CEL-SCI Corporation Reports Second Quarter Fiscal 2019 Financial Results

On May 14, 2019 CEL-SCI Corporation (NYSE American: CVM) reported financial results for the quarter ended March 31, 2019 (Press release, Cel-Sci, MAY 14, 2019, View Source [SID1234536282]). The Company also reported key clinical and corporate developments achieved during the quarter.

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Clinical and Corporate Developments included:

At the end of March 2019, the IDMC (Independent Data Monitoring Committee) had an official review of the Phase 3 study and recommended to "continue the trial until the appropriate number of events has occurred".
CEL-SCI’s Phase 3 head and neck cancer study continued to follow all 928 patients who were enrolled. The Company is now awaiting final study results. All that remains to be done in this pivotal Phase 3 study, the largest in the world in head and neck cancer, is to continue to track patient survival until it can be determined if the primary endpoint has been met. The primary endpoint of the study, a 10% improvement in overall survival of the Multikine* treatment regimen plus Standard of Care (SOC) vs. SOC alone, will be determined after a total of 298 events (deaths) have occurred in the two main comparator arms of the study and have been recorded in the study database. These final results could come soon since the last patients were treated in September 2016.
The Journal of Clinical & Cellular Immunology published an article titled, "Why Don’t We Have a Vaccine Against Autoimmune Diseases?" co-written by Dr. Ken Rosenthal of Roseman University College of Medicine, and CEL-SCI’s Roy Carambula, Research Associate and Daniel Zimmerman Ph.D., Senior Vice President of Research, Cellular Immunology. As presented in the article, vaccines for autoimmune diseases need to be therapeutic and focused on cellular immunity as CEL-SCI’s LEAPS vaccine platform does, as compared to most current vaccines that elicit a specific antibody response.
On May 11, 2019, Dr. Zimmerman presented new data for its LEAPS therapeutic antigen-specific treatment for rheumatoid arthritis at the American Association of Immunologists 103rd Annual Meeting. The work was performed in conjunction with researchers at Rush University Medical Center, Chicago, Illinois.
CEL-SCI’s LEAPS platform technology was selected by the U.S. National Institutes of Health (NIH) for sponsorship to exhibit and showcase its presentation at the BIO International Convention, to be held June 3-6, 2019 in Philadelphia.
The U.S. Patent and Trademark Office issued two patents to CEL-SCI for its LEAPS platform vaccine technology. One is titled "Method for inducing an immune response and formulations thereof" and the other is titled "Method for inducing an immune response for treatment of cancer and autoimmune diseases or conditions".
Between April 1, 2019 and May 13, 2019, the Company received approximately $7.6 million through the exercise of warrants to purchase shares of the Company’s common stock.
"During the second quarter of fiscal 2019, we were pleased to receive the IDMC’s recommendation to continue with our Phase 3 study until the appropriate number of events have occurred. Since the IDMC reviews study data that is blinded to us, we believe their recommendation affirms the study’s potential to meet the primary survival endpoint. We believe this is a very positive sign," stated CEL-SCI CEO, Geert Kersten. "In addition to the Phase 3 head and neck cancer, we continue to advance the development of our LEAPS vaccine platform through new patents, new published scientific papers, and ongoing studies with the National Institutes of Health."

CEL-SCI reported a net loss of $5.2 million for the six months ended March 31, 2019 versus a net loss of $10.9 million for the six months ended March 31, 2018. CEL-SCI reported a net loss of $6.4 million for the quarter ended March 31, 2019 versus a net loss of $4.7 million for the quarter ended March 31, 2018.

During the six months ended March 31, 2019, the Company’s cash decreased by approximately $4.8 million. Significant components of this decrease included net cash used to fund the Company’s regular operations, including its Phase 3 clinical trial, of approximately $7.8 million and approximately $0.2 million to purchase long term assets. The decrease was offset by net proceeds from the exercise of warrants of approximately $3.3 million.

Molecular Templates to Present at the Oppenheimer New York Oncology Insight Summit and the UBS Global Healthcare Conference

On May 14, 2019 Molecular Templates, Inc., (Nasdaq: MTEM) a clinical stage biopharmaceutical company focused on the discovery and development of Engineered Toxin Bodies (ETBs), a new class of targeted biologic therapies that possess unique mechanisms of action in oncology, reported that Eric Poma, Ph.D., Chief Executive Officer and Chief Scientific Officer, will present a corporate overview at the Oppenheimer New York Oncology Insight Summit, and the UBS Global Healthcare Conference, both taking place in New York City (Press release, Molecular Templates, MAY 14, 2019, View Source [SID1234536267]).

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Oppenheimer New York Oncology Insight Summit
Date: Thursday, May 16
Format: One-on-One Meetings

UBS Global Healthcare Conference
Date: Monday, May 20
Time: 8:00am Eastern Time
Format: Fireside Chat
Webcast: https://cc.talkpoint.com/ubsx001/052019a_as/?entity=62_RJ1HXDS

FDA Approves BAVENCIO® (avelumab) Plus INLYTA® (axitinib) Combination for Patients with Advanced Renal Cell Carcinoma

On May 14, 2019 EMD Serono, the biopharmaceutical business of Merck KGaA, Darmstadt, Germany in the US and Canada, and Pfizer Inc. (NYSE: PFE) reported that the US Food and Drug Administration (FDA) has approved BAVENCIO (avelumab) in combination with INLYTA (axitinib) for the first-line treatment of patients with advanced renal cell carcinoma (RCC) (Press release, EMD Serono, MAY 14, 2019, View Source [SID1234536283]). This is the first FDA approval for an anti-PD-L1 therapy as part of a combination regimen for patients with advanced RCC. The approval of BAVENCIO in combination with INLYTA was based on positive results from the Phase III JAVELIN Renal 101 study (NCT02684006), in which the combination significantly improved median progression-free survival (PFS) compared with sunitinib by more than five months in the intent-to-treat (ITT) patient population (HR: 0.69 [95% CI: 0.56–0.84]; 2-sided p-value=0.0002; median PFS for BAVENCIO in combination with INLYTA: 13.8 months [95% CI: 11.1-NE]; sunitinib: 8.4 months [95% CI: 6.9-11.1]). The ITT population included patients regardless of PD-L1 expression and across IMDC (International Metastatic Renal Cell Carcinoma Database) prognostic risk groups (favorable 21%, intermediate 62% and poor 16%).1

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"As we look to continue to improve outcomes for people with advanced RCC, new treatment approaches have the potential to benefit patients," said Robert J. Motzer, M.D., Jack and Dorothy Byrne Chair in Clinical Oncology, Memorial Sloan Kettering Cancer Center, New York, US, and principal investigator for JAVELIN Renal 101. "With today’s FDA approval of avelumab in combination with axitinib, we can now offer patients with advanced RCC a first-line treatment option that combines a PD-L1 immunotherapy with a well-known VEGFR TKI to provide a significant reduction in the risk of disease progression or death and doubling of the response rate compared with sunitinib."

