Full Press Release Details
Chi-Med Reports 2020 Interim Results and Provides Updates on Key Clinical Programs
Strong global pipeline progress three U.S. FDA1 Fast Track Designations; surufatinib U.S. NDA2 preparations underway; and initiation of global Phase III for fruquintinib
Two further NDAs submitted in China savolitinib in MET3 Exon 14 skipping mutation NSCLC4, and surufatinib in pancreatic NET5
Expansion of commercial activities in oncology Chi-Med to be responsible for medical detailing and marketing for Elunate throughout Mainland China starting October 2020
Company to Host Results Call & Webcast Today at 1 p.m. BST / 8 a.m. EDT / 8 p.m. HKT
Hong Kong, Shanghai & Florham Park, NJ: Thursday, July 30, 2020: Hutchison China MediTech Limited ( Chi-Med ) (Nasdaq/AIM: HCM), an innovation-driven, commercial-stage biopharmaceutical company, today announces its unaudited financial results for the six months ended June 30, 2020 and provides updates on key clinical and commercial developments.
During the first half of 2020, we continued to build our fully integrated business in China, from research and development to manufacturing and commercialization and sales, with a focus on oncology, said Mr. Simon To, Chairman of Chi-Med. NDAs for surufatinib and savolitinib are currently under review by the China NMPA6 and we are now preparing for multiple potential launches employing our newly-established commercial organization in oncology, covering all provinces in Mainland China.
We are also one of a few China-based biotech companies working to realize the global potential of our home-grown innovative drug candidates, he added. We currently have nine novel drug candidates in clinical trials, many with global potential, and an additional five drug candidates at the IND7-enabling stage.
Over the past three years, we have significantly expanded our international development footprint and, in the first half of 2020, locked in global registration strategies for surufatinib and fruquintinib, while our global partnership with AstraZeneca8 is approaching the same for savolitinib. A deep pipeline of unpartnered earlier-stage oncology assets follows, with most notably, global development of our Syk9 and PI3K 10 assets progressing well and our IDH 1/211 inhibitor expected to start Phase I in the United States this year.
We believe that the anticipated launches of multiple innovative oncology drugs over the next twelve to eighteen months will address a broad range of unmet medical needs and benefit a large number of patients globally, propelling Chi-Med into a new phase of growth.
FIRST HALF 2020 OPERATING HIGHLIGHTS
Set out below are some of Chi-Med's operating highlights so far this year. For more details, please refer to Operations Review below.
I.PREPARING TO LAUNCH MULTIPLE ONCOLOGY DRUGS IN CHINA
Savolitinib NDA submitted for potential first-in-class selective MET TKI12 in China:
Surufatinib Two NDAs with first China launch in NET planned for late 2020:
Fruquintinib Commercial progress on Elunate (fruquintinib capsules):
Established in-house oncology commercial organization Team now in place for imminent launches:
Surufatinib U.S. NDA under preparation:
Fruquintinib global Phase III registration study in CRC28 underway:
Savolitinib AstraZeneca collaboration making progress in lung and kidney cancer:
KEY EVENTS PLANNED FOR BALANCE 2020 & EARLY 2021
| CHINA EVENTS: A FULLY INTEGRATED ONCOLOGY BUSINESS IN CHINA | |
| Fruquintinib | Elunate China commercialization Chi-Med to assume medical detailing and marketing activities for Elunate in all China on October 1, 2020; and Enrollment completion of FRUTIGA Phase III complete enrollment of China registration study in second-line gastric cancer. |
| Surufatinib | Presentation of SANET-p Phase III data pancreatic NET patients study at ESMO 37 2020 conference; Acceptance of NDA in pancreatic NET following recent NDA submission based on positive SANET-p Phase III interim analysis; Phase II/III interim analysis for futility in second-line BTC 38 in China; and Potential NDA approval and launch for non-pancreatic NET first un-partnered oncology drug launch for Chi-Med in China. |
