I appreciate the detailed summary of the allogenic CAR-T landscape. I was not aware that Allogene was so far along. I will have to look more closely at them. It seems to me that CRSP and NKTX are at similar stages as DTIL with the first gene tech and I think the stealth cell technology for Prcision has promise that may leap frog the first generation allogenic therapies. I like DTIL relative to them both regarding the CAR-T platform, but you are more knowledgeable here and I would appreciate your opinion.
Although, my primary interest in DTIL is their gene editing platform which I believe is superior to CRSPR technology. I need to read more thoroughly the literature on NHP use of CRSPR, but my first pass leads me to believe that off target affects will always be a hurdle with the use of CRSPR to edit genes in vivo for large animals , and especially humans. It is one thing to create animal models of disease and quite another to treat disease without serious safety risk suitable for humans. I don’t consider their hemoglobinopathy programs to be in vivo editing as they are editing stem cells ex vivo and reintroducing them to the patient. This isn’t too dissimilar to the CAR-T approach. I do think DTIL should challenge them in that space, but they would be playing catch up and would need to differentiate in some way to capture significant market share, not being first to market. These diseases likely will not command the market size that the other programs will IMO. We shall see how the current treatments being launched and late stage development programs do commercially. Perhaps, I am wrong and biased but I think these diseases will not produce blockbuster or near blockbuster revenue. The payer mix here is mostly government.
Muscular Dystrophies are a different story., as are mitochondrial diseases. There are high cost treatments in some MDs and SMA has been quite lucrative. DMD has been handicapped by therapies without demonstrated efficacy that charge very, very high prices and target small subsets of the disease. The high prices, however, are a good thing when looking to price a one and done technology. Beyond these diseases you start to look at things that are not rare or ultra-rare. That could capture crazy big revenue for multiple diseases. This is why I believe DTIL is significantly undervalued. Eli Lilly’s move to me validates my thinking. The future royalties for the six diseases is on top of sales, not profits which to me could mean significant revenue. There are many more targets available beyond these six. That gets me excited about the potential here. The other CAR-T companies don’t have this.
To me CAR-T is the fuel, but gene editing is the rocket. Appreciate your feedback. Thanks,
Dendream
