Ariad Pharmaceuticals Inc fka ARIA

[NP1986]

The bigger long-term "threat" - although it would be a very good thing indeed for patients - is that someone figures out a way to combine a TKI (likely ponatinib) with something else and allows patients to go off therapy for extended periods.

They are already testing whether it is "safe" to discontinue Gleevec in patients who achieve a CMR - it is a study being conducted by a French co-operative group, from what I recall. I think if the long-term results show no significant detriment, this strategy could gain traction and it is likely that 2nd and 3rd generation TKIs will be favored over Gleevec. Like you said, it could represent a short-term upside for ponatinib but in the long term would limit the market size.

I think combination treatments are possible, but safety and tolerability are probably going to be a significant barrier to overcome, especially for chronic phase patients. I think we are more likely to see them first being used in refractory patients rather than upfront as a potentially curative treatment.