Ann: IMU Meets Endpoints in Phase 1b Gastric Cancer Trial, page-95

Few Pennies,

One can look at tumor size, and report on that - but our patients have advanced metastatic cancers, meaning that the cancer is spreading to other parts of the body. So the antibodies, while working on the large measurable tumors, are also working elsewhere in the body.

We know also that tumors tend to get worse before getting better with immunotherapies. I think a 20% tumor increase was mentioned somewhere, can't remember where. But it'll vary with people.

So if we assume all ten patients had a 20% increase in tumor size initially.

5 now have a greater than 30% reduction, so that's a big swing in a small time frame from 20% plus. And we don't know how much of a reduction these guys have, they might average 50% for all we know.

4 are between an increase of 20% and a reduction of 30%. So again, they could have bounced off the 20% increase and now be sitting at a 15% decrease for all we know. Which is fantastic in 56 days, given that there's a period of tumor growth too.

1 (a bit unknown) but probably has a tumor growth measured at above 20%.

But even with this person it does not mean that they are not responding to our treatment. Because we are only looking at the larger tumors as a measurement. They may have a number of smaller tumors and cancerous cell throughout their body that the antibodies that they have produced are fighting.

Just as an analogy, if you think of tumors as blocks of ice in an old oil drums full of water, and the oil drums are outside in freezing cold weather. There are 10 oil drums in total (our patients). We are trying to melt the ice away, so we light a fire (the fire representing our drug).

It takes a while to get the fire warm, so more water has turned to ice, and the water has become even colder (our 20% increase). But later our fire starts to take hold and warm the water and melt away some of the ice blocks.

Now our person who has not responded, is perhaps an oil drum with initially very cold water, and many small cubes of ice. The treatment is working, and working away hard - but there is much ice to melt and many cubes, and the larger cubes are still getting bigger. They will be the last ones to melt away.

ok, it's just an analogy, but I think some people were hoping that we might have a cure for cancer, but now believe we haven't. But we still might have. It takes time to break the tumors down, especially if the patients are heavily metastasised. And they have only had the treatment for 56 days, which includes a known down time period.

cheers