May 29, 2025 • 40 mins
“If you can image it, if you can light it up, then you know where it’s going to go,” Lantheus’ CEO Brian Markison says as he explains the future of imaging agents to Bloomberg Intelligence. “You know it’s going to get to the tumor, and then if you can attach basically a warhead to it, then you can deliver targeted radiation to that tumor.” In this episode of the Vanguards of Health Care podcast, Markison sits down with Bloomberg Intelligence analyst Matt Henriksson for an in-depth interview to discuss how the Pylarify and Definity imaging agents enhance disease detection compared with traditional imaging platforms. They also dive into the importance of manufacturing and logistics to get the agents to the right hospital at the right time and the future pipeline with a portfolio of agents under development to detect Alzheimer’s and neuroendocrine tumors.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:19):
Welcome to another episode of the Vanguards of Healthcare series.
My name is Matt Hendrickson, the medical technology analyst at
Bloomberg Intelligence, which is the in house equity research platform
of Bloomberg LP. We are pleased to have with us
today Brian Marcusson, CEO of Lanthias Holdings, a medical device
company that is a key leader in radio pharmaceutical oncology.
(00:41):
You can dive deeper into the financials by typing in
l NTCH equity go on your Bloomberg terminal. Brian, thank
you for joining us.
Speaker 2 (00:49):
Yeah, it's great to be here. Thanks for having me.
Speaker 1 (00:51):
Yeah. Absolutely, And why don't we just start with you've
been about twelve almost fifteen months into the CEO role.
Talk about the path that got you to that's ee
rule and then also the transition of Lantheus from that
fifteen months ago to where it is now.
Speaker 2 (01:10):
Yeah, So my path to this point is actually kind
of interesting, and it's rooted in a little bit of history.
I guess I should start with my passion for the
pharmaceutical industry. And you know, I started in the farmer
industry right out of college, and I was looking at
that or medical school and had a few student loans
(01:33):
to take care of, which are roll paid off by
the way, and decided to go get a job right
away in the former industry, and I went and I
was really attracted to Bristol Myers at the time because
of their oncology portfolio, and I was a science major
fascinating with oncology, and long story short, I was working
in Bristol Myers' incology and when Bristol merged with SQUIB
(01:57):
in nineteen eighty nine, I had to go back and
looked this up. SQUIB came with scribt Diagnostics and basically
a medical imaging company that had contrast agents for cat scans,
CT scanning, MRI and also some nuclear medicine products as well,
(02:18):
so PET scanning. So it was very interesting and I
was coincidentally the first employee from Bristol Myers to go
into scrib Diagnostics during the right after the merger, and
I ran marketing for Script Diagnostics and it was a
lot of fun and I became enamored with the space.
(02:38):
Scrib Diagnostics changed hands over time, I went on and
did other things over time, but then when scrib Diagnostics
was ultimately bought by private equity firm Vista Capital. They
asked me to come on the board and help given
my history and expertise in the field, because when you're
in the cancer business, you really never go that far
(02:59):
from it. And so I went on the board became
chairman of the board. Over time, recruited the previous CEO,
Marianne Hano, who's done a phenomenal job over the past
ten years, just incredible, and transitioned into the CEO role
(03:20):
by agreement with the board naturally because I had time
and I was available, just finishing up a previous employment assignment,
and Marianne expressed a desire to retire because she was
in the role for ten years, and ten years in
this business as CEO of a publicly traded company, I
think it defies the odds, and I give her a
lot of credit for staying in the role that long,
(03:42):
and we talked her into staying longer than she would
have wanted to. So it really worked that well for her,
and it worked that well for me because my passion
for this business, I think you can feel it in
this conversation, is endless. I'm just fascinated by the advances
we're making in science. Love to be in it. And
love to see it continue to grow. Yeah.
Speaker 1 (04:04):
Well, and also kudos for paying off your student loans.
And so maybe you know you've been in this industry
for a while. You were talking about the acquisition from
nineteen eighty nine, So you know, we're looking at thirty
five plus years of diagnostic background. We don't need a
full history lesson. But what is the current landscape of
(04:26):
the imaging market environment and how has that changed over
the past five years or thirty five years.
Speaker 2 (04:32):
Well, I think you know, it really continues to advance
on multiple fronts. You know, you have more targeted tracers
that are able to differentiate affected, diseased or cancer cells
from normal tissue. You also have advances in the equipment itself,
the sensitivity specificity of the cameras to pick up images.
(04:56):
And then at the same time, you have advanced AI
algorithm that are helping readers interpret these images. And you know,
all of that's coming together and it continues to advance.
So the older technologies, if you will, there's nothing wrong
with them. It's just that we keep getting better and
better on multiple fronts at the same time.
Speaker 1 (05:19):
Okay, and then there's also the you know what's for
me that's new is just the use of imaging agents,
because you know, my background is more limited in this
imaging space. And you know, I would have thought that
it was just you know, a clearer picture that they
can look at. But walk me through how an imaging
agent can actually help the doctor better with those images,
(05:43):
even as they get better quality, even as you can
get AI involved.
Speaker 2 (05:48):
Yeah, and I you know, I thought about how I
would explain this because I get asked this question quite
a bit, and I think the way to look at
it is ever RIS and CAT scans they get structure. Okay,
so MRIs use they use magnets and radio waves. A
CT scan uses X rays and that's structure. So they
(06:11):
give you like lego blocks. So they're very good with
or without contrast media for delineating let's say a tumor. Right,
what a PET scan will do is give you function,
so it's it's very very different. It will be able
to detect the illness or the or the function at
(06:33):
a cellular level, which is which is amazing when you
think about it. And with structure CT MRI you can
look at change from let's say now to later. Right,
So let's say you have somebody with a what would
you you would call a marker lesion in the LUG
got the bit you can look at it and you
(06:54):
can see its size, and then three months later, six
months later, you can see what's happened to it with
the CT or MRI because it's structure. But with a
PET scan you can actually look at what is happening
with that lesion. So, for example, with a fluorinated doxy glucose,
(07:15):
you can look at metabolism. So is that cancer cell
really chewing up glucose utilizing glucose, meaning it's growing and
feeding right, so it gives you a sense of how
aggressive it could be or not it's utilizing you know
therefore whether it's growing and so I think what you're
(07:35):
getting really with PET scans is a lot of a
lot of function, which is critically important down to the
cellular level. With MRIs and CT scans, you're getting structure.
So they're all useful. For example, in prostate cancer, when
(07:56):
a urologist is suspicious of prostate cancer, naturally they'll do
a physical exam and a digital rectal exam hopefully, and
then they will proceed to an MRI impossible biopsy. The
MRI you're really looking at that prostate bet because you
can't put someone in an MRI machine for twenty four
(08:17):
hours and get every single slice of every single part
of or.
Speaker 1 (08:20):
Also sounds like a horrible experience with the patient.
Speaker 2 (08:23):
Yeah, especially if you've ever had an MRI. It is
quite noisy, despite the music that they can play for you.
I've actually fallen asleep in an MRI, which is a
whole other thing. But anyway, I think with a PET scan,
it's a full body scan, highly targeted. You're getting function right,
(08:43):
and you can you know, some of our you know,
bigger centers can get it done in fifteen minutes per patient,
so it's really exceptional.
Speaker 1 (08:51):
Yeah. So, I mean it sounds like a combination of
accuracy and higher efficiency in getting these tests done.
