ImmunoGen, Inc.

Q2 2021 Earnings Conference Call

7/30/2021

spk01: Immunogen Second Quarter 2021 Financial and Operating Results Conference Call. Today's conference is being recorded. At this time, I'd like to turn the call over to Courtney Okonik, Senior Director of Corporate Communications and Investor Relations. Please go ahead.
spk06: Good morning, and thank you for joining today's call. Earlier today, we issued a press release that includes a summary of our recent progress and second quarter 2021 financial results. This press release and a recording of this call can be found under the Investors and Media section of our website at immunogen.com. With me today are Mark Kennedy, our President and CEO, Anna Birkenblit, our Chief Medical Officer, and Susan Altshuler, our CFO.
spk05: During today's call, we will review key accomplishments for the business over the last three months, our financial results, and upcoming anticipated events.
spk06: During the discussion, we will use forward-looking statements, and our actual results may differ materially from such statements. Descriptions of the risks and uncertainties associated with an investment in Immunogen are included in our SEC filings.
spk05: And with that, I'll turn the call over to Mark.
spk02: Thanks, Courtney. Good morning, everyone, and thank you for joining us today. Over the past three months, we continue to advance our pipeline of novel ADC candidates and execute on our strategic objectives as we prepare to transition to a fully integrated oncology company with the potential for two innovative products on the market next year. With top-line data from our pivotal Sirea study on track for release next quarter, we've accelerated preparations for the BLA submission and commercial launch of Mervituximab. Given these near-term catalysts, we see this as an opportune moment to briefly review with you the U.S. market opportunity and dynamics in ovarian cancer. Starting with growth, analyst reports and other industry data project that the ovarian cancer market in the U.S. will increase from approximately $1.6 billion today to over $3 billion in 2026, driven largely by the launch of novel targeted agents like Mervituximab and the continued uptake of PARP inhibitors. Looking at epidemiology, each year in the U.S., roughly 20,000 women are diagnosed with ovarian cancer and 14,000 will die from the disease. With just a 50% five-year survival rate, ovarian is one of the deadliest cancers impacting women today. Based on our clinical experience having tested more than 2,000 patient samples, our data suggests that approximately 40% of ovarian tumors express high levels of folate receptor alpha, which is the target patient population for Mervituximab. Despite advances in earlier line settings with PARP inhibitors as maintenance, the majority of ovarian cancer patients relapse and become resistant to platinum-based chemotherapy. Treatment options for these patients are limited with poor outcomes and diminished quality of life. Against this discouraging landscape, our goal is to establish Mervituximab as the standard of care for FR-alpha-high advanced ovarian cancer. With positive data from SREA, we anticipate Mervituximab's initial indication will cover second- to fourth-line patients with FR-alpha-high platinum-resistant ovarian cancer who've been previously treated with Avastin. We believe this represents more than 2,000 patients in the U.S., With confirmatory data from Mirasol, our label would expand to over 4,000, as Avast and Naive patients would also be eligible. Beyond the platinum-resistant setting, we're initiating Piccolo, a single-arm study of Mervituximab monotherapy in FR-alpha-high later-line recurrent platinum-sensitive ovarian cancer, aligned with our strategy to generate data that support Mervituximab displacing single-agent chemotherapy. Anna will share more details on that trial in a minute. We also continue to generate highly encouraging data supporting the potential of Mervituximab to become the combination agent of choice for ovarian cancer. We were pleased to share final data from our Mervituximab plus Avastin doublet in an oral presentation last month at ASCO. These data demonstrated compelling anti-tumor activity in patients with FR-alpha high recurrent ovarian cancer regardless of platinum status. We believe the publication of these data, together with the Mervetuximab plus Avastin cohort published in 2019, could support compendia listing in close proximity to the initial monotherapy approval for Mervetuximab ahead of formal label expansion for this combination. Given this potential, as I mentioned at the top of the call, we've accelerated our work in preparation for the BLA submission and commercial launch of Mervetuximab. To this end, we continue to engage with the ovarian cancer medical community to educate on the robust data sets already generated with Mervituximab and to increase awareness of folate receptor alpha as a promising biomarker for patient selection for targeted therapy. In parallel, we are gearing up to submit the BLA in the first quarter of 2022 to support potential accelerated approval in the second half of the year. And with commercial inventory in place, we are finalizing plans for distribution. So we've got a lot going on and look forward to keeping you updated on our progress as we approach the potential launch of Mervituximab next year. The remainder of our innovative portfolio of ADCs is also progressing. IMGN 632, our CD123 targeting ADC, also has the potential to launch in 2022 in BPDCN and is also being studied in combinations in AML with data from our AML cohort expected at ASH next quarter. IMGC 936, And Atom9 targeting ADC that we're co-developing with Macrogenics is advancing through dose escalation. And IMGN151, our next generation antifoliate receptor alpha ADC, is on track for an IND submission by year end. So with that, I'll turn the call over to Anna to provide some additional insight into our clinical programs and more on our medical education initiatives. Anna?
