Galena presentation 11 jan 17
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Transcript of Galena presentation 11 jan 17
HEMATOLOGY &
ONCOLOGY FOCUSED
COMPANY
January 11, 2017
FORWARD LOOKING STATEMENT
This presentation contains forward-looking statements within the meaning of the
Private Securities Litigation Reform Act of 1995. Such statements include, but are
not limited to, statements about future expectations, plans and prospects for the
development and commercialization of the Company's product candidates,
including patient enrollment in our clinical trials, present or future licensing,
collaborative or financing arrangements, expected outcomes with regulatory
agencies, and projected market opportunities for product candidates are subject
to a number of risks, uncertainties and assumptions, including those identified
under “Risk Factors” in the Company’s most recently filed Annual Report on Form 10-K and Quarterly Report on Form 10-Q and in other filings the
Company periodically makes with the SEC. Actual results may differ materially
from those contemplated by these forward-looking statements. The
Company does not undertake to update any of these forward-looking statements
to reflect a change in its views or events or circumstances that occur after the
date of this presentation.
2
DIVERSIFIED PIPELINE
Diversified
pipeline with
multiple mid-
to late stage
clinical trials
HEMATOLOGY
•GALE-401 (Anagrelide Controlled Release)
•Targeting MPNs
•Phase 3 Initiation in ET in Q2
IMMUNOTHERAPY
• NeuVax™ (nelipepimut-S)
• Targeting HER2
• Multiple Phase 2 clinical trials ongoing & planned
IMMUNOTHERAPY
•GALE-301/GALE-302
•Targeting Folate Binding Protein
•Early stage trials ongoing
3
DEVELOPMENT PIPELINE
PRODUCT THERAPETIC AREA PHASE 1 PHASE 2 PHASE 3 BLA / NDA
Hematology
GALE-401 (Anagrelide CR) Essential Thrombocythemia
Immunotherapy: Breast Cancer
NeuVax™ + Herceptin® Node-positive or node negative/triple negative, HER2 IHC 1+/2+
NeuVax™ + Herceptin® High risk, node-positive or negative, HER2 IHC 3+
NeuVax™ Ductal Carcinoma in Situ (DCIS)
Immunotherapy: Gastric Cancer
NeuVax™ Gastric, HER2 IHC 1+/2+/3+
Immunotherapy: Gynecological Cancer
GALE-301 Ovarian & Endometrial
GALE-301 + GALE-302 Ovarian & Breast
*NeuVax is an investigational product. Efficacy has not been established. Herceptin is a registered trademark of Genentech.
Ongoing Planned
4
2b
VADIS
GALE-401
Anagrelide Controlled Release (CR)
ANAGRELIDE
Anagrelide immediate release (IR) approved by the FDA to treat Myleoproliferative Neoplasms (MPNs)
• Indicated for the treatment of patients with thrombocythemia, secondary to myeloproliferative disorders to reduce the elevated platelet count and the risk of thrombo-embolic events
• Only drug approved to treat Essential Thrombocythemia (ET)
Anagrelide suppresses megakaryocytopoiesis by inhibiting PDE III-dependent and PDE III-independent mechanisms
No DNA damaging or cytotoxic effect
6
GALE-401: ANAGRELIDE CONTROLLED RELEASE (CR)
A proprietary, controlled release (CR) formulation of anagrelide
• 505(b)2 regulatory path allows for abbreviated submission package and potentially faster approval timelines
• Strong IP through 2029
Six trials conducted to date
• Five Phase 1 studies in healthy volunteers
• Phase 2 pilot study in patients with myeloproliferative neoplasms (MPNs)
Potential Clinical Benefits
• Consistent efficacy
• Potentially faster onset of action and indication of improved tolerability compared to anagrelide IR
• More convenient treatment regimen
• Favorable PK profile
Multiple life cycle management opportunities
7
Re
sult
s Reduces Cmax
Maintains Area Under the Curve (AUC)
