Professional Documents
Culture Documents
DNDN Cowen
DNDN Cowen
Dendreon
Initiating With Outperform (1)
■ What Are Shares Worth? Our sum of the parts analysis suggests the NPV
of Provenge's U.S. market opportunity is worth $28/share. Ex-US markets, an
often overlooked opportunity, could be worth another $13-15 depending on
whether Dendreon chooses to partner or retain full control of this asset.
Inclusive of net cash/NOLs ($6/share), minimal pipeline value ($0-2/share),
and applying a 10% discount for risk of non-approval, DNDN's stock could
be 50-65% undervalued relative to the market (see table on page 5).
DNDN (01/29) $27.70 Revenue $MM
Mkt cap $4.1B FY 2008 2009E 2010E 2011E 2012E
Dil shares out 149.1MM Dec Actual Prior Current Prior Current Current Current
Avg daily vol 2,505.6K Q1 — — 0.0A — 0.0 — —
52-wk range $2.6-30.9 Q2 — — 0.0A — 5.0 — —
Dividend Nil Q3 — — 0.0A — 35.0 — —
Dividend yield Nil Q4 — — 0.1 — 50.0 — —
BV/sh NA Year 0.1 — 0.1 — 90.0 400.0 800.0
Net cash/sh $4.05 EV/S — — 30000.0x — 33.3x 7.5x 3.8x
Debt/cap 1.0%
ROE (LTM) NA
5-yr fwd EPS NA EPS $
growth (Norm) FY 2008 2009E 2010E 2011E 2012E
Dec Actual Prior Current Prior Current Current Current
Q1 — — (0.14)A — (0.19) — —
Q2 — — (1.14)A — (0.19) — —
Q3 — — (0.31)A — (0.08) — —
S&P 500 1076.7 Q4 — — (0.17) — (0.04) — —
Year (0.73) — (1.74) — (0.50) 0.70 2.35
P/E — — — — — 39.6x 11.8x
Provenge’s Revenge
Dendreon’s flagship product is Provenge, a personalized immunotherapy for late
stage prostate cancer. Provenge has demonstrated the ability to prolong survival in
two randomized controlled trials and is awaiting FDA approval in patients with
metastatic castrate-resistant prostate cancer (CRPC), a potential $2B+ U.S.
opportunity. The product has a PDUFA date of May 1, 2010.
Provenge’s trials and tribulations have provided a wild ride for investors. Despite
marginal data from two initial Phase III studies, a March 2007 FDA advisory panel
surprised the Street when it voted in favor of regulatory approval. Two months later,
Provenge received a Complete Response letter from the FDA, essentially requesting
confirmation of the drug’s survival benefit in a third ongoing (much larger, and
prospectively designed) Phase III study, IMPACT. Provenge rapidly became the
subject of a high profile public (and to some extent political) debate, when the FDA’s
decision was criticized by patient advocacy groups and certain members of
Congress. In April 2009, Provenge was back in the spotlight of the medical and
investment communities when positive data from the 512-patient, SPA-sponsored
IMPACT study were presented at the annual meeting of the American Urology
Association. IMPACT demonstrated a 4-month improvement in median survival in
patients treated with Provenge relative to placebo (p=0.032).
CRPC is the second-leading cause of cancer death in men, yet there remain few
therapies to treat the condition. Taxotere chemotherapy has become the treatment
choice for around 50% of patients with metastatic disease despite its harsh toxicity
profile. Provenge has now succeeded in improving survival in men regardless of
whether they are candidates for Taxotere. This survival advantage has come with a
tolerability profile that could be better than that of any approved anticancer
therapy. All signs suggest that Provenge is poised to transform the prostate cancer
treatment paradigm.
Dendreon shares were among the best performers in biotech during 2009.
Nonetheless, we believe Provenge’s tortuous development history and novel
mechanism, and the reluctance of many investors to accept any FDA risk have kept
many potential Dendreon shareholders on the sidelines pending approval. Based on
our assessment of the evidence and discussions with many prostate cancer
specialists, we conclude that Provenge is 90% or more likely to be approved in 2010.
Factors that give us confidence around this catalyst include the positive survival
data seen in two Phase III studies, Provenge’s benign safety profile relative to other
cancer therapies, support from multiple thought-leading oncologists and the prior
positive FDA panel vote. With Dendreon management gearing up its commercial
efforts (district sales managers have been hired), it would appear that management’s
confidence in FDA approval is also high. In this report, we also address specific
aspects of investor concern, including: nuances around trial statistics and design;
inconsistencies between the PFS and survival results; and the potential for CMC
considerations to delay manufacturing approval. Importantly, we apply a 10%
discount to our overall valuation of DNDN shares to reflect our 90% estimate for
likelihood of FDA approval.
2 February 1, 2010
Dendreon
2. No news following early Q1:10 reinspection is good news. Dendreon had indicated re-inspection of its NJ production
facility would take place in early Q1, and we believe it occurred in January. At the end of the inspection the company would
be informed of the result, and any material deficiency (one that would result in a delay) would have to be disclosed.
3. Provenge unlikely to require a REMS program. REMS programs are the reason many approvals are delayed. As a safe and
well tolerated cancer therapy, with a built in product tracking system, Provenge is not expected to require a REMS.
4. Dendreon has begun hiring its commercial team. In late 2009, Dendreon hired Hans Bishop as COO, to oversee
commercial operations. District sales managers have been hired, and sales reps are expected to be added shortly.
An estimated 30-35K new cases of CRPC occur annually in the U.S. Although patients
with hormone dependent prostate cancer are initially well controlled on anti-
androgen therapies, chemotherapy remains the only option for patients whose
disease progresses. Given the harsh side effect profiles of these agents (Taxotere,
mitoxantrone/prednisone) patients usually defer treatment until late in the course
of disease. With a benign safety profile and a substantial efficacy benefit over
chemotherapy alone, Provenge fills an important niche in the treatment paradigm.
With a seemingly high level of awareness among physicians and patients, our
oncology consultants expect rapid and widespread adoption of Provenge into this
setting. Assuming 60-65% peak penetration of its labeled market, and pricing in-line
with other high-priced oncology biologics, we estimate Provenge could achieve
$1.5B per year in peak U.S. sales, and $2B+ in peak ex-U.S. sales. Potential sources of
upside to our estimates include use of Provenge in patients with symptomatic
disease (roughly 10-20% of all metastatic CRPC), in patients with non-metastatic
CRPC (a market that is roughly similar in size to metastatic CRPC), and repeat
(booster) dosing in previously treated patients. Additionally, early evidence suggests
Provenge may also have activity in earlier stage (androgen-dependent) disease, a
several-fold larger market opportunity.
