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“This Tiny, Unknown Biotech is About to Unleash Its ‘Holy Grail’ Drug”

Biotech Supertrader teases that "This May be the Most Radical Advance in Medicine in the Last 100 Years"

By Travis Johnson, Stock Gumshoe, January 8, 2014

Robert Morris is helming a biotech-focused stock newsletter that’s called Biotech Supertrader (modesty has no place in the world of newsletter promotions, of course), and I’ve never covered this letter before so I thought I ought to have a look at the latest teaser we’ve been asked about.

Morris, incidentally, has been featured in our pages before — but that was back when he was editor of China Stock Insider at the same publisher. That letter, like almost all China-focused investment newsletters, seems to have disappeared quietly into that good night … which probably tells you that it’s time to invest in China again, since the newsletter publishers are ignoring the Middle Kingdom and rushing out their pitches about biotech and tech stocks. At the time, Morris was teasing NQ Mobile (NQ), which has turned out to be pretty good if you bought it down there in the $6-8 neighborhood (though it’s been a wild ride).

So now what’s he pitching for his Biotech Supertrader?

Well, the destruction of “Man’s deadliest disease”, of course. Here’s how the teaser gets our attention:

“This Tiny, Unknown Biotech is About to Unleash Its ‘Holy Grail’ Drug on Man’s Deadliest Disease

“Their ‘Guided Missile Approach’ Could Save Thousands of Lives Each Year

“It’s about to become the most talked about advancement in cancer treatment in our lifetimes and you can lock in a life-transforming fortune if you act quickly….

“I’m urging my subscribers to load up on this stock NOW….

“I’ve just uncovered a tiny, unknown biotechnology company with a new cancer drug in phase 3 clinical trials which is showing remarkable success at treating several types of cancer.

“Their scientists have found an innovative approach to cancer care which involves a breakthrough in treatment. It goes deep inside the inner workings of our cells.

“Plus, this medicine looks to be many times more effective and with fewer side effects than the chemo, radiation, and drug therapies currently available.”

If there’s one thing that investors know can make them rich and make them feel good about themselves and the world, it’s a cure for cancer — we’ve seen that effective cancer treatments can and do (occasionally) turn little biotech stocks into gigantic successes, so the dream lives on that you’re going to catch one of these lottery tickets and own the next Genentech. Will we be so lucky? Well, let’s see which one he’s pitching:

“When this drug wins FDA approval – which I believe it will – this small company’s $4.16 stock price will go straight to the moon.

“And the market for this drug is absolutely huge!

“You see, this small biotech is targeting its new drug, let’s call it ‘drug S’, at cancers of the blood and bone marrow. And it is already in very promising phase 3 trials for these two types of cancer.

“But here’s where it gets really interesting. It looks like the drug this company is developing will also work on other types of cancer!

“There are positive signs it works on Non-Small Cell Lung Cancer (NSCLC) too. There are 1.1 million people with this type of malignancy. Just in the United States alone there are over 300,000 patients with this disease according to The American Cancer Society. Each desperate for a cure.

“Plus it looks like ‘drug S’ may turn out to be an effective treatment for ovarian Cancer. There are more than 204,000 new cases of ovarian cancer diagnosed worldwide each year with 22,280 of these in the United States according to the National Cancer Institute estimates.”

So … who is it? Thinkolator sez this is Cyclacel Pharmaceuticals (CYCC)

Cyclacel is indeed a little biotech around $4 (it closed at $4.35 yesterday), with a market capitalization of only about $80 million — so be careful, we’re a big enough group here that if just a small percentage of Stock Gumshoe readers got enthused about this stock it could drive the shares up, less than a million dollars worth of shares trade each day (Biotech Supertrader says they limited their readership to 750 people — I don’t know if that’s still their cap or if they’ve hit it, but we’ll have more folks than that reading this free article).

And like many biotech stocks, it’s got some impressive scientists and it’s been losing money for a long time as they’ve been searching for a viable drug (their current lead drug also was a big focus of theirs back when it was in Phase 1 trials five or more years ago, so that’s a good reminder of the time these things take, it’s just starting Phase 3 trials now). It looks like they must have gone public in 2004, when they were about eight years old, and a quick scan of ten years of their financials over at Morningstar indicates that they’ve never generated more than a token amount of revenue (meaning, they’ve probably had some research collaboration payments or partnership funding, but never got a product to market), and have accumulated more than $250 million in losses to date. And had two reverse splits to keep the price from sinking far into penny territory.

So that’s not unusual, but it means that — as with all developmental-stage biotechs — it’s not about the financials or the fundamentals, it’s about what’s going to happen in their clinical trials and whether things are going well enough that they can continue to finance the trials … which get much more expensive as you progress through Phase 2 and Phase 3.

