This conference call transcript was computer generated and almost certianly contains errors. This transcript is provided for information purposes only.EarningsCall, LLC makes no representation about the accuracy of the aforementioned transcript, and you are cautioned not to place undue reliance on the information provided by the transcript.
spk10: Ladies and gentlemen, thank you for standing by, and welcome to the Excel Exist Q1 2022 Financial Results Conference Call. At this time, all participants are in a listen-only mode. After the speaker presentation, there will be a question and answer session. To ask a question during the session, you will need to press star 1 on your telephone. Please be advised that today's conference is being recorded. If you require any further assistance, please press star 0. I would now like to hand the conference over to your speaker, Ms. Susan Hubbard, Executive Vice President of Public Affairs and Investor Relations. Please go ahead.
spk01: Thank you, Cherie, and thank you all for joining us for the Exalexa's first quarter 2022 financial results conference call. Joining me on today's call are Mike Morrissey, our President and CEO, Chris Center, our Chief Financial Officer, PJ Haley, our Executive Vice President of Commercials, Vicki Goodman, our Chief Medical Officer, and Peter Lamb, our Chief Scientific Officer, who will together review our progress for the first quarter 2022 and in March 31st, 2022. During the call today, we will refer to financial measures not calculated according to generally accepted accounting principles. Please refer to today's press release, which is posted on our website, for an explanation of our reasons for using such non-GAAP measures, as well as tables deriving these measures from our GAAP results. During the course of this presentation, we will be making forward looking statements regarding future events and the future performance of the company. This includes statements about possible developments regarding discovery, product development, regulatory, commercial, financial, and strategic matters. Actual events or results could, of course, differ materially. We refer you to the documents we file from time to time with the SEC, which under the heading Risk Factors, identify important factors that could cause actual results to differ materially from those expressed by the company verbally and in writing today, including without limitation, risks and uncertainties related to product commercial success, market competition, regulatory review and approval processes, conducting clinical trials, compliance with applicable regulatory requirements, our dependence on collaboration partners, and the level of costs associated with discovery, product development, business development, and commercialization activities. And with that, I'll now turn the call over to Mike.
spk09: All right. Thank you, Susan, and thanks to everyone for joining us on the call today. ExoLux has had a strong first quarter 2022 across all components of our business. We continue to grow the Cabo's antigen franchise and advance a diversified pipeline of clinical and discovery programs while focusing on important upcoming milestones, including top-line results for ongoing pivotal trials, ASCO preparation, and the Cabo and the trial starting on May 16th. We'll keep our prepared remarks short today so we can address your important questions. Key highlights from Q1 include first, the Cabo Zantanet business continues to grow and generate the funds to advance our portfolio of next generation therapies for oncology. Cabo Medics maintained its status as the leading TKI for RCC. The Cabo franchise grew 37% year over year compared to first quarter 2021, marking its sixth consecutive quarter of growth. Second, our emerging bi-coastal development team is focused on expanding potential CAVO indications with numerous expected top-line results for important COSMIC and CONTACT pivotal trials and advancing our growing pipeline of clinical compounds, including XL092, XB002, XL102, and XL114, including the upcoming initiation of the pivotal trial program for XL092. Third and finally, our drug discovery network of internal and collaborative efforts along with extensive business development activities across both small molecule and biologic platforms continues to advance at a rapid pace with the selection of up to five new development candidates expected in 2022. So with that, please see our press release issued an hour ago for our first quarter financial results and an extensive list of key corporate milestones achieved in the quarter. I'll now turn the call over to Chris.