Provenge price per patient (000's) $75 $75 $75 $77 $78 $80 $81
U.S. Provenge sales in CRPC ($MM) $90 $400 $800 $1,200 $1,350 $1,425 $1,500
February 1, 2010 3
Dendreon
4 February 1, 2010
Dendreon
Given the proximity of U.S. launch, the Street is largely focused on Provenge’s U.S.
market, and few have considered Provenge’s value ex-U.S. Dendreon management
believes that the ex-U.S. opportunity for the drug is at least as large, and perhaps up
to 2x larger, than that in the U.S. Dendreon has indicated to investors that it is
seeking to partner ex-U.S. rights to Provenge to allow management to focus on U.S.
commercialization. That said, the company has indicated that any ex-U.S. deal would
need to make economic sense, as judged by management’s assessment of the deal’s
NPV relative to Provenge’s ex-U.S. value in Dendreon’s hands. Modeling out both
scenarios (incorporating a 12 month delay and lower peak sales under the latter
scenario) and making assumptions around typical deal terms, suggests that ex-U.S.
Provenge is worth about $13/share to Dendreon under a partnership scenario, or
$15/share should Dendreon elect to go it at alone.
We also credit the company with $1-2 in value for its NOL tax credits, $4/share in
value for the balance sheet and $0-2/share for its technology platform and pipeline
programs. Our conclusions are outlined in the table below. In addition to relatively
conservative 12% (U.S.) and 15% (ex-U.S.) Provenge NPV discount rates, we further
discount our overall sum of the parts valuation by 10%, to account for the small (but
existent) regulatory risk.
NOL's NPV $2
Net Cash $4
Pipeline/Platform $0-2
February 1, 2010 5
Dendreon
Upcoming Milestones
Milestone/Event Timing
Provenge PDUFA date May 1
Pricing and launch of Provenge in the U.S. Q2:10
Discussions with EMEA regarding EU filing for Provenge H2:10
Potential ex-U.S. partner signed for Provenge 2010
Updates from ongoing Provenge trials (PROACT, PROTECT, NEOACT) 2010
Start Phase I/II Neuvenge bladder cancer trial YE:10
NJ Provenge production facility fully operational H1:11
Begin CA9 clinical cancer program 2011
Atlanta and LA Provenge production facilities come on line Mid 2011
Source: Cowen and Company
6 February 1, 2010
Dendreon
Q1:09A Q2:09A Q3:09A Q4:09E 2009E Q1:10E Q2:10E Q3:10E Q4:10E 2010E
Provenge U.S. Sales 5.0 35.0 50.0 90.0
Provenge ex-U.S. royalty 0.0
Other Revenue
Total Revenue 0.0 0.0 0.0 0.0 0.1 0.0 5.0 35.0 50.0 90.0
COGS 1.6 11.2 16.0 28.8
Gross margin 68% 68% 68% 68%
R&D 11.8 13.3 16.5 18.0 59.6 18.5 19.0 20.5 21.5 79.5
SG&A 5.2 7.6 9.3 12.0 34.1 15.0 18.0 21.5 25.0 79.5
Total Expenses 17.0 20.9 25.8 30.0 93.7 33.5 38.6 53.2 62.5 187.8
Operating margin (U.S.) NM
Operating Income/Loss (17.0) (20.9) (25.8) (30.0) (93.7) (33.5) (33.6) (18.2) (12.5) (97.8)
Interest Income 0.3 0.2 0.2 0.5 1.2 1.0 1.0 1.0 1.0 4.0
Interest Expense (1.1) (0.2) (0.6) (0.6) (2.5) (0.5) (0.5) (0.5) (0.5) (2.0)
Gain (loss) from valuation of warrant liability 2.4 (105.8) (19.4) 0.0 (122.8) 0.0 0.0 0.0 0.0 0.0
Other Income (Expense), net
Pre-tax Income/Loss (15.4) (126.7) (45.6) (30.1) (217.8) (33.0) (33.1) (17.7) (12.0) (95.8)
Tax rate (%) 0%
Provision for income taxes 0.0
GAAP Net Income (Loss) (15.4) (126.7) (45.6) (30.1) (217.8) (33.0) (33.1) (17.7) (12.0) (95.8)
Stock based compensation 1.8 6.5 10.4 10.0 28.7 7.0 7.0 7.0 7.0 28.0
Non-GAAP Net Income (Loss) (13.6) (120.2) (35.1) (20.1) (189.0) (26.0) (26.1) (10.7) (5.0) (67.8)
GAAP EPS ($0.16) ($1.20) ($0.40) ($0.25) ($2.01) ($0.25) ($0.24) ($0.13) ($0.09) ($0.70)
Non-GAAP EPS ($0.14) ($1.14) ($0.31) ($0.17) ($1.74) ($0.19) ($0.19) ($0.08) ($0.04) ($0.50)
Basic Shares 95.8 105.9 113.4 119.0 108.5 134.5 135.5 136.5 137.5 136.0
Diluted Shares 95.8 105.9 113.4 119.0 108.5 134.5 135.5 136.5 137.5 136.0
non-GAAP EPS excludes stock-based compensation and 1x items.
Source: Cowen and Company
Total Expenses 70.6 93.7 187.8 325.0 454.0 562.0 594.0 598.5 605.0
Operating margin (U.S.) NM 19% 43% 53% 56% 58% 60%
Operating Income/Loss (70.5) (93.7) (97.8) 75.0 346.0 666.6 905.5 1,114.5 1,295.0
Interest Income 3.6 1.2 4.0 6.0 8.0 8.0 8.0 10.0 12.0
Interest Expense (5.2) (2.5) (2.0) (1.0) (1.0) (1.0) (1.0) 0.0 0.0
Gain (loss) from valuation of warrant liability 0.4 (122.8)
Other Income (Expense), net
Pre-tax Income/Loss (71.6) (217.8) (95.8) 80.0 353.0 673.6 912.5 1,124.5 1,307.0
Tax rate (%) 0% 0% 0% 3% 3% 35% 35% 35% 35%
Provision for income taxes 2.4 10.6 235.8 323.4 394.1 457.5
GAAP Net Income (Loss) (71.6) (217.8) (95.8) 77.6 342.4 437.8 589.1 730.4 849.6
Stock based compensation 5.9 28.7 28.0 32.0 32.0 36.0 40.0 40.0 40.0
Non-GAAP Net Income (Loss) (65.8) (189.0) (67.8) 108.6 373.5 461.2 614.9 756.3 875.6
GAAP EPS ($0.79) ($2.01) ($0.70) $0.50 $2.15 $2.70 $3.55 $4.35 $5.00
Non-GAAP EPS ($0.73) ($1.74) ($0.50) $0.70 $2.35 $2.85 $3.70 $4.50 $5.15
Basic Shares 90.4 108.5 136.0 140.0 143.0 146.0 150.0 152.0 154.0
Diluted Shares 90.4 108.5 136.0 156.0 159.0 162.0 166.0 168.0 170.0
non-GAAP EPS excludes stock-based compensation and 1x items.
