Gerard Michel
Analyst · Roth Capital. Please proceed with your question
Thank you everyone for joining today. As many of you know, this is my first earnings call since joining Delcath in October. In addition to the expected updates on clinical progress and financial results, I will first explain why I found the Delcath opportunities so compelling that I chose to join the company. I think this will be useful for investors to know the story well and especially valuable for the many investors who are either looking at the story for the first time or taking a second look after ceasing the fall [ph] of the company years ago. And obvious first question, when looking at any opportunity, whether a career move or an investment opportunity is whether the company is offering or developing a product or service that addresses a real unmet need. I believe that Delcath clearly has such a product. The drug device combination Melphalan/HDS and the standalone CE mark device CHEMOSAT available in the EU, are designed to administer high dose chemotherapy to the liver while controlling systemic exposure and associated effects. The lead indication is metastatic ocular melanoma. And while an orphan indication with an estimated 1,200 to 1,500 patients here in the U.S., there is no standard-of-care and the existing treatments have not been shown to offer significant benefit to patients. Upon diagnosis of liver metastasis, patients have a very poor prognosis from this devastating disease. What is clear that there is an unmet need? The next key question is whether the ongoing focus for all would demonstrate adequate efficacy. The trial's primary endpoint is overall response rate. In our submission to the FDA, we based the outcome of the trial on the hypothesis that Melphalan/HDS is more efficacious than immuno-oncology agents. One category of treatments frequently used in patients with metastatic ocular melanoma, given their approved label for metastatic melanoma. For analytical purposes, the FOCUS trial should demonstrate an overall response rate of at least 21% to show superiority over the response rate calculated from a meta analysis that was conducted on immuno-oncology trials in metastatic ocular melanoma. It is important to note that all previously published studies, even the first pivotal trial with the first-generation filter exceeded this targeted overall response rate. In these studies, the overall response rates are vary from 27% to 72%, with the last three studies using the second generation device ranging from 47% to 72%. While these last three published studies were all single or dual center studies, which often have higher response rates. And the last study focused on earlier stage patients who generally seem to have a better response rate, we do fully expect the trial results to be somewhere within the range of all four studies and be well in excess of the 21% target overall response rate. All of this information was critical to my conclusion that Delcath is nearing the end of a development program, which lead to an efficacious product addressing an unmet need. While the lead indication is an ultra orphan indication, we believe Melphalan/HDS will eventually have a role in treating other solid tumors of the liver in the U.S., as it already does in the EU. In addition to ocular melanoma, the liver is the predominant site of metastasis for colorectal cancer and gastrointestinal neuroendocrine tumors. Complete surgical resection might represent a curative option in patients with isolated hepatic metastasis. The resection is not possible in most patients because of the number of location or size of the hepatic metastasis. Hepatic metastasis can also co-occur with many other malignancies, such as breast cancer, renal cell carcinoma, cutaneous melanoma, and soft tissue sarcoma. Liver is often the life-limiting organ for cancer patients. And overall survival is usually under 12 months. There have been a variety of studies and case reports in many of these tumor types that support further investment to investigate the possible efficacy of Melphalan/HDS in a broader set of tumor types, thereby dramatically expanding the market potential for Melphalan/HDS. Of course, turning this potential into reality will take time. And the first step is approval in a single indication, which is currently our primary focus. A second critical factor, which I examined carefully before deciding to join Delcath is whether there is adequate evidence to conclude that the safety of the second generation Melphalan/HDS device is meaningfully improved over the device studied in the pivotal trial conducted 10 years ago. In that trial four deaths occurred due to the treatment. And despite the clear signals of efficacy, the risks associated with device led the FDA to conclude that the benefits of the product did not outweigh the risks with the first-generation product. The safety issues were multifactorial, but there were two that are most noteworthy. The first was patient selection. In the first pivotal trial, many patients had extensive liver disease and were not restricted by volume of tumor burden in the liver. These patients accounted for a disproportionate percentage of the adverse events. We now know that like most key chemotherapeutic regimes, some patients are just too sick to tolerate treatment. Patients were treated in the first pivotal trial that would have been excluded from many other liver directed therapies and systemic chemotherapeutic agents. A second, and perhaps the most important change, was improving the filtration, efficiency and consistency. The previous generation filter whose manufacturer was outsourced was inconsistent in its filtration efficiency and at an unacceptable rate of hematological toxicities due to both the design of the filter and inadequate manufacturing controls. To this end, the company changed the design of the filter, in-source manufacturing the filter, and develop validated physical and functional release specifications for the filter and its critical sub components. The evidence for the improved safety is again in the public domain. I will not go through the safety findings of each of the three published studies mentioned previously, but I will mention results from the most recent study Leiden University Medical Center. A publication reporting the results of the study, the authors noted that all the adverse events were well manageable or self-limiting, and there were no treatment related deaths. The investigators also noted that the hematologic and hypnotic toxicity percentages were significantly lower compared to studies using the earlier generation of CHEMOSAT, which utilized a different filter system. Finally, based on a validated quality of life tool used in the trial, the investigators concluded the CHEMOSAT is well tolerated with maintenance of quality of life with only a mild and temporary impairment of physical functioning noted six weeks at the second CHEMOSAT treatment. It is important to note that there's not been a single treatment related death [ph] in over 1,000 treatments in Europe, and then in the FOCUS trial, which still has nine patients undergoing treatments. 