Speaker 2 (08:57):
Yeah. So if you look, for example, at a traditional
bone scan for prostate cancer, the way this happens is
a urologist is looking at all the factors and they're
trying to determine if the prostate cancer itself because of
a rising PSA above a certain level. Other factors that
lead to what they call a Gleason score, would determine
(09:20):
whether or not you would want a bone scan. But
the bone scan. Really, you know, you're trying to scan
the patient, but it's not that specific. So a fracture
could look something like a lesion. But with a PSMA
PET scan, which is highly specific for prostate cancer, again,
(09:41):
you get the whole body and your likelihood of finding
the lesion is extraordinarily high compared to bone scan. And
when we look at CLAIMS data, we're looking at a
proportional drop in bone scans with a proportional increase in
PSMA PET scan. Okay, you know, which probably leads us
(10:02):
to the discussion on polarify.
Speaker 1 (10:06):
Oh yeah, exactly. But and then also just so I
under have a better understanding ps M A that that
is a protein specific What's what's the terminology for it?
Speaker 2 (10:19):
Again, Well, it's it's a prostate specific.
Speaker 1 (10:25):
There we are, okay, and that's that's the they Ultimately
what's being detected.
Speaker 2 (10:28):
It's detected on the surface of the cell. Yeah, okay,
of the day cancer. But here here's the here's the
main point. It's p s M A expression is one
hundred to one thousand times greater in prostate cancer than
normal tissue. Okay, And it's roughly available in ninety five
(10:52):
percent of all prostate cancers. So in order for a
tracer to be really effective, like Polarify, you have to
have an extraordinarily high expression rate in that can and
a very very low profile in normal tissue, so that
when you give the tracer and it's absorbed on the cell,
(11:13):
you know you're looking at cancer versus normal tissue.
Speaker 1 (11:17):
Yeah, no, exactly.
Speaker 2 (11:19):
That's what makes this tracer so exceptional.
Speaker 1 (11:21):
Perfect something. Just sticking with the Polarify and you talk about,
you know, being able to be accurate at the tumor
but having a low profile elsewhere. How does your technology
differ from some of the more traditional imaging agents or
some of the older imaging agents that are out there.
Speaker 2 (11:42):
Yeah, I think the advance really here is a greater
specificity for targeted therap, targeted diagnostic, also greater resolution because
of the positronic mission profile of the radio tracer. You
(12:03):
really are getting phenomenal resolution when compared to the older
imaging techniques. So you're getting function versus structure, and you're
getting much higher resolution and also much greater specificity for
the lesion versus the background, which would be the normal tissue.
Speaker 1 (12:24):
That's great, and then so and then it just kind
of dive in a little bit deeper. Those are a
certain mechanism that has been discovered that allows that to happen.
Is it just the manufacturing process makes it more efficient.
Just anything like that that is kind of you know,
differentiates you from the competition.
Speaker 2 (12:45):
Yeah. Well, I think the other part of this is
that since it's a what we call an FA teenage
and it's made with at the cyclotron, and there's currently
we have sixty three Cuatron partners in the country, and
it's a variety of different companies that are called pet
(13:06):
manufacturing facilities, and we serve you know, most of the
US population, particularly we have extra coverage in the high
population densities. But I think our half life allows us
to make the product at scale and then deliver numerous
doses to patients and clinicians that are scanning the patients obviously,
(13:30):
you know, at key points during the day, so we
can run a batch on a cyclotron, have it delivered
in fairly short order while that half life is counting down,
and we can deliver it at scale. So I think
that's a really important part of the message here is
that the surety of our supply chain is extremely strong.
Speaker 1 (13:53):
And so we talk about the manufacturing strategy, but what's
the commercial strategy forgetting Polarify out there. I mean, I
feel like there's got to be market awareness strategies that
are going on just to understand let the hospitals and
the doctors know the benefits of doing a pet CT
(14:15):
scan versus just a traditional CT scan, to kind of
get that foundation on top of the structure, right.
Speaker 2 (14:22):
I think, as you can imagine, our approach is multifactorial.
We follow the science, so that's number one, right, and
we have, you know, a medical science team that is
responsible really for helping to educate and address questions that
come up from providers. We have an outstanding sales and
(14:47):
commercial team. Some of them are purely focused on referral,
some of them are focused on the nuclear medicine clinician themselves.
Some of them are focused on our larger accounts in
our account strategy and our contracting strategy. And we also
provide a terrific support group to the practice to help
(15:09):
them understand patient access, market access, if you will, reimbursement.
Where we're I think at the top of our game
here and interacting with CMS insurance companies and helping the
provider actually understand their patient mix and reimbursement capability better
than they even know it themselves, because we have a
(15:30):
highly specialized group there. So we try to surround the
customer with everything they need, and we have a customer
experience team. So even if there's a problem at the
local level at a single institution with a single patient
and a dose that needs to be delivered at a
certain time, we're there. We're on the spot. We're interacting
(15:52):
with the pet manufacturing facility and the institution or the
outpatient imaging center, whoever it is. Try to make sure
that there's a seamless delivery from beginning that order all
the way to the delivery and injection of the dose
into a patient.
Speaker 1 (16:08):
Okay. And then there's also a lot of moving parts,
particularly in twenty twenty five, there's several reimbursement updates as
well as the recent Nevardis approval for plu Victo. So
with all those moving parts, how does twenty twenty five
(16:31):
look as kind of a transition year? And then how
does it kind of you know, from twenty twenty six beyond,
does it turn back into kind of a volume growth story?
Speaker 2 (16:42):
Yeah? I think, you know, I think a couple of things.
We're blending a few things here with the expanded label
for Plevicto, that can really only build our total addressable market.
And we've taken special note of that, and we believe
that Polarify is it an excellent tracer to be used
(17:04):
in conjunction withvic code. So I think that expands the
market considerably. I mean, today we're estimating that radio ligan
therapy scans, if you will, there's about thirty thousand in
twenty twenty five. It's a rough estimate, and we think
that will grow to probably around two hundred thousand or
(17:27):
more by the end of the decade. So it's a
substantial increase. And of all the different populations that feed
our TAM and prostate cancer, that one grows most significantly.
Speaker 1 (17:39):
And then the just the reimbursement landscape.
Speaker 2 (17:42):
Yeah, so I think number one, I think we really
welcome what CMS has proposed in their rule with separate
payment for tracers in the outpatient medicare setting. That's a
significant tailwind for patient and for the industry. Traditionally, what
(18:03):
would have happened at the expiry have passed through a
product like Polarify would have been lumped into a general payment,
and what that would have done was significantly underpaid Polarify.
But it would have also elevated that total lumped payment
back to the provider, So it would have had a
(18:24):
disproportional effect on things that cost far less than they
normally would. So the separate payment is huge. Now we
think ultimately that CMS will gravitate toward average selling price.
It's much more transparent, it's easier to calculate, it's easier
to see the company's self report. But having said that,
(18:45):
we're now.
Speaker 3 (18:46):
At you mean unit cost calculation or MUC as it's called,
and Polarify is reimburse separately, which is great, but it's
at a meaningful discount relative to its average selling price
in the Medicare advantage or FIFA service population.
Speaker 1 (19:05):
Okay, and then I'm assuming then that that's kind of
you build you need to build, or you need to
show that clinical data to them to kind of rea
to kind of re emphasize the need for that reimbursement
rate to go up for the fef for service or
is that is that not an urgent part of the
strategy at this point, Well.
