Thane Wettig
Analyst · William Blair. Your line is open
Thank you, Joanne. Good afternoon, everyone, and welcome to our first quarter 2025 earnings call. On today's call, I will provide a status update on the transformation of FibroGen, which includes the divestiture of FibroGen China and a laser focus on our U.S. pipeline opportunities, specifically the exciting prospects for FG-3246 and FG-3180, our potential first-in-class antibody drug conjugate targeted in CD46 and our PET imaging agent in metastatic castration-resistant prostate cancer and for Roxadustat in the treatment of anemia due to lower-risk myelodysplastic syndrome. Then David DeLucia, our CFO who will review the financials, after which we will open the call for your questions. On Slide 3, I would like to highlight the strategic priorities we've set forth for FibroGen this year. I'll begin by providing an update on the sale of FibroGen China to AstraZeneca. As we've stated previously, this is a truly transformative transaction for FibroGen as it simplifies our operations, allows for the payoff of our term loan facility with Morgan Stanley tactical value and provides the most efficient pathway to access the company's net cash held in China. At the time of the announcement in February, the total consideration for the sale was expected to be approximately $160 million which included an equity value of $85 million and expected net cash in China of approximately $75 million. We are pleased to share that we expect the total consideration to now be approximately $185 million, which is a $25 million increase from our initial guidance due to greater than expected net cash in China at closing. Importantly, the increase in expected proceeds extends the company's cash runway into the second half of 2027. We now expect the transaction to close in the third quarter of this year. Second, we remain hyper focused on advancing FG-3246 and FG-3180 in metastatic castration-resistant prostate cancer or mCRPC, in which we continue to make important progress. We recently announced in March the publication of the full trial results from the Phase 1 monotherapy study of FG-3246 in patients with mCRPC in the Journal of Clinical Oncology, which highlights the promising potential of its anticancer activity, especially when considering the unselected heavily pretreated patient population. We believe the trial results demonstrate that the CD46 target is active and provide key insights into the potential clinical impact of targeting CD46 expressing tumors. We are excited to share that we've recently received notification from the FDA clearing the IND for FG-3180, our companion PET imaging agent. This marks an important achievement for FibroGen as it paves the pathway for FG-3180 to be used alongside FG-3246 in the upcoming Phase 2 dose optimization monotherapy trial, which is expected to start in the third quarter. Third, for Roxadustat, FibroGen recently filed a Type C meeting request with the FDA to gain feedback on the potential path forward for Roxadustat in anemia associated with lower-risk myelodysplastic syndromes, an indication with significant unmet medical need. In the post hoc subgroup analysis from the MATTERHORN Phase 3 trial, Roxadustat showed promise in reducing transfusion dependence in patients with a higher transfusion burden at baseline. We expect FDA feedback in the third quarter that will provide important clarity on the path forward for Roxadustat in the U.S. with the aim of realizing additional value for this wholly-owned asset. Altogether, we are confident that our refined focus, multiple near-term catalysts across both clinical programs and our existing strong foundation position us well to create value for shareholders now and in the future. I will now provide a brief overview of our FG-3246 and FG-3180 programs in mCRPC. Slide 5 highlights the high unmet need in late stage prostate cancer. There are approximately 290,000 men diagnosed with prostate cancer each year in the U.S. Of these, there are 65,000 drug treatable patients where the cancer has metastasized and become castrate resistant, resulting in a grim five year survival rate of approximately 30%. There remains a significant opportunity for new treatments that can extend survival for these men with a total addressable market of well over $5 million in annual sales. FG-3246 could become a non-PSMA treatment option that is so desperately needed given the significant unmet need in mCRPC. Turning to Slide 6, we highlight the novelty of our target, a tumor selective epitope of CD46. CD46 and this specific CD46 epitope have several distinguishing features. First, CD46 is upregulated during tumorigenesis and helps tumors evade complement dependent cytotoxicity. The CD46 epitope is highly expressed in mCRPC tissues with lower inter patient variability and higher median expression compared with PSMA as depicted in the graph on the right hand portion of the slide. Importantly, the expression of CD46 is upregulated in the progression from localized castration sensitive prostate cancer to metastatic castration-resistant prostate cancer and further overexpressed following treatment with androgen signaling inhibitors. And the CD46 epitope is also overexpressed in colorectal cancer and other solid tumors. Turning to Slide 7, FG-3246 is a potential first-in-class ADC in development for mCRPC with a novel targeting antibody YS5, which binds to the tumor selective epitope