Hat tip SMar on StockTwits

[Ryan]

https://www.targetedonc.com/view/imetel ... lofibrosis

Checking this out now, ESPECIALLY the part about RWD mOS..

[rccola335]

I was just coming to post that article I saw on Twitter

[Secret Third Arm]

So essentially the BAT survival is rapidly closing on Imetelstat and may actually hurt the chances of showing significant benefit? It also seems that the longer the trial is forced to progress the more likely BAT will erase any advantage for Imetelstat. Unless I’m misunderstanding?

[biopearl123]

STA, there are several notable points in this abstract. To my read the expansion of the BAT arm that was compared to the IMbark data was restricted to patients before 2016:

“For the head-to-head OS comparison, IMbark eligibility criteria were applied to the real-world population to identify a closely matched cohort—restricted to patients diagnosed before 2016 who had received ruxolitinib but were relapsed or refractory—minimizing temporal confounding from more recently diagnosed patients with inherently better outcomes.”

And so reflected the expected shorter OS numbers we have seen. No mention of Imetelstat after that period except tangentially (see below). The BAT patients after 2019 have lived astounding longer, far longer than most of us imagined and previous data suggested. It’s good for them but maybe not for the study. We are not graced with actual Imetelstat data from a similar time except for the following mention that the (much) longer BAT OS was thought to be due to shorter time to initiation of Rux, and shorter treatment with Rux before transition to other lines of therapy or a clinical trial. (what clinical trial and were they still in the BAT OS numbers if they did??) We have no idea if these changes in approaches to Rux therapy also applied to the IMpact Imetelstat arm which would have to give us much longer Imet OS to mean anything.

In short, my read (and it’s a difficult abstract to wade through) suggests that the “conclusion” of Imetelstat effect of 30.7 months and BAT of 15.4 months is based on data from before 2016. The real findings are that after that time BAT is astoundingly better. But I don’t think this abstract tells us if Imetelstat OS has also improved over this time as well. That is probably intentional and forces us to wait for IMpact. But it will have to be a heck of an improvement over these surprising later BAT numbers to mean anything. It could turn out to be a long run for a short slide. Still BAT does not modify disease. Imetelstat if it truly does will have to show a very profound effect.

We have been looking to reasons why this study is taking so long and perhaps this abstract tells us we have found them.

[Ryan]

The trial design should be the saving grace here, it will control for the muuuuuch longer lifespans. No wonder this trial is taking so long. Eye-opening information.

[mistergern]

BP - I think you may be misreading the study results - I think the new mOS for BAT patients of 39 months is referring to 39 months from diagnosis not 39 months after ending treatment with Rux - please feedback if I'm not understanding this correctly.

[biopearl123]

MG I will go back and look and I hope you are right!! In the meantime maybe run some simulations, as Ryan says these numbers could explain the extremely long study time.

[biopearl123]

MG if you go to the table included in the abstract in the last box it shows RW mOS numbers pre and post 2016 and 2019. I was going by that. Let me know what you think.