Source: Cowen and Company
February 1, 2010 7
Dendreon
Provenge’s tortuous history and the reluctance to take on regulatory risk have kept
many potential DNDN investors on the sidelines, providing the possibility of
significant stock price performance upon approval. While approval is not assured,
DNDN bulls point to the positive survival data from two Phase III studies, the
consistency of the data across trials, and most importantly the fact that Dendreon
has satisfied the requirements of the FDA’s 2007 Complete Response letter. Investor
concerns include the inconsistency between primary and secondary endpoints
(survival and PFS), the potential for outstanding manufacturing issues to impact or
delay approval, and a lack of confidence in the FDA’s willingness to approve a
therapy with such a novel (and to some extent, undetermined) mode of action.
Based on our discussions with leading prostate cancer experts and statisticians, we
conclude that Provenge is 90% or more likely to be approved in 2010. A summary of
Provenge’s regulatory history and reasons for our confidence are outlined below.
Most importantly, we acknowledge that handicapping any FDA decision is fraught
with hazard, and reflect this by discounting our fair value estimate for DNDN stock
by 10%.
8 February 1, 2010
Dendreon
Relatively benign AE profile Relative to chemotherapies, and even some biologics, Provenge is very well tolerated.
Increased risk of cerebrovascular events may be the only potential labeling concern
Physician community no longer Survival data from the IMPACT trial have convinced many previously skeptical opinion
skeptical leading oncologists that Provenge’s benefits are real
Biological markers correlate with Although questions about Provenge’s mode of action persist, the correlation between
benefit CD54 upregulation and survival supports the view that immune activation is important
FDA review process is fairly Provenge has already endured one FDA review cycle, including a public advisory panel
transparent which ended with a favorable recommendation. IMPACT should represent the final hurdle
Political considerations The outcry from patient advocates and Congress that followed a May 2007 Complete
Response letter will make it difficult for the FDA to reject Provenge without good reason
Survival results confounded by There is little evidence to believe this is the case in either IMPACT, or the previously FDA-
subsequent therapies reviewed D9901A trial. Various subset analyses suggest the opposite
Amendments to IMPACT study Statistical consultants do not believe early changes in trial design compromise the
compromise the results integrity of the study. All changes were previously vetted with the FDA under an SPA
IMPACT data have yet to be Multiple external and internal parties collected and analyzed the IMPACT data. There is
reviewed no reason to suspect fraudulent activity
CMC considerations could delay Dendreon has addressed all issues raised in the May 2007 CR letter. Although a recent
approval inspection could uncover new deficiencies, any such issues should be easily addressable
Initial Phase III Studies Provide Mixed Data, But Clear Evidence Of
Activity
Dendreon’s original 2006 BLA submission for Provenge was based on data from two
similarly designed, randomized, double-blind, placebo-controlled Phase III studies in
men with metastatic castrate-resistant prostate cancer (CRPC). Eligibility criteria
included histologically documented prostate adenocarcinoma (with >25% of tumor
cells staining positive for PAP, a prostate cancer surface antigen), asymptomatic (in
terms of pain score) metastatic disease (either in the bone or soft tissue), and
evidence of tumor progression after hormonal therapy (either by radiographic or
PSA criteria).
February 1, 2010 9
Dendreon
The trials randomized patients 2:1 to receive either Provenge or placebo. Following
progression (defined as either radiological, clinical or pain progression) patients in
the placebo arms were permitted to cross over and receive a preserved version of
Provenge (prepared from frozen apheresed PBMC’s collected at the start of the study
for potential crossover use). Patients in both arms of the studies were permitted to
receive Taxotere after progression. Both studies had a primary endpoint of time to
progression (defined by objective radiographic criteria, clinical progression and
pain progression criteria).
D9901, which enrolled 127 patients (82 received Provenge while 45 received
placebo), failed to meet its primary endpoint, demonstrating TTP of 11.0 weeks vs.
9.1 weeks for the Provenge and control arms, respectively (p=0.085). However a 3-
year survival analysis performed as part of the follow-up, demonstrated a
statistically significant improvement in median survival (25.9 vs. 21.4 months; HR =
0.58; p=0.01). Additional details from the FDA’s briefing documents are outlined
below, and support the notion that Provenge is efficacious in this setting;
• Use of subsequent chemotherapy (Taxotere) was roughly balanced between
the two arms (54% vs. 63% in the placebo arm) and a sensitivity analysis
demonstrated no evidence that improved survival could be attributed to
potentially earlier use of chemotherapy in the treatment arm.
• Prostate cancer-specific deaths were 20% lower in the treatment arm.
• Data demonstrated a trend towards increased survival in patients with
higher CD54 upregulation (a cell surface marker on dendritic cells, measured
as a surrogate for immune activation).
10 February 1, 2010
Dendreon
Relative to other cancer therapies, Provenge appears to be very well tolerated. In the
pooled safety data from the two studies, the most common AE’s were Grade 1/2
chills, fatigue, fever, and back pain (the majority lasted 24-48 hours and were
treated on an out-patient basis). SAE’s were generally equally balanced between the
two arms, with the exception of cerebrovascular events (8/147 vs. 0/78 in these
studies; 3.9% vs. 2.6% when all other Provenge studies are included).
Based on data from D9901 and D9902A, Dendreon filed a BLA with the FDA, which
was reviewed at a March 2007 FDA Cellular, Tissue and Gene Therapies advisory
panel meeting. The Provenge briefing documents for the meeting concluded that
“the lack of a pre-specified primary method for survival analyses renders it difficult
to estimate the type I error of this survival analysis” and that therefore “doubts
remain about the persuasiveness of the efficacy data”. Nonetheless, the FDA went on
to acknowledge overall survival as the gold standard amongst cancer endpoints, “An
improvement in survival is of unquestioned clinical benefit. The endpoint is precise
and easy to measure, documented by the date of death. Bias is not a factor in endpoint
measurement…. Demonstration of a statistically significant improvement in overall
survival is usually considered to be clinically significant and has often supported new
drug approval”. The FDA did not question the company’s analysis of the data, or any
of the key findings.
These data made for a somewhat controversial panel, which ultimately voted 17 to 0
in favor of the safety of Provenge and 13 to 4 in favor of the drug demonstrating
substantial evidence of efficacy in this indication. However, in May 2007 Dendreon
received a Complete Response letter requesting additional clinical data in support
of the BLA’s efficacy claim, as well as additional information regarding the CMC
portion of the BLA. With respect to the efficacy claim, the FDA informed Dendreon
that it would accept either a positive interim analysis or final analysis of survival
from the then ongoing Phase III IMPACT (D9902B) study.
February 1, 2010 11
Dendreon
As with the D9901 study, sensitivity analyses demonstrated that the treatment
effect was consistent across multiple patient subsets, including when adjusting for
use and timing of docetaxel following Provenge (we discuss this issue in greater
detail later in our report). Based on these data, as well as additional CMC work,
Dendreon submitted an amended BLA filing to the FDA in early November 2009, and
Provenge has been granted a May 1st 2010 PDUFA date for this indication.
12 February 1, 2010
Dendreon
Based on our analysis of Provenge’s Phase III data sets, checks with multiple
physicians and statistician consultants and a review of FDA documents related to
Provenge, we handicap the likelihood of FDA approval at 90% or more. Below we
provide a discussion of what we believe to be the most significant factors favoring
regulatory approval, and address the concerns raised by Provenge skeptics.
