On July 25, 2017 Eli Lilly and Company (NYSE: LLY) reported financial results for the second quarter of 2017 (Press release, Eli Lilly, JUL 25, 2017, View Source [SID1234519864]). Schedule your 30 min Free 1stOncology Demo! $ in millions, except per share dataSecond Quarter%
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2017
2016Change
Revenue$5,824.3
$5,404.8
8%
Net Income – Reported1,008.0
747.7
35%
EPS – Reported0.95
0.71
34%
Net Income – Non-GAAP1,177.4
908.8
30%
EPS – Non-GAAP1.11
0.86
29%
Certain financial information for 2017 and 2016 is presented on both a reported and a non-GAAP basis. Some numbers in this press release may not add due to rounding. Reported results were prepared in accordance with generally accepted accounting principles (GAAP) and include all revenue and expenses recognized during the periods. Non-GAAP measures exclude the items described in the reconciliation tables later in the release. The company’s 2017 financial guidance is also being provided on both a reported and a non-GAAP basis. The non-GAAP measures are presented to provide additional insights into the underlying trends in the company’s business.
"Lilly delivered strong revenue growth in the second quarter, building on the momentum of Trulicity, Taltz and the other new products in our portfolio," said David A. Ricks, Lilly’s chairman, president and CEO. "To deliver on our mission and maximize our opportunity, we have four key priorities — launching with excellence, replenishing the pipeline, driving productivity, and building talent and capability in our core areas of focus."
Today the company is providing an update to its oncology research and development strategy. In addition to building upon new oncology products such as Cyramza (ramucirumab), Lartruvo (olaratumab) and abemaciclib, Lilly will pursue new standard-of-care changing therapies that target tumor dependencies in molecularly enriched populations, build rational combinations that overcome resistance, and develop next-generation immunotherapies. Using this framework, Lilly will now focus on seven pipeline assets for priority internal development and three additional assets which are pending data from ongoing trials. The company has or will seek external partners on the other molecules in clinical development as appropriate.
Additional details will be provided in the company’s 2017 second-quarter earnings call.
Key Events Over the Last Three Months
Regulatory
· The U.S. Food and Drug Administration (FDA) granted Priority Review designation for abemaciclib, a cyclin-dependent kinase (CDK) 4 & 6 inhibitor. The company’s submission of abemaciclib includes two indications: abemaciclib monotherapy for patients with hormone-receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer who had prior endocrine therapy and chemotherapy for metastatic disease; and abemaciclib in combination with fulvestrant in women with HR+, HER2- advanced breast cancer who had disease progression following endocrine therapy.
· The FDA granted Fast Track designation for tanezumab for the treatment of chronic pain in patients with osteoarthritis and chronic low back pain. Tanezumab, which is being studied in collaboration with Pfizer, is an investigational humanized monoclonal antibody that selectively targets, binds to and inhibits nerve growth factor.
· The company and Incyte announced that a resubmission to the FDA for the New Drug Application (NDA) for baricitinib, a once-daily oral medication for the treatment of moderate-to-severe rheumatoid arthritis, will be delayed beyond 2017. The companies will be further discussing the path forward with the agency and evaluating options for resubmission, including the potential for an additional clinical study, as requested by the FDA. The length of time to a resubmission for the NDA will depend on which option the companies pursue and further FDA discussions, but is anticipated to be a minimum of 18 months.
· Japan’s Ministry of Health, Labor and Welfare granted marketing approval for Olumiant (baricitinib) 2-mg and 4-mg tablets for the treatment of rheumatoid arthritis (including the prevention of structural injury of joints) in patients with inadequate response to standard-of-care therapies. Olumiant is part of a collaboration with Incyte.
Clinical
· The company announced that galcanezumab, an investigational treatment for the prevention of episodic and chronic migraine, met its primary endpoint in three Phase 3 studies demonstrating statistically significant reductions in the number of monthly migraine headache days compared to placebo at both studied doses.
· The company announced that a Phase 3 study of Cyramza met its primary endpoint of progression-free survival, demonstrating a statistically significant improvement. The Phase 3 global, randomized, double-blinded, placebo-controlled trial is evaluating ramucirumab in combination with docetaxel in patients with locally advanced or unresectable or metastatic urothelial carcinoma whose disease progressed on or after platinum-based chemotherapy.
· The company passed an interim analysis in a Phase 3 study of lanabecestat in patients with early Alzheimer’s disease. As a result, Lilly will make a $50 million milestone payment in the third quarter of 2017 as part of the company’s collaboration with AstraZeneca.
Business Development/Other
· The UK Supreme Court has decided in the litigation relating to alternative salt forms of Alimta (pemetrexed disodium) that Actavis’s products directly infringe Lilly’s vitamin regimen patents in the UK, France, Italy and Spain. The UK Supreme Court also affirmed the indirect infringement finding by the UK Court of Appeal.
· The company entered into a settlement agreement with generic companies to resolve pending patent litigation in the U.S. District Court for the Eastern District of Virginia regarding the Cialis (tadalafil) unit dose patent. This patent was set to expire on April 26, 2020. As part of the agreement, Cialis exclusivity is now expected to end at the earliest on September 27, 2018.
· The company and Nektar Therapeutics announced a strategic collaboration to co-develop NKTR-358, a novel immunological therapy discovered by Nektar. NKTR-358, which achieved first human dose in Phase 1 clinical development in March of 2017, has the potential to treat a number of autoimmune and other chronic inflammatory conditions. Subject to clearance under the Hart-Scott-Rodino Antitrust Improvements Act and other customary closing conditions, Lilly expects to provide an initial payment of $150 million to Nektar in 2017.
· The company and KeyBioscience entered into a new collaboration focused on the development of Dual Amylin Calcitonin Receptor Agonists (DACRAs), a potential new class of treatments for metabolic disorders such as type 2 diabetes. Lilly will provide an initial payment of $55 million to KeyBioscience in the third quarter of 2017.
