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spk21: Welcome to the Iovance biotherapeutics conference call to discuss the full year 2023 results and recent corporate updates. My name is Kevin and I'll be your operator for today's call. At this time, all participants are on a listen-only mode. Later, we will conduct a question and answer session. Please note that this conference is being recorded. I will now turn the call over to Sarah Pellegrino, Senior Vice President, Investor Relations and Corporate Communications, Iovance. Sarah, you may begin.
spk30: Thank you, Operator. Good afternoon, and thank you for joining our conference call and webcast to discuss full year 2023 results and recent corporate updates. Dr. Fred Vogt, our Interim President and Chief Executive Officer, will provide a brief introduction. Jim Ziegler, EVP Commercial, will highlight our initial insights for the U.S. commercial launch of Amtagvi following the recent U.S. Food and Drug Administration, or FDA, approval in advanced melanoma, Igor Balinski, Chief Operating Officer, will highlight commercial manufacturing and capacity expansion plans. Frederick Graf Finkenstein, our Chief Medical Officer, will summarize key clinical pipeline highlights. And John Mark Belleming, Chief Financial Officer, will review our financial results. Dr. Brian Gassman, EVP Medical Affairs, and Raj Puri, EVP Regulatory Strategy and Translational Medicine, are also on the call and available for the Q&A session. Before we start, I would like to remind everyone that statements made during this call will include forward-looking statements regarding Iovance's goals, business focus, business plans and transactions, revenue, commercial activities, clinical trials and results, regulatory approvals and interactions, plans and strategies, research and preclinical activities, potential future applications of our technologies, manufacturing capabilities, regulatory feedback and guidance, payer interactions, licenses and collaborations, cash position and expense guidance, and future updates. Forward-looking statements are subject to numerous risks and uncertainties, many of which are beyond our control, including the risks and uncertainties described from time to time in our SEC filing. Our results may differ materially from those projected during today's call. We undertake no obligation to publicly update any forward-looking statements. With that, I will turn the call over to Fred.
spk18: Thank you, Sarah, and good afternoon, everyone. I'm pleased to host our 2023 full-year results conference call. Throughout last year, we executed toward our first approval of commercial lawns while advancing our pipeline. On today's call, we have a variety of exciting topics to cover on the heels of the US FDA's recent approval of Abtagme, the first one-time T-cell therapy for a cell tumor. Antagni's label allows it to become the first treatment option for advanced melanoma patients after anti-PD-1 and targeted therapy. The strength of this label also reflects a best-case scenario with strong efficacy data from pivotal cohort four as well as pooled cohorts two and four. In the first few days of U.S. launch, we were seeing strong demand and momentum for Antagni. Consequently, we also expect increased demand for Prolucan. Thirty authorized treatment centers, or ATCs, were ready for approval, and nearly all have identified a patient. Jim will provide more detail later in the call. The first tumor resection occurred on the first business day after approval, and commercial manufacturing began the following day at our IVAN Cell Therapy Center, or ICPC. This is a testament to the high unmet medical need and the great excitement around this new therapy, as well as our commercial manufacturing readiness. Igor will talk today about our capacity to serve our near-term commercial launch clinical trials and ongoing expansion plans. In addition to the U.S. launch, our near-term expansion plans for AMTAGV are focused on addressing many thousands of additional patients by entering new geographies and broadening the label to include frontline advanced melanoma as well as other indications. For example, our planning global expansion has the potential to double the total number of addressable patients for AMTAGV and post-anti-PD-1 melanoma. We remain on track to submit regulatory dossiers this year in the European Union in the first half of the year, followed by the United Kingdom and Canada in the second half. In addition, our Phase III TILVAS-301 trial continues with strong momentum in several countries to support regulatory submissions and frontline advanced melanoma. We are also pleased with the progress with our robust development pipeline across solid tumor cancers. Frederick will speak later about some key highlights in our ongoing clinical trial programs. Today, Iovane is a fully integrated company and is now the first company to commercialize the T cell therapy for solid tumor indications. We are well positioned to execute on our regulatory pipeline manufacturing commercial launch activities to remain the global leader in TIL cell therapy. Jim will now describe the ongoing activities related to our U.S. launch.
spk11: Thank you, Fred. Each year, approximately 8,000 people in the U.S. die from melanoma. Until now, there have been no FDA-approved treatment options for patients with advanced melanoma whose disease progressed following an immune checkpoint inhibitor and, if appropriate, a targeted therapy. For these patients, MTAGV ushers in a new era for the melanoma treatment landscape as a one-time cell therapy that is manufactured specifically for each patient to address a significant unmet need. Today, I will highlight our launch activities, ATC onboarding, as well as access and reimbursement. There is strong level of ATC commitment with 30 onboard today. These onboarded ATCs are engaged in various stages of the process, including patient identification, reimbursement authorization, scheduling and tumor tissue procurement, and manufacturing. In the less than two weeks following approval, the majority of our activated ATCs have at least one identified patient and are in the process of establishing financial clearance for reimbursement, including prior authorizations, and single case agreements. There are at least 20 patients in the process, which includes 10 patients with scheduled or pending manufacturing slots. The number of ATCs engaged in this process reflects the high unmet need and a sense of urgency to offer mTAGV for their advanced melanoma patients. In addition, We continue to onboard and remain on track to have approximately 50 active ATCs in total by the end of May. We are also pleased with the initial market access and inpatient reimbursement trends for MTagV. These are consistent with approved CAR T products with the benefit of increased speed resulting from both our preparation and the ATCs experience. We continue to anticipate prior authorizations to include coverage consistent with label, medical coverage policies within about 90 to 180 days, and single case agreements for commercially insured patients. I want to acknowledge our strong cross-functional teams who have worked tirelessly to ensure our launch readiness and execution. We are confident in our ability to deliver a successful commercial launch. I will now turn the call over to Igor, who will highlight our manufacturing readiness and capabilities.
spk16: Thank you, Jim. MTAGV, as well as our investigational TIL cell therapies, are manufactured using our proprietary process to collect the patient's TIL cells from a portion of their tumor, multiply them into billions, and return them back to the patient to fight cancer. The US FDA has approved commercial manufacturing at our internal facility, the Eye Events Cell Therapy Center, or ICTC, as well as at a nearby contract manufacturer. These facilities are built to support up to several thousand patients annually. As Fred mentioned, the first tumor resection occurred on the first business day after approval, and commercial manufacturing of MTAGVI is officially underway. We are currently staffed to meet the anticipated needs of our U.S. launch, as well as our ongoing and planned clinical trials. In the BLA submission for MTAGVI, we have included the capacity demonstration study higher than our immediate needs. This means that we can increase near-term capacity through increased staffing without requiring additional capacity authorizations. In addition, we're building further capacity to align with our near-term and long-term manufacturing needs. As we prepare to expand and tag the into new markets and indications and advance our solid tumor pipeline, expansion within the ICDC facility is already starting. build out of additional clean rooms within the existing shell space at ICDC can significantly increase capacity to over 5,000 patients annually over the next few years. Longer term, our future expansion plans may bring our manufacturing capacity above 10,000 patients annually. In summary, our team is excited to provide MTAGV to patients in need. We're laser focused on the quality of the manufacturing process in the spirit of doing everything right first time at every step from incoming receipt of the tumor sample through the manufacturing and product release process to outbound shipment of the final antagonistic product to the ATCs and to patients. I'm available to answer additional questions during the Q&A, and I will now hand the call over to Friedrich.
spk27: Thank you, Igor. I'm pleased to speak today about the key highlights within our clinical pipeline in solid tumors, which, as you know, represent more than 90% of all diagnosed cancers in the U.S. I'll begin with TILVANS301, our registrational phase three trial in frontline advanced melanoma. TILVANS301 is well underway to support accelerated and full approvals of Antagly in combination with Pembrolizumab in frontline advanced melanoma. Global site activation and patient enrollment continue with strong momentum in the U.S., Europe, Australia, Canada, and additional countries. TILVANS-301 is also the confirmatory trial to support full approval of octagonal post-anti-PD-1 advanced melanoma. Shifting to our program in non-small cell lung cancer and our single arm registrational phase two trial, IOV LUN202, in post-anti-PD-1 non-small cell lung cancer. Enrollment in the registrational cohort is estimated to complete in 2025. Following the partial clinical hold for new patients, we are working collaboratively with the US FDA and believe we have provided all the necessary information to resume new patient enrollment in the near future. We are also preparing to start up a new Phase II trial in post-anti-PD-1 endometrial cancer, which is expected to include patient populations who are deficient and proficient in mismatch repair. Tilt-cell therapy, based on its mechanism of action, may benefit both of these patient populations. We look forward to providing more details in advancing this trial this year. IOVANCE is the leader in tilt cell therapy, including next-generation approaches that have the potential to optimize outcomes for patients. We continue to investigate our genetically modified PD-1 inactivated tilt therapy IOV4001 in the GM1-201 trial. This is the first in-human trial in previously treated advanced melanoma or non-small cell lung cancer patients. This was just a snapshot of the many activities and progress across our follow-tumor pipeline, and I'm happy to address questions about these programs and additional trials during the Q&A session. I will now hand the call to Jean-Marc. Jean-Marc?
