Needham Virtual Healthcare Conference
John Scarlett, M.D.
Chairman and Chief Executive Officer, Geron Corporation April 15, 2020
Needham Virtual Healthcare Conference John Scarlett, M.D. Chairman - - PowerPoint PPT Presentation
Needham Virtual Healthcare Conference John Scarlett, M.D. Chairman and Chief Executive Officer, Geron Corporation April 15, 2020 Forward-Looking Statements Except for the historical information contained herein, this presentation contains
Chairman and Chief Executive Officer, Geron Corporation April 15, 2020
Except for the historical information contained herein, this presentation contains forward-looking statements made pursuant to the “safe harbor” provisions of the Private Securities Litigation Reform Act of 1995. Investors are cautioned that such statements, include, without limitation, those regarding: (i) Geron’s scheduled meeting with the FDA in the second quarter of 2020 to discuss a potential regulatory approval path in MF, including a Phase 3 trial design, and plan to make a decision by mid-year 2020 regarding any potential late-stage development of imetelstat in MF; (ii) that in 2020 Geron expects to present: (a) more mature data from the Phase 2 IMerge clinical trial, including durability of transfusion independence, and (b) new analyses of Phase 2 IMbark data supporting observed potential improvement in
plus patent term extensions expected to provide coverage in the U.S. until 2033; (v) that Geron’s 2020 operating expenses will be lower than previously announced; (vi) that the U.S. revenue potential for imetelstat in lower risk MDS could exceed $500 million; and (vii) other statements that are not historical facts, constitute forward looking statements. These statements involve risks and uncertainties that can cause actual results to differ materially from those in such forward-looking
COVID-19 and overcomes the clinical, safety, efficacy, technical, scientific, intellectual property, manufacturing and regulatory challenges to enable complete enrollment of the IMerge Phase 3 trial, if at all; (ii) whether regulatory authorities permit the further development of imetelstat on a timely basis, or at all, without any clinical holds; (iii) whether imetelstat is demonstrated to be safe and efficacious in clinical trials; (iv) whether any future efficacy or safety results may cause the benefit-risk profile of imetelstat to become unacceptable; (v) whether the Company decides not to pursue late-stage development of imetelstat in MF; (vi) whether the MDS and MF data that the Company expects to present strengthens or supports the rationale for the Company to complete IMerge or pursue a Phase 3 clinical trial in MF; (vii) whether imetelstat actually demonstrates disease-modifying activity in patients; (viii) that Geron may not be able to prepare for discussions with the FDA in the second quarter of 2020, or at all, and its decision regarding potential late-stage development of imetelstat in MF, if any, may be delayed beyond mid-2020; (ix) that Geron may not successfully market or that competition could cause imetelstat not to achieve at least $500 million, or greater than $500 million, in U.S. revenue for MDS; and (x) whether imetelstat has adequate patent protection and freedom to operate. Additional information on the above risks and uncertainties and additional risks, uncertainties and factors that could cause actual results to differ materially from those in the forward-looking statements are contained in Geron’s periodic reports filed with the Securities and Exchange Commission under the heading “Risk Factors,” including Geron’s annual report on Form 10-K for the year ended December 31, 2019. Undue reliance should not be placed on forward-looking statements, which speak only as of the date they are made, and the facts and assumptions underlying the forward-looking statements may change. Except as required by law, Geron disclaims any obligation to update these forward-looking statements to reflect future information, events or circumstances. 2
Operating Remotely
Clinical Development
– Complete enrollment in the IMerge Phase 3 trial by the end of 2020 – Commence a proof of concept study in high risk MDS and acute myeloid leukemia (AML) by the end of 2020
Managing 2020 Operating Expenses
– Suspended travel and in-person meetings – Re-evaluating near-term hiring plan
Next business update related to COVID-19 to be provided on Q1 2020 quarterly conference call
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Imetelstat, a Novel Drug with a Unique Target
In-House Leadership and Expertise Establishes a Foundation for Potential Future Growth
Late-Stage Clinical Development
were opened for enrollment.
registration-enabling Phase 3 trial design. Geron’s decision on any potential late-stage development in MF planned by mid-year 2020.
