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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington D. C. 20549
FORM
10-K
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|
☒
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ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES
EXCHANGE ACT OF 1934
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For the fiscal year ended
June 30,
2022
or
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☐
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TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES
EXCHANGE ACT OF 1934
|
For the transition period from
Commission file number
001-37823
Kintara Therapeutics, Inc.
(Exact name of registrant as specified in its charter)
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Nevada
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99-0360497
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(State or other jurisdiction of
incorporation or organization)
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(I.R.S. Employer
Identification No.)
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9920 Pacific Heights Blvd,
Suite 150
San Diego,
CA
92121
(Address of principal executive offices) (Zip Code)
(858)
350-4364
(Registrant’s telephone number, including area code)
Securities registered pursuant to Section 12(b) of the
Act:
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Title of each class
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Trading Symbol(s)
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Name of each exchange on which registered
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Common Stock
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KTRA
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The
Nasdaq Capital
Market
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Securities registered pursuant to Section 12(g) of the Act:
None.
Indicate by check mark if the registrant is a well-known seasoned
issuer as defined in Rule 405 of the Securities Act.
☐
Yes
☒
No
Indicate by check mark if the registrant is not required to file
reports pursuant to Section 13 or Section 15(d) of the Act.
☐
Yes
☒
No
Indicate by check mark whether the registrant (1) has filed all
reports required to be filed by Section 13 or 15(d) of the
Securities Exchange Act of 1934 during the preceding 12 months (or
for such shorter period that the registrant was required to file
such reports), and (2) has been subject to such filing requirements
for the past 90 days.
☒
Yes
☐
No
Indicate by check mark whether the registrant has submitted
electronically every Interactive Data File required to be submitted
pursuant to Rule 405 of Regulation S-T (§ 232.405 of this chapter)
during the preceding 12 months (or for such shorter period that the
registrant was required to submit such files).
☒
Yes
☐
No
Indicate by check mark whether the registrant is a large
accelerated filer, an accelerated filer, a non-accelerated filer,
smaller reporting company, or an emerging growth company. See the
definitions of “large accelerated filer”, “accelerated filer”,
“smaller reporting company,” and “emerging growth company” in Rule
12b-2 of the Exchange Act.
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Large accelerated filer
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Accelerated filer
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Non-accelerated filer
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Smaller reporting company
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Emerging growth company
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☐
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If an emerging growth company, indicate by check mark if the
registrant has elected not to use the extended transition period
for complying with any new or revised financial accounting
standards provided pursuant to Section 13(a) of the Exchange
Act.
☐
Indicate by check mark whether the registrant has filed a report on
and attestation to its management’s assessment of the effectiveness
of its internal control over financial reporting under Section
404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the
registered public accounting firm that prepared or issued its audit
report.
☐
Indicate by check mark whether the registrant is a shell company
(as defined by Rule 12b-2 of the Act)
☐
Yes
☒
No
As of December 31, 2021, the aggregate market value of the issued
and outstanding common stock held by non-affiliates of the
registrant, based upon the closing price of our common stock of
$0.51 was approximately $24.7
million. For purposes of the above statement only, all directors,
named executive officers and 10% shareholders are assumed to be
affiliates. This determination of affiliate status is not
necessarily a conclusive determination for any other
purpose.
Number of shares of common stock outstanding as of September 26,
2022 was
80,807,316.
DOCUMENTS INCORPORATED BY REFERENCE –
None
Auditor Name: Marcum LLP Auditor Location: San Francisco, CA
Auditor Firm ID:
688
FORM 10-K
FOR THE FISCAL YEAR ENDED JUNE 30, 2022
TABLE OF CONTENTS
i
PART
I
Item 1. Business.
Background
Kintara Therapeutics, Inc. is a clinical stage, biopharmaceutical
company focused on the development and commercialization of new
cancer therapies.
On June 10, 2020, we entered into an Agreement and Plan of Merger
and Reorganization (the “Merger Agreement”) dated as of June 9,
2020, by and among Adgero Acquisition Corp., our wholly-owned
subsidiary incorporated in the State of Delaware (“Merger Sub”),
and Adgero Biopharmaceuticals Holdings, Inc., a Delaware
corporation (“Adgero”). On August 19, 2020, upon the terms and
subject to the conditions set forth in the Merger Agreement, Merger
Sub merged with and into Adgero (the “Merger”), the separate
corporate existence of Merger Sub ceased, and Adgero continued its
existence under Delaware law as the surviving corporation in the
Merger and became our direct, wholly-owned subsidiary.
Following the completion of the Merger, we changed our name from
DelMar Pharmaceuticals, Inc. to Kintara Therapeutics, Inc. and
began trading on The Nasdaq Capital Market LLC under the symbol
“KTRA”.
We are the parent company of Del Mar Pharmaceuticals (B.C.) Ltd.
("Del Mar (BC)"), a British Columbia, Canada corporation, and
Adgero. We are also the parent company to 0959454 B.C. Ltd.
("Callco") and 0959456 B.C. Ltd. ("Exchangeco") which are British
Columbia, Canada corporations. Callco and Exchangeco were formed to
facilitate the reverse acquisition that occurred in 2013. In
addition, we are the parent company to Adgero Biopharmaceuticals
Inc. ("Adgero Bio").
References to “we”, “us”, and “our”, refer to Kintara and our
wholly-owned subsidiaries, Del Mar (BC), Adgero, Adgero Bio,
Callco, and Exchangeco.
We are dedicated to the development of novel cancer therapies for
patients with unmet medical needs. Our mission is to benefit
patients by developing and commercializing anti-cancer therapies
for patients whose solid tumors exhibit features that make them
resistant to, or unlikely to respond to, currently available
therapies, with particular focus on orphan cancer
indications.
Our two lead candidates are VAL-083, a novel, validated,
DNA-targeting agent, for the treatment of drug-resistant solid
tumors such as glioblastoma multiforme (“GBM”) and potentially
other solid tumors, including ovarian cancer, non-small cell lung
cancer (“NSCLC”), and diffuse intrinsic pontine glioma (“DIPG”) and
REM-001, a late-stage photodynamic therapy (“PDT”) for the
treatment of cutaneous metastatic breast cancer (“CMBC”), basal
cell carcinoma nevus syndrome (“BCCNS"), and access graft failure
in hemodialysis patients. PDT is a treatment that uses light
sensitive compounds, or photosensitizers, that, when exposed to
specific wavelengths of light, act as a catalyst to produce a form
of oxygen that induces local tumor cell death.
Recent Highlights
•
On September 8, 2022, we announced that three posters were accepted
for data presentation at the 2022 Society for Neuro-Oncology
(“SNO”) Annual Meeting. The 2022 SNO Annual Meeting will be held
from November 16 through November 20, 2022 in Tampa,
Florida.
•
On August 9, 2022, we announced that we had received a Study May
Proceed letter from the United States Food and Drug Administration
("FDA") to begin our 15-patient study evaluating REM-001 PDT for
the treatment of CMBC. This study is intended to aid in the design
of a planned Phase 3 registrational study.
•
On August 2, 2022, we entered into a purchase agreement with
Lincoln Park Capital Fund, LLC (“Lincoln Park”), pursuant to which
Lincoln Park has committed to purchase up to $20.0 million of
shares of our common stock, subject to the satisfaction of the
conditions contained in the agreement as well certain limitations
contained therein.
•
On June 15, 2022, we received notice from the FDA that we were
granted Fast Track Designation ("FTD") for VAL-083 for the
treatment of patients with newly-diagnosed unmethylated
GBM.
•
On June 3, 2022, we received written notification from the Listing
Qualification Department of The Nasdaq Stock Market LLC ("Nasdaq")
granting our request for a 180-day extension to regain compliance
with Nasdaq's minimum bid price requirement under Nasdaq Listing
Rule 5550(a)(2). We have until November 28, 2022 to meet the
requirement.
2
•
On May 27, 2022, we announced that our first European site,
University Hospital Zurich in Zurich, Switzerland had been
activated for the VAL-083 treatment arm in the Global Coalition for
Adaptive Research ("GCAR") registrational Phase 2/3 clinical trial
for GBM, titled Glioblastoma Adaptive Global Innovative Learning
Environment ("GBM AGILE Study").
•
On April 14, 2022, we closed a registered direct financing with
certain institutional investors pursuant to which we issued an
aggregate of 16,226,416 shares of common stock and warrants to
purchase 16,226,416 shares of common stock for approximately $7.9
million in net proceeds after deducting placement agent fees and
other offering expenses payable by us. The warrants have an
exercise price of $0.41 per share and expire on April 14,
2027.
Targeted Clinical Milestones
(Calendar Quarters)
Below are our planned, or expected, milestones for the respective
time periods noted:
Around the end of Q3 2022
•
REM-001 - enroll first patient – CMBC fifteen-patient study leading
into pivotal study
Around the end of Q3 2023
•
REM-001 - topline results – CMBC fifteen-patient study leading into
pivotal study
Around the end of Q4 2023
•
VAL-083 - topline results 12 months after last patient randomized -
GCAR GBM AGILE International Registrational Study
Product Pipeline
3
VAL-083
Background
VAL-083 is a first-in-class, small-molecule, DNA-targeting
chemotherapeutic that has demonstrated activity against a range of
tumor types in prior Phase 1 and Phase 2 clinical studies sponsored
by the US National Cancer Institute (“NCI”). “First-in-class” means
that VAL-083 embodies a unique molecular structure which is not an
analogue, or derivative, of any approved product, or product under
development, for the treatment of cancer. As part of our business
strategy, we leverage and build upon these prior NCI investments
and data from more than 40 NCI Phase 1 and Phase 2 clinical
studies, which includes an estimated 1,200 patient safety
database.
In GBM, we are part of the GBM AGILE Study which is a
registrational Phase 2/3 clinical study for GBM. The study is a
revolutionary, patient centered, adaptive platform study for
registration evaluating multiple therapies for patients with
newly-diagnosed and recurrent GBM. Patients in the GBM AGILE Study
are tested for their O6-methyl
guanine methyltransferase ("MGMT") methylation status prior to
enrollment. VAL-083 is being evaluated in all three GBM patient
subtypes in this study: newly-diagnosed methylated MGMT;
newly-diagnosed unmethylated MGMT; and recurrent.
We have also completed two open-label, biomarker-driven, Phase 2
studies in MGMT-unmethylated GBM. MGMT is a DNA-repair enzyme that
is associated with resistance to temozolomide ("TMZ" or
Temodar®),
the current standard-of-care chemotherapy used in the treatment of
GBM. More than 60% of GBM patients have MGMT-unmethylated tumors
and exhibit a high expression of MGMT which is correlated with TMZ
treatment failure and poor patient outcomes as indicated in the
current National Comprehensive Cancer Network (“NCCN”) guidelines
for GBM treatment. Our research demonstrates that VAL-083’s
anti-tumor activity is independent of MGMT expression. In our
completed Phase 2 studies we used MGMT as a biomarker to identify
patients for treatment with VAL-083 in three distinct GBM patient
populations.
In addition, we have undertaken research in ovarian cancer. Ovarian
cancer is the fifth most common cancer in women and is the leading
cause of death among women diagnosed with gynecological
malignancies. We are in the process of evaluating the best path
forward in ovarian cancer including the potential combination of
VAL-083 with PARP inhibitors. The FDA granted orphan drug
designation for the use of VAL-083 in the treatment of ovarian
cancer.
We have a broad patent portfolio to protect our intellectual
property. Our patents and patent applications claim methods of use
of VAL-083 and related compounds, synthetic methods, and quality
controls for the manufacturing process of VAL-083. We believe that
our portfolio of intellectual property rights provides a defensible
market position for the commercialization of VAL-083. In addition,
VAL-083 has been designated by the FDA as an orphan drug under the
Orphan Drug Act and the European Medicines Agency (“EMA”) for the
treatment of gliomas, including GBM. The FDA has also granted
Orphan Drug description to VAL-083 for the treatment of
medulloblastoma and ovarian cancer.
Our corporate strategy is to advance VAL-083 and REM-001 on an
indication-by-indication basis, and then to consider out-licensing
when a corporate development program has matured enough to warrant
proper licensing valuations. In addition to VAL-083’s applicability
to multiple solid tumor indications, we are also constantly
evaluating licensing or acquiring additional product candidates, in
order to establish a product pipeline and to position us for
long-term sustainability and growth of shareholder value. We
believe the experience of our clinical development team will
position us to efficiently develop possible drug candidates that we
may acquire, or license, in the future.
We intend to continue to evaluate options for our strategic
direction. These options may include raising additional capital,
the acquisition of another company and/or complementary assets, our
sale, or another type of strategic partnership.
MGMT-unmethylated GBM
GBM is the most common and the most lethal form of glioma.
Approximately 30,000 new cases of GBM are diagnosed per year in the
United States and Europe combined. Within the GBM patient
population, over 60% of patients are unmethylated with respect to
their MGMT status.
Measurement of MGMT methylation status has become routine in
clinical practice as a biomarker that correlates with resistance to
the standard-of-care chemotherapy with TMZ and patient outcomes in
GBM. Over 60% of GBM patients’ tumors are characterized as
“MGMT-unmethylated” and exhibit a high expression of MGMT, a
naturally occurring DNA-repair enzyme, the activity of which
nullifies the chemotherapeutic activity of TMZ. The lack of
specific therapies for MGMT-unmethylated GBM is a significant unmet
medical need. Current NCCN guidelines state that the treatment
benefit of TMZ is likely to be lower in GBM patients with an
unmethylated MGMT promoter.
4
We have demonstrated that VAL-083’s anti-tumor mechanism is active
independent from the MGMT status
in vitro.
We believe this distinct mechanism of action suggests the potential
of VAL-083 as a replacement for the current standard-of-care
chemotherapy, TMZ, in both MGMT methylated and MGMT-unmethylated
GBM. We have utilized MGMT-methylation status to identify GBM
patients who are unlikely to respond to TMZ and have included only
MGMT-unmethylated patients in our current Phase 2 clinical studies
of VAL-083. We have recently received approval to treat
newly-diagnosed methylated, newly-diagnosed unmethylated, and
recurrent GBM patients as part of our treatment arm in the GCAR GBM
AGILE study.
We believe that our research highlights the opportunity for VAL-083
as a potential new standard-of-care in the treatment of both MGMT
methylated and MGMT-unmethylated GBM.
VAL-083 Clinical Studies
GBM AGILE Study
On October 21, 2020, we announced we had entered into a definitive
agreement with GCAR and on January 13, 2021, we announced the
initiation of patient recruitment for the VAL-083 study arm of the
GBM AGILE Study. VAL-083 is currently being evaluated in all three
GBM patient subtypes in the GBM AGILE Study: newly-diagnosed
methylated MGMT; newly-diagnosed unmethylated MGMT; and recurrent.
The GBM AGILE Study employs a cost-efficient, adaptive study design
with a stage 1 (Phase 2) learning and adapting phase and a stage 2
(Phase 3) expansion and confirmation phase. The GBM AGILE Study is
currently enrolling patients in our arm of the study at 39 clinical
sites in the United States, four in Canada, and two in Europe. GCAR
plans to enroll 150-200 patients in the Kintara arm of the study at
over 40 sites in the U.S. and Canada with potential to increase
this total to 65 clinical study centers worldwide. The GBM AGILE
Study, which was designed by GCAR with input from the FDA, calls
for companies participating in this platform study to only disclose
data at the end of the study to protect the integrity of the trial
arm data. Therefore, we expect to announce topline data from the
GBM AGILE Study around the end of calendar 2023.
GCAR has previously announced that the GBM AGILE Study has screened
over 1,000 patients and that enrollment rates for the study are 3
to 4 times greater than traditional GBM studies, with active sites
averaging 0.75 to 1 patient per site per month. As a result of the
accelerated enrollment rate, we expect to announce topline data
from our arm of the study around the end of calendar year
2023.
The GBM AGILE Study is an international, innovative platform study
designed to more rapidly identify and confirm effective therapies
for patients with glioblastoma through response adaptive
randomization and a seamless Phase 2/3 design. The study, conceived
by over 130 key opinion leaders, is conducted under a master
protocol, allowing multiple therapies or combinations of therapies
from different pharmaceutical partners to be evaluated
simultaneously. With its innovative design and efficient
operational infrastructure, we believe data from the GBM AGILE
Study can be used as the foundation for a New Drug Application
(“NDA”) and biologics license application submissions and
registrations to the FDA and other health authorities.
GCAR is a 501(c)(3) nonprofit organization uniting physicians,
clinical researchers, advocacy and philanthropic organizations,
biopharma, health authorities, and other key stakeholders in
healthcare to expedite the discovery and development of treatments
for patients with rare and deadly diseases by serving as a sponsor
of innovative and complex studies including master protocols and
platform studies. GCAR is the sponsor of GBM AGILE. Key strategic
partners for the GBM AGILE study effort include the National Brain
Tumor Society (“NBTS”), National Foundation for Cancer Research,
and Asian Fund for Cancer Research.
Phase 2 Study in Newly-Diagnosed MGMT-unmethylated GBM
In September 2017, we initiated a single arm, biomarker driven,
open-label Phase 2 study in newly-diagnosed MGMT-unmethylated GBM
patients at Sun Yat-sen University Cancer Center (“SYSUCC”) in
Guangzhou, China. The study was conducted under our collaboration
agreement with Guangxi Wuzhou Pharmaceutical Company.
In this Phase 2 study, VAL-083 was combined with radiotherapy as a
potential replacement for standard-of-care chemoradiation with TMZ
in patients with MGMT-unmethylated GBM. The goals of the study were
to confirm the safety of the three-day VAL-083 dosing regimen in
combination with radiotherapy and to investigate efficacy outcomes
of the combination of VAL-083 and radiotherapy in MGMT-unmethylated
GBM patients.
We have completed enrollment of this study with a total of 29
newly-diagnosed, MGMT-unmethylated GBM patients and we have also
completed treatment of the patients on this study. The efficacy
endpoints of the study include tumor response, as assessed by the
Response Assessment in NeuroOncology (“RANO”), and progression-free
survival (“PFS”), progression-free survival at six months (“PFS6”),
and overall survival (“OS”), compared to historical results in the
target population. The study was conducted in two parts: (1)
Dose-confirmation: VAL-083 in cohorts (20, 30 and 40 mg/m2/day IV
daily x 3 every 21 days) to assess safety and activity when
administered concurrently with x-ray therapy (“XRT”) to confirm the
maximum tolerated dose (“MTD”), and (2) Expansion:
5
VAL-083 was studied in 20 additional patients at the target dose,
as determined by the dose-confirmation part of the study,
administered concurrently with XRT. Assessments of safety and
tolerability were used to support further clinical development of
VAL-083 in combination with radiotherapy. Pharmacokinetic
assessments of VAL-083 in plasma and cerebral spinal fluid (“CSF”)
were used to correlate drug exposure in the central nervous system
with patient outcomes.
Dose-confirming cohorts studying 20, 30, and 40 mg/m2/day x three
every 21 days have been completed. Based on the dose confirmation
phase of the study, we have selected 30 mg/m2/day for combination
with irradiation for the treatment of newly-diagnosed
MGMT-unmethylated GBM patients. This study was fully enrolled at 29
patients.
On April 10, 2021, at the virtual AACR Annual Meeting, we provided
top-line results on patient data as follows:
•
For the 29 patients as of the March 11, 2021, cut-off date, median
PFS with VAL-083 was 9.3 months (95% confidence interval (“CI”)
6.4-12.0 months). Additionally, for the 25 patients initially
receiving the treatment dose that is being carried forward into the
GBM AGILE pivotal Phase 3 study of 30 mg/m2/day on days 1, 2 and 3
of a 21-day cycle, median PFS was reported to be 8.7 months (CI
6.4-12.5 months); and
•
For the 29 patients as of the March 11, 2021, cut-off date, median
overall survival (“mOS”) with VAL-083 was 19.6 months (CI 14.0-22.4
months). Additionally, for the 25 patients initially receiving the
treatment dose that is being carried forward into the GBM AGILE
pivotal Phase 3 study of 30 mg/m2/day on days 1, 2 and 3 of a
21-day cycle, mOS was reported to be 19.1 months (CI 12.0-22.3
months).
While this was not a head-to-head study, this PFS and mOS data
compares favorably to historical TMZ control data of 5.0 months and
6.9 months PFS and 12.7 months and 16.0 months mOS as indicated by
published data from Hegi et al. (2005 - New England Journal of
Medicine), Tanguturi et al. (2017 – NeuroOncology), and Alnahhas et
al. (2020 - Neurooncol Adv), respectively.
Multiple treatment cycles of VAL-083 at the 30 mg/m2/day dose in
combination with standard radiation treatment (2 Gray/day, 5
days/week) was shown to be generally safe and
well-tolerated.
Phase 2 Study in Recurrent GBM and Newly-Diagnosed
MGMT-unmethylated GBM
Recurrent Study Arm
In February 2017, we initiated a biomarker driven, open-label,
single-arm Phase 2 study in collaboration with the University of
Texas MD Anderson Cancer Center ("MD Anderson") for recurrent GBM
patients. This biomarker-driven study (testing for MGMT methylation
status) has been completed. The study enrolled a total of 89
patients with 35 patients (35 efficacy evaluable) initially
receiving a dose of VAL-083 at 40 mg/m2/day,
and 54 patients (48 efficacy evaluable) initially receiving the
treatment dose of 30 mg/m2/day
on days 1, 2 and 3 of a 21-day cycle. This 30 mg dose corresponds
to the dose being studied in the currently enrolling VAL-083 study
arm of the GBM AGILE study.
The study was designed to determine the potential of VAL-083
treatment to improve overall survival in GBM patients whose tumors
have recurred following treatment with TMZ. These patients will not
have been treated previously with Avastin®.
On November 18, 2021, at the Society for Neuro-Oncology (“SNO”)
Annual Meeting we reported top-line patient data as
follows:
•
mOS for the 48 efficacy evaluable patients initially receiving the
treatment dose of 30 mg/m2/day
was 8.0 months (95% CI 6.6-10.3 months); and
•
For the 83 efficacy evaluable patients who have completed at least
one cycle of treatment mOS was 7.6 months (CI 6.1-9.2
months).
While this was not a head-to-head study, historically, lomustine,
which is the most commonly used chemotherapy for these patients,
has demonstrated mOS of 7.2 months as indicated by published data
from Wick et al. (2017 – New England Journal of
Medicine).
All patients have completed treatment. A detailed description of
this study can be found at clinicatrials.gov, Identifier Number:
NCT02717962.
6
Newly-Diagnosed Adjuvant Study Arm
On July 24, 2019, we announced the enrollment of the first patient
in the newly-diagnosed adjuvant arm of the Phase 2 study being
conducted at MD Anderson. The newly-diagnosed adjuvant arm was
originally planned for 24 patients, but based on encouraging
outcomes, we increased the newly-diagnosed adjuvant arm enrollment
from the originally planned 24 patients to include up to 12
additional patients. These patients will have had initial cycles of
TMZ concomitant with radiation but will not have yet started
subsequent cycles of TMZ (i.e., maintenance stage TMZ
patients).
On November 18, 2021, at the SNO Annual Meeting we reported
top-line patient data as follows:
•
PFS for the 36 efficacy evaluable patients is 9.5 months (95% CI
8.2-10.8); and
•
mOS for the 36 efficacy evaluable patients is 16.5 months (CI
13.6-19.3 months).
While this was not a head-to-head study, this PFS and mOS data
compares favorably to historical TMZ control data of 5.0 months and
6.9 months PFS and 12.7 months and 16.0 months mOS as indicated by
published data from Hegi et al. (2005 - New England Journal of
Medicine), Tanguturi et al. (2017 – NeuroOncology), and Alnahhas et
al. (2020 - Neurooncol Adv), respectively
Based on published data from our MD Anderson and SYSUCC clinical
studies, we believe there is a significant opportunity to treat GBM
patients in the pre-TMZ maintenance stage (i.e.,
adjuvant).
All patients have completed treatment. A detailed description of
this study can be found at clinicaltrials.gov, Identifier Number:
NCT02717962.
Safety Across Studies
Consistent with prior studies, myelosuppression was the most common
adverse event with VAL-083 in both the recurrent GBM and adjuvant
treatment setting at MD Anderson. In the 30 mg/m2/day
starting dose cohort (the dose being studied in the GBM AGILE
Study) five subjects have experienced a serious adverse event
(“SAE”) possibly related to VAL-083 in the recurrent group and one
patient experienced a possible drug-related SAE in the
newly-diagnosed adjuvant group.
In the newly-diagnosed first-line study completed at SYSUCC, three
subjects experienced an SAE possibly related to VAL-083. Multiple
treatment cycles of VAL-083 at the 30 mg/m2/day
dose in combination with standard radiation treatment (2 Gray/day,
5 days/week) were shown to be generally safe and
well-tolerated.
VAL-083 Fast Track Designation
The FDA has granted us FTD for VAL-083 in recurrent and
newly-diagnosed unmethylated GBM.
The FTD is designed to expedite the review of drugs that show
promise in treating life-threatening diseases and address unmet
medical needs, with the goal of getting new treatments to patients
earlier. FTD provides sponsors with an opportunity for increased
frequency for communication with the FDA to ensure an optimal
development plan and to collect appropriate data needed to support
drug approval. Additional benefits of the FTD may include an
Accelerated Approval, a Priority Review, and a Rolling Review.
Accelerated Approval is granted to drugs that demonstrate an effect
on a surrogate, or intermediate endpoints, reasonably likely to
predict clinical benefit. Priority Review shortens the FDA review
process for a new drug from ten months to six months and is
appropriate for drugs that demonstrate significant improvements in
both safety and efficacy of an existing therapy. Rolling Review
provides a drug company the opportunity to submit completed
sections of its NDA for review by the FDA. Typically, NDA reviews
do not commence until the drug company has submitted the entire
application to the FDA. Through the FTD, the FDA attempts to ensure
that questions raised during the drug development process are
resolved quickly, often leading to earlier approval and increased
access for patients.
Current Treatments for Gliomas and Glioblastoma
Multiforme
Gliomas are a type of Central Nervous System (“CNS”) tumor that
arises from glial cells in the brain or spine. Glial cells are the
cells surrounding nerves. Their primary function is to provide
support and protection for neurons in the CNS.
Common symptoms of GBM include headaches, seizures, nausea,
weakness, paralysis and personality or cognitive changes such as
loss of speech or difficulty in thinking clearly. GBM progresses
quickly and patients’ conditions deteriorate rapidly progressing to
death. The outlook for GBM patients is generally poor. The overall
median survival in newly diagnosed GBM patients
7
with best available treatments is less than 15 months, and two-year
and five-year survival rates are approximately 30% and 10%,
respectively. Median overall survival in newly-diagnosed,
unmethylated GBM patients is 12.2 months.
The recommended treatment regimen for GBM includes surgical
resection to remove as much of the tumor as possible (“debulking”)
followed by radiotherapy with concomitant and adjuvant chemotherapy
with TMZ with or without tumor treating fields (“TTF”). GBM
patients whose tumors exhibit an unmethylated promoter for the gene
encoding the DNA repair enzyme MGMT, a biomarker correlated with
resistance to TMZ, may be treated with radiation alone following
surgery.