| Savolitinib | Potential NDA approval and launch for NSCLC monotherapy in MET Exon 14 skipping mutation NSCLC. If approved, this will be the first approval worldwide and the first selective c-MET TKI approval in China. Material milestone triggering event. |
| Early-stage Assets | HMPL-689 (PI3K ) Phase I/Ib NHL data potential presentation of China data at major scientific conference; HMPL-689 (PI3K ) Potential registration study start in indolent NHL in China; HMPL-523 (Syk) Potential registration study start in indolent NHL in China; and HMPL-523 (Syk) completion of dose escalation in ITP 39 . |
| GLOBAL EVENTS: REALIZING THE GLOBAL POTENTIAL OF OUR ONCOLOGY ASSETS | |
| Fruquintinib | Global Phase III study (FRESCO-2) expansion of registration study in CRC in 10 countries including the U.S., Europe and Japan; and Presentation of U.S. Phase Ib data preliminary data from study of third and later line CRC patients at ESMO 2020 conference. |
| Surufatinib | U.S. NDA submission for pancreatic- and non-pancreatic NET U.S. NDA rolling submission beginning in late 2020 through early 2021. |
| Savolitinib | Internal interim analyses on SAVANNAH Complete the review of the first internal interim analysis and conduct further interim analysis to inform regulatory strategy; Potential endorsement of global Phase III in kidney cancer savolitinib monotherapy in MET-driven PRCC; Potential endorsement of global Phase III in NSCLC Tagrisso combination in EGFRm 40 positive, MET positive, NSCLC. Material milestone triggering event; Potential endorsement of global registration study in NSCLC savolitinib in MET Exon 14 skipping mutation NSCLC; and Enrollment completion of SAVANNAH AstraZeneca to complete enrollment of Phase II study, with registration potential, of savolitinib/Tagrisso combination. |
| Early-stage Assets | HMPL-523 (Syk) Global Phase Ib expansion in indolent NHL in the U.S. and Europe; HMPL-306 (IDH 1/2) U.S. IND submission and initiation of Phase I ; and HMPL-689 (PI3K ) Global Phase Ib expansion in indolent NHL in the U.S. and Europe. |
FINANCIAL HIGHLIGHTS
The items below are selected financial data for the six months ended June 30, 2020. All dollars are expressed in U.S. dollar currency unless otherwise stated. For more details, please refer to Financial Review , Operations Review and Interim Unaudited Condensed Consolidated Financial Statements below.
INNOVATION PLATFORM (our R&D operations):
COMMERCIAL PLATFORM (our commercial operations):
During the first half of 2020, we performed in-line with published guidance, with dividends from our Commercial Platform offsetting a material portion of our R&D expenses as expected.
Over the balance of 2020, cash investments will rise in a number of areas including: several major global clinical and regulatory activities such as the global FRESCO-2 Phase III for fruquintinib and the submission of the U.S. NDA for surufatinib; the first phase of construction of our new large-scale oncology manufacturing facility in Shanghai; and expansion of our commercial activities in oncology in China, specifically our new commercial role on Elunate and preparation for the surufatinib launch.
We assume at this stage that the financial impact of the COVID-19 outbreak will not be material to the Group. Since we cannot predict how the situation will evolve, we will monitor and adjust if needed, as new material information emerges. We therefore provide unchanged Financial Guidance for 2020 below.
| H1 2020 | 2020 Current | Adjustments | |||||||
| Actual | Guidance | vs. Previous Guidance | |||||||
| Adjusted (non-GAAP) Innovation Platform segment operating loss | $ | (81.2) million | $ | (180) (210) million | nil | ||||
| Adjusted (non-GAAP) Group net cash flows excluding financing activities | $ | (32.5) million | $ | (140) (160) million | nil |
Use of Non-GAAP Financial Measures and Reconciliation References in this announcement to adjusted Innovation Platform segment operating loss, adjusted Group net cash flows excluding financing activities and financial measures reported at CER are based on non-GAAP financial measures. Please see the Use of Non-GAAP Financial Measures and Reconciliation below for further information relevant to the interpretation of these financial measures and reconciliations of these financial measures to the most comparable GAAP measures, respectively.