· The company and Purdue University announced a strategic collaboration to conduct life science research in a five-year agreement, where Lilly will provide up to $52 million.
· The company announced completion of a $90 million expansion of its Biotechnology Center in San Diego, California. Lilly’s new space will help foster and accelerate the discovery of medicines within the company’s core therapeutic areas of immunology, diabetes, oncology and neurodegeneration, as well as the emerging area of pain.
Second-Quarter Reported Results
In the second quarter of 2017, worldwide revenue was $5.824 billion, an increase of 8 percent compared with the second quarter of 2016. The revenue increase was driven by a 5 percent increase due to volume and a 4 percent increase due to realized prices, partially offset by a 1 percent decrease due to the unfavorable impact of foreign exchange rates. The increase in worldwide volume was largely due to 8 percent pharmaceutical growth driven by Trulicity and other new products, including Taltz, Basaglar, Jardiance, Lartruvo and Cyramza. These volume increases were partially offset by decreased volumes for Cialis, Zyprexa, Alimta and Strattera. The increase in realized prices was primarily driven by Cialis and Forteo. Revenue decreased for animal health products, despite the inclusion of $78.3 million in revenue from the acquisition of Boehringer Ingelheim Vetmedica’s U.S. feline, canine and rabies vaccine portfolio.
Revenue in the U.S. increased 15 percent, to $3.324 billion, due to higher realized prices for several pharmaceutical products, primarily driven by Cialis and Forteo, and increased volume for new pharmaceutical products, driven by Trulicity, Taltz, Basaglar, Jardiance and Lartruvo. The increase in revenue was partially offset by decreased volume for several established pharmaceutical products, including Cialis and Strattera, as well as decreased revenue for animal health products.
Revenue outside the U.S. decreased 1 percent, to $2.500 billion, due to the loss of exclusivity of Zyprexa in Japan and Cymbalta in Canada and Europe, as well as increased competition, lower realized prices and loss of exclusivity for Alimta in several countries. The unfavorable impact of foreign exchange rates and decreases for food and companion animal products also contributed to lower revenue. These declines were largely offset by increased volume for several new pharmaceutical products, including Trulicity and Cyramza.
Gross margin increased 8 percent, to $4.273 billion, in the second quarter of 2017 compared with the second quarter of 2016. Gross margin as a percent of revenue was 73.4 percent, an increase of 0.5 percentage points compared with the second quarter of 2016. The increase in gross margin percent was primarily due to higher realized prices and manufacturing efficiencies, partially offset by negative product mix and higher expenses to support new pharmaceutical products.
Operating expenses in the second quarter of 2017, defined as the sum of research and development, and marketing, selling and administrative expenses, remained flat at $2.958 billion. Research and development expenses decreased 6 percent, to $1.251 billion, or 21.5 percent of revenue. This decrease was driven primarily by a $100.0 million charge in the second quarter of 2016, related to a development milestone for lanabecestat, an oral beta secretase cleaving enzyme (BACE) inhibitor currently in development with AstraZeneca as a potential treatment for early Alzheimer’s disease. Marketing, selling and administrative expenses increased 5 percent, to $1.707 billion, due to increased expenses related to new pharmaceutical products, partially offset by decreased expenses related to late life-cycle products. Operating expenses were 50.8 percent of revenue in the second quarter of 2017, a reduction of 3.9 percentage points compared with the second quarter of 2016, as a result of higher revenue and flat operating expenses.
In the second quarter of 2017, the company recognized asset impairment, restructuring and other special charges of $50.0 million. The charges are primarily associated with integration costs and asset impairments related to the acquisition and integration of Novartis Animal Health. In the second quarter of 2016, the company recognized asset impairment, restructuring and other special charges of $58.0 million, composed of integration costs, severance costs and asset impairments related to the acquisition and integration of Novartis Animal Health.
Operating income in the second quarter of 2017 was $1.264 billion, an increase of $341.1 million compared with the second quarter of 2016, primarily driven by higher gross margin.
Other income (expense) was expense of $3.9 million in the second quarter of 2017, compared with income of $21.2 million in the second quarter of 2016.
The effective tax rate was 20.0 percent in the second quarter of 2017, compared with 20.8 percent in the second quarter of 2016.
In the second quarter of 2017, net income increased 35 percent, to $1.008 billion, and earnings per share increased 34 percent, to $0.95, compared with $747.7 million and $0.71, respectively, in the second quarter of 2016. The increases in net income and earnings per share were primarily driven by higher operating income.
Second-Quarter Non-GAAP Measures
On a non-GAAP basis, second-quarter 2017 gross margin increased 9 percent, to $4.465 billion. Gross margin as a percent of revenue was 76.7 percent, an increase of 0.7 percentage points compared with the second quarter of 2016. The increase in gross margin percent was primarily due to higher realized prices and manufacturing efficiencies, partially offset by negative product mix and higher expenses to support new pharmaceutical products.
Operating expenses were 50.8 percent of revenue in the second quarter of 2017, a reduction of 3.9 percentage points compared with the second quarter of 2016, as a result of higher revenue and flat operating expenses.
Operating income increased $358.6 million, or 31 percent, to $1.509 billion in the second quarter of 2017, due to higher gross margin.
The effective tax rate was 21.7 percent in the second quarter of 2017, compared with 22.4 percent in the second quarter of 2016.
In the second quarter of 2017, net income increased 30 percent, to $1.177 billion, and earnings per share increased 29 percent, to $1.11, compared with $908.8 million and $0.86, respectively, in the second quarter of 2016. The increases in net income and earnings per share were driven by higher operating income.
For further detail of non-GAAP measures, see the reconciliation below as well as the Reconciliation of GAAP Reported to Selected Non-GAAP Adjusted Information table later in this press release.
