Vaxart Provides Business Update and Reports Third Quarter 2021 Financial Results

On November 4, 2021 Vaxart, Inc. (NASDAQ: VXRT) reported its business update today for the third quarter of 2021, reporting strong forward momentum in developing its oral vaccine platform consisting of tablet vaccines that it believes may revolutionize public health (Press release, Vaxart, NOV 4, 2021, View Source [SID1234594560]).

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During the third quarter, Vaxart started the first Phase II trial of its investigational COVID-19 oral tablet vaccine and dosed its first subjects. Vaxart expects the full data set from this study to be available in Q1 2022.

Duke University published the results of its study of Vaxart’s COVID-19 vaccine candidate, finding that Vaxart’s oral tablet vaccine reduced the airborne transmission of SARS-CoV-2 virus in a hamster preclinical model.

The Company also expanded its research and manufacturing capabilities, enhancing its ability to advance its pipeline of vaccine candidates.

"Vaxart made significant progress this quarter toward its goal of developing a next-generation oral tablet COVID-19 vaccine," said Andrei Floroiu, Vaxart’s Chief Executive Officer. "We have started our United States Phase II trial and anticipate beginning international trials in the near future. This is an important milestone, as our candidate is the only oral COVID-19 vaccine to progress to Phase II trials in the U.S."

"Our view has been that an oral tablet vaccine could transform how the world is protected from COVID-19 and other infections because they are easy to distribute and administer. Now we added evidence suggesting the differentiated mucosal mechanism of action could be yet another improvement over injectable alternatives," added Mr. Floroiu.

"The progress we made in our vaccine research this quarter was significant," said Dr. Sean Tucker, Vaxart’s founder and Chief Scientific Officer. "We already learned from an earlier human influenza challenge study that our oral flu vaccine candidate inhibited the shedding of viral RNA better than injectable vaccines. Our published hamster study showed that our vaccine candidate can reduce transmission of SARS-CoV-2, even when there is infection breakthrough in a vaccinated subject."

"The implications are significant because existing injected vaccines do not always protect against viral shedding and transmission to other people. A vaccine that reduces shedding and reduces the probability of infection could make a big difference in protecting lives and public health."

Recent Business Highlights

Corporate Developments

Vaxart recently brought online its own GMP manufacturing facility and is now producing vaccines at two GMP plants. This has allowed the Company to manufacture all of the COVID-19 vaccine oral tablets for the clinical trials started and planned to start this year, and to begin manufacturing vaccines for its upcoming norovirus Phase II trials.
Vaxart scaled up its research, quality and manufacturing capabilities, increasing its R&D employee headcount by more than 35% during the quarter.
The Company created two advisory boards, the Scientific and Clinical Advisory Board and the Manufacturing and Quality Advisory Board, to provide expertise as the Company grows its scientific and manufacturing capabilities.
Vaxart named Dr. James F. Cummings as its Chief Medical Officer. Dr. Cummings is a board-certified infectious disease physician with extensive experience in vaccine, drug and diagnostics development, and will help guide the Company’s development of its vaccines.
Widely respected biotech executive Dr. Julie Cherrington joined Vaxart’s Board of Directors, deepening the pool of expertise on its board.
Preclinical and Clinical

Clinical COVID-19 Vaccine Developments

Vaxart made significant progress in Q3 2021 to advance its transformative approach to vaccines.

