ITEM
1. Financial Statements
Celcuity
Inc.
Condensed
Balance Sheets
See
accompanying notes to the financial statements
Celcuity
Inc.
Condensed
Statements of Operations
(unaudited)
See
accompanying notes to the financial statements
Celcuity
Inc.
Statements
of Changes in Stockholders’ Equity
Three
Months Ended March 31,2023
See
accompanying notes to the financial statements
Celcuity
Inc.
Condensed
Statements of Changes in Stockholders’ Equity
Three
Months Ended March 31,2022
| |
Shares | | |
Amount | | |
Capital | | |
Deficit | | |
Total | |
| |
Common Stock | | |
Additional Paid-In | | |
Accumulated | | |
| |
| |
Shares | | |
Amount | | |
Capital | | |
Deficit | | |
Total | |
Balance at December 31, 2021 | |
| 14,918,887 | | |
$ | 14,919 | | - |
$ | 124,622,405 | | |
$ | (55,926,847 | ) | |
$ | 68,710,477 | |
Stock-based compensation | |
| - | | |
| - | | |
| 756,271 | | |
| - | | |
| 756,271 | |
Exercise of common stock options, net of shares withheld for exercise price | |
| 1,415 | | |
| 1 | | - |
| 7,413 | | |
| - | | |
| 7,414 | |
Net loss | |
| - | | |
| - | | |
| - | | |
| (7,934,447 | ) | |
| (7,934,447 | ) |
Balance at March 31, 2022 (unaudited) | |
| 14,920,302 | | |
$ | 14,920 | | - |
$ | 125,386,089 | | |
$ | (63,861,294 | ) | |
$ | 61,539,715 | |
See
accompanying notes to the financial statements
Celcuity
Inc.
Condensed
Statements of Cash Flows
(unaudited)
See
accompanying notes to the financial statements
CELCUITY
INC.
NOTES
TO CONDENSED FINANCIAL STATEMENTS (unaudited)
(For
the Three Months Ended March 31, 2023 and 2022)
1.
Organization
Nature
of Business
Celcuity
Inc., a Delaware corporation (the “Company”), is a clinical-stage biotechnology company focused on development of targeted
therapies for multiple solid tumor indications. The Company’s lead therapeutic candidate is gedatolisib, a potent pan-PI3K and
mTOR inhibitor. Its mechanism of action and pharmacokinetic properties are highly differentiated from other currently approved and investigational
therapies that target PI3K or mTOR alone or together. A Phase 3 clinical trial, VIKTORIA-1, evaluating gedatolisib in combination with
fulvestrant with or without palbociclib in patients with HR+/HER2- advanced breast cancer is currently enrolling patients. Its CELsignia
companion diagnostic platform is uniquely able to analyze live patient tumor cells to identify new groups of cancer patients likely to
benefit from already approved targeted therapies. The Company was co-founded in 2012 by Brian F. Sullivan and Dr. Lance G. Laing and
is based in Minnesota. The Company has not generated any revenues to date.
2.
Basis of Presentation, Summary of Significant Accounting Policies and Recent Accounting Pronouncements
Basis
of Presentation
The
accompanying unaudited financial statements include the accounts of the Company and have been prepared in accordance with Article 10
of Regulation S-X promulgated by the Securities and Exchange Commission (“SEC”). Accordingly, as permitted by Article 10,
the unaudited financial statements do not include all of the information required by accounting principles generally accepted in the
United States (“U.S. GAAP”). The balance sheet at December 31, 2022 was derived from the audited financial statements at
that date and does not include all the disclosures required by U.S. GAAP. In the opinion of management, all adjustments which are of
a normal recurring nature and necessary for a fair presentation have been reflected in the financial statements. These unaudited condensed
financial statements should be read in conjunction with the audited financial statements as of and for the year ended December 31, 2022
and the related footnotes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2022. Operating
results for the three months ended March 31, 2023 are not necessarily indicative of the results to be expected during the remainder of
the current year or for any future period.
Accounting
Estimates
Management
uses estimates and assumptions in preparing these unaudited condensed financial statements in accordance with U.S. GAAP. Those estimates
and assumptions affect the reported amounts of assets and liabilities, the disclosure of contingent assets and liabilities, and the reported
revenues and expenses. Actual results could differ from those estimates and the difference could be material. Significant items subject
to such estimates and assumptions include the valuation of stock-based compensation and prepaid or accrued clinical trial costs.
Risks
and Uncertainties
The
Company is subject to risks common to companies in the development stage including, but not limited to, dependency on the clinical and
commercial success of its diagnostic tests, ability to obtain regulatory approval of its diagnostic tests, the clinical and commercial
success of its initial drug product, gedatolisib, the need for substantial additional financing to achieve its goals, uncertainty of
broad adoption of its approved products, if any, by physicians and consumers, and significant competition.
Clinical
Trial Costs
The
Company records prepaid assets or accrued expenses for prepaid or estimated clinical trial costs conducted by third-party service providers,
which includes the conduct of preclinical studies and clinical trials. These costs can be a significant component of the Company’s
research and development expenses. The Company primarily relies on a compilation of progress reports from third-party service providers,
including the respective invoicing, to record actual expenses, along with determining changes to prepaid assets and accrued liabilities.
To date, the company believes utilization of third-party reports most accurately reflects expenses incurred. As the current VIKTORIA-1
Phase 3 trial ramps up site activation and patient enrollment, the Company’s estimated expenses in future periods and actual services
performed may vary from these estimates, and these estimates may become more significant. Changes in these estimates that result in material
changes to the Company’s prepaid assets or accrued expenses could materially affect the Company’s results of operations.
Recently
Adopted Accounting Pronouncements
In
June 2016 and related amendments, the FASB issued Accounting Standards Update (ASU) No. 2016-13, Financial Instruments – Credit
Losses (Topic 326). This guidance changes the methodology to be used to measure credit losses for certain financial instruments and financial
assets. The new methodology requires the recognition of an allowance that reflects the current estimate of credit losses expected to
be incurred over the life of the financial asset. The Company adopted this standard effective January 1, 2023. The adoption of the standard
did not have a material impact on the Company’s consolidated financial statements.
3.
Net Loss Per Common Share
Basic
and diluted net loss per common share is determined by dividing net loss attributable to common stockholders by the weighted-average
common shares outstanding during the period. For all periods presented, the common shares underlying the options and warrants have been
excluded from the calculation because their effect would be anti-dilutive. Therefore, the weighted-average shares outstanding used to
calculate both basic and diluted loss per common share are the same.
For
the three months ended March 31, 2023 and 2022, potentially dilutive securities excluded from the computations of diluted weighted-average
shares outstanding were preferred stock on an as-if-converted to common stock basis of 10,958,730 and zero shares of common stock, respectively,
options to purchase 2,068,458 and 1,353,406 shares of common stock, respectively, warrants to purchase 7,266,102 and 377,652 shares of
common stock, respectively, and 3,273 and 2,964 shares of restricted common stock, respectively.
4.
Investments
Debt
securities for which the Company has the positive intent and ability to hold to maturity are classified as held-to-maturity and reported
at historical cost adjusted for amortization of premiums and accretion of discounts. Expected credit losses, if any, are recorded through
the establishment of an allowance for credit losses. All of the Company’s held-to-maturity
investment securities are U.S. Treasury and agencies securities that are guaranteed or otherwise
supported by the United States government and have no history of credit losses. Accordingly, the Company does not expect to incur any
credit losses on held-to-maturity investment securities and has no allowance
for credit losses recorded for these securities.
