Reflection - down, but definitely not out.4 Sep 2023 19:08
So have been away with work today and playing catch-up on things. I note the negative reaction to this but wanted to provide some balance. Cards on the table, my holdings have not changed and I'm happy to sit tight.
A few things that sprung to mind. Patients on this trial are at the end of their journey, many will have exhausted all other options. As such, their tumours are heterogeneous mixes, with many different lineages. What we may have seen is a response in some cell lineages but not in others. Hence the quoted reduction in tumour bulk. This means that what hasn't responded to Modi-1 remains within the patient and then has an opportunity to grow again.
I think many people fail to realise this and think that a tumour is a single cell type (in many cases this is true with easy to treat tumours or for other diseases at an earlier stage). The more difficult to treat or the later stage tumours are, the more likely they are mixes of different subpopulations which react differently to treatment.
This is where the biopsy/resection group should help answer some of these questions. Is there a subpopulation of cells which respond well to Modi-1. If so, what is it? What biomarkers can be identified on that population? Phase 1 of the modi trial is predominantly about safety and understanding the drug. Phase 2 onwards would be honing the patient population who will most benefit from the drug.
Furthermore, as mentioned earlier, these patients have exhausted many treatments. They have gone through round upon round of chemo/immuno. All of which will have put selective pressures on the cells and basically selected for the most difficult to kill lineages. These are genetically unstable populations where the cancer is basically using every tool possible to survive. If Modi-1 trial shows that the treatment is safe and tolerated well with patients. Then there is nothing to say moving forward Scancell opt to go into earlier stage patient populations. Still in these difficult to treat cancers, but where the patient hasn't been through so much beforehand.
I would say on balance, whilst this is a setback. We're not down and out and we're really only at the beginning. As data flows in, we understand more about the drug in humans and how it is working and can tailor trials/patient populations accordingly.
Yes it's sad, but it is part and parcel of pharma research unfortunately.
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