Christian Itin
Analyst · Mizuho. Mara, you're up
Thank you, Olivia, and good morning to you all, and thank you for joining us. It's my pleasure to review our progress for the second quarter in 2022. Please move to Slide 4. For those who are new to Autolus and as a refresher for those of you who know us well, we are building a fully integrated CAR T company. Building on our broad platform of cell programming technologies, we're generating CAR T products that are tailored to the specific tumor setting we're addressing. We had a successful quarter with multiple readouts from our clinical programs at the European Hematology Association Congress in Vienna in June, which gives us great confidence in the inherent value of our pipeline and the progress achieved. We continue to enroll patients into the pivotal FELIX trial, where we're investigating obe-cel for the treatment of relapsed/refractory adult acute lymphoblastic leukemia patients. And in April, we obtained a Regenerative Medicine Advanced Therapy or RMAT designation from the FDA. As a consequence, we now have preferred regulatory access for obe-cel in all key territories, the U.S., Europe and the U.K. and have met with the FDA in the context of a Type B meeting to discuss the regulatory pathway going forward. We're on track to enhance the initial results for the FELIX trial in Q4 2022, which will be provided by way of a press release, and we're planning on presenting the full data set at a medical conference in mid-2023, most likely at ASCO.As previously announced, in addition to the primary morphological cohort in the FELIX trial, we have expanded the MRD cohort to enroll up to 50 patients. In clinical practice, patients get evaluated on a regular basis for recurrence of disease, typically using flow analysis or PCR of their bone marrow samples. Indication of minimal residual disease levels of leukemic - leukemia triggers treatment of the patients rather than waiting for full-blown morphological relapse to occur. This additional cohort does not impact our planned filing time lines as the primary data will be based on the data from the morphological cohort. However, we do believe the MRD cohort will broaden the data set across the full range of tumor burden and align with current clinical practice. We remain fully focused on generating the data package needed to file for BLA approval for obe-cel for the treatment of adult patients with acute lymphoblastic leukemia and remain confident in obe-cel's potential to be a best-in-class treatment in a growing market. As I mentioned, EHA was a very busy meeting for us with data readouts from multiple clinical programs, and I'll go into more detail about the specific data later in this presentation. But in summary, obe-cel continues to show what we believe to be best-in-class activity with a high level of sustained complete remissions in B-NHL patients without inducing severe cytokine release syndrome or any neurotoxicity. In addition, we have now seen first activity in primary CNS lymphoma patients. Beyond obe-cel, we have seen first and promising results from the dual targeting AUTO1/22 program in children with acute lymphoblastic leukemia, who are ineligible for chemotherapy. The data presented at EHA, we believe, are demonstrating clinical proof of concept with a high level of activity and a well-manageable safety profile. We're particularly excited about AUTO4 reaching clinical proof of concept in patients with peripheral T cell lymphoma, reaching metabolic CRs while maintaining a well-manageable safety profile. This data validates a novel targeting approach, which is very important, given the high unmet need and difficult to treat patient population. With two new programs reaching clinical proof of concept, our pipeline beyond obe-cel is advancing well, and we're pleased with how it's shaping up. Finally, we're pleased in the quarter to dose our first patient in the Phase 1 study of AUTO8 for the treatment of patients with relapsed refractory multiple myeloma and are also on track for AUTO6 NG, our first solid tumor program to start a Phase 1 in the second half of the year. The build of our commercial manufacturing facility in Stevenage is progressing on track and within schedule, and I'll cover that in more detail later in the presentation. Moving to Slide 5. With that, let's focus on our lead product, obe-cel and move to Slide 6. Just to remind you, obe-cel has a unique mechanism of action built on a highly specific engagement of CD19 coupled with a fast release from CD19 once the kill of the leukemic cell has been initiated. This fastest engagement is based on the fast off-rate of the CAT binder and drives three key properties of obe-cel, reduction of the amitocytokine release per target selling counter, which in turn will reduce the amount of immunotoxicity in the patients, reduced exhaustion in the CAR T cell and improved engraftment and overall persistence of the product. And those of you not familiar, I refer you to a paper by Sara Ghorashian at Nature Medicine in 2020. Moving to Slide 7. There still remains a very high unmet medical need for adult ALL patients with approximately 8,400 new cases diagnosed yearly worldwide in the last-line setting, approximately 3,000 patients of these cases reside in the U.S. and Europe. Whilst combination chemotherapy enables 90% of adult ALL patients to achieve CRS to achieve CRs, complete remissions, only 30% to 40% will achieve long-term remission. Once relapsed patients have a median overall survival of less than a year. Current approved therapies for adult patients of Blincyto and Tecartus and Tecartus is currently approved in the U.S. and has a favorable CHMP opinion in Europe and is expected to be approved in