I would highly recommend that you stop talking and start listening.
It's all pretty well known that you have a lot of cash in IMU. They have released results recently and you probably think that they are pretty good. So, let's use them as a little case study so that you can understand why those who have invested significantly more into RAC than you are significantly less concerned.
While matching the cost of Yescarta ($375,000 per treatment) and at an estimated 100% penetration, IMU states the peak sales opportunity for Azer-cel in DLBCL is $2.4B USD. You have money invested in this company, so you must think it is a worthwhile opportunity. There are several other allogeneic compounds further along than Azer-cel competing for first-in-class treatment. Azer-cel is hoping to secure a third-line option for DLBCL treating roughly 6,400 patients. For the sake of this analysis, we will assume that any of the other approved first- or second- line treatments that are often used as third-line options are not going to take patients away from you.
Dosing Bisantrene once every three weeks (Q3W) is like giving an antibiotic once a month instead of every day for 2-weeks - it works, but it just isn't going to do what it is designed to do. Of all the indications utilizing Q3W dosing, Bisantrene is the most active in lymphoma with an average 20% objective response rate (ORR) and 37% disease control rate (DCR). Bisantrene is the worlds first anti-cancer agent with off-target cardioprotective effects and as such, there is not a competitor anywhere in sight.
The well established front-line treatment for DLBCL is called R-CHOP which includes the anti-cancer agents rituximab, doxorubicin, cyclophosphamide, vincristine, and prednisone. Roughly 24,000 people in the US receive 6 cycles of this treatment each year, which means there are 144,000 (24,000 x 6) doses of Doxorubicin for DLBCL alone each year. Adding Bisantrene into this first-line treatment demonstrates that this is a $2.2B USD peak sales opportunity.
Through unique mechanisms oncologists have never seen before, Bisantrene is aiming to harmonize with known therapies to make them work better and be safer. The DLBCL opportunity is only a single indication where Doxorubicin is indicated and used frequently. Doxorubicin is approved for use in 15 cancer types and used off label in 7. Bisantrene has demonstrated objective repsonses in 22 different cancer types despite >80% of the clinical trials not using the compound correctly. Bisantrene has no competitors within the space and will be considered in the front-line treatment where it would be exposed to the entire DLBCL patient population. Bisantrene has also demonstrated clear synergy with a substantial number of drugs, including cyclophosphamide, so the likelihood of that simply just continuing is high.
The breast cancer opportunity for Doxorubicin CPACS is 3-4x larger than DLBCL and it is the second most successful once every three week indication Bisantrene was used in. Also, while the US is large, 95% of Doxorubicin doses happen outside of the US.
Do you want to consider what might happen with 4 or 8 successful indication, or maybe a blanket approval for wherever Doxorubicin is prescribed, Bisantrene can be used in combination?
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