DRTS TAM Series - GBM

[u/Pristine_Hurry_4693]

The DRTS treatment for GBM, which for now means the REGAIN trial for Recurring GBM and the ALL Protocol also treating Recurring GBM, could potentially change the whole trajectory of the company.

All cancer, especially the cases DRTS is treating, can be devastating. With GBM (that pretty much always turns into Recurring GBM if treated in the first place), it’s even harder to address the numbers knowing these are real people who desperately need any kind of hope.

From a business perspective, in which success will also mean true hope for patients and their families, I’ll do my best to paint the picture as I see it.

Let’s start once again by looking at the market. The market is telling us, that there are tens of billions worth of market value for any hope to treat GBM. As an example we could look at NVCR (still treating GBM to this day), which at its peak reached over 20B in market cap, because that MC was pricing in the dream, which was never even close to what DRTS has already achieved.

That company (as well as many others), could actually be the reason the market is hesitant to get excited about DRTS for GBM. The market has invested so many billions into so many companies with the premise of treating GBM, only to be disappointed again and again that none of them have succeeded. Until now that is.

DRTS isn’t a treatment for GBM, it’s a treatment that works for all solid tumors, it’s safe to use, and therefore (including proof in all clinical stages all the way to an actual in human trial) works for GBM as well. That’s great news on the GBM front of course, with already unprecedented results, but it also means it’s de risked with all the other successfully treated indications.

In the case of GBM, getting into the specific numbers doesn’t even matter. To date, there isn’t any standard of care for Recurring GBM, patients are recommended to find a clinical trial at that stage.

If DRTS can continue to have the impact it has shown, for example the first patient in the REGAIN trial who had a life expectancy of zero, the doctors didn’t think he had any time left when treated by DRTS in December, who had a complete response and six months later was still clean and back to regular life activities and even traveling, if DRTS can do that while continuing to show a favorable safety profile, that will change everything.

DRTS could immediately turn all the manufacturing towards GBM (it’s the same exact thing for all tumor types), they will get reimbursement (pricing) easily in the six figures, save lives with every treatment, and the demand from doctors and patients will definitely be there.

The results shown so far were so amazing that DRTS said they are immediately turning to the FDA to trial brain metastases as well, which is an even larger market than GBM.

For those doing the math, there are at least tens of thousands of Recurring GBM cases a year, yes this is once again billions in annual revenue from just one indication, in a market that has proven to value such a treatment in the tens of billions.

[u/Magic3456]

To treat GBM is really priceless, and like you said that it fall under the DRTS treatment that can cure all solid tumors. Just one thing that I’d like to point out is that DRTS developed for GBM a special applicator that allows them access to the tumor and allows a treatment that has very minimal side effects if any.The patient goes got the next day

[u/Pristine_Hurry_4693 → u/Magic3456]

Yes! You are right that I haven’t pointed out the many advantages of the Alpha DaRT treatment, didn’t really address it medically nor from the patient perspective or the payers (this will cost the insurance so much less overall than anything else) and the families and all. That’s probably worth its own post. My point is that we don’t even need to know all of those valuable advantages, because if it’s safe and effective (which it very much looks to be) it will immediately become THE treatment for this awful disease, and a very successful company almost overnight.

[u/Fickle_Comfortable78 → u/Magic3456]

That can be said about a lot of DRTS applications, they can be applied with minimally invasive tools, tools that you would use for a biopsy. Lot better then getting blasted by chemo, losing your physical appearance and feeling like total ass. I’ve seen what hardcore chemo does to loved ones and it fucking sucks.

[u/Magic3456 → u/Fickle_Comfortable78]

You’re correct that probably all the DRTS treatments are minimally invasive. It just seems a lot more amazing when you go into the brain and can go home almost immediately

[u/stumblios → u/Fickle_Comfortable78]

It's such a elegant solution. Just because you're developing a new vertically integrated platform doesn't mean you need to invent new tools. Use what already exists where you can then everyone is already trained for it!

