Earnings Labs

Puma Biotechnology, Inc. (PBYI)

Q3 2017 Earnings Call· Thu, Nov 9, 2017

$7.55

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Transcript

Operator

Operator

Good afternoon. My name is Sherry. I will be your conference call operator today. At this time all participants are in a listen-only-mode. After the speaker's formal remarks, there will be a question-and-answer session. [Operator Instructions] As a reminder this call is being recorded. I would now like to turn the conference over to Mariann Ohanesian, Senior Director of IR for Puma Biotechnology. You may begin your conference.

Mariann Ohanesian

Analyst

Thank you, Sherry. Good afternoon and welcome to Puma’s conference call to discuss our third quarter 2017 financial results. Joining me on the call today are Alan Auerbach, Chief Executive Officer, President and Chairman of the Board of Puma Biotechnology; Steven Lo, Chief Commercial Officer; and Charles Eyler, SVP of Finance and Treasurer. After market closed today, Puma issued a news release detailing third quarter 2017 financial results. That news release, the slides that Steve will refer to and a webcast of this call are accessible via the home page in Investor Sections of our website at pumabiotechnology.com. The webcast and presentation slides will be archived on our website and available for replay for the next 90 days. Before I turn the call over to Alan for an overview of our performance and operations, I would like to point out that during this conference call, we may be making forward-looking statements within the meaning of Federal Securities Laws and based on current expectations, forecasts, and assumptions. Such statements are only predictions, which are subject to risks and uncertainties that could cause actual results to differ materially from those described in the forward-looking statements. Please refer to the documents that we filed from time to time with the SEC and which are available on our website, including the company’s annual report and Form 10-K for the fiscal year ended December 31, 2016 for information concerning the risks and other factors that could affect the company. You are caution not to place undue reliance on these forward-looking statements, which speak only as of the date of this live conference call, November 9, 2017. The company undertakes no obligation to revise or update any forward-looking statements to reflect the events or circumstances after the date of this conference call, except as required by law. During today’s call, we may refer to certain non-GAAP financial measures that involve adjustments to our GAAP figures. We believe these non-GAAP metrics may be useful to investors, a supplement to, but not a substitute for our GAAP financial measures. Please refer to our third quarter news release for a reconciliation of our GAAP and non-GAAP results. I will now turn the call over to Alan.

Alan Auerbach

Analyst

Thank you, Mariann, and thank you all for joining our call today. In the third quarter of 2017, Puma achieved an important milestone with the FDA approval and launch of NERLYNX in the United States. NERLYNX is approved and commercially available for the treatment of patients with early stage HER-2 positive breast cancer, who have previously been treated with a trastuzumab containing regimen. In a moment, I will turn the call over to Steve Lo, Puma’s Chief Commercial Officer, who will discuss the launch and commercial progress to-date with NERLYNX. Also in the third quarter, we presented the results for the five-year follow-up from the Phase III trial referred to as the ExteNET study, which was presented at the European Society of Medical Oncology meeting. This data showed that after a median follow-up of 5.2 years, treatment with neratinib resulted in a 27% reduction in the risk of invasive disease recurrence or death versus placebo. Hazard ratio was 0.73 with a p-value of 0.008. The five-year iDFS rate for the neratinib arm was 90.2% and the five-year iDFS rate for the placebo arm was 87.7%. Looking forward, we have several additional milestones that we anticipate for neratinib. This includes reporting additional data from our Phase II CONTROL study on the addition of budesonide or colestipol to loperamide prophylaxis on neratinib-associated diarrhea in patients with HER2-positive early stage breast cancer, which we anticipate will be presented at the San Antonio Breast Cancer Symposium in the fourth quarter of 2017. In addition, in the first quarter of 2018, we anticipate receiving a decision from the committee from additional products for human use also known as the CHMP in Europe on our application for the approval of the neratinib for use in the European Union for extended adjuvant treatment of HER2-positive early stage breast cancer. Also in the first half of 2018, we anticipate the results from the Phase III trial of neratinib in third-line HER2-positive metastatic breast cancer also known as the [indiscernible]. I will now turn the call over to Steve Lo, who will discuss our U.S. commercialization strategy and progress to-date with NERLYNX.

