Michael Weiss
Analyst · Ladenburg Thalmann. Please proceed with your question
Thank you, Sean, and thank you, Jenna, and thank you all for joining us this morning. We had another exciting quarter of positive progress along with positive data and like to start by reviewing some of the highlights for the third quarter of 2017. First, we announced the successful outcome from the first preplanned interim analysis for the diffuse large C-cell cohort in the UNITY-NHL trial, where based on preset hurdles of overall response, the DSMB recommended continued enrollment in the TG-1101 plus TGR-1202 combination arm, referred to as U2, and replacement of the single-agent TGR-1202 arm with U2 plus bendamustine. We also received a special protocol assessment from the FDA for the TG-1101 Phase III program in patients with multiple sclerosis and announced that the trials were open for enrollment. We commenced clinical development of our anti-PD-L1 monoclonal antibody. We completed full enrollment into the UNITY-CLL Phase III clinical trial, which puts us on track for topline overall response data in the second quarter of 2018. We presented three posters at ECTRIMS, showing complete elimination of GD-enhancing lesions and robust B-cell depletion through six months. Last week, we announced that six abstracts were accepted for presentation at ASH next month and those abstracts are now available on the ASH website. And last but not least, we met with the FDA regarding the use of the GENUINE study for filing for accelerated approval and confirmed that approval would be a review issue, consistent with all of our previous guidance. On this last topic, we encourage investors to carefully review the FDA guidance for industry on expedited programs for serious conditions, drugs and biologics dated May 2014. I believe once you have read the document, you will understand better how the rules that accelerate approval work and how they apply to our situation. Let me simply restate that using overall response for accelerated approval in CLL is not an issue. However, as we stated in the PR, the FDA-provided guidance that if another agent obtained full approval before we could obtain accelerated approval, we would need to show meaningful benefit over that agent as well. As noted in the PR, we will continue to evaluate new available therapies as they become approved. And related to that, the guidance referenced earlier describes many ways in which one may prove meaningful advantage over available therapy without conducting a head-to-head trial which would not be required here. And we believe TG-1101 plus ibrutinib has some strong attributes on its side. Finally, whether we provide a meaningful advantage over available therapy would be a review issue based on the written submission as part of our BLA filing. Lastly, in the press release, we announced that the FDA was open to a discussion on the potential use of PFS from the GENUINE study to support full approval of TG-1101. The nice part of the potential use of PFS and full approval is it would take us out of the more rigid rules of accelerated approval and not require us to compare to all available therapies. We'd also avoid the need for post approval trial and will provide much more robust label claim. We plan to have an initial meeting with the FDA by the end of this year to begin discussing the viability of this approach. It is possible these discussions may require multiple back-and-forth before a decision will be made regarding the potential use of PFS. As stated in the PR, our goal would be to reach an agreement that permits the use of the GENUINE PFS data for full approval in a similar timeframe to potential filing for accelerated approval, based on overall response. With that, let's move on to our flagship UNITY-CLL and UNITY-NHL programs. Starting with our UNITY-CLL trial, which we continue to believe, is the main value driver for TG, its shareholders and for patients. We were very excited to announce that full enrollment has now been reached nearly nine months ahead of our initial projections. This update puts us on track for topline overall response data in the second quarter of 2018 and a potential filing in the second half of 2018. Again, as a brief reminder, the UNITY-CLL Phase III trial is a randomized study of TG-1101 in combination with TGR-1202, again, our U2 combination compared to an active control arm of alemtuzumab plus chlorambucil in patients with both treatment-naïve and relapsed or refractory chronic lymphocytic leukemia. This trial is being conducted under special protocol assessment with the FDA. It is a large global randomized study of over 600 patients, and if successful, we would anticipate a very broad label for the treatment of CLL setting up the U2 regimen as a flexible treatment option to be used by doctors in any CLL setting. The strong demand for the study reinforces our belief in the need for novel treatment options for CLL. We believe U2 will become one of the leading treatments for first and second-line CLL, representing a significant market opportunity. In addition to the significant opportunity in CLL, there's a great need for novel treatments in the NHL, non-Hodgkin's lymphoma. And PI3K delta inhibitors appear to be some of the most active novel agents in this area. We believe our UNITY-NHL trial is designed to showcase the unique profile of TG-1101 and