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All I know about them so far is that they say they’ve got enough cash to get through enrollment in their key Phase 3 study for “drug S” (which is sapacitabine) as of September when they last updated their investor presentation, but I know nothing about the science or the competing cancer drugs that are out there or how fabulous this particular one might be, so I asked our favorite medical writer, Doc Gumshoe (who, yes, is not a doctor) to check them out quickly and chime in. Here’s what he could share after looking into them for a few minutes (he’s just looking at the medical stuff, not so much the “investor presentations”):

    Cyclacel’s Prospects

    Cyclacel has three drugs in development at this time, and is involved in eight clinical trials with these drugs, not including two clinical trials that have been terminated. Their top contender is sapacitabine which targets the division of cancer cells. If you can prevent cancer cells from dividing and reproducing, you have the cancer whipped, so targeting cancer cell division (or mitosis, which is the technical term) is a highly promising avenue for treating cancer. However, we need to take note of the fact that sapacitabine is one of a large number of drugs that propose to fight cancer by this method.

    At present, all eight of Cyclacel’s clinical trials involve sapacitabine. Of these, at least one has been completed – a Phase 1 study of the safety and pharmacology of the drug. Four others are current, with no information about results. These are likely Phase 1 or small Phase 2 studies, to assess safety, determine what a correct dose might be, and evaluate whether the drug does what it’s supposed to do in human subjects with the target diseases, which in this case include acute myeloid leukemia (AML), cutaneous T-cell lymphoma, and some advanced solid tumors. Prior to the clinical trials, sapacitabine has demonstrated impressive results in delaying the spread of metastatic liver cancers in mice.

    From what I can gather from public sources (i.e., the NIH Clinical Trials Registry), there is one Phase 3 trial, which started recruiting patients in February of 2013 and is expected to be completed in late 2015. The trial is in elderly patients with AML, and compares alternating cycles of sapacitabine and decitabine with decitabine alone. Decitabine (Dacogen) is FDA-approved for treating AML and also targets cancer cells’ replication by attacking their DNA.

    It is possible that the Phase 3 trial by itself could lead to FDA approval for sapacitabine, depending on the strength of the results. However, that trial would not get the drug approved for use as monotherapy, since it is not being investigated as monotherapy. My guess is that Cyclacel is planning more trials of sapacitabine as monotherapy, perhaps in younger patients. And my further guess is that FDA approval is still quite a long way off.

    Sapacitabine is also in a Phase 3 trial with cyclophosphamide and rituximab for the treatment of relapsed chronic lymphocytic leukemia. Cyclophosphamide (marketed under several trade names) is a well-established chemotherapy agent used in a number of cancers, and has led to remission in many cases; however, it is associated with truly harrowing adverse effects. Rituximab (Rituxan, Genentech) is used not only in cancers but in some autoimmune diseases. And sapacitabine is also being studied in patients with previously-treated non-small-cell lung cancers.

    Although the piece from Biotech Supertrader said that the drug – identified as “drug S” –is also a promising treatment for ovarian cancer, I find no clue that it is being studied in such patients. [ed note: that’s because that “promise” is in the lab still, not in people — they had a press release about this in the Fall, “75% of Ovarian Cancer Patient Samples Highly Sensitive to Sapacitabine”, not studied in patients but on patient samples]

    Cyclacel has two other drugs in development: selicilib and a drug designated as CYC116. One selicilib study has been terminated, and in a second Phase 1 study, selicilib is used with sapacitabine in patients with advanced solid tumors. Remember, however, that Phase 1 studies are many rungs of the ladder below what’s needed to gain FDA approval.

    CYC116 is an aurora kinase inhibitor, meaning that it blocks the action of an intracellular enzyme that facilitates cancer cell mitosis. This is a promising avenue of cancer treatment, however, the traffic on this avenue is fairly heavy, and includes several other classes of drugs including tyrosine kinase inhibitors, and taxol based agents such as paclitaxel (Taxol, Bristol Myers Squibb); docetaxel (Taxotere, Sanofi-Aventis), Abraxane (a newer formulation of paclitaxel from Celgene) and others.

    CYC116 supposedly also inhibits vascular endothelial growth factor (VEGF), which induces the growth of blood vessels that nourish cancer cells. Inhibiting VEGF is a well-established means of combating cancer, and CYC116 could hardly be characterized as a radically new departure in cancer treatment.

    The one trial involving this agent has been terminated. That, of course, does not mean that development of CYC116 stops dead in its tracks – there are many reasons why a trial can be terminated, and ours is not to speculate without more information.

    Beyond those three drugs, it’s hard to guess what Cyclacel may have up its corporate sleeve. It is certainly true that a successful cancer drug – even if only moderately successful– can be transformational for the biotech that develops the drug. But the drugs that Cyclacel has under development do not appear to this skeptical observer to be radically new departures in cancer treatment.

    It’s important to remember, when trying to estimate the likelihood of a single drug demonstrating sufficient efficacy and safety to gain FDA approval and market share, that the competitive field is vast. As I mentioned earlier, Cyclacel has a total of 8 clinical trials in process at this time.

