You know, I was thinking...
Individual checkpoint inhibitor therapies, e.g., Yervoy, Keytruda, Opdivo, etc. individually cost nearly $150,000 per year per patient. These drugs serve as the foundation to most immuno oncology regimens. Combining checkpoint inhibitors to improve efficacy comes with toxicities and obviously higher costs.
If indeed a high proportion of pre-existing partially exhausted TIL correspond with equal efficacy when comparing a monotherapy (anti-pd1) to a combination therapy (anti-CTLA4 and anti-pd1), then it seems apparent that you can achieve desired efficacies with anti-pd1 monotherapies - and potentially save a lot of money - as long as those exhausted TIL phenotypes are elevated. If ONCS is capable of achieving such a goal - i.e. getting to the point where they can increase the exhausted TIL phenotypes - then they may considerably reduce costs by negating the need for combination checkpoint inhibitor therapies. They essentially create the right TME conditions for monotherapy anti-pd1 drugs, for example. Can ONCS electroporate their product for under $150K/per year/per person to demonstrate savings?
Then of course we have the possibility that ONCS may start developing their own gene-encoded checkpoint inhibitors that could be delivered (via electroporation) systemically (e.g. anti-pd1) and intramurally (e.g. anti-CTLA4). It's right there in their patent application claims - this could lead to a significant disruption in the checkpoint inhibitor market and lead to massive savings in health care if they actually do it.
