Leerink Swank Report

May 6, 2013

Reason for report:

PROPRIETARY - SURVEY

Howard Liang, Ph.D.(617) [email protected]

Rene Shen(212) [email protected]

Gena Wang, Ph.D.(212) [email protected]

BIOTECHNOLOGYProstate Cancer Survey Finds Robust Uptake of New HormonalAgents

• Bottom Line: MEDACorp conducted a survey of 50 US urologists andoncologists (25 in each specialty) with a majority of them practicing in thecommunity setting. The survey suggests significant use of Xtandi (MDVN[OP]/Astellas) in the pre-chemo setting already and a near-term salestrajectory that appears to be ahead of expectations. For DNDN's (MP)Provenge, the survey suggests declining use since the end of 2012.

• In aggregate, survey respondents manage twice as many pre-chemo castration-resistant prostate cancer (CRPC) patients as post-chemo patients. Together with a longer treatment duration (expectedto be 2x), the survey results suggest that the pre-chemo market is likelyseveral times as big as the post-chemo market.

• Survey finds a substantial increase of Zytiga and Xtandi of 41%and 80%, respectively, from Dec. 2012 to March 2013. The magnitudeof increase in Zytiga use matches the sequential sales growth reportedfor Zytiga. For both drugs, the growth was mainly driven by pre-chemouse and by urologists. Both Zytiga and Xtandi are projected to growsubstantially through the rest of 2013, by 84% and 167%, respectively,relative to March 2013, indicating that the market is by no meanssaturated. By physician projections, the number of patients on Xtandi willhave nearly caught up with Zytiga by the end of 2013.

• A little over half of current Xtandi patients had previously receivedZytiga, although this differed significantly between oncologistsand urologists, with the latter group having a much lower proportion ofXtandi patients post-Zytiga (28% vs. 70%) that also declined in the last3 months (from 44% to 28%). Most physicians in both specialties treat toprogression, although nearly a quarter (24%) of urologists indicated that inpost-Zytiga patients Xtandi would be continued post-progression.

• Majority of survey respondents consider the efficacy and safety/tolerability profiles of Zytiga and Xtandi to be similar in the post-chemo setting. Differences in perception by urologists and oncologistsmay be explained in part by the limited promotion of Xtandi to date tourologists. Assuming PREVAIL demonstrates a statistically significantoverall survival (OS) benefit, one-year after presumed Xtandi approval inthe pre-chemo setting, Xtandi is projected to overtake Zytiga with a 43%market share in the first-line metastatic setting vs. 34% for Zytiga. If Xtandishows only an OS trend, these shares would reverse.

• Survey respondents report declining use of Provenge sinceDecember 2012. However, Provenge usage is projected to rebound withrobust growth by the end of 2013. Although many respondents indicateddeclining use of Provenge after Zytiga pre-chemo approval and Xtandilaunch, interestingly this appears to mainly affect the casual users and tohave limited impact on existing heavy users.

S&P 500 Health Care Index: 552.34

Companies Highlighted:DNDN, JNJ, MDVN

Please refer to pages 28 - 31 for Important Disclosures, Price Charts and Analyst Certification.

SURVEY DEMOGRAPHICS

Our survey sample consists of both urologists and medical oncologists with a majority of

them practicing in the community setting. On our behalf, MEDACorp conducted a survey of 25

oncologists and 25 urologists to assess market dynamics in the treatment of castrate resistant

prostate cancer (CRPC). The survey was fielded and followed up from April 5 to April 29, 2013.

In order to get a respondent cohort that is experienced in treating CRPC, physicians had to treat at

least 30 metastatic castration-resistant prostate cancer patients personally over the past 12

months. The survey respondents are composed of 14 physicians (28%) from the academic

medical centers, 6 physicians (12%) from community hospitals, 1 physician (2%) from a VA

hospital, 27 physicians (54%) from private practice and 2 physicians (4%) from a clinic. Practice

settings were similar for oncologists and urologists in our survey.

Survey Question: What best describes your primary practice setting?

All

respondents

(n=50)

Oncologists

(n= 25)

Urologists

(n=25)

Academic medical center 28% 28% 28%

Community hospital 12% 12% 12%

VA hospital 2% 4% 0%

Private practice 54% 52% 56%

Clinic 4% 4% 4%

Other 0% 0% 0%

Source: MEDACorp survey, “Treatment of Prostate Cancer”, April 2013

PRE- AND POST-CHEMOTHERAPY MARKETS

As expected, urologists treat a population with earlier stage disease. The surveyed

physicians treat 248 prostate cancer patients on average for a total of >12,000 patients. Of CRPC

patients, oncologists see 50 patients on average, while urologists see 63 patients on average,

though the median is closer, at 40 and 43, respectively. Oncologists see a higher number of

metastatic patients as a percentage of their overall prostate cancer practice at 53% on average vs.

16% for urologists, reflecting a generally earlier stage population seen by urologists. .

Survey Question: How many prostate cancer patients do you personally manage currently?


Mean Median Total Mean Median Total Mean Median Total

Total (n=50) 248 155 12,396 56 42 2,804 22.6% 26.8% 22.6%

Oncologist (n=25) 94 80 2,346 50 40 1,241 52.9% 50.0% 52.9%

Urologist (n=25) 402 450 10,050 63 43 1,563 15.6% 9.6% 15.6%

Prostate cancer patients CRPC patientsCRPC as % of overall

Prostate Cancer Pts

2

BIOTECHNOLOGY May 6, 2013

In aggregate, physicians manage approximately twice as many patients in the pre-chemo

setting as in the post-chemo setting, with urologists seeing nearly 3 times as many. When

we break out the CRPC population into the 1st line metastatic (or pre-chemo), currently undergoing

treatment with 1st line chemotherapy, and post-chemo population we find that oncologists have a

higher percentage of patients (vs. urologists) in the latter two categories. On average, oncologists

are treating 20 patients in the pre-chemo setting, 16 patients in the 1st line chemo setting and 14

patients in the post-chemo setting. Urologists have 36 patients in the pre-chemo setting, 13 in the

1st line chemo setting and 13 patients in the post-chemo setting on average. For urologists, 58%

of their CRPC patients are in the pre-chemo setting compared with 40% for oncologists. In the

post-chemo setting, oncologists have 29% of their patients fitting this criteria compared with 21%

for urologists. This highlights the change in prescriber base that occurs as medications such as

Zytiga and eventually Xtandi move from the post-chemo to the pre-chemo space.

Survey Question: How many of your castration-resistant prostate cancer (CRPC) patients

are in the following categories?


ZYTIGA, XTANDI UTILIZATION TRENDS

Survey respondents, especially urologists, report a substantial increase in their use of both

Zytiga and Xtandi from December 2012 to March 2013. Though urologists on average had

fewer patients on Zytiga or Xtandi in December, they increased their usage of these agents by

76% and 209%, respectively, in 1Q:13. Oncologists also increased their usage of the two agents,

though by a more modest percentage (18-36%). In aggregate, the average number of patients

receiving Zytiga increased from 5.6 at the end of December 2012 to 7.9 at the end of March,

representing a 41% increase. The average number of patients receiving Xtandi in our survey

sample increased from 2.5 at the end of December 2012 to 4.6 at the end of March,

corresponding to an 80% increase. JNJ (OP) reported a 41% revenue increase sequentially for

US Zytiga sales in the 1Q:13, equal to the 41% reported by our survey respondents. However,

there were inventory adjustments in the 4Q:12 for Zytiga sales that impacted the comparison. IMS

script data had only a 14% increase sequentially. Furthermore, as the urologists and oncologists

reported drastically different growth rates for Zytiga in our survey, the mix of specialty will be an

important factor when determining the growth rate.