    For the sake of perspective, it’s worth knowing that at present there are 41,445 cancer trials being conducted. So those are the odds.

So there you have it — it’s almost impossible to find a development-stage biotech whose financials look great or that makes your heart go pit-a-pat over their valuation, especially in a biotech bull market like we’ve seen over the past year or so, and Cyclacel doesn’t jump out as spectacular on that front either, not unless you’re a big believer in the promise of their specific drug. They’re a small stock and they don’t get much attention, other than from the analysts who probably helped them sell shares in secondary offerings in recent years, and there aren’t any major “skin in the game” insiders as far as I can tell (the CEO owns $1 million worth of shares, but he gets paid more than that every year), and there’s only one really focused owner on the institutional side that seems to have any kind of biotech focus (Eastern Capital owns about 7% of the shares, roughly $5 million worth … don’t know much about them).

So I don’t see a lot to make them stand out other than Robert Morris’ apparent enthusiasm for the shares (which certainly goes over the top, he calls his special report “The End of Cancer Worries Forever“), and I don’t know enough about the science to be a believer (though, to be fair, I almost never speculate on developmental biotechs because they’re so hit-driven and I’m not smart enough to be a hit-picker in the sector). It is at least encouraging that they are enrolling patients for Phase 3, and that they probably won’t have to raise more money before they have some indication of how the trial is going, but sometime in the next year or two they’re probably going to have to either get good results from this trial that let them raise cash at a good price, or have promising enough results that some big pharma company wants to jump in and help fund development of “drug S” (or just buy up the whole company, as happens with some regularity when a little biotech gets promising results).

Oh, and they are presenting at an investor conference next week, so maybe they’ll have something interesting to share then. As you can tell, this one doesn’t jump into my cup of tea … but these kinds of stocks almost never do. Sound interesting to you? Interested in the science or the lottery-ticket possibilities of $80-million developmental biotechs? Have any experience with Robert Morris or know whether or not we should consider him a biotech savant? Let us know with a comment below.

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karmaswimswami
February 5, 2014 11:29 am

Thanks Siva, for the paper. David Suhy of Benitec, one of the co-authors, had mentioned last fall it was coming out. Certainly its findings are consistent with an anticipation that TT-034 will work in humans.

When HCV began rolling into the clinics in the late 90’s, everybody noticed that the inflammatory activity was portal. The liever is a system of portal triads (hepartic arteriole, portal venule and bile ductule) surrounded by central veins. And vice versa. Each central vein is surrounded by portal triads, each portal triad is surrounded by central veins. And yet the damage, the lymphoid aggregates, the incipient scarring emergence from the portal tract. What this is telling us, I feel, is that the virus like that multi-cellular environment in the portal area….it can go from hepatocyte to cholangiocyte to endothelium and back.

What George posted is true. How this will all wash out as regards how much TT-034 gets into a given cell versus how many genome copies are there, is not known. But HCV only infects a minority of hepatocytes, no more than 15 per cent. TT-034 is anticipated to get to all hepatocytes. HCV does live in (a minority of) all liver cells. Liver cells is not the same as hepatocytes; it is hepatocytes plus cholangiocytes, macrophages, stellate cells, sinuisoidal lining cells, intrahepatic lymphs. It has been shown but not yet published that TT-034 transduced hepatocytes shed exosomes with inhibiting RNA. So what I am saying is that an equilibirum will set in, and cells using up their shRNA will get more of it as shed exosomes from neighboring cells fuse with them.

karmaswimswami
February 5, 2014 11:35 am

I wish I had pushed Novo Nordisk (NVO) harder. In a down market, it has kept going up and is hitting new highs today on news of a patch-deliverable form of one of its incretin mimetics (GLP-1 receptor agonists). These have heretofore needed injection, and some people are appalled by the idea of injections. It is good news. This company controls the diabetes market, and will continue to do so. If you believe diabetes is a problem and a growing one (and it really is), you may want to be long NVO. The best pharmaceutical protein chemists on earth. I don’t know why insiders aren’t reported as buying, but the company is in Copenhagen. Maybe the reporting mechanism for insider transactions is different. Does anyone know?

I love this company and am glad to own shares.

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karmaswimswami
February 5, 2014 12:16 pm
Reply to  karmaswimswami

I meant also to point out that while this is a global/multinational $109 billion company that controls the markets for insulin, incretin mimetics, and hemophilia drugs. It is still only 7.9 per cent owned by institutions. That is bound to change. More and more type II diabetic patients will be put on incretin mimetics (exenatide, liraglutide, semaglutide) as these cause significant weight loss. NVO has a huge pipeline, and its anti-IL-21 monoclonal antibody for lupus looks appealing.I have great expectations here.

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Alan Harris
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Alan Harris
February 5, 2014 12:57 pm

So its still a buy @ £40.89?

