Troy Wilson
Analyst · Cowen. Your line is now open
Thank you, Pete, and thank you all for joining us this afternoon. I'd like to start by introducing the two newest members of our senior leadership team, Kathleen Ford, our Chief Operating Officer; and James Basta, our Chief Legal Officer. Kathy, joined us in July, at a time when strategic prioritization and operational execution became our highest priorities, and she has made an immediate impact. She most recently served at Merck Serono, where she lead clinical and development operations towards successful drug registrations in both the U.S. and Europe. Jim, joined us just yesterday from Biogen, where he spent the past 13 years, most recently as Senior Vice President, Chief Corporation Counsel. He brings a healthy balance of strong business partnering and corporate guardianship, and we're excited to have him on Board. Both are welcome additions to our team. Now, let me bring you up to speed on each of our programs beginning with tipifarnib in HRAS mutant solid tumors. Last week, we reported updated data from our ongoing Phase 2 trial of tipifarnib in HRAS mutant head and neck squamous cell carcinomas, at the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics or the Triple Meeting in Boston. We were very pleased because the results demonstrate a compelling level of clinical activity for tipifarnib in a difficult to treat patient population. They validate our strategy to enrich for clinical activity and the data strongly support the design of our ongoing AIM-HN registration-directed trial. However, before I discuss the significance of these results in more detail, let me quickly recap the data themselves. As of the October 17, 2019 data cut-off date, a total of 21 HNSCC patients with high HRAS mutant variant allele frequency were enrolled in the ongoing RUN-HN trial, of whom 18 were valuable for efficacy. 10 of the 18 efficacy evaluable patients achieved a confirmed partial response for an objective response rate of 56%. In addition, eight patients experienced disease stabilization, including two who achieved an unconfirmed PR, one of whom was awaiting a confirmatory response assessment as of the data cut-off date. The median progression-free survival of the 18 evaluable patients treated with tipifarnib was 6.1 months compared to 2.8 months on their last prior therapy, including 8.3 months among patients who achieved a PR on tipifarnib, and 4.5 months for those patients with stable disease. Patients had a median of two prior lines of therapy ranging from 0 to 6, with no responses observed on their last prior therapy. As a reminder, the overall response rate for the three therapies currently approved for the treatment of HNSCC in the second line, pembrolizumab, nivolumab and cetuximab range from 13% to 16%, with progression-free survival of approximately two months. Recall that in our previous update from the RUN-HN trial presented at the European Society for Medical Oncology Conference or ESMO in October 2018, the data showed a significant association between tumor, HRAS mutant allele frequency and clinical benefit from tipifarnib. We also reported that although the trial was evaluating starting doses between 600 and 900 milligrams BID, our retrospective analysis of patients on study revealed that due to interruptions and discontinuations at the higher dose, the median dose for patients at the end of cycle one was approximately 600 milligrams BID. Based upon these observations, we introduced two changes into the RUN-HN study. First, we require a minimum HRAS mutant variant allele frequency, as an entry criterion for enrollment. And second, we established 600 milligrams BID as the starting dose. Notably, we implemented the same changes to the protocol for our AIM-HN registration directed trial, which was initiated shortly thereafter in November 2018. Since the ESMO 2018 update a year ago, we prospectively enrolled 10 new patients with high HRAS mutant variant allele frequency in the RUN-HN trial. Of the eight efficacy evaluable patients, three achieved a confirmed PR, five had stable disease, including two patients who achieved an unconfirmed PR, one of whom is pending a confirmatory response assessment. Of the two, non-evaluable patients, one discontinued prior to an initial tumor response assessment, the other was awaiting an initial response assessment as of the data cutoff date. With regard to dose, a total of five efficacy evaluable HNSCC patients started at the 600 milligram dose in the RUN-HN trial, all of whom achieved an objective clinical response. We believe there are three key takeaways from last week's RUN-HN update. Number one, the requirement of a minimum HRAS mutant variant allele frequency suggest an effective means to enrich for clinical activity in patients with HRAS mutant HNSCC. Number two, the 600 milligram BID starting dose appears to be better tolerated in this patient population and sufficient to drive durable anti-tumor activity. And number three, given that the run RUN-HN trial is a multi-center study, including more than 30 clinical sites around the world, the data reflect valuable real-world experience with tipifarnib in this clinical setting. Taken together, the results presented at the Triple Meeting reinforce our view that tipifarnib can provide meaningful clinical benefit to HNSCC patients, with HRAS mutations, and they further increase our confidence in the design, outcome, and probability of success of AIM-HN, our registration directed trial of tipifarnib in HRAS mutant HNSCC. AIM-HN was initiated exactly one year ago and is now open in more than 75 clinical sites in the U.S., Europe, and Asia. The AIM-HN study is designed to enroll at least 59 evaluable HNSCC patients with high HRAS mutant variant allele frequency, who have received prior platinum-based therapy. We continue to believe that the AIM-HN study will take approximately two years for full enrollment. However, given the design of the study, there is the potential that the primary efficacy endpoint of AIM-HN could be met if and when 15 confirmed objective responses are observed. Also, it's worth noting that since the introduction of the minimum HRAS mutant allele frequency requirement, we continue to find that approximately 5% of the patients we screen meet the HRAS variant allele frequency requirement for enrollment. Our primary goal for the tipifarnib programs is to generate a data package sufficient to support a first application for marketing approval in HRAS mutant HNSCC. However, with the compelling signals of activity demonstrated from the Triple Meeting data, we're also evaluating how we might pursue opportunities for combination with