Calidi Biotherapeutics Announces FDA Authorization of IND for a Phase 1 Clinical Trial of NeuroNova in Patients with Recurrent High-Grade Glioma

On August 2, 2022 Calidi Biotherapeutics, Inc. (Calidi), a clinical-stage biotechnology company that is pioneering allogeneic cell-based platforms to revolutionize oncolytic virus therapies, reported that City of Hope has received U.S. Food and Drug Administration (FDA) authorization to proceed with a phase 1 physician-sponsored clinical trial that will use Calidi’s licensed oncolytic virotherapy platform, NSC-CRAd-S-pk7 (NeuroNova), a cutting-edge therapeutic candidate comprising tumor-tropic neural stem cells delivering an oncolytic adenovirus selectively to tumor sites in patients with recurrent high-grade glioma (Calidi’s NNV-2 program) (Press release, Calidi Biotherapeutics, AUG 2, 2022, View Source [SID1234617260]).

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The phase 1 physician-sponsored clinical trial will be an open-label, non-randomized, multicenter study. Once the phase 1 trial is funded, it will address the safety and tolerability of administering serial doses of NeuroNova in adult patients with recurrent histologically confirmed high-grade gliomas (WHO grade III or IV). Secondary endpoints will evaluate treatment efficacy, including progression-free and overall survival as well as any immune response to NeuroNova. This physician-sponsored study will be led by principal investigator Jana Portnow, M.D., Professor in City of Hope’s Department of Medical Oncology & Therapeutics Research and Co-Director of the Brain Tumor Program at City of Hope, a National Cancer Institute-designated comprehensive cancer center and a founding member of the National Comprehensive Cancer Network. City of Hope is one of the largest cancer research and treatment organizations in the United States.

A previously completed phase 1 dose escalation clinical trial, in newly diagnosed glioma patients, of a single dose of NSC-CRAd-S-pk7 (NeuroNova) given as an adjunct to radiation and temozolomide (Calidi’s NNV-1 program) demonstrated that NeuroNova was well tolerated in the patient population and showed promising preliminary results of efficacy [J Fares et al, Lancet Oncology, 2021, 22(8):1103-1114].

"Worldwide, an estimated 270,000 people were diagnosed with a primary brain tumor in 2020, with a five-year survival rate of only 5%. Recurrent glioma patients have poor prognosis with a median survival of less than one year. Developing our drug candidate for this indication represents a significant milestone that will empower us to help more individuals survive this devastating disease," said Calidi Biotherapeutics CEO and Chairman of the Board Allan J. Camaisa. "As Calidi undertakes this endeavor, we are pleased to have exclusive commercialization rights to this technology and thrilled to collaborate with two scientific trailblazers who have worked together on this project for over a decade: Dr. Karen Aboody, Professor in the Department of Stem Cell Biology and Regenerative Medicine, Scientific Leader of the Neuro-oncology Disease Team at City of Hope, and Dr. Maciej (Matt) Lesniak, Chair of the Department of Neurological Surgery, at Northwestern University Feinberg School of Medicine."

"Our team at City of Hope is excited to be a part of the development of NeuroNova. Despite their potential, the first-generation oncolytic virus therapies given as free virus were not very effective — most likely due to rapid inactivation by the patient’s immune system. Our new platform uses stem cells like a ‘Trojan horse’ to shield the oncolytic viral particles from immune inactivation and deliver them to the tumor sites. This results in significantly more virus distributed at the tumor sites, inducing a greater self-amplifying anti-tumor response. This may also result in a secondary anti-tumor immune response," said City of Hope’s Dr. Karen Aboody.
"In addition to significant experience with this technology, City of Hope has a proven track record in GMP manufacturing of cell and gene therapy agents."

About NeuroNova
The NeuroNova platform, NSC-CRAd-S-pk7, is an allogeneic, "off-the-shelf" therapy comprised of an immortalized Neural Stem Cell (NSC) line loaded with an engineered oncolytic adenovirus. Upon surgical resection of a tumor, NSC-CRAd-S-pk7 is injected into the walls of the resection cavity, resulting in viral infection and destruction of any remaining tumor cells. Calidi holds an exclusive worldwide licensing agreement for patents covering the NSC-CRAd-S-pk7 technology.