Speaker 2 (19:25):
You know, differentiating the asset and showing the benefits of
Polarify are always front and center with us. Again, we
follow the science. However, you know, we have ongoing dialogues
with CMS, working with them to hopefully move to an
average selling price format, and a lot of the industry
(19:46):
that's in the same you know basket as we are.
They're also lobbying CMS for the same thing as well
as a lot of support from legislatures around the country
that are very sympathetic that is U any of them
happen to be of a population and age where this
is very important to that.
Speaker 1 (20:04):
Yeah, and I think I think as the awareness builds,
I think, yeah, that it should be something that catches
the Medicare's attention. There. You know, we could probably spend
the rest of the conversation on Polarify, but I mean,
in you know, there's a lot more in the pape
line as well, and the products that are already approved.
(20:25):
Why don't we just you know, quickly talk about some
of the products that are already approved in the market,
mainly uh Difinity and uh Fliccado. How does that those
two products round out the portfolio currently right?
Speaker 2 (20:41):
Well, Definity is really our agent. We own it Flicardo
we out licensed to GE Healthcare. But well we'll talk
about that a little bit. Diffinity is very different than
the other agents we've been just talking about, like Clarify.
You know, Diffinity is a lipid micro sphere suspension basically
(21:03):
that has an acoustic resonance that's different than normal blood.
So in an echo cardiogram and an ultrasound you can
pick up that resonance and it's really used to look
at left ventricular function and chamber and the wall thickening.
So it's a very useful tool for an indeterminate echo cardiogram,
(21:28):
and Diffinity has been the market leader now for many
years based on its efficacy and safety profile. And again
also it's not an easy drug to manufacture. In fact,
these microbubbles or these microspheres need to be all uniform
in size and texture, and you really need highly specialized equipment.
(21:48):
So we're you know, I think take a lot of
pride in our ability to deliver Diffinity every time, on time,
right to our customers. We don't have the the burning
clock here like we do with with the radio nuclei tracers,
so we have a little more time here. But I
think our skill set and dealing with hot products if
(22:11):
you will, that have a half life that's ticking down
every single second. Brings that urgency to our Difinity manufacturing,
which is outstanding. So anyway, with Definity market leader, great
efficacy data, tremendous years of experience behind it, and a
safety track record that's exceptional along with outstanding manufacturing. So
(22:35):
that's Definity. With Flacado, we're very happy to see it
in the hands of GE. They certainly have the bandwidth
to take this on. You know, if you look at
cardiovascular disease CD, it is still you know, one of
the most if not the most significant cause of death
(22:55):
in the US, and the number of people that die
every year I think is abound four hundred thousand patients diet.
So having an advanced tracer to look at myocardial perfusion
like Focardo, I think is being widely embraced by the community.
(23:15):
I think really it's a matter of the blocking and tackling.
This is another cyclotron produced F eighteen product, So there's
blocking and tackling that needs to occur to get this
out into practice in the marketplace, and that will take time.
That's a build. But the ability to look at the sensitivity, specificity,
the resolution versus the older spec technology I think is
(23:39):
clearly embraced by the cardiovanskuild community. So this should be
an extremely successful drug for both GE and for us,
and we look forward to collecting a very nice royalty.
Speaker 1 (23:49):
Yeah. And so when you talk about the cyclotron though,
is it are you is Lanthia's in charge of the
manufacturing it or is it GE Healthcare is taken over
that for.
Speaker 2 (24:00):
The Cardo you know, and and Polarify, we independently contract
with the pet manufacturing facilities, okay, and those are independently
run like Cardinal as one of the largest PMF networks.
Pet Net, which is owned by Siemens, also has an
(24:20):
extraordinarily large network. Sophie and Pharma Logic are both very
strong partners of ours. Sophie in particular has a great
PMF network, Pharma Logics right behind them. Both of them
are expanding and are delivering exceptional service and we partner
with them. And there's others like Jubilant that have pet
you know, PMF facilities as well. And I'm probably leaving
(24:43):
somebody out, and I apologize in advance for that.
Speaker 1 (24:46):
That's that's okay, Yeah, okay. So yeah, so it's okay,
So that then it just turns into the royalty check
as g Healthcare does in charge of the marketing and
all that, and then you know, turning into the pipeline.
Then you guys have a very nice slide in your
presentation deck during earnings calls. And I count seventeen different
(25:09):
candidates across various disease states. Once again, I don't think
we have time to go through all seventeen. And also
I don't want you to pick your favorite child, but
which of these are your favorite children? Yeah?
Speaker 2 (25:24):
No, if you wind me up, we could talk about
this all down. I think we have a number of
favorites here. I think one is r r M two candidate,
which targets gr what's called GRPR and GRPR interestingly enough,
(25:47):
is also expressed on prostate cancer and can be expressed
to a similar extent as psma. So not everybody expresses
psma to a very high So when you're looking at
a radioligant therapy, which would be a PSM a targeted therapy,
(26:08):
you can think about r M two or product that
targets GRPR expression as something that's very interesting because as
one regulates up, the other regulates down. So you can
have a point in time where psm a expression is
extraordinarily low, but GRPR expression is kind of high. Because
(26:32):
you know, these tumors change over time, right, and their
Russian profile changes over time. And none of these radioligant
therapies ultimately will be used by themselves. They'll all be
used in combination with other modalities, either together in a
regiment or sequentially. So this one is very interesting because
(26:54):
of the expression profile is very high in cancer and
very low in normal tissue. The other asset that I
really really am excited about is our l l RC
fifteen agent, and we're looking to target osteo sarcoma. Ostio
sarcoma is devastating for children. It's nothing really new, that's
(27:18):
a breakthrough has come along in quite some time. And
we hope to be in the clinic by the end
of this calendar year, but certainly in the beginning of
next year. And we we believe we have an extremely
strong chance to show activity against osteosarcoma. And and when
you look at you know this young population, this disease
(27:41):
is so devastating. If we can do anything there, it
will be amazing and then the it has it has
potential across in other tumor types. But right now we're
really focused on the greatest medical need, which would be
ostio Sarkova. Then you know, the next the next place
I need to go because I'll get you know, I'll
have a revolt by the team is our neuroscience portfolio.
(28:05):
So we're doing what I call it Gretzky. We are
going to be We're planning to be where the puck
is going, not where it is. And we're very excited
about that because if you look at the it's not
just here, it's happens to be worse than other countries.
But if you look at our aging population and get
Alzheimer's dementia globally, this is a crisis. And with the
(28:31):
recent approval of two therapeutics, one by Eastside Biogen, one
by Eli Lilly, you have an overnight transformation in the
Alzheimer's the ad market okay, and now tracers. Over the
past year, beta amyloid tracers have exhibited in very very
interesting growth, all driven and coupled with new therapies. So
(28:56):
the new therapies they have their pros and cons their
advocacy profile can be improved, their safety profile can be improved.
But they're here and they represent a major advance. But
you do need a beta amyloid scan and hopefully a
TOEL scan to understand what's happening in the brain. And
our neuro portfolio is going to be the most relevant
(29:22):
in the field with the pending acquisition of Life Molecular
Imaging that comes along with Neurosek, and we're very excited
about Neurosek. It's got a reasonable share in the market today.