spk06: Thanks, Mark. Just a few more details on the final data from our FORWARD2 study evaluating Mervituximab in combination with Avastin in patients with medium and high FR-alpha expressing recurrent ovarian cancer for whom a non-flatinum-based combination regimen is appropriate. These data were presented during an oral session at ASTHO in June. The combination demonstrated robust anti-tumor activity in patients with high FR-alpha expression, including a confirmed overall response rate of 64%, a median duration of response of 11.8 months, and a median progression-free survival of 10.6 months, with manageable adverse events that were consistent with the side effect profiles of each agent. We are highly encouraged by these findings as we believe they reinforce Mervituximab's potential to serve as a combination agent of choice in ovarian cancer and support its use in earlier lines of therapy. Additionally, a randomized Phase II investigator-sponsored study with Dr. Philip Harder in Germany is now underway, evaluating Mervituximab plus carboplatin compared to standard of care in approximately 140 recurrent platinum-sensitive ovarian cancer patients. These data, along with the outcomes from the ongoing 70-patient neoadjuvant IST led by Dr. Rebecca Arendt at UAB, will further inform our path forward as we consider our label expansion options for Mervituximab in combination with carboplatin. Turning to Mervituximab monotherapy beyond Sirea and Mirasol, this quarter we plan to initiate patient enrollment in PICOLO, our new single-arm study of Mervituximab monotherapy in third-line plus FR-alpha-high recurrent platinum-sensitive ovarian cancer patients. with a primary endpoint of confirmed overall response rate and a secondary endpoint of duration of response. With the incorporation of PARP inhibitors as maintenance in frontline and in platinum-sensitive first relapse, more ovarian cancer patients are recurring with later-line disease that is still technically platinum-sensitive with a platinum-free interval of greater than six months. But these patients may not be suitable for another platinum-based therapy. This is because of the cumulative risk of hypersensitivity reactions with repeated exposure to platinum, as well as other potential toxicities related to platinum. In addition, patients who recur after their tumors have been under selective pressure from a maintenance PARP inhibitor may not be as sensitive to additional platinum as those who recur in the absence of maintenance therapy. The PICOLO trial is designed to address this increasing unmet need for an effective non-platinum option in later lines of platinum-sensitive disease. As Mervituximab lives closer to potential approval, we continue to educate the medical community on the importance of establishing folate receptor alpha as an important biomarker in ovarian cancer. These medical education efforts include advisory boards with pathologists and oncologists, biomarker workshops and symposia at Congresses, and presentations at upcoming Congresses. We're working with Roche Tissue Diagnostics and Roche Diagnostics Corporation to develop and commercialize the companion diagnostic for folate receptor alpha. With the groundwork we are laying, we expect physicians to assess folate receptor alpha expression as part of their standard diagnosis and treatment decision process following approval of Mervituximab and the companion diagnostic. Moving to our second pivotal program, we continue to enroll frontline and relapsed refractory BPD-CM patients in our Phase 2 study of IMGM 632 and expect top-line data in the first half of next year. Recall that 632 is also advancing in a Phase 1B2 dose escalation study in combination with azacitidine and denetoclax in patients with relapsed refractory AML and as a monotherapy in patients with MRD-positive AML. We look forward to presenting initial AML combination data for IMGN 632 with venetoclax and azacitabine and ASH in December. As Mark mentioned, we are also excited about the advancement of IMGC 936 and IMGN 151 and look forward to updating you on our progress with both of these ADCs. With that, I'll turn the call over to Susan to cover the financials.