RCC is a type of cancer where PD-L1 expression may contribute to inhibition of the immune response against the tumor.2 It is also a highly vascular tumor, in which vascular endothelial growth factor (VEGF) plays a key role.3

"A kidney cancer diagnosis is life-changing for both patients and their loved ones, and having a treatment strategy for their disease quickly becomes a priority," said Dena Battle, President, KCCure. "The approval of new treatments such as BAVENCIO in combination with INLYTA gives patients with advanced RCC much-needed options."

There is a significant unmet need for first-line treatments that delay progression and have an acceptable safety profile. Approximately 20% to 30% of patients are first diagnosed with RCC at the advanced stage, and 30% of patients treated for an earlier stage go on to develop metastases.4,5 About half of patients living with advanced RCC do not go on to receive additional treatment after first-line therapy,6,7 for reasons that may include poor performance status or adverse events from their initial treatment.6,8,9

"Today’s approval of BAVENCIO in combination with INLYTA builds on Pfizer’s long heritage in bringing innovation to the RCC community with the hopes of making a significant and meaningful impact on the lives of patients," said Andy Schmeltz, Global President, Pfizer Oncology. "For more than 12 years, Pfizer has led the field in its commitment to developing new treatments for patients with advanced kidney cancer."

"With today’s FDA approval of BAVENCIO in combination with INLYTA, we feel privileged that we can offer patients with first-line advanced renal cell carcinoma a new treatment option," said Rehan Verjee, President, EMD Serono, and Global Head of Innovative Medicine Franchises, Merck KGaA, Darmstadt, Germany.

In JAVELIN Renal 101, the objective response rate (ORR) was doubled in the ITT population with BAVENCIO in combination with INLYTA versus sunitinib (51.4% [95% CI: 46.6-56.1] vs. 25.7% [95% CI: 21.7-30.0]). With a median overall survival (OS) follow-up of 19 months, data for the trial’s other primary endpoint of OS were immature, with 27% of deaths in the ITT population, and the trial is continuing as planned. The most common adverse reactions (≥20%) were diarrhea, fatigue, hypertension, musculoskeletal pain, nausea, mucositis, palmar-plantar erythrodysesthesia, dysphonia, decreased appetite, hypothyroidism, rash, hepatotoxicity, cough, dyspnea, abdominal pain and headache. Serious adverse reactions occurred in 35% of patients receiving BAVENCIO in combination with INLYTA. The incidence of major adverse cardiovascular events (MACE) was higher with BAVENCIO in combination with INLYTA versus sunitinib.1 Findings from the study have been published in The New England Journal of Medicine.10

The European Medicines Agency (EMA) validated the Type II variation application for BAVENCIO in combination with INLYTA in advanced RCC in March 2019, and a supplemental application for BAVENCIO in combination with INLYTA in unresectable or metastatic RCC was submitted in Japan in January 2019.

The alliance is committed to providing patient access and reimbursement support through its CoverOne program to patients who have been prescribed BAVENCIO. This program provides a spectrum of patient access and reimbursement support services intended to help US patients prescribed BAVENCIO receive appropriate access. CoverOne may be reached by phone at 844-8COVER1 (844-826-8371) or online at www.CoverOne.com.

Pfizer is committed to ensuring that patients who are prescribed INLYTA have access to this innovative therapy. Patients in the US have access to Pfizer Oncology Together, which offers personalized support and financial assistance resources to help patients access their prescribed Pfizer Oncology medications. For more information, please call 1-877-744-5675 or visit PfizerOncologyTogether.com.

In an effort to streamline the patient enrollment process, EMD Serono and Pfizer have partnered to create a single enrollment form for the BAVENCIO and INLYTA combination for patients with advanced RCC that can be processed through both CoverOne and Pfizer Oncology Together. Each program will independently conduct the access and reimbursement activities for the product for which it is responsible.

About Renal Cell Carcinoma
In 2019, an estimated 73,820 new cases of kidney cancer will be diagnosed in the US, and approximately 14,770 people will die from the disease.11 RCC is the most common form of kidney cancer, accounting for about 2% to 3% of all cancers in adults.12,13 Approximately 20% to 30% of patients with kidney cancer are first diagnosed at the advanced stage.4 The five-year survival rate for patients with metastatic RCC is approximately 12%.14

About the JAVELIN Renal 101 study
The Phase III JAVELIN Renal 101 study is a randomized (1:1), multicenter, open-label study of BAVENCIO in combination with INLYTA in 886 patients with untreated advanced RCC regardless of tumor PD-L1 expression [intent-to-treat (ITT) population]. Patients with autoimmune disease or conditions requiring systemic immunosuppression were excluded. The major efficacy outcome measures were PFS as assessed by a Blinded Independent Central Review (BICR) using RECIST v1.1 and OS in patients with PD-L1-positive tumors using a clinical trial assay (PD-L1 expression level ≥1%). If PFS was statistically significant in patients with PD-L1-positive tumors, it was then tested in the ITT population. The hazard ratio for PFS in patients with PD-L1-positive tumors was HR 0.61 (95% CI: 0.48, 0.79). PFS and OS in the ITT population, overall response and safety are included as secondary endpoints. The study is continuing for OS.

About the JAVELIN Clinical Development Program
The clinical development program for avelumab, known as JAVELIN, involves at least 30 clinical programs and about 10,000 patients evaluated across more than 15 different tumor types. In addition to RCC, these tumor types include gastric/gastro-esophageal junction cancer, head and neck cancer, Merkel cell carcinoma, non-small cell lung cancer, and urothelial carcinoma.

