Mitchell Steiner
Analyst · Cantor Fitzgerald. Please go ahead
Thank you, Sam, and good morning. Also joining me today are Michele Greco, CFO and CAO; Phil Greenberg, Executive Vice President, Legal; and Sam Fisch, Director of Investor Relations. Thank you for joining our call. Veru is an oncology and urology biopharmaceutical company developing novel medicines for the management of prostate cancer, as well as other cancer types. Today, we will update you on the clinical development of our drug pipeline and the commercialization of our products, as well as provide financial highlights for the fourth fiscal quarter and year-end fiscal year 2019. We are delivering on our strategy to be the prostate cancer company. We are dedicated to the development and commercialization of products to address unmet medical needs for prostate cancer treatment and supportive care. We will remain opportunistic as our cancer drug product candidates have shown efficacy against other cancer types in animal models and they ultimately show efficacy in man as well. The markets for prostate cancer treatment and prostate cancer supportive care are well established as multi-billion dollar markets. And given our core expertise and the number and type of drugs in our pipeline, we are uniquely positioned to understand, develop and commercialize medicines for these unmet medical needs of prostate cancer patients. Here is a brief update on the advancement of the prostate cancer drug pipeline. We have made significant progress with our open-label Phase 1b/2 clinical trial, the VERU-111, a novel proprietary first-in-class oral selective antitubulin agent for metastatic castration-resistant prostate cancer patients, who have also become resistant to novel androgen blocking agents enzalutamide or abiraterone, but prior to IV chemotherapy, also referred to as a pre-chemotherapy stage or chemotherapy naive. In other words, the open-label Phase 1b/2 trial is targeting those patients whose prostate cancer is progressing that is spreading, but before they are offered IV Cabazitaxel taxane chemotherapy. This pre-chemotherapy space in men who have failed a novel androgen blocking agent is currently the fastest growing unmet medical need segment in advanced prostate cancer. We have reached a point in our Phase 1b/2 clinical study that our clinical results have become relevant to our decisions going forward for the clinical development of VERU-111 and positions Veru solidly as an oncology biopharmaceutical company. Accordingly, I will share some of the pertinent details while the full results will be released formally in an upcoming scientific meeting. As a relevant benchmark, a New England Journal of Medicine article was recently published in October of 2019 by Dr. de Wit et al on the use of cabazitaxel in men with metastatic castration-resistant prostate cancer who were previously treated with docetaxel, but who had cancer progression while receiving an androgen blocking agent to either abiraterone or enzalutamide. These men are at a similar stage of treatment as the men, we are currently enrolling in our Phase 1b portion of the Phase 1b/2 study. Interestingly, imaging-based progression-free survival is the primary endpoint, which was defined as the time from randomization until objective tumor progression, progression of bone metastasis or death. A total of 255 men underwent randomization to either IV cabazitaxel or another androgen blocking agent which studies results noted that the imaging-based progression-free survival with the additional androgen blocking agent was a median of 3.7 months with a range of 2.8 months to 5.1 months. And for cabazitaxel, it was a median of eight months with a range of 5.7 months to 9.2 months. Veru did not run a head-to-head study with cabazitaxel versus VERU-111. So any comparison has limitations, but nonetheless the intent is to use this valuable information to put into perspective our current ongoing results when compared to a recently reported contemporary study. Now, let's turn our attention to our Phase 1b/2 clinical study. In the Phase 1b/2 study, the objective is to determine the maximum tolerated dose of VERU-111 by finding the dose limiting toxicity that indicates that higher doses are not tolerated by the patients. By the studies design, the maximum tolerated dose is determined by treating three patients at a time with an oral daily dose VERU-111 for seven days followed by two weeks off drug which treatment schedule represents one cycle. For patients that tolerate treatment, we increased the schedule to two weeks on drugs, and