spk05: Susan? Thanks, Anna. Starting with our results for the second quarter of 2021, We generated $16.9 million in revenue, which consisted primarily of non-cash royalty revenues. Operating expenses were $44.3 million, comprised of $34.6 million of R&D expenses, compared with $22.9 million in 2020, $9.7 million of G&A expenses, compared to $9.8 million in 2020. We ended the second quarter with $239.5 million in cash and cash equivalents on the balance sheet. Our financial guidance for 2021 remains unchanged. We expect revenues to be between 65 and $75 million, operating expenses between 200 and $210 million, and cash and cash equivalents at year end to be between 140 and $150 million. Our current cash runway continues to be sufficient to fund operations into the second half of 2022. With that, we'll open the call for questions. Operator?
spk01: Thank you. As a reminder, to ask a question, you'll need to press the star, then the one key on your touchtone telephone. To withdraw your question, press the pound key. And our first question comes from John Newman with Canaccord. Your line is open.
spk12: Hi, guys. Thanks for taking my question. Just wondering if you could talk a bit more about the rationale behind the Piccolo study. Also curious if you could talk about how that will mesh with your strategy for expanding verbituximab in other lines of therapy going forward after approval. Thank you.
spk02: Yeah, so maybe I'll ask Anna to talk about the medical rationale and what we're seeing in terms of an increasing population of these patients and why that might be the case. And then I can talk a little bit more about the broader strategy.
spk06: Yeah, so we know that platinum historically has been the most active agent in ovarian cancer, and therefore when patients recur after platinum-based therapy, if their platinum-free interval is greater than six months, they typically get another line of platinum. Unfortunately for patients with each line of platinum, there's a law of diminishing returns, if you will, and their disease-free or progression-free survival gets shorter and shorter. And at some point, they develop platinum-resistant disease. However, as more and more patients are being treated with PARP inhibitors in maintenance after achieving a CR or PR from platinum-based therapy, this is extending their platinum-free interval. And so patients may now have, still have technically platinum-sensitive recurrent disease, but their platinum-free interval, if you will, has been artificially extended by PARP inhibitor maintenance and the selective pressure that that has been putting on the tumor. So this emerging population of patients may not be the same as patients in the olden days, if you will, who had a platinum-free interval of six to 12 months, but their tumors saw nothing in the interim. And so we anticipate that there will be more data out there as more patients are becoming part of this category that will guide a further understanding of what the benchmark in this population is. But what I can tell you right now is based on anecdotal data from earlier in the Mervituximab program where patients with recurrent platinum-sensitive disease did receive Mervituximab monotherapy, Mervituximab is quite active. And so that's why we're beginning the PICOLO study this quarter, and that will help us further understand the efficacy profile for Mervituximab in this later line recurrent platinum-sensitive population that is growing with an increasing unmet need.
spk02: So, John, maybe just to frame this in the context of the broader development plan and expected labels for the product. So our initial label comes in platinum-resistant disease, and there we're looking to displace single agent chemotherapy. Single agent chemo is about half the market in platinum resistant disease today, so the goal is to supplant that. The remainder of the platinum resistance base is treated with generally a range of combinations, specifically Avastin-based chemo combinations. The data that we published at ASCO in June really speaks to the opportunity there and we think we've got compelling data to support a compendia listing for that indication. When you look at the platinum sensitive space, as Anna was talking about, patients as their first line therapy are treated with carbo-pack or carbo-gem combinations, often as a triplet with Avastin followed by heart maintenance, although the share of patients getting maintenance is maybe smaller than one might imagine. When you get to third-line platinum, however, or third-line therapy, what you see is only about 30% of patients are receiving platinum-based chemo, and so there's a big gap, you know, the remainder of that population that we could target either with the MERV-BEV combo, and again, some of the data that we had at ASCO, we had a 69% response rate with the MERV-BEV combo in platinum-sensitive patients, but this is really a gap where we think a monotherapy could fit in The data in terms of patient numbers is a little sketchy in terms of third line platinum sensitive. Our best estimate based on DRG and some physician surveys is there are about 2,000 patients in third line. And as I said, about 30% of those patients get a platinum-based chemo regimen. So that leaves just the remainder of that population to go after.
spk12: Excellent. Thank you.
spk01: Thank you. Our next question comes from Michael Schmidt with Guggenheim Securities. Your line is open.
spk11: Hey, good morning, guys. This is for Michael. Thanks for taking our questions. I think we have a quick one on . Do you think a retreatment with is possible with some of other backbones of a combo therapies? And if so, with various combo regimens currently being evaluated, how could each MRF combo regimen be sequenced?