Europe later in the year. Both therapies are highly active, but frequently followed by subsequent treatments typically including ALLO stem cell transplant. Blincyto has a favorable safety profile with few patients experiencing severe cytokine release syndrome and ICANs, power limitations on convenience due to the need for continuous IV infusion during its 4-week treatment cycles. Tecartus is more challenging to manage and induces elevated levels of severe CRS, high level of ICANs and neurotoxicity and require steroids and vasopressors for many patients to manage adverse events. Both therapies have been shown to be highly active. However, most patients progress rapidly and require subsequent allograft to achieve durability. Moving to Slide 8. Building on its unique mechanism of action, obe-cel has shown a high overall response rate with favorable - with a favorable safety profile and sustained event-free survival that tracks long-term persistence in those patients. As mentioned before, obe-cel has been granted orphan drug designation by the FDA and EMA for ALL and obtained prime designation by EMA for the EU, ILAP designation by the MHRA for the U.K., and most recently, RMAT designation by the FDA for the U.S. Moving to Slide 9. Based on what we believe is potentially a transformational data from the ALLCAR study, we are treating patient - we're conducting the pivotal FELIX study trial with approximately 90 patients in the so-called morphological cohort. We're treating currently patients at 34 sites across the U.S., the U.K. and Spain. We're on track with our previous guidance and expect to announce initial results in the fourth quarter this year, which will be in the shape of a press release. We're planning on presenting full data at a medical conference in the first half of 2023, as indicated, currently thinking about ASCO. In order to maximize outcomes from the FELIX trial, in parallel, we've initiated an additional cohort of up to 50 patients in the second related complete remission in second or later complete remission, we have minimal residual disease, so-called MRD-positive patients. However, this additional cohort does not impact our planned filing time lines as the primary data will be based on the data from the morphological cohort. Moving to Slide 10 and switching gears as we move into Slide 11. Obe-cel's unique profile means it could be applicable to a broad range of indications. We're consequently evaluating the product outside of acute lymphoblastic leukemia in B-cell non-Hodgkin's lymphomas in a set of ongoing Phase 1 clinical studies. As I mentioned, we have positive clinical readouts at the recent EHA Congress from Phase 1 studies in B-cell non-Hodgkin's lymphoma and primary CNS lymphoma presented by a way of a poster EHA as well as an oral presentation of the first AUTO1/22 Phase 1 data in pediatric ALL patients at that event, and I'll cover this data in the upcoming slides. Slide 12. As a reminder, the academic ALLCAR19 study has been extended as a basket study where we're testing obe-cel in a variety of B-cell malignancies. To date, we've treated 17 patients with follicular lymphoma, DLBCL and mantle cell lymphoma and no patient experienced high-grade CRS and none had any grade of neurotoxicity. Of the 17 patients dosed, 16 achieved a metabolic complete remission, seven of seven follicular lymphoma patients, six of seven DLBCL patients and three of three mantle cell lymphoma patients. We lost one patient to COVID and one mantle cell lymphoma patient relapsed. 14 of the 16 patients remain in metabolic CR with a median follow-up of 9.2 months, the longest being 19.1 months in follow-up at the last data cut. And obviously, the data will continue to mature and will give us more insights as we go forward. We've also started treating some CLL patients and from the three patients that have reached initial evaluation two went into molecular CR in the bone marrow, but have some residual lymphadenopathy on CT scan. We expect to have follow-up data from this ALLCAR extension study again in the second half of this year. Turning to Slide 13. We're also exploring obe-cel in primary CNS lymphoma in our academic carousel study. This is a type of aggressive B-cell lymphoma, but because of its anatomic location, it has been - it has a particularly poor prognosis. Initial treatment is often intensive and outcomes for these patients tends to be poor. And the data we presented at EHA, we didn't see high-grade cytokine release syndrome, two patients experienced neurotoxicity grade three and grade 4, respectively. One patient improved with steroids and anakinra. The second patient had several neurological deficits consistent with progressive disease and did not respond to steroids and anakinra. Overall, you can see on the right-hand side of this slide, that despite these patients having no disease outside of the CNS and having had lots of rituximab treatment, we still see really nice expansion of obe-cel in peripheral blood, and we expect to provide more data from this study in 2023. Moving to Slide 14. Our initial experience with obe-cel and children achieved a high level of sustained complete remissions while without experiencing high-grade cytokine release syndrome. For those children who relapsed, most had lost CD19 expression on their leukemic cells at the time of relapse. Here, we're taking the next step in obe-cel life cycle with AUTO1/22 a dual-targeting product building obe-cel and adding a highly potent CD22 targeting chimeric antigen receptor. The CD22 CAR was designed to be active against leukemic cells with low levels of CD22 expression on their surface. We evaluated AUTO1/22 and an extension of the CARPALL study in children who were ineligible for