It's highly synergistic with what we do with our PMF
(29:42):
PET manufacturing facility partners with Polarify, so we believe we
can bring scale and we can help grow neurosk beyond
even its current growth levels. The other part of it
is with our pipeline MK sixty two forty are tow
agent NAV which is a second generation beta amyloid agent,
(30:04):
and then hopefully when we close on Life Molecular Imaging,
they have an exciting cow agent as well called p
I twenty six twenty. The ability for us to leverage
the current infrastructure of life molecular imaging is a phenomenal
cost avoidance strategy for Lantheas today because we do not
(30:25):
need to build our own commercial team. In the acquisition
of Life Molecular Imaging comes an outstanding commercial team. So
we've had a lot of conversations with them, preliminary, you know,
you know, not jumping ahead too soon waiting for the
acquisition to close, but a lot of excitement between the
(30:45):
teams to see what we can do for each other.
You know, if you come back to Polarify, you know,
we built the first blockbuster, billion dollar diagnostic, and we're
going to bring that expertise and energy to now the
neuro Alzheimer's debent your market.
Speaker 1 (31:02):
And it's interesting too because you know, so many times
in an m and a deal or even a spin off,
just the concern of these sales teams of whether or
not they have their job once the merger happens or
once the spin off is complete causes more disruption, almost
sometimes than posts the merger is closed. But it sounds
(31:25):
like you're telling them keep going as business as usual
and you'll just be part of the team. It'll just
be a Lantheist name instead of a Life Molecular name.
Speaker 2 (31:35):
Yeah. I've been doing mergers and acquisitions most of my
career and many of them have been synergy plays where
you're looking to extract a lot of cost out of
the acquired company. I think this is very different life.
Molecular imaging has an extraordinary capability in drug development, particularly
(31:59):
in diagnos right They are active right now in a
couple of phase three clinical trials, one for duras seek
for cardiac emilidoses, which is a very interesting area of
study lately and recently had a number of new drugs
been approved to treat that condition. So you're looking at
(32:20):
amyloid deposition in the heart, and if you have a
greater increase in deposition, that's obviously very bad for you.
So to keep it at its most simplistic level. The
other thing they're doing is right now they're doing a
major phase three program with PI twenty six twenty, which
is a tow agent. So they have a core lab space,
(32:42):
lab capability, chemistry capability which is exceptional. And the team
there has been together for many years, led by an
extraordinary individual as well, and we're very excited to welcome
them on and bifurcate responsibilities between what we do in
Massachusetts what they do in Berlin, and then that would
also lead to Evergreen, which we recently acquired. We closed
(33:05):
on that acquisition and with Evergreen, what we picked up
is a state of the art manufacturing facility that's designed
for the products of today radio like and therapies, and
a discovery group early development, if you will, led by
doctor Thomas Reiner, who is an exceptional clinician in the field,
(33:31):
and we've got a number of early targets that are
in development right now. And in fact, we are in
the clinic in a phase one study in small cell
lung cancer with one of doctor rhinos targets called CCK
two R, and we're very hopeful that we'll see some
signs of life with a small cell lung cancer asset. Yeah.
Speaker 1 (33:52):
And then you know, one of the things just turning
back to Alsteimer's because it is such an important disease
that needs to be an especialist with the aging population,
and you know, I feel like anyone you talk to
has had someone affected by it. It sounds like there
is you know, in going with your Wayne Gretzky metaphor,
(34:14):
I'm going to go with you know, the multiple shots
on goal here, because there's there seems to be multiple
agents for how imaging for beta amyloid imaging. Is this
something that you envision that one of these will be
the clear U polarified type winner, or is this something
where you expect doctors to have a tool set and
(34:35):
be able to use one or the other or even
multiple versions to kind of really diagnose the disease date
for these patients.
Speaker 2 (34:44):
I think it's more of a portfolio play as opposed
to a single shot on goal. I think the towel
market has yet to really develop, and I think there's
advantages of a TAU tracer like MK sixty two forty
that have not really sort of come to light in
(35:05):
mainstream neurology today, and that's something that we're going to
have to spend some time educating about. But you know,
and I think with beta amyloid I think neuroseek as
a first generation workhorse amyloid scan is perfect for what
we need today and it's what the market's using. But
when we look at our second generation NAV, it's sensitivity
(35:29):
and specifhysicity is much is greater than the first generation eurosic,
meaning you can look at much earlier disease detection at
smaller quantities of disease, so you're much more specific, and
I think what we're seeing with the two therapeutics that
approved today. You know, the earlier you catch dementia and
(35:53):
the earlier you treat, the better your chance of having
an impact. That's positive. Now, what's interesting with the tau
tracer is tau deposition usually follows beta amyloid deposition. So
there's a good chance that I'm right now and you
at some level of beta amyloid deposition. Hopefully neither one
(36:15):
of us has TAT If we want to show tau deposition,
that's the real lookout because TAO is more closely correlated
to basically the supply of ada Alzheimer's dementia. And when
you get a toel scan, you can actually see the
region in the brain that's affected, and you can correlate
(36:37):
that directly with symptomatology. So is it gait, is it vision,
is it memory? All of those things can be traced
back to a region that tau deposition could be affecting
and therefore have an effect on the patient. And then
again you can look longitudinally to see how your therapy
is working with a beta amyloid scan and a TAB scan.
Speaker 1 (37:00):
Like I said, it's all very important, especially with how
the population is aging. I guess just to close out
this episode, I mean we covered a lot of ground here,
including the rarity of being a CEO for ten years.
Let's go in the future. Let's assume that you're reaching
your ten year anniversary mark. How does this imaging work.
(37:23):
Do you think this is something where this could become
standard of care or is it a step in the
right direction there?
Speaker 2 (37:31):
Well, I think Polarify is already standard of care, especially
in patients with biochemical recurrence of prostate cancer. I think
it'll become standard of care ubiquitously in very early stages
of prostate cancer, and eventually we'll be used up front
for staging. I think because a PSO a Polarify scan
(37:55):
is more sensitive than the blood test PSA.
Speaker 1 (37:59):
SO.
Speaker 2 (38:00):
I think what you're going to see is the pet
market is exploding. Nuclear medicine here is really right now
a center of innovation. And also hospitals at out patient
imaging centers are all doing extremely well with these new
studies and these new tests, because what's happening is we're
(38:21):
changing management, so we're getting new information clarifies the perfect
example where we're getting information we didn't have before that's
leading to a change of patient management. So the innovation
here is phenomenal. Now on the therapeutic side, radio nuclei
therapy or a lot of people we just refer to
(38:43):
it as URLT. You likend therapy. If you can image it,
if you can light it up, then you know where
it's going to go. You know it's going to get
to the tumor and that if you can attach basically
a warhead to it, then you know you can deliver
targeted radiation to that tumor and then you can image
the result over time, which is really quite interesting. So well,
(39:06):
that's why a lot of the big former companies now
have doubled down on investing in the space because they're
seeing the potential. So you know, basically, the way I
look at it is if you can light it up,
that means you can get a drug there. It's that simple.
But it's really not that simple as you can imagine.
Speaker 1 (39:24):
Well, no, and I think you've definitely you've definitely brought
that story home with talking about the development of the
agents as well as the manufacturing of it. But yeah, no,
it sounds like it's going to be a very exciting decade.
In this new imaging agent market. But Brian, thank you
so much for joining us today. I appreciate you hopping on.
Speaker 2 (39:44):
Yeah, it was by pleasure and I really enjoyed it,
so thank you.