Steven Lo

Analyst

Thank you, Alan. I am very pleased to be able to discuss the initial launch of NERLYNX with you this afternoon. We are off to a good start and look forward to continuing this momentum going forward. First of all, a reminder that during my presentation, I will be making forward-looking statements. Our launch strategy had a two-phase approach in which we would be ready with the commercial infrastructure, specialty pharmacy channel, medical information, reimbursement and the patient services hub at the time of FDA approval. This would ensure we were open for business in a soft launch so that NERLYNX prescriptions would be filled. Also during the launch preparations, we had already recruited, identified and selected experienced field sales personnel with oncology and specifically breast cancer experience who would be hired and trained upon the FDA approval of NERLYNX. This, in fact, occurred and during the month of August we hired and trained 85 clinical sales specialists, 12 nurse educators, and over 20 other field personnel to actively promote NERLYNX starting in September. We are pleased to say the second phase of the launch was also executed as planned and we are fully staffed and have been actively calling on healthcare providers since early September. I will now provide you with our launch results since our FDA approval. On the day of the FDA approval, we received numerous inquiries from both physicians and patients. We received the first NERLYNX prescriptions within three days and our reimbursement and patient services group known as Puma Patient Lynx was able to assist patients and physician offices immediately. We were able to shift commercial drug into the specialty pharmacies within a week and the first patients received commercial drug during that second week. Our launch strategy was to engage all stakeholders, targeted physicians…

Charles Eyler

Analyst

Thanks, Steve. Let me start with a quick summary of our financial results for the third quarter. Please note that I will make comparisons to Q1 of 2017, and Q2 of 2017, as we believe this is a better indication of our progress in becoming a commercial company. For more information, I recommend that you refer to our 10-Q which was filed today and which includes our condensed consolidated financial statements. With the third quarter of 2017, we reported a net loss on $77.2 million or a loss of $2.07 per share. Our net loss for Q2 and Q1 of 2017 were $77.8 million and $72.8 million respectively. Net revenue from NERLYNX sales were $6.1 million with a cost of sales up approximately $1.5 million included in Puma's cost of sales for NERLYNX in the quarter is an amortization of a milestone payment to license or that was approximately $600,000 for the quarter. On an ongoing basis, Puma will recognize as a fixed cost approximately $945,000 each quarter book to cost of sales. SG&A expenses based on GAAP with $32.5 million for the third quarter of 2017 compared to $24.9 million, and $18.4 million for the second and first quarters of 2017 respectively. Non-GAAP SG&A expenses were $24.2 million for the third quarter compared to $17.5 million and $11.1 million for second quarter and first quarter of 2017. The increase in SG&A expenses was primarily due to the increase in staff related expenses, professional fees and travel expenses much of which is related to our product launch in July. Research and development expenses based on GAAP were $49.5 million in the third quarter compared to $53.3 million and $54.8 million for second and first quarters of 2017 respectively. On a non-GAAP basis, R&D expenses were $31.3 million compared to $33.7…

Alan Auerbach

Analyst

Thank you, Charles and Steve. With the U.S. approval and launch of NERLYNX in the third quarter, we began providing early stage HER2-positive breast cancer patients with an additional option to reduce their risk of disease recurrence. We are pleased with the feedback that we have received from patients, prescribers and payers during the initial launch. And we look forward to continuing to execute our commercial activities throughout the remainder of 2017, and beyond. This concludes today’s presentation. We will now turn the floor back to the operator for Q&A. Operator?

Operator

Operator

Thank you. We will now begin the question-and-answer session. [Operator Instructions]. Our first question is from Our first question is from Cory Kasimov with JPMorgan. Please state your question.

Unidentified Analyst

Analyst

Hey, guys. Congratulations on the quarter. This is Sean on for Cory and thanks for taking my question. So, at this point, can you guys maybe say what percentage of prescriptions are coming from the academic setting versus the community setting? And are there any early trends that you guys can point to in regards to prescriber behavior, are there any groups that are more likely to prescribe to more than all comers population others that tend to be kind of more discriminating of the data as it relates to say for example receptor positivity?

Alan Auerbach

Analyst

Yeah. So, we’ve mostly seen use of NERLYNX in the community setting. Yes. I think you know that’s where the majority of the prescribers are, I think it’s 85% or 90% of them and that’s definitely where we’re seeing the uptick. In terms of hormone receptor positive or hormone receptor negative, etcetera, we’re seeing it across the board. We’re definitely seeing some physicians just using it in certain patient groups, but we’re also seeing them treating just according to the label, according to the ITT basically, so all comers.

Unidentified Analyst

Analyst

Okay. Great. And in just these initial couple of months of launch, do you guys have any insight in regards to how many of the patients treated so far were kind of in that group that were beyond the two years’ post your last Herceptin treatment that were included in the ExteNET trial, trying to just kind of figure out if there are some sort of bolus affecting in this group that’s further out and I kind of maybe I’m looking at July and it seems the numbers were higher in that one, so just kind of wondering if there were some of that going on? Thanks.