The
following table summarizes the Company’s held-to-maturity investment securities at amortized cost as of March 31, 2023
and December 31, 2022:
Schedule
of Investment
| |
Amortized Cost, as Adjusted | | |
Gross Unrealized Holding Gains | | |
Gross Unrealized Holding Losses | | |
Estimated Fair Value | |
| |
March 31, 2023 | |
| |
Amortized
Cost, as
Adjusted | | |
Gross Unrealized
Holding Gains | | |
Gross
Unrealized
Holding
Losses | | |
Estimated Fair
Value | |
| |
| | |
| | |
| | |
| |
Governmental Agency Securities | |
$ | 21,755,483 | | |
$ | 2,077 | | |
$ | - | | |
$ | 21,757,560 | |
U.S. Treasury Notes | |
| 102,083,744 | | |
| 11,822 | | |
| - | | |
| 102,095,566 | |
Total | |
$ | 123,839,227 | | |
$ | 13,899 | | |
$ | - | | |
$ | 123,853,126 | |
| |
Amortized Cost, as Adjusted | | |
Gross Unrealized Holding Gains | | |
Gross Unrealized Holding Losses | | |
Estimated Fair Value | |
| |
December 31, 2022 | |
| |
Amortized
Cost, as
Adjusted | | |
Gross Unrealized
Holding Gains | | |
Gross
Unrealized
Holding
Losses | | |
Estimated Fair
Value | |
| |
| | |
| | |
| | |
| |
Governmental Agency Securities | |
$ | 46,230,893 | | |
$ | 29,517 | | |
$ | - | | |
$ | 46,260,410 | |
U.S. Treasury Notes | |
| 97,785,061 | | |
| 41,639 | | |
| - | | |
| 97,826,700 | |
Total | |
$ | 144,015,954 | | |
$ | 71,156 | | |
$ | - | | |
$ | 144,087,110 | |
The
Company had no investments as of March 31, 2022.
5.
Commitments
Operating
and Finance Leases
The
Company leases its corporate space in Minneapolis, Minnesota. In March 2023, the Company signed the fourth amendment to extend this lease
through April 30, 2026. This amendment provides for monthly rent, real estate taxes and operating expenses. The Company recorded an incremental
$355,578 in the operating right-of-use (“ROU”) asset and lease liability pertaining to this amendment.
Clinical
Research Studies
The
Company enters into contracts in the normal course of business to conduct research and development programs internally and through third
parties that include, among others, arrangements with vendors, consultants, CMO’s, and CRO’s. The Company currently has four
Phase 2 clinical trial agreements in place to evaluate targeted therapies selected with one of our CELsignia tests. Timing of milestone
payments related to the Phase 2 clinical trials are uncertain and the contracts generally provide for termination following a certain
period after notice, therefore the Company believes that non-cancelable obligations under the agreements are not material. The Company
also has a license agreement in place with Pfizer to research, develop, manufacture and commercialize gedatolisib. In conjunction with
the license agreement, the Company continued a Phase 1b study – B2151009 related to gedatolisib. These patients subsequently transitioned
to an Expanded Access study – CELC-G-001. Contracts related to the Phase 1B study and the Expanded Access study, are generally
based on time and material. In addition, contracts related to the Company’s Phase 3 clinical study (VIKTORIA-1) are generally cancelable
with reasonable notice within 120 days and the Company’s obligations under these contracts are primarily based on services performed
through termination dates plus certain cancelation charges, if any, as defined in each of the respective agreements. In addition, these
agreements may, from time to time, be subjected to amendments as a result of any change orders executed by the parties. As of March 31,
2023, the Company had only one material non-cancelable contractual commitment with respect to these arrangements, which totaled approximately
$2.2 million.
6.
Stockholders’ Equity
Capital
Stock
At
December 31, 2022, the Company’s authorized capital stock consisted of 65,000,000 shares of $.001 par value common stock, of which
21,667,250 shares were outstanding, and 2,500,000 shares of $.001 par value preferred stock, of which 1,120,873 shares were outstanding.
On
March 31, 2023, one of the Company’s preferred shareholders elected to convert 25,000 shares of Series A Convertible Preferred
Stock into 250,0000 shares of Common Stock, in accordance with the Securities Purchase Agreement dated May 15, 2022. The cost basis of
the shares transferred is $5.75 per share.
At
March 31, 2023, the Company’s authorized capital stock consisted of 65,000,000 shares of common stock, of which 21,941,372 shares
were outstanding, and 2,500,000 shares of preferred stock, including 1,850,000 shares designated as Series A Preferred Stock, of which
1,095,873 shares were outstanding. As of March 31, 2023, no dividends have been declared on the Company’s capital stock.
7.
Stock-Based Compensation
The
following table summarizes the activity for all stock options outstanding for the three months ended March 31:
Schedule
of Stock Options Activity
| |
2023 | | |
2022 | |
| |
Shares | | |
Weighted
Average
Exercise Price | | |
Shares | | |
Weighted
Average
Exercise Price | |
Options outstanding at beginning of year | |
| 1,976,586 | | |
$ | 6.34 | | |
| 1,315,321 | | |
$ | 11.97 | |
Granted | |
| 119,985 | | |
| 11.36 | | |
| 119,500 | | |
| 10.01 | |
Exercised | |
| 24,122 | | |
| 5.30 | | |
| (1,415 | ) | |
| 5.24 | |
Forfeited | |
| (3,991 | ) | |
| 6.55 | | |
| (80,000 | ) | |
| 13.01 | |
Balance at March 31 | |
| 2,068,458 | | |
$ | 6.65 | | |
| 1,353,406 | | |
$ | 11.75 | |
| |
| | | |
| | | |
| | | |
| | |
Options exercisable at March 31: | |
| 1,114,767 | | |
$ | 5.91 | | |
| 625,912 | | |
$ | 9.68 | |
| |
| | | |
| | | |
| | | |
| | |
Weighted Average Grant Date Fair Value for options granted during the period: | |
| | | |
$ | 7.81 | | |
| | | |
$ | 6.72 | |
The
following table summarizes additional information about stock options outstanding and exercisable at March 31, 2023:
Schedule
of Stock Options Outstanding and Exercisable
Options Outstanding | |
Options Exercisable |
Options Outstanding | |
Weighted Average Remaining Contractual Life | | |
Weighted Average Exercise Price | | |
Aggregate Intrinsic Value | | |
Options Exercisable | |
Weighted Average Exercise Price | | |
Aggregate Intrinsic Value | |
|
2,068,458 | |
| 7.85 | | |
$ | 6.65 | | |
$ | 7,795,439 | | |
|
1,114,767 | |
$ | 5.91 | | |
$ | 5,004,674 | |
The
Company recognized stock-based compensation expense for stock options of $1,222,328 and $709,509 for the three months ended March 31,
2023 and 2022, respectively. In May 2022, the Company modified the exercise price on 776,324 stock option awards to $5.50, the closing
market price on the Nasdaq Capital Market on May 17, 2022. The effect of this modification on stock-based compensation was $39,612 and
$0 for the three months ending March 31, 2023 and 2022, respectively. The effect of this modification on stock-based compensation over
the remaining service period will be approximately $277,000. In December 2021, the Company modified the exercise price on 311,000 stock
option awards to $13.44, the closing market price on the Nasdaq Capital Market on December 15, 2021. No director or officer awards were
modified. The effect of this modification on stock-based compensation was $16,924 and $28,029 for the three months ended March 31, 2023
and 2022, respectively. The effect of this modification on stock-based compensation over the remaining service period will be approximately
$156,000. In May 2020, the Company modified the exercise price on 203,750 stock option awards to $5.10, the closing market price on the
Nasdaq Capital Market on May 14, 2020. No director or officer awards were modified. The effect of this modification on stock-based compensation
was $7,108 and $11,614 for the three months ended March 31, 2023 and 2022, respectively. The effect of this modification on stock-based
compensation over the remaining service period will be approximately $13,000.