Vaxart began dosing subjects in October for its Phase II clinical trial in the United States, which is expected to enroll 96 subjects.
The Company expects data from this study to be available during Q1 2022.
The study will be conducted with subjects split evenly between COVID-19 naïve and mRNA vaccinated subjects.
During Q4 2021, Vaxart expects to start Phase Ib clinical testing in India.
The Company expects to launch additional international clinical trials in 1H 2022.
Preclinical COVID-19 Vaccine Developments

A Duke University-led study published in bioRxiv in October showed that Vaxart’s investigational oral tablet vaccine candidate reduced the airborne transmission of SARS-CoV-2 virus in a hamster model.
These results are consistent with those from Vaxart’s Phase II human flu challenge study, which showed that Vaxart’s oral tablet flu vaccine was better at reducing shedding than the injectable flu vaccine comparator.
Vaxart’s preclinical study also demonstrated that the Company’s oral vaccine platform induces robust systemic and mucosal responses.
The study suggested that mucosal vaccines may protect not only vaccinated, but also unvaccinated animals.
Vaxart will submit the results of its nonhuman primate study for publication in Q4 2021. Results from that study prompted Vaxart to move forward with its S-only vaccine candidate in Phase II clinical trials. This S-only vaccine candidate produced better antibody responses and cross-reactivity against all variants tested than Vaxart’s S+N vaccine candidate.
Norovirus Vaccine Developments

Norovirus is a highly infectious illness that affects around 20 million Americans annually, with an annual economic impact of approximately $10.5 billion in the United States.

Vaxart has almost completed enrollment in its Phase Ib placebo-controlled, dose-ranging, repeat dose trial investigating its oral norovirus vaccine candidate in elderly subjects aged 55 to 80 years. This study is designed to evaluate the safety and immunogenicity of Vaxart’s vaccine candidate.
The Company anticipates completing enrollment in its norovirus VXA-G1.1-104 study in Q4 2021.
Vaxart is also conducting an additional norovirus vaccine study to evaluate the optimal timing for boost administration under VXA-NVV-105. This study has completed enrollment.
The Company expects initial data to be available from these studies in Q1 2022 and more complete data by Q2 2022.
Vaxart is preparing to launch its norovirus challenge study in Q1 2022 to evaluate the safety and clinical efficacy of its oral vaccine candidate.
Manufacturing Updates

As noted above, Vaxart is now producing vaccines at two GMP manufacturing plants in California, including its own GMP manufacturing facility.
As a result, Vaxart has produced the tablets for its Phase II and Phase Ib COVID-19 studies and is starting to produce norovirus vaccine for additional clinical studies.
Financial Results for the Three Months Ended September 30, 2021

Vaxart ended the quarter with cash, cash equivalents and available-for-sale debt securities of $204.0 million, compared to $198.9 million as of June 30, 2021. The increase was primarily due to net receipts of $20.3 million from the Company’s $250 million at-the-market facility entered into in October 2020 and $0.3 million from the exercise of warrants and options, partially offset by $14.2 million of cash used in operations and $1.3 million spent on property and equipment.
The Company reported a net loss of $17.6 million for the third quarter of 2021, compared to $8.1 million for the third quarter of 2020. Net loss per share for the third quarter of 2021 was $0.14, compared to a net loss of $0.08 per share in the third quarter of 2020. The increase in net loss per share was primarily due to the increase in net loss, resulting from a significant increase in research and development expenses.
Revenue for the third quarter of 2021 was $200,000, compared to $265,000 in the third quarter of 2020. The decrease was due to lower royalty revenue from sales of Inavir in Japan.
Research and development expenses were $12.4 million for the third quarter of 2021, compared to $4.6 million for the third quarter of 2020. The increase was mainly due to increases in headcount and related costs and in manufacturing and clinical trial expenses related to our COVID-19 and norovirus vaccine candidates.
General and administrative expenses were $5.0 million for the third quarter of 2021, compared to $4.2 million for the third quarter of 2020. The increase was mainly due to an increase in headcount and related costs.
About Vaxart
Vaxart is a clinical-stage biotechnology company developing a range of oral recombinant vaccines based on its proprietary delivery platform. Vaxart vaccines are designed to be administered using tablets that can be stored and shipped without refrigeration and eliminate the risk of needle-stick injury. Vaxart believes that its proprietary tablet vaccine delivery platform is suitable to deliver recombinant vaccines, positioning the company to develop oral versions of currently marketed vaccines and to design recombinant vaccines for new indications. Vaxart’s development programs currently include tablet vaccines designed to protect against coronavirus, norovirus, seasonal influenza, and respiratory syncytial virus (RSV), as well as a therapeutic vaccine for human papillomavirus (HPV), Vaxart’s first immune-oncology indication. Vaxart has filed broad domestic and international patent applications covering its proprietary technology and creations for oral vaccination using adenovirus and TLR3 agonists.

