Unlike most trials that avoid patients who failed other therapies, Corvus intentionally included them, considering it a 'stacking deck against yourself'. This high-risk bet, based on their drug's unique mechanism, paid off by showing efficacy in a tough-to-treat population and demonstrating a lack of cross-resistance.

Progress in drug development often hides inside failures. A therapy that fails in one clinical trial can provide critical scientific learnings. One company leveraged insights from a failed study to redesign a subsequent trial, which was successful and led to the drug's approval.

CellSci's drug trial ran into a stricter FDA under one administration after a period of more lenient approvals under the previous one. This political "pendulum swing" can derail promising drugs, showing that regulatory risk is not static but subject to unpredictable political change.

In the CREST trial, the FDA's critique heavily emphasized an overall survival hazard ratio above one. Though statistically insignificant and based on immature data, this single figure created a powerful suggestion of potential harm that overshadowed the positive primary endpoint and likely contributed to the panel's divided vote.

The FDA halted two REGENXBIO gene therapies with similar constructs after a safety event in one trial. However, it spared a third therapy from the same company that used a different design, indicating regulators assess risk at the technology platform level, not just the company or disease level.

While depth of response strongly predicts survival for an individual patient, the FDA analysis concludes it cannot yet be used as a surrogate endpoint to replace overall survival in pivotal clinical trials. It serves as a measure of drug activity, similar to response rate, but is not sufficient for drug approval on its own.

The speaker's experience at a previous biotech highlights the extreme personal risk in the industry. After receiving a Complete Response Letter from the FDA, the entire commercial team that had been built in anticipation of a launch had to be let go, including the Chief Commercial Officer.

Actuate's CEO advises against out-licensing different indications of a single molecule to separate partners, calling it "splitting the baby." Because all programs rely on a single, shared safety database, one partner's negative safety event would impact all other programs, making the model unworkable.

The GLORA-IV trial is designed with a dual endpoint, evaluating both patient response rate and overall survival. This structure creates an alternative pathway for regulatory approval based on response rates, which can be assessed faster than survival, strategically de-risking the lengthy and expensive trial process.