About BAVENCIO (avelumab)
BAVENCIO is a human anti-programmed death ligand-1 (PD-L1) antibody. BAVENCIO has been shown in preclinical models to engage both the adaptive and innate immune functions. By blocking the interaction of PD-L1 with PD-1 receptors, BAVENCIO has been shown to release the suppression of the T cell-mediated antitumor immune response in preclinical models.15-17 BAVENCIO has also been shown to induce NK cell-mediated direct tumor cell lysis via antibody-dependent cell-mediated cytotoxicity (ADCC) in vitro.17-19 In November 2014, EMD Serono and Pfizer announced a strategic alliance to co-develop and co-commercialize BAVENCIO.

BAVENCIO Approved Indication in the US
BAVENCIO (avelumab) in combination with INLYTA (axitinib) is indicated in the US for the first-line treatment of patients with advanced renal cell carcinoma (RCC).

BAVENCIO Important Safety Information from the US FDA-Approved Label
BAVENCIO can cause immune-mediated pneumonitis, including fatal cases. Monitor patients for signs and symptoms of pneumonitis, and evaluate suspected cases with radiographic imaging. Administer corticosteroids for Grade 2 or greater pneumonitis. Withhold BAVENCIO for moderate (Grade 2) and permanently discontinue for severe (Grade 3), life-threatening (Grade 4), or recurrent moderate (Grade 2) pneumonitis. Pneumonitis occurred in 1.2% of patients, including one (0.1%) patient with Grade 5, one (0.1%) with Grade 4, and five (0.3%) with Grade 3.

BAVENCIO can cause hepatotoxicity and immune-mediated hepatitis, including fatal cases. Monitor patients for abnormal liver tests prior to and periodically during treatment. Administer corticosteroids for Grade 2 or greater hepatitis. Withhold BAVENCIO for moderate (Grade 2) immune-mediated hepatitis until resolution and permanently discontinue for severe (Grade 3) or life-threatening (Grade 4) immune-mediated hepatitis. Immune-mediated hepatitis occurred with BAVENCIO as a single agent in 0.9% of patients, including two (0.1%) patients with Grade 5, and 11 (0.6%) with Grade 3.

BAVENCIO in combination with INLYTA can cause hepatotoxicity with higher than expected frequencies of Grade 3 and 4 alanine aminotransferase (ALT) and aspartate aminotransferase (AST) elevation. Consider more frequent monitoring of liver enzymes as compared to when the drugs are used as monotherapy. Withhold BAVENCIO and INLYTA for moderate (Grade 2) hepatotoxicity and permanently discontinue the combination for severe or life-threatening (Grade 3 or 4) hepatotoxicity. Administer corticosteroids as needed. In patients treated with BAVENCIO in combination with INLYTA, Grades 3 and 4 increased ALT and AST occurred in 9% and 7% of patients, respectively, and immune-mediated hepatitis occurred in 7% of patients, including 4.9% with Grade 3 or 4.

BAVENCIO can cause immune-mediated colitis. Monitor patients for signs and symptoms of colitis. Administer corticosteroids for Grade 2 or greater colitis. Withhold BAVENCIO until resolution for moderate or severe (Grade 2 or 3) colitis until resolution. Permanently discontinue for life-threatening (Grade 4) or recurrent (Grade 3) colitis upon reinitiation of BAVENCIO. Immune-mediated colitis occurred in 1.5% of patients, including seven (0.4%) with Grade 3.

BAVENCIO can cause immune-mediated endocrinopathies, including adrenal insufficiency, thyroid disorders, and type 1 diabetes mellitus.

Monitor patients for signs and symptoms of adrenal insufficiency during and after treatment, and administer corticosteroids as appropriate. Withhold BAVENCIO for severe (Grade 3) or life-threatening (Grade 4) adrenal insufficiency. Adrenal insufficiency was reported in 0.5% of patients, including one (0.1%) with Grade 3.

Thyroid disorders can occur at any time during treatment. Monitor patients for changes in thyroid function at the start of treatment, periodically during treatment, and as indicated based on clinical evaluation. Manage hypothyroidism with hormone replacement therapy and hyperthyroidism with medical management. Withhold BAVENCIO for severe (Grade 3) or life-threatening (Grade 4) thyroid disorders. Thyroid disorders, including hypothyroidism, hyperthyroidism, and thyroiditis, were reported in 6% of patients, including three (0.2%) with Grade 3.

Type 1 diabetes mellitus including diabetic ketoacidosis: Monitor patients for hyperglycemia or other signs and symptoms of diabetes. Withhold BAVENCIO and administer antihyperglycemics or insulin in patients with severe or life-threatening (Grade ≥3) hyperglycemia, and resume treatment when metabolic control is achieved. Type 1 diabetes mellitus without an alternative etiology occurred in 0.1% of patients, including two cases of Grade 3 hyperglycemia.

BAVENCIO can cause immune-mediated nephritis and renal dysfunction. Monitor patients for elevated serum creatinine prior to and periodically during treatment. Administer corticosteroids for Grade 2 or greater nephritis. Withhold BAVENCIO for moderate (Grade 2) or severe (Grade 3) nephritis until resolution to Grade 1 or lower. Permanently discontinue BAVENCIO for life-threatening (Grade 4) nephritis. Immune-mediated nephritis occurred in 0.1% of patients.

BAVENCIO can result in other severe and fatal immune-mediated adverse reactions involving any organ system during treatment or after treatment discontinuation. For suspected immune-mediated adverse reactions, evaluate to confirm or rule out an immune-mediated adverse reaction and to exclude other causes. Depending on the severity of the adverse reaction, withhold or permanently discontinue BAVENCIO, administer high-dose corticosteroids, and initiate hormone replacement therapy, if appropriate. Resume BAVENCIO when the immune-mediated adverse reaction remains at Grade 1 or lower following a corticosteroid taper. Permanently discontinue BAVENCIO for any severe (Grade 3) immune-mediated adverse reaction that recurs and for any life-threatening (Grade 4) immune-mediated adverse reaction. The following clinically significant immune-mediated adverse reactions occurred in less than 1% of 1738 patients treated with BAVENCIO as a single agent or in 489 patients who received BAVENCIO in combination with INLYTA: myocarditis including fatal cases, pancreatitis including fatal cases, myositis, psoriasis, arthritis, exfoliative dermatitis, erythema multiforme, pemphigoid, hypopituitarism, uveitis, Guillain-Barré syndrome, and systemic inflammatory response.

