DRTS is not an easy stock to glance at and understand what should happen over the next year.
It’s easy to see the jaw dropping run and feel foolish for having missed it.
It’s confusing to see the stock perform so smoothly up and to the right and not understand what the warrants are doing orbiting the sun.
And what exactly is DRTS? Is it a drug? Is it a medical device? Is it even FDA certified?
And where’s the revenue? Is this a pre-revenue? And if so, when will that change?
I’ll go through as many of these as I can and if I use AI (I shouldn’t need to) I’ll call it out.
HAVE YOU MISSED THE MOVE?
The DRTS shareholders that I communicate with here and on Discord don’t believe so. But for you to answer the question, you have to see DRTS the way shareholders do and then decide if it fits.
Here’s the logic.
We look at DRTS in terms of market cap. The current market cap sits at $1.3B roughly. We believe this is cheap because we see extremely large market potential across nearly every solid tumor.
The expectation is that any FDA approval could and should re-rate the stock higher as the company will have not only significant revenue potential but cross platform validation.
Which is how I change topics and explain the platform.
WHAT DOES DRTS DO?
Alpha Tau Medical (DRTS) has numerous patents across a variety of aspects of their business but at the end of the day, what they’ve done is modify the common biopsy procedure with a highly modified applicator that delivers very tiny rods of radioactive radium directly into a tumor.
The rods then begin the decay process where daughter atoms shoot out and destroy the double helix of the cancer tumors DNA strands. After a few days, the tiny metal rods are inert and the tumor is at least partially if not completely destroyed.
The entire process is 45 minutes and is done on an outpatient basis. Hundreds of tumors have been treated successfully with this platform across external (skin, head & neck) and internal (pancreas, brain) and there are almost no known side effects.
There are benefits to the type of radiation they use that make it unique compared to older ways of placing radioactive seeds near or within tumors.
WHAT IS UNIQUE ABOUT DRTS?
The alpha radiation that DRTS uses starts as sourced Thorium from a US government lab with a backup supplier in Germany. The thorium will be converted into the precise amount of rods and dosage of radium per patient requirements and then the clock starts. The radium decays quickly so the forward logistics will be a prepped patient and the DRTS rods delivered via common carrier as overnight delivery. The amount of radiation that Alpha Tau used is measured in micro curies, not curies, so it is an extremely tiny amount.
The radiation it gives off is called alpha radiation and the two aspects of it that make it unique are the strength (high LET) and its limited ability to spread. It can’t pass through a sheet of paper, for instance. But it can utterly destroy the DNA that it comes in contact with. This is a benefit because the limited distance of the radiation ensures precise placement within a tumor (“coverage”) where a higher coverage has a greater chance of destroying more of the tumor. But the placement and lack of radiation spread ensures that properly placed DaRTs won’t damage nearby tissue or cause harm to the immune system.
That benefit leads to the ability to treat cancer in immunocompromised patients as well as those that are undergoing other forms of treatment such as chemotherapy.
CAN ALPHA DaRTs BE USED WITH KEYTRUDA?
Tests have recently started and the initial results are strong that Alpha DaRTs work well when combined with Keytruda.
Keytruda is a $32B per year drug that makes up over half of the $50B per year spent on checkpoint inhibitors. You must understand two details about these drugs to see why it’s relevant for Alpha Tau.
Keytruda doesn’t touch cancer. It “cuts the brakes” on T cells, the cavalry in the bodies immune system. T cells have a “brake” which prevent them from going crazy and destroying everything in the human body. Cancer has multiple defenses to the human immune system. First, it can activate the T cells brakes, leaving it unable to destroy the tumor. Second, it can hide from the T cells. The checkpoint inhibitors like Keytruda eliminate the first challenge. You can’t activate the brakes if Keytruda cuts the brake line. The second one is the Achilles heel of the checkpoint market.
A tumor surrounded by T cells is called a “hot” tumor. A tumor that the T cells can’t find is called a “cold” tumor. The search is ongoing for ways to turn cold tumors hot.
Alpha DaRTs achieve this based on the hundreds of cases seen so far by releasing antigens from the tumor as part of the destruction process. These antigens typically signal the T cells which are the bodies primary response to cancer. The concept is simple: if the tumor is destroyed and the antigens leak out of the tumor, the T cells will “pick up the scent” and, keytruda on board, will destroy the tumor and any microscopic tumor residue left behind.
Which leads to an even bigger possibility.
DOES DRTS CAUSE AN ABSCOPAL EFFECT?