Kymriah. The children either relapsed after receiving Kymriah and could not be retreated or they had extramedullary disease, i.e., singular lesions in tissue without having disease in the bone marrow, the normal location of acute leukemia. This is a very challenging group of patients to treat out of 11 children, four had prior Kymriah therapy, and three of them had lost CD19 expression, seven of the children have extramedullary disease. Moving to Slide 15. Data were presented at EHA in an oral presentation and showed that 9 of the 11 patients achieved a molecular CR on day 28. AUTO1/22 was well manageable with no patients experienced high-grade cytokine release syndrome. No patient relapse with antigen loss and two of the CD19 negative patients achieved a molecular complete remission, demonstrating the isolated activity of the CD22 CAR. We will continue to follow the patients and we'll update you later in the year. Moving to Slide 17. Here is a brief depiction of our broad cell programming toolkit we developed over the last few years. All in, the technologies cover programming modules for targeting, control, shielding and enhancing CAR T cell activity. More than 100 patent families cover our product and sell programming technologies. Recent illustrations of three technology applications were shown at ASGCT Annual Meeting in May. Each one of our product candidate applies one or several of the technologies to maximize its impact on the specific cancer it is designed to tackle. Moving to Slide 18. This slide shows more of our next-generation programs beyond obe-cel. A program, we're excited about is AUTO4, which is in Phase 1 study in T-cell lymphoma, and I'll give you an update of the data we presented at EHA in just a minute. During the first quarter, as I mentioned, AUTO8 moved into the clinic in a Phase 1 clinical study in multiple myeloma patients and were now dosing patients. I also want to reiterate our first solid tumor program, AUTO6NG and GD2-positive solid tumors will be moving into the clinic second half of this year. This program has a clinically de-risked chimeric antigen receptor to GD2 and contains multiple programming modules to enhance its activity. Turning to Slide 19. We're actively exploring T-cell lymphoma, which is an aggressive disease with a very poor prognosis for patients. You might recall our EHA analyst call by Dr. Horwitz from the Department of Medicine Lymphoma Service at Memorial Sloan Kettering Cancer Center, talked about the majority of patients being either refractory or relapsing after initial treatment. Standard of care is variable and often based on intensive chemotherapy treatment. Median survival for patients with relapsed or refractory disease is less than six months. T-cell lymphomas are clonal diseases that either express TRBC1 or TRBC2. The T cell receptor beta chain constant domain one or two or short TRBC1 or TRBC2 are expressed on more than 95% of all T-cell lymphoma subtypes. Only lymphomas derived from gamma-delta T cells or NK T cells lack TRBC1 or TRBC2. AUTO4 targets TRBC1 and it is the first product candidate to do so using next-generation sequencing, we identify patients with TRBC1-expressing T-cell lymphoma. These TRBC1-positive patients are then treated on the currently open AUTO4 study. And in the future, we plan to open a study targeting TRBC2-positive patients with AUTO5 as well. AUTO4 is designed to selectively kill lymphoma cells in a manner that we believe will preserve a portion of the patient's normal healthy T cells to maintain immunity. Turning to Slide 20. To date, we've treated 10 patients with increasing doses of AUTO4 in the so-called LibrA T1 study. We evaluated four dose levels ranging from 25 million cells to 450 million cells and have seen no dose-limiting toxicities and only mylotytopenias. In terms of cytokine release syndrome, which just saw 1 grade three cytokine release syndrome at the highest dose level, so the four was generally very well tolerated. We've seen metabolic complete remissions in five of the seven evaluable patients with three of three patients at 450 million cell dose achieving a metabolic CR. Two of the complete remissions at 450 million cell level are ongoing at three and six months, and we expect to have longer follow-up on these patients in the second half of this year. Moving to Slide 22. The manufacturing of cell therapies is complex and requires a great deal of skill and experience. We're building a new manufacturing facility in Stevenage in the U.K. This location is about a mile from our current clinical manufacturing operations at the so-called CGT facility and will allow us to transition our entire operation, including our experienced staff to the new facility in an expedition and efficient way, both minimizing start-up risks and costs for the commercial supply. As evidenced by our successful manufacturing of CAR T products for the pivotal study with centers across the U.S. and Europe, the location is well suited for global supply with easy access to several international airports, including London Heathrow. The new 70,000 square foot facility will provide all of us with a capacity of approximately 2,000 cell therapy batches a year with the ability to expand further when needed. You can see on this slide a rendering of what the facility will look like once completed by the end of the year. We're on track to commence GMP operations in mid-2023. For our clinical supply operations, we currently operate with four shifts seven days a week, our commercial manufacturing model will continue the 7-day a week pattern for the 365 days a year. With that, we're moving to Slide 24, and I'd like to pass over to Lucinda for our second quarter 2022 financial update. Lucinda?