BAVENCIO can cause severe or life-threatening infusion-related reactions. Premedicate patients with an antihistamine and acetaminophen prior to the first 4 infusions and for subsequent infusions based upon clinical judgment and presence/severity of prior infusion reactions. Monitor patients for signs and symptoms of infusion-related reactions, including pyrexia, chills, flushing, hypotension, dyspnea, wheezing, back pain, abdominal pain, and urticaria. Interrupt or slow the rate of infusion for mild (Grade 1) or moderate (Grade 2) infusion-related reactions. Permanently discontinue BAVENCIO for severe (Grade 3) or life-threatening (Grade 4) infusion-related reactions. Infusion-related reactions occurred in 25% of patients, including three (0.2%) patients with Grade 4 and nine (0.5%) with Grade 3.

BAVENCIO in combination with INLYTA can cause major adverse cardiovascular events (MACE) including severe and fatal events. Consider baseline and periodic evaluations of left ventricular ejection fraction. Monitor for signs and symptoms of cardiovascular events. Optimize management of cardiovascular risk factors, such as hypertension, diabetes, or dyslipidemia. Discontinue BAVENCIO and INLYTA for Grade 3-4 cardiovascular events. MACE occurred in 7% of patients with advanced RCC treated with BAVENCIO in combination with INLYTA compared to 3.4% treated with sunitinib. These events included death due to cardiac events (1.4%), Grade 3-4 myocardial infarction (2.8%), and Grade 3-4 congestive heart failure (1.8%).

BAVENCIO can cause fetal harm when administered to a pregnant woman. Advise patients of the potential risk to a fetus including the risk of fetal death. Advise females of childbearing potential to use effective contraception during treatment with BAVENCIO and for at least 1 month after the last dose of BAVENCIO. It is not known whether BAVENCIO is excreted in human milk. Advise a lactating woman not to breastfeed during treatment and for at least 1 month after the last dose of BAVENCIO due to the potential for serious adverse reactions in breastfed infants.

Please see full US Prescribing Information and Medication Guide available at View Source

INLYTA Important Safety Information from the US FDA-Approved Label
Hypertension including hypertensive crisis has been observed with INLYTA. Blood pressure should be well controlled prior to initiating INLYTA. Monitor for hypertension and treat as needed. For persistent hypertension, despite use of antihypertensive medications, reduce the dose. Discontinue INLYTA if hypertension is severe and persistent despite use of antihypertensive therapy and dose reduction of INLYTA, and discontinuation should be considered if there is evidence of hypertensive crisis.

Arterial and venous thrombotic events have been observed with INLYTA and can be fatal. Use with caution in patients who are at increased risk or who have a history of these events.

Hemorrhagic events, including fatal events, have been reported with INLYTA. INLYTA has not been studied in patients with evidence of untreated brain metastasis or recent active gastrointestinal bleeding and should not be used in those patients. If any bleeding requires medical intervention, temporarily interrupt the INLYTA dose.

Cardiac failure has been observed with INLYTA and can be fatal. Monitor for signs or symptoms of cardiac failure throughout treatment with INLYTA. Management of cardiac failure may require permanent discontinuation of INLYTA.

Gastrointestinal perforation and fistula, including death, have occurred with INLYTA. Use with caution in patients at risk for gastrointestinal perforation or fistula. Monitor for symptoms of gastrointestinal perforation or fistula periodically throughout treatment.

Hypothyroidism requiring thyroid hormone replacement has been reported with INLYTA. Monitor thyroid function before initiation of, and periodically throughout, treatment.

No formal studies of the effect of INLYTA on wound healing have been conducted. Stop INLYTA at least 24 hours prior to scheduled surgery.

Reversible Posterior Leukoencephalopathy Syndrome (RPLS) has been observed with INLYTA. If signs or symptoms occur, permanently discontinue treatment.

Proteinuria has been observed with INLYTA. Monitor for proteinuria before initiation of, and periodically throughout, treatment with INLYTA. For moderate to severe proteinuria, reduce the dose or temporarily interrupt treatment.

Liver enzyme elevation has been observed during treatment with INLYTA. Monitor ALT, AST, and bilirubin before initiation of, and periodically throughout, treatment.

For patients with moderate hepatic impairment, the starting dose should be decreased. INLYTA has not been studied in patients with severe hepatic impairment.

INLYTA can cause fetal harm. Advise patients of the potential risk to the fetus and to use effective contraception during treatment.

Avoid strong CYP3A4/5 inhibitors. If unavoidable, reduce the dose. Grapefruit or grapefruit juice may also increase INLYTA plasma concentrations and should be avoided.

Avoid strong CYP3A4/5 inducers and, if possible, avoid moderate CYP3A4/5 inducers.

For more information and full Prescribing Information, visit www.INLYTA.com.

ADVERSE REACTIONS (BAVENCIO + INLYTA)
Fatal adverse reactions occurred in 1.8% of patients with advanced renal cell carcinoma (RCC) receiving BAVENCIO in combination with INLYTA. These included sudden cardiac death (1.2%), stroke (0.2%), myocarditis (0.2%), and necrotizing pancreatitis (0.2%).

The most common adverse reactions (all grades, ≥20%) in patients with advanced RCC receiving BAVENCIO in combination with INLYTA (vs sunitinib) were diarrhea (62% vs 48%), fatigue (53% vs 54%), hypertension (50% vs 36%), musculoskeletal pain (40% vs 33%), nausea (34% vs 39%), mucositis (34% vs 35%), palmar-plantar erythrodysesthesia (33% vs 34%), dysphonia (31% vs 3.2%), decreased appetite (26% vs 29%), hypothyroidism (25% vs 14%), rash (25% vs 16%), hepatotoxicity (24% vs 18%), cough (23% vs 19%), dyspnea (23% vs 16%), abdominal pain (22% vs 19%), and headache (21% vs 16%).

Selected laboratory abnormalities (all grades, ≥20%) worsening from baseline in patients with advanced RCC receiving BAVENCIO in combination with INLYTA (vs sunitinib) were blood triglycerides increased (71% vs 48%), blood creatinine increased (62% vs 68%), blood cholesterol increased (57% vs 22%), alanine aminotransferase increased (ALT) (50% vs 46%), aspartate aminotransferase increased (AST) (47% vs 57%), blood sodium decreased (38% vs 37%), lipase increased (37% vs 25%), blood potassium increased (35% vs 28%), platelet count decreased (27% vs 80%), blood bilirubin increased (21% vs 23%), and hemoglobin decreased (21% vs 65%).