spk06: Yeah, so there certainly is precedent for re-treatment even with non-targeted cytotoxics in ovarian cancer. So obviously we just talked about re-treatment with platinum in a lot of detail. Retreatment with tubulin-directed inhibitors like Paclitaxel actually also is beneficial in ovarian cancer. There's very nice data showing that patients who received prior Q3-week Paclitaxel may benefit from subsequent weekly Paclitaxel. And as you know, the payload for Mervituximab is a tubulin-directed inhibitor. So there certainly is the potential for repeated treatment with Mervituximab, you know, based on the mechanism of action of the payload. Switching to the target, we did show in our biopsy cohort several years ago now that patients who receive Mervituximab and then have a subsequent biopsy after a couple of cycles of merpetuximab, still express folate receptor alpha, so it's not quickly downregulated that would suggest resistance.
spk11: Got it. That's very helpful. Thank you.
spk01: Thank you. Our next question comes from Boris Peeker with Cowan. Your line is open.
spk04: Good morning. Good morning. Maybe one question on Mervetuximab and another on 632. On Mervetuximab, can you just comment on the Piccolo study timeframe and when we'll be getting any kind of updates from it, how it overlaps with some of the other clinical studies ongoing?
spk06: Yeah, so Piccolo is on track to start this quarter. And I think it's a little too early to say, Boris. Certainly, you know, once the trial is up and running, you know, at future calls, we can certainly provide some guidance regarding timings. Right now, our key focus is the Sirea, BLA, and Mirasol, and we're getting Piccolo up and running, and we look forward to the data from that study because we think it's a really increasing population with unmet need.
spk04: Got it. On 632, can you maybe set some data expectation at ASH? And also just want to understand from the regulatory perspective, as monotherapy and MRD-positive disease, What's the FDA's view on MRD-positive to MRD-negative conversion as the regulatory endpoint?
spk06: Yeah, so at ASH, we anticipate presenting all the data that we have for the triplet of 632 with azacitidine and venetoclax. You may recall we started off with doublet, combining with azacitidine and with venetoclax, and then we moved into the triplet dose escalation. So we will have, I would say, a robust data set at ASH, dose escalating, exploring 632 with azacitidine and zanetoclax that will give a good sense of the safety profile of the triplet, the tolerability of the triplet, as well as the anti-leukemia activity that we're seeing at this point that supports further development in the relapsed refractory setting and ultimately perhaps in the frontline setting. Moving to your question regarding MRD positive to negative conversion, clearly that is not yet a precedent for approval in the AML setting. There is a precedent in the ALL setting, but that was a bit different because there was prior phase three data with overall survival benefit for the drug where it then allowed for subsequent consideration of approval. in terms of MRD conversion. I think it's a little premature to assume that it would be an appropriate endpoint for FDA. I would also note that Onureg did get their approval, that's the oral azacitidine, in a broader population in maintenance, so not just MRD-positive patients. when you look at the subset data for Onureg, the MRD-positive subset in their study doesn't do so well. And so there is certainly, I would say, a remaining unmet need there. Hope that clarifies for us.
spk04: Great. Thank you very much for that kind of question.
spk01: Thank you. Our next question comes from Swayam Pakula, Ramakhan, with HC Wainwright. Your line is open.
spk08: Thank you. This is RK from HC Wainwright. A couple of quick questions. On the press release you have a note saying that IMGC 936 is being looked at in multiple solid tumors. Is it possible for you to enumerate at least some of the major tumors that you're looking at?
spk06: Sure. So IMGC936 targets ADAM9, which is a member of the matrix metalloproteinase and disintegrant family, and it is expressed highly across multiple solid tumors. including pancreatic cancer, gastroesophageal cancer, triple negative breast cancer, and lung cancer. It's also expressed in other tumor types as well. And so we've already generated very nice preclinical data showing the distribution of expression across those solid tumors, supporting their inclusion in the phase one dose escalation study. We are enrolling all Pummers given the anticipated ADAM9 expression in these tumor types. We're collecting tumor tissue on all patients. so that retrospectively we can look at ADAM9 by immunohistochemistry, and then we'll be well-positioned to develop a companion diagnostic for patient selection should we need it.
spk08: Just to follow up on that, any timing at all in terms of data, and then also regarding 151, what work needs to be done before we can launch it into the clinic? Okay.