spk02: Thank you, Frédéric. Today I will review our current cash position as well as our full-year results for the year ended on December 31, 2023. I will also highlight our 2024 outlook. As of February 22nd, 2024, our unedited cash position is approximately $485.2 million, which includes net proceeds of approximately $197.1 million net of underwriting and other offering expenses from a follow-on equity financing in February of 2024. The current cash position and anticipated revenue from both entirely and for looking are expected to be sufficient to found current and planned operation well into the second half of 2025. Shifting to our full year financial results, net loss for the fourth quarter under December 31st, 2023 was $116.4 million or 45 cents per share compared to a net loss of $105.3 million or $0.64 per share for the fourth quarter under December 31st, 2022. Net loss for the year under December 31st, 2023 was $444 million or $1.89 per share compared to a net loss of $395.9 million, or $2.49 per share, for the year ended December 31st, 2022. The net loss for the year ended December 31st, 2023 includes amortization of intangible assets acquired as part of the Proloquium transaction. Revenue from the fourth quarter and year ended December 31st, 2023 was $482,000 and $1 million, respectively, and comprised of product sales of Prolooking following the acquisition in May 2023. There was no revenue for the fourth quarter and year ended December 31st, 2022. Cost of sales for the fourth quarter and year end, December 31st, 2023, was $4.4 million and $10.8 million, respectively, and comprised of cost of inventory associated with sales and producing, as well as $3.9 million and $9.7 million, respectively, of non-cash amortization expenses for the required intangible assets for developed technology. There were no cost of revenue for the fourth quarter and year ended December 31st, 2022. Research and development expenses were $87.5 million for the fourth quarter ended December 31st, 2023, an increase of $6.9 million compared to $80.6 million for the same period ended December 31st, 2022. Research and development expenses were $344.1 million for the year ended December 31, 2023, an increase of $49.3 million compared to $294.8 million for the same period ended December 31, 2022. The increases in research and development expenses in the fourth quarter and the year ended December 31st, 2023, over the prior year periods, were primarily attributable to increases in headcount and related costs to support increased production capacity and commercial manufacturing readiness, and clinical trial costs driven primarily by the initiation of our Phase III TLDANS 301 clinical trial. Selling general and administrative expenses were $29.9 million for the fourth quarter under December 31, 2023, an increase of $3.4 million compared to $26.5 million for the same period under December 31, 2022. Selling general and administrative expenses were $106.9 million for the year under December 31, 2023, an increase of $2.8 million compared to $104.1 million for the same period ended December 31st, 2022. The increase in selling general and administrative expenses in the fourth quarter and the year ended December 31st, 2023 compared to the prior year periods was primarily attributable to increasing net count and related costs to support the growth in the overall business and related corporate infrastructure professional fees and travel costs, as well as costs associated with pro-looking integration activities. This increase was partially offset by an increase in stock-based compensation expenses, legal and other costs. For additional information, please see this afternoon's press release and our annual report on Form 10-K to be filed later today. Regarding our outlook for this year, We continue to guide toward full-year 2024 cash burn in the range of $320 to $340 million, excluding one-time expenses. And we will continue to leverage opportunities to optimize spending. The U.S. launch of MTAG-V, as well as the sales of Pollukin, used in conjunction with the MTAG-V treatment regimen, are expected to drive significant revenue in the second half of 2024 and into 2025 and beyond. Revenue recognition for MTAG-V occurs upon infusion, like other cell therapies, so we expect to begin recognizing and reporting significant revenue in the second quarter of this year. I will now turn the call over to the operator to begin the question and answer session.
spk21: Thank you. Ladies and gentlemen, if you have a question or a comment at this time, please press star 1-1 on your telephone. If your question has been answered and you wish to move yourself from the queue, please press star 1-1 again. We'll pause for a moment while we compile our Q&A roster.
spk09: Our first question comes from with Wells Fargo.
spk21: Your line is open.
spk29: Great. Thanks for taking our questions and congrats on this initial momentum. Just curious about the 10 patients. Sounds like you have 10 patients that are already at the stage of scheduling manufacturing slot. Wondering how long did these patients' reimbursement process took Does that give you any updated thinking, a way of thinking of the average time from patient identification to tumor resection? And also, we see the word, you know, some of these 10 patients are pending for manufacturing slots. Just wondering what does that mean and, you know, what's behind the word pending? Thank you.
spk18: Yeah, Jan. Hi, Jan. It's Fred. It obviously moved very quickly for the centers that were able to schedule these patients, the 10 patients that are in there that are either scheduled for a slot or soon to schedule for a slot, or all moving through the process much more quickly. Some centers move fast, some centers move slow. What we're seeing here, I think, is some pent-up demand and real excitement for the MPAC relaunch. I'll let Jim add. Jim, do you want to add any comments to that?
spk11: Thanks, Fred. I think, Anand, it's still too early to tell what we've guided before based upon our experience in cell therapy approvals. It takes a couple of days for prior authorization and a couple of weeks for single case agreement. As Fred pointed out, there has been some quick movement because of the sense of urgency at these ATCs. To further define what pending means, ATCs basically will schedule a slot once they know they have successful reimbursement. So pending is that They're registered, they're ready to go, but they're not quite ready to pull the trigger on that slot yet.
spk29: Great. If I can have a very quick follow-up. Namely, you mentioned, you know, manufacturing could be conducted at CTC or the CDMO. Just wondering how are you distributing the flow to these two facilities and if you would mind commenting on the margin for the CDMO. Thank you very much.
spk18: Yeah, Jan, we can't really say what their margin is. They know that. Obviously, that's their business. We think it's competitive with what we do, so we employ a make versus buy strategy at IVANS, and we constantly look at internal manufacturer versus external. That keeps everything in tight competition, and we think that's the best way to run a business. Does that answer your question?
spk29: Right. How would you distribute the flow to ITC2C versus CDMO?
spk18: Yeah, so we have internal algorithms for doing that, and I can't share the full details, but we distribute the flow somewhat evenly across the two sites. And as we expand and as we grow, I think we'll be able to manage that even more tightly as we learn a little bit more right now about how the sites perform and who's doing the best here. But we run them as an internally competitive system. And again, just to make sure it's really clear, there is no real issue at all with capacity between the two. We have tons of capacity right now for this launch.
spk29: Great. Thanks for all the, Carter, and congrats on the progress.
spk21: Thank you. One moment for our next question. Our next question comes from Tyler Van Buren with TD Cowan. Your line is open.
spk15: Great. Hey, guys. Thanks for taking the question. The patients in process for mTagV is a very encouraging update, given that we're just a week and a half in. But as we think about the 20 mTagV patients in process, does this constitute the majority of the initial bolus in the 30 ATCs with the majority of sites having at least one patient, as you noted? Or would you be more likely to characterize it as a fraction? And just as a quick second question, with the MAA to be submitted in the first half and other XUS submissions, will Iovance be launching LifeLoose whole broad, or do you expect to partner?
spk18: Yeah, Tyler, that's a tiny fraction, we think, of the patients out there. It's not the initial bolus. The bolus is going to go on for quite some time, and our sales team is out there, and they've got a lot of information, and it looks like this is going to be sustainable for quite some time. On the MAA front, we intend to do that ourselves. We're not looking for a partner right now to do that. We think that could potentially dilute the value of our assets.
spk09: Thank you. One moment for our next question. Our next question comes from Peter Lawson with Barclays.
spk21: Your line is open.
spk13: Great. Thank you. Thanks for taking the questions, and congrats on the progress. Just wondering if you kind of talk through how you're thinking about how revenue gets booked and the impact of the patients on the I-Advanced Care program and kind of how you see patients coming in on that program versus not on that program.