Mean Pre-Chemo 1st Line Chemo Post-Chemo Pre-Chemo 1st Line Chemo Post-Chemo

Total 28 15 14 50% 26% 24%

Oncologists 20 16 14 40% 32% 29%

Urologists 36 13 13 58% 22% 21%

# of patients by line of therapy % of patients by line of therapy

3





Overall use of both Zytiga and Xtandi saw substantial increase in the pre-chemo setting

while post-chemo use held steady or had a more modest increase. In the pre-chemo setting,

the average number of patients increased from 2.6 for each respondent in December 2012 to 3.9

in March 2013 (+50%), following the FDA approval in this setting in December 2012. Although

Xtandi has not yet been approved for pre-chemo use and in fact has not yet reported Phase III

data in this setting, the increase for Xtandi in the pre-chemo setting was more dramatic on a

relative basis, from 0.7 to 1.9 patients per physician over the same period. In the post-chemo

setting, Zytiga use held steady (average of 3.0 patients per respondent at the end of both

December and March) and Xtandi use continued to increase from 1.8 to 2.6 patients per

respondent. Therefore, for both products, there was more growth, on an absolute basis, in the

pre-chemo setting as compared to post-chemo setting. For Zytiga, as of the end of December

2012, pre-chemo patients represented slightly less than half (46%) of the patients prescribed

Zytiga by our survey respondents and this increased to 62% at the end of March due to growth in

the pre-chemo patients. For Xtandi, the percentage of pre-chemo patients as a percent of total

Xtandi patients increased from 28% to 42% over the same period.

By physician specialty, increased pre-chemo use is predominantly driven by urologists.

Oncologists had 48% more patients on Zytiga in the pre-chemo setting in March than in

December. The increase in Xtandi is relatively modest from 0.9 patients on average to 1.3

patients on average. The increase for Zytiga was more pronounced but similar on a percentage

basis from 3.2 to 4.7 patients over the same period. Urologists use more Xtandi and Zytiga than

Mean Total Pre-chemo Post-chemo Total Pre-chemo Post-chemo Post-Zytiga Total Pre-chemo Post-chemo Total Pre-chemo Post-chemo Post-Zytiga

Total (n=50) 5.6 2.6 3.0 2.5 0.7 1.8 1.6 7.9 4.8 3.0 4.6 1.9 2.6 2.4

Oncologists (n=25) 6.7 3.2 3.6 3.8 0.9 2.9 2.6 8.0 4.7 3.3 5.2 1.3 3.9 3.6

Urologists (n=25) 4.4 2.0 2.4 1.3 0.5 0.8 0.6 7.8 5.0 2.8 4.0 2.6 1.4 1.1

% Increase Total Pre-chemo Post-chemo Total Pre-chemo Post-chemo Post-Zytiga

Total (n=50) 41% 88% 1% 80% 174% 43% 51%

Oncologists (n=25) 18% 48% -8% 36% 39% 35% 41%

Urologists (n=25) 76% 150% 15% 209% 433% 75% 100%

# on Zytiga

Dec-12 Mar-13

# on Zytiga# on Xtandi # on Xtandi

% Increase from Dec 2012 to Mar 2013

# on Zytiga # on Xtandi

Mean Pre-chemo Post-chemo Pre-chemo Post-chemo Post-Zytiga Pre-chemo Post-chemo Pre-chemo Post-chemo Post-Zytiga

Total (n=50) 46% 54% 28% 72% 61% 62% 38% 42% 58% 52%

Oncologists (n=25) 47% 53% 24% 76% 67% 59% 41% 25% 75% 70%

Urologists (n=25) 45% 55% 38% 63% 44% 64% 36% 65% 35% 28%

Dec-12 Mar-13

# on Zytiga # on Xtandi # on Xtandi# on Zytiga

1Q:13 vs. 4Q:12

growth rate

Zytiga (reported) 41%

Zytiga (survey: total) 41%

Zytiga (survey: oncologists) 18%

Zytiga (survey: urologists) 76%

Zytiga (IMS) 14%

4


oncologists in the pre-chemo setting. On average, urologists in the survey had 5 patients on

Zytiga and 2.6 patients on Xtandi in March of 2013, compared with 4.7 and 1.3 for oncologists.

Urologists drove increased use of Zytiga and Xtandi in the pre-chemo setting both on a relative

and absolute basis.



0.0

1.0

2.0

3.0

4.0

5.0

Dec 2012 Mar 2013

Mean number of patients

treated

Oncologists Usage of Zytiga and Xtandi in the Pre-Chemo Setting

Zytiga

Xtandi

+48%

+39%

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Dec 2012 Mar 2013

Mean number of patients

treated

Urologists Usage of Zytiga and Xtandi in the Pre-Chemo Setting

Zytia

Xtandi

+150%

+433%

5


In aggregate, a little over half of Xtandi patients had previously received Zytiga, but this

differed significantly between oncologists and urologists. As of March 2013, approximately

52% of patients receiving Xtandi had previously received Zytiga and this declined somewhat from

61% three months prior in December 2012. There is a notable difference between specialties,

and post-Zytiga patients represented 70% of Xtandi patients for oncologists but only 28% for

urologists. We did not specifically ask whether post-Zytiga patients are also post-chemo, but

based on our conversations with MEDACorp physicians, we believe that there is some use of

Xtandi ahead of chemo in patients who progressed on Zytiga.


The overall number of patients on Zytiga and Xtandi is expected to be significantly higher

by the end of 2013. For Zytiga, a greater than 80% increase in patients is expected between

March 2013 and December 2013. For Xtandi, the increase is even more steep, a >150% increase

in patient numbers, albeit from a lower base. Thus the relative market share of Zytiga to Xtandi

across all of CRPC was 63%/37% in our survey as of March 2013, but is expected to be 54%/46%

by the end of 2013.


Dec-12 Mar-13 Dec-12 Mar-13

Total (n=50) 72% 58% 61% 52%

Oncologists (n=25) 76% 75% 67% 70%

Urologists (n=25) 63% 35% 44% 28%

Post-Zytiga SettingPost-Chemo Setting

% of Xtandi Usage in the…

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

Dec-12 Mar-13 Dec-13 Dec-12 Mar-13 Dec-13

Zytiga Xtandi

# of Patients on Treatment

Mean Number of Patients on Zytiga and Xtandi

Total (n=50)

Oncologists (n=25)

Urologists (n=25)

6




Most oncologists continue patients on Zytiga until progression; however, more urologists

are willing to continue treatment past progression. In our survey, oncologists indicated that

they treated with Zytiga until PSA or radiographic progression in most cases, with 16% willing to

treat post progression as long as it was well tolerated by the patient. Urologists were more willing

to continue treatment post progression, with 32% using this criteria, but 16% would stop treatment

upon a rise in PSA.

Survey Question: Please explain how you decide when to discontinue Zytiga treatment in the post-chemotherapy setting assuming tolerability is not limiting?


