John Scarlett
Analyst · Lazard Capital Markets
Thanks, Graham, and good afternoon, everyone. As you know, 2011 was a year of significant change for Geron. In the past, the company was known as a leader for developing therapies from human embryonic stem cells for the treatment of a variety of chronic and degenerative conditions, including spinal cord injury. Last year, we made the decision to narrow the focus of the company to the oncology programs and to divest our stem cell programs. We're currently talking to a number of interested parties in what is a competitive process for these programs. As I'm sure all of you will understand, while this process is ongoing, we can't give any further color on these discussions or really speculate on the potential outcome.
Even before Geron began working in stem cells, the company had begun developing telomerase inhibitors for cancer. The current product candidate, imetelstat, was put into the clinic by Geron in 2005. Subsequently, the company committed to deepen its oncology development capabilities and hired our Chief Medical Officer, Steve Kelsey, in 2009. Steve and his team put imetelstat into Phase II clinical studies beginning in July of 2010. At the end of 2010, Geron in-licensed GRN1005 in order to begin a second oncology development program, in this case, focusing on brain metastases. Both imetelstat and GRN1005 are first-in-class compounds that target major unmet medical needs in cancer.
With regard to imetelstat, we're currently sponsoring 4 ongoing Phase II studies. Two of these studies are in solid tumors, one in metastatic breast cancer and one advanced non-small cell lung cancer. The other 2 studies are in hematologic malignancies, one in essential thrombocythemia and one in multiple myeloma. The choice of these indications and the design of these studies are based on several key observations from a nonclinical and Phase I studies in imetelstat, as well as what we believe are some of the implications of imetelstat mechanism of action as a telomerase inhibitor.
For several reasons we believe that imetelstat will be most successful in solid tumors when used predominantly to prevent or delay tumor regrowth after debulking therapy. Against solid tumors, the effect of imetelstat is predominantly cytostatic rather than cytotoxic. meaning that its primary effect is on the inhibition of tumor cell growth rather than on direct induction of tumor cell death.
Imetelstat has also been shown to be an effective inhibitor of cancer progenitor cell proliferation in a wide variety of tumor types. As a consequence, in our metastatic breast cancer study, paclitaxel, which is a cytotoxic drug, is being given in order to debulk the tumor, while imetelstat, although given together with the induction of paclitaxel therapy, is intended to prevent recurrence and relapse of the tumor being driven by cancer regenerative cells. Similarly, in our advanced non-small cell lung cancer study, patients received a platinum complaint and containing doublet induction chemotherapy in order to debulk the tumor or stop progression of the disease. In the study, they then received single-agent maintenance therapy with imetelstat. The intent is to prevent or delay progression after chemotherapy by inhibiting cancer progenitor cell-driven recurrence.
I'd like to give you a couple more specifics about each of these solid tumors studies. Our metastatic breast cancer trial is specifically designed to compare the effect of imetelstat in combination with paclitaxel to paclitaxel alone in HER2-negative patients. In addition, approximately 30% of patients in both arms of the trial are also receiving Avastin, which was perspectively capped to ensure that there would be a sufficient number of patient in the non-Avastin cohort for analysis. We will stratify the results for the Avastin and non-Avastin-treated patients.
Our advanced non-small cell lung cancer trial is specifically designed to evaluate imetelstat as a maintenance therapy after induction chemotherapy with a platinum-based doublet regimen. The comparator arm will receive observation only, except that in both the comparator and imetelstat arms of the study, those patients with non-squamos tumor histology who received Avastin during induction therapy, are continuing to receive Avastin maintenance during the course of the trial. Again, we will stratify the results for the Avastin and the non-Avastin-treated patients.
