PharmD, EM/CritCare, RCT purist, Biotech analysis & investing

St Louis, MO
Joined November 2017
Thank you Claude for flagging this important governance issue 🤣
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Anyone looked into $LTGO's "high degree of penetration into peripheral nerve tissue" claims. Foot-note doing some heavy lifting here. Onzotrigine is much less potent than suzetrigine, Does the entire claim boil down to lower albumin binding and higher dosing...?
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CC: @phsiao4 Just stumbled across your awesome med-chem account today. Wonder if you've ever looked into Nav1.8 inhibitors? This likely second-to-market and much less potent drug put up better efficacy than journavx (cross trial) and claims better tissue penetration.
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The company's tool molecule appeared to be a state independent inhibitor although no mention for the pipeline candidate. Would make a great thread if it piques your interest.
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STL Biotech retweeted
Replying to @EganPeltan
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STL Biotech retweeted
Here replotted the PK of MRG007 (#ESMO26) vs. AMT-676 (#ESMOGI26) in the same format. Enjoy @JacobPlieth
So for the CDH17 ADC PK nerds (looking at you @MaverickNY @raffcolo ) here's Multitude AMT-676 vs $AVBP MRG007 #ESMO26
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$XBI — the G12D rundown, through biased eyes: $INCY — interesting early data at ESMO over the weekend, and the molecule has promise. Importantly, it is an ON/OFF inhibitor, which is likely a key distinction in G12D where both conformations can play a role in disease maintenance and progression. However, there are questions as to its overall potency, perhaps. $RVMD — zoldonrasib, as an ON only inhibitor faces an uphill battle, and its tox profile could be problematic for combination. Note that company has yet to initiate a combo of zoldonrasib with cetuximab. And also note zoldonrasib efficacy in combo with PRMT $TNGX — perhaps on the low side? Maybe the ON-only nature, along with PK/PD and potency is leaving efficacy on the table. $RHHBY — not enough data to tell, through their G12C perhaps signals that their other allele specific molecules could pass muster… $VSTM — 7375 is ON/OFF, potent, with linear PK/PD and with a differentiated safety profile — little to no rash or stomatitis leading to attractive combo partner with cetuximab. And good initial data in the U.S. and China. $VSTM is my choice. But they will have to get a move on. $xbi
Can someone just tell me who has the Divarasib of G12D? I'm Tired. $INCY $RVMD $RHHBY $VSTM
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Can someone just tell me who has the Divarasib of G12D? I'm Tired. $INCY $RVMD $RHHBY $VSTM
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STL Biotech retweeted
The lack of hype around the ADC race for CRC is surprising. It's by far the largest indication without a clear winner and one where Topo inhibitors (irinotecan) are known to work and used routinely $AVBP $CTMX $MGNX $ABBV
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Took losses IONS ARVN BIOA Took profits on IMVT LNTH acquired In and out of ABVX few times small profits
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Current biotech portfolio, largest to smallest: $GH $RVMD $IDYA $TNGX $CYTK $TYRA $BHVN $KURA & $SNDX $LTGO $CTMX $SLDB WL: $GMAB , $INCY
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🆙#ESMO26 Poster: #LCSM 🔥SHR-4849 (IDE849), an ADC Targeting Delta-Like Ligand 3 (DLL3), in Relapsed Small Cell Lung Carcinoma (SCLC) and Other Neuroendocrine Carcinomas (NECs): Long-Term Results From the Phase 1 Study 🎙️Dr. Haifeng Liu 🔢3815P 🎯SCLC ≥1.8mg/kg: ORR 68.3% (Confirmed 55.4%), DCR 94.1% 🎯Median PFS 6.8mo, 12-Mo OS 64.1% 🎯Brain Mets ORR 76.9% 🎯Other NECs ORR 47.4% (n=122; 8.7-Mo Median Follow-Up) ☑️NCT06443489 🔗 cslide.ctimeetingtech.com/es… @OncoAlert @Larvol @myESMO @IASLC
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STL Biotech retweeted
Between $GMAB, $ZYME, $CORT ( base:0x9bba915f036158582c20b51113b925f243a1a1a1/ $ABBV not to be forgotten as well for paving the way), the list goes on Crazy amount of competition in the ovarian cancer space (but exciting time for patients!)
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STL Biotech retweeted
#ESMO26 is a wrap. A few thoughts. It is a privilege to be an oncologist. To everyone who took the time to meet with me, lend their expertise or mentor me in some way: thank you. I am grateful. Also, to the patients who contributed their time, hope and lives to allow these studies to happen, thank you. This is what allows progress. 1. ESMO absolutely brought incredible advancements. So did China. This was the first global conference where the USA has clearly been dethroned as the de facto biomedical trial leader (5 of the 7 Presidential Symposium late-breakers focused on new drugs were Chinese developed). Chinese patients will be getting access to the latest biomedical advances, first. 2. The molecular era is here for KRAS. Expect it to come to early lines, in every tumor, fast. Expect sexy combos. (I am personally very excited about Genmab + Incyte's LGR5-EGFR + G12D but also think Verastem’s and RevMed’s G12D’s look great.) 3. Some advances look meaningful but are minor. PD1-VEGF beats PD1, but it wasn't compared to PD1 + VEGF. The benefit looks similar to adding bev (duh). 4. Cellular therapy is finally here for solid tumors. Get your systems ready now, it takes years to truly prepare. The 66% response rate for TezR (SL-28) across all-comer solid tumors blew my mind. 5. ADCs will hit CRC/GI quickly, and in a few years there will be many questions about sequencing. Please please please stop using the same payloads. 6. Medical education is more important than ever with how fast the field is moving. If anyone has advice on how @TheGutOncLab can disseminate information better (like the people at @OpenMedicineHQ and @OncoAlert do), please let me know. Here's to next year. Already getting ready for @ASCO GI @TheGutOncLab @Onco_Nexus
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Anyone seen the updated ph1 data for precemtabart tocentecan (Precem-TcT) in mCRC? Was supposed to be presented today #ESMO26 #824P Relevant $ABBV $CTMX
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If $SNDX stays in the low teens, its a no brainer for $INCY, right? Save, what ~300m over next 5 years on Niktimvo. They've got the balance sheet for it, plus Reviforj obviously a fit and would help smooth Jakafi -> povo. Was IPF ever even baked in for SNDX?