Zytiga Xtandi

Total (n=50) 83.7% 166.7%

Oncologists (n=25) 94.0% 158.9%

Urologists (n=25) 73.2% 176.8%

% Increase in Projected Patients

from Mar to Dec 2013

Dec-12 Mar-13 Dec-13

Total (n=50) 31.4% 36.7% 45.7%

Oncologists (n=25) 36.1% 39.3% 46.4%

Urologists (n=25) 22.5% 33.8% 44.9%

Xtandi Market Share*

*Market share is defined as Xandi patients as a percentage of

patients on Xtandi and Zytiga.

Oncologists Urologists

Continue treatment post-progression as long as the patient can tolerate it 16% 32%

Treat to radiographic progression 36% 16%

Treat to PSA progression 48% 32%

Treat until PSA starts to rise 0% 16%

Other: both PSA progression and ragiographic progression (1x) 0% 4%

7


The practice of continuing Xtandi beyond progression appears relatively uncommon. Since

a substantial portion of current Xtandi use is in post-Zytiga patients, the duration of Xtandi could

be expected to be relatively short as current data suggest that both drugs are much less effective

in patients who had prior hormonal treatment such as ketoconazole. Anecdotally some physicians

have indicated that they continue the patient on drug post-progression, and we were interested in

how common this practice is. Based on our survey, treating beyond progression is relatively

uncommon among oncologists (8% in our survey) and appeared more common among urologists

but still represent less than a quarter of the surveyed urologists.

Survey Question: If you have used or plan to use Xtandi in patients who were previously treated with Zytiga, please explain how you decide when to discontinue Xtandi treatment in these patients assuming tolerability is not limiting.


The approval of Xtandi has an effect on the decision of when to stop treatment with Zytiga

for 30% of the physicians in the survey. Overall, 30% of physicians indicated that they had

changed their criteria on when to discontinue Zytiga treatment following the availability of Xtandi. It

is likely that at least in some cases patients are no longer continued on Zytiga post-progression

but switched to Xtandi instead. Most comments indicated that this was due to the availability of

another agent that could demonstrate additional efficacy or be better tolerated in certain patients.

Survey Question: Has the approval of Xtandi in the post-chemotherapy setting changed when you stop treatment with Zytiga in the post-chemotherapy setting?



Continue treatment post-progression as long as the patient can tolerate it 8% 24%

Treat to PSA progression 48% 16%

Treat until PSA starts to rise 4% 24%

Treat to radiographic progression 36% 8%

I have not used or do not plan to use Xtandi in patients who were previously treated with Zytiga 4% 20%

Other: both symptomatic radiographic progression and PSA progression (x1), not sure (x1) 0% 8%

Yes No

Total survey respondents

(N=50)30% 70%

8


PHYSICIAN PERCEPTION ABOUT ZYTIGA AND XTANDI

More than 50% of respondents considered the efficacy and safety of Xtandi and Zytiga to

be similar in the post-chemotherapy setting, although it is possible that the difference

between oncologist and urologist perceptions may reflect the early stage of marketing

efforts for Xtandi. This result was true for both oncologists and urologists in our survey. Only 1

or 2 of the 50 respondents considered there to be a meaningful differences in safety or efficacy

between Xtandi and Zytiga. If we consider the difference in percentage of respondents that

believe that Zytiga is better than Xtandi, we see that the percentage of oncologists that consider

Zytiga to have better efficacy than Xtandi is approximately equal to the percentage that consider it

to have worse efficacy. However, on safety, we see that 36% of oncologists (9/26) believe that

Xtandi has better safety and tolerability than Zytiga, but only 4% (or 1 oncologist) believed the

inverse is true. In contrast, urologists consider the safety and tolerability of Xtandi to be similar to

Zytiga, but 28% consider Zytiga to have superior efficacy while only 8% consider Xtandi to be

more efficacious. As Xtandi is only approved for the post-chemo setting, MDVN and partner

Astellas have had limited presence in the urologist setting, therefore it is possible that the gap in

physician perception between the specialties may have been contributed to by the stage of

commercial promotion.

Survey Question: Please indicate your perception of the relative efficacy and safety / tolerability / convenience of Zytiga and Xtandi in the post-chemotherapy setting.


Likely due to lack of Phase III data for Xtandi, urologists view the efficacy and safety of

Zytiga to be superior to Xtandi in the pre-chemo setting while oncologists consider Zytiga

to be better on efficacy but worse on safety/tolerability. In the pre-chemo setting, 12% of

oncologists and 16% of urologists were unable to respond to the question due to lack of data and

experience. Urologists experienced with both agents considered the safety and efficacy of Zytiga

Survey categories Efficacy

Safety,

tolerability and

convenience

Efficacy

Safety,

tolerability and

convenience

Zytiga meaningfully better than Xtanti 4.0% 0.0% 8.0% 8.0%

Zytiga modestly better than Xtandi 16.0% 4.0% 20.0% 16.0%

Zytiga and Xtandi are about the same 64.0% 60.0% 56.0% 52.0%

Xtandi modestly better than Zytiga 12.0% 28.0% 8.0% 16.0%

Xtandi meaningfully better than Zytiga 4.0% 8.0% 0.0% 4.0%

Unable to rate due to lack of data and experience 0.0% 0.0% 8.0% 4.0%

Regrouping of categories Efficacy

Safety,

tolerability and

convenience

Efficacy

Safety,

tolerability and

convenience

Zytiga better 20.0% 4.0% 28.0% 24.0%

Zytiga similar to Xtandi 64.0% 60.0% 56.0% 52.0%

Xtandi better 16.0% 36.0% 8.0% 20.0%

Unable to rate 0.0% 0.0% 8.0% 4.0%

% considering Zytiga better minus Xtandi better 4.00% -32.00% 20.00% 4.00%



Post-chemo

9


to be better than Xtandi, though 44% considered the two agents to be similar. While more

oncologists considered the efficacy of Zytiga to be superior to Xtandi, a higher percentage viewed

Xtandi to have the better safety and tolerability profile in the pre-chemo setting. We believe these

impressions of the relative profiles of these agents will likely change upon the release of the

Phase III PREVAIL results for Xtandi in the pre-chemo setting and once the Xtandi marketing

team can promote the agent for the pre-chemo setting.

Survey Question: Please indicate your perception of the relative efficacy and safety /

tolerability / convenience of Zytiga and Xtandi in the pre-chemotherapy setting.


Survey categories Efficacy

Safety,

tolerability and

convenience

Efficacy

Safety,

tolerability and

convenience

Zytiga meaningfully better than Xtanti 16.0% 4.0% 8.0% 4.0%

Zytiga modestly better than Xtandi 28.0% 8.0% 28.0% 28.0%

Zytiga and Xtandi are about the same 20.0% 44.0% 44.0% 44.0%

Xtandi modestly better than Zytiga 20.0% 24.0% 4.0% 4.0%

Xtandi meaningfully better than Zytiga 4.0% 8.0% 0.0% 0.0%

Unable to rate due to lack of data and experience 12.0% 12.0% 16.0% 16.0%

Regrouping of categories Efficacy

Safety,

tolerability and

convenience

Efficacy

Safety,

tolerability and

convenience

Zytiga better 44.0% 12.0% 36.0% 32.0%

Zytiga similar to Xtandi 20.0% 44.0% 44.0% 44.0%

Xtandi better 24.0% 32.0% 4.0% 4.0%

Unable to rate 12.0% 12.0% 16.0% 16.0%

% considering Zytiga better minus Xtandi better 20.00% -20.00% 32.00% 28.00%

Pre-chemoOncologists Urologists


10


Lack of statistically significant OS benefit for Xtandi in PREVAIL is projected to lead to a

less than 10% decline in market share over the scenario with only an OS trend, although

this would correspond to a 20%+ loss on a relative basis. One year after presumed Xtandi

approval in the pre-chemo setting, assuming PREVAIL shows a statistically significant overall

survival benefit, Xtandi is projected to overtake Zytiga with a 43% market share as the first-line

treatment for metastatic prostate cancer compared to 34% for Zytiga. If Xtandi shows a non-

statistically significant overall survival trend, these market share projections would reverse (34%

for Xtandi vs. 44% for Zytiga). We believe this reflects physicians’ impressions that Zytiga does

confer an OS benefit and that the agents are similar in efficacy and safety/tolerability in the post-

chemotherapy setting.

