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Friday, January 11, 2019

JP Morgan Day 3: Replimune


Replimune (REPL) outlined of the existing problem with their immune checkpoint blockade
therapy. They explained that the majority of patients do not respond to the therapy because they
require an inflamed tumour and a pre-existing immune response to the cancer. Replimune aims
to create genetically-armed oncolytic immunotherapy products to maximally activate the
immune response against cancer in order to promote a response to immune checkpoint blockade
therapies such as anti-PD1. Officials stated that an IPO was conducted in July 2018 and they
currently have $150m, which will fund operations until H2 2021.
Replimune summarised the trials planned for the company’s most advanced oncolytic immunegene therapy, RP1, which is based on a strain of herpes simplex virus that already has a good
safety and efficacy profile demonstrated through TVEC. In collaboration with Bristol Myers
Squibb, Replimune is conducting a two-part Phase I/II trial. The first part analyses the safety and
tolerability of RPG-1 alone and then in combination with nivolumab in advanced solid tumours.
The second part analyses the efficacy of RP1 with nivolumab in four types of solid tumours in a
signal finding setting. The company has completed enrollment of the RPG-1 alone part of the
Phase I study and opened recruitment for the RPG-1 plus nivolumab part. They expect results
from the full Phase I portion of the Phase I/II trial to be released in H2 2019.
In addition, Replimune confirmed that the Phase II part will initiate in H1 2019 in patients with
melanoma and non-melanoma skin cancers, microsatellite instability high cancers and bladder
cancer. Results from this trial are expected in H2 2020 and will determine which indication they
will progress into late stage development. Officials highlighted their 50/50 cost sharing
partnership with Regeneron, where they plan to initiate a registration-directed Phase II trial in
cutaneous squamous cell carcinoma (CSCC). They pointed out that this disease has a worsening
mortality rate, which is overtaking that of melanoma. They also noted that Cemiplimab is
effective with a 50% response rate, however, the complete response rate is only 5%. As a result,
officials believe that CSCC is a good indication for initial approval of RP1 in an accelerated fashion.
The Phase II trial is set to begin in H1 2019 and will enroll approximately 240 patients, results are
anticipated for H2 2021.
Officials switched their focus from RP1 to provide an update on its pipeline product candidates
RP2 and RP3. These are similar to RP1 and deliver proteins that act as the immune response is
being generated. Replimune believes that systemic antibody approaches are suboptimal here.
They explained that RP2 expresses GALV-GP-R and GM-CSF as well as anti-CTLA-4 antibody and
aims to be used in combination with anti-PD-1/PDL-1 therapy. Officials confirmed that a Phase I
trial for RP2 alone and in combination with anti-PD1 treatment will initiate in H12019.
Furthermore, Replimune revealed that the RP3 product that will be used in Phase I trials will
express CD40L and 4-1BBL as well as anti-CTLA-4 and GALV-GP-R to promote both an innate and
adaptive immune response. Officials reiterated that a Phase I trial is expected to begin in H1
2020. The aim for these products is to target more challenging indications compared to RP1,
although these indications have not been disclosed. Finally, Replimune summarised their
manufacturing status and announced that they have leased a large facility, which is sufficient to
produce material for all commercial needs. Consequently, an additional facility will only be
needed for redundancy purpose for later stage development and commercialisation, which will
begin in H2 2020.

JP Morgan Day 3: Molecular Partners


Molecular Partners (MOLN.SW) CEO Patrick Amstutz restated several milestones achieved during
2018 and updated the expected clinical progress it expects to make with its DARPin engine
through 2019. To recap, DARPin-based drugs are 10% of the size of traditional monoclonal
antibodies, but the peptide sequences enable high affinity and low immunogenicity against the
specified targets, while also having a tunable half-life. The proof-of-concept for this technology is
being provided by abicipar in wet AMD, which is a relatively simple DARPin that binds vascular
endothelial growth factor (VEGF) and has a polyethylene tail that allows for extended dosing
intervals compared to marketed drugs such as Lucentis.
Molecular Partners and its partner Allergan are planning to file abicipar for approval in wet AMD
from H1 2019. This will include data from the MAPLE study, which is investigating an optimized
product that will theoretically reduce the 15% rate of intraocular inflammation seen in the Phase
III SEQUOIA and CEDAR studies. Looking beyond wet AMD, Phase III testing in DME is expected to
begin during H2 2019. Marketed anti-VEGF ophthalmological products are approved across a
range of neovascular retinal disorders, so this subsequent expansion to DME is important to
increase abicipar’s overall competitiveness.
The wholly-owned multi-targeting DARPin antagonist MP0250 was also presented at length, and
specifically the opportunity within multiple myeloma. Binding human serum albumin (HSA),
hepatocyte growth factor (HGF) and VEGF, MP0250 is hypothesized to block escape pathways
and innate resistance against standard-of-care drugs, thus positioning itself as a later-line
treatment. This year, Molecular Partners expects data from the ongoing Phase II multiple
myeloma and EGFR-mutated NSCLC studies, as well as initiating a new multiple myeloma study in
combination with immunomodulatory drugs such as Revlimid, Pomalyst and Otezla.
Lastly, Molecular Partners highlighted its first immuno-oncology candidate MP0310, which is
intended to overcome the dose-limiting systemic toxicity of current 4-1BB agonists. The drug is
partnered to Amgen in a $50m upfront deal and will benefit from the company’s rich portfolio of
bi-specific T cell engagers. First-in-human trials are expected to start in H2 2019.