EpiVax licenses Tregitope Technology to Maruho Co., Ltd. for development of Tregitope-based Therapies to Treat Autoimmune Condition

On November 4, 2021 EpiVax, Inc. ("EpiVax") reported an important commercial licensing agreement with Maruho Co., Ltd. ("Maruho") for EpiVax’s patented Tregitope technology (Press release, EpiVax, NOV 4, 2021, View Source [SID1234594558]). This marks an exciting step for Maruho and EpiVax towards continued expansion of the Tregitope program and translation to the clinic.

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Tregitopes are immune-modulating peptides derived from human immunoglobulin. Tregitopes were first discovered in 2008 by EpiVax co-founders Dr. Anne De Groot and William Martin. EpiVax has since validated many more Tregitopes and has developed a strong Tregitope patent estate. With a wide range of therapeutic applications, Tregitopes can be co-formulated or fused to proteins to induce antigen-specific tolerance. EpiVax is currently licensing Tregitope for additional indications with commercial and academic partners. More information on the EpiVax Tregitope Platform is available here.

Similar to intravenous immunoglobulin G (IVIG) therapy, Tregitopes engage regulatory T cells and downregulate inflammation in a wide range of disease models. This mechanism of action has been studied in academic collaborations at McGill University, Harvard Medical School, and undisclosed commercial partners. There have been many peer-reviewed publications on the Tregitope platform in recent years. A full list can be found here.

Maruho will be able to leverage their Tregitope license to enhance their in-house therapeutic development strategies for autoimmune conditions. Annie De Groot MD, CEO/CSO of EpiVax, said "This agreement reflects the potential for Tregitopes, natural Treg epitopes that help regulate immune responses, to be used for the treatment of conditions that afflict patients around the world".

Castle Biosciences’ Full DecisionDx® Portfolio of Dermatologic Tests to Be Interfaced with EMA® Electronic Health Records System

On November 4, 2021 Castle Biosciences, Inc. (Nasdaq: CSTL), a company applying innovative diagnostics to inform disease management decisions and improve patient outcomes, reported its agreement with ModMed to establish an interface with ModMed’s electronic health records system, EMA (Press release, Castle Biosciences, NOV 4, 2021, View Source [SID1234594543]). The interface is designed to enable dermatologic clinicians to order Castle’s DecisionDx skin cancer tests from directly within a patient’s medical record in EMA.

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"At Castle, we are excited to facilitate the ordering of our skin cancer portfolio from directly within one of the most widely utilized dermatologic electronic health records systems, EMA," said Toby Juvenal, chief commercial officer of Castle Biosciences. "We are committed to impacting patient care, and our diagnostic tests are designed to provide clinically-actionable information to clinicians and patients to inform disease management decisions. The EMA platform has been ranked #1 by dermatologists for the past eight years by Black Book. Our interface with this system is expected to streamline the ordering process and allow for delivery of Castle’s test results within the system."

Castle’s full suite of skin cancer tests will be available to order within EMA: DecisionDx-Melanoma for cutaneous melanoma, DecisionDx-SCC for cutaneous squamous cell carcinoma and the Company’s Comprehensive Diagnostic Offering for difficult-to-diagnose melanocytic lesions (comprised of myPath Melanoma and DecisionDx DiffDx-Melanoma). Castle’s interface with EMA is expected to be complete by year-end 2021.