Chemotherapy will still be appropriate for a minority of patients even with the new oral

agents. Chemotherapy will continue to hold market share in the 1st line metastatic CRPC with

~23% of patients expected to receive these agents. A MEDACorp key opinion leader explained

that for some patients with visceral metastases or aggressive tumor -- about 20% of the patients in

this setting by his estimate -- it is appropriate to give chemotherapy first to attempt to control the

disease before giving a hormonal agent.

Generic Zytiga is projected to have a negative impact on Xtandi, but it appears to take more

share from chemotherapy. Xtandi will lose market share once Zytiga is generic; however, there

will still be substantial usage of Xtandi in 28% of the patients in our survey. With generic Zytiga,

chemotherapy usage in frontline metastatic CRPC expected to fall from 23% to 14%. This would

appear to indicate that the high cost of the oral hormonal agents may be another reason why

chemotherapy is used as the first agent in metastatic prostate cancer patients.

Survey Question: If both Zytiga and Provenge are approved in the pre-chemotherapy/1st

line metastatic setting, how do you see your market share usage of the two agents in this

setting?


One year after Xtandi pre-chemo

approval, if Xtandi demonstrates

statistically significant OS

One year after Xtandi pre-

chemo approval, if Xtandi

demonstrates non-statistically

significant OS

Once Zytiga is generic

Oncologists

Zytiga 1st line market share 35% 46% 53%

Xtandi 1st line market share 44% 36% 30%

Chemo 1st line market share 21% 18% 17%

Urologists

Zytiga 1st line market share 34% 41% 63%

Xtandi 1st line market share 42% 31% 27%

Chemo 1st line market share 25% 28% 10%

11


The vast majority of physicians across both medical specialties would prefer to use the

other hormonal agent first prior to chemotherapy after progression on 1st

line therapy.

Many physicians cited the better tolerability of Xtandi and Zytiga over chemotherapy as their

reason for sequencing the two agents prior to cytotoxic therapy.

Survey Question: Do you anticipate using the alternate agent (Zytiga or Xtandi) once a

patient progresses on 1st

line therapy? Or would you prefer to use chemotherapy upon

progression?


SEIZURE CASES ON XTANDI

More oncologists than urologists have prescribed Xtandi. For the 25 oncologists in our

survey, only 8% (2/25) had not yet prescribed Xtandi, and one of those was looking to prescribe

the agent to the appropriate patient. On the urology side, more than half of the survey

respondents (13/25) had no clinical experience with Xtandi. Reasons for not having prescribed

Xtandi spanned a range of responses, but reimbursement and not yet identifying an appropriate

patient were common.

Survey Question: Have you prescribed Xtandi? No, please explain.


Yes, use alternative agent if patient progresses No, use chemotherapy upon progression

Oncologists (n=25) 76% 24%

Urologists (n=25) 76% 24%


Yes 92% 48%

No 8% 52%

Reasons for not prescribing Xtandi No clinical situation yet for use No candidates identified yet

Too expensive Reimbursement issues

I am not comfortable.

not covered with insurance

Have not had approved yet

Have preferred Zytiga

I have one patient currently on Xtandi that was

prescribed by Medical Oncologist

patient's can not afford post chemo Xtandi

not yet

not yet availab le on formulary

Oncology shared patient

plan to

plan to in future

12


For physicians prescribing Xtandi, urologists and oncologists had similar numbers of

patients on drug. Of the 35 respondents who had prescribed Xtandi, on average they had

prescribed the drug to 7-8 patients and the results were similar for oncologists and urologists. In

total, there were 265 patients prescribed Xtandi under the care of physicians in our survey.


There were a total of 4 patients with seizures in our survey. Two physicians had each seen

two patient seizures after prescribing Xtandi. Both physicians indicated that these seizures had

changed their willingness to prescribe Xtandi. We note that 4 seizures in 265 total Xtandi patients

yield a 1.5% incidence rate, similar to the 0.9% rate listed in the FDA label.

PROVENGE UTILIZATION TRENDS Survey respondents report declining use of Provenge since December 2012. We inquired

about Provenge usage for the respondents. On average, each physician only treated 1-2 patients

per month, thus we aggregated the number of patients by specialty. We see that the number of

patients treated per month declined in January and February by 16% in each month compared to

the previous month, but stabilized in March (1% decline month-over-month) for both urologists and

oncologists. The average monthly number of patients treated with Provenge in 1Q:13 declined by

25% compared to December 2012, and the number of patients receiving Provenge in the last

month of 1Q:13 (March) vs. 4Q:12 (December) declined by 30%. On an individual doctor basis,

18% of the survey respondents reported an increase in the average monthly Provenge volume in

1Q:13 vs. December 2012, 22% reported no change, but the majority (60%) reported a decline.

This distribution is essentially identical for urologists and oncologists, therefore our survey did not

detect a gain of Provenge among urologists during 1Q. Potential contributors to the Provenge

volume decline may include the effect of Medicare and private insurance co-pay resetting at the

beginning of the year, and Zytiga pre-chemo approval in December and the Xtandi launch in

September and compendium listing in December. While it is difficult to tease out the contribution

of each, continued decline from January to February leads us to believe that the decline is not only

due to reimbursement resetting, and increased use of oral hormonal agents had an impact.

Mean Median Total

Oncologists (n=23) 7.7 5.0 178

Urologists (n=12) 7.3 5.0 87

Total (n=35) 7.6 5.0 265

Xtandi Patients

13



However, Provenge usage is projected to rebound, with a robust 73% growth in patient

numbers for 4Q:13 compared with 1Q:13. Below we see a table with the monthly usage of

Provenge from December 2012 to March 2013 as well as the projected usage in 4Q:13. Across

both urologists and oncologists, there is a marked increase expected in Provenge usage. The

vast majority of urologists in our survey (76%) expect to increase Provenge prescribing in 4Q:13

compared with 1Q:13. Similarly, 56% of oncologists expected an increase in prescribing. Only

8% of respondents in both specialties expected to decrease their Provenge prescribing. Relative

to Dec. 2012 levels, total number of patients on Provenge in our survey sample is projected to

increase by 34% in Dec. 2013, and this is relatively consistent between urologists and oncologists.

On an individual prescriber basis, we see that there is a wide range of Provenge usage. A few

physicians are projecting very high usage in December 2013, while many physicians are

projecting no usage of Provenge at the end of December 2013.


