Tom Davis
Analyst · Guggenheim Securities. Your line is open
Thanks, Anthony. First, I want to echo Anthony's comments regarding ACT IV. The study was a major undertaking, especially in a subset population within an orphan disease. To execute study of this size and scope with the level of quality that is built into it is impressive. We believe this accomplishment is a reflection of the positive view physicians have about rindo, both from a safety and potential efficacy perspective. The ACT IV study was designed to confirm our experience with Rintega in three prior Phase 2 studies. In those non-randomized studies, we identified a clinically significant survival benefit, including long-term survival of up to six months in patients with minimal residual disease or small tumor burden after surgery. That said, we have sized the ACT IV to detect a more modest, but still clinically meaningful survival benefit, reflecting approximately three months. We are confident that given the scope and scientific rigor applied to ACT IV, that we have positioned Rintega as best we can for success in this study. In total as you outlined in Slide 7, 745 patients were enrolled in to ACT IV to ensure reaching the required 374 patients with minimal residual disease as assessed by central review. These 374 patients with minimal residual disease are the 374 patient population needed for the primary assessment of overall survival. All patients, including patients with disease that exceeded this threshold will be included in a secondary analysis of overall survival, as well as analysis of progression free survival, safety and tolerability and quality of life. Our recent experience with patients with bulky disease in the ReACT study give us great confidence in with potential might for an effect in this broader group of patients with more expensive tumor burden. As per data readouts for ACT IV, this survival study is event-driven and will be able to more accurately predict the timing for final data readout as we accrue events through interim analyses at 50% and 75%. These interim analyses will be reviewed by an independent data monitoring committee and are in place to assess the safety and potential futility or success of the study. They will result in the communication of go, no-go decisions to the company based on predetermined hurdles. They will not provide us with interim data readouts, but their timing will certainly help us better assess when we can expect final data. Right now, we continue to estimate that the first interim will occur somewhere in mid-2015. The hurdle is extremely high for early stoppage for success of 50% events. As we have said in the past, the most likely scenario is that the study continues. Again, we will certainly communicate the outcome of these assessments as they occur. Now onto Slide 8, where we provide the data from ReACT, a Phase 2 study of patients with relapsed recurrent EGFRvIII-positive glioblastoma. As Anthony mentioned, the most compelling feature of these data are the overall complementary nature, where all endpoints support Rintega's activity. In the bev-naive patients, we presented randomized data showing us statistically significant PFS6 benefits by investigator read 27% versus 11% in the control arm with the value P-value 0.48. Again, this study was designed to take PFS6 difference with a one-sided alpha of 0.2, so we are meeting our higher hurdle here been written into the study. Further, on Slide 9, our clear benefit was also seen in overall survival with early and consistent separation of the curves, a median difference of 12 months versus 8.8 months with a hazard ratio of 0.47 and a P value of 0.02. Our investigator share the belief that a 3.2 month difference at the median is meaningful to patients and their families while the tail even more important, especially V3 patients, where long-term survival is rarely seen. I want to point out that there are patients on the curve in both arms, patients without regression. Those patients are noted by arrows. They are most likely to improve the data as the average survival after progression is approximately three to four months in this population. There are far more patients without regression in the study treatment arm than controlled arm, so it is likely that these curves will only improve. On Slide 10, the higher percentage of confirmed responses, 24% versus 17%, all responses 38% versus 30% and ability to taper off steroids for two months or more, 50% versus 11%, all support Rintega treatment effect. Slide 11 correlates to biology with an association between rapid robust immune response and better survival with the within the Rintega-treated patients. As Anthony introduced, Rintega induces a remarkable EGFRv3 directed immune response in most patients and these data support the development of this immune response is important in the treatment effect. We are continuing to dissect the important elements of this new response and how it relates to clinical outcome. The bev-refractory data are also supportive when compared with historical