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Only reason against i can think of is if they want to use cash for something big, a la gmab-mrus
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STL Biotech retweeted
Not enough people are screaming with excitement about how insanely good these numbers are! 82% ORR, with 100% 9 month PFS in 2 L MTAP del PDAC with ongoing responses at 12 months. Pure insanity! #precisionmedicine 🤌
Encouraging early results from Tango Therapeutics' vopimetostat combinations with daraxonrasib and zoldonrasib in PDAC, particularly the preservation of activity in later-line disease. #ESMO26 Daraxonrasib + vopimetostat: 81.8% confirmed ORR (18/22), including 85.7% (6/7) in 2L and 84.6% (11/13) in 3L, with 100% disease control. Nine-month PFS was estimated at 88.4% overall. Zoldonrasib + vopimetostat: 54.2% confirmed ORR (19/35), including one CR. Impressive early activity, but several questions deserve attention: • Molecular context: Tango directed KRAS G12D patients toward zoldonrasib, while its daraxonrasib PDAC cohort was predominantly G12V/G12R, with no reported G12D. The FDA's exploratory daraxonrasib monotherapy analysis showed ORRs of 50% in G12V, 24% in G12D, and 7% in G12R. How much of the combination activity reflects molecular selection versus complementary PRMT5 inhibition? A response breakdown by mutation would be particularly informative, especially for G12R. • Response maturity and patient accounting: At the August cutoff, daraxonrasib's 18/22 responses included 11 confirmed and seven awaiting confirmation. Tango subsequently confirmed all seven, bringing the confirmed ORR to 81.8%. But what happened to the seven additional treated PDAC patients excluded by the 14-week evaluability rule? Were their outcomes also updated? The confirmed 18/22 corresponds to 62.1% (18/29) using the all-treated denominator. Likewise, zoldonrasib's confirmed 19/35 corresponds to 48.7% (19/39), with four patients outside the efficacy analysis. These are fixed-numerator sensitivity calculations, not formally reported ITT/mITT ORRs. Updating response-confirmation status without providing corresponding follow-up for initially unevaluable patients leaves an important question unanswered. • Phase 3 dose selection: Daraxonrasib's headline 81.8% ORR pools two dose levels, including three efficacy-evaluable patients at the higher vopimetostat dose. Yet the proposed Phase 3 regimen uses the lower dose. What is the confirmed ORR, response durability, and delivered dose intensity specifically at the proposed Phase 3 dose? And how reliably might activity observed predominantly in 2L/3L translate into the planned first-line population? • Baseline fitness: ECOG 0 was 58.6% in the daraxonrasib cohort versus 33.3% with zoldonrasib. How much does this imbalance influence comparisons between the two combinations? • Tolerability,➡️attenuation or redistribution @Aiims1742? PRMT5 inhibition may attenuate certain RAS-inhibitor toxicities through MAPK signaling. But does it genuinely reduce the overall toxicity burden, or merely redistribute it? At the proposed Phase 3 dose, Tango reported no Grade 3 rash, yet 40% Grade 3 treatment-related adverse events overall. Increasing vopimetostat produced three dose-limiting toxicities in two of four patients. Could selective attenuation of RAS-associated rash coexist with additional PRMT5-associated toxicity, without widening the therapeutic window? Matched-exposure comparisons would be particularly informative. The zoldonrasib combination's 38.5% nausea and vomiting rates reinforce the need to assess overall tolerability rather than isolated adverse events. • Pharmacokinetics: Vopimetostat increased zoldonrasib exposure approximately 1.5–2.4-fold. How much of the observed activity reflects complementary biology versus increased inhibitor exposure? • Dose intensity: With substantial interruptions and reductions, what proportion of the planned dose was actually delivered for each component over successive cycles? Were these modifications predominantly front-loaded or cumulative, and did patients maintain adequate exposure over time?
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Well well well… This was certainly my favorite RCC / kidney cancer presentation and heralding a significant shift in the RCC landscape! 45% response in heavily pretreated pts. Highly impressive! Needs to move into frontline combinations! Congrats @montypal + colleagues
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$PFE Wild to me that I spend a ridiculous amount of time looking at a variety of different therapeutic and competitive landscapes to invest in pipeline drugs and Pfizer hardly ever comes up. What are they doing over there
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Which of these ~20B biotechs is most likely to join the lg/mega cap biotech mt Rushmore (GILD, VRTX, AMGN, REGN)
51%$GMAB
8%$BNTX
18%$INCY
22%$ALNY
268 votes • Final results
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