spk03: Thanks, Mike. For the first quarter of 2022, the company reported total revenues of approximately $356 million, which included Cabo's Antidote franchise net product revenues of $310.3 million. Cabo Medics net product revenues were $302.8 million, which included approximately $9 million in clinical trial sales. Gross to net for the Kawasaki franchise in the first quarter 2022 was 30.8%, which is significantly higher than the gross to net of 24.5% we experienced in Q4 2021. This increase in gross to net deductions in the first quarter 2022 translates to an approximate $28 million impact when compared to the fourth quarter 2021. This increase in gross net was primarily driven by higher 340B utilization, higher Medicare Part D, and higher copay assistance, primarily associated with patients in high-deductible medical insurance plans. Historically, we have experienced higher Medicare Part D and copay assistance expenses in the first quarter of the year due to many Part D patients moving through the donor hall and commercial patients satisfying their deductibles during the start of the year. Our 340B utilization in the first quarter was at a historically high level. Our trade inventory weeks on hand remained relatively flat when compared to the fourth quarter of 2021. Total revenues also included approximately $46 million in collaboration revenues earned primarily from Ipsen, Takeda, and Genentech. Our total operating expenses for the first quarter of 2022 were approximately $273 million compared to $334 million in the fourth quarter of 2021. R&D expense was the primary driver of the decrease in total operating expenses, which was primarily related to lower licensing expenses. Provision for income taxes for the first quarter of 2022 was approximately $17 million compared to approximately $23 million in the fourth quarter of 2021. The company reported gap net income of approximately $69 million or 21 cents per share on a fully diluted basis for the first quarter of 2022. The company also reported non-gap net income of approximately $84 million or 26 cents per share on a fully diluted basis. Non-GAAP net income excludes the impact of approximately $15 million of stock-based compensation expense net of the related income tax effect. Cash-in investments for the quarter ended March 31, 2022, was approximately $2 billion. And finally, we are reiterating our full year 2022 financial guidance, which is detailed on slide 13 of our earnings presentation. And with that, I'll turn the call over to PJ.
spk06: Thank you, Chris. The first quarter of 2022 was a strong quarter for the Cabozantinib franchise as we built on the significant momentum of 2021 and the milestone of surpassing $1 billion of U.S. net product revenue. The team continues to execute at a high level, which has resulted in Cabomedics continuing to be the number one prescribed TKI in RCC. Furthermore, Cabomedics' total prescriptions or TRX, have now grown for six consecutive quarters. Demand growth is being driven primarily by the long duration of therapy for patients on cabomedics in combination with nivolumab in the first-line setting. Prescription trends remain strong in Q1 2022. Year-over-year TRX growth in Q1 2022 was 37% relative to Q1 2021. Given the clinical data from the Checkmate 90R study, we anticipate these first-line combination patients to receive therapy for approximately a year and a half on average, thus driving a significantly longer treatment duration for coblometics. We are encouraged by the fact that in our data, we see a near doubling of the amount of new patient starts at the 40 milligram dose in Q1 2022 since the Checkmate 90R launch in January 2021. This is further indication that the combination uptake in the first-line setting is robust. Turning to the TKI market basket of CaboMedix and Leida, Sutton, Votrient, and Linvima, CaboMedix TRX market share has increased every quarter since Q1 2021, and the share in Q1 2022 was 36%. As we've discussed previously, the first-line RCC market is very competitive, and we are pleased with the performance of CaboMedix in combination with Nivolumab in this setting. Furthermore, we're still not seeing any significant competitive impact on our market share. Uptake in the first line is broad across clinical risk groups and practice settings, and prescriber experience to date has been very positive. We believe that all of this taken together with the momentum in the business positions Cabo Medics for continued growth throughout 2022. Turning to other settings, we are pleased that the Cabo Medics second line RCC business remained strong and was stable in Q1 while growth continued in the first line setting. In HCC, our business was stable in Q1 and Cabo Medics continues to be the most prescribed TKI in the second line setting for patients treated immunotherapy-containing regimens in the first line. With regards to second-line DTC, we are pleased with the launch, and in Q1, we continue to see strength in new patient starts and demand in this indication. Looking beyond the six current U.S. indications for cabozantinib, we are planning for numerous lifecycle expansion opportunities as they begin to have top-line data readouts in 2022. We look forward to having the opportunity, pending data and approval, to bring CaboMedix to many more patients in need of additional treatment options. Our team remains highly focused and motivated to compete every day to bring the benefit of CaboMedix to all eligible patients as we continue to build the franchise and serve patients. And with that, I'll turn the call over to Vicki.
