Mitchell Steiner
Analyst · Cantor Fitzgerald. Go ahead
Thank you, Sam, and good morning. With me on this morning's call 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 with a focus on developing novel medicines for the management of prostate cancer. Before I provide the update on the clinical development of our drug pipeline and the commercialization of our products, as well as provide financial highlights for the third quarter fiscal year 2020, it is important to reflect on the great progress we have made transforming our company into an oncology biopharmaceutical company that's supported in part by a growing revenue cash generating sexual health business. Not only are we planning for 2021 two Phase 3 registration trials; one for VERU-111, our novel oral tubulin targeting agent to treat metastatic castrate resistant prostate cancer, and the other for VERU-100, our three-month GnRH antagonist long-acting depot to treat hormone sensitive advanced prostate cancer, but also we expect to continue to grow our base sexual health business. In fact, we've had 10 quarters of continued significant growth for FC2 and PREBOOST, known by the brand name Roman Swipes, and we plan to submit an NDA for TADFIN, the combination of Tadalafil and Finasteride for BPH, late this year to continue to profits for even more revenue. The model is working. The transformation is near complete. Now, let's focus on the significant progress we have made on the advancement of our drug pipeline. VERU-111 is a novel oral first-in-class tubulin targeting agent that cross links and disrupts alpha and beta tubulin subunits of microtubules. VERU-111 is in its clinical development to treat metastatic castration, a novel androgen receptor targeting, which is Enzalutamide and Abiraterone resistant prostate cancer, but prior to IV chemotherapy; a growing unmet medical need in advanced prostate cancer. The Phase 1b clinical study enrolled 39 subjects from seven clinical sites in the United States. A standard 3x3 design was used to establish the maximum tolerated dose to select a recommended clinical dose of Phase 2 study, and to assess preliminary evidence of anti-tumor activity. The maximum tolerated dose of VERU-111 was determined to be 72 milligrams as three of 11 of these men had reversible grade 3 diarrhea. No grade 3 diarrhea was observed with doses of 63 milligrams or less per day. At doses of VERU-111 of 63 milligrams or lower per day, the most common adverse events were mild-to-moderate nausea, vomiting, diarrhea, and fatigue. There were no reports of neurotoxicity and no neutropenia observed at 63 milligrams and lower with continuous oral 21-day daily dosing cycle. We have seen evidence of anti-tumor efficacy with PSA declines and objective tumor responses. Ten men or 25% of the study subjects received at least four 21-day cycles of oral VERU-111. The study is ongoing as subjects are still on study without tumor progression. The median duration of treatment without progress so far is 10.5 months with a range of 5.5 to 16 months. To better understand the clinical relevance of these preliminary findings, it is important to note that all patients with metastatic castrate resistant prostate cancer at the time of enrollment into the Phase 1b had evidence of disease progression with at least one of the novel androgen receptor targeted agents, Abiraterone and Enzalutamide, that 44% of the subjects in the Phase 1b has failed both Enzalutamide and Abiraterone, and contemporary studies recently reported in the scientific literature for this similar population of men, the median observed time to cancer progression, while being treated with an alternative antigen-blocking targeting agent was approximately 3.6 months and even less like 2.5 months for men that have failed both the androgen receptor targeting agents, Abiraterone and Enzalutamide. We are also near completion in the enrollment of our approximately 40 men in the open-label Phase 2 portion of the clinical trial in 14 U.S. centers. The patient population for this portion of the trial is men with metastatic castration novel entry blocking agent resistant prostate cancer, and prior to any IV chemotherapy, and we're using the recommended dose and schedule selected from the Phase 1b, which is the 63 milligram oral daily dosing for continuous 21 days per cycle. Like the Phase 1b, we have already observed significant PSA declines in the Phase 2 clinical study. We have the clinical safety and antitumor efficacy data necessary from the Phase 1b clinical study to move forward to select the patient population, VERU-111 dose and schedule for the Phase 3 registration trial. By late fall, we will have additional clinical data on the 63 milligram