Wugen Announces Data Presentation at the 63rd Annual Society of Hematology (ASH) Annual Meeting

On November 4, 2021 Wugen, Inc., a clinical-stage biotechnology company developing a pipeline of off-the-shelf cell therapies to treat a broad range of hematological and solid tumor malignancies, reported it will present preclinical data on the characterization of WU-CART-007 at the 63rd Annual Meeting of the American Society of Hematology (ASH) (Free ASH Whitepaper) which will be held virtually and in-person in Atlanta, Georgia from December 11-14, 2021 (Press release, Wugen, NOV 4, 2021, View Source [SID1234594542]). The results demonstrate preclinical safety and anti-tumor activity of WU-CART-007. Wugen is preparing to begin enrollment for a Phase 1/2 clinical trial for relapsed or refractory (R/R) T-cell acute lymphoblastic leukemia (T-ALL) or lymphoblastic lymphoma (LBL) (NCT#04984356).

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The details of Wugen’s presentation at ASH (Free ASH Whitepaper) are as follows:

Title: Characterization of WU-CART-007, an Allogeneic CD7-Targeted CAR-T Cell Therapy for T-Cell Malignancies
Abstract Number: 2772
Poster session: Session 703. Cellular Immunotherapies: Basic and Translational
Date and time: Sunday, December 12, 2021, 6:00 – 8:00 p.m. ET
Location: Hall B5 (Georgia World Congress Center)
Authors: Tom Leedom, Alexander S. Hamil, Ph.D., Somayeh Pouyanfard, Jennifer Govero, Ph.D., Rachel Langland, B.Sc., Anna Ballard, Ph.D., Liz Schwarzkopf, Andrew Martens, Andrew Espenschied, Pooja Vinay, M.S., Michael James, Nitin Mahajan, Ph.D., David H. Spencer, M.D., Kenneth M. Chrobak, Ph.D., Matthew L Cooper, Ph.D., and Ayman Kabakibi, Ph.D.

Puma Biotechnology Reports Third Quarter 2021 Financial Results

On November 4, 2021 Puma Biotechnology, Inc. (Nasdaq: PBYI), a biopharmaceutical company, reported financial results for the third quarter ended September 30, 2021 (Press release, Puma Biotechnology, NOV 4, 2021, View Source [SID1234594541]). Unless otherwise stated, all comparisons are for the third quarter of 2021 compared to the third quarter of 2020.

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"Our operating results continued to be negatively impacted by the effects of COVID-19 and its limitations to our access to healthcare providers during the third quarter"

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Product revenue, net consists entirely of sales revenue from NERLYNX, Puma’s first commercial product. Product revenue, net for the third quarter of 2021 was $43.4 million, compared to product revenue, net of $49.3 million for the third quarter of 2020. Product revenue, net for the first nine months of 2021 was $138.1 million, compared to product revenue, net of $146.7 million for the first nine months of 2020.

Based on accounting principles generally accepted in the United States (GAAP), Puma reported a net loss of $44.7 million, or $1.09 per share, for the third quarter of 2021, compared to a net loss of $31.5 million, or $0.79 per share, for the third quarter of 2020. Net loss for the first nine months of 2021 was $33.4 million, or $0.82 per share, compared to a net loss of $45.0 million, or $1.14 per share, for the first nine months of 2020.

Non-GAAP adjusted net loss was $40.4 million, or $0.99 per share, for the third quarter of 2021, compared to non-GAAP adjusted net loss of $23.9 million, or $0.60 per share, for the third quarter of 2020. Non-GAAP adjusted net loss for the first nine months of 2021 was $5.0 million, or $0.12 per share, compared to non-GAAP adjusted net loss of $17.9 million, or $0.45 per share, for the first nine months of 2020. Non-GAAP adjusted net loss excludes stock-based compensation expense. For a reconciliation of GAAP net loss to non-GAAP adjusted net loss and GAAP net loss per share to non-GAAP adjusted net loss per share, please see the financial tables at the end of this news release.

