The All-Everything INSPIRE Interim Review – No Illusions!

I/we are long Onconova Therapeutics (ONTX)

November 17, 2017 – Always do your own due diligence and consult a professional financial advisor before making any investment decision.

No sane person retains a long position in a developmental biotechnology company that is less than two months away from running out of cash. And yet, even after several articles and videos attesting to this fact, many investors seem perilously unaware that this is the predicament we find ourselves in with Onconova. I can attribute this to my limited self-published exposure and the casual investor’s limited due diligence.  It doesn’t help at all that the issue, unsurprisingly, wasn’t addressed directly in the Q&A session that followed the Q3 Conference Call by sell-side analysts covering ONTX.

Once a thriving enterprise with a deep pocketed partner, Onconova is now the ugly duckling of the developmental space with all of its pipeline eggs riding precariously in a shaky interim review basket. With a market-cap of less than $20m and a phase-3 trial not funded anywhere near to completion, this DSMB futility analysis now represents the biggest binary event in recent biotech history. Utilizing five hypothetical press release headlines to capture the five distinct possible outcomes, we’ll examine the effects that these will have on the company and, more importantly, on the share price. But before we do, a brief word about the most recent public offering.

920k New Shares Will Flood The Market Weekly

It has long been stated that equity raises are a necessary evil in the realm of biotechnology investment. That “necessary evil” today is accentuated by excessive executive remuneration and a Wall Street banking system replete with blood sucking greed merchants who work in coordination with each other to line their already bursting pant pockets. A stunning example of this would be Synergy Pharmaceuticals (SGYP) recent equity raise that was a tethered prelude to a loan facility requirement hidden from public view.

That noted, Onconova’s recent stock offering of 920k shares at $1.50 each, though dilutive by discount, hardly constitutes anything that could be characterized as evil or even draconian. Depressing – yes. Evil – no. The paltry proceeds of just over $1m will likely see them through to the interim analysis of INSPIRE and no further. The biggest drawback will be on the upward price movement of the stock as daily over the next several weeks the lion’s share will be sold back into the market for a profit of between 5 and 50%. It’s easy, therefore, to see how wealth begets wealth on Wall Street.

So, why not do a more aggressive warrant laden raise with interest bearing preferred shares that could have seen them through to the conclusive data readout in middle to late 2018? Perhaps, only God and CEO Ramesh Kumar know this for sure but that’s the first question I’m going to try to answer in this article. So, from the least to the most likely scenario we have these three.

  • The equity lenders didn’t see a future beyond this coming interim review that warranted a larger sum of money or a greater corporate involvement (see headlines 1 and 2 below).
  • CEO Ramesh Kumar has thoroughly rebuffed these back alley bankers in order to protect the value of his and our shares.
  • Kumar sees a positive interim review triggering a non-dilutive, income generating event the size and nature of which remains known only to him (see headlines 4 and 5 below).

A Myriad Of Ways To Look At This Offering

It’s clear that Ramesh Kumar seeks to arrive at the interim analysis of INSPIRE with his company fully intact and uncompromised by the vulture capitalists of Wall Street’s underbelly. No one can convince me that he wasn’t given the opportunity to raise ten to twenty million dollars in a creatively structured offering that would have decimated the value of our holdings. By doing so, he could have made it past a futility boundary breach intact. As it is, such an event would likely result in the end of Onconova as we now know it. Kumar, therefore, is either confident of what he has or is rolling the dice like the rest of us are.

For Claity’s Sake – Let’s Play The Hypothetical Headline Game

INSPIRE is not a prototypical phase-3 trial. The structure is far more similar to that of a phase-2 endeavor – open label and unblinded. It’s also adaptive after an interim review the parameters of which have only recently been agreed upon by the FDA and European Medicines Agency. The fact that both regulatory bodies are working closely with the company on all aspects of this trial attests to not only the need for new leukemia therapies but that, additionally, these agencies find therapeutic value in rigosertib. I don’t believe that most casual investors understand any of this. In fact, I think they’re all about to get a heavy dose of due-diligence-neglected when the interim review turns out positive. That stated, the declining share price worries me in that the network of clinical trial physicians is not encumbered by absolute silence. Mitigating these concerns is the multi-country, worldwide stage that this study has been set upon. Therefore, we trudge bravely into the night unaware of the dangers though others might be.

