Howard Robin
Analyst · Brean & Murray
Thank you, Jennifer. Thanks to everyone for joining us this afternoon. Today I will focus on the significant progress we made in the first quarter with our partnered programs and our priority pipeline. Following that, John will provide a quick review of financials. Nektar had a lot of momentum in the first quarter of 2012. We strengthened our balance sheet with a royalty sale that raised $124 million. We advanced our two lead clinical pain candidates, NKTR-181 for chronic pain and NKTR-192 for acute pain, and finally, the FDA approved the 8th product enabled by Nektar Technology, Affymax's OMONTYS. By the end of 2012, we anticipate 4 late stage Nektar drug candidates will either be in or poised to enter Phase III clinical trials. Three of these programs, Naloxegol and Opioid-Induced Constipation, BAX 855 in Hemophilia and Amikacin Inhale and Pneumonia are being developed and funded by our strategic pharmaceutical partners with a potential for significant partnership economics to Nektar.
The fourth Phase III program, NKTR-102 in metastatic breast cancer is proprietary to Nektar. And as I just mentioned, Nektar is also rapidly advancing 2 new proprietary opioid molecules through the clinic. I'll talk more about the progress made in Q1 with these new opioid candidates in a moment.
First, an update on Naloxegol with AstraZeneca. As you know, we are excited about the scope of AstraZeneca's global Phase III program from Naloxegol which is under investigation for the treatment of opioid induced constipation. The two pivotal registration studies will each include an estimated 630 patients with non-cancer pain and opioid induced constipation and will evaluate the safety and efficacy of Naloxegol in chronic pain patients. The primary endpoint for both studies is based on a 12 week treatment period. In addition there is a 52 week open label safety study which includes over 1,100 patients. These three studies complete the registration package for Naloxegol. As a reminder, the 52 week safety study for Naloxegol completed enrollment in November of 2011 and last week, the first of the two 630 patient pivotal studies completed enrollment as well. Both pivotal studies and the safety study are continuing on track for mid-year 2013 filings in both the US and the EU. Upon acceptance of these filings, Nektar is entitled to $95 million of our $235 million in filing and launch milestones under the agreement with AstraZeneca. The remaining $140 million are due when Naloxegol is approved and launched in the US and EU. AstraZeneca is responsible for all costs of development and commercialization of Naloxegol.
There are more than 100 million patients taking prescription opioids for chronic pain worldwide and about 50% of these patients taking opioids for chronic pain experience constipation. So we are very excited about the potential of Naloxegol to address this significant need. In addition to the $235 million in filing and launch milestones under the agreement with AstraZeneca, Nektar is also entitled to significant escalating double digit royalties on product sales of Naloxegol with up to $375 million in additional sales milestones at certain commercial sales levels.
Now let's talk about NKTR-102, Nektar's targeted topoisomerase 1 inhibitor. NKTR-102 recently received its use end name, etirinotecan pegol. The promising cancer treatment is being developed as a single agent in multiple tumor settings. Enrollment for the BEACON Phase III study of a single agent NKTR-102 in metastatic breast cancer is proceeding nicely and on track for completion by the end of 2013. BEACON is a an open label randomized head to head trial which will enroll approximately 840 patients comparing single agent NKTR-102 to an agent of physician's choice with a primary endpoint of overall survival. The FDA and EMA have agreed with our proposed study design, a primary endpoint of overall survival and our comparator arm. We've initiated over 60 sites in the US and enrollment is ahead of schedule. In Q1 we received the necessary approvals of our ex-US sites and we began initiating sites in Europe. We are planning up to 160 sites worldwide.
As the first and only topo 1 inhibitor being developed in breast cancer, NKTR-102 offers a different mechanism of action than Microtubule inhibitors, the most commonly used drugs to treat these patients. These agents can exhibit cross resistance with each other and have overlapping side effects. We believe NKTR-102 could provide physicians and patients with a new therapeutic option in the fight against breast cancer. If the BEACON study is successful, NKTR-102 will have the opportunity to become a worldwide standard of care in advanced breast cancer.