Alan Harris
Guest
Alan Harris
February 5, 2014 12:59 pm
Reply to  Alan Harris

Sorry, Ill re-phrase that…… so would YOU still be tempted to buy at £40.89. Of course, what I do is my responsibility.

sivapann
Member
sivapann
February 5, 2014 1:04 pm

FDA approves swallowable ‘PillCam’ after almost a decade (video):

The pillcam is used for doing colonoscopy
You probably know that Covidien acquired Given Imaging’s Pillcam a few weeks ago.

http://www.engadget.com/2014/02/04/fda-approves-pillcam-colon-colonoscopy

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Alan Harris
Guest
Alan Harris
February 5, 2014 1:13 pm
Reply to  sivapann

Do they throw in a free Rachel Welch? I Buy!!

Alan Harris
Guest
Alan Harris
February 5, 2014 1:17 pm
Reply to  Alan Harris

There again, she might block my plumbing……….£100 call out charge? I think I better think it out again.

Alan Harris
Guest
Alan Harris
February 5, 2014 1:20 pm
Reply to  Alan Harris

OMG…Ive suddenly developed a hat by my name ! What does this mean?

David B.
Member
February 5, 2014 2:38 pm
Reply to  Alan Harris

A magnifying glass and then a hat Alan. If your hairline is like mine, perhaps they were searching for follicles, gave up and donated a hat to you. Either that or you’re being monitored by the U. S. government (but who isn’t!).

Roblites
Roblites
February 5, 2014 1:06 pm

Thinking of buying some calls. More news out this March. What do you think Dr.KSS?
“The $297 million market capped development stage bio tech firm Achillion
Pharmaceuticals, Inc. (NASDAQ:ACHN) reported in Mid-January, that it has positive updates from its evaluator tests of patented compounds which it has developed as potential cures for hepatitis C (HCV). On the back of strong and positive results emanating from the test data, the New Haven based drug maker has also released a reworked milestone for developing the target drug in 2014.”

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David B.
Member
February 5, 2014 1:30 pm
Reply to  Roblites

It looks as if much of big pharma is investing considerably in immunotherapy. This field holds great promise. Dr. KSS or others, do you have some favorite companies poised to profit in this area? Personally, I love Xencor, but would like to know others thoughts.

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sivapann
Member
sivapann
February 5, 2014 2:05 pm

Thanks George and Dr KSS for your insights on the latest Benitec abstract. I also noticed that there were a few Pfizer authors referred in the abstract,. Does that mean that they are still involved and engaged in this trial?

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George
Member
George
February 5, 2014 3:41 pm
Reply to  sivapann

I would make no such assumption.
The Pfizer authors are in research and not development. The site they were at also closed and I do not believe the authors I know are still at the company. It is common to write the papers as/after you leave a company life Pfizer. That said, any ongoing activity would be with other people in Conn.

ockrazor
ockrazor
February 5, 2014 2:42 pm

Have you guys been watching EXAS.

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karmaswimswami
February 5, 2014 2:43 pm

Roblites: I really would not buy calls in Achillion. In fact, I might even buy puts. While other companies are getting their agents FDA approved and to market, Achillion’s agents are not even in phase III yet! This company has had horrible execution.

The “cure” oral regimens for HCV will consist of an NS5a inhibitor, and NS5 b inhibitor, +/- NS3/4 (proteinase) inhibitor, +/- ribavirin. My feeling is that first of all, the proteinase inhibitor class if full, even over. Achillion has a PI still in phase 1. What are they thinking? Right now I see no evidence that PI’s are even necessary. Its NS5a and NS5b inhibitors will be strictly me-too. They will not prove to have efficacy superior to other agents. I do not know what Achillion has been doing, why they have sat on their thumbs in all of this, but by the time they get their agents to market (2018 at the earliest), hundreds of thousands of people will have been cured, and physicians will be accustomed to drugs they are already giving. Achillion didn’t merely blink in this race. They have had their eyes closed. The FDA halted development of its only named agent, the PI sovaprevir. Aside from these HCV drugs this company has nothing in development. I predict short interest will grow from here. It is a grossly overvalued company with its farthest along agents not even through phase II yet.

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Roblites
Roblites
February 5, 2014 2:52 pm

David, I think the buzz in immunotherapy is “immuno-oncology” or antibody based cancer immunotherapy. I hold French firm, Innate Pharma SA., US over the counter IPHYF, which is working with NVO , Dr. KSS’s favorite ( scroll up a bit ) and Bristol-Myers. The IMUC, NWBO, DNDN, CLDX,Etc. apparoach is waining.