Conference Call and Audio Webcast Presentation Scheduled Today at 1 p.m. BST / 8 a.m. EDT / 8 p.m. HKT Investors may participate in the call as follows: +44 20 3194 0569 (U.K.) / +1 646 722 4977 (U.S.) / +852 3027 6500 (Hong Kong), or access a live audio webcast of the call via Chi-Med's website at www.chi-med.com/investors/event-information/.
Additional dial-in numbers are also available at Chi-Med's website. Please use participant access code 54962123#.
Chi-Med (Nasdaq/AIM: HCM) is an innovative, commercial-stage, biopharmaceutical company committed, over the past twenty years, to the discovery and global development of targeted therapies and immunotherapies for the treatment of cancer and immunological diseases. It has a portfolio of nine cancer drug candidates currently in clinical studies around the world and extensive commercial infrastructure in its home market of China. For more information, please visit: www.chi-med.com.
| 1 | |
| Investor Enquiries | |
| Mark Lee, Senior Vice President | +852 2121 8200 |
| Annie Cheng, Vice President | +1 (973) 567 3786 |
| Media Enquiries | |
| Americas Brad Miles, Solebury Trout | +1 (917) 570 7340 (Mobile) bmiles@troutgroup.com |
| Europe Ben Atwell / Alex Shaw, FTI Consulting | +44 20 3727 1030 / +44 7771 913 902 (Mobile) / +44 7779 545 055 (Mobile) Chi-Med@fticonsulting.com |
| Asia Joseph Chi Lo / Zhou Yi, Brunswick | +852 9850 5033 (Mobile), jlo@brunswickgroup.com / +852 9783 6894 (Mobile), yzhou@brunswickgroup.com |
| Nominated Advisor | |
| Freddy Crossley / Atholl Tweedie, Panmure Gordon (UK) Limited | +44 (20) 7886 2500 |
Unless the context requires otherwise, references in this announcement to the Group, the Company, Chi-Med, Chi-Med Group, we, us, and our, mean Hutchison China MediTech Limited and its consolidated subsidiaries and joint ventures unless otherwise stated or indicated by context.
Past Performance and Forward-Looking Statements
The performance and results of operations of the Group contained within this announcement are historical in nature, and past performance is no guarantee of future results of the Group. This announcement contains forward-looking statements within the meaning of the safe harbor provisions of the U.S. Private Securities Litigation Reform Act of 1995. These forward-looking statements can be identified by words like will, expects, anticipates, future, intends, plans, believes, estimates, pipeline, could, potential, first-in-class, designed to, objective, guidance, pursue, or similar terms, or by express or implied discussions regarding potential drug candidates, potential indications for drug candidates or by discussions of strategy, plans, expectations or intentions. You should not place undue reliance on these statements. Such forward-looking statements are based on the current beliefs and expectations of management regarding future events, and are subject to significant known and unknown risks and uncertainties. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those set forth in the forward-looking statements. There can be no guarantee that any of our drug candidates will be approved for sale in any market, or that any approvals which are obtained will be obtained at any particular time, or that any such drug candidates will achieve any particular revenue or net income levels. In particular, management's expectations could be affected by, among other things: unexpected regulatory actions or delays or government regulation generally; the uncertainties inherent in research and development, including the inability to meet our key study assumptions regarding enrollment rates, timing and availability of subjects meeting a study's inclusion and exclusion criteria and funding requirements, changes to clinical protocols, unexpected adverse events or safety, quality or manufacturing issues; the inability of a drug candidate to meet the primary or secondary endpoint of a study; the impact of the COVID-19 pandemic or other health crises in China or globally; the inability of a drug candidate to obtain regulatory approval in different jurisdictions or gain commercial acceptance after obtaining regulatory approval; global trends toward health care cost containment, including ongoing pricing pressures; uncertainties regarding actual or potential legal proceedings, including, among others, actual or potential product liability litigation, litigation and investigations regarding sales and marketing practices, intellectual property disputes, and government investigations generally; and general economic and industry conditions, including uncertainties regarding the effects of the persistently weak economic and financial environment in many countries and uncertainties regarding future global exchange rates. For further discussion of these and other risks, see Chi-Med's filings with the U.S. Securities and Exchange Commission and on AIM. Chi-Med is providing the information in this announcement as of this date and does not undertake any obligation to update any forward-looking statements as a result of new information, future events or otherwise.
