Ali Fattaey
Analyst · Simos Simeonidis
Thank you very much, Dan, and good morning. I'm very excited to join the Curis team and working with Dan, Mike and Maurizio in this very exciting year for Curis to advance our programs and our company's goal. In joining the company, I will initially spend most of my efforts working with our Chief Medical Officer, Maurizio, and focus on our clinical drug candidates. And we'll be working with the teams to establish and execute the development plan and regulatory path for each one of our drug candidates. I'll start with CUDC-427. And as Dan indicated, it's an IAP antagonist that we recently in-licensed from our partner, Genentech. This drug is particularly interesting to me, first, because it is a new class of targeted anticancer drug. It works by a different mechanism that in our industry, by and large, we've focused on, namely tyrosine kinase -- receptor tyrosine kinase as in components of their pathway. CUDC-427 works really by a different mechanism. Secondly, we should note that evasion from programmed cell death or apoptosis is a hallmark characteristic of all human cancers and is also a fundamental mechanism for developing resistance to current treatment regimens and anticancer therapy that are used. Now CUDC-427 targets this particular trait, the evasion of apoptosis in cancer cells, and it does this by antagonizing the inhibitors of apoptosis or IAP proteins within tumor cells. The IAPs function really to regulate both the intrinsic signals for apoptosis induction in cells and also some of the IAP proteins are components of extrinsic signaling pathways, namely those of the tumor necrosis factor or TNF family of receptors. By antagonizing the IAP proteins within cells, CUDC-427 interferes with these pathways, the intrinsic and extrinsic signaling pathways for apoptosis induction. And this really provides us with the basis for using the drug candidate, particularly in combination with other anticancer agents. As a brief introduction, IAP proteins are a family of functionally and structurally related proteins. And it includes the X-linked IAP, or XIAP, to cellular IAPs, referred to as cIAP 1 and cIAP 2, and the melanoma IAP, or ML-IAP. CUDC-427 antagonizes the function of all of these 4 IAP proteins. And consistent with the role of the IAPs in cancer development, we do find course mutations, amplifications, chromosomal translocations and other alterations at the IAP gene in a number of solid tumor and hematologic malignancies. We also find increased IAP expression that's been associated with an unfavorable prognosis and a poor outcome for patients in a number of cancer settings. With that introduction, moving on to CUDC-427 as a drug, CUDC-427 is administered orally and that's important. It works as a monomer to antagonize IAP. This differentiates it from other molecules in this class that work as dimers. The current consensus developing in the field with the clinical experience in this category of molecules is that the oral monomer inhibitors of IAP appear to be better tolerated in the clinic than those have worked as dimers, and it's also obviously administered as an oral agent as opposed to being administered as an intravenous treatment regimen. Oral dosing using a daily schedule of administration is also likely to give us a much greater flexibility when we combine CUDC-427 with other anticancer agents for different cancer indications. As a reminder, in 2012, Genentech completed a Phase I clinical trial of CUDC-427, in which 42 patients with either solid tumors or lymphomas received the drug as a daily oral dose as a single agent, and they received the drug for the first 2 weeks of the 21-day cycle and these treatment cycles were repeated until disease progression or study discontinuation for any other reason. The primary endpoints of it are as expected for a Phase I trial and it was primarily evaluating the safety, tolerability, pharmacokinetics and determining the maximum tolerated dose, as well as a potential recommended dose for further clinical studies, all of which, we are currently evaluating. Secondary endpoints of the Genentech-sponsored trial of CUDC-427 included preliminary assessment of antitumor activity and the evaluation of the pharmacodynamic markers for this drug. I should note also that Genentech plans to -- Genentech and investigators conducting this trial plan to present the full-study results at a medical meeting by midyear this year. Now with regards to our plans for CUDC-427 as an antagonist of IAP protein, we believe that the ability of CUDC-427 to work in combination and in concert with other anticancer agents such as chemotherapy is likely to provide us the most effective treatment for patients, provide us the opportunity to develop the drug candidates in the broadest range of different human cancer indications and also likely to give us the fastest regulatory path