Biotech Values

[rfj1862]

I think this is a far too pessimistic view for oncology investments, and not an accurate characterization of oncology. It sure as hell isn't easy. Yes there are some cancers that are primarily driven by a single gene being over-expressed or inappropriately expressed, like Burkitts lymphoma. However, cancers are usually far more complex with multiple gene drivers then add in heterogeneity within tumors, as well as distributed among the patient population. This heterogeneity arises later in disease progression, largely due to genetic instability providing variations that can drive selection for tumor cells that can evade the immune system and or to treatments.

In my view, genotyping tumors will provide the means for more combination treatments where individual drugs aren't very effective but the combination provides synergistics effect

First, yes I am aware that heterogeneity exists and the impact of clonal evolution under selective pressure.

The key word here is "relatively." And yes, while there are few broad tumor types that have a single driver (like CML), there are many molecularly defined subsets of tumors that are driven predominantly (but perhaps not completely) by a single targetable mutation (ALK, ROS1, EGFR, etc in NSCLC).

But you are making my argument from an investment standpoint for me. Okay so a particular combination will work for the 0.5% x 0.5% of patients who carry both actionable mutations. Do I want to be involved from an investment standpoint in the development of such combinations? No. Great for patients, not great for investments.

I am not arguing at all about the value of precision medicine for patients, I am only making the point that as the molecular pathophysiology of cancers is further dissected, treatments will become increasingly targeted to smaller populations. Either a) the populations become so small that the company will never make money or b) therapies will become so extravagantly expensive that nobody will be able to get them anyway.

This is in contrast to inherently highly polygenic diseases like RA, ulcerative colitis, or multiple sclerosis, where they are so highly variable that precision medicine just doesn't really work yet (and will not for the next several decades). Thus they are still a viable investment because the drugs that come out can treat broad populations. Companies researching diseases of consumption like NASH and obesity also remain highly investable due to the size of these populations and the fact that precision medicine is largely irrelevant in this space, with the exception of the small population of patients with strong genetic drivers of liver disease or obesity.