Mitchell Steiner
Analyst · Cantor Fitzgerald. Please go ahead
Thank you, Sam, and good morning. With me on this morning's call are Michele Greco, CFO and CAO. Dr. Gary Barnette, Chief Scientific Officer; Phil Greenberg, Executive Vice-President, Legal; and Sam Fisch, you've met, Director of Investor Relations. Thank you for joining our call. Veru is a late clinical-stage oncology biopharmaceutical company focused on developing novel medicines for the management of two of the most prevalent cancers, prostate cancer and breast cancer. We continue to invest cash generated from our sexual health commercial business into the clinical development of our high-value oncology drug candidates so, that our current shareholders can realize the maximum value of our oncology biopharmaceutical company. This morning we will discuss another record quarter from our sexual health business, the progress of our prostate cancer and breast cancer drug pipelines, Veru 111 for the treatment of COVID-19, the upcoming NDA submission for TADFIN. And then we will provide financial highlights for a record first quarter of fiscal year 2021. Let's now focus on some of the financial highlights in Veru's sexual health business. We had net revenues in the US FC2 prescription business in Q1 of fiscal year 2020 of $9.1 million compared to $6.1 million in Q1 of fiscal year 2020 which is up 50%. That should be Q1 fiscal year 2021 of $9.1 million compared to $6.1 million in Q1 in the fiscal year 2020 which is up 50%. Gross Profit for Q1 fiscal year 2021 was $10.8 million compared to Q1 fiscal year 2020 of $7.3 million, which is up 49%, operating income was $19.2 million, which includes a gain of $18.4 million on the sale of the PREBOOST business and the adjusted operating income which excludes the sale, the gain on the sale of PREBOOST was $800,000 in Q1 fiscal year 2021, compared to an operating loss of $1.8 million in Q1 fiscal year 2020. In fact, to give you a sense of our continuation of the growth trajectory for Q1 fiscal year 2020, we sold 81,000 units FC2 in the US prescription market, while in Q1 fiscal year 2021; we sold 116,000 units of FC2 in the US prescription market, an increase of 43%. TADFIN which is tadalafil 5 mg, finasteride 5 mg combination capsule is being developed to treat lower urinary tract infections caused by benign prostatic hyperplasia. It contains both tadalafil which is also approved for the treatment of erectile dysfunction and finasteride. We expect to submit the NDA for TADFIN next week. We also received a waiver for the PDUFA -- FDA PDUFA fees for this NDA submission in the approximate amount of $2.4 million. We plan to launch TADFIN if approved via third-party telemedicine channels and when launched will be a near-term source of additional revenue for Veru. In oncology, we are focused in providing new and novel oral therapies with favorable safety profiles following resistance to endocrine therapy but prior to proceeding to IV chemotherapy for both advanced prostate and breast cancers. We are excited to advance our prostate cancer drug candidates Veru-111 and Veru-100, as well as our breast cancer drug candidates Enobosarm and the additional indication for Veru-111 into registration clinical studies. Veru anticipates registration clinical trials for four oncology indications and the additional registration clinical trial with Veru-111 for COVID-19 making a total of five potential registration clinical trials in all to commence in calendar year 2021. In prostate cancer, the company continues to make strong clinical progress advancing Veru-111 as a treatment for metastatic castration and androgen receptor targeting agent-resistant prostate cancer and for Veru-100 the androgen deprivation therapy for advanced prostate cancer. Veru-111 is an oral first-in-class new chemical entity that targets crosslinks and disrupts the alpha and beta-tubulin subunits of microtubules to disrupt the cytoskeleton. Veru-111 is being evaluated in an open label Phase 1b and Phase 2 clinical studies in men with metastatic castration and androgen receptor targeting agent-resistant prostate cancer. The Phase 1b clinical study completed enrollment of 39 men and is ongoing. The Phase 1b study has yielded promising efficacy and safety clinical results based on the Phase 1b study results, the recommended Phase 2 dose of 63 milligrams oral daily continuous dosing for 21-day cycles. Daily chronic drug administration appears feasible and safe. The recommended Phase 2 dose, there were no reports of neutropenia, neurotoxicity, or grade 3 diarrhea. The efficacy results show PSA declines in responses as well as objective and durable tumor responses. Furthermore, median radiographic progression-free survival in the men who have had at least four cycles of Veru-111 is 12.4 months. There are still three men on the study with two patients approaching two years without prostate cancer progression. In September 2020, the Phase 2 clinical study completed enrollment of approximately 40 men with metastatic castration-resistant prostate cancer who have also become resistant to the androgen receptor targeting