spk18: Yeah, Peter, in the press release, we talk about I-Advanced Care as we're talking about the the system that we use to register patients. Iovance Cares also includes patient assistance services. Right now, we're seeing commercial patients come through that are financially able to pay the full amount for TagV. But don't confuse the two. Iovance Cares, when we say they're registered in the system, that's our system that all the patients track through, no matter what they all go through that system.
spk13: Does that help? Gotcha. Perfect. Thank you. And then how should we think about how long it would take to kind of start booking revenues? Is that a kind of a 30, 40 day period before we can think about that or is it longer? So is it kind of beginning of 2Q versus late 2Q?
spk18: So we recognize revenue at the time of infusion. Jean-Marc was talking about that earlier and we talked about that last year too. Just like the other self-therapies, we recognize when we actually infuse the antagonist into the arm of the patient. So obviously if we just commence manufacturing, you gotta add some time for manufacturing and release of the product, and then the infusions will occur and you'll see us accrue revenue at that point. It's not very far away. We're talking weeks now until that starts to happen. But there is a time lag, and that's why we've been talking about first quarter versus second quarter versus third quarter revenues here. Dr. Martin, anything to that?
spk02: No, I think you characterized it properly, so we will have the first infusion coming, you know, sometimes after all the manufacturing process, the release will happen, and then we'll book the revenue. Now it's a question of several weeks still.
spk13: Anything you can say about the patients that have already been selected? Do they kind of, are they later line, earlier line? Any details around that? Great, thank you. Yeah, Jim, could you get this?
spk11: Yes, it's probably not appropriate to comment too much other than this patient had been identified and was ready to go. The center that we're talking about had worked them up, and as soon as we got approval, moved literally within hours.
spk13: Great. Thanks so much.
spk21: One moment for our next question.
spk09: Our next question comes from Colleen Cussie with Baird.
spk21: Your line is open.
spk32: Great. Thanks. Good afternoon. Congrats on the progress, and thanks for taking our questions. On the example of the tumor resection that happened the next business day, did that patient have reimbursement lined up already, or does that speak to the confidence of the center in eventually getting reimbursement? And as an add-on to that, can you just speak to the early reimbursement success rate so far?
spk18: Yeah, Colleen, you got partially cut off there for the first question, but I think what you're asking is whether the first patient had their financial clearance already worked up. Is that what you're saying?
spk00: Yeah, exactly.
spk18: Yeah, so that center, Jim can comment more, but that center basically wanted to get ahead so fast that they are doing it in parallel, essentially. And then, Jim, do you want to comment on Colleen's second question about how the financial clearance is going overall?
spk11: Yeah. Colleen, it's still a bit too early to tell, but what I would say is the payers appreciate the unmet need, understand the clinical value of mTAGV, and to date, we haven't had any issues. But I would provide the disclaimer that we are very, very early on. Just going back to that first patient and having a very competent, experienced team, When this particular ATC reached out to the payer, the payer reached out to our account manager, connected the dots, and everything moved very smoothly and very quickly in this particular situation.
spk32: Great. That's really helpful. Thank you. And one quick follow-on, if I can, on Europe. Can you just remind us, have EU regulators historically approached this review similar to US regulators? Is there anything unique about this? filing versus the U.S. filing? And just remind us what timelines would be in Europe, please.
spk20: Raj, do you want to take that one? Raj isn't available. I can answer it, Colleen.
spk18: The accelerated approval, like I say, in Europe as well, we won't know that until we actually get further in the MAA process. And it can be a 11-month versus a 14-month review period. We will obviously aim for the fastest review as possibly get with EMA. EMA has been very cooperative and very interested in getting this drug to European patients.
spk31: Great. Thanks for taking our questions, and congrats again.
spk21: Thank you. One moment for our next question.
spk09: Our next question comes from Michael Yee with Jefferies.
spk21: Your line is open.
spk36: Hi, this is Dina Ahn for Mike. Just wanted to say congrats again on the approval and thanks for the updates today. Just a quick question on how we should think about the cadence of how patients would be treated in the coming months. I know you mentioned that you have the 20 patients sort of in process and those could be infused weekly, but how can we sort of think about the bolus and the cadence of how many new patients would be identified per site in the next coming months? And just quickly on the slots and capacity, How many slots were actually approved by the FDA and is the manufacturing success rate likely to be in spec of at least 80% or how should we model and assume that? Thank you.
spk18: Yeah, so on the cadence of treatment, we expect essentially a large bolus to go through, just as you can see from all the banks and the analysts getting KOL calls and stuff like that. There's a lot of patients waiting for antagonists, so we think we're going to be really busy here for the next couple of months. And then after that, we think we're going to continue to be busy, as you can see from those same KOL interactions. Most of the sites have several patients a month, and when you average that all out across 30, moving to 50 ATCs, that's a very large number of patients every month for us to contend with. So we expect the cadence to essentially be as bolus and then move to a steady state. That's helpful. On slots and capacity, we haven't actually publicly disclosed the total amount of slots that we've got between MUCHI and RITC. The facility is enormous, and I think we'll be able to handle any load that comes in with what we've got. And we're very happy with the fact that the FDA gave us a lot of space to be able to manufacture. And then regarding the success rate, we don't really – we can't really disclose at this point what the percentage is and what's happening. We don't really know yet. We're still working on that and still testing. We think it's going to be quite high. We will be successful manufacturing in the vast majority of cases. But, again, we're only 12 – literally 12 days into launch right now, so we still need a little bit more time to figure that out.
spk37: Got it. Thank you.
spk21: One moment for our next question.
spk09: Our next question comes from Joseph Ketanzar with Piper Sandler.
spk21: Your line is open.
spk26: Hey, guys. I appreciate you taking my questions here. I wanted to maybe follow up on manufacturing capacity, but ask it in a slightly different way. So as we think about the dynamic of a bolus and the early indicators of demand you just mentioned today, to what extent, if at all, will you have to stagger receipt of tumor samples? Meaning, are the ATCs going to have to dictate the timing of their resection based on your ability to provide a slot, or are ATCs able to resect and send samples pretty much at their choosing? And then sort of my second question, I know it's still the early days, but with the 50 ATCs planned to be onboarded by the end of May, are there any plans to add ATCs beyond that? And if so, to what extent, and what's the timing around that? Thanks.
spk18: Igor, do you want to take the first part? Maybe, Jim, we could talk a little bit about the Plan PASS-50, too?
spk16: Yes. Yes, great. Joe, thanks for the question. So we have, as I mentioned, we have ample capacity to support launch as well as the clinical trials. And the way we designed our capacity, part of that was extensive research, understanding the preferences of each and every ATC about the typical surgery dates. And all of that's accounted for in our plans. We expect to accommodate basically be completely flexible as to what ATCs need to do and provide all the capacity they need to treat all the patients who are in the queue right now. And as additional ATCs on board, we plan to do the same. And also, as I mentioned, the capacity authorization enables us to hire additional staff and increase capacity without conducting additional filings with the agency.
spk11: Joe, this is Jim. The 50 ATCs that we identified by the end of May is going to pick up the significant portion of the treated patients in the country. We will continue to monitor the need to expand from that point, but what we want to do is make sure that with these top centers, we reinforce success, we build their service line, and make sure that they're successful in the treatment. And just a reminder, what I I mentioned before, like the CAR T market, there's a concentration of care at the top centers. We expect the top 40 to do about 80% of all the treatments for MTAGV.
spk26: Okay. Got it. Thanks. That's helpful, and I appreciate you taking my question.
spk21: One moment for our next question. Our next question comes from with Truer Securities. Your line is open.
spk28: Hey, guys. I just want to maybe ask a little bit more about insurance coverage. Could you tell us a bit about what proportion of lives in the U.S. have some degree of coverage right now and what proportion have preferential coverage right now? I know it's only day 12 or 13 since approval, but just want to get an idea of where you are right now. And then if you can also maybe look down look down into the year, where do you plan on getting that to in the next six months?
spk11: Great. This is Jim. I'll just remind you that in the corporate deck, we have our payer mix. About three quarters of our payer mix has strong coverage in reimbursement. This includes 55% commercial, and in Medicare, 4% are IPPS exempt, where these centers are reimbursed at cost. and 70% are Medicare Advantage. So I would say that we have a lot of tailwinds in terms of coverage. And right now, initial indications, granted we're very, very early on in launch, is that coverage seems to be appropriate and payers are ensuring access at this moment.
