Daniel R. Passeri
Analyst · Cowen and Company
Yes, thanks, Mike. Good morning, everyone, and thanks for joining us today. We've seen continued progress during the second quarter with each of our 4 development programs. During this period, Genentech continued to advance its U.S. commercial launch of Erivedge in advanced basal cell carcinoma, and Roche has made progress with its efforts provide Erivedge to advanced BCC patients outside of the U.S. with recent submissions for regulatory approval in Australia, Canada, Israel, Mexico and Switzerland. Importantly, we received the $4 million milestone payment upon Roche's submission to Australian authorities. In addition, Roche filed for commercial approval of Erivedge in advanced BCC in Europe in December of last year. Including the most recent filing in Australia, Roche has now submitted regulatory applications in a significant number of territories and this clearly highlights its global strength and commitment to the development and commercialization of Erivedge. Internally, Curis is focused on the ongoing Phase I clinical study in locally advanced head and neck cancer patients with our IV formulation of CUDC-101, as well as preparing IND filings for the second half of 2012 to begin Phase I testing of the oral formulation of CUDC-101, as well as our oral PI3 kinase/HDAC inhibitor designated CUDC-907. Lastly, our partner, Debiopharm, has advanced our Hsp90 inhibitor, which is currently designated Debio 0932, into Phase Ib testing and also plans to initiate a Phase I/II clinical trial in non-small cell lung cancer patients in the near future. So I'm going to begin with the launch of Erivedge, which, this is to remind everyone, a first-in-class Hedgehog pathway inhibitor, which recently received FDA approval during the first quarter of this year for the treatment of adults with a type of basal cell carcinoma, or BCC, that has spread to other parts of the body that is metastatic or that has come back after surgery or their health care provider decides cannot be treated with surgery or radiation. And we refer to these categories of disease as advanced BCC. Roche for the x U.S. markets and its subsidiary, Genentech, for the U.S. are responsible for commercialization of Erivedge in advanced BCC as well for its continued clinical development. During Roche's recent mid-year update, the company indicated that it had recorded net sales of approximately CHF 10 million, which converts to approximately USD 10.5 million during the first 6 months of 2012. Roche had previously reported approximately USD 5.4 million in net sales of Erivedge for the first quarter of 2012. Despite the slight decrease in net sales recorded by Roche for the second quarter of 2012, our prescription data that we track appears to demonstrate that the prescriptions in the second quarter have increased severalfold from prescription levels observed in the first quarter of 2012, and that there is a consistent increase in prescription on a monthly basis over the period since Erivedge launched in February. Upon Erivedge's approval, pharmacies that distribute Erivedge likely established inventories necessary to satisfy current/future prescription demand for Erivedge. Because Roche records net sales for Erivedge when Erivedge is sent to the distributer, a portion of the first quarter net sales were likely attributed to this inventory buildup. While our net sales will ultimately drive the value of our royalty interest in Erivedge, we remain highly encouraged by the apparent positive prescription demand trends at this early stage of product launch, and we look forward to continuing to monitor this in the future and reporting on updates as it becomes available. Earlier this year, Roche communicated that it estimates that approximately 1.5% of all BCCs fall within the category of advanced BCC, and we believe that this represents a significant market opportunity for the drug. Roche also noted that the initial Erivedge uptake has been encouraging. Furthermore, payor coverage appears to be excellent with no significant reimbursement hurdles. Based upon the early market launch metrics and the estimates of potential patients, we continue to believe that advanced BCC market represents a significant value proposition for our shareholders, and we anticipate Erivedge's continued growth in the U.S. and globally, if approved, in other territories. As I mentioned earlier, Roche is working to secure approval for Erivedge in several of the territories, including Europe, Australia, Canada, Israel, Mexico and Switzerland. We're eligible to receive potential additional milestone payments upon regulatory approvals for Erivedge in advanced BCC in Europe and Australia, as well as royalty revenue in all territories in which Erivedge is sold. Roche