In addition, this announcement contains statistical data and estimates that Chi-Med obtained from industry publications and reports generated by third-party market research firms. Although Chi-Med believes that the publications, reports and surveys are reliable, Chi-Med has not independently verified the data and cannot guarantee the accuracy or completeness of such data. You are cautioned not to give undue weight to this data. Such data involves risks and uncertainties and are subject to change based on various factors, including those discussed above.
This announcement contains inside information for the purposes of Article 7 of Regulation (EU) No 596/2014.
Chi-Med Group revenue for the six months ended June 30, 2020 was $106.8 million (H1-19: $102.2m). Revenue from the Commercial Platform increased to $99.0 million (H1-19: $94.9m) driven mainly by our Prescription Drugs business which included manufacturing revenue and royalties from the commercial sale of Elunate as well as increased sales by our Hutchison Sinopharm business. Revenue from the Innovation Platform was $7.8 million in the first half of 2020 (H1-19: $7.3m).
Group revenues do not include the revenues of our two large-scale, 50/50 joint ventures in China, SHPL46 (Prescription Drugs) and HBYS (Consumer Health), since these are accounted for using the equity method.
In the first half of 2020, our Commercial Platform, which is a material source of profit and cash flow for Chi-Med, recorded a segment operating profit of $37.3 million (H1-19: $34.1m). Profit growth was primarily driven by the strong performance of SHPL, which effectively navigated challenges from COVID-19 and the discontinuation of distribution rights for Seroquel in May 2019. Increased manufacturing revenue and royalties from Elunate also contributed, while the weakening of the RMB against the U.S. dollar in the first half of 2020 reduced the operating profit of our Commercial Platform in U.S. dollar terms by about 5%.
The Innovation Platform incurred a segment operating loss of $73.4 million47 (H1-19: operating loss of $67.2m) as a result of the expansion of discovery activities, clinical pipeline development and related organizational growth.
Net corporate unallocated operating loss, primarily Chi-Med Group overhead and operating costs, increased to $9.7 million (H1-19: $7.3m) mainly due to expanded administrative expenses and a lower level of interest income as a result of the decline in market interest rates.
Consequently, Chi-Med Group's operating loss was $45.7 million (H1-19: operating loss of $40.3m).
The aggregate of interest and income tax expenses of the Chi-Med Group, as well as net income attributable to non-controlling interests was $4.0 million (H1-19: $5.0m).
The resulting total Group net loss attributable to Chi-Med was $49.7 million (H1-19: net loss of $45.4m).
As a result, Group net loss attributable to Chi-Med in the first half of 2020 was $0.07 per ordinary share / $0.36 per American depositary share, which was unchanged from the first half of 2019.
Cash inflows from our Commercial Platform, as well as our R&D collaborations with AstraZeneca and Lilly, offset a material portion of our R&D expense. As a result, total Chi-Med Adjusted (non-GAAP) Group net cash flows excluding financing activities was -$32.5 million (H1-19: -$34.2m) despite the aforementioned $73.4 million Innovation Platform segment operating loss.
The Chi-Med Group held cash, cash equivalents and short-term investments of $281.0 million as of June 30, 2020 (December 31, 2019: $217.2m). Subsequently, in early July 2020, we completed a private placement with General Atlantic raising an additional $100.0 million in gross proceeds, to further strengthen our cash position.
Outstanding Chi-Med Group level bank loans as of June 30, 2020 amounted to $26.8 million (December 31, 2019: $26.8m) and additional unutilized bank facilities available to the Group totaled $119.3 million (December 31, 2019: $119.3m).
The primary source of cash to the Chi-Med Group from our Commercial Platform are dividends from our two non-consolidated Commercial Platform joint ventures, SHPL and HBYS. During the first half of 2020, the Chi-Med Group received dividends of $35.3 million (H1-19: $18.2m) from SHPL and HBYS. As of June 30, 2020, SHPL and HBYS held $103.3 million (December 31, 2019: $62.7m) in cash and cash equivalents with no outstanding bank loans.
