Jarrod Longcor
Analyst · Ladenburg
Sure. So, as you mentioned, there's a number of steps that go into the -- obviously, the start-up process, just sort of lay out a few, I mean, generally, the way the process actually starts is that, and I'll just sort of give probably way too much granularity here, but at the time of beginning the process, right, where you start is the contracting with the CRO and getting the documentation in place with the CRO. And that means not just the contract, but it's all the supporting documentation. So all of the necessary investigator letters, all of the necessary documents for the operation of the study and the SOPs and making sure everything lines up. After that, then you move into the next phase, which is really site identification, where you identify -- which sites you want to target, which countries you want to go to, and so on and so forth from that. That then goes into what's called a feasibility step where you submit to those various sites and investigators a feasibility questionnaire where they again, request -- they get basically a protocol synopsis, they review it, they determine if they're interested in participating, and they provide you with a sense of how many patients they may or may not -- how many patients they might enroll in what time frame. After that, you move into what's called the qualification phase, which is obviously, with the radiopharmaceutical, it's not like taking an oral antibiotic per se, right? In this case, you've got to have an infusion suite, you got to be able to handle and licensed for handling I 131. And so you have to go through all of that process and you have to collect all that documentation as well. Then you move through and, as you said, you get into the IRB phase. The IRB phase comes, site contracting comes that can sometimes go in parallel, sometimes not. And that depends -- depending, as Jim said, we've got a lot of interest from both community centers as well as academic centers. When you think about community centers, we can use a central IRB, that allows them to approve more rapidly and move more rapidly. However, some of the more academic centers tend to have a local IRB in addition to that central IRB, so there's an extra IRB review process. In addition to that, many of the academic centers also have an internal committee that have to review the protocol with the final full protocol and statistical analysis plan, where they then vote to participate and go from that step to the next step, which would then be the contracting. After that, you have to train the centers and begin all that process, and then you do site -- the true site initiation, which allows them to open and begin screening for patients, and then first patient in. That's sort of all of that execution and operational stuff is going on in the background. And as we said in our prepared remarks, we have initiated much of that, and we are on track to have what we believe our first sites open in a handful of months here over the next coming months, with the potential first patient in late this year, early next year. As it relates to then the FDA submission and what's the gating aspect for that, that is -- the gating aspect by FDA's definition is the site has to be their site. The study has to be initiated and "ongoing." So initiated at the time of submission, ongoing at the time of regulatory action, the definition of which is not defined by the FDA. They will not provide any clear direct guidance on that subject. So you are left to sort of estimate what you think that might be. We know what they're asking is basically that companies are executing diligently against the confirmatory studies for acceptance of their accelerated approval application, and diligently continue to execute that by the time they are doing regulatory action. Our interpretation of that is that we want to have a number of sites open somewhere -- perhaps 10 to 20 sites open at the time of submission. And we want to be in a position that we've gotten a couple of patients enrolled, preferably at the time of submission, and then having somewhere between 5% or more patients enrolled by the time there's regulatory action, that's 6 to 8 months after the submission goes in. Does that help?