Ozlem Tureci
Analyst · Cory Kasimov from JP Morgan. Please ask your question
Thank you, Ugur. In the interest of time, I'm going to focus my remarks to the four programs highlighted on Slide 9. These include BNT111, our FixVac melanoma; BNT122, our iNeST program; BNT311, our anti-PD-L1/anti-4-1BB antibody; and BNT411, our TLR7 agonist. For further details on the status of other programs, please refer to our full quarterly update which was released this morning. So let's start on Slide 10 with BNT111, our melanoma FixVac program. As a reminder, BNT111 is composed of four non-mutated melanoma antigens: NY-ESO-1; MAGE-A3; tyrosinase; and a novel antigen from our own libraries, TPTE. In July, we published interim Phase 1 data in nature from our ongoing Lipo-MERIT trial. The Lipo-MERIT trial is a multicenter open-label dose-escalation study to evaluate safety and tolerability of vaccinated patients with stage 3B-C and stage IV melanoma. Efficacy was evaluated in a subset of 42 checkpoint inhibitor experienced patients with a data cutoff in July 2019. As I reported earlier, at the data extraction date, three patients out of 25 in the FixVac monotherapy group experienced a partial response, seven patients showed stable disease, and one patient showed a complete metabolic remission of metastatic lesion. Of the 17 patients treated with the combination of FixVac, of BNT111, and an anti-PD-1, six patients showed a partial response. Of note, at our target dose for the Phase 2 trial of 100 micrograms, we observed that five of 10 patients had a partial response to FixVac in combination with anti-PD-1 therapy. The publication in nature summarized on Slide 11 highlighted extensive biomarker and immunological data. This supports the mechanism of action and the observed clinical activity of FixVac alone and in combination with anti-PD-1. Importantly, treatment with BNT111 resulted in the expansion and activation of circulating tumor antigen-specific T cells with memory function that exhibited strong cytotoxic activity against tumor cells. These vaccine-induced T cells displayed a Th1 phenotype. In 20 patients tested by post-IVS interferon-gamma ELISpot, all showed immune response against at least one of the used tumor-associated antigens. Most patients demonstrated CD4 or concurrent CD4 and CD8 T cell responses. In 50 patients tested by ex-vivo interferon-gamma ELISpot, which only captures high-magnitude responses, more than 75% of patients showed immune responses against at least one tumor-associated antigen, most of which were high-magnitude CD8-positive T cells. T cells ramped up within four to eight weeks to single-digit or low double-digit percentages of total circulating CD8-positive T cells. Under monthly maintenance treatment, the levels of T cells continued to slowly increase or remain stable up to over one year. Safety was assessed in 89 patients. Overall, FixVac treatment was well tolerated with no dose-limiting toxicity observed. Most common adverse events were mild to moderate transient flu-like symptoms, such as pyrexia and chills. As Ugur mentioned earlier, we recently announced a strategic collaboration with Regeneron and plan to pursue an accelerated development program for the combination of FixVac and Regeneron's anti-PD-1 agent, Libtayo, in the second-line treatment setting for advanced melanoma patients that have progressed after prior PD-1 blockade. Under the terms of agreement, we and Regeneron have agreed to share development costs equally. If approved, each party will retain full commercial rights for their respective product and would record revenues related to its own product. We plan to initiate a randomized Phase 2 trial in the fourth quarter of 2020 and expect to provide more details on the study in the third-quarter 2020. Now, moving to Slide 12 to BNT122, our individualized neoantigen-specific immunotherapy, or iNeST, platform program, which is partnered with Roche/Genentech. A data update for the Phase 1a monotherapy and 1b combination with Tecentriq basket trials in multiple solid tumors was reported in June as part of our AACR virtual annual meeting, too. This is the first time that we have shown safety and immunogenicity data across different tumor types outside of melanoma. The patient populations in these cohorts were heavily pretreated, many with refractory and recurrent disease with a high proportion of low PD-L1 expresser. Treatment with BNT122 alone and in combination with Tecentriq was well tolerated, with the majority of adverse events being Grade 1 or Grade 2, and there were no dose-limiting toxicities. In the majority of patients treated with BNT122 alone and in combination with Tecentriq, ex-vivo T cell responses against multiple neoantigens were detected. We also detected BNT122-induced T cells in infiltrates of patient's tumors. In the Phase 1a monotherapy portion of the trial, 26 patients underwent at least one tumor assessment. One patient assessed with gastric cancer and metastatic liver lesions had a durable complete response and remains on study after one and a half years, and the rest patients had stable disease. In the Phase 1b combination portion of the trial, in 108 patients that underwent at least one tumor assessment, one patient had a complete response, eight patients had partial responses, and 53 patients had stable disease. We continue to believe that iNeST is well suited to earlier lines of therapy across a range of solid tumors. We have depicted our ongoing Phase 2 trial in first-line melanoma and our planned adjuvant clinical trial for iNeST on Slide 13. We expect to provide an enrollment update from the randomized Phase 2 trial of BNT122 plus pembrolizumab in first-line melanoma in the second half of 2020, and an interim data update is anticipated in the second half of 2021. We are going to start two Phase 2 studies in the adjuvant setting. One is in an IO-sensitive cancer type, namely evaluating the efficacy and safety of iNeST plus Tecentriq, compared with Tecentriq alone, in patients with early and adjuvant stage non-small cell lung cancer. The second study is in an IO-insensitive cancer type, namely a multisite open-label Phase 2 randomized trial to compare the efficacy of iNeST versus watchful waiting