In Platinum-Resistant Ovarian Cancer, we have now treated over 170 women NKTR-102 in our Phase II study and expansion. As of the end of April, there were approximately 17 patients still on study drug. As we mentioned at our most recent R&D day, over the next several months we will collect final data from this study including response rate, progression free survival and safety. Following a review and analysis of the data from the complete Phase II trial in ovarian cancer, we plan to meet with the FDA and EMA to discuss our regulatory options and possible next steps for the development of NKTR-102 in ovarian cancer.
Moving on to Amikacin Inhale, partnered with Bayer. Amikacin Inhale could be the first product to treat serious pulmonary infections by delivering antibiotic directly into lungs and is being developed for use in the ICU setting. Nektar and Bayer are continuing preparation, device production and stability studies for the start of Phase III. Bayer is now beginning the process of engaging a CRO for these Phase III studies. The timing of Phase III start will be finalized once the CRO is in place. The Phase III program for Amikacin Inhale will be conducted under an SPA and will enroll approximately 1,200 patients with a primary endpoint of clinical test of cure. Amikacin Inhale has considerable potential economic value for Nektar. Nektar will receive a flat 30% royalty in the United States and an average ex-US royalty of approximately 20% on all product sales.
Another important program I want to discuss is BAX 855, which is partnered with Baxter. BAX 855 is currently in a Phase I (2) clinical study in hemophilia patients which is expected to be completed this year. Baxter plans to initiate Phase III with BAX 855 by the end of 2012. BAX 855 uses Nektar's proprietary PEGylation technology to create a long acting Factor VIII molecule to treat hemophilia A, a pegylated ADVATE. We are very excited about the potential of this new important biologic candidate. In preclinical studies BAX 855 achieved the profile that supports its potential to be dosed less frequently than ADVATE. Baxter is a world leader in the treatment of hemophilia and ADVATE has sales of over $2 billion annually. Analysts estimate a market potential of between $3 billion and $4 billion for long-acting Factor VIII products. We are very pleased to be partnered with Baxter on this innovative new long-acting ADVATE. Under our agreement, Nektar will receive significant royalties on net sales of BAX 855 upon commercialization.
Now I would like to talk about the progress we made in Q1 with our two new opioid analgesics programs. NKTR-181 for chronic pain and NKRT-192 for acute pain, both programs capitalized on the ability of our technology to modulate the entry of small molecules into the CNS. These new highly compelling pain drugs put Nektar at the forefront of solving an increasingly important and serious issue that the FDA has focused on, the abuse and diversion of opioids. Our approach is completely different than approaches which have been tried before such as formulations or pro drugs. NKTR-181 and NKTR-192 are two entirely novel opioid molecules, each with their own distinct pharmacological profile, and each representing a sizable market opportunity for Nektar. NKTR-181 is a novel opioid molecular structure that has been specifically engineered to have a number of important properties inherent to the molecule.
First, it has been designed to enter the CNS slowly to avoid the dopamine rush of traditional opioids which is associated with euphoria and can lead to abuse, addiction and misuse. The slower rate of entry should also reduce other serious CNS mediated side effects seen with traditional opioids such as sedation and respiratory depression.
Second, NKTR-181 is a long-acting profile, also inherent to its structure which will allow it to provide consistent analgesia for chronic pain conditions. Because NKTR-181's benefits are inherent to its chemical structure and not a result of a physical barrier or formulation, it is the molecule and can't be crushed, melted or otherwise manipulated to release rapid acting opioid. This is an important property of NKTR-181 that can help address the issue of diversion.
In Q1 we made great progress preparing NKTR-181 for Phase II development. We completed all of the Phase I development work including validation of tablets for the Phase II study. We also finalized the Phase II study design and are currently recurring clinical sites to allow us to start the study in July of this year.
The Phase II study will be a placebo controlled trial of NKTR-181 in chronic pain patients. The study will evaluate the efficacy and safety of NKTR-181 in approximately 200 patients with osteoarthritis of the knee using a randomized withdrawal design. This design is a standard study design for the development of opioid compound and it features 2 stages. In the first stage, patients are titrated to an effective twice daily dose of NKTR-181. In the second stage, these patients were randomized to receive either NKTR-181 or placebo. The Phase II study will enable us to establish analgesics doses for NKTR-181 in chronic pain patients. Importantly we will also be assessing multiple secondary endpoints in the trial in order to establish a differentiated profile for NKTR-181. These endpoints will include analysis of CNS mediated side effects typically seen with standard opioid therapies. We expect this study to complete in the first half of 2013. We will also be conducting a human abuse liability study which will compare the likability of NKTR-181 to commonly abused opioids in approximately 25 recreational drug users.