Moleculin Biotech, Inc. Reports Financial Results for the First Quarter Ended March 31, 2019

On May 14, 2019 Moleculin Biotech, Inc., (NASDAQ: MBRX) ("Moleculin" or the "Company"),
a clinical stage pharmaceutical company with a broad portfolio of drug candidates targeting highly resistant tumors, reported its financial results for the first quarter ended March 31, 2019 (Press release, Moleculin, MAY 14, 2019, View Source [SID1234536268]). Additionally, the Company announced potential upcoming milestones and recent corporate developments.

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Management Discussion
Walter Klemp, Chairman and CEO of Moleculin, said, "We are off to a very good start in 2019, as we have achieved significant milestones with the development of our oncology portfolio. This time last year we had just commenced our first clinical trial for one drug. Today, we have three drugs in four clinical trials under way with a fifth clinical trial that may start before year end. We are excited with the progress that has been achieved and we expect that 2019 will be the ‘year of data’ where we provide progress reports as our various drug candidates proceed through their respective clinical trials."

"One of the highlights of the just completed quarter was FDA ‘Fast Track’ designation for Annamycin, our drug candidate for the treatment of adults with relapsed or refractory acute myeloid leukemia. Fast Track represents an important first step toward accelerated approval. We presented the FDA a proposal for the designation, and they determined that Annamycin should be eligible for accelerated approval. This potentially cuts years off our development timeline and should make Annamycin attractive to development partners much sooner. We also announced pre-clinical data supporting the expansion of Annamycin indications to include lung cancer."

"It bears noting we announced last week that our Annamycin clinical trial in Poland is generating very encouraging results," continued Mr. Klemp. "We have completed the first cohort of the trial and 2 out of 3 patients treated responded sufficiently to qualify for a potentially curative bone marrow transplant. Although we are still early in the trial, we believe this small sample size is indicative of what Annamycin is designed to produce. The standard of care failed these relapsed or refractory patients, and we believe Annamycin has provided new hope for an improved quality of life, and, or possibly, an extension of life.

"We continue to see strong anti-tumor activity with WP1066, our flagship Immune/Transduction Modulator in a wide range of animal models. The data is showing positive results of combining our drug candidate WP1066 with checkpoint inhibitors, suggesting that WP1066 may have the ability to improve the outcome of immune checkpoint therapy in tumors that have been resistant to these therapies. We believe this represents an important new approach to treating many types of cancer. We are extremely excited with the ongoing results of this preclinical research. These important developments, along with regulatory approvals, complement our vision of developing numerous drugs that support our ‘multiple shots on goal’ strategy.

"Also, during the quarter, the FDA granted Orphan Drug Designation for WP1066 for the treatment of glioblastoma, one of the most aggressive forms of brain tumors. The FDA grants Orphan Drug Designation to drugs and biologics that are intended for the treatment of rare diseases. In addition to glioblastoma, WP1066 could be effective in the treatment of a range of highly resistant tumors including acute myeloid leukemia ("AML") and pancreatic cancer."

Mr. Klemp concluded, "This just completed first quarter yielded a number of important developments that set the stage for a successful 2019 and the years ahead. As we continue through our various clinical trials and preclinical research, we are heartened with the tangible progress being made and that we are advancing toward our goal of developing effective treatments for rare and difficult cancers that eclipse the outcomes of the standard of care. Providing hope to patients, where it might have been lost, is a driving force for the entire Moleculin team."

Recent milestones and accomplishments include:

Next Generation Anthracycline – Annamycin

Announcement of additional positive interim safety and efficacy data from our ongoing study of Annamycin in Poland. After receiving a single starting dose of 120 mg/m2 in the first cohort of the dose escalation phase of the trial, 2 of 3 patients treated responded sufficiently to qualify for a potentially curative bone marrow transplant. Additionally, no patients in the U.S. or in the European trials, to date, have shown any signs of cardiotoxicity. The results for all 3 patients were reviewed by the Safety Review Committee, which determined that no drug-related adverse events were observed that would prevent advancing the trial to the next higher dose level of 150 mg/m2.

FDA grants Fast Track Designation of our drug Annamycin for the treatment of relapsed or refractory acute myeloid.

Announcement that we have found Annamycin to be active against metastases to the lungs in pre-clinical testing. Annamycin significantly improved survival in an aggressive form for triple negative breast cancer metastasized to the lungs in animal models.

U.S. clinical trial completed the first cohort and is currently recruiting patients for the second cohort to be given a dose level of 120 mg/m2.

Immune/Transcription Modulators – WP1066 Portfolio

Agreement with Emory University to conduct pediatric brain tumor trial. This will be a Phase 1 clinical trial of WP1066 in children with recurrent or refractory malignant brain tumors. The study will be conducted at the Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta.

Announcement that preclinical data supporting activity of our STAT3-inhibiting Immune/Transcription Modulators was presented by Dr. Waldemar Priebe, Founder and Chair of the Scientific Advisory Board of Moleculin, Inc. at the 2019 Annual Meeting of the American Association for Cancer Research (AACR) (Free AACR Whitepaper) ("AACR") in Atlanta, GA. The presentation included data resulting from preclinical evaluation in pancreatic cancer models of STAT3 inhibitors WP1066 and WP1732. WP1066 is an orally bioavailable drug with significant brain uptake that is currently in Phase I clinical studies in patients with brain tumors. Complementary to WP1066, we believe STAT3 inhibitor WP1732 may be suitable for IV administration and demonstrates high uptake by the pancreas without uptake to the brain.

Announcement of the first two patients enrolled in our European clinical trial of WP1220 for the topical treatment of cutaneous T-Cell Lymphoma (CTCL).

FDA granted Orphan Drug Designation for our drug candidate WP1066 for the treatment of glioblastoma, the most aggressive form of brain tumor.

Announcement that we have shown that WP1066, an Immune/Transduction Modulator, appears to counteract resistance to checkpoint blockade therapy (specifically, immune checkpoint target PD-L1) in our own sponsored research.