has indicated that it currently anticipates possible European approval by the EMA in either late 2012 or early 2013. And we estimate that potential regulatory approval in Australia could occur during the first half of 2013. In addition to the lead indication of advanced BCC, Genentech is also conducting a separate Phase II clinical trial of Erivedge in patients with operable nodular BCC, which is a less severe form of the disease and accounts for a significant percentage of the approximately 2 million cases of BCC diagnosed annually in the U.S. This Phase II trial is the first study to assess the ability of Erivedge to provide complete histological clearance of a BCC tumor, which is an important first step in determining the efficacy of Erivedge in less severe forms of BCC where BCC lesions are generally treated surgically. Our thought at this time is that the drug would likely be used possibly as a neoadjuvant prior to surgery in severe cases of operable BCC. This trial is designed to test Erivedge as a single-agent therapy in a 3-cohort trial of approximately 75 patients with operable nodular BCC in a U.S.-based, open label trial. Data from the first cohort was recently published in April in the Journal of Investigative Dermatology. This cohort evaluated the safety and efficacy of 12 weeks of daily 150 milligram dosing of Erivedge in 24 patients with newly diagnosed nodular operable BCC. At the end of the treatment period, patients then underwent Mohs surgery with independent pathology review. Pathologically confirmed complete clearance was reported in 10 patients or 42% of the cohort. While clinical complete and partial responses were reported in 23 patients or 96% of the patients treated, we obviously view this early data as highly encouraging. The most frequent adverse events, or AEs, were similar to those observed in previous studies with Erivedge and included muscle spasm in approximately 79% of the cohort; ageusia, which is loss of the sensation of taste, in 42%; alopecia or hair loss in 38%; and dysgeusia, which is taste alteration, in 38%; fatigue in 21%; and nausea in 21%. Most AEs were grade 1 and 2, and 7 out of the 24 or 29% of the cohort reported grade 3 AEs, including 12 patients with muscle spasm. No serious AEs were reported in this cohort. Eight patients or 33% of the cohort discontinued from the study, including 2 that were due to AEs. Cohort 2 is fully enrolled, and accrual for cohort 3 is ongoing with full study results expected in the second half of 2013. To provide further clarification of the study design with these cohorts, cohort 2 is designed to follow patients after the 12-week treatment period where they'll be followed up for an additional 24 weeks after treatment period to assess their ability of response. So that is the Mohs surgery will not be performed until after that 24-week follow-up period. Cohort 3 is designed to treat for 8 weeks, followed by a 4-week drug holiday, then treatment for an additional 8-week period. This cohort is designed to assess if there's a treatment benefit that can be enhanced with longer overall drug exposure while ameliorating the associated AEs by providing the drug holiday. In addition to the operable BCC study being conducted by Genentech, multiple trials in other cancer types are ongoing by third-party investigators, including the exploration of Erivedge in basal cell nevus syndrome or Gorlin syndrome, medulloblastoma, sarcoma, glioblastoma multiforme, as well as in pancreatic, small cell lung cancer, gastroesophageal junction, gastric, breast, prostrate among others. We expect that some of these studies may yield data in 2013 and -- I'm sorry, 2012 and 2013. For example, preliminary results were recently reported at the American Association for Cancer Research's Pancreatic Cancer: Progress and Challenges conference. This early study reported on 20 previously untreated metastatic pancreatic cancer patients. These patients were treated for 4 weeks with Erivedge monotherapy and followed by continued daily treatment with Erivedge and intermittent gemcitabine. 