The
Black-Scholes option-pricing model was used to estimate the fair value of equity-based awards with the following weighted-average assumptions
for the three months ended March 31:
Schedule
of Assumptions for Fair Value of Equity-based Awards
| |
2023 | | |
2022 | |
Risk-free interest rate | |
| 3.64% - 4.14 | % | |
| 1.68% - 2.41 | % |
Expected volatility | |
| 79.8 | % | |
| 76.2% - 76.5 | % |
Expected life (years) | |
| 5.25 to | | |
| 6.04 to 6.08 | |
Expected dividend yield | |
| 0 | % | |
| 0 | % |
The
inputs for the Black-Scholes valuation model require management’s significant assumptions. Prior to the Company’s initial
public offering, the price per share of common stock was determined by the Company’s board based on recent prices of common stock
sold in private offerings. Subsequent to the initial public offering, the price per share of common stock is determined by using the
closing market price on the Nasdaq Capital Market on the grant date. The risk-free interest rates are based on the rate for U.S. Treasury
securities at the date of grant with maturity dates approximately equal to the expected life at the grant date. The expected life is
based on the simplified method in accordance with the SEC Staff Accounting Bulletin Nos. 107 and 110. The expected volatility is estimated
based on historical volatility information of peer companies that are publicly available in combination with the Company’s calculated
volatility since being publicly traded.
All
assumptions used to calculate the grant date fair value of non-employee options are generally consistent with the assumptions used for
options granted to employees. In the event the Company terminates any of its consulting agreements, the unvested options issued in connection
with the agreements would also be cancelled.
No
restricted stock awards were granted during the three months ended March 31, 2023 and 2022. The Company had 3,273 and 2,964 shares of
restricted stock outstanding as of March 31, 2023 and 2022, respectively, and 0 shares of restricted stock vested during the three months
ended March 31, 2023 and 2022. The Company recognized stock-based compensation expense for restricted stock of $4,642 and $20,344 for
the three months ended March 31, 2023 and 2022, respectively.
The
Company initially reserved a maximum of 750,000
shares of common stock for issuance under the 2017 Amended and Restated Stock Incentive Plan (the “2017 Plan”). The
number of shares reserved for issuance was automatically increased by 102,998, 149,189
and 216,673
shares on January 1, 2021, 2022 and 2023, respectively, and will increase
automatically on January 1 of each year from 2024 through 2027 by the number of shares equal to 1.0% of the aggregate number of
outstanding shares of Company common stock as of the immediately preceding December 31. At the Annual Meeting held on May 12,
2021 and May 12, 2022, the stockholders approved a one-time, 500,000
increase each year for a total of 1,000,000
increase, to the number of shares reserved for issuance under the 2017 Plan. However, the Company’s board may reduce the
amount of the increase in any particular year. The total remaining shares available for grant under the Company’s 2017 Plan as
of March 31, 2023 was 343,114.
Total
unrecognized compensation cost related to stock options and restricted stock is estimated to be recognized as follows:
Schedule
of Unrecognized Compensation Cost
| |
| | |
2023 | |
$ | 2,781,277 | |
2024 | |
| 2,291,390 | |
2025 | |
| 1,474,943 | |
2026 | |
| 435,113 | |
2027 | |
| 6,198 | |
Total estimated compensation cost to be recognized | |
$ | 6,988,921 | |
The
Company recognized stock-based compensation expense related to its employee stock purchase plan of $46,312 and $26,148 for the three
months ended March 31, 2023 and 2022, respectively. The Company initially reserved a total of 100,000 shares for issuance under the employee
stock purchase plan. The number of shares reserved for issuance was automatically increased by 51,499, 74,594 and 108,337 shares on January
1, 2021, 2022 and 2023, respectively, and will increase automatically on each subsequent January 1 by the number of shares equal to 0.5%
of the total outstanding number of shares of Company common stock as of the immediately preceding December 31. However, the Company’s
board may reduce the amount of the increase in any particular year. The total remaining shares available for issuance under the employee
stock purchase plan as of March 31, 2023 was .
The
Company recognized total stock-based compensation expense as follows for the three months ended March 31:
Schedule
of Stock-based Compensation Expense
| |
2023 | | |
2022 | |
| |
Three Months Ended | |
| |
March | |
| |
2023 | | |
2022 | |
Stock-based compensation expense in operating expenses: | |
| | | |
| | |
Research and development | |
$ | 654,471 | | |
$ | 450,520 | |
General and administrative | |
| 618,811 | | |
| 305,751 | |
Total | |
$ | 1,273,282 | | |
$ | 756,271 | |
8.
Debt
On
April 8, 2021, the Company entered into a loan and security agreement (the “Loan Agreement”) with Innovatus Life Sciences
Lending Fund I, LP, a Delaware limited partnership (“Innovatus”) in its capacity as Collateral Agent and sole Lender. On
August 9, 2022, the Company amended the Loan Agreement. Under the amended Loan Agreement, Innovatus, as Lender, has agreed to loan up
to $75 million, a $50 million increase from the original Loan Amount. As of March 31, 2023, term loans totaling $35 million are outstanding
under the Loan Agreement, including the initial Term A loan of $15 million which was funded on April 8, 2021, and a $20 million Term
B loan which was funded on December 22, 2022.
Long-term
debt consisted of the following at March 31, 2023 and December 31, 2022:
Schedule
of Long-term Debt
| |
March 31, 2023 | | |
December 31, 2022 | |
Note payable | |
$ | 35,000,000 | | |
$ | 35,000,000 | |
Add: PIK interest (added to principal) | |
| 1,193,259 | | |
| 755,075 | |
Add: final fee | |
| - | | |
| - | |
Less: unamortized debt issuance costs | |
| (653,555 | ) | |
| (707,001 | ) |
Less: unamortized debt discount | |
| (61,442 | ) | |
| (65,000 | ) |
Total long-term debt | |
$ | 35,478,262 | | |
$ | 34,983,074 | |
Future
principal payments, including the incurred PIK interest, are as follows:
Schedule
of Long Term Debt Future Principal Payments
| |
Years Ending December 31, | |
| |
| |
2025 | |
$ | 13,572,473 | |
2026 | |
| 18,096,629 | |
2027 | |
| 4,524,157 | |
Total | |
$ | 36,193,259 | |
ITEM
2. Management’s Discussion and Analysis of Financial Condition and Results of Operations
You
should read the following discussion and analysis of our financial condition and results of operations together with our unaudited condensed
financial statements and the related notes appearing under Item 1 of Part I of this Quarterly Report on Form 10-Q (this “Quarterly
Report”). Some of the information contained in this discussion and analysis or set forth elsewhere in this Quarterly Report, including
information with respect to our plans and strategy for our business and expected financial results, includes forward-looking statements
that involve risks and uncertainties. You should review the “Risk Factors” discussed in our Annual Report on Form 10-K for
the year ended December 31, 2022, filed with the SEC on March 23, 2023 and elsewhere in this Quarterly Report for a discussion of important
factors that could cause actual results to differ materially from the results described in or implied by the forward-looking statements
contained in the following discussion and analysis.
