When a promising ALS drug failed Phase 2 trials, the company shut down. The drug's original founder, Dr. Ari Azhir, still believed in the science, repurchased the asset and all its data, and ultimately uncovered its true potential, leading to a new FDA application.

Praxis Interactive's essential tremor drug succeeded in Phase 3 despite an earlier data monitoring committee (DMC) recommendation to stop for futility. This rare outcome shows that interim analyses on a small fraction of patients can be misleading due to high variance, and continuing a trial against DMC advice can be a winning strategy.

An overall survival (OS) benefit in an adjuvant trial may not be meaningful for patients in systems (e.g., the U.S.) with guaranteed access to the same effective immunotherapy upon recurrence. The crucial, unanswered question is whether treating micrometastatic disease is inherently superior to treating macroscopic disease later, a distinction current trial data doesn't clarify.

To demonstrate its drug could overcome resistance, Actuate designed a trial where patients who had already failed a specific chemotherapy were given the exact same regimen again, but this time with Actuate's drug added. The resulting increased efficacy across eight different cancers provided powerful, direct proof of the drug's mechanism.

After reacquiring a "failed" ALS drug, Neuvivo's team re-analyzed the 200,000 pages of trial data. They discovered a programming error in the original analysis. Correcting this single mistake was a key step in reversing the trial's outcome from failure to success.

A significant criticism of the pivotal KEYNOTE-564 trial is that only half the patients in the control arm received standard-of-care immunotherapy upon relapse. This lack of subsequent optimal treatment complicates the interpretation of the overall survival benefit, raising questions about its true magnitude.

Re-analysis revealed the drug's efficacy was concentrated in patients 65 and younger, extending survival by 17.1 months. This effect was missed in the original trials because it was diluted by the non-responsive older population, whose declined immune systems could not fully engage with the treatment.

Contrary to market convention, a trial delay can be a bullish signal. When an independent data monitoring committee (IDMC) recommends adding more patients, as with Bristol's ADEPT-2 study, it implies they've seen a therapeutic signal worth salvaging, potentially increasing the trial's ultimate chance of success.

Immunotherapies can be effective even without causing significant tumor shrinkage. Immunocore's drug KimTrack had a low 5-7% objective response rate (ORR) but demonstrated a massive overall survival (OS) benefit, challenging the reliance on traditional chemotherapy metrics for evaluating modern cancer treatments.