agents, but prior to proceeding to IV chemo, although the study is still ongoing daily chronic drug administration also continues to be feasible and safe. At 63 milligrams daily continuous dosing there were no reports of neutropenia. There is a single report of minor neurotoxicity and manageable and fewer cases of diarrhea. Like the Phase 1b, we have observed efficacy results including PSA declines and responses as well as objective and durable response -- tumor responses including complete and partial responses. Thus in the Phase 2 clinical study Veru-111 continues to show objective antitumor activity and a good safety profile. We will be presenting updated clinical results of the Phase 1b as well as the Phase 2 clinical trials at the ASCO genitourinary cancer symposium taking place February 11th through the 13th in 2021 and the Abstract is 325053, clinical study of Veru-111 an oral cytoskeletal disruptor in metastatic castration-resistant prostate cancer who have failed an androgen receptor targeting agent and the presentation will be done by Dr. Mark Markowski who is Assistant Professor of Oncology; Johns Hopkins Kimmel Comprehensive Cancer Center and the principal investigator on the study. As we already have enough safety and efficacy data at selected dose with Veru-111 and proceed to a Phase III, the Company had an FDA meeting in July of 2020 and received positive input from FDA on the pivotal Phase III trial design for VERU-111. The Company received regulatory clarity that the indication of treatment in men with metastatic castration-resistant prostate cancer who have failed one androgen receptor targeting agent prior to IV chemotherapy was acceptable, that an open label randomized study using an alternative androgen receptor targeting agent as an active control is reasonable and that the primary endpoint may be radiographic progression-free survival. By allowing radiographic progression-free survival as the primary endpoint the sample size of the Phase 3 study is planned for approximately 240 men. The Phase 3 pivotal clinical study will evaluate Veru-111 for men with metastatic castration-resistant prostate cancer who have also become resistant to one androgen receptor targeting agent and will be called the VERACITY Phase 3 study. The Company has submitted the Phase 3 protocol design to FDA for its input, and anticipate starting the VERACITY Phase 3 study in first quarter of calendar year 2021. It is interesting to note that we have a real opportunity for VERU-111 to be the leader in the pre-chemotherapy space in metastatic prostate cancer by pursuing the indication of the treatment of metastatic castration and androgen receptor-targeted agent-resistant prostate cancer. Use of androgen-receptor targeted agents have moved earlier in the treatment sequence of advanced prostate cancer. The two currently approved indications for the androgen-receptor targeted agents are for hormone-sensitive metastatic prostate cancer and for non-metastatic castration-resistant prostate cancer. When patients progress or fail and androgen-receptor-targeted agents both these settings they will now have metastatic castrate resistant and androgen-receptor-targeted agent-resistant prostate cancer the very indication we're pursuing in the Phase 3 clinical trial. So, all roads lead to this indication. Next, I will update you on Veru-100 as androgen deprivation therapy for the palliative treatment of advanced prostate cancer. Veru-100 is a novel proprietary long-acting gonadotropin-releasing hormone, GnRH antagonist peptide, three month subcutaneous depot formulation designed to address the current limitations of commercially available androgen deprivation therapies known as ADT. Androgen deprivation therapy is currently the mainstay of advanced prostate cancer treatment and is used as a foundation of treatment throughout the course of the disease. Furthermore, ADT is continued even as other endocrine chemotherapy or radiation treatments are added or stopped. There are no GnRH antagonist depot injectable formulations commercially approved for the treatment beyond one-month duration. If Phase 2 study to evaluate Veru-100 dosing is anticipated to begin in the first half of calendar year 2021, and the Phase 3 registration study in approximately 100 men is anticipated to start in the second half of calendar year 2021. Next, I will discuss the progress of our breast cancer drug pipeline, which includes enobosarm and Veru-111. The most common type of breast cancer is ER-positive breast cancer with estrogen as one of the main drivers of proliferation, tumor progression, and metastasis. Consequently treatments that target the estrogen receptor are the mainstay of breast cancer therapy. Typically women are treated with several lines of estrogen-receptor targeted agents like selective estrogen receptor modulators SERMs which includes tamoxifen non-steroidal aromatase inhibitor like letrozole and anastrozole, selective estrogen receptor degraders like fulvestrant and these standards of care now include treatment with CDK 4/6 inhibitors. Unfortunately, almost all of women being treated will