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I agree Ophidian, the potential is there, the question is, what price will it be retail, what will the discounted price be, and how many cycles will NICE allow before adding a cap. A lot will depend on the tail of that curve too.
agree- I think what will be very interesting is the how avacta will price their molecules and where they drop the price in discussions and how much of a knock on effect this will have on their other indications. Its all very exciting for people like me to sit here and think about lol
without this BB turning into a cesspit again, in regards to health economics, NICE usually require the ICER to be less than £50k for indications that meet "end of life criteria" which will be a lot of the indications which avacta will apply for a license for (dependant on what is SOC at the time and what our efficacy data is). If the indication doesn't meet end of life criteria, the ICER is lowered to £30k. These ICER's are not easy to reach, countless modelling needs to occur to extrapolate the OS and PFS data. There are many unasnwered questions, will there be a 2 year stopping rule? can you be rechallenged with IO's in the 2L setting, how much uncertainty is there around the endpoints? could we apply for a PIM and then EAMS to create some RWE?
As I said, lets stay grounded, we are worrying about things 5 years down the line here.
I think you are missing my point. It doesn't matter what the government does, this is based on data and cost effectivness. Big pharma companies have many many new molecules arriving and these are the molecules avacta will be competing with. We don't know the efficacy or safety of many of them, nor do we know it for avacta in a proper phase 2 or phase 3 study. The other issue is cost effectiveness which is extremeley nuanced in oncology.
Half the game is getting a license, the other massive hurdle is getting reimbursment (for the UK anyway). I am an avacta holder and have been for years, I just don't want people getting ahead of themselves. Lets see how things unfold with our fingers crossed.
People are getting far too excited here and jumping to PD-L1 inbhibitors. The treatment paradigm isn't so simple. PD1/PDL1 monotherapies are the foundation for treatment in many metastatic areas with PD1/PDL1+chemo combinations slowly becoming the new standard of care. The theory being, chemotherapy works quickly to destroy tumour cells, releases tumour associated antigens which can then be recognised by the immune system to create T-cells and the PD1/PDL1 pathway can kick in to increase T cell killing potential in the tumour types which are abudandt in PD-L1 expression. There are also IO/IO combinations e.g. PD-L1 + CTLA4 inhibitors and PD-L1 plus VEGF inhibitors i.e. in HCC.
The next step, is a plethora of new molecules including personalised cancer vaccines, T-cell bi specifics, antibody drug conjugates with anti-TIGIT molecules being the first. As well as this, immunotherapy is moving further back in the treatment pathway, from metastatic to adjuvant and then neoadjuvant.
My point is, it will take a LOT for avacta to change the game here and shape the market and this is many many years away. By all means, it could happen, but a LOT has to go right for even one molecule to go from Phase 1 to 3, attain an MHRA license (and FDA and EMA) and then gain NHS reimbursment.
Oncology is a lot more nuanced.
I think we will get something in Feb, March at the latest. As I have mentioned a few times, selfishly, I would love the SP to dip to add more. I honestly don't think we will get another opportunity like this for a long time, at least not with such a low risk level, so the more that I can add at good prices, the better.
For once in my life I am going to try and trade this. Just sold half and will buy back when it dips to add a few more shares. We still have a good 3 months before we get the data (the RNS on recruitment being finalised is irrelevant to me as we know it will be finalised) so i don't anticipate any strong drivers for the SP until then. Lets see if it pays off!
its definitely not a rotten end to the day. As I mentioned before, there was no way SJ was going to mention us today, he will in Jan/Feb though and that is all that matters. I still expect the SP to hover around the 150-170 mark until then. We are completely de-risked here, I cannot remember a time where I was this confident on PIII results and todays new cemented that further.
My advice, keep adding on any dips and reap the rewards Q1 next year.