On May 11, 2023 Geron Corporation (Nasdaq: GERN), a late-stage clinical biopharmaceutical company, reported that five abstracts related to imetelstat, a first-in-class telomerase inhibitor, have been accepted at the European Hematology Association (EHA) (Free EHA Whitepaper) Annual Meeting taking place from June 8-11, 2023 in Frankfurt, Germany and virtually (Press release, Geron, MAY 11, 2023, View Source [SID1234631506]). The three EHA (Free EHA Whitepaper) abstracts on IMerge Phase 3 data expand upon and further confirm the differentiating qualities of imetelstat that can address current unmet needs for lower risk MDS patients compared to available treatments. In addition, abstracts submitted by Geron collaborators covering a translational analysis from a subset of IMerge Phase 2 patients and imetelstat MF pre-clinical data were accepted for oral and poster presentation, respectively.

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"The longer follow-up data for one-year TI and additional analyses from IMerge Phase 3 in lower risk MDS we are presenting at EHA (Free EHA Whitepaper) further confirm the unprecedented durability of imetelstat, as well as provide deeper insight into the clinically meaningful benefit/risk profile of imetelstat in these patients," said Faye Feller, M.D., Executive Vice President, Chief Medical Officer of Geron. "The strong correlation of reduction in MDS-associated mutations with clinical benefits observed in these patients provides strong evidence for the potential of disease modification with imetelstat. Further, patient reported outcomes presenting sustained meaningful improvement in fatigue is particularly important as fatigue is a specific concern for lower risk MDS patients, and because improvement in fatigue has not been seen with currently available treatments. Overall, as these analyses are completed and as the data continue to mature, a highly compelling and differentiated profile supporting strong clinical benefit is being reinforced for imetelstat in lower risk MDS."

IMerge Phase 3 Clinical Data – Lower Risk Myelodysplastic Syndromes (MDS)

Abstract #S165: "Continuous Transfusion Independence with Imetelstat in Heavily Transfused Non-Del(5q) Lower Risk Myelodysplastic Syndromes Relapsed/Refractory to Erythropoiesis Stimulating Agents in IMerge Phase 3"

Oral Presentation on June 9 in session s417 "MPN and MDS: Targeting red cells and platelets" (14:45-16:00 CEST)
Presenter: Uwe Platzbecker, MD, University Hospital of Leipzig

The abstract reports top-line results from IMerge Phase 3 with a data cut-off of October 2022 for the primary analysis and January 2023 for ≥1-yr transfusion independence (TI). As reported in January 2023, imetelstat demonstrated statistically significant and clinically meaningful efficacy with robust 8-week TI, 24-week TI, and 1-year TI rates.

With 3 months additional follow-up, 17.8% (21/178) of imetelstat-treated patients versus 1.7% (1/60) of placebo-treated patients achieved 1-year TI (P = 0.002), representing 63.6% of 24-week TI imetelstat responders. The continuous TI for more than one year represents substantial relief from transfusion-associated complications for this lower risk MDS patient population.

As reported in January, 39.8% (47/118) of imetelstat-treated patients versus 15.0% (9/60) of placebo-treated patients achieved the study primary endpoint of 8-week TI (P < 0.001). In addition, the rate of 8-week TI was also significantly higher for imetelstat-treated patients versus placebo-treated patients across MDS subtypes, including in RS negative and RS positive patients. Median TI duration using Kaplan Meier estimates (95% CI) was 51.6 (26.9–83.9) weeks for imetelstat-treated patients versus 13.3 (8.0–24.9) weeks for placebo-treated patients (P < 0.001). Key secondary endpoint of 24-week TI was achieved in 28.0% (33/118) of imetelstat-treated patients versus 3.3% (2/60) of placebo-treated patients (P < 0.001).

New data on variant allele frequency (VAF) reductions were also reported in the abstract. For four genes frequently mutated in MDS, the VAF reductions were greater in patients treated with imetelstat than placebo: SF3B1 (P < 0.001), TET2 (P = 0.032), DNMT3A(P = 0.019) and ASXL1 (P = NS). Furthermore, SF3B1 VAF reduction correlated with longer TI duration in imetelstat-treated patients (P < 0.001). These reductions and correlations, together with the durable and continuous TI observed in the trial, support imetelstat’s disease-modifying potential.

The most common Grade 3/4 adverse events with imetelstat were thrombocytopenia and neutropenia with similar rates of Grade ≥3 bleeding and infections observed on imetelstat and placebo. These cytopenias were of short duration, and >80% resolved to Grade ≤2 within 4 weeks. The abstract also noted no new safety signals were identified in the trial.

Abstract #S164: "Disease Modifying Activity of Imetelstat in Patients with Heavily Transfused Non-Del(5q) Lower-Risk Myelodysplastic Syndromes Relapsed/Refractory to Erythropoiesis Stimulating Agents in IMerge Phase 3"

Oral Presentation on June 11th in session "s448 MDS biology and translational updates" (11:30 – 12:45 CEST)
Presenter: Valeria Santini, MD, University of Florence School of Medicine

As noted in the abstract, a main therapeutic goal in lower risk MDS is to alter disease biology by eradicating malignant clones. MDS-initiating cells carrying cytogenetic abnormalities, mutant alleles, or both and arise from malignant stem and progenitor cells. SF3B1, involved in RNA splicing, and TET2, involved in DNA methylation, are recurrently mutated genes in lower risk MDS., Measuring change in VAF of these genes is used to denote disease burden.