General

Announcement of Dr. Martin Tallman, Chief of Leukemia for Memorial Sloan Kettering Cancer Center has joined the Company’s Science Advisory Board (SAB).

Jonathan Foster, Executive Vice president and Chief Financial Officer of Moleculin, stated, "We finished the first quarter with cash of approximately $8.8 million and we received additional gross proceeds of $16.6 million subsequent to the quarter end from a public offering and the exercise of various warrants. The strengthening of our balance sheet provides us the ability to fund our ongoing research programs and clinical trials. We believe our existing cash and cash equivalents will be sufficient to fund our planned operations well into 2020. Currently, we have four clinical trials ongoing, and we will continue to carefully focus on being capital efficient through this important developmental process."

Anticipated Milestones

Anticipated Milestones
Potential Timeframe
Next Generation Anthracycline – Annamycin

Initial IRB (Institutional Review Board) approvals and site initiations of various clinical sites participating in our Phase 1/2 clinical trial of Annamycin
Accomplished and ongoing 2019
Complete cohort of 150 mg/m2 – prior trial recommended Phase II dose (RP2D)
2019 (Starting in Europe)
Start treating patients in Annamycin Phase 1/2 clinical trial in Poland
Accomplished and ongoing 2019
Announcement of initial clinical data for Annamycin trial
Accomplished and ongoing 2019
Announced completed first cohort of 120 mg/m2 in Poland and 100 mg/m2 in the U.S.
Accomplished
Poland clinical trial (MB-105) begins Phase 2
2020
Approach FDA on U.S. trial (MB-104) regarding dose expansion using Poland trial data
2020
Announced FDA grants Fast Track Designation to Annamycin for treatment of relapsed or refractory acute myeloid leukemia (AML)
Accomplished
Immune/Transcription Modulators – WP1066 Portfolio

Announced FDA grants Orphan Drug Designation to WP1066 for treatment of glioblastoma
Accomplished
Announcement of initial clinical data from WP1066 clinician sponsored trial
2019
Phase 1 surgical cohort begins in MD Anderson clinical trial of WP1066 for brain tumors
Second Half of 2019
Transfer clinician MD Anderson-sponsored WP1066 IND to Moleculin
Second Half of 2019
Emory Physician Led Pediatric Medulloblastoma Trial begins
Second Half of 2019
Announcement of further benefits of our sponsored research agreement with MD Anderson
Accomplished and Ongoing into 2019
Announced filing and approval of Clinical Trial Authorization for WP1220 for the treatment of cutaneous T-cell lymphoma (CTCL) in Poland
Accomplished
Assess WP1220 initial patient data
Q4-2019
IND for WP1732 submitted
2020
Dose first patient in Phase I trial for WP1732
2020
Announce further preclinical research results on WP1066 portfolio
Accomplished and ongoing 2019
Metabolism/Glycosylation Inhibitors – WP1122 Portfolio

Begin preclinical work on WP1122
Accomplished
File IND for WP1122
2020
General Clinical

Announce a fourth approved clinical trial
Accomplished
Announce a fifth approved clinical trial
2019

First Quarter Highlights and Recent Corporate Developments

Moleculin Announces Additional Positive Interim Results in First Cohort of Phase 1/2 Clinical Studies of Annamycin in Acute Myeloid Leukemia in Europe – 2 of 3 patients qualify to proceed to a potentially curative bone marrow transplant; trial advances to next higher dose level – May 7, 2019, the Company announced additional positive interim safety and efficacy data from its ongoing open label, single arm Phase 1/2 study of Annamycin in Poland. After receiving a single starting dose of 120 mg/m2 in the first cohort of the dose escalation phase of the trial, 2 of 3 patients treated responded sufficiently to qualify for a potentially curative bone marrow transplant. The results for all 3 patients were reviewed by the Safety Review Committee, which determined that no drug-related adverse events were observed that would prevent advancing the trial to the next higher dose level of 150 mg/m2. To date in the European trial, one patient experienced grade 2 mucositis (which resolved to grade 1 within 2 days) and no other adverse events related to Annamycin have been reported. No additional patient data have been developed in the Company’s parallel US clinical trial, which is currently recruiting its second cohort to be given a dose level of 120 mg/m2 (the U.S. trial started at a lower initial dose of 100 mg/m2).

Moleculin Announces $15.0 Million Registered Direct Offering – April 23,2019, the Company announced that it has entered into definitive agreements with institutional investors to purchase an aggregate of 9,375,000 units at a public offering price of $1.60 per unit in a registered direct offering, which offering was closed on April 25, 2019. Each unit is comprised of one share of common stock and 0.5 of a warrant to purchase one share of common stock. Each warrant has an exercise price of $1.75 per share and is exercisable immediately. The warrants will expire five years from the date of issuance. The gross proceeds of the offering were approximately $15.0 million, prior to deducting the placement agent fees and other estimated offering expenses.

Moleculin Receives FDA Approval of Fast Track Designation for Annamycin – April 18, 2019, the Company announced that the FDA has approved its request for Fast Track Designation for its drug, Annamycin, for the treatment of relapsed or refractory AML.

A drug that receives Fast Track designation is eligible for some or all of the following:

More frequent meetings with FDA to discuss the drug’s development plan and ensure collection of appropriate data needed to support drug approval;

More frequent written communication from FDA about such things as the design of the proposed clinical trials and use of biomarkers;

Eligibility for Accelerated Approval and Priority Review, if relevant criteria are met;

Rolling Review, which means that a drug company can submit completed sections of its Biologic License Application (BLA) or New Drug Application (NDA) for review by FDA, rather than waiting until every section of the NDA is completed before the entire application can be reviewed. BLA or NDA review usually does not begin until the drug company has submitted the entire application to the FDA.

Moleculin Announces Significant Discovery in Lung Cancer Models – Annamycin Found to be Active Against Metastases to the Lungs in Pre-Clinical Testing – April 17, 2019, the Company announced that its ongoing sponsored research at The University of Texas MD Anderson Cancer Center has now demonstrated that Annamycin is able to significantly improve survival in an aggressive form of triple negative breast cancer metastasized to the lungs in animal models. The Company believes its success in increasing the survival rate in mice with this tumor model in combination with the previously observed high uptake of Annamycin by the lungs is a promising indication that supports additional clinical research in lung and metastatic lung cancers.