Speaker 1 (39:47):
Oh and likewise, and thank you to our listeners for
tuning in today. We hope you join us for future episodes,
and if you want to stay up to date, please
click the subscribe button on Spotify or your favorite streaming platform.
Take care.
Speaker 2 (40:17):
Pass uses uses
Speaker 1 (40:30):
Bases
Welcome to another episode of the Vanguards of Healthcare series.
My name is Matt Hendrickson, the medical technology analyst at
Bloomberg Intelligence, which is the in house equity research platform
of Bloomberg LP. We are pleased to have with us
today Brian Marcusson, CEO of Lanthias Holdings, a medical device
company that is a key leader in radio pharmaceutical oncology.
(00:41):
You can dive deeper into the financials by typing in
l NTCH equity go on your Bloomberg terminal. Brian, thank
you for joining us.
Speaker 2 (00:49):
Yeah, it's great to be here. Thanks for having me.
Speaker 1 (00:51):
Yeah. Absolutely, And why don't we just start with you've
been about twelve almost fifteen months into the CEO role.
Talk about the path that got you to that's ee
rule and then also the transition of Lantheus from that
fifteen months ago to where it is now.
Speaker 2 (01:10):
Yeah, So my path to this point is actually kind
of interesting, and it's rooted in a little bit of history.
I guess I should start with my passion for the
pharmaceutical industry. And you know, I started in the farmer
industry right out of college, and I was looking at
that or medical school and had a few student loans
(01:33):
to take care of, which are roll paid off by
the way, and decided to go get a job right
away in the former industry, and I went and I
was really attracted to Bristol Myers at the time because
of their oncology portfolio, and I was a science major
fascinating with oncology, and long story short, I was working
in Bristol Myers' incology and when Bristol merged with SQUIB
(01:57):
in nineteen eighty nine, I had to go back and
looked this up. SQUIB came with scribt Diagnostics and basically
a medical imaging company that had contrast agents for cat scans,
CT scanning, MRI and also some nuclear medicine products as well,
(02:18):
so PET scanning. So it was very interesting and I
was coincidentally the first employee from Bristol Myers to go
into scrib Diagnostics during the right after the merger, and
I ran marketing for Script Diagnostics and it was a
lot of fun and I became enamored with the space.
(02:38):
Scrib Diagnostics changed hands over time, I went on and
did other things over time, but then when scrib Diagnostics
was ultimately bought by private equity firm Vista Capital. They
asked me to come on the board and help given
my history and expertise in the field, because when you're
in the cancer business, you really never go that far
(02:59):
from it. And so I went on the board became
chairman of the board. Over time, recruited the previous CEO,
Marianne Hano, who's done a phenomenal job over the past
ten years, just incredible, and transitioned into the CEO role
(03:20):
by agreement with the board naturally because I had time
and I was available, just finishing up a previous employment assignment,
and Marianne expressed a desire to retire because she was
in the role for ten years, and ten years in
this business as CEO of a publicly traded company, I
think it defies the odds, and I give her a
lot of credit for staying in the role that long,
(03:42):
and we talked her into staying longer than she would
have wanted to. So it really worked that well for her,
and it worked that well for me because my passion
for this business, I think you can feel it in
this conversation, is endless. I'm just fascinated by the advances
we're making in science. Love to be in it. And
love to see it continue to grow. Yeah.
Speaker 1 (04:04):
Well, and also kudos for paying off your student loans.
And so maybe you know you've been in this industry
for a while. You were talking about the acquisition from
nineteen eighty nine, So you know, we're looking at thirty
five plus years of diagnostic background. We don't need a
full history lesson. But what is the current landscape of
(04:26):
the imaging market environment and how has that changed over
the past five years or thirty five years.
Speaker 2 (04:32):
Well, I think you know, it really continues to advance
on multiple fronts. You know, you have more targeted tracers
that are able to differentiate affected, diseased or cancer cells
from normal tissue. You also have advances in the equipment itself,
the sensitivity specificity of the cameras to pick up images.
(04:56):
And then at the same time, you have advanced AI
algorithm that are helping readers interpret these images. And you know,
all of that's coming together and it continues to advance.
So the older technologies, if you will, there's nothing wrong
with them. It's just that we keep getting better and
better on multiple fronts at the same time.
Speaker 1 (05:19):
Okay, and then there's also the you know what's for
me that's new is just the use of imaging agents,
because you know, my background is more limited in this
imaging space. And you know, I would have thought that
it was just you know, a clearer picture that they
can look at. But walk me through how an imaging
agent can actually help the doctor better with those images,
(05:43):
even as they get better quality, even as you can
get AI involved.
Speaker 2 (05:48):
Yeah, and I you know, I thought about how I
would explain this because I get asked this question quite
a bit, and I think the way to look at
it is ever RIS and CAT scans they get structure. Okay,
so MRIs use they use magnets and radio waves. A
CT scan uses X rays and that's structure. So they
(06:11):
give you like lego blocks. So they're very good with
or without contrast media for delineating let's say a tumor. Right,
what a PET scan will do is give you function,
so it's it's very very different. It will be able
to detect the illness or the or the function at
(06:33):
a cellular level, which is which is amazing when you
think about it. And with structure CT MRI you can
look at change from let's say now to later. Right,
So let's say you have somebody with a what would
you you would call a marker lesion in the LUG
got the bit you can look at it and you
(06:54):
can see its size, and then three months later, six
months later, you can see what's happened to it with
the CT or MRI because it's structure. But with a
PET scan you can actually look at what is happening
with that lesion. So, for example, with a fluorinated doxy glucose,
(07:15):
you can look at metabolism. So is that cancer cell
really chewing up glucose utilizing glucose, meaning it's growing and
feeding right, so it gives you a sense of how
aggressive it could be or not it's utilizing you know
therefore whether it's growing and so I think what you're
(07:35):
getting really with PET scans is a lot of a
lot of function, which is critically important down to the
cellular level. With MRIs and CT scans, you're getting structure.
So they're all useful. For example, in prostate cancer, when
(07:56):
a urologist is suspicious of prostate cancer, naturally they'll do
a physical exam and a digital rectal exam hopefully, and
then they will proceed to an MRI impossible biopsy. The
MRI you're really looking at that prostate bet because you
can't put someone in an MRI machine for twenty four
(08:17):
hours and get every single slice of every single part
of or.
Speaker 1 (08:20):
Also sounds like a horrible experience with the patient.
Speaker 2 (08:23):
Yeah, especially if you've ever had an MRI. It is
quite noisy, despite the music that they can play for you.
I've actually fallen asleep in an MRI, which is a
whole other thing. But anyway, I think with a PET scan,
it's a full body scan, highly targeted. You're getting function right,
(08:43):
and you can you know, some of our you know,
bigger centers can get it done in fifteen minutes per patient,
so it's really exceptional.
Speaker 1 (08:51):
Yeah. So, I mean it sounds like a combination of
accuracy and higher efficiency in getting these tests done.
