Replies to post #44228 on Ariad Pharmaceuticals Inc fka ARIA

[investor maven]

How Drug dosing is set...

The drive for a high initial dose is driven by the Clinicians who as oncologists have been working for years under the premise that the "Maximum Tolerable Dose" is the goal. This is based on how chemotherapy works, where many dangerous and life threatening SAEs are common and expected.Thay also want to see benefit as fast as possible, especially for the patients with the most advanced disease.

With the designed, targeted molecules like the TKI, this is how the dosing was built, from low to higher and higher doses until toxicity was seen and the clinical dose is set below that.

Obviously, the final dose set for Iclusig was based on clinical data showing that 45 mg was safe (as it is for the vast majority of the patients, as evidenced by the data presented at ASH 2013). Some patients probably got higher doses during the early trials and possibly for many this was safe too.

I don’t remember that clotting or CV events were an issue in the Phase I study, so the higher incidence for those rose over time. Remember that the rate of SAE stayed the same, but since the patients lived longer - more events occurred over time.

[zipjet]

Executives are constantly making decisions with incomplete and conflicting information. Doing this skillfully and the willingness to make decisions when others will not, makes a good President or CEO.

Getting some decisions wrong happens to the best of them.

My read (and I am NOT scientifically trained) is that the CV events are a function of cumulative injury over time. IF that injury and the resulting CV events takes LONGER than control of the cancer THEN starting with a higher dose and reducing as the cancer is controlled makes sense to me.

My sense is that this triangulating to an optimal approach is best left to the clinicians and their collective experience.

zip