This is perhaps a startling thought to many people. But while I do find it provocative, it is perhaps not very far-fetched and has its merits. Of course, if one believes that Provenge is a guaranteed blockbuster than the thought is simply absurd. But if one takes what I consider a more realistic view that the path to Provenge’s success is extremely difficult then, perhaps, getting rid of Provenge is not such a bad idea.
Dendreon is burning close to 100 million dollars per year, with most of the money going to Provenge clinical trials, building manufacturing facilities for Provenge, preparing the sales force for Provenge, etc. Provenge, Provenge, Provenge – everything else seems to be on the back burner. While the company still has cash at the moment, it is running out of it fast. In fact, the money will have to be raised sometime in 2006, before or soon after the launch of Provenge. Dendreon will likely to be starving for cash till 2008 before the money from the Provenge sales may start trickling down. And what if the trickle is very meager? Two-three years from now new cheaper drugs could well outcompete Provenge and reduce it to a fancy expensive drug with limited patient base. There are several competitors that could bring their drugs relatively soon after Provenge hits the market. Prostvac-VF from Therion, GVAX from Cell Genesys (CEGE), and DN-101 from Novacea come to mind. While these drugs are likely to be approved after Provenge, they will most likely be much cheaper to produce because they are not custom-manufactured for each patient. With so many drugs targeting the prostate cancer, the ability of a company to deliver drugs that are competitive price-wise could be the most critical for winning a substantial share of the market.
I would go as far as to suggest that the scenario according to which Provenge is not even able to pay for the cost of its own development is quite likely. At the same time, the cash that Dendreon has now could be used to more speedily pursue highly promising Trp8 inhibitors that are currently in the pre-clinical development. ~130M in cash is large enough to push Trp8 program well into phase II clinical trials. It may be unfortunate that the money will be spent on Provenge, a possible money sink with no meaningful return to the shareholders. DNDN should continue to produce good setup for the short-term trader but it may not be such a great play for the long-term investor.
Tuesday, November 22, 2005
Sunday, November 20, 2005
How soon will we see antagomirs in the clinic? Is Alnylam a Buy?
Are antagomirs the best compounds that could be practical for treating multiple human diseases? Could companies like Alnylam (ALNY) initiate first clinical trials using antagomirs relatively soon? I believe the answers to both questions are yes.
The paper published a couple of days ago by the scientists from Alnylam, the Rockefeller, and NY University (see the abstract below) provides perhaps the most convincing evidence from animal studies that RNAi-related approaches could be practical for treating multiple human diseases. While the experiments were done in mice, there is little doubt that the approach could be tailored to humans. Two points in the paper are critical. First, there is very specific and potent inhibition of the targeted miRNAs. Second, the application of the “drug”, antagomir, delivered via simple intravenous injection, affected most tissues in the animals. Both the amounts of antagomirs introduced and the delivery method (intravenous injection) are likely feasible for humans.
When could the first clinical trials be initiated in humans? Now that there is an antagomir tool to knock down miRNAs, what we need are target miRNAs that could be involved in human diseases. While there are many protein coding genes known or suspected to be involved in various diseases, almost nothing is known about miRNAs in this respect. But, this is going to change were quickly via research in the academia and the industry. There are already examples of miRNAs implicated in cancer. For instance, miRNA let-7 is a suspected tumor suppressor. Knocking out a tumor suppressor won’t stop cancer. So other miRNAs that are required for cancer survival and not cancer suppression are needed. I am sure the research to locate such miRNAs is in high gear already. We will probably see the first clinical trials using antigomirs in the 1-2 years.
Simple calculation shows that the antagomir dose used on mice (80 mg/kg) translates to about 6 g/injection for an adult person. Now, with 6 g/dose what could be the price tag to synthesize compounds like antagomirs? Antagomir synthesis is essentially the same as synthesis of modified RNA oligonucleotides. My estimates are that antagomirs could cost around 1000$/g or 6,000$/dose for humans. So, even if the drug’s effect could last around a month like in mice, the medicine is still pricey. Of course, the price should come down as the scale of the synthesis is increased but I still see the expensive price of synthesis as a potential problem for commercialization of antagomir-base therapies.
Nature. 2005 Oct 30; [Epub ahead of print]
Silencing of microRNAs in vivo with 'antagomirs' Krutzfeldt J, Rajewsky N, Braich R, Rajeev KG,
Tuschl T, Manoharan M, Stoffel M.Laboratory of Metabolic Diseases, The Rockefeller University, 1230 York Avenue,New York, New York 10021, USA.