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karmaswimswami
February 5, 2014 3:09 pm

Roblites: IPHYF intrigues me really a lot. What interests me most is the anti-MICA antibody. MICA is a protein shed by many solid tumors in exosomes. When MICA binds to its receptor on natural killer lymphocytes, those lymphocytes lose their cytotoxicity. An anti-MICA antibody would mop up the MICA and allow NK-mediated injury to tumors. This could have critical relevance for restoring immune function against tumors, and appeals to me so much more than the leukapheresis/GMCSF/shake-and-bake recipes of GALE, DNDN and others. I will look further into it.

arch1
February 5, 2014 3:14 pm

Travis I think you follow this thread so I ask is any way to preserve it as ideal of what thread
should be. With guidance of DR.KSS it continues to inform tho long-running at least as it seems to me as “newbie”. Most threads I have tried to follow for some small info
(not GS) soon degenerate into much heat & noise devoid of light. Also more excrement
thrown than monkey cage in zoo. I am in process of going back to beginning & read
what I have missed . Brilliance,humor & ability to ask right questions on part of Gumshoes
(Irregulars?) is really astounding to me. I am not easily impressed as a rule.

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gummydave
gummydave
February 5, 2014 3:43 pm

Excellent point Frank. It’s so refreshing to have such a long thread without it descending into name calling or politics. Congratulations to all for keeping it flowing!
And as for Dr Karma’s unbelievable knowledge and generosity, I’m beginning to suspect we’re taking part in a trial run of IBM’s healthcare supercomputer 🙂

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karmaswimswami
February 5, 2014 3:49 pm

I agree with and like what Frank said. Things are very good here. So many companies under consideration, a high level of discussion, and people getting along and treating each other as they should, which is most important of all. And Alan, in reply to what you said earlier, I do have time to write a column if that is desired. It is a nice group of folks who are bright and eager to learn, and I think it would be worthwhile to devote more column inches to specific topics, like virus hepatitis, what it does, how it is treated; like the ins and out and pathways in diabetes; like the immune system and how it works (and doesn’t work) in cancer. If people learn about physiology and medicine, they will be able to make better investing decisions. Many of the topics we discuss really are challenging for a layperson to learn without some assistance, but materia medica can be made accessible.

Frank is quite right about other forums and bulletin boards. Post something intelligent on Seeking Alpha that calls a company into question, and in 60 seconds there are 10 angry longs whose ox you have gored and who are prepared to hurl profanity at you, insult you, and degrade you. Nobody there wants to learn. They want their biases confirmed and their cognitive distortions embraced. It is an environment so rabid that every page has bloggers who need to be blowdarted with Thorazine. 90 per cent of the “debate” on SA is ad hominem savagery. GS isn’t that way, and enormous good is coming of what we are doing here. I’d like to see all of us be friends, learn together, make money together, and avoid losing money together. We seem to be doing all of those. Let’s acknowledge what we are doing right and keep doing that.

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Alan Harris
Guest
Alan Harris
February 5, 2014 4:01 pm
Reply to  karmaswimswami

That makes life v simple. Travis has held out the offer. Siva is willing to do the excell ish stuff. If you can write the column and keep each thread focussed so that it doesnt become a 350 thread maze of sub topics about someones ingrowing toe nail, while still being compassionate enough to occassionally pour balm on their/our open wounds……………… I (and many many others here,) will see off (or simply ignore) the Yahoo ya boo crowd.
Done deal!!…..?

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Alan Harris
Guest
Alan Harris
February 5, 2014 4:10 pm
Reply to  Alan Harris

Travis, hows about a thumbs up and thumbs down marker. 5 thumbs down and the comment is deleted/obscurred so that others dont have to read crap/fluff/abuse/off topic/pump and dump/advertising for call girls/boys. GS is at a point where it could become mainsteam simply because its remains relevant and constructive…..lets keep it that way.

arch1
February 5, 2014 4:30 pm
Reply to  Alan Harris

Alan If I were in hype hoopla newsletter crowd I would advocate
uniting to give Travis $$$$$$$$$$$ millions to shut down. I think
he is bound to cost them bigtime.

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arch1
February 5, 2014 4:17 pm
Reply to  karmaswimswami

Dr. KSS thank you for agreeing,I am sometimes right but always frank.

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arch1
February 5, 2014 3:56 pm

Gummydave Thank you for kind words. on other point I don,t think I Been Mugged
responsible. Remember movie computer that said” I can,t do that Dave” was named
HAL,rumored to have been chosen as letters one notch below those in well Known
firm

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KennyG
Guest
KennyG
February 5, 2014 4:18 pm
Reply to  arch1

“They want their biases confirmed and their cognitive distortions embraced. ” That simple sentence brilliantly describes the environment of SA. I don’t know why an author worth their salt would subject themselves to the slanderous insults of many of the respondents. I agree with Dr. KSS that we have an intelligent discussion going on in this GS thread with people wanting to learn as well as make money if possible. I am also taken by the compassion shown here to those that post comments, not necessarily for the investment aspect, but because of personal health issues. Let’s continue with this going forward.

