David Young
Analyst · Craig-Hallum. Please go ahead
Thank you, Jim. Good evening. Thank you for joining us. During my time with you today, I’ll be updating you on our pipeline and briefly discuss what you should be expecting over the next 15 months. I will not be covering all the details on each slide, but the slide will be posted on our website as Jim said previously. Let’s go to our first slide, Slide 3. This slide provides you with a snapshot of the Processa highlights. The first four major bullets are the highlights that I’m sure most of you have already heard or read about. The last three major bullets or the more recent highlights, I will be discussing bullets five and six, our key accomplishments in the third quarter and some milestones to expect over the next 15 months in more depth in subsequent slides. The last bullet represents something that has happened recently, and we are only in the beginning stages of our discussions. Next slide. Slide 4 describes the criteria that we have used to select drugs in our pipeline. Again, this is a slide that many of you have already seen or heard about. Next slide. Now let’s look at a summary of our pipeline, instead of going into the details of each drug using the slide, I’d like to point out that we have four drugs in clinical development, 499, 12852, 3117 and 6422. 6422 which we are rebranding as next-generation capecitabine. We expect these same four drugs to be in Phase 3 in 2023 to 2025 and all four drugs to be FDA approved and commercialized between 2025 and 2028 in four different $1 billion markets. I will only be briefing you on the status of next-generation capecitabine and 499, which are now being clinically evaluated and 12852, which we expect to be in patients in the first half of 2022. Let’s first look at next-generation capecitabine since the interim results are hot off the press. Next slide. Next-generation capecitabine, which we previously designated as 6422 is a chemotherapy treatment. That includes 6422, a chemotherapy modifier administered with capecitabine, currently one of the cornerstone chemotherapy drugs used in cancer and the oral prodrug form of 5-FU. As you can see from the diagram, looking at the right side of the metabolic scheme for 5-FU, 5-FU is currently metabolized through the DPD enzyme to a metabolite called FBAL, which has no therapeutic effects and could cause side effects. 6422 irreversibly inhibits existing DPD in the body, shutting down the right side of 5-FU metabolism to FBAL. The shutdown of the right side results in 5-FU metabolism shifting to the left side. The side that forms 5-FU nucleotide, which kills cancer cells, but also normal cells being to synthesize such as neutrophils. This shift however does not last forever because de novo DPD is formed over time. And if no 6422 is present, the new DPD can metabolize 5-FU to FBAL. We would expect that as long as Next Generation Capecitabine inhibits DPD less FBAL is in the body than current capecitabine. And Next Generation Capecitabine is more potent as determined by a greater 5-FU the systemic exposure per milligram of capecitabine dose. So what did our interim Phase 1b with only one dose of 6422 and seven days of capecitabine tell us 24 to 48 hours after administering a single dose of 6422 less than 10% of 5-FU was metabolized to FBAL compared to 80% reporter for FDA approved capecitabine. And the potency of Next Generation Capecitabine as determined by the 5-FU systemic exposure per milligram of capecitabine administered was at least 50 times greater than reporter for current FDA approved capecitabine. And in some patients, it was even a 100 times greater. We also determined from this interim analysis that the improved metabolism profile and increased potency is transient and did not last for seven days after a single dose of 6422. Next slide. We believe that the change in 5-FU metabolism over the seven days occurs, because existing DPD is inhibited for 24 to 48 hours after a dose of 6422. New DPD is then formed and no 6422 exists to irreversibly inhibit the new DPD. Therefore, we are modifying the Phase 1b protocol to better understand the timeline of DPD inhibition and de novo formation. So we can select regimens of 6422 that will inhibit DPD as long as capecitabine is administered. By achieving this, we not only expect Next Generation Capecitabine to be more potent than current capecitabine, but we also expect to have a product that can provide a better benefit risk profile, important to FDA and to patients. The information for the modified protocol would be extremely valuable and may allow us to treat cancer patients using a personalized or precision medicine approach, which likely would result in Next Generation Capecitabine taking over all the existing capecitabine market, as well as some of the 5-FU market for multiple types of cancer. I would like to point out that we also are evaluating other regulatory submissions that can expedite the