Of the 178 patients enrolled in IMerge Phase 3, 22.0% of imetelstat-treated patients and 21.7% of placebo-treated patients had baseline cytogenetic abnormalities. Cytogenetic response was observed in 34.6% (9/26) of imetelstat treated patients (95% CI=17.2–55.7) versus 15.4% (2/13) of placebo-treated patients (95% CI=1.9–45.5). In addition, imetelstat-treated patients demonstrated a higher rate of ≥50% VAF decreases in SF3B1, TET2, DNMT3A, and ASXL1 mutations as compared with placebo.

Imetelstat-treated patients achieving 8-week TI, 24-week TI, and 1-year TI had higher VAF reductions in SF3B1and TET2 mutations compared with placebo-treated patients.

Additionally, both 8-week TI and 24-week TI responders on imetelstat had significantly greater VAF reductions in SF3B1 mutation versus non-responders (P<0.001, for both) on imetelstat. Importantly, greater VAF reductions in SF3B1 mutation for imetelstat-treated patients correlated significantly with hemoglobin increase; r=−0.626 (P<0.001), and longer TI duration; r=−0.549 (P<0.001). The abstract concludes that these data, taken together with robust rates of TI that are continuous and durable in the trial, may indicate improvement of the ineffective erythropoiesis characteristic of lower risk MDS with imetelstat and suggest imetelstat may alter the underlying biology of disease in these patients.

Abstract #P732: "Analysis of Patient Reported Fatigue in IMerge Phase 3 Trial of Imetelstat vs. Placebo in Heavily Transfused Non-Del(5q) Lower Risk Myelodysplastic Syndromes Relapsed/Refractory to Erythropoiesis Stimulating Agents (ESA)"

Poster on June 9 at 18:00 – 19:00 CEST
Presenter: Mikkael Sekeres, MD, University of Miami Health System and Sylvester Comprehensive Cancer Center

The abstract noted that patients with lower risk MDS and anemia experience severe fatigue that negatively impacts overall functioning and daily life. The goals for lower risk MDS treatments are to minimize transfusions and improve patient-reported outcomes (PRO). However, fatigue can also be commonly reported with currently available treatments.

In the trial, an exploratory analysis of patient-reported fatigue was conducted using Functional Assessment of Chronic Illness Therapy, or FACIT, a validated 13-item patient questionnaire, to measure the rate of deterioration or improvement of fatigue during treatment with imetelstat or placebo. Proportion of sustained meaningful deterioration/improvement was defined as percentage of patients with ≥3-point decrease/increase on the FACIT Fatigue Scale (0–52) for ≥2 consecutive treatment cycles. Time-to-deterioration/improvement was estimated by Kaplan-Meier analysis.

118 patients on imetelstat and 57 patients on placebo were assessed for PRO. Overall, 50.0% of imetelstat-treated patients reported sustained meaningful improvement in fatigue versus 40.4% of placebo-treated patients. In addition, imetelstat-treated patients reported a shorter median time to first sustained meaningful improvement in fatigue versus placebo-treated patients; 28.3 vs 65.0 weeks, respectively, hazard ratio=1.34 (95% CI, 0.82–2.20).

After 12 weeks, more imetelstat-treated patients reported improvement in the FACIT Fatigue Scale than placebo-treated patients. In addition, in imetelstat-treated patients, a significantly higher proportion of TI responders had sustained meaningful improvement in fatigue scores versus non-responders. This was consistent across 8-week TI and 24-week TI and hematologic improvement-erythroid (HI-E) response per 2006 International Working Group criteria, for imetelstat-treated patients, which was not an association observed in placebo-treated patients.

With both imetelstat- and placebo-treated patients reporting similar rates of deterioration in fatigue, these data suggest that imetelstat did not worsen the rate of deterioration, which has been reported with other available treatments. Importantly, imetelstat-treated patients were more likely to have sustained meaningful improvement in fatigue, as well as experience such improvement more quickly. The abstract concludes that a significant association between TI and HI-E responses and sustained meaningful improvement in fatigue support the clinical benefit of imetelstat treatment.

Translational Analysis from IMerge Phase 2 – Lower Risk MDS

Abstract #S169: "Modulation of the immune landscape in lower-risk myelodysplastic syndromes with imetelstat-induced transfusion independency"

Oral Presentation on June 9 in session "s417 MPN and MDS: Targeting red cells and platelets" (14:45-16:00 CEST)
Presenter: Nicolas Chapuis, Assistance Publique-Hopitaux de Paris, Centre-Universite Paris Cite

As noted in an abstract by Geron collaborators, this analysis aimed to identify biological pathways associated with the clinical response, by analyzing bone marrow mononuclear cell transcriptome and peripheral blood immune cell landscape of a subset of patients with lower risk MDS enrolled in the IMerge Phase 2 clinical trial. The abstract concludes that low inflammatory features at baseline and induction of an adaptive immune profile by imetelstat are associated with the TI response, suggesting that immune cell remodeling could contribute to hematopoietic activity of imetelstat treatment.