in patients with circulating tumor DNA-positive Stage 2 high-risk and Stage 3 colon cancer. Now, moving to Slide 14, to the two DuoBody programs we have partnered with Genentech. On Slide 15, you see one of them, BNT311, the anti-PD-L1/anti-4-1BB bispecific antibody that combine constitutive TPI blockade and conditional costimulatory activity, a mechanism of action which led to enhanced proliferation of antigen-specific activated T cells in the presence of PD-L1 positive cells in preclinical studies. Based on the preclinical data we have generated, we believe this molecule could represent a powerful new checkpoint immune modulator with seropositive potential across a range of solid tumors. We expect to provide the first human data in the second half of 2020. This update will include dose-escalation data from the Phase 1/2 trial in multiple solid tumors. We believe it has broad potential in a range of target tumors, including those where checkpoint therapy is currently established but also in more difficult tumors where first-generation checkpoint inhibitors have not been as successful. Finally, now turning to Slide 16, we recently initiated clinical testing for BNT411 from our toll-like receptor binding program. This molecule is engineered for high potency and has high selectivity for the TLR7 receptor at the sero particularly active dose range. We expect the molecule to activate both the adaptive and innate immune system, in particular, in combination with cytotoxic therapies and checkpoint inhibitors. Preclinical studies suggest a type 1 interferon-dominated release of cytokines and chemokines and potent stimulation of antigen-specific CD8 T cells, but also B cells details, and innate immune cells, such as NK cells and macrophages. In early July 2020, the first patient was dosed in the Phase 1/2a first-in-human open-label dose-escalation trial with expansion cohorts to evaluate the safety, pharmacokinetics, pharmacodynamics, and preliminary efficacy. BNT411 will be posted as the monotherapy in patients with solid tumors; and in combination with Tecentriq, carboplatin, and etoposide in patients with chemotherapy-naive, extensive-stage small-cell lung cancer. Now, these were the highlights from our oncology programs. I'll now provide an update on our COVID-19 vaccine program. Now, moving to Slide 18, which recaps how far we have come in the race to develop a COVID-19 vaccine. We began work on multiple vaccine candidates in late January following use of the coronavirus outbreak in China. Approximately six months later, we initiated a pivotal Phase 2b/3 trial aimed at supporting an approval of our vaccine in the U.S. Our goal with Pfizer is to be in a position to file for approval or emergency authorization from the FDA as early as the fourth quarter of 2020 if the trial hits our enrollment targets and is deemed to be successful. I will come back to Phase 2b/3 trial design in a few minutes. On Slide 19, you see the four-vaccine variance we have taken into clinical testing. These variants vary based on the type of mRNA construct used and the antigen target. Two of the variance target for RBD domain; and the other two, the full-length spike protein. Both our B1 and B2 candidates have received FDA fast track status. In late July, we, along with Pfizer, selected BNT162b2 as our lead candidate for the Phase 2b/3 trial. BNT162b2 encodes for a modified version of a full spike protein and utilizes our nucleoside-modified RNA construct. The decision to advance the BNT162b2 was made after an extensive review of the preclinical and available clinical data and in consultation with the FDA. For the Phase 2b/3 trial, the 30-microgram dose level in a two-dose regimen was chosen. Now moving to Slide 20. BNT162b2 vaccinated participants displayed a favorable breadth of epitopes recognized in T cell responses specific to the SARS-CoV-2 antigen. The candidate also demonstrated concurrent induction of both high-magnitude CD4 and CD8 T cell responses. These T cell responses were observed against both the RBD and the remainder of the spike glycoprotein. We believe that immune recognition of more spike T cell epitopes may have the potential to generate more consistent responses across diverse populations and in older adults. Preliminary data for BNT162b2 suggested a favorable reactogenicity profile. Systemic events were generally mild to moderate and transient, lasting one to two days. Events included fever, fatigue, and chills. There has not been any serious adverse events observed in our BNT162 program. Data collection from the Phase 1/2 trial for all four vaccine candidates is continuing. We plan to submit data on BNT162b2 for peer review and potential publication in the next few weeks. We also intend to also post the manuscript on the preprint server at that time. Moving to Slide 21. I'd like to spend a few minutes to outline the design of our ongoing Phase 2b/3 trial. The study is expected to enroll up to 30,000 participants age 18 to 85 years, starting in the U.S. and expanding to include approximately 120 sites globally. The trial regions will include areas with significant anticipated SARS-CoV-2 transmission. The Phase 2b/3 trial is a one-to-one vaccine candidate to placebo, randomized, observer-blinded study to obtain the safety, immune response, and efficacy data needed for regulatory review. The primary endpoint is prevention of COVID-19 in participants without evidence of SARS-CoV-2 infection before vaccination, as well as prevention of COVID-19 in participants regardless of SARS-CoV-2 infection before vaccination. The primary efficacy analysis will be an event-driven analysis based on the number of participants with symptomatic COVID-19 disease. We reduced polymerase chain reaction to confirm infection of SARS-CoV-2 since antibody tests to confirm previous exposure. One of the secondary endpoints includes prevention of severe COVID-19 disease. The trial design allows for interim analysis and unblinded reviews by an independent external data monitoring committee. Assuming clinical success, we, along with Pfizer, may potentially seek regulatory review in Q4 as early as October 2020. With that, I will now hand over to Sean to provide an overview on our commercial update.