Michael Weiss
Analyst · Jefferies. Please, go ahead
Thanks, Jenna, and thanks to everyone for joining us this morning. Well, as everyone is aware, TG has been throwing a few curve balls over the last few months. The good news, though, for those of you who are baseball fans, I actually think these are hanging curve balls that we can hit out of the park. And if we are able to do that, I genuinely believe that we'll be in a much stronger position because of it. I'll provide more color momentarily, but let's start by reviewing some of the developments, good and bad, that occurred over the last 12 months or so. Most recently, in Ag terms, we presented additional analysis of the data from the ULTIMATE I and II Phase III trials of ublituximab and relapsing forms of MS, which we believe continue to highlight and support the potential utility of ublituximab as a treatment option for patients with RMS. We strengthened our balance sheet by extending our term loan facility and ended 2021 with more than $350 million in cash. Towards the end of the year, we had a strong presence at the 2021 ASH Conference with three oral presentations and three poster presentations, with two of the oral presentations being chosen for highlights of ASH. Just before ASH, we announced that the FDA was planning to review the CLL, BLA/sNDA and ODAC meeting to occur in the March-April timeframe. Related to the issues to be covered at ODAC just a few weeks ago, FDA placed studies investigating U2 and it's components in CLL and NHL on a partial clinical hold. Also in the fourth quarter of 2021, we announced our biologics license application or BLA for ublituximab to target -- to treat patients with relapsing forms of multiple sclerosis was accepted by the FDA, and was granted a PDUFA goal date of September 28, 2022. We also continue to advance our early stage pipeline and presented data from TG-1701, our BTK inhibitor, several times throughout the year. We completed an enrollment of approximately 165 CLL patients into the ultra V phase II trial and launched the phase III portion of that study. We published results from some of our key trials in major publications, including an integrated safety analysis of UKONIQ in blood advances. UNITY-NHL Phase IIb trial of umbralicib [ph] monotherapy in patients with relapsed or refractory non-Hodgkins lymphoma in the Journal of Clinical Oncology, and the genuine trial evaluating ublituximab plus ibrutinib in patients with relapsed or refractory high-risk CLL in Lancet Hematology. And of course, in quarter one of 2021, a little over a year ago today, we received FDA approval of UKONIQ to treat patients with relapsed refractory marginal zone lymphoma and follicular lymphoma, marking our very first FDA approval. With that, let me review our late-stage development programs, following which I'll turn the call over to our Chief Commercialization Officer, Adam Waldman, to discuss some of the commercialization highlights. So let's begin with a discussion of the ultimate I and II Phase III trials which evaluated ublituximab monotherapy compared to teriflunomide [ph] in relapsing forms of MS. As noted in the past, both studies met their primary endpoint with ublituximab treatment demonstrating a statistically significant reduction in annualized relapse rate, referred to as ARR, with ublituximab treatment resulting in historically low levels of annualized relapse rate. In addition to the primary endpoint, we've had the opportunity over the past year to present several different sub-analysis of this data, all of which have strengthened our confidence in the utility of ublituximab to provide a meaningful treatment option to patients with RMS, if approved. On the regulatory front, we were extremely pleased to announce the FDA accepted our BLA for ublituximab to treat patients with RMS and granted a PDUFA goal date as I mentioned earlier of September 28, 2022. Adam will discuss our launch prep activities, but let me highlight again that we have built an all-star team of MS talent from around the industry. These folks have fantastic relationships in the MS community which have enabled us to gain invaluable insights. After spending several days last week at ECTRIMS [ph] in back to back to back meetings, I'm more confident than ever in the potential of ublituximab in RMS. With the CD-20 [ph] class already accounting for the largest portion of new starts and switches, which is sometimes referred to as the dynamic market, we see ublituximab as having the potential to play an important role in the treatment of relapsing forms of MS. All right, now, let's talk about our CLL BLA/sNDA and the upcoming ODAC. So I just want to remind everyone, first and foremost, that the UNITY CLL study, which was -- which is the primary study supporting the BLA/sNDA was conducted under special protocol assessment and met it's primary endpoint of progression-free survival, and all key secondary endpoints. We submitted a BLA/sNDA for the U2 combination in the treatment of CLL and received a PDUFA goal date of March 25, 2022. In September of 2021, we received a request from the FDA to conduct an analysis of overall survival. While OS is stated as a secondary endpoint, there was no plan to analyze it prior to the end of the trial, which has not yet occurred. Importantly, the UNITY CLL study was not powered for overall survival which would have required dramatically more overall survival events. And in addition, a significant number of patients on the control arm crossed over to the U2 arm collectively making the OS results hard to interpret. Furthermore, since we were not planning an OS analysis until the end of the trial, not all the data was collected at the time FDA requested the overall survival analysis, leaving about 15% of the patients with outdated or missing survival status. Despite these material shortcomings, we conducted the analysis and sent it to the FDA as requested. As has been reported previously, that analysis showed an imbalance in favor of the control arm, the hazard ratio was 1.23, but when excluding COVID, it was 1.0; a hazard ratio above 1.0 implies potential harm of a therapy, and below 1.0 a potential benefit. Given the shortcomings of the OS analysis, and similar results from other pivotal Phase III studies in CLL, we didn't see this OS imbalance as concerning. Some of those examples included the original overall survival analysis from CLL-14 which was the approval study for venetoclax plus obinutuzumab. Similar to our trial, the control arm was obinutuzumab + chlorambucil, and at the time of approval, the hazard ratio was 1.24. No adjustment there because of course, that study was conducted before COVID, so that would not have been a confounding factor. We also took a look at the overall survival results from the ILLUMINATE study, which was used for approval of ibrutinib plus obinutuzumab. Again, similarly, the control arm was obinutuzumab clamber cell [ph], same as ours. The overall survival outcome in this study was even more peculiar. Here, the hazard ratio was 0.921 to below 1.0 at the time of approval, but in long-term follow-up turned negative against ibrutinib with a hazard ratio of 1.083. Both of these instances highlight the challenges of using underpowered overall survival analysis. So, I think everyone could imagine our surprise when in November of 2021 the FDA notified us that they plan to host a meeting of the Oncologic Drugs Advisory Committee, referred to as ODAC. And ODAC being much easier to say, of course, in connection with it's review of the BLA for ublituximab and the sNDA [indiscernible] stemming from the OS imbalance. It is also evident what the regulatory action see for other PI3K inhibitors, that there is a concern with the overall class that is influencing the way the FDA is viewing this data. We spent the next two months trying to close the information gap. We were pleased to report about a month ago that we're able to reduce the missing survival information from 15% down to 5%. And we were further pleased to report at a high level that the capture of the additional survival data, the overall survival analysis, both in the ITT and the COVID-censored populations, the overall survival hazard ratio has improved from what we had seen in the original submission to the FDA. We provided that update to the FDA late last month. We also spent considerable amount of time doing a deep dive into the survival data, literally reviewing patient-by-patient to try to understand causality. For now, I will be brief and in summary will say, from TG standpoint, and that of our independent external medical and statistical advisors, that the totality of the UNITY-CLL data suggests that the overall safety profile is generally in line with currently available tumors [ph] for CLL, especially when focusing on treatment-related deaths. Since we received notification of the ODAC, the team has been hard at work preparing for the upcoming meeting and we're looking forward to the opportunity to showcase under critical review that UKONIQ is a unique PI3K inhibitor with a differentiated toxicity and tolerability profile. And with the potential to fill an unmet need in the treatment of CLL. With that, I'll turn the call over to Adam Waldman, our Chief Commercialization Officer, to share a bit about our current commercialization efforts and preparations for potential launches later this year. Adam?