Af­ter Kite Phar­ma stuns an­a­lysts with news of a death in lead CAR-T study, safe­ty ques­tions sour launch fore­cast

There may nev­er have been a right way for Kite Phar­ma to an­nounce that a pa­tient in one of its CAR-T stud­ies died from cere­bral ede­ma — but wait­ing more than a week and then bring­ing it up on the quar­ter­ly call with an­a­lysts def­i­nite­ly wasn’t the way to go. That route seems to have on­ly bright­ened the glar­ing spot­light that im­me­di­ate­ly swiveled over to com­pa­ny ex­ecs as they tried to ex­plain, and down­play, the death.

David Nieren­garten, Wed­bush an­a­lyst

To­day, in a note to in­vestors, Wed­bush an­a­lyst David Nieren­garten high­light­ed the mine field that Kite — which saw its shares plunge 13% yes­ter­day — is try­ing to nav­i­gate on this top­ic.

While Kite CMO David Chang re­peat­ed­ly em­pha­sized in the call just how sick this pa­tient was be­fore he died, Nieren­garten sees some dis­turb­ing sim­i­lar­i­ties with Juno’s old lead drug, JCAR015, which im­plod­ed in Phase III af­ter it killed 5 peo­ple in two dif­fer­ent groups — be­fore and af­ter a clin­i­cal hold by the FDA.

In his note to in­vestors this morn­ing, Nieren­garten said:

We al­so see the death as ad­di­tion­al ev­i­dence against the use of CD28 co-stim­u­la­to­ry do­mains in CAR-T de­signs — re­call, JUNO scrapped its CD28-con­tain­ing CAR-T JCAR015 pro­gram that caused mul­ti­ple fa­tal­i­ties due to cere­bral ede­ma in the ROCK­ET study of adult ALL pa­tients. We see high risk for safe­ty prob­lems in axi-cel’s on­go­ing stud­ies in adult and pe­di­atric ALL pa­tients, as well as for pipeline CAR-Ts KITE-585 (BC­MA) and KITE-796 (CLL-1/CLEC12A) that both uti­lize a CD28 co-stim­u­la­to­ry do­main.

David Chang, Kite

While Kite ex­ecs, led by CEO Arie Bellde­grun, want to fo­cus on near-term op­por­tu­ni­ties for a lead CAR-T that’s neck-and-neck with No­var­tis in seek­ing a pi­o­neer­ing FDA OK, Nieren­garten sees in­creased risk — even with an ex­pect­ed ap­proval. And ri­vals may well com­pli­cate the pic­ture even more at the up­com­ing AS­CO meet­ing.

“We see adop­tion as be­ing lim­it­ed by physi­cian aware­ness and com­fort re­gard­ing risk/ben­e­fit pro­file,” notes Nieren­garten. “We see lit­tle push­back from pay­ers, giv­en the lim­it­ed ini­tial pa­tient pop­u­la­tion and one-time na­ture of the treat­ment, and as­sume the price re­ceived by KITE from each pro­ce­dure to be $325k. We await da­ta from Juno’s (JUNO, NEU­TRAL) JCAR017 at AS­CO, as well as NVS’s CAR-T CTL019 Juli­et study at ICML in June to gain fur­ther in­sight in­to mar­ket dy­nam­ics go­ing for­ward.”

Arie Bellde­grun

Juno nev­er did ful­ly ex­plain just what went wrong with JCAR015. It’s first ex­pla­na­tion, try­ing to pin the blame on flu­dara­bine, was clear­ly off base. Long time ob­servers nev­er thought that was cred­i­ble. And Juno wound up shelv­ing the whole thing and go­ing the next-wave ap­proach with JCAR017.

It didn’t help that two top Kite ex­ecs, in­clud­ing Chang, cashed in some stock op­tions be­tween the time they learned of the death and the time it was an­nounced. Those sales may have been pro­grammed in well ahead of time, but the op­tics are al­ways bad.

Kite now has lit­tle room for er­ror. The risk of an­oth­er lethal cere­bral ede­ma case pop­ping up is cre­at­ing doubts just when Kite needs to ex­ude con­fi­dence and cer­tain­ty.

2019 Trin­i­ty Drug In­dex Eval­u­ates Ac­tu­al Com­mer­cial Per­for­mance of Nov­el Drugs Ap­proved in 2016

Fewer Approvals, but Neurology Rivals Oncology and Sees Major Innovations

This report, the fourth in our Trinity Drug Index series, outlines key themes and emerging trends in the industry as we progress towards a new world of targeted and innovative products. It provides a comprehensive evaluation of the performance of novel drugs approved by the FDA in 2016, scoring each on its commercial performance, therapeutic value, and R&D investment (Table 1: Drug ranking – Ratings on a 1-5 scale).

How to cap­i­talise on a lean launch

For start-up biotechnology companies and resource stretched pharmaceutical organisations, launching a novel product can be challenging. Lean teams can make setting a launch strategy and achieving your commercial goals seem like a colossal undertaking, but can these barriers be transformed into opportunities that work to your brand’s advantage?
We spoke to Managing Consultant Frances Hendry to find out how Blue Latitude Health partnered with a fledgling subsidiary of a pharmaceutical organisation to launch an innovative product in a
complex market.
What does the launch environment look like for this product?
FH: We started working on the product at Phase II and now we’re going into Phase III trials. There is a significant unmet need in this disease area, and everyone is excited about the launch. However, the organisation is still evolving and the team is quite small – naturally this causes a little turbulence.