Overview
Celcuity
is a clinical-stage biotechnology company focused on the development of targeted therapies for treatment of multiple solid tumor indications.
The Company’s lead therapeutic candidate is gedatolisib, a pan-PI3K/mTOR inhibitor. Its mechanism of action and pharmacokinetic
properties are highly differentiated from other currently approved and investigational therapies that target PI3K or mTOR alone or together.
The Company initiated VIKTORIA-1, a Phase 3 study evaluating gedatolisib in patients with HR+/HER2- advanced breast cancer in 2022 and
is currently enrolling patients. Its CELsignia companion diagnostic platform is uniquely able to analyze live patient tumor cells to
identify new groups of cancer patients likely to benefit from already approved targeted therapies.
Gedatolisib,
is a potent, well-tolerated, small molecule reversible dual inhibitor, administered intravenously, that selectively targets all Class
I isoforms of PI3K and mammalian target of rapamycin (mTOR). In April 2021, we obtained exclusive global development and commercialization
rights to gedatolisib under a license agreement with Pfizer, Inc. We believe gedatolisib’s unique mechanism of action, differentiated
chemical structure, favorable pharmacokinetic properties, and intravenous formulation offer distinct advantages over currently approved
and investigational therapies that target PI3K or mTOR alone or together.
|
● |
Overcomes
limitations of therapies that only inhibit a single Class I PI3K isoform or only one mTOR kinase complex. |
Gedatolisib
is a pan-class I isoform PI3K inhibitor with low nanomolar potency for the p110α, p110β, p110γ, and p110δ isoforms
and mTORC1 and mTORC2 complexes. Each PI3K isoform and mTOR complex is known to preferentially affect different signal transduction events
that involve tumor cell survival, depending upon the aberrations associated with the linked pathway. When a therapy only inhibits a single
Class 1 isoform (e.g., alpelisib, a PI3K-α inhibitor ) or only one mTOR kinase complex (e.g., everolimus, an mTORC1 inhibitor),
numerous feedforward and feedback loops between the PI3K isoforms and mTOR complexes cross-activate the uninhibited sub-units. This,
in turn, induces compensatory resistance that can reduce the efficacy of isoform specific PI3K or single mTOR kinase complex inhibitors.
Inhibiting all four PI3K isoforms and both mTOR complexes, as gedatolisib does, thus prevents the confounding effect of isoform interaction
that may occur with isoform-specific PI3K inhibitors and the confounding interaction between PI3K isoforms and mTOR.
|
● |
Better
tolerated by patients than oral PI3K and mTOR drugs. |
Gedatolisib
is administered intravenously (IV) on a four-week cycle of three weeks-on, one week-off, in contrast to the orally administered pan-PI3K
or dual PI3K/mTOR inhibitors that are no longer being clinically developed. Oral pan-PI3K or PI3K/mTOR inhibitors have repeatably been
found to induce significant side effects that were not well tolerated by patients. This typically leads to a high proportion of patients
requiring dose reductions or treatment discontinuation. The challenging toxicity profile of these drug candidates ultimately played a
significant role in the decisions to halt their development, despite showing promising efficacy. By contrast, gedatolisib stabilizes
at lower concentration levels in plasma compared to orally administered PI3K inhibitors, resulting in less toxicity, while maintaining
concentrations sufficient to inhibit PI3K/mTOR signaling.
Isoform-specific
PI3K inhibitors administered orally were developed to reduce toxicities in patients. While the range of toxicities associated with isoform-specific
inhibitors is narrower than oral pan-PI3K or PI3K/mTOR inhibitors, administering them orally on a continuous basis still leads to challenging
toxicities. The experience with an FDA approved oral p110-α specific inhibitor, Piqray, illustrates the challenge. In its Phase
3 pivotal trial Piqray was found to induce a Grade 3 or 4 adverse event (AE) related to hyperglycemia in 39% of patients evaluated. In
addition, 26% of patients discontinued alpelisib due to treatment related adverse events. By contrast, in the 103-patient dose expansion
portion of the Phase 1b clinical trial with gedatolisib, only 7% of patients experienced Grade 3 or 4 hyperglycemia and less than 10%
discontinued treatment.
As
of March 31, 2023, 492 patients with solid tumors have received gedatolisib in eight clinical trials sponsored by Pfizer. Of the 492
patients, 129 were treated with gedatolisib as a single agent in three clinical trials. The remaining 363 patients received gedatolisib
in combination with other anti-cancer agents in five clinical trials. Additional patients received gedatolisib in combination with other
anti-cancer agents in nine investigator sponsored clinical trials.
A
Phase 1b trial (B2151009) evaluating patients with HR+/HER2- metastatic breast cancer was initiated in 2016 and subsequently enrolled
138 patients. Seven patients from this study continue to receive study treatment, as of March 31, 2023, each of whom have received study
treatment for more than four years. The B2151009 clinical was an open label, multiple arm Phase 1b study that evaluated gedatolisib in
combination with palbociclib (CDK4/6 inhibitor) and fulvestrant or letrozole in patients with HR+/HER2- advanced breast cancer. Thirty-five
patients were enrolled in two dose escalation arms to evaluate the safety and tolerability and to determine the maximum tolerated dose
(MTD) of gedatolisib when used in combination with the standard doses of palbociclib and endocrine therapy (letrozole or fulvestrant).
The MTD was determined to be 180 mg administered intravenously once weekly. A total of 103 patients were subsequently enrolled in one
of four expansion arms (A, B, C, D).
High
objective overall response rates (ORR) were observed in all four expansion arms and were comparable in each arm for PIK3CA WT and PIK3CA
MT patients. In treatment-naïve patients (Arm A), ORR was 85%. As of the data cut-off date, December 12, 2022, for Expansion Arm
A, median progression free survival (mPFS) was 48.6 months. In patients who received prior hormonal therapy alone or in combination with
a CDK4/6 inhibitor (Arms B, C, and D), ORR ranged from 32% to 77%. Each arm achieved its primary endpoint target, which was reporting
higher ORR in the study arm than ORR from either the PALOMA-2 (ORR=55%) study that evaluated palbociclib plus letrozole for Arm A or
the PALOMA-3 study (ORR=25%) that evaluated palbociclib plus fulvestrant for Arms B, C, and D. For all enrolled patients, a clinical
benefit rate (CBR) of ≥79% was observed. Median progression-free survival (PFS) was 12.9 months for patients who received a prior
CDK4/6 inhibitor and were treated in the study with the Phase 3 dosing schedule (Arm D).