We are an innovative, commercial-stage biopharmaceutical company based in China aiming to become a fully integrated global leader in the discovery, development and commercialization of targeted therapies and immunotherapies for the treatment of cancer and immunological diseases.
Our Innovation Platform is a comprehensive drug discovery and development operation, with a large team of about 550 scientists and staff (December 31, 2019: ~500) in China and at our international operation in New Jersey. Currently, we have nine self-discovered drug candidates in clinical trials, with five in global clinical development.
PRODUCT PIPELINE PROGRESS
Savolitinib is an oral, potent, and highly selective small molecule inhibitor of MET, a receptor tyrosine kinase which has been shown to function abnormally in many types of solid tumors promoting tumor growth, angiogenesis, and metastasis. In global partnership with AstraZeneca, savolitinib has been studied in over 1,000 patients to date, both as a monotherapy and in combinations. In clinical studies it has shown promising clinical efficacy in patients with MET gene alterations in multiple tumor types with an acceptable safety profile.
Savolitinib Lung cancer:
MET is a prime target in NSCLC. The table below shows a summary of the clinical studies for savolitinib in lung cancer patients.
| Treatment | Name, Line, Patient Focus | Sites | Phase | Status/Plan | NCT # | |||||
| Savolitinib | MET Exon 14 skipping | China | II Registration | NDA accepted | NCT02897479 | |||||
| Savolitinib | MET Exon 14 skipping | Global | Registration | In planning | N/A | |||||
| Savolitinib + Tagrisso | SAVANNAH: 2L/3L EGFRm+; Tagrisso refractory; MET+ | Global | II Registration potential | Enrolling | NCT03778229 | |||||
| Savolitinib + Tagrisso | 2L/3L EGFRm+; Tagrisso refractory; MET+ | Global | III | In planning | N/A |
NDA accepted in MET Exon 14 skipping mutation NSCLC (NCT02897479) It is estimated that 2-3% of NSCLC patients have MET Exon 14 skipping mutation, which leads to poor prognosis. In late 2019, we completed a 70 patient Phase II registration study that formed the basis for NDA which was accepted by the China NMPA in May 2020.
Results of the Phase II study were presented at ASCO in June 2020 and showed that as of the March 31, 2020 data cut off, ORR was 49.2% and DCR was 93.4% in 61 efficacy evaluable patients. Median DoR was 9.6 months (95% confidence interval [ CI ] 5.5 not reached [ NR ]) with maturity of 40%. Median PFS was 6.9 months (95% CI 4.2 19.3) with maturity of 50%. Median OS was 14.0 months (95% CI: 9.7 NR) with maturity of 46%. A total of 36% of patients in the Phase II study harbored pulmonary sarcomatoid carcinoma with Exon 14 skipping mutation, a particularly aggressive sub-type of NSCLC. Treatment na ve patients accounted for 40% of the treated patients (mostly those unfit to receive first line chemotherapy) while the remainder had received prior treatments. Clinical data demonstrated an acceptable safety profile with a low adverse event ( AE ) related discontinuations rate of 14.3%.
AstraZeneca and Chi-Med continue to explore the global development pathway for savolitinib in MET Exon 14 skipping mutation NSCLC.
EGFR48 TKI-resistance in NSCLC MET-amplification is a major mechanism for acquired resistance to both first generation EGFR TKIs, such as Iressa and Tarceva , as well as third-generation EGFR TKIs like Tagrisso , an EGFR TKI owned by AstraZeneca. As many as 30% of EGFR mutation positive NSCLC patients develop MET amplification driven resistance to EGFR TKIs. During the past three years, savolitinib has been studied extensively in these patients in the TATTON and SAVANNAH studies, and meeting their needs represents our major focus.
