Telix Pharmaceuticals Limited

ASX:TLX

Telix Pharmaceuticals Limited

ASX:TLX
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$22.91 (-0.3%)
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Pinned straw:
Remorhaz
Added 2 months ago

Detail of the Phase III study for TLX's CA9 targeting agent Zircaix, for diagnosis of ccRCC was just published in The Lancet Oncology

(alas I don't know enough about the technology or the science to meaningfully interpret the results but on the surface it sounds favourable)


DISC: Held in RL & SM
mikebrisy
Added 2 months ago

@Remorhaz good catch.

85.5% sensitivity and 87% specificity is not particularly great for renal cancers in general. However, these are soft cell carcinomas, which I understand present further challenges in diagnosis. (E.g., low contrast difference from normal tissue in MRI). I’m non expert in these areas, and this is a quick perspective from some desk research this evening. So I agree with you that it looks encouraging, at first glance. But I need to do more work on this tomorrow. The key question is how the results compare with approved alternative tests for soft cell.

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Aaronfzr
Added 2 months ago

Ive read the paper a couple of times now, and have briefly read up on the diagnostic / imaging pathways for renal masses. I think this paper is encouraging but there some limitations.


1) Accuracy is sub-gold standard

As mentioned above, the sensitivity and specificity is not quite good enough to to say with near-certainty that a person does or does not have clear cell renal cancer.

  • A positive result will likely proceed to surgery, and the removed kidney will probably be (but not always) be cancerous
  • A negative result might mean the person has no cancer at all, and roughly equal chances that they do have a clear cell cancer which was missed, or another renal cancer subtype
  • A negative test would have to proceed to either more scans or a renal biopsy, and possibly result in the kidney getting taken out anyway unless a firm diagnosis is made on biopsy


Current treatment is usually pretty aggressive, generally if people have good kidney function the surgeon will take out the kidney regardless (all or part, depending if its cancer or not). These data don't quite seem compelling enough to change practice of renal surgeons.... if the test is positive, they'll remove the kidney, and if it's negative there's a good chance they'll remove the kidney.


2) Diagnosing small masses

Sensitivity / specificity was actually a slightly better in the smaller lesions, and could be a really good screening tool to characterise smaller tumours. Surgeons and patients may have greater confidence to wait and pursue other tests following a negative result for a small lesion, or greater confidence to take the kidney out for a small lesion if they can show its probably cancer.


3) Diagnosing metastatic disease

Being able to find and define small metastatic deposits may be very helpful for targeting the cancer if it has spread outside the kidney. Positive result may be diagnostic for metastatic clear cell, and allow chemo or radiation treatment to target those deposits.


Tl;dr - actually encouraging with potential for clinical applications despite sub-gold standard accuracy


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