NorthWest Biotherapeutics Inc (NWBO)

[froggmister]

Ex likes to throw out the resection imbalance theory to explain the DCVax-L advantage in the trial vs ECAs, but that's built on some fuzzy assumptions.

How close is the -L trial population to the the near total resection population? One would assume very close as they had intent for near total resection.

The Musella podcast seems to say this is not the case. One of the subgroup analysis pieces she discusses is residual disease; if they were successful in recruiting 331 patients with near total resection this subgroup analysis would have been impossible. In addition, the data she presented is that DCVAX-L did very well with greater residual disease, and she gives a hypothesis for why that might be the case. Unfortunately the slides are not available from that presentation.

There is actually a greater survival advantage in patients with significant residual disease (SRD) compared to minimal residual disease (MRD). As a surgeon we always taught and we thought that taking out as much of the tumor as possible leads to a better prognosis, and that still is the case; you see in the MRD group that survival is still longer than the survival in the SRD cohort, but the relative survival advantage is greater in this group. What this kind of suggests is that perhaps…one thing that dendritic cell vaccination that we know it does is that it gets T-cells into the tumors, and perhaps in order to have a more diverse repertoire of antigen presentation in epitope spreading, there may need to be some residual tumor still there so T-cells that are still there, once they get into the tumor and get activated there may need to be residual tumor there to enhance the immune response and promote epitope spreading.