JP Morgan Day 3: Five Prime


Five Prime Therapeutics (FPRX) provided an overview of five assets, one in a pivotal Phase III trial
(bemarituzumab), one in a Phase II trial (cabiralizumab) and three others in Phase I development.
Bemarituzumab (bema) is a first-in-class antibody specific for FGFR2b, a splice variant of the
fibroblast growth factor receptor FGFR2 expressed on tumor cells. Bema blocks growth factor
binding to FGFR2b and also targets the tumor cells for killing by ADCC. FGFR2 gene amplification
is seen in about 10% of gastric cancer patients and is associated with significantly reduced
survival (2-year OS of 48.1% vs 19.8%). A pivotal Phase III trial (FIGHT) was initiated in September
2018 and is evaluating Bema + chemotherapy (modified FOLFOX6) compared to placebo +
chemotherapy in front-line FGFR2B overexpressing gastric cancer and gastroesophageal junction
(GEJ) cancer. Safety lead-in data for this trial is expected next week at the ASCO-GI meeting.
Cabiralizumab (cabira) is an antibody that blocks the Colony Stimulating Factor 1 Receptor (CSF1-
R) present on tumor activated macrophages (TAMs) and is being developed in collaboration with
BMS. Binding of cabira to CSF1-R leads to depletion of TAMs. Similar to PD-L1 on tumor cells but
using a different mechanism, TAMs can inhibit cytotoxic T cells and high TAM levels are
associated with poor prognosis in pancreatic and other cancers. In March 2018, BMS initiated an
open label Phase II study of cabira administered in combination with Opdivo with and without
chemotherapy in patients with second-line pancreatic cancer. This study is expected to complete
enrollment in 2019 (40 patients in each of 4 arms) and is designed to generate data supporting a
front-line or second-line pivotal study. In 2018 BMS also expanded cabira development within
pancreatic (including combinations with radiotherapy, anti-CD40 antibodies or gemcitabine) and
into other tumor settings (including melanoma, NSCLC, RCC and in January 2019, biliary tract
cancer).
FPA150 is an antibody that inhibits activity of B7-H4, a checkpoint inhibitor that is related to PDL1 and is present on tumor cells. This first-in-class therapy is wholly owned by Five Prime. B7-H4
is expressed in multiple solid tumors that are not well served by current checkpoint inhibitors.
Moderate to high levels of B7-H4 have been reported in approximately 60% of patients with
breast cancer and 50% of patients with ovarian and endometrial cancer. There is very little
expression on normal tissue. FPA150 is currently being evaluated in a Phase Ia/Ib trial evaluating
monotherapy activity in patients with B7-H4 overexpressing tumors. Phase Ia dose escalation
was initiated in March 2018 (any solid tumor) and an exploratory cohort with a basket of B7-H4
overexpressing tumors was initiated in October 2018. Once an optimal dose has been identified
(1H of 2019), the trial will expand to Phase Ib and will enroll patients with breast (HR+/HER2- and
TNBC), ovarian and endometrial cancers with B7-H4 overexpression. Data from the dose
escalation cohort will be presented at ASCO (Q2 2019) while data from the exploratory cohort is
expected to be presented at ESMO (Q4 2019).
FPT155 is a first-in-class CD80-Fc fusion protein. CD80 is a co-stimulatory molecule expressed on
antigen presenting cells and which binds CD28 on T cells to provide the co-stimulatory signal
required for T cell activation (in addition to MHC-TCR binding). FPT155 is designed to bind the
antigen presenting cell (through the IgG1 Fc moiety) and CD-28 present on T cells to enhance costimulation of T cells without superagonism. A Phase Ia/Ib trial initiated in Australia in November
2018 enrolling patients with any solid tumor to look for monotherapy activity. An exploratory
cohort with a basket of solid tumors is planned and once an optimal dose is identified the trial will
expand to Phase Ib with select solid tumor cohorts. Phase I data will be presented at a medical
conference in 2H 2019.
The final asset presented was BMS-986258 an antibody to TIM3 licensed to BMS. TIM3 is an
immune checkpoint receptor and BMS-986258 was designed to block interaction between TIM3
and phosphatidylserine, a key lipid found in the tumor microenvironment. A Phase I/II clinical
trial initiated in March 2018 and starts with a dose escalation of BMS-986258 (arm A), BMS986258 + rHuPH20 (arm A1) and BMS-986258 + Opdivo (arm B). The Phase II portion of the trial
will evaluate BMS-986258 + Opdivo (arm C). BMS-986258 is the first of three candidates from
the IO research collaboration with BMS. The collaboration provides for up to $300 million in
milestone payments per collaboration product and tiered royalties.
As of December 31st 2018, Five Prime has $270 million in cash, cash equivalent and marketable
securities. FY 2019 operating activities are estimated at $117-122 million and EOY 2019 cash is
estimated at $148-153 million not including any milestone payments.

JP Morgan Day 3: AMAG


AMAG Pharmaceutical’s (AMAG) presentation highlighted that compared to guidance issued a
year ago, preliminary 2018 financial results exceeded their earlier expectations by $64M on the
top-line and $50M on the bottom line, with total revenue expected to be $471-476m and
adjusted EBITDA at $115-125m. They had announced earlier in the week, though, that there had
been a negative impact from temporary supply constraints for Makena, which has also been
hampered by the entry of generics in 2018, though the supply constraints have been resolved.
The company stressed the successful performance of intravenous iron therapy, Ferraheme, which
experienced 30% in growth in 2018, bringing in $135m in net revenue. Initially approved for
anemia due to chronic kidney disease, Ferraheme received FDA label expansion in Feb 2018 for
patients with iron-deficiency anemia who cannot tolerate oral iron formulations, further
increasing its market potential.
Whilst generic versions of the first-generation, intramuscular formulation of Makenna have been
on the market for around six months, AMAG have held approximately 50% of the entire Makena
product volume with the second-generation branded SC auto-injector. Furthermore, AMAG’s
authorised generic partner maintained a significant share of the generic Makena market,
approximately 50% in Q4 2018. So while the franchise had preliminary Q4-2018 net revenues of
$46-48m, down from $80.2m in Q3 2018 (partly due to a supply constraint, as noted above), the
company felt the SC auto-injector has stabilized the franchise and going forward, despite the
introduction of more generics, they expected continued Makena revenues for 2019 of around
$40-50m/quarter. The resolution of the supply constraint would give some boost in January and
there may be share gains for the SC autoinjector, but these would be offset by price pressures.
In women’s health, the company highlighted Intrarossa as a key future cash driver. Following its
launch in July 2017 in moderate to severe dyspareunia due to menopause, the company
announced 2018 annual revenues of $15-16m, with strong and growing physician and patient
support for the therapy driven by the direct-to-consumer campaign. Looking forward, AMAG also
anticipate a commercial launch for Vyleesi in 2H 2019, their investigational product for low sexual
desire/libido associated with distress, following positive results from two large Phase III trials.
With the condition affecting approximately 12 million women in the US, AMAG predicts an annual
peak revenue opportunity of more than $700m for the therapy. In pre-eclampsia, the company
also highlighted the future potential of orphan therapy, AMAG-423, which demonstrated positive
results in a small Phase II trial and is currently enrolling patients in a larger Phase III study. Topline data for the trial is expected in 1H 2020, with an FDA approval and commercial launch
anticipated in 1H 2021.
The company also reported on the recent acquisition of Phase II pipeline agent, Ciraparantag, a
next-generation broad spectrum reversal agent for the novel oral anticoagulants (NOACs). With
200,000 patients per year estimated to require urgent reversal of NOAC treatment, AMAG
approximates an annual US peak revenue opportunity of more than $500m for the therapy.
AMAG plans to initiate a Phase IIIa trial for Ciraparantag in H2 2019.
With $400m of cash and securities as of December 2018, the company continues to explore
licensing/acquiring long-lived, durable products.

