David Berman
Analyst · Jefferies. Please proceed with your question
Thank you very much, Ralph We continue to make good progress in our oncology and infectious disease clinical pipeline. And today, I'm going to focus on two programs. First, I'm going to share recently published KIMMTRAK data, which we believe provide insights for how we will develop PRAME. And second I'm going to update you on PRAME, including the original 18 melanoma patients from ESMO, and I'm very proud to also introduce our new Phase 3 study in first-line cutaneous melanoma. We presented the Phase 3 first-line ctDNA data for KIMMTRAK result at AACR earlier this year. And there are two points that I take from these data. First, a majority of patients are benefiting from KIMMTRAK since most patients are having ctDNA reduction. And second, KIMMTRAK has higher activity in first-line compared to second-line based on the three-fold higher rates of ctDNA clearance. This informs for our platform including PRAME, that where possible we should strive to move to earlier lines of therapy. Also at AACR, we presented that KIMMTRAK at three years has long-term survival benefit in second-line uveal melanoma compared to historical controls. We have been following these patients to look for a long-term survival tale since this is the hallmark of other IO therapies such as checkpoints. These data are very encouraging and we will share that three-year survival update on the first line Phase 3 study later this year. The emergence of the long-term survival benefit, however, increases our confidence that this platform can be transformative to patients, and we hope to extend with PRAME to other tumors. Turning to cutaneous melanoma. We recently published the final results for KIMMTRAK plus checkpoint combinations. Most of the data has previously been shared. However, there were several insights I would like to emphasize. First, the durability of partial responses and disease control for this combination is remarkable with some ongoing for over two years. This increases our interest to study PRAME plus checkpoints. Second, the safety profile was consistent with each therapy alone, providing confidence for combining PRAME safely with checkpoints. And finally, we have historically dosed ImmTAC's monotherapy on a weekly basis. However, we had hypothesized that we can switch to less frequent dosing when impacts are combined on a backbone of an active therapy and after initial disease control. In this study, we successfully piloted switching from weekly to monthly KIMMTRAK at one year with most of these patients maintaining their disease control. This provides confidence for doing similar with PRAME. These are some of the many insights we are applying to the PRAME program. At ESMO '22, we shared the initial PRAME monotherapy Phase 1 data that led to the expansions in melanoma, lung, endometrial, and ovarian carcinoma as a monotherapy in heavily pretreated patients and in combination with standards of care, since this will allow us to move into early lines of therapy. We always anticipated to see signals earlier in some tumors that would provide confidence to start registrational trials. And today, I am very pleased to announce our first Phase 3 registrational trial, PRISM-301 in first-line cutaneous melanoma. Here with the ESMO melanoma data we shared last year, which included 18 melanoma patients; seven cutaneous melanoma, all had prior ipilimumab and either nivolumab or pembrolizumab; and 11 uveal melanoma patients, roughly half of which were tebentafusp naive and have had prior tebentafusp. Here is an update on those original 18 melanoma patients. We continue to see strong durability, including partial responses ranging from 6 months to 17 months. Even in some patients with tumor shrinkage did not meet the criteria for a RECIST partial response, we see durable disease control. Some of these patients are still on therapy. The cutaneous melanoma activity is remarkable to me given these patients are heavily pretreated and the fact that F106C is being administered as a monotherapy. As a monotherapy, the durable responses and disease control from F106C in melanoma were clearly compelling. This, coupled with the well-tolerated safety profile, our belief in combinability with checkpoints and the insights that our platform will work best in a first-line setting let us to consider opening a Phase 3 first-line melanoma trial with the primary endpoint of progression-free survival. In additional to the original 18 patients, the emerging data from the newly enrolled cutaneous melanoma patients, which although has less follow-up, increases our conviction to start the Phase 3 trial now. Finally, the platform insights into how we can design a more patient friendly and less frequent dosing regimen in first-line solidified our decision to move forward. We had a successful Type B meeting with the FDA who agreed to the Phase 3 design and for us to start the study now. And I will walk you through that study design. PRISM-MEL301 was designed with help from global melanoma experts and input from the FDA. We will randomize previously untreated metastatic cutaneous melanoma patients who are HLA-0201 positive in two arms, the experimental arm, nivolumab plus F160C versus a control arm of either nivolumab or nivolumab plus relatlimab. The selection of therapy within the control arm will be country-specific and will not be investigator choice. This is the first Phase 3 trial we are aware of to randomize to a controller that includes checkpoint doublet. The primary endpoint is progression-free survival and the secondary endpoint are survival and response rate. The F106C regimen, shown on the slide, reflects a growing confidence on how to dose ImmTAC when in combination with an active backbone. Because we had multiple doses that were clinically active and well tolerated, we agreed with the FDA to include an initial randomization to two F106C doses, 40 micrograms and 160 micrograms. This approach is consistent with FDA's Project Optimus. We will drop one of the two F106C doses after an initial interim analysis. But importantly, there is no pause in their recruitment and all patients in the go-forward dose are included in the intent-to-treat analysis. This is a really exciting time for us at Immunocore. The PRISM-MEL-301 study represents the first Phase 3 study for the PRAME target and for a TCR therapeutic in first-line cutaneous melanoma, which is one of the largest melanoma indications, an opportunity of over 10,000 patients per year. The Phase 1/2 Study 101 is still enrolling the four monotherapy expansions at the 160-microgram dose. And we continue to look at the other tumors, lung, ovarian, and endometrial for the next tumor for development. Per the Project Optimus FDA discussions, we will also enroll some more patients with the same tumor types in the 40-microgram cohort, which will serve to help confirm the dose. The combinations with standard of care are also progressing and these will provide safety that will allow us to move into the early lines where we believe our platform will be most active. Finally, based on our excitement for PRAME, we are building a franchise around this target with our half-life extension and our PRAME-A24 programs on track for regulatory submissions next year. I'm now going to hand it back to Bahija.