Gedatolisib
combined with palbociclib and endocrine therapy demonstrated a favorable safety profile with manageable toxicity. The majority of treatment
emergent adverse events were Grade 1 and 2. The most frequently observed adverse events included stomatitis/mucosal inflammation, the
majority of which were Grade 1 and 2. The most common Grade 4 AEs were neutropenia and neutrophil count decrease, which were assessed
as related to treatment with palbociclib. No grade 5 events were reported in this study.
We
are currently enrolling patients in a Phase 3, open-label, randomized clinical trial (VIKTORIA-1) to evaluate the efficacy and safety
of two regimens in adults with HR+/HER2- advanced breast cancer whose disease has progressed after prior CDK4/6 therapy in combination
with an aromatase inhibitor: 1) gedatolisib in combination with palbociclib and fulvestrant; and 2) gedatolisib in combination with fulvestrant.
Two hundred clinical sites in North America, Europe, South America, Asia, and Australia have been selected to participate in the study.
The first clinical site was activated in the third quarter of 2022. The first dosage of a subject in the trial occurred in December 2022.
The
VIKTORIA-1 clinical trial will enable separate evaluation of subjects according to their PIK3CA status. Subjects who meet eligibility
criteria and are PIK3CA WT will be randomly assigned (1:1:1) to receive a regimen of either gedatolisib, palbociclib, and fulvestrant
(Arm A), gedatolisib and fulvestrant (Arm B), or fulvestrant (Arm C). Subjects who meet eligibility criteria and are PIK3CA MT will be
randomly assigned (3:3:1) to receive a regimen of either gedatolisib, palbociclib, and fulvestrant (Arm D) or alpelisib and fulvestrant
(Arm E), or gedatolisib and fulvestrant (Arm F)
Our
proprietary CELsignia diagnostic platform is the only commercially ready technology we are aware of that uses a patient’s living
tumor cells to identify the specific abnormal cellular process driving a patient’s cancer and the targeted therapy that best treats
it. This enables us to identify patients whose tumors may respond to a targeted therapy, even though they lack a previously associated
molecular mutation. By identifying cancer patients whose tumors lack an associated genetic mutation but have abnormal cellular activity
a matching targeted therapeutic is designed to inhibit, CELsignia CDx can expand the markets for a number of already approved targeted
therapies. Our current CDx identifies breast and ovarian cancer patients whose tumors have cancer drivers potentially responsive to treatment
with human epidermal growth factor receptor 2-negative (HER2), mesenchymal-epithelial transition factor (c-MET), or phosphatidylinositol
3-kinases (PI3K) targeted therapeutics. While U.S. Food and Drug Administration (“FDA”) approval or clearance is not currently
required for CELsignia tests offered as a stand-alone laboratory developed test, if we are partnered with a drug company to launch a
CELsignia test as a companion diagnostic for a new drug indication, we would be required to obtain premarket approval, or PMA, in conjunction
with the pharmaceutical company seeking a new drug approval for the matching therapy.
We
are supporting the advancement of new potential indications for four different targeted therapies, controlled by other pharmaceutical
companies, that would rely on a CELsignia CDx to select patients. Four Phase 2 trials are underway to evaluate the efficacy and safety
of these therapies in CELsignia selected patients. These patients are not currently eligible to receive these drugs and are not identifiable
with a molecular test.
Supporting
the development of a potential first-in-class targeted therapy for breast cancer, like gedatolisib, with our CELsignia platform is a
natural extension of our strategy to use our CELsignia CDx to enable new indications for other companies’ targeted therapies. By
combining companion diagnostics designed to enable proprietary new drug indications with targeted therapies that treat signaling dysregulation
our CDx identifies, we believe we are uniquely positioned to improve the standard-of-care for many early and late-stage breast cancer
patients. Our goal is to play a key role in the multiple treatment approaches required to treat breast cancer patients at various stages
of their disease. With each program, we are:
|
● |
Leveraging
the proprietary insights CELsignia provides into live patient tumor cell function |
|
|
|
|
● |
Using
a CELsignia CDx to identify new patients likely to respond to the paired targeted therapy |
|
|
|
|
● |
Developing
a new targeted therapeutic option for breast cancer patients |
|
|
|
|
● |
Maximizing
the probability of getting regulatory approval to market the targeted therapy indication |
Under
our April 2021 license agreement with Pfizer to research, develop, manufacture and commercialize gedatolisib, we paid a $5.0 million
upfront fee and granted to Pfizer $5.0 million shares of Company common stock, which fee and grant were effected and expensed to research & development in full for the quarter in which we signed the license agreement. In addition, we are also required to make milestone
payments to Pfizer upon achievement of certain development and commercial milestone events, up to an aggregate of $335.0 million. Additionally,
the Company will pay Pfizer tiered royalties on sales of gedatolisib at percentages ranging from the low to mid-teens, which may be subject
to deductions for expiration of valid claims, amounts due under third-party licenses and generic competition. Unless earlier terminated,
the license agreement will expire upon the expiration of all royalty obligations. The royalty period will expire on a country-by-country
basis upon the later of (a) 12 years following the date of first commercial sale of such product in such country, (b) the expiration
of all regulatory or data exclusivity in such country for such product or (c) the date upon which the manufacture, use, sale, offer for
sale or importation of such product in such country would no longer infringe, but for the license granted in the license agreement, a
valid claim of a licensed patent right.
The
Company has the right to terminate the license agreement for convenience upon 90 days’ prior written notice. Pfizer may not terminate
the agreement for convenience. Either the Company or Pfizer may terminate the license agreement if the other party is in material breach
and such breach is not cured within the specified cure period. In addition, either the Company or Pfizer may terminate the license agreement
in the event of specified insolvency events involving the other party.
Recent
Developments
In
May 2023, updated data from the Company’s Phase 1b study in treatment naïve patients with HR+, HER2- advanced breast
cancer was presented at the European Society for Medical Oncology (ESMO) Breast Cancer Annual Congress. These patients, from
Expansion Arm A and Escalation Arm A of the clinical trial, were treated with gedatolisib in combination with palbociclib and
letrozole. As of a database update on March 16, 2023, median progression free survival (mPFS) in treatment naïve patients in
Expansion Arm A was 48.6 months (n=30) and Escalation Arm A was 45.8 months (n=11). When treatment naïve patients from both
Escalation Arm A and Expansion Arm A arms are combined (N=41), mPFS was 48.6 months and mDOR was 46.9 months. These results compare
favorably to published data with other therapies in this setting.
In
April 2023, Celcuity presented a poster at the American Association for Cancer Research (AACR) Annual Meeting 2023 highlighting preclinical
data of gedatolisib’s superior anti-proliferative potency and efficacy in endometrial, ovarian and cervical cancer cell lines compared
to the other PI3K, AKT, and mTOR inhibitors evaluated regardless of PTEN, P13K or AKT mutational status.
In
February 2023, the company presented data from preclinical studies evaluating gedatolisib and other PI3K, AKT, and mTOR inhibitors in
prostate cancer cell lines at the American Society of Clinical Oncology Genitourinary Cancers Symposium. The presentation demonstrated
gedatolisib’s superior potency and efficacy across different prostate cancer cell lines relative to the other PI3K, AKT, and mTOR
inhibitors evaluated regardless of PTEN or PI3K mutational status.