spk06: Yeah, so timing for IMGC936, we're in dose escalation and we anticipate data early next year, you know, at which point we'll have recommended phase two dosing, you know, safety and a sense of the tumor types that are of greatest interest. Moving to 151, we're on track to file the IND before the end of the year. We're doing, you know, the last bits and bobs of what we need to from a TOCS perspective and a CMC perspective.
spk08: Thank you very much, Ana. Thanks for taking all my questions. Sure.
spk01: Thank you. Our next question comes from Andy Tsai with William Blair. Your line is open.
spk03: Great. Thanks for taking my questions, and congratulations on all the progress. So regarding the PICOLA study that you're planning to start this quarter, I am just wondering how much enrollment optimization can you achieve with a study, just given your existing network of clinical trial sites for Soraya and Marisol?
spk06: I think the short answer is a lot. given that, you know, we've studied Mervituximab now in well over 100 sites, closer to around 200 sites throughout the globe. So, you know, we're, again, like we did with Soray and Mirasol, we're picking the best of the best sites who have high patient volumes, participate in clinical trials with high data quality following GCP, and, you know, have the patient population that's appropriate here.
spk02: And experience with our drugs. Yes.
spk03: Right. That's helpful. Thank you. And also, maybe taking a macro view on the folder receptor ADC space, maybe, Mark or Anna, perhaps you can opine on the Bristol-Myers and eSci collaboration that was announced earlier this month. And also, kind of looking at the pipeline, you know, you have four assets right now. In the event of a successful SIRREA trial, how should we think about future R&D investment going forward?
spk02: Sure. So maybe I'll let Anna tackle the competitive landscape, and then we can talk about where we're going as a business.
spk06: Yeah. So we consider the BMS-ASI deal really, you know, validating in terms of them recognizing, as we do, that folate receptor alpha is an important target in the treatment of cancer. What I would say is that the publicly available data for their compound, MORAB202, are at this point limited to a single site in Japan. As you may recall, they have linked up their failed scarlatuzumab naked FR-alpha antibody with aribulin, which is their cytotoxic that is approved for later-line breast cancer. And so, based on the data from dose escalation in that one site in Japan, they have certainly seen activity in tumor types that are known to express folate receptor alpha. And so, certainly, I think that formed the foundation for their agreement. They are currently in a U.S. study open at a handful of sites on their dose escalating. They don't yet have a recommended phase two dose and schedule, but, you know, we'll We'll follow them, and I think from our perspective, not only is it validating for FR-alpha, but it makes us that much more excited to get IMGN151 in the clinic as soon as possible because we really know from our preclinical data that it's designed to address a broader population of FR-alpha positive tumors and really has the chance to really move the field even further than Mervituximab will.
spk02: So, Andy, in terms of the future direction for the business, so you may recall when we restructured back in 2019, we chose four programs to move forward. And given the progress over the last two years, I'd say we chose well. But at that time, we had programs that we shelved. And in particular, we have a new class of Camp De Thiessen payloads that have been internally developed. As we look ahead and with some success in SREA, the objective will be to move those programs off the shelf and in particular pursue additional development of this Camp to Thiefs and payload. We have a fair amount of inbound interest with respect to the immunogen platform broadly in terms of linkers and payloads and specific interest in this new class. In addition to that, akin to the relationship that we have with Macrogenics, we continue to have folks approach us about co-development collaborations where they've identified an antibody that they think would be a good candidate for an ADC. And so those discussions are ongoing as well. And so we do expect, following a positive outcome in Sirea, to begin to expand the portfolio levering our existing technology and our ability to combine with antibodies to generate novel ADCs. So that's absolutely the direction that we're headed.
spk03: That's very helpful. Thanks for answering my questions, Mark and Anna. Sure.
spk01: Thank you. Our next question comes from Kenan McKay with RBC Capital Markets. Your line is open.
spk09: Hi, this is Sudan Loganathan on from Kenan's team. Thanks for taking the question. So first, I wanted to ask kind of what the benchmark is kind of discussed, you know, amongst the physician population for the single-arm piccolo study for mevirtuximab as a monotherapy. So, you know, kind of what, you know, would, you know, what would, kind of give the confidence to the physicians to use that as a mod therapy class. And then kind of where the conviction comes from you guys on the FR-alpha, you know, target for ovarian cancer and then, you know, how that could grow, you know, into a mod therapy for other indications. And then secondly, just kind of a large picture question just on any headwinds that you see from the COVID-19 pandemic kind of macro environment to enrollment for some of the other pipeline studies that's already been kind of determined, or could there be some headwinds there going forward? So, thanks.