Net cash provided by operating activities for the third quarter of 2021 was $10.5 million, compared to net cash provided by operating activities of $1.7 million for the third quarter of 2020. Net cash provided by operating activities for the first nine months of 2021 was $26.1 million, compared to net cash provided by operating activities of $6.4 million for the first nine months of 2020. At September 30, 2021, Puma had cash, cash equivalents and marketable securities of $87.5 million, compared to cash, cash equivalents and marketable securities of $93.4 million at December 31, 2020.

"Our operating results continued to be negatively impacted by the effects of COVID-19 and its limitations to our access to healthcare providers during the third quarter," said Alan H. Auerbach, Chairman, Chief Executive Officer and President of Puma. "Net revenue for the quarter was also negatively impacted by approximately $3.5 million due to inventory reduction at our specialty pharmacies and specialty distributors. We are encouraged with the uptake in the implementation of dose escalation of NERLYNX that was seen in the quarter, which we believe is due to the label expansion that occurred in July. We are also pleased with the continued commercial progress of NERLYNX globally, with the most recent regulatory approval received in the South Korean market by our sub-licensee Bixink Therapeutics. Our team remains committed to providing support to patients battling breast cancer, and we look forward to providing updated neratinib clinical trial data at the San Antonio Breast Cancer Symposium next month."

Mr. Auerbach added, "We anticipate the following key milestones over the next 12 months: (i) reporting top line data from the randomized cohort of the Phase II SUMMIT trial of neratinib in hormone receptor positive breast cancer that has a HER2 mutation (Q4 2021); (ii) reporting data from the Phase II INSIGhT trial of neratinib in patients with glioblastoma at the Society of NeuroOncology (SNO) Annual Meeting (Q4 2021); (iii) conducting a Type C meeting with the FDA to discuss potential for accelerated approval of neratinib in HER2-mutated hormone receptor positive breast cancer (Q4 2021); (iv) reporting data from the Phase II TBCRC-022 trial of the combination of Kadcyla plus neratinib in patients with HER2-positive breast cancer with brain metastases who have previously been treated with Kadcyla (H1 2022); (v) reporting Phase II data from the SUMMIT trial of neratinib in non-small cell lung cancer patients with EGFR exon 18 mutations (H1 2022); (vi) conducting a meeting with the FDA to discuss the potential for an accelerated approval pathway for neratinib in non-small cell lung cancer patients with EGFR exon 18 mutations who have previously been treated with an EGFR tyrosine kinase inhibitor (2022); (vii) reporting Phase II data from the SUMMIT trial of neratinib in cervical cancer patients with HER2 mutations (H1 2022); and (viii) receiving regulatory decisions for the extended adjuvant HER2-positive early stage breast cancer indication in additional countries (Q4 2021/H1 2022)."

Revenue

Total revenue consists of product revenue, net from sales of NERLYNX, license revenue and royalty revenue. For the third quarter of 2021, total revenue was $46.2 million, of which $43.4 million was product revenue, net and $2.8 million was royalty revenue. This compares to total revenue of $50.8 million for the third quarter of 2020, of which $49.3 million was product revenue, net and $1.5 million was royalty revenue. For the first nine months of 2021, total revenue was $197.8 million, of which $138.1 million was product revenue, net, $50.3 million was license revenue received from Puma’s sub-licensees, which included a $50 million upfront payment for providing development, manufacturing and commercial rights to NERLYNX in Greater China to Pierre Fabre, and $9.4 million was royalty revenue. This compares to total revenue of $172.6 million for the first nine months of 2020, of which $146.7 million was product revenue, net, $22.7 million was license revenue from Puma’s sub-licensees, and $3.2 million was royalty revenue.

Operating Costs and Expenses

Total operating costs and expenses were $55.2 million for the third quarter of 2021, compared to $62.9 million for the third quarter of 2020. Operating costs and expenses for the first nine months of 2021 were $203.3 million, compared to $191.8 million for the first nine months of 2020.