Imetelstat Pre-Clinical Data in Myelofibrosis (MF)

Abstract # P1008 : "The telomerase inhibitor imetelstat differentially targets JAK2V617F- versus CALR-mutant Myeloproliferative Neoplasm cells and inhibits JAK-STAT signaling"

Poster on Friday, June 9 at 18:00-19:00 CEST
Presenter: Nicolas Chatain, PhD, University Hospital Aachen

An abstract by Geron collaborators reports on a single patient study which analyzed clonal evolution of the myeloproliferative neoplasms mutation profile during a two-year course of imetelstat treatment. In the study, using the human TF-1MPL and murine 32DMPL cell lines, the authors demonstrated a stronger effect of imetelstat on CALRdel52-positive vs. JAK2V617F-positive cell viability (p=0.0361 and p=0.0311 for 5 μM imetelstat, respectively), and this was associated with an immediate downregulation of JAK2 protein phosphorylation and downstream signaling as well as a reduction of telomerase reverse transcriptase (hTERT) and STAT3 mRNA expression. The authors report these data confirm that imetelstat reduces hTERT expression and telomere length (TL) and JAK2 and CALR clones by targeting the JAK/STAT signaling, particularly in CALR-mutated cells. According to the abstract conclusion, the data propose that CALR-mutated clones are highly vulnerable to imetelstat treatment.

About IMerge Phase 3

The Phase 3 portion of the IMerge Phase 2/3 study is a double-blind, 2:1 randomized, placebo-controlled clinical trial to evaluate imetelstat in patients with IPSS Low or Intermediate-1 risk (lower risk) transfusion dependent MDS who were relapsed after, refractory to, or ineligible for, erythropoiesis stimulating agent (ESA) treatment, had not received prior treatment with either a HMA or lenalidomide and were non-del(5q). To be eligible for IMerge Phase 3, patients were required to be transfusion dependent, defined as requiring at least four units of packed red blood cells (RBCs), over an eight-week period during the 16 weeks prior to entry into the trial. The primary efficacy endpoint of IMerge Phase 3 is the rate of RBC-TI lasting at least eight weeks, defined as the proportion of patients without any RBC transfusion for at least eight consecutive weeks since entry to the trial (8-week TI). Key secondary endpoints include the rate of RBC-TI lasting at least 24 weeks (24-week TI), the duration of TI and the rate of hematologic improvement erythroid (HI-E), which is defined as a rise in hemoglobin of at least 1.5 g/dL above the pretreatment level for at least eight weeks or a reduction of at least four units of RBC transfusions over eight weeks compared with the prior RBC transfusion burden. A total of 178 patients were enrolled in IMerge Phase 3 across North America, Europe, Middle East and Asia.

About Imetelstat

Imetelstat is a novel, first-in-class telomerase inhibitor exclusively owned by Geron and being developed in hematologic malignancies. Data from non-clinical studies and clinical trials of imetelstat provide strong evidence that imetelstat targets telomerase to inhibit the uncontrolled proliferation of malignant stem and progenitor cells in myeloid hematologic malignancies resulting in malignant cell apoptosis and potential disease-modifying activity. Imetelstat has been granted Fast Track designation by the U.S. Food and Drug Administration for both the treatment of adult patients with transfusion dependent anemia due to Low or Intermediate-1 risk MDS that is not associated with del(5q) who are refractory or resistant to an erythropoiesis stimulating agent, and for adult patients with Intermediate-2 or High-risk MF whose disease has relapsed after or is refractory to janus associated kinase (JAK) inhibitor treatment. Geron plans to submit a New Drug Application (NDA) in the U.S. in June 2023 and a Marketing Authorization Application (MAA) in the EU in the second half of 2023 in the lower risk MDS indication.

On May 11, 2023 GENFIT (Nasdaq and Euronext: GNFT), a late-stage biopharmaceutical company dedicated to improving the lives of patients with rare and severe liver diseases, reported its cash position as of March 31, 2023 and revenues for the first three months of 2023 (Press release, Genfit, MAY 11, 2023, https://ir.genfit.com/news-releases/news-release-details/genfit-reports-first-quarter-2023-financial-information [SID1234631505]).

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Cash Position

As of March 31, 2023, the Company’s cash, cash equivalents and current financial assets amounted to €128.6 million compared with €222.2 million as of March 31, 2022, and €140.2 million as of December 31, 2022.

The decrease in cash, cash equivalents and current financial assets between December 31, 2022 and March 31, 2023 consists of costs arising out of the ordinary course of business related to the progress of our research and development pipeline.

The decrease in cash, cash equivalents and current financial assets between March 31, 2022 and March 31, 2023 notably includes the initial consideration of CHF40.0 million (€41.9 million) for the acquisition of Versantis AG on September 29, 2022, a payment of CHF2.4 million (€2.4 million) representing a net cash adjustment made at year end in accordance with the Versantis AG Share Purchase Agreement, and related acquisition costs totaling €1.7 million.

