A mere 20-25% improvement in survival in this patient population is not going to get clinicians hugely excited

That same survival improvement (26%) was enough to get oncologists so hot about Taxotere that they've tried to launch literally dozens of new trials to push the drug into earlier-stage patients. Taxotere PCa sales have underwhelmed because patients refuse to take it due to side effects. Hell, even Maha Hussein said the side effect profile is so concerning that she believe it is OK to refer Taxotere-naive patients to clinical trials instead of giving them Taxotere. I've spoken with more than a few docs are uncomfortable with Taxotere's 2% kill rate. I know only a handful that will give Taxotere to an asymptomatic patient unless the patient insists. Urologists largely will not prescribe Taxotere because they don't have the facilities to handle the side effects.

Provenge has no such barriers to adoption by patients. It has no side effects that last longer than a couple of days. It doesn't submit the patients to the disruption caused by losing one of every three weeks for over seven months like Taxotere does. Urologists will prescribe Provenge in droves.

As far as the "bother", all the hassle in on Dendreon's side. Patients certainly have no more hassle than with chemo or any other IV cancer drug -- less because they get a total of six doctor visits for the drug in their lifetime. Those visits are likely boring, sure.

Docs using Provenge will have a slightly more strict scheduling requirement than they are used to, but otherwise they just tell the patient where to show up and when. The contract apheresis centers have all the logistics figured out on the outbound, Dendreon has it all figured out in Jersey, doctors just hook up the IV after the inbound, and FedEx has got it handled in between.

I acknowledge the drug SOUNDS different enough that salespeople will have to do a good job educating docs that it isn't the nightmare they've heard about with fully autologous immunotherapies. Adoption won't be instant. Those thinking that Provenge will sell a billion in the first year or even the second year are dreaming. Once docs have been through it a few times, it will seem as natural as any other oncology drug.