SAVANNAH Phase II study of combination with Tagrisso in patients who have progressed following Tagrisso due to MET amplification or overexpression (NCT03778229) The SAVANNAH study is a single-arm, open-label study, with the potential for registration, enrolling in North and South America, Europe and Asia. SAVANNAH followed the successful TATTON study, a Phase Ib/II expansion study of savolitinib in combination with Tagrisso in over 220 EGFR mutation positive TKI refractory NSCLC patients, with data presented at both AACR and ESMO Asia in 2019 and published in The Lancet Oncology this year.
In late July 2020, AstraZeneca and Chi-Med conducted a first internal interim analysis for SAVANNAH, and review of early safety and efficacy data is ongoing.
Savolitinib Kidney cancer:
MET is a clear genetic driver in RCC49. The table below shows a summary of the clinical studies for savolitinib in kidney cancer patients.
| Treatment | Name, Line, Patient Focus | Sites | Phase | Status/Plan | NCT # | |||||
| Savolitinib monotherapy | MET-driven PRCC | Global | III | In planning | N/A | |||||
| Savolitinib + Imfinzi | CALYPSO: PRCC | UK/Spain | II | Interim data ASCO GU 2020 | NCT02819596 | |||||
| Savolitinib + Imfinzi | CALYPSO: Clear cell RCC; VEGFR TKI 50 refractory | UK/Spain | II | Enrolling - Data in 2020 | NCT02819596 |
MET+ Papillary Renal Cell Carcinoma ( PRCC ) PRCC is the most common of the non-clear cell renal cell carcinomas, representing approximately 14% of kidney cancer. Approximately 400,000 new cases of kidney cancer were diagnosed globally in 2018, equating to about 56,500 cases of PRCC, with approximately half harboring MET driven disease. No targeted therapies have been approved specifically for PRCC.
SAVOIR Phase III in MET-positive PRCC (NCT03091192) In late 2018, the SAVOIR study, a global Phase III study of savolitinib monotherapy compared with sunitinib in patients with MET-driven PRCC, was stopped due to confounding results from a separate, external, retrospective observational study.
Results from 60 randomized patients (33 savolitinib, 27 sunitinib) were followed through August 19, 2019 with data presented at ASCO in May 2020. Although patient numbers and follow-up were limited, trends in efficacy were promising. In terms of OS, savolitinib patients had not reached median OS at data cut-off, compared to 13.2 months for sunitinib patients (HR51 0.51; 95% CI: 0.21 1.17; p=0.110). Median PFS was 7.0 months for savolitinib patients, compared to 5.6 for sunitinib patients (HR 0.71; 95% CI 0.37 1.36; p=0.313). Responses were observed in 27% and 7% of savolitinib and sunitinib patients, respectively. This difference did not reach statistical significance due to the small sample size. None of the 9 responders on savolitinib treatment experienced disease progression as of data cut-off, compared to 1 of 2 responders on sunitinib treatment. Sunitinib response rate was in range with previous studies. In terms of safety, Grade 3 AEs were reported in 42% of savolitinib patients versus 81% of sunitinib patients, with AEs leading to dose modification in 30% and 74% of savolitinib and sunitinib patients, respectively.
Based on these data, Chi-Med and AstraZeneca are actively evaluating the opportunity to restart clinical work in PRCC for monotherapy savolitinib.
Savolitinib and Immunotherapy Combinations Major evidence is emerging demonstrating that MET plays an important role in the tumor microenvironment, leading to reduced anti-tumor activity of immune cells in many solid tumors. Therefore, combining immunotherapies with a MET inhibitor is hypothesized to enhance anti-tumor activity. Chi-Med and AstraZeneca, as well as others, are currently conducting several clinical studies of anti-PD-1/PD-L1 antibodies in combination with MET inhibitors aimed at validating this hypothesis.
CALYPSO Phase II in combination with Imfinzi PD-L1 inhibitor in RCC (NCT02819596) The CALYPSO study is an investigator initiated open-label Phase I/II study of savolitinib in combination with Imfinzi , an anti-PD-L1 antibody owned by AstraZeneca. The study is evaluating the safety and efficacy of the savolitinib/Imfinzi combination in patients with PRCC and clear cell RCC at sites in the U.K. and Spain.
