John Scarlett
Analyst · FBR & Company. Your line is now open
Thanks, Olivia, good afternoon, everyone and thanks for joining. During the third quarter there were two important events for imetelstat that I would like to highlight. First, two papers on imetelstat were published as back to back articles in the September 3 issue of the New England Journal of Medicine. The paper reported results on Geron's proof of concept study in patients with essential thrombocytopenia and the Mayo Clinic pilot study in myelofibrosis where unprecedented molecular and bone marrow responses were observed in the studies. These data suggest imetelstat has disease modifying activity through the selected innovation of the malignant progenitor cell of the malignant clones responsible for the underlying diseases. The papers are available online in the New England Journal of Medicine website. Also in September the first patient was dosed in the IMbark myelofibrosis study. This study is the first to be initiated under the collaboration with Janssen. As we previously described IMbark is a one to one randomized single blind multicenter Phase 2 clinical study to evaluate the activity of two dose levels of imetelstat either 9.4 or 4.7 mgs/kg. Approximately 200 patients a 100 patients per dosing arm, with DIPSS intermediate-2 or high-risk myelofibrosis who have relapsed after or are refractory to a JAK inhibitor are planned to the enrolled in the study. The co-primary efficacy endpoints are spleen response and symptom response rate. The endpoints -- or these endpoints for the basis for the approval of JAK. Secondary efficacy endpoints include the number of patients achieving CR or PR, CI and a linear spleen and symptoms responses as well as an assessment of overall survival. We believe the depth of response captured by the secondary outcomes is clearly unique to imetelstat and is further validated in the trial will enable clear differentiation of imetelstat effects compared to JAK inhibitors. Exploratory endpoints for the study includes cytogenetic and molecular response as well as Leukemia free survival. We hope these evaluation will lead to more insight into the underlying molecular pathology myelofibrosis and how imetelstat may affect such diseases processes. I would like to use the remainder of our time today to discuss the unmet medical need and myelodysplastic syndromes or MDS and the designers Janssen plan to Phase 2-3 study of imetelstat in patients with lower risk MDS that is expected to be uploaded to clintrials.gov shortly. The term MDS describes a group of disorders associated with malignant progenitor cell clones where both the bone marrow and profile blood cells may have abnormal or dysplastic cell morphology and this is of course with the disorder was originally named for. MDS is characterized clinically by the ineffective production of red blood cells frequently resulting in severe anemia. In addition, low numbers of white blood cells and other cytopenias may cause life-threatening infections or bleeding. Transformation to secondary acute myeloid leukemia or ML occurs in up to 30% MDS cases and results in poor overall survival. MDS is the most common of the myeloid malignancies and is primarily a disease of the elderly. It is believed that approximately 12,000 reported new cases in the U.S. every year and the approximately 60,000 people estimated to be living with the disease may be an underestimate of the incidence in prevalence. The majority of patients approximately 70% fall into what is considered to be lower risk groups at diagnosis. According to the International Prognostic Scoring System or IPSS that takes into account the presence of a number of disease factors such as side cytopenias, cytogenetic and blast counts and assigns relative risks of progression to acute leukemia and overall survival. When initially diagnosed with MDS approximately 80% of patients have anemia or low red cell counts and low hemoglobin. Chronic anemia is a predominant clinical problem in lower risk MDS. Many of these patients become dependent on blood transfusions which can lead to elevated levels of iron in the blood and the other tissues that the body has no normal way to get rid of. Iron overload is potentially dangerous condition. Studies in patients with MDS have shown that iron overload resulting from regular blood cell transfusions is associated with poor overall survival and a higher risk of developing leukemia. This negative effect on survival depends on the number of red cell transfusion received per month. Two units per month may reduce life expectancy by up to 50%. The primary goal of therapy for lower risk patients with anemia is to restore or improve the production of red blood cells so that patients can become transfusion independent. Current treatment options for anemia are inadequate. Development of targeted therapies for MDS is not yet been successful and no new drug has been approved for MDS in the United States since at least 2006. Erythropoiesis Stimulating Agents or ESAs such as Epo improve anemia in approximately 60% of patients but the effect is transient with a median duration of responsible of approximately three years. Those patients who