oral daily for 21 continuous days per cycle in almost all of the Phase 2 subjects. Recently, we have received positive FDA input, agreement, and regulatory clarity for our proposed Phase 3 registration trial program. The Phase 3 trial was designed to be an open-label, single pivotal randomized clinical study to evaluate the efficacy and safety of VERU-111 versus an alternative androgen receptor targeting agent in men with metastatic castration resistant prostate cancer, who have developed cancer progression, while receiving one androgen receptor targeting agent. The primary endpoint will be radiographic progression free survival. By having radiographic progression free survival is the primary endpoint. The sample size of the Phase 3 study could be potentially between 200 and 300 men, which is substantially smaller size study, clinical study that might otherwise have been required, if the primary endpoint was overall survival. We plan to submit the final Phase 3 clinical registration study protocol to FDA in the fourth quarter of calendar year 2020. We anticipate starting the global Phase 3 pivotal registration clinical study in the first quarter of calendar year 2021. We also plan to meet with the European Medicines Agency to obtain their input as well. This pre-chemotherapy space in men who have metastatic castration and androgen receptor targeting agent resistant prostate cancer is currently one of the fastest-growing unmet medical needs segments in advanced prostate cancer. There are currently no FDA approved drugs for this indication. According to IQVIA, oral drugs Abiraterone and Enzalutamide to advanced prostate cancer over $6 billion in 2018 global annual sales, and $3.1 billion in the U.S. Men who have failed these novel androgen receptor targeted agents of the same patients with VERU-111 is currently targeting, which we estimate represents about $5 billion annual global market. In summary, the objective with respect to the clinical development of VERU-111, which has a unique drug mechanism of action, as it does not target the androgen receptor, is to position VERU-111 as the next go-to drug in men who have metastatic castrate resistant prostate cancer and who have developed prostate cancer progression, while being treated with an androgen receptor targeting agent like Abiraterone or Enzalutamide but prior to using IV chemotherapy, an advantage of VERU-111 an oral medication with a favorable safety profile is that it can also be prescribed not only by the medical oncologist but also the urologists. The results from the VERU-111 clinical program firmly positions Veru as an oncology focused biopharmaceutical company, the results from the Phase 1b 2 two clinical study, VERU-111 have been accepted for oral presentation at the prestigious European Society for Medical Oncology, ESMO Virtual Congress in 2020, to be held September 19, to the 21. Mark Markowski, MD PHD, Assistant Professor of Oncology at the Johns Hopkins Sidney Kimmel comprehensive cancer center will be the presenter. Next, I will update you on VERU-100, our proprietary peptide drug candidate for the treatment of hormone sensitive advanced prostate cancer and established multibillion dollar global market. Target product profile for VERU-100 is commercially and scientifically compelling is having a number of anticipated advantages over currently available androgen deprivation therapies. VERU-100 is a long-acting gonadotropin-releasing hormone antagonist, also known as GnRH antagonist. This formulation was designed to be administered as a small volume subcutaneous three-month depot injection without a loading dose, as a GnRH antagonist it is intended to immediately suppressed testosterone with no testosterone surge upon initial and repeated administration, and no testosterone micro increases, which may adversely affect patient outcomes a problem which potentially occurs with the approved LHRH agonist drugs like Lupron, Zoladex, and Eligard. As previously mentioned, we received agreement from FDA that development program for VERU-100 may follow an expedited pathway based on this FDA input, the company plans to commence a single open-label multi-center dose finding Phase 2 clinical trial in approximately 35 men, followed by a single open-label multi-center Phase 3 registration clinical trial in only approximately 100 men. Veru has made great progress and scaling up the GMP manufacturing of the drug product for the clinical trials of VERU-100, the company intends to submit an investigational new drug application by the end of 2020. So that we can commence the open-label Phase 2 clinical study by Q4 calendar year 2020. The Phase 3 registration study is expected to start in the second-half