Cost of Sales

Cost of sales was $10.3 million for the third quarter of 2021, compared to $10.0 million for the third quarter of 2020. Cost of sales was $51.8 million for the first nine months of 2021, of which $20.0 million was a termination fee paid to a former sub-licensee for the return of commercial rights to NERLYNX in Greater China, compared to cost of sales of $28.4 million for the first nine months of 2020.

Selling, General and Administrative Expenses

Selling, general and administrative (SG&A) expenses were $26.1 million for the third quarter of 2021, compared to $29.6 million for the third quarter of 2020. SG&A expenses for the first nine months of 2021 were $93.8 million, compared to $89.9 million for the first nine months of 2020.

The $3.9 million increase in SG&A expenses for the first nine months of 2021 compared to the first nine months of 2020 resulted primarily from an increase in stock-based compensation of approximately $9.8 million, partially offset by decreases in payroll and related costs of approximately $1.5 million, professional fees and expenses of approximately $2.2 million, travel and meetings costs of approximately $0.6 million, and other expenses of approximately $1.3 million.

The $9.8 million increase in stock-based compensation expense for the first nine months of 2021 consisted of a $13.6 million incremental expense resulting from a modification to the term of Mr. Auerbach’s warrant and an increase of $3.4 million from new grants, partially offset by decreases of approximately $5.9 million for stock awards that have fully vested and $1.3 million from stock awards forfeited.

Research and Development Expenses

Research and development (R&D) expenses were $18.8 million for the third quarter of 2021, compared to $23.3 million for the third quarter of 2020. R&D expenses for the first nine months of 2021 were $57.7 million, compared to $73.5 million for the first nine months of 2020.

The $15.8 million decrease in R&D expenses for the first nine months of 2021 compared to the first nine months of 2020 resulted primarily from decreases in stock-based compensation expense of approximately $8.5 million, clinical trial expenses of approximately $2.6 million, internal R&D expenses of approximately $3.3 million, and consultant and contractors’ costs of approximately $1.3 million.

Total Other Expenses

Total other expenses were $35.7 million for the third quarter of 2021, compared to $19.4 million for the third quarter of 2020. Total other expenses were $27.7 million for the first nine months of 2021, compared to $25.8 million for the first nine months of 2020. The $1.9 million increase for the first nine months of 2021 compared to the first nine months of 2020 resulted primarily from an increase in debt extinguishment loss of approximately $8.1 million, partially offset by a decrease in legal verdict expense of approximately $6.2 million and other immaterial fluctuations.

Conference Call

Puma Biotechnology will host a conference call to report its third quarter 2021 financial results and provide an update on the Company’s business and outlook at 1:30 p.m. PDT/4:30 p.m. EDT on Thursday, November 4, 2021. The call may be accessed by dialing 1-888-437-3179 (domestic) or 1-862-298-0702 (international). Please dial in at least 10 minutes in advance and inform the operator that you would like to join the "Puma Biotechnology Conference Call." A live webcast of the conference call and presentation slides may be accessed on the Investors section of the Puma Biotechnology website at View Source A replay of the call will be available shortly after completion of the call and will be archived on Puma’s website for 90 days.

About Puma Biotechnology

Puma Biotechnology, Inc. is a biopharmaceutical company with a focus on the development and commercialization of innovative products to enhance cancer care. Puma in-licenses the global development and commercialization rights to PB272 (neratinib, oral), PB272 (neratinib, intravenous) and PB357. Neratinib, oral was approved by the U.S. Food and Drug Administration in 2017 for the extended adjuvant treatment of adult patients with early stage HER2-overexpressed/amplified breast cancer, following adjuvant trastuzumab-based therapy, and is marketed in the United States as NERLYNX (neratinib) tablets. In February 2020, NERLYNX was also approved by the FDA in combination with capecitabine for the treatment of adult patients with advanced or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting. NERLYNX was granted marketing authorization by the European Commission in 2018 for the extended adjuvant treatment of adult patients with early stage hormone receptor-positive HER2-overexpressed/amplified breast cancer and who are less than one year from completion of prior adjuvant trastuzumab-based therapy. NERLYNX is a registered trademark of Puma Biotechnology, Inc.