immune therapy, chemotherapy, and cetuximab in the broader population, including the lower HRAS mutant variant allele frequency population. Given the role of HRAS mutations is a mechanism of resistance to standard therapies, we believe tipifarnib could potentially be expanded to 15% to 20% of the HNSCC population, a meaningful commercial opportunity and one in which today, there are no direct competitors to tipifarnib. Although we believe combinations in earlier lines of therapy in HNSCC represent immediate opportunities for future label expansion for tipifarnib, we're also laying the groundwork for expansion to other HRAS mutant solid tumor indications. For example, in September, we reported that an investigator-sponsored Phase 2 trial of tipifarnib in HRAS mutant urothelial carcinomas met its primary efficacy endpoint prior to completion of enrollment. The trial is being conducted at the Samsung Medical Center in Seoul, South Korea. Further analysis of the trial is ongoing and data are expected to be presented at a future medical meeting. In addition, an investigator-sponsored Phase 2 trial of tipifarnib in lung squamous cell carcinomas continues to enroll patients. The trial is being conducted by a lung cancer consortium. They consist of more than 150 public and private oncology centers in Spain. Meanwhile, the discovery of CXCL12 pathway biomarkers offers the potential to expand the opportunity for tipifarnib well beyond HRAS mutant solid tumors. In June, we showed the first prospective validation of CXCL12 pathway biomarkers to enrich for clinical activity in our ongoing Phase 2 trial of tipifarnib in peripheral T-cell lymphoma, including a 50% complete response rate and a 100% clinical benefit rate in a subset of heavily pretreated patients with angioimmunoblastic T-cell lymphoma or AITL. An aggressive form of T-cell lymphoma often characterized by high levels of CXCL12 expression. We believe the Phase 2 proof of concept data in PTCL, AITL presented at the European Hematology Association Congress and International Conference on Malignant Lymphoma earlier this year, support multiple registrational opportunities in relapsed-refractory lymphoma. And we continue to gather feedback from key opinion leaders and regulatory authorities around next steps for this program. Given the high level of clinical activity observed thus far in the AITL cohort, we continue to enroll patients in that cohort in order to acquire more experience regarding safety and tolerability in this patient population. I'm pleased to report that additional data, including new patients from the AITL cohort, have been accepted for an oral presentation by Dr. Thomas Witzig of the Mayo Clinic at the upcoming American Society of Hematology Annual Meeting in December. Based on our growing body of data, we believe CXCL12 pathway biomarkers may have the potential to unlock the therapeutic value of farnesyltransferase inhibition across multiple hematologic and solid tumor indications, including diffuse large B-cell lymphoma, acute myeloid leukemia, cutaneous T-cell lymphoma, and pancreatic cancer. Over time, we believe this would enable registrational strategies for tipifarnib in multiple hematologic and solid tumor indications. In further support of our development strategy for tipifarnib, I'm pleased to report that the U.S. Patent and Trademark Office recently issued a new patent, further extending our exclusivity to the use of any farnesyl transferase inhibitor for the treatment of CXCL12 expressing PTCL or AML. This adds to our growing portfolio of patents involving CXCL12 pathway biomarkers, and it follows the issuance of another patent this year, directed to a method of treating patients with advanced metastatic relapsed or refractory HRAS mutant HNSCC, using any farnesyltransferase inhibitor. These new patents expire in 2037 and 2036, respectively, excluding any possible patent term extension. We believe these new patents strengthen our competitive advantage as we continue to advance the development of tipifarnib and we intend to continue to aggressively pursue intellectual property protection, both in the U.S. and abroad. Now, let's spend a moment on each of the emerging pipeline programs beginning with our ERK inhibitor KO-947. KO-947 is a potent and selective small-molecule inhibitor of ERK which we are advancing as a potential treatment for patients with tumors that have dysregulated activity of the MAPK pathway. Our preclinical data suggest that KO-947 has anti-tumor activity in KRAS or BRAF mutant adenocarcinomas, as well as certain subsets of squamous cell carcinomas. We continue to evaluate dosing regimens for KO-947, including a once-weekly dosing schedule and a more frequent intermittent schedule with a goal of reaching a recommended Phase 2 dose or maximum tolerated dose by the end of this year or early next year. We were encouraged to see data from an early stage ERK inhibitor presented at the Triple Meeting last week, including single-agent responses using a similar weekly dosing schedule with intermittent therapy. Although most of the patients enrolled in our study to date have been in more difficult to treat populations such as pancreatic and colorectal cancer, the observation of single-agent responses from an ERK inhibitor support our confidence to move forward with KO-947. continue to believe our Phase 1 strategy will provide a solid foundation to make data-driven decisions on the path forward for KO-947. Our other emerging pipeline program is KO-539, a potent selective small-molecule inhibitor of the menin-mixed lineage leukemia or menin-MLL protein-proteign interaction. Our preclinical data for KO-539 support the potential for potent anti-tumor activity in multiple genetically-defined subsets such as tumors with MLL fusions or rearrangements, as well as NPM1 mutation. In September, we dosed the first patient in our Phase 1 clinical trial of KO-539 in patients with relapsed or refractory acute myeloid leukemia, giving us our third wholly-owned clinical-stage oncology asset. The Phase 1 open-label dose-escalation study is designed to determine the maximum tolerated dose of KO-539, which will be administered as a once-daily oral dose in 28 continuous day cycles. Upon completion of the dose-escalation portion of the trial, expansion cohorts are planned to assess the safety and activity of KO-539 in specific genetic subgroups, such as NPM1 mutant. We believe KO-539 represents a differentiated approach to the treatment of patients with AML, and we look forward to sharing further updates with you. With that, I'll now turn the call over to Marc for a discussion of our financial results for the third quarter of 2019.