Patients with an unmethylated MGMT promoter have high levels of
MGMT, a naturally-occurring DNA repair enzyme that repairs
tumor-fighting lesions induced by TMZ thus allowing a patient’s
tumor to continue to grow despite treatment, which leads to poor
outcomes. Measurement of MGMT methylation status has become routine
in clinical practice as biomarker that correlates with response to
TMZ and patient outcomes in GBM.
Probability of GBM Patient Survival Correlated to Expression of
MGMT Enzyme (Unmethylated promoter = High MGMT Expression and
Significantly Shorter Survival)
TTF (Optune®)
is a non-invasive technique for adults with GBM. TTF uses
alternating electrical fields to disrupt tumor cell division, or
cause cell death, thereby preventing the tumor from growing or
spreading as quickly. A clinical study reported that GBM patients
treated with TTF combined with TMZ experienced longer survival than
those treated with TMZ alone.
The majority of GBM patients’ tumors recur within 6 – 12 months of
initial treatment. Experimental therapy through clinical studies is
recommended under NCCN guidelines for eligible patients. NCCN
guidelines also recommend treatment with systemic chemotherapy,
such as lomustine (“CCNU”). For patients who are eligible for
additional surgical debulking, local chemotherapy with carmustine
(“BCNU”) wafers may be employed. CCNU and BCNU target the same
DNA-site as TMZ and are also subject to MGMT-related
resistance.
Avastin (Avastin®,
an anti-VEGF antibody) recently received full approval in the US,
Canada, Australia, and Japan as a single agent for patients with
recurrent GBM following prior therapy. Avastin carries an FDA
“black-box warning” related to severe, sometimes fatal, side
effects such as gastrointestinal perforations, wound healing
complications and hemorrhage. There are no data demonstrating an
improvement in disease-related symptoms or increased survival for
GBM patients treated with Avastin.
Recurrent GBM patients, especially those whose tumors progress
following treatment with Avastin, have limited or no treatment
options and a very poor prognosis. According to published
literature, the median survival for GBM patients whose tumors
progress following Avastin is less than five months.
8
VAL-083 Mechanism of Action
Chemotherapy forms the basis of treatment in nearly all cancers. We
believe that VAL-083 may be effective in treating tumors exhibiting
biological features that cause resistance to currently available
chemotherapy, particularly for patients who have failed, or become
resistant to, other treatment regimens.
Based on published research and our own data, the cytotoxic
functional groups, and the mechanism of action of VAL-083 are
functionally different from alkylating agents commonly used in the
treatment of cancer. VAL-083 has previously demonstrated activity
in cell-lines that are resistant to other types of chemotherapy. No
evidence of cross-resistance has been reported in published
clinical studies.
Our research suggests that VAL-083 attacks cancer cells via a
unique mechanism of action that is distinct from other
chemotherapies used in the treatment of cancer. Our data indicate
that VAL-083 forms inter-strand crosslinks at the
N7
position of guanine on the DNA of cancer cells. Our data also
indicate that this crosslink forms rapidly and is not easily
repaired by the cancer cell, resulting in cell-cycle arrest and
lethal double-strand DNA breaks in cancer cells. VAL-083 readily
crosses the blood brain barrier. Published preclinical and clinical
research demonstrate that VAL-083 is absorbed more readily in tumor
cells than in normal cells.
In vitro,
our data also demonstrate that VAL-083’s distinct mechanism may be
able to overcome drug resistance against a range of cancers. For
example, VAL-083 is active against MGMT-unmethylated GBM cells
which are resistant to treatment with TMZ and nitrosoureas. VAL-083
also retains a high level of activity in p53 mutated non-small cell
lung cancer (“NSCLC”), ovarian cancer and medulloblastoma cell
lines that are resistant to platinum-based chemotherapy.
Importantly, clinical activity against each of the tumors mentioned
above was established in prior NCI-sponsored Phase 2 clinical
studies. We believe that these historical clinical data and our own
research support the development of VAL-083 as a potential new
treatment for multiple types of cancer.
The main dose-limiting toxicity (“DLT”) related to the
administration of VAL-083 in previous NCI-sponsored clinical
studies and our own clinical studies is myelosuppression,
particularly thrombocytopenia. Myelosuppression, including
thrombocytopenia, is a common side effect of chemotherapy.
Myelosuppression is the decrease in cells responsible for providing
immunity, carrying oxygen, and causing normal blood clotting.
Thrombocytopenia is a reduction in platelet counts which assist in
blood clotting. Modern medicine allows for better management of
myelosuppressive side effects. We believe this offers the potential
opportunity to improve upon the drug’s already established efficacy
profile by substantially increasing the dose of VAL-083 that can be
safely administered to cancer patients.
There is no evidence of lung, liver, or kidney toxicity even with
prolonged treatment by VAL-083. Data from the Chinese market where
the drug has been approved for more than 15 years supports the
safety findings of the NCI studies.
9
VAL-083 is Active Independent of MGMT
We have presented data at several peer reviewed meetings
demonstrating that VAL-083 is active independent of MGMT resistance
in GBM cell lines and other CNS tumor cells. Our research, along
with that of others, demonstrates that VAL-083’s unique cytotoxic
mechanism forms DNA cross-links at the N
7position
of guanine and retains cytotoxic activity independent of MGMT
expression
in vitro.
Our studies demonstrate that VAL-083 has more potent activity
against brain tumor cells in comparison to TMZ and overcomes
resistance associated with MGMT, suggesting the potential to
surpass the current standard-of-care in the treatment of
GBM.
In addition, historical NCI clinical study data and our own
research support the activity of VAL-083 as a potentiator of
radiotherapy. Radiotherapy in combination with TMZ is the current
standard of care in the treatment of newly diagnosed GBM. Our
research demonstrates that TMZ and radiotherapy are ineffective
against GBM cells exhibiting a high expression of MGMT, whereas
VAL-083 potentiates the tumor-killing effect of radiation
independent of MGMT expression. Furthermore, the combination of
VAL-083 and radiation has been demonstrated to be active against
GBM cancer stem cells (“CSCs”) in vitro. CSCs are often resistant
to chemotherapy and form the basis for tumor recurrence and
metastasis. GBM CSCs display strong resistance to TMZ, even where
MGMT expression is low. However, our data demonstrates that GBM
CSCs are susceptible to VAL-083 independent of MGMT
expression.
Other Indications for VAL-083—Potential Future
Opportunities
VAL-083 in Ovarian Cancer
With the FDA approval for our investigational new drug (“IND”)
application for ovarian cancer, we have future plans for a phase
1/2, open-label, multicenter study of VAL-083 in patients with
Recurrent Platinum Resistant Ovarian Cancer (“REPROVe”).
Platinum-based chemotherapy is the standard-of-care in the
treatment of ovarian cancer. Nearly all ovarian cancer patients
eventually become resistant to platinum (“Pt”) based chemotherapy
leading to treatment failure and poor patient outcomes. We have
demonstrated that VAL-083 is active against Pt-resistant ovarian
cancer in vitro. However, based on ongoing evaluation and input
from our ovarian cancer advisory board, we are reassessing the
development of VAL-083 for the treatment of ovarian cancer. We are
in the process of evaluating the best path forward in ovarian
cancer and are evaluating strategic options, including the
potential combination of VAL-083 with PARP inhibitors. As a result,
we have inactivated the IND while we explore alternative study
designs.
VAL-083 in Lung Cancer
Lung cancer is a leading cause of cancer death around the world and
effective treatment for lung cancer remains a significant global
unmet need despite advances in therapy. Incidence of lung cancer in
the United States is approximately 47 per 100,000 with the majority
(85%) being NSCLC, the most common type of lung cancer. Globally,
the market for lung cancer treatment may exceed $24 billion by 2033
according to a report published by Evaluate Pharma.
10
The activity of VAL-083 against solid tumors, including lung
cancer, has been established in both preclinical and human clinical
studies conducted by the NCI. We have developed nonclinical data to
support the utility of VAL-083 in the modern treatment of lung
cancer. In an established murine xenograft model of NSCLC, the
activity of VAL-083 was compared to standard platinum-based therapy
with cisplatin against human NSCLC cell lines A549 (TKI-sensitive)
and H1975 (TKI-resistant). In the study, VAL-083 demonstrated
superior efficacy and safety in the treatment of TKI-susceptible
(A549) tumors and in TKI-resistant (H1975) tumors.
Central Nervous System Metastases of Solid Tumors
The successful management of systemic tumors by modern targeted
therapies has led to increased incidence of mortality due to CNS
metastases of lung cancer and other solid tumors. In June 2013, we
split our Phase 1/2 clinical study protocol into two separate
studies: one focusing solely on refractory GBM and the other
focusing on secondary brain cancers caused by other tumors that
have spread to the brain.
Based on historical clinical activity and our own research, we
believe that VAL-083 may be suitable for the treatment of patients
with CNS metastases who currently have limited treatment options.
Subject to the availability of financial and operating resources,
we plan to develop a separate protocol for the continued
exploration of VAL-083 in patients with secondary brain cancer
caused by a solid tumor spreading to the brain.
Pediatric Brain Tumors
Tumors of the brain and spine make up approximately 20 percent of
all childhood cancers and they are the second most common form of
childhood cancer after leukemia.
The activity of VAL-083 against childhood and adolescent brain
tumors has been established in both preclinical and human clinical
studies conducted by the NCI. We have presented data indicating
that VAL-083 offers potential therapeutic alternatives for the
treatment of pediatric brain tumors including SHH-p53 mutated
medulloblastoma. In March 2016, the FDA granted orphan drug
designation for the use of VAL-083 in the treatment of
medulloblastoma. Subject to the availability of resources, we
intend to collaborate with leading academic researchers for the
continued exploration of VAL-083 as a potential treatment of
childhood brain tumors.
Additional Indications for VAL-083
In historical studies sponsored by the NCI in the United States,
VAL-083 exhibited clinical activity against a range of tumor types
including central nervous system tumors, solid tumors, and
hematologic malignancies. We have gathered nonclinical data
supporting the activity of VAL-083 in different types of cancer
that are resistant to modern targeted therapies and we believe that
the unique cytotoxic mechanism of VAL-083 may provide benefit to
patients in a range of indications. We intend to continue to
research these opportunities, and if appropriate, expand our
clinical development efforts to include additional
indications.
VAL-083 Target Markets
|
|
|
VAL-083 target markets
|
|
Estimated
Global
Sales
|
Glioblastoma multiforme by 2027
|
|
>$1.0B1
|
Ovarian cancer by 2028
|
|
>$6.0B1
|
Non-small cell lung cancer by 2027
|
|
>$22.0B2
|
Sources: 1 - GlobalData; 2 - iHealthcareAnalyst.
DNA-targeting agents such as alkylating agents or platinum-based
chemotherapy form the mainstay of chemotherapy treatments used in
the treatment of cancers. For example, TMZ had peak annual sales of
$1.1 billion in 2010, while bendamustine, had peak annual sales of
$0.8 billion in 2014.
We believe VAL-083 is a first-in-class DNA targeting agent with a
novel mechanism of action. VAL-083’s anti-cancer activity was
established in a range of tumor types in prior NCI-sponsored
clinical studies. Based on this novel mechanism, we have
demonstrated that the anti-cancer activity is maintained against
tumor cells that are resistant to other DNA-targeting agents. We
believe this positions VAL-083 as a potential
chemotherapy-of-choice for patients whose tumors are resistant to
current standard-of-care chemotherapy in orphan and major cancer
indications.
11
Our ongoing research and development activities are focused on
indications where VAL-083 demonstrated promising activity in prior
NCI-sponsored studies and where our research suggests an
opportunity to address significant unmet medical needs due to the
failure of existing treatments.
Glioblastoma Multiforme
Newly diagnosed patients suffering from GBM are initially treated
through invasive brain surgery, although disease progression
following surgical resection is nearly 100%.
Temodar®
in combination with radiation is the front-line therapy for GBM
following surgery. Global revenues of branded Temodar reached $1.1
billion in 2010. Approximately 60% of GBM patients treated with
Temodar®
experience tumor progression within one year. Median overall
survival in newly-diagnosed, unmethylated GBM patients is 12.2
months.
Bevacizumab (Avastin®)
has been approved for the treatment of GBM in patients failing
Temodar®.
In clinical studies, approximately 20% of patients failing
Temodar®
respond to Avastin®
therapy and no improvement in median survival was
reported.
The market for refractory (Avastin-failed) GBM is limited to those
jurisdictions where Avastin is approved for the treatment of GBM.
The United States, Canada, Australia, Japan and Switzerland
represent the major markets where Avastin is used in the treatment
of GBM.
Based on a November 2018 report from GlobalData, we believe there
is a projected market opportunity for GBM of approximately $800
million, estimated to reach approximately $1.8 billion by
2027.
REM-001
Background
Through REM-001, we are developing our PDT for the treatment of
rare, unmet medical needs. REM-001 (rostaporfin injectable
emulsion) is a second-generation photosensitizer formulated as an
intravenous, isotonic, isosmotic lipid emulsion containing the
photo-activated active ingredient tin ethyl etiopurpurin ("SnET2"),
also known as rostaporfin. PDT is a two-stage light-based treatment
modality that utilizes a photosensitizing drug and light energy.
The tumor-destroying effect of PDT is based on photo-oxidation. The
process involves the administration of a photosensitizing drug that
preferentially localizes to, and is retained by, tumor cells and
tumor neovasculature. Administration of local light illumination to
the tumor activates the photosensitizing drug which is inactive
unless exposed to a specific range of light. Ideally, the light is
delivered at the specific wavelength that allows for maximum
absorption by the photosensitizing drug, as well as optimal tissue
penetration. The light activation initiates a cascade of energy
transfer events in which the excited photosensitizer reacts with
cellular oxygen to generate reactive oxygen species.
REM-001 therapy is a combination therapy, comprising three
components: a laser light source, a light delivery device, and the
drug REM-001 (collectively the "REM-001 Therapy"). In use, REM-001
is first administered by intravenous infusion and allowed to
distribute within the body and be taken up by the tumors. Tumors
are then illuminated with light using the light delivery device
which is attached to the laser light source (the KINTARA 665 Laser
System), so that the accumulated REM-001 can be activated for the
desired clinical effect.
Our lead indication for REM-001 is CMBC which is a disease that may
strike individuals with advanced breast cancer and for which
effective treatment options are limited. In four Phase 2 and/or
Phase 3 clinical studies in CMBC patients, primarily targeting
patients who had previously received chemotherapy and failed
radiation therapy, REM-001 Therapy was able to reduce, or
eliminate, a substantial number of the treated CMBC tumors.
Specifically, our analysis of the data collected from these studies
indicates that in approximately 80% of evaluable tumor sites
treated with REM-001 Therapy, there was a complete response;
meaning that follow-up clinical assessments indicated no visible
evidence of the tumor remaining. We believe clinical data indicates
that REM-001 Therapy holds promise as a treatment to locally
eliminate, or slow the growth of, treated cutaneous cancerous
tumors in this difficult-to-treat patient population.
Based on previous data, we believe REM-001 Therapy provides
promising safety and efficacy in CMBC patients and that, taken
together, these results provide strong support for REM-001 Therapy
as a potential therapy for this disease. Furthermore, we believe
the approvable letter previously granted to Miravant Medical
Technologies Inc. ("Miravant") with respect to its NDA for REM-001
in an aspect of Age-related Macular Degeneration ("AMD") may
indicate that many of the elements required for approval have
already been completed for REM-001.
12
Numerous approaches have been utilized to treat CMBC patients,
including various forms of chemotherapy, radiation therapy,
surgical excision, hyperthermia, cryotherapy, electro-chemotherapy,
topical drugs, and intra-lesional chemotherapy injections. However,
for the most part, we believe that these therapies are often
inadequate given the limited efficacy, toxicities and/or side
effects of each. We believe our REM-001 Therapy has several
advantages for this indication: it can be highly directed to the
tumor site, has minimal systemic effects or normal tissue
toxicities, can be used in conjunction with other therapies, and
can be periodically repeated.
We believe REM-001 Therapy also may hold promise as a treatment for
cutaneous metastatic cancers other than CMBC, as well as
locally-advanced basal cell cancer such as often occurs in patients
with BCCNS and cutaneously recurrent basal cell cancer. On January
16, 2018, the FDA granted our request that SnET2 (the active
pharmaceutical ingredient in REM-001) be designated as an orphan
drug for treatment of BCCNS.
In addition, we believe REM-001 Therapy also holds promise for
certain cardiovascular conditions, including de novo treatment of
cardiovascular access sites in hemodialysis patients to ameliorate
current high failure rates. We hold an orphan drug designation for
SnET2 for the prevention of access graft failure in hemodialysis
patients. We have been working to further develop this indication,
including engaging with a key opinion leader in this area and
submitting a National Institute of Health grant proposal for
late-stage preclinical research that we believe could lead directly
to an IND and clinical study. On July 17, 2020, we received
notification that that grant had been awarded.
REM-001 Regulatory Filings
The IND for REM-001 Therapy, IND 39,940, was filed in June 1992
with the FDA’s Division of Oncology and Pulmonary Drug Products. On
August 9, 2022, we announced that we had received a Study May
Proceed letter from the FDA to begin our 15-patient study
evaluating REM-001 PDT for the treatment of CMBC.
Clinical Development Plans
CMBC
Our plan is to conduct an initial open-label, 15-patient study in
CMBC to confirm planned dose and optimized study design followed by
a Phase 3 clinical study in CMBC. We have received a Study May
Proceed letter from the FDA to begin our 15-patient study
evaluating REM-001 PDT for the treatment of CMBC. At this time, we
estimate the necessary pivotal study design will be a Phase 3
multi-center study that would enroll CMBC patients who have
received prior radiation therapy and chemotherapy.
Our plan is to use new lasers that are functionally equivalent to
the lasers used in previous studies. Our laser is a portable
solid-state diode laser system that is intended for use in PDT as
the source of photoactivation of Rostaporfin for the treatment of
subjects with cutaneous cancer lesions. Our laser system consists
of the Kintara 665 laser with a fiber-coupled illuminator. In the
case of cutaneous treatment, such as with CMBC, the light delivery
device consists of an optical fiber which has a modified end to
allow it to deliver a uniform light treatment field to the tumor.
We have had clinical light delivery devices built by a contract
medical device manufacturer using the previous basic design and
tested to the same performance specifications as used
previously.
The REM-001 Drug
REM-001 is a light activated photosensitizer drug used in PDT.
During light activation, photosensitizer drugs act as a catalyst
and absorb light energy which they transfer to surrounding
oxygen-containing molecules to create reactive oxygen species
(“ROS”). ROS can initiate various biological mechanisms of
action:
•
Apoptosis—Certain photosensitizer drugs associate with the cells’
mitochondria. When light activated, these drugs generate ROS that
alter mitochondria membrane permeability to allow the release of
activators that initiate a programmed cell death process known as
apoptosis. Apoptosis is a desirable means of inducing tumor cell
death as it is the body’s natural mode for eliminating damaged
cells.
•
Necrosis—At higher doses these photosensitizer-generated ROS can
overwhelm a cell and induce cellular necrosis.
•
Anti-angiogenesis—As they grow, tumors develop their own
micro-vasculature network. ROS can be used to create permeability
in these micro-vessels which reduces their effectiveness and cuts
off the tumor’s blood supply.
13
REM-001 is a second-generation photosensitizer drug designed with
the following attributes to overcome several of the shortcomings of
earlier, first generation photosensitizer drugs:
•
It is activated with longer wavelength, deeper penetrating
light;
•
It has a stronger light absorption coefficient;
•
It is a synthetic single molecule; and
•
It causes transient photosensitivity of shorter
duration.
REM-001 Safety and Toxicology
PDT carries what we believe is an inherent safety advantage since
it uses photosensitizer compounds that are largely inactive except
when they are being illuminated by intense light at specific
wavelengths. Nevertheless, drug molecules, including
photosensitizer molecules, can carry safety or toxicology risks on
their own. REM-001 has previously undergone preclinical and
clinical studies throughout its development cycle and has undergone
certain tests typically required for FDA drug approval. REM-001 has
been safely administered to over 1,100 patients in prior clinical
studies. Most significantly, REM-001 has been previously reviewed
by the FDA as part of the NDA submitted by Miravant for the use of
REM-001 to treat an aspect of AMD, a non-CMBC indication. Following
that review, the FDA granted an approvable letter for REM-001 in an
aspect of AMD in 2004, with final approval contingent on, among
other things, the successful completion of a Phase 3 study. While
not definitive, we believe this letter, along with feedback we
received from FDA meetings, indicates that it is unlikely that
there will be significant safety or toxicology issues associated
with REM-001 that would ultimately prevent marketing
approval.
Based on our review of previous clinical data of CMBC studies, pain
was the most common treatment-related adverse event experienced by
patients in these studies. The second most common safety issue
experienced with REM-001 was a transient photosensitivity, meaning
extended exposure in bright light and direct sunlight should be
avoided. Transient photosensitivity occurs with all
photosensitizers to some degree. We believe this issue can be
addressed by minimizing one’s exposure to bright light and sunlight
for two to four weeks after treatment. In general, the potentially
treatment-related adverse events observed in these CMBC studies
were expected in nature (pain, edema, skin photosensitivity) and
severity, and mostly resolved during the course of the
studies.
REM-001 Therapy Target Markets
Our development plan for REM-001 Therapy is focused on the
treatment of rare unmet needs in cancer, particularly those where
the tumor can be accessed with a light delivery fiber
device.
CMBC
While most internal cancers can metastasize to the skin, the
internal cancer where this most commonly occurs is breast cancer.
Radiotherapy is often used as an adjunctive therapy in breast
cancer, in part to help prevent the development of local
recurrences including CMBC. However, breast cancer survivors may
still develop CMBC lesions, even over a decade after their original
cancer treatment. In fact, physicians often watch for cutaneous
(skin surface) metastases as a sign of breast cancer recurrence. A
2003 meta-analysis of approximately 20,000 cancer patients found
that 24% of metastatic breast cancer patients included in the
analysis had developed cutaneous metastases, which was the highest
rate of skin metastases of any cancer type. Given that
approximately 168,000 women in the U.S. suffer from metastatic
breast cancer, we believe the prevalence of CMBC may approach
40,000 in the United States. In many cases of CMBC, surgical
excision is not possible, so various standard cancer therapies,
particularly radiotherapy or chemotherapy, are the first course of
treatment. We believe these therapies are inadequate given the
well-known dose limiting toxicities, limited efficacy, and/or side
effects of each. We are not aware of any prospective clinical
studies that have led to FDA approval of a therapy specifically for
the treatment of CMBC and we do not expect any to be approved in
the near future.
According to a market assessment from Charles River Associates
(2018), there is an estimated market opportunity of approximately
$500 million for the treatment of CMBC.
Cutaneous Metastatic Cancers
A meta-analysis has shown that approximately five percent of people
with internal (non-melanoma, non-lymphatic, non-leukemic) cancers
develop cutaneous metastatic tumors in their skin. Based on an
estimated incidence of 1,500,000 such internal cancers in the
United States, this means that the incidence of such cutaneous
metastases is approximately 75,000 with a substantially higher
prevalence given the fact that individuals often live with
metastatic cancer for years. Regardless of the primary source of
the cancer, these cutaneous metastatic tumors often begin as small
skin nodules but, as the cancer spreads, more nodules form and
can
14
eventually cover large areas of skin. With progression, the tumor
field generally becomes more painful as tumors may grow larger and
more numerous, ulcerate, bleed and carry a strong odor. Part of our
goal is to treat these cutaneous tumors as early as possible to
either cause them to be locally eliminated or to slow their growth
sufficiently to reduce their late-stage development.
Basal Cell Carcinoma Nevus Syndrome
In addition to the clinical studies that Miravant conducted with
REM-001 Therapy in CMBC, it also generated clinical data for
patients with BCCNS who developed extensive basal cell carcinoma.
BCCNS is a rare but serious condition that is often characterized
by the formation of multiple and recurring cutaneous basal cell
carcinoma lesions. According to Cancer.net, as of April 2020,
approximately 1 in 40,000 individuals in the U.S. have an
underlying genetic condition that causes BCCNS and approximately
90% of these have BCCNS and it has been recognized as an orphan
indication by FDA. In a previous Phase 1/2 clinical study (CA001B),
14 patients with BCCNS were enrolled and treated with REM-001
Therapy using the same dosing conditions as were used in the CMBC
studies. A total of 157 lesions were treated in these patients and
showed a 91% overall response rate. This was composed of a 68%
complete response rate (no remaining visible evidence of a lesion)
and a 23% partial response rate (lesion was reduced in size by more
than 50%). In addition, 7% of lesions had stable disease (any
increase in lesion size was less than 25%). The various response
rates are shown in the graph below and are similar to the results
seen in CMBC patients as we would expect. Based on these results we
requested, and were granted, an orphan drug designation for
SnET2.
Until the FDA approval of the drugs Odomzo (2015) and Erivedge
(2012) treatment options for these BCCNS patients were very
limited. However, we believe that, based on their package inserts,
Odomzo and Erivedge have dose limiting toxicity profiles which are
broader in scope than the primarily transient adverse effects
observed to-date with REM-001 Therapy. We believe that the
potential toxicity limitations related to the existing therapies
for BCCNS, plus the positive initial Phase 1/2 data generated in
clinical studies with REM-001 Therapy, suggest that REM-001 Therapy
could be a viable alternative in treating recurrent basal cell
carcinoma in BCCNS patients.
Current and Experimental Treatments for CMBC
As with many cancers, the current standard treatment for CMBC is
surgical excision. However, this is often not feasible due to the
extent of the tumor field or the condition of the skin,
particularly in patients who have had radiation therapy. A number
of other therapies have been used on patients with CMBC, including
various forms of chemotherapy, radiation therapy, hyperthermia,
cryotherapy, electro-chemotherapy, topical drugs and intra-lesional
chemotherapy injections. Researchers have also attempted to combine
therapies in an effort to improve efficacy. However, we believe
that these therapies are often inadequate given the limited
efficacy, toxicities and/or side effects of each. The side effects
associated with therapies may be particularly difficult for
patients who may have already experienced extensive surgery along
with a full course of radiation and/or systemic chemotherapy. Also,
the fact that CMBC tumors continue to develop following these
therapies is a signal that the tumor cells may have developed a
resistance to some of these approaches. Based on our discussions
with clinicians and literature reviews, and the March 3, 2017,
response from FDA, we believe that treatment of unresectable CMBC
tumors is a largely unmet medical need, particularly in patients
who have already received extensive radiation and
chemotherapy.
15
Clinical Results in CMBC
While we have not conducted any clinical studies, we have
undertaken an analysis of the Phase 1 and four Phase 2 and/or Phase
3 CMBC clinical studies done previously with REM-001 Therapy by
Miravant. We have concluded that in these studies REM-001 Therapy
provided higher tumor response rates than are generally seen with
alternative CMBC treatments. However, this program was discontinued
in 1998. Our review of clinical records further indicates that
following this decision, Miravant continued to monitor patients in
the CMBC studies and collected data as required by protocol, but
they conducted no further treatment of CMBC patients with REM-001
Therapy. We believe that Miravant primarily chose to discontinue
this program in order to focus its REM-001 development efforts on
an aspect of “wet” AMD.