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Alan Harris
Guest
Alan Harris
February 5, 2014 4:32 pm
Reply to  arch1

Quick note: I know sometimes the text goes off screen when typing, so it seems necessary to hit carriage return. This leads to gaps when finally displayed. But if you just keep typing it sorts itself out. Just a thought.

karmaswimswami
February 5, 2014 4:07 pm

Siva: you earlier mention PillCams, capsule endoscopy. I honestly think the time for investing in tech like that really passed about 15 years ago. Capsules studies have absolutely horrible limitations. GI doctors hate them, not because they keep patients from being endoscoped, but because reviewing the studies is pure hell for which reimbursement is very low. Thousands of images, rife with tumbling, cam-rolling artefact. I know doctors who would rather stick their head in a beehive or have a root canal than read PillCam studies. Reviewing them gives you headaches and nausea. Clinics will not invest in them because they always lose money on the investment. In the oughties, Medicare reimbursement for reviewing small bowel capsule enteroscopy study was $60, and it might mean reviewing images for 90 minutes. What often happens is the clinic just gets a nurse to review and doesn’t bill for it. It just never works out. Places by them to be sexy, to attract patients, and always end up selling the systems.

The second issue is that they really drive up health care costs because invariably they come with recommendations for endoscopy. A bleb, a spot, a wayward vessel, a strange discoloration is seen, and the Pill drifts quickly on buy. You cannot do biopsies through PillCams. You cannot do polypectomy through PillCams. You cannot even SEE what you need to see with PillCams. A good GI tract exam requires overcoming the fact that there are just thousands of mucosal folds. To see it properly, you have to distend the colon with air, segment by segment. In colonoscopy, you sedate the patient, drive to the cecum with as little air as possible, and then slowly, in corkscrew fashion, withdraw the scope. You insufflate and desufflate each segment with air. If there is fecal matter, which there usually is, you irrigate all of that away. You get a GOOD look.

Some are saying, well, PillCams will be used for when colonoscopy is incomplete. That makes no sense. A competent endoscopist can get to the cecum, the far right colon, 98 per cent of the time (if not more…it has been years since I missed reaching a cecum). In my view the only use for capsule endoscopy will remain imaging the great expanse of small bowel, which goes on and on, in cases of occult GI bleeding. Such cases are not common.

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Alan Harris
Guest
Alan Harris
February 5, 2014 4:19 pm
Reply to  karmaswimswami

I can also see the lawyers rubbing their hands. ‘Oh what about frame 3279? It shows a cell that is slightly grey. Shouldnt that have given you cause for concern?’
Before long, so much time will be taken by every patients condition that yourll need a dedicated doctor for every patient.
Look where that got Michael Jackson !

JackLec
Member
JackLec
February 5, 2014 5:38 pm
Reply to  karmaswimswami

This post reminds me of Mauna Kea Tech, a company operating in a similar field. They make a thin optic fibers microscope that adapts to endoscopes and allows to check many polyps and suspicious lesions at the cellular level, which helps chosing the perfect site to make a confirmation biopsy. I am interested in investing there, as their hardware has received reimbursment codes for their use ($927). (code 43252 for œsophagus, stomach, duodenal endoscopy, and code 43206 for oesophagus only). I would really be thankful to know from someone who had hands-on experience with endoscopy, especially someone as discerning as Dr KarmaSwimSwami, if this tool is really useful and priced realistically at those reimbursment levels for the doctors to use it.
Otherwise the company claims to be alone in its category and plans to extend its applications to lungs and bladder. Small market cap for the moment at 130MEuros (France based), they still are in the process of trying to accelerate their sales which have remained frankly weak for the moment. Thanks in advance!

Roblites
Roblites
February 5, 2014 4:42 pm

Dr. KSS, (I think I started the Dr. KSS. if you would be more comfortable with another “moniker” please let us know). Along with Innate Pharma ,IPHYF, I think AGEN is in the ball park.
Relative to keeping this as is, I really am enjoying this group. I Twitter 135 people who are up to their ears in biotech and provides me much up to the moment information which I’d be delighted to share. Not into every day. I have a real job. I’m also a techie chart guy, 25 years which is handy. I’m a bit possessed with 60+ “microbio” stocks. My point, there are probably many potential contributors in this blog and hope it is a vehicle with longevity. Of coarse, you are the glue.

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Alan Harris
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Alan Harris
February 5, 2014 4:58 pm
Reply to  Roblites

Then lets get you together with Siva. Contact GS central and send a private message so that your email address doesnt get published. Eazi Peazi.

Alan Harris
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Alan Harris
February 5, 2014 5:03 pm
Reply to  Alan Harris

Damn! My name has been down graded to a magnifying glass. Ok, who complained?