Aymeric Le Chatelier, Ipsen

A $1B-plus drug stum­bles in­to an­oth­er big PhI­II set­back -- this time flunk­ing fu­til­i­ty test -- as FDA hold re­mains in ef­fect for Ipsen

David Meek

At the time Ipsen stepped up last year with more than a billion dollars in cash to buy Clementia and a late-stage program for a rare bone disease that afflicts children, then CEO David Meek was confident that he had put the French biotech on a short path to a mid-2020 launch.

Instead of prepping a launch, though, the company was hit with a hold on the FDA’s concerns that a therapy designed to prevent overgrowth of bone for cases of fibrodysplasia ossificans progressiva might actually stunt children’s growth. So they ordered a halt to any treatments for kids 14 and under. Meek left soon after to run a startup in Boston. And today the Paris-based biotech is grappling with the independent monitoring committee’s decision that their Phase III had failed a futility test.

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UP­DAT­ED: FDA’s golodirsen CRL: Sarep­ta’s Duchenne drugs are dan­ger­ous to pa­tients, of­fer­ing on­ly a small ben­e­fit. And where's that con­fir­ma­to­ry tri­al?

Back last summer, Sarepta CEO Doug Ingram told Duchenne MD families and investors that the FDA’s shock rejection of their second Duchenne MD drug golodirsen was due to some concerns regulators raised about the risk of infection and the possibility of kidney toxicity. But when pressed to release the letter for all to see, he declined, according to a report from BioPharmaDive, saying that kind of move “might not look like we’re being as respectful as we’d like to be.”

He went on to assure everyone that he hadn’t misrepresented the CRL.

But Ingram’s public remarks didn’t include everything in the letter, which — following the FDA’s surprise about-face and unexplained approval — has now been posted on the FDA’s website and broadly circulated on Twitter early Wednesday.

The CRL raises plenty of fresh questions about why the FDA abruptly decided to reverse itself and hand out an OK for a drug a senior regulator at the FDA believed — 5 months ago, when he wrote the letter — is dangerous to patients. It also puts the spotlight back on Sarepta $SRPT, which failed to launch a confirmatory study of eteplirsen, which was only approved after a heated internal controversy at the FDA. Ellis Unger, director of CDER’s Office of Drug Evaluation I, notes that study could have clarified quite a lot about the benefit and risks associated with their drugs — which can cost as much as a million dollars per patient per year, depending on weight.

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Roche's check­point play­er Tecen­triq flops in an­oth­er blad­der can­cer sub­set

Just weeks after Merck’s star checkpoint inhibitor Keytruda secured FDA approval for a subset of bladder cancer patients, Swiss competitor Roche’s Tecentriq has failed in a pivotal bladder cancer study.

The 809-patient trial — IMvigor010 — tested the PD-L1 drug in patients with muscle-invasive urothelial cancer (MIUC) who had undergone surgery, and were at high risk for recurrence.

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Gilead claims Tru­va­da patents in HHS’ com­plaint are in­valid

Back in November, the Department of Health and Human Services took the rare step of filing a complaint against Gilead for infringing on government-owned patents related to the HIV drug Truvada (emtricitabine/tenofovir disoproxil fumarate) for pre-exposure prophylaxis (PrEP).

But on Thursday, Gilead filed its own retort, making clear that it does not believe it has infringed on the Centers for Disease Control and Prevention’s (CDC) Truvada patents because they are invalid.

Gilead dusts off a failed Ebo­la drug as coro­n­avirus spreads; Ex­elix­is boasts pos­i­tive Ph I/II da­ta

→ Less than a year ago Gilead’s antiviral remdesivir failed to make the cut as investigators considered a raft of potential drugs that could be used against an Ebola outbreak. But it may gain a new mission with the outbreak of the coronavirus in China, which is popping up now around the world.

Gilead put out a statement saying that they’re now in discussions with health officials in the US and China about testing their NUC against the virus. It’s the latest in a growing lineup of biopharma companies that are marshaling R&D forces to see if they can come up with a vaccine or therapy to blunt the spread of the virus, which has now sickened hundreds, killed at least 17 people and led the Chinese government to start quarantining cities.

Alex Karnal (Deerfield)

Deer­field vaults to the top of cell and gene ther­a­py CD­MO game with $1.1B fa­cil­i­ty at Philadel­phi­a's newest bio­phar­ma hub

Back at the beginning of 2015, Deerfield Management co-led a $10 million Series C for a private gene therapy startup, reshaping the company and bringing in new leaders to pave way for an IPO just a year later.

Fast forward four more years and the startup, AveXis, is now a subsidiary of Novartis marketing the second-ever gene therapy to be approved in the US.

For its part, Deerfield has also grown more comfortable and ambitious about the nascent field. And the investment firm is now putting down its biggest bet yet: a $1.1 billion contract development and manufacturing facility to produce everything one needs for cell and gene therapy — faster and better than how it’s currently done.

Tri­fec­ta of sick­le cell dis­ease ther­a­pies ex­tend life ex­pectan­cy, but are not cost-ef­fec­tive — ICER

Different therapeutic traits brandished by the three approved therapies for sickle cell disease all extend life expectancy, but their impact on quality of life is uncertain and their long-term cost-effectiveness is not up to scratch according to the thresholds considered reasonable by ICER, the non-profit concluded in a draft guidance report on Thursday.

Sickle cell disease (SCD), which encompasses a group of inherited red blood cell disorders that typically afflict those of African ancestry, impacts hemoglobin — and is characterized by episodes of searing pain as well as organ damage.