0

20

40

60

80

100

120

Dec-12 Jan-13 Feb-13 Mar-13

Total Number of Provenge Patients

Treated

Dec-12 Jan-13 Feb-13 Mar-13

Total 112 94 79 78

Oncologists (n=25) 58 49 43 44

Urologists (n=25) 54 45 36 34

Total Number of Provenge Treatments by Specialty

Dec-12 Jan-13 Feb-13 Mar-13 Oct-13 Nov-13 Dec-13

# of Provenge Patients

Total 112 94 79 78 142 142 150

Oncologists (n=25) 58 49 43 44 75 75 80

Urologists (n=25) 54 45 36 34 67 67 70

% change Dec 12 to Dec 13

Total (n=50) 34%

Oncologists (n=25) 38%

Urologists (n=25) 30%

% change for 1Q:13 to 4Q:13

Total (n=50) 73%

Oncologists (n=25) 69%

Urologists (n=25) 77%

14




From the change in projected Provenge usage by current use in Provenge, we see that the

increase in usage is across a wide spectrum of prescribing physicians. Some physicians

who are not prescribing Provenge currently intend to start prescribing the agent. Of the 27

physicians who had not prescribed Provenge in March 2013, 15 expected to prescribe the agent in

December 2013. Furthermore, the most active users also intend to increase their prescribing.

Only a couple of the current users expected their prescribing to decrease by year-end 2013. We

do not fully understand the reason for the projected increased use of Provenge by the end of

2013, considering that Provenge has been approved for 3 years and its sales trajectory has been

relatively flat.

Increase No Change Decrease

Total 66% 26% 8%

Oncologists 56% 36% 8%

Urologists 76% 16% 8%

% of Respondents by Expected Change in

Provenge Prescribing from 1Q to 4Q 2013

0

5

10

15

20

25

30


Reported Provenge Pateints in Dec 2012


0

5

10

15

20

25

30


Projected Provenge Pateints in Dec 2013


15



Although many respondents indicated declining usage of Provenge after Zytiga pre-chemo

approval and Xtandi post-chemo approval, this appears to mainly affect the casual users

and to have limited impact on existing heavy users. When we examine the users of Provenge

(who had prescribe the agent to at least 1 patient during March 2013), we see that the highest

prescribers expect no effect from the recent label expansion of Zytiga or the Xtandi approval.

However, users who only infuse 1 patient a month are more likely to decrease their usage of

Provenge due to the availability of new agents.

-2

0

2

4

6

8

10

12

0 2 4 6 8 10 12 14 16 18

Projected Change in Provenge Patients in December 2013

# of Provenge Patients Treated in March 2013

Change in Expected Number of Provenge Patients by Current Patients Treated

Change in Number of Patients

16


Survey Question: How has your usage of Provenge changed with the Zytiga pre-chemo

approval and the Xtandi post-chemo approval?


Despite Xtandi’s lack of prednisone co-administration, physicians do not consider its

approval as a positive for Provenge usage. However, for the vast majority of prescribers, they

expect no change in usage from the approval of Xtandi in the pre-chemo setting. A few

prescribers do expect less usage of Provenge due to another agent being available, while only a

couple of physicians expect to increase usage of Provenge due to the lack co-administration of

prednisone with Xtandi.

# Provenge Pts -

March 2013Comments Usage Change Specialty

16 it has not changed significantly so far. No change Oncologist

14 It has stayed relatively the same. No change Urologist

6 I have used it less because of more options. Less Oncologist

5 no. No change Oncologist

5 use of provenge has remained constant since more men

being treated with one of three therapies, where in past

chemotherapy was only option

No change Urologist

4 not much as i still use provenge No change Oncologist

3 No fifteenth rationale No change Oncologist

3 No. It remains foundational therapy No change Urologist

3 It hasn't. No change Urologist

3 less provenge use. provenge is labor intensive to utilizeNo change Urologist

2 PROVENGE WILL BE USED IN BIOCHEMICAL FAILURE WITH CASTRATE RESISTANTNo change Oncologist

2 no, will still use provenge first No change Oncologist

2 No i use provenge first No change Urologist

1 slightly less use as Zytiga easier to arrange Less Oncologist

1 have had problems with steroid use with abiraterone Less Oncologist

1 I reduced the use of Provenge Less Oncologist

1 Decreased use of provenge Less Oncologist

1 No change, the indications are separate No change Oncologist

1 no change No change Oncologist

1 decrease use of provenge since zytiga is oral Less Urologist

1 I will not go up due to cost of Zytiga Less Urologist

1 n/a No change Urologist

1 Diminished. Much less complicated with Zytiga Less Urologist

17


Survey Question: Will your usage of Provenge change as a result of the approval of Xtandi

in pre-chemo patients (which does not require co-administration of prednisone)? Please

explain:


MEDACorp performed this survey on behalf of a Leerink Swann LLC analyst. The analyst in

conjunction with MEDACorp developed the questions contained in the survey.

4

# Provenge Pts -

March 2013Comments Usage Change Specialty

16 It has not changed so far. No Oncologist

14 It may. I will have to wait for more data before changing usage of

provengeUnclear Urologist

6 Yes, similar to reason above. Less Oncologist

5 no No Oncologist

5 use of provenge to remain same as more men now being treated

for CRPC. not needing prednisone is nice but not significant

enought to influence therapies.

No Urologist

4 no No Oncologist

3 No will not No Oncologist

3 No. It remains foundational therapy No Urologist

3 It will not. No Urologist

3 less provenge use for same reasons above Less Urologist

2 NO. I AM USING PROVENGE ONLY IN A ELECTED GROUP OF

PATIENTSNo Oncologist

2 no, will still use provenge first in all appropriate pts No Oncologist

2 Yes more use if no prednisone Increase Urologist

1 not sure but possib ly Unclear Oncologist

1 will use with xtandi No Oncologist

1 It is already minimal. If the patient requests Provenge it will be fine.No Oncologist

1 Decreased use of Provenge Less Oncologist

1 No change, the indications are separate No Oncologist

1 no change No Oncologist

1 same No Urologist

1 No. Prefer Zytiga No Urologist

1 yes better tolerance Increase Urologist

1 Yes. Provenge is more complicated to my practice routine. Less Urologist

18


TREATMENT OF PROSTATE CANCER

Respondent Distribution

Geographic Distribution

Source: Google Maps

Specialty Oncology and Urology

Trend Prostate Cancer

Number of Respondents 25 Oncologists and 25 Urologists

Respondent Distribution United States

Survey Date April 2013

Responses represent an average of the aggregate responses (n=50) unless otherwise noted. Inclusion Criteria Screener 1: How many metastatic castration-resistant prostate cancer patients have you personally managed over the past 12

months?

Mean Median Sum

Number of metastatic castration-resistant prostate cancer patients I personally managed over the past 12 months

82.4 50 4,121

Screener 2: What is your medical specialty?

50.0% Oncologists

50.0% Urologists

0.0% Other

Survey Questions

1. Which best describes your primary practice setting?

28.0% Academic medical center

12.0% Community hospital

2.0% VA hospital

54.0% Private practice

4.0% Clinic

0.0% Other

2. How many prostate cancer patients do you personally manage currently? Of these, how many are castration-resistant prostate

cancer (CRPC) patients?

Mean Median Sum

Total number of prostate cancer patients that you personally manage 247.9 155 12,396

Castration-resistant prostate cancer (CRPC) 56.1 42 2,804

19


How many of your castration-resistant prostate cancer (CRPC) patients are in the following categories?

Mean Median Sum

Metastatic castration-resistant prostate cancer (mCRPC) before receiving chemotherapy

27.7 21 1,384

mCRPC currently receiving first-line chemotherapy 14.6 10 729

mCRPC after first-line chemotherapy 13.5 10 676

How many of the patients you personally managed were treated with Provenge during the following time periods?