We expect that our existing cash, cash equivalents and current financial assets will enable us to fund our operating expenses and capital expenditure requirements until approximately the fourth quarter of 2024. This is based on current assumptions and without taking exceptional events into account, including potential milestone payments should the ELATIVE study be successful. In addition, as we continue to advance our current product candidates, conduct preclinical studies and conduct clinical trials, we expect that our cash used in operational activities will amount to approximately €60 million in 2023.

Revenues

Revenues2 for the first three months of 2023 amounted to €5.0 million compared to €3.9 million for the same period in 2022.

Of the €5.0 million in revenues for the first three months of 2023, €4.1 million is attributable to the partial recognition of the €40.0 million deferred income described below. €0.8 million is attributable to re-billings made in accordance with the 2021 licensing and collaboration agreement with IPSEN, referenced below. €0.1 million in revenue was generated from the services rendered by GENFIT to Ipsen in accordance with the Transition Services Agreement signed in 2022, in order to facilitate the transition of certain activities related to the Phase 3 clinical trial evaluating elafibranor in Primary Biliary Cholangitis.

Revenues for the first three months of 2022 are mainly attributable to the partial recognition of the €40.0 million deferred income described below.

In 2021, GENFIT received a €120.0 million upfront payment from Ipsen, out of which €80.0 million was recognized as 2021 revenue, and €40.0 million was recognized as deferred revenue. The remainder is recognized as revenue over time and in line with the progress of the ELATIVE double-blind study, in accordance with IFRS 15 and the terms of the strategic licensing and collaboration agreement with Ipsen on December 17, 2021.

On May 11, 2023 Galera Therapeutics, Inc. (Nasdaq: GRTX), a clinical-stage biopharmaceutical company focused on developing and commercializing a pipeline of novel, proprietary therapeutics that have the potential to transform radiotherapy in cancer, reported financial results for the first quarter ended March 31, 2023, and provided recent corporate updates (Press release, Galera Therapeutics, MAY 11, 2023, View Source [SID1234631504]).

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"Galera has made tremendous progress since the start of the year, securing Priority Review designation for our avasopasem NDA, raising $30 million in a registered direct offering, and expanding our commercial leadership team," said Mel Sorensen, M.D., Galera’s President and CEO. "In February, the FDA granted priority review and assigned a PDUFA date of August 9, 2023, to the NDA for avasopasem for the reduction of radiotherapy-induced severe oral mucositis in patients with head and neck cancer. In preparation for the potential U.S. commercial launch of avasopasem in 2023, we built out our commercial leadership team, appointing leading life sciences executives with demonstrated success launching and commercializing market-leading oncology therapies. We look forward to bringing avasopasem to market as potentially the first FDA approved drug for radiotherapy-induced SOM in patients with head and neck cancer."

Recent Corporate Updates

Radiotherapy-Induced Toxicity Programs:

Severe Oral Mucositis (SOM)

In February 2023, the Company announced that the U.S. Food and Drug Administration (FDA) accepted for filing and granted priority review to the New Drug Application (NDA) for avasopasem manganese (avasopasem) for radiotherapy-induced SOM in patients with head and neck cancer (HNC) undergoing standard-of-care treatment. With Priority Review designation, the Prescription Drug User Fee Act (PDUFA) target date assigned by the FDA for the NDA is August 9, 2023. The FDA indicated in its acceptance of filing letter that it is not planning to hold an advisory committee meeting on the application.
Dr. Carryn Anderson, M.D., Clinical Associate Professor of Radiation Oncology at the University of Iowa, presented a net treatment benefit analysis from the Phase 3 ROMAN trial at the European Congress on Head and Neck Oncology (ECHNO), which took place March 8-11, 2023, in Lisbon, Portugal. The analysis demonstrated the overall impact of avasopasem in reducing the burden of SOM.
Elizabeth Cullen, MSN, ARNP, Nurse Practitioner at the University of Iowa Hospitals and Clinics, presented data from the Phase 3 ROMAN trial and additional information describing the general workflow management for the infusion of avasopasem prior to radiation therapy during the Phase 3 ROMAN study at the Oncology Nursing Society (ONS) Congress, which took place April 26-30, 2023, in San Antonio, TX.
An abstract featuring avasopasem, "One-year reductions in cisplatin-related chronic kidney disease (CKD) in patients with head and neck (HNC) cancer treated with avasopasem manganese: A prespecified analysis from the phase 3 ROMAN trial," has been selected for a poster presentation as part of the Head and Neck Cancer session at the upcoming American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting, taking place June 2-6, 2023, in Chicago, IL.
Esophagitis

In May 2022, the Company announced topline results from the open-label, single-arm Phase 2a AESOP trial evaluating avasopasem for its potential to reduce the incidence of radiotherapy-induced esophagitis in patients with lung cancer. The results demonstrated that avasopasem was generally well tolerated and substantially reduced the incidence of severe esophagitis in patients with lung cancer receiving chemoradiotherapy compared to expectations based on review of historical data in the literature. Based on these data, Galera intends to pursue a strategy for avasopasem, if approved for the reduction of SOM, to support the use of avasopasem to reduce radiotherapy-induced esophagitis in patients with lung cancer as a medically accepted indication in published drug compendia.
Anti-Cancer Programs:

Locally Advanced Pancreatic Cancer (LAPC)

Enrollment is ongoing in the randomized, placebo-controlled Phase 2b GRECO-2 trial of rucosopasem in combination with stereotactic body radiation therapy (SBRT) in patients with LAPC. The primary endpoint of the trial is overall survival. The trial is enrolling well. As a result, the Company plans to expand the target enrollment from 160 to 220 patients in order to accrue the necessary events (number of deaths) for data analysis sooner. Completion of enrollment is now anticipated in the first half of 2024, and topline data readout is expected by the end of 2024.
Non-Small Cell Lung Cancer (NSCLC)

Enrollment is ongoing in the randomized, placebo-controlled Phase 2 stage of the GRECO-1 trial of rucosopasem in combination with SBRT in patients with NSCLC. Completion of enrollment continues to be anticipated in the second half of 2023, and topline data readout is expected in the second half of 2024.
General Corporate Updates

On February 17, 2023, the Company completed a registered direct offering, which resulted in the issuance and sale of 14,320,000 shares of common stock and warrants to purchase up to 14,320,000 shares of common stock at a combined offering price of $2.095 per share and accompanying warrant, generating gross proceeds of $30 million. The Company received net proceeds of $27.6 million, after deducting placement agent fees and offering expenses.
On May 1, 2023, the Company expanded its commercial leadership team with the appointment of accomplished pharmaceutical sales, market access, and commercial operations executives, including Patrick Campbell as Vice President of Sales & Account Management, Elizabeth Turner as Vice President of Market Access, and Henning Thorsen as Vice President of Commercial Operations. The new executives joined Lorraine Walker, Pharm.D., the Company’s Vice President of Marketing. Under the direction of the Company’s Chief Commercial Officer, Mark Bachleda, Pharm.D., MBA, the team is responsible for building out commercial operations, strategy development, and execution in preparation for the potential U.S. commercial launch of avasopasem in 2023.
First Quarter 2023 Financial Highlights

Research and development expenses were $7.3 million in the first quarter of 2023, compared to $8.1 million for the same period in 2022. The decrease was primarily attributable to a decrease in avasopasem development costs, partially offset by an increase in rucosopasem development costs.
General and administrative expenses were $6.6 million in the first quarter of 2023, compared to $5.0 million for the same period in 2022. The increase was primarily attributable to avasopasem commercial preparations.
Galera reported a net loss of $(17.7) million, or $(0.50) per share, for the first quarter of 2023, compared to a net loss of $(15.4) million, or $(0.58) per share, for the same period in 2022.
As of March 31, 2023, Galera had cash, cash equivalents and short-term investments of $47.8 million. Galera expects that its existing cash, cash equivalents and short-term investments will enable Galera to fund its operating expenses and capital expenditure requirements into the fourth quarter of 2023.

On May 11, 2023 Equillium, Inc. (Nasdaq: EQ), a clinical-stage biotechnology company leveraging a deep understanding of immunobiology to develop novel therapeutics to treat severe autoimmune and inflammatory disorders with high unmet medical need, reported financial results for the first quarter 2023 and provided corporate and clinical development updates (Press release, Equillium, MAY 11, 2023, View Source [SID1234631502]).

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"In the first quarter of 2023, we made excellent progress advancing Equillium’s wholly-owned multi-cytokine inhibitors, EQ101 and EQ102, in their respective clinical programs in alopecia areata and first-in-human development, as well as continuing to advance our pivotal Phase 3 EQUATOR study in aGVHD and Phase 1b EQUALISE study in lupus nephritis," said Bruce Steel, chief executive officer at Equillium. "With the Ono Pharmaceutical partnership now in place, and Equillium in a strong financial position, our team is focused on achieving near-term milestones in the multi-cytokine programs before the end of the year, including initial data from the EQ101 Phase 2 study in alopecia areata. While we believe the multi-cytokine programs represent a significant source of long-term value, we remain highly engaged in the ongoing development of itolizumab and plan to report topline data from the EQUALISE study in lupus nephritis in the first half of 2024 and remain currently on track for the interim review of the Phase 3 EQUATOR study later in 2024. We look forward to these two milestones as they will establish Ono’s option exercise timeline for itolizumab, which if exercised would result in a payment of approximately $371 million and significantly extend Equillium’s cash runway."

Highlights Since the Beginning of 2023:

•
Announced oral and ePoster presentations at the Tandem Meetings of the American Society of Transplantation and Cellular Therapy and the Annual Meeting of the European Society for Blood and Marrow Transplantation, respectively, highlighting additional long-term data from the Phase 1b EQUATE study in acute graft-versus-host disease (aGVHD). The data demonstrate promising outcomes in subjects with severe aGVHD, notably rapid and durable high rates of overall clinical response​, Day 29 response associated with improved progression-free survival through one year and that responders were able to taper steroids by 70% at Day 29 and 99% at Day 169​. Equillium is now actively enrolling the pivotal Phase 3 EQUATOR study in aGVHD (NCT05263999).