Second Quarter
2017
2016% Change
Earnings per share (reported)$0.95
$0.71
34%
Amortization of intangible assets.12
.11
Asset impairment, restructuring and other special charges.03
.04
Inventory step up costs associated with the acquisition of Boehringer Ingelheim Vetmedica’s U.S. feline, canine and rabies vaccine portfolio.01
—
Earnings per share (non-GAAP)$1.11
$0.86
29%
Numbers may not add due to rounding.
Year-to-Date Results
For the first six months of 2017, worldwide revenue increased 8 percent, to $11.053 billion, compared with $10.270 billion in the same period in 2016. Reported net income and earnings per share were $897.2 million and $0.85, respectively. Net income and earnings per share, on a non-GAAP basis, were $2.217 billion and $2.10, respectively.
Year-to-Date Non-GAAP Measures
For further detail of non-GAAP measures, see the reconciliation below as well as the Reconciliation of GAAP Reported to Selected Non-GAAP Adjusted Information table later in this press release.
Year-to-Date
2017
2016% Change
Earnings per share (reported)$0.85
$1.12
(24)%
Acquired in-process research and development.81
—
Amortization of intangible assets.23
.22
Asset impairment, restructuring and other special charges.19
.16
Inventory step up costs associated with the acquisition of Boehringer Ingelheim Vetmedica’s U.S. feline, canine and rabies vaccine portfolio.02
—
Venezuela charge—
.19
Earnings per share (non-GAAP)$2.10
$1.69
24%
Numbers may not add due to rounding.
Select Revenue Highlights
(Dollars in millions)Second Quarter
Year-to-Date
Established Pharmaceutical Products2017
2016
% Change
2017
2016
% Change
Humalog$678.4
$701.9
(3)%
$1,386.8
$1,308.2
6%
Cialis627.3
630.5
(0)%
1,160.9
1,207.2
(4)%
Alimta532.9
607.1
(12)%
1,022.8
1,171.3
(13)%
Forteo446.7
367.6
22%
794.2
686.3
16%
Humulin357.8
332.3
8%
672.3
688.7
(2)%
Strattera186.6
224.6
(17)%
382.8
412.7
(7)%
Cymbalta206.6
236.5
(13)%
381.2
435.2
(12)%
Erbitux159.1
180.6
(12)%
313.5
348.6
(10)%
Zyprexa140.8
210.7
(33)%
288.3
423.4
(32)%
Effient142.9
135.1
6%
270.7
266.6
2%
New Pharmaceutical Products
Trulicity480.2
201.3
139%
853.1
344.9
147%
Cyramza186.3
147.0
27%
357.6
278.0
29%
Taltz138.7
19.3
618%
235.4
19.3
1,118%
Jardiance(a)103.2
40.1
157%
177.1
78.3
126%
Basaglar86.6
16.3
432%
132.6
27.2
388%
Lartruvo47.4
—
NM
89.5
—
NM
Olumiant4.8
—
NM
6.6
—
NM
Portrazza2.3
4.0
(43)%
5.9
5.7
3%
Subtotal1,049.5
428.0
145.2%
1,857.8
753.4
146.6%
Animal Health784.8
859.8
(9)%
1,554.2
1,614.4
(4)%
Total Revenue5,824.3
5,404.8
8%
11,052.6
10,269.9
8%
(a) Jardiance includes Glyxambi and Synjardy
NM – not meaningful
Numbers may not add due to rounding
Selected Established Pharmaceutical Products
Humalog
For the second quarter of 2017, worldwide Humalog revenue decreased 3 percent compared with the second quarter of 2016, to $678.4 million. Revenue in the U.S. decreased 7 percent, to $390.4 million, due to lower realized prices and, to a lesser extent, decreased volume. Revenue outside the U.S. increased 2 percent, to $288.0 million, driven by increased volume and, to a lesser extent, higher realized prices, partially offset by the unfavorable impact of foreign exchange rates.
Cialis
For the second quarter of 2017, worldwide Cialis revenue remained flat at $627.3 million. U.S. revenue of Cialis was $381.0 million in the second quarter, a 1 percent decrease compared with the second quarter of 2016, driven by decreased demand offset almost entirely by higher realized prices. Revenue of Cialis outside the U.S. remained flat at $246.3 million, driven by the unfavorable impact of foreign exchange rates and decreased volume, almost entirely offset by higher realized prices.
Alimta
For the second quarter of 2017, Alimta generated worldwide revenue of $532.9 million, which decreased 12 percent compared with the second quarter of 2016. U.S. revenue of Alimta decreased 6 percent, to $274.3 million, driven by decreased demand due to competitive pressure, partially offset by higher realized prices. Revenue outside the U.S. decreased 18 percent, to $258.6 million, driven by increased competition, lower realized prices, loss of exclusivity in several countries and, to a lesser extent, the unfavorable impact of foreign exchange rates.
Forteo
Second-quarter 2017 worldwide revenue for Forteo was $446.7 million, a 22 percent increase compared with the second quarter of 2016. U.S. revenue increased 34 percent, to $249.8 million, driven by higher realized prices and, to a lesser extent, increased volume. Revenue outside the U.S. increased 9 percent, to $196.9 million, driven by increased volume and, to a lesser extent, higher realized prices, partially offset by the unfavorable impact of foreign exchange rates.
Humulin
Worldwide Humulin revenue for the second quarter of 2017 increased 8 percent compared with the second quarter of 2016, to $357.8 million. U.S. revenue increased 11 percent, to $226.5 million, driven by higher realized prices and, to a lesser extent, increased volume. Revenue outside the U.S. increased 3 percent, to $131.3 million, driven by increased volume, partially offset by lower realized prices and, to a lesser extent, the unfavorable impact of foreign exchange rates.
