Puma shares ripped af­ter grow­ing grade 3 di­ar­rhea threat is high­light­ed in an ab­stract

Simos Sime­oni­dis, RBC Cap­i­tal

The skep­tics ripped in­to Puma Biotech­nol­o­gy $PBYI to­day, tear­ing a 20% chunk out of its share price by ear­ly af­ter­noon on Mon­day af­ter get­ting a glimpse of its lead can­cer drug’s con­tin­u­ing prob­lems spurring se­vere cas­es of di­ar­rhea in pa­tients.

The re­ac­tion quick­ly set in af­ter Puma post­ed an ab­stract for an up­com­ing can­cer sym­po­sium which spelled out the in­creas­ing rates in ner­a­tinib tri­als. RBC’s Simos Sime­oni­dis sat down to com­pare the num­bers, and reached a few un­set­tling con­clu­sions. Here’s a note he post­ed Mon­day af­ter­noon:

In an ab­stract re­leased this morn­ing, Puma dis­closed da­ta from the Phase II CON­TROL tri­al in the ex­tend­ed ad­ju­vant set­ting show­ing that treat­ment with lop­eramide helps low­er the ~40% Grade 3 (G3) di­ar­rhea seen in the Ex­teNET Phase III tri­al. How­ev­er, the num­bers re­leased to­day show that the G3 rates went up com­pared to what was dis­closed last year… Specif­i­cal­ly, in pa­tients in the orig­i­nal lop­eramide pro­to­col, the rate of G3 di­ar­rhea in­creased to 21.4% from 18.5%. Fur­ther­more, in the amend­ed pro­to­col arm, the amount of G3 di­ar­rhea more than dou­bled from 13% to 28.6%. Over­all, the blend­ed rate be­tween these two arms was 27.1% vs. 16% last year.

The com­pa­ny had re­cent­ly dis­closed they had added a new arm to the study, com­bin­ing the cor­ti­cos­teroid budes­onide to help with the pro­phy­lax­is reg­i­men. To­day’s re­lease of the wors­en­ing (vs. last year’s da­ta) di­ar­rhea, helps ex­plain the need for this change in the tri­al. While we view the 12.5% rate of G3 di­ar­rhea as po­ten­tial­ly promis­ing, we point to the small n (16 pa­tients) and to the fact that these da­ta are still ear­ly (i.e. it is pos­si­ble that they ac­tu­al­ly get worse over time, just as the da­ta from arms 1 and 2 did). The up­date in San An­to­nio should have slight­ly more ma­ture da­ta; how­ev­er, we view the fact that lop­eramide alone no longer ap­pears suf­fi­cient to pro­phy­laxe against se­vere di­ar­rhea as a sig­nif­i­cant neg­a­tive for ner­a­tinib and the stock.

One key point here: Sime­oni­dis has been cau­tious but pos­i­tive about ner­a­tinib’s prospects as a new treat­ment for breast can­cer as it un­der­goes scruti­ny at the FDA. Datasets on 5-year sur­vival and lop­eramide pro­phy­lax­is had im­proved sen­ti­ment around the com­pa­ny’s chances, he not­ed last Sep­tem­ber 20, when the FDA ac­cept­ed Puma’s ap­pli­ca­tion for re­view.

The bear po­si­tion on Puma is that the drug could be too tox­ic even for the FDA, which has proven will­ing to put up with sig­nif­i­cant threats for drugs ini­tial­ly aimed at dy­ing pa­tients. Bulls be­lieve that the safe­ty bar is low enough to clear.

In­vestors were way ahead of Sime­oni­dis to­day, dri­ving down the com­pa­ny stock as Twit­ter quick­ly spread the word to any­one who hadn’t heard al­ready.

Aerial view of Genentech's campus in South San Francisco [Credit: Getty]

Genen­tech sub­mits a big plan to ex­pand its South San Fran­cis­co foot­print

The sign is still there, a quaint reminder of whitewashed concrete not 5 miles from Genentech’s sprawling, chrome-and-glass campus: South Francisco The Industrial City. 

The city keeps the old sign, first erected in 1923, as a tourist site and a kind of civic memento to the days it packed meat, milled lumber and burned enough steel to earn the moniker “Smokestack of the Peninsula.” But the real indication of where you are and how much has changed both in San Francisco and in the global economy since a couple researchers and investors rented out an empty warehouse 40 years ago comes in a far smaller blue sign, resembling a Rotary Club post, off the highway: South San Francisco, The Birthplace of Biotech.

Here comes the oral GLP-1 drug for di­a­betes — but No­vo Nordisk is­n't dis­clos­ing Ry­bel­sus price just yet

Novo Nordisk’s priority review voucher on oral semaglutide has paid off. The FDA approval for the GLP-1 drug hit late Friday morning, around six months after the NDA filing.