Cash Resources
Upregulated telomerase is a key feature of these malignancies
5 RBCs, red blood cells; WBCs, white blood cells
Telomerase and Heme Malignancies
cells allowing for normal and controlled cell turnover
malignant stem and progenitor cells, resulting in uncontrolled proliferation associated with disease progression in hematologic myeloid malignancies, such as MDS and MF
malignant stem and progenitor cells proliferation of abnormal RBCs, WBCs or Platelets drive clinical manifestations
myeloid malignancies
Telomerase Upregulated
malignant progenitor cells malignant hematopoietic stem cell
Targeting telomerase to inhibit malignant cells driving hematologic myeloid malignancies
6 RBCs, red blood cells; WBCs, white blood cells
Imetelstat inhibits telomerase activity
Imetelstat induces apoptosis of malignant stem and progenitor cells Enables potential recovery of normal RBCs, WBCs, Platelets
Telomerase Upregulated
malignant progenitor cells malignant hematopoietic stem cell
Imetelstat Disease-Modifying Potential
thereby: ➢ Induces apoptosis (death) of malignant stem and progenitor cells ➢ Enables potential recovery of normal RBC, WBC and platelet counts and function
A novel telomerase inhibitor discovered and developed by Geron
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permeability/tissue distribution
2 trials
➢ Composition of matter patent coverage through 2024 in EU and 2025 in U.S. ➢ Patent term extension includes potential five-years in EU, through 2029 and through 2030 in U.S. ➢ Methods of use patents until 2033 for MF in EU and until 2033 for both MDS and MF in U.S. ➢ Expected market exclusivity extension related to orphan drug designation in EU for up to ten years and in U.S. for up to seven years
Potential applications of telomerase inhibition across multiple indications
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Evidence of clinical activity in multiple myeloid malignancies after treatment with imetelstat
Telomerase Upregulated
malignant progenitor cells malignant hematopoietic stem cell
Essential Thrombocythemia (ET)
Excess platelets with abnormal functionality
Polycythemia Vera (PV)
Excess red blood cells with abnormal functionality
Myelofibrosis (MF)
Fibrosis of marrow and disruption of blood production
Myelodysplastic Syndromes (MDS)
Abnormal production and maturation of blood cells
Acute Myeloid Leukemia (AML)
Abnormal production and maturation of blood cells; High proportion of immature white blood cells (blasts)
Significant unmet medical need
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Diverse group of hematologic malignancies with disordered and ineffective hematopoiesis in the bone marrow, characterized by abnormal cell morphology and counts (anemia and other cytopenias)
Chronic anemia is the hallmark of low and intermediate-1 (lower risk) MDS
– Lower quality-of-life due to multiple, often lengthy office visits per month, and substantial costs ($29-$51K/yr) – Iron overload which may cause liver and heart complications potentially leading to organ failure – Shorter survival (~3.5 years); 2 units of RBC monthly may reduce life expectancy by 50%
Historical treatment options have been suboptimal, with low rates of transfusion independence and limited durability
Reblozyl (luspatercept), an erythrocyte maturation agent, was the first new approval since 2006 in lower risk MDS
Cogle, Curr Hematol Malig Rep; 2015, 10272-10281 Greenberg et al, Blood 1997; 89:2079-2088 Geron Proprietary Market Research
Imetelstat target patient population*
Lower risk MDS patients in the U.S.
Lower risk MDS cases diagnosed annually in the U.S.
A significant addressable market opportunity
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U.S. revenue potential for imetelstat in lower risk MDS could exceed $500M
* Lower risk MDS patients without chromosomal 5q deletion (non-del(5q)), relapsed/refractory to erythropoiesis stimulating agents (ESAs), prior to being treated with lenalidomide or hypomethylating agents (HMAs)
Part 1 – Phase 2 portion
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ClinicalTrials.gov (NCT02598661)
Imetelstat 7.5mg/kg every 4 weeks
prior to trial entry
equivalent) or serum erythropoietin (sEPO) >500 mU/mL
discretion as clinically needed and local guidelines
Transfusion Dependent, Low or Intermediate-1 Risk MDS, non- del(5q), R/R to ESAs, no prior treatment with lenalidomide or HMAs (n=38) 1° Efficacy: Red Blood Cell (RBC) Transfusion Independence (TI) ≥8 weeks 2° Efficacy: RBC-TI ≥24 weeks; time to and duration of RBC-TI; hematologic improvement (HI); reduction in RBC burden
IMerge Part 1: Phase 2 Portion single arm, open label
Meaningful and durable transfusion independence
a Kaplan Meier method
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Data Reported at European Hematology Association (EHA) Annual Congress in June 2019
38 Median baseline transfusion burden, units/8 weeks (range) 8 (4-14) Rate of 8-week RBC-TI, % (n) 42% (16/38) Rate of 24-week RBC-TI, % (n) 29% (11/38) Median time to onset of RBC-TI, weeks (range) 8.3 (0.1-40.7) Median duration a of RBC-TI, weeks (range) 85.9 (8.0-140.9) Hematologic improvement – erythroid (HI-E), % (n) ≥1.5 g/dL increase in hemoglobin lasting ≥8 weeks Transfusion reduction by ≥4 units/8 weeks 68% (26/38) 32% (12/38) 68% (26/38) Mean relative reduction of RBC transfusion burden from baseline, %
EHA 2019 Presentation: Fenaux P, et.al.