Impact
of COVID-19 on our Business
Although
we have largely returned to normal operations in our facility, the COVID-19 pandemic continues and its effect on our operations and financial
condition will depend in large part on future developments which cannot be reasonably estimated at this time. Future developments include
the duration, scope and severity of the pandemic, the emergence of new virus variants that are more contagious or harmful than prior
variants, actions taken by governmental authorities, suppliers, clinical trial sites, and other business partners to contain or mitigate
the pandemic’s impact, and the potential adverse effects on the suppliers, labor market and general economic activity.
As
we continue to advance our clinical trial collaborations, we remain in close contact with our current clinical sponsors, and principal
investigators, as well as prospective pharmaceutical company and clinical collaborators, to monitor the impact of COVID-19 on our trial
enrollment timelines and collaboration discussions. We experienced delays in the enrollment of patients in our ongoing clinical trials
and now expect interim results from the FACT-1 and FACT-2 trials to be delayed until the first half of 2024 and final results approximately
nine months later. We could experience further delays in clinical trials and collaborations with pharmaceutical companies and sponsors
if new variants emerge or if the spread of COVID-19 once again accelerates. Due to the inherent uncertainty associated with the COVID-19
pandemic, we are unable to predict the impact the pandemic may have on our clinical trial work and overall financial condition.
Results
of Operations
We
have not generated any revenue from sales to date, and we continue to incur significant research and development and other expenses related
to our ongoing operations. As a result, we are not and have never been profitable and have incurred losses in each period since our inception
in 2012. For the three months ended March 31, 2023 and 2022, we reported a net loss of approximately $11.9 million and $7.9 million,
respectively. As of March 31, 2023, we had an accumulated deficit of approximately $108.2 million. As of March 31, 2023, we had
cash and cash equivalents and short-term investments of approximately $157.5 million.
Components
of Operating Results
Revenue
To
date, we have not generated any revenue. With the execution of the Pfizer license agreement in April 2021, whereby we acquired exclusive
world-wide licensing rights to develop and commercialize gedatolisib, we initiated a Phase 3 clinical trial, VIKTORIA-1, in 2022 to support
potential regulatory approval to market gedatolisib. If we obtain regulatory approvals to market gedatolisib, we expect to generate revenue
from sales of the drug for the treatment of breast cancer patients. Additionally, we will seek to generate revenue from partnership agreements
with pharmaceutical companies to provide companion diagnostics for such pharmaceutical partners’ existing or investigational targeted
therapies. If a new drug indication is received that requires use of our companion diagnostic to identify eligible patients, we expect
to generate revenues from sales of tests to treating physicians.
Research
and Development
Since
our inception, we have primarily focused on research and development of gedatolisib, a PI3K/mTOR targeted therapy and our CELsignia platform
and corresponding tests. Research and development expenses primarily include:
|
● |
employee-related
expenses related to our research and development activities, including salaries, benefits, recruiting, travel and stock-based compensation
expenses; |
|
● |
laboratory
supplies; |
|
● |
consulting
fees paid to third parties; |
|
● |
clinical
trial costs; |
|
● |
validation
costs for gedatolisib |
|
● |
facilities
expenses; and |
|
● |
legal
costs associated with patent applications. |
Internal
and external research and development costs are expensed as they are incurred. As we continue development of gedatolisib, manage the
VIKTORIA-1 Phase 3 trial, and other clinical trials to evaluate the efficacy of targeted therapies in cancer patients selected with one
of our CELsignia tests, the proportion of research and development expenses allocated to external spending will grow at a faster rate
than expenses allocated to internal expenses.
General
and Administrative
General
and administrative expenses consist primarily of salaries, benefits and stock-based compensation related to our executive, finance and
support functions. Other general and administrative expenses include professional fees for auditing, tax, and legal services associated
with being a public company, director and officer insurance, investor relations and travel expenses for our general and administrative
personnel.
Sales
and Marketing
Sales
and marketing expenses consist primarily of professional and consulting fees related to these functions. To date, we have incurred immaterial
sales and marketing expenses as we continue to focus primarily on the development of our first drug, gedatolisib, managing the VIKTORIA-1
Phase 3 trial, and development of our CELsignia platform and corresponding CELsignia tests. We would expect to begin to incur increased
sales and marketing expenses in anticipation of the commercialization of our first drug, gedatolisib, and CELsignia tests. These increased
expenses are expected to include payroll-related costs as we add employees in the commercial departments, costs related to the initiation
and operation of our sales and distribution network and marketing related costs.
Interest
Expense
Interest
expense is primarily due to a Loan Agreement and finance lease obligations.
Interest
Income
Interest
income consists of interest income earned on our cash, cash equivalents, and investment balances.
Results
of Operations
Comparison
of the Three Months Ended March 31, 2023 and 2022
| |
Three Months Ended | | |
| | |
| |
| |
March 31, | | |
Increase (Decrease) | |
| |
2023 | | |
2022 | | |
$ | | |
Percent Change | |
Statements of Operations Data: | |
| | | |
| | | |
| | | |
| | |
Operating expenses: | |
| | | |
| | | |
| | | |
| | |
| |
| | | |
| | | |
| | | |
| | |
Research and development | |
$ | 11,278,493 | | |
$ | 6,696,313 | | |
$ | 4,582,180 | | |
| 68 | % |
General and administrative | |
| 1,269,044 | | |
| 811,292 | | |
| 457,752 | | |
| 56 | |
Total operating expenses | |
| 12,547,537 | | |
| 7,507,605 | | |
| 5,039,932 | | |
| 67 | |
Loss from operations | |
| (12,547,537 | ) | |
| (7,507,605 | ) | |
| (5,039,932 | ) | |
| 67 | |
| |
| | | |
| | | |
| | | |
| | |
Other income (expense) | |
| | | |
| | | |
| | | |
| | |
Interest expense | |
| (1,242,012 | ) | |
| (435,001 | ) | |
| (807,011 | ) | |
| 186 | |
Interest income | |
| 1,851,132 | | |
| 8,159 | | |
| 1,842,973 | | |
| n/a | |
Other income (expense), net | |
| 609,120 | | |
| (426,842 | ) | |
| 1,035,962 | | |
| n/a | |
Net loss before income taxes | |
| (11,938,417 | ) | |
| (7,934,447 | ) | |
| (4,003,970 | ) | |
| 50 | |
Income tax benefits | |
| - | | |
| - | | |
| - | | |
| - | |
Net loss | |
$ | (11,938,417 | ) | |
$ | (7,934,447 | ) | |
$ | (4,003,970 | ) | |
| 50 | % |
Research
and Development
Our
research and development expenses for the three months ended March 31, 2023 were approximately $11.3 million, representing an increase
of approximately $4.6 million, or 68%, compared to the same period in 2022. Of the $4.6 million increase in research and development
expense, $0.8 million was related to increased employee and consulting expenses, of which $0.2 million was in the form of non-cash stock-based
compensation. The remaining $3.8 million increase of research and development costs is related to costs supporting activities for the
VIKTORIA-1 pivotal trial and other existing clinical trials.
Conducting
a significant amount of research and development is central to our business model. We plan to increase our research and development expenses
for the foreseeable future as we seek to develop gedatolisib, manage the VIKTORIA-1 Phase 3 trial, discover new cancer sub-types, and
develop and validate additional CELsignia tests to diagnose such sub-types. We also expect to incur increased expenses to support companion
diagnostic business development activities with pharmaceutical companies as we develop additional CELsignia tests and initiate a clinical
trial for gedatolisib.