Much of the focus at the March 2007 FDA panel centered around the fact that
survival was not the prospectively defined primary endpoint in D9901 or D9902A.
This ultimately formed the basis of the FDA’s Complete Response letter, in which the
agency requested supportive survival data from IMPACT, an SPA-backed Phase III in
which survival was defined as the primary endpoint early on in the study. With
Provenge now having met the “clear and unambiguous” efficacy hurdle outlined in
the FDA’s Complete Response letter, consultants believe the Agency’s concerns
around Provenge’s efficacy have now been all but satisfied by IMPACT.
The most common adverse events in Provenge’s three Phase III trials were Grade 1/2
chills, fatigue, fever, and back pain. Adverse events were mostly transient and
resolved within 24-48 hours. At the March 2007 FDA panel, questions were raised
around Provenge’s propensity to cause cerebrovascular events, with 8/147 patients
in the first two Phase III studies suffering a CVA, versus zero patients in the control
arm. However, when data from all Provenge studies were included (i.e. including P-11
and IMPACT data) the CVA rate was 3.9% for Provenge vs. 2.6% in control patients.
Meanwhile, Provenge’s safety profile in IMPACT (summarized below) demonstrated
no difference the rate of CVA’s. Ultimately the FDA panel voted 17-0 in favor of
Provenge’s safety profile.
February 1, 2010 13
Dendreon
Provenge appears to be better tolerated than any major oncology product that we
are aware of. As such, the overall risk/benefit profile (on which the FDA judges all
new drug applications) for Provenge appears to be highly favorable.
Prior to Dendreon’s April 2009 announcement that the IMPACT study met its
primary endpoint, our oncology consultants had been skeptical of Provenge, and its
likelihood of demonstrating a significant survival advantage in a much larger Phase
III study. Physicians cited Provenge’s unvalidated mechanism as a dendritic cell
vaccine, its single antigen target (in what they consider a biologically heterogeneous
disease), and a clinical dataset with conclusions predicated largely on retrospective
analyses from small studies.
Our physician checks indicate a high degree of enthusiasm for Provenge amongst
oncologists following the presentation of the IMPACT data at AUA in April 2009.
Despite a relatively borderline p-value (0.032), they view the trial’s Hazard Ratio for
survival (0.775) as indicative of solid efficacy. They note that Provenge has now
shown a statistically significant survival benefit in two separate studies (versus the
FDA’s usual requirement of one positive study in oncology indications).
Furthermore, they view the data as highly consistent across all three studies in
terms of median survival benefit (3-4 months) as well as lack of a significant benefit
in PFS.
14 February 1, 2010
Dendreon
Meier survival curves from D9901 and D9902A indicate an improved survival
benefit in Provenge-treated patients who achieved higher levels of CD54. The FDA
acknowledged these data in Provenge’s March 2007 FDA briefing documents.
Findings from IMPACT are similar.
The FDA’s 2007 review of Provenge provides investors with a level of visibility into
the regulatory process that is rare for unapproved products. Based on the briefing
documents for the Cellular, Tissue and Gene Therapy advisory panel, the panel
proceedings, and the requirements in a Complete Response letter, it would appear
that the FDA was relatively close to being convinced of Provenge’s clinical benefits
based on the D9901 and D9902A data. The record provides a clear path for approval
of Provenge, and positive data from the IMPACT study appear to satisfy the FDA's
outstanding request for confirmatory efficacy data.
Given the outcome of the 2007 review process, we think it is unlikely that the FDA
would choose to convene a second FDA panel to review positive data from IMPACT. A
review of the FDA’s advisory committee calendar for 2010 also indicates that no
panel meetings for either ODAC or the Cellular, Tissues and Gene Therapy
committees have been scheduled prior to Provenge’s May 1st PDUFA date. Of course
we caveat that the FDA has been known to delay PDUFA dates, or even schedule
advisory panel meetings after a drug’s PDUFA date.
CBER's Cellular, Tissue and Gene Therapy division retains control over Provenge's
BLA, and according to the company, is receiving input from CDERs Oncology review
division. Given that an advisory panel previously recommended Provenge for
approval based on mixed data from D9901 and D9902A, it would seem likely that
should an FDA panel be reconvened to review the IMPACT data, Provenge would
again receive a positive vote
February 1, 2010 15
Dendreon
The failure of the FDA to approve Provenge in 2007 became a subject of intense
scrutiny by non-profit groups and later by Congress. After the favorable panel vote,
a prominent oncologist and researcher at Memorial Sloan Kettering Cancer Center
(and also a panel member who voted against approval), wrote a letter to the FDA
outlining reasons against approving Provenge’s BLA. This letter later leaked to an
influential newsletter (The Cancer Letter) leading to angry protests (on blogs and
websites) from patients and patient advocate groups.
These events have led to a high level of public awareness around Provenge’s
regulatory review, and would seem to raise an already high bar for an FDA rejection
decision.
Much of the discussion at the March 2007 FDA panel was focused on Provenge’s
failure to demonstrate a statistically significant improvement on D9901 and
D9902A’s primary endpoint, PFS. Many theories have been put forth to explain the
disconcordance in the data sets between PFS/response rates and survival (some of
which are outlined below). Nonetheless, our read of the evidence and our
discussions with prostate cancer experts suggest this is unlikely to have any bearing
on the FDA’s final evaluation. Our reasons are set forth below.
First, a review of the prostate cancer literature confirms the view that there are no
validated surrogate endpoints for assessing benefit in metastatic CRPC. This is
because of difficulty in objectively quantifying changes in tumors that have
metastasized to the bone (RECIST criteria are not applicable). A study published by
Scher, et al in 2005 demonstrated that when RECIST criteria are applied to men with
CRPC, less than half of patients have measurable target lesions greater than 2cm in
size. Another study by Scher, et al published in 2007, demonstrated that the overall
association between PFS and survival was weak to moderate (0.4 for radiographic
PFS), and again concluded that current measure of PFS in CRPC are not strong
surrogates for survival. Factors thought to contribute to this lack of correlation
include interval censoring of progression data, and the discontinuation of therapy
early in follow-up because of imaging changes that may not reflect true failure of
the treatment. The FDA appears to be on board with this thinking, given that it is
16 February 1, 2010
Dendreon
Second, our consultants think the lack of PFS benefit in all three Phase III studies is
in-line with what might be expected from a slow acting immunotherapy, and is
consistent with data seen from other cancer vaccine studies. In fact, a recently
issued FDA guidance document titled “Clinical considerations for therapeutic cancer
vaccines” appears to support our consultants’ views, stating that: “Because cancer
vaccines need time to elicit an immune response that could manifest as biological
activity (i.e. a tumor specific immune response), a delayed effect can be expected in
the subjects who have received the vaccine. Subjects may experience disease
progression prior to the onset of biological activities or effects from the vaccine”.