Safety profile consistent with previous imetelstat clinical trials in hematologic myeloid malignancies
ClinicalTrials.gov (NCT02598661)
Similar activity across different patient subgroups
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EHA 2019 Presentation: Fenaux P, et.al.
Similar 8-week TI responses across different patient subgroups
RS) vs. RS- (Other)
High (4-6 units) vs. Very High (>6 units)
mU/mL vs. > 500 mU/mL
ClinicalTrials.gov (NCT02598661)
Potential disease-modifying activity observed Impact on biomarkers of MDS disease suggest potential effect on malignant progenitor cell clones and disease modification
➢ 75% (12/16) of patients who achieved an 8-week RBC-TI also had a Hgb rise ≥ 3g/dL from the
pretreatment level, which suggests recovery of normal hematopoiesis
➢ Improvement in cytogenetics of the cells in the bone marrow
▪
5/6 patients achieved 8-week RBC-TI and all had a ringed-sideroblast WHO subtype
▪
3/3 patients with trisomy 8 achieved 8-week RBC-TI and 2/3 achieved 24-week RBC-TI
▪
2/3 patients with available post-treatment cytogenetic data achieved partial cytogenetic response
➢ Reduction in proportion of cells carrying SF3B1 mutation
transfusion independence lasting over a year
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EHA 2019 Presentation: Fenaux P, et.al.
ClinicalTrials.gov (NCT02598661)
Targeting different disease burdened patient populations
IMerge Part 1 – Phase 2 MEDALIST** – Phase 3
Imetelstat Luspatercept Placebo
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153 76 Non-del(5q), R/R to ESAs, no prior treatment with lenalidomide or HMAs Target patient population Non-del(5q), R/R to ESAs, no prior treatment with lenalidomide or HMAs RS+ and RS- MDS subtype Ring-sideroblasts (RS) RS+ only 8 (4-14) Median baseline transfusion burden
# units/8 weeks (range)
5 (2-20) 66 patients had < 4 units / 8 weeks 42.1% (16/38) 8-week RBC-TI rate, % (n) 47.7% (73/153) 15.8% (12/76) 68.4% (26/38) Rate of transfusion reduction (HI-E), % (n) 64.1% (98/153) 26.3% (20/76) 28.9% (11/38) 24-week RBC-TI rate, % (n) Not reported/assessed 42.1% (16/38) 8-week RBC-TI rate, % (n)
Patients with baseline transfusion burden ≥ 4 units / 8 weeks
31.8% (34/107) 7.1% (4/56)
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EHA 2019 Presentation: Treatment with Imetelstat Provides Durable Transfusion Independence in Heavily Transfused Non-Del(5q) Lower Risk MDS Relapsed/Refractory to Erythropoiesis-Stimulating Agents; Fenaux P, et.al. **MEDALIST sponsor – Celgene/Acceleron. ASH 2019 Presentation: Assessment of Longer-Term Efficacy and Safety in the Phase 3, Randomized, Double-Blind, Placebo-Controlled MEDALIST Trial of Luspatercept to Treat Anemia in IPSS-R Very Low-, Low-, or Int-Risk RBC Transfusion-Dependent MDS with Ring Sideroblasts; Fenaux P, et al
*Geron acknowledges that there are limitations when comparing results from an open label Phase 2 trial to a blinded, placebo-controlled Phase 3 trial, and also
that luspatercept has a relatively benign safety profile.
Currently enrolling
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Imetelstat (n = ~115) 7.5mg/kg every 4 weeks Placebo (n = ~55) Randomize (2:1) Double-blind Transfusion Dependent, Low or Intermediate-1 Risk MDS, non-del(5q), R/R to ESAs, no prior treatment with lenalidomide or HMAs (n = ~170) 1° Efficacy: Red Blood Cell (RBC) Transfusion Independence (TI) ≥8 weeks 2° Efficacy: RBC-TI ≥24 weeks; time to and duration of RBC-TI; hematologic improvement (HI); reduction in RBC burden
Clinical Trial Design for IMerge Part 2: Phase 3 Portion
Phase 3 Trial Design
Current Status/Progress
➢ First patient was dosed in October 2019 ➢ As of the end of March 2020, 66% of planned clinical sites were opened for enrollment
ClinicalTrials.gov (NCT02598661)
Tefferi, JCO 2005; 23:8520-8530 Tefferi, Mayo Clin Proc 2012; 87:25-33 Gangat et al, JCO 2011; 29:392-397
Significant unmet medical need
Estimated Int-2/High-risk MF Patient Population in the U.S.