18 of the 20 patients were assessed for response after receiving 3 cycles when the cycles are 28-day periods of therapy. Although a subset of patients had evidence of disease progression on Erivedge, in this case GDC-0449, monotherapy per resist criteria continuation of 0449 with addition of gemcitabine resulted in resist-defined confirmed partial responses in 5 patients, that's 28%, with 4 additional patients having stable disease, yielding a 50% PFS rate at 3 months. The percentage of pancreatic circulating stem cells decreased in 56% of patients. And of these patients, the mean relative decrease was approximately 60%. Interestingly, Sonic hedgehog expression was more highly expressed in patients that achieved a partial response to stable disease as compared to those with progression. So we look forward to providing additional updates on this and other ongoing studies as warranted, as well as on Erivedge program as a whole on an ongoing basis in the future. I'd like to now turn next briefly to CUDC-101, which is our first-in-class EGFR, Her2 and HDAC inhibitor and is our most advanced proprietary program. We're currently advancing an IV formulation of the drug in an ongoing head and neck cancer clinical study and are also advancing an oral form of CUDC-101 towards IND filing in the coming months. We are continuing to recruit patients in the ongoing Phase I clinical trial of CUDC-101 in combination with the current standard of care, which is cisplatin and radiations -- and radiation in patients with locally advanced head and neck cancer. The primary objective of this study is to evaluate the safety and tolerability of CUDC-101 when administered in combination with the current standard of care, which consists again of radiation and intermittent cisplatin. This trial was originally designed to include only those patients whose cancers are human papillomavirus, or HPV, negative. During the second quarter, however, we amended the protocol in this Phase I portion to include HPV-positive head and neck cancer patients with a prior smoking history in order to assess a wider patient population to enroll in this study, while still focusing on the more aggressive forms of this cancer that are less responsive to standard chemoradiation. We're currently in the second of 2 plans, CUDC-101 dose levels at 275 milligrams per meter squared, having successfully progressed to the first dose cohort in which patients received every-other-day dozing of CUDC-101 as an IV at 225 milligrams per meter squared dose level. Patients in the first cohort experienced no dose-limiting toxicities and all patients received benefit from treatment. Our current goal is to complete the dose escalation portion of this study at the 275 milligrams per meter squared in the fourth quarter of this year and then to treat approximately 10 additional patients at the maximum tolerated dose, or MTD, determined in this study in order to further characterize its suitability as the recommended dose for Phase II study. We are operating this study through 4 study centers currently and are working at additional centers in order to expedite patient enrollment later this year. Assuming the successful outcome of this study, we plan to progress CUDC-101 as an IV form and to randomize Phase II study, comparing the safety and efficacy of cisplatin and radiation therapy with or without CUDC-101 in 2013. We view the head and neck cancer indication to be an ideal initial commercial path with our current IV formulation of CUDC-101 as the drug targets the primary driving mechanisms of the more aggressive forms of head and neck cancer. Synergy has been reported with HDAC inhibition and radiation, and our preclinical data has shown that CUDC-101 synergizes with cisplatin and the IV dosing schedule aligns very well with current standard of care, where patients are required to go to the clinic every day weekday for 7 consecutive weeks. We're also continuing to work on advancing an oral formulation of CUDC-101 into clinical development. We believe that an oral formulation has the potential to make CUDC-101 more competitive in certain cancers where there are investigational or commercially available molecules that are administered orally, and it would also allow us to try various dosing schedules for enhancing exposure, particularly as a single agent. Importantly, we have made significant progress towards advancing an oral formulation of CUDC-101 and currently expect we'll file an IND for an oral version of CUDC-101 in the second half of 2012. Moving on to the rest of our pipeline. We have advanced an oral formulation of CUDC-907, which is our proprietary synthetic small molecule dual inhibitor of PI3 kinase and HDAC towards clinical testing. We expect to file an IND during the second half of this year and then initiate a Phase I study shortly thereafter. CUDC-907 is being developed in collaboration with the Leukemia & Lymphoma Society, or LLS, under which LLS will support our ongoing clinical development of CUDC-907. Under this agreement, LLS will fund approximately 50% of an anticipated $8 million in direct costs of the development of CUDC-907 through Phase Ib or Phase IIa clinical testing for a total potential funding of up to $4 million from the LLS. Our scientists recently published preclinical data on this drug candidate in the Journal of Clinical Cancer Research, the publication focused on CUDC-907's biological activity in cell culture and animal models of various hematological