Selected New Pharmaceutical Products
Trulicity
Second-quarter 2017 worldwide Trulicity revenue was $480.2 million. U.S. revenue was $380.9 million, driven by growth in the GLP-1 market and increased share of market for Trulicity. Revenue outside the U.S. was $99.3 million, primarily driven by uptake in Europe and Japan.
Cyramza
For the second quarter of 2017, worldwide Cyramza revenue was $186.3 million, an increase of 27 percent compared with the second quarter of 2016. U.S. revenue was $68.7 million, an increase of 1 percent, driven by higher realized prices, partially offset by decreased demand due to competitive pressure. Revenue outside the U.S. was $117.6 million, an increase of 49 percent, primarily due to strong volume growth in Japan, partially offset by lower realized prices.
Taltz
For the second quarter of 2017, Taltz generated worldwide revenue of $138.7 million. U.S. revenue was $124.4 million, an increase of $36.6 million compared with the first quarter of 2017, reflecting strong launch uptake.
Jardiance
The company’s worldwide Jardiance revenue during the second quarter of 2017 was $103.2 million, an increase of 157 percent compared with the second quarter of 2016. U.S. revenue increased 157 percent, to $66.8 million, driven by increased share of market for Jardiance and growth in the SGLT2 class. Revenue outside the U.S. was $36.3 million. Jardiance is part of the company’s alliance with Boehringer Ingelheim, and Lilly reports as revenue a portion of Jardiance’s gross margin.
Basaglar
For the second quarter of 2017, Basaglar generated worldwide revenue of $86.6 million. U.S. revenue was $59.5 million, an increase of $37.5 million compared with the first quarter of 2017, reflecting strong launch uptake. Basaglar is part of the company’s alliance with Boehringer Ingelheim, and Lilly reports as revenue total sales, with payments made to Boehringer Ingelheim for its portion of the gross margin reported as cost of sales.
Lartruvo
For the second quarter of 2017, Lartruvo, a treatment in combination with doxorubicin for a subset of adult patients with advanced soft tissue sarcoma, generated worldwide revenue of $47.4 million. U.S. revenue was $39.7 million, an increase of $1.7 million compared with the first quarter of 2017.
Olumiant
For the second quarter of 2017, Olumiant, a treatment for moderate-to-severe rheumatoid arthritis, generated worldwide revenue of $4.8 million.
Animal Health
In the second quarter of 2017, worldwide animal health revenue totaled $784.8 million, a decrease of 9 percent compared with the second quarter of 2016. Worldwide food animal revenue decreased 14 percent, to $473.0 million, driven by market access pressure and competitive pressure in cattle and swine. Worldwide companion animal revenue increased 1 percent, to $311.8 million, driven by the inclusion of $78.3 million in revenue from the acquisition of Boehringer Ingelheim Vetmedica’s U.S. feline, canine and rabies vaccine portfolio, largely offset by wholesaler buying patterns in the second quarter of 2016 and worldwide competitive pressure. The company expects these pressures to continue, to a lesser extent, for the balance of 2017.
2017 Financial Guidance
The company has revised certain elements of its 2017 financial guidance on a reported basis and on a non-GAAP basis. Earnings per share for 2017 are being decreased to be in the range of $2.51 to $2.61 on a reported basis. Earnings per share for 2017 are being increased to be in the range of $4.10 to $4.20 on a non-GAAP basis.
2017
Expectations% Change from 2016
Earnings per share (reported)$2.51 to $2.61(3)% to 1%
Acquired in-process research and development charges related to the acquisition of CoLucid Pharmaceuticals and the collaborations with Nektar Therapeutics and KeyBioscience.94
Amortization of intangible assets (1).44
Asset impairment, restructuring and other special charges, including Novartis Animal Health integration costs.19
Inventory step-up costs associated with the acquisition of Boehringer Ingelheim Vetmedica’s U.S. feline, canine and rabies vaccines portfolio (1).03
Earnings per share (non-GAAP)$4.10 to $4.2016% to 19%
(1) Subject to acquisition accounting adjustments
Numbers may not add due to rounding
The company now anticipates 2017 revenue between $22.0 billion and $22.5 billion. Excluding the impact of foreign exchange rates, the company expects revenue growth from new pharmaceutical products including Trulicity, Taltz, Basaglar, Cyramza, Jardiance and Lartruvo, as well as a number of established pharmaceutical products including Trajenta, Forteo and Humalog.
Gross margin percentage is now expected to be approximately 72.5 percent on a reported basis, and approximately 76.0 percent on a non-GAAP basis.
Marketing, selling and administrative expenses are still expected to be in the range of $6.4 billion to $6.6 billion. Research and development expenses are now expected to be in the range of $5.0 billion to $5.2 billion.
The 2017 tax rate is now expected to be approximately 23.5 percent on a reported basis. The 2017 tax rate is still expected to be approximately 22.0 percent on a non-GAAP basis.
The following table summarizes the company’s 2017 financial guidance:
2017 Guidance
Prior
Revised
Revenue$21.8 to $22.3 billion
$22.0 to $22.5 billion
Gross Margin % of Revenue (reported)Approx. 73.5%
Approx. 72.5%
Gross Margin % of Revenue (non-GAAP)Approx. 77.0%
Approx. 76.0%
Marketing, Selling & Administrative$6.4 to $6.6 billion
Unchanged
Research & Development$4.9 to $5.1 billion
$5.0 to $5.2 billion
Other Income/(Expense)$0 to $100 million
Unchanged
Tax Rate (reported)Approx. 24.5%
Approx. 23.5%
Tax Rate (non-GAAP)Approx. 22.0%
Unchanged
Earnings per Share (reported)$2.60 to $2.70
$2.51 to $2.61
Earnings per Share (non-GAAP)$4.05 to $4.15
$4.10 to $4.20
Capital ExpendituresApprox. $1.2 billion
Approx. $1.1 billion
Non-GAAP adjustments are consistent with the earnings per share table above.