of calendar year 2021. Androgen deprivation therapy is a $2.8 billion global market that appears to be moving towards supporting GnRH antagonists over LHRH agonists like Lupron, Leuprolide, and Eligard, Zoladex, the LHRH agonist is a class have a blackbox warning for an increased risk of cardiovascular events including heart attacks and stroke. The GnRH antagonist class does not have the same black box warning. Recently, a randomized Phase 3 study in 930 men that compared and LHRH agonists to GnRH antagonists confirmed that the incidence of cardiovascular events was significantly low in men receiving GnRH antagonists. Based on the study published by Dr. Neal Shore and his colleagues in the New England Journal of Medicine in 2020, the incidence of adverse cardiovascular events was 54% lower when antagonists versus an agonist. Furthermore, in men who have a history of adverse cardiovascular events, the incidence of new adverse cardiovascular events was 80% lower with an antagonist versus an agonist. Therefore it appears that GnRH antagonist may become the drug of choice if ADT because of their better safety profile. Currently, there are no GnRH antagonist injectable treatments commercially approved for beyond one month making VERU-100 if approved the only commercially available long acting GnRH antagonist treatment depot. Our next product candidate is Zuclomiphene, novel proprietary oral non-steroidal estrogen receptor agonist being evaluated to treatment of hot flashes, the most common side effect in men with androgen deprivation therapy for advanced prostate cancer and a major reason why men want to stop androgen deprivation therapy. The next step is to have an end of Phase 2 meeting with FDA for the Zuclomiphene and to obtain agreement on the Phase 3 clinical program design that will be acceptable for approval. We will provide details of design and the timing of the study after we have met with the FDA. Although Veru is focused on prostate cancer and oncology due to the urgency of the current global pandemic, the fact that no effective therapies have been found and that VERU-111 has the potential to treat both the SARS-CoV 2 infection and the associated reactive severe lung inflammation and COVID-19 patients at high risk for acute respiratory distress syndrome. The company is evaluating VERU-111 18 milligrams for this COVID-19 indication. Drugs that target microtubules have broad anti-viral activity by disrupting the intracellular transport of viruses such as SARS-CoV-2 along the microtubules. Microtubule trafficking is critical for viruses to cause infection, and furthermore, microtubule depolymerisation agents that target alpha and beta tubulin subunits of microtubules like colchicine have had evidence of strong anti-inflammatory effects, including the potential to treat the cytokine release syndrome, also known as the cytokine storm, induced by the SARS-CoV-2 viral infection that seems to be associated with the high COVID-19 mortality rates. In fact, we recently reported the results of an in vitro study conducted by a team of researchers at the University of Tennessee Health Science Center to determine if VERU-111 can suppress toxic shock levels of these key cytokines of the cytokine storm. The effects of VERU-111 on cytokine production was assessed by stimulating isolated mouse spleen cells with an endotoxin that causes shock and this is called lipopolysaccharide, we just call the LPS. The cells was stimulated with LPS for one hour and then incubated overnight with VERU-111 to mimic the clinical cytokine release clinical situation and the cytokine level was then analyzed, and a concentration that represents blood levels of VERU-111 observed in clinically dosed patients, VERU-111 at 40 nanomolar significantly reduce at a p-value less than 0.001, the production of key cytokines known to be involved with the COVID-19 cytokine storm. TNF alpha was minus 31%, IL-1 alpha was minus 123%, IL-1 beta was minus 97%, IL-6 was minus 85%, and IL-8 homologue was minus 96%. This reduction was similar to or greater than depending on the specific cytokine to what's been observed with dexamethasone at 10 nanomolar, which is a steroid and a known inhibitor of toxic shock cytokine production. Suppression of these key cytokines may be an effective way to prevent clinical deterioration of patients with COVID-19 to ARDS. Veru is currently enrolling at a double-blind randomized 1:1 placebo-controlled Phase 2 clinical trial evaluating daily oral doses of Veru-111 18 milligrams versus placebo for 21 days in 40 hospitalized patients, who have tested positive for SARS-CoV-2 virus and who are at high risk to ARDS. The primary efficacy endpoint will be the proportion of