Further information about Puma Biotechnology may be found at www.pumabiotechnology.com.

Important Safety Information Regarding NERLYNX (neratinib) U.S. Indication

NERLYNX (neratinib) tablets, for oral use

INDICATIONS AND USAGE: NERLYNX is a kinase inhibitor indicated:

As a single agent, for the extended adjuvant treatment of adult patients with early stage HER2-positive breast cancer, to follow adjuvant trastuzumab-based therapy.
In combination with capecitabine, for the treatment of adult patients with advanced or metastatic HER2-positive breast cancer, who have received two or more prior anti-HER2 based regimens in the metastatic setting.
CONTRAINDICATIONS: None

WARNINGS AND PRECAUTIONS:

Diarrhea: Manage diarrhea through either NERLYNX dose escalation or loperamide prophylaxis. If diarrhea occurs despite dose escalation or loperamide, treat with loperamide, additional antidiarrheals, fluids, and electrolytes as clinically indicated. Withhold NERLYNX in patients experiencing severe and/or persistent diarrhea. Permanently discontinue NERLYNX in patients experiencing Grade 4 diarrhea or Grade ≥ 2 diarrhea that occurs after maximal dose reduction.
Hepatotoxicity: Monitor liver function tests monthly for the first 3 months of treatment, then every 3 months while on treatment and as clinically indicated. Withhold NERLYNX in patients experiencing Grade 3 liver abnormalities and permanently discontinue NERLYNX in patients experiencing Grade 4 liver abnormalities.
Embryo-Fetal Toxicity: NERLYNX can cause fetal harm. Advise patients of potential risk to a fetus and to use effective contraception.
ADVERSE REACTIONS:

The most common adverse reactions (reported in ≥ 5% of patients) were as follows:

NERLYNX as a single agent: Diarrhea, nausea, abdominal pain, fatigue, vomiting, rash, stomatitis, decreased appetite, muscle spasms, dyspepsia, AST or ALT increased, nail disorder, dry skin, abdominal distention, epistaxis, weight decreased, and urinary tract infection.
NERLYNX in combination with capecitabine: Diarrhea, nausea, vomiting, decreased appetite, constipation, fatigue/asthenia, weight decreased, dizziness, back pain, arthralgia, urinary tract infection, upper respiratory tract infection, abdominal distention, renal impairment, and muscle spasms.
To report SUSPECTED ADVERSE REACTIONS, contact Puma Biotechnology, Inc. at 1-844-NERLYNX (1-844-637-5969) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

DRUG INTERACTIONS:

Gastric acid reducing agents: Avoid concomitant use with proton pump inhibitors. Separate NERLYNX by at least 3 hours with antacids. Separate NERLYNX by at least 2 hours before or 10 hours after H2-receptor antagonists. Or separate NERLYNX by at least 3 hours with antacids.
Strong CYP3A4 inhibitors: Avoid concomitant use.
P-gp and moderate CYP3A4 dual inhibitors: Avoid concomitant use.
Strong or moderate CYP3A4 inducers: Avoid concomitant use.
Certain P-gp substrates: Monitor for adverse reactions of P-gp substrates for which minimal concentration change may lead to serious adverse reactions when used concomitantly with NERLYNX.
USE IN SPECIFIC POPULATIONS:

Lactation: Advise women not to breastfeed.
Please see Full Prescribing Information for additional safety information.

To help ensure patients have access to NERLYNX, Puma has implemented the Puma Patient Lynx support program to assist patients and healthcare providers with reimbursement support and referrals to resources that can help with financial assistance. More information on the Puma Patient Lynx program can be found at www.NERLYNX.com or 1-855-816-5421.