General
and Administrative
Our
general and administrative expenses for the three months ended March 31, 2023 were approximately $1.3 million, representing an increase
of approximately $0.5 million, or 56%, compared to the same period in 2022. Non-cash stock-based compensation accounted for $0.3 million
of the $0.5 million increase. The remaining $0.2 million of the $0.5 million increase resulted from professional fees and other expenses
associated with being a public company.
We
anticipate that our general and administrative expenses will increase in future periods, reflecting both increased costs in connection
with the potential future commercialization of gedatolisib and CELsignia tests, an expanding infrastructure, and increased professional
fees associated with being a public company.
Interest
Expense
Interest
expense for the three months ended March 31, 2023 was $1.2 million and represents an increase of $0.8 million compared to the same period
in 2022. Interest expense is primarily the result of a Loan Agreement that was executed in April 2021 and amended in August 2022. The
increase is due to rising interest rates and the incremental $20 million funding of Term Loan B in December 2022. The $1.2 million of
interest expense includes $0.5 million of non-cash interest expense.
Interest
Income
Interest
income for the three months ended March 31, 2023 increased $1.8 million compared to the same period in 2022. The increase was primarily
the result of higher market interest rates and the closing of additional financing activities, leading to higher cash, cash equivalents
and short-term investment balances.
Liquidity
and Capital Resources
Since
our inception, we have incurred losses and cumulative negative cash flows from operations. Through March 31, 2023, we have funded our
operations primarily through private placements and registered offerings of our equity securities and unsecured convertible notes, and
borrowings under loan agreements. From inception through March 31, 2023, we raised an aggregate of approximately $223.7 million of net
proceeds through sales of our securities, and as of March 31, 2023 had $35.0 million of borrowings under loan agreements. As of March
31, 2023, our cash and cash equivalents and short-term investments were approximately $33.6 million and $123.8.0 million, respectively,
and we had an accumulated deficit of approximately $108.2 million.
Private
Placement. On December 9, 2022, we issued 6,182,574 shares of common stock, 1,120,873 shares of Series A Preferred Stock and warrants
exercisable for 6,956,450 shares of common stock to certain institutional and other accredited investors pursuant to a Securities Purchase
Agreement entered into on May 15, 2022. Pursuant to the Securities Purchase Agreement, the closing (funding) of the private placement
occurred following dosage of the first patient in the Company’s Phase 3 study, VIKTORIA-1. Investors purchased shares of common
stock and Series A Preferred Stock at a price of $5.75 per share (on an as converted to common stock basis), with forty percent (40%)
warrant coverage (on an as converted to common stock basis) and customary resale registration rights. The warrants have an exercise price
of $8.05 per share. The private placement generated gross proceeds of approximately $100 million before deducting placement agent fees
and other offering expenses of $4.3 million.
Open
Market Sale AgreementSM. On February 4, 2022, we entered into an Open Market Sale AgreementSM with Jefferies
LLC, as agent, pursuant to which we may offer and sell, from time to time, through Jefferies, shares of our common stock having an aggregate
offering price of up to $50,000,000. On October 12, 2022, pursuant to this agreement, the Company sold 500,000 shares of common stock
in a single transaction at a price of $10.35 per share, generating gross proceeds of $5.2 million ($4.8 million net of commissions and
offering expenses). At March 31, 2023, $44.8 million of common stock remains available for sale under the Jefferies agreement.
Innovatus
Loan Agreement. On April 8, 2021, we entered into a Loan Agreement with Innovatus Life Sciences Lending Fund I, LP (“Innovatus”),
under which Innovatus agreed to loan up to $25 million in three tranches consisting of (i) a $15.0 million non-contingent Term A loan
that was funded on April 8, 2021, (ii) a $5 million Term B loan with a deadline of March 31, 2022, and (iii) a $5 million Term C loan
to be funded upon our request, subject to our ability to achieve certain milestones, no later than March 31, 2023. On August 9, 2022,
the Company amended the Loan Agreement with Innovatus to provide for up to $75 million in term loans. As of March 31, 2023, term loans
totaling $35 million are outstanding under the Loan Agreement, including the initial Term A loan of $15 million which was funded on April
8, 2021, and a $20 million Term B loan which was funded on December 22, 2022 following the closing of the $100 million private placement
described above. Additionally, the Company will be able to draw on two additional tranches of $10 million and one additional tranche
of $20 million upon achievement of certain clinical trial milestones and satisfaction of certain financial covenants determined on a
pro forma as-funded basis. Funding of these additional tranches is also subject to other customary conditions and limits on when the
Company can request funding for such tranches.
We
expect that our research and development and general and administrative expenses will increase as we continue to develop gedatolisib,
manage the VIKTORIA-1 Phase 3 trial, conduct research related to the discovery of new cancer sub-types, conduct clinical trials, and
pursue other business development activities. We would also expect to incur sales and marketing expenses as we commercialize gedatolisib
and our CELsignia tests. We expect to use cash on hand, together with the funds to be received under the Securities Purchase Agreement
described above, to fund our research and development expenses, clinical trial costs, capital expenditures, working capital, sales and
marketing expenses, and general corporate expenses.
Based
on our current business plan, we believe that our current cash, cash equivalents and short-term investments together with available borrowings
under the Innovatus Loan Agreement will provide sufficient cash to finance our operations and pay obligations when due for at least the
next twelve months.
Our
expectations as to how long our current capital resources will be sufficient to fund our operations are based on assumptions that may
not be accurate, and we could use our current capital resources sooner than we currently expect. In addition, we may seek to raise additional
capital to finance capital expenditures and operating expenses over the next several years as we launch our integrated therapeutic and
companion diagnostic strategy and expand our infrastructure, commercial operations and research and development activities, and to take
advantage of financing or other opportunities that we believe to be in the best interests of the Company and our stockholders. Additional
capital may be raised through the sale of common or preferred equity or convertible debt securities, entry into debt facilities or other
third-party funding arrangements. The sale of equity and convertible debt securities may result in dilution to our stockholders and those
securities may have rights senior to those of our common shares. Agreements entered into in connection with such capital raising activities
could contain covenants that would restrict our operations or require us to relinquish certain rights. Additional capital may not be
available on reasonable terms, or not at all.
Cash
Flows
The
following table sets forth the primary sources and uses of cash for the three months ended March 31:
| |
2023 | | |
2022 | |
| |
| |
Net cash provided by (used in): | |
| | | |
| | |
Operating activities | |
$ | (12,867,838 | ) | |
$ | (5,933,032 | ) |
Investing activities | |
| 21,867,551 | | |
| (11,635 | ) |
Financing activities | |
| 67,948 | | |
| (46,288 | ) |
Net increase (decrease) in cash and cash equivalents | |
$ | 9,067,661 | | |
$ | (5,990,955 | ) |
Operating
Activities
Net
cash used in operating activities was approximately $12.9 million for the three months ended March 31, 2023 and consisted primarily of
a net loss of approximately $11.9 million and working capital changes of $1.0 million, offset by non-cash expense items of approximately
$0.1 million. Non-cash expense items of approximately $0.1 million primarily consisted of $1.3 million of stock-based compensation expense
and non-cash interest expense of $0.5 million, offset by $1.7 million of non-cash interest income. The approximately $1.0 million of
working capital changes was primarily due to a decrease in accrued expenses. The net cash used in operating activities was approximately
$5.9 million for the three months ended March 31, 2022 and consisted primarily of a net loss of approximately $7.9 million, offset
by non-cash expense items of $1.0 million and working capital changes of $1.0 million. Non-cash expense items of approximately $1.0 million
primarily consisted of $0.7 million of stock-based compensation expense, non-cash interest expense of $0.2 million, and depreciation
expense of $0.1 million. The approximately $1.0 million of working capital changes was primarily due to an increase in accounts payable
and accrued expenses.