one week off, and then three weeks continuously on drug, until there is evidence of prostate cancer progression. This will allow us to assess the durability of the anticancer response. We have treated 33 men to-date. The escalating doses of VERU-111 tested so far are 4.5 milligrams, 9 milligrams, 18 milligrams, 27 milligrams, 36 milligrams, 45 milligrams, 54 milligrams, 63 milligrams, 72 milligrams and 81 milligrams. As for safety, VERU-111 appears to be generally well tolerated. There are no reports of neutropenia, which is the dose limiting toxicity of an IV taxane. There have been no reported complaints of neurotoxicity, a side effect that also commonly occur with IV taxanes. There have been a few isolated mild liver enzyme changes that in some instances resolved while on drug. There have been reports of side effects consistent with VERU-111 or other antitubulin cytotoxic effects such as mild to moderate diarrhea, nausea, vomiting and fatigue. We have not yet reached a dose limiting toxicity with VERU-111 in order to determine a maximum tolerated dose. We know that with oral dosing VERU-111, it's getting absorbed into the bloodstream, which means we have bioavailability, with VERU-111 concentration going up with increasing drug doses. In fact, we have achieved VERU-111 blood concentrations in humans that match the efficacy concentrations we measured in the pre-clinical animal studies, where prostate cancer tumor shrunk. Furthermore, we are achieving drug concentrations at VERU-111 in a range of those of docetaxel and cabazitaxel approved doses without the safety observations that are typically observed with these drugs. Although this is a safety study, we do see significant anti-tumor activity. As a reminder, in the DeWitt study published in New England Journal of Medicine, adding another androgen blocking agent resulted in imaging based progression free survival median of 3.7 months and treatment with IV cabazitaxel resulted in imaging-based free progression medium of eight months. In our Phase 1b, we have 20 men in the study that have the potential to be treated for 4.5 months, which means they are in that lower dosing range because they were in the studies earlier. And even without having determined in optimal dose or a dose schedule yet, there were four men who are still ongoing in the trial with no tumor progression at 9.75 months, 8.4 months, 8.4 months, 5.6 months. All of these men have experienced PSA reductions from base of peak values. Another six men have progressed at 4.2 months. The patient still in the trial at 9.75 months has had a PSA reduction of 63% and had two of his cancerous lymph nodes shrink as measured by CT scan. Another patient on the study with stable disease stopped losing weight, reported that his fatigue resolved and had a PSA reduction. It appears, looking at the Dewitt study that VERU-111 is an active compound similarly to cabazitaxel but better than adding another androgen blocking agent. And that is also well tolerated with a wide safety margin. Wide safety margin means that we are seeing anti-cancer activity at doses where we are not seeing drug toxicity. Again, we will present the full clinical results in an upcoming major scientific meeting. As we have not yet reached dose limiting toxicity, we will continue to test higher doses of VERU-111 until we reach a maximum tolerated dose in the current Phase 1b/2 study. Nonetheless, given the current efficacy and safety profile, early in 2020, we plan to expand the clinical program of VERU-111 to a study of three additional tumor types or indications where we've had demonstrated anti-cancer activity in pre-clinical animal studies. The planned new cancer types are metastatic pancreatic cancer, metastatic breast cancer and post-chemotherapy metastatic castration and taxane-resistant metastatic prostate cancer, metastatic breast cancer and metastatic pancreatic cancer. We plan to report top line clinical results with the Phase 2 clinical trial evaluating zuclomiphene for the treatment of hot flashes caused by androgen deprivation therapy, submit the NDA for TADFIN, complete GMP manufacturing of clinical supply for VERU-100, submit the IND and complete the Phase 2 clinical trial. The secured partnerships with some of the other drug products and continues to demonstrate robust growing revenues from our commercial products PREBOOST/Roman Swipes and FC2. We are committed to driving shareholder value by becoming the prostate cancer and providing a continuum-of-care for prostate cancer patients. With that, I'll now open the call to questions. Operator?