Mean Median Sum

December 2012 2.2 1 112

January 2013 1.9 1 94

February 2013 1.6 1 79

March 2013 1.6 0 78

How many of the patients you personally managed were treated with Zytiga and Xtandi at the end of December 2012 and at the end of March 2013, respectively?

At the end of December 2012

Mean Median Sum

Number of patients receiving Zytiga 5.6 4 278

Of patients receiving Zytiga, how many patients had already received chemotherapy?

3.0 2 149

Number of patients receiving Xtandi 2.5 1 127

Of patients receiving Xtandi, how many patients had already received chemotherapy?

1.8 1 92

Of patients receiving Xtandi, how many patients had already received Zytiga?

1.6 1 78

At the end of March 2013

Mean Median Sum


Of patients receiving Zytiga, how many patients had already received chemotherapy?

3.0 3 151


Of patients receiving Xtandi, how many patients had already received chemotherapy?

2.6 2 132

Of patients receiving Xtandi, how many patients had already received Zytiga?

2.4 2 118

Please project the number of patients on Provenge during the following time periods:

Mean Median Sum

October 2013 2.8 2 142

November 2013 2.8 2 142

December 2013 3.0 2 150

Please project the number of patients on Zytiga and Xtandi at the end of 2013.

Mean Median Sum



20


3. Please explain how you decide when to discontinue Zytiga treatment in the post-chemotherapy setting assuming tolerability is not limiting?

26.0% Treat to radiographic progression

40.0% Treat to PSA progression

8.0% Treat until PSA starts to rise

24.0% Continue treatment post-progression as long as the patient can tolerate it

0.0% I have not used or do not plan to use Xtandi in patients who were previously treated with Zytiga

2.0% Other: both PSA progression and radiographic progression (1x)

4. Has the approval of Xtandi in the post-chemotherapy setting changed when you stop treatment with Zytiga in the post-

chemotherapy setting?

30.0% Yes

70.0% No

Please explain. See Appendix for a summary of responses

5. If you have used or plan to use Xtandi in patients who were previously treated with Zytiga, please explain how you decide when to discontinue Xtandi treatment in these patients assuming tolerability is not limiting.

22.0% Treat to radiographic progression

32.0% Treat to PSA progression

14.0% Treat until PSA starts to rise

16.0% Continue treatment post-progression as long as the patient can tolerate it

12.0% I have not used or do not plan to use Xtandi in patients who were previously treated with Zytiga

4.0% Other: both symptomatic radiographic progression and PSA progression (1x)

6. Please indicate your perception of the relative efficacy and safety / tolerability / convenience of Zytiga and Xtandi in the post-

chemotherapy setting.

Efficacy Safety, tolerability and convenience

Zytiga meaningfully better than Xtanti 6.0% 4.0%

Zytiga modestly better than Xtandi 18.0% 10.0%

Zytiga and Xtandi are about the same 60.0% 56.0%

Xtandi modestly better than Zytiga 10.0% 22.0%

Xtandi meaningfully better than Zytiga 2.0% 6.0%

Unable to rate due to lack of data and experience 4.0% 2.0%

Please indicate your perception of the relative efficacy and safety / tolerability / convenience of Zytiga and Xtandi in the pre-chemotherapy setting.

Efficacy Safety, tolerability and convenience

Zytiga meaningfully better than Xtanti 12.0% 4.0%

Zytiga modestly better than Xtandi 28.0% 14.0%

Zytiga and Xtandi are about the same 32.0% 42.0%

Xtandi modestly better than Zytiga 12.0% 18.0%

Xtandi meaningfully better than Zytiga 2.0% 8.0%

Unable to rate due to lack of data and experience 14.0% 14.0%

21


7. Have you prescribed Xtandi?

70.0% Yes

30.0% No: See Appendix

How many patients have you prescribed Xtandi to in any setting? (n=35)

Mean Median Sum

Number of patients to whom you’ve personally prescribed Xtandi to in any setting 7.6 5 265

Have you seen a case of seizure in patients receiving Xtandi? (n=35)

5.7% Yes

94.3% No

How many patients have had seizures after receiving Xtandi? (n=2)

Mean Median Sum

Number of patients who have had seizures while receiving Xtandi 2.0 2 4

Has this experience changed your willingness to prescribe Xtandi? (n=2)

100.0% Yes

0.0% No

8. If both Zytiga and Provenge are approved in the pre-chemotherapy/1st line metastatic setting, how do you see your market

share usage of the two agents in this setting?

One year after Xtandi pre-chemo approval, if Xtandi demonstrates statistically significant OS

One year after Xtandi pre-chemo approval if Xtandi demonstrates non-statistically significant OS trend

Once Zytiga is generic

Zytiga 1st line market share 34.2% 43.7% 58.0%

Xtandi 1st line market share 42.8% 33.5% 28.1%

Chemotherapy 23.0% 22.8% 13.9%

9. Do you anticipate using the alternate agent (Zytiga or Xtandi) once a patient progresses on 1

st line therapy? Or would you

prefer to use chemotherapy upon progression?

76.0% Yes, prefer to use alternate agent if patient progresses on 1st line therapy

24.0% No, prefer to use chemotherapy upon progression

Please explain: See Appendix for a summary of responses

10. How has your usage of Provenge changed with the Zytiga pre-chemo approval and the Xtandi post-chemo approval? Please explain: See Appendix for a summary of responses

11. Will your usage of Provenge change as a result of the approval of Xtandi in pre-chemo patients (which does not require co-

administration of prednisone)? Please explain: See Appendix for a summary of responses

22


Appendix: Summary of responses. Question 4: Has the approval of Xtandi in the post-chemotherapy setting changed when you stop treatment with Zytiga in the post-

chemotherapy setting? Please explain.

1 No, PFS benefits seen with both.

2 Generally go to Xtandi prior to Jevtana

3 Still have chemotherapy in between prior to using Xtandi

4 Use Zytiga until response ends and then move to Xtandi

5 I still treat till clinical or radiographic progression

7 I use Xtandi after Zytiga

8 Approval of Xtandi is for chemotherapy failures so use or no[ne] use of Zytiga should not be an issue

9 Has influenced no change

10 No impact of one over the other

11 I generally do not stop Zytiga for Xtandi

12 I use Zytiga until it is no longer clinically helpful for the patient.

13 Xtandi after Zytiga

14 No. PSA doubling in 3 months or less would be a clear indication for change. Otherwise 2 consecutive progressions 3 months apart.

15 Decrease its use in favor of Xtandi

16 Use less

17 I have been using Zytiga in pre chemo setting

19 My pattern of treatment remains the same due to expense of Xtandi

20 Still treat to PSA progression

21 One more agent available to treat patients after they fail Zytiga

22 Still treat to progression or toxicity

23 I have more Zytiga experience

24 Additional option now available.

25 Will still treat to PSA progression

26 I switch to Xtandi on PSA progression

27 Don’t think that will make a difference. I imagine both will be approved pre and/or post chemo.

28 Has not changed current practice

29 No, I continue to use Zytiga in the post chemotherapy setting despite the approval of Xtandi. I am using more Zytiga in pre-chemotherapy setting however.

