Replies to post #260720 on NorthWest Biotherapeutics Inc (NWBO)

[Doc logic]

Umibe5690,

I agree with all that you said but flipper44 and I are basing our opinions on what we have seen from multiple sources of longer term research and the intent of this protocol. I do believe that an upgraded version of L is now able to confer benefit to rGBM patients but that this is being seen outside of the context of this trial. The L trial design really did put a lid on potential benefit from crossover because of the 3 month period to do so and the 2 month gap between most scans. That would leave up to 5 months for a progressing tumor to develop before treatment. Any slight enlargement noted would be monitored closely but less than 25% from one scan to another was not counted as progression so my guess is that the average amount of time for true progression to have occurred before crossover on average was expected to be about 3 months. On the other hand, if I was a patient I would have wanted immediate access to the treatment and would have asked for the earliest possible chance to get it by looking my doctor right in the eye and expressing my position. In other words, I would want any borderline scan (subjective call) to be called progression to know I was getting the treatment ASAP. I would expect some clinicians would be more than willing to be understanding about that to decrease the lag time. From the gist of earlier discussions about reading scans by our resident radiologists and other Drs. I would guess there is some leeway for interpretation. How much, I do not know. If this is a realistic possibility as a breakaway from absolute strictest intetpretation of protocol because of clinician choice then there might have also been a little more benefit seen in some crossover patients from both treatment and SOC/placebo in this trial especially if clinicians are convinced that the treatment is working. This is another reason I can not ascribe a zero benefit to crossover but I didn't mention it because I do not know how realistic this possibility is and join flipper44 with the understanding of the "intent" of the protocol. Best wishes.