of CD46 along with an MMAE payload. MMAE is a validated payload that is approved as a part of a number of ADCs and other oncology indications. FG-3246 represents an androgen receptor agnostic approach, clinically differentiating it from other prostate cancer treatments currently in development. A companion PET imaging agent, FG-3180, utilizes the same YS5 targeting antibody as FG-3246 and is also under clinical development. In preclinical studies, the PET imaging agent has demonstrated specific targeting of and uptake by CD46 positive tumor cells. We believe that having a patient selection biomarker would not only allow us to better enrich the patient population in the Phase 3 portion of the clinical development program, it would also enable differentiation for FG-3246 in the prostate cancer treatment paradigm. In addition, FG-3180 could represent an important commercial opportunity as a companion diagnostic to FG-3246, similar to the existing PSMA PET agents such as Pylarify. We are excited to announce that we have recently received IND clearance for FG-3180 paving the way for the FG-3180 to be an important component for the upcoming Phase 2 dose optimization study that I will touch on in a moment. Slide 8 recaps the top line results from the Phase 1 monotherapy study with full details published in the peer reviewed Journal of Clinical Oncology in March of this year. The completed monotherapy study included a total of 56 metastatic castration-resistant prostate cancer patients who were biomarker unselected and were heavily pretreated, receiving a median of five lines of therapy prior to FG-3246. In the efficacy evaluable population of 40 patients, a median radiographic progression free survival of 8.7 months was observed. There was an overall response rate of 20% confirmed by RECIST 1.1 and PSA reductions of greater than 50% were achieved in 36% of patients. Adverse events were consistent with those observed with other MMAE-based ADC therapies. Additional highlights from the JCO publication include expression of CD46 being observed in 80% of evaluable biopsies in patients enrolled during the dose expansion phase, which is consistent with results previously reported from a prospectively obtained cohort of patients who underwent metastatic CRPC biopsy. 20 patients had a valuable circulating tumor DNA at baseline on treatment defined as before the cycle two day one dose and at the end of treatment or disease progression. In nine of these 20 patients or 45% of those evaluable, there was a greater than 50% decline from baseline in ctDNA fraction after just one cycle of treatment. A tighter dose response relationship appeared to be observed for objective tumor response by imaging as opposed to serum PSA decline, which may be related to the independence of CD46 from the androgen signaling pathway and expression of CD46 in androgen receptor independent tumor clones. And finally, antitumor activity was observed in patients who had received more than one previous line of ARPI therapy as well as those who had received taxane chemotherapy in the metastatic castration sensitive setting, the latter being notable given similar mechanisms of action of taxanes and MMAE. Based on the totality of the data from the Phase 1 monotherapy trial, we are encouraged by the clinical activity of FG-3246 in targeting CD46 in mCRPC. On Slide 9, we highlight the rPFS results of FG-3246 in this Phase 1 study versus other comparable early stage studies. As covered on the previous slide, the Phase 1 study of FG-3246 demonstrated an rPFS of 8.7 months across a robust sample size of 40 heavily pretreated patients. While we cannot make direct comparisons to these trials due to the differences in study design and prior prostate cancer treatments, we are encouraged by these rPFS results, which is a recognized regulatory endpoint in prostate cancer trials. On Slide 10, we highlight previously reported preliminary efficacy data from the Phase 1b portion of the ongoing investigator sponsored combination study with Enzalutamide. These interim results included data on 17 biomarker unselected patients, 70% of which were pretreated with at least two prior ARSIs. In addition to establishing the Phase 2 dose of FG-3246, the IST also demonstrated an encouraging 10.2 months of radiographic progression free survival with PSA declines observed in 71% of evaluable patients. We expect to report the Phase 2 top line results in the fourth quarter of this year, which will also include data on CD46 expression in patients treated with FG-3180, our PET biomarker during the Phase 2 portion of the IST. On Slide 11, we depict a comparison of the initial results from the monotherapy trial in heavily pretreated patients and the combination trial for FG-3246 versus the rPFS results from second line therapies in late stage trials. Again, while we cannot make direct comparisons to these trials due to the differences in study design and previous prostate cancer treatments, we are encouraged that FG-3246 demonstrates what we believe to be competitive rPFS results. Slide 12 highlights the Phase 2 monotherapy dose optimization trial design that is based on our discussion with the FDA. We plan to initiate the study next quarter and expect to enroll 75 patients in the post-ARSI pre chemo setting across three dose levels to determine the optimal dose for Phase 3 based on efficacy, safety and PK parameters. It is important to note that FG-3180 