I asked questions in the webcast (part 1 in the thread), let’s see what was answered, the moderator shortened some questions.
Q. Is the FDA guidance now such that AA and final approval together (in the announcement “entire HR MDS”) cover r/r and first-line, which would mean that regarding the survival of non-randomized Phase 2 patients in the r/r setting, it is not relevant for r/r marketing authorizations this September? And not for responses?
A. The FDA does not need more information on r/r. Potential AA brings preliminary marketing authorization for first-line and r/r. Faron was previously under the impression that first-line responses could only lead to r/r approval. Hence Faron’s current satisfaction. (However, I recall that they would have mentioned trying for AA with Phase 2 results a long time ago, as some others had received approvals earlier.) And Faron started asking a year ago what kind of Phase 3 is needed for r/r marketing authorization, and now a significantly larger market is available. (Albeit with initial slowdowns)
Q. Run-in phase at the beginning of Phase 3. What is the more precise protocol for those patients who received the dose that is being discontinued? How many patients are needed, and is it mainly about adverse event analysis? What ultimately made the FDA require a mini-Phase 2 trial at the beginning? Project Optimus or a specific observation?
A. 40+40+40, so 80 will be in the final analysis. There were only a few patients at the 1 mg/kg dose and Project Optimus. Even the smallest dose showed efficacy and only minor side effects. (So the logic is; what if the efficacy is the same but the side effects are less. Faron is not entirely sure about this efficacy matter)
Q. How many study sites are targeted/in discussions for Phase 3? Is Asia included in any case?
A. 80-90 sites. Europe and USA. Japan from Asia at least. Multicontinental.
Q. What was discussed with the FDA about biomarkers (MDS)?
A. Practically all patients are Clever-1 positive. No difference in responses is observed based on Clever-1 concentration between patients. The FDA did not require a biomarker either. All MDS patients are included for approval purposes.
Q. Treatment of TP53 patients as a separate entity?
A. They respond to Bex+aza treatment with responses similar to non-TP53 mutation patients (WT). They are stratified so that the placebo and Bex groups have the same number of TP53 patients, so it does not affect the results between groups.
Q. Preclinical lymphoma study. The previous deadline was the end of June 25. When will it be announced whether development will continue or not? If it continues, will there likely be data for scientific meetings? Any other announcement? Would there be no need for patenting, as Faron was just granted a patent until 2040 for the treatment of Clever-1-positive cancers, which include these lymphomas?
A. It has certainly not been forgotten. Progress has been made. Patient samples have been studied, but we are not yet at the point where a go/no-go decision can be made on whether to proceed to clinical patient studies. More preclinical work will be done. This will be reported in future webcasts. Bono reiterates that we are talking about the most common lymphomas.
Q. Sarcoma trial Bexar in France, which cytostatic/medication is combined with Bex? Radiation therapy? What stage of disease are the patients in question? All soft tissue sarcomas including r/r GIST?
A. The cytostatic is doxorubicin, decades old, which is standard treatment worldwide. It is given with Bex as a first-line treatment for metastatic soft tissue sarcoma.