Phase 2/3 Studies
After completion of the Phase 1 dose finding study, four Phase 2/3
studies were conducted with REM-001 Therapy for the treatment of
CMBC as summarized below. These studies all used the same dosimetry
as described above and most of the patients had been previously
treated with radiation therapy and chemotherapy. The light delivery
devices used in these studies were the ML1-0400 or the functionally
equivalent ML2-0400. The laser light source used in three of the
studies was the Miravant DD2 laser and one study used the KTP model
laser manufactured by LaserScope. Each study was conducted under
the cancer IND using Good Clinical Practices with safety and
efficacy data collected accordingly. In connection with our
acquisition of the Miravant assets, ownership of that IND has been
transferred to us.
The table below summarizes the CMBC Studies. Studies CA008, CA009
and CA019 required that the patients enrolled had received prior
radiation therapy. Study CA013 did not have this specific inclusion
requirement but our review of the data indicates that at least 50
of the 56 patients in CA013 had received prior radiation therapy. A
second difference across the studies is that studies CA008, CA009
and CA019 had a 24-week follow-up period while study CA013 had a
52-week follow-up period. Also, in studies CA008 and CA009 two
tumor lesions on each patient were randomly selected as controls
and did not receive light activation. CA013 was conducted in Europe
by a corporate partner of Miravant. Beyond these differences and
those device differences noted above, we believe there were no
other substantive differences between the studies and that all
studies enrolled similar patients.
16
Table of Phase 2 and/or 3 CMBC Studies
(Note: SnET2 is now called REM-001)
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Trial Title
|
|
Phase
|
|
|
Location
|
|
Total
Patients
|
|
|
Total
Patients
Previously
Treated with
Radiotherapy
|
|
|
Included
Randomly
Selected
Control
Tumors
|
CA008:
Open-Label Randomized No Treatment
Concurrent Controlled Study of Single Dose
Tin Ethyl Etiopurpurin (SnET2) Photodynamic
Therapy (PDT) in Patients with Advanced
Breast
Cancer Who Have Failed Radiation Therapy for
the
Management of Cutaneous Metastatic Breast
Carcinoma (24 Week Follow Up)
|
|
2/3
|
|
|
U.S.
|
|
|
32
|
|
|
|
32
|
|
|
Yes
|
CA009:
Open-Label Randomized No Treatment
Concurrent Controlled Study of Single Dose
Tin Ethyl Etiopurpurin (SnET2) Photodynamic
Therapy (PDT) in Patients with Advanced
Breast
Cancer Who Have Failed Radiation Therapy for
the
Management of Cutaneous Metastatic Breast
Carcinoma (24 Week Follow Up)
|
|
2/3
|
|
|
U.S.
|
|
|
36
|
|
|
|
36
|
|
|
Yes
|
CA013:
Multinational, Open-Label Study of Single Dose
Tin Ethyl Etiopurpurin (SnET2) Photodynamic
Therapy
(PDT) in Patients with Advanced Breast Cancer for
the
Management of Cutaneous Metastases of Breast
Carcinoma (52 Week Follow Up)
|
|
|
2
|
|
|
Europe
|
|
|
56
|
|
|
|
50
|
|
|
No
|
CA019:
Open-Label Study of Single Dose Tin Ethyl
Etiopurpurin (SnET2) Photodynamic Therapy (PDT)
in
Patients with Advanced Breast Cancer Who Have
Failed
Radiation Therapy for the Management of
Cutaneous
Metastatic Breast Carcinoma (24 Week Follow
Up)
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3
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|
U.S.
|
|
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25
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|
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25
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|
No
|
The primary endpoints for studies CA008 and CA009 were objective
tumor response rate, quality-of-life change, device performance and
patient safety. Our review of the tumor response rate and
quality-of-life endpoints indicated they were defined as
follows:
•
Tumor Response:
Measured as paired response difference, as calculated by the
percentage of a patient’s evaluable lesions that respond minus the
percentage of the patient’s control lesions that respond with this
difference averaged over all treated patients.
•
Quality of Life Change:
Measured using the Dermatologic Life Quality Index (DLQI, A.Y.
Finlay and O.K. Khan, “Dermatology Life Quality Index (DLQI—a
simple practical measure for routine clinical use”. Clinical and
Experimental Dermatology 1994; 19: 210-2 16) with change measured
from baseline measurements.
No significant device failures were observed in either study.
Secondary endpoints in CA008 and CA009 were patient disease burden,
duration of response and patient pain assessment. Previous analysis
indicated, for patients for which data was available, there was a
treatment benefit in disease burden (p = 0.0017 for CA008, p =
0.0020 for CA009) and duration of response (p < 0.001 for CA008,
not significant in CA009) when comparing treated and control
lesions. In terms of pain, there was no significant change in pain
in CA008 and a treatment related increase in pain at 4 Weeks
post-treatment in CA009. Treatment related pain, particularly
during the first month after treatment, was the most commonly
reported adverse event and was often treated with
analgesics.
17
Studies CA013 and CA019 used similar endpoints with one notable
exception. Tumor Response as Measured by Paired Response was not
possible in these studies since this measurement relies on control
lesions and CA013 and CA019 did not include controls. Miravant did
not conduct an efficacy analysis of these two studies but we have
conducted an analysis of the Quality of Life and Clinical Success
endpoints used in the pivotal CA008 and CA009 studies. Results from
that analysis are shown in the following table:
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Clinical Success
|
|
24 Week Quality of Life Change
|
|
Study
|
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Eligible
Patients (N)
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|
Average
Rate of
Clinical
Success (%)
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95%
Confidence
Interval
|
|
Eligible
Patients (N)
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Mean ± SD
|
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P value
|
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CA013
|
|
|
32
|
|
|
|
88
|
%
|
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71% - 97%
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16
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1.3 ± 3.6
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|
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1.00
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|
CA019
|
|
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18
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|
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|
83
|
%
|
|
45% - 86%
|
|
|
11
|
|
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2.5 ± 4.7
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|
|
1.00
|
|
The most common adverse events seen in these four studies (CA008,
CA009, CA013, CA019) were pain and photosensitivity, both of which
are expected with this therapy. In the four studies there were a
total of 17 serious adverse events (SAE’s) that were judged by
investigators to be possibly, probably or definitely related to
treatment. None of these were classified by the investigator as
life threatening and none resulted in death. Of these 17 SAE’s,
eight were related to necrosis of the treated lesions, three were
related to treatment field infection, four were treatment related
pain, one was a photosensitivity skin reaction and one was an
allergic reaction.
We believe that the data from these studies show that REM-001
Treatment is a promising therapy for CMBC. However, because there
are no approved therapies for CMBC, we have no basis for comparing
these results to existing therapies. Based on the FDA’s March 3,
2017 response, we believe the FDA will view these results as
supportive data and our plan is to conduct a new pivotal Phase 3
study to support a new drug application.
The figure below shows the results of this initial preliminary
analysis of the clinical data and depicts the percentage of
evaluable lesions in each CMBC Study for which there was a complete
response; i.e. where all visible clinical evidence of the tumor is
gone after treatment with REM-001 Therapy.
Manufacturing
VAL-083
VAL-083 is a small-molecule chemotherapeutic. Chemical synthesis of
the active pharmaceutical ingredient (“API”) was initially
established by the NCI. We have made improvements to this process
and have obtained patents on these improvements. The current
manufacturing process involves fewer than five synthetic
steps.
VAL-083 drug product is a lyophilized (freeze-dried) formulation
that is reconstituted for intravenous injection. We anticipate that
overall cost of goods for an eventual commercial product will be
similar to other injectable, small-molecule
pharmaceuticals.
18
For our now-completed clinical study that was conducted in China,
the supply of VAL-083 was provided through our collaboration with
Guangxi Wuzhou Pharmaceutical Company. To-date, they have not
achieved the quality of GMP manufacturing systems necessary to meet
FDA manufacturing standards.
To address the need to meet FDA standards, we have engaged
third-party contract manufacturers with the capabilities to
establish the processes, procedures and quality systems necessary
to meet U.S., Canadian, E.U. and other international manufacturing
requirements in accordance with Good Manufacturing Practice
(“cGMP”) regulations. We have used drug supply from these
third-parties for our ongoing GCAR study.
We have developed and patented certain intellectual property
related to quality controls that are used in the release of VAL-083
for our clinical studies.
REM-001
The manufacturing process for the API in REM-001 was developed over
a ten-year period and we believe is now well established and
suitable for commercial scale production. This process was also
included as part of Miravant’s prior NDA for the use of REM-001 to
treat an aspect of AMD, which underwent an FDA review where an
approvable letter was granted. The final REM-001 drug product is a
lipid-based formulation and was previously produced at a commercial
scale by a contract manufacturer for use in Miravant’s previous
clinical studies and commercialization activities. We do not own or
operate manufacturing facilities for the production of REM-001, nor
the laser light source, or light delivery device for use with
REM-001 Therapy. We are dependent on third-party suppliers and
manufacturing organizations for both commercial and clinical study
supplies of all of our raw materials, the REM-001 drug substance,
drug product and the REM-001 Therapy, laser light source, and light
delivery device.
We have engaged a contract manufacturer who has manufactured the
starting material for our API, and then manufactured two API lots
under GMP and has stability testing ongoing. We have also engaged a
contract manufacturer who has manufactured a drug product lot under
GMP for use in our planned 15-patient clinical study. With the
feedback from the FDA that we could utilize the existing supply of
laser systems or devices that were functionally equivalent, an
in-depth assessment was made to determine which pathway would be
appropriate. It has been determined that the existing lasers that
were utilized in the previous clinical studies will not be used in
the current clinical studies. We engaged a third-party contract
medical device manufacturer who has built new lasers and
light-delivery devices. We have also engaged an affiliate of this
manufacturer to train the clinical staff in the use of the units,
provide regulatory support for the devices, and maintain the
devices while being used in the study. We believe there are readily
available supplies of all raw materials needed for the manufacture
of REM-001 and the related required light device components to
satisfy future requirements.
Research and Development Collaborations
Guangxi Wuzhou Pharmaceutical Company
Pursuant to a memorandum of understanding and collaboration
agreement, dated October 25, 2012, we have established a strategic
collaboration with Guangxi Wuzhou Pharmaceutical Company, a
subsidiary of publicly traded Guangxi Wuzhou Zhongheng Group Co.,
Ltd. (SHG: 600252) (the “Guangxi Agreement”). VAL-083 is approved
for the treatment of chronic myelogenous leukemia (“CML”) and lung
cancer in China and Guangxi Wuzhou Pharmaceutical Company is the
only manufacturer licensed by the CFDA to produce the product for
the China market. Through the Guangxi Agreement, we have been
provided with drug product for our now-completed Phase 2 study in
China as well as for certain completed clinical studies in the
United States. In addition, we have secured certain commercial
rights in China.
Pursuant to the Guangxi Agreement, we have granted to Guangxi
Wuzhou Pharmaceutical Company a royalty-free license to certain of
our intellectual property for use in China as it relates to quality
control and drug production methods for VAL-083. In addition,
subject to successful agreement on definitive commercial terms, we
have agreed that Guangxi Wuzhou Pharmaceutical Company will be our
exclusive supplier of VAL-083 for clinical studies and commercial
sales, subject to Guangxi Wuzhou Pharmaceutical Company obtaining
and maintaining cGMP certification by the FDA, EMA or other
applicable regulatory agencies, and Guangxi Wuzhou Pharmaceutical
Company being able to meet volumes ordered by us. To-date, Guangxi
Wuzhou Pharmaceutical Company has not achieved cGMP certification
with respect to the manufacturing of VAL-083.
This Guangxi Agreement also provides us with certain exclusive
commercial rights related to drug supply. Specifically, the Guangxi
Agreement establishes an exclusive supply relationship between us
and Guangxi Wuzhou Pharmaceutical Company for the Chinese market
and all markets outside China. Guangxi Wuzhou Pharmaceutical
Company agreed that it may not sell VAL-083 for markets outside of
China to any other purchaser other than us, provided that, during
the first three years following regulatory clearance for marketing
of VAL-083 in a particular country or region, we meet proposed
sales volumes set by Guangxi Wuzhou Pharmaceutical Company for the
country or region. In addition, Guangxi Wuzhou Pharmaceutical
Company granted us a pre-emptive right in China
19
(subject to our acceptance of proposed sales volume and prices) to
purchase VAL-083 produced by Guangxi Wuzhou Pharmaceutical
Company.
With respect to the Phase 3, or registration study, for GBM to be
undertaken in China in order to ultimately commercialize VAL-083 in
China, we are not under an obligation to participate in such a
study. However, our participation in such a study in China, for the
Chinese market, would be part of a larger negotiation process
between us and Guangxi Wuzhou Pharmaceutical Company to determine
how such a study would be conducted. We plan to execute a Phase 3
study and to seek approval for VAL-083 outside of China and we have
no dependency, or obligations, to Guangxi Wuzhou Pharmaceutical
Company with respect to studies we plan to conduct outside of
China.
The term of the Guangxi Agreement (except as it relates to the
exclusive rights in the China market) is indefinite, subject to
termination upon written agreement of all parties, or if either
party breaches any material term and fails to remedy such breach
within 30 days of receipt of notice of the breach, or if any action
to be taken thereunder is not agreed to by both parties, provided
that such matter is referred to the chief executive officer of both
parties, and they are unable to resolve such matter within 90 days.
No payments have been made to date under the Guangxi Agreement to,
or from, either Kintara or Guangxi Wuzhou Pharmaceutical
Company.
St. Cloud Asset Purchase Agreement
Adgero acquired certain Miravant assets, including the REM-001
Therapy and the associated technology and intellectual property,
through an asset purchase agreement with St. Cloud Investments, LLC
(“St. Cloud”), dated November 26, 2012, as amended (the “St. Cloud
Agreement”). In conjunction with the merger with Adgero which
closed on August 19, 2020, we assumed the St. Cloud Agreement. St.
Cloud was previously a Miravant creditor and acquired these
Miravant assets pursuant to a foreclosure process St. Cloud
completed under California law. Pursuant to the terms of the St.
Cloud Agreement, we are obligated to make certain payments under
the agreement.
As of June 30, 2022, the amounts still to be paid or owed under
that agreement are as follows:
•
Upon the earlier of (i) a subsequent equity financing to take place
after we conduct a Phase 2B clinical study in which fifty patients
complete the study and their clinical data can be evaluated or (ii)
the commencement of a clinical study intended to be used as a
definitive study for market approval in any country, we are
obligated to pay an aggregate amount of three hundred thousand
dollars ($300,000) in cash or an equivalent amount of common stock,
with two hundred forty thousand dollars ($240,000) to St. Cloud and
sixty thousand dollars ($60,000) to Steven Rychnovsky,
PhD.
•
Upon receipt of regulatory approval of REM-001 Therapy, we are
obligated to pay an aggregate amount of seven hundred thousand
dollars ($700,000) in cash or an equivalent amount of common stock,
with five hundred and sixty thousand dollars ($560,000) to St.
Cloud and one hundred forty thousand dollars ($140,000) to Steven
Rychnovsky, PhD.
With respect to the $300,000 and $700,000 potential milestone
payments referenced above (each a “Milestone Payment”), if either
such Milestone Payment becomes payable, and in the event we elect
to pay either such Milestone Payment in shares of our common stock,
the value of the common stock will equal the price per share of the
most recent financing, or, if we are considered to be a
publicly-traded company, the average of the closing price per share
of our common stock over the twenty (20) trading days following the
first public announcement of the applicable event described
above.
In addition, we must pay to St. Cloud and Steven Rychnovsky, PhD,
in the aggregate, a royalty fee of six percent (6%) of net sales
during the royalty term on a country-by-country and
product-by-product basis with St. Cloud receiving a royalty rate of
four and eight tenths percent (4.8%) and Steven Rychnovsky, PhD,
receiving a royalty of one and two tenths percent (1.2%). The
royalty term for a product commences on the first commercial sale
of the product, such as REM-001 Therapy, in any country, and the
royalty fee must be paid within 30 days of each calendar quarter
during which revenue is collected. The royalty term terminates on
the later of (i) the invalidation, revocation, lapse or expiration
of the last to expire valid claim on any patent acquired in the St.
Cloud Agreement that would be infringed by the sale of the product
in the country where the commercial sale takes place or (ii) the
expiration of the period for which we hold exclusive marketing
rights of the product in the country, if we were granted those
rights under the St. Cloud Agreement.
Patents and Proprietary Rights
Our success will depend in part on our ability to protect our
existing product candidates and the products we acquire or license
by obtaining and maintaining a strong proprietary position. To
develop and maintain our position, we intend to continue relying
upon the validity and enforceability of our patents patent
protection, orphan drug status, Hatch-Waxman exclusivity, trade
secrets, know-how, continuing technological innovations and
licensing opportunities.
20
There is no guarantee that patents will be granted with respect to
any patent applications we may submit, own or license in the
future, nor can we be sure that any of our existing patents or any
patents we may own or license in the future will be useful in
protecting our technology.
VAL-083
We have filed patent applications claiming the use of, and
improvements related to VAL-083. Our patent filings also include
proposed treatment regimens, improvements to the manufacturing
process, formulation and composition of the active pharmaceutical
ingredient, and finished dosage forms of VAL-083. We are
prosecuting and maintaining our patent applications in the United
States and other jurisdictions which we deem important for the
potential commercial success of VAL-083.
Our patents and patent applications for VAL-083 can be summarized
in fourteen series as follows:
•
Series I is generally directed to synthesis of
VAL-083.
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|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent No. 8,563,758
|
|
Method Of Synthesis Of Substituted Hexitols Such As
Dianhydrogalactitol
|
|
|
United States Patent No. 8,921,585
|
|
Method Of Synthesis Of Substituted Hexitols Such As
Dianhydrogalactitol
|
|
|
United States Patent No. 9,085,544
|
|
Method Of Synthesis Of Substituted Hexitols Such As
Dianhydrogalactitol
|
|
|
United States Patent No. 9,630,938
|
|
Method Of Synthesis Of Substituted Hexitols Such As
Dianhydrogalactitol
|
|
|
PCT Patent Application Serial No. PCT/US2011/048032
|
|
Method Of Synthesis Of Substituted Hexitols Such As
Dianhydrogalactitol. Patents granted in various
countries.
|
|
2031
|
•
Series II is generally directed to use of VAL-083 to treat a range
of diseases and conditions, including but not limited to
malignancies.
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent No. 9,066,918
|
|
Compositions And Methods To Improve The Therapeutic Benefit Of
Suboptimally Administered Chemical Compounds Including Substituted
Hexitols Such As Dianhydrogalactitol And
Diacetyldianhydrogalactitol
|
|
|
United States Patent No. 9,901,563
|
|
Compositions And Methods To Improve The Therapeutic Benefit Of
Suboptimally Administered Chemical Compounds Including Substituted
Hexitols Such As Dianhydrogalactitol And
Diacetyldianhydrogalactitol
|
|
|
•
Series III is generally directed to analytical methods for
VAL-083.
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent No. 9,759,698
|
|
Improved Analytical Methods For Analyzing And Determining
Impurities In Dianhydrogalactitol
|
|
|
United States Patent No. 10,145,824
|
|
Improved Analytical Methods For Analyzing And Determining
Impurities In Dianhydrogalactitol
|
|
|
United States Patent No. 9,029,164
|
|
Improved Analytical Methods For Analyzing And Determining
Impurities In Dianhydrogalactitol
|
|
|
PCT Patent Application Serial No. PCT/IB2013/000793
|
|
Improved Analytical Methods For Analyzing And Determining
Impurities In Dianhydrogalactitol. Patents granted in various
countries.
|
|
2033
|
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
PCT Patent Application Serial No. PCT/US2014/066087
|
|
Improved Analytical Methods For Analyzing And Determining
Impurities In Dianhydrogalactitol
|
|
2034
|
21
•
Series IV is generally directed to the use of VAL-083 to treat GBM
or medulloblastoma.
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent No. 11,234,955
|
|
Use Of Substituted Hexitols Including Dianhydrogalactitol And
Analogs To Treat Neoplastic Disease And Cancer Stem Cells Including
Glioblastoma Multiforme And Medulloblastoma
|
|
|
United States Patent No. 9,687,466
|
|
Use Of Substituted Hexitols Including Dianhydrogalactitol And
Analogs To Treat Neoplastic Disease And Cancer Stem Cells Including
Glioblastoma Multiforme And Medulloblastoma
|
|
|
United States Patent No. 10,201,521
|
|
Use Of Substituted Hexitols Including Dianhydrogalactitol And
Analogs To Treat Neoplastic Disease And Cancer Stem Cells Including
Glioblastoma Multiforme And Medulloblastoma
|
|
|
United States Patent Application Serial No. 17/583,141
|
|
Use Of Substituted Hexitols Including Dianhydrogalactitol And
Analogs To Treat Neoplastic Disease And Cancer Stem Cells Including
Glioblastoma Multiforme And Medulloblastoma
|
|
|
PCT Patent Application Serial No. PCT/US2013/022505
|
|
Use Of Substituted Hexitols Including Dianhydrogalactitol And
Analogs To Treat Neoplastic Disease And Cancer Stem Cells Including
Glioblastoma Multiforme And Medulloblastoma. National phase
applications pending and granted in various countries.
|
|
2033
|
•
Series V is generally directed to the veterinary use of
VAL-083.
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent No. 9,814,693
|
|
Veterinary Use Of Dianhydrogalactitol, Diacetyldianhydrogalactitol,
And Dibromodulcitol To Treat Malignancies
|
|
|
•
Series VI is generally directed to the use of VAL-083 to treat
tyrosine-kinase-inhibitor-resistant malignancies.
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent Application Serial No. 17/177,665
|
|
Methods For Treating Tyrosine-Kinase-Inhibitor-Resistant
Malignancies In Patients With Genetic Polymorphisms Or Ahi1
Dysregulations Or Mutations Employing Dianhydrogalactitol,
Diacetyldianhydrogalactitol, Dibromodulcitol, Or Analogs Or
Derivatives Thereof
|
|
|
PCT Patent Application Serial No. PCT/US2013/047320
|
|
Methods For Treating Tyrosine-Kinase-Inhibitor-Resistant
Malignancies In Patients With Genetic Polymorphisms Or Ahi1
Dysregulations Or Mutations Employing Dianhydrogalactitol,
Diacetyldianhydrogalactitol, Dibromodulcitol, Or Analogs Or
Derivatives Thereof. National phase applications pending and
granted in various countries.
|
|
2033
|
•
Series VII is generally directed to the use of VAL-083 to treat
recurrent malignant glioma and progressive secondary brain
tumor.
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent No. 11,026,914
|
|
Use Of Dianhydrogalactitol And Analogs And Derivatives Thereof To
Treat Recurrent Malignant Glioma Or Progressive Secondary Brain
Tumor
|
|
|
PCT Application Serial No. PCT/US2014/040461
|
|
Use Of Dianhydrogalactitol And Analogs And Derivatives Thereof To
Treat Recurrent Malignant Glioma Or Progressive Secondary Brain
Tumor. National phase applications pending and granted in various
countries.
|
|
2034
|
22
•
Series VIII is generally directed to the use of VAL-083 to treat
non-small-cell lung cancer.
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent Application Serial No. 14/710,240
|
|
Use of Dianhydrogalactitol and Analogs or Derivatives Thereof in
Combination With Platinum-Containing Antineoplastic Agents to Treat
Non Small-Cell Carcinoma of the Lung and Brain
Metastases
|
|
|
PCT Patent Application Serial No. PCT/US2015/024462
|
|
Use of Dianhydrogalactitol and Analogs or Derivatives Thereof to
Treat Non-Small Cell Carcinoma of the Lung and Ovarian Cancer.
National phase applications pending and granted in various
countries.
|
|
2035
|
•
Series IX is generally directed to the use of VAL-083 and radiation
to treat NSCLC and GBM.
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent Application Serial No. 15/525,933
|
|
Dianhydrogalactitol Together with Radiation to Treat Non-Small-Cell
Carcinoma of the Lung and Glioblastoma Multiforme.
|
|
|
PCT Patent Application Serial No. PCT/US2015/059814
|
|
Dianhydrogalactitol Together with Radiation to Treat Non-Small-Cell
Carcinoma of the Lung and Glioblastoma Multiforme. National phase
applications pending and granted in various countries.
|
|
2035
|
•
Series X is generally directed to the use of VAL-083 in NSCLC and
ovarian cancer:
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent Application Serial No. 15/759,104
|
|
Use of Dianhydrogalactitol And Derivatives Thereof in the Treatment
of Glioblastoma, Lung Cancer and Ovarian Cancer.
|
|
|
•
Series XI is generally directed to the use of VAL-083 in the
treatment of CNS malignancies:
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent Application Serial No. 15/771,631
|
|
Use of Dianhydrogalactitol or Derivatives and Analogs Thereof for
Treatment of Pediatric Central Nervous System
Malignancies.
|
|
|
•
Series XII is generally directed to the analysis and resolution of
VAL-083 preparations:
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent No. 10,591,445
|
|
Methods for analysis and Resolution of Preparations of
Dianhydrogalactitol and Derivatives and Analogs Thereof.
|
|
|
PCT Patent Application Serial No.
PCT/US2016/063362
|
|
Methods for analysis and Resolution of Preparations of
Dianhydrogalactitol and Derivatives and Analogs Thereof. National
phase applications pending and granted in various
countries.
|
|
2036
|
•
Series XIII is generally directed to combinations:
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent Application Serial No. 16/609,721
|
|
Use of Dianhydrogalactitol and Analogs and Derivatives in
Combination VEGF inhibitors to Treat Cancer
|
|
|
|
|
|
|
|
23
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent Application Serial No. 16/489,122
|
|
Use of Dianhydrogalactitol and Analogs and Derivatives in
Combination with a P53 Modulator or a PARP Inhibitor
|
|
|
PCT Patent Application Serial No.
PCT/US2018/020314
|
|
Use of Dianhydrogalactitol and Analogs and Derivatives in
Combination with a P53 Modulator or a PARP Inhibitor. National
phase applications pending.
|
|
2038
|
•
Series XIV is generally directed to the use of VAL-083 in the
treatment of diffuse intrinsic pontine glioma:
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent Application Serial No. 16/768,827
|
|
Use of Dianhydrogalactitol or Derivatives and Analogs Thereof to
Treat Diffuse Intrinsic Pontine Glioma.
|
|
|
In addition to patent protection, we may also seek orphan drug
status whenever it is available. If a product which has an orphan
drug designation subsequently receives the first regulatory
approval for the indication for which it has such designation, the
product is entitled to orphan exclusivity, meaning that the
applicable regulatory authority may not approve any other
applications to market the same drug for the same indication,
except in very limited circumstances, for a period of seven years
in the U.S. and Canada, and 10 years in the E.U. Orphan drug
designation does not prevent competitors from developing or
marketing different drugs for the same indication or the same drug
for a different clinical indication.
VAL-083 has been granted protection under the Orphan Drug Act by
the FDA and the European Medicines Agency ("EMA") for the treatment
of gliomas, including GBM. The FDA has also granted Orphan Drug
protection to VAL-083 for the treatment of medulloblastoma and
ovarian cancer.
In February 2012, the FDA granted orphan drug status to VAL-083 for
the treatment of glioma. In January 2013, the EMA also granted
orphan drug protection to VAL-083 for the treatment of glioma. In
the spring of 2016, the FDA Office of Orphan Products Development
granted orphan drug designations to VAL-083 for the treatment of
ovarian cancer and medulloblastoma.