Speaker 2 (08:57):
Yeah. So if you look, for example, at a traditional
bone scan for prostate cancer, the way this happens is
a urologist is looking at all the factors and they're
trying to determine if the prostate cancer itself because of
a rising PSA above a certain level. Other factors that
lead to what they call a Gleason score, would determine
(09:20):
whether or not you would want a bone scan. But
the bone scan. Really, you know, you're trying to scan
the patient, but it's not that specific. So a fracture
could look something like a lesion. But with a PSMA
PET scan, which is highly specific for prostate cancer, again,
(09:41):
you get the whole body and your likelihood of finding
the lesion is extraordinarily high compared to bone scan. And
when we look at CLAIMS data, we're looking at a
proportional drop in bone scans with a proportional increase in
PSMA PET scan. Okay, you know, which probably leads us
(10:02):
to the discussion on polarify.
Speaker 1 (10:06):
Oh yeah, exactly. But and then also just so I
under have a better understanding ps M A that that
is a protein specific What's what's the terminology for it?
Speaker 2 (10:19):
Again, Well, it's it's a prostate specific.
Speaker 1 (10:25):
There we are, okay, and that's that's the they Ultimately
what's being detected.
Speaker 2 (10:28):
It's detected on the surface of the cell. Yeah, okay,
of the day cancer. But here here's the here's the
main point. It's p s M A expression is one
hundred to one thousand times greater in prostate cancer than
normal tissue. Okay, And it's roughly available in ninety five
(10:52):
percent of all prostate cancers. So in order for a
tracer to be really effective, like Polarify, you have to
have an extraordinarily high expression rate in that can and
a very very low profile in normal tissue, so that
when you give the tracer and it's absorbed on the cell,
(11:13):
you know you're looking at cancer versus normal tissue.
Speaker 1 (11:17):
Yeah, no, exactly.
Speaker 2 (11:19):
That's what makes this tracer so exceptional.
Speaker 1 (11:21):
Perfect something. Just sticking with the Polarify and you talk about,
you know, being able to be accurate at the tumor
but having a low profile elsewhere. How does your technology
differ from some of the more traditional imaging agents or
some of the older imaging agents that are out there.
Speaker 2 (11:42):
Yeah, I think the advance really here is a greater
specificity for targeted therap, targeted diagnostic, also greater resolution because
of the positronic mission profile of the radio tracer. You
(12:03):
really are getting phenomenal resolution when compared to the older
imaging techniques. So you're getting function versus structure, and you're
getting much higher resolution and also much greater specificity for
the lesion versus the background, which would be the normal tissue.
Speaker 1 (12:24):
That's great, and then so and then it just kind
of dive in a little bit deeper. Those are a
certain mechanism that has been discovered that allows that to happen.
Is it just the manufacturing process makes it more efficient.
Just anything like that that is kind of you know,
differentiates you from the competition.
Speaker 2 (12:45):
Yeah. Well, I think the other part of this is
that since it's a what we call an FA teenage
and it's made with at the cyclotron, and there's currently
we have sixty three Cuatron partners in the country, and
it's a variety of different companies that are called pet
(13:06):
manufacturing facilities, and we serve you know, most of the
US population, particularly we have extra coverage in the high
population densities. But I think our half life allows us
to make the product at scale and then deliver numerous
doses to patients and clinicians that are scanning the patients obviously,
(13:30):
you know, at key points during the day, so we
can run a batch on a cyclotron, have it delivered
in fairly short order while that half life is counting down,
and we can deliver it at scale. So I think
that's a really important part of the message here is
that the surety of our supply chain is extremely strong.
Speaker 1 (13:53):
And so we talk about the manufacturing strategy, but what's
the commercial strategy forgetting Polarify out there. I mean, I
feel like there's got to be market awareness strategies that
are going on just to understand let the hospitals and
the doctors know the benefits of doing a pet CT
(14:15):
scan versus just a traditional CT scan, to kind of
get that foundation on top of the structure, right.
Speaker 2 (14:22):
I think, as you can imagine, our approach is multifactorial.
We follow the science, so that's number one, right, and
we have, you know, a medical science team that is
responsible really for helping to educate and address questions that
come up from providers. We have an outstanding sales and
(14:47):
commercial team. Some of them are purely focused on referral,
some of them are focused on the nuclear medicine clinician themselves.
Some of them are focused on our larger accounts in
our account strategy and our contracting strategy. And we also
provide a terrific support group to the practice to help
(15:09):
them understand patient access, market access, if you will, reimbursement.
Where we're I think at the top of our game
here and interacting with CMS insurance companies and helping the
provider actually understand their patient mix and reimbursement capability better
than they even know it themselves, because we have a
(15:30):
highly specialized group there. So we try to surround the
customer with everything they need, and we have a customer
experience team. So even if there's a problem at the
local level at a single institution with a single patient
and a dose that needs to be delivered at a
certain time, we're there. We're on the spot. We're interacting
(15:52):
with the pet manufacturing facility and the institution or the
outpatient imaging center, whoever it is. Try to make sure
that there's a seamless delivery from beginning that order all
the way to the delivery and injection of the dose
into a patient.
Speaker 1 (16:08):
Okay. And then there's also a lot of moving parts,
particularly in twenty twenty five, there's several reimbursement updates as
well as the recent Nevardis approval for plu Victo. So
with all those moving parts, how does twenty twenty five
(16:31):
look as kind of a transition year? And then how
does it kind of you know, from twenty twenty six beyond,
does it turn back into kind of a volume growth story?
Speaker 2 (16:42):
Yeah? I think, you know, I think a couple of things.
We're blending a few things here with the expanded label
for Plevicto, that can really only build our total addressable market.
And we've taken special note of that, and we believe
that Polarify is it an excellent tracer to be used
(17:04):
in conjunction withvic code. So I think that expands the
market considerably. I mean, today we're estimating that radio ligan
therapy scans, if you will, there's about thirty thousand in
twenty twenty five. It's a rough estimate, and we think
that will grow to probably around two hundred thousand or
(17:27):
more by the end of the decade. So it's a
substantial increase. And of all the different populations that feed
our TAM and prostate cancer, that one grows most significantly.
Speaker 1 (17:39):
And then the just the reimbursement landscape.
Speaker 2 (17:42):
Yeah, so I think number one, I think we really
welcome what CMS has proposed in their rule with separate
payment for tracers in the outpatient medicare setting. That's a
significant tailwind for patient and for the industry. Traditionally, what
(18:03):
would have happened at the expiry have passed through a
product like Polarify would have been lumped into a general payment,
and what that would have done was significantly underpaid Polarify.
But it would have also elevated that total lumped payment
back to the provider, So it would have had a
(18:24):
disproportional effect on things that cost far less than they
normally would. So the separate payment is huge. Now we
think ultimately that CMS will gravitate toward average selling price.
It's much more transparent, it's easier to calculate, it's easier
to see the company's self report. But having said that,
(18:45):
we're now.
Speaker 3 (18:46):
At you mean unit cost calculation or MUC as it's called,
and Polarify is reimburse separately, which is great, but it's
at a meaningful discount relative to its average selling price
in the Medicare advantage or FIFA service population.
Speaker 1 (19:05):
Okay, and then I'm assuming then that that's kind of
you build you need to build, or you need to
show that clinical data to them to kind of rea
to kind of re emphasize the need for that reimbursement
rate to go up for the fef for service or
is that is that not an urgent part of the
strategy at this point, Well.
Speaker 2 (19:25):
You know, differentiating the asset and showing the benefits of
Polarify are always front and center with us. Again, we
follow the science. However, you know, we have ongoing dialogues
with CMS, working with them to hopefully move to an
average selling price format, and a lot of the industry
(19:46):
that's in the same you know basket as we are.