Spherix Announces Closing Of Public Offering Of Common Stock
On July 24, 2017 Spherix Incorporated ("Spherix" or the "Company") (NASDAQ: SPEX), an intellectual property development company committed to fostering of technology, reported that it has closed its previously announced firm commitment underwritten public offering of 1,250,000 shares of its common stock at a price to the public of $2.00 per share (Press release, Spherix, JUL 24, 2017, View Source [SID1234538992]).
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The total gross proceeds of the offering are approximately $2.5 million. After deducting the underwriter’s discount and other offering expenses payable by Spherix, the net proceeds to the Company are approximately $2.1 million.
Anthony Hayes, the Chief Executive Officer of Spherix, stated, "One of the purposes of this offering is to raise capital to explore potential acquisition opportunities. Looking beyond our recent investment in Hoth Therapeutics, we hope to use these proceeds to find other similar opportunities."
Laidlaw & Company (UK) Ltd. acted as the sole underwriter for the offering.
The shares were offered pursuant to a registration statement on Form S-1 (File No. 333-218216) that was declared effective by the Securities and Exchange Commission (SEC) on July 18, 2017. The securities were offered only by means of a prospectus. A final prospectus supplement related to the offering has been filed with the SEC, and is available on the SEC’s website at www.sec.gov and may also be obtained from Laidlaw & Company (UK) Ltd., Attention: Syndicate Department, 546 Fifth Avenue, 5th Floor, New York, New York 10036, telephone (212) 953-4900, email: [email protected].
This press release shall not constitute an offer to sell, or the solicitation of an offer to buy, nor may there be any sale of these securities in any state or jurisdiction in which such an offer, solicitation or sale would be unlawful prior to registration or qualification under the securities laws of any such state or jurisdiction.
H3 Biomedicine and University of British Columbia Scientists Report Preclinical Data Describing Immune Evasion Mechanism in Muscle-Invasive Bladder
On July 24, 2017 H3 Biomedicine Inc., a clinical stage biopharmaceutical company specializing in the discovery and development of precision medicines for oncology and a member of Eisai’s global Oncology Business Group, and the Vancouver Prostate Centre and Vancouver Coastal Health Research Institute (VCHRI) reported, that data on one of H3’s pre-clinical programs focusing on muscle-invasive bladder cancer, has been published in the current issue of Nature Communications (Press release, H3 Biomedicine, JUL 24, 2017, View Source [SID1234519877]). The paper, which is titled "Evasion of immunosurveillance by genomic alterations of PPARγ/RXRα in bladder cancer," can be found at View Source
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"While the majority of the field was focused on manipulating function of immune cells, H3 explored a novel paradigm by focusing on tumor cells and their potential to effectively inhibit immune cell function," said Ping Zhu, Ph. D., Executive Director of Target Discovery at H3 Biomedicine. "Years ago when we built our immuno-oncology platform, our hope was to identify genomically-altered genes in tumors that may extend their reach beyond the tumor cell to influence immune response."
Muscle-invasive bladder cancer is an aggressive form of cancer with limited therapeutic options available to patients. In the past year, agents designed to target the immune system have been approved for bladder cancer; however, the median survival in patients with second-line disease remains less than a year, and less than a third of first-line patients respond to treatment. Based on this unmet need, researchers at H3 Biomedicine took a novel approach to understanding how tumors can overcome the debilitating effects of the immune system.
The publication in Nature Communications reports that a significant proportion of bladder tumors showing focal amplification of PPARγ and hotspot mutations in RXRα, lead to hyperactivity of the peroxisome proliferator-activated receptor gamma (PPARγ) pathway. Deep molecular characterization in cell lines and clinical samples also showed that tumors increased the activity of this pathway to prevent immune cells from infiltrating the tumors increasing the survival of the tumor cells. In collaboration with a team of Drs. Mads Daugaard and Peter Black at the University of British Columbia, the Vancouver Prostate Centre and VCHRI, the scientists further confirmed the association of PPARγ pathway activity with immune evasion in additional cohorts of bladder tumors.
"The fact that PPARγ and its binding partner RXRα can so potently suppress immune cell infiltration into tumors may explain the lack of response to immune-directed therapies in this class of tumor," said Manav Korpal, Ph. D., Senior Investigator at H3 Biomedicine. "One way to potentially combat this class of tumor is to combine immune-directed therapies with compounds that modulate PPARγ function."
Novocure™ Announces a Phase 1b Clinical Trial to Evaluate the Safety of Marizomib and Temozolomide in Combination with Optune® as Adjuvant Therapy in Patients with Glioblastoma
On July 24, 2017 Novocure (NASDAQ:NVCR) reported a new arm for a phase 1b study to evaluate the safety of marizomib and temozolomide in combination with Optune, Novocure’s Tumor Treating Fields (TTFields) delivery system, as adjuvant treatment for patients with newly diagnosed glioblastoma (GBM) following radiation therapy with concurrent temozolomide (Press release, NovoCure, JUL 24, 2017, View Source [SID1234519860]). The trial is the first to study Optune in combination with an investigational drug.
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Marizomib is a novel, brain-penetrant proteasome inhibitor developed by Triphase Accelerator Corporation and acquired by Celgene Corporation. Celgene is responsible for marizomib’s development.
"This collaboration marks an important first step toward testing Optune with a promising new investigational compound for the treatment of GBM," said Principal Investigator Dr. Roger Stupp, Associate Director for Strategic Initiatives at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. "Optune is the first treatment in over a decade to improve survival in GBM. I believe that combining Optune with new pharmacologic treatments in clinical trials, like this phase 1b study, will help advance our understanding of how to treat this devastating disease."
Celgene and Triphase modified their current phase 1b multicenter, open-label study of marizomib in combination with temozolomide and radiotherapy in patients with grade IV malignant gliomas to include Optune. A cohort of 12 GBM patients will be treated with Optune in combination with marizomib and temozolomide after initial treatment with radiation and temozolomide has been completed.