Alan Harris
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Alan Harris
February 5, 2014 5:10 pm
Reply to  Alan Harris

Hold on, its a hat again….I cant keep up.

karmaswimswami
February 5, 2014 5:02 pm

Alan: you asked earlier if I would buy more Novo Nordisk, NVO. By now with appreciation, that is a large piece of what I have in biotech, and even within biotech one should be diversified. I think of it as my diabetes ETF holding. For me, more would not be what I need, but I do think it has a long way up to go yet. People investing in biotech should diversify their risk allocation. It is safe, pays a dividend, but is nowhere near as big as traditional big pharma. It really has operations in every corner of the globe now. With its ongoing rise, firms have to be looking to acquire shares. If you look at the pipeline it is enormous, with products at every stage in development. They are talking of spinning out their bioinformatics business, which would be a boon to shareholders. So yes, I think people should be buyers here. It recently did a big split, 5 to 1. Growth has been stable for several years and I predict that will continue.

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Alan Harris
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Alan Harris
February 5, 2014 5:07 pm
Reply to  karmaswimswami

Thanks for the clarity

karmaswimswami
February 5, 2014 6:53 pm

Xencor has some appeal. It is another immunotherapy company, devising marker-specific monoclonal antibodies. Their most interesting item in development is XmAb5574, which they are co-developing with Morphosys for B-cell neoplasms. This antibody is directed against B-lymphocyte cell surface marker CD-19. Xencor’s antibodies have a modified Fc portion that causes the antibodies, after they bind to lymphocytes, to be attractive and tightly associated with NK cells, which have the ability to destroy the adjacent lymphocyte.

The relevant background here pertains to rituximab (Rituxan), an anti-CD20 agent with a similar Fc tail. Ritixumab has had wide use for 15 years treating diseases of aberrant B-cells including non-Hodgkin (solid) lymphomas as well as liquid lymphocyte cancers (lymphocytic leukemias). Its problem is its toxicity. It acts as a daisy cutter for all B lymphocytes, and patients get sick, leukopenic, and often have stormy hospitalizations. SInce 2011 there has been a huge pharma push to go after CD19, another B-cell marker, to gauge effectiveness relative to toxicity. Right now several companies are exploring antiCD19 approaches usually using entrained T cells to go after CD19. Xencor is enrolling in two major phase II studies of its agent, for CLL and for NHL.

This company went public on 3 December at $5.75, and has had much gyration in price since then. If you are in I would hold. I personally would wait to buy, as I think it is likely to cool off before settling into a predictable trading range. That the phase II trials for XmAb5574 are still listed as recruiting implies we won’t have phase II data for another couple of years, which gives some time to observe price movements and choose a point at which to get in.

If you look at the company’s pipeline overview here, it is impressive:
http://www.xencor.com/pipeline/pipeline-overview/
The partnering is somewhat Byzantine, and I am interested to know what the undisclosed targets of the monoclonals are. But they are not chasing fatuous goals at all, and look more promising than many we have talked about here.

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David B.
Member
February 5, 2014 8:26 pm
Reply to  karmaswimswami

I concur KSS: Xencor certainly has an impressive pipeline for a small cap and its science is solid. They are actually putting into action the ideals of a Nobel laureate who was way way ahead of his time–his name escapes me right now but I believe his theories date back to the early 1900’s, science just had not caught up with him yet. Xencor could certainly be one of those diamonds in the rough.

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arch1
February 5, 2014 8:40 pm
Reply to  David B.

David could you be thinking of Linus Pauling? He certainly took a lot of abuse for
his molecular models around that time>

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karmaswimswami
February 5, 2014 8:26 pm

To JackLec: you hit the jackpot today! Wow! Mauna Kea is doing optical coherence tomographic endoscopy systems. I first saw this technique being used in an exploratory, investigative way at University Hosptials in Cleveland (not The Clinic) in 1999 and it blew my mind to watch it. The theory behind OCT is complex physics, but think of it as almost being like performing real time electron microscopy during endoscopy. The resolution is phenomenal. Where it will shine is not obviously for things like colon polyps, but rather in Barrett esophagus, where you will be able to look and determine if a patient has high-grade dysplasia (tantamount to cancer) without doing, you know, 30 biopsies and making everything bleed. It will shine for infiltrating tumors in the stomach as well. A particular hellish thing about ulcerative colitis is its malignant potential. With this, you will be able to sweep a colon and find cancer, again without doing literally dozens of biopsies. To do 80-100 biopsies during a severe UC exam is not uncommon. Ditto for colonic involvement with mantle cell lymphoma.

What is the deal with MKEAF shares here? They seem not to have traded since the summer. Is there any other way to buy in short of a European exchange? How can we find out about their penetrance into the market here? Community places won’t buy this, but all of the academic centers will be acquiring these systems, I predict.

Basically, heretofore, endoscopists have accomplished this kind of thing crudely by selective deployment of dyes, such as Lugol iodine, carmine green and methylene blue during endoscopy. That can show you where to obtain biopsies. But with OCT, one really looks at cells and cell morphology and can discern dysplasia and anaplasia. This really will completely revise how endoscopy is practiced.