CALYPSO PRCC cohort Interim data for the PRCC cohort of the CALYPSO Phase II study were presented at ASCO GU 2020 reporting an ORR of 27%, median PFS of 4.9 months (95% CI: 2.5, 12.0) and median OS of 12.3 months (95% CI: 5.8, 21.3). Tolerability was in line with established single agent safety profiles. Chi-Med and AstraZeneca continue to accumulate clinical data and explore development in PRCC, and possibly other tumor types, for the savolitinib and Imfinzi combination.
Savolitinib Gastric cancer:
MET-driven gastric cancer has a very poor prognosis. Multiple Phase II studies have been conducted in Asia to study savolitinib in MET-driven gastric cancer patients. The VIKTORY study is an investigator initiated Phase II umbrella study in gastric cancer in South Korea in which a total of 715 patients were successfully sequenced into 10 molecular-driven patient groups. Patients with MET amplification (25/715, or 3.5% of patients) were treated with savolitinib monotherapy, reporting an ORR of 50% (10/20, 95% CI: 28.0, 71.9) and meeting pre-specified 6-week PFS rates. The investigators of VIKTORY have concluded that encouraging clinical efficacy of savolitinib in MET-amplified gastric cancer warrants further study.
Surufatinib is a novel, oral angio-immuno kinase inhibitor that selectively inhibits the tyrosine kinase activity associated with VEGFR52 and FGFR, both shown to be involved in tumor angiogenesis, and CSF-1R53, which plays a key role in regulating tumor-associated macrophages, promoting the body's immune response against tumor cells. Surufatinib has been studied in over 800 patients to date, both as a monotherapy and in combinations.
Chi-Med currently retains all rights to surufatinib worldwide. A summary of the clinical studies of surufatinib is shown in the table below.
| Treatment | Name, Line, Patient Focus | Sites | Phase | Status/Plan | NCT # | |||||
| Surufatinib monotherapy | SANET-ep: Non-pancreatic NET | China | III | Met primary endpoint; NDA accepted | NCT02588170 | |||||
| Surufatinib monotherapy | SANET-p: Pancreatic NET | China | III | Met primary endpoint; NDA submitted; acceptance imminent | NCT02589821 | |||||
| Surufatinib monotherapy | NETs | US/EU/JP | Ib | To file US rolling NDA starting Q4 2020 | NCT02549937 | |||||
| Surufatinib monotherapy | BTC and soft tissue sarcoma | US | Ib | Enrolling | NCT02549937 | |||||
| Surufatinib monotherapy | Chemotherapy refractory BTC | China | IIb/III | Enrolling | NCT03873532 | |||||
| Surufatinib + Tuoyi (PD-1) | Solid tumors (eight indications) | China | II | Enrolling | NCT04169672 | |||||
| Surufatinib + Tyvyt (PD-1) | Solid tumors | China | I | Enrolling | NCT04427774 | |||||
| Surufatinib + tislelizumab (PD-1) | Solid tumors | Global | I | In planning | N/A |
Surufatinib Neuroendocrine Tumors (NET):
NETs present in the body's organ system with fragmented epidemiology. About 55-75% of NETs originate in the gastrointestinal ( GI ) tract and pancreas, 25-30% in the lung or bronchus, and a further 10-20% in other organs or unknown origins.
Global development of surufatinib in NET In June 2020, we held a pre-NDA meeting with the U.S. FDA for the treatment of patients with advanced NET and have reached an agreement that the completed SANET-ep (non-pancreatic NET) and SANET-p (pancreatic NET) studies, along with existing data from surufatinib in U.S. non-pancreatic and pancreatic NET patients, could form the basis to support a U.S. NDA submission.
The FDA granted Fast Track Designations for our pancreatic and non-pancreatic NET development programs in April 2020, following Orphan Drug Designation for pancreatic NET in November 2019. We have initiated preparatory work for the U.S. NDA and intend to utilize a rolling submission under Fast Track Designation status. The rolling NDA allows completed portions of an NDA to be submitted and reviewed by the FDA on an ongoing basis. The planned initial NDA submission is late 2020.
Regulatory interactions in Europe are also underway to confirm the clinical development strategy and potential path to registration with MAA submission targeted for 2021.