JP Morgan Day 3: Novocure


Following a positive Q4 2018 preliminary revenue announcement days before their JPM 2019
presentation ($69.6m Q4, $248m for 2018), Novocure (NVCR) began with a review regarding
Optune’s adoption in 2018. The company emphasized a more than 40% growth in prescriptions
for newly diagnosed glioblastoma, a promising collaboration with Zai Lab to accelerate clinical
trial enrollment in China, and approval for national reimbursement in Sweden, which the
company views as a positive signal for reimbursement in other European markets. The company
also submitted a HDE application to the FDA for unresectable malignant pleural mesothelioma in
2018 and is optimistic about an approval and launch in the US in 2019. Leading up to 2022, the
company expects readouts for Optune in several indications, including for the HEPANOVA trial in
liver cancer, the LUNAR trial for non-small cell lung cancer (NSCLC), the METIS trial for brain
metastases arising from NSCLC, the PANOVA-3 in pancreatic cancer, and the INNOVATE-3 trial in
ovarian cancer.

Goldman Sachs Adds Iqvia To Its ‘Conviction Buy’ List


For the second time in a week, Goldman Sachs updated its Conviction Buy list, this time adding Iqvia Holdings Inc IQV 0.47%.

The Analyst

Goldman analyst Robert Jones reiterated his Buy rating for Iqvia and lowered his price target from $152 to $151.

The Thesis

The outlook for contract research organizations like Iqvia is strong heading into 2019.
Jones said Iqvia has the most upside in the CRO group due to its attractive valuation and its potential to beat consensus revenue estimates in coming quarters. He said Iqvia will hit an inflection point on revenue growth this year, and the stock currently trades at a discount to peers and its own multiple in terms of its two-year forward PEG ratio.
In addition, Jones said a reduction in secondary offerings should help stabilize the stock and pave the way for a decline in net leverage.
Jones says some CRO investors are concerned about the potential for a slowdown in biotech demand, are worried about the durability of CRO backlogs given large-scale pharma M&A and are troubled by the possibility of a global macro slowdown. However, he says Iqvia is well-positioned despite the concerns.
“IQV is the best positioned on exposure to customer concentration (a concern relating to Pharma M&A) and ‘emerging biotech’ vs CRO peers – 2 areas of investor concern for the group,” he wrote in the note.
Jones said public/private funding, R&D growth and FDA approvals, three drivers of demand growth for CROs, are all looking healthy at the moment.

JP Morgan Day 3: Supernus


Supernus’ (SUPN) CEO Jack Khattar began by giving an update on the company’s financials with
2018 net sales guidance around $388-395M based mainly on strong prescription growth of
Trokendi XR and Oxtellar XR, and a total 2018 projected operating income of $120-125M. Annual
Trokendi XR and Oxtellar XR prescriptions grew by 36% and 12%, respectively, from 2017 owing
to their positive differentiating factors as compared to other products within the neurology
market.
Management further highlighted the Company’s lead pipeline candidates SPN-812 for the
treatment of ADHD and SPN-810 for impulsive aggression, both of which are in Phase III
development. For both drugs, the company is currently developing strong IP with expected
patient expirations in 2029-2033. While SPN-812 is already used in the EU as a successful
antidepressant, Supernus has completed three positive Phase III trials in children/adolescents
demonstrating that the norepinephrine reuptake inhibitor is a clinically efficacious in the
treatment of ADHD. One Phase III trial (P304 Study) is ongoing and top-line data is expected in Q1
2019. Management emphasized that the primary endpoints were met in all three Phase III trials
supported by positive and strong P-values. Significantly, the non-stimulating drug consistently
demonstrates a fast onset of action and works from Week 1, which will be a key differentiating
factor. SPN-812 is also well-tolerated and is efficacious in reducing both hyperactivity and
inattention, something which management believes will further differentiate it from potential
competitors. Company guidance predicts a peak market share of 5-10% with 4.5-10M potential
prescriptions of SPN-812.
With no approved therapies for impulsive aggression, Supernus presented a positive outlook for
its dopamine-2 receptor targeted pipeline candidate, SPN-810. Impulsive aggression occurs
across ADHD, autism, bipolar disorder, and PTSD, representing a $6.3B market opportunity. SPN810 has Fast Track Designation and is currently in three ongoing Phase III trials. Supernus stated
that data from the P301 and P302 trials in pediatric patients are expected in the second half of
2019, and data from the P503 trial in adolescents will be released in 2020.