data. At a minimum seeing several objective responses in the event-stage patients, responses that could only be due to rindo therapy gives us greater confidence in the activity of the vaccine. As we said on the call, it is now the results in bev-naïve patients were not yet final in November since we presented these interim data in November, we have taken the following steps. First, we have been in initial and formal discussions with the FDA, which led to our decision to apply for Breakthrough designation. We believe the FDA's decision to grant this designation underscores Rintega's therapeutic potential for patients with glioblastoma and speaks to the potential clinical relevance of this particular subset. We have been very candid about the fact that bevacizumab naïve group within ReACT was not designed to be an approval study, but given the dearth of treatment options for patients facing this disease and a statistically significant survival benefit the study demonstrated at the interim, with the urging of our investigators, we feel that we have an obligation to patients to formally discuss the final data set with the regulators assuming that it remains consistent. To this end, we have arranged for a full expert read for the primary PFS6 standpoint and we believe we will have a final data set by mid-year, including mature overall survival. It is our intention to present the data is peer-reviewed medical meeting in the same timeframe. Likewise, assuming the data remain consistent, we would as previously guided anticipate having conversations with the FDA and EMA in a similar timeframe. These discussions can take time and are usually not completed in a single meeting. We will communicate the outcome of this process when it comes to a conclusion. The bottom-line is, as Dr. Reardon said when we announced the results at SNO, if final data consistent with the results presented to-date it would offer new hope for physicians treating glioblastoma patients and their families. Given the clinical need here, we are going to going to thoughtfully move through this process to best position the final data set for success. With that, let me move on to glembatumumab or glemba on Slide 12. First METRIC study, Phase 2 randomized study of glemba in patients with metastatic triple negative breast cancers that over express gpNMB, which represents about 40% of the triple negative patient population. In November 2014, we announced that we were implementing a protocol amendment for a few key reason, namely to align the study with an evolving clinical practice to allow us to pursue full approval in Europe and to improve enrollment. Since this time, the FDA in central European regulatory authorities have reviewed the revised protocol design and we continue to believe the METRIC study could support marketing approval in both, the U.S. and Europe with positive data. Today, 95 sites are opened to enrollment across the United States, Canada and Australia and we plan to expand the study into European Union later this year. Many of our existing sites with protocol amendment through their IRBs in December and January, so we have only a month or two of enrollment under new protocol, but even with this limited data set, I am pleased to report that the patient enrollment is accelerating nicely. We will continue to evaluate enrollments over the next few months, so that we can better predict when we will expect enrollment to complete, but it currently looks likely to complete in approximate the middle of 2016. In the meantime, we have expanded the glemba program overall. In December, we initiated a Phase 2 study of glemba in patients with Stage III or IV, unresectable melanoma. Unlike breast cancer in metastatic melanoma, the vast majority of patients approximately 85% over express gpNMB, given the high expression rates in this study, we will take all-comers and then conduct a retrospective analysis to assess whether or not potential clinical benefit is linked to the degree of gpNMB expression. Early studies in melanoma suggest that this maybe the case, plans the expansion of glemba into other indications are also moving ahead assay optimization and validation for the Phase 2 study in squamous cell lung cancer was completed in late 2014 and the study will start this year. As we previously disclosed, we have also entered into a corporative research and development agreement CRADA with the National Cancer Institute. On two additional studies of glemba with room for further development into other indications, the first studies will be conducted in uveal melanoma and pediatric osteosarcoma. As the NCI initiate these studies, we will update on their progress. Next up for discussion is Varlilumab or varli on Slide 13. Varli is a fully human monoclonal antibody that targets CD-27. In November, we presented Phase 1 data from the completed solid tumor and the B cell malignancy dose escalation cohorts and the solid tumor expansion cohorts at the Society for the Immunotherapy of Cancer Annual Meeting. The study continues to maintain a very