TGR-1202. As everyone hopefully remembers, this study now has three independent parts targeting different subtypes of NHL, including diffuse large B-cell, follicular and marginal zone. Starting with the diffuse large B-cell. As a reminder, our goal here is to develop the combination of U2 plus bendamustine for the treatment of patients with relapsed refractory diffuse large B-cell. We believe this combination is highly active, well-tolerated, off-the-shelf treatment option for these very advanced patients. As noted earlier, we announced the successful completion of the first preplanned interim analysis, and we are now enrolling in the triple combination arm of U2 plus bendamustine in addition to continuing enrollment in the U2 doublet arm. Next, let’s discuss the follicular cohort. We are currently enrolling into a single arm of TGR-1202 monotherapy in the same population that supported the recent approval of copanlisib. We view their approval as being positive for us in a number of ways. First, we believe they have pioneered a regulatory approach that we are rapidly imitating, and second, they also demonstrated that PI3K delta targeted inhibitors can be both active and not have idelalisib-like toxicity. This fact was largely overlooked at the time of their approval. It's important to note that we don't view copanlisib as a major competitive threat as it is an IV drug that needs to be given weekly until progression. We've heard from a number of clinicians that, that will significantly impact its utilization. Lastly, we have the marginal zone reformer cohort. As mentioned during our last call, we are using the ibrutinib approval study as a point of reference, and this arm is also open to enrollment. With that, let's switch gears and briefly review the exciting developments happening on the MS front. For this special protocol assessment for our Phase III program in hand, we're excited to announce during the third quarter that enrollment has begun into the Phase III ULTIMATE II and ULTIMATE II trials. Currently, many of our U.S. sites are open, and we're actively working to get our ex U.S. sites onboard and hope to have the majority of sites open by early next year. Complementing the launch of the Phase III trials, we've recently presented three posters at the ECTRIMS-ACTRIMS meeting last month and subsequently hosted a conference call with Dr. Edward Fox, the Director of the MS Clinic of Central Texas and the principal investigator for our Phase II trial. Hopefully, you will had a chance to listen, but he highlighted some of the key data presented at the conference, including 100% or complete elimination of all T1 GD-enhancing lesions at week 24 in the first 20 patients, 99% median B-cell depletion was observed at week four and maintained at week 24 for the first 24 patients. And 96% of subjects, 23 of 24, were relapse-free at week 24. The only reported relapse occurred in the patient initially randomized to the placebo arm, and the relapse occurred just 12 days after the patient's first infusion of 150 milligrams of TG-1101, but before the patient received their first 450-milligram dose of TG-1101, which was to be given on day 15. The patient remains on study and has now received the second and third infusions of TG-1101 and, to-date, has remained relapse free. And lastly, TG-1101 was well tolerated across all patients, including those receiving rapid infusions as well as one hour for the 450-milligram Phase III dose and produced similar levels of B-cell depletion with no identified change in infusion-related reactions or overall safety profile. Finally, I want to briefly review the recently published ASH abstracts. We'll have six presentations at the ASH conference this year. Some of the clinical abstract highlights included updated data from the integrated analysis of TGR-1202 in 336 patients with relapsed refractory lymphoid malignancies exposed to a TGR-1202-based regimen for upwards of four-plus years, which demonstrated a favorable safety profile. Importantly, the most common Grade 3/4 adverse events typically seen with first-generation PI3K delta inhibitors were rare with transaminitis less than 3%, colitis less than 1%, and pneumonitis less than 0.5%. In another abstract, results from the study looked at patients with chronic lymphocytic leukemia who were intolerant to prior BTK or PI3K delta inhibitor therapy and subsequently initiated TGR-1202 monotherapy, which showed that TGR-1202 was well tolerated, but none of the 22 patients discontinuing due to TGR-1202 intolerance with a median follow-up of six months. In the final clinical abstract, TG-1101 plus TGR-1202 plus a PD-1 inhibitor was discussed. While still small numbers, 60%, three of five, BTK refractory CLL patients responded to the triple combination. Ibrutinib refractory patients are becoming an emerging challenge with very short overall survival and very limited treatment options. This will clearly be an area of interest for development of our proprietary PL-1 inhibitor. In addition to the formal ASH presentations, we'll be hosting an investor reception with a panel of leading experts on Sunday, December 10, at 8 PM at the Ritz-Carlton Atlanta Downtown. And we welcome and encourage all of you to join us. With that, let me turn the call over to the conference operator to begin the Q&A session. Following which, I will return to make some concluding remarks.