The primary objective for the Optune portion of the study is to determine the safety of the combination of marizomib and temozolomide with the addition of Optune in patients entering the adjuvant treatment phase. Secondary objectives for the Optune portion of the study include assessing preliminary clinical activity of the combination of Optune, marizomib and temozolomide in patients entering adjuvant therapy, progression-free survival and overall survival. The protocol has been submitted to an institutional review board, and this arm of the trial is expected to open in the third quarter of 2017.
"We believe TTFields has the potential to be an excellent development candidate in combination with other solid tumor cancer treatments," said Dr. Eilon Kirson, Novocure’s Chief Science Officer and Head of Research and Development. "As innovators in cancer treatment, we know collaboration is essential to improve patient outcomes. We hope this is the first collaboration of many."
Tumor Treating Fields in combination with temozolomide and marizomib is experimental for the treatment of glioblastoma. Limited by law to investigational use only.
Merck Provides Update on Phase 3 Study of KEYTRUDA® (pembrolizumab) Monotherapy in Patients with Previously Treated Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma (HNSCC)
On July 24, 2017 Merck (NYSE: MRK), known as MSD outside the United States and Canada, reported that the pivotal phase 3 KEYNOTE-040 trial investigating KEYTRUDA (pembrolizumab), the company’s anti-PD-1 therapy, in previously treated patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) did not meet its pre-specified primary endpoint of overall survival (OS) (HR, 0.82 [95% CI, 0.67-1.01]; p = 0.03 [one-sided]). The safety profile observed in KEYNOTE-040 was consistent with that observed in previously reported studies of KEYTRUDA; no new safety signals were identified.
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In August 2016, the U.S. Food and Drug Administration (FDA) approved KEYTRUDA for the treatment of patients with recurrent or metastatic HNSCC with disease progression on or after platinum-containing chemotherapy. The current indication remains unchanged and clinical trials continue, including KEYNOTE-048 (ClinicalTrials.gov, NCT02358031), a phase 3 clinical trial of KEYTRUDA in the first-line treatment of recurrent or metastatic HNSCC.
"We are encouraged by the positive impact that KEYTRUDA has had on many cancer patients, including those with previously treated recurrent or metastatic head and neck cancer, and we remain confident that KEYTRUDA is an important therapy for this difficult-to-treat cancer," said Roger Dansey, M.D., senior vice president and therapeutic area head, oncology late-stage development, Merck Research Laboratories. "We look forward to sharing the comprehensive data analysis from KEYNOTE-040 with the scientific community at an upcoming medical meeting."
The KEYTRUDA clinical development program includes more than 30 tumor types in more than 500 clinical trials, including more than 300 trials that combine KEYTRUDA with other cancer treatments. Specific to head and neck cancer, Merck’s broad clinical development program encompasses multiple registration-enabling or supportive studies investigating KEYTRUDA (pembrolizumab) as monotherapy and in combination with other cancer treatments across multiple lines of therapy.
About KEYNOTE-040
KEYNOTE-040 is a randomized, multi-center, pivotal phase 3 study (ClinicalTrials.gov, NCT02252042) investigating KEYTRUDA as a monotherapy versus standard treatment (methotrexate, docetaxel or cetuximab) for the treatment of recurrent or metastatic HNSCC. The primary endpoint is OS; secondary endpoints include progression-free survival (PFS) and overall response rate (ORR). The study, which opened in November 2014, enrolled 495 patients to receive KEYTRUDA (200 mg fixed dose every three weeks) or investigator-choice chemotherapy (methotrexate [40 mg/m2 on Days 1, 8, and 15 of each 3-week cycle], docetaxel [75 mg/m2 on Day 1 of each 3-week cycle], or cetuximab [400 mg/m2 loading dose on Day 1 and 250 mg/m2 IV on Days 8 and 15 of Cycle 1], followed by cetuximab [250 mg/m2 on Days 1, 8, and 15 of each subsequent 3-week cycle]). Patients enrolled in the study had been previously treated with 1-2 platinum-containing systemic regimens.
About Head and Neck Cancer
Head and neck cancer describes a number of different tumors that develop in or around the throat, larynx, nose, sinuses and mouth. Most head and neck cancers are squamous cell carcinomas that begin in the flat, squamous cells that make up the thin surface layer of the structures in the head and neck. The leading modifiable risk factors for head and neck cancer include tobacco and heavy alcohol use. Other risk factors include infection with certain types of HPV, also called human papillomaviruses. Each year there are approximately 400,000 cases of cancer of the oral cavity and pharynx, in addition to approximately 160,000 cancers of the larynx, resulting in approximately 300,000 deaths.
About KEYTRUDA (pembrolizumab) Injection
KEYTRUDA is an anti-PD-1 therapy that works by increasing the ability of the body’s immune system to help detect and fight tumor cells. KEYTRUDA is a humanized monoclonal antibody that blocks the interaction between PD-1 and its ligands, PD-L1 and PD-L2, thereby activating T lymphocytes which may affect both tumor cells and healthy cells.
Studies of KEYTRUDA – from the largest immuno-oncology program in the industry with more than 500 trials – include a wide variety of cancers and treatment settings. The KEYTRUDA (pembrolizumab) clinical program seeks to understand factors that predict a patient’s likelihood of benefitting from treatment with KEYTRUDA, including the exploration of several different biomarkers across a broad range of tumors.
KEYTRUDA is administered as an intravenous infusion over 30 minutes every three weeks for the approved indications. KEYTRUDA for injection is supplied in a 100 mg single-dose vial.
KEYTRUDA (pembrolizumab) Indications and Dosing
Melanoma
KEYTRUDA is indicated for the treatment of patients with unresectable or metastatic melanoma at a fixed dose of 200 mg every three weeks until disease progression or unacceptable toxicity.