favorable safety profile and proof of concept has been observed with strong biological activity and apparent clinical benefits in selected patients We reported in November that the complete response in the patient with Hodgkin lymphoma continued at 18.9 months. To our knowledge that response is still ongoing, more recently, we confirmed to get the partial response in the patient with renal cell carcinoma is not only ongoing 11-plus months but includes further decrease in tumor volume. Finally, our stable disease numbers have been updated since November with 13 patients ranging from 3 to 30.7-plus months. Importantly, these data suggest that these durable responses and stable disease can be maintained in patients long after they have stopped the treatment. For the patients in this range, including the patient out over 30 months are renal cell carcinoma patients and we think this is an interesting area to further explore in clinical trials. At this point, our focus is on clinical trial collaboration with Bristol-Myers Squibb to evaluate the safety, tolerability and preliminary activity of Opdivo combined with varli. The study was initiated in December and is opened to enrollment. Again, while Celldex and BMS is sharing development costs, Celldex is managing the study. We also entered a clinical trial collaboration with Oncothyreon on a combined study of ONT-10, their therapeutic vaccine targeting tumor associated antigen MUC1 and varli in breast and ovarian cancer. This study is run and funded by Oncothyreon and was initiated in November. Multiple efforts are also underway for additional Phase 2 studies of varli and we will provide updates on these studies as they are initiated. These include a Phase 1/2 study of varli and Yervoy in patients with metastatic melanoma, plus CDX-1401 in NY-ESO positive patients. We are very close on this one. A Phase 1/2 of varli plus sunitinib and renal cell carcinoma and a Phase 1/2 study of varli plus B-raf and mek pathway agents, which will be followed sequentially by a checkpoint inhibitor for patients with B-raf mutated metastatic melanoma. Moving onto CDX-1401 on Slide 14, I just mentioned the combo study with Yervoy and varli. As Anthony said earlier, the inclusion of CDX-1401 in this study is based on published data showing an increased response to checkpoint inhibitors if patients had a preexisting immune response to NY-ESO. Also, long-term follow-up for patients who developed NY-ESO immunity went on to subsequent checkpoint inhibitor therapy after completing the Phase 1 study of 1401. These data are based on small ends, but the effect was striking and suggest that the strong immune response generated CDX-1401 may predispose patients to better response to checkpoint blockade. Six of eight patients who received checkpoint inhibitors as next therapy had significant clinical responses after treatment, including four of six patients with melanoma and two of two patients with PDL-1 negative non-small cell lung cancer, so this study should give us very good information across both, Varli and 1401. In addition to the planned Varli Yervoy 1401 combo study, there are two additional studies of CDX-1401 currently ongoing and open to enrollment, and NCI-sponsored Phase 2 study of CDX-1401 and CDX-301 two of our pipeline agents in patients with metastatic melanoma and investigator-sponsored Phase 1/2 study of CDX-1401 and in IDO inhibitor in patients with NY-ESO-1 positive ovarian cancer. This study is being conducted at the Roswell Park Cancer Institute. This brings us to CDX-301 on Slide 15, a potent hematopoietic cytokine that stimulates the expansion of hematopoietic stem cells and dendritic cells. In addition to the study I just mentioned, testing 301 in combination with CDX-1401, in September, we opened a pilot study CDX-301 alone and in combination with Mozobil in hematopoietic stem cell transplantation. Finally, CDX-301 is being evaluated in a very interesting investigator-sponsored Phase 1/2 study that involves intratumoral injection of CDX-301 in combination with low-dose radiotherapy for patients with low-grade B-cell lymphomas. Finally, new to the pipeline is CDX-014 on Slide 16. This is a programming you will be hearing more about over the remainder of the year CDX-O14 is a fully human monoclonal ADC that targets T-cell immunoglobulin and mucin domain-1 or TIM-1 which is much easier to say. A molecule that is upregulated in clear cell cancers, including renal cell and ovarian carcinomas associated with kidney injury and the shedding of its ectodomain is a predictive biomarker for tumor progression. That said, it has very restricted expression in healthy tissues, making it a promising target for antibody mediated therapy. We are completing manufacturing in IND enabling studies to support the initiation of Phase 1 clinical studies in renal cell carcinoma and potentially other TIM-1 expressing tumors in 2016. This concludes our clinical program updates, I will now turn the call over to Chip to review the financials for the fourth quarter and year-end 2014.