3 All-or-Nothing Biotech Stocks We're Closely Watching

By Markets Fool.com

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Every small-cap biotechnology investor knows the industry is prone to binary events. Whether it's receiving updates from an important clinical trial or hearing from regulators about an approval decision, some biotech stocks can face all-or-nothing moments that can either send the stock soaring or cause it to crash.

Knowing that, we asked three of our Motley Fool contributors to highlight a biotech stock that will be facing a binary event in the not-to-distant future that they think is worth keeping an eye on. Read below to see if any of the companies they highlighted look worthy of your (speculative!) investment dollar.

Todd Campbell:Neratinib is being developed byPuma Biotechnology for use in breast cancer patients with a specific genetic makeup that have undergone prior treatment.

Recently, Puma Biotechnology's managementpresentedclinical trial data for theuse of neratinib in the extended adjuvant setting. After breast cancer surgery, patients received standard of care, including one year of Herceptin,and then they wererandomized to either receive neratinib or placebo. At year three, disease-free survival was about 2% to 3% better in the neratinib arm than it was in the placebo arm of the study.

However, roughly 40% of neratinibpatients suffered from grade 3diarrhea, and that raisesdoubt thatpatients would stick with neratinib therapy ifthe drug passesmuster with the FDA.

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To address thatconcern, Puma Biotechnology is studying the use of Imodium alongside neratinib, and interim datareported in December shows that Imodium co-therapy reduced the rate of grade 3diarrhea tobelow 20%.

Puma Biotechnology expects to file forFDAapproval of neratinib this year, and that filing will include efficacy data and Imodium safety data, when it's available.

Overall, given thatthe improvement in efficacy offered by neratinib is arguably small, the Imodium trial is stillongoing, and the market opportunity in breast cancer is conceivably north of $1 billion annually, Puma Biotechnology is one all-or-nothing biotech company I'm watching like a hawk in2016.

Brian Feroldi:One all-or-nothing biotech stock I have my eye on right now is Acadia Pharmaceuticals , a company that focuses on diseases of the central nervous system. Acadia's future is currently almost entirely dependent on Nuplazid, its lead compound that is currently pending regulatory approval as a treatment option for Parkinson's Disease Psychosis, or PDP.

In phase 3 clinical trials, Nuplazid helped patients with PDP better control the symptoms of their diseases when compared to placebo. Nuplazid also helped to improve patients' sleep cycles, and it reduced the burden of care placed on their caregivers -- all while demonstrating placebo-like safety.

Currently there are no approved drugs on the market today that treat PDP, so the FDA has designatedNuplazid as breakthrough therapy and given the drug priority review. The FDA has set a target PDUFA decision date of May 1st, but an advisory committee meeting to discuss the drug has been scheduled for March 29th. The outcome of that meeting should give investors a good idea of which way the agency is leaning.

Acadia Pharmaceuticals' stock isn't for the faint of heart -- nearly all of its market value is riding on the success of Nuplazid. If the FDA gives the drug the green light, it's likely Acadia's stock will soar, but if the FDA decides to reject the drug, the company's stock will be crushed.

Sean Williams: It pretty much doesn't get more "all-or-nothing" than Geron , a small-cap drug developer that has just one drug (albeit a promising one) in its pipeline.

Imetelstat is a cancer drug being studied as a treatment for myelofibrosis (a rare cancerous disease of the bone marrow that leads to scarring and an inability to produce normal blood cells) as well as myelodysplastic syndromes and essential thrombocythemia.

What makes Geron's drug so intriguing, and what caught the attention of Johnson & Johnson , which subsequently partnered with Geron, is its success in treating myelofibrosis.

Right now, there's just one drug approved by the Food and Drug Administration for myelofibrosis patients:Incyte's Jakafi. Jakafi is a JAK inhibitor that works by alleviating symptoms associated with myelofibrosis, such as an enlarged spleen or anemia. Incyte has ridden this approval to $601 million in total sales in 2015. But, in terms of efficacy, Jakafi does nothing to slow or reverse myelofibrosis. In phase 1 clinical trials, we did witness partial and complete responses in myelofibrosis patients taking imetelstat. This was something the medical community had never before seen, and it's a direct threat to Incyte's revenue stream.

The downside? Imetelstat was at one time on clinical hold because of liver function test abnormalities in some patients. This hold was eventually removed by the FDA, but there are still lingering concerns about the drug's long-term safety.

Also, the fact that Geron has just one product in development makes it inherently risky. Johnson & Johnson's $35 million upfront payment does help pad Geron's pockets for now, and the company could earn another $900 million in development, regulatory, and sales-based milestones. However, the fact that losses will continue for the near term is something investors should come to terms with. Additionally, if imetelstat doesn't gain approval, Geron has nothing to fall back on save for its remaining cash.

If imetelstat succeeds in gaining FDA approval, it could very well become a blockbuster drug. The big question is whether or not you believe its results and safety record would pass muster with the FDA.

The article 3 All-or-Nothing Biotech Stocks We're Closely Watching originally appeared on Fool.com.

Brian Feroldi has no position in any stocks mentioned. Sean Williams has no position in any stocks mentioned. Todd Campbell has no position in any stocks mentioned. The Motley Fool recommends Johnson & Johnson. Try any of our Foolish newsletter services free for 30 days. We Fools may not all hold the same opinions, but we all believe that considering a diverse range of insights makes us better investors. The Motley Fool has a disclosure policy.