Lastly, we take heed of Provenge’s March 2007 FDA briefing documents detailing the
FDA’s stance towards survival endpoints in oncology studies: “Survival is the most
reliable cancer endpoint, and when studies can be conducted to adequately assess it, it
is usually the preferred endpoint. An improvement in survival is of unquestioned
clinical benefit. The endpoint is precise and easy to measure… Bias is not a factor in
endpoint measurement”. With respect to D9901, the FDA goes on to state that “the
survival analyses were post hoc, and it is difficult to estimate the true type I error rate
for the survival effect with Provenge treatment observed in D9901”. Hence we think
that Dendreon’s prospective demonstration of improved survival in IMPACT will be
deemed sufficient evidence of Provenge’s efficacy to warrant FDA approval.
The design of Provenge’s Phase III studies allowed for patients in the placebo arm to
cross over and receive Provenge upon progression. Patients in both arms of the
studies were also permitted to receive Taxotere during the study. Some investors
have rightly speculated that crossover might have translated into a difference in
timing of subsequent chemotherapy treatment between the two arms. In theory, the
survival benefit in the studies could have resulted from earlier administration of
Taxotere chemotherapy to patients in the Provenge arm.
While we believe this is a legitimate question raised, according to the IMPACT data
presentation, use of Taxotere was well balanced between the two arms, with 50% of
patients in the Provenge arm, and 52% of patients in the placebo arm receiving
Taxotere treatment. Dendreon also performed a sensitivity analysis to assess the
issue of chemotherapy timing, using a time-dependent covariate analysis. Dendreon
confirmed that Provenge’s hazard ratio remain statistically significant when
adjusted for use and timing of Taxotere (HR=0.763; p=0.036). Furthermore, in the
D9901A study, FDA briefing documents state that “the analysis did not suggest that
increased survival in the treatment group could be attributable to earlier use of
chemotherapy in general or taxanes specifically”.
February 1, 2010 17
Dendreon
In support of the view that timing of chemotherapy is not responsible for the
observed survival difference between the two arms, the literature (Oh, et al, Urology
2006) indicates that the timing of Taxotere therapy (early versus late) does not
correlate with survival benefit.
Another factor that Dendreon bears speculate may have confounded the survival
analysis, relates to a different form of Provenge administered to cross-over patients
in the placebo arm of IMPACT. ‘Frovenge’, as one consultant referred to it, is
prepared from a frozen sample of PBMC’s collected upon entry into the study. In
theory, toxicity from this form of Provenge could have accounted for the observed
difference in survival. Consultants believe there is little reason to suggest that such
a preparation would decrease a patient’s survival. Furthermore, Dendreon has
indicated that it observed trends in all three trials toward improved survival in
placebo patients who crossed over to receive Provenge (relative to placebo patients
who did not cross over). Also, while we caution that comparisons across trials are
not scientifically rigorous, it is also interesting to note that in both D9901 and
IMPACT (studies in which 76% and 65% of control patients crossed over to receive
Provenge, respectively), the median survival for control arm patients (21.4 and 21.7
months, respectively) was considerably higher than would be expected for
metastatic CRPC patients based on other studies (for example median survival in the
TAX-327 study was 18.9 months in patients receiving the approved dose of
Taxotere). This further supports the notion that (frozen) Provenge is in fact
contributing to prolonged survival.
As originally designed, the IMPACT study’s primary endpoint was PFS. However, the
failure of D9901 to achieve significance on this endpoint (and its success in
achieving an improvement in overall survival) prompted the company in 2005 to
change the primary endpoint of IMPACT to survival. The other major change made to
the study at that time was to enroll patients with all Gleason Scores (previously, the
company had elected to enroll only patients with Gleason scores of 7 or less, based
18 February 1, 2010
Dendreon
on post-hoc subset analyses from earlier studies). All changes were discussed and
agreed to by the FDA.
Our statistical consultants do not expect this change to compromise the statistical
integrity of the study, nor to bear negatively in any way on the FDA’s review process.
This reflects that fact that changes were made early on in the study, were agreed to
by the FDA, and the view that that survival is viewed as the more definitive and
robust of the two endpoints.
One additional point worth noting relates the October 2008 interim analysis of the
IMPACT data. Some investors have postulated that DNDN’s decision to publicly
release data related to the study’s hazard ratio at that time point could have biased
future follow-up, and somehow increased the rate of Type I error in the final data
analysis. Our statistical consultant believes there is little relevance for such an
argument in a survival-based study. Furthermore, Dendreon’s management team
discussed and signed off on the final press release with the FDA prior to its
publication.
Some investors are concerned that the IMPACT trial has not yet been reviewed by the
FDA or published in a peer reviewed medical journal. As a result, they are fearful
that key conclusions, such as the improvement in overall survival, may be altered
upon further review. Indeed the p-value on survival (p=0.032) is not particularly
robust, and only modestly lower than what was pre-specified in the trial’s protocol
(p=0.043).
Biotechnology investors are keenly aware that blatant scientific fraud can be a risk
factor (e.g. Sequenom, TKT). However, several reasons lead us to believe the quality
of the IMPACT data are as advertised.
1. Data have been presented at the late breaking session of an important medical
meeting (AUA) by a prestigious clinician (Dr. David Penson of USC).
4. The results from Provenge’s D9901 and D9902A trials did not change after
review by the FDA in 2007.
5. Several members of management have sold DNDN shares in the months since
the IMPACT data were presented. Given the consequences that could be
associated with fraudulent selling, we believe senior management isn’t aware of
any corporate malfeasance.
February 1, 2010 19
Dendreon
information on the chemistry, manufacturing, and controls (CMC) section of the BLA.
At the time, the company indicated that it could satisfy the FDA with the information
requested in a timely manner. A redacted copy of the CR letter indicates the FDAs
requests were fairly mundane and related to things such as:
• Inadequate labeling and handling flow of samples (quality control steps for
maintaining the identity of the samples)
• Request for more data on handling of multiple samples in the same room
The company has since implemented additional controls and procedures, including
a Laboratory Information Management System (LIMS) that includes bar coded sample
tracking, to enhance quality control. Prior to the resubmission of the BLA in
November 2009, Dendreon discussed each of the CMC items in the Complete
Response letter with the FDA.
Our confidence that Dendreon has taken the appropriate measures to satisfy the
FDA’s 2007 concerns is high. Nonetheless, we cannot rule out CMC risk as a barrier
to timely FDA approval. Provenge’s manufacturing process is unique amongst
therapeutics, and includes multiple steps that need to be completed in a timely and
competent manner. The company indicated FDA re-inspection of its New Jersey
manufacturing facility would occur in early 2010, and while we believe the
inspection went off with out a hitch, there is always some risk that the FDA could dig
up novel issues that could delay approval. While it is possible that CMC issues could
prevent timely approval of Provenge, we don’t believe any such issues are
insurmountable. The Provenge manufacturing process is not rocket science, but
rather composed of discrete processes (recombinant antigen production,
leukapheresis, centrifugation/purification of APCs, incubation, activity and sterility
testing) that have been performed in medical centers and diagnostic/research labs
for decades. Dendreon adequately performed these tasks for hundreds of patients
enrolled in Phase III trials, and all that is required for FDA approval is adequate scale
up.