Anticipated Upcoming Milestones:

•
EQ101: Phase 2 clinical study in subjects with alopecia areata – initial data anticipated in 2H 2023, topline data anticipated in mid-2024

1 Option exercise payment is denominated in Japanese yen (5 billion) and subject to currency exchange rates at the time of payment.

•
EQ102: Phase 1 first-in-human study in healthy volunteers and subjects with celiac disease – single ascending dose/multiple ascending dose data anticipated in 2H 2023, celiac disease patient data anticipated in 2024
•
Itolizumab: EQUALISE lupus nephritis topline data anticipated in 1H 2024, EQUATOR aGVHD interim review anticipated in 2024

First Quarter 2023 Financial Results

Revenue for the first quarter of 2023 was $8.9 million and was derived from itolizumab development funding from Ono Pharmaceutical Co, Ltd. (Ono) and amortization of the upfront payment from Ono.

Research and development (R&D) expenses for the first quarter of 2023 were $9.3 million, compared with $10.8 million for the same period in 2022. The decrease was primarily due to a decrease in employee compensation and benefits related to lower headcount, a greater estimated Australian R&D tax incentive and a decrease in non-clinical research expenses, partially offset by an increase in clinical development expenses primarily related to the EQ102 and EQUATOR clinical studies.

General and administrative (G&A) expenses for the first quarter of 2023 were $3.7 million, compared with $3.5 million for the same period in 2023. The increase was primarily driven by greater legal and other professional fees, partially offset by lower employee compensation and benefits, directors and officers insurance expenses, and consulting expenses.

Net loss for the first quarter of 2023 was $3.9 million, or $(0.11) per basic and diluted share, compared with a net loss of $37.4 million, or $(1.17) per basic and diluted share for the same period in 2022. The decrease in net loss was primarily attributable to acquired in-process research and development (IPR&D) expenses in the first quarter of 2022 resulting from the Bioniz acquisition. Revenue related to the Ono partnership, including amortization of the upfront payment and itolizumab development funding in the first quarter of 2023 also contributed to the lower net loss compared to the first quarter of 2022, which was prior to the Ono partnership.

Cash, cash equivalents and short-term investments totaled $62.0 million as of March 31, 2023, compared to $71.0 million as of December 31, 2022. Cash used in operating activities in the first quarter of 2023 was $8.0 million, which included payment of $2.6 million for annual bonuses to employees. Equillium believes that its cash, cash equivalents and short-term investments will be sufficient to fund its operations into 2025.

About Multi-Cytokine Platform and EQ101 & EQ102

Our proprietary multi-cytokine platform generates rationally designed composite peptides that selectively block key cytokines at the shared receptor level targeting pathogenic cytokine redundancies and synergies while preserving non-pathogenic signaling. This approach is expected to avoid the broad immuno-suppression and off-target safety liabilities that may be associated with other therapeutic classes, such as Janus kinase inhibitors. Many immune-mediated diseases are driven by the same combination of dysregulated cytokines, and we believe identifying the key cytokines for these diseases will allow us to target and develop customized treatment strategies for multiple autoimmune and inflammatory diseases.

Current platform assets include EQ101, a first-in-class, selective, tri-specific inhibitor of IL-2, IL-9 and IL-15, and EQ102, a first-in-class, selective, bi-specific inhibitor of IL-15 and IL-21.

About Itolizumab

Itolizumab is a clinical-stage, first-in-class anti-CD6 monoclonal antibody that selectively targets the CD6-ALCAM signaling pathway to downregulate pathogenic T effector cells while preserving T regulatory cells critical for maintaining a balanced immune response. This pathway plays a central role in modulating the activity and trafficking of T cells that drive a number of immuno-inflammatory diseases.

On May 11, 2023 Loxo@Lilly, the oncology unit of Eli Lilly and Company (NYSE: LLY), reported that data from its oncology portfolio will be presented at the 2023 European Hematology Association (EHA) (Free EHA Whitepaper) Annual Meeting, to be held June 8 – 11, 2023, in Frankfurt, Germany, and virtually (Press release, Eli Lilly, MAY 11, 2023, View Source [SID1234631501]). The company-sponsored abstracts include new analyses of clinical data in approved and investigational uses based on the BRUIN Phase 1/2 trial evaluating Jaypirca (pirtobrutinib) in patients with B-cell malignancies previously treated with a covalent Bruton’s tyrosine kinase (BTK) inhibitor, including mantle cell lymphoma (MCL) and chronic lymphocytic leukemia (CLL).

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A list of presentations, along with their viewing details, are shared below.