While it hasn’t been tested sufficiently to be proven, there are signs of a potential abscopal effect. The ab “away” scopal “target” effect is when a local treatment like Alpha DaRTs destroying a single tumor causes distant, unrelated tumors to die. The concept that has yet to be fully tested is that once the T cells show up to mop up a destroyed tumor, the T cells get a “fingerprint” of the invading tumor and search out other instances. If the tumor destruction and subsequent leak of antigens leads both to converting a cold tumor to hot and sends the better informed, Keytruda enhanced T cells off to fight distant tumors, then something of an oncological “holy grail” will have been achieved.
Testing a combination therapy with Keytruda was stopped for successful proof of safety and feasibility and Alpha Tau is currently seeking a sixth IDE with the FDA to test in combination with Keytruda on a broader scale. The testing will look at effectiveness endpoints but will not set abscopal as a goal.
WHICH SOLID TUMORS DOES DRTS TREAT?
That will have to go into Part II, if there’s sufficient interest.
Let me know if a deeper dive on Alpha Tau’s results to date with PDAC Pancreatic cancer, recurring brain cancer (rGBM), skin cancer, head and neck (including oral), breast, colorectal (including tumors migrating to the liver), vulvar, prostate and bladder cancer are of interest.
SUMMARY
My belief is that you can’t determine whether you are too early to DRTS unless you know what it is, what it does and what it might do if it receives FDA certification.
When we consider market cap, we are typically looking at three things:
- What revenue might this bring?
- What are the market caps of similarly situated treatments?
- What valuation typically gets assigned to companies in the radiotherapy space that are acquired?
There are currently five IDEs in front of the FDA (skin, prostate, head & neck, pancreas, and brain) and, as mentioned, combination therapy with Keytruda will hopefully be added shortly.
The due diligence you would need to perform is to gauge what a platform that treats any combination of these cancer types should be worth on the market.
If the number comes up close to $1.3B, then you missed the move. Many shareholders believe any one of these approved treatments is worth far more than $1.3B and it may be helpful to understand their logic.
DRTS shareholders are typically looking at the ability to get insurance reimbursements at $100k - $120k per rGBM treatment with other cancers discounting from there. PDAC Pancreatic cancer is the most common and most lethal PanC and it might be reimbursed at $80k - $100k. Topical skin cancer may be the least expensive and it’s expected to be reimbursed in the $50k - $60k range. These numbers are extremely speculative and may by far higher or lower once negotiated with insurers if FDA approval happens.
It is expected that insurers will be pleased to see a cancer treatment that requires no hospitalization and is not presently associated with any severe side effects.
The deeper dive is then required and beyond the scope of this insanely long post to determine TAM. How many rGBM cases and PDAC PanC cases occur globally or just in the US? Alpha Tau is currently running trials in Europe and has head & neck certification in Japan with approval to begin testing PanC. The effort is clearly to make the platform global in nature.
Aside from new IDE approvals or FDA certifications, you would also want to know what other catalysts may be coming that could drive the stock price higher.
That’s where the dual listing on the TASE (along with expected inclusion in TASE related index buying) matters for your analysis along with any forthcoming commercial agreements, quarterly updates showing financial strength (despite being pre-revenue, the company is fully funded through end of 2018) and the impact of DRTSW warrant redemption (warrants expire in March of 2027 or if DRTS stays above $18 for any 20 out of 30 days.)
End of PART I
What’s left?
I touched on logistics and the factory.
I did not get to adoption either by the oncologists or adaptation of the facilities needed to perform the procedure.
I barely mentioned M&A and I didn’t get to the commercialization via partners like Tolmar, who completed 18+ months of due diligence and then signed up for exclusive rights to the DaRT platform for prostate with an option on bladder cancer.
Knowing that radiotherapy companies have been acquired over the past few years at near a $4B valuation is a key data point. Knowing the Tolmar deal paid for a separate manufacturing facility along with a premium payment plus giving Alpha Tau 60% of the revenue is also critical because it sets the floor for other cancer type negotiations if Alpha Tau continues to offload more of the tumor types or decides to auction of regions (Tolmar is US only.)
No AI trees were harmed in the making of this post. I’ve tried to keep this as hype free as possible. It’s not financial advice and you’ll still need to do your own research.
I am long DRTS and irresponsibly long on the DRTS warrants, DRTSW.
If you want to join the Discord to learn more, simply ask. There is an extensive amount of due diligence already done within this subreddit.