Alan Auerbach

Analyst

Yeah. So, we look at it as there’s three patient groups that can be treated with NERLYNX. One of the ones, where they’re coming off their 12 months 12 months of Herceptin and they're being sequenced directly onto NERLYNX. The second group are the ones where they perhaps completed their adjuvant Herceptin six months ago or a year ago and they're coming in once every six months for the physical exam where the doctor is physically checking them for you know any evidence of recurrence and that's when the doctor is discussing NERLYNX with them at that time. The third are the ones where you know these are patients where perhaps they're not coming in as frequently for their physical exams. They completed adjuvant Herceptin four years ago or more. And again, that's another discussion that the physician wants to have. We have certainly heard from physicians that a number of them are indeed calling back their patients, especially from you know four years ago, five years ago, et cetera., I don't know, if we start to see that yet. I think we are seeing it in the first two buckets, you know which is the patients coming directly off adjuvant Herceptin and those who may have finished it three months, six months, nine months to go, et cetera. So, I think we still have that you know those two to continue to penetrate and then also the ones from further out as well. In terms of the bolus as you described it in July, most of that bolus that you're referring to in terms of sales was just the initial stocking. I think as Steve mentioned, we had about a $1 million or so which was just the initial stocking. So, if you look at the monthly net in July was you know little over $2 million, about a $1 million of that was just the initial stocking. So, I think that probably worked itself off through demand in August, through August, September, October you were probably seeing pure you know pure demand driven sales.

Unidentified Analyst

Analyst

Okay. Great. Thanks. And congrats again.

Operator

Operator

Our next question is from Alitalia Young with Credit Suisse. Please state your questions. Please state your question.

Alethia Young

Analyst

Hey, guys. Thanks for taking my question. Congrats on the progress so far. A couple from me. One, can you talk a little about the gross to net, I think I missed that, if you had in the script. What -- that’s kind of tracking at and what that expectation should be? Also do you have a quantitative number for the percentages were like metastatic? And then my last question is just can you talk a little bit about anecdotally what you're seeing with the diarrhea management in the real world or are they using loperamide, or are they using other regimens, any color you can give on that? Thanks.

Alan Auerbach

Analyst

Thanks, Alethia. Okay. On the gross to net – our gross to net is about 14%. I don't know if Charles mentioned that in his speech. So, I apologize if he didn't. Our gross to net is 14%. In terms of the percent of patients who are metastatic, it's running roughly around 5% of the patients treated. So, it's definitely the minority of the patients and the majority are in the indication of the extended adjuvant. In terms of your last question, which is very good in terms of what exact regimens docs are using to manage the diarrhea, we really don't track that, so we unfortunately don't have any real insight. We hear anecdotally that some physicians are starting them with loperamide, and then if there's diarrhea they're using either budesonide or colestipol as kind of a rescue medication. We're hearing others who are saying that some of them are using the combinations of loperamide/budesonide, loperamide/colestipol et cetera. So, we don't really get the exact regimens that we're using. Remember that in the community, a lot of these docs don't just treat breast cancer, they also treat other solid tumors as well. So, they can treat colon cancer or they can treat lung cancer and things like that. So, they can treat color cancer or they can treat lung cancer and things like that. In colon cancer, as you know, irinotecan, Camptosar is used quite frequently, and there you have to be very aggressive in prophylaxing the patients with loperamide, so that knowledge is probably helping in the management of the diarrhea with NERYLNX. On the lung cancer side, you know, afatinib which I believe is called Gilotrif from Boehringer Ingelheim it's very similar to neratinib in the fact that it's an oral drug that's a irreversible pan-HER inhibitor has a very similar diarrhea characteristics to neratinib, which is you know Grade 3 diarrhea that happens up front. So, again I think the docs probably have knowledge of managing that which is probably helping with the management of the diarrhea with NERYLNX.

Alethia Young

Analyst

And then just a follow-up to that. I know in Steve's comments, he mentioned that you know, he was saying potentially better tolerability in the real world, just wondering if you can unpack that? Thanks.

Steven Lo

Analyst

Yes. This is Steve. So, understand that in the commercial setting, we have specialty pharmacies in place. And so, as soon as a patient is on the medication, the specialty pharmacies call and remind the patients to take their loperamide if it's prescribed. In these community practices, we've also educated -- our nurse managers have educated the nurses into practice, and so the nurses also provide great instructions to the patients before they're on the medication. And then finally as well, the specialty pharmacies will follow-up with calls to ensure that they're adhering to the medication and believe in have things such as text reminders.