They're also lobbying CMS for the same thing as well
as a lot of support from legislatures around the country
that are very sympathetic that is U any of them
happen to be of a population and age where this
is very important to that.
Speaker 1 (20:04):
Yeah, and I think I think as the awareness builds,
I think, yeah, that it should be something that catches
the Medicare's attention. There. You know, we could probably spend
the rest of the conversation on Polarify, but I mean,
in you know, there's a lot more in the pape
line as well, and the products that are already approved.
(20:25):
Why don't we just you know, quickly talk about some
of the products that are already approved in the market,
mainly uh Difinity and uh Fliccado. How does that those
two products round out the portfolio currently right?
Speaker 2 (20:41):
Well, Definity is really our agent. We own it Flicardo
we out licensed to GE Healthcare. But well we'll talk
about that a little bit. Diffinity is very different than
the other agents we've been just talking about, like Clarify.
You know, Diffinity is a lipid micro sphere suspension basically
(21:03):
that has an acoustic resonance that's different than normal blood.
So in an echo cardiogram and an ultrasound you can
pick up that resonance and it's really used to look
at left ventricular function and chamber and the wall thickening.
So it's a very useful tool for an indeterminate echo cardiogram,
(21:28):
and Diffinity has been the market leader now for many
years based on its efficacy and safety profile. And again
also it's not an easy drug to manufacture. In fact,
these microbubbles or these microspheres need to be all uniform
in size and texture, and you really need highly specialized equipment.
(21:48):
So we're you know, I think take a lot of
pride in our ability to deliver Diffinity every time, on time,
right to our customers. We don't have the the burning
clock here like we do with with the radio nuclei tracers,
so we have a little more time here. But I
think our skill set and dealing with hot products if
(22:11):
you will, that have a half life that's ticking down
every single second. Brings that urgency to our Difinity manufacturing,
which is outstanding. So anyway, with Definity market leader, great
efficacy data, tremendous years of experience behind it, and a
safety track record that's exceptional along with outstanding manufacturing. So
(22:35):
that's Definity. With Flacado, we're very happy to see it
in the hands of GE. They certainly have the bandwidth
to take this on. You know, if you look at
cardiovascular disease CD, it is still you know, one of
the most if not the most significant cause of death
(22:55):
in the US, and the number of people that die
every year I think is abound four hundred thousand patients diet.
So having an advanced tracer to look at myocardial perfusion
like Focardo, I think is being widely embraced by the community.
(23:15):
I think really it's a matter of the blocking and tackling.
This is another cyclotron produced F eighteen product, So there's
blocking and tackling that needs to occur to get this
out into practice in the marketplace, and that will take time.
That's a build. But the ability to look at the sensitivity, specificity,
the resolution versus the older spec technology I think is
(23:39):
clearly embraced by the cardiovanskuild community. So this should be
an extremely successful drug for both GE and for us,
and we look forward to collecting a very nice royalty.
Speaker 1 (23:49):
Yeah. And so when you talk about the cyclotron though,
is it are you is Lanthia's in charge of the
manufacturing it or is it GE Healthcare is taken over
that for.
Speaker 2 (24:00):
The Cardo you know, and and Polarify, we independently contract
with the pet manufacturing facilities, okay, and those are independently
run like Cardinal as one of the largest PMF networks.
Pet Net, which is owned by Siemens, also has an
(24:20):
extraordinarily large network. Sophie and Pharma Logic are both very
strong partners of ours. Sophie in particular has a great
PMF network, Pharma Logics right behind them. Both of them
are expanding and are delivering exceptional service and we partner
with them. And there's others like Jubilant that have pet
you know, PMF facilities as well. And I'm probably leaving
(24:43):
somebody out, and I apologize in advance for that.
Speaker 1 (24:46):
That's that's okay, Yeah, okay. So yeah, so it's okay,
So that then it just turns into the royalty check
as g Healthcare does in charge of the marketing and
all that, and then you know, turning into the pipeline.
Then you guys have a very nice slide in your
presentation deck during earnings calls. And I count seventeen different
(25:09):
candidates across various disease states. Once again, I don't think
we have time to go through all seventeen. And also
I don't want you to pick your favorite child, but
which of these are your favorite children? Yeah?
Speaker 2 (25:24):
No, if you wind me up, we could talk about
this all down. I think we have a number of
favorites here. I think one is r r M two candidate,
which targets gr what's called GRPR and GRPR interestingly enough,
(25:47):
is also expressed on prostate cancer and can be expressed
to a similar extent as psma. So not everybody expresses
psma to a very high So when you're looking at
a radioligant therapy, which would be a PSM a targeted therapy,
(26:08):
you can think about r M two or product that
targets GRPR expression as something that's very interesting because as
one regulates up, the other regulates down. So you can
have a point in time where psm a expression is
extraordinarily low, but GRPR expression is kind of high. Because
(26:32):
you know, these tumors change over time, right, and their
Russian profile changes over time. And none of these radioligant
therapies ultimately will be used by themselves. They'll all be
used in combination with other modalities, either together in a
regiment or sequentially. So this one is very interesting because
(26:54):
of the expression profile is very high in cancer and
very low in normal tissue. The other asset that I
really really am excited about is our l l RC
fifteen agent, and we're looking to target osteo sarcoma. Ostio
sarcoma is devastating for children. It's nothing really new, that's
(27:18):
a breakthrough has come along in quite some time. And
we hope to be in the clinic by the end
of this calendar year, but certainly in the beginning of
next year. And we we believe we have an extremely
strong chance to show activity against osteosarcoma. And and when
you look at you know this young population, this disease
(27:41):
is so devastating. If we can do anything there, it
will be amazing and then the it has it has
potential across in other tumor types. But right now we're
really focused on the greatest medical need, which would be
ostio Sarkova. Then you know, the next the next place
I need to go because I'll get you know, I'll
have a revolt by the team is our neuroscience portfolio.
(28:05):
So we're doing what I call it Gretzky. We are
going to be We're planning to be where the puck
is going, not where it is. And we're very excited
about that because if you look at the it's not
just here, it's happens to be worse than other countries.
But if you look at our aging population and get
Alzheimer's dementia globally, this is a crisis. And with the
(28:31):
recent approval of two therapeutics, one by Eastside Biogen, one
by Eli Lilly, you have an overnight transformation in the
Alzheimer's the ad market okay, and now tracers. Over the
past year, beta amyloid tracers have exhibited in very very
interesting growth, all driven and coupled with new therapies. So
(28:56):
the new therapies they have their pros and cons their
advocacy profile can be improved, their safety profile can be improved.
But they're here and they represent a major advance. But
you do need a beta amyloid scan and hopefully a
TOEL scan to understand what's happening in the brain. And
our neuro portfolio is going to be the most relevant
(29:22):
in the field with the pending acquisition of Life Molecular
Imaging that comes along with Neurosek, and we're very excited
about Neurosek. It's got a reasonable share in the market today.
It's highly synergistic with what we do with our PMF
(29:42):
PET manufacturing facility partners with Polarify, so we believe we
can bring scale and we can help grow neurosk beyond
even its current growth levels. The other part of it
is with our pipeline MK sixty two forty are tow
agent NAV which is a second generation beta amyloid agent,
(30:04):
and then hopefully when we close on Life Molecular Imaging,
they have an exciting cow agent as well called p
I twenty six twenty. The ability for us to leverage
the current infrastructure of life molecular imaging is a phenomenal
cost avoidance strategy for Lantheas today because we do not
(30:25):
need to build our own commercial team. In the acquisition
of Life Molecular Imaging comes an outstanding commercial team. So
we've had a lot of conversations with them, preliminary, you know,
you know, not jumping ahead too soon waiting for the
acquisition to close, but a lot of excitement between the
(30:45):
teams to see what we can do for each other.