The primary end point for both of these randomized studies is progression-free survival. The breast cancer study completed enrollment last month, and the lung cancer study is expected to complete enrollment in the second quarter. We continue to expect top line data for both trials by the end of the year, but because these are exempt-driven trials, the actual release of top line data will occur after a pre-specified number of progression events has occurred, and the initial analysis of the studies has been completed. In the 2 single arm studies of imetelstat in hematologic malignancies, we are directly assessing the impact of the drug on the cancer progenitor cells associated with essential thrombocythemia or ET and multiple myeloma. This is possible because of the accessibility of the malignant progenitor cell responsible for these disease in bone marrow biopsies and blood sample.
In the case of ET, we are evaluating the ability of imetelstat to reduce the number of platelets in the blood, as well as its effect on the underlying disease, which can be assessed by looking at specific mutations of service molecular biomarkers for the disease. If imetelstat reduces the number of platelets and the proportion of cells exhibiting these molecular markers in peripheral blood, we believe it will indicate a specific effect of the drug on the malignant progenitor cells in the bone marrow that are responsible for ET, rather than simply a nonspecific effect on the bone marrow. Although this trial is enrolling behind our initial projections, we continue to expect that we will have sufficient data by the end of the year to consider further developing imetelstat for the treatment of ET or other myeloproliferative neoplasm such as myelofibrosis.
The multiple myeloma study is not intended to be a development trial for myeloma. It's a small study designed to directly measure the effect of imetelstat on the proliferation of myeloma progenitor cells in the bone marrow of patients who've been treated with the drug. Because cancer progenitor cells in this disease reside in the bone marrow and because clinicians routinely take bone marrow samples to monitor the treatment of multiple myeloma, this gives us the opportunity to directly access the actual cancer progenitor cells responsible for the disease.
If we can directly confirm such an effect of imetelstat on these cancer progenitor cells, we believe it would confirm the hypothesis that imetelstat is a cancer progenitor cell inhibitor. That would differentiate imetelstat and its mechanism of action from other conventional anti-cancer drugs. Although this study is enrolled very slowly because a second site has recently been initiated, we still expect to have sufficient data to make a top line assessment of the drug's effect on these cancer progenitor cells by the end of the year.
We'd also like to make you aware of 2 independently sponsored trials of imetelstat that were initiated in 2011, both of which complement our company-sponsored Phase II program. We would also like to make you aware of 2 -- I'm sorry. The first is a Phase I trial in patients with HER2-positive metastatic breast cancer, in which imetelstat is used in combination with Herceptin. This study is being conducted in Indiana University and is based on preclinical data suggesting that imetelstat may reverse resistance to Herceptin in HER2-positive breast cancer. Approximately 18 patients are expected to be enrolled in the study.
The second independent trial with imetelstat, which is a Phase I NCI-sponsored cooperative group study is being conducted in pediatric patients with refractory or recurrent solid tumors or lymphoma. This trial also includes patients who have neuroblastoma where there is a strong scientific rationale for telomerase inhibition. The study is being conducted by the Children's Oncology Group and is expected to enroll up to 45 patients.
As in the investigator-sponsored study in HER2-positive metastatic breast cancer, we do not control the conduct and timing of this study, and we are not in a position to provide update on these trials as if they were Geron-sponsored trial.
I'd like to now turn briefly to our second clinical stage product candidate, GRN1005. 1005 is a novel peptide drug conjugate designed to utilize a physiologic molecular transport mechanism known as LRP-1 to deliver paclitaxel across the blood-brain barrier into the brain where it can treat brain metastases. There are currently no drug therapies approved for brain metastases, and the therapies that are used have extremely modest activity. Radiation-based therapies are standard of care, but it is toxic, and recurrences after radiation therapy are common. Metastases in the brain continue to represent a large unmet medical need.