Lowers peak plasma concentration
Maintains Platelet Lowering
GALE-401 PHASE 1 TRIALS
8 Multiple Phase 1 studies in n=98 healthy volunteers; Agrylin is a registered trademark of Shire.
Anagrelide CR Platelet Lowering GALE-401 Median Cmax
Anagrelide IR Median Cmax
GALE-401: PHASE 2 PILOT STUDY FINAL RESULTS
9 Source: Verstovsek et al, Final Results of Anagrelide Controlled-Release (Gale-401) Safety, Efficacy and Pharmacokinetics
in Subjects with Myeloproliferative Neoplasms (Mpn)-Related Thrombocytosis, ASH 2015 Poster Presentation.
Well tolerated with primarily Grade 1 and 2 toxicities in n=14/18
Efficacy compares favorably to historical anagrelide IR
• Platelet response:
ORR = 83.3% (15/18)
CR = 61.1% (11/18)
PR = 22.2% (4/18)
• Time to response was 1 to 9 weeks (defined as platelet count ≤ 600 x109/L)
Anagrelide IR historical time to response ranged from 4 to 12 weeks
Safety profile indicates a potential benefit for GALE-401 compared to anagrelide IR
GALE-401 DEMONSTRATES IMPROVED AE PROFILES IN KEY CATEGORIES
Related Adverse Events (AEs)
GALE-401*
(N=18)
n (%)
AGRYLIN^
(n=942)
%
Cardiac 6 (33) 42
General# 5 (27.8) 83
Gastrointestinal 9 (50) 92
Respiratory, thoracic and mediastinal 2 (11) 18
Skin and subcutaneous tissue 2 (11) 14
Musculoskeletal and connective tissue 1 (6) 6
Nervous system 9 (50) 65
Vascular 3 (16) <5
Hepatobiliary 2 (11) <5
Blood and Lymphatic 1 (6) <5
Number of AEs/patient 2.3 3.3
10 Not a head-to-head trial. *GALE-401 related AE data from Phase 2 study; ^Anagrelide IR data from the product label. #General AEs referred to fatigue, peripheral edema, and malaise
ADVANTAGES OF CR FORMULATION
11
Anagrelide IR^ GALE-401* Benefits
w/CR Formulation
Therapeutic index# Limited - dose escalation to
optimal effect is challenging Larger - Possibility of achieving
desired effect with lower dose
Pharmacokinetics (PK)
• Half life
• Cmax
• 2-3 hours
• 4x GALE-401
Improved PK profile
• 20 hours
• 25% of IR
Onset of Action As early as 4 weeks As early as 1 week for faster
onset of action
Doses per day 2 to 4 times a day 2 times a day
Targeting 1x/day in future trials
Dosing regimen 2 to 10 mg per day Mean 2 mg per day
Safety Profile
• Treatment Related AEs
• # of AE/Patient
• 42.1%
• 3.3 • 30%
• 2.3
Not a head-to-head trial. ^Anagrelide IR data from the product label/Agrylin Package Insert. *GALE-401 profile from Phase 1 and 2 studies. #Therapeutic Index distance between therapeutic dose curve and toxic dose.