eventually develop resistance to estrogen receptor targeted endocrine and CDK 4/6 inhibitor therapies and alternative treatment approaches with different mechanisms of action will be required including IV chemotherapy. Interestingly, like the estrogen receptor, the androgen receptor is found in over 85% of breast cancers. What is androgen receptors function in breast cancer, that it stimulated inhibit [ph] breast cancer growth. The recent publication in Nature Medicine of an international study headed by Dr. Hickey and her team has provided scientific evidence establishing that the androgen receptor is a tumor suppressor in estrogen-receptor positive breast cancer. This means the androgen receptor is activated by androgen. It's strongly suppresses estrogen receptor positive breast cancer growth. This explains why historically when synthetic antigens were used to treat breast cancer they demonstrated good activity but unfortunately the masculinization side effects, increase in hematocrit, liver toxicity has prohibited their use as a viable treatment. Contrast enobosarm an oral first-in-class new chemical entity is a selective androgen receptor targeted activating agent and is being developed for the treatment of AR positive, ER positive, HER2 negative metastatic breast cancer but prior to IV chemotherapy. Enobosarm represents a new advancement in endocrine therapy for advanced breast cancer in decades. Enobosarm has extensive non-clinical and clinical experience having been evaluated in over 25 separate clinical studies involving more than 2,100 subjects, including five prior Phase 2 clinical studies in advanced breast cancer involving more than 250 patients. In addition to suppressing androgen receptor, estrogen receptor breast cancer cell proliferation and tumor growth enobosarm has other potential beneficial clinical properties. In preclinical studies enobosarm has demonstrated "builds and heals" and trabecular bone and therefore has a potential to treat osteoporosis and skeletal-related events and cancer. Enobosarm has also been shown to reduce fat to build muscle to improve physical function in clinical studies involving elderly subjects and patients with cancer cachexia including breast cancer patients. And furthermore, because of its tissue selectivity enobosarm has a favorable side effect profile with no masculinization and so facial hair and acne, no increase in hematocrit, and no liver toxicity. The science supporting the efficacy of enobosarm and the targeting of the androgen receptor ER positive advanced breast cancer was also the subject in Nature Medicine study published this month by an independent group of breast cancer experts led by Dr. Hickey and in their study they showed that using breast cancer tissue for patients who have resistance to estrogen receptor targeted and CDK 4/6 inhibitor therapies. Enobosarm monotherapy exhibited significant anti-tumor activity. The combination of enobosarm and a CDK 4/6 inhibitor demonstrating even greater anti-tumor activity. The data suggests that enobosarm restores sensitivity of a CDK 4/6 inhibitor resistant breast cancer tissue to suppression by CDK 4/6 inhibitor. Two positive Phase 2 studies involving 150 women with androgen receptor positive, estrogen receptor positive metastatic breast cancer was conducted. We will focus on the second of these two studies. The G200802 Phase 2 study, which is a two-arm study evaluating 9 mg and 80 mg of enobosarm daily oral dosing in 136 women with AR positive, ER positive, HER2 negative advanced breast cancer. The patients in the study were heavily pretreated having failed around three endocrine-treatments and 88% received prior chemotherapy. The primary investigator for the study was Dr. Beth Overmoyer, Founder and Director of the Inflammatory Breast Cancer Program at Dana-Farber Cancer Institute in Boston, Massachusetts, and Assistant Professor of Medicine at Harvard Medical School. The completed Phase 2 study results were recently presented as a spotlight presentation at the San Antonio Breast Cancer Symposium this past December by Professor Carlo Palmieri, Professor of Translational Oncology and Medical Oncology at the University of Liverpool. The Abstract 811 entitled efficacy and safety of enobosarm a selective androgen receptor modulated to target the androgen receptor in women with advanced ER positive, AR positive breast cancer final results from an international Phase 2 randomized study. According to this study enobosarm therapy strongly establishes the relevance of targeting the androgen receptor with a selective androgen receptor activating agent as women with heavily pretreated estrogen receptor targeted resistant AR positive, ER positive metastatic breast cancer have favorable clinical benefit rates and objective and durable tumor responses. In fact, the presence of the androgen receptor was required as enobosarm's anti-tumor activity was not seen in AR negative, ER positive advanced breast cancer subjects. AR staining [ph] status will be a critical inclusion criteria in the Phase 3 clinical trial design to enrich the study for population -- patient population