An interesting conversation guys. My 2c worth ...
Stage 4 Men
Being right up against the exit door once this cancer has evolved past the last 3 blocks, I think it's exponentially harder (not linearly harder) to stop it ... let alone add any PFS or Survival months. It's harder for men to tolerate the full cycles of treatment. Noxopharm says that LuPIN's projected trial outcomes easily exceed any other stage 4 registration study claims. By a long way I'd say.
PSA responses are bound to be biologically lower in stage 4. In our case, lower PSA responses lead to a lower % of patients being offered the full 6 cycles of treatment ... which further pulls down the survival months and making any direct comparison even more skewed. I'd like to at least remove the compounding effect portion by making a Lutetium 6 cycle to 6 cycle comparison, with only the stage being different. 46% of LuPIN men received full 6 treatment cycles and will be the group of men who will have added the vast majority of months. Quite likely I've missed it, but I can't find the % of TheraP men who received their full 6 cycles. If it were say 60%, then that's an important first-up adjustment.
Stage 3 Men
Noxopharm says the performance is "even more remarkable when other treatments tested in men with considerably less advanced disease". This has to be a reference to Stage 3 trials and Noxopharm will certainly be aware of the TheraP Trial because Assoc Prof Louise Emmett is also an author of it.
The 2014 Trial using 177Lu-PSMA-617 alone added 13.3 months (95% CI 10.5-18.0), on 6 weeks of 4 cycles max. The TheraP Trial used 6 week of 6 cycle max. At the 24 months suggested by
Zenox, that extra 2 cycles has to boost median survival by 80% or a full 10.7 months. If it actually does that will be very big news and great for these men.From our perspective, I've tried to estimate the future dose announcement re Veyonda, given LuPIN is a dose escalation trial. Using the two interim reports, the 12 months between them and the timing of the dose escalation, I think the increasing dose of Veyonda makes a difference. It's rough and DYOR but my ball park figures are:
Cohort 1 - 400mg - 16 months achieved
Cohort 2 - 800mg - 19 months achieved
Cohort 3 - 1200mg - 22 months current projection
I'd throw in a guess that Lutetium alone might give 15 months at stage 4. My belief is that 400 and 800mg dosages of Veyonda are well below optimum levels, so though I think the study's current projection for cohort 3 is 22 months, it is underestimating what cohort 3 is going to achieve. Ignoring that, Veyonda gives a near 50% boost to Lutetium's performance on those figures.For our partner drug owner to possibly ignore us, it first needs to make that very large jump in it's own performance and then for Veyonda to add fixed months to that performance, rather than maintaining a % enhancement of it. Conceptually, as we are only trial in combination with other treatments, I regard Veyonda as primarily an enhancer of its partner treatment. Worst case, as a general rule a drug that adds a mere 3 months to a common cancer is the hurdle to becoming a billion dollar drug. I believe we will do multiples of it.
Fun to speculate but any hard comparison figures, positive or negative, can't be taken too seriously atm imo. There are an awful lot of moving parts I've summing over.