spk06: Yeah, so the benchmark question regarding PICOLO is an important one. So, you know, we're targeting later line platinum sensitive disease, and these are patients who didn't really exist in the past, or if they did at very small numbers, and actually, frankly, they were mostly BRCA mutant patients because those patients whose tumors have BRCA mutations are exquisitely sensitive to platinum, and they're the ones who can get multiple lines of platinum and continue to get benefit, again, each with a diminishing return. So now that part maintenance is being incorporated, not just for BRCA mutations, but also for HRD and even in an untargeted fashion where admittedly the benefit is less, there are more patients with this later line platinum sensitive disease. And there are, to our knowledge, no, I would say, level one evidence papers to support a firm benchmark. I'm very personally interested in the data that will be coming out over the next year or so that will shed light on what the appropriate benchmark is. You know, guardrails-wise, the data that are out there, admittedly from older populations that are less relevant now, include response rates in second, third-line platinum-sensitive disease for non-platinum single agents of 10 to 12%. And in the later line, you know, three to four priors who are platinum sensitive and have a BRCA mutation, the response rate is about 30%. If you look at platinum doublets in patients who've just had one prior line, the response rate is about 40, 45%. So imagine it dropping, you know, with each line of therapy. And this is why we really believe there's a high unmet need for these patients. And again, based on the anecdotal data that we have, we're quite excited about the potential for Mervituximab in this population. That was your first question. Your second question was other indications. So for Mervituximab, we are supporting a couple of investigator-sponsored trials in endometrial cancer. One is a monotherapy in high-grade serous endometrial cancer and one in combination with pembrolizumab. You know, we have some data from overtuximab monotherapy in endometrial cancer already that suggests that could be an interesting additional target. I think we're saving lung cancer and triple negative breast cancer for IMGN151. And then your last question was regarding COVID-19 headwinds. Yes, there are COVID-19 headwinds. I mean, with the Delta variant emerging now and the recent CDC guidance around masking, it will be interesting to see, frankly, how hospitals and clinical sites may be changing their working policies. I don't think it's going to necessarily impact patient care because patients with recurrent ovarian cancer need treatment. But I wouldn't be surprised if, you know, there are, like we've already experienced some delays in contract turnover, IRB meetings, you know, the paperwork aspect of clinical trials if people are working from home. But what I'd also say is during COVID over this past year, we've gotten really good at managing through those with our contingencies.
spk09: Great. Thank you so much for all the color on those questions. Appreciate it.
spk01: Thank you. Our next question comes from Kelly Shee with Jeffries. Your line is open.
spk07: Before taking my questions, I also have a question for Piccolo trial. At this stage, what drives the decision to only include alpha high patients? Given that you mentioned there are large online needs in the third line of platinum-sensitive patients, and also based on the previous experience, MERV is active in the FR-alpha intermediate patients. Thank you.
spk06: Yeah, we know now, having studied Mervituximab in well over 800 patients, the higher the FR-alpha expression, the deeper and more durable the tumor shrinkage So you are absolutely right that Mervituximab is active in patients with medium F or alpha expression, which is about 20% of the population. We know from the Forward One study that it's probably about the same in terms of its activity with single agent chemotherapy. But, you know, we're really trying to move the field forward and have the potential to be the agent of choice. And we want to go where we can benefit patients the most. And that's really the 40% with high FR alpha expression. And that's, you know, based on archival tumor tissue. It's irrespective of platinum sensitivity or resistance.
spk07: Thank you for the caller.
spk01: Thank you. Our next question comes from Joe Cantanzaro with Piper Sandler. Your line is open.
spk10: Hey, guys. Thanks so much for taking my questions here. Anna, you mentioned the Phase I experience with Mervituximab in platinum-sensitive patients. Just wondering the extent of prior PARP exposure in that population and whether there's any reason to think that extended PARP maintenance could potentially impact subsequent sensitivity to Mervituximab And then just with regards to cash guidance and it being sufficient into the second half of 2022, what is that inclusive of? And again, specifically around the potential commercial launches of both Mervituximab and 632. Thanks.
