DATA.

  • Reply to

    Competition for EXAS?

    by joethius Feb 7, 2015 9:01 AM
    marsala1234 marsala1234 Feb 7, 2015 10:45 AM Flag

    don't have time - but just took a quick look at their website. They listed 2 publications -neither of which was an actual study. Is it possible they have NO Trial data? If so - they are likely at least 5-10 years away from finding out if it actually works or not and any type of approval. Not worried.

  • Reply to

    Comparison?

    by ekiernan2003 Jan 14, 2015 10:52 AM
    marsala1234 marsala1234 Jan 14, 2015 3:11 PM Flag

    Ekiernan - I think the best comparison is actually a company called Digene which was first to market on the HPV tests for cervical cancer. Third Wave was actually 3rd to market many years after Digene.
    I think Exact and Digene are very similar. Both developed DNA screens for slow growing cancers. HPV screening is more complicated than CRC screening and as a result the adoption of HPV screening as the standard of care was fairly slow in the medical community. So after the initial hype the stock went to $40 only to go down to $6 when adoption was slow and Roche was seen as a close competitor. But eventually the medical community adopted it, Roche couldn't get an FDA approved test to market and Qiagen eventually bought out Digene for $1.6 Bilion at $61 per share.

    I think Exact has several advantages over Digene.
    1) No competition in foreseeable future
    2) Its test isn't that much different from FIT conceptually so docs don't need to take a big leap in process or thought to use the test.
    3) Cologuard will be much more consumer driven as the alternative (colonoscopy) is very undesirable vs HPV testing which is done with the normal Pap smear anyway
    4) We are getting $500/test vs $20/ test (they had to share most of the profits with the labs)
    5) CRC is MUCH more prevalent and deadly than cervical cancer
    6) Exact has a promising pipeline - Digene was a one test company
    7) No government agency Mandated HPV use. By 2016 after USPSTF decision Cologuard coverage will likely be mandatory

    So, based on the above I see Exas as being a safer investment with less volatility and I will be holding through the usual 20% dips as I think the future is bright!

  • Reply to

    JP Morgan

    by kdalglish14 Jan 13, 2015 2:03 PM
    marsala1234 marsala1234 Jan 13, 2015 6:22 PM Flag

    Ranjo - The American Gastroenterological Association says:
    Colonoscopic surveillance should begin after eight years in patients with pancolitis, and 15 years in patients with colitis involving the left colon
    ●Colonoscopy should be repeated every one to two years

    So I would guess interval would be yearly.

  • New article in Medscape includes Cologuard in top 10 for 2014 - nothing new but good promo.

    Multitarget Stool DNA Testing for Colorectal-Cancer Screening

    Imperiale TF, Ransohoff DF, Itzkowitz SH, et al

    N Engl J Med. 2014;370:1287-1297

    How Do Stool Screening Tests Compare?



    The latest iteration of fecal DNA testing is a combination assay that includes molecular tests for KRAS mutations, aberrant NDRG4 and BMP3 methylation, beta-actin, and an immunoassay for hemoglobin by fecal immunochemical testing (FIT). This study compared the performance of this new assay with FIT in detecting CRC in patients undergoing screening colonoscopy.

    The sensitivity of the fecal DNA assay was 92.3% for CRC overall (as well as consistent across stages I-III), compared with 73.8% for FIT. Moreover, the sensitivities were 69.2% for high-grade dysplasia and 42.4% for sessile serrated polyps (≥ 1cm), compared with 46.2% and 5.1%, respectively, for FIT.

    Clearly, this assay is an effective alternative technology for CRC screening. Whether this will achieve screening in patients who otherwise resist colonoscopy remains to be seen. Furthermore, the cost-effectiveness of detection and prevention of CRC death remains uncertain.

  • Reply to

    It's time...

    by xzw7yx_2000 Dec 9, 2014 9:38 AM
    marsala1234 marsala1234 Dec 9, 2014 11:42 AM Flag

    Kleeno - believe me I'm enjoying the ride. Been here since 2006. I'm just saying never say never and sometimes taking a bit off the table to diversify an out of whack portfolio allows you the strength to stay in for the long hall. Everyone has a different mentality for risk.

  • Reply to

    It's time...

    by xzw7yx_2000 Dec 9, 2014 9:38 AM
    marsala1234 marsala1234 Dec 9, 2014 11:21 AM Flag

    Ranjo- we thought we knew Amarins final destination too :). Nothing wrong with re-balancing the portfolio a bit after a big run, while keeping a good core position. Boy - does exas look strong though.

EXAS
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