Blueprint Medicines Reports Second Quarter 2022 Results

On August 2, 2022 Blueprint Medicines Corporation (NASDAQ: BPMC) reported that financial results and provided a business update for the second quarter ended June 30, 2022 (Press release, Blueprint Medicines, AUG 2, 2022, View Source [SID1234617259]).

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"We are now one year into the AYVAKIT launch in advanced systemic mastocytosis (SM) and continue to see a significant expansion of our prescriber base as well as strong patient demand, reinforcing our conviction in the growth opportunity in SM," said Kate Haviland, Chief Executive Officer of Blueprint Medicines. "We are on track to announce topline data from our registration-enabling PIONEER trial in August, which will catalyze our ability to bring AYVAKIT’s transformative potential to patients living with non-advanced SM. In addition, we continue to make significant progress across our pipeline of innovative investigational medicines in EGFR-mutant and CDK2-vulnerable cancers. We look forward to sharing more about our strategic vision, including the opportunities we see in SM, EGFR-mutant lung cancer, and CDK2-vulnerable cancers, and how our expanding research platform will continue to drive innovation at an Investor Day on November 1, 2022 in New York, NY. With our strong revenue performance, a clinical-stage pipeline of five significant assets, and well over $1 billion in cash on our balance sheet as of today, we are uniquely positioned to drive near- and long-term value for all of our stakeholders by delivering transformative precision medicines to patients around the world."

Second Quarter 2022 Highlights and Recent Progress

AYVAKIT/AYVAKYT (avapritinib): systemic mastocytosis (SM) and PDGFRA gastrointestinal stromal tumor (GIST)

Reported global net product revenues of $28.5 million for the second quarter of 2022.
Presented new retrospective analyses at the European Hematology Association (EHA) (Free EHA Whitepaper) 2022 Congress, showing that AYVAKIT significantly improved overall survival in patients with advanced SM when compared to real-world data for prior best available therapies, including midostaurin and cladribine. Read the press release here.
Upon request by the FDA, changed the primary endpoint for the registrational PIONEER Part 2 trial of AYVAKIT in patients with non-advanced SM to the mean change in total symptom score (TSS).
GAVRETO (pralsetinib): RET-altered cancers

As previously recorded and reported by Roche, GAVRETO global product sales were 7 million CHF, which excludes sales in the Greater China territory driven by CStone Pharmaceuticals.
Received approval in Hong Kong, China, via the collaboration with CStone Pharmaceuticals, for the treatment of RET fusion-positive non-small cell lung cancer (NSCLC).
Corporate

Announced strategic financing collaborations with Sixth Street Partners (Sixth Street) and Royalty Pharma plc (Royalty Pharma) (NASDAQ: RPRX) for up to $1.25 billion, of which $175 million was funded as of June 30, 2022, and an additional $400 million funded in July 2022. Read the press release here.
Licensed a development candidate-stage KIT exon 13 inhibitor, and licensed the compound to IDRx, Inc., a recently launched clinical-stage biopharmaceutical company, in exchange for a 15 percent Series A preferred equity investment and up to $217.5 million in future milestone payments and tiered percentage royalty payments.
Published an inaugural Corporate Responsibility Report, highlighting the company’s long-standing commitment to delivering sustainable value to patients with cancer and blood disorders, as well as the communities in which Blueprint Medicines operates. Read the press release here and access the report here.
Announced the appointment of Habib Dable, former Chief Executive Officer of Acceleron Pharma, Inc., to the company’s Board of Directors. Read the press release here.
Key Upcoming Milestones

The company plans to achieve the following near-term milestones:

Present topline data from the registrational PIONEER Part 2 trial for avapritinib in non-advanced SM in August 2022 and submit a supplemental new drug application to the FDA for AYVAKIT in non-advanced SM in the second half of 2022.
Share the strategic vision for Blueprint, including opportunities in SM, EGFR-mutant lung cancer, and CDK2-vulnerable cancers, and how our expanding research platform has the potential to deliver the promise of precision medicine to more patients at an Investor Day on November 1, 2022 in New York, NY.
Present updated BLU-945 monotherapy data and initial dose escalation data for BLU-945 in combination with osimertinib from the Phase 1/2 SYMPHONY trial in EGFR-mutant NSCLC in the second half of 2022.
Present initial clinical data from the Phase 1/2 HARMONY trial of BLU-701 in EGFR-mutant NSCLC in the second half of 2022.
Present initial data from the HARBOR trial of BLU-263 in non-advanced SM in the second half of 2022.
Present initial clinical data from the Phase 1/2 CONCERTO trial of BLU-451 in EGFR-mutant NSCLC in the first half of 2023.
Present initial clinical data from the Phase 1/2 VELA trial of BLU-222 in CDK2-vulnerable cancers in the first half of 2023.
Second Quarter 2022 Results

Revenues: Revenues were $36.5 million for the second quarter of 2022, including $28.5 million of net product revenues from sales of AYVAKIT/AYVAKYT and $8.0 million in collaboration revenues. Blueprint Medicines recorded revenues of $27.3 million in the second quarter of 2021, including $8.5 million of net product revenues from sales of AYVAKIT/AYVAKIT, $2.9 million of net product revenues from sales of GAVRETO and $15.9 million in collaboration revenues.
Cost of Sales: Cost of sales was $4.9 million for the second quarter of 2022, as compared to $6.5 million for the second quarter of 2021.
R&D Expenses: Research and development expenses were $128.5 million for the second quarter of 2022, as compared to $80.0 million for the second quarter of 2021. This increase was primarily due to increased costs associated with the progression of our clinical trials and increased costs related to early discovery effort. Research and development expenses included $10.5 million in stock-based compensation expenses for the second quarter of 2022.
SG&A Expenses: Selling, general and administrative expenses were $58.7 million for the second quarter of 2022, as compared to $49.3 million for the second quarter of 2021. This increase was primarily due to increased costs associated with expanding our commercial infrastructure for commercialization of AYVAKIT/AYVAKYT. General and administrative expenses included $14.9 million in stock-based compensation expenses for the second quarter of 2022.
Net Loss: Net loss was $159.7 million for the second quarter of 2022, or a net loss per share of $2.68, as compared to a net loss of $108.4 million for the second quarter of 2021, or a net loss per share of $1.86.
Cash Position: As of June 30, 2022, cash, cash equivalents and investments were $947.2 million, as compared to $1,034.6 million as of December 31, 2021. Cash as of June 30, 2022, does not include $400 million gross proceeds received from our strategic non-dilutive financing agreements with Sixth Street, which closed and were funded in July 2022.
Financial Guidance

Blueprint Medicines anticipates approximately $180M to $200M in total revenues in 2022, including approximately $115M to $130M in AYVAKIT net product revenues. The company continues to expect that its existing cash, cash equivalents and investments, together with anticipated future product revenues, will provide sufficient capital to enable the company to achieve a self-sustainable financial profile.

Conference Call Information

Blueprint Medicines will host a live conference call and webcast at 8:00 a.m. ET today to discuss second quarter 2022 financial results and recent business activities. The conference call may be accessed by dialing 844-200-6205 (domestic) or 929-526-1599 (international), and referring to conference ID 694684. A webcast of the call will also be available under "Events and Presentations" in the Investors & Media section of the Blueprint Medicines website at View Source The archived webcast will be available on Blueprint Medicines’ website approximately two hours after the conference call and will be available for 30 days following the call.

Aptose Reports Results for the Second Quarter 2022

On August 2, 2022 Aptose Biosciences Inc. ("Aptose" or the "Company") (NASDAQ: APTO, TSX: APS), a clinical-stage precision oncology company developing highly differentiated oral kinase inhibitors to treat hematologic malignancies, reported financial results for the three months ended June 30, 2022 and provided a corporate update (Press release, Aptose Biosciences, AUG 2, 2022, View Source [SID1234617258]).

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The net loss for the quarter ended June 30, 2022 was $10.6 million ($0.11 per share) compared with $13.5 million ($0.15 per share) for the quarter ended June 30, 2021. The net loss for the six months ended June 30, 2022 was $22.0 million ($0.24 per share) compared with $29.7 million ($0.33 per share) for the six months ended June 30, 2021. Total cash and cash equivalents and investments as of June 30, 2022 were $62.4 million. Based on current operations, Aptose expects that cash on hand and available capital provide the Company with sufficient resources to fund planned Company operations including research and development into the first quarter of 2024.

"Our mandate at Aptose is to develop targeted kinase inhibitors to safely and effectively treat patients with deadly hematologic malignancies and to avoid the rapid emergence of drug resistance," said William G. Rice, Ph.D., Chairman, President and Chief Executive Officer. "Acute myeloid leukemia (AML) is not a single-mutation disease, but rather a highly heterogeneous cancer that can emerge from a different spectrum of genetic and epigenetic alterations in each patient. For this reason, Aptose’s lead clinical agent, HM43239, was designed as a highly targeted myeloid kinase inhibitor to suppress specific pathways operative in AML and to treat the disease in multiple subpopulations of AML, rather that treating a single target and a prescriptive subpopulation that generally leads to rapid mutational escape. The breadth of activity of HM43239 could support sizable markets in FLT3-mutated patients (including those previously treated with FLT3 inhibitors), TP53-mutated patients, NPM1-mutated/MLL-rearrangement patients and the RUNX1/DNMT3A/RAS-mutated populations. Plus, the robust safety profile of HM43239 to date supports potential use as the agent of choice for combination therapy and for use in maintenance therapy."

"Although it is very challenging to achieve complete remissions with a single agent in the relapsed/refractory (R/R) AML patient population, 239 has achieved such activity even in AML patients with highly adverse mutations," said Rafael Bejar, M.D., Ph.D., Senior Vice President and Chief Medical Officer. "Patients with FLT3 mutation who already have been failed by FLT3 inhibitors have a grim prognosis, yet our current data with HM43239, albeit early, reveal a significant response rate of about 43 percent, and this genetically- and phenotypically defined population represents a potential path for accelerated approval."

Key Corporate Highlights

Aptose Appoints Chief Financial Officer – In June, Aptose appointed Fletcher Payne to the position of Senior Vice President, Chief Financial Officer. In this role, Mr. Payne will lead Aptose’s financial operations and serve as a member of the Company’s executive management team. With a healthcare tenure of more than two decades, Mr. Payne brings to Aptose extensive experience in corporate finance, strategy and operations within the biotechnology industry. He most recently served as CFO of Syapse, where he completed several financings and oversaw accounting, finance, corporate development, and legal functions. Prior, he was CFO at Catalyst Bioscience, a publicly traded biotech company. Mr. Payne also served in a CFO capacity and senior financial positions at CytomX Therapeutics, Plexxikon Inc., Rinat Neuroscience Corporation, Dynavax Technologies Corporation, and Cell Genesys, among others.

HM43239 Remissions Across Three Safe Doses in Diverse AML Patient Populations – HM43239 (239), an oral, myeloid kinase inhibitor in an international Phase 1/2 trial in patients with R/R AML, thus far has delivered composite complete remissions (CRc) at three separate dose levels (80 mg, 120 mg and 160mg) and no drug-related discontinuations, DLTs, SAEs, QTc prolongations, or safety concern trends have been observed at these doses. Among patients treated with ≥ 80 mg HM43239, an overall response rate (ORR) of 43% has been observed for R/R AML patients with FLT3 mutations who failed prior therapy with FLT3 inhibitors. Since our KOL event on June 2nd, 2022 that highlighted the safety and efficacy of HM43239, the pace of enrollment has increased markedly and continues to enroll at the 120 mg and 160 mg dose levels, with the goals of understanding the breadth of activity of 239 in patients with diverse mutations, observing signs of additional clinical activity in certain of these patients early in their course of treatment, and identifying the most efficacious and safe doses to treat R/R AML. In addition, Aptose is now further exploring the 40 mg dose level to identify the lowest dose level that can deliver responses and exposures in the therapeutic range. Current plans take HM43239 into an Expansion Trial beginning 2H2022 as a single agent, and then combination therapy, in R/R AML patients as a planned segue into registrational trials for accelerated approval in subpopulations of R/R AML patients with high unmet medical needs.

Rapid Clinical Evaluation of Luxeptinib "G3" Formulation in Patients – Luxeptinib (Lux), a dual lymphoid and myeloid kinase inhibitor, currently is being evaluated in a Phase 1 a/b study in patients with R/R AML and higher risk MDS, and in a separate Phase 1 a/b study in patients with R/R refractory B-cell malignancies. The company is continuing to observe signs of clinical activity with the original Lux formulation, and two R/R B-cell cancer patients still on study at the 900 mg BID level have observed 35% or more in tumor reductions thus far. Aptose is ahead of schedule in the clinical evaluation of a new formulation (G3) of luxeptinib, that may enable greater exposures from a reduced pill burden and lower dosages. In the ongoing studies in AML and B-cell malignancies, a single dose of G3 formulation at four different dose levels has been administered to patients. PK profiles of the G3 formulation have been collected and computational modeling is ongoing to simulate PK parameters if G3 were dosed continuously at different dose levels and on different dosing schedules. Such studies will define how the G3 might be dosed in patients going forward.
RESULTS OF OPERATIONS

A summary of the results of operations for the three and six-month periods ended June 30, 2022 and 2021 is presented below:

The net loss for the three-month period ended June 30, 2022 decreased by $2.9 million to $10.6 million as compared with $13.5 million for the comparable period in 2021. The net loss for the six-month period ended June 30, 2022 decreased by $7.7 million to $22.0 million as compared with $29.7 million for the comparable period in 2021. Components of the net loss are presented below:

Research and Development

Research and development expenses consist primarily of costs incurred related to the research and development of our product candidates. Costs include the following:

External research and development expenses incurred under agreements with third parties, such as CROs, consultants, members of our scientific advisory boards, external labs and CMOs; and
Employee-related expenses, including salaries, benefits, travel, and stock-based compensation for personnel directly supporting our clinical trials and manufacturing, and development activities.
We have ongoing Phase 1 clinical trials for our product candidates HM43239 and luxeptinib. HM43239 was licensed to Aptose in the fourth quarter of 2021 and we have assumed sponsorship, and the related costs, of the HM43239 study effective January 1, 2022. In the fourth quarter of 2021, we discontinued the APTO-253 program and are exploring strategic alternatives for this compound.

We expect our research and development expenses to be higher for the foreseeable future as we continue to advance HM43239 and luxeptinib into larger clinical trials.

The research and development expenses for the three-month and six-month periods ended June 30, 2022, and 2021 were as follows:

Research and development expenses decreased by $2.5 million to $7.3 million for the three-month period ended June 30, 2022 as compared with $9.8 million for the comparative period in 2021. Changes to the components of our research and development expenses presented in the table above are primarily as a result of the following events:

Program costs for HM43239 were $2.3 million for the three-month period ended June 30, 2022. The Company in-licensed the development rights of HM43239 in the fourth quarter of 2021 and assumed sponsorship, and the related costs, of the study effective January 1, 2022.

Program costs for luxeptinib decreased by approximately $3.3 million, primarily due to lower manufacturing costs as a result of the current formulation requiring less API than the prior formulation and also from lower clinical trial costs, mostly related to lower contractor costs required to support the trials.

Program costs for APTO-253 decreased by approximately $931 thousand, due to the Company’s decision on December 20, 2021 to discontinue further clinical development of APTO-253.

Personnel-related expenses decreased by $125 thousand, related to fewer employees in the current three-month period and partially offset by salary increases and certain employees hired during the second half of 2021.

Stock-based compensation decreased by approximately $461 thousand in the three months ended June 30, 2022, compared with the three months ended June 30, 2021, primarily due to stock options granted with lower grant date fair values, in the current period.
Research and development expenses decreased by $3.3 million to $14.7 million for the six-month period ended June 30, 2021 as compared with $18.1 million for the comparative period in 2021. Changes to the components of our research and development expenses presented in the table above are primarily as a result of the following events:

Program costs for HM43239 were approximately $3.5 million for the six-month period ended June 30, 2022. The Company in-licensed the development rights of HM43239 in the fourth quarter of 2021 and assumed sponsorship, and the related costs, of the study effective January 1, 2022.

Program costs for luxeptinib decreased by approximately $4.5 million, primarily due to lower manufacturing costs as a result of the current formulation requiring less API than the prior formulation and also from lower clinical trial costs, mostly related to fewer contractors needed to support the trials.

Program costs for APTO-253 decreased by approximately $1.9 million, due to the Company’s decision on December 20, 2021 to discontinue further clinical development of APTO-253.

Personnel-related expenses increased by $421 thousand, mostly related to certain employees hired in 2021 to support our clinical trials and manufacturing activities, salary plan, and offset by lower personnel in the current three-month period.