Who needs cable TV? The Gumshoe channel is the best show on earth! Tell me more about this company. You are right about the reimbursement codes. How do we find out about sales?

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techscan
Irregular
techscan
February 5, 2014 9:00 pm
Reply to  karmaswimswami

Bloomberg BW has some basic info on financials and people but no news [http://investing.businessweek.com/research/stocks/snapshot/snapshot.asp?ticker=MKEA:FP]

They have an English language website [http://www.maunakeatech.com/].

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tanglewood
February 5, 2014 9:25 pm
Reply to  karmaswimswami

Dr Kss, I noticed for the dyes during endoscopy, you didn’t mention rose bengal!

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tanglewood
February 5, 2014 10:33 pm
Reply to  karmaswimswami

Dr Kss, Sales (10 million Euro) are on the company website that Louis just linked;
http://www.maunakea-corp.com/images/stories/MKT_2013_Sales_PR_01082013.pdf

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JackLec
Member
JackLec
February 6, 2014 5:06 am
Reply to  karmaswimswami

Happy to know that I contributed to the conversation constructively here. True they are offering some serious tech here, the only real question that keeps me from buying a decent amount of shares is the actual size of their potential market. Unfortunately I don’t know anything about its MKEAF listing in the US ( I live in France), and all the legal data I can find on it, even on the english website, turns out to be french (But I see that you make an extensive use of the latin side of english which makes me think you may also have excellent knowledge of a latin language, could that be ?) Anyway here is a usefull (french) link, along with a short summary of the company’s situation as I understand it for the moment:

The system is divided into what I would call the « Main Equipment » (aprox. 114,000 Euros (160,000$ in the US ) and a consumable probe that has to be replaced every 10 to 20 uses (4,000 Euros).

In their IPO doc (link below) they say their potential total sales amounts to 1,200 Meuros in main equipment and 500M euros in probes, based on the following numbers; 
Main equipment becomes obsolete every 5 years.
2500 hospitals do surgery in the US, 5000 in Europe.
55Million of endoscopy procedures are realised in the US every year of which approx 50% are colonoscopies and 40% « Esophagoscopy »
45% of colonoscopies require a biopsy, while it seems 66% of the later end up with a biopsy motivated by Barrett esophagus concerns. Pancreatic endoscopy is also mentionned.
Link (page 56 and forward, http://www.maunakea-corp.com/images/stories/pdf/Documents/DDB_enregistr_AMF_NI._11_035_le_6_juin_2011_BD.pdf)
They cite what seems to be legit studies to support their numbers, but of course the sales sales calculation seem very simplistic and optimistic for the middle term (as well as the target number of hospitals). But…to which extent? Which share of the biopsy-aimed endoscopies will actually need their system? I have no Idea.

In their last results publication, they claimed to have an installed basis of 356 Units (up from 180 when they went public in 2011 june). Which is small compared the total number of hospitals they count on, but already big if this is gonna be used only by elite and research hospitals. They still haven’t reached profitability (and they still have a bit of a way to go to get there, I would say they roughly need to triple sales, given their cash burning rate, that ranged between 15 million in 2012 an 10 millons last year, but this is very roughly guessed). Their system has been reviewed many times and has been subject of positive publications worldwide (probably easily findable with the name of their system which is Cellvizio).

Here is a comparative sales summary of the 2 last years broken down into Quarters T1, T2 etc… (trimestres in French). The company’s price has fallen and remained below the IPO price because much faster growth was expected (30-50% per year) while it remained more around 20% and below. They claim this is partly because they still had to get approvals and get their sales forces operational.

In K€

 2013
 
 2012
 
 Variation %
 
T1
1 784
1 611
+11%
T2
2 536
1 907
+33%
T3
2 731
2 069
+32%
T4
2 927
3 222
-9%
Chiffre d’affaires total
9 977
8 809
+13%

Hope this aproximative and partial data can help for the moment.

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karmaswimswami
February 5, 2014 8:55 pm

David B: Yes, you are thinking of Paul Ehrlich and the 1908 prize. He had a notion of molecules such as antibodies or aptamers going after pathogens, and thought of killing the pathogens by attaching toxins to the antibodies, as many cancer chemotherapeutics now do. Ehrlich referred to this as being a zauberkugel for an infection or cancer, imperfectly translated as “magic bullet.” It helps to picture Ehrlich declaring this forcefully, as of course Ehrlich means, approximately, “for real,” in German.

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David B.
Member
February 6, 2014 6:04 pm
Reply to  karmaswimswami

Yes, Paul Ehrlich is the man who was well ahead of his time. Xencor is putting much of his theory into practice over 100 years later–quite amazing. I do believe that the science is “ehrlich”–the real deal. Let’s hope that for my portfolio and for humanity that their robust pipeline proves to be “ehrlich.”

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