Bone marrow hypercellularity and fibrosis, constitutional symptoms, splenomegaly and decreased survival are key disease features of Int-2/High-risk MF
Currently two JAKi on the market
75% five-year discontinuation rate from ruxolitinib, due to suboptimal response and loss of therapeutic effect After discontinuation from ruxolitinib, median overall survival (OS) in multiple studies reported to be 14-16 months
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Reticulin stain Reticulin stain - Fibrosis H&E stain - Hypercellularity H&E stain
normal
bone marrow
myelofibrosis
bone marrow
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Trial Population:
with a JAKi
Outcomes:
➢ 10% of patients achieved > 35% reduction in spleen volume (SVR) ➢ 32% of patients achieved > 50% improvement in total symptom score (TSS) ➢ Median OS was 29.9 months
ClincialTrials.gov (NCT02426086)
Intermediate-2 or High- risk MF R/R to JAKi treatment
Randomize (1:1)
Imetelstat 9.4 mg/kg every 3 weeks Imetelstat 4.7 mg/kg every 3 weeks Co-1° Efficacy: Spleen response rate and symptom response rate 2° Efficacy: CR, PR and CI, anemia response per 2013 IWG-MRT criteria, duration of responses,
Exploratory: Cytogenetic and molecular responses, leukemia free survival
Clinical activity in relapsed/refractory MF patients
ASH 2018 Presentation: Mascarenhas J, et. al.
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Symptom response at 24 weeks
N=59
❑ 19 (32%) patients in the 9.4 mg/kg arm had ≥ 50% symptom response using total symptom score (TSS) at Week 24
ASH 2018 Presentation: Mascarenhas J, et. al.
ClincialTrials.gov (NCT02426086)
Data suggest potential improvement in survival
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Clinical cut-off (10/22/2018):
Median overall survival:
ASH 2018 Presentation: Mascarenhas J, et. al.
29.9 mos
ClincialTrials.gov (NCT02426086) *Newberry et al, Blood 2017; 130:1125-1131 Kuykendall et al, Ann Hematol 2018; 97:435-441 Spiegel et al, Blood Advances 2017; 1:1729-1738
After discontinuation of ruxolitinib:
~14-16 months*
Corroborates potential survival benefit
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Kuykendall A., et al, EHA 2019 Poster
IMbark Phase 2 Data vs. Real-World Data (RWD) Results: Analyses suggest potential survival benefit and lower risk of death for imetelstat vs. BAT from RWD
more than double the median OS of 12.0 months for BAT from RWD
closely-matched RWD from patients treated with BAT
Purpose: Assess potential overall survival benefit with imetelstat treatment
Moffitt Cancer Center who had discontinued ruxolitinib and were subsequently treated with best available therapy (BAT)
each dataset to mimic the effect of randomization and improve comparability
Acknowledging the limitations of such comparative analyses between RWD and clinical trial data, favorable OS of imetelstat treatment in this very poor- prognosis patient population warrants further evaluation
33.8 mos 12.0 mos
Planned next steps
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EOP2 Meeting with the FDA Granted Fast Track designation by the FDA for Int-2/High-risk MF
Q3 2019 Q4 2019 2019 2020
Q4 Q1 Q3 Q2
Discuss with FDA potential regulatory approval path for imetelstat in MF, including registration-enabling Phase 3 trial design Geron decision regarding any late-stage development in MF
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Phase 3 IMerge Clinical Trial in Lower Risk MDS ❑ Complete enrollment (timing to be determined)* Potential Registration Strategy in MF ❑ Scheduled meeting with FDA in second quarter 2020 to discuss potential regulatory approval path for imetelstat in MF, including registration-enabling Phase 3 trial design ❑ Plan to make a decision regarding any potential late-stage development by mid-year 2020 Updated Data and New Analyses from Phase 2 Trials in MDS and MF in 2020 ❑ Expect to present more mature IMerge Phase 2 data, including durability of transfusion independence ❑ Expect to present new analyses of IMbark Phase 2 data supporting observed potential improvement in overall survival as an indicator of disease-modifying activity Additional Hematologic Myeloid Malignancy Indications ❑ Start high risk MDS and AML proof of concept study (timing to be determined)*
* Based on Geron’s business update related to COVID-19, on April 2, 2020, the Company stated that it no longer expects to complete enrollment in the IMerge Phase 3 trial or to commence a proof of concept study in high risk MDS and acute myeloid leukemia (AML) by the end of 2020. Geron continues to monitor the affects of COVID-19 and expects to provide an update on its next quarterly conference call.
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