Peter,
Looking at the disclosed side effects of CHOP and the Rit+CHOP study, it would seem to me that Bex+Flu should have a distinct edge on the side-effect front.
I mentioned that I got to talk to Dr. Leonard, one of the authors of the Bex+Flu poster. During that conversation, I mentioned that I had been doing some comparisons of Bex+Flu vs. Rit+CHOP, and thought that I might be seeing a somewhat less severe side-effects profile from the Bex+Flu regimen.
He smiled and said something to the effect of, "you know, on this regimen, patients don't lose their hair."
My immediate thought was, "hey, I'm focused on serious stuff like grade 4 hematological toxicity, what are you talking about hair?"
But he continued, something to the effect of, "you know that's very important to many of these patients."
Indeed, there was no alopecia reported from the Bex+Flu study, nor has it been reported from either agent as monotherapy. By contrast, most literature on CHOP chemotherapy indicates roughly 100% incidence of alopecia. While I initially shrugged off the observation as relatively unimportant, I'm starting to see what Dr. Leonard may have been driving at. Namely, cancer patients have to deal with tremendous burdens, emotional and psychological as well as physical. Perhaps we shouldn't underestimate the psychological and emotional value for these patients of maintaining a normal appearance during their fight, of not being obviously recognizable to all as someone going through toxic therapies to fight a deadly disease.
This patient preference might ultimately prove to be a bigger factor in the Bex+Flu vs. Rit+CHOP equation than we investors may have considered. However, as I've mentioned already (and Rick and some others have mentioned as well) the progression-free survival data from Rit+CHOP is very strong right now, and goes much further back than what we know about Bex+Flu. Rit continues to benefit from the longer period of clinical experience that we have with using it. In the early going, I would expect to see a preponderance of Rit+CHOP first-line treatment based on the available survival data, especially among the oncologists and patients having a more conservative bent. The exciting thing for Coulter is that Bex+Flu has now been shown to be a serious contender in first-line treatment (beyond the salvage-only role once envisioned by some), and we can already see some key toxicity advantages it might have over the current front-runner.
As soon as I get a chance, I'm going to post some detailed toxicity data from the Bex+Flu poster, and compare it to published results from Rit+CHOP (got a copy of the journal article from the IDPH booth, they had full text of all the Rit studies, very nice). I might add that Dr. Leonard would absolutely not characterize Bex+Flu as a superior first-line regimen at this point - as we would expect, he very clearly stated we are many, many years from knowing any such thing about any of the currently emerging therapies.
Cheers,
Gordon |