In addition to our patents and orphan drug protection, we intend to
rely on the Hatch-Waxman Amendments for five years of data
exclusivity for VAL-083.Under the Hatch-Waxman Amendments, newly
approved drugs and indications benefit from a statutory period of
non-patent marketing exclusivity. These amendments provide
five-year data exclusivity to the first applicant to gain approval
of an NDA for a new chemical entity, meaning that the FDA has not
previously approved any other new drug containing the same active
ingredient. The Hatch-Waxman Amendments prohibit the approval of an
abbreviated new drug application, also known as an ANDA or generic
drug application, during the five-year exclusive period if no
patent is listed. If there is a patent listed and the ANDA
applicant certifies that the NDA holder’s listed patent for the
product is invalid or will not be infringed, the ANDA can be
submitted four years after NDA approval. Protection under the
Hatch-Waxman Amendments will not prevent the filing or approval of
another full NDA; however, the applicant would be required to
conduct its own pre-clinical studies and adequate and
well-controlled clinical studies to demonstrate safety and
effectiveness. The Hatch-Waxman Amendments also provide three years
of data exclusivity for the approval of NDAs with new clinical
studies for previously approved drugs and supplemental NDAs, for
example, for new indications, dosages or strengths of an existing
drug, if new clinical investigations were conducted by or on behalf
of the sponsor and were essential to the approval of the
application. This three-year exclusivity covers only the new
changes associated with the supplemental NDA and does not prohibit
the FDA from approving ANDAs for drugs containing the original
active ingredient.
We also rely on trade secret protection for our confidential and
proprietary information. We believe that the substantial costs and
resources required to develop technological innovations, such as
the manufacturing processes associated with VAL-083, will help us
to protect the competitive advantage of our product
candidate.
The protection of intellectual property rights in China (where
VAL-083 is manufactured pursuant to a collaboration agreement with
the only manufacturer presently licensed by the CFDA to produce the
product for the China market, and where VAL-03 is approved for the
treatment of CML and lung cancer) is relatively weak compared to
the United States, which may negatively affect our ability to
generate revenue from VAL-083 in China.
Our policy is to require our employees, consultants, outside
scientific collaborators, sponsored researchers and other advisors
to execute confidentiality agreements upon the commencement of
employment or consulting relationships with us. These agreements
provide that all confidential information developed or made known
to the individual during the course of the individual’s
relationship with us is to be kept confidential and not disclosed
to third parties except in specific circumstances. In the case of
employees and consultants, the agreements provide that all
inventions conceived by the individual shall be our exclusive
property.
24
REM-001
Our product pipeline for REM-001 is based on technology that was
originally developed by Miravant. We acquired this technology,
which includes scientific and regulatory data and product know-how,
through an asset purchase agreement. We rely on trade secret
protection for our confidential and proprietary information related
to REM-001 and have filed patent applications to protect our
intellectual property.
Our patent applications for REM-001 can be summarized as
follows:
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent Application Serial No. 17/614,132
|
|
Methods for the production of Nickel (II)
Etioporphyrin-I.
|
|
|
PCT Patent Application Serial No.
PCT/US2021/053362
|
|
Methods for the production of Nickel (II)
Etioporphyrin-I.
|
|
2041
|
|
|
|
|
|
Patent or Patent Application No.
|
|
Title
|
|
Expiry
|
United States Patent Application Serial No. 17/546,715
|
|
Methods for treating cutaneous metastatic cancers.
|
|
|
PCT Patent Application Serial No.
PCT/US2021/062603
|
|
Methods for treating cutaneous metastatic cancers.
|
|
2041
|
We own proprietary regulatory data for REM-001 which includes two
INDs for use of REM-001 in oncology and ophthalmology, and one NDA
for use of REM-001 to treat age-related macular degeneration
("AMD"). The FDA granted our request that tin ethyl etiopurpurin
(the active pharmaceutical ingredient in REM-001) be designated as
an orphan drug for treatment of basal cell carcinoma nevus syndrome
("BCCNS"). We also hold an orphan drug designation that was
initially awarded to Miravant for tin ethyl etiopurpurin for the
prevention of access graft disease in hemodialysis
patients.
Government Regulation and Product Approval
Regulation by governmental authorities in the U.S. and other
countries is a significant factor, affecting the cost and time of
our research and product development activities, and will be a
significant factor in the manufacture and marketing of any approved
products. Our product candidates will require regulatory approval
by governmental agencies prior to commercialization. In particular,
our products are subject to rigorous preclinical and clinical
testing and other approval requirements by the FDA and similar
regulatory authorities in other countries. Various statutes and
regulations also govern or influence the manufacturing, safety,
reporting, labeling, transport and storage, record keeping and
marketing of our products. The lengthy process of seeking these
approvals, and the subsequent compliance with applicable statutes
and regulations, require the expenditure of substantial resources.
Any failure by us to obtain, or any delay in obtaining, the
necessary regulatory approvals could harm our business.
The regulatory requirements relating to the testing, manufacturing
and marketing of our products may change from time to time and this
may impact our ability to conduct clinical studies and the ability
of independent investigators to conduct their own research with
support from us.
The clinical development, manufacturing and marketing of our
products are subject to regulation by various authorities in the
U.S., the E.U. and other countries, including, in the U.S., the
FDA, in Canada, Health Canada, and, in the E.U., the EMA. The
Federal Food, Drug, and Cosmetic Act, the Public Health Service Act
in the U.S. and numerous directives, regulations, local laws and
guidelines in Canada and the E.U. govern the testing, manufacture,
safety, efficacy, labeling, storage, record keeping, approval,
advertising and promotion of our products. Product development and
approval within these regulatory frameworks takes a number of years
and involves the expenditure of substantial resources.
Regulatory approval will be required in all the major markets in
which we seek to develop our products. At a minimum, approval
requires the generation and evaluation of data relating to the
quality, safety, and efficacy of an investigational product for its
proposed use. The specific types of data required and the
regulations relating to this data will differ depending on the
territory, the drug involved, the proposed indication and the stage
of development.
In general, new chemical entities are tested in animals until
adequate evidence of safety is established to support the proposed
clinical study protocol designs. Clinical studies for new products
are typically conducted in three sequential phases that may
overlap. In Phase 1, the initial introduction of the pharmaceutical
into either healthy human volunteers or patients with the disease
(20 to 50 subjects), the emphasis is on testing for safety (adverse
effects), dosage tolerance, metabolism, distribution, excretion and
clinical
25
pharmacology. Phase 2 involves studies in a limited patient
population (50 to 200 patients) to determine the initial efficacy
of the pharmaceutical for specific targeted indications, to
determine dosage tolerance and optimal dosage and to identify
possible adverse side effects and safety risks. Once a compound
shows preliminary evidence of some effectiveness and is found to
have an acceptable safety profile in Phase 2 evaluations, Phase 3
studies are undertaken to more fully evaluate clinical outcomes in
a larger patient population in adequate and well-controlled studies
designed to yield statistically sufficient clinical data to
demonstrate efficacy and safety.
In the U.S., specific preclinical data, manufacturing and chemical
data, as described above, need to be submitted to the FDA as part
of an IND application, which, unless the FDA objects, will become
effective 30 days following receipt by the FDA. Phase 1 studies in
human volunteers may commence only after the application becomes
effective. Prior regulatory approval for human healthy volunteer
studies is also required in member states of the E.U. Currently, in
each member state of the E.U., following successful completion of
Phase 1 studies, data are submitted in summarized format to the
applicable regulatory authority in the member state in respect of
applications for the conduct of later Phase 2 studies. The
regulatory authorities in the E.U. typically have between one and
three months in which to raise any objections to the proposed
study, and they often have the right to extend this review period
at their discretion. In the U.S., following completion of Phase 1
studies, further submissions to regulatory authorities are
necessary in relation to Phase 2 and 3 studies to update the
existing IND.
Authorities may require additional data before allowing the studies
to commence and could demand that the studies be discontinued at
any time if there are significant safety issues. In addition to the
regulatory review, studies involving human subjects must be
approved by an independent body. The exact composition and
responsibilities of this body will differ from country to country.
In the U.S., for example, each study will be conducted under the
auspices of an independent institutional review board ("IRB") at
each institution at which the study is conducted. The IRB considers
among other things, the design of the study, ethical factors, the
privacy of protected health information as defined under the Health
Insurance Portability and Accountability Act, the safety of the
human subjects and the possible liability risk for the institution.
Equivalent rules to protect subjects’ rights and welfare apply in
each member state of the E.U. where one or more independent ethics
committees, which typically operate similarly to an IRB, will
review the ethics of conducting the proposed research. Other
regulatory authorities around the rest of the world have slightly
differing requirements involving both the execution of clinical
studies and the import/export of pharmaceutical products. It is our
responsibility to ensure we conduct our business in accordance with
the regulations of each relevant territory.
In order to gain marketing approval, we must submit a dossier to
the relevant authority for review, which is known in the U.S. as an
NDA and in the E.U. as a marketing authorization application
(“MAA”). The format is usually specific and laid out by each
authority, although in general it will include information on the
quality of the chemistry, manufacturing and pharmaceutical aspects
of the product as well as the nonclinical and clinical data. Once
the submitted NDA is accepted for filing by the FDA, it undertakes
the review process that currently takes on average 10 months,
unless an expedited priority review is granted which takes six
months to complete. Approval can take several months to several
years, if multiple 10-month review cycles are needed before final
approval is obtained, if at all.
The approval process can be affected by a number of factors. The
NDA may require additional preclinical, manufacturing data or
clinical studies which may be requested at the end of the 10-month
NDA review cycle, thereby delaying approval until additional data
are submitted and may involve substantial unbudgeted
costs.
In addition to obtaining approval for each product, in many cases
each drug manufacturing facility must be approved. The regulatory
authorities usually will conduct an inspection of relevant
manufacturing facilities, and review manufacturing procedures,
operating systems and personnel qualifications. Further inspections
may occur over the life of the product. An inspection of the
clinical investigation sites by a competent authority may be
required as part of the regulatory approval procedure. As a
condition of marketing approval, the regulatory agency may require
post-marketing surveillance to monitor for adverse effects or other
additional studies as deemed appropriate. After approval for the
initial indication, further clinical studies may be necessary to
gain approval for any additional indications. The terms of any
approval, including labeling content, may be more restrictive than
expected and could affect the marketability of a
product.
The FDA offers a number of regulatory mechanisms that provide
expedited or accelerated approval procedures for selected drugs in
the indications on which we are focusing our efforts. These include
accelerated approval under Subpart H of the agency’s NDA approval
regulations, fast track drug development procedures, breakthrough
drug designation and priority review. At this time, we have not
determined whether any of these approval procedures will apply to
our current drug candidates.
By leveraging existing preclinical and clinical safety and efficacy
data, we seek to build upon an existing knowledge base to
accelerate our research. In addition, through our focus on
end-stage population which has no current treatment options,
regulatory approval for commercialization may sometimes be achieved
in an accelerated manner. Accelerated approval by the FDA in this
category may be granted on objective response rates and duration of
responses rather than demonstration of survival benefit. As
a
26
result, studies of drugs to treat end-stage refractory cancer
indications have historically involved fewer patients and generally
have been faster to complete than studies of drugs for other
indications. We are aware that the FDA and other similar agencies
are regularly reviewing the use of objective endpoints for
commercial approval and that policy changes may impact the size of
studies required for approval, timelines and expenditures
significantly.
The U.S., E.U. and other jurisdictions may grant orphan drug
designation to drugs intended to treat a “rare disease or
condition,” which, in the U.S., is generally a disease or condition
that affects no more than 200,000 individuals. In the E.U., orphan
drug designation can be granted if: the disease is life threatening
or chronically debilitating and affects no more than 50 in 100,000
persons in the E.U.; without incentive, it is unlikely that the
drug would generate sufficient return to justify the necessary
investment; and no satisfactory method of treatment for the
condition exists or, if it does, the new drug will provide a
significant benefit to those affected by the condition. If a
product that has an orphan drug designation subsequently receives
the first regulatory approval for the indication for which it has
such designation, the product is entitled to orphan exclusivity,
meaning that the applicable regulatory authority may not approve
any other applications to market the same drug for the same
indication, except in very limited circumstances, for a period of
seven years in the U.S. and 10 years in the E.U. Orphan drug
designation does not prevent competitors from developing or
marketing different drugs for the same indication or the same drug
for different indications. Orphan drug designation must be
requested before submitting an NDA or MAA. After orphan drug
designation is granted, the identity of the therapeutic agent and
its potential orphan use are publicly disclosed. Orphan drug
designation does not convey an advantage in, or shorten the
duration of, the review and approval process. However, this
designation provides an exemption from marketing and authorization
fees charged to NDA sponsors under the Prescription Drug
Act.
Maintaining substantial compliance with appropriate federal, state
and local statutes and regulations requires the expenditure of
substantial time and financial resources. Drug manufacturers are
required to register their establishments with the FDA and certain
state agencies, and after approval, the FDA and these state
agencies conduct periodic unannounced inspections to ensure
continued compliance with ongoing regulatory requirements,
including cGMPs. In addition, after approval, some types of changes
to the approved product, such as adding new indications,
manufacturing changes and additional labeling claims, are subject
to further FDA review and approval. The FDA may require
post-approval testing and surveillance programs to monitor safety
and the effectiveness of approved products that have been
commercialized. Any drug products manufactured or distributed by us
pursuant to FDA approvals are subject to continuing regulation by
the FDA, including:
•
record-keeping requirements;
•
reporting of adverse experiences with the drug;
•
providing the FDA with updated safety and efficacy
information;
•
reporting on advertisements and promotional labeling;
•
drug sampling and distribution requirements; and
•
complying with electronic record and signature
requirements.
In addition, the FDA strictly regulates labeling, advertising,
promotion and other types of information on products that are
placed on the market. There are numerous regulations and policies
that govern various means for disseminating information to
health-care professionals as well as consumers, including to
industry sponsored scientific and educational activities,
information provided to the media and information provided over the
Internet. Drugs may be promoted only for the approved indications
and in accordance with the provisions of the approved
label.
The FDA has very broad enforcement authority and the failure to
comply with applicable regulatory requirements can result in
administrative or judicial sanctions being imposed on us or on the
manufacturers and distributors of our approved products, including
warning letters, refusals of government contracts, clinical holds,
civil penalties, injunctions, restitution and disgorgement of
profits, recall or seizure of products, total or partial suspension
of production or distribution, withdrawal of approvals, refusal to
approve pending applications, and criminal prosecution resulting in
fines and incarceration. The FDA and other agencies actively
enforce the laws and regulations prohibiting the promotion of
off-label uses, and a company that is found to have improperly
promoted off-label uses may be subject to significant liability. In
addition, even after regulatory approval is obtained, later
discovery of previously unknown problems with a product may result
in restrictions on the product or even complete withdrawal of the
product from the market.
Sales of our product candidates, if approved, will depend, in part,
on the extent to which such products will be covered by third-party
payors, such as government health care programs, commercial
insurance and managed healthcare organizations. These third-party
payors are increasingly limiting coverage or reducing
reimbursements for medical products and services. In addition, the
U.S. government, state legislatures and foreign governments have
continued implementing cost-containment programs, including
price
27
controls, restrictions on reimbursement and requirements for
substitution of generic products. Third-party payors decide which
therapies they will pay for and establish reimbursement levels.
Third-party payors often rely upon Medicare coverage policy and
payment limitations in setting their own coverage and reimbursement
policies. However, decisions regarding the extent of coverage and
amount of reimbursement to be provided for any drug candidates that
we develop will be made on a payor-by-payor basis. Each payor
determines whether or not it will provide coverage for a therapy,
what amount it will pay the manufacturer for the therapy, and on
what tier of its formulary it will be placed. The position on a
payor’s list of covered drugs, or formulary, generally determines
the co-payment that a patient will need to make to obtain the
therapy and can strongly influence the adoption of such therapy by
patients and physicians. Adoption of price controls and
cost-containment measures, and adoption of more restrictive
policies in jurisdictions with existing controls and measures,
could further limit our net revenue and results. Decreases in
third-party reimbursement for our product candidates or a decision
by a third-party payor to not cover our product candidates could
reduce physician usage of our product candidates, once approved,
and have a material adverse effect on our sales, results of
operations and financial condition.
Because of our current and future arrangements with healthcare
professionals, principal investigators, consultants, customers and
third-party payors, we will also be subject to healthcare
regulation and enforcement by the federal government and the states
and foreign governments in which we will conduct our business,
including our clinical research, proposed sales, marketing and
educational programs. Failure to comply with these laws, where
applicable, can result in the imposition of significant civil
penalties, criminal penalties, or both. The U.S. laws that may
affect our ability to operate, among others, include: the federal
Health Insurance Portability and Accountability Act of 1996, or
HIPAA, as amended by the Health Information Technology for Economic
and Clinical Health Act, which governs the conduct of certain
electronic healthcare transactions and protects the security and
privacy of protected health information; certain state laws
governing the privacy and security of health information in certain
circumstances, some of which are more stringent than HIPAA and many
of which differ from each other in significant ways and may not
have the same effect, thus complicating compliance efforts; the
federal healthcare programs’ Anti-Kickback Statute, which
prohibits, among other things, persons from knowingly and willfully
soliciting, receiving, offering or paying remuneration, directly or
indirectly, in exchange for or to induce either the referral of an
individual for, or the purchase, order or recommendation of, any
good or service for which payment may be made under federal
healthcare programs such as the Medicare and Medicaid programs;
federal false claims laws which prohibit, among other things,
individuals or entities from knowingly presenting, or causing to be
presented, claims for payment from Medicare, Medicaid, or other
third-party payors that are false or fraudulent; federal criminal
laws that prohibit executing a scheme to defraud any healthcare
benefit program or making false statements relating to healthcare
matters; the Physician Payments Sunshine Act, which requires
manufacturers of drugs, devices, biologics, and medical supplies to
report annually to the U.S. Department of Health and Human Services
information related to payments and other transfers of value to
physicians (defined to include doctors, dentists, optometrists,
podiatrists and chiropractors) and teaching hospitals, and
ownership and investment interests held by physicians and their
immediate family members; and state law equivalents of each of the
above federal laws, such as anti-kickback and false claims laws
which may apply to items or services reimbursed by any third-party
payor, including commercial insurers.
In addition, many states have similar laws and regulations, such as
anti-kickback and false claims laws that may be broader in scope
and may apply regardless of payor, in addition to items and
services reimbursed under Medicaid and other state programs.
Additionally, to the extent that our product is sold in a foreign
country, we may be subject to similar foreign laws.
We are also subject to numerous environmental and safety laws and
regulations, including those governing the use and disposal of
hazardous materials. The cost of compliance with and any violation
of these regulations could have a material adverse effect on our
business and results of operations. Although we believe that our
safety procedures for handling and disposing of these materials
comply with the standards prescribed by state and federal
regulations, accidental contamination or injury from these
materials may occur. Compliance with laws and regulations relating
to the protection of the environment has not had a material effect
on our capital expenditures or our competitive position. However,
we are not able to predict the extent of government regulation, and
the cost and effect thereof on our competitive position, which
might result from any legislative or administrative action
pertaining to environmental or safety matters.
Competition
The development and commercialization of new drug products is
highly competitive. We expect that we will face significant
competition from major pharmaceutical companies, specialty
pharmaceutical companies and biotechnology companies worldwide with
respect to VAL-083 and REM-001 and any other product candidates
that we may seek to develop or commercialize in the future.
Specifically, due to the large unmet medical need, global
demographics and relatively attractive reimbursement dynamics, the
oncology market is fiercely competitive and there are a number of
large pharmaceutical and biotechnology companies that currently
market and sell products or are pursuing the development of product
candidates for the treatment of cancer. Our competitors may succeed
in developing, acquiring or licensing technologies and drug
products that are more effective, have fewer or more tolerable side
effects or are less costly than any product candidates that we are
currently developing or that we may develop, which could render our
product candidates obsolete and noncompetitive.
28
All of the top ten global pharmaceutical companies, and many of the
mid-size pharmaceutical companies, have a strong research and
development and commercial presence in oncology. Smaller companies
also focus on oncology, including companies such as Clovis
Oncology, Inc., Epizyme, Inc., ImmunoGen, Inc., Incyte Corporation,
Infinity Pharmaceuticals, Inc., MacroGenics, Inc., Merrimack
Pharmaceuticals, Inc., Onconova Therapeutics, Inc., Pharmacyclics,
Inc., Puma Biotechnology, Inc. and Seagen, Inc.
We are currently participating in the GCAR GBM AGILE Study to
facilitate the advancement of VAL-083's clinical development. In
addition to us, there are four product candidates being studied:
Bayer Pharmaceuticals (Regorafenib), Kazia Therapeutics
(Paxalisib), Biohaven Pharmaceutical Holding Company (troriluzole)
and Vigeo Therapeutics (VT1021). All of these companies are seeking
approval in GBM.
Several companies are marketing and developing oncology
immunotherapy products. Companies with approved marketed oncology
products for GBM are Merck (Temodar
®)
and Genentech (Avastin
®).
Companies with oncology immunotherapy product candidates in
clinical development for GBM include, but are not limited to,
Northwest Biotherapeutics (DCVax-L), Celldex Therapeutics
(Rindopepimut (CDX-110) and ImmunoCellular Therapeutics
(ICT-107).
We are not aware of any therapies specifically approved for CMBC in
the US. IGEA Medical S.p.A. is developing an electro-chemotherapy
treatment for CMBC. Pinnacle Biologics Inc., a subsidiary of Advanz
Pharma Healthcare Corp., sells Photofrin, a first-generation PDT
product for treatment of certain endobronchial non-small-cell lung
cancers and esophageal cancers. Photofrin is currently in Phase 2
studies in recurrent glioma. To our knowledge, there is no reported
development program for Photofrin in CMBC. Rogers Sciences Inc. is
a medical device company that is developing a light delivery device
for use with PDT treatment of cutaneous cancers that they are
currently clinically testing in a Phase 2 study in CMBC
patients.
There are numerous therapies currently used to treat CMBC patients
including chemotherapy, radiation therapy, surgical excision,
hyperthermia, cryotherapy, electro-chemotherapy, topical drugs and
intra-lesional chemotherapy injections, but, to our knowledge,
there are no PDT therapies currently approved by the FDA for the
treatment of CMBC or similar cutaneous cancers. Some topical PDT
agents have been approved by the FDA for actinic keratosis which is
a precancerous skin condition and they have been approved in some
other countries for some conditions that we believe pose low
medical risk such as basal cell cancer and acne.
In the BCCNS field we are aware of approved drugs in the U.S.,
including vismodegib (Eviredge), Odomzo (sonidegib), imiquimod and
topical fluorouracil that are sometimes use off-label. PellePharm
also recently completed a Phase 3 study in BCCNS but, to our
knowledge, has not received marketing approval.
Our commercial opportunity could be reduced or eliminated if our
competitors develop and commercialize products that are safer, more
effective, have fewer or less severe side effects, are more
convenient or are less expensive than any products that we may
develop. Our competitors also may obtain FDA or other marketing
approval for their products before we are able to obtain approval
for ours, which could result in our competitors establishing a
strong market position before we are able to enter the
market.
Many of our existing and potential future competitors have
significantly greater financial resources and expertise in research
and development, manufacturing, preclinical testing, conducting
clinical studies, obtaining marketing approvals and marketing
approved products than we do. Mergers and acquisitions in the
pharmaceutical and biotechnology industries may result in even more
resources being concentrated among a smaller number of our
competitors. Smaller, or early stage, companies may also prove to
be significant competitors, particularly through collaborative
arrangements with large and established companies. These
competitors also compete with us in recruiting and retaining
qualified scientific and management personnel and establishing
clinical study sites and patient registration for clinical studies,
as well as in acquiring technologies complementary to, or necessary
for, our programs.
We expect that our ability to compete effectively will depend upon
our ability to:
•
successfully and rapidly complete adequate and well-controlled
clinical studies that demonstrate statistically significant safety
and efficacy and to obtain all requisite regulatory approvals in a
cost-effective manner;
•
maintain a proprietary position for our manufacturing processes and
other technology;
•
produce our products in accordance with FDA and international
regulatory guidelines;
•
attract and retain key personnel; and
•
build or access an adequate sales and marketing infrastructure for
any approved products.
Failure to do one or more of these activities could have an adverse
effect on our business, financial condition or results of
operations.
29
Corporate History
We are a Nevada corporation formed on June 24, 2009, under the name
Berry Only Inc. On January 25, 2013, we entered into and closed an
exchange agreement (the “Exchange Agreement”), with Del Mar (BC),
Callco, Exchangeco and the security holders of Del Mar (BC). Upon
completion of the Exchange Agreement, Del Mar (BC) became a
wholly-owned subsidiary of ours (the “Reverse
Acquisition”).
On August 19, 2020, we merged with Adgero and changed our name from
DelMar Pharmaceuticals, Inc. to Kintara Therapeutics, Inc. We are
the parent company to the following entities:
•
Del Mar (BC), a British Columbia, Canada corporation incorporated
on April 6, 2010, which is a clinical stage company with a focus on
the development of drugs for the treatment of cancer;
•
Adgero, a Delaware corporation incorporated on October 26, 2015,
which is a clinical-stage company with a focus on the development
of photodynamic therapy for the treatment of rare, unmet medical
needs, specifically orphan cancer indications;
•
Adgero Bio, a Delaware corporation incorporated on November 16,
2007; and
•
Callco and Exchangeco are British Columbia, Canada corporations.
Callco and Exchangeco were formed to facilitate the Reverse
Acquisition.
Research and Development
During the years ended June 30, 2022, and 2021, we recognized $15.2
million and $11.8 million, respectively, in research and
development expenses.
Employees
We have three full-time employees and retain the services of
approximately 20 persons on an independent contractor/consultant
and contract-employment basis. As such, we currently operate in a
“virtual” corporate structure in order to minimize fixed personnel
costs.
Available Information
We maintain an internet website at www.kintara.com. We do not
incorporate the information on our website into this report and you
should not consider it part of this report.
30
Item 1A. Risk
Factors
Summary of Risk Factors
•
We have a limited operating history, are not profitable and may
never become profitable.
•
We have expressed substantial doubt about our ability to continue
as a going concern.
•
We face significant risks related to the COVID-19 pandemic, which
could have material and adverse impacts on our business, financial
condition, liquidity and results of operations.
•
Our business is heavily dependent on the successful development,
regulatory approval and commercialization of our product
candidates.
•
We will require substantial additional capital to fund our
operations, and if we fail to obtain necessary financing, we may
not be able to complete the development and commercialization of
any of our product candidates.
•
Our product candidates will face significant competition and may be
unable to compete effectively.
•
Various government regulations could limit or delay our ability to
develop and commercialize our products or otherwise negatively
impact our business.
•
The commercial potential of our products is difficult to predict.
The market for any product, or for companion animal diagnostics and
medical devices overall, is uncertain and may be smaller than we
anticipate, which could significantly and negatively impact our
revenue, results of operations and financial
condition.
•
Our ability to obtain intellectual property protection for our
products is limited.
•
We will rely on third parties to conduct certain portions of our
development activities. If these third parties do not successfully
carry out their contractual duties or meet expected deadlines, we
may be unable to obtain regulatory approval for or commercialize
our product candidates.
•
We will rely on third-party manufacturers to produce our products.
If we experience problems with any of these suppliers, the
manufacturing of our product candidates or products could be
delayed.