to its approval as a new anticancer drug. It's now well documented that IAP antagonists synergize and work in concert with a number of different chemotherapy and other targeted anticancer agents as well. Now while we evaluate all the available data from our partner, Genentech, and the Genentech-sponsored study and as we finalize our clinical development plans, we are preparing for development of CUDC-427 in Phase II clinical studies in combination with other anticancer agents. And we are also exploring the therapeutic potential of single-agent CUDC-427 in selected cancer patient populations that may have specific genetic alterations. Our trials will also incorporate plans to evaluate each patient enrolled in these studies to help us identify subpopulation of patients that may be particularly sensitive to CUDC-427 effect. And we look forward to elaborating on all of these trials and our clinical plans and indications and the combination therapies that will be used for the trials in our studies closer to the time that the results of the Genentech-sponsored Phase I clinical study results will be presented again by Genentech and their investigators at a meeting in the middle of this year. Finally, we believe that CUDC-427 is entering a very exciting emerging field, where competing molecules are also in early stages of clinical development. And CUDC-427 will provide us with an opportunity to be a leader in this very promising anticancer treatment field. Now I'd like to move on to CUDC-907, which is our proprietary PI3 kinase and HDAC inhibitor in one molecule. We believe that CUDC-4 -- I apologize, CUDC-907 may be able to overcome some of the potential limitations of single-target PI3 kinase inhibitors that are in development at the moment by concomitantly inhibiting the cellular HDAC activity in one molecule. Again, I'd like to point out that, Maurizio, our Chief Medical Officer's team have done an excellent job of starting the first clinical trial of this drug candidate and the investigators have begun dosing advanced lymphoma and multiple myeloma patients with an oral formulation of CUDC-907 in this Phase I clinical study. The Phase I clinical trial is designed as a standard dose escalation study in which CUDC-907 is orally administered to patients. And the primary objective of the study, of course, being a Phase I is the safety, determining the safety, tolerability, the maximum tolerated dose and potentially the recommended Phase II dose for further development of CUDC-907. The secondary objectives of this study, as we've indicated, are to assess pharmacokinetics of the drug and evaluate biomarkers of activity and also to assess preliminary anticancer activity of CUDC-907 in this patient population of lymphoma and multiple myeloma patients. To date, 2 patients have been treated at one of our trial centers with a third patient expected to initiate dosing as of today, and again, congratulations to Dr. Voi for the rapid enrollment of patients in this trial. And this would conclude the -- or completes the enrollment in the first cohort of patients in this study. 2 additional leading clinical centers have also been recruited by Dr. Voi and are expected to initiate patient enrollment shortly in this trial. As we've noted before, in preclinical studies, CUDC-907 has demonstrated very potent anti-proliferative activity and based on these results, we are very optimistic that CUDC-907 as a single-agent drug candidate targeting both PI3 kinase and HDAC has the potential to provide improved clinical benefit in cancer patients. As we know, the PI3 kinase space has attracted a lot of attention in recent months, and we are pleased to be enrolling patients in this trial and look forward to discussing further details from this trial as data become available from the study. CUDC-907 is being developed in collaboration with the Leukemia & Lymphoma Society, under which LLS, the society, will support our ongoing clinical development of CUDC-907. Under the agreement, LLS will fund approximately 50% of our direct clinical costs for 907 through Phase Ib or Phase IIa clinical testing for total potential funding of up to $4 million. To date, we have recognized $1.1 million in milestone payments from LLS in recent months as a result of advancing CUDC-907 to IND filing in beginning the Phase I clinical trial. And of course, this represents an important capital to support our continued development of this molecule, and we thank the Leukemia and Lymphoma Society for their commitment to this drug candidate. Finally, we look forward to providing updates as this molecule, 907, progresses further in its ongoing Phase I clinical study. And as I indicated, I'm very pleased to join the company and we have a very exciting year with our clinical programs going forward. At this point, I would like to point back to Dan, who'll provide more update on our partnered programs.