ESSENTIAL THROMBOCYTHEMIA (ET)
One of the major MPNs
Characterized by increased number of platelets
• ET is a neoplastic stem cell disorder causing dysregulated production of large numbers of abnormal megakaryocytes
Chronic condition
• Median Overall Survival: 14.7 years
• Up to 50% of patients may be asymptomatic at presentation
Associated with vascular complications
12
Arrows indicate Megakaryocytes
ET has Larger Number of Megakayocytes
Sources: Haematologica. 2009 June; 94(6): 865, Am J Hematology. 2008 May;83(5):359)
ET OVERVIEW
Diagnosis
• Chronic hematologic malignancy with no known cause
• Clinical presentation of symptoms
• Diagnostic tools
• Blood test
• Bone marrow biopsy
• Gene mutation test
Common Symptoms
• Headache
• Vision disturbances or migraines
• Dizziness or lightheadedness
• Coldness or blueness of fingers or toes
• Burning, redness, and pain in the hands and feet
Thrombotic Complications
• Stroke
• Transient ischemic attack (TIA)
• Heart attack
• DVT or pulmonary embolus
• Blood clotting in unusual locations
Risk Factors
• Women 1.5x more likely
• Patients >60 years old, with 20% <40 years
• Mutations
• JAK2 - 50%
• CALR ~25%
13 Source: MPN Research Foundation
ET: CURRENT TREATMENT OPTIONS
Hydroxyurea
Other Therapies
•Generally initial treatment option
•Cytotoxic Myelosuppressive drug (reduces other blood cells as well)
• Increased risk of developing acute leukemia after long term
•Avoided in younger patients
•~25% of patients intolerant/refractory
• Anagrelide IR
• Interferon
• Busulfan • Retry hydroxyurea • Observation
14
PIVOTAL, PHASE 3 TRIAL
15
Failed or Intolerant to Hydroxyurea
GALE-401
(Anagrelide CR)
BEST AVAILABLE THERAPY
Anagrelide IR (sizable population)
Interferon
Busulfan
Retry hydroxyurea
Observation
Sources: Mehta et al, (2014) Epidemiology of myeloproliferative neoplasms in the United States, Leukemia & Lymphoma; Sever et al (2014) Therapeutic options for patients with polycythemia vera and essential thrombocythemia refractory/resistant to hydroxyurea, Leukemia & Lymphoma
Targeting the reduction of platelets in ET patients
• Limited competition with very few agents in development
• US Prevalence: 135,000 - 175,000
Estimate up to 25% of those patients who fail or are intolerant to initial treatment with hydroxyurea may be trial candidates
Planned next steps
• Q1: Finalize Phase 3 clinical trial protocol
• Q2: Initiate pivotal trial
Expected trial completion YE 2019
NEUVAX™ (nelipepimut-S)
Targeting HER2
ELICITS A STRONG CD8+ T-CELL RESPONSE
NeuVax contains the immunodominant peptide derived from the extracellular region of the HER2 protein
NeuVax binds to antigen presenting cells (APCs)
NeuVax stimulates APCs to activate CD8+ cytotoxic T lymphocytes (CTLs)
CTLs rapidly replicate to seek out and destroy HER2 expressing tumor cells and micro-metastases
Booster series maintains long term immunologic response
Demonstrated inter- and intra-antigenic epitope spreading
17 Sources: Peoples GE, et al (2005) JCO, 23(300, 7536-7545; Mittendorf EA, et al (2006) Surgery, 139(3): 407-418. Peoples, et al, ASCO 2012 Poster Presentation
0.4
1.8
0.7 0.5
0.0
0.5
1.0
1.5
2.0
2.5
% N
eu
Va
x sp
ecific
CD
8+
T c
ells
NeuVax Specific CD-8 CTLs: Pre-, Post, Mean and Long-Term (6 months)
Pre Max Mean Long-Term
T-Cell
CD28
OX40
GITR
CD122
CD27
CD360
HVEM
CD137
CTLA-4
PD-1
TIM-3
BTLA
VISTA
LAG-3
Activating Receptors Inhibitory Receptors
NEUVAX STIMULATES T-CELL PROLIFERATION AND EXPANSION
18
T cells
Checkpoint inhibitors
Indirect Immune Modulators
Co-stimulators
Immune Inhibitory Enzymes
T cells
T cells
T cells
T cells
T cells
T cells
T cells
T cells
T cells
CORRELATION BETWEEN HER2 & MHC-1
There is an inverse correlation between HER2 and MHC class I
HER2 overexpression is associated with decreased expression of components of the antigen processing/ presentation pathway
19
COMBINATION IMMUNOTHERAPY ENHANCES ANTIGEN PRESENTATION
Trastuzumab/HER2 complexes are internalized and processed by proteasomes into short peptides
which are then presented on MHC class I molecules
PBMC from HER2/neu peptide, E75, vaccinated patients efficiently recognize and
lyse trastuzumab-treated HER2/neu-expressing tumor cell lines
20
Trastuzumab
HER2/neu
Breast tumor cell
HER2/neu –derived peptide presented on MHC-I
HER2/neu-derived peptide
20.0
25.0
30.0
35.0
40.0
45.0
50.0
55.0
60.0
Av
era
ge
% C
yto
tox
icit
y 5
1 C
r
0 ug 10 ug 50 ug
* p=0.015
Trastuzumab
Hypothesis: Trastuzumab treatment will enhance response to vaccination by making tumor cells more
visible to T-cells/immune system
Interim Analysis at 1 Year
DFS
Standard of Care: Standard Herceptin dosing every 3 weeks for 1 year 6 doses of NeuVax given every 3 weeks starting with third dose of Herceptin
+ 1 booster dose every 6 months thereafter
+ Dosing to disease progression;
36 mo follow up
Primary Endpoint
DFS at 24 mos.
