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Re: DewDiligence post# 4351

Friday, 06/22/2007 12:19:30 AM

Friday, June 22, 2007 12:19:30 AM

Post# of 12660
Program-survival bias refers only to the underlying efficacy per se—not to the clinical-trial design. To reiterate: the efficacy observed in phase-2 programs that end up advancing to phase-3 is biased on the high side relative to the true efficacy of the drugs in question. This bias is either underestimated or not understood by many biotech investors.

That's just another simpleton-ish tautology as it only restates the assertion that phase-2 trials do not predict phase-3 trials well without any explanation of the cause.

Below is an old article that you likely got the idea of "program-survival bias" from:

http://www.oncolink.org/conferences/article.cfm?c=3&s=26&ss=155&id=1082

Two pertinent points: (1) most phase-2's are not randomized and (2) most phase-2's are small. (1) means selection bias or special treatment can come into play while (2) means imbalances are rampant (perhaps partially due to 1). So any observation from phase-2's would/should be questionable. The article then concluded that "A careful analysis of P2Ts is crucial prior to designing RCTs and future P2Ts should include adequate number of patients. Additionally, randomized P2Ts may provide a more efficient trial design."

Both D9901 and D9902a were randomized trials with smallish but good size. They would be good predictors of how D9902b will turn out. So to say "Actually, DNDN did run a couple of phase-2 trials in HRPC: 9901 and 9902a." (post 4327) to apply the result of most phase-3's failing to replicate phase-2's efficacy observation to conclude that D9902b would likely fail shows either a lack of rigorous thinking or worse, rigorous and deceptive thinking.


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