Stock-based compensation decreased by approximately $893 thousand in the six months ended June 30, 2022, compared with the three months ended June 30, 2021, primarily due to stock options granted with lower grant date fair values, in the current period.
General and Administrative

General and administrative expenses consist primarily of salaries, benefits and travel, including stock-based compensation for our executive, finance, business development, human resource, and support functions. Other general and administrative expenses are professional fees for auditing and legal services, investor relations and other consultants, insurance and facility related expenses.

We expect that our general and administrative expenses will increase for the foreseeable future as we incur additional costs to support the expansion of our pipeline of activities. We also expect our intellectual property related legal expenses to increase as our intellectual property portfolio expands.

The general and administrative expenses for the three-month and six-month periods ended June 30, 2022, and 2021 were as follows:

General and administrative expenses for the three-month period ended June 30, 2022 were $3.3 million as compared with $3.7 million for the comparative period in 2021, a decrease of approximately $325 thousand. The decrease was primarily as a result of the following:

General and administrative expenses, other than stock-based compensation and depreciation of equipment, increased by approximately $613 thousand in the three months ended June 30, 2022 primarily as a result of higher salaries expenses and higher professional fees.

Stock-based compensation decreased by approximately $924 thousand in the three months ended June 30, 2022, compared with the three months ended June 30, 2021, primarily due to lower grant date fair value of options which were granted in the current period.
General and administrative expenses for the six-month period ended June 30, 2022 were $7.4 million as compared with $11.7 million for the comparative period, a decrease of approximately $4.2 million. The decrease was primarily a result of the following:

General and administrative expenses, other than share-based compensation and depreciation of equipment, increased by approximately $409 thousand in the six months ended June 30, 2021, primarily as a result of higher salaries expense and higher professional fees.

Stock-based compensation decreased by approximately $4.6 million in the six months ended June 30, 2022, compared with the six months ended June 30, 2021, primarily due to lower grant date fair value of options granted in the current period, and additional compensation recognized in the comparative period for modifications made to then vested and unvested stock options for one officer, as part of a separation and release agreement.
Conference Call and Webcast

Aptose will host a conference call today to discuss results for the quarter ended June 30, 2022:

*Please note the change in platform. Analysts interested in participating in the question-and-answer session will pre-register for the event from the participant registration link above to receive the dial-in numbers and a personal PIN, which are required to access the conference call. They also will have the option to take advantage of a new Call Me button and the system will automatically dial out to connect to the Q&A session.

The audio webcast also can be accessed through a link on the Investor Relations section of Aptose’s website here. A replay of the webcast will be available on the Company’s website for 30 days.

The press release, the financial statements and the management’s discussion and analysis for the quarter ended June 30, 2022 will be available on SEDAR at www.sedar.com and EDGAR at www.sec.gov/edgar.shtml.

Aprea Therapeutics to Participate in the 2022 Wedbush PacGrow Healthcare Conference

On August 2, 2022 Aprea Therapeutics, Inc. (Nasdaq: APRE), a biopharmaceutical company focused on developing and commercializing novel cancer therapeutics targeting DNA damage response pathways, reported that Oren Gilad Ph.D, President and Chief Executive Officer, will participate in a panel discussion on synthetic lethality at the 2022 Wedbush PacGrow Healthcare Conference on Tuesday, August 9, 2022 at 12:35 p.m. ET (Press release, Aprea, AUG 2, 2022, View Source [SID1234617257]). The panel discussion will be hosted by Robert Driscoll, Ph.D. Senior Vice President, Healthcare Equity Research Wedbush PacGrow Lifesciences.

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Apollo Endosurgery, Inc. Reports Record Global Revenue in Second Quarter 2022

On August 2, 2022 Apollo Endosurgery, Inc. ("Apollo") (Nasdaq: APEN), a global leader in less invasive medical devices for gastrointestinal and bariatric procedures, reported financial results for the second quarter ended June 30, 2022 and recent corporate highlights (Press release, Apollo Endosurgery, AUG 2, 2022, View Source [SID1234617256]).