20 February 1, 2010
Dendreon
February 1, 2010 21
Dendreon
is primarily directed toward urologists, under whom the bulk of earlier-stage CRPC
patients are managed. In total, our consultants estimate that Provenge could
ultimately be used in 80% or more of eligible patients.
Provenge price per patient (000's) $75 $75 $75 $77 $78 $80 $81
U.S. Provenge sales in CRPC ($MM) $90 $400 $800 $1,200 $1,350 $1,425 $1,500
Our model assumes 30-35K new metastatic CRPC patients per year in the U.S., 85% of
who present with minimally symptomatic disease. We assume Provenge is launched
shortly after its May 1, 2010 PDUFA date, with 60% penetration into metastatic CRPC
patients within 3-4 years of launch, and more gradual share gains beyond 2013. We
estimate a course of three Provenge treatments is priced at $75K/patient, a figure
that is roughly in-line with other cancer therapies with demonstrated survival
benefits, and we think in-line with management’s thinking. Our estimate of $1.5B in
peak U.S. sales assumes roughly 18-19K patients per year are treated with Provenge
at peak.
In our view the greatest source of potential upside to these numbers lies in the
potential for reimbursement of Provenge in earlier-stage (non-metastatic) CRPC,
which we estimate could represent another 30,000 patients per year. Consultants
note that there is some ambiguity in terms of when a patient is officially diagnosed
as having metastatic disease. In their opinion, borderline patients with advanced
CRPC but no documented metastases will likely also seek treatment with Provenge.
We also acknowledge that the number of pre-existing metastatic HRPC patients (i.e.
the prevalence) is significantly higher than the incidence rate we model (we estimate
90-100K patients in the U.S.). We have conservatively elected not to include these
patients in our model, reflecting capacity/production constraints in the initial 1-2
years of Provenge’s launch (discussed in greater detail below). We do not account for
these patients beyond this time, as median survival for these patients is on the order
of 18-19 months.
22 February 1, 2010
Dendreon
The patient’s blood sample must first undergo leukapheresis (a procedure in which
white blood cells are separated from the blood sample). This takes place at an
apheresis center. Each of these centers must be validated and contracted by
Dendreon. Dendreon estimates there are approximately 600 apheresis centers in the
U.S. Approximately 75 of these sites were used in the Phase III IMPACT study, and
management estimates 150-200 sites will be utilized at peak. Dendreon has
contracted directly with many leading apheresis service providers (for example, The
American Red Cross, the New York blood center), and will incentivize centers by
reimbursing at higher rates than would be typical for a leukapheresis procedure
(typically in the $700-800 range). Management and consultants are confident that
multiple centers can be validated before Provenge’s approval providing sufficient
capacity at apheresis centers to meet potential demand.
February 1, 2010 23
Dendreon
The white cell sample is then shipped by courier to one of Dendreon’s three
manufacturing facilities (New Jersey, and eventually L.A. or Atlanta). Dendreon is
working with established couriers that specialize in the time sensitive delivery of
materials including medical products. Each individual sample is labeled with a bar
code that should ensure patient samples are not mixed, and allow each sample to be
trackable by a GPS-like computer system.
Manufacture Of Provenge
This is the only step in the process that is managed entirely by Dendreon. The
process of making Provenge is depicted below. Specific cells known as Antigen
Presenting Cells (or APC’s) are first separated out for a patient’s white blood sample.
The cells are then incubated with an Antigen-Delivery-Cassette (GM-CSF combined
with Prostatic Acid Phosphatase, an antigen that is widely expressed on the surface
of prostate cancer cells) for a period of up to two days. This set of “activated” APC’s
then undergo quality assurance testing including evaluation of surrogate markers
for immune stimulation (such as CD54). The sample is then formulated with a buffer
to create the final Provenge infusion, which is shipped back to the physician and
administered to the patient as a simple one hour infusion in the physician’s office
(no pre-medication is needed). The entire cycle is repeated three times, at two-
weekly intervals, following which Dendreon collects payment from the physician.
At full capacity, Dendreon will operate three manufacturing sites: one each in New
Jersey, L.A., and Atlanta. Dendreon built out 25% its NJ facility in 2006, and this has
been used for the manufacture of Provenge since 2007. The company also intends to
launch Provenge from this existing facility. Build-out of the remaining 75% of
capacity is underway and is on track to complete in H1:11, while L.A. and Atlanta are
expected to provide additional capacity by mid-2011. Because the three facilities
have a modular construct with the same design and equipment for the GMP
manufacturing core, this should dramatically reduce the engineering time required
24 February 1, 2010
Dendreon
to build the facilities. We estimate it will take 12-14 months to build each facility,
and perhaps 4-6 months for validation and inspection.
Dendreon has provided an indication of the potential revenue that each facility will
be capable of providing when complete. New Jersey (48 workstations at full
capacity) will be capable of providing $500MM-$1B in yearly revenues, while LA and
Atlanta (36 workstations each) will be capable of generating $375-$750MM each in
yearly revenues.
Based on these figures, Dendreon has guided to a ‘step-wise’ launch for Provenge,
estimating that the initial manufacturing capacity (25% of NJ facility) is capable of
producing $60-125MM in 2010 revenues (assuming Provenge is approved on its May
1st PDUFA date). 2011 (and to some extent 2012) should be a transition year, as
build-out of the remaining workstations in NJ, and the LA an Atlanta facilities is
completed.
We are confident that Dendreon can execute on the timely build-out, validation and
inspection of its three facilities. The New Jersey facility has been successfully
manufacturing clinical supply of Provenge since 2007, and assuming it is approved
for commercial use, we see no reason why Dendreon cannot successfully scale up
the process in this and other locations. Although manufacturing, logistical, training
or other access-related issues could always produce minor delays to expected
timelines, such delays shouldn’t detract from the high level of patient-driven
demand that drives our peak sales estimates, and ultimately our valuation estimates.
February 1, 2010 25
Dendreon
NOL's NPV $2
Net Cash $4
Pipeline/Platform $0-2
26 February 1, 2010
Dendreon
Most drugs in late stage development for prostate cancer would be used in
conjunction with Provenge, either just before or just after therapy. These include
JNJ’s abiraterone, Medivation’s MDV3100, and Roche’s Avastin. The only potential
head on threat to Provenge on our radar screen comes from Bavarian Nordic’s
PROSTVAC. PROSTVAC is an off the shelf vaccine comprised of seven monthly
injections of two different poxyviruses that overexpress PSA and three immune
enhancing co-stimulatory molecules. A 125-patient Phase II trial conducted in a
prostate cancer population similar to that of Provenge trials demonstrated
PROSTVAC improved survival relative to placebo control (HR=0.559, p=0.006).
