Ali Fattaey
Analyst · Cowen and Company
Thank you, Mani. Good morning, and thank you for joining us today. I will begin with an update on the status of the clinical study of our proprietary drug candidate CUDC-427, a trial that we initiated in July of this year. For context, I'd like to review prior clinical experience with CUDC-427. CUDC-427 was tested in a 42-patient Phase I dose escalation study sponsored by Genentech, the results of which were presented at the ASCO conference in June this year. That study examined escalating doses of CUDC-427, starting at 5 milligrams, and enrolled patients in 11 dose cohorts up through a 600-milligram daily dose using a schedule of 14 days on, followed by 7 days off, in 21-day treatment cycles. Maximum tolerated dose of the drug was not determined in that study. Regarding safety, one DLT of grade 3 fatigue was documented at the 450-milligram dose level. Grade 3 or higher adverse events that were attributed to CUDC-427, included elevated serum levels of AST and ALT liver enzymes in 2 patients, anemia, fatigue, neutropenia, pruritus or itching sensation, fever or rash experienced in one patient each. In that study, no serious adverse events, or SAE's, were attributed to CUDC-427, and overall, the drug candidate was deemed to be reasonably well tolerated. Potent biomarker activity as measured by over 90% decrease in cIAP protein levels, which is a target for this drug, was observed starting at the 90-milligram dose. Drug exposure at levels equivalent to ED50 and ED90 based on animal models were reached in the clinic at daily doses of approximately 90-milligram and 450-milligram respectively. Drug half-life was recorded as approximately 4 to 8 hours. Complete tumor regressions, albeit unconfirmed, were recorded in 1 patient with ovarian cancer and another patient with MALT lymphoma. And disease stabilization was experienced by 8 other patients. We initiated an additional Phase I trial of CUDC-427 in July this year, to expand upon findings from the Genentech trial by addressing important considerations, including; A, safety, tolerability and maximum tolerated dose of a more intensive dose regimen of single agent CUDC-427, namely twice-daily continuous treatment without a drug holiday. And B, potential clinical benefit in ovarian and fallopian tube cancer patients, with defined genetic alterations. In this study, 9 patients have been enrolled into 1 of 3 dose cohorts testing, 200-milligram, 300-milligram, or 400-milligram twice daily dosing. During the course of treatment, one patient with stage 4 breast cancer metastatic to the liver, lung, bone and ovaries who was enrolled in the mid-dose cohort experienced grade 3 serious adverse events of increased AST and ALT liver enzymes. Unlike all prior clinical experience with CUDC-427, this patient's liver enzymes and later her bilirubin level, continued to rise following discontinuation of CUDC-427 and the patient died of liver failure one month following CUDC-427 discontinuation. In response to our reporting of this event, on November 5, yesterday, we received written notification from the FDA placing the CUDC-427 Phase I trial on a partial clinical hold. Under this partial clinical hold, new patients may not be enrolled in this study until we provide FDA with requested additional data and analysis on patients treated with CUDC-427, and a proposed protocol amendment is submitted and accepted by the FDA. To date, no other patients treated with CUDC-427 have experienced a serious event of this magnitude or nature. We will provide the FDA with their requested information and data analyses. We are in the process of assessing CUDC-427's pharmacogenetics, concomitant medications, patient specifics and other trial parameters related to this event in the context of all prior clinical experience with CUDC-427. We expect that these analysis will not only help elucidate factors that may have contributed to this patient's clinical course, but should also inform proved future developments of CUDC-427. Based on clinical data obtained to date, we continue to believe that CUDC-427 could play an important role as monotherapy for patients with genetically-defined cancers, and in combination with chemotherapy or other targeted anticancer agents in select indications such as breast cancer. Accordingly, assuming that we are able to satisfactorily respond to the FDA's information request, and the FDA removes the partial clinical hold so that we can reinitiate enrollment in the clinical study, our development plan for CUDC-427 currently remains unchanged. I will now turn to our other clinical stage, proprietary drug candidate CUDC-907, which is a dual PI3 kinase and HDAC inhibitor. I'd like to note that CUDC-907 is being developed in collaboration with the Leukemia and Lymphoma Society or LLS, and we thank the LLS for its important guidance and support in the development of this drug candidate. CUDC-907 is being tested in a Phase I dose escalation trial in patients with relapsed refractory lymphomas and multiple myelomas. Patients may be enrolled at 3 different centers to receive CUDC-907 administered using one of the following 3 schedules: once daily, 3 times per week, or 2 times per week administration. Based on preliminary PK results from the once daily treatment schedule, we have seen encouraging drug exposure, and a metabolism profile for CUDC-907 in patients, which is similar to that observed in animal models. To date, common observed adverse events of reversible thrombocytopenia and gastrointestinal effect including diarrhea, have been consistent with known side affects of HDAC and PI3 kinase inhibition. No unexpected toxicity [ph] signals have been observed thus far in this trial. While, study findings are still preliminary, clinical benefit in some patients have been observed. We are planning to share additional results from this study at the upcoming American Society of Hematology Annual Meeting or ASH in early December. In addition to the ongoing trial in hematologic indications, we are also planning to initiate an additional Phase I trial in which CUDC-907 will be studied in solid tumor patients. We expect to provide additional details regarding this trial, and as we get closer to its initiation. I'd now also like to thank Jaye Viner, our Chief Medical Officer, and Tania Chander, our Vice President of Product Development, and their team as well as all members of the Curis staff for their hard work and their contribution to the discussion that we are having today. I'll now turn the call back to Dan to provide for more details on our partnered programs. Dan?