who most likely to benefit from enobosarm therapy. These subset analysis of AR staining in enobosarm anti-tumor activity from the Phase 2 clinical study will be presented at upcoming scientific meetings. Enobosarm appears safe and was well tolerated in this day without virilizing effects, increase in hematocrit, or liver toxicity and also quality of life measurements demonstrated overall improvement including mobility, anxiety, depression, and pain. The 9 mg dose was selected for Phase 3 as a 9 mg cohort had similar tumor responses with slightly better toxicity profile than the 18 mg dose cohorts. We also performed a post-hoc subset analysis of the Phase 2 clinical data to understand whether enobosarm had any anti-tumor efficacy in patients that had AR-positive, ER-positive metastatic breast cancer who are also resistant to both an estrogen receptor targeting agent and a CDK 4/6 inhibitor. In the nine women who fit these criteria enobosarm treatment resulted in objective tumor responses of 33%. We had two complete responses and one partial response in these nine women. Clinical benefit rate at 24 weeks of 60% and a radiographic progression-free survival of 7.7 months. Although small numbers, one can conclude that Enobosarm has anti-tumor activity in women with AR-positive, ER-positive metastatic breast cancer that's resistant to estrogen receptor targeting agents and CDK 4/6 inhibitors. These subset analysis of CDK 4/6 inhibitor resistance and enobosarm antitumor activity from the Phase 2 clinical study will also be presented at upcoming scientific meetings by targeting the androgen receptor in ER-Positive metastatic breast cancer enobosarm introduces a novel endocrine therapy to patients with breast cancer, that have exhausted endocrine therapies targeting the estrogen receptor but prior to IV chemotherapy. In October of 2020, the Company met with the FDA to discuss the enobosarm clinical breast cancer program. The FDA agreed to the Phase 3 registration clinical trial to study, to evaluate the efficacy and safety of enobosarm 9 mg versus an active control, which can be either exemestane to tamoxifen. For the treatment of AR positive, ER positive, HER2 negative breast cancer and patients who have failed a non-steroidal aromatase inhibitor fulvestrant and a CDK 4/6 inhibitor. The Phase 3 study will be called the ARTEST study and the primary endpoint will be radiographic progression-free survival. It should be noted that we and key breast cancer experts in the field were intrigued by the preclinical study results reported in Nature Medicine that showed the combination of enobosarm with a CDK 4/6 inhibitor actually restored CDK 4/6 inhibitor sensitivity and suppressing AR positive, ER positive metastatic breast cancer that was resistant to both an Estrogen Receptor Targeted Agent and a CDK 4/6 inhibitor, which is, as you know the target population in our planned Phase 3 ARTEST clinical study. Consequently, the Phase 3 ARTEST trial is now designed to have three treatment arms. Enobosarm alone, enobosarm in combination with a CDK 4/6 inhibitor, and an active control with either exemestane or tamoxifen. The trial sample size will remain approximately 240 women. The pivotal Phase 3 open label randomized active control ARTEST study is anticipated to commence next quarter. Next, I will update you on the Phase 2b clinical study evaluating Veru-111 for the treatment of taxane resistant metastatic triple-negative breast cancer. Metastatic triple-negative breast cancer is an aggressive form of breast cancer that is present in approximately 15% of all breast cancers. This form of breast cancer does not express the estrogen receptor, the progesterone receptor, or HER2 and is resistant to endocrine therapies. The first line of treatment usually involves IV taxane chemotherapy and almost all women will eventually develop taxane resistance. Preclinical studies and triple in human triple-negative breast cancer grown in animal models demonstrate that Veru-111 significantly inhibits cancer from proliferation migration, metastases, and invasion of triple-negative breast cancer cells and tumors that have become resistant to paclitaxel, which is a taxane. Using the safety information from the Phase 1b and Phase 2 Veru-111 prostate cancer clinical studies in the total of approximately 80 men, we plan to meet with FDA in the first half of calendar year 2021 to discuss the Phase 2b clinical trial design for possible accelerated approval for Veru-111 versus an active control Trodelvy, for patients with taxane-resistant triple-negative breast cancer, making the proposed trial a potential registration trial. The Phase 2b clinical study is planned to commence in the second half of clinical year -- calendar year 2021 and as I mentioned, this would represent a second major clinical oncology indication the Veru-111. We announced this past Monday, positive results from the Phase 2 clinical trial evaluating Veru-111 for the treatment of hospitalized patients with COVID-19 who had high risk for acute respiratory distress syndrome. Veru-111 in this setting is a novel once a day orally dosed