•
If we fail to attract and keep key personnel and members of
management, we may be unable to successfully develop any of our
existing or future product candidates, conduct our in-licensing and
development efforts and commercialize any of our existing or future
products.
•
Any failure by us to protect our intellectual property rights or
maintain the right to use certain intellectual property may
negatively affect our ability to compete.
•
We expect that the price of our common shares will fluctuate
substantially.
•
Substantial future sales of shares of our common stock could cause
the market price of our common stock to decline.
•
Issuance of our common stock upon exercise of convertible
securities may depress the price of our common stock.
•
We have incurred significant costs as a result of operating as a
U.S. public company, and our management will continue to devote
substantial time to new compliance initiatives.
An investment in our common stock involves a high degree of risk.
In determining whether to purchase our common stock, an investor
should carefully consider all of the material risks described
below, together with the other information contained in this report
before making a decision to purchase our securities. An investor
should only purchase our securities if he or she can afford to
suffer the loss of his or her entire investment.
Risks Related to Our Business
We have expressed substantial doubt about our ability to continue
as a going concern.
As discussed in Note 1 to the consolidated financial statements for
the year ended June 30, 2022, our consolidated financial statements
for the year ended June 30, 2022, include an explanatory paragraph
that such financial statements were prepared assuming that we will
continue as a going concern. A going concern basis assumes that we
will continue our operations for the foreseeable future and
contemplates the realization of assets and the settlement of
liabilities in the normal course of business.
We are in the clinical stage and have not generated any revenues
to-date. For the year ended June 30, 2022, we reported a loss of
approximately $22.7 million and a negative cash flow from
operations of approximately $20.4 million. We had an accumulated
deficit
31
of approximately $136.4 million and had cash and cash equivalents
of approximately $11.8 million as of June 30, 2022. We do not have
the prospect of achieving revenues until such time that our product
candidates are commercialized, or partnered, which may not ever
occur. In the near future, we will require additional funding to
maintain our clinical studies, research and development projects,
and for general operations. These circumstances indicate
substantial doubt exists about our ability to continue as a going
concern within one year from the date of filing of the consolidated
financial statements.
Despite the completion of two registered direct financings during
the year ended June 30, 2022 for aggregate net proceeds of
approximately $21.6 million, we will need additional financing to
complete all of our planned operations. Consequently, management is
pursuing various financing alternatives to fund our operations so
we can continue as a going concern. On August 2, 2022 we entered
into a stock purchase agreement with Lincoln Park (the "Purchase
Agreement"), pursuant to which Lincoln Park has committed to
purchase up to $20.0 million of our shares of common stock, subject
to certain limitations. However, due to the uncertainty of the
timing and amount of cash available under the Purchase Agreement,
the Purchase Agreement does not alleviate our going concern. In
addition, the coronavirus (“COVID-19”) pandemic has created
significant economic uncertainty and volatility in the credit and
capital markets. Management plans to secure the necessary financing
through the issue of new equity and/or the entering into of
strategic partnership arrangements but the ultimate impact of the
COVID-19 pandemic on our ability to raise additional capital is
unknown and will depend on future developments, which are highly
uncertain and cannot be predicted with confidence, including the
duration of the COVID-19 outbreak and any new information which may
emerge concerning the severity of the COVID-19 pandemic. We may not
be able to raise sufficient additional capital and may tailor our
drug candidates development programs based on the amount of funding
we are able to raise in the future. Nevertheless, there is no
assurance that these initiatives will be successful.
The financial statements do not give effect to any adjustments to
the amounts and classification of assets and liabilities that may
be necessary should we be unable to continue as a going concern.
Such adjustments could be material.
We are a clinical stage company, have a history of operating
losses, and expect to incur significant additional operating
losses.
We are a clinical stage company
with a history of operating losses. For the fiscal years ended June
30, 2022 and 2021, we had net losses of approximately $22.7 million
and $38.3 million, respectively and an accumulated deficit of
approximately $136.4 million at June 30, 2022. Our prospects must
be considered in light of the uncertainties, risks, expenses, and
difficulties frequently encountered by companies in similar stages
of operations. We expect to incur substantial additional net
expenses and losses over the next several years as our research,
development, clinical studies, and commercial activities
increase.
The amount of future losses and when, if ever, we will achieve
profitability are uncertain. Our ability to generate revenue and
achieve profitability will depend on, among other things,
successful completion of the preclinical and clinical development
of our product candidates; obtaining necessary regulatory approvals
from the FDA and international regulatory agencies; successful
manufacturing, sales and marketing arrangements; and raising
sufficient funds to finance our activities. If we are unsuccessful
at some or all of these undertakings, our business, prospects and
results of operations may be materially adversely
affected.
We will need to raise additional capital, which may cause dilution
to our stockholders, restrict our operations or require us to
relinquish rights to technologies or product candidates.
Until such time, if ever, as we can generate substantial product
revenues, we expect to finance our cash needs through a combination
of public or private equity offerings, debt financings and/or
license and development agreements with collaboration partners. As
of June 30, 2022, we had cash and cash equivalents of approximately
$11.8 million. We expect the cash available at June 30, 2022, and
the potential cash received from the sale of shares under our
Purchase Agreement with Lincoln Park, to fund our planned
operations for less than one year from the date of filing this
report on Form 10-K. We will need to raise additional capital to
fund our planned operations. While we have a Purchase Agreement
with Lincoln Park, potential funds available under that agreement
are not certain as to amount or timing and as a result, we do not
have any committed external source of funds.
To the extent that we raise additional capital through sales of our
common stock under our Lincoln Park agreement or through the sale
of other equity or convertible debt securities, then-existing
stockholders’ interests may be materially diluted, and the terms of
such securities could include liquidation or other preferences that
adversely affect their rights as common stockholders. Debt
financing and preferred equity financing, if available, may involve
agreements that include restrictive covenants that limit our
ability to take specified actions, such as incurring additional
debt, making capital expenditures or declaring dividends. In
addition, debt financing would result in fixed payment
obligations.
If we raise funds through collaborations, strategic partnerships or
marketing, distribution or licensing arrangements with third
parties, we may have to relinquish valuable rights to our
technologies, future revenue streams, research programs or product
candidates or grant licenses on terms that may not be favorable to
us. If we are unable to raise additional funds through equity or
debt financings when needed, we may be required to delay, limit,
reduce or terminate our product development or future
commercialization efforts or grant rights to develop and market
product candidates that we would otherwise prefer to develop and
market ourselves
32
Our inability to obtain additional financing could adversely affect
our ability to meet our obligations under our planned clinical
studies and could negatively impact the timing of our clinical
results.
Our ability to meet our obligations and continue the research and
development of our product candidates is dependent on our ability
to continue to raise adequate financing. We may not be successful
in obtaining such additional financing in the amount required at
any time, or for any period, or, if available, that it can be
obtained on terms satisfactory to us. In the event that we are
unable to obtain such additional financing, we may be unable to
meet our obligations under our planned clinical studies and we may
have to tailor the drug development programs for our drug
candidates based on the amount of funding we raise which could
negatively impact the timing of our clinical results. In addition,
we could be required to cease our operations.
We face significant risks related to the COVID-19 pandemic, or the
widespread outbreak of any other communicable disease, which could
have material and adverse impacts on our business, financial
condition, liquidity and results of operations.
In December 2019 a novel strain of coronavirus, COVID-19 was
reported to have surfaced in Wuhan, China and on March 11, 2020, it
was declared a pandemic by the World Health Organization. The
ultimate impact of the COVID-19 pandemic on our operations is
unknown and will depend on future developments, which are highly
uncertain and cannot be predicted with confidence, including the
duration of the COVID-19 outbreak, new information which may emerge
concerning the duration and severity of the COVID-19 pandemic, and
any additional preventative and protective actions that
governments, or us, may determine are needed.
The COVID-19 pandemic did not cause significant disruption to our
Phase 2 clinical studies. Each of our now-completed Phase 2
clinical studies was conducted at respective single sites which
reduced the risk of study disruption. Any disruptions to patient
treatments for our Phase 2 studies were within allowances under
each study protocol. Access to the sites by our clinical monitors
was limited during the COVID-19 pandemic but the recording of study
data in both studies and patient treatments at both study sites was
conducted per protocol.
Regarding the VAL-083 study arm of the GBM AGILE Study that is
currently being conducted at multiple sites in the United States,
Canada, and Europe, we have not experienced any significant impacts
on patient enrollment or treatment. With respect to the REM-001
drug supply, we are currently experiencing some delays in contract
manufacturing schedules and supplies which we attribute to
COVID-19. The current delays could have an impact on our REM-001
program timeline.
Changes in circumstances surrounding COVID-19, such as additional
travel limitations imposed by governmental authorities could result
in new patients being unable to be enrolled in our studies, or
existing patients being unable to continue to receive treatment,
could impact the cost of our studies as we may have to enroll
additional patients in order to obtain the data necessary to be
able to conclude our studies. We cannot predict whether any of our
clinical testing sites will withdraw from participation in any of
our studies temporarily, or permanently. In addition, even if we
are able to fully enroll and treat all patients in our studies,
obtaining full data could be impacted by an inability to ship and
analyze samples, or otherwise complete data assessment. Further, if
the patients enrolled in our clinical studies become infected with
COVID-19, we may have more adverse events and deaths in our
clinical studies as a result. We may also face difficulties
enrolling patients in our clinical studies if the patient
populations that are eligible for our clinical studies are impacted
by the coronavirus disease. Vulnerable patients, such as the cancer
patients enrolled in our clinical studies, may be at a higher risk
of contracting COVID-19 and may experience more severe symptoms
from the disease, adversely affecting our chances for regulatory
approval, or requiring further clinical studies. The continued
spread of COVID-19 globally, and the resulting travel restrictions
in place by governments to help stop the spread of COVID-19, could
adversely impact our clinical study operations, including the
ability of our principal investigators and site staff to travel to
our clinical study sites, and our ability to recruit and retain
principal investigators and site staff who, as healthcare
providers, may have heightened exposure to COVID-19 if an outbreak
occurs in their geography.
In addition, the continued impact resulting from the COVID-19
outbreak in areas where we have manufacturing operations for our
clinical drug supply, or where our suppliers or distributors
operate, or if the COVID-19 outbreak in these areas were to
increase in severity, and the measures taken by the governments of
countries affected, could adversely affect our business, financial
condition, or results of operations by limiting our ability to
manufacture or ship materials, or by forcing temporary closure of
facilities that it relies upon.
The spread of COVID-19, which has caused a broad impact globally,
may materially affect us economically. While the potential economic
impact brought by, and the duration of, COVID-19 may be difficult
to assess or predict, a widespread pandemic could result in
significant disruption of global financial markets, reducing our
ability to access capital, which could in the future negatively
affect our liquidity. In addition, a recession or market correction
resulting from the spread of COVID-19 could materially affect
ongoing business and the value of our common stock.
33
While our common stock is expected to continue listing on The
Nasdaq Capital Market LLC, there is no guarantee as to how long
such listing will be maintained.
Our common stock is listed for trading on The Nasdaq Capital Market
LLC. We must satisfy Nasdaq’s continued listing requirements,
including, among other things, a minimum closing bid price
requirement of $1.00 per share for 30 consecutive business days. If
a company’s common stock trades for 30 consecutive business days
below the $1.00 minimum closing bid price requirement, Nasdaq will
send a deficiency notice, advising that such company has been
afforded a “compliance period” of 180 calendar days to regain
compliance with the applicable requirements. Thereafter, if such a
company does not regain compliance with the bid price requirement,
a second 180-day compliance period may be available, provided (i)
it meets the continued listing requirement for market value of
publicly held shares and all other applicable requirements for
initial listing on Nasdaq, including stockholder equity
requirements, which we may be unable to satisfy (except for the bid
price requirement), and (ii) it provides written notice to Nasdaq
of its intention to cure this deficiency during the second
compliance period by effecting a reverse stock split, if necessary.
In the event the company does not regain compliance with Rule
5550(a)(2) prior to the expiration of the initial 180 calendar day
period, and if it appears to the Staff of the Listing
Qualifications Department of The Nasdaq Stock Market LLC (the
“Nasdaq Staff”) that the company will not be able to cure the
deficiency, or if the company is not otherwise eligible, the Nasdaq
Staff will provide the company with written notification that its
securities are subject to delisting from Nasdaq. At that time, the
company may appeal the delisting determination to a Hearings
Panel.
On December 3, 2021, we received a letter from the Nasdaq Staff
indicating that, based upon the closing bid price of our common
stock for the prior 30 consecutive business days, we were not in
compliance with the requirement to maintain a minimum bid price of
$1.00 per share for continued listing on Nasdaq, as set forth in
Nasdaq Listing Rule 5550(a)(2) (the “Minimum Bid Price
Requirement”). In accordance with Nasdaq Listing Rule
5810(c)(3)(A), we were provided a grace period of 180 days, or
until June 1, 2022, to regain compliance with the Minimum Bid Price
Requirement.
On May 17, 2022, we submitted a request to Nasdaq for an additional
180-day extension to regain compliance with the Minimum Bid Price
Requirement. On June 2, 2022, we received a letter from Nasdaq
advising that we had been granted a 180-day extension to November
28, 2022, to regain compliance with the Minimum Bid Price
Requirement, in accordance with Nasdaq Listing Rule
5810(c)(3)(A).
We will continue to monitor the closing bid price of our common
stock and may, if appropriate, consider implementing available
options, including but not limited to, implementing a reverse stock
split of our outstanding securities, to regain compliance with the
Minimum Bid Price Requirement. If we do not regain compliance
within the allotted compliance period, Nasdaq will provide notice
that our common stock will be subject to delisting. We would then
be entitled to appeal that determination to a Nasdaq hearings
panel. There can be no assurance that we will regain compliance
with the Minimum Bid Price Requirement during this 180-day
extension.
If we fail to meet any of the other continued listing requirements,
including stockholder equity requirements, our securities may be
delisted from The Nasdaq Capital Market LLC and trade on the OTC
Markets Group Inc. or other small trading markets, which could
reduce the liquidity of our common stock materially and result in a
corresponding material reduction in the price of our common stock.
In addition, delisting could harm our ability to raise
capital through alternative financing sources on terms acceptable
to us, or at all, and may result in the potential loss of
confidence by investors, employees and business development
opportunities. Such a delisting likely would impair your ability to
sell or purchase our common stock when you wish to do so. Further,
if we were to be delisted from Nasdaq, our common stock may no
longer be recognized as a “covered security” and we would be
subject to regulation in each state in which it offers securities.
Thus, delisting from Nasdaq could adversely affect our ability to
raise additional financing through the public or private sale of
equity securities, would significantly impact the ability of
investors to trade our securities and would negatively impact the
value and liquidity of our common stock.
The Series C Preferred Stock has rights, preferences and privileges
that will not be held by, and will be preferential to, the rights
of holders of our common stock, which could adversely affect the
liquidity and financial condition of the Company, and may result in
the interests of the holders of Series C Preferred Stock differing
from those of the holders of our common stock.
The Series C Preferred Stock ranks on parity with the shares of our
Series A Preferred Stock with respect to liquidation preferences.
Upon any dissolution, liquidation or winding up, whether voluntary
or involuntary, holders of Series C Preferred Stock will be
entitled to receive distributions out of our assets in an amount
per share equal to $1,000 plus all accrued and unpaid dividends,
whether capital or surplus before any distributions shall be made
on any shares of our common stock.
In addition, holders of Series C Preferred Stock will be entitled
to dividends, payable in shares of our common stock at a rate of
10%, 15%, 20% and 25% of the number of shares of common stock
issuable upon conversion of the Series C Preferred Stock, on the
12th,
24th,
36th
and 48th
month, anniversary of the initial closing of the Private Placement,
which occurred on August 19, 2020.
34
Dividends will be payable in shares of our common stock and will
only be payable to those holders that continue to hold Series C
Preferred Stock on the respective anniversary dates of August 19,
2020.
These dividend obligations to the holders of Series C Preferred
Stock could limit our ability to obtain additional financing, which
could have an adverse effect on our financial condition. The
preferential rights described above could also result in divergent
interests between the holders of shares of Series C Preferred Stock
and the holders of our common stock.
Any issuance of our common stock upon conversion of the Series C
Preferred Stock will cause dilution to our then existing
stockholders and may depress the market price of our common
stock.
The Series C Preferred Stock accrues dividends in shares of our
common stock at an initial rate of 10% per annum and following the
forty-eight-month anniversary of the initial closing of the Private
Placement which occurred on August 19, 2020, such dividend rate
will increase to 25% per annum. Each class of Series C Preferred
Stock has a Conversion Price that will be equal to the lesser of
(i) the closing price of our common stock on Nasdaq on the date
immediately preceding the signing of the applicable binding
agreements for the applicable closing date of the Private Placement
for which the Series C Preferred Stock is issued or (ii) the
average closing price of the our common stock on Nasdaq for the
five trading days immediately preceding the signing of the
applicable binding agreements for the applicable closing date of
the Private Placement for which the Series C Preferred Stock is
issued, subject to adjustment. The Conversion Prices for the Series
C-1 Preferred Stock, Series C-2 Preferred Stock and Series C-3
Preferred Stock are $1.16, $1.214 and $1.15,
respectively.
The issuance of our common stock upon conversion of the Series C
Preferred Stock and as payment of dividends on the Series C
Preferred Stock will result in immediate and substantial dilution
to the interests of holders of our common stock, and such dilution
will increase over time in connection with the accrual of dividends
on the Series C Preferred Stock.
We may incur future indebtedness that will rank senior to the
Series C Preferred Stock or issue additional series of preferred
stock that rank on a parity with, or senior to, the Series C
Preferred Stock as to dividend payments and liquidation
preference.
We may incur substantial amounts of additional debt and other
obligations that will rank senior to the Series C Preferred Stock,
and the terms of the Series C Preferred Stock do not limit the
amount of such debt or other obligations that we may incur. The
terms of the Series C Preferred Stock will not prohibit us from
issuing additional series of preferred stock that would rank on
parity with the Series C Preferred Stock. The Articles allow for
the board of directors to create new series of preferred stock
without further approval by its stockholders, which could adversely
affect the rights of the holders of the Series C Preferred Stock
and common stock. The issuances of other series of preferred stock
could have the effect of reducing the amounts available to the
Series C Preferred Stock in the event of liquidation. If we issue
preferred stock with voting rights that dilute the voting power of
our common stock, the market price of our common stock could
decrease, adversely affecting the value of the Series C Preferred
Stock. Additional issuances and sales of preferred stock, or the
perception that such issuances and sales could occur, may cause
prevailing market prices for our common stock to decline and may
adversely affect our ability to raise additional capital in the
financial markets at times and prices favorable to it.
If we are unable to effectively maintain a system of internal
control over financial reporting, we may not be able to accurately
or timely report our financial results and our stock price could be
adversely affected.
Section 404 of the Sarbanes-Oxley Act of 2002 and related
regulations require us to evaluate the effectiveness of our
internal control over financial reporting as of the end of each
fiscal year, and to include a management report assessing the
effectiveness of our internal control over financial reporting in
our Annual Report on Form 10-K for that fiscal year. Any failure to
implement new or improved controls, or difficulties encountered in
the implementation or operation of these controls, could harm our
operations, decrease the reliability of our financial reporting,
and cause us to fail to meet our financial reporting obligations,
which could adversely affect our business and reduce our stock
price.
We
are subject to state laws in California that require gender and
diversity quotas for boards of directors of public companies
headquartered in California.
In September 2018, California enacted SB 826, requiring public
companies headquartered in California to maintain minimum female
representation on their boards of directors as follows: by December
31, 2019, public company boards must have a minimum of one female
director; by December 31, 2021, public company boards with five
members will be required to have at least two female directors, and
public company boards with six or more members will be required to
have at least three female directors. On May 13, 2022, the Los
Angeles Superior Court declared SB 826 unconstitutional and,
although the California Secretary of State has directed counsel to
file an appeal of the decision, the State of California is
currently precluded from enforcing SB 826.
35
Additionally, on September 30, 2020, California enacted AB 979,
requiring public companies with principal executive offices in
California to each have at least one director from an
underrepresented community based on ethnicity and sexual
orientation by December 31, 2021. By December 31, 2022, each of
these companies will be required to have at least two directors
from such underrepresented communities if such company has more
than four but fewer than nine directors, or at least three
directors from underrepresented communities if the company has nine
or more directors. On April 1, 2022, the Los Angeles Superior Court
declared AB 979 unconstitutional and, although the California
Secretary of State has filed a notice of appeal in the case, the
State of California is currently precluded from enforcing AB
979.
If the State of California successfully appeals the court decisions
regarding SB 826 or AB 979, we cannot assure that we can recruit,
attract and/or retain qualified members of the board and continue
to meet gender and diversity quotas as required by California law
(provided that such laws are not repealed before the compliance
deadlines), which may cause certain investors to divert their
holdings in our securities and expose us to financial penalties
and/or reputational harm.
We are a clinical stage company and may never achieve
commercialization of our product candidates or
profitability.
We are a clinical stage of development and commercialization of our
technologies and product candidates. We have not yet begun to
market any products and, accordingly, have not begun or generate
revenues from the commercialization of our products. Our products
will require significant additional clinical testing and investment
prior to commercialization. A commitment of substantial resources
by us and, potentially, our partners to conduct time-consuming
research and clinical studies will be required if we are to
complete the development of our product candidates. There can be no
assurance that our product candidates will meet applicable
regulatory standards, obtain required regulatory approvals, be
capable of being produced in commercial quantities at reasonable
costs or be successfully marketed. Our product candidates are not
expected to be commercially available for several years, if at
all.
We are currently focused on the development of two product
candidates.
Our product development efforts are currently focused on two
product candidates: VAL-083 for GBM and REM-001 for CMBC. If either
VAL-083 or REM-001 fail to achieve clinical endpoints or exhibit
unanticipated toxicity or if a superior product is developed by a
competitor, our prospects for obtaining regulatory approval and
commercialization for either candidate may be negatively impacted.
In the long-term, we hope to establish a pipeline of multiple
product candidates. However, at this time we do not have any formal
agreements granting us any rights to such additional product
candidates.
Even if we are able to commercialize any product candidate that we
develop, the product may become subject to unfavorable pricing
regulations, third-party payor reimbursement practices or
healthcare reform initiatives that could harm our
business.
The commercial success of our current or future product candidates
will depend substantially, both domestically and abroad, on the
extent to which the costs of our product candidates will be paid by
health maintenance, managed care, pharmacy benefit and similar
healthcare management organizations, or reimbursed by government
health administration authorities (such as Medicare and Medicaid),
private health coverage insurers and other third-party payors. If
reimbursement is not available, or is available only to limited
levels, we may not be able to successfully commercialize our
products. Even if coverage is provided, the approved reimbursement
amount may not be high enough to allow us to establish and maintain
pricing sufficient to realize a meaningful return on our
investment.
There is significant uncertainty related to third-party payor
coverage and reimbursement of newly approved drugs. Marketing
approvals, pricing and reimbursement for new drug products vary
widely from country to country. Some countries require approval of
the sale price of a drug before it can be marketed. In many
countries, the pricing review period begins after marketing or
product licensing approval is granted. In some non-U.S. markets,
prescription pharmaceutical pricing remains subject to continuing
governmental control even after initial approval is granted. As a
result, we might obtain marketing approval for a product in a
particular country, but then be subject to price regulations that
delay commercial launch of the product, possibly for lengthy time
periods, which may negatively impact the revenues we are able to
generate from the sale of the product in that country. Adverse
pricing limitations may hinder our ability to recoup our investment
in one or more product candidates, even if our product candidates
obtain marketing approval.
Our ability to commercialize VAL-083, REM-001, or any other product
candidates will depend in part on the extent to which coverage and
reimbursement for these products and related treatments will be
available from government health administration authorities,
private health insurers and other organizations. Government
authorities and third-party payors, such as private health insurers
and health maintenance organizations, decide which medications they
will cover and establish reimbursement levels. The healthcare
industry is acutely focused on cost containment, both in the United
States and elsewhere. Government authorities and third-party payors
have attempted to control costs by limiting coverage and the amount
of reimbursement for particular medications, which could affect our
ability to sell our product candidates profitably. These payors may
not view our products, if any, as cost-effective, and coverage and
reimbursement may not be available to our customers, or may not be
sufficient to allow our products, if any, to be
36
marketed on a competitive basis. Cost-control initiatives could
cause us to decrease the price we might establish for products,
which could result in lower than anticipated product revenues. If
the prices for our products, if any, decrease or if governmental
and other third-party payors do not provide adequate coverage or
reimbursement, our prospects for revenue and profitability will
suffer.
There may also be delays in obtaining coverage and reimbursement
for newly approved drugs, and coverage may be more limited than the
indications for which the drug is approved by the FDA or comparable
non- U.S. regulatory authorities. Moreover, eligibility for
reimbursement does not imply that any drug will be paid for in all
cases or at a rate that covers our costs, including research,
development, manufacture, sale and distribution. Reimbursement
rates may vary, by way of example, according to the use of the drug
and the clinical setting in which it is used. Reimbursement rates
may also be based on reimbursement levels already set for lower
cost drugs or may be incorporated into existing payments for other
services.
In addition, increasingly, third-party payors are requiring higher
levels of evidence of the benefits and clinical outcomes of new
technologies and are challenging the prices charged. We cannot be
sure that coverage will be available for any product candidate that
we, or third-parties, commercialize and, if available, that the
reimbursement rates will be adequate. Further, the net
reimbursement for drug products may be subject to additional
reductions if there are changes to laws that presently restrict
imports of drugs from countries where they may be sold at lower
prices than in the United States. An inability to promptly obtain
coverage and adequate payment rates from both government-funded and
private payors for any of our product candidates for which we
obtain marketing approval could have a material adverse effect on
our operating results, our ability to raise capital needed to
commercialize products and our overall financial
condition.
Pursuant to the terms of our Series B Preferred Stock that has now
been fully converted to common stock, the Valent Technologies, LLC
(“Valent”) Patent Assignment Agreement, and the St. Cloud Agreement
we may be required to pay royalties.
Pursuant to the terms of the Valent Patent Assignment Agreement, as
amended, and our Series B Preferred Stock Certificate of
Designation and the related Series B Preferred Royalty Agreement,
we will be required to pay royalties if we receive revenue from
product sales or from the partnering of VAL-083. If we obtain FDA,
EMA, or other regulatory approvals of VAL-083, and/or if we
generate sales of VAL-083, or we receive any proceeds from the
licensing or other disposition of VAL-083, we are required to pay
to the former holders of our Series B Preferred Stock, a
single-digit royalty. In addition, we are required to pay a future
royalty on all revenues derived from the development and
commercialization of VAL-083 to Valent. The royalty payment rights
will expire when the patents covering the applicable product
expire.
Also, under our St. Cloud agreement, we must pay to St. Cloud and
Steven Rychnovsky, PhD, in the aggregate, a royalty fee of six
percent (6%) of net sales during the royalty term on a
country-by-country and product-by-product basis with St. Cloud
receiving a royalty rate of four and eight tenths percent (4.8%)
and Steven Rychnovsky, PhD, receiving a royalty of one and two
tenths percent (1.2%). The royalty term for a product commences on
the first commercial sale of the product, such as REM-001 Therapy,
in any country, and the royalty fee must be paid within 30 days of
each calendar quarter during which revenue is collected. The
royalty term terminates on the later of (i) the invalidation,
revocation, lapse or expiration of the last to expire valid claim
on any patent acquired in the St. Cloud Agreement that would be
infringed by the sale of the product in the country where the
commercial sale takes place or (ii) the expiration of the period
for which we hold exclusive marketing rights of the product in the
country, if we are granted those rights under the St. Cloud
Agreement.
We are dependent on obtaining certain patents and protecting our
proprietary rights.
Our success will depend, in part, on our ability to obtain patents,
maintain trade secret protection and operate without infringing on
the proprietary rights of third parties or having third parties
circumvent our rights. We have filed and are actively pursuing
patent applications for our products. The patent positions of
biotechnology, biopharmaceutical and pharmaceutical companies can
be highly uncertain and involve complex legal and factual
questions. Thus, there can be no assurance that any of our patent
applications will result in the issuance of patents, that we will
develop additional proprietary products that are patentable, that
any patents issued to us or those that already have been issued
will provide us with any competitive advantages or will not be
challenged by any third parties, that the patents of others will
not impede our ability to do business or that third parties will
not be able to circumvent our patents. Furthermore, there can be no
assurance that others will not independently develop similar
products, duplicate any of our products not under patent
protection, or, if patents are issued to us, design around the
patented products we developed or will develop.
We may be required to obtain licenses from third parties to avoid
infringing patents or other proprietary rights. No assurance can be
given that any licenses required under any such patents or
proprietary rights would be made available, if at all, on terms we
find acceptable. If we do not obtain such licenses, we could
encounter delays in the introduction of products or could find that
the development, manufacture or sale of products requiring such
licenses could be prohibited.
37
A number of pharmaceutical, biopharmaceutical and biotechnology
companies and research and academic institutions have developed
technologies, filed patent applications or received patents on
various technologies that may be related to or affect our business.
Some of these technologies, applications or patents may conflict
with our technologies or patent applications. Such conflict could
limit the scope of the patents, if any, that we may be able to
obtain or result in the denial of our patent applications. In
addition, if patents that cover our activities are issued to other
companies, there can be no assurance that we would be able to
obtain licenses to these patents at a reasonable cost or be able to
develop or obtain alternative technology. If we do not obtain such
licenses, we could encounter delays in the introduction of
products, or could find that the development, manufacture or sale
of products requiring such licenses could be prohibited. In
addition, we could incur substantial costs in defending ourselves
in suits brought against us on patents it might infringe or in
filing suits against others to have such patents declared
invalid.
Patent applications in the U.S. are maintained in secrecy and not
published if either: (i) the application is a provisional
application or (ii) the application is filed and we request no
publication, and certify that the invention disclosed “has not and
will not” be the subject of a published foreign application.
Otherwise, U.S. applications or foreign counterparts, if any,
publish 18 months after the priority application has been filed.
Since publication of discoveries in the scientific or patent
literature often lag behind actual discoveries, we cannot be
certain that we or any licensor were the first creator of
inventions covered by pending patent applications or that we or
such licensor was the first to file patent applications for such
inventions. Moreover, we might have to participate in interference
proceedings declared by the U.S. Patent and Trademark Office (the
“USPTO”) to determine priority of invention, which could result in
substantial cost to us, even if the eventual outcome were favorable
to us. There can be no assurance that our patents, if issued, would
be held valid or enforceable by a court or that a competitor’s
technology or product would be found to infringe such
patents.
Moreover, we may be subject to third-party preissuance submissions
of prior art to the USPTO, or become involved in opposition,
derivation, reexamination,
inter partes
review, post-grant review or interference proceedings challenging
our patent rights or the patent rights of others. An adverse
determination in any such submission, proceeding or litigation
could reduce the scope of, or invalidate, our patent rights, allow
third parties to commercialize our technology or products and
compete directly with us, without payment to us, or result in our
inability to manufacture or commercialize products without
infringing third-party patent rights.
Even if our patent applications issue as patents, they may not
issue in a form that will provide us with any meaningful
protection, prevent competitors from competing with us, or
otherwise provide us with any competitive advantage. Our
competitors may be able to circumvent our patents by developing
similar or alternative technologies or products in a non-infringing
manner.
The issuance of a patent is not conclusive as to its inventorship,
scope, validity or enforceability, and our patents may be
challenged in courts or patent offices in the United States and
abroad. Such challenges may result in loss of exclusivity or
freedom to operate, or in patent claims being narrowed, invalidated
or held unenforceable, in whole or in part, which could limit our
ability to stop others from using or commercializing similar or
identical technology and products, or limit the duration of the
patent protection of our technology and products. Given the amount
of time required for the development, testing and regulatory review
of new product candidates, patents protecting such candidates might
expire before or shortly after such candidates are commercialized.
As a result, our owned and licensed patent portfolio may not
provide us with sufficient rights to exclude others from
commercializing products similar or identical to ours.
In addition, the protection of intellectual property rights in
China (where one of our clinical product candidates, VAL-083, is
manufactured pursuant to a collaboration agreement with the only
manufacturer presently licensed by the CFDA to manufacture VAL-083
for the China market, and where VAL-083 is approved for the
treatment of CML and lung cancer) is relatively weak compared to
the United States, which may negatively affect our ability to
generate royalty revenue from sales of VAL-083 in China.
Much of our know-how and technology may not be patentable. To
protect our rights, we require employees, consultants, advisors and
collaborators to enter into confidentiality agreements. There can
be no assurance, however, that these agreements will provide
meaningful protection for our trade secrets, know-how or other
proprietary information in the event of any unauthorized use or
disclosure. Further, our business may be adversely affected by
competitors who independently develop competing technologies,
especially if we obtain no, or only narrow, patent
protection.
We do not hold any patents covering our laser light source or light
delivery device for REM-001.
Our laser light source and light delivery device are not currently
covered by any patents; We do not have any patents pending, and do
not currently intend to seek patent protection for these devices.
As a result, competitors may be able to offer and sell products or
drug delivery technology, as the case may be, using the same
technology as our laser light source and/or light delivery devices,
so long as these competitors do not infringe any other valid
patents that it or third-parties hold.
38
While we plan to protect our proprietary information related to our
laser light source and light delivery device as trade secrets
through certain agreements with our employees, consultants, agents
and other organizations to which we have disclosed our proprietary
information, we cannot give any assurance that these agreements
will provide effective protection for our proprietary information
in the event of unauthorized use or disclosure of such information.
If other laser light sources or light delivery devices are approved
and marketed, we will be unable to prevent them from competing with
REM-001 Therapy in the marketplace using a different drug molecule
that is not encompassed by any of our owned or licensed patents. We
expect that the presence of one or more competing products would
reduce our market share and could negatively impact price levels
and third-party reimbursement policies for REM-001 Therapy, any of
which would materially affect our business.
We may be unable to protect our patents and proprietary
rights.
Our future success will depend to a significant extent on our
ability to:
•
obtain and keep patent protection for our products and technologies
on an international basis;
•
enforce our patents to prevent others from using our
inventions;
•
maintain and prevent others from using our trade secrets;
and
•
operate and commercialize products without infringing on the
patents or proprietary rights of others.
We can provide no assurance that our patent rights will afford any
competitive advantages and these rights may be challenged or
circumvented by third parties. Further, patents may not be issued
on any of our pending patent applications in the U.S. or abroad.
Because of the extensive time required for development, testing and
regulatory review of a product candidate, it is possible that
before a product candidate can be commercialized, any related
patent may expire, or remain in existence for only a short period
following commercialization, reducing or eliminating any advantage
of the patent.
If we sue others for infringing on our patents, a court may
determine that such patents are invalid or unenforceable. Even if
the validity of our patent rights is upheld by a court, a court may
not prevent the alleged infringement of our patent rights on the
grounds that such activity is not covered by our patent
claims.
In addition, third parties may sue us for infringing on their
patents. In the event of a successful claim of infringement against
us, we may be required to:
•
defend litigation or administrative proceedings;
•
pay substantial damages;
•
stop using our technologies and methods;
•
stop certain research and development efforts;
•
develop non-infringing products or methods; and
•
obtain one or more licenses from third parties.
If required, we can provide no assurance that we will be able to
obtain such licenses on acceptable terms, or at all. If we are sued
for infringement, we could encounter substantial delays in
development, manufacture and commercialization of our product
candidates. Any litigation, whether to enforce our patent rights or
to defend against allegations that we infringed third-party rights,
will be costly, time consuming, and may distract management from
other important tasks.
As is commonplace in the biotechnology and pharmaceutical industry,
we employ individuals who were previously employed at other
biotechnology or pharmaceutical companies, including our
competitors or potential competitors. To the extent our employees
are involved in research areas which are similar to those areas in
which they were involved at their former employers, we may be
subject to claims that such employees and/or we have inadvertently
or otherwise used or disclosed the alleged trade secrets or other
proprietary information of the former employers. Litigation may be
necessary to defend against such claims, which could result in
substantial costs and be a distraction to management and which may
have a material adverse effect on us, even if we are successful in
defending such claims.
39
We are subject to various government regulations.
The manufacture and sale of human therapeutic and diagnostic
products in the U.S., Canada and foreign jurisdictions are governed
by a variety of statutes and regulations. These laws require
approval of manufacturing facilities, controlled research and
testing of products and government review and approval of a
submission containing manufacturing, preclinical and clinical data
in order to obtain marketing approval based on establishing the
safety and efficacy of the product for each use sought, including
adherence to current cGMP during production and storage, and
control of marketing activities, including advertising and
labeling.
VAL-083, REM-001 and any other products we may develop will require
significant development, preclinical and clinical testing and
investment of substantial funds prior to its commercialization. The
process of obtaining required approvals can be costly and
time-consuming, and there can be no assurance that we will
successfully develop any future products that will prove to be safe
and effective in clinical studies or receive applicable regulatory
approvals. Markets other than the U.S. and Canada have similar
restrictions. Potential investors and shareholders should be aware
of the risks, problems, delays, expenses and difficulties which we
may encounter in view of the extensive regulatory environment which
controls our business.
We may request priority review for our product candidates in the
future. The FDA may not grant priority review for our product
candidates. Moreover, even if the FDA designated such product for
priority review, that designation may not lead to a faster
regulatory review or approval process and, in any event, would not
assure FDA approval.
We may be eligible for priority review designation for our product
candidates if the FDA determines such product candidate offers
major advances in treatment or provides a treatment where no
adequate therapy exists. A priority review designation means that
the goal for the FDA to review an application is six months, rather
than the standard review period of ten months. The FDA has broad
discretion with respect to whether or not to grant priority review
status to a product candidate, so even if we believe a particular
product candidate is eligible for such designation or status, the
FDA may decide not to grant it. Thus, while the FDA has granted
priority review to other oncology disease products, our product
candidates, should we determine to seek priority review, may not
receive similar designation. Moreover, even if our product
candidate is designated for priority review, such a designation
does not necessarily mean a faster regulatory review process or
necessarily confer any advantage with respect to approval compared
to conventional FDA procedures. Receiving priority review from the
FDA does not guarantee approval within an accelerated timeline or
thereafter.
We believe we may in some instances be able to secure approval from
the FDA or comparable non-U.S. regulatory authorities to use
accelerated development pathways. If we are unable to obtain such
approval, we may be required to conduct additional preclinical
studies or clinical studies beyond those that it contemplates,
which could increase the expense of obtaining, and delay the
receipt of, necessary marketing approvals.
We anticipate that we may seek an accelerated approval pathway for
our product candidates. Under the accelerated approval provisions
in the Federal Food, Drug, and Cosmetic Act (“FDCA”), and the FDA’s
implementing regulations, the FDA may grant accelerated approval to
a product designed to treat a serious or life-threatening condition
that provides meaningful therapeutic benefit over available
therapies upon a determination that the product has an effect on a
surrogate endpoint or intermediate clinical endpoint that is
reasonably likely to predict clinical benefit. The FDA considers a
clinical benefit to be a positive therapeutic effect that is
clinically meaningful in the context of a given disease, such as
irreversible morbidity or mortality. For the purposes of
accelerated approval, a surrogate endpoint is a marker, such as a
laboratory measurement, radiographic image, physical sign, or other
measure that is thought to predict clinical benefit, but is not
itself a measure of clinical benefit. An intermediate clinical
endpoint is a clinical endpoint that can be measured earlier than
an effect on irreversible morbidity or mortality that is reasonably
likely to predict an effect on irreversible morbidity or mortality
or other clinical benefit. The accelerated approval pathway may be
used in cases in which the advantage of a new drug over available
therapy may not be a direct therapeutic advantage, but is a
clinically important improvement from a patient and public health
perspective. If granted, accelerated approval is usually contingent
on the sponsor’s agreement to conduct, in a diligent manner,
additional post-approval confirmatory studies to verify and
describe the drug’s clinical benefit. If such post-approval studies
fail to confirm the drug’s clinical benefit, the FDA may withdraw
its approval of the drug.
Prior to seeking such accelerated approval, we will seek feedback
from the FDA and will otherwise evaluate our ability to seek and
receive such accelerated approval. There can also be no assurance
that after our evaluation of the feedback and other factors we will
decide to pursue or submit an NDA, for accelerated approval or any
other form of expedited development, review or approval. Similarly,
there can be no assurance that after subsequent FDA feedback that
we will continue to pursue or apply for accelerated approval or any
other form of expedited development, review or approval, even if we
initially decide to do so. Furthermore, if we decide to submit an
application for accelerated approval or under another expedited
regulatory designation (e.g., breakthrough therapy designation),
there can be no assurance that such submission or application will
be accepted or that any expedited development, review or approval
will be granted on a timely basis, or at all. The FDA or other
non-U.S. authorities could also require us to conduct further
studies prior to considering our application or granting approval
of any type. A failure to obtain accelerated approval or
any
40
other form of expedited development, review or approval for any of
our product candidates that we decide to seek accelerated approval
for would result in a longer time period to commercialization of
such product candidate, could increase the cost of development of
such product candidate and could harm our competitive position in
the marketplace.
We have conducted, and may in the future conduct, clinical studies
for certain of our product candidates at sites outside the United
States, and the FDA may not accept data from studies conducted in
such locations.
We have conducted and may in the future choose to conduct one or
more of our clinical studies outside the United States. Although
the FDA may accept data from clinical studies conducted outside the
United States, acceptance of this data is subject to certain
conditions imposed by the FDA. For example, the clinical study must
be well designed and conducted and performed by qualified
investigators in accordance with ethical principles. The study
population must also adequately represent the U.S. population, and
the data must be applicable to the U.S. population and U.S. medical
practice in ways that the FDA deems clinically meaningful.
Generally, the patient population for any clinical studies
conducted outside of the United States must be representative of
the population for whom we intend to seek approval in the United
States. In addition, while these clinical studies are subject to
the applicable local laws, FDA acceptance of the data will be
dependent upon its determination that the studies also complied
with all applicable U.S. laws and regulations. There can be no
assurance that the FDA will accept data from studies conducted
outside of the United States. If the FDA does not accept the data
from any of our clinical studies that we determine to conduct
outside the United States, it would likely result in the need for
additional studies, which would be costly and time-consuming and
delay or permanently halt our development of the product
candidate.
In addition, the conduct of clinical studies outside the United
States could have a significant impact on us. The risks inherent in
conducting international clinical studies include:
•
foreign regulatory requirements that could restrict or limit our
ability to conduct our clinical studies;
•
administrative burdens of conducting clinical studies under
multiple foreign regulatory schema;
•
foreign exchange fluctuations; and
•
diminished protection of intellectual property in some
countries.
If our clinical studies fail to demonstrate safety and efficacy to
the satisfaction of the FDA and comparable non-U.S. regulators, we
may incur additional costs or experience delays in completing, or
ultimately be unable to complete, the development and
commercialization of our product candidates.
We are not permitted to commercialize, market, promote or sell any
product candidate in the United States without obtaining marketing
approval from the FDA. Comparable non-U.S. regulatory authorities,
such as the EMA, impose similar restrictions. We may never receive
such approvals. We must complete extensive preclinical development
and clinical studies to demonstrate the safety and efficacy of our
product candidates in humans before we will be able to obtain these
approvals.
Clinical testing is expensive, difficult to design and implement,
can take many years to complete and is inherently uncertain as to
outcome. We have not previously submitted an NDA to the FDA or
similar drug approval filings to comparable non-U.S. regulatory
authorities for any product candidate.
Any inability to successfully complete preclinical and clinical
development could result in additional costs to us and impair our
ability to generate revenues from product sales, regulatory and
commercialization milestones and royalties. In addition, if (1) we
are required to conduct additional clinical studies or other
testing of our product candidates beyond the studies and testing
that we contemplate, (2) we are unable to successfully complete
clinical studies of our product candidates or other testing, (3)
the results of these studies or tests are unfavorable, uncertain or
are only modestly favorable, or (4) there are unacceptable safety
concerns associated with our product candidate, we, in addition to
incurring additional costs, may:
•
be delayed in obtaining marketing approval for our product
candidates;
•
not obtain marketing approval at all;
•
obtain approval for indications or patient populations that are not
as broad as we intended or desired;
•
obtain approval with labeling that includes significant use or
distribution restrictions or significant safety warnings, including
boxed warnings;
•
be subject to additional post-marketing testing or other
requirements; or
•
be required to remove the product from the market after obtaining
marketing approval.
41
If we experience any of a number of possible unforeseen events in
connection with clinical studies of our product candidates,
potential marketing approval or commercialization of our product
candidates could be delayed or prevented.
We may experience numerous unforeseen events during, or as a result
of, clinical studies that could delay or prevent marketing approval
of our product candidates, including:
•
clinical studies of our product candidates may produce unfavorable
or inconclusive results;
•
we may decide, or regulators may require us, to conduct additional
clinical studies or abandon product development
programs;
•
the number of patients required for clinical studies of our product
candidates may be larger than we anticipate, patient enrollment in
these clinical studies may be slower than we anticipate or
participants may drop out of these clinical studies at a higher
rate than we anticipate;
•
data safety monitoring committees may recommend suspension,
termination or a clinical hold for various reasons, including
concerns about patient safety;
•
regulators or IRBs may suspend or terminate the study or impose a
clinical hold for various reasons, including noncompliance with
regulatory requirements or concerns about patient
safety;
•
patients with serious, life-threatening diseases included in our
clinical studies may die or suffer other adverse medical events for
reasons that may not be related to our product
candidates;
•
participating patients may be subject to unacceptable health
risks;
•
patients may not complete clinical studies due to safety issues,
side effects, or other reasons;
•
changes in regulatory requirements and guidance may occur, which
require us to amend clinical study protocols to reflect these
changes;
•
our third-party contractors, including those manufacturing our
product candidates or components or ingredients thereof or
conducting clinical studies on our behalf, may fail to comply with
regulatory requirements or meet their contractual obligations to us
in a timely manner or at all;
•
regulators or IRBs may not authorize us or our investigators to
commence a clinical study or conduct a clinical study at a
prospective study site;
•
we may experience delays in reaching or fail to reach agreement on
acceptable clinical study contracts or clinical study protocols
with prospective study sites;
•
patients who enroll in a clinical study may misrepresent their
eligibility to do so or may otherwise not comply with the clinical
study protocol, resulting in the need to drop the patients from the
clinical study, increase the needed enrollment size for the
clinical study or extend the clinical study’s
duration;
•
we may have to suspend or terminate clinical studies of our product
candidates for various reasons, including a finding that the
participants are being exposed to unacceptable health risks,
undesirable side effects or other unexpected characteristics of a
product candidate;
•
regulators or IRBs may require that we or our investigators suspend
or terminate clinical research for various reasons, including
noncompliance with regulatory requirements or their respective
standards of conduct, a finding that the participants are being
exposed to unacceptable health risks, undesirable side effects or
other unexpected characteristics of the product candidate or
findings of undesirable effects caused by a chemically or
mechanistically similar drug or drug candidate;
•
the FDA or comparable non-U.S. regulatory authorities may fail to
approve or subsequently find fault with the manufacturing processes
or facilities of third-party manufacturers with which we enter into
agreements for clinical and commercial supplies;
•
the FDA or comparable non-U.S. regulatory authorities may disagree
with our clinical study design or our interpretation of data from
preclinical studies and clinical studies;
•
the supply or quality of raw materials or manufactured product
candidate or other materials necessary to conduct clinical studies
of our product candidates may be insufficient, inadequate, delayed,
or not available at an acceptable cost, or we may experience
interruptions in supply; and
•
the approval policies or regulations of the FDA or comparable
non-U.S. regulatory authorities may significantly change in a
manner rendering our clinical data insufficient to obtain marketing
approval.
42
Product development costs for us will increase if we experience
delays in testing or pursuing marketing approvals and we may be
required to obtain additional funds to complete clinical studies
and prepare for possible commercialization of our product
candidates. We do not know whether any preclinical tests or
clinical studies will begin as planned, will need to be
restructured or will be completed on schedule, or at all.
Significant preclinical or clinical study delays also could shorten
any periods during which we may have the exclusive right to
commercialize our product candidates or allow our competitors to
bring products to market before we do and impair our ability to
successfully commercialize our product candidates and may harm our
business and results of operations. In addition, many of the
factors that cause, or lead to, clinical study delays may
ultimately lead to the denial of marketing approval of our product
candidates.
If we experience delays or difficulties in the enrollment of
patients in clinical studies, our product candidates may not
achieve clinical development on our anticipated timeline, or at
all, and our receipt of necessary regulatory approvals could be
delayed or prevented.
We may not be able to initiate or continue clinical studies for
VAL-083, REM-001 or any other product candidate if we are unable to
locate and enroll a sufficient number of eligible patients to
participate in clinical studies. Patient enrollment is a
significant factor in the timing of clinical studies, and is
affected by many factors, including:
•
the size and nature of the patient population;
•
the severity of the disease under investigation;
•
the proximity of patients to clinical sites;
•
the eligibility criteria for the study;
•
the design of the clinical study;
•
efforts to facilitate timely enrollment;
•
competing clinical studies; and
•
clinicians’ and patients’ perceptions as to the potential
advantages and risks of the drug being studied in relation to other
available therapies, including any new drugs that may be approved
for the indications we are investigating.
Our inability to enroll a sufficient number of patients for our
clinical studies could result in significant delays or may require
us to abandon one or more clinical studies altogether. Enrollment
delays in our clinical studies may result in increased development
costs for our product candidates, delay or halt the development of
and approval processes for our product candidates and jeopardize
our ability to achieve our clinical development timeline and goals,
including the dates by which we will commence, complete and receive
results from clinical studies. Enrollment delays may also delay or
jeopardize our ability to commence sales and generate revenues from
our product candidates. Any of the foregoing could cause our value
to decline and limit our ability to obtain additional financing, if
needed.
Positive results in previous clinical studies of VAL-083 and
REM-001 may not be replicated in future clinical studies, which
could result in development delays or a failure to obtain marketing
approval.
Positive results in previous clinical studies of VAL-083 and
REM-001 may not be predictive of similar results in future clinical
studies. Also, interim results during a clinical study do not
necessarily predict final results. A number of companies in the
pharmaceutical and biotechnology industries have suffered
significant setbacks in late-stage clinical studies even after
achieving promising results in early-stage development.
Accordingly, the results from the completed preclinical studies and
clinical studies for VAL-083 and REM-001 may not be predictive of
the results we may obtain in later stage studies. Our clinical
studies may produce negative or inconclusive results, and we may
decide, or regulators may require us, to conduct additional
clinical studies. Moreover, clinical data are often susceptible to
varying interpretations and analyses, and many companies that
believed their product candidates performed satisfactorily in
preclinical studies and clinical studies have nonetheless failed to
obtain FDA or EMA, or other regulatory agency, approval for their
products.
If we are required by the FDA to obtain approval of a companion
diagnostic test in connection with approval of VAL-083, and we do
not obtain, or face delays in obtaining such FDA approval, we may
not be able to commercialize VAL-083 and our ability to generate
revenue will be materially impaired.
If the FDA determines that a companion diagnostic device is
necessary to the safe and effective use of a novel therapeutic
product, the FDA will require that the companion diagnostic be
approved or cleared for that indication along with that
therapeutic
43
product. Companion diagnostics are developed in conjunction with
clinical programs for the associated therapeutic product candidate
and are subject to regulation as medical devices by the
FDA.
If the FDA requires a companion diagnostic for the safe and
effective use of VAL-083 in the MGMT unmethylated GBM population
and a satisfactory companion diagnostic is not approved and
commercially available, we may be required to create or obtain one
that would be subject to regulatory approval requirements. The
process of obtaining or creating such diagnostic is time consuming
and costly. Any delay or failure to develop or obtain regulatory
approval or clearance of a companion diagnostic could delay or
prevent approval or continued marketing of such drug product
candidate.
FDA approval of VAL-083, REM-001, or future product candidates may
be denied.
There can be no assurance that the FDA will ultimately approve our
NDAs. The FDA may deny approval of VAL-083 or REM-001 for many
reasons, including:
•
we may be unable to demonstrate to the satisfaction of the FDA that
our products are safe and effective for its intended
uses;
•
the FDA may disagree with our interpretation of data from the
clinical studies;
•
we may be unable to demonstrate that any clinical or other benefits
of our products outweigh any safety or other perceived risks;
or
•
we may not be able to successfully address any other issues raised
by the FDA.
If VAL-083 or REM-001 fail to receive FDA approval, our business
and prospects will be materially adversely impacted.
We expect to rely on orphan drug status to develop and
commercialize our product candidates, but our orphan drug
designations may not confer marketing exclusivity or other expected
commercial benefits as anticipated.
Market exclusivity afforded by orphan drug designation is generally
offered as an incentive to drug developers to invest in developing
and commercializing products for unique diseases that impact a
limited number of patients. The FDA may grant orphan drug
designation to drugs intended to treat a rare disease or condition,
which is generally a disease or condition that affects fewer than
200,000 individuals in the United States. Qualification to maintain
orphan drug status is generally monitored by the regulatory
authorities during the orphan drug exclusivity period, currently
seven years from the date of approval in the United
States.
For VAL-083, we have been granted orphan drug designation in the
United States for GBM, ovarian cancer, and medulloblastoma, and in
Europe for GBM. In addition, for REM-001 the FDA granted our
request that tin ethyl etiopurpurin (the active pharmaceutical
ingredient in REM-001) be designated as an orphan drug for
treatment of BCCNS. We also hold an orphan drug designation that
was initially awarded to Miravant for tin ethyl etiopurpurin for
the prevention of access graft disease in hemodialysis
patients.
We expect to rely on orphan drug exclusivity for our product
candidates. It is possible that the incidence and prevalence
numbers for GBM, CMBC, and access graft disease could change.
Should the incidence and prevalence of these diseases materially
increase, it is possible that the orphan drug designation, and
related market exclusivity, in the United States could be lost.
Further, while we have been granted these orphan designations, the
FDA can still approve different drugs for use in treating the same
indication or disease, which would create a more competitive market
for us and our revenues, if any, will be diminished.
Further, it is possible that another company also holding orphan
drug designation for the same product candidate will receive
marketing approval for the same indication before we do. If that
were to happen, our applications for that indication may not be
approved until the competing company’s period of exclusivity
expires. Even if we are the first to obtain marketing authorization
for an orphan drug indication, there are circumstances under which
a competing product may be approved for the same indication during
the seven-year period of marketing exclusivity, such as if the
later product is shown to be clinically superior to the orphan
product, or if the later product is deemed a different product than
ours. Further, the seven-year marketing exclusivity would not
prevent competitors from obtaining approval of the same product
candidate as ours for indications other than those in which we have
been granted orphan drug designation, or for the use of other types
of products in the same indications as our orphan
products.
44
If the market opportunities for our product candidates are smaller
than we believe they are, our future revenues may be adversely
affected and our business may suffer. Because the target patient
populations of our product candidates are small, we must be able to
successfully identify patients and capture a significant market
share to achieve and maintain profitability.
We focus our research and product development on treatments for
orphan cancer indications. Our projections of both the number of
people who have failed other therapies or have limited medical
options, are based on estimates. These estimates may prove to be
incorrect and new studies may change the estimated incidence or
prevalence. The number of patients in the United States, Europe and
elsewhere may turn out to be lower than expected or may not be
otherwise amenable to treatment with our products, or new patients
may become increasingly difficult to identify or gain access to,
all of which would adversely affect our results of operations and
our business. Additionally, because our target patient populations
are small, we will be required to capture a significant market
share to achieve and maintain profitability.
We may be required to suspend or discontinue clinical studies due
to unexpected side effects or other safety risks that could
preclude approval of our products.
Our clinical studies may be suspended at any time for a number of
reasons. For example, we may voluntarily suspend or terminate our
clinical studies if at any time we believe that they present an
unacceptable risk to the clinical study patients. In addition, the
FDA or other regulatory agencies may order the temporary or
permanent discontinuation of our clinical studies at any time if
they believe that the clinical studies are not being conducted in
accordance with applicable regulatory requirements or that they
present an unacceptable safety risk to the clinical study
patients.
Administering any product candidate to humans may produce
undesirable side effects. These side effects could interrupt, delay
or halt clinical studies of our product candidates and could result
in the FDA or other regulatory authorities denying further
development or approval of our product candidates for any or all
targeted indications. Ultimately, some or all of our product
candidates may prove to be unsafe for human use. Moreover, we could
be subject to significant liability if any volunteer or patient
suffers, or appears to suffer, adverse health effects or even death
as a result of participating in our clinical studies.
Our product candidates may cause undesirable adverse events or have
other properties that could delay or prevent their regulatory
approval, limit the commercial profile of an approved label, and/or
result in significant negative consequences following regulatory
approval, if any, including withdrawal from the market.
The REM-001 Therapy may exhibit undesirable and unintended side
effects that may prevent or limit its commercial adoption and use.
Even upon receiving approval by the FDA and other regulatory
authorities, our products may later exhibit adverse side effects
that prevent widespread use or necessitate withdrawal from the
market. The manifestation of such side effects could cause its
business to suffer.
Undesirable adverse events caused by our product candidates could
cause us or regulatory authorities to interrupt, delay or halt
clinical studies and may result in a more restrictive label, a
delay or denial of regulatory approval by the FDA or other
comparable regulatory authorities, or a significant change in our
clinical protocol or even our development plan. For example, in the
four clinical studies of REM-001 therapy conducted by Miravant,
there were a total of 17 serious adverse events, a large portion of
which were related to necrosis of treated lesions. One adverse
event that has been seen with REM-001 Therapy is a period of
photosensitivity after receiving REM-001 Therapy. This period of
photosensitivity is generally dose dependent and typically declines
over time. A second such adverse event is pain that arises or
results from the treatment. Treatment-related pain has been
experienced by some patients and it is often treated with
analgesics but in some cases more aggressive treatment can be
required.
If clinical studies of our product candidates reveal a high and
unacceptable severity or prevalence of certain adverse events, our
studies could be suspended or terminated and the FDA and/or other
comparable regulatory authorities could order us to cease further
development of, or deny approval of, our product candidates for any
or all targeted indications. Adverse events related to our
candidates also may affect patient recruitment or the ability of
enrolled subjects to complete the study and could result in
potential liability claims. Any of these occurrences may
significantly harm our reputation, business, financial condition
and prospects.
Additionally, adverse events associated with our future approved
products candidates may lead to potentially significant negative
consequences, which include, but are not limited to, the
following:
•
suspension of our marketing of the product;
•
withdrawal or revocation by regulatory authorities of their
approvals of or the licenses for the product;
45
•
the requirement by regulatory authorities to conduct additional
post-approval clinical studies, add additional warnings to, or
otherwise change, the label of the product, or create a medication
guide outlining the risks of such side effects for distribution to
patients;
•
restrictions on the distribution of the product or imposition of
burdensome implementation requirements on us through the
establishment of a Risk Evaluation and Mitigation Strategy (“REMS”)
or similar strategy as may be required by the FDA or a comparable
regulatory authority;
•
changes in the way the product is distributed or
administered;
•
regulatory investigations, government enforcement actions or
litigation proceedings, and being held liable for harm caused to
subjects or patients;
•
removal of products from the marketplace; and
•
harm to our reputation.
Any of these events could prevent us from achieving or maintaining
market acceptance of any particular product candidate that is
approved and could significantly harm our business, results of
operations and prospects.
Our plan to achieve marketing approval of REM-001 Therapy depends
partly on the accuracy of its preliminary efficacy analysis of
REM-001 Therapy CMBC study data. While we believe the results of
our preliminary efficacy analysis accurately reflect the actual
clinical study results, a detailed analysis overseen by regulatory
experts may yield different results.
We plan to utilize existing REM-001 Therapy clinical study data as
supportive data when seeking marketing approval of REM-001 Therapy
for the treatment of CMBC. Between February 1996 and January 1999,
Miravant, with support from certain corporate partners, conducted
four clinical studies for the treatment of CMBC using REM-001
Therapy. As part of our review of REM-001 Therapy’s data package,
we noted that while Miravant’s investigators had done a safety
analysis of all treated patients, these reports indicated an
efficacy analysis was only performed on two of their four clinical
studies. Notably, there had been no efficacy analysis on the other
two studies which constituted approximately half of the CMBC
patients who were treated with REM-001 Therapy. We originally
performed a preliminary efficacy analysis on the data from all four
CMBC studies, including the two that had not previously been
analyzed. We then engaged regulatory experts who were either former
FDA employees with directly related experience in reviewing similar
oncology treatments who were then acting as independent consultants
or individuals who have provided senior regulatory guidance to
major pharmaceutical or medical device companies in situations that
led to regulatory approval. These individuals guided us in
conducting a second more in-depth analysis that yielded results
consistent with our original analysis. Following that, we compiled
a briefing document and submitted questions to FDA. While we
believe the results of our preliminary efficacy analysis, and
subsequent analysis conducted under the guidance of these experts
which was consistent with its original preliminary analysis,
accurately reflect the actual clinical study results and that the
age of the underlying data from the clinical studies is not
material, a more in-depth review may yield different conclusions.
Such differing results may negatively impact our ability to pursue
or achieve, or result in delays to obtain, marketing approval of
REM-001 Therapy. There can be no certainty that results from our
analyses done to date or results from future analyses that we may
undertake will be sufficiently complete to satisfy FDA requests or
that any results will be favorable to us.
We intend to use laser light devices that the FDA finds to be
functionally equivalent to the Miravant devices in our planned
clinical studies. If we are unable to demonstrate functional
equivalence between the Miravant device and our intended laser
light device or if the FDA refuses to allow the use of our intended
laser light device, we will be unable to complete clinical studies
for REM-001 Therapy and our business will be materially
impaired.
Our REM-001 Therapy product consists of three parts, the DD series
laser light source (or equivalent), the ML2-0400 light delivery
device (or equivalent) and the drug REM-001. Pursuant to the
Miravant oncology IND, the FDA previously approved all three
components to be used together in certain Miravant CMBC Studies.
Our plan is to use new lasers that are functionally equivalent to
the Miravant DD2, the laser used in certain prior Miravant clinical
studies, for CMBC. The light delivery devices we plan to use in our
CMBC program are the same basic design developed and used
previously by Miravant in its clinical studies. Our plan is to have
clinical light delivery devices built by a contract medical device
manufacturer using the basic Miravant design and tested to the same
performance specifications as used previously. If the FDA finds
that our intended laser light device is not functionally equivalent
to the Miravant devices, the FDA may not approve any marketing
application for REM-001.
Our REM-001 Therapy clinical study data may not be deemed
acceptable by the FDA to support our new drug
applications.
In seeking regulatory approval for REM-001, we intend to rely at
least in part upon data gathered by Miravant in its initial Phase 1
studies and in four later Phase 2/3 clinical studies that were
conducted approximately 20 years ago. Based on our initial
interactions with the FDA, we believe the agency will accept these
results as supportive data but we cannot ultimately be certain that
the FDA will
46
accept data that old to support our new drug applications. Also
based on our initial interactions with the FDA, we believe our
plans for manufacturing investigational test materials will lead to
investigational test materials that FDA will recognize as being
sufficiently comparable to Miravant’s materials and also suitable
for further investigational studies but FDA may later raise
questions about the similarity of Miravant’s investigational
testing material versus its manufactured investigational testing
material, or may raise questions about the processes and methods
under which this old data was collected or may raise additional
concerns regarding the elapsed time period. If the FDA does not
accept this data, we will have to incur significant costs which may
require additional capital to redo some or all of the Miravant
studies or supplement these studies with additional
studies.
We may not receive regulatory approvals for our product candidates
or there may be a delay in obtaining such approvals.
Our products and our ongoing development activities are subject to
regulation by regulatory authorities in the countries in which we
or our collaborators and distributors wish to test, manufacture or
market our products. For instance, the FDA will regulate the
product in the U.S. and equivalent authorities, such as the EMA,
will regulate in Europe. Regulatory approval by these authorities
will be subject to the evaluation of data relating to the quality,
efficacy and safety of the product for its proposed use, and there
can be no assurance that the regulatory authorities will find our
data sufficient to support product approval of VAL-083 or any
future product candidates.
The time required to obtain regulatory approval varies between
countries. The FDA is required to facilitate the development and
expedite the review of drugs and biologics that are intended for
the treatment of a serious or life-threatening disease or condition
and which demonstrate the potential to address unmet medical needs
for the condition. Filling an unmet medical need is defined as
providing a therapy where none exists or providing a therapy that
may be potentially better than available therapy. Under the fast
track program, the sponsor of a new drug or biologic candidate may
request the FDA to designate the product for a specific indication
as a fast track product concurrent with or after the filing of the
IND for the product candidate. The FDA must determine if the
product candidate qualifies for FTD within 60 days after receipt of
the sponsor’s request. In the U.S., for products without “Fast
Track” status, it can take over eighteen (18) months after
submission of an application for product approval to receive the
FDA’s decision. Even with FTD, FDA review and decision can take
over twelve (12) months.
In December 2017, the FDA granted FTD for VAL-083 in patients with
recurrent GBM and in June 2022, the FDA granted FTD for VAL-083 for
the treatment of patients with newly-diagnosed unmethylated
GBM.
Different regulators may impose their own requirements and may
refuse to grant, or may require additional data before granting, an
approval, notwithstanding that regulatory approval may have been
granted by other regulators. Regulatory approval may be delayed,
limited or denied for a number of reasons, including insufficient
clinical data, the product not meeting safety or efficacy
requirements or any relevant manufacturing processes or facilities
not meeting applicable requirements as well as case load at the
regulatory agency at the time.
We may fail to comply with regulatory requirements.
Our success will be dependent upon our ability, and our
collaborative partners’ abilities, to maintain compliance with
regulatory requirements, including cGMP, and safety reporting
obligations. The failure to comply with applicable regulatory
requirements can result in, among other things, fines, injunctions,
civil penalties, total or partial suspension of regulatory
approvals, refusal to approve pending applications, recalls or
seizures of products, operating and production restrictions and
criminal prosecutions.
Even if one of our product candidates receives marketing approval,
it may fail to achieve the degree of market acceptance by
physicians, patients, third-party payors and others in the medical
community necessary for commercial success and the market
opportunity for the product candidate may be smaller than our
estimates.
We have never commercialized a product. Even if VAL-083, REM-001,
or any other product candidates is approved by the appropriate
regulatory authorities for marketing and sale, it may nonetheless
fail to gain sufficient market acceptance by physicians, patients,
third-party payors and others in the medical community. For
example, physicians are often reluctant to switch their patients
from existing therapies even when new and potentially more
effective or convenient treatments enter the market. Further,
patients often acclimate to the therapy that they are currently
taking and do not want to switch unless their physicians recommend
switching products or they are required to switch therapies due to
lack of reimbursement for existing therapies.
Efforts to educate the medical community and third-party payors on
the benefits of our product candidates may require significant
resources and may not be successful. If our product candidates are
approved but do not achieve an adequate level of market
47
acceptance, we may not generate significant revenues and we may not
become profitable. The degree of market acceptance of VAL-083,
REM-001, or any other product candidate, if approved for commercial
sale, will depend on a number of factors, including:
•
the efficacy and safety of the product;
•
the potential advantages of the product compared to alternative
treatments;
•
the prevalence and severity of any side effects;
•
the clinical indications for which the product is
approved;
•
whether the product is designated under physician treatment
guidelines as a first-line therapy or as a second- or third-line
therapy;
•
limitations or warnings, including distribution or use
restrictions, contained in the product’s approved
labeling;
•
our ability to offer the product for sale at competitive
prices;
•
our ability to establish and maintain pricing sufficient to realize
a meaningful return on our investment;
•
the product’s convenience and ease of administration compared to
alternative treatments;
•
the willingness of the target patient population to try, and of
physicians to prescribe, the product;
•
the strength of sales, marketing and distribution
support;
•
the approval of other new products for the same
indications;
•
changes in the standard of care for the targeted indications for
the product;
•
the timing of market introduction of our approved products as well
as competitive products and other therapies;
•
availability and amount of reimbursement from government payors,
managed care plans and other third-party payors;
•
adverse publicity about the product or favorable publicity about
competitive products; and
•
potential product liability claims.
The potential market opportunities for our product candidates are
difficult to estimate precisely. Our estimates of the potential
market opportunities are predicated on many assumptions, including
industry knowledge and publications, third-party research reports
and other surveys. While we believe that our internal assumptions
are reasonable, these assumptions involve the exercise of
significant judgment on the part of our management, are inherently
uncertain and the reasonableness of these assumptions has not been
assessed by an independent source. If any of the assumptions proves
to be inaccurate, the actual markets for our product candidate
could be smaller than our estimates of the potential market
opportunities.
If one of our product candidates receives marketing approval and
we, or others, later discover that the drug is less effective than
previously believed or causes undesirable side effects that were
not previously identified, our ability to market the drug could be
compromised.
Clinical studies of our product candidates are conducted in
carefully defined subsets of patients who have agreed to enter into
clinical studies. Consequently, it is possible that our clinical
studies may indicate an apparent positive effect of a product
candidate that is greater than the actual positive effect, if any,
or alternatively fail to identify undesirable side effects. If,
following approval of one of our product candidates, we, or others,
discover that the drug is less effective than previously believed
or causes undesirable side effects that were not previously
identified, any of the following adverse events could
occur:
•
regulatory authorities may withdraw their approval of the drug or
seize the drug;
•
we may be required to recall the drug or change the way the drug is
administered;
•
additional restrictions may be imposed on the marketing of, or the
manufacturing processes for, the particular drug;
•
we may be subject to fines, injunctions or the imposition of civil
or criminal penalties;
•
regulatory authorities may require the addition of labeling
statements, such as a “black box” warning or a
contraindication;
•
we may be required to create a Medication Guide outlining the risks
of the previously unidentified side effects for distribution to
patients;
•
we could be sued and held liable for harm caused to
patients;
•
the drug may become less competitive; and
48
•
our reputation may suffer.
Any of these events could have a material and adverse effect on our
operations and business and could adversely impact our stock
price.
Any product candidate for which we obtain marketing approval, along
with the manufacturing processes, qualification testing,
post-approval clinical data, labeling and promotional activities
for such product, will be subject to continual and additional
requirements of the FDA and other regulatory
authorities.
These requirements include submissions of safety and other
post-marketing information, reports, registration and listing
requirements, good manufacturing practices, or GMP requirements
relating to quality control, quality assurance and corresponding
maintenance of records and documents, and recordkeeping. Even if
marketing approval of any of our product candidates is granted, the
approval may be subject to limitations on the indicated uses for
which the product may be marketed or to conditions of approval, or
contain requirements for costly post-marketing testing and
surveillance to monitor the safety or efficacy of the product. The
FDA closely regulates the post-approval marketing and promotion of
pharmaceutical products to ensure such products are marketed only
for the approved indications and in accordance with the provisions
of the approved labeling.
In addition, later discovery of previously unknown problems with
our products, manufacturing processes, or failure to comply with
regulatory requirements, may lead to various adverse results,
including:
•
restrictions on such products, manufacturers or manufacturing
processes;
•
restrictions on the labeling or marketing of a
product;
•
restrictions on product distribution or use;
•
requirements to conduct post-marketing clinical
studies;
•
requirements to institute a risk evaluation mitigation strategy, or
REMS, to monitor safety of the product post-approval;
•
warning letters issued by the FDA or other regulatory
authorities;
•
withdrawal of the products from the market;
•
refusal to approve pending applications or supplements to approved
applications that we submit;
•
recall of products, fines, restitution or disgorgement of profits
or revenue;
•
suspension, revocation or withdrawal of marketing
approvals;
•
refusal to permit the import or export of our products;
and
•
injunctions or the imposition of civil or criminal
penalties.
If we are unable to establish sales, marketing and distribution
capabilities or enter into acceptable sales, marketing and
distribution arrangements with third parties, we may not be
successful in commercializing any product candidates that we
develop, if and when those product candidates are
approved.
We do not have a sales, marketing or distribution infrastructure
and have limited experience in the sale, marketing or distribution
of pharmaceutical products. To achieve commercial success for any
approved product, we must either develop a sales and marketing
organization, outsource these functions to third parties, or
license our product candidates to others. If approved, we may seek
to license VAL-083 or REM-001 to a large pharmaceutical company
with greater resources and experience than us. We may not be able
to license VAL-083 or REM-001 on reasonable terms, if at all. The
development of sales, marketing and distribution capabilities will
require substantial resources, will be time-consuming and could
delay any product launch. We expect that we will commence the
development of these capabilities prior to receiving approval of
our product candidates. If the commercial launch of a product
candidate for which we recruit a sales force and establish
marketing and distribution capabilities is delayed or does not
occur for any reason, we could have prematurely or unnecessarily
incurred these commercialization costs. Such a delay may be costly,
and our investment could be lost if we cannot retain or reposition
our sales and marketing personnel. In addition, we may not be able
to hire or retain a sales force in the United States that is
sufficient in size or has adequate expertise in the medical markets
that we plan to target. If we are unable to establish or retain a
sales force and marketing and distribution capabilities, our
operating results may be adversely affected. If a potential partner
has development or commercialization expertise that we believe is
particularly relevant to our product candidates, then we may seek
to collaborate with that potential partner even if we believe we
could otherwise develop and commercialize the product
independently.
49
We expect to seek one or more strategic partners for
commercialization of our product candidates outside the United
States. As a result of entering into arrangements with third
parties to perform sales, marketing and distribution services, our
product revenues or the profitability of these product revenues may
be lower, perhaps substantially lower, than if we were to directly
market and sell products in those markets. Furthermore, we may be
unsuccessful in entering into the necessary arrangements with third
parties or may be unable to do so on terms that are favorable to
us. In addition, we may have little or no control over such third
parties, and any of them may fail to devote the necessary resources
and attention to sell and market our products
effectively.
If we do not establish sales and marketing capabilities, either on
our own or in collaboration with third parties, we will not be
successful in commercializing our product candidates.
We face substantial competition from other pharmaceutical and
biotechnology companies and our operating results may suffer if we
fail to compete effectively.
The development and commercialization of new drug products is
highly competitive. We expect that we will face significant
competition from major pharmaceutical companies, specialty
pharmaceutical companies and biotechnology companies worldwide with
respect to VAL-083, REM-001, and any other product candidates that
we may seek to develop or commercialize in the future.
Specifically, due to the large unmet medical need, global
demographics and relatively attractive reimbursement dynamics, the
oncology market is fiercely competitive and there are a number of
large pharmaceutical and biotechnology companies that currently
market and sell products or are pursuing the development of product
candidates for the treatment of cancer. Our competitors may succeed
in developing, acquiring or licensing technologies and drug
products that are more effective, have fewer or more tolerable side
effects or are less costly than any product candidates that we are
currently developing or that we may develop, which could render our
product candidates obsolete and noncompetitive. All of the top ten
global pharmaceutical companies and many of the mid-size
pharmaceutical companies have a strong research and development and
commercial presence in oncology. Several companies are marketing
and developing oncology immunotherapy products.
Our commercial opportunity could be reduced or eliminated if our
competitors develop and commercialize products that are safer, more
effective, have fewer or less severe side effects, are more
convenient or are less expensive than any products that we may
develop. Our competitors also may obtain FDA or other marketing
approval for their products before we are able to obtain approval
for ours, which could result in our competitors establishing a
strong market position before we are able to enter the
market.
Many of our existing and potential future competitors have
significantly greater financial resources and expertise in research
and development, manufacturing, preclinical testing, conducting
clinical studies, obtaining marketing approvals and marketing
approved products than our does. Mergers and acquisitions in the
pharmaceutical and biotechnology industries may result in even more
resources being concentrated among a smaller number of our
competitors. Smaller or early stage companies may also prove to be
significant competitors, particularly through collaborative
arrangements with large and established companies. These
competitors also compete with us in recruiting and retaining
qualified scientific and management personnel and establishing
clinical study sites and patient registration for clinical studies,
as well as in acquiring technologies complementary to, or necessary
for, our programs.
If we are unable to obtain, or are delayed in obtaining, state
regulatory licenses for the distribution of our products, we would
not be able to sell our product candidates.
The majority of states require manufacturer and/or wholesaler
licenses for the sale and distribution of drugs into that state.
The application process is complicated, time consuming and requires
dedicated personnel or a third-party to oversee and manage. If we
are delayed in obtaining these state licenses, or denied the
licenses, even with FDA approval, we would not be able to sell or
ship product into that state which would adversely affect our sales
and revenues.
We rely on key personnel and members of management and, if we are
unable to retain or motivate key personnel or management, or hire
qualified personnel, we may not be able to grow
effectively.
We are dependent on certain members of our management, scientific
and drug development staff and consultants, the loss of services of
one or more of whom could materially adversely affect
us.
We currently have three full-time employees, and retain the
services of approximately 20 persons on an independent
contractor/consultant and contract-employment basis. Our ability to
manage growth effectively will require us to continue to implement
and improve our management systems and to recruit and train new
employees. Although we have done so in the past and expect to do so
in the future, there can be no assurance that we will be able to
successfully attract and retain skilled and experienced
personnel.
50
Our success depends in large part upon our ability to attract and
retain highly qualified personnel. We compete in our hiring efforts
with other pharmaceutical and biotechnology companies, as well as
universities and nonprofit research organizations, and we may have
to pay higher salaries to attract and retain personnel, which would
be very costly.
We may be subject to foreign exchange fluctuation.
Our functional and reporting currency is the United States dollar.
We maintain bank accounts in United States and Canadian dollars. A
portion of our expenditures are in foreign currencies, most notably
in Canadian dollars and Euros, and therefore we are subject to
foreign currency fluctuations, which may, from time to time, impact
our financial position and results. We may enter into hedging
arrangements under specific circumstances, typically through the
use of forward or futures currency contracts, to minimize the
impact of increases in the value of the Canadian dollar. In order
to minimize our exposure to foreign exchange fluctuations we may
hold sufficient Canadian dollars to cover our expected Canadian
dollar expenditures.
Product liability lawsuits against us could divert our resources,
cause us to incur substantial liabilities and limit
commercialization of any products that we may develop.
We face an inherent risk of product liability claims as a result of
the clinical testing of our product candidates despite obtaining
appropriate informed consents from our clinical study participants.
We will face an even greater risk if we commercially sell any
product that we may develop. For example, we may be sued if any
product we develop allegedly causes injury or is found to be
otherwise unsuitable during clinical testing, manufacturing,
marketing or sale. Any such product liability claims may include
allegations of defects in manufacturing, defects in design, a
failure to warn of dangers inherent in the product, negligence,
strict liability or a breach of warranties. Claims could also be
asserted under state consumer protection acts. If we cannot
successfully defend ourselves against product liability claims, we
may incur substantial liabilities or be required to limit
commercialization of our product candidates. Regardless of the
merits or eventual outcome, liability claims may result
in:
•
decreased demand for our product candidates or products that we may
develop;
•
injury to our reputation and significant negative media
attention;
•
withdrawal of clinical study participants;
•
significant costs to defend resulting litigation;
•
substantial monetary awards to study participants or
patients;
•
reduced resources of our management to pursue our business
strategy; and
•
the inability to commercialize any products that we may
develop.
Although we maintain general liability insurance, this insurance
may not fully cover potential liabilities that we may incur. The
cost of any product liability litigation or other proceeding, even
if resolved in our favor, could be substantial. We will need to
increase our insurance coverage if and when we begin selling any
product candidate that receives marketing approval. In addition,
insurance coverage is becoming increasingly expensive. If we are
unable to obtain or maintain sufficient insurance coverage at an
acceptable cost or to otherwise protect against potential product
liability claims, it could prevent or inhibit the development and
commercial production and sale of our product candidates, which
could adversely affect our business, financial condition, results
of operations and prospects.
Risks Related to Our Dependence on Third Parties
We rely on third parties to conduct clinical studies for our
product candidate. Any failure by a third-party to meet our
obligations with respect to the clinical development of our product
candidate may delay or impair our ability to obtain regulatory
approval for our product candidate.
We rely on academic institutions and private oncology centers to
conduct our clinical studies. Our reliance on third parties to
conduct clinical studies could, depending on the actions of such
third parties, jeopardize the validity of the clinical data
generated and adversely affect our ability to obtain marketing
approval from the FDA or other applicable regulatory
authorities.
Such clinical study arrangements provide us with information rights
with respect to the clinical data, including access to and the
ability to use and reference the data, including for our own
regulatory filings, resulting from the clinical studies. If
investigators or institutions breach their obligations with respect
to the clinical studies of our product candidate, or if the data
proves to be inadequate, then our ability to design and conduct any
future clinical studies may be adversely affected.
51
We rely, and expect to continue to rely, on third parties to
conduct our clinical studies, and those third parties may not
perform satisfactorily, including failing to meet deadlines for the
completion of such studies.
We currently rely on third-party clinical research organizations,
or CROs, to conduct our clinical studies. We expect to continue to
rely on third parties, such as CROs, clinical data management
organizations, medical institutions and clinical investigators, to
conduct our clinical studies. Our agreements with these third
parties generally allow the third-party to terminate the agreement
at any time. If we are required to enter into alternative
arrangements because of any such termination the introduction of
our product candidates to market could be delayed.
Our reliance on these third parties for research and development
activities will reduce our control over these activities but will
not relieve us of our responsibilities. For example, we design our
clinical studies and will remain responsible for ensuring that each
of our clinical studies are conducted in accordance with the
general investigational plan and protocols for the study. Moreover,
the FDA requires us to comply with standards, commonly referred to
as good clinical practices, or GCPs, for conducting, recording and
reporting the results of clinical studies to assure that data and
reported results are credible and accurate and that the rights,
integrity and confidentiality of study participants are protected.