356 treatments have been given to 91 patients, and we can confidently state that the adverse event profile is within the range as seen in the published studies. This study is utilizing an independent data safety monitoring board, which has met seven times as planned during the course of the trial. And there has never been need to pause the trial for reasons of unacceptable safety risk, or a safety concern. In summary, given the totality of the safety and efficacy data available, I reached the conclusion that the FOCUS trial is likely to produce the data necessary to support a compelling case that Delcath Melphalan/HDS as a high probability of approval to treat metastatic ocular melanoma and given the multiple smaller studies and case reports in other tumor types, Melphalan/HDS has significant potential to expand into larger markets over time. While compelling that in itself was not adequate to convince me to join Delcath, beyond just the data an important question is whether the team is in place to execute. While the team is lean and key positions need to be filled, John Purpura, our COO; and Johnny John -- Dr. Johnny John, our Vice President of Clinical and Medical Affairs, have done an excellent job planning and executing on all aspects of the development program, including manufacturing process validation, regulatory strategy, and clinical development. I would not have joined if I was not confident in their capabilities. In addition, we have a strong experience and reinvigorated board, with a wealth of experience supporting the management team. Since my arrival, John Purpura, Johnny John, and I have set the company's near-term priorities as follows. One, complete the FOCUS trial and submit an approvable NDA; two, prepare for the commercialization of Melphalan/HDS in the United States; three, raise the awareness of Delcath in the investor community; four, prioritize additional indications for Melphalan/HDS and then design and execute a development plan for the higher value indications. I will touch briefly upon each of these priorities. Starting with the FOCUS trial and NDA submission, Delcath enrolled and started treating the final patient October 2, 2020. The next milestone is the release of top line data, which we will project will occur early in 2021. In that release, we intend to share the primary endpoint, overall response rate, as well as duration of response and an evaluation of safety. We are currently projecting submission of the NDA to the FDA in the first quarter of 2022, which would still allow for 2020 launch. The primary dating item to our submission is data monitoring, which requires site access. Due to the increase rates of COVID-19 cases, many sites have recently increased access restrictions. While we are utilizing remote monitoring where feasible, not all sites are equipped to support remote monitoring and not all data can be remotely monitored. In addition, when lockdowns end, the number of days of access is being reduced due to the high -- due to the high demand from multiple sponsors. Our projections assumes the current and future access restrictions are limited in duration to a few months. Given the rapidly changing landscape, it is difficult to project a submission date with a high degree of confidence. And our assumptions could prove to be overly optimistic or pessimistic. In an effort to minimize for the delays, we are attempting to negotiate increased site access when restrictions are lifted and also intend subject to FDA feedback to adjust our monitoring plans, to focus on the CRF pages, most important to the efficacy and safety endpoints, a strategy, which we believe is consistent with current FDA guidance on monitoring. I must stress that the team's focus is not primarily speed, but quality. Our goal is not to submit an NDA as quickly as possible, but to submit an approvable NDA in a timely manner. Regarding the second priority, commercialization planning is underway, with a well-known consulting firm helping lay the groundwork to ensure appropriate patient access and reimbursement. In addition, we expected to announce some significant hires over the coming few months in commercial roles. One small, but exciting step towards commercialization is the choice of a trade name. In September, the FDA conditionally accepted the name HEPZATO kit for use in the U.S. Going forward, we will use HEPZATO or HEPZATO kit when referring to Melphalan/HDS, the combination drug device product. I look forward in the coming quarters to providing additional updates and details on our pre-launch activities. Our third priority is to raise awareness with the investor community. Delcath has not received much intention for many years for a variety of reasons. It is not the first company that has had some missteps, been forgotten and then continued to be overlapped. Look, despite the mounting evidence of significant progress and value creation, to raise awareness Delcath will need to deliver on its milestones and the management team will need to be transparent with an accessible to the investor community. To that end, I plan on getting out on the virtual road on a regular basis and maintaining an open and of course, Reg FD compliant line of communication with our current and potential shareholders. Consistent with our efforts to raise awareness, last week, we hosted a key opinion leader call with Dr. Mark Burgmans, Head of Interventional Radiology at the Leiden University Medical Center in the Netherlands and investigator in this study had previously mentioned which side of the use of CHEMOSAT in earlier stage ocular melanoma patients. Our fourth strategic priority is the prioritization of additional indications for HEPZATO and the subsequent design and execution of development plans for the higher value indications. Over the next six months we will be reviewed the incidents, unmet need, available efficacy data and develop requirements for a broad set of liver cancers in order to select a portfolio follow on to indications, which will maximize the value of HEPZATO and CHEMOSAT platform. A key part of that process will be to convene disease specific advisory boards to ensure that we have -- we choose the highest potential indications, and as importantly, the optimum development plan. In 2017, we initiated the ALIGN trial, a global Phase III clinical trial for intrahepatic cholangiocarcinoma based on promising data generated from commercial treatments in Europe. Presently, we have paused up work on the ALIGN trial, while we revisit the protocol to determine changes, which may boost recruitment rates. In the interim, the clinical team is focusing its efforts on the FOCUS trial inclusion and subsequent NDA filing In summary, I believe HEPZATO was a clinically differentiated, high-value platform with potential to address multiple cancer indications of high unmet medical need. I am committed to leading the organization towards its goal of making HEPZATO the first product specifically labeled for metastatic ocular melanoma patients, a population which currently has limited therapeutic options. I look forward to building shareholder value, both through the successful commercialization of HEPZATO in metastatic ocular melanoma and longer term initiating additional targeted clinical programs to expand the market opportunity of this platform technology. I look forward to taking your questions, but first, we'll turn the call over to Christine to review the financials.