Alan Auerbach

Analyst

And Alethia, also realized from a numbers perspective, I believe in ExteNET, the number of patients who discontinued taking neratinib was somewhere in the range of like 20% to 27%, I think it was 20% due to diarrhea, like 6% or 7% just due to patient due to patient request, meaning they probably you know may have had diarrhea or some other GI discomforts. So, all in, discontinuations were somewhere in like that you know 26%, 27% range. Commercially right now, as Steve mentioned, we’re seeing it at 11%. So, that appears – again, it’s early, we’re monitoring this, but it appears right now – it appears to be lower than what we’ve seen in accident.

Alethia Young

Analyst

Great. Thank you guys.

Operator

Operator

Our next question is from Yigal Nochomovitz with Citigroup. Please state your question.

Yigal Nochomovitz

Analyst

Hi Alan and team. Congrats on the first quarter of sales. A few questions here. Number one, were there any patients in the EAP program that are reflected in the rollover commercial in the numbers you are reporting? Second, are you planning to give fiscal year 2018 revenue guidance? And then third just overall on the market, I think one of the numbers that a lot of folks are using is the 36,000 adjuvant Herceptin patients per year in the United States, sort of the funnel for NERLYNX. But I’m just wondering if you have a more updated number since I think that one might be a bit out of date? Thanks.

Alan Auerbach

Analyst

Hey, Yigal. Let me go through your three questions. So first of all, on the EAP, we had – did not do anything to try to convert the patients in the expanded access program over to commercial supply. You know a lot of those patients came in six months or so ago and we really didn’t do anything to try to force them into commercial supply. I don’t know that we have had any converted over, Steve is shaking head no. I don’t think we have had any who converted over. So, we’re just continuing to give them through the EAP. On your second with regarding guidance, no early in the launch of the drug we are not providing any revenue guidance either quarterly or annually. Once we get a little more experienced with the sales we may do that at a later date, but we did not give any guidance for the third quarter, we're not giving any for the fourth or the fiscal year 2017. And we're not getting any for 2018 at this point. If we change that we'll obviously communicate that to investors. Regarding your last question which is the number of patients on adjuvant Herceptin. The 36,000 number it probably the best one to go with. The only caveat I would make is that you know if you look at the Herceptin curves from any of the Adjutant trials there is a percent of patients who do have disease recurrence in that first year. So, you probably and I don't think it's very high it's probably in the low to mid-single-digits. You probably need to just take whatever that -- whatever three, four, five percent out because if they recur obviously they become static and that wouldn't be applicable to the success management population.

Yigal Nochomovitz

Analyst

All right. And sir, that – we actually do that in our model. And then one other things if I could just follow up. Of the 64, that discontinued do you have any senses to what percentage of those were metastatic, as Steve mentioned?

Alan Auerbach

Analyst

I think, he was only a few cases, again the metastatic business is as Dale mentioned less than 5%. So, but certainly to once you discontinue it I can say that metastatic lender are reflected in that number.

Yigal Nochomovitz

Analyst

Got it. Thank you.

Operator

Operator

Our next question is from Michael Smith with Leerink Partners. Please state your question.

Michael Smith

Analyst

Hey guys, thanks for taking my questions, and congrats on getting NERLYNX on the market, something that we market. Something that we've seen with a handful of other drug launches in the oncology space is that, companies in some cases, sort of, covering patient assistance programs by giving away free drug as much as 20% or 30% of demand. Is that something that, that you've been encountered to so far in the launch?

Alan Auerbach

Analyst

Yeah. So, thanks for your question, Michael. With regard to patients who don't have insurance and therefore, you know, we provide them with free drug, we do indeed do that. So far, that's only been about 5% of the patients. It has not -- I'm aware, you've seen other companies and I've seen them as well, where that number gets up to like 20%-25%. We have not seen that in this patient population, so right now it's about 5%.

Michael Smith

Analyst

Great. Do you have any, any sense of how much of your target patient population is Medicare/Medicaid?

Alan Auerbach

Analyst

About 10%.

Michael Smith

Analyst

Okay. Perfect. And, I have a balance sheet question actually and this relates to the Pfizer milestone payments that are due at some point. Can you just provide some information on the amount and timing of those milestone payments, when they are potentially going to be due? Thanks.

Alan Auerbach

Analyst

Yeah. So, our public guidance on that is that, there is $187 million in milestone payments that will be paid to Pfizer. That includes, regulatory milestones, when we get approval in certain territories and then there's also sales based milestones. We've not given any indication or any guidance on how much those are or when they're paid, you can assume the regulatory ones would be paid upon the approval you can assume the regulatory ones would be paid upon the approval in various countries. The sales once you know, you can imagine there’s, there are certain revenue thresholds and when we hit them, they would be a onetime payment. So, you know, you can kind of just manage that to your own expectations.