Our reliance on third parties that we do not control does not
relieve us of these responsibilities and requirements. We also are
required to register ongoing clinical studies and post the results
of completed clinical studies on a government-sponsored database,
Clinicaltrials.gov, within specified timeframes. Failure to do so
can result in fines, adverse publicity and civil and criminal
sanctions.
Furthermore, these third parties may also have relationships with
other entities, some of which may be our competitors. If these
third parties do not successfully carry out their contractual
duties, meet expected deadlines or conduct our clinical studies in
accordance with regulatory requirements or our stated protocols, we
will not be able to obtain, or may be delayed in obtaining,
marketing approvals for our product candidates and will not be able
to, or may be delayed in our efforts to, successfully commercialize
our product candidates.
We also expect to rely on other third parties to store and
distribute drug supplies for our clinical studies. Any performance
failure on the part of our distributors could delay clinical
development or marketing approval of our product candidate or
commercialization of our products, producing additional losses and
depriving us of potential product revenue.
We may seek to enter into collaborations with third parties for the
development and commercialization of our product candidates. If we
fail to enter into such collaborations, or such collaborations are
not successful, we may not be able to capitalize on the market
potential of our product candidates.
We may seek third-party collaborators for development and
commercialization of our product candidates. Our likely
collaborators for any marketing, distribution, development,
licensing or broader collaboration arrangements include large and
mid-size pharmaceutical companies, regional and national
pharmaceutical companies, non-profit organizations, government
agencies, and biotechnology companies. We are currently party to a
limited number of such arrangements and have limited control over
the amount and timing of resources that our collaborators dedicate
to the development or commercialization of our product candidate.
Our ability to generate revenues from these arrangements will
depend on our collaborators’ abilities to successfully perform the
functions assigned to them in these arrangements.
Collaborations involving our product candidates currently pose, and
will continue to pose, the following risks to us:
•
collaborators have significant discretion in determining the
efforts and resources that they will apply to these
collaborations;
•
collaborators may not pursue development and commercialization of
our product candidate or may elect not to continue or renew
development or commercialization programs based on preclinical or
clinical study results, changes in the collaborators’ strategic
focus or available funding, or external factors such as an
acquisition that diverts resources or creates competing
priorities;
•
collaborators may delay clinical studies, provide insufficient
funding for a clinical study program, stop a clinical study or
abandon a product candidate, repeat or conduct new clinical studies
or require a new formulation of a product candidate for clinical
testing;
•
collaborators could independently develop, or develop with third
parties, products that compete directly or indirectly with our
product candidate if the collaborators believe that competitive
products are more likely to be successfully developed or can be
commercialized under terms that are more economically attractive
than ours;
•
collaborators with marketing and distribution rights to one or more
products may not commit sufficient resources to the marketing and
distribution of such product or products;
52
•
collaborators may not properly maintain or defend our intellectual
property rights or may use our proprietary information in such a
way as to invite litigation that could jeopardize or invalidate our
intellectual property or proprietary information or expose us to
potential litigation;
•
collaborators may infringe the intellectual property rights of
third parties, which may expose us to litigation and potential
liability;
•
disputes may arise between the collaborators and us that result in
the delay or termination of the research, development or
commercialization of our product candidate or that result in costly
litigation or arbitration that diverts management attention and
resources; and
•
collaborations may be terminated and, if terminated, may result in
a need for additional capital to pursue further development or
commercialization of the applicable product
candidates.
Collaboration agreements may not lead to development or
commercialization of our product candidates in the most efficient
manner or at all. If a collaborator of ours were to be involved in
a business combination, the continued pursuit and emphasis on our
product development or commercialization program could be delayed,
diminished or terminated.
If we are not able to establish collaborations, we may have to
alter our development and commercialization plans.
Our drug development programs and the potential commercialization
of our product candidates will require substantial additional cash
to fund expenses. We may decide to collaborate with pharmaceutical
and biotechnology companies for the development and potential
commercialization of our product candidates.
We face significant competition in seeking appropriate
collaborators. Whether we reach a definitive agreement for a
collaboration will depend, among other things, upon our assessment
of the collaborator’s resources and expertise, the terms and
conditions of the proposed collaboration and the proposed
collaborator’s evaluation of a number of factors. Those factors may
include the design or results of preclinical studies or clinical
studies, the likelihood of approval by the FDA or similar
regulatory authorities outside the United States, the potential
market for the subject product candidate, the costs and
complexities of manufacturing and delivering such product candidate
to patients, the potential of competing products, the existence of
uncertainty with respect to our ownership of technology, which can
exist if there is a challenge to such ownership without regard to
the merits of the challenge and industry and market conditions
generally. The collaborator may also consider alternative product
candidates or technologies for similar indications that may be
available to collaborate on and whether such a collaboration could
be more attractive than the one with us for our product candidate.
We may also be restricted under future license agreements from
entering into agreements on certain terms with potential
collaborators. Collaborations are complex and time-consuming to
negotiate and document. In addition, there have been a significant
number of recent business combinations among large pharmaceutical
companies that have resulted in a reduced number of potential
future collaborators.
We may not be able to negotiate collaborations on a timely basis,
on acceptable terms, or at all. If we are unable to do so, we may
have to curtail the development of our product candidates, reduce
or delay our development program, delay our potential
commercialization or reduce the scope of any sales or marketing
activities, or increase our expenditures and undertake development
or commercialization activities at our own expense. If we elect to
increase our expenditures to fund development or commercialization
activities on our own, we may need to obtain additional capital,
which may not be available to us on acceptable terms or at all. If
we do not have sufficient funds, we may not be able to further
develop our product candidate or bring it to market and generate
product revenue.
We currently manufacture VAL-083 at a single location. Any
disruption at this facility could adversely affect our business and
results of operations.
We have engaged a single manufacturer to produce VAL-083 GMP active
pharmaceutical ingredient and a single manufacturer to produce
VAL-083 drug product for our clinical studies. In addition, we
previously have relied on our manufacturing partner, Guangxi Wuzhou
Pharmaceutical Company, for the manufacture of clinical supply of
VAL-083 for our preclinical studies as well as our now-completed
Phase 2 clinical study conducted in China. If our manufacturer’s
facilities were damaged or destroyed, or otherwise subject to
disruption, it would require substantial lead-time to replace our
clinical supply. In such event, we would be forced to rely entirely
on other third-party contract manufacturers for an indefinite
period of time. We do not currently have established relationships
with any back-up manufacturers. At this time no drug product has
been manufactured by a third-party back-up manufacturer. Any
disruptions or delays by our third-party manufacturers or Guangxi
Wuzhou Pharmaceutical Company or their failure to meet regulatory
compliance could impair our ability to develop VAL-083, which would
adversely affect our business and results of operations.
53
We rely on these third-party manufacturers to provide drug product
supply for all of our clinical studies for VAL-083. There is no
assurance that such a supplier will be able to meet our needs from
a technical, timing, or cost-effective manner. Our failure to
execute appropriate agreements with such a third-party manufacturer
would delay, or halt, our clinical studies.
We do not have a clinical supply of REM-001 and we do not have our
own manufacturing facilities. If a third-party manufacturer fails
to meet applicable regulatory requirements or to supply us for any
reason, we will be unable to complete clinical studies for REM-001
Therapy and our business will be materially impaired.
We have engaged manufacturers to produce REM-001 GMP pharmaceutical
ingredient for our planned clinical studies. Our plan calls for the
use third-party manufacturers to produce the product for us. If and
when approved, we intend to have a third-party manufacture
commercial supplies of the product as well. We have not yet
completed the transfer of the technology or manufactured the
product at these facilities and our failure to timely do so will
delay the commencement of our clinical studies and may also impact
the timing for the submission of our NDA for REM-001
Therapy.
We rely on these third-party manufacturers to provide drug product
supply for all of our planned clinical studies for REM-001. There
is no assurance that such suppliers will be able to meet our needs
from a technical, timing, or cost-effective manner. Our failure to
execute appropriate agreements with such a third-party manufacturer
would delay, or halt, our clinical studies.
We do not have a clinical supply of light delivery devices for use
with REM-001 Therapy. Moreover, we do not have our own
manufacturing facilities nor have we contracted a third-party to
manufacture these devices for us. If a third-party manufacturer
fails to meet applicable regulatory requirements or to supply us
for any reason, we will be unable to complete clinical studies for
REM-001 Therapy and our business will be materially
impaired.
We do not have a clinical supply of REM-001 Therapy light delivery
devices. Our plan calls for the use of a third-party manufacturer
to produce these devices for us. The failure of a third-party
manufacturer to supply such devices in a timely and cost-effective
manner will delay the commencement of our clinical studies and may
also impact the timing for the submission of our NDA for REM-001
Therapy.
We are planning to use laser light devices that the FDA finds to be
functionally equivalent to the Miravant devices in our planned
clinical studies. We do not have our own manufacturing facilities
for conducting these activities nor have we contracted a
third-party to manufacture these devices for us. If we are unable
to contract a third-party manufacturer, or if a third-party
manufacturer fails to meet applicable regulatory requirements or to
supply it for any reason, we will be unable to complete clinical
studies for REM-001 Therapy and our business will be materially
impaired.
Our plan relies on using laser light devices that the FDA finds to
be functionally equivalent to the Miravant devices. Our plan calls
for the use of a third-party manufacturer to produce new laser
devices for us. The failure of a third-party manufacturer to supply
such devices in a timely and cost-effective manner will delay the
commencement of our clinical studies and may also impact the timing
for the submission of our NDA for REM-001 Therapy.
We may become subject to liabilities related to risks inherent in
working with hazardous materials.
Our discovery and development processes involve the controlled use
of hazardous and radioactive materials. We are subject to federal,
provincial and local laws and regulations governing the use,
manufacture, storage, handling and disposal of such materials and
certain waste products. Although we believe that our safety
procedures for handling and disposing of such materials comply with
the standards prescribed by such laws and regulations, the risk of
accidental contamination or injury from these materials cannot be
completely eliminated. In the event of such an accident, we could
be held liable for any damages that result and any such liability
could exceed our resources. We are not specifically insured with
respect to this liability. Although we believe that we are in
compliance in all material respects with applicable environmental
laws and regulations and currently do not expect to make material
capital expenditures for environmental control facilities in the
near-term, there can be no assurance that we will not be required
to incur significant costs to comply with environmental laws and
regulations in the future, or that our operations, business or
assets will not be materially adversely affected by current or
future environmental laws or regulations.
Risks Related to Our Common Stock
The market price of our common stock is, and is likely to continue
to be, highly volatile and subject to wide fluctuations.
The market price of our common stock is highly volatile and could
be subject to wide fluctuations in response to a number of factors
that are beyond our control, including:
54
•
variations in our quarterly operating results;
•
announcements that our revenue or income are below analysts’
expectations;
•
general economic slowdowns;
•
sales of large blocks of our common stock; and
•
announcements by us or our competitors of significant contracts,
acquisitions, strategic partnerships, joint ventures or capital
commitments.
Our Articles allow for our board of directors to create new series
of preferred stock without further approval by our stockholders,
which could adversely affect the rights of the holders of our
common stock.
Our board of directors has the authority to fix and determine the
relative rights and preferences of preferred stock. Our board of
directors has the authority to issue up to 5,000,000 shares of our
preferred stock (of which 278,530 shares have been designated
Series A Preferred Stock and are issued and outstanding as of June
30, 2022 and 1,000,000 shares have been designated as Series B
Preferred Stock of which none are issued and outstanding as of June
30, 2022) without further stockholder approval. In addition, 28,400
have been designated as Series C (22,000 as Series C-1, 2,700 as
Series C-2, and 3,700 as Series C-3) of which 16,838 are issued and
outstanding as of June 30, 2022. As a result, our board of
directors could authorize the issuance of additional series of
preferred stock that would grant to holders the preferred right to
our assets upon liquidation, the right to receive dividend payments
before dividends are distributed to the holders of common stock and
the right to the redemption of the shares, together with a premium,
prior to the redemption of our common stock. In addition, our board
of directors could authorize the issuance of a series of preferred
stock that has greater voting power than our common stock, or that
is convertible into our common stock, which could decrease the
relative voting power of our common stock or result in dilution to
our existing stockholders. Although we have no present intention to
issue any additional shares of preferred stock or to create any
additional series of preferred stock, we may issue such shares in
the future.
Issuance of our common stock upon exercise of warrants or options,
or conversion of the Series C Preferred Stock may depress the price
of our common stock.
As of September 26, 2022, we had 80,807 shares of common stock
issued and outstanding, outstanding warrants to purchase 35,704
shares of common stock, warrants to purchase 2.4 shares of our
Series C Preferred Stock that upon exercise are convertible into
2,100 shares of common stock, outstanding stock options to purchase
12,291 shares of common stock, 17 outstanding shares of Series C
Preferred Stock that are convertible into 14,497 shares of common
stock. All common stock warrants and stock options are convertible,
or exercisable into, one share of common stock. The Series C
Preferred Stock (issued in three series) is convertible into shares
of common stock at $1.16 per share (Series C-1), $1.214 per share
(Series C-2) or $1.15 per share (Series C-3), respectively. The
Series C Preferred stock purchase warrants are convertible into
Series C Preferred Stock at $1,000 per share for either Series C-1,
Series C-2, or Series C-3 Preferred Stock, as
applicable.
The issuance of shares of our common stock upon the exercise of
outstanding warrants or options, or the conversion of our Series
C-1, C-2, and C-3 Series Preferred Stock, could result in
substantial dilution to our stockholders, which may have a negative
effect on the price of our common stock.
We do not intend to pay cash dividends on our common stock for the
foreseeable future.
We have paid no cash dividends on our common stock to date and we
do not anticipate paying any dividends to holders of our common
stock in the foreseeable future. While our future dividend policy
will be based on the operating results and capital needs of the
business, we currently anticipate that any earnings will be
retained to finance our future expansion and for the implementation
of our business plan. Investors should take note of the fact that a
lack of a dividend can further affect the market value of our
common stock, and could significantly affect the value of any
investment in us.
55
FORWARD-LOOKING STATEMENTS
This annual report on Form 10-K contains forward-looking statements
made pursuant to the safe harbor provisions of the Private
Securities Litigation Reform Act of 1995 under Section 27A of the
Securities Act of 1933, as amended, and Section 21E of the
Securities Exchange Act of 1934, as amended. Forward-looking
statements include statements with respect to our beliefs, plans,
objectives, goals, expectations, anticipations, assumptions,
estimates, intentions and future performance, and involve known and
unknown risks, uncertainties and other factors, which may be beyond
our control, and which may cause our actual results, performance or
achievements to be materially different from future results,
performance or achievements expressed or implied by such
forward-looking statements. All statements other than statements of
historical fact are statements that could be forward-looking
statements. You can identify these forward-looking statements
through our use of words such as “may,” “can,” “anticipate,”
“assume,” “should,” “indicate,” “would,” “believe,” “contemplate,”
“expect,” “seek,” “estimate,” “continue,” “plan,” “point to,”
“project,” “predict,” “could,” “intend,” “target,” “potential” and
other similar words and expressions of the future.
There are a number of important factors that could cause the actual
results to differ materially from those expressed in any
forward-looking statement made by us. These factors include, but
are not limited to:
•
our ability to raise funds for general corporate purposes and
operations, including our research activities and clinical
studies;
•
the impact of the COVID-19 pandemic on our business and operations
or on the economy generally;
•
our ability to recruit qualified management and technical
personnel;
•
the cost, timing, scope and results of our clinical
studies;
•
our ability to expand our international business;
•
our ability to obtain and maintain required regulatory approvals
for our products;
•
our expectations regarding the use of our existing
cash;
•
our ability to realize the anticipated benefits from the
acquisition of Adgero;
•
our ability to obtain or maintain patents or other appropriate
protection for the intellectual property utilized in our current
and planned products;
•
our ability to develop and commercialize products without
infringing the intellectual property rights of third parties;
and
•
the other factors discussed in the “Risk Factors” section and
elsewhere in this Annual Report.
The foregoing does not represent an exhaustive list of matters that
may be covered by the forward-looking statements contained herein
or risk factors that we are faced with that may cause our actual
results to differ from those anticipated in our forward-looking
statements. Please see “Risk Factors” in this Annual Report on Form
10-K under Part I, Item 1A, for additional risks which could
adversely impact our business and financial performance.
All forward-looking statements are expressly qualified in their
entirety by this cautionary notice. You are cautioned not to place
undue reliance on any forward-looking statements, which speak only
as of the date of this report or the date of the document
incorporated by reference into this report. We have no obligation,
and expressly disclaim any obligation, to update, revise or correct
any of the forward-looking statements, whether as a result of new
information, future events or otherwise. We have expressed our
expectations, beliefs and projections in good faith and we believe
they have a reasonable basis. However, we cannot assure you that
our expectations, beliefs or projections will result or be achieved
or accomplished.
56
Not required for a smaller reporting company.
Item 2. Properties.
Our corporate headquarters are currently located at 9920 Pacific
Heights Blvd, Suite 150, San Diego CA, 92121. The current rent at
that location under a one-year renewable lease is $2.4 thousand per
year. We also rent our administrative offices located at Suite
720-999 West Broadway, Vancouver, British Columbia, Canada on a
month-to-month basis at a rate of $3.4 thousand (CA$4.4 thousand)
per month. During the year ended June 30, 2022, we recorded a total
of $41.4 thousand as rent expense (2021 - $40 thousand).
In addition, Valent, which is owned by Dr. Dennis Brown, our Chief
Scientific Officer, leases facilities in California and we have
access to such facilities pursuant to an informal unwritten
arrangement with Valent. Our leased premises, academic
relationships, and access to the Valent facility are sufficient to
meet the immediate needs of our business, research and
operations.
Item 3. Legal
Proceedings.
There are no legal proceedings to which we are a party or any of
our property is the subject.
Item 4. Mine Safety
Disclosures.
Not applicable.
57
PART
II
Item 5. Market for Registrant’s Common Equity, Related
Stockholder
Matters and Issuer Purchases of Equity Securities.
Since August 20, 2020, our common stock has been listed on The
Nasdaq Capital Market LLC under the symbol “KTRA”. From July 12,
2016, until August 19, 2020, our common stock was listed on The
Nasdaq Capital Market LLC under the symbol “DMPI”. Previously, our
common stock was quoted on the OTC.QX, and prior to that, on the
OTCQB.
As of September 26, 2022, there were approximately 801 holders of
record of our common stock.
Dividends
We have never declared or paid any cash dividends on our common
stock. We currently intend to retain future earnings, if any, to
finance the expansion of our business. As a result, we do not
anticipate paying any cash dividends in the foreseeable
future.
Sales of Unregistered Securities
None.
Issuer Purchases of Equity Securities
None.
Item 6.
Reserved
58
Item 7. Management’s Discussion and Analysis of
Financial Condition and Results of Operations
MANAGEMENT’S DISCUSSION AND ANALYSIS OF FINANCIAL
CONDITION
AND RESULTS OF OPERATIONS
This Management’s Discussion and Analysis (“MD&A”) contains
“forward-looking statements”, within the meaning of the Private
Securities Litigation Reform Act of 1995, which represent our
projections, estimates, expectations, or beliefs concerning, among
other things, financial items that relate to management’s future
plans or objectives or to our future economic and financial
performance. In some cases, you can identify these statements by
terminology such as “may”, “should”, “plans”, “believe”, “will”,
“anticipate”, “estimate”, “expect” “project”, or “intend”,
including their opposites or similar phrases or expressions. You
should be aware that these statements are projections or estimates
as to future events and are subject to a number of factors that may
tend to influence the accuracy of the statements. These
forward-looking statements should not be regarded as a
representation by us or any other person that our events or plans
will be achieved. You should not unduly rely on these
forward-looking statements, which speak only as of the date of this
report. Except as may be required under applicable securities laws,
we undertake no obligation to publicly revise any forward-looking
statement to reflect circumstances or events after the date of this
report or to reflect the occurrence of unanticipated
events.
You should review the factors and risks we describe under “Risk
Factors” in this report on Form 10-K for the year ended June 30,
2022 and in our other filings with the Securities and Exchange
Commission, available at www.sec.gov. Actual results may differ
materially from any forward-looking statement.
Impact of Coronavirus (“COVID-19”) on our Operations, Financial
Condition, Liquidity and Results of Operations
In December 2019 a novel strain of coronavirus, COVID-19 was
reported to have surfaced in Wuhan, China and on March 11, 2020, it
was declared a pandemic by the World Health Organization. The
ultimate impact of the COVID-19 pandemic on our operations is
unknown and will depend on future developments, which are highly
uncertain and cannot be predicted with confidence, including the
duration of the COVID-19 outbreak, new information which may emerge
concerning the duration and severity of the COVID-19 pandemic, and
any additional preventative and protective actions that
governments, or us, may determine are needed.
The COVID-19 pandemic did not cause significant disruption to our
Phase 2 clinical studies. Each of our now-completed Phase 2
clinical studies was conducted at respective single sites which
reduced the risk of study disruption. Any disruptions to patient
treatments for our Phase 2 studies were within allowances under
each study protocol. Access to the sites by our clinical monitors
was limited during the COVID-19 pandemic but the recording of study
data in both studies and patient treatments at both study sites was
conducted per protocol.
Regarding the VAL-083 study arm of the GBM AGILE Study that is
currently being conducted at multiple sites in the United States,
Canada and Europe, we have not experienced any significant impacts
on patient enrollment or treatment. With respect to the REM-001
drug supply, we are currently experiencing some delays in contract
manufacturing schedules and supplies which we attribute to
COVID-19. The current delays could have an impact on our REM-001
program timeline.
Including aggregate net proceeds of approximately $21.6 million
received from two registered direct financings that closed on
September 28, 2021 and April 14, 2022, respectively, as well as the
potential proceeds available under our Purchase Agreement with
Lincoln Park, we estimate that we have cash available to fund
planned operations for less than one year from the date of issuance
of our June 30, 2022 consolidated financial statements. The
COVID-19 pandemic has created significant economic uncertainty and
volatility in the credit and capital markets. The ultimate impact
of the COVID-19 pandemic on our ability to raise additional capital
is unknown and will depend on future developments, which are highly
uncertain and cannot be predicted with confidence, including the
duration of the COVID-19 outbreak and new information which may
emerge concerning the severity of the COVID-19 pandemic. We may not
be able to raise sufficient additional capital and may tailor our
drug candidate development programs based on the amount of funding
we are able to raise in the future. Nevertheless, there is no
assurance that these initiatives will be successful.
Corporate History
We are a Nevada corporation formed on June 24, 2009, under the name
Berry Only, Inc. On January 25, 2013, we entered into and closed
the Exchange Agreement with Del Mar (BC), Callco, Exchangeco and
the security holders of Del Mar (BC). Upon completion of the
Exchange Agreement, Del Mar (BC) became our wholly-owned subsidiary
which we refer to as the Reverse Acquisition.
On June 10, 2020, we entered into the Merger Agreement by and among
Merger Sub and Adgero. On August 19, 2020, upon the terms, and
subject to the conditions set forth in the Merger Agreement, Merger
Sub merged with and into Adgero, the separate corporate existence
of Merger Sub ceased, and Adgero continued its existence under
Delaware law as the surviving corporation in the
59
Merger and became our direct, wholly-owned subsidiary. As a result
of the Merger, each issued and outstanding share of Adgero common
stock (other than treasury shares held by Adgero), was converted
automatically into the right to receive 1.5740 shares, or the
Exchange Ratio, of our common stock, and cash in lieu of any
fractional shares. Also, each outstanding warrant to purchase
Adgero Common Stock was converted into a warrant exercisable for
that number of shares of our common stock equal to the product of
(x) the aggregate number of shares of Adgero Common Stock for which
such warrant was exercisable and (y) the Exchange Ratio.
Following the completion of the Merger, we changed our name from
DelMar Pharmaceuticals, Inc. to Kintara Therapeutics, Inc. In
conjunction with the closing of the Merger, and through a series of
three private placement closings, we issued a total of 25,028
shares of Series C Preferred Stock at a purchase price of $1,000
per share for total aggregate gross proceeds of $25 million, or net
proceeds of approximately $21.6 million.
The Series C Stock was issued in three series at conversion prices
equal to $1.16, $1.214 and $1.15, respectively. As a result, we
issued a total of 25,028 shares of Series C Stock, which are
convertible into an aggregate 21,516,484 shares of common stock. As
part of the private placement, we issued Placement Agent Warrants
to purchase 2,504 shares of Series C Stock to the placement agent.
The Placement Agent Warrants have an exercise price of $1,000 per
share, provide for a cashless exercise feature and are exercisable
for a period of four years from the date of the initial closing of
the private placement. The Series C Stock and the shares of Series
C Stock issuable upon exercise of the Placement Agent Warrants will
be entitled to receive dividends, payable in shares of our common
stock, at a rate of 10%, 15%, 20%, and 25%, of the number of shares
of common stock issuable upon conversion of the Series C Stock, on
the 12th, 24th, 36th and 48th month anniversary of the initial
closing of the private placement, which occurred on August 19,
2020, provided that the holder of such shares has not converted the
shares of Series C Stock prior to the applicable dividend
rate.
Outstanding Securities
As of September 26, 2022, we had 80,807 shares of common stock
issued and outstanding, outstanding warrants to purchase 35,704
shares of common stock, warrants to purchase 2.4 shares of our
Series C Preferred Stock that upon exercise are convertible into
2,100 shares of common stock, outstanding stock options to purchase
12,291 shares of common stock, 17 outstanding shares of Series C
Preferred Stock that are convertible into 14,497 shares of common
stock. All common stock warrants and stock options are convertible,
or exercisable into, one share of common stock. The Series C
Preferred Stock (issued in three series) is convertible into shares
of common stock at $1.16 per share (Series C-1), $1.214 per share
(Series C-2) or $1.15 per share (Series C-3), respectively. The
Series C Preferred stock purchase warrants are convertible into
Series C Preferred Stock at $1,000 per share for either Series C-1,
Series C-2, or Series C-3 Preferred Stock, as
applicable.
On June 21, 2022, we amended our articles of incorporation, as
amended, to increase the number of authorized shares of common
stock from 175,000,000 to 275,000,000 shares.
Related Parties
We acquired our initial patents and technology rights from Valent,
an entity owned by Dr. Dennis Brown, our Chief Scientific Officer.
As a result, Valent is a related party.
Selected Annual Information
The financial information reported herein has been prepared in
accordance with accounting principles generally accepted in the
United States. Our functional currency at June 30, 2022 and June
30, 2021 is the US$ and our financial data is expressed in
thousands, except par value and per share amounts unless otherwise
noted. The following tables represent selected financial
information for us for the periods presented.
Selected Balance Sheet data
(in thousands)
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|
|
|
|
$
|
|
|
$
|
|
Cash and cash equivalents
|
|
|
11,780
|
|
|
|
10,537
|
|
Working capital
|
|
|
9,268
|
|
|
|
9,013
|
|
Total assets
|
|
|
15,948
|
|
|
|
13,543
|
|
Total stockholders’ equity
|
|
|
11,795
|
|
|
|
10,581
|
|
60
Selected Statement of Operations data (in thousands, except per
share data)
For the years ended
|
|
|
|
|
|
|
|
|
|
|
June 30,
2022
|
|
|
June 30,
2021
|
|
Expenses
|
|
|
|
|
|
|
Research and development
|
$
|
|
15,173
|
|
$
|
|
11,815
|
|
General and administrative
|
|
|
|