will be an integral part of the study as we seek to demonstrate the correlation between CD46 expression and response to the ADC in this all comers population. One other important design element is the use of G-CSF as primary prophylaxis to mitigate Grade 3 or greater adverse events associated with neutropenia commonly seen with MMAE payloads. The addition of G-CSF may enable a better tolerated and more consistent treatment with the ADC, minimizing dose interruptions or dose reductions, extending duration of therapy and potentially enhancing the efficacy of the ADC. We are planning an interim analysis in the second half of 2026, which will include efficacy, safety, PK and exposure response data and we intend to share relevant data to all stakeholders as they become available given the open label design. Slide 13 highlights why we are so optimistic about the potential for our Phase 2 study to further build upon the strong efficacy seen in the Phase 1 study. We believe there are three factors that could drive rPFS even higher than the 8.7 months that was observed in the Phase 1 monotherapy trial. First, preliminary evidence of an exposure response relationship, which allows us to focus our Phase 2 study on three of the highest tolerated doses from the Phase 1 dose escalation and expansion study; second, utilizing primary prophylaxis with G-CSF to combat against neutropenia, potentially allowing patients more consistent exposure to the ADC with fewer dose interruptions or adjustments; third, enrolling patients in earlier lines of therapy versus the median five prior lines of therapy in the Phase 1 trial. We believe that these design elements have the potential to improve upon the Phase 1 results and achieve an rPFS in the 10 to 12 month range, which we believe is the benchmark for commercial competitiveness. On Slide 14, we show our long-term development strategy for FG-3246 and FG-3180, which we believe provides significant optionality in prostate cancer. We have a robust Phase 2 monotherapy trial in the pre-chemo setting in mCRPC to further build upon the compelling efficacy data of 8.7 months of rPFS in 40 heavily pretreated biomarker unselected patients from the Phase 1 monotherapy study. In addition, this study will explore the correlation between CD46 expression and response to the ADC, potentially validating FG-3180 as a predictive patient selection biomarker in future studies. We are confident that our development pathway for FG-3246 unlocks sequential or parallel registration pathways as FG-3246 will be evaluated in multiple lines of therapy in monotherapy and or in combination with an ARSI and in an all comers population or patients with high expression of CD46. Slide 15 shows the recent and upcoming catalysts for the FG-3246 and FG-3180 program. We are very pleased to have received IND clearance for FG-3180 as this marks an important milestone as we explore its potential to be used as a diagnostic tool and potential biomarker for patient selection in the treatment of mCRPC. We plan to initiate the Phase 2 monotherapy trial in the third quarter, which will include FG-3180 to enable assessment of its diagnostic performance and the potential correlation between CD46 expression and response to FG-3246. To summarize on Slide 16, FG-3246 targets a novel epitope on prostate cancer cells with first-in-class potential. It is important to note that there are no other CD46 targeted projects in clinical development. Targeting CD46 with FG-3246 has already demonstrated promising early efficacy signals with an acceptable safety profile, both in monotherapy and combination settings. We are excited for the upcoming milestones and look forward to updating you on the program as the studies progress. Turning to Roxadustat. Slide 18 highlights the unmet need and the potential for Roxadustat in patients with anemia associated with lower-risk MDS. There is a lack of effective second line and beyond treatments given that the currently available therapies are only effective in approximately 50% of patients. In addition, there are no oral options available or in late stage development, which could be a meaningful differentiator for Roxadustat and potentially translate into a significant commercial opportunity. Moving on to Slide 19, we highlight data from the Phase 3 MATTERHORN study of Roxadustat in a subgroup of patients with anemia of lower-risk MDS who entered the trial with a higher transfusion burden. In this post hoc analysis Roxadustat demonstrated a meaningful difference in transfusion independence versus placebo, results that are highly similar to the pivotal trials for two recently approved therapies for anemia associated with lower-risk MDS. On Slide 20, we highlight the significant opportunity for Roxadustat in lower-risk MDS. Based on other lower-risk MDS development programs, we believe the indication would support an orphan drug designation, which would provide seven years of data exclusivity in the U.S. This potential exclusivity combined with an attractive market opportunity and efficient commercial model provides a significant economic opportunity for further development of Roxadustat. We look forward to near term discussions with the FDA, which could pave the way for developing Roxadustat for anemia associated with lower-risk MDS on our own or through a potential partnership. With that, I will now turn the call over to Dave to discuss the company's financials. Dave?