MicroRNAs (miRNAs) are an abundant class of non-coding RNAs that are believed tobe important in many biological processes through regulation of gene expression.The precise molecular function of miRNAs in mammals is largely unknown and abetter understanding will require loss-of-function studies in vivo. Here we showthat a novel class of chemically engineered oligonucleotides, termed'antagomirs', are efficient and specific silencers of endogenous miRNAs in mice.Intravenous administration of antagomirs against miR-16, miR-122, miR-192 andmiR-194 resulted in a marked reduction of corresponding miRNA levels in liver,lung, kidney, heart, intestine, fat, skin, bone marrow, muscle, ovaries andadrenals. The silencing of endogenous miRNAs by this novel method is specific,efficient and long-lasting. The biological significance of silencing miRNAs withthe use of antagomirs was studied for miR-122, an abundant liver-specific miRNA.Gene expression and bioinformatic analysis of messenger RNA fromantagomir-treated animals revealed that the 3' untranslated regions ofupregulated genes are strongly enriched in miR-122 recognition motifs, whereasdownregulated genes are depleted in these motifs. Analysis of the functionalannotation of downregulated genes specifically predicted that cholesterolbiosynthesis genes would be affected by miR-122, and plasma cholesterolmeasurements showed reduced levels in antagomir-122-treated mice. Our findingsshow that antagomirs are powerful tools to silence specific miRNAs in vivo andmay represent a therapeutic strategy for silencing miRNAs in disease. PMID: 16258535 [PubMed - as supplied by publisher]
The paper published a couple of days ago by the scientists from Alnylam, the Rockefeller, and NY University (see the abstract below) provides perhaps the most convincing evidence from animal studies that RNAi-related approaches could be practical for treating multiple human diseases. While the experiments were done in mice, there is little doubt that the approach could be tailored to humans. Two points in the paper are critical. First, there is very specific and potent inhibition of the targeted miRNAs. Second, the application of the “drug”, antagomir, delivered via simple intravenous injection, affected most tissues in the animals. Both the amounts of antagomirs introduced and the delivery method (intravenous injection) are likely feasible for humans.
When could the first clinical trials be initiated in humans? Now that there is an antagomir tool to knock down miRNAs, what we need are target miRNAs that could be involved in human diseases. While there are many protein coding genes known or suspected to be involved in various diseases, almost nothing is known about miRNAs in this respect. But, this is going to change were quickly via research in the academia and the industry. There are already examples of miRNAs implicated in cancer. For instance, miRNA let-7 is a suspected tumor suppressor. Knocking out a tumor suppressor won’t stop cancer. So other miRNAs that are required for cancer survival and not cancer suppression are needed. I am sure the research to locate such miRNAs is in high gear already. We will probably see the first clinical trials using antigomirs in the 1-2 years.
Simple calculation shows that the antagomir dose used on mice (80 mg/kg) translates to about 6 g/injection for an adult person. Now, with 6 g/dose what could be the price tag to synthesize compounds like antagomirs? Antagomir synthesis is essentially the same as synthesis of modified RNA oligonucleotides. My estimates are that antagomirs could cost around 1000$/g or 6,000$/dose for humans. So, even if the drug’s effect could last around a month like in mice, the medicine is still pricey. Of course, the price should come down as the scale of the synthesis is increased but I still see the expensive price of synthesis as a potential problem for commercialization of antagomir-base therapies.
Nature. 2005 Oct 30; [Epub ahead of print]
Silencing of microRNAs in vivo with 'antagomirs' Krutzfeldt J, Rajewsky N, Braich R, Rajeev KG,
Tuschl T, Manoharan M, Stoffel M.Laboratory of Metabolic Diseases, The Rockefeller University, 1230 York Avenue,New York, New York 10021, USA.
MicroRNAs (miRNAs) are an abundant class of non-coding RNAs that are believed tobe important in many biological processes through regulation of gene expression.The precise molecular function of miRNAs in mammals is largely unknown and abetter understanding will require loss-of-function studies in vivo. Here we showthat a novel class of chemically engineered oligonucleotides, termed'antagomirs', are efficient and specific silencers of endogenous miRNAs in mice.Intravenous administration of antagomirs against miR-16, miR-122, miR-192 andmiR-194 resulted in a marked reduction of corresponding miRNA levels in liver,lung, kidney, heart, intestine, fat, skin, bone marrow, muscle, ovaries andadrenals. The silencing of endogenous miRNAs by this novel method is specific,efficient and long-lasting. The biological significance of silencing miRNAs withthe use of antagomirs was studied for miR-122, an abundant liver-specific miRNA.Gene expression and bioinformatic analysis of messenger RNA fromantagomir-treated animals revealed that the 3' untranslated regions ofupregulated genes are strongly enriched in miR-122 recognition motifs, whereasdownregulated genes are depleted in these motifs. Analysis of the functionalannotation of downregulated genes specifically predicted that cholesterolbiosynthesis genes would be affected by miR-122, and plasma cholesterolmeasurements showed reduced levels in antagomir-122-treated mice. Our findingsshow that antagomirs are powerful tools to silence specific miRNAs in vivo andmay represent a therapeutic strategy for silencing miRNAs in disease. PMID: 16258535 [PubMed - as supplied by publisher]
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