spk11: Thank you, PJ. Good afternoon. Today I will cover our progress towards our organizational expansion to the East Coast, Exelix's East, as well as progress on our pipeline and highlights of cabozantinib data to be presented at the upcoming ASCO meeting in June. As we announced early this year, we are developing a presence in Greater Philadelphia as we seek to access talent on both coasts to support our expanding development organization. We have made progress since the last quarterly update, including signing a lease for intermediate term space in King of Prussia, Pennsylvania, which we expect to occupy by July of this year and which can hold approximately 140 office-based employees. We have also identified a potential long-term build-to-suit site of approximately 200,000 square feet in close proximity to our intermediate term space in King of Prussia and and we have begun hiring to open roles within the development organization in King of Prussia, supported by an ongoing recruitment campaign to raise awareness of our presence in the Philadelphia area. I'm excited by the opportunity to create a bi-coastal presence across two biotechnology hubs operating as one team focused on the singular mission of developing medicines to improve the lives of patients with cancer. Turning now to an update on our pipeline, beginning with our cabozantinib registrational trials. We remain on track for three Phase III readouts this year. For COSMIC 313, evaluating cabozantinib in combination with nivolumab and ipilimumab in intermediate and poor-risk renal cell carcinoma, we expect to release top-line results in July. An interim readout for the primary endpoint of overall survival for contact O1 and readout of the progression-free survival endpoint for contact O3 in combination with atezolizumab in PD-1-experienced non-small-cell lung cancer and renal cell carcinoma, respectively, are expected in the second half of 2022. Contact O2, our Phase III study in combination with atezolizumab in metastatic castrate-resistant prostate cancer, is expected to complete enrollment this year. We continue to make progress on our pipeline molecules. XL092, our next-generation MET, AXL, MER, and VEGFR tyrosine kinase inhibitor, is being explored in combination with several checkpoint inhibitors and IO combinations and is progressing towards registrational studies. We recently initiated dosing on a nivolumab-based immuno-oncology combination study in genitourinary malignancies, and we are amending that protocol to remove the triplet combination of BEMPEG with XL092 and nivolumab and replace it with an alternative triplet combination. We also continue to explore additional potential combination approaches with novel agents and have made progress with several partners to bring novel combinations into the clinics. Our first planned Phase III for XL092, STELR303, and third-line non-MSI-high colorectal cancer will be initiated in the second quarter of this year. As a reminder, data supporting this study comes from two studies of cabozantinib in colorectal cancer, which were presented at ASCO GI in January and demonstrated promising activity in comparison to historical controls of regorafenib, the current standard of care. XB002, our first antibody drug conjugate, which targets tissue factor without interfering with the coagulation pathway in preclinical models, continues in dose escalation. Thus far, it has been well tolerated with no bleeding events observed. We are now also initiating dose finding for combinations, beginning with an XB002 dose level, which has cleared safety evaluation in the monotherapy cohort. A Phase I study of XL102, our oral CDK7 inhibitor, is expected to move into both single-agent and combination expansion cohorts after completion of ongoing dose escalation and determination of a Phase II dose. Finally, the XL114 Phase I trial is now open for enrollment. We expect to provide Phase I clinical updates for XL092, XB002, and XL102 in the second half of this year. Finally, we are pleased that five cabozantinib abstracts have been accepted for oral presentations at the upcoming ASCO meeting, and I'd like to highlight three of these. These include two presentations based on COSMIC-021, our multi-tumor signal-finding study, the first in three distinct populations of bladder cancer patients, and the other from two cohorts of non-small-cell lung cancer patients previously treated with immune checkpoint inhibitors and platinum-based chemotherapy who received either cabozantinib plus atezolizumab or cabozantinib alone. Additionally, an investigator-sponsored Phase II study evaluating the addition of cabozantinib to pembrolizumab in PD-L1-positive squamous cell carcinoma of the head and neck will be presented. And with that, I'll turn it over to Peter.
spk04: Thank you, Vicki. I am pleased to provide a quick overview of the excellence of preclinical pipelines. We have a broadening pipeline derived from both internal and collaboration efforts with over 10 programs in progress, giving us the possibility of advancing up to five compounds into preclinical development in 2022. As you can see in the pipeline slide, the preclinical pipeline is a balanced mix of small molecules and biotherapeutics, which is reflective of how we see the clinical pipeline evolving in the future. We're continuing to accelerate the expansion of the log pipeline both through internal growth and through business development activities. Last year, our internal small molecule discovery group occupied new laboratories on our Alameda campus, and we have further embarked on expansion of our lab space in Alameda to accommodate future growth. In addition, we've located a site in Pennsylvania for an east coast laboratory expansion which will allow us to tap into the locally available talent pool and will complement our newly open development offices in the same area. We also have significant ongoing efforts on the business development front aimed at providing us access to novel targets, capabilities, and technologies that would complement and accelerate our ongoing biotherapeutics and small molecule strategies. In addition, we're assessing late preclinical and early clinical assets with the aim of identifying multiple opportunities to invest in. We're looking broadly at both small molecule and biotherapeutics opportunities that have the potential to address significant solid tumor populations where we have conviction in the science and visibility into a development strategy. We look forward to providing additional updates on these BD discussions as they come to fruition. I'll now turn the call back over to Max.