Michael Smith

Analyst

Great. Well, thanks for taking my question and congrats on the launch.

Operator

Operator

Our next question is from Chris Shibutani from Cowen and Company. Please state your question.

Chris Shibutani

Analyst

Great. Thank you very much. Two questions. One, on the work that you're doing in the prophylaxis regimen. You said we'll see some more data at San Antonio and it sounds as if that was one of the gating factors that you said to the European filing. Have you submitted that information and is that underlying your confidence in the first quarter European timing and also are you submitting that information for a label update in the U.S. And if so, when might we see a label update in the U.S. to include those additional regimens?

Alan Auerbach

Analyst

So, the CONTROL data will be updated at the San Antonio Breast Cancer Meeting. It will include more patients in the colestipol arm specifically. That data will be submitted to the EMA as part of our response to the 180-day questions. Once we send that to the EMA, they will then respond back to us in the first quarter of 2018 and their response will be – from the CHMP will either be a recommendation for approval or a recommendation for not approval or they can take it to an oral hearing, which is similar to the FDA’s version of ODAC or they can issue another list of 180-day questions. We are planning at some point to submit that for an updated label to our currently marketed label with the FDA that would probably occur sometime in 2018 and when we get better clarity on that, we’ll communicate that to investors.

Chris Shibutani

Analyst

And I think we’re deep enough into Q&A where I can ask the question about your strategic optionality thinking, obviously with a potential European approval or a commercial partner would be the logical path, I think you said that previously Alan, as well as thinking about the scope of opportunity for this drug worldwide including the U.S. sales, you plan to sell in the U.S. Update us on your thinking with regard to other partners or strategic options. Thanks.

Alan Auerbach

Analyst

Yeah. So, the company doesn't provide any guidance or commentary regarding discussions with strategics, partnering or mergers and acquisitions.

Chris Shibutani

Analyst

Then on outside the U.S. commercialization.

Alan Auerbach

Analyst

Outside the U.S. commercialization, I think we have one of three options. One is we can do it ourselves. One is we can decide to partner with another company or if we choose to take the path of selling the entire company that would obviously be part of it. Today is not the day we're making that decision, but when we do make that decision we'll do it in the best interest of investors.

Chris Shibutani

Analyst

Thanks for letting me ask the question.

Operator

Operator

Our next question is from [Ian Hanks] with Bank of America. Please ask your question.

Unidentified Analyst

Analyst

Hi. Good afternoon. Thanks for taking the question. Alan, maybe can you confirm that all the script numbers you just provided in the slide deck is from the specialty pharmacy channel, do you have any other channel and if there is how big was that number? And then secondly, can you talk a little bit more about the formulary access, do you expect in 2018 you might have better coverage in terms of a formal coverage and tier status, what's a typical co-pay for a patient on earnings now?

Steven Lo

Analyst

Okay. Hi, this is Steve. I will take the – your questions regarding formulary status, as well as your question around what’s outside the specialty pharmacy channel. So, as I talked about in my remarks, patients are either in the specialty pharmacy channel or the specialty distribution channel where they can receive NERLYNX in the office of the physician. Right now, we have greater than 95% of our business in the specialty pharmacy channel. So, I would say the specialty distribution channel is fairly small if you were to model that. Secondly, in terms of formulary status, remember this is an oral oncolytic, it’s not really competing with another product that would displace it. So, formulary status isn’t really the game with the payers here, it’s ensuring that the product clears through the prior authorization. And as I’ve stated before, we have had no problems with getting NERLYNX reimbursed in the extended adjuvant setting. And your final question was around co-pay. So, one of the things that we’ve done in our commitment to access for patients is, we have a co-pay assistance program where like other companies, we help patients with their co-pay. And in this case with NERLYNX, patients pay no more than $10 on their co-pay. And we found that to have been very successful and that is one of the reasons why you see patients getting – most of these patients getting on drugs in 10 days or less.

Unidentified Analyst

Analyst

Great. Thank you.

Operator

Operator

This concludes our question-and-answer session. I would like to turn the conference back to Mariann for closing remarks.

Mariann Ohanesian

Analyst

We appreciate your interest in Puma Biotechnology. As a reminder This call may be accessed by a replay of the webcast at pumabiotechnology.com beginning in about an hour. Thank you again for your time and attention today.

Operator

Operator

Ladies and gentlemen, thank you for participating in today’s conference call. This concludes our program. Everybody have a great day. You may now disconnect.