What the casual investor is privy to, however, is that Onconova’s previous big pharma partner, Baxter, bailed after the ON-TIME prelude failed. What they can’t seem to appreciate is that the runway to a return on such a large investment was extended beyond that which BAX could afford to bear. These kinds of pragmatic decisions are made all the time by retail investors but if big pharma pulls the plug it’s assumed the value proposition has altogether vanished. And let’s not forget the graveyard that blood cancers are to promising compounds nor the act of desperation that data mining often is when companies are trying to remain relevant. Is it any surprise then that so many investors have long since pushed onto warmer climes? I think not.

Regardless, and, in fact, because of this, the value proposition here is enormous on both sides of the risk/reward ledger. To illustrate this let’s utilize an analytical tool I just now invented called; The Hypothetical Headline Game. We’ll start with the one press release that no long wants to wakeup to and that every long dreads. We’ll also assign a share price to each event and a strategy. As a reminder, these are products of my tormented imagination only.

Headline #1: “The DSMB Has Stopped Onconova’s Pivotal INSPIRE Trial For Futility”

Of course, that’s not how the actual headline would read because biotech companies always spin to the positive. Instead, you’d likely see something about rigosertib’s substantial treatment effect that failed to reach statistical significance. Unfortunately, the end result would be the same – an intraday sell off that would result in a sub-$5m market-cap accompanied by an inability to raise sufficient capital to fund the pipeline moving forward.

If you don’t think this could happen, think again! There’s lots that we don’t know about the so-called “high-risk” patients from other historical MDS trials that would substantially sharpen our perspective in this one.  I’d be tempted to say that big pharma has access to such data as do large investment funds all of whom have now steered clear of involvement in ONTX but the genetic testing used to identify the ITT population in this study is a relatively new development.  Consequently, fear of the unknown seems to be the factor driving most of the trading paralysis.  Additionally, the incredibly high bar to hurdle for the primary endpoint of overall survival – 37% is dissuading as well.

Stock Price: $0.50 to Zero – Strategy: Stay Away From Sharp Objects

Headline #2: “As Recommended By The DSMB Onconova Will Increase The Size Of The INSPIRE Trial”

This usually indicates that a study is under-powered to successfully achieve its primary endpoint. And because this would be off putting to partnering interest, leaving the company in need of further capital, the overall effect would be a negative on par with an outright crossing of the futility boundary. A smack of reality would likely follow a smattering of hope.

Stock Price: $1 to Zero – Strategy: Stay Away From Loaded Guns

Headline #3: “The INSPIRE Trial Will Advance With Only The Very High Risk Patient Population”

This is the second “shot on goal” that CEO Ramesh Kumar has often referred to in public presentations. What percentage of MDS patients who have failed hypomethylating agents fall into this category I’m not sure but CEO Kumar would undoubtedly be telling us at every opportunity he was given. More importantly, success here would provide Onconova with a foot in the door to commercialization of rigosertib.  If the U.S. market opportunity for second line treatment was between three and five hundred million dollars annually, then that would, at the very least, be cut in half. Whether an ex-U.S. partner would step forward with anything substantial, again, I’m not sure. But the market would likely rally behind Kumar’s narrative.  Interestingly, according to Kumar, the intent to treat population of INSPIRE appears to be weighted toward this group already.  From the Q3 Conference Call we have this remark.

And our prediction was that compared to the previous trial, the new trial which is designed for higher risk patients, the very high risk group would be larger. And I can tell you that that’s exactly what we are finding out that in the new ITT population, the very high risk group continues to be the majority of the patients, a significant majority of the patients.

Unfortunately, a price crushing equity raise chock full of warrants and preferred shares would likely follow.  Interestingly, the company published a supplemental prospectus to this most recent offering detailing an exercise of 3.29m warrants with a weighted average exercise price of $5.10 per share which can be found on page 18.  Though diluting our existing shares by nearly a third, the company would access $16m in badly needed cash.  This might curtail the need for the blood letting I would expect should my $4 target price come true.  In any event, a necessary evil would surely follow in the wake of this news.