Moleculin Announces Agreement with Emory University to Conduct Pediatric Brain Tumor Trial – April 11, 2019, the Company announced it has entered into an agreement with Emory University to conduct a Phase 1 clinical trial of WP1066 in children with recurrent or refractory malignant brain tumors. The study will be conducted at the Aflac Cancer & Blood Disorders Center at Children’s Healthcare of Atlanta.

Moleculin Announces Preclinical Pancreatic Cancer Data Presented at American Association for Cancer Research (AACR) (Free AACR Whitepaper) Annual Meeting – April 3, 2019, the Company announced that preclinical data supporting activity of its STAT3-inhibiting Immune/Transcription Modulators was presented by Dr. Waldemar Priebe, Founder and Chair of the Scientific Advisory Board of Moleculin, Inc. at the 2019 Annual Meeting of the American Association for Cancer Research (AACR) (Free AACR Whitepaper) in Atlanta, GA.

AACR Abstract:

View Source

The presentation included data resulting from preclinical evaluation in pancreatic cancer models of STAT3 inhibitors WP1066 and WP1732, both discovered at The University of Texas MD Anderson Cancer Center and licensed by Moleculin. WP1066 is an orally bioavailable drug with significant brain uptake that is currently in Phase 1 clinical studies in patients with brain tumors. Complementary to WP1066, we believe STAT3 inhibitor WP1732 may be suitable for IV administration and demonstrates high uptake by the pancreas without uptake to the brain.

Moleculin Announces Pricing of Underwritten Public Offering – March 27, 2019, the Company announced the pricing of an underwritten public offering of an aggregate of 5,250,000 units at a public offering price of $1.00 per unit, which offering was closed on March 29, 2019. Each unit is comprised of one share of common stock and 0.5 of a warrant to purchase one share of common stock for a total of 5,250,000 shares of common stock and warrants to purchase 2,625,000 shares of common stock. Each warrant has an exercise price of $1.10 per share and is exercisable immediately. The warrants will expire five years from the date of issuance. The gross proceeds of the offering were $5.25 million, prior to deducting the underwriting discount and other estimated offering expenses.

Moleculin Announces First Patients Enrolled in Lymphoma Clinical Trial – March 19, 2019, the Company announced that the first two patients have been enrolled in its European clinical trial of WP1220 for the topical treatment of cutaneous T-cell lymphoma (CTCL). The Company is targeting CTCL with a topical p-STAT3 inhibitor in light of the significant role that STAT3 appears to play in CTCL skin lesions. The intent is to take an early read on the first five patients in this trial to assess whether the activity supports an expansion of clinical testing of this topical drug. The Company expects preliminary data to be available during 2019.

Moleculin Announces Memorial Sloan Kettering Chief of Leukemia Joins Science Advisory Board – March 18, 2019, the Company announced that Dr. Martin Tallman, Chief of Leukemia for Memorial Sloan Kettering Cancer Center has joined the Company’s Science Advisory Board (SAB).

Moleculin Announces Outlicensing Deal to Accelerate Preclinical and Clinical Development – February 20, 2019, the Company announced that it has entered into a sublicense agreement with WPD Pharmaceuticals (WPD), located in Poland. The agreement provides WPD with exclusive rights, subject to current license agreements, to develop and market a range of Moleculin’s technologies in certain European countries (which does not include the UK, France, Italy and Spain) in exchange for contributing a minimum of $4 million in development expenditures agreed upon by Moleculin during the term of the agreement plus an

ongoing royalty on future revenues. The agreement is specifically geared to provide Moleculin with the benefit of European Union (EU) grant funding, which may be available to companies like WPD that are formed and present in EU countries.

Moleculin Announces Approval for Third Drug to Commence Clinical Trials – MBRX will now have three distinctive oncology drugs in clinic in four ongoing clinical trials – WP1220, a STAT3 inhibitor, to begin clinical trials in Poland for the treatment of CTCL, a rare and deadly skin cancer – February 07, 2019, the Company announced it has received approval to begin clinical trials in Poland for its Immune/Transduction Modulator, WP1220, for the topical treatment of CTCL. CTCL is a potentially deadly form of skin cancer involving skin lesions that often have high levels of activated STAT3 (p-STAT3). As a potent inhibitor of p-STAT3, the Company believes WP1220 may be ideally suited to treat these lesions through topical application, which is what this clinical trial is designed to evaluate. The Company has three unique drug candidates in four ongoing clinical trials for the potential treatment of rare and difficult cancers.

Moleculin Announces the FDA has Granted Orphan Drug Designation for its Brain Tumor Drug – February 05, 2019, the Company announced that the FDA has granted Orphan Drug Status for its drug candidate WP1066 for the treatment of glioblastoma, the most aggressive form of brain tumor. The Company believes that WP1066 represents a new class of drugs which it calls "Immune/Transduction Modulators" because it has demonstrated the ability in preclinical testing in animals to both stimulate a natural immune response to tumors and directly attack tumor cells by inhibiting multiple key oncogenic transcription factors, including STAT3, HIF1-α and c-Myc.

In addition to the glioblastoma trial at MD Anderson, the Company has received interest from additional investigators, including Emory University and Mayo Clinic for conducting clinical trials for the treatment of pediatric brain tumors, as well as others interested in treating a range of highly resistant tumors including AML and pancreatic cancer.

Moleculin Announces Dr. James L. Abbruzzese, Chief of Medical Oncology Division at Duke University, Joins Science Advisory Board – Dr. Abbruzzese to add significant pancreatic cancer expertise to advance drug development – January 17, 2019, the Company announced that Dr. James L. Abbruzzese, Chief of Oncology at Duke University has joined Moleculin’s Science Advisory Board. Dr. Abbruzzese is recognized as one of the world’s leading experts in the clinical study and treatment of pancreatic cancer and the addition of his expertise will be invaluable to the Company’s efforts in developing a potential treatment for pancreatic cancer.