You know, if you come back to Polarify, you know,
we built the first blockbuster, billion dollar diagnostic, and we're
going to bring that expertise and energy to now the
neuro Alzheimer's debent your market.
Speaker 1 (31:02):
And it's interesting too because you know, so many times
in an m and a deal or even a spin off,
just the concern of these sales teams of whether or
not they have their job once the merger happens or
once the spin off is complete causes more disruption, almost
sometimes than posts the merger is closed. But it sounds
(31:25):
like you're telling them keep going as business as usual
and you'll just be part of the team. It'll just
be a Lantheist name instead of a Life Molecular name.
Speaker 2 (31:35):
Yeah. I've been doing mergers and acquisitions most of my
career and many of them have been synergy plays where
you're looking to extract a lot of cost out of
the acquired company. I think this is very different life.
Molecular imaging has an extraordinary capability in drug development, particularly
(31:59):
in diagnos right They are active right now in a
couple of phase three clinical trials, one for duras seek
for cardiac emilidoses, which is a very interesting area of
study lately and recently had a number of new drugs
been approved to treat that condition. So you're looking at
(32:20):
amyloid deposition in the heart, and if you have a
greater increase in deposition, that's obviously very bad for you.
So to keep it at its most simplistic level. The
other thing they're doing is right now they're doing a
major phase three program with PI twenty six twenty, which
is a tow agent. So they have a core lab space,
(32:42):
lab capability, chemistry capability which is exceptional. And the team
there has been together for many years, led by an
extraordinary individual as well, and we're very excited to welcome
them on and bifurcate responsibilities between what we do in
Massachusetts what they do in Berlin, and then that would
also lead to Evergreen, which we recently acquired. We closed
(33:05):
on that acquisition and with Evergreen, what we picked up
is a state of the art manufacturing facility that's designed
for the products of today radio like and therapies, and
a discovery group early development, if you will, led by
doctor Thomas Reiner, who is an exceptional clinician in the field,
(33:31):
and we've got a number of early targets that are
in development right now. And in fact, we are in
the clinic in a phase one study in small cell
lung cancer with one of doctor rhinos targets called CCK
two R, and we're very hopeful that we'll see some
signs of life with a small cell lung cancer asset. Yeah.
Speaker 1 (33:52):
And then you know, one of the things just turning
back to Alsteimer's because it is such an important disease
that needs to be an especialist with the aging population,
and you know, I feel like anyone you talk to
has had someone affected by it. It sounds like there
is you know, in going with your Wayne Gretzky metaphor,
(34:14):
I'm going to go with you know, the multiple shots
on goal here, because there's there seems to be multiple
agents for how imaging for beta amyloid imaging. Is this
something that you envision that one of these will be
the clear U polarified type winner, or is this something
where you expect doctors to have a tool set and
(34:35):
be able to use one or the other or even
multiple versions to kind of really diagnose the disease date
for these patients.
Speaker 2 (34:44):
I think it's more of a portfolio play as opposed
to a single shot on goal. I think the towel
market has yet to really develop, and I think there's
advantages of a TAU tracer like MK sixty two forty
that have not really sort of come to light in
(35:05):
mainstream neurology today, and that's something that we're going to
have to spend some time educating about. But you know,
and I think with beta amyloid I think neuroseek as
a first generation workhorse amyloid scan is perfect for what
we need today and it's what the market's using. But
when we look at our second generation NAV, it's sensitivity
(35:29):
and specifhysicity is much is greater than the first generation eurosic,
meaning you can look at much earlier disease detection at
smaller quantities of disease, so you're much more specific, and
I think what we're seeing with the two therapeutics that
approved today. You know, the earlier you catch dementia and
(35:53):
the earlier you treat, the better your chance of having
an impact. That's positive. Now, what's interesting with the tau
tracer is tau deposition usually follows beta amyloid deposition. So
there's a good chance that I'm right now and you
at some level of beta amyloid deposition. Hopefully neither one
(36:15):
of us has TAT If we want to show tau deposition,
that's the real lookout because TAO is more closely correlated
to basically the supply of ada Alzheimer's dementia. And when
you get a toel scan, you can actually see the
region in the brain that's affected, and you can correlate
(36:37):
that directly with symptomatology. So is it gait, is it vision,
is it memory? All of those things can be traced
back to a region that tau deposition could be affecting
and therefore have an effect on the patient. And then
again you can look longitudinally to see how your therapy
is working with a beta amyloid scan and a TAB scan.
Speaker 1 (37:00):
Like I said, it's all very important, especially with how
the population is aging. I guess just to close out
this episode, I mean we covered a lot of ground here,
including the rarity of being a CEO for ten years.
Let's go in the future. Let's assume that you're reaching
your ten year anniversary mark. How does this imaging work.
(37:23):
Do you think this is something where this could become
standard of care or is it a step in the
right direction there?
Speaker 2 (37:31):
Well, I think Polarify is already standard of care, especially
in patients with biochemical recurrence of prostate cancer. I think
it'll become standard of care ubiquitously in very early stages
of prostate cancer, and eventually we'll be used up front
for staging. I think because a PSO a Polarify scan
(37:55):
is more sensitive than the blood test PSA.
Speaker 1 (37:59):
SO.
Speaker 2 (38:00):
I think what you're going to see is the pet
market is exploding. Nuclear medicine here is really right now
a center of innovation. And also hospitals at out patient
imaging centers are all doing extremely well with these new
studies and these new tests, because what's happening is we're
(38:21):
changing management, so we're getting new information clarifies the perfect
example where we're getting information we didn't have before that's
leading to a change of patient management. So the innovation
here is phenomenal. Now on the therapeutic side, radio nuclei
therapy or a lot of people we just refer to
(38:43):
it as URLT. You likend therapy. If you can image it,
if you can light it up, then you know where
it's going to go. You know it's going to get
to the tumor and that if you can attach basically
a warhead to it, then you know you can deliver
targeted radiation to that tumor and then you can image
the result over time, which is really quite interesting. So well,
(39:06):
that's why a lot of the big former companies now
have doubled down on investing in the space because they're
seeing the potential. So you know, basically, the way I
look at it is if you can light it up,
that means you can get a drug there. It's that simple.
But it's really not that simple as you can imagine.
Speaker 1 (39:24):
Well, no, and I think you've definitely you've definitely brought
that story home with talking about the development of the
agents as well as the manufacturing of it. But yeah, no,
it sounds like it's going to be a very exciting decade.
In this new imaging agent market. But Brian, thank you
so much for joining us today. I appreciate you hopping on.
Speaker 2 (39:44):
Yeah, it was by pleasure and I really enjoyed it,
so thank you.
Speaker 1 (39:47):
Oh and likewise, and thank you to our listeners for
tuning in today. We hope you join us for future episodes,
and if you want to stay up to date, please
click the subscribe button on Spotify or your favorite streaming platform.
Take care.
Speaker 2 (40:17):
Pass uses uses
Speaker 1 (40:30):
Bases
Host
Jonathan Palmer
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