spk09: All right, thanks, Peter. As you heard on the call today, the Excel team has executed across all components of our business in Q1 with significant progress across our pipeline, clinical development, and commercial activities. We're excited about the potential for the multiple growth drivers ahead of us to move the business forward and, most importantly, put Exalexis in a position to help many more cancer patients. I'll close here by thanking the Exalexis team for their individual and collective efforts to support our many drug discovery, development, and commercial activities. We have the vision, determination, and resources to become a multi-product enterprise and expand our reach to serve cancer patients across the globe. We look forward to updating you on our progress in the future. Thank you for your continued support and interest in Exalexis, and we're happy to now open the call for questions.
spk10: Thank you. As a reminder, to ask a question, you will need to press star 1 on your telephone. To withdraw your question, press the pound key. Please stand by while we compile the Q&A roster. Our first question will come from Ashtika Gunawardine with Truist. Please go ahead.
spk17: Hey, guys. Thanks for taking my questions. Just wanted to check on the gross net a little bit here for Q1. It's a little higher than what I was used to at Cabo. Just want to check and see if there was anything unusual about this quarter and if this is the right seasonal inflection to assume going forward for future first quarters. And then I have a follow-up for Vicky, please.
spk03: Go ahead. Hi, Estika. It's Chris. So I guess starting off, I mean, as PJ talked about, we had strong growth and we've had growth over the last six quarters. So that's an important element to this. There was the seasonality aspects of it around Medicare Part D where you have patients going through the donor hole and also the co-pay assistance for commercial patients and those patients going through their deductibles and usually in the beginning part of a year. And then on top of that, the 340B... was at a higher level, or as I said, the highest level we've seen. And we've seen that segment of our gross to net grow over the last several years. And I think it's growing from an industry perspective also. So those are the three primary drivers of what we saw in gross to net in Q1.
spk17: Okay. So would it be right to kind of assume a similar kind of rate for Q1 2023 as well?
spk03: Yeah, I wouldn't project that out for next year. But, you know, those seasonality items are those items that I mentioned that have a seasonality effect will be there next year, too, just based on what we've seen over the last several years.
spk17: Got it. Okay. And then, Vicky, I think I heard you say that there will be data for 092 in the second half. Can you give us any sort of details as to which studies will be presented and what we are looking for from the data?
spk11: Yes, so it will be the first in humans for 092, so that's stellar 001, and what you can expect to see is data from expansion cohorts this year.
spk17: Wonderful. Thanks so much.
spk01: Thank you, Asika.
spk10: Thank you. Our next question will come from Michael Schmidt with Guggenheim. Please go ahead.
spk14: Hey, guys. Thanks for taking my questions. Obviously, there's a lot of focus on the ANDA trial next week with MSN, as you mentioned. But there's obviously also a second set of patents that have been asserted with a trial that's been scheduled for next year. Mike, without speculating on the outcome of the near-term trial, how should investors think about the relationship between those two sets of patents and How should we think about read through from a potential ruling in this first trial with respect to the second next year? And then I had a follow up.
spk09: Yeah, Michael, thanks for the question. Yeah, look, I think we've been pretty careful to not get ahead of ourselves in the context of this whole topic, so I'm certainly not going to do that today. You're correct. We've been very, I think, inappropriately aggressive in protecting our IP. That's what we do here relative to making the investments in the discovery and development and broad development of CABO and compounds in the future. So it shouldn't be surprising that the IPS data is growing over time. But in terms of the actual details and the nuances there, I just don't want to get into that right now for all the obvious reasons. So third question, stay tuned for what happens next week, and we'll go from there.
spk14: All right, great. And then a question on the ASCO presentation. from COSMIC 021 in lung cancer in particular. I guess, will this be just a longer follow-up from the data that we've seen before, or will there be additional patients that have been treated in the study? And could you remind us how the lung cancer patient characteristics from 021 compare with those in the Phase III Contact 01 study?
spk11: Yeah, sure. So the data that are going to be presented are from two cohorts, as I mentioned, of COSMIC-021, cohort 7, and cohort 20. And so one is cabozantinib in combination with atezolizumab, and the other is cabozantinib alone. The patients have previously been treated with immune checkpoint inhibitors as well as platinum-based chemotherapy, and so the population is similar to contact O1, and we'll be presenting roughly two years of follow-up for these patients, presenting response, other efficacy outcomes, as well as safety data for those patients.
spk14: Okay, great. Thank you.
spk10: Thank you. Our next question will come from Andy Shea with William Blair. Please go ahead.