patients that are alive without respiratory failure at day 22, secondary endpoints with this trial include the measured improvements in the WHO disease severity scale, which is an 8 point ordinal scale, which compares COVID-19 disease symptoms and signs, including hospitalization to progression of pulmonary symptoms to mechanical ventilation as well as death. Based on VERU-111 having antiviral activity and also confirmed in this in vitro study that VERU-111 may have ability to suppress key cytokines in the COVID-19 patients were even more hopeful that in the Phase 2 study with COVID-19 patients at high risk ARDS that VERU-111 will improve patient outcomes. As an aside, this current cytokine study also further supports the use of VERU-111 in prostate cancer as cytokines IL-6, IL-1 and IL-8 appeared to play key roles in the promotion of prostate cancer progression, metastasis and drug resistance as well. The ability of VERU-111 to suppress these cytokines may benefit men who have metastatic castrate resistant prostate cancer, which is the primary indication that VERU-111 is being developed for. There's really no downside to conducting this small study, especially if we can get non-dilutive funding for future clinical testing and VERU-111 shows efficacy for this indication, the upside will be substantial patients. Veru's ability to advance the clinical development of our proprietary prostate cancer drugs that address unmet medical needs and large markets is being substantially supported by the sexual health business, which currently is comprised of two commercial sources of revenue, the FC2 female internal condom as well as PREBOOST/Roman Swipes, which is a 4% Benzocaine wipes for premature ejaculation. The company also expects a third source of revenues from TADFIN for which an NDA is expected to be submitted in late 2020 or early 2021, and this will provide additional resources to support the company's clinical development programs. As you can see from the earnings release in Q3 fiscal year 2020 and year-to-date fiscal year 2020, we continue to have significant growth in revenue from these commercial products. Although Ms. Greco will cover the detailed financial results highlights in a few moments, I would like to make a few comments. We again have the pleasure of reporting robust growth in fiscal year 2020 and expect further increases in FC2 sales in both U.S. prescription sales and public sector for the rest of the year. Focusing now on Veru's commercial segments, which is the sexual health business currently comprising of FC2 and PREBOOST/Roman Swipes and drug commercialization costs, the company's net revenues increased again in fiscal year-to-date 2020 it was $30.8 million compared to fiscal year-to-date 2019 of only $23.1 million, representing an increase of 33%. Our income from operations for this segment of the business was $17.6 million for fiscal year-to-date 2020, up from $11.4 million in fiscal year-to-date 2019, an increase of 54%. In fact, to give you a sense of our growth trajectory for all of fiscal year 2019, we sold 159,000 units of FC2 into the U.S. prescription market, while we sold just in the first three quarters of fiscal year 2020, 234,000 units of FC2 into the U.S. prescription market. As you can see, our base commercial business is doing very well and as a standalone business would be quite valuable as we're experiencing significant growing revenue and income from operations, it should also be noted that we do not have a sales force and minimally spend on marketing and selling these products. This continued revenue growth and profit and positive cash flow from base commercial business has allowed us to substantially invest in the development of our prostate cancer clinical programs, which enhances the value of Veru for our shareholders. We intend to continue this revenue growth trajectory with not only the current growth of revenues from FC2 and PREBOOST, but also from the revenues that we expect to generate from the commercialization of the company's proprietary to Tadalafil/Finasteride combination capsule for the treatment of symptoms of BPH called TADFIN. We're collecting 12 months stability data on TADFIN manufacturing batches and expect to submit the NDA by the end of 2020, early 2021. In the U.S., we're exploring the eventual commercial launch of TADFIN through telemedicine channels. As you have seen, we've had great success with our other products using this sales channel. We expect TADFIN to add substantial near-term revenues with high gross margins, the existing and growing revenues from FC2 in PREBOOST/Roman swipes. I will now turn the call over to Michele Greco, CFO and CAO, to discuss the financial highlights. Michele?