30 Proceeding with recommendations from medical oncology here

31 Has not changed as far as I am aware.

32 I still use Zytiga as first line Rx

33 Have not used Xtandi yet

34 Quicker to switch

35 It has had no impact

36 Would be more apt to switch from Zytiga to Xtandi after PSA progression

37 Yes. We have had some responders that have failed or progressed on Zytiga

38 No effect

39 Difficult for patient to afford out of pocket Xtandi, Xtandi is more expensive than Zytiga

40 Easier use of this class of med. Adrenal sparing

41 Not sure about latest change

42 I would still use.

43 No clear superiority of one agent over the other

44 Can continue Zytiga

46 No bearing on when to stop Zytiga

47 Adverse reaction

48 About to start using Xtandi. No experience thus far

49 Zytiga end-point is determined by clinical response

50 Cost prohibitive to patient

23


Question 7: Have you prescribed Xtandi? No, please explain

8 No clinical situation yet for use

23 Too expensive

28 No candidates identified yet

30 Reimbursement issues

31 I am not comfortable.

32 Not covered with insurance

33 Have not had approved yet

35 Have preferred Zytiga

36 I have one patient currently on Xtandi that was prescribed by Medical Oncologist

39 Patients cannot afford post chemo Xtandi

41 Not yet

43 Not yet available on formulary

44 Oncology shared patient

45 Plan to

48 Plan to in future

Question 9: Do you anticipate using the alternate agent (Zytiga or Xtandi) once a patient progresses on 1

st line therapy? Or

would you prefer to use chemotherapy upon progression?

1 I would switch back to cytotoxic chemotherapy.

2 Depends on many circumstances however to include pace of disease

3 Different mechanism of action

4 To avoid chemotherapy

5 As most patients don’t want chemo.

6 Especially for visceral disease

7 It will be up to the patient to decide

8 They work by different mechanisms so patients will ultimately see both drugs most of the time

9 Seems like it would be better tolerated

10 Would like to maximize hormonal tx just like in breast cancer, prior to starting chemo

11 Both Zytiga and Xtandi has shown efficacy

12 Prefer oral medications whenever possible.

13 Patients prefer pills to chemo

14 I considered and still consider to use either Zytiga or Xtandi. We (oncologists) in this case I always use another hormonal agent after first line hormonal failure

15 Would need data showing that one can do it.

16 Don’t think it’s different

17 I prefer to keep chemo last.

18 Toxicity issue

19 If a patient has no response or short response to Zytiga or Xtandi , I would want a proven survival benefit with chemotherapy to give to appropriate patients

20 It depends on rapidity or aggressiveness of disease

21 Options available come handy to treat

22 Want to delay chemo as long as possible

23 It depends on PS

24 Other chemotherapy has demonstrated some efficacy on progressed tumors. The alternate agent can be considered in the future with additional trial results proving their superior efficacy.

25 Better side effect profile

26 More tolerable

27 Would be able to manage patients myself this way as opposed to referral to Med Onc.

28 No data yet to help guide this situation - unable to answer

29 If patients fail Zytiga or Xtandi, they will have better disease free survival if they are started on chemotherapy

30 Might not need oncology right away

31 Too many medications with toxicity, I don't want to use it unless approved and am comfortable with.

32 I may add hi dose ketoconazole, avodart and consider chemotherapy

24


33 Better other before chemo

34 Less toxicity

35 Have seen benefits from chemo

36 I believe these oral agents are preferable to chemo from convenience and toxicity standpoint. Cost remains a significant concern.

37 In conjunction with med onc, would prefer to delay chemo rx as long as possible

38 Less side effects

39 Will use Zytiga, more affordable, better reduction in PSA

40 Yes I believe hormonal manipulation early handsome benefits

41 I understand that some of these agents are/were not approved before first line chemo in prostate cancer patients. I like to use these agents wherever the indications are.

42 Chemo better.

43 Less toxic side effects and better tolerability and compliance

44 NCCN guidelines before change

45 Consider other options

46 Limit chemotherapy toxicity, ease of administration

47 Depends on the patient, a shift to chemotherapy happens very rarely (less than 1%) but can happen. Otherwise, would rather the alternate agent.

48 Zytiga is much well tolerated than chemo and easier to administer

49 Less toxic. Treatment in my hands, rather than oncologist

50 Continue to monitor the patient.

Question 10: How has your usage of Provenge changed with the Zytiga pre-chemo approval and the Xtandi post-chemo

approval?

1 I have used it less because of more options.

2 Slightly less use as Zytiga easier to arrange

3 Have had problems with steroid use with abiraterone

4 Using it less

5 Not much as I still use Provenge

6 About the same

7 I reduced the use of Provenge

8 Still use Provenge for minimally symptomatic patients

9 No

10 Decreased use of Provenge

11 It has not changed significantly so far.

12 It has not changed, since I do not use it.

13 Don’t use Provenge

14 No change

15 Much deceased

16 No real rationale, just practice patterns.

17 I have been using less and less of Provenge with Zytiga approval. I do use it in biochemical failure prostate cancer with minimal bone disease or no appreciable metastatic disease in selected group of patients.

18 None

19 No change, the indications are separate

20 No change

21 Decreased

22 No, will still use Provenge first

23 Didn't change

24 No.

25 Don't use Provenge.

26 Less

27 Provenge use down.

28 No change - I believe Provenge should be used in many patients before Xtandi and Zytiga

29 Use of Provenge has remained constant since more men being treated with one of three therapies, where in past chemotherapy was only option

30 No

25


31 I have not used Provenge yet.

32 Decrease use of Provenge since Zytiga is oral

33 No I use Provenge first

34 No. It remains foundational therapy

35 I will not go up due to cost of Zytiga

36 I don't use much Provenge although our cancer center is a recently approved site. Our patients still have to travel a considerable distance for the apheresis. I believe it still has a role in managing CRPC but will probably use more now for those patients who have failed Zytiga/Xtandi and prior to chemo.

37 Decreased

38 Stopped

39 Yes, use Provenge first, and then Zytiga, only Xtandi if patient can pay out of pocket

40 Not much do not believe in usefulness

41 Yes

42 It hasn't.

43 Decrease use of Provenge

44 Earlier use of Zytiga

45 Decrease

46 No change. Do not use

48 Less Provenge use. Provenge is labor intensive to utilize

49 Diminished. Much less complicated with Zytiga

50 It has stayed relatively the same.

19 I have used it less because of more options.

20 Slightly less use as Zytiga easier to arrange

21 Have had problems with steroid use with abiraterone

22 Using it less

23 Not much as I still use Provenge

24 About the same

25 I reduced the use of Provenge

26 Still use Provenge for minimally symptomatic patients

Question 11: Will your usage of Provenge change as a result of the approval of Xtandi in pre-chemo patients (which does not

require co-administration of prednisone)? Please explain:

1 Yes, similar to reason above.

2 Not sure but possibly

3 Will use with Xtandi

4 Will increase AFTER maximal endocrine therapy

5 No

6 No

7 It is already minimal. If the patient requests Provenge it will be fine.

8 No will use in low symptom patient

9 No

10 Decreased use of Provenge

11 It has not changed so far.

12 No.

13 Don’t use Provenge

14 No change

15 Yes, decrease

16 No will not

17 No. I am using Provenge only in a selected group of patients

18 Less use

19 No change, the indications are separate

20 No change

21 Yes, decreased further

22 No, will still use Provenge first in all appropriate patients

23 No

26


24 No

25 No

26 Moderately.

27 Probably remain the same. Zytiga already approved pre chemo.

28 No change - I believe Provenge should be used in many patients before Xtandi and Zytiga

29 Use of Provenge to remain same as more men now being treated for CRPC. Not needing prednisone is nice but not significant enough to influence therapies.