Investing
Activities
Net
cash provided by investing activities for the three months ended March 31, 2023 was approximately $21.9 million and consisted primarily
of net proceeds from maturities of short-term investments in government securities (U.S. Treasury Bills and U.S. government securities)
and minimal purchases of property and equipment. Net cash used in investing for the three months ended March 31, 2022 were minimal and
consisted of purchases of property and equipment.
Financing
Activities
Net
cash provided by financing activities for the three months ended March 31, 2023 was minimal and primarily consisted of proceeds from
the exercise of employee stock options, slightly offset by payments for secondary registration and debt issuance costs. The net cash
provided by financing activities for the three months ended March 31, 2022 was minimal and primarily consisted of payments for secondary
registration costs.
Recent
Accounting Pronouncements
From
time-to-time new accounting pronouncements are issued by the Financial Accounting Standards Board or other standard setting bodies and
adopted by us as of the specified effective date. Unless otherwise discussed in Note 2 to our unaudited condensed financial statements
included in Item 1 of Part I of this Quarterly Report, we believe that the impact of recently issued standards that are not yet effective
will not have a material impact on our financial position or results of operations upon adoption.
Critical
Accounting Policies and Use of Estimates
Our
management’s discussion and analysis of financial condition and results of operations is based on our unaudited condensed financial
statements, which have been prepared in accordance with U.S. GAAP. The preparation of these financial statements requires us to make
estimates and assumptions that affect the reported amounts of assets and liabilities and the disclosure of contingent assets and liabilities
at the date of the financial statements, as well as the reported expenses during the reporting periods. These items are monitored and
analyzed by us for changes in facts and circumstances, and material changes in these estimates could occur in the future. We base our
estimates on historical experience and on various other factors that we believe are reasonable under the circumstances; the results of
which form the basis for making judgments about the carrying value of assets and liabilities that are not readily apparent from other
sources. Changes in estimates are reflected in reported results for the period in which they become known. Actual results may differ
materially from these estimates.
Our
significant accounting policies are more fully described in Note 2 to our unaudited condensed financial statements included in Item 1
of Part I of this Quarterly Report.
Private
Securities Litigation Reform Act
The
Private Securities Litigation Reform Act of 1995 provides a “safe harbor” for forward-looking statements. Such forward-looking
information is included in this Quarterly Report and in other materials filed or to be filed by us with the SEC (as well as information
included in oral statements or other written statements made or to be made by us). Forward-looking statements include all statements
based on future expectations. This Quarterly Report contains forward-looking statements that involve risks and uncertainties including,
but not limited to, (i) our clinical trial plans and the estimated costs for such trials, including the timing of launching a Phase 3
clinical trial for gedatolisib; (ii) our expectations with respect to costs and timelines to develop, validate and launch CELsignia tests
and to continue to develop gedatolisib; (iii) our beliefs related to the perceived advantages of our CELsignia tests compared to traditional
molecular or other diagnostic tests; (iv) the expected benefits of gedatolisib; (v) our expectations regarding the timeline of patient
enrollment and results from clinical trials, including the existing clinical trial for gedatolisib; (vi) the future payments that may
be owned to Pfizer under the license agreement; (vii) our expectations regarding partnering with pharmaceutical companies and other third
parties; (viii) our expectations regarding revenue from sales of CELsignia tests and revenue from milestone or other payment sources;
(ix) our plans with respect to research and development and related expenses for the foreseeable future; (x) our expectations regarding
business development activities, including companion diagnostic related activities with pharmaceutical companies, expanding our sales
and marketing functions and the costs associated with such activities; (xi) our expectations with respect to the CELsignia tests and
the analytical capabilities and potential impact of such tests; (xii) our beliefs regarding the ability of our cash on hand to fund our
research and development expenses, capital expenditures, working capital, sales and marketing expenses, and general corporate expenses,
as well as the increased costs associated with being a public company; (xiii) our plans with respect to potentially raising capital,
and (xiv) our expectations regarding the impact that the COVID-19 pandemic and related economic effects will have on our business and
results of operations.
In
some cases, you can identify forward-looking statements by the following words: “anticipate,” “believe,” “continue,”
“could,” “estimate,” “expect,” “intend,” “may,” “ongoing,” “plan,”
“potential,” “predict,” “project,” “should,” “will,” “would,”
or the negative of these terms or other comparable terminology, although not all forward-looking statements contain these words. Forward-looking
statements are only predictions and are not guarantees of performance. These statements are based on our management’s beliefs and
assumptions, which in turn are based on their interpretation of currently available information.
These
statements involve known and unknown risks, uncertainties and other factors that may cause our results or our industry’s actual
results, levels of activity, performance or achievements to be materially different from the information expressed or implied by these
forward-looking statements. Certain risks, uncertainties and other factors include, but are not limited to, our limited operating history;
the potential impact of the COVID-19 pandemic on our business; our initial success being heavily dependent on the success of our CELsignia
HER2 Pathway Activity Test; our inability to develop and commercialize gedatolisib; our inability to determine whether our CELsignia
tests are currently commercially viable; challenges we may face in developing and maintaining relationships with pharmaceutical company
partners; the complexity and timeline for development of CELsignia tests and gedatolisib; the uncertainty and costs associated with clinical
trials; the uncertainty regarding market acceptance by physicians, patients, third-party payors and others in the medical community,
and with the size of market opportunities available to us; the pricing of molecular and other diagnostic products and services that compete
with us; uncertainty with insurance coverage and reimbursement for our CELsignia tests; difficulties
we may face in managing growth, such as hiring and retaining a qualified sales force and attracting and retaining key personnel; changes
in government regulations; tightening credit markets and limitations on access to capital; and obtaining and maintaining intellectual
property protection for our technology and time and expense associated with defending third-party claims of intellectual property infringement,
investigations or litigation threatened or initiated against us. These and additional risks, uncertainties and other factors are
described more fully in our Annual Report on Form 10-K for the year ended December 31, 2022 and elsewhere in this Quarterly Report. Copies
of filings made with the SEC are available through the SEC’s electronic data gathering analysis and retrieval system (EDGAR) at
www.sec.gov.
You
should read the cautionary statements made in this Quarterly Report as being applicable to all related forward-looking statements wherever
they appear in this Quarterly Report. We cannot assure you that the forward-looking statements in this Quarterly Report will prove to
be accurate. Furthermore, if our forward-looking statements prove to be inaccurate, the inaccuracy may be material. You should read this
Quarterly Report completely. Other than as required by law, we undertake no obligation to update these forward-looking statements, even
though our situation may change in the future.