Biotech Values

[biomaven0]

Well "dead" may be too strong a word, but I'm trying to be practical here.

To make a convincing case for second-line, I think you would need a decent-sized randomized trial against another 2nd-line agent that went out a good few years. Absent that, I just don't see significant 2nd-line use even if one could make a good argument for it based on cross-trial comparisons. (An exception might be if you can do some deep sequencing and show that the other 2nd-line agents would be fruitless - but that is simply not routine practice right now).

Part of the issue is that the harder you look for VTE's the more you will find them, including some non-symptomatic cases. So that makes cross-trial comparisons trickier (and suggests to me that the VTE's for the other 2nd-line drugs are likely under-reported to some degree). The only way to control for that issue is with a randomized trial.

Peter