Lung Cancer
KEYTRUDA, as a single agent, is indicated for the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) whose tumors have high PD-L1 expression [tumor proportion score (TPS) ≥50%] as determined by an FDA-approved test, with no EGFR or ALK genomic tumor aberrations.
KEYTRUDA, as a single agent, is also indicated for the treatment of patients with metastatic NSCLC whose tumors express PD-L1 (TPS ≥1%) as determined by an FDA-approved test, with disease progression on or after platinum-containing chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving KEYTRUDA.
KEYTRUDA, in combination with pemetrexed and carboplatin, is indicated for the first-line treatment of patients with metastatic nonsquamous NSCLC. This indication is approved under accelerated approval based on tumor response rate and progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.
In metastatic NSCLC, KEYTRUDA is administered at a fixed dose of 200 mg every three weeks until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.
When administering KEYTRUDA in combination with chemotherapy, KEYTRUDA should be administered prior to chemotherapy when given on the same day. See also the Prescribing Information for pemetrexed and carboplatin.
Head and Neck Cancer
KEYTRUDA (pembrolizumab) is indicated for the treatment of patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) with disease progression on or after platinum-containing chemotherapy. This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials. In HNSCC, KEYTRUDA is administered at a fixed dose of 200 mg every three weeks until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression.
Classical Hodgkin Lymphoma
KEYTRUDA is indicated for the treatment of adult and pediatric patients with refractory classical Hodgkin lymphoma (cHL), or who have relapsed after three or more prior lines of therapy. This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials. In adults with cHL, KEYTRUDA is administered at a fixed dose of 200 mg every three weeks until disease progression or unacceptable toxicity, or up to 24 months in patients without disease progression. In pediatric patients with cHL, KEYTRUDA is administered at a dose of 2 mg/kg (up to a maximum of 200 mg) every three weeks until disease progression or unacceptable toxicity, or up to 24 months in patients without disease progression.
Urothelial Carcinoma
KEYTRUDA is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who are not eligible for cisplatin-containing chemotherapy. This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.
KEYTRUDA is also indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy.
In locally advanced or metastatic urothelial carcinoma, KEYTRUDA (pembrolizumab) is administered at a fixed dose of 200 mg every three weeks until disease progression or unacceptable toxicity, or up to 24 months in patients without disease progression.
Microsatellite Instability-High (MSI-H) Cancer
KEYTRUDA is indicated for the treatment of adult and pediatric patients with unresectable or metastatic microsatellite instability-high (MSI-H) or mismatch repair deficient (dMMR)
· solid tumors that have progressed following prior treatment and who have no satisfactory alternative treatment options, or
· colorectal cancer that has progressed following treatment with fluoropyrimidine, oxaliplatin, and irinotecan.
This indication is approved under accelerated approval based on tumor response rate and durability of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials. The safety and effectiveness of KEYTRUDA in pediatric patients with MSI-H central nervous system cancers have not been established.
In adult patients with MSI-H cancer, KEYTRUDA is administered at a fixed dose of 200 mg every three weeks until disease progression, unacceptable toxicity, or up to 24 months in patients without disease progression. In pediatric patients with MSI-H cancer, KEYTRUDA is administered at a dose of 2 mg/kg (up to a maximum of 200 mg) every three weeks until disease progression or unacceptable toxicity, or up to 24 months in patients without disease progression.
Selected Important Safety Information for KEYTRUDA (pembrolizumab)
KEYTRUDA can cause immune-mediated pneumonitis, including fatal cases. Pneumonitis occurred in 94 (3.4%) of 2799 patients receiving KEYTRUDA, including Grade 1 (0.8%), 2 (1.3%), 3 (0.9%), 4 (0.3%), and 5 (0.1%) pneumonitis, and occurred more frequently in patients with a history of prior thoracic radiation (6.9%) compared to those without (2.9%). Monitor patients for signs and symptoms of pneumonitis. Evaluate suspected pneumonitis with radiographic imaging. Administer corticosteroids for Grade 2 or greater pneumonitis. Withhold KEYTRUDA (pembrolizumab) for Grade 2; permanently discontinue KEYTRUDA for Grade 3 or 4 or recurrent Grade 2 pneumonitis.
KEYTRUDA (pembrolizumab) can cause immune-mediated colitis. Colitis occurred in 48 (1.7%) of 2799 patients receiving KEYTRUDA, including Grade 2 (0.4%), 3 (1.1%), and 4 (<0.1%) colitis. Monitor patients for signs and symptoms of colitis. Administer corticosteroids for Grade 2 or greater colitis. Withhold KEYTRUDA for Grade 2 or 3; permanently discontinue KEYTRUDA for Grade 4 colitis.
KEYTRUDA can cause immune-mediated hepatitis. Hepatitis occurred in 19 (0.7%) of 2799 patients receiving KEYTRUDA, including Grade 2 (0.1%), 3 (0.4%), and 4 (<0.1%) hepatitis. Monitor patients for changes in liver function. Administer corticosteroids for Grade 2 or greater hepatitis and, based on severity of liver enzyme elevations, withhold or discontinue KEYTRUDA.
KEYTRUDA can cause hypophysitis. Hypophysitis occurred in 17 (0.6%) of 2799 patients receiving KEYTRUDA, including Grade 2 (0.2%), 3 (0.3%), and 4 (<0.1%) hypophysitis. Monitor patients for signs and symptoms of hypophysitis (including hypopituitarism and adrenal insufficiency). Administer corticosteroids and hormone replacement as clinically indicated. Withhold KEYTRUDA for Grade 2; withhold or discontinue for Grade 3 or 4 hypophysitis.