Bavarian Nordic intends to initiate Phase III testing in late 2010. We think data might
be available in the 2014 timeframe
Revenue Assumptions: Our U.S. Provenge NPV analysis is outlined below. Our
revenue assumptions for the first six years of launch are outlined on page 22.
Beyond 2016, we model medium-term (2016-22) Provenge sales growth of 3% per
year in the U.S., achieved predominantly by patient population growth. Beyond 2022,
we apply a 0% terminal growth rate (acknowledging that Provenge’s significant
longevity could be offset by competition from newer therapies and unanticipated
treatment paradigm changes). These assumptions imply U.S. sales of $1.5B by 2016
and $1.8B at peak in 2022.
Taxes: Dendreon has accumulated $529MM in U.S. Federal NOL tax credits and
$76MM in State NOL’s as of year-end 2008. Therefore, the company’s tax expense
should benefit for at least 1-2 years after profitability (we model Dendreon breaking
even in mid to late 2011). For valuation purposes we have elected to tax Provenge
February 1, 2010 27
Dendreon
profits at 35% beginning at launch, and add back the value of NOL’s separately
within our sum-of-the-parts analysis.
CapEx: We also incorporate an initial CapEx cost into Provenge’s NPV, to reflect the
fact that Dendreon has yet to build out full manufacturing capacity for Provenge
(only 10% of anticipated capacity has been built out to date). Management has
guided that Provenge’s three U.S. manufacturing facilities are expected to cost $50-
80MM each. This is consistent with a recently filed 8-K that outlines the company’s
Atlanta facility construction contract (the agreement specifies a maximum price for
this work of $40MM). We conservatively model $75MM in U.S. CapEx costs per year
from 2010-2012.
Discount Rate: As applied to a DCF or NPV analysis, a discount rate represents the
return an investor should demand for assuming a level of risk associated with the
investment. Determining an appropriate discount rate for any pre-commercial
biotech company is clearly fraught with hazard. In the case of Provenge, the main
potential risks are regulatory and commercial. On the regulatory side, Provenge has
established an overall survival benefit in two Phase III studies, with consultants
unanimously predicting FDA approval. That said, Provenge’s novel first-in-class
therapeutic approach to cancer represents relatively unchartered territory at the
FDA. Overall, we view FDA approval as 90% likely. We account for this risk not in
adjusting the discount rate, but instead in discounting our overall sum-of-the-parts
value by 10%. We apply a 12% discount rate to our U.S. Provenge NPV estimates, to
account for the remaining commercial and execution risk. These assumptions yield
a fair value for the U.S. Provenge franchise of $28/share.
28 February 1, 2010
Dendreon
$MM 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
U.S. Provenge Sales 90 400 800 1,200 1,350 1,425 1,500 1,575 1,622 1,671 1,704
Y/Y Growth 344% 100% 50% 13% 6% 5% 5% 3% 3% 2%
U.S. Provenge COGS 29 120 224 312 324 314 300 315 324 334 341
As a % of U.S. Provenge Sales 32% 30% 28% 26% 24% 22% 20% 20% 20% 20% 20%
U.S. Provenge Sales & Marketing Expense 75 100 115 114 128 128 135 134 138 134 136
As a % of U.S. Provenge Sales 83% 25% 14% 10% 10% 9% 9% 9% 9% 8% 8%
U.S. Provenge Development Expense 60 75 90 100 100 100 100 100 100 100 100
As a % of U.S. Provenge Sales 67% 19% 11% 8% 7% 7% 7% 6% 6% 6% 6%
Total Provenge Expenses 164 295 429 526 552 542 535 549 562 568 577
DNDN Operating Income From U.S. Provenge (74) 105 371 674 798 883 965 1,026 1,060 1,103 1,127
Provenge Operating Margin -82% 26% 46% 56% 59% 62% 64% 65% 65% 66% 66%
Tax-Adjusted EBIT (74) 68 241 438 519 574 627 667 689 717 733
Tax rate 0% 35% 35% 35% 35% 35% 35% 35% 35% 35% 35%
Less: Capital Expenditures (related to initial manufacturing facility build-out) (75) (75) (75)
Provenge-Related Free Cash Flow (149) (7) 166 438 519 574 627 667 689 717 733
Years 0.42 1.42 2.42 3.42 4.42 5.42 6.42 7.42 8.42 9.42 10.42
Discount Factor 0.95 0.85 0.76 0.68 0.61 0.54 0.48 0.43 0.39 0.34 0.31
NPV of Provenge Cash flows (142) (6) 126 297 314 311 303 288 265 247 225
February 1, 2010 29
Dendreon
Dendreon management has indicated that it intends to out-license the ex-U.S. rights
to Provenge in prostate cancer, and focus its own efforts on a successful U.S. launch.
Dendreon envisages that a partner could build out European manufacturing
facilities for Provenge and take responsibility for Provenge’s EMEA filing in CRPC. As
such, a partner might be able to accelerate commercial ex-U.S. timelines by 12
months or more.
Management has yet to discuss with European authorities whether the existing
datasets on Provenge are sufficient to support approval. Dendreon intends to hold
such meetings after it secures FDA approval. Despite a lack of certainty,
management believes consistent survival results from multiple trials should
support EMEA approval, and it is not aware of any specific issue that might preclude
such a result. Dendreon will need to create a local supply chain for Provenge in
Europe prior to filing for approval, and this task could be rate limiting to filing the
MAA.
While it is the company’s stated intention to partner rights to Provenge outside the
U.S., management also acknowledges that it intends to do the right thing for
shareholders and that its decision to sign or not sign a partner will be heavily NPV
dependent.
Given the size of the ex-U.S. opportunity, management estimates demand for
Provenge could be as much as two fold higher outside the U.S. than that in the U.S.
Hence it is clear that Provenge’s ex-U.S. opportunity is a big part of the company’s
value, regardless of whether Dendreon chooses to partner the asset. For illustrative
purposes, we model out both scenarios and provide an estimate of what each might
be worth. Our valuation analyses indicate that both strategies would result in similar
NPV’s ($13-15/share), and therefore we are fairly agnostic as to whether Dendreon
chooses to partner Provenge on the fairly robust economic terms that underlie our
analysis or retain ownership of this asset ex-U.S. The assumptions behind our
analyses are outlined below.
Deal Terms: There are few precedents for such late-stage (post Phase III) oncology
deals. Below, we summarize some of the late stage oncology deals (involving
products with expected peak sales >$1B) to help handicap what might be considered
a fair deal for ex-U.S. rights to Provenge in CRPC.
Drug Year of Deal Development Stage Licensee/Licensor Upfronts Milestones Royalties (est.)
Tarceva 2001 Post Phase II OSI/Roche $25M (+$35M Equity) $162M 20-21%
Erbitux (U.S.) 2001 Post Phase III ImClone/BMY $1B + $1B Equity 39%
Provenge 2010? Post Phase III Any Established Oncology $150M $500M 22-28%
Player In Big Pharma
30 February 1, 2010
Dendreon
Relative to the other major oncology products we’ve listed, Provenge is at a later
stage in development, and by our estimates has greater peak potential sales. Our
NPV assumes Dendreon receives $150MM in upfront payments, and ultimately
receives $500MM in milestone payments ($100MM upon European filing acceptance,
$150MM upon MAA approval, and $250MM in other regulatory and commercial
milestones). We model a 22% royalty rising to 28% with escalating sales. Other
assumptions are outlined below:
• A 0% terminal growth rate (to account for potential competition from newer
therapies, and unanticipated changes in the prostate cancer treatment
paradigm over time).