300 adjuvant breast cancer patients, randomized 1:1
Single blind (subject)
Node positive or high risk node negative
HLA A2/A3+
HLA A24/A26+
HER2 IHC 1+/2+
Stratified by nodal status and HER2 status
Study Population
NEUVAX+TRASTUZUMAB: HER2 1+/2+ PHASE 2 STUDY
GM-CSF
+ GM-CSF
21
NEUVAX: MULTIPLE SETTINGS AND COMBINATION STRATEGY
Phase Treatment
HER2 Status Indication Trial Status
Targeted
Enrollment
Completion
Planned
Data
Readouts
Collaborations
2b
Combination
w/trastuzumab
HER2 1+, 2+
BREAST
Node Positive or
High Risk Node
Negative
HLA A2+, A3+,
A24+, A26+
Enrolling
U.S. only
33 centers
n=300
Q2 2017
Q2, 2018
Interim
Analysis
1H, 2019
Final Data
2
Combination
w/trastuzumab
high risk
HER2 3+
BREAST
Node Positive
HLA A2+, A3+
Enrolling
U.S. only
28 centers
n=100
Q4 2017
1H, 2019
Interim
Analysis
2
Single agent
VADIS Study
HER2 1+, 2+,
3+
BREAST
Ductal Carcinoma
in Situ (DCIS)
HLA A2+
Enrolling
U.S. only
4 centers
N=48
2
Single agent
HER2 1+, 2+,
3+
GASTRIC
HLA A2+, A3+
Planned
India Only
N=50
22
Targeting Folate Binding Protein
GALE-301 & GALE-302
GALE-301 & GALE-302
24 Source: U.S. Ovarian Cancer http://seer.cancer.gov/statfacts/html/ovary.html
Targeted cancer immunotherapies: GALE-301 (E39) & GALE-302 (E39’)
Folate Binding Protein (FBP) is over-expressed (20-80 fold) in >90% of ovarian and endometrial cancers
FBP has very limited tissue distribution and expression in non-malignant tissue making it an ideal immunotherapy target
Current treatments are generic
• Carboplatin and paclitaxel
• High recurrence rate
Most patients relapse with poor prognosis
GALE-301: OPTIMAL DOSE GROUP SHOWS PRELIMINARY EFFICACY
Source: Peoples, et. al, Poster Presentation, American Society of Clinical Oncology 2016 25
Phase 1/2a trial ongoing
Phase 1: Determined optimal dose and demonstrated safety and potent immune response
Phase 2a Preliminary data:
• At 16 months median follow-up:
Overall recurrence rate was 44.8% in the VG versus 54.5% in the CG (p=0.58),
Recurrence rate of 23.5% in patients who received booster inoculations.
