The horse, the rider, the race

Who decides on the winning strategy?

One of the best sources out there for pipeline reports is Evaluate Vantage. I love these tables for their constant reminder that the IDEA Razor (“if you gave the same drug to two different companies in phase I, who’d do best…”) plays out in real time constantly. For example, the ‘blood thinners’ table below (does anyone really call them ‘blood thinners’ still?)… (Click the table for the direct link.)

But, that reveals rather a small number of horses in a head to head race… Look at oncology and suddenly, whoa, steady horsey…

One ‘class’, dozens of approaches. How does your horse win?

If you were to look down from above (the perspective that these tables provide), how would you pick a winner? Even if ‘winning’ was about ‘who gets there first?’, would you just pick the one who’s furthest ahead at the moment? Does phase III even mean that in oncology any more? Would you pick by the horse, or the rider of the horse (is BMS more likely to be good at this than Roche?)?

Or, would you pick by the path they have laid out? Here’s a tip: if someone has picked a path as tight as ‘combo in head and neck cancer’, and they’re in phase I, their decision process is suboptimal. If they’re doing ‘dose escalation’ as their pI strategy, but no more, you know the horse has four legs, but no other useful information. Unfortunately, that’s all the useful information they will have too - a phase I like that is designed to make sure the horse can leave the stalls, not to evaluate if it can win a race. It might only manage a walk once through the gate, but you won’t know until then, and neither will they… Let’s remember: that’s their strategy, it’s not an essential approach.

If you complicate it further, by remembering that ‘winning’ in pharma is not a ‘first past the post’ race (the horse may need to win many races this season, instead of just one, or it may need to win steeplechases as well as sprints), you can see how little information any of us have when looking at pipelines this way. We’re left to extrapolate most of the rest of what might happen - the molecules themselves reveal no clues.

The real difference is not in the horse, nor the rider, but the owner of the stable.