Rybelsus will be the first GLP-1 pill to enter the type 2 diabetes market — a compelling offering that analysts have pegged as a blockbuster drug with sales estimates ranging from $2 billion to $5 billion.

Ozempic, the once-weekly injectable formulation of semaglutide, brought in around $552 million (DKK 3.75 billion) in the first half of 2019.

As Nas­daq en­rolls the fi­nal batch of 2019 IPOs, how have the num­bers com­pared to past years?

IGM Biosciences’ upsized IPO haul, coming after SpringWorks’ sizable public debut, has revved up some momentum for the last rush of biotech IPOs in 2019.

With 39 new listings on the books and roughly two more months to go before winding down, Nasdaq’s head of healthcare listings Jordan Saxe sees the exchange marking 50 to 60 biopharma IPOs for the year.

“December 15 is usually the last possible day that companies will price,” he said, as companies get ready for business talks at the annual JP Morgan Healthcare Conference in January.

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Oxitec biologist releases genetically modified mosquitoes in Piracicaba, Brazil in 2016 [credit: Getty Images]

In­trex­on unit push­es back against claims its GM mos­qui­toes are mak­ing dis­ease-friend­ly mu­tants

When the hysteria of Zika transmission sprang into the American zeitgeist a few years ago, UK-based Oxitec was already field-testing its male Aedes aegypti mosquito, crafted to possess a gene engineered to obliterate its progeny long before maturation.

But when a group of independent scientists evaluated the impact of the release of these genetically-modified mosquitoes in a trial conducted by Oxitec in Brazil between 2013 and 2015, they found that some of the offspring had managed to survive — prompting them to speculate what impact the survivors could have on disease transmission and/or insecticide resistance.

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[via AP Images]

Pur­due threat­ens to walk away from set­tle­ment, asks to pay em­ploy­ees mil­lions in bonus­es

There are two updates on the lawsuit against Purdue Pharma over its role in fueling the opioid epidemic, as the Sackler family threatens to walk away from their pledge to pay out $3 billion if a bankruptcy judge does not stop outstanding state lawsuits against them. At the same time, the company has asked permission to pay millions in bonuses to select employees.

Purdue filed for chapter 11 bankruptcy this week as part of its signed resolution to over 2,000 lawsuits. The deal would see the Sackler family that owns Purdue give $3 billion from their personal wealth and the company turned into a trust committed to curbing and reversing overdoses.

David Grainger [file photo]

'Dis­con­nect the bas­tard­s' — one biotech's plan to break can­cer cell­s' uni­fied de­fens­es

Chemotherapy and radiotherapy are the current gladiators of cancer treatment, but they come with well-known limitations and side-effects. The emergence of immunotherapy — a ferocious new titan in oncologist’s toolbox — takes the brakes off the immune system to kill cancer cells with remarkable success in some cases, but the approach is not always effective. What makes certain forms of cancer so resilient? Scientists may have finally pieced together a tantalizing piece of the puzzle, and a new biotech is banking on a new approach to fill the gap.

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A fa­vorite in Alex­ion’s C-suite is leav­ing, and some mighty sur­prised an­a­lysts aren’t the least bit hap­py about it

Analysts hate to lose a biotech CFO they’ve come to trust and admire — especially if they’re being blindsided by a surprise exit.

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Scott Gottlieb, AP Images

Scott Got­tlieb is once again join­ing a team that en­joyed good times at the FDA un­der his high-en­er­gy stint at the helm

Right after jumping on Michael Milken’s FasterCures board on Monday, the newly departed FDA commissioner is back today with news about another life sciences board post that gives him a ringside chair to cheer on a lead player in the real-world evidence movement — one with very close ties to the FDA.

Aetion is reporting this morning that Gottlieb is joining their board, a group that includes Mohamad Makhzoumi, a general partner at New Enterprise Associates, where Gottlieb returned after stepping out of his role at the FDA 2 years after he started.

Gottlieb — one of the best connected execs in biopharma — knows this company well. As head of FDA he championed the use of real-world evidence to help guide drug developers and the agency in gaining greater efficiencies, which helped set up Aetion as a high-profile player in the game.

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Tower Bridge in London [Shutterstock]

#UK­BIO19: Join GSK’s Hal Bar­ron and a group of top biotech ex­ecs for our 2nd an­nu­al biotech sum­mit in Lon­don

Over the past 10 years I’ve made a point of getting to know the Golden Triangle and the special role the UK biopharma industry plays there in drug development. The concentration of world class research institutes, some of the most accomplished scientists I’ve ever seen at work and a rising tide of global investment cash leaves an impression that there’s much, much more to come as biotech hubs are birthed and nurtured.