Moleculin Announces Positive Data for its Pancreatic Cancer Drug Candidate – WP1732 – now second lead drug demonstrating enhanced activity in combination with immune checkpoint blockade antibodies – January 03, 2019, the Company announced that in preliminary animal studies, a second of its lead drugs, water-soluble, WP1732, has demonstrated enhanced activity in combination with checkpoint blockade antibodies in pancreatic cancer. This is significant for several reasons. It shows that this is a consistent capability across the Company’s platform of Immune/Transduction Modulators and it further supports independent research suggesting that STAT3 may be a key to enabling checkpoint blockade activity in otherwise resistant tumors. Importantly, though, when coupled with its recent findings that WP1732 accumulates disproportionately in the pancreas, the Company believes it points to WP1732 as a potentially pivotal new approach to treating pancreatic cancer. Expansion of the WP1732 and WP1066 in vivo studies are in progress.

Financial Results for the First Quarter ended March 31, 2019

Research and Development Expense. Research and development ("R&D") expense was $2.9 million and $1.2 million for the three months ended March 31, 2019 and 2018, respectively. The increase of approximately $1.7 million is mainly related to the increase in clinical activity and slight increase in R&D headcount over the prior period.

General and Administrative Expense. General and administrative expense was $1.6 million and $1.4 million for the three months ended March 31, 2019 and 2018, respectively. The increase of approximately $0.2 million was mainly attributable to an increase in G&A related payroll costs, as well as increases in stock-based compensation costs attributable to new employees and new employee stock options.

Net Loss. The net loss for the three months ended March 31, 2019 was $4.0 million, which included non-cash income of $0.5 million on the gain in fair value of our warrant liability, which was offset by non-cash charges of $0.3 million related to stock-based compensation and other stock-based expenses.

Liquidity and Capital Resources

As of March 31, 2019, the Company had cash and cash equivalents of $8.8 million. Subsequent to the three months ended March 31, 2019, the Company received gross proceeds of approximately $16.6 million, as a result of a completed public offering and the exercise of various warrants from past public offerings.

Cash used in operations was $3.8 million for the three months ended March 31, 2019. This $1.0 million increase over the prior year of $2.8 million was mainly due to: 1) developing, manufacturing and testing drug product as we prepared for clinical trials; 2) an increase in R&D headcount and associated payroll costs; 3) an increase in sponsored research and related expenses; and 4) an increase in license fees. These are all a reflection of the increased clinical and pre-clinical activity and the associated increase in G&A support for our three core drug technologies as compared to the prior year.

In March 2019, the Company completed an underwritten offering of 5,250,000 units, each unit consisting of one share of common stock, and 0.5 of a warrant to purchase one share of common stock. The public offering price of the units was $1.00 per unit, and the underwriter agreed to purchase the units from the Company at a price of $0.93 per Unit. The warrants included in the units are immediately exercisable at a price of $1.10 per share, subject to adjustments in certain circumstances, and will expire five years from the date of issuance. The net proceeds from the transaction was approximately $4.65 million after deducting the underwriting discount and estimated offering expenses.

Subsequent to the three months ended March 31, 2019, on April 23, 2019, the Company entered into definitive agreements with institutional investors to purchase an aggregate of 9,375,000 units at a public offering price of $1.60 per unit in a registered direct offering. Each unit is comprised of one share of common stock and 0.5 of a warrant to purchase one share of common stock resulting in gross proceeds of $15.0 million. Each warrant has an exercise price of $1.75 per share and is exercisable immediately. The warrants will expire five years from the date of issuance. The offering closed on April 25, 2019.

Also, 1,408,018 shares were issued due to the exercise of various warrants related to past public offerings, subsequent to March 31, 2019 and through the date of filing of these financial statements. Gross proceeds received due to these exercises approximated $1.6 million.

The Company believes that its existing cash and cash equivalents as of March 31, 2019, combined with the additional funds raised via the issuance of equity described above, will be sufficient to fund planned

operations into the second quarter of 2020. Any additional issuances should extend the funding of our planned operations significantly beyond the second quarter of 2020. Such plans are subject to our stock price, market conditions, changes in planned expenses depending on clinical enrollment progress, the use of drug product or a combination thereof.

Milestone Pharmaceuticals Announces Full Exercise of Underwriters’ Option to Purchase Additional Shares in Its Initial Public Offering

On May 14, 2019 Milestone Pharmaceuticals Inc. (Nasdaq: MIST), a Phase 3 clinical-stage biopharmaceutical company dedicated to developing and commercializing etripamil for the treatment of cardiovascular indications, reported that the underwriters for its initial public offering of common shares have fully exercised their option to purchase an additional 825,000 common shares at the public offering price of $15.00 per share (Press release, Milestone Pharmaceuticals, MAY 14, 2019, View Source [SID1234536284]). The gross proceeds to Milestone from the exercise of the option, are expected to be approximately $12.4 million, bringing the total gross proceeds of Milestone’s initial public offering to approximately $94.9 million before deducting underwriting discounts, commissions and offering expenses. All of the common shares were offered by Milestone. The closing of the option exercise is expected to occur on May 15, 2019, subject to satisfaction of customary closing conditions.

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Milestone’s common shares are listed on the Nasdaq Global Select Market under the ticker symbol "MIST."

Jefferies LLC, Cowen and Company, LLC, and Piper Jaffray & Co. served as joint book-running managers for the offering. Oppenheimer & Co. Inc. served as lead manager for the offering.

The shares were offered by Milestone pursuant to registration statements that were declared effective by the U.S. Securities and Exchange Commission ("SEC") on May 8, 2019. A prospectus relating to and describing the terms of the offering has been filed with the SEC and is available on the SEC’s website at www.sec.gov.

The offering of these shares was made only by means of a prospectus. Copies of the final prospectus relating to this offering may be obtained from Jefferies LLC, Attention: Equity Syndicate Prospectus Department, 520 Madison Avenue, 2nd Floor, New York, NY 10022, or by telephone at (877) 821-7388, or by e-mail at [email protected], or from Cowen and Company, LLC, c/o Broadridge Financial Solutions, 1155 Long Island Avenue, Edgewood, NY 11717, Attention: Prospectus Department, by telephone at 631-592-5973 or by email at [email protected], or from Piper Jaffray & Co., Attention: Prospectus Department, 800 Nicollet Mall, J12S03, Minneapolis, MN 55402, by telephone at (800) 747-3924 or by email at [email protected].

This press release shall not constitute an offer to sell or the solicitation of an offer to buy, nor shall there be any sale of Milestone’s common shares in any jurisdiction in which such offer, solicitation or sale would be unlawful prior to the registration or qualification under the securities laws of such state or jurisdiction.