spk07: Oh, great. Thanks for taking my questions, and congratulations on the very robust quarter-over-quarter growth. So I just want to follow up on Michael's question, actually, the last one. So I think, you know, I don't want to put words in his mouth. I think he was He's asking whether we're going to see the 80 patients. I remember that cohort seven actually expanded from 30 patients to 50 patients. So I'm also curious whether we're going to see the totality of data from the entirety of that cohort. And I have a question for PJ. In terms of slide 18, you know, one of the interesting dynamics that we observed from the five quarters that you illustrated, is that if you add up the market share of LaVima and Enlighta, they actually stayed pretty constant. So is it fair to say that LaVima's introduction kind of took away shares exclusively from Enlighta?
spk09: So why don't we start with the PGA question first, and then I'll loop back and just give a quick kind of high-level summary on ASCO.
spk06: Great. Yeah. Thanks, Andy. With regards to the market share, you know, as I mentioned, we're certainly pleased with the progress. You know, as you pointed out, we've been growing. And, you know, as one does look at the prescription data for Enlighta and Pembroke, it does seem to be, relatively speaking, a zero-sum game. You know, they both have the Pembroke-Lizumab backbone, so I think it's not entirely surprising that one is cannibalizing the other. The other point I would make with regard to the limbatinib data is that these data do include other tumor types. And if you look at a different data source from Brand Impact, it would point out, for example, that approximately 40% of the limbatinib data or prescriptions or usage, I should say, is from endometrials. So that's another sort of piece of context there. as that indication launched approximately a year ago. So I think to sum it up, I think you're right. What we see generally across data sources is, as I mentioned, we're not seeing impact on our share. We're seeing strength both in share and demand growth. We're very pleased with that. And it does seem to be that the competitors are sort of potentially cannibalizing each other.
spk09: That's great. Thanks, PJ. Andy, in terms of ASCO, again, don't want to get into the weeds on the abstract before it's published. I think you can expect a pretty fulsome update.
spk07: Got it. Okay. So one more scientific question if you don't mind. So if you look at the oncofetal protein 5P4, it's been a known cancer target for a while, pretty popular as a vaccine, cancer vaccine target back in the day. So You know, recently there's been, you know, one business development activity going on. So I'm just curious if there's any sort of paper or study that catalyzed recent interest. Obviously, you know, you guys are advancing XP 010 going forward. So any sort of pitfalls or learnings that you wish to kind of incorporate as you advance that task and go forward?
spk09: Thank you. Peter, take that one.
spk04: Yeah, thanks for that. Thanks for the question, Andy. Yes, you are. You are obviously correct. I mean, 5G forwards, you know, being a target of interest for various biotherapeutic and vaccine approaches, as you indicate for some time. So it's a known public domain target. I think. And that's for good reason. I think its expression pattern is compelling, whereby it's overexpressed in a variety of solid tumors at pretty decent levels and has minimal expression in most normal tissues. So, obviously, that still stands. I think for us, it really falls into the category of targets that I sort of spoke to before, which are good targets, which I think would really benefit from the kind of next-generation approaches to ADCs that we're taking. So in a way, it falls into the same bucket as XB002. So our aim here is to develop a next-gen ADC. As we discussed, we have antibodies from Invenra, which we've characterized extensively, transferred to our partners at Catalan to be using there, you know, very contemporary site-specific conjugation technology to make a, you know, a well-constructed ADC with a highly defined DAR that has, you know, at this point, compelling preclinical efficacy and safety data. So, yeah, we're excited to be moving XB010 forward. As you say, we're not alone in finding this to be a good target in a variety of approaches, so we'll see how each one plays out.
spk07: Great. Thanks for answering all my questions.
spk01: You bet, Annie. Thank you.
spk10: Thank you. Our next question will come from Yaron Werber with Cowan. Please go ahead.
spk05: Great. Thanks for taking my question. I have a couple of questions. Maybe the first one, Mike, the contact O3 data that the Cabo Dyscentric, right, versus Cabo and Second Line RCC interim data that can have, do you expect we'll have more, it's a PFS OS endpoint, do you expect to have more PFS data or do we have a little bit OS And also, can you put it in context for us just a little bit? You're already dominating second line. So commercially, what does contact 03 mean for you? And then I have a quick follow-up.
spk09: Yeah, I'll let Vicki opine on the first part of your question. Second part of your question, commercially, you know, obviously any good data we can generate, any line that raises the bar for standard of care, we want to pursue, and we have pursued with first line with the triplet 313 and second line with contact 03. You know, we're in the business of improving outcomes for patients, and that's just a matter of getting the data in the appropriate trial with the appropriate population. So I think, again, if that looks good, we can potentially move the needle even further for those patients. Vicki, you want to opine on the first part of the question?