spk08: Great. Thanks for taking my questions.
spk21: One moment for our next question. Our next question comes from Randy Benjamin with Citizens JMP. Your line is open.
spk25: Hey, Greg, guys. Thanks for taking the questions. Maybe just to start off, are you seeing multiple patients potentially getting treated this early in the launch from the same ATC? Or do you think this early on, maybe it's more of a once the reimbursement and infusion takes place, the next patient will get online? Just trying to understand that. you know, how you see that developing. And then maybe one for Friedrich. You know, you have the cohort 1A data expected at a medical meeting. Would love to know, you know, should we just be expecting longer follow-up? Will we have more patients, you know, for that update? And related to that, you guys have other trials that are ongoing. Could we get additional clinical data from either 4001 or, you know, one of the other studies that's ongoing this year?
spk18: So, Rennie, we had a technical issue here. We couldn't hear most of the first question. Can you just – we heard the part of the clinical question when you asked that, but what was the first question again?
spk25: Yeah, so I'm just trying to understand from the ATCs that are on board, are they – like, you know, you have patients going through the process. Is each ATC pretty much putting one patient on? And then they're kind of going to wait until an infusion takes place before they bring another patient on? Or are you seeing ATCs like putting, you know, two or three patients on and they've just, you know, go ahead and ramping right away?
spk18: They're ramping right away. That's the easy question. They're ramping right away. They're not limited in any way by that. And then I guess the second part of the question, Frederick, could you, that one came through clearly at least here. Can you hear it? Can you take that one?
spk27: Yeah, I heard that. So thanks, Rene. So your question was about the core 1A data. So as a reminder for everyone, that's the cohort and study IOBCOM 202 that's involving checkpoint and better naive patients with advanced melanoma to be treated with tilapia. supportive study for TILVANs. And you were asking is it more patients or more follow-up. It's both. And it's obviously great to bring out some more data here in the context of us having TILVANs enrolling. We haven't really said anything about additional publications at this time, so stay posted on that.
spk25: Okay. Can I just ask a follow-up for both those questions again? Do you see any, you know, at any point in the process, do you see an area where there could be a potential bottleneck? And then from the clinical trial perspective, is there any color you can provide just regarding the FDA hold? You know, Friedrich, I think you mentioned you've already replied to the FDA. Correct me if I'm wrong. Do you expect there to be back and forth, or do you feel like it was pretty straightforward and the hold should be lifted pretty soon?
spk27: Jim, do you want to go first, and then I take the question about L122?
spk11: Sure. Randy, just to circle back on your question about multiple patients, it's still very early on, but we are seeing multiple patients from centers, even multiple patients on a given day in the scheduling calendar. So I think you should expect that as we ramp up and ATCs become more comfortable that you'll see demand with multiple patients from ATCs going forward.
spk27: And on your question regarding the LUN202 studies, we're confident that we gave them what they needed, them being the FDA in this case, in order to see what our plans are. We're expecting a response soon and to start enrolling fairly soon as well.
spk10: Perfect. Thanks for that question. Yeah, this is Raj. Can I also add that to Friedrich's comment regarding the clinical hold? As Friedrich mentioned, the FDA has everything they need to lift the clinical hold, and we are actually expecting really soon the resolution of this hold to begin enrolling the patients again.
spk24: Thanks for taking the questions.
spk21: One moment for our next question. Our next question comes from Andrea Tan with Goldman Sachs. Your line is open.
spk03: Good afternoon. Thanks for taking our question. Friedrich, maybe a follow-up to the last question there, but I just wanted to confirm if you could share any more details on the basis of the partial clinical hold, if it was any different from your initial thoughts back in December. That would be helpful. Thank you. No.
spk27: There's nothing, there's no information or no new aspects that we would have learned in the meantime from our interactions with the FDA. So the basis, we discussed in quite a bit of detail. In December, we've been working on addressing that. And as we said, we have addressed in our response about the involvement of new patients. Again, just as a reminder, this was a partial hold, right? So we are We are in agreement with the FDA to be able to offer the therapy to patients who were already involved and who had available products. So that also hasn't changed. So again, no new information, nothing unexpected or new that we didn't know back then.
spk09: Thank you.
spk21: One moment for our next question. Our next question comes from Kelsey Goodwin with Guggenheim. Your line is open.
spk05: Oh, hey. Good afternoon. I guess just to build a bit on some of the prior questions. First, for the app... We're not able to hear you, Kelsey. Oh, okay, can you hear me better now?
spk19: Operator, we're unable to hear Kelsey's question. Can you hear us?
spk21: One moment. We'll move on to the next question and come back to Kelsey. One moment. Can you guys still hear me?
spk17: Yeah, operator, we can hear you. We're just having a difficult time hearing the analysis. All right, one moment.
spk21: Our next question comes from Ben Burnett with Stifel. Your line is open.
spk22: Great. Thank you very much. I just had just a question to help with the model. Can you talk about the price of Prolucan and just how much incremental revenue per patient this will be? And I guess as sort of a follow-up to that, is this handled the same regardless if the patient has commercial insurance versus government insurance?
spk09: Could you repeat the question, please?
spk16: The first part of the question was cut off.
spk22: Apologies. I wanted to ask about Prolucan and how much incremental revenue per patient you might expect on top of the MTAG-B price tag. And then sort of the follow-up to that was, would that be handled the same regardless of commercial insurances involved versus government insurance?
spk11: Sure, why don't I take the first part and then John-Marc, you can jump in. So, as you know, for the MTAG-B regimen, Prolucan would be used six doses on average, 18 vials per dose at a WAC of 5,551. What I would share is that the cost would be the same, the reimbursement would be the same, whether you are commercial or government at this point, with the exception of you know, mandatory discounts for government sectors.
spk22: I see. Okay. That's all. Well, thank you. And just maybe one question for Jean-Marc. To what extent does the cash runway assumption that you mentioned earlier incorporate a revenue estimate for MTAG-B?
spk09: Hello, this is Jean-Marc. Are you there? Could you repeat that question one more time, Ben?
spk22: Certainly. I was just curious, to what extent does the cash runway assumption that was mentioned earlier in the prepared remarks, I guess, incorporate a revenue estimate for MTagV? I'm curious if you could maybe speak to that estimate.
spk09: Can you hear me now? Yes, we can hear you now.
spk02: Okay, sorry. We're having some technical difficulties there. So thank you for the question, Ben. So, yes, we do have to take into account some revenue from the entire degree and looking into a cash runway. But, of course, obviously we have been very conservative in the way we have taken those revenues. So I'm not disclosing more. But, again, conservatively on the revenue side, we have enough cash well into the second half of 2025.
spk21: Understood. Thanks so much. Ladies and gentlemen, this concludes today's presentation. I will now turn the call back over to Fred for any closing remarks.
spk18: Operator, can you confirm that you can hear me just because of the technical difficulties?
spk21: Yes, I can hear you.
spk18: Thank you again for joining the I-Advanced Biotherapeutics fourth quarter and full year 2023 financial results and corporate updates conference call. 2024 is already off to an incredible start for I-Advanced. Our mission is to remain the global leader in innovating, developing, and delivering health therapies. and we've now planted a firm stake in the ground as the pioneers of the first commercial tilt therapy. This is also a momentous occasion for the oncology community that has been advancing research in cell therapy for solid tumors for decades. We're thankful to all the scientists, researchers, healthcare providers, and institutions who have contributed to the field, to the patients and their loved ones who have participated in tilt therapy clinical trials. It takes a large and coordinated effort to deliver this type of first-in-class category therapy to patients, and this achievement is a testament to the unwavering commitment and expertise and collaborative efforts of many. Thank you to those in the healthcare, advocacy, and patient communities, as well as the regulators, our partners, and the local communities in Philadelphia, San Carlos, and Tampa that made this U.S. approval possible. I would also like to thank our shareholders and covering analysts for their support. And lastly, I want to thank our exceptional IVANS team. We could not be here without their cross-functional efforts and our collective, steadfast commitment to following the science. We look forward to providing further updates on the ANTAGV launch and our pipeline on the first quarter 2024 conference call in May. Please feel free to reach out to our investors relations team for follow-up and apologies for the technical difficulties today. Thank you.
spk30: This concludes today's conference call. Thank you for participating. You may now disconnect. you Thank you. Thank you.