• Two year DFS estimate in 1000 mcg dose group is 73.5% vaccine vs. 38.1% control (p=.03)
• GALE-301 plus GM-CSF is well tolerated and elicits a strong in vivo immune response with primarily Grade 1 and Grade 2 toxicities
Estimated 24 months Disease Free Survival by
Dosing Cohort
CURRENT CLINICAL DEVELOPMENT
26
Phase Treatment Cancer Type Current
Status
# of Enrolled
Patients
1/2a GALE-301 Ovarian, Endometrial
HLA A2+ Ongoing 51
1b GALE-301 &
GALE-302
Ovarian, Breast
HLA A2+ Ongoing 39
Multiple data presentations inform the design & target patient populations for future trials
Low expressors appear to show improved disease free survival (DFS) due to immunotolerance from significantly higher endogenous exposure to the FBP antigen
Different doses/schedules appear to correspond to various types of cancer:
• Breast patients = lower FBP exposure and may require lower 500mcg dose
• Ovarian patients = higher FBP expression and may require higher 1000mcg dose
• E39’ (GALE-302) may prevent T-Cell exhaustion
Sources: KM Peace, et. al, Phase Ib Trial of Two Folate Binding Protein (FBP) Peptide Booster Vaccines (E39 and E39′) in Breast and Ovarian Cancer Patients, SITC 2016; Jackson et. al, A Phase Ib Trial Comparing Different Doses/Schedules of a Folate Binding Protein(FBP)-derived Peptide Vaccine,
E39, and its Attenuated Version, E39’, to Induce Long-term FBP-specific Immunity in Disease-free Cancer Patients. ACS Oral Presentation 2016.
CORPORATE OVERVIEW
27
LEADERSHIP TEAM
28
Mark W. Schwartz, Ph.D. President & CEO Apthera, Bayhill Therapeutics, Calyx Therapeutics, Trega Biosciences, Incyte Genomics, DuPont Diagnostics
Bijan Nejadnik, M.D. Executive VP, Chief Medical Officer Jazz Pharmaceuticals, Johnson & Johnson, Stanford, Johns Hopkins, UC Davis
Stephen Ghiglieri EVP, Chief Financial Officer MedData Inc., NeurogesX, Hansen Medical, Inc., Oacis Healthcare Systems, Oclassen Pharmaceuticals
Remy Bernarda, SVP, Investor Relations & Corporate Communications IR Sense, Hana Biosciences, Knight Equity Markets, Bear Stearns, Goldman Sachs
John Burns, CPA VP, Finance & Corporate Controller Pixelworks, Moss Adams
Tom Knapp, Esq. Interim General Counsel Sucampo, Exemplar Law Partners, NorthWestern Energy, Paul Hastings, The Boeing Company
FINANCIAL OVERVIEW
Cash Position (as of 30 Sept 16) $24.5 million
Restricted Cash (as of 30 Sept 16 - $18.5 relating to Debenture)
$18.9 million
Projected Cash Burn from Operations
Q4, 2016 $7 - $9 million
Quarterly in 2017 $7 - $8.5 million⌃
Shares Outstanding (as of 31 Oct 16) 10.85 million*
Market Cap (as of 6 Jan 17) ~$25 million
29 ⌃Specific guidance expected in Q1 after finalization of Phase 3 trial details.
*Shares adjusted to account for reverse stock split effective November 14, 2016
2017 MILESTONES
30
PROGRAM MILESTONE PROJECTED
DATE
GALE-401
(anagrelide CR)
Finalize Phase 3 Clinical Trial Protocol Q1
Initiate Phase 3 Clinical Trial Q2
NeuVax™
(nelipepimut-S)
Enroll first patient in DCIS Trial Q1
Complete enrollment in
NeuVax/Trastuzumab 1+/2+ Combination
Trial
Q2
Complete enrollment in
NeuVax/Trastuzumab 3+ Combination Trial Q4
Interim Data Analysis: NeuVax/Trastuzumab
1+/2+ Combination Trial Q2, 2018
GALE-301
GALE-302 Review data and develop path forward 2H
THANK YOU
NASDAQ: GALE