spk11: Sure. So for contact 03, right, it is a primary readout for the progression-free survival endpoint. And obviously, PFS matures at an earlier time than overall survival. So it's expected to be primarily a readout of PFS at this point.
spk05: Okay, great. And then secondly, and I apologize if I'm reading too much into it, but contact 03 is obviously called out fairly prominently in the press release under the CABO highlights Contact 01, which also has data on the second half, is not discussed quite as much. Maybe just give us a little bit of a sense, or COSMIC 313 for that matter, just give us maybe a little bit of a sense, kind of how did you think about what to include in the press release? Thank you.
spk09: Yeah, everyone, it's Mike. Yeah, I think you're probably over-interpreting that, so I wouldn't read into that in any shape, manner, or form. They're all important trials for us. We're pushing those all really hard. If successful, they could all move the needle. So stay tuned for data.
spk05: Okay, thank you.
spk10: Thank you. Our next question will come from Jay Olson with Oppenheimer. Please go ahead.
spk16: Well, hi. Thank you for the update, and thank you for taking the questions. Can you comment on how you expect the HCC competitive landscape to evolve over time and maybe some of the key learnings from COSMIC 312 and first-line HCC that you plan to apply to your next study? And also, maybe if you could comment on that needs in first-line HCC with the potential for VEGF-free regimens on the horizon.
spk06: Yeah. Hi, Jay. This is PJ. I'll just maybe briefly comment. Certainly, HCC was for a long time an area of significant unmet need for patients really across all lines. There's been rapid sort of evolution of the field with doublets in the first line and many therapies in the second line. As I mentioned earlier, With regards to Cabo Medics and our current second-line indication, we're very pleased with the business there, and we're the leading TKI at this point in patients who have received an immunotherapy or checkpoint-containing regimen in the first line, so we're pleased with that and certainly looking to build upon that, and I think, you know, Beyond that, you know, while there has been a lot of great developments for patients in HCC, there's certainly much more that can be done for them. And we're certainly excited, you know, at a high level to continue to do that, particularly as we look forward to XL092 and, you know, other programs.
spk16: Okay, great. Thank you. And maybe if I could sneak in one more. You have a very strong cash position and an increasingly broad clinical and preclinical portfolio. How are you prioritizing the various development options you have in front of you?
spk09: Yeah, Jay, it's Mike. I would say we are... very, very focused on generating data, using that data to help us understand where we can differentiate and how that can then, again, raise the bar for patients from the standpoint of standard of care. So we have a very strong conduit between development and commercial and discovery that helps us take data and move compounds forward aggressively based upon that data. Once we have conviction, as we generate conviction, where we can take that in terms of novel combinations across multiple different indications. But you're right, we're in a very good position, especially in today's somewhat tenuous market, on a macro level, to be able to have the cash flows that we've got and certainly the balance sheet that we've got to be able to make those investments both internally as well as considering external options. So we're all about building the team, building the portfolio, driving top-line growth, helping more patients.
spk16: Super helpful. Thank you for taking the question. You're welcome.
spk10: Thank you. Our next question will come from Akash Tiwari with Jefferies. Please go ahead.
spk12: Hey, guys. A few, if I may. I just want to hit on the gross net point again. It looks like you had a 5% jump sequentially in Q1 2021 as well, but we are seeing gross net kind of go from the 23% range to now over 30. Could we see long term gross net levels approach something at a kind of 35 to 40% run rate? That would be very helpful on the IP case. Are there any circumstances where you would agree to a settlement of around 2028 or 2029 with MSN? And then finally, Do you have any additional color on what the average duration on drug that you've seen with Cabo and first-line RCC in the real-world setting? Is it tracking roughly to what we've seen in your clinical trial? Thank you.
spk09: Yeah, Akash, it's Mike. I'll attempt to answer all three in rapid succession. On the growth to net issue, certainly don't want to speculate what's going to happen in the future. The numbers that we saw, Q1 versus Q4, that's the data, so take it for what it's worth. I think this is a trend if you've been tracking either biotech and or pharma data. Earnings calls over the last few weeks, you'll see this is not, actually this is a very general trend across oral oncolytics, so we're not overly surprised to see that others are being impacted as we were in Q1 versus Q4, so that's the data, but what happens in the future, I'm not gonna speculate or predict, that's just not proper here or anywhere. In terms of IP, like I said with Michael's question, don't want to get into the details there, so thanks for the question, but I really can't answer that. And then finally on duration, you know, it's been a year plus relative to the launch of 9ER, so it's still early in the context of duration of treatment commercially versus what we've seen in terms of PFS and duration of treatment in 9ER. So as time goes on, we'll be able to get a better picture of that by using a variety of different methods, and we'll be happy to report that when that's more mature. Thanks so much. You bet.