spk33: Thank you. Bye. Thank you. you
spk21: Welcome to the Iovance Biotherapeutics Conference call to discuss the full year 2023 results and recent corporate updates. My name is Kevin and I'll be your operator for today's call. At this time, all participants are on a listen-only mode. Later, we will conduct a question and answer session. Please note that this conference is being recorded. I will now turn the call over to Sarah Pellegrino, Senior Vice President, Investor Relations and Corporate Communications, Iovance. Sarah, you may begin.
spk30: Thank you, Operator. Good afternoon, and thank you for joining our conference call and webcast to discuss full year 2023 results and recent corporate updates. Dr. Fred Vogt, our Interim President and Chief Executive Officer, will provide a brief introduction. Jim Ziegler, EVB Commercial, will highlight our initial insights for the U.S. commercial launch of Amtagvi following the recent U.S. Food and Drug Administration, or FDA, approval in advanced melanoma, Igor Balinski, Chief Operating Officer, will highlight commercial manufacturing and capacity expansion plans. Frederick Graf Finkenstein, our Chief Medical Officer, will summarize key clinical pipeline highlights. And John Mark Belleming, Chief Financial Officer, will review our financial results. Dr. Brian Gassman, EVP Medical Affairs, and Raj Puri, EVP Regulatory Strategy and Translational Medicine, are also on the call and available for the Q&A session. Before we start, I would like to remind everyone that statements made during this call will include forward-looking statements regarding Iovance's goals, business focus, business plans and transactions, revenue, commercial activities, clinical trials and results, regulatory approvals and interactions, plans and strategies, research and preclinical activities, potential future applications of our technologies, manufacturing capabilities, regulatory feedback and guidance, payer interactions, licenses and collaborations, cash position and expense guidance, and future updates. Forward-looking statements are subject to numerous risks and uncertainties, many of which are beyond our control, including the risks and uncertainties described from time to time in our SEC filing. Our results may differ materially from those projected during today's call. We undertake no obligation to publicly update any forward-looking statements. With that, I will turn the call over to Fred.
spk18: Thank you, Sarah, and good afternoon, everyone. I'm pleased to host our 2023 full-year results conference call. Throughout last year, we executed toward our first approval of commercial lines while advancing our pipeline. On today's call, we have a variety of exciting topics to cover on the heels of the US FDA's recent approval of Abtagme, the first one-time T-cell therapy for a cell tumor. Antagni's label allows it to become the first treatment option for advanced melanoma patients after anti-PD-1 and targeted therapy. The strength of this label also reflects a best-case scenario with strong efficacy data from pivotal cohort 4 as well as pooled cohorts 2 and 4. In the first few days of U.S. launch, we were seeing strong demand and momentum for Antagni. Consequently, we also expect increased demand for Prolucan. 30 authorized treatment centers, or ATCs, were ready for approval, and nearly all have identified a patient. Jim will provide more detail later in the call. The first tumor resection occurred on the first business day after approval, and commercial manufacturing began the following day at our IVAN Cell Therapy Center, or ICPC. This is a testament to the high unmet medical need and the great excitement around this new therapy, as well as our commercial manufacturing readiness. Igor will talk today about our capacity to serve our near-term commercial launch, clinical trials, and ongoing expansion plans. In addition to the U.S. launch, our near-term expansion plans for MTGV are focused on addressing many thousands of additional patients by entering new geographies and broadening the label to include frontline advanced melanoma as well as other indications. For example, our planning global expansion has the potential to double the total number of addressable patients for MTGV and post-anti-PD-1 melanoma. We remain on track to submit regulatory dossiers this year in the European Union in the first half of the year, followed by the United Kingdom and Canada in the second half. In addition, our Phase III TILVADS-301 trial continues with strong momentum in several countries to support regulatory submissions and frontline advanced melanoma. We are also pleased with the progress with our robust development pipeline across solid tumor cancers. Frederick will speak later about some key highlights in our ongoing clinical trial programs. Today, Iovane is a fully integrated company and is now the first company to commercialize the T cell therapy for solid tumor indications. We are well positioned to execute on our regulatory pipeline manufacturing commercial launch activities to remain the global leader in TIL cell therapy. Jim will now describe the ongoing activities related to our U.S. launch.
spk11: Thank you, Fred. Each year, approximately 8,000 people in the U.S. die from melanoma. Until now, there have been no FDA-approved treatment options for patients with advanced melanoma whose disease progressed following an immune checkpoint inhibitor and, if appropriate, a targeted therapy. For these patients, MTAGV ushers in a new era for the melanoma treatment landscape as a one-time cell therapy that is manufactured specifically for each patient to address a significant unmet need. Today, I will highlight our launch activities, ATC onboarding, as well as access and reimbursement. There is strong level of ATC commitment with 30 onboard today. These onboarded ATCs are engaged in various stages of the process, including patient identification, reimbursement authorization, scheduling and tumor tissue procurement, and manufacturing. In the less than two weeks following approval, the majority of our activated ATCs have at least one identified patient and are in the process of establishing financial clearance for reimbursement, including prior authorizations, and single case agreements. There are at least 20 patients in the process, which includes 10 patients with scheduled or pending manufacturing slots. The number of ATCs engaged in this process reflects the high unmet need and a sense of urgency to offer mTAGV for their advanced melanoma patients. In addition, We continue to onboard and remain on track to have approximately 50 active ATCs in total by the end of May. We are also pleased with the initial market access and inpatient reimbursement trends for MTagV. These are consistent with approved CAR T products with the benefit of increased speed resulting from both our preparation and the ATCs experience. We continue to anticipate prior authorizations to include coverage consistent with label, medical coverage policies within about 90 to 180 days, and single case agreements for commercially insured patients. I want to acknowledge our strong cross-functional teams who have worked tirelessly to ensure our launch readiness and execution. We are confident in our ability to deliver a successful commercial launch. I will now turn the call over to Igor, who will highlight our manufacturing readiness and capabilities.
spk16: Thank you, Jim. Antagamy, as well as our investigational TIL cell therapies, are manufactured using our proprietary process to collect the patient's TIL cells from a portion of their tumor, multiply them into billions, and return them back to the patient to fight cancer. The US FDA has approved commercial manufacturing at our internal facility, the Eye Events Cell Therapy Center, or ICTC, as well as at a nearby contract manufacturer. These facilities are built to support up to several thousand patients annually. As Fred mentioned, the first tumor resection occurred on the first business day after approval, and commercial manufacturing of MTAGVI is officially underway. We are currently staffed to meet the anticipated needs of our U.S. launch, as well as our ongoing and planned clinical trials. In the BLA submission for MTAGVI, we have included the capacity demonstration study higher than our immediate needs. This means that we can increase near-term capacity through increased staffing without requiring additional capacity authorizations. In addition, we're building further capacity to align with our near-term and long-term manufacturing needs. As we prepare to expand and tag into new markets and indications and advance our solid tumor pipeline, expansion within the ICDC facility is already starting. build out of additional clean rooms within the existing shell space at ICDC can significantly increase capacity to over 5,000 patients annually over the next few years. Longer term, our future expansion plans may bring our manufacturing capacity above 10,000 patients annually. In summary, our team is excited to provide Antagly to patients in need. We are laser focused on the quality of the manufacturing process in the spirit of doing everything right first time at every step from incoming receipt of the tumor sample through the manufacturing and product release process to outbound shipment of the final antagonistic product to the ATCs and to patients. I'm available to answer additional questions during the Q&A, and I will now hand the call over to Friedrich.
spk27: Thank you, Igor. I'm pleased to speak today about the key highlights within our clinical pipeline in solid tumors, which, as you know, represent more than 90% of all diagnosed cancers in the U.S. I'll begin with TILVANS301, our registrational phase three trial in frontline advanced melanoma. TILVANS301 is well underway to support accelerated and full approvals of Antagly in combination with Pembrolizumab in frontline advanced melanoma. Global site activation and patient enrollment continue with strong momentum in the U.S., Europe, Australia, Canada, and additional countries. 2VANS301 is also the confirmatory trial to support full approval of Obtacne and post-anti-PD-1 advanced melanoma. Shifting to our program in non-small cell lung cancer and our single arm registrational phase two trial, IOV LUN202, in post-anti-PD-1 non-small cell lung cancer. Enrollment in the registrational cohort is estimated to complete in 2025. Following the partial clinical hold for new patients, we are working collaboratively with the US FDA and believe we have provided all the necessary information to resume new patient enrollment in the near future. We are also preparing to start up a new Phase II trial in post-anti-PD-1 endometrial cancer, which is expected to include patient populations who are deficient and proficient in mismatch repair. Tilt-cell therapy, based on its mechanism of action, may benefit both of these patient populations. We look forward to providing more details in advancing this trial this year. IOVAMS is the leader in tilt cell therapy, including next-generation approaches that have the potential to optimize outcomes for patients. We continue to investigate our genetically modified PD-1 inactivated tilt therapy IOV4001 in the GM1-201 trial. This is the first in-human trial in previously treated advanced melanoma or non-small cell lung cancer patients. This was just a snapshot of the many activities and progress across our follow-tumor pipeline, and I'm happy to address questions about these programs and additional trials during the Q&A session. I will now hand the call to Jean-Marc. Jean-Marc?