spk06: Yeah, so, you know, the anecdotal data that we have, Joe, is, I would say, limited but quite encouraging. And there are certainly patients in our experience who've had a prior PARP inhibitor and have recurrent platinum-sensitive disease and do very nicely with myrbotuximab. You know, throughout our program, when we've looked at patients who've had a prior PARP inhibitor, you know, whatever trial we look at, we see very nice activity for Mervituximab. And that's not surprising because, you know, there's no reason to believe there's a cross-resistance mechanism. You know, PARP inhibitors interfere with the ability to repair DNA damage. We're a tubulin-directed agent. And so, again, prior PARP use really doesn't seem to impact the efficacy of Merv.
spk05: Great. And on the guidance that goes into the second half of 2022, that includes spend for pre-launch prep and BLA filing commercialization work for both Mervituximab and 632. We feel that we're in a strong place. We've been adding additional capital from our ATM facility. That said, I focus on the year-end cash now. We're looking for ways supplement that between now and then. But with a positive readout, we don't think capital formation will be an issue.
spk02: Yeah, maybe just to put a little finer point on some of what Susan was saying in terms of what we're doing from an operational perspective. So those numbers include Salesforce build. It includes production of additional launch inventory for the business. build out of the medical affairs function. So baked into that number is, you know, a fully formed organization ready to launch the drug in the second half of the year.
spk10: Okay, thanks. That's helpful.
spk02: Yep.
spk01: Thank you. Our next question comes from Jessica Phi with J.P. Morgan. Your line is open.
spk00: Hi, good morning. This is Daniel for Jessica Phi. Thanks for taking our question. Maybe a question for Anna. Targeting CD123 in AML hasn't been as effective as the anti-tumor benefits we've observed in BPD-CN. Could you maybe frame for us what could be driving a differentiated outcome in those two settings and how 622 can be differentiated here in AML?
spk06: Yeah, so I think what you're referring to is the activity of alzheimer's or tigraxifus or SL401, which is approved for BPD-CN. It's a CD123 fusion protein with a diphtheria toxin. And BPD-CN has the highest levels of CD123 expression, so if it's going to work anywhere, it's going to work there. And I think their, you know, monotherapy experience in AML was quite disappointing. They really didn't have appreciable monotherapy activity in AML. That contrasts with our experience with IMGN 632. You may recall at ASH we've had a couple oral presentations now showing actually quite reasonable monotherapy activity for IMGN 632 in relapsed refractory AML with very nice CRIs. It didn't quite meet our bar for a single arm, you know, fast to approval strategy in the relapsed refractory setting, but certainly highly active. Our drug is highly active as a monotherapy in AML, and I think it's just because we have a better drug, frankly.
spk00: Got it. Thank you.
spk01: Thank you. Our next question comes from John Newman with Canaccord. Your line is open.
spk12: Hi, guys. It's a little noisy. Thanks for taking the follow-up. It's a question for Mark and Anna. This is probably a difficult question to answer, but, you know, there's been a lot of conversation on prior calls about the accelerated approval pathway to the Mervituximab, but given the current timing for the program, BLA submission in early 2022, and then top-line data for Mirasol, I believe in the third quarter of 2022, isn't it reasonable to assume that the FDA will be able to get a look at the top-line data from Mirasol, which could give them more confidence in the accelerated approval based on Sirea? Thanks.
spk02: Yeah, so I think you have to deconstruct this and ask the question, you know, what is the regulatory environment here and then ask the questions about practical considerations that overlay that. But from a regulatory perspective, we file under sub-party looking for accelerated approval. The standard there is to demonstrate a substantial improvement over available therapy. The FDA gave us the benchmark in terms of overall response rate, which is the primary endpoint for our study, and then secondarily looking at duration of response. And so if we meet those criteria under Subpart E with the data that we generate from SREA, there's no basis for the FDA to delay regulatory action on the filing. So I think that's the first point. Yes. Mirasol data are available at the time of the regulatory decision, and those data are positive. We think they'll be positive. Yes, that would certainly bolster their ability to make a decision on Mervituximab. But again, I think the base criterion here is what are the applicable regulatory standards for accelerated approval, and we think we're going to meet those with SAREA, and that will be the basis for regulatory action.
spk12: Okay, great.
spk02: Thank you.
spk01: Thank you, and I'm showing no other questions in the queue. I'd like to turn the call back to Mark Ennedy for any closing remarks.
spk02: Great. Well, thanks very much for your time today, and we look forward to keeping you updated on our progress into the fourth quarter with a SREA readout and also data on 632 at ASH. Thanks very much, and have a nice weekend.
spk01: This concludes today's conference call. Thank you for participating. You may now disconnect.
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