spk10: Thank you. Our next question will come from Do Kim with Piper Sandler. Please go ahead.
spk13: Good afternoon, everyone, and thanks for taking my question. This is E.K. on for DOE. Just a couple. First is pipeline-related for XL114. Given that there's going to be some competitor data with J&J's in the second half, I'm curious to understand how you guys' thoughts around molecule differentiation, given that, if I'm not mistaken, you have a covalent inhibitor versus their allosteric inhibitor. In addition to that, what type of plans do you have in terms of potentially combining your Malt-1 inhibitor with, you know, like a Venetoclax or B2K? I did not see that in the clinicaltrials.gov post, so that's my first question.
spk09: Okay, Peter, want to take a shot at that one?
spk04: Yeah, absolutely. Yeah, kind of obviously looking forward to seeing what the J&J data show. I just would point out that the J&J compound is a direct inhibitor of the MALT1 paracaspase activity, so binds directly to the proteins. XL114 actually has a different mechanism of action. It does not bind directly to MALT1. It does, however, inhibit activation of the MALT1 complex. So mechanistically, it's somewhat differentiated from the J&J approach. You know, speaking more broadly about the potential for the compound, certainly it has potential in a variety of B and T cell lymphomas, particularly, obviously, one area of interest is in patients who failed on BTK inhibitors since the Point of action for XL114 is downstream of BTK. There's also some data that MALT1 activation and inhibition of it may also have a role in combination with immune checkpoint inhibitors. That's something that we're exploring pretty clinically right now, so we'll see how those data play out. But maybe I'll just leave it there. 114 has a differentiated mechanism of action. So, you know, ultimately how the clinical data compare will obviously be of great interest.
spk13: Thanks, Peter. I appreciate the call. Just the last two questions, one quick one. If you can talk about any type of impact COVID may have had on CABO cells this past quarter, despite the obvious increased demand and strength that was seen. And lastly, with the COSMIC 313 data expected in July, if you can briefly just discuss how you guys are envisioning physicians utilizing it in practice and how it might have a higher standard given the potential safety profile that might be borne out. Just some color around that would also be helpful for us. Thank you for taking the questions.
spk06: Great. PJ, go ahead. Yeah, thanks for the question, EK. With regards to, you know, the COVID impact, I would say, you know, broadly, we're largely beyond a significant impact to the business, as you pointed out, with demand growth, not only for Cabo Medics, but also the TKI market itself grew 7% quarter over quarter. So, you know, I think largely that's in the rearview mirror, but I will say there's certainly still limited access in many accounts and that's varied across, you know, the country versus community or academia, et cetera. And, you know, we view that as we're excited about the opportunities these accounts are starting to open up so we can have, you know, just a greater chance to share our data with them and hopefully continue to drive Cabo Medics and Nivolumab for appropriate patients. And with regards to 313 and the triplet at a very high level, I think we're certainly excited to see the data. I know the KOLs broadly are certainly excited to see the readout there as well because it is the first triplet in the space. So I think that in and of itself is great. It is looking at comparing to nivolumab and IPI. in the poor and intermediate risk groups. And I just point out that NEVO IPI, you know, has a, you look across data sources, has a 20% to 25% market share in the first-line setting. So I think, you know, that could potentially be some low-hanging fruit given positive data and approval, et cetera, that that might be a good opportunity for the addition of CAVO in that setting. Also, I think one possibility there is they do have I think about a 20%, if I'm recalling correctly, primary progression rate in the 214 trials. So, you know, given the totality of the data with CABA, we think that's certainly, you know, an opportunity to improve upon that as well. So, you know, I think it's going to be important to really look at the totality of the data in this data readout, whether it's, you know, all the radiographic data, obviously the primary endpoint of PFS data, as well as, you know, what we see in survival at that point, as well as safety. So I think it'll be really exciting to see and sort of dive into the data. So we're looking forward to that.
spk10: Great. Thank you. Thanks. Thank you. Thank you. Our next question will come from Peter Lawson with Barclays. Please go ahead.