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Second Quarter 2022 Selected Financial Results

Second Quarter and Recent Corporate Highlights
•Grew second quarter 2022 U.S. revenue by 18% and OUS revenue by 15% (23% in constant currency) over the same period in 2021;
•Grew second quarter 2022 Endoscopic Suturing System (ESS) revenue 23% (27% in constant currency) over the same period in 2021;
•Grew second quarter 2022 Intragastric Balloon (IGB) revenue 6% (9% in constant currency) over the same period in 2021;
•Increased second quarter 2022 revenue from the Company’s top 10 direct accounts by 53% over the same period in 2021;
•Received FDA De Novo marketing authorization in July 2022 for Apollo ESGTM and Apollo REVISETM, new endoscopic systems for the treatment of patients with obesity
•Announced publication of the MERIT Study on July 28, 2022 in The LANCET; and
•Appointed Sharon O’Keefe to the Board of Directors, deepening Apollo’s Board-level expertise in hospital systems and health care delivery.
"This was a solid quarter for Apollo, with record revenue driven by growth across all products, both domestic and international," said Chas McKhann, Apollo’s president and CEO. "Importantly, we also secured De Novo marketing authorization from the FDA for endoscopic sleeve gastroplasty (ESG) and endoscopic bariatric revision (REVISE). This authorization positions Apollo to play a leading role in the market for next generation weight loss solutions. We remain focused on driving our business as a whole, in addition to preparing to take advantage of our new weight loss indication in the U.S. market, which we believe will be an important growth driver."
Selected GAAP and Non-GAAP Financial Results for Second Quarter 2022 Compared to Second Quarter 2021
Total worldwide revenues of $19.3 million for the second quarter of 2022 reflected an increase of 16% compared to $16.6 million in revenue during the second quarter of 2021. Revenue results in the second quarter include $0.6 million of foreign currency impact. On a constant currency basis, total revenue in the second quarter of 2022 increased 20% compared with the prior year second quarter. Compared to the second quarter of 2021, U.S. product sales increased 18% and OUS increased 15% (or 23% on a constant currency basis).

Compared to the second quarter of 2021, total ESS product sales increased $2.4 million, or 23%, due to the continued strong demand for OverStitch and X-Tack products. Total IGB product sales increased $0.3 million compared to the prior year quarter.
Gross margin increased to 57% for the second quarter of 2022, from 55% in the second quarter of 2021, due to higher product sales resulting in overhead efficiencies and improved variable gross margin on ESS products, net of 200 basis points of foreign exchange headwinds.
Total operating expenses increased $3.2 million compared to the second quarter of 2021. The increase primarily was due to the expansion of the U.S. salesforce in the latter half of 2021, and an increase in marketing spend to drive increased revenue as the Company scales the business and focuses on driving increased utilization of its products.
Net loss for the second quarter of 2022 was $10.4 million compared to $3.0 million for the second quarter of 2021 due to changes in unrealized foreign exchange of $3.3 million between periods and the $2.9 million gain on forgiveness of PPP loan in the prior year.
Non-GAAP adjusted EBITDA, which excludes interest, taxes, depreciation, amortization, unrealized foreign exchange and stock-based compensation, and gain on forgiveness of PPP loan, in the second quarter 2022 was a loss of $4.3 million, compared to a loss of $1.9 million in the second quarter 2021.
The Company had $140.7 million in cash and committed cash at June 30, 2022, including cash, cash equivalents and restricted cash of $75.7 million.
"We continue to manage cash investment prudently, with a focus on near-term growth initiatives," said Jeff Black, Chief Financial Officer. "We saw a $2.1 million sequential improvement in cash flow over the first quarter of 2022. We exited the second quarter with a multi-year runway and clear line of sight to a cash flow break-even business."
2022 Outlook
The Company is reiterating fiscal year 2022 revenue guidance to be in the range of $73 million to $75 million, inclusive of up to $3 million in foreign currency headwinds. The Company continues to monitor the potential and uncertain impact of adverse economic conditions in the U.S. and OUS. Continued or sustained COVID-19 pandemic, inflationary or recessionary pressures could impact the Company’s ability to achieve these financial projections.
Conference Call
Apollo will host a live webcast audio call with slides today at 3:30 p.m. CT / 4:30 p.m. ET. Investors are invited to join the live call via webcast from the Investors section of the Company’s corporate website at www.apolloendo.com. An audio-only option is available is available by dialing +1-973-528-0011 and referencing access code 481278 or the "Apollo Endosurgery Second Quarter 2022 Earnings Call." Investors who opt for audio-only will need to download the related slides at www.apolloendo.com.
A replay of the webcast will be made available on Apollo’s website, www.apolloendo.com, shortly after completion of the call.