Provenge Huge for Dendreon?
Board: Dendreon Corporation

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By oncqueen
April 5, 2007

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Telcomonster, all:

While I am tickled with the paper "profit" I have made on Dendreon so far, I'm holding onto all of mine. I don't know what the short-term share price will be, but I think this approach is going to be a keeper long-term.

In oncology, approval is initially generally very limited, for certain subsets of patients only. Often, there is substantial "off-label use" as well ("Gee, if it's so great in horribly advanced cancer, it's probably better than what I have now for less advanced cancer"). Taxol was first approved for use in advanced breast cancer that didn't respond to other drugs, then was used as first-line therapy for advanced breast cancer, and finally now is used like water for adjuvant therapy (preventative chemotherapy) for breast cancer that is at high risk to relapse because of positive nodes, etc. It's gone from a narrow sliver of the market to the lion's share, but it took a few years.

I treat some patients every week with chemo for prostate cancer, when they are out of other options. It's not hellish torture, but people certainly have fatigue, numbness of the fingers and toes, sometimes irritated eyes, and other common side effects, but there is a small risk of serious infections and other life-threatening side effects.

Some men choose chemo in an attempt to live to see that grandchild born, others do not, but fear of side effects is undoubtedly the most important factor in whether or not a man chooses Hospice vs. treatment. I believe most men WILL choose to try Provenge, assuming that it will get covered by Medicare and/or insurance, because of its minimal side effects and hassle factor. But I think that this is just the "tip of the iceberg."

The potential REST of the iceberg is those men who have hormone responsive prostate cancer, or are at high risk of relapse without hormone therapy. Men don't LIKE to have tender, swollen breasts, hot flashes, and impotence, and if this proves (hasn't been studied yet, but you bet your boots they will) to do the trick instead, it will be like printing money; all men have a prostate, and with people living longer and longer, there is a huge market.

I was at tumor board (a meeting of oncologists, pathologists, radiologists, surgeons, radiation oncologists, and others who discuss difficult cases) a few weeks ago and a respected urologist was in to poll us. He had a 45-year-old man with high-risk prostate cancer and had recommended the standard hormonal therapy, but the gentleman refused because of those same quality of life issues. He was in to see if any of us oncologists would be willing to give him chemo instead as adjuvant therapy. The man was willing to do CHEMO but not the standard hormone rx!!!!

My dad has prostate cancer and has said that if he ever relapses, it won't be worth it to receive the hormonal treatment. Again, please understand that Provenge has NOT been studied for this approach yet, but I think it will be. As someone with a family member with prostate cancer, I am thrilled that there will probably be broader application someday, to give more grandchild time and fishing time with a great quality of life, and as an investor, my greedy pulse pounds harder, and I'm willing to let it all ride.


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