Stock Price: $1-$4 – Strategy: Possibly Sell at $4

Headline #4: “Onconova’s Pivotal Phase-3 INSPIRE Trial Will Continue As Planned”

This is the headline every ONTX shareholder would greet with more than a ho-hum sense of relief. It would be validation of both the trial and my investment thesis.  However, I believe that this would presage an even bigger event taking the form of a commercial and developmental partnership that would be announced within days of the news release. Any agreement has to be attractive to both parties and Onconova needs only a small upfront payment of $30m to remain relevant through the INSPIRE data readout in late 2018. That’s an attractive amount to a big pharma entity with a strong oncology sales force (think Celgene). Onconova could be equally demure where sales royalties and milestones were concerned in exchange for full funding of the frontline combination study featuring oral rigosertib in conjunction with Vidaza (azacitidine).

As good as this would be it is nowhere near as good as it gets.  The result, however, would be a soaring share price followed by a standard public offering that we all could live with.

Stock Price: $6-$18 – Strategy: Hold or Sell at the Top

Headline #5: “INSPIRE Is Stopped Early For Success”

This is the extremely unlikely, though not unheard of, catalyst that is almost always followed by news that the trial’s control arm has been moved to treatment with the successful agent, in this case, rigosertib. The stock of said company moves in multiples and not by percentages. What kind of exponential gain are we talking about here? Well, that’s both easy and difficult to explain.

Easy, because the readily accessed patient population represents a potential U.S. market of an honest $300m conservatively and can be addressed by a small sales staff as cancer centers are common domains of cancer treatment. U.S. and European approval would be a foregone conclusion as the company has worked closely with both regulatory bodies and there are no other approved second line treatments.

The terms of that partnership I addressed earlier would be sweetened on both the front and back ends of the agreement with contingencies relative to frontline approval. All of this would spur the market to reappraise the value of Onconova’s pipeline assets and future prospects.

Difficult, because putting a dollar amount to all of this would be hard to do without appearing overly exuberant. Regardless, my conservative guess would be an immediate jump to the mid-30’s followed by a steady climb past $50 per share.  Note that $30 a share would represent a market-cap of only $421.83m a figure I find woefully short of a fair value mark.  Consequently, I believe it would take the market sometime to catch up to the new reality of ONTX.

Stock Price: $35-$50 – Strategy: Buy a Boat

In Conclusion

All signs point to failure.  The market is not enthusiastic about our chances.  That early halt I referenced above is likely a pipe dream born out of a growing sense of desperation surrounding an equity in decline. That noted, every dream realized is in some way founded upon the same shifting foundation.  And those who stand strong must be prepared for whatever comes.  By reading this with comprehension, it is my hope that you’re less likely to slip unexpectedly and that you wobble a bit more gracefully.

Always be well…

Thaumaturgical Disclaimer

As a practicing person of magic and aspiring warm-hearted wizard, I’ve utilized tarot cards as a basis for sub-analysis of biotech equities for the past three years and in my personal life for nearly four decades.

Mental Illness Disclaimer

I’ve been diagnosed as suffering from manic depression. Therefore, my reactions to events can sometimes be more pronounced than the facts warrant. I owe investors complete transparency and am the only ideator in biotech to provide that. Please focus on the ideas presented and don’t hesitate to contact me with any factual errors found in the article text.

General Disclaimer

Any information or opinion expressed herein may not be true, accurate or correct and it does not constitute a suggestion to buy, sell, hold or adopt any investment strategy for this stock or any stock that may be mentioned. Reliance upon information in this article is at the sole discretion of the reader. The sole purpose of my article is to entertain by providing an opinion and information the accuracy of which is as good as the public sources it was derived from. For example, KOL’s often utilize exaggerative terminolgy to describe a product or asset they are promoting on behalf of a biotechnology company they’re associated with. Do not act on anything I have written, a CEO has spoken of, or a sell side analyst has stated. Rather, do your own due diligence and consult a professional investment advisor before making any investment decision. Acting on what any one writer has imparted to you is foolish at best. I have no better access to resources than you do. I sometimes make mistakes. And there are a myriad of things, which can happen in lieu of any forward-looking statement I have made. Any stock featured or mentioned in an article I compose is subject to all manner of influences, which can change its value in dramatic fashion both higher and lower. These events can be of a wide variety – news related; managerial decisions; trial failures; stock manipulations; and so on. I make every effort to declare positions I have in stocks I cover or mention in an article but reserve the right to move in and out of said investments at my own discretion based upon the wisdom of doing so. I implore you to do your own due diligence and invest at your own considerable risk attaining the just reward your efforts have wrought. Additionally, if you are aware of any misstatements of fact contained in this or any article I have written, you are encouraged to email me immediately at the link given in the header above or address them in the comments section