KEYTRUDA can cause thyroid disorders, including hyperthyroidism, hypothyroidism, and thyroiditis. Hyperthyroidism occurred in 96 (3.4%) of 2799 patients receiving KEYTRUDA, including Grade 2 (0.8%) and 3 (0.1%) hyperthyroidism. Hypothyroidism occurred in 237 (8.5%) of 2799 patients receiving KEYTRUDA, including Grade 2 (6.2%) and 3 (0.1%) hypothyroidism. The incidence of new or worsening hypothyroidism was higher in patients with HNSCC, occurring in 28 (15%) of 192 patients with HNSCC, including Grade 3 (0.5%) hypothyroidism. Thyroiditis occurred in 16 (0.6%) of 2799 patients receiving KEYTRUDA, including Grade 2 (0.3%) thyroiditis. Monitor patients for changes in thyroid function (at the start of treatment, periodically during treatment, and as indicated based on clinical evaluation) and for clinical signs and symptoms of thyroid disorders. Administer replacement hormones for hypothyroidism and manage hyperthyroidism with thionamides and beta-blockers as appropriate. Withhold or discontinue KEYTRUDA for Grade 3 or 4 hyperthyroidism.
KEYTRUDA can cause type 1 diabetes mellitus, including diabetic ketoacidosis, which have been reported in 6 (0.2%) of 2799 patients. Monitor patients for hyperglycemia or other signs and symptoms of diabetes. Administer insulin for type 1 diabetes, and withhold KEYTRUDA and administer antihyperglycemics in patients with severe hyperglycemia.
KEYTRUDA can cause immune-mediated nephritis. Nephritis occurred in 9 (0.3%) of 2799 patients receiving KEYTRUDA, including Grade 2 (0.1%), 3 (0.1%), and 4 (<0.1%) nephritis. Monitor patients for changes in renal function. Administer corticosteroids for Grade 2 or greater nephritis. Withhold KEYTRUDA (pembrolizumab) for Grade 2; permanently discontinue KEYTRUDA for Grade 3 or 4 nephritis.
KEYTRUDA can cause other clinically important immune-mediated adverse reactions. These immune-mediated reactions may occur in any organ system. For suspected immune-mediated adverse reactions, ensure adequate evaluation to confirm etiology or exclude other causes. Based on the severity of the adverse reaction, withhold KEYTRUDA and administer corticosteroids. Upon improvement to Grade 1 or less, initiate corticosteroid taper and continue to taper over at least 1 month. Based on limited data from clinical studies in patients whose immune-related adverse reactions could not be controlled with corticosteroid use, administration of other systemic immunosuppressants can be considered. Resume KEYTRUDA when the adverse reaction remains at Grade 1 or less following corticosteroid taper. Permanently discontinue KEYTRUDA for any Grade 3 immune-mediated adverse reaction that recurs and for any life-threatening immune-mediated adverse reaction.
The following clinically significant immune-mediated adverse reactions occurred in less than 1% (unless otherwise indicated) of 2799 patients: arthritis (1.5%), exfoliative dermatitis, bullous pemphigoid, rash (1.4%), uveitis, myositis, Guillain-Barré syndrome, myasthenia gravis, vasculitis, pancreatitis, hemolytic anemia, and partial seizures arising in a patient with inflammatory foci in brain parenchyma. In addition, myelitis and myocarditis were reported in other clinical trials, including classical Hodgkin lymphoma, and postmarketing use.
Solid organ transplant rejection has been reported in postmarketing use of KEYTRUDA. Treatment with KEYTRUDA may increase the risk of rejection in solid organ transplant recipients. Consider the benefit of treatment with KEYTRUDA vs the risk of possible organ rejection in these patients.
KEYTRUDA can cause severe or life-threatening infusion-related reactions, including hypersensitivity and anaphylaxis, which have been reported in 6 (0.2%) of 2799 patients. Monitor patients for signs and symptoms of infusion-related reactions, including rigors, chills, wheezing, pruritus, flushing, rash, hypotension, hypoxemia, and fever. For Grade 3 or 4 reactions, stop infusion and permanently discontinue KEYTRUDA.
Immune-mediated complications, including fatal events, occurred in patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) after being treated with KEYTRUDA. Of 23 patients with cHL who proceeded to allogeneic HSCT after treatment with KEYTRUDA on any trial, 6 patients (26%) developed graft-versus-host-disease (GVHD), one of which was fatal, and 2 patients (9%) developed severe hepatic veno-occlusive disease (VOD) after reduced-intensity conditioning, one of which was fatal. Cases of fatal hyperacute GVHD after allogeneic HSCT have also been reported in patients with lymphoma who received a PD-1 receptor–blocking antibody before transplantation. These complications may occur despite intervening therapy between PD-1 blockade and allogeneic HSCT. Follow patients closely for early evidence of transplant-related complications such as hyperacute GVHD, severe (Grade 3 to 4) acute GVHD, steroid-requiring febrile syndrome, hepatic VOD, and other immune-mediated adverse reactions, and intervene promptly.
Based on its mechanism of action, KEYTRUDA (pembrolizumab) can cause fetal harm when administered to a pregnant woman. If used during pregnancy, or if the patient becomes pregnant during treatment, apprise the patient of the potential hazard to a fetus. Advise females of reproductive potential to use highly effective contraception during treatment and for 4 months after the last dose of KEYTRUDA.
KEYTRUDA was discontinued due to adverse reactions in 17% of 192 patients with HNSCC. Serious adverse reactions occurred in 45% of patients. The most frequent serious adverse reactions reported in at least 2% of patients were pneumonia, dyspnea, confusional state, vomiting, pleural effusion, and respiratory failure. The most common adverse reactions (reported in at least 20% of patients) were fatigue (46%), decreased appetite (22%), and dyspnea (20%).
It is not known whether KEYTRUDA is excreted in human milk. Because many drugs are excreted in human milk, instruct women to discontinue nursing during treatment with KEYTRUDA and for 4 months after the final dose.