1005 was in-licensed from Angiochem in December of 2010 following the completion of Phase I clinical trial. The final Phase I data in solid tumor brain metastases were presented at the AACR-NCI-EORTC Joint Conference on Molecular Targets and Cancer Therapeutics in November of 2011. And they showed encouraging single-agent activity. Patients receiving 1005 had a 20% overall response rate using measurements of both intracranial and extracranial disease. Approximately 24% of patients with brain metastases had a greater than 30% shrinkage and brain lesions, and 50% of patients with lung lesions had a greater than 30% shrinkage in those legions. These data strongly suggest that GRN1005 has activity against cancers inside and outside of the brain compartment, both of which can cause death in patients who have brain metastases.
So in the fourth quarter of 2011, we initiated 2 1005 clinical trial. One in patients with brain metastases from non-small cell lung cancer and a second trial in patients with brain metastases from breast cancer. The non-small cell lung cancer trial is a single-arm, single-agent study evaluating overall response rate, which includes both intra-cranial and extra-cranial disease. And that overall response rate is the primary endpoint.
The breast cancer trial is also a single arm study, which includes 2 cohorts, a cohort of patients with HER2-positive disease and a cohort with HER2-negative disease. There are 50 patients in each of those 2 cohorts. The patients with HER2-positive disease will also be treated with Herceptin. The primary endpoint for the study is intra-cranial response rate.
Although both of these trials have just begun enrollment, investigator interest in early patient enrollment appears strong, and we continue to expect top line data by the end of the second quarter of 2013. We are also pursuing an active discovery research program at Geron with the goal of generating new candidates for our clinical pipeline. It is an important internal effort, and these projects are at an early stage of development and thus, of the details of these projects must remain proprietary.
Finally, I'd like to highlight that we have recently made a number of key new hires, Graham Cooper, who has joined us on this call actually joined the company as CFO in the first week of January this year. He was previously a successful investment banker prior to joining Orexigen as CFO, which he took public in 2007. Stephen Rosenfield, who's a General Counsel at several successful private and public biotech companies in past including Tercica and InterMune, joined us recently as Geron's General Counsel.
I'd like to conclude this call today by sharing with you why I'm very enthusiastic about Geron. First, it's clear to me that our approaches to cancer treatment with both imetelstat and 1005 are unique and have a potential to impact the lives of patients who currently have poor prognoses. With regard to imetelstat, the telomerase enzyme is responsible for the limitless replicative potential that is common to all cancers, and as such, is one of the most important biologic targets in cancer research. However, unlike many other important molecular targets in cancer, there are virtually no other companies in molecules lined up to address this target. And that's because the telomerase enzyme is unique and requires very special chemistry.
It took Geron a long time to develop the necessary nucleic acid chemistry to make this molecule and make it as an effective molecule. So we now have a molecule that inhibits telomerase and has appropriate potency, pharmacokinetics and pharmacodynamic properties to be a lead clinical candidate and, of course, now we're on the brink of finding out whether inhibiting this enzyme will lead to the important clinical benefits we all hope for. If it does, we're in a very good business position. We've developed a substantial intellectual property position due to the highly-innovative nature of the chemistry we had evolved in order to actually make imetelstat and because no other company currently has a telomerase inhibitor in clinical development for pretty much the same reason.
Similarly, 1005, which the company brought in a little over a year ago, is also a first-in-class compound. In this case, with the excellent Phase I data, and it is certainly intended to treat brain metastases for which there are currently no approved drug therapies.
The second reason for my enthusiasm is that Geron has developed strong technical research group over the last number of years, and has now established a high-quality oncology drug development team, the members of which have successfully developed a number of important oncology products. I believe we're well-positioned to develop the products we have in the clinic today in a highly professional and confident manner.
The third reason for my enthusiasm is that we have sufficient financial resources to be able to achieve milestones that have the potential to create significant shareholder value without requiring additional dilution. It's my goal to deploy the company's resources in the most productive manner possible, which I believe we are doing.
So in summary, today, we're building a high-performance organization based on a culture of responsibility, accountability and transparency with the ambition to powerfully impact how cancer is treated.
So thank you very much for attending this call and for your interest in the company. And operator, we'd now be happy to take questions.