Medicine

Abstract Title

Presentation Details

Jaypirca (pirtobrutinib)

Genomic Evolution and Resistance to Pirtobrutinib in Covalent BTK-Inhibitor (cBTKi) Pre-treated Chronic Lymphocytic Leukemia (CLL) Patients: Results from the Phase 1/2 BRUIN Study

Abstract Number: S146

Session Type: Oral

Session Date / Time: June 9 at 14:45 – 16:00 CEST

Jaypirca (pirtobrutinib)

Comparison of Bleeding-Related Events in Patients who Received Pirtobrutinib with and without Antithrombotic Agents

Abstract Number: P1088

Session Type: Poster

Session Date / Time: June 9 at 18:00 – 19:00 CEST

Jaypirca (pirtobrutinib)

Matching-Adjusted Indirect Comparison (MAIC) of Pirtobrutinib vs Venetoclax Continuous Monotherapy in Patients with Relapsed/Refractory CLL Previously Treated with a Covalent BTK Inhibitor

Abstract Number: P623

Session Type: Poster

Session Date / Time: June 9 at 18:00 – 19:00 CEST

Jaypirca (pirtobrutinib)

Patient-Reported Outcomes (PRO) Among Patients with Mantle Cell Lymphoma Receiving Pirtobrutinib After Prior Covalent BTKi: Interim PRO Analysis from the BRUIN Phase 1/2 Study

Abstract Number: P1112

Session Type: Poster

Session Date / Time: June 9 at 18:00 – 19:00 CEST

LOXO-338

A First-in-Human Phase 1 Study of Oral LOXO-338, a Selective BCL2 Inhibitor, in Patients with Advanced Hematologic Malignancies

Abstract Number: P636

Session Type: Poster

Session Date / Time: June 9 at 18:00 – 19:00 CEST

About Jaypirca (pirtobrutinib)
Jaypirca (pirtobrutinib, formerly known as LOXO-305) (pronounced jay-pihr-kaa) is a highly selective (300 times more selective for BTK versus 98% of other kinases tested in preclinical studies), non-covalent (reversible) inhibitor of the enzyme BTK.1 BTK is a validated molecular target found across numerous B-cell leukemias and lymphomas including mantle cell lymphoma.2,3 Jaypirca is a U.S. FDA-approved oral prescription medicine, 100 mg or 50 mg tablets taken as a once-daily 200 mg dose with or without food until disease progression or unacceptable toxicity.

INDICATION FOR JAYPIRCA
Jaypirca is a kinase inhibitor indicated for the treatment of adult patients with relapsed or refractory (R/R) mantle cell lymphoma (MCL) after at least two lines of systemic therapy, including a BTK inhibitor.

This indication is approved under accelerated approval based on response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in a confirmatory trial.

IMPORTANT SAFETY INFORMATION FOR JAYPIRCA (pirtobrutinib)

Infections: Fatal and serious infections (including bacterial, viral, or fungal) and opportunistic infections have occurred in patients treated with Jaypirca. In the clinical trial, Grade ≥3 infections occurred in 17% of 583 patients with hematologic malignancies, most commonly pneumonia (9%); fatal infections occurred in 4.1% of patients. Sepsis (4.5%) and febrile neutropenia (2.9%) occurred. Opportunistic infections after Jaypirca treatment included, but are not limited to, Pneumocystis jirovecii pneumonia and fungal infection. Consider prophylaxis, including vaccinations and antimicrobial prophylaxis, in patients at increased risk for infection, including opportunistic infections. Monitor patients for signs and symptoms, evaluate promptly, and treat appropriately. Based on severity, reduce dose, temporarily withhold, or permanently discontinue Jaypirca.

Hemorrhage: Fatal and serious hemorrhage has occurred with Jaypirca. Major hemorrhage (Grade ≥3 bleeding or any central nervous system bleeding) occurred in 2.4% of 583 patients with hematologic malignancies treated with Jaypirca, including gastrointestinal hemorrhage; fatal hemorrhage occurred in 0.2% of patients. Bleeding of any grade, excluding bruising and petechiae, occurred in 14% of patients. Major hemorrhage occurred in patients taking Jaypirca with (0.7%) and without (1.7%) antithrombotic agents. Consider risks/benefits of co-administering antithrombotic agents with Jaypirca. Monitor patients for signs of bleeding. Based on severity, reduce dose, temporarily withhold, or permanently discontinue Jaypirca. Consider benefit/risk of withholding Jaypirca 3-7 days pre- and post-surgery depending on type of surgery and bleeding risk.

Cytopenias: Grade 3 or 4 cytopenias, including neutropenia (24%), anemia (11%), and thrombocytopenia (11%), have developed in patients with hematologic malignancies treated with Jaypirca. In a clinical trial, Grade 4 neutropenia (13%) and Grade 4 thrombocytopenia (5%) developed. Monitor complete blood counts regularly during treatment. Based on severity, reduce dose, temporarily withhold, or permanently discontinue Jaypirca.

Atrial Fibrillation and Atrial Flutter: Atrial fibrillation or flutter were reported in 2.7% of patients, with Grade 3 or 4 atrial fibrillation or flutter reported in 1% of 583 patients with hematologic malignancies treated with Jaypirca. Patients with cardiac risk factors such as hypertension or previous arrhythmias may be at increased risk. Monitor for signs and symptoms of arrhythmias (e.g., palpitations, dizziness, syncope, dyspnea) and manage appropriately. Based on severity, reduce dose, temporarily withhold, or permanently discontinue Jaypirca.