development of Next Generation Capecitabine. And even though, we’ve had to call an audible after seeing the interim data, the timeline to initiate Phase 3, and the timeline for approval has not changed. Next slide. Let me quickly review 499, our Phase 2b drug for which we have FDA orphan designation. And now as an unmet medical need condition that initially appears to be a dermatological condition, but as a condition that affects the skin and tissues below the skin. And now can last from months to years with complications such as infections, amputation of the limb and cancer. Also its occur in about 30% of the patients and conclusive diagnosis can only be accomplished through a biopsy where the histological presentation is different than other ulcers, such as diabetic ulcers. All sort of NL is a serious condition with no approved drugs. The prevalence of ulcer to NL is 22,000 to 65,000 patients in the U.S., with the U.S. potential market of approximately $1 billion. The NL ulcers can occur naturally over the clinical course or they can occur from contact trauma to the lesion, because the skin becomes more fragile and brittle. More importantly, natural complete healing of moderate to severe ulcers during the first one to two years after onset encourage in the less than 5% of these patients. As I said before, there is no FDA approved treatment for NL. No standard of care. And all drugs used off-label are inadequate, because of dose limiting side effects, which prevent the drugs to be given at a high enough dose to see significant efficacy in a formal file. This includes a drug called pentoxifylline or as I often call it PTX. PTX does work in closing the ulcers in some patients, but side effects limit the dose that can be administered. 499 is the deuterated analog of a metabolite of PTX. In our Phase 2a NL trial complete wound closure was achieved in the only two patients who presented with ulcers and each patient had contract – contact trauma ulcers while on the drug. And those also is also closed within one month. Next slide, in our Phase 2b randomized placebo-controlled trial, three patients have enrolled. One patient is in screening and one patient failed screening. A total 20 patients are to be enrolled. The interim analysis expected in mid-2022 are both placebo and treated patients is critical to guiding us in our development program, as well as future regulatory submissions to expedite the development and approval of 499 in ulcerative NL. We expect to complete our Phase 2b study in 2022 and initiate our Phase 3 trial in 2023. Next slide. The last drug that I’ll cover in this update is 12852, a very potent and specific 5HT4 agonist. You may recall that this drug is being developed for the treatment of gastroparesis. There’s only one drug approved for gastroparesis medical UltraMind while other drugs are used unsuccessfully off-label. All these drugs have side effects that significantly limit their use. Given the high specificity and potency for the 5HT4 receptor, the side effect profile appears to be significantly better for 12852 than all of the drugs used for gastroparesis, which would make 12852 is the drug of choice in this $1 billion market. To date, we have received a study to proceed letter from the FDA for our Phase 2a trial. The trial is a placebo-controlled randomized dose response trial, evaluating the gastric emptying rate and symptoms and gastroparesis patients. The study is expected to roll at first patient in the first half of 2022 with final analysis in the second half of 2022 or at the beginning of 2023. Next slide, over the next six months to nine months, we expect for Next Generation Capecitabine to interact with the FDA regarding our modification to the Phase 1b protocol, to modify the Phase 1b protocol in order to evaluate the timeline for DPD inhibition and DPD de novo formation. To restart the Phase 1b trial enrolling patients mid first half of 2022. To complete an interim analysis on the timeline of DPD inhibition and for 499, we expect to complete enrollment of patients for interim analysis and possibly complete the interim analysis. And for 12852, we expect to begin enrollment of the Phase 2a trial. Also, since we are now evaluating, if we qualify for regulatory submissions to expedite development and approval, for example, FastTrack and breakthrough therapy, we expect to have at least one additional regulatory submission for one of our pipeline drugs within the next six months to nine months. Next slide. This table is just a repeat of the first table to remind you where we are now and what we expect to achieve in 2022 and beyond. I hope this earnings call has given everyone a better understanding of what we’ve accomplished over the last three months, as well as what we expect to accomplish over the next 6 months to 15 months. This concludes my remarks. I’ll now pass it to the operator to open the phone lines for Q&A. Operator, can you please poll for questions?