cancers with a particular focus on B-cell lymphoma and multiple myeloma, which are the primary cancers that we'll be exploring in the Phase I clinical trial that we expect to initiate early 2013. And we look forward to providing updates on this molecule as the compound reaches Phase I clinical testing. Our Hsp90 program is being developed by our licensee, Debiopharm, and the lead candidate is designated Debio 0932. This is an orally available small molecule non-geldanamycin Hsp90 inhibitor. Debiopharm recently completed the dose escalation portion of a Phase I clinical trial of Debio 0932 and presented data from this study at the annual meeting of the American Society of Clinical Oncology in June of this year. Debio 0932 was tested as a monotherapy in 50 patients in this portion of the study, including 22 patients that received Debio 0932 every other day and 28 patients that received daily dosing of Debio 0932. Debio 0932 was generally well tolerated in this study with mostly adverse events classified as grade 1 or 2, and that is mild or moderate, with no apparent dose or -- excuse me, with no apparent dose or schedule relationship. In particular, no ocular or cardiac toxicities and no consistent changes in hematology or biochemistry parameters were observed. The most common adverse events included asthenia, which is loss of strength or energy; constipation; decreased appetite; diarrhea; nausea; and vomiting. Antitumor activity was assessed in 45 of the 50 patients enrolled in the study, with 2 patients having achieved partial responses including one patient with breast cancer and one patient that was K-RAS-mutant lung cancer. Stable disease was observed in 12 patients and disease progression was observed in the remaining 31. The recommended dose for further study was determined to be a 1,000 milligrams daily and Debiopharm advanced Debio 0932 into Phase Ib expansion portion of the study in the beginning of 2012 after its 1,000 milligram daily dozing level. The primary objectives of the Phase Ib portion of the study are to further assess the safety profile, pharmacokinetics and pharmacodynamics of Debio 0932 and to make a preliminary assessment of the antitumor activity. Debiopharm expects that approximately 30 patients with advanced solid tumors will be treated in this portion of the study, including patients with non-small cell lung cancer. Debiopharm also indicated that it plans to initiate a combination Phase I/II study in patients with non-small cell lung cancer in the second half of 2012. This study will include patients with advanced non-small cell lung cancer Stage IIIB or IV with EGFR wild-type receptor. K-RAS mutation status will be assessed and will be used as a stratification factor. The study will consist of 3 parts. Part A is an open-label dose escalation study of Debio 0932 in combination with standard of care in patients who are candidates for first-line or second-line treatment. The first-line standard of care consists of cisplatin and gemcitabine in the case of squamous histology and cisplatin and pemetrexed in the case of non-squamous histology. Second-line standard of care consists of docetaxel. Part B is a randomized, double-blind, placebo-controlled study of Debio 0932 in combination with first-line standard of care to 138 patients who did not receive prior systemic treatment for advanced non-small cell lung cancer. Patients who subsequently developed progressive disease in Part B will then enter into Part C. So Part C is a second randomization, which is -- will assign patients to double-blind treatment with docetaxel plus placebo or docetaxel plus Debio 0932. Approximately 100 patients are expected to enter Part C. Part B has a primary endpoint of progression-free survival at 6 months. Key secondary endpoints include best overall response rate, duration of objective response, change in tumor size from baseline until 6 months and overall survival. Part C has a primary endpoint of change in tumor size from baseline until 6 months. Key secondary endpoints include best overall response rate, duration of objective response, progression-free survival at 6 months and overall survival. Potential pharmacogenomic, tumor pharmacogenetic, proteomic and pharmacogenetic factors predictive of response to Debio 0932 will be assessed. We are eligible for our next milestone payment under our license agreement with Debiopharm if and when Debiopharm treats its fifth patient in Phase II clinical studies, assuming that Debiopharm advances Debio 0932 into Phase II clinical testing. We currently anticipate that Phase II testing could commence in 2013. At this point, I'd look at turn the call back over to Mike for financial discussions. And then following Mike's remark, we'll open the call up for question-and-answers.