spk02: Thank you, Frédéric. Today, I will review our current cash position as well as our four-year results for the year ended on December 31, 2023. I will also highlight our 2024 outlook. As of February 22nd, 2024, our unedited cash position is approximately $485.2 million, which includes net proceeds of approximately $197.1 million net of underwriting and other offering expenses from a follow-on equity financing in February of 2024. The current cash position and anticipated revenue from both entirely and for looking are expected to be sufficient to found current and planned operation well into the second half of 2025. Shifting to our full year financial results, net loss for the fourth quarter under December 31st, 2023 was $116.4 million or 45 cents per share compared to a net loss of one hundred and five point three million dollars or sixty four cents per share for the fourth quarter and December 31st, 2022. Net loss for the year on December 31st, 2023 was four hundred forty four million dollars or one dollar and eighty nine cents per share. compared to a net loss of $395.9 million, or $2.49 per share, for the year ended December 31st, 2022. The net loss for the year ended December 31st, 2023 includes amortization of intangible assets acquired as part of the forelooking transaction. Revenue from the fourth quarter and year ended December 31st, 2023 was $482,000 and $1 million, respectively, and comprised of product sales of Prolooking following the acquisition in May 2023. There was no revenue for the fourth quarter and year ended December 31st, 2022. Cost of sales for the fourth quarter and year end, December 31st, 2023, was $4.4 million and $10.8 million, respectively, and comprised of cost of inventory associated with sales and producing, as well as $3.9 million and $9.7 million, respectively, of non-cash amortization expenses for the required intangible assets for developed technology. There were no cost of revenue for the fourth quarter and year ended December 31st, 2022. Research and development expenses were $87.5 million for the fourth quarter and the December 31st, 2023, an increase of $6.9 million compared to $80.6 million for the same period and the December 31st, 2022. Research and development expenses were $344.1 million for the year ended December 31, 2023, an increase of $49.3 million compared to $294.8 million for the same period ended December 31, 2022. The increases in research and development expenses in the fourth quarter and the year ended December 31st, 2023, over the prior year periods, were primarily attributable to increases in headcount and related costs to support increased production capacity and commercial manufacturing readiness, and clinical trial costs driven primarily by the initiation of our Phase III TLDANS 301 clinical trial. Selling general and administrative expenses were $29.9 million for the fourth quarter under December 31, 2023, an increase of $3.4 million compared to $26.5 million for the same period under December 31, 2022. Selling general and administrative expenses were $106.9 million for the year under December 31, 2023, an increase of $2.8 million compared to $104.1 million for the same period ended December 31st, 2022. The increase in selling general and administrative expenses in the fourth quarter and the year ended December 31st, 2023 compared to the prior year periods was primarily attributable to increasing net count and related costs to support the growth in the overall business and related corporate infrastructure professional fees and travel costs, as well as costs associated with pro-looking integration activities. This increase was partially offset by an increase in stock-based compensation, expenses, legal, and other costs. For additional information, please see this afternoon's press release and our annual report on Form 10-K to be filed later today. Regarding our outlook for this year, We continue to guide toward full-year 2024 cash burn in the range of $320 to $340 million, excluding one-time expenses. And we will continue to leverage opportunities to optimize spending. The U.S. launch of MTAG-V, as well as the sales of Pollukin, used in conjunction with the MTAG-V treatment regimen, are expected to drive significant revenue in the second half of 2024 and into 2025 and beyond. Revenue recognition for MTAG-V occurs upon infusion, like other cell therapies. So we expect to begin recognizing and reporting significant revenue in the second quarter of this year. I will now turn the call over to the operator to begin the question and answer session.
spk21: Thank you. Ladies and gentlemen, if you have a question or a comment at this time, please press star 1-1 on your telephone. If your question has been answered and you wish to move yourself from the queue, please press star 1-1 again. We'll pause for a moment while we compile our Q&A roster.
spk09: Our first question comes from with Wells Fargo.
spk21: Your line is open.
spk29: Great. Thanks for taking our questions and congrats on this initial momentum. Just curious about the 10 patients. Sounds like you have 10 patients that are already at the stage of scheduling manufacturing slot. Wondering how long did these patients' reimbursement process took Does that give you any updated thinking, a way of thinking of the average time from patient identification to tumor resection? And also, we see the word, you know, some of these 10 patients are pending for manufacturing slots. Just wondering what does that mean and, you know, what's behind the word pending? Thank you.
spk18: Yeah, Jan. Hi, Jan. It's Fred. It obviously moved very quickly for the centers that were able to schedule these patients, the 10 patients that are in there that are either scheduled for a slot or soon to schedule for a slot or all moving through the process much more quickly. Some centers move fast. Some centers move slow. What we're seeing here, I think, is some pent-up demand and real excitement for the MPAC relaunch. I'll let Jim add. Jim, do you want to add any comments to that?
spk11: Thanks, Fred. I think, Anand, it's still too early to tell. What we've guided before based upon our experience in cell therapy approvals is it takes a couple of days for prior authorization and a couple of weeks for single case agreement. As Fred pointed out, there has been some quick movement because of the sense of urgency at these ATCs. To further define what pending means, ATCs basically will schedule a slot once they know they have successful reimbursement. So pending is that They're registered, they're ready to go, but they're not quite ready to pull the trigger on that slot yet.
spk29: Great. If I can have a very quick follow-up. Namely, you mentioned, you know, manufacturing could be conducted at CTC or the CDMO. Just wondering how are you distributing the flow to these two facilities and if you would mind commenting on the margin for the CDMO. Thank you very much.
spk18: Yeah, Jan, we can't really say what their margin is. They know that. Obviously, that's their business. We think it's competitive with what we do, so we employ a make versus buy strategy at IVANS, and we constantly look at internal manufacturer versus external. That keeps everything in tight competition, and we think that's the best way to run a business. Does that answer your question?
spk29: Right. How would you distribute the flow to ITC2C versus CDMO?
spk18: Yeah, so we have internal algorithms for doing that, and I can't share the full details, but we distribute the flow somewhat evenly across the two sites. And as we expand and as we grow, I think we'll be able to manage that even more tightly as we learn a little bit more right now about how the sites perform and who's doing the best here. But we run them as an internally competitive system. And again, just to make sure it's really clear, there is no real issue at all with capacity between the two. We have tons of capacity right now for this launch.
spk29: Great. Thanks for all the credit and congrats on the progress.
spk21: Thank you. One moment for our next question. Our next question comes from Tyler Van Buren with TD Cowan. Your line is open.
spk15: Great. Hey, guys. Thanks for taking the question. The patients in process for mTagV is a very encouraging update, given that we're just a week and a half in. But as we think about the 20 mTagV patients in process, does this constitute the majority of the initial bolus in the 30 ATCs with the majority of sites having at least one patient, as you noted? Or would you be more likely to characterize it as a fraction? And just as a quick second question, with the MAA to be submitted in the first half and other XUS submissions, will Iovance be launching LifeLoose whole broad or do you expect to partner?
spk18: Yeah, Tyler, that's a tiny fraction we think of the patients out there. It's not the initial bolus. The bolus is going to go on for quite some time and our sales team is out there and they've got a lot of information and it looks like this is going to be sustainable for quite some time. On the MAA front, we intend to do that ourselves. We're not looking for a partner right now to do that. We think that could potentially dilute the value of our assets.
spk09: Thank you. One moment for our next question. Our next question comes from Peter Lawson with Barclays.
spk21: Your line is open.
