Replies to post #513165 on NorthWest Biotherapeutics Inc (NWBO)

[meirluc]

Doc, when comparing early to later administration of DCVax-L, one also has to take into consideration the percentage of ndGBM and rGBM patients who are able to live 2-3 years (longer than the average patient) and not base the comparison only on 5 year survival. Another wild card that may favor rGBM patients is the possibility that a certain percentage of those patients can undergo additional treatment with their resected post progression tumor vaccine. Such a vaccine could be a powerful weapon not only because of it's homology to the tumor but also because it is directed against a tumor that is often enriched with hypermutated mesenchymal phenotype components that increase the vulnerability of the tumor to the vaccine.

You are of course right that the nGBM treated population, treated with DCVax-L from the get go, may end up with a much higher fraction of 5 year survivors than the later treated rGBM patients. However, we still don't know that and we therefore have to wait for the JA.

[meirluc]

Doc, here is another puzzle. The November 2018 SNO update estimated that 50 patients will survive at least 58.4 months from surgery. That is equivalent to 55.3 months from randomization. The NYAS presentation's overall survival graph for ndGBM (treatment) patients shows that 25 such patients were alive at both 55 and 60 months from randomization.

While we do have 25 such long living treatment patients, from where do we get the additional 25 long livers? The post progression survival graph of the 64 crossover patients displayed in the May 10 NYAS presentation, suggests that not many crossover patients survived 5 years on trial and few if any such long livers are likely to emerge from the 35 permanent placebos. Even if the November 2018 SNO estimate was based on data collected let's say during March 2018, it is hard to believe that the 5 year survival prediction would exaggerate the number of long livers to such an extent because by March 2018, all the patients were already at least 28 months on trial.

I hope that the JA will clarify the mystery surrounding the number of 5 year survivors and their distribution among the three treatment groups (treatment, crossover, permanent placebos).