• Provenge pricing of $65K/year (below the $75K/year price tag in the U.S.).
These assumptions imply a value for the ex-U.S. Provenge franchise of $13/share.
February 1, 2010 31
Dendreon
$MM 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022
Ex-U.S. Provenge Sales 130 650 1,200 1,600 1,840 2,024 2,176 2,285 2,342 2,400
Y/Y Growth 400% 85% 33% 15% 10% 8% 5% 3% 3%
Royalty on ex-U.S. Provenge Sales 29 150 288 400 469 526 577 617 632 648
Royalty rate 22% 23% 24% 25% 26% 26% 27% 27% 27% 27%
Ex-U.S. Provenge-related revenue to DNDN 150 0 100 179 200 338 450 519 576 577 617 632 648
Y/Y Growth 79% 12% 69% 33% 15% 11% 0% 7% 2% 2%
Ex-U.S. Provenge Cash Flow to DNDN 30 0 80 143 160 270 360 415 461 461 493 506 518
Years 0.42 1.42 2.42 3.42 4.42 5.42 6.42 7.42 8.42 9.42 10.42 11.42 12.42
Discount Factor 0.94 0.82 0.71 0.62 0.54 0.47 0.41 0.35 0.31 0.27 0.23 0.20 0.18
NPV of Provenge Cash flows 28 0 57 89 86 127 147 147 142 124 115 103 91
32 February 1, 2010
Dendreon
• Modestly lower gross margins versus the U.S. (68% at launch, rising to 79% at
peak), reflecting a slightly lower price ex-U.S.
• A tax rate of 5% (in-line with that of other U.S. corporations with overseas
intellectual property, manufacturing and operations).
• 15% discount rate; 0% terminal growth rate beyond 2022, as per our former
scenario.
These assumptions also imply a value for the ex-U.S. Provenge franchise of
$15/share.
February 1, 2010 33
Dendreon
$MM 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Ex-U.S. Provenge Sales & Marketing Expense 50 100 150 175 195 210 220 230
As a % of ex-U.S. Provenge Sales 103% 31% 19% 16% 15% 14% 14%
Total Provenge Expenses 0 100 206 386 527 607 655 684 705
DNDN Operating Income From Ex-U.S. Provenge 0 (100) (109) 101 373 593 725 834 927
Provenge Operating Margin -111% 21% 41% 49% 53% 55% 57%
Less: Capital Expenditures (related to initial manufacturing facility build-out) (100) (100) (100)
Ex-U.S. Provenge-Related Free Cash Flow (100) (100) (200) (103) 96 354 563 689 792 880
Years 1.42 2.42 3.42 4.42 5.42 6.42 7.42 8.42 9.42 10.42
Discount Factor 0.82 0.71 0.62 0.54 0.47 0.41 0.35 0.31 0.27 0.23
NPV of Provenge Cash flows (82) (71) (124) (56) 45 145 200 212 212 205
34 February 1, 2010
Dendreon
Owing to its history of operating losses through 2008, DNDN had $529MM and
$76MM in U.S. Federal and state net operating loss tax credits as of YE:08. We model a
further $90-100MM operating loss in each of 2009 and 2010. As the company
achieves sustained profitability, management expects to utilize these NOLs to offset
future tax expenses, meaning Dendreon should only be subject to the alternative
minimum tax (AMT) rate of 2-3% over these years. U.S. NOLs expire between 2009
and 2028. Our NPV analysis assumes the majority of NOL’s are used to offset taxes in
the 2011-13 timeframe. Discounting these tax savings back at 5% implies a value of
about $1-2/share for Dendreon.
As of the end of Q3:09, Dendreon’s cash and investments totaled $260MM. Dendreon
issued a further 17.25MM shares in its December 2009 follow-on offering, raising an
additional $410MM in cash. We assume that all of Dendreon’s $52.5MM in
convertible debt is converted into equity (at the conversion price of $10.28/share),
implying approximately 5.1MM additional shares. To determine fully diluted share
count, we also add 5MM shares related to stock options and restricted stock, and a
further 6MM shares to account for dilution from warrants. Adding these shares to
the 17.25MM shares issued in December 2009 and Dendreon’s previous basic share
count (115.9MM shares as of November 5, 2009) implies the current fully diluted
share count stands at around 149MM shares. Deducting $65MM in estimated Q4:09
cash expenses, implies a current cash balance of $605MM, or roughly $4/share.
February 1, 2010 35
Dendreon
Dendreon’s future development plans for Provenge focus on expansion into earlier
stage prostate cancer (neoadjuvant and androgen-dependent prostate cancer). In the
future, Dendreon could choose to evaluate the benefits of additional Provenge
‘booster’ courses, providing a source of potential upside to our Provenge estimates.
Below we summarize key ongoing studies of Provenge:
PROACT (P07-2): Phase II study initiated in August 2008, enrolling 120 patients with
metastatic CPRC. This study is exploring the effect of antigen concentration on CD54
upregulation, immune response, and overall survival. All patients will receive three
courses of Provenge but will be randomized into one of three cohorts that will
receive Provenge manufactured with different concentrations of the immunizing
antigen.
PROTECT (P-11): The PROvenge Treatment and Early Cancer Treatment study is a
Phase III trial in earlier (hormone-sensitive) prostate cancer patients (n=175
enrolled). Preliminary data were presented at ASCO 2007. Although the study missed
its primary endpoint (proportion of patients with PSA>3), it demonstrated
significance on the secondary endpoint of PSA doubling time (PSADT), producing a
35% prolongation in PSADT vs. placebo (p=0.046), as calculated 90 days following
randomization. Patients in the study continue to be followed for survival and other
clinical endpoints.
NEOACT (P07): The NEOadjuvant Active Cellular immunotherapy Phase II study was
initiated in August 2008, and is evaluating Provenge in 30-40 patients with localized
prostate cancer who are scheduled to undergo a radical prostatectomy. This study
also randomizes half of patients to receive a ‘booster’ dose of Provenge after radical
prostatectomy.
In addition, the OpenACT study, which was initiated after the Phase III IMPACT
study, is an open-label study enrolling patients with metastatic CPRC, providing
patients with access to Provenge and ensuring the company’s NJ facility remains
active during Provenge’s scale up.
36 February 1, 2010
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February 1, 2010 37
Dendreon
Addendum
STOCKS MENTIONED IN IMPORTANT DISCLOSURES
Ticker Company Name
DNDN Dendreon
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was, is, or will be related, directly or indirectly, to the specific recommendations or views expressed in this report.
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38 February 1, 2010
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