small molecule with both broad antiviral and anti-inflammatory activities, which may serve a two-pronged approach to the treatment of COVID-19 virus infection and the subsequent debilitating inflammatory effects that lead to ARDS and death. We conducted a double-blind, randomized, placebo-controlled Phase 2 clinical trial evaluating daily oral once-a-day dosing of the Veru-111 18 mg versus placebo in approximately 40 hospitalized COVID-19 patients who had high risk with acute respiratory distress syndrome. This trial was conducted in five sites across the United States, patient received either Veru 111 18 mg or placebo, as well as standard of care for 21 days or until they were released in the hospital. The primary efficacy endpoint was the proportion of patients that were alive without respiratory failure at day 29. Here are the highlights of some of the clinical efficacy and safety results. For the primary endpoint in a modified intent-to-treat, mITT population Veru-111 treatment compared to placebo had a statistically significant and clinically meaningful improvement in a proportion of patients alive without respiratory failure of 94.4% in Veru-111 treated group 18 and 70% the placebo group 20 at day 29. And this represents an 81% relative reduction and treatment failures of p-value of 0.05. Here are some of the secondary endpoints in the ITT population Veru-111 reduced the proportion of patients who died on the study from 30% with 6 out of 20 in the placebo group 2, 5.3% which is 1 of 19 in the Veru-111 treated group, this is an 82% relative reduction in mortality in the Veru-111 treated group, P-value there is 0.044. The miTT population Veru-111 showed a clinically meaningful reduction in average days in ICU, Veru-111 patients three days versus placebo 9.5 days, and that P-value of 0.04. Veru-111 had a clinically meaningful reduction in days on mechanical ventilation from an average of 5.4 days in the placebo group to 1.6 days in the Veru-111 treated group. During the study the standard of care included the treatment with either Remdesivir and/or dexamethasone under an Emergency Use Authorization. A subgroup analysis of patients that receive standard of care was conducted in patients that received standard of care Veru-111 treatment resulted in a clinically meaningful reduction and average days in the ICU Veru-111 was for 1.43 days versus in the placebo 8.83 days P-value of 0.024. And average days on mechanical ventilation Veru-111 had 0 days, versus placebo 6 days with P-values 0.0427. In the Veru-111 group that also receive standard of care no patient required mechanical ventilation on this small study. Furthermore Veru-111 was well tolerated and had a very good safety profile. Company has been granted and expedited end of Phase 2 meeting with FDA to discuss next steps, including a Phase 3 clinical registration trial design Veru-111 COVID-19 program. The company expects that this confirmatory study will have a similar trial design as a completed Phase 2 study to evaluate daily oral doses Veru-111 versus placebo with a primary efficacy endpoint of proportion of patients that are alive without respiratory failure at day 29. We expect the Phase 3 clinical trial will be conducted in approximately 200 hospitalized patients who have COVID-19 and/or at high risk for acute respiratory distress syndrome. Company is expected to have sufficient clinical drug supply on hand to complete this Phase 3 clinical study once agreed upon by FDA the Phase 3 is expected to commence in April 2021, and is anticipated to be completed by the Fourth quarter of calendar year 2021. We will seek funding from the Biomedical Advanced Research and Development Authority of the US Department of Health and Human Resources -- and Human Services BARDA and other agencies to try to fund the estimated amount of commercial drug to supply the needs of the US population assuming confirmatory part of the results and FDA approval. Due to the unprecedented urgency of the global pandemic and the fact that COVID-19 continues to mutate into virus forms that may not be substantially mitigated by current vaccines or by any of the currently approved antibody drugs of therapeutic we are in need of an effective broad-spectrum antiviral drugs. Veru-111 has the potential to be both that broad-spectrum antiviral agent and that anti-inflammatory agent. The strength of the study, whether it was blinded, placebo controlled randomized study that also allowed standard of care for both the treated and placebo groups in hospital patients at high risk for ARDS. Based on the strength of these promising clinical results. The company continues to be duty bound during this persistent global pandemic to pursue this COVID-19 indication even though it's not the primary focus of the company. We are committed during the deadly pandemic to push ahead with Veru-111 clinical development as a treatment against COVID-19 and we have the resources to conduct our planned Phase 3 without impacting the cancer drugs, clinical development. I will now turn the call over to Michele Greco, CFO, CAO, to discuss the financial highlights. Michele?