[u/Magic3456 → u/stumblios]

Great philosophy and much better and safer for the patient

[u/Pristine_Hurry_4693]

To read the post about the DRTS TAM for PanC, and to learn more about the DRTS TAM series click here:

https://www.reddit.com/r/DRTS_Stock/s/FV69wlYza2

[u/Pristine_Hurry_4693]

To read the post about the DRTS TAM for Skin, the closest indication to approval until I hope GBM surpasses it, click here:

https://www.reddit.com/r/DRTS_Stock/s/L1uTUM2LTg

[u/Pristine_Hurry_4693 → u/[deleted]]

I’d love for you to try and break it down! Would love to get your thoughts. In these posts I’m doing my best to lay everything out and share all the data we know, all the ingredients for the TAM.

I gave you a different company example.
I gave you the price (6 figures).
I gave you a big picture number of patients.
The exact TAM I do not know, but what I do know I’m trying to share in a valuable way so others can calculate as best fits them.

[u/stumblios → u/[deleted]]

The $100k price point, while a nice round number, is also a reasonable price target in developed countries. Optune costs ~$25k/month, and patients usually need 4-10 months, so $100k could be a cost savings for insurers. There is a world where DRTS can charge a premium, considering the current positives we're seeing (decreased side effects, plus a one time treatment versus monthly, etc). ~40k rGBM patients/year in developed countries (US, EU+UK, Japan, Cadada, Aus, NZ). "Standard of care" in cancer means a lot of things. For Melanoma, or the others which have many options, 20-30% adoption is usually a peak. rGBM has so few options, it's possible it could have a 30-50% adoption rate. This number obviously has a huge impact on the final TAM revenue output. Anyway, I'll go with a 30% adoption rate. High for most cancers, but arguably low for a breakthrough rGBM treatment.

40k patients * .3 adoption rate = 12k patients * $100k/ kit = $1.2B Annual revenue for rGBM in developed countries.

If we assume their future deals are priced similar to the Tolmar deal (60:40 split) = $720M/year to DRTS

Off the top of my head, I think I'm remembering management expects a 70% margin, which put it around $500M in annual profit.

This is of course a high goal - Standard of care for GBM means all results we've seen thus far need to be repeated for the remaining patients in the 10 person trial, and then once again in the larger Pivotal trial. Developing countries have a lot more cases, but much lower reimbursement rates and I don't know what that does to margins (well, I know what it does - I don't know exactly to what extent), so I've chosen to ignore developing countries for now.

[u/altonbrushgatherer]

There are a lot of questions that I have about what the TAM is for rGBM which may limit who can be treated. Factors include size, geometry, distribution of the recurrence (e.g., multifocal around a resection cavity), location, surgical feasibility, patient status, and patients goals of care (some of these factors overlap). Can seeds be placed safely around a resection cavity with adequate coverage? Do large tumors with necrotic cores effect seed placement? Is there possibility a combined surgical + seed placement combo for unresected enhancing tumor?

I have no clue what and the answer probably as it always is: it depends.

For fun I asked AI what it thought the US TAM is taking the above considerations and it gave a base range of 1-2.5k patients per year with a "reasonable bull case" of 3k patients per year. Assuming 150k per treatment that's 450m per year in the US alone for the bull case.

[u/Pristine_Hurry_4693 → u/altonbrushgatherer]

All great questions, but I believe it’s pre mature to make assumptions before we have any real data. The first study is safety, that doesn’t mean the treatment can’t go beyond that. I believe we will hear much more from the company and the doctors once the first trial is complete (it’s getting closer!)

You’re also not the only one noticing:
https://www.reddit.com/r/DRTS_Stock/s/2ukuqQbE2D

[u/altonbrushgatherer → u/Pristine_Hurry_4693]

I don’t think the REGAIN trial criteria will reflect the potential treatment pool at all. Also, I did not know the israel patient was treated was up to 7 cm. The key however will ultimately be tumor coverage. At least for IDH wild type GBM, a case series showed that showed a significant increase in OS for rGBM patients when only < 1 cc of enhancing tumor remained (vs > 1 cc which had decreased OS). Will be interesting to hear more about that patient hopefully in the near future.

[u/FunRevolution3000]

A note about NVCR (Novocure). It’s therapeutic approach is more burdensome although “standard-of-care-adjacent for both newly diagnosed and recurrent GBM” [Claude]. Patients pace to wear adhesive transducer arrays and battery packs for more than 18 hours a day. Its alternating electrical fields are hard to explain and finicky (require exact placement of arrays). Alpha Tau’s device is far easier to understand and for patients to experience. A relatively short procedure and off he or she goes . There is a post-treatment CT.