Second Primary Malignancies: Second primary malignancies, including non-skin carcinomas, developed in 6% of 583 patients with hematologic malignancies treated with Jaypirca monotherapy. The most frequent malignancy was non-melanoma skin cancer (3.8%). Other second primary malignancies included solid tumors (including genitourinary and breast cancers) and melanoma. Advise patients to use sun protection and monitor for development of second primary malignancies.

Embryo-Fetal Toxicity: Based on animal findings, Jaypirca can cause fetal harm in pregnant women. Administration of pirtobrutinib to pregnant rats during organogenesis caused embryo-fetal toxicity, including embryo-fetal mortality and malformations at maternal exposures (AUC) approximately 3-times the recommended 200 mg/day dose. Advise pregnant women of potential risk to a fetus and females of reproductive potential to use effective contraception during treatment and for one week after last dose.

Adverse Reactions (ARs) in Patients with Mantle Cell Lymphoma Who Received Jaypirca
Serious ARs occurred in 38% of patients. Serious ARs occurring in ≥2% of patients were pneumonia (14%), COVID-19 (4.7%), musculoskeletal pain (3.9%), hemorrhage (2.3%), pleural effusion (2.3%), and sepsis (2.3%). Fatal ARs within 28 days of last dose of Jaypirca occurred in 7% of patients, most commonly due to infections (4.7%), including COVID-19 (3.1%).

Dose Modifications and Discontinuations: ARs led to dosage reductions in 4.7%, treatment interruption in 32%, and permanent discontinuation of Jaypirca in 9% of patients. ARs resulting in dosage modification in >5% of patients included pneumonia and neutropenia. ARs resulting in permanent discontinuation of Jaypirca in >1% of patients included pneumonia.

ARs (all Grades %; Grade 3-4 %) in ≥10% of Patients: fatigue (29; 1.6), musculoskeletal pain (27; 3.9), diarrhea (19; -), edema (18; 0.8), dyspnea (17; 2.3), pneumonia (16; 14), bruising (16; -), peripheral neuropathy (14; 0.8), cough (14; -), rash (14; -), fever (13; -), constipation (13; -), arthritis/arthralgia (12; 0.8), hemorrhage (11; 3.1), abdominal pain (11; 0.8), nausea (11; -), upper respiratory tract infections (10; 0.8), dizziness (10; -).

Select Laboratory Abnormalities (all Grades %; Grade 3 or 4 %) that Worsened from Baseline in ≥10% of Patients: hemoglobin decreased (42; 9), platelet count decreased (39; 14), neutrophil count decreased (36; 16), lymphocyte count decreased (32; 15), creatinine increased (30; 1.6), calcium decreased (19; 1.6), AST increased (17; 1.6), potassium decreased (13; 1.6), sodium decreased (13; -), lipase increased (12; 4.4), alkaline phosphatase increased (11; -), ALT increased (11; 1.6), potassium increased (11; 0.8). Grade 4 laboratory abnormalities in >5% of patients included neutrophils decreased (10), platelets decreased (7), lymphocytes decreased (6).

All grade ARs with higher frequencies in the total BRUIN population of patients with hematologic malignancies (n=583) were decreased neutrophil count (41%), bruising (20%), diarrhea (20%).

Drug Interactions
Strong CYP3A Inhibitors: Concomitant use with Jaypirca increased pirtobrutinib systemic exposure, which may increase risk of Jaypirca adverse reactions. Avoid use of strong CYP3A inhibitors during Jaypirca treatment. If concomitant use is unavoidable, reduce Jaypirca dosage according to the approved labeling.

Strong or Moderate CYP3A Inducers: Concomitant use with Jaypirca decreased pirtobrutinib systemic exposure, which may reduce Jaypirca efficacy. Avoid concomitant use of Jaypirca with strong or moderate CYP3A inducers. If concomitant use with moderate CYP3A inducers is unavoidable, increase the Jaypirca dosage according to the approved labeling.

Sensitive CYP2C8, CYP2C19, CYP3A, P-gP, BCRP Substrates: Concomitant use with Jaypirca increased their plasma concentrations, which may increase risk of adverse reactions related to these substrates for drugs that are sensitive to minimal concentration changes. Follow recommendations for these sensitive substrates in their approved labeling.

Use in Special Populations
Pregnancy and Lactation: Inform pregnant women of potential for Jaypirca to cause fetal harm. Verify pregnancy status in females of reproductive potential prior to starting Jaypirca and advise use of effective contraception during treatment and for one week after last dose. Presence of pirtobrutinib in human milk and effects on the breastfed child or on milk production is unknown. Advise women not to breastfeed while taking Jaypirca and for one week after last dose.

Geriatric Use: In the pooled safety population of patients with hematologic malignancies, 392 (67%) were ≥65 years of age. Patients aged ≥65 years experienced higher rates of Grade ≥3 ARs and serious ARs compared to patients <65 years of age.

Renal Impairment: Severe renal impairment (eGFR 15-29 mL/min) increases pirtobrutinib exposure. Reduce Jaypirca dosage in patients with severe renal impairment according to the approved labeling. No dosage adjustment is recommended in patients with mild or moderate renal impairment.

PT HCP ISI MCL APP

Please see Prescribing Information and Patient Information for Jaypirca.