spk02: Thank you. Thanks for taking the questions. A question for Michael, PJ, just then. Well, the gross-to-net, if there's anything you can point to, what drove the gross-to-net, if there's one element or multiple drivers, and then any kind of guidance you can provide around the gross-to-net going forward.
spk09: Thanks, Peter. Yeah, so, again, we won't comment on gross-to-net going forward in terms of future years. Chris can provide some updates, again, at a high level on what you said previously about what drove the gross-to-net.
spk03: Thanks, Mike. So, Peter, I mean, what we talked about earlier was, you know, there's the seasonality effect of Medicare Part D, patients going through the donor hall, those on copay assistance, the commercial patients using our copay assistance programs and they go through their deductibles at the beginning of the calendar year is another driver and those have happened in prior years also. This year we saw a higher 340B utilization in Q1 when we compare it to the second half of last year where it was relatively flat. And then for this year, I think we're looking right now at a 29% gross to net percentage, and obviously that's an estimate right now, and that can change based on different utilization patterns of 340B or co-pay assistance or Medicare or Medicaid and so on. But that's our current estimate as we're thinking about it.
spk02: Thank you. And that's captured in the guidance, and then I guess kind of a follow-up question really about demand trend. What was that during the quarter, and what was that? in any way different from last year that we should be thinking of it.
spk09: Peter, you broke up there. Could you say that again slowly, please?
spk02: Yeah. So around the demand trends and month by month, was there anything different there from last quarter?
spk06: You know, Peter, it's PJ. I would just say, you know, we continue to see, as I mentioned, six quarters of growth and strength in the demand trend. So, you know, I think nothing out of the ordinary in terms of what we see generally speaking. It's just, you know, we're pleased it's being driven by, as I mentioned in my prepared remarks, you know, primarily longer duration of therapy on the first-line patients. benefiting from the combination of Cabo Medix and Ebola.
spk02: Okay. I know a number of companies mentioned January and February being weak. Did you see that kind of trend?
spk06: You know, as I mentioned, I think overall we're just seeing, you know, steady progression of the business and strength.
spk08: Yeah, maybe you can reiterate for Peter what the TRX growth was for the quarter.
spk06: Yeah, thanks. Happy to, Mike. The TRX growth Q over Q was 11%, which is, you know, as I mentioned, also for the market. That growth was 7%, so we also grew above the market. And like I said, you know, no significant differences between months. We've just seen steady growth, as I mentioned, with really being driven by the combination patients. Thanks, PJ. Great. Thank you so much.
spk10: Thank you. As a reminder, ladies and gentlemen, if you would like to ask a question, please press star 1 on your telephone. Our next question comes from Chris Shibutani with Goldman Sachs. Please go ahead.
spk15: Good afternoon. Thanks for the question. Just to making sure that I understand, with COSMIC 313, the 10Q has the timing from July. I think this is a slight revision versus the first half of 2022, if anything. color in terms of what caused the readout to shift the timeline there. The second would be on Stellar 002, the study involving XL092. I believe there were some treatment arms, including BEMPEG. Can you just maybe provide any additional insight into any recent updates given the NECTAR's BEMPEG program?
spk09: Vicky, go ahead.
spk11: Yes. So I'll cover 313 first. Just to be clear on that, we've reached the number of events that we need for our primary analysis of PFS. Data cleaning in advance of the top line results is ongoing. And based on our assessment of where that stands currently, we now expect to deliver it into July. So you're correct. That timeline has moved a little bit. But we have a pretty clear picture of when that data will be now coming in. With respect to 092, I want to make sure I understood your question correctly. Stellar 002 had three arms, a combination with nivolumab, a combination with NEVO and IPI, and then a combination of NEVO and BEMPEG, all with 092 in genitourinary tumors. And as I mentioned in my prepared remarks, we are removing the BEMPEG arm, you know, following the recent Phase III readouts for that molecule and the discontinuation of the program. We are looking at what I believe to be a promising replacement with another triplet, and, you know, stay tuned for further details on that.
spk15: Great. Thank you for that.
spk10: And I'm showing no further questions in the queue at this time. I would now like to turn the call back over to Ms. Susan Hubbard for any closing remarks.
spk01: Yeah, thank you, Cherie, and thank you all for joining us today. We certainly welcome your follow-up questions. questions and anything that you all would like to answer, so please feel free to give either myself or Veronica a call.
spk10: Ladies and gentlemen, this concludes today's conference call. Thank you for your participation. You may now disconnect.
Disclaimer