do not respond or who relapse quickly are predicted to have a poor survival. When Lenalidomide or Revlimid is approved for transfusion dependent anemia in the 10% to 20% of MDS patients who have a particular cytogenetic abnormality known as the LIP5Q and which a portion of the cells in their bone marrow have a dilution of long arm as chromosome 5. In a recent clinical trial of linomide in patients without 5Q and who are resistant to ESAs, approximately 27% became transfusion independent with a medium duration of just eight months. The initial testing of imetelstat patients in MDS occurred in the Mayo Clinic pilot study conducted by Dr. Ayalew Tefferi. Preliminary data from these patients have been accepted as an oral presentation at the 57th American Society of Hematology or ASH and the Annual Meeting to be held in Orlando, Florida from December 5 to December 8. Accepted abstract were published this morning on the ASH website. In Dr. Tefferi study nine patients with MDS-RARS were treated with imetelstat. MDS-RARS stands for refractory anemia with ringed sideroblasts and is a subtype of MDS in which patients have an increased risk of progression to AML and shortened survival. Seven of the patients in Dr. Tefferi’s studies were classified by IPSS as intermediate one risk and two patients were intermediate two risk. At the start of the study all patients were anemia with hemoglobin of less than 10 g/dL and eight of the nine patients were considered to be transfusion dependent according to the 2006 IWG criteria for MDS. Seven of the nine patients have received prior treatments including six previously received ESAs. All nine patients were given imetelstat as a starting dose of 7.5 mg/kg every four weeks. This was lower than the dose of 9.4 mg/k every three weeks given to the MF patients and Dr. Tefferi’s other cohort MDS study and that was in order to minimize the risk per myelosuppression in patients with already compromised bone marrow. The abstract used made the 2015 as a cutoff date for data and reported the medium duration of treatment of imetelstat to be 13.7 months with a range of 6.6 to 17.9 months. During treatment with imetelstat three of the eight patients or 38% who had been deemed transfusion dependent at the start of the study became transfusion independent, which was defined as not requiring transfusions for at least eight weeks. Among these patients transfusion independent started between weeks 9 and 14 of treatment and the medium duration was 28 weeks with a range of 9 to 37 weeks. As of the data cutoff abstract four patients remained on active treatment. Five patients discontinued treatment for the following reasons. One patient died during active therapy deemed unrelated to imetelstat. One patient was diagnosed with a second malignancy. One patient progressed into acute leukemia and two patients were deemed to have an insufficient response. Safety data are consistent with prior imetelstat study and information is reported in the abstract. Additional and updated efficacy and safety data will be reported during the oral presentation in December. The planned MDS study of imetelstat to be conducted by Janssen named emerge is a Phase 2-3 clinical study to evaluate imetelstat in transfusion dependent patients with IPSS low or intermediate one risk MDS following prior treatment with an erythropoiesis stimulating agent or ESA. Multiple medical centers across North and South America Europe and Asia are planned to participate in this clinical trial with the first side expected to be open for patient enrollment by the end of 2015. Details of the study designed and eligibility criteria as well as participating medical centers that will be updated on an ongoing basis will be made available to the public on the clintrials.gov website. Today, I would like to describe the basic design of the Emerge study and comment on the rational for several of the design elements. The study will consist of two parts and approximately 200 patients will be enrolled. Part one is a Phase 2 open label single arm design to assess the safety and efficacy of imetelstat. Up to 30 patients will be enrolled in part one and all will receive imetelstat. Janssen will review and asses data in part one and if supportive of a satisfactory benefit risk profile part two of the study will be initiated. Part two is a Phase 3 double blind randomized placebo controlled design to compare the efficacy of imetelstat against placebo. Approximately 170 patients will be enrolled in part two and will be assigned randomly in a 2:1 ratio to receive either imetelstat or placebo. Part two has been designed to enable registration of the drug for approval if the data from the trail are positive. The inclusion criteria for the study require, excuse me, the inclusion criteria for the study require that at the time of enrollment, each patient must be red blood cell at transfusion dependent. imetelstat for placebo in part two will be administered as an intravenous infusion. The starting dose will be 7.5 milligrams for kilogram every four weeks. The dose may be escalated according to certain conditions laid out in the protocol. Dose reductions for adverse events will follow protocol