3 ms·
Oncologist here. You can think of drug development as an extremely wide funnel with a minuscule exit hole. At any given time a medium sized pharmaceutical compa
by sam537 4y ago
Oncologist here.
You can think of drug development as an extremely wide funnel with a minuscule exit hole.
At any given time a medium sized pharmaceutical company has 300-500 drug candidates.
From this group 50 make it to phase 1 trials. 40 get slashed due to toxicity, company abandons them, gets bought by third party and sits in sleepy storage.
10 advance to phase 2 trials where 5-8 may not end up having enough efficacy/too toxic, does not improve survival.
The remaining 3-5 advance to phase 3 where they can suffer the above as well.
Tl:dr: Things usually work in the lab where all ideas start. Until a compound goes through thorough human experimentation believe little.
- nighthawk454 4y agoThanks, that's an interesting insight into the dropoff rate for these ideas. Do you have an opinion on what the bottleneck is? Volume of ideas, length of testing, or perhaps flawed approach in general?
- pfdietz 4y agoThe extreme complexity of biology. There's no substitute to just trying things and seeing if they work, because you will never understand what's going on beforehand.
- sam537 4y agoThis is the bottleneck for one company. We have many companies this size doing the same thing. The issue is large companies (novartis/BMS) sometimes sit on compounds and refuse to develop because they think it may not be worth it, may think a certain disease (read market) is saturated, or they may be waiting for the 'right time'. It can be frustrating. Smaller companies have 2-3 compounds which they actively work to develop but most of them end up getting acquired by the big fish.
- dvirsky 4y agoSounds like this one is pretty advanced down the funnel, having successfully passed phase 1 human trials, or am I missing something?
- abcc8 4y agoPhase 1 trials are used to determine drug toxicity. All that reault really says is that the new drug won't itself kill the patients. It still needs to be compared relative to the standard of care in larger phase 2 and 3 trials.
- tempestn 4y agoHowever, the article also describes patients in the trial having positive effects. Yes, it's not an efficacy trial, but if it was specifically used on patients who have exhausted all other clinical options, there were no significant adverse side-effects, and there were beneficial effects for some substantial number of patients, that sounds pretty hopeful to me. Of course it's possible issues will still be discovered, but this is a long way from a top-of-funnel lab result.
- ncmncm 4y agoThanks. I had read of success infecting tumors with virus, that the immune system will control only outside the tumor. But I didn't hear any more about it. What happened with that?
- Gatsky 4y agoGlad to see another oncologist on HN!