30 Possibly less

31 I haven’t used Provenge yet

32 Same

33 Yes more use if bo prednisone

34 No. It remains foundational therapy

35 No. Prefer Zytiga

36 See above answer. Will use Xtandi more after developing castrate resistance, especially since don't need prednisone, prior to using Provenge or chemo. Would also delay referral to Med Onc if using Xtandi first.

37 Yes it will decrease because these pts have better performance status earlier in the disease stage and they would have been candidate for Provenge but will now likely try Xtandi first

38 Limit it

39 Yes, will use Xtandi, definitely a benefit not to have to use prednisone

40 No still not using it much

41 It will go down

42 It will not.

43 May decrease

44 No

45 Yes

46 No. Do not use

47 Yes better tolerance

48 Less Provenge use for same reasons above

49 Yes. Provenge is more complicated to my practice routine.

50 It may. I will have to wait for more data before changing usage of Provenge

19 Yes, similar to reason above.

20 Not sure but possibly

21 Will use with Xtandi

22 Will increase AFTER maximal endocrine therapy

23 No

24 No

25 It is already minimal. If the patient requests Provenge it will be fine.

26 No will use in low symptom patient

27



Disclosures AppendixAnalyst CertificationI, Howard Liang, Ph.D., certify that the views expressed in this report accurately reflect my views and that no part ofmy compensation was, is, or will be directly related to the specific recommendation or views contained in this report.

28


29


Distribution of Ratings/Investment Banking Services (IB) as of 03/31/13IB Serv./Past 12

Mos.Rating Count Percent Count PercentBUY [OP] 107 61.14 32 29.91HOLD [MP] 68 38.86 0 0.00SELL [UP] 0 0.00 0 0.00

Explanation of RatingsOutperform (Buy): We expect this stock to outperform its benchmark over the next 12 months.

Market Perform (Hold/Neutral): We expect this stock to perform in line with its benchmark over the next 12months.

Underperform (Sell): We expect this stock to underperform its benchmark over the next 12 months.The degreeof outperformance or underperformance required to warrant an Outperform or an Underperform rating shouldbe commensurate with the risk profile of the company.

For the purposes of these definitions the relevant benchmark will be the S&P 600® Health Care Index forissuers with a market capitalization of less than $2 billion and the S&P 500® Health Care Index for issuers witha market capitalization over $2 billion.

From October 1, 2006 through January 8, 2009, the relevant benchmarks for the above definitions were theRussell 2000® Health Care Index for issuers with a market capitalization of less than $2 billion and the S&P500® Health Care Index for issuers with a market capitalization over $2 billion.

Definitions of Leerink Swann Ratings prior to October 1, 2006 are shown below:

Outperform (Buy): We expect this stock to outperform its benchmark by more than 10 percentage points overthe next 12 months.

Market Perform (Hold/Neutral): We expect this stock to perform within a range of plus or minus 10 percentagepoints of its benchmark over the next 12 months.

Underperform (Sell): We expect this stock to underperform its benchmark by more than 10 percentage pointsover the next 12 months.

For the purposes of these definitions, the relevant benchmark were the Russell 2000® Health Care Index forissuers with a market capitalization of less than $2 billion and the S&P 500® Index for issuers with a marketcapitalization over $2 billion.

30


Important DisclosuresThis information (including, but not limited to, prices, quotes and statistics) has been obtained from sourcesthat we believe reliable, but we do not represent that it is accurate or complete and it should not be relied uponas such. All information is subject to change without notice. This is provided for information purposes onlyand should not be regarded as an offer to sell or as a solicitation of an offer to buy any product to which thisinformation relates. The Firm, its officers, directors, employees, proprietary accounts and affiliates may have aposition, long or short, in the securities referred to in this report, and/or other related securities, and from timeto time may increase or decrease the position or express a view that is contrary to that contained in this report.The Firm's salespeople, traders and other professionals may provide oral or written market commentary ortrading strategies that are contrary to opinions expressed in this report. The Firm's asset management groupand proprietary accounts may make investment decisions that are inconsistent with the opinions expressed inthis report. The past performance of securities does not guarantee or predict future performance. Transactionstrategies described herein may not be suitable for all investors. Additional information is available uponrequest by contacting the Publishing Department at One Federal Street, 37th Floor, Boston, MA 02110.

Like all Firm employees, analysts receive compensation that is impacted by, among other factors, overallfirm profitability, which includes revenues from, among other business units, the Private Client Division,Institutional Equities, and Investment Banking. Analysts, however, are not compensated for a specificinvestment banking services transaction.

Leerink Swann Consulting LLC, an affiliate of Leerink Swann LLC, is a provider of evidence-based strategyand consulting to the healthcare industry.Leerink Swann LLC makes a market in Dendreon Corporation and Medivation, Inc.Leerink Swann LLC is willing to sell to, or buy from, clients the common stock of Johnson & Johnson on aprincipal basis.In the past 12 months, an affiliate of the Firm, Leerink Swann Consulting LLC, has received compensation forproviding non-securities services to: Johnson & Johnson.

©2013 Leerink Swann LLC. All rights reserved. This document may not be reproduced or circulated withoutour written authority.

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Leerink Swann LLC Equity Research

Director of Equity Research John L. Sullivan, CFA (617) 918-4875 [email protected]

Associate Director of Research Alice C. Avanian, CFA (617) 918-4544 [email protected] Healthcare Strategy John L. Sullivan, CFA (617) 918-4875 [email protected]

Alice C. Avanian, CFA (617) 918-4544 [email protected]

Biotechnology Howard Liang, Ph.D. (617) 918-4857 [email protected]

Joseph P. Schwartz (617) 918-4575 [email protected]

Marko Kozul, M.D. (415) 905-7221 [email protected]

Michael Schmidt, Ph.D. (617) 918-4588 [email protected]

Irene Lau (415) 905-7256 [email protected]

Rene Shen (212) 277-6074 [email protected]

Gena Wang, Ph.D. (212) 277-6073 [email protected] Life Science Tools Dan Leonard (212) 277-6116 [email protected]

and Diagnostics John L. Sullivan, CFA (617) 918-4875 [email protected]

Justin Bowers, CFA (212) 277-6066 [email protected]

Pharmaceuticals/Major Seamus Fernandez (617) 918-4011 [email protected]

Swati Kumar (617) 918-4576 [email protected]

Specialty Pharmaceuticals,

Generics

Jason M. Gerberry, JD

Christopher W. Kuehnle, JD

(617) 918-4549

(617) 918-4851

[email protected]

[email protected] Medical Devices, Cardiology & Danielle Antalffy (212) 277-6044 [email protected] Orthopedics Richard Newitter (212) 277-6088 [email protected]

Robert Marcus, CFA (212) 277-6084 [email protected]

Healthcare Technology David Larsen, CFA (617) 918-4502 [email protected] & Distribution Christopher Abbott (617) 918-4010 [email protected]

Sr. Editor/Supervisory Analyst Mary Ellen Eagan, CFA (617) 918-4837 [email protected]

Supervisory Analysts Robert Egan [email protected]

Amy N. Sonne [email protected]

Research Assistant Paul Matteis (617) 918-4585 [email protected]

New York 1251 Avenue of Americas, 22nd Floor New York, NY 10020 (888) 347-2342

BostonOne Federal Street, 37th Floor

Boston, MA 02110 (800) 808-7525

San Francisco 201 Spear Street, 16th Floor

San Francisco, CA 94105 (800) 778-1164

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