U.S. Phase Ib NET cohorts (NCT02549937) At ASCO 2020, preliminary data presented from the two NET cohorts in the ongoing U.S. Phase Ib trial for surufatinib demonstrated efficacy comparable to China data in heavily pretreated patients with pancreatic or non-pancreatic NETs. The safety profile is also consistent with the larger pool of surufatinib safety data. As of April 21, 2020, 16 patients with pancreatic NET were treated for a median of 7.1 months (range 2.0-17.5) and 16 patients with non-pancreatic NET were treated for a median of 4.9 months (range of 1.0-10.2). All 32 patients have pretreated progressive NETs (median prior lines of treatment: 3; range 1-8). Confirmed response was observed in 18.8% of pancreatic NET patients; all remaining patients had stable disease (including 1 unconfirmed response), for a DCR of 100%. In the non-pancreatic NET cohort all patients had stable disease (including 1 unconfirmed response). The study is ongoing.
Pharmacokinetic and safety data from these cohorts was presented at AACR 2020, demonstrating similar profiles of surufatinib between Chinese and U.S. patients, meaning that race had minimal effect on exposure.
Phase III study of surufatinib in non-pancreatic NET (SANET-ep) (NCT02588170) In late 2019, an NDA for surufatinib for the treatment of patients with advanced non-pancreatic NET was accepted for review by the China NMPA. The NDA is supported by data from the SANET-ep study, a Phase III study in China in patients with grade 1 and 2 advanced non-pancreatic NET.
A 198-patient interim analysis was conducted on SANET-ep in mid-2019, leading the IDMC to determine that the trial had met the pre-defined primary endpoint of PFS and should be stopped early. The positive results of this trial were highlighted in an oral presentation at the 2019 ESMO Congress. Median PFS per investigator assessment was 9.2 months for patients treated with surufatinib, as compared to 3.8 months for patients in the placebo group (HR 0.334; 95% CI: 0.223, 0.499; p<0.0001). Efficacy was also supported by Blinded Independent Image Review Committee assessment. Surufatinib was well-tolerated in this study and the safety profile is consistent with observations in prior clinical studies.
In late 2019, the China NMPA granted Priority Review status to the NDA for surufatinib in non-pancreatic NET.
Phase III study of surufatinib in pancreatic NET (SANET-p) (NCT02589821) In early 2020, an interim analysis was conducted on SANET-p, also leading the IDMC to recommend that the study stop early as the pre-defined primary endpoint of PFS had been met. Following the success of SANET-p, we submitted our NDA to the China NMPA and are now awaiting formal acceptance. The results of this study will be presented at ESMO 2020.
The positive SANET-ep and SANET-p Phase III studies now position surufatinib to potentially be approved in the full spectrum of advanced-NET disease in China. We believe that no other approved targeted therapy can address and treat all subtypes of NETs.
Surufatinib Biliary Tract Cancer (BTC):
Phase IIb/III study of surufatinib monotherapy in second line BTC (NCT03873532) In early 2019, based on preliminary Phase Ib/IIa data, we initiated a registration-intent Phase IIb/III study comparing surufatinib with capecitabine in patients with unresectable or metastatic BTC whose disease progressed on first-line chemotherapy. The primary endpoint is OS and we expect to conduct an interim analysis for futility in 2020. If the interim analysis is positive, we will consider moving the study into Phase III.
Surufatinib Combinations with Checkpoint Inhibitors:
Surufatinib's ability to inhibit angiogenesis, block the accumulation of tumor associated macrophages and promote infiltration of effector T cells into tumors, could help improve the anti-tumor activity of PD-1 antibodies.
In late 2018, we entered into a global collaboration with Junshi to evaluate the combination of surufatinib with Tuoyi (PD-1). We have completed a Phase I dose-finding study and presented the data at the AACR in April 2020. The data showed that surufatinib plus Tuoyi were well tolerated with no unexpected safety signals observed. At the RP2D, a DCR of 100% and ORR of 63.6% were reported for 11 efficacy evaluable patients, with 2 unconfirmed PRