When the FDA ap­proved Blue­print’s first drug three months ago, they split their de­ci­sion. Ay­vak­it would be ap­proved for gas­troin­testi­nal stro­mal tu­mors (GIST) with a rare mu­ta­tion called PDGFRa. The oth­er half of their ap­pli­ca­tion for plain old fourth line GIST would have to wait. Reg­u­la­tors want­ed to know how the drug per­formed in a Phase III tri­al.

Re­sults are now in from that Phase III tri­al and they spelled a death-knell. In a study of 476 pa­tients with third or fourth line GIST, Ay­vak­it (avapri­tinib) per­formed worse on the pri­ma­ry end­point than the al­ready-ap­proved Bay­er GIST drug, re­go­rafenib. Pro­gres­sion-free sur­vival was 4.2 months, com­pared with 5.6 months for Ay­vak­it.

Jeff Al­bers

Blue­print’s drug did have a high­er re­sponse rate — 17% com­pared with 7% — but that ap­peared as lit­tle con­so­la­tion. The com­pa­ny is dis­con­tin­u­ing de­vel­op­ment of the drug for those pa­tients.

“We will con­tin­ue to ad­vance our pipeline with clear near-term pri­or­i­ties in sys­temic mas­to­cy­to­sis and RET-al­tered can­cers,” CEO Jeff Al­bers said in a state­ment.

The com­pa­ny’s stock $BPMC took a sig­nif­i­cant hit, falling 20% from $70.90 to $56.71, ef­fec­tive­ly eras­ing over $800 mil­lion in val­ue.

Cowen’s Marc Frahm sug­gest­ed, though, that this was an over­re­ac­tion, writ­ing in a note to in­vestors that “GIST was not the the­sis.” The drug could still be po­ten­tial­ly used off-la­bel in fourth line GIST, Frahm wrote, but they were still re­mov­ing 3rd and 4th line GIST from their fu­ture sales pro­jec­tions. Nev­er­the­less, he ar­gued the tri­al said lit­tle about Ay­vak­it’s po­ten­tial in sys­temic mas­to­cy­to­sis — a rare dis­ease where mast cells ac­cu­mu­late in or­gans — or, in com­bi­na­tion with an­oth­er ex­per­i­men­tal drug, in can­cers with RET mu­ta­tions.

“We have re­moved sales for the broad 3/4L GIST in­di­ca­tions but con­tin­ue to view BPMC shares as un­der­val­ued,” Frahm wrote, pric­ing them at $83.

An­drew Berens at SVB Leerink was less up­beat but echoed the call for cau­tion. The fail­ure will “fun­da­men­tal­ly hit” Blue­print, he said, but the greater po­ten­tial lay else­where.

“Over­all, we be­lieve that GIST is less im­por­tant to the BPMC the­sis and think that in­vestors are like­ly to step in af­ter this read­out for more long-term op­por­tu­ni­ties in RET-dri­ven ma­lig­nan­cies and sys­temic mas­to­cy­to­sis (SM) with up­com­ing cat­a­lyst,” Berens wrote.

Blue­print had been in a two-per­son race with De­ci­phera to get a drug ap­proved for GIST — a rare form of sar­co­ma in the di­ges­tive sys­tem — dri­ven by a mu­ta­tion to the platelet-de­rived growth al­pha gene, or PDGFRa. Ay­vak­it was ap­proved un­der ac­cel­er­at­ed ap­proval, while De­ci­phera awaits an Au­gust de­ci­sion date from the FDA. Both com­pa­nies are al­so pur­su­ing sys­temic mas­to­cy­to­sis and 2nd line GIST.

De­ci­phera does not have a tri­al for 3rd line GIST, but Berens said the com­pa­ny could ben­e­fit if on­col­o­gists de­cide to try their drug off-la­bel in that set­ting.

So­cial im­age: Jeff Al­bers, Blue­print CEO (CN­BC)

When AstraZeneca trumpeted “momentous” and “transformative” results for Tagrisso earlier this year at ASCO, some practitioners threw cold water on the ADAURA fervor. Sure, the disease-free survival data look good, but overall survival is the endpoint that matters when it comes to choosing adjuvant therapy for non-small cell lung cancer patients, the experts said.

The OS data still aren’t here, but AstraZeneca is back at ESMO to bolster their case with a look at brain metastasis data.

Late in August, as negotiations on a pricing deal with President Trump reached a boiling point, PhRMA president Stephen Ubl sent an email update to the 34 biopharma chiefs that sit on his board. He wrote that if the industry did not agree to pay for a $100 “cash card” sent to seniors before November, White House chief of staff Mark Meadows was going to tell the news media Big Pharma was refusing to “share the savings” with the elderly — and that all of the blame for failed drug pricing negotiations would lie squarely on the industry.