In the first quarter we also initiated our first clinical study of NKTR-192. This novel mu-opioid analgesic molecule has a completely distinct profile from NKTR-181. It is designed to have a short acting profile and a relatively fast onset of analgesic action in order to treat more acute pain conditions. In similar to NKTR-181, NKTR-192 is engineered to enter the CNS at much slower rates than standard opioids in order to reduce the associated abuse liability and central nervous systems side effect that are typical of the class.
In Q1 we began enrolling healthy subjects into the first single ascending dose Phase I study of NKTR-192 which is designed to characterize its pharmacokinetic profile in humans. This study should complete shortly. Following this first study, we plan to conduct a second Phase I study which will evaluate multiple ascending doses and look at both pharmacokinetics and pharmacodynamics for NKTR-192.
With NKTR-181 and NKTR-192, we are now positioned to address 2 very significant segments of the pain market, chronic and acute pain, and we are excited about their advancement in the pipeline.
One of the most remarkable things about NKTR's advanced polymer conjugate technology platform is its flexibility to create new small molecules such as NKTR-181 and NKTR-192 as well as new biologics like OMONTYS BAX 855 and NKTR-214. Further, the mechanism of action of the resulting new molecular entity is generally well understood since these are known targets. This helps to reduce the development risk and increase the probability of success while still allowing us to address significant unmet needs.
With the recent approval of Affymax's OMONTYS, Nektar's proprietary technology platform has now successfully created 8 approved therapeutics. OMONTYS is a first example of an engineered small peptide enabled by polymer conjugation, a class of molecules that has been difficult to develop due to their short circulating half-life. We continue to invent new ways of capitalizing on our platform and our new advances in polymer conjugate technology have enabled new small molecules in biologic candidates that Nektar and our partners are advancing in the clinic today. They are very few technologies in the pharmaceutical industry that have evolved to successfully produce such a diverse pipeline. We are using polymer conjugations in ways now that we could not have conceived of even a few years ago. I am exceptionally proud of the scientists at Nektar that are continually seeking new discoveries with our platform.
At our recent R&D day in New York, we discussed several preclinical candidates from our research pipeline that showcased how far Nektar's technology has progressed in recent years. Among these, is NKTR-214, a new engineered immunostimulatory cytokine for cancer. NKTR-214 is designed to selectively target tumor tissue and activate the potent IL-2 signaling pathway through beneficial IL-2 receptors on natural killer cells which attack tumor cells. At the same time, it's designed to reduce the activation of the alternate IL-2 receptors on regulatory cells which dampen the anti-tumor response. Equally important, it reduces the activation of the alternate IL-2 receptors present on pulmonary endothelial cells which cause severe vascular side effects and have limited traditional anti-tumor cytokine therapy. This is the first time that polymer conjugation technology is being used to tune the receptor selectivity of a therapeutic and we are excited about this unique capability. The ability to alter the receptor selectivity of both protein and small molecule drug candidates allows us to explore new applications of drugs that have multiple targets or where receptor selectivity is a key mediator of their action.
Another product candidate in preclinical development also capitalized on additional core strengths of our polymer conjugation platform. NKTR-171 leverages our ability to restrict entry of molecules into the CNS by creating an orally peripherally restricted sodium channel blocker to treat neuropathic pain conditions without CNS side effects. NKT-125 leverages the same approach to create an oral peripherally restricted anti-histamine molecule that doesn’t cause sedation at the highly potent therapeutic doses and NKTR-228 capitalizes on the ability of our technology to increase solubility and extend half-life. This new drug candidate could allow IV dosing of long-acting calcimimetics at the time of dialysis providing a better treatment option for renal patients than the current standard of care.
These late stage preclinical programs capitalize on different aspects of our technology platforms demonstrating the breadth and depth of opportunities available to us. As we advance these molecules and others through pre-clinical development this year, we expect to identify our next IND candidate by the end of 2012. It continues to be our objective to advance at least one new drug candidate each year into clinical development.
With that, I'll now turn the call over to John. John?