spk13: Great. Thank you. Thanks for taking the questions, and congrats on the progress. Just wondering if you kind of talk through how you're thinking about how revenue gets booked and the impact of the patients on the I-Advanced Care program and kind of how you see patients coming in on that program versus not on that program.
spk18: Yeah, Peter, in the press release, when we talk about I-Advanced Care, we're talking about the the system that we use to register patients. Iovance Cares also includes patient assistance services. Right now, we're seeing commercial patients come through that are financially able to pay the full amount for TagV. But don't confuse the two. Iovance Cares, when we say they're registered in the system, that's our system that all the patients track through, no matter what they all go through that system.
spk13: Does that help? Gotcha. Perfect. Thank you. And then how should we think about how long it would take to kind of start booking revenues? Is that a kind of a 30, 40 day period before we can think about that or is it longer? So is it kind of beginning of 2Q versus late 2Q?
spk18: So we recognize revenue at the time of infusion. Jean-Marc was talking about that earlier and we talked about that last year too. Just like the other self-therapies, we recognize when we actually infuse the antagonist into the arm of the patient. So obviously if we just commence manufacturing, you've got to add some time for manufacturing and release of the product, and then the infusions will occur and you'll see us accrue revenue at that point. It's not very far away. We're talking weeks now until that starts to happen. But there is a time lag, and that's why we've been talking about first quarter versus second quarter versus third quarter revenues here. Dr. Martin, anything to that?
spk02: No, I think you characterized it properly, so we will have the first infusion coming, you know, sometimes after all the manufacturing process, the release will happen, and then we'll book the revenue. Now it's a question of several weeks still.
spk13: Anything you can say about the patients that have already been selected? Do they kind of, are they later line, earlier line? Any details around that? Great, thank you. Yeah, Jim, could you get this?
spk11: Yes, it's probably not appropriate to comment too much other than this patient had been identified and was ready to go. The center that we're talking about had worked them up, and as soon as we got approval, moved literally within hours.
spk13: Great. Thanks so much.
spk21: One moment for our next question.
spk09: Our next question comes from Colleen Cussie with Baird.
spk21: Your line is open.
spk32: Great. Thanks. Good afternoon. Congrats on the progress, and thanks for taking our questions. On the example of the tumor resection that happened the next business day, did that patient have reimbursement lined up already, or does that speak to the confidence of the center in eventually getting reimbursement? And as an add-on to that, can you just speak to the early reimbursement success rate so far?
spk18: Yeah, Colleen, you got partially cut off there for the first question, but I think what you're asking is whether the first patient had their financial clearance already worked up. Is that what you're saying?
spk00: Yeah, exactly.
spk18: Yeah, so that center, Jim can comment more, but that center basically wanted to get ahead so fast that they are doing it in parallel, essentially. And then, Jim, do you want to comment on... Colleen, second question about how the financial clearance is going overall.
spk11: Yeah. Colleen, it's still a bit too early to tell, but what I would say is the payers appreciate the unmet need, understand the clinical value of MTAG-V, and to date, we haven't had any issues. But I would provide the disclaimer that we are very, very early on. Just going back to that first patient and having a very competent, experienced team, When this particular ATC reached out to the payer, the payer reached out to our account manager, connected the dots, and everything moved very smoothly and very quickly in this particular situation.
spk32: Great. That's really helpful. Thank you. And one quick follow-on, if I can, on Europe. Can you just remind us, have EU regulators historically approached this review similar to US regulators? Is there anything unique about this?
spk18: filing versus the u.s filing and just remind us what timelines would be in europe please uh raj do you want to take that one rogers isn't available i can answer calling the accelerated approval like saying in europe as well we won't know that until we actually get further in the maa process and it can be a level on first the 14-month review period uh we will obviously aim for the fastest uh review as possibly get with EMA. EMA has been very cooperative and very interested in getting this drug to European patients.
spk31: Great. Thanks for taking our questions, and congrats again.
spk21: Thanks. One moment for our next question.
spk09: Our next question comes from Michael Yee with Jefferies.
spk21: Your line is open.
spk36: Hi, this is Dina Ahn for Mike. Just wanted to say congrats again on the approval and thanks for the updates today. Just a quick question on how we should think about the cadence of how patients would be treated in the coming months. I know you mentioned that you have the 20 patients sort of in process and those could be infused weekly, but how can we sort of think about the bolus and the cadence of how many new patients would be identified per site in the next coming months? And just quickly on the slots and capacity, How many slots were actually approved by the FDA and is the manufacturing success rate likely to be in spec of at least 80% or how should we model and assume that? Thank you.
spk18: Yeah, so on the cadence of treatment, we expect essentially a large bolus to go through, just as you can see from all the banks and the analysts getting KOL calls and stuff like that. There's a lot of patients waiting for MTAGV, so we think we're going to be really busy here for the next couple of months. And then after that, we think we're going to continue to be busy, as you can see from those same KOL interactions. Most of the sites have several patients a month, and when you average that all out across 30, moving to 50 ATCs, that's a very large number of patients every month for us to contend with. So we expect the cadence to essentially be as bolus and then move to a steady state. That's helpful. On slots and capacity, we haven't actually publicly disclosed the total amount of slots that we've got between MUCHI and our ITTC facility, but it's enormous, and I think we'll be able to handle any load that comes in with what we've got. And we're very happy with the fact that the FDA gave us a lot of space to be able to manufacture. And then regarding the success rate, we don't really – we can't really disclose at this point what the percentage is and what's happening. We don't really know yet. We're still working on that and still testing. We think it's going to be quite high. We will be successful in manufacturing in the vast majority of cases. But, again, we're only 12 – literally 12 days into launch right now, so we still need a little bit more time to figure that out.
spk37: Got it. Thank you.
spk21: One moment for our next question.
spk09: Our next question comes from Joseph Ketanzar with Piper Sandler.
spk21: Your line is open.
spk26: Hey, guys. I appreciate you taking my questions here. I wanted to maybe follow up on manufacturing capacity, but ask it in a slightly different way. So as we think about the dynamic of a bolus and the early indicators of demand you just mentioned today, to what extent, if at all, will you have to stagger receipt of tumor samples? Meaning, are the ATCs going to have to dictate the timing of their resection based on your ability to provide a slot, or are ATCs able to resect and send samples pretty much at their choosing? And then sort of my second question, I know it's still the early days, but with the 50 ATCs planned to be onboarded by the end of May, are there any plans to add ATCs beyond that? And if so, to what extent, and what's the timing around that? Thanks.
spk18: Yeah, Igor, do you want to take the first part? Maybe, Jim, we could talk a little bit about the Plan PASS-50, too?
spk07: Yes.
spk16: Yes, great. Joe, thanks for the question. So we have, as I mentioned, we have ample capacity to support launch as well as the clinical trials. And the way we designed our capacity, part of that was extensive research, understanding the preferences of each and every ATC about the typical surgery dates. And all of that's accounted for in our plan. We expect to accommodate basically be completely flexible as to what ATCs need to do and provide all the capacities they need to treat all the patients who are in the queue right now. And as additional ATCs on board, we plan to do the same. And also, as I mentioned, the capacity authorization enables us to hire additional staff and increase capacity without conducting additional filings with the agencies.
spk11: Joe, this is Jim. The 50 ATCs that we identified by the end of May is going to pick up the significant portion of the treated patients in the country. We will continue to monitor the need to expand from that point, but what we want to do is make sure that with these top centers, we reinforce success, we build their service line, and make sure that they're successful in the treatment. And just a reminder, what I I mentioned before, like the CAR T market, there's a concentration of care at the top centers. We expect the top 40 to do about 80% of all the treatments for MTAGV.
spk26: Okay. Got it. Thanks. That's helpful, and I appreciate you taking my question.
spk21: One moment for our next question. Our next question comes from with Truer Securities. Your line is open.
spk28: Hey, guys. I just want to maybe ask a little bit more about insurance coverage. Could you tell us a bit about what proportion of lives in the U.S. have some degree of coverage right now and what proportion have preferential coverage right now? I know it's only day 12 or 13 since approval, but just want to get an idea of where you are right now. And then if you can also maybe look down look down into the year, where do you plan on getting that to in the next six months?
spk11: Great. This is Jim. I'll just remind you that in the corporate deck, we have our payer mix. About three quarters of our payer mix has strong coverage in reimbursement. This includes 55% commercial, and in Medicare, 4% are IPPS exempt, where these centers are reimbursed at cost. And 70% are Medicare Advantage. So I would say that we have a lot of tailwinds in terms of coverage. And right now, initial indications, granted we're very, very early on in launch, is that coverage seems to be appropriate and payers are ensuring access at this moment.
spk08: Great. Thanks for taking my questions.
spk21: One moment for our next question. Our next question comes from Randy Benjamin with Citizens JMP. Your line is open.
spk25: Hey, Greg, guys. Thanks for taking the questions. Maybe just to start off, are you seeing multiple patients potentially getting treated this early in the launch from the same ATC? Or do you think this early on, maybe it's more of a once the reimbursement and infusion takes place, the next patient will get online? Just trying to understand that. you know, how you see that developing. And then maybe one for Friedrich. You know, you have the cohort 1A data expected at a medical meeting. Would love to know, you know, should we just be expecting longer follow-up? Will we have more patients, you know, for that update? And related to that, you guys have other trials that are ongoing. Could we get additional clinical data from either 4001 or, you know, one of the other studies that's ongoing this year?
spk18: So, Rennie, we had a technical issue here. We couldn't hear most of the first question. Can you just – we heard the part of the clinical question when you asked that, but what was the first question again?
spk25: Yeah, so I'm just trying to understand from the ATCs that are on board, are they – like, you know, you have patients going through the process. Is each ATC pretty much putting one patient on? And then they're kind of going to wait until an infusion takes place before they bring another patient on? Or are you seeing ATCs like putting, you know, two or three patients on and they've just, you know, go ahead and ramping right away?
spk18: They're ramping right away. That's easy question. They're ramping right away. They're not limited in any way by that. And then I guess the second part of the question, Frederick, could you, that one came through clearly at least here. Can you hear it? Can you take that one?
spk27: Yeah, I heard that. So thanks, Rene. So your question was about the core 1A data. So as a reminder for everyone, that's the cohort and study IOBCOM 202 that's involving checkpoint and better naive patients with advanced melanoma to be treated with of study for TILVANs. And you were asking is it more patients or more follow-up. It's both. And it's obviously great to bring out some more data here in the context of us having TILVANs enrolling. We haven't really said anything about additional publications at this time, so stay posted on that.
spk25: Okay. Can I just ask a follow-up for both those questions again? Do you see any, you know, at any point in the process, do you see an area where there could be a potential bottleneck? And then from the clinical trial perspective, is there any color you can provide just regarding the FDA hold? You know, Friedrich, I think you mentioned you've already replied to the FDA. Correct me if I'm wrong. Do you expect there to be back and forth, or do you feel like it was pretty straightforward and the hold should be lifted pretty soon?
spk27: Jim, do you want to go first, and then I take the question about L122?
spk11: Sure. Randy, just to circle back on your question about multiple patients, it's still very early on, but we are seeing multiple patients from centers, even multiple patients on a given day in the scheduling calendar. So I think you should expect that as we ramp up and ATCs become more comfortable that you'll see demand with multiple patients from ATCs going forward.
spk27: And on your question regarding the LUN202 studies, we're confident that we gave them what they needed, them being the FDA in this case, in order to see what our plans are. We're expecting a response soon and to start enrolling fairly soon as well.
spk25: Perfect.
spk10: Thanks for that question. Yeah, this is Raj. Can I also add that to Friedrich's comment regarding the clinical hold? As Friedrich mentioned, the FDA has everything they need to lift the clinical hold, and we are actually expecting really soon the resolution of this hold to begin enrolling the patients again.
spk24: Thanks for taking the questions.
spk21: One moment for our next question. Our next question comes from Andrea Tan with Goldman Sachs. Your line is open.
spk03: Good afternoon. Thanks for taking our question. Friedrich, maybe a follow-up to the last question there, but I just wanted to confirm if you could share any more details on the basis of the partial clinical hold, if it was any different from your initial thoughts back in December. That would be helpful. Thank you. No.
spk27: There's nothing, there's no information on it, no new aspects that we would have learned in the meantime from our interactions with the FDA. So the basis, we discussed in quite a bit of detail In December, we've been working on on addressing that. And as we said, we have addressed and our response about the involvement of new patients. Again, just as a reminder, this was a partial hold right so we are we are in agreement with the FDA to be able to offer the therapy to patients who were already enrolled and who had available products. So that also hasn't changed. So again, no new information, nothing unexpected or new that we didn't know back then.
spk09: Thank you.
spk21: One moment for our next question. Our next question comes from Kelsey Goodwin with Guggenheim. Your line is open.
spk05: Oh, hey. Good afternoon. I guess just to build a bit on some of the prior questions. First, for the average- We're not able to hear you, Kelsey. Oh, okay, can you hear me better now?
spk19: Hello? Operator, we're unable to hear Kelsey's question. Can you hear us?
spk21: One moment. We'll move on to the next question and come back to Kelsey. One moment. Can you guys still hear me?
spk17: Yeah, operator, we can hear you. We're just having a difficult time hearing the Alice. All right, one moment.
spk21: Our next question comes from Ben Burnett with Stifel. Your line is open. Great.
spk22: Thank you very much. I just had just a question to help with the model. Can you talk about the price of Prolucan and just how much incremental revenue per patient this will be? And I guess as sort of a follow-up to that, is this handled the same regardless if the patient has commercial insurance versus government insurance?
spk09: Could you repeat the question, please?
spk16: The first part of the question was cut off.
spk22: Apologies. I wanted to ask about Prolucan and how much incremental revenue per patient you might expect on top of the MTAG-B price tag. And then sort of the follow-up to that was, would that be handled the same regardless of commercial insurances involved versus government insurance?
spk11: Sure, why don't I take the first part and then John-Marc, you can jump in. So, as you know, for the MTAGV regimen, Prolucan would be used six doses on average, 18 vials per dose at a whack of 5,551. What I would share is that the cost would be the same, the reimbursement would be the same, whether you are commercial or government at this point, with the exception of you know, mandatory discounts for government sectors.
spk22: I see. Okay. That's all. Well, thank you. And just maybe one question for Jean-Marc. To what extent does the cash runway assumption that you mentioned earlier incorporate a revenue estimate for MTagdy?
spk09: Jean-Marc, are you there? Could you repeat that question one more time, Ben?
spk22: Certainly. I was just curious, to what extent does the cash runway assumption that was mentioned earlier in the prepared remarks, I guess, incorporate a revenue estimate for MTAG-B? I'm curious if you can maybe speak to that estimate.
spk09: Can you hear me now? Yes, we can hear you now.
spk02: Okay, sorry. We're having some technical difficulties there. So thank you for the question, Ben. So, yes, we do have to take into account some revenue from EntagV and looking into a cash runway. But, of course, obviously we have been very conservative in the way we have taken those revenues. So I'm not disclosing more. But, again, conservatively on the revenue side, we have enough cash well into the second half of 2025.
spk21: I understand. Thanks so much. Ladies and gentlemen, this concludes today's presentation. I will now turn the call back over to Fred for any closing remarks.
spk18: And operator, can you confirm that you can hear me just because of the technical difficulties?
spk21: Yes, I can hear you.
spk18: Thank you again for joining the I-Advanced Biotherapeutics fourth quarter and full year 2023 financial results and corporate updates conference call. 2024 is already off to an incredible start for I-Advanced. Our mission is to remain the global leader in innovating, developing, and delivering health therapies. and we've now planted a firm stake in the ground as the pioneers of the first commercial tilt therapy. This is also a momentous occasion for the oncology community that has been advancing research in cell therapy for solid tumors for decades. We're thankful to all the scientists, researchers, healthcare providers, and institutions who have contributed to the field, to the patients and their loved ones who have participated in tilt therapy clinical trials. It takes a large and coordinated effort to deliver this type of first-in-class category therapy to patients, and this achievement is a testament to the unwavering commitment and expertise and collaborative efforts of many. Thank you to those in the healthcare, advocacy, and patient communities, as well as the regulators, our partners, and the local communities in Philadelphia, San Carlos, and Tampa that made this U.S. approval possible. I would also like to thank our shareholders and covering analysts for their support. And lastly, I want to thank our exceptional IVANS team. We could not be here without their cross-functional efforts and our collective, steadfast commitment to following the science. We look forward to providing further updates on the ANTAGV launch and our pipeline on the first quarter 2024 conference call in May. Please feel free to reach out to our investors relations team for follow-up and apologies for the technical difficulties today. Thank you.
spk30: This concludes today's conference call. Thank you for participating. You may now disconnect.
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