Safi R. Bahcall
Management
Thank you, Vojo. I'll briefly discuss our strategy in breast cancer and how the recently announced results might impact that strategy. Over the past year, we've indicated that our top 3 priorities following second-line lung cancer were: Number one, expansion in lung cancer, including first line in additional combinations; Number two, metastatic breast cancer; and number three, neo-adjuvant breast cancer. Our interest in breast cancer comes from the known role of Hsp90 in fueling breast cancer growth. Patients with reduced Hsp90 expression live longer. Those results are the most compelling validation for Hsp90 as a target in any tumor type that we are aware of. Breast cancer treatment today can be divided broadly into 3 categories: For HER2-positive disease, HER2 targeting agents are backbone therapy. Patients are treated with a HER2 targeting agent such as Herceptin in all stages of disease, neo-adjuvant, adjuvant, metastatic. And they cycle through different therapies -- different chemotherapies added in combination on top of that backbone. For ER or PR-positive disease, hormonal therapy is your backbone therapy. For triple negative disease, however, there's been no standard of care, no backbone therapy. What does a drug need to become backbone therapy? Three things: Number one, single-agent activity. Herceptin, for example, is a modest but not overwhelming single agent activity in HER2-positive disease; number two, favorable safety, particularly in breast cancer and particularly for early-stage treatment, quality of life is very important to patients; and number three, ability to combine. Herceptin has, for example, is very rarely used as a single agent. Nonoverlapping toxicities, synergistic or additive activity and favorable safety are all critical to becoming backbone therapy. Results with ganetespib to date support all 3 of these criteria. Many of our investigators came to us over a year ago encouraging us to develop ganetespib as backbone therapy for triple negative disease, neo-adjuvant, adjuvant and metastatic setting, and that is our goal. Together with lead investigators, we have developed protocols for 2 registrational trials, one in the metastatic setting, the ENCHANT-2 trial and one in the neo-adjuvant setting, the ENCHANT-3 trial. We are hopeful that these trials will begin next year. As we have said previously, we will wait to complete certain ongoing partnership discussions, some of which relate to plans in breast cancer before launching these trials. The recently announced results from ENCHANT-1 don't really change our thinking in any way. They simply confirm earlier signals of single-agent activity. I've asked Dr. Iman El-Hariry to join us for the Q&A session. She is a breast cancer oncologist who's been in industry developing breast cancer drugs for over 10 years before joining us at Synta several years ago. She has led our breast cancer program for ganetespib since inception. But first to Keith.