cost specified algorhythm. All patients will receive supportive care including transfusion or myeloid growth factors as needed per investigator discussion and according to local standard practices. The primary efficacy endpoint for both parts of this study is the rate of red blood cell transfusion independents lasting at least eight weeks defined as the proportion of patients without any red blood cell transfusion during any consecutive eight weeks since entry to the study. Excuse me, transfusion independents were eight weeks is a clinically meaningful and robust endpoint, which is included in the 2006 IWG response criteria for MDS and has been the basis for regulatory approvals in MDS. The secondary efficacy endpoints for both parts of this study included proportionate patients achieving red blood cell transfusion independents lasting at least 24 weeks as well as the time to and duration of red blood cell transfusion independents. In addition the proportion of patients achieving hematologic improvement including what is referred to as hematologic improvement erythroid and the proportion of patients achieving CRs or PRs both for 2006 IDVG criteria will be assessed. Assessment of CR and PR will capture the depth of the response. Other secondary endpoints include the proportion of patients requiring red blood cell transfusions and the amount, the proportion of patients requiring the use myeloid growth factors in the dose as well as assessments of the change in the patient's quality of life using several different validated instruments. Patients will be followed for an assessment of overall survival and time to progression to AML. The time to progression to AML and overall survival are important endpoints considering the natural history of the MDS includes transformation to acute leukemia in a meaningful proportion of patients. Safety outcomes will be assessed by procedures and measures consistent with previous imetelstat studies and include enhanced data collection and reporting for hepatobiliary associated laboratory filings and adverse events. The primary analysis of efficacy from both parts of the study is schedule to occur 12 months after the last patient is enrolled. The decision to advance from part one to part two of the study is not dependent on the primary analysis and may occur on the basis of an internal review by Janssen of the open label data to determine whether the data is supportive of the satisfactory benefit of this profile. The primary analysis will also evaluate secondary endpoints. We expect to report topline results from the primary analysis from part two of the study and that detailed information will be subsequently submitted for presentation at a future medical conference. We remain very enthusiastic about imetelstat and are pleased with the progress that Janssen has been making with the drug. The launch of two big clinical trials within one year of announcing collaboration is quite a remarkable accomplishment even for a company with the resources and expertise of Janssen. As we've indicated since announcing our collaboration with Janssen, imetelstat is our sole product and we would therefore like to diversify our pipeline. We're seeking new oncology products, programs or companies that we believe to be exciting and a strategic fit both scientifically and from business perspective to maximize the potential of our company for shareholders. We continue to conduct a substantial and meaningful effort to evaluate a number of potential candidates and we cannot say whether this will result in a transaction. However performing a rigorous and comprehensive process takes time and we're not in a position to make further comments about future timing of such transactions if any on the call today. Before we open the call to questions, I wanted to finish by conforming that there will be two oral presentations at ASH related to imetelstat. In addition to Dr. Tefferi's oral presentation of the data that we just described for the MDS large cohort of the male pilot study there will also be an oral presentation of data from the proof of concept study in ET investigating the dynamics of additional mutations besides JAK2, V617F CALR and nipple mutations following imetelstat treatment. Both presentations are scheduled to occur in the same session entitled Myeloproliferative Syndromes Clinical Early and Late Stage Trials in MPMs. This will be held on Saturday December 5, 2015, between 9:30 and 11 AM Eastern Time. A third imetelstat abstract containing nonclinical data evaluating the activity of the imetelstat in a non-clinical model of AML was selected for presentation as a poster in a Saturday evening poster session. This information is also contained in a press release we issued this morning. We are planning to host a webcast event for investors and analysts to discuss the data presented at ASH as well as the designs of the Phase 2 embark and Phase 2-3 emerge studies being conducted by Janssen. Stay tuned for more information and we look forward to seeing you there. Thank you for listening. I would be very pleased to answer questions in the time we have remaining. So with the operator let's open the call to questions please.