Nothing kills biotech companies like an active placebo.  More often than not the press release after a failed trial points the finger at a “surprisingly large placebo response” against which the active drug had little scope to excel.

It’s easy to assume that this placebo effect has its origins in some almost mystical neuropharmacology, where simply believing you are being treated with a powerful new drug is sufficient to induce a miraculous recovery – and as a result that there is little you can do to mitigate against the effect.

But in reality by far the largest proportion of the placebo effect originates from the design of our clinical trials, and can be readily neutralised by careful adherence to a few simple principles.  The first step to eliminating the avoidable failure that comes from high placebo response rates is to recognise that it’s not in the lap of the gods – but in the hands of your Chief Medical Officer.   All you need is the almost-magical power of a run-in period.

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The sale of Avila to Celgene may mark the pinnacle of the market for kinase inhibitors in cancer.  Where might early stage drug discoverers in cancer start looking now if they want to create successes like Avila in five to eight years time?

Excitement for different kinds of therapeutic target in cancer goes in waves – and with cancer by far and away the leading indication for biotechs (judged by the number of molecules in development), predicting the “next big thing” is an important and valuable skill for early stage investors. What comes next after kinase inhibitors and epigenetic modulators?

With anti-infectives, all therapeutic strategies rely, in some way or another, on exploiting the (often subtle) differences between pathogen and host.  So too with cancer – only the differences tend to be an order of magnitude smaller.   It has been known for a long time that different metabolic pathways dominate in cancer cells, but recent research has focused on a couple of key metabolic “switches” that might be different enough from normal cells to represent viable therapeutic targets.

Will these metabolic switches prove to be effective new targets, particularly in combination with other strategies that deprive tumours of their blood supply and so make them more reliant on anaerobic metabolism?  Its too early to tell, but the science has moved far enough forward now to make it worth renting a few square metres of this virgin new territory just in case metabolic inhibitors become the focus of the next big “land grab” in cancer.

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