8/14/2023

speaker
Abigail
Conference Call Operator

Good afternoon, ladies and gentlemen. Welcome to the Plus Therapeutics second quarter 2023 results conference call. Before we begin, we want to advise you that over the course of the call and question and answer session, forward-looking statements will be made regarding events, trends, business prospects, and financial performance, which may affect Plus Therapeutics' future operating results and financial position. All such statements are subject to risks and uncertainties, including the risks and uncertainties described under the risk factor section included in PLUS Therapeutics' annual report on Form 10-K and quarterly reports on Form 10-Q filed with the Securities and Exchange Commission from time to time. PLUS Therapeutics advises you to review these risk factors in considering such statements. PLUS Therapeutics assumes no responsibility to update or revise any forward-looking statements to reflect events, trends, or circumstances after the date they are made. It is now my pleasure to turn the floor over to Dr. Mark Hedrick, PLUS Therapeutics' president and chief executive officer. Sir, you may begin.

speaker
Dr. Mark Hedrick
President and Chief Executive Officer

Thank you, Abigail. Good afternoon, everyone, and thank you once again for taking the time to join us today as we provide an overview of recent business highlights and discuss our 2023 second quarter financial results. Joining me for the call today is Dr. Norman LaFrance, our chief medical officer, and Mr. Andrew Sims, our chief financial officer. I'll begin the call by reviewing our recent clinical and regulatory progress with a focus on the second quarter, and then turn the call over to Andrew to review our financials. And Norman will then be joining us for Q&A. I'll begin with updates on our two lead CNS cancer programs. First, an update on our respect LM trial for patients with leptomeningeal metastases or LM. In Q2, we completed enrollment in the phase one part A, that's cohorts one through three. And as is called for in the protocol, we reviewed the safety data with the FDA and they approved us to continue the part B of the phase one. specifically dose escalation from cohorts four and beyond until a DLT is observed. At the Snow ASCO CNS Cancer Conference last week in San Francisco, we reported the results from our Respect LM Phase 1 Part A trial. Recall that we've treated 10 patients with a single administration, except for one patient that received a second treatment off trial under compassionate use. It is mentioned that was in three dose escalation cohorts. Thus far, we found that rhenium obispumata circulated fully in the CSF space within minutes of injection and remained concentrated in the CSF space for at least seven days following administration. Critical organs outside the central nervous system, including blood, spleen, and liver, showed de minimis absorbed radiation doses well below critical safety levels. In contrast, Target organs in subarachnoid spinal CSF showed linear increases in absorbed dose that correlated with administered dose. In Part A, we dosed from 6.6 millicuries up to 26.4 millicuries, and we achieved absorbed doses of up to 102 gray to the ventricles and cranial subarachnoid space. So to summarize the dosing or dosimetry findings, the radiation is clearly getting to the target organs, and the off-target effects thus far are minimal through cohort three. In terms of safety, consistent with the low off-target absorbed doses, no dose-limiting toxicities have been observed. Furthermore, the overall safety profile was favorable. Approximately 83% of adverse events were mild or moderate, and the majority were not related to treatment. The favorable safety profile provided the basis for moving forward into Part B of Phase 1. However, we've also assessed whether there were disease target effects by measuring tumor cell counts, survival, and symptomatic improvement. Recently, a highly specific and sensitive CSF tumor cell enumeration technology called CNS-side assay has been approved, and we are employing it in the RESPECT-LM trial. In our view, the technology is a significant advance in CSF tumor assessment over standard of care. In part A, we found that tumor cell counts trended lower immediately after treatment and were sustained through day 28 post-treatment. At 28 days, tumor cell counts were reduced on average of 53% and up to 91% over preoperative baselines. And then generally we noted a rebound in tumor cell counts at 56 days. Our view is that effective therapies in the management of LM, such as potentially rhenium-obispo-meta, can disrupt the care of LM, but the addition of a reliable tumor cell enumeration technology can magnify that therapeutic and commercial impact. Current means of LM diagnosis, specifically the triad of imaging, clinical symptomatology, and CSF analysis of cells. We use now the old stalwarts of protein, glucose, and cytology. Both lack sensitivity and specificity. Specifically, tumor cell enumeration may allow earlier diagnosis, diagnosis of subclinical cases, and LM is about two to four times underdiagnosed, and then support decisions on redosing patients through their treatment course. Finally, in terms of survival, as of today, five of the 10 treated patients in the Phase 1 Part A are alive, and the median overall survival is at 10 months. This compares favorably with the published overall survival rates of approximately three to nine months observed with standard of care. As a note, as part of the SNO-ASCO meeting in San Francisco in which the Phase 1 data was presented, PLUS co-hosted a KOL roundtable with Dr. Justin Waltz, which also included two respect LM investigators from the University of Texas Health Sciences at San Antonio and Dr. Priya Kumtekar from the Neurology and Medicine Departments at Northwestern University's Feinberg School of Medicine. This KOL roundtable is available for replay on our website in about an hour. During the KOL roundtable, Drs. Brenner and Kumtekar provided a comprehensive discussion about the ongoing RESPECT-LM Phase 1-2a dose escalation clinical trial with emphasis on epidemiology, diagnosis, safety and tolerability, dosing, and efficacy. We urge everyone that's interested to watch the webinar for a deeper look at LM and the RESPECT clinical trial findings thus far. In terms of next steps for LM, the clinical development plan is to continue to dose escalate to the maximum tolerated dose, and in parallel, expand the phase one dose escalation trial to explore multiple dosing. This approach is critical to enhancing the potential for the clinical benefit of rinium-obispo-meta in these patients, which will require further FDA discussions. As mentioned, we did treat in Part A one patient with a second dose of rinium-obispo-meta outside the trial under compassionate use, and that patient continues to do quite well and is over a year out from her initial treatment. Now, with respect to our trial called Respect GBM for patients with recurrent glioblastoma, or GBM, we continue to enroll both our active Phase I and Phase II trials. Our phase one now has enrolled four patients in cohort eight with tumor sizes being treated in that with greater than 20 milliliters, and they were treated with an administered radiation dose of 41.5 millicuries in a treatment volume of 16.4 milliliters. We have now successfully used up to five catheters per treatment in multiple patients, and no DLTs have thus far been observed. We plan to treat six total patients in this cohort in case it's the last cohort, but we will also assess whether to continue dose escalation or make other dosing changes with an eye toward any potential amendments we might deem to make in the Phase 2 protocol. Our Phase 2 continues to enroll patients with tumor sizes of 20 cc's or less using an administered radiation dose of 22.3 millicuries in a treatment volume of 18.8 milliliters, excuse me, 8.8 milliliters. We remain on track to complete phase two enrollment by the end of 2024. In order to continue to meet our clinical trial enrollment goals, we have expanded our internal clinical team, including adding a VP of clinical operations and also adding additional select CROs to support the trials. The impact of these decisions are already being felt and will become increasingly more apparent as we end 2023 and go into 2024 and beyond. As we respect GBM trials or open-label trials, we are analyzing the data in an ongoing manner in our GBM data readouts going forward. First, we intend to publish the Phase I data of equal to 21 patients in peer-reviewed literature, and that's in process. Second, we intend to evaluate the feasibility, safety, and efficacy in the ongoing Phase I trial. The extended Phase I trial is evaluating the safety at these higher dosages and volumes as mentioned, and the impact of these higher doses and volumes on RNL distribution and tumor coverage, and then also, finally, on the effects on large tumors. And I think it should be obvious from some of the data I mentioned before in terms of volume and administered dose that we're really pushing the limits in terms of what's achievable in convection-enhanced delivery in the brain in terms of targeted radiation and volume. and that data will be presented at the Society for Neuro-Oncology meeting in November. Third, we continue to periodically assess the actively enrolling Phase II alone and in a pooled fashion with representative data from the Phase I, and that data will also be presented at the SNO meeting in November. Fourth, we have recently reported top-line data from a propensity-matched real-world data analysis of recurrent GBM patients receiving either bavucizumab or convection-enhanced delivery. That data will be used as a real-world control comparator arm for the phase one and phase two trials and also for regulatory purposes, including as it relates to potential pivotal trial design. More detailed data will be presented on the real-world propensity match trial at Snow in 2023 as well. I think we have five posters or presentations at Snow this year. In terms of the GBM program in general, we continue to demonstrate feasibility and safety without dose-limiting toxicities and promising efficacy signals as we've presented before. One thing I just wanted to highlight beyond the safety profile is what we've observed relating to the dose response data, specifically the correlation between overall survival and both increasing radiation-absorbed dose to the tumor and increasing percent coverage of the tumor volume. In summary, we have learned that for each 100 gray increase in total dose and distribution volume, the risk of death decreases by 45.6%. And for each 10% increase in the ratio of treated to total tumor volume, the risk of death decreases by 66.9%, with neither a threshold for either. Both have very low P values, and this provides us with gathering confidence that there is indeed a meaningful treatment effect. Now, in terms of our planned pediatric brain cancer trial, we have formally responded to the FDA request for additional safety data from adults, and assuming no new request, we anticipate IND approval and then moving forward with our pediatric brain cancer trial in the second half of 2023. As mentioned previously, In the past, management's practice is to rely heavily on grants or other third-party funding through Phase II for each active program. We currently have a number of grant submissions in excess of $1 million under review, including two specifically dedicated to the brain cancer program. Our second radiotherapeutic drug is making steady regulatory and development progress. We recently received feedback from the FDA on our prerequest for designation. The question is whether that drug will be deemed a device, a drug, or a combination product. Specifically, the FDA notified us that the BAM radioembolic product will be regulated as a device, primarily by CDRH. This is consistent with the two Generation 1 products that are now on the market that collectively share a market opportunity of about $1.3 billion. Obviously, the benefits of this device-based approach would be that there are established regulatory reimbursement pathways already out there and potential speed to market. In terms of drug production and manufacturing, we continue to expand and shore up existing supplier agreements and work to build in supply chain redundancy including as it relates to isotope availability. For example, we recently contracted with Pyramol Pharma Solutions to produce additional CGMP liposome intermediate products to meet the forecasted increase in demand for rhenium-186-obispo-meta for ongoing and planned clinical trials. Our view is that we are where we should be today in terms of our supply chain, and we are executing on a longer-term plan to stay ahead of the curve as we move our radiotherapeutic products closer to market. With that summary on our clinical development programs and other important company updates, I'll turn the floor over to our Chief Financial Officer, Andrew Sims, who will review the financials. Andrew?

speaker
Andrew Sims
Chief Financial Officer

Thank you, Mark. Good afternoon, everyone. Please refer to our press release issued earlier today for a summary of our financial results for the 2023 second quarter ended June 30, 2023. First, regarding the balance sheet, as of June 30, 2023, cash and cash equivalents were 10.9 million compared to 18.1 million as of December 31, 2022. In addition, this month we were notified that CPREIT released approximately 1.9 million in additional cash anticipated to flow to the company's balance sheet in August. As a reminder, the company benefits from both a $3 million NIH award for the RESPECT-GBM clinical trial through phase two and a $17.6 million award from CPRIT for the RESPECT-LM trial through phase two. Going forward in years two and three, grant funding is forecast to be $6.7 million and $7.1 million respectively. likely split into two or more advance payments each year. Furthermore, the company has discretionary or stockholder-approved access to capital from its ATM and equity line of credit of at least $49 million. Now, in the income statement, the company recognized $1.9 million of grant revenue in the second quarter of 2023, which represents CPRIG's share of costs incurred to fund a portion of our LM clinical program. Total operating expenses for the second quarter of 2023 were $3.3 million, compared to total operating expenses of $5.1 million for the same period the prior year. The decrease is due primarily to the company completing one-off investments in the GMP development of the company's lead drug, Renium-186 Abysmometa, in Q3 2022. In addition, we incurred lower legal and professional fees in 2023 versus the prior year. Interest expense decreased from $181,000 for the second quarter of 2022 to $112,000 for the second quarter of 2023. This decrease reflects the continued principal pay down on the company's Oxford debt. Net loss for the quarter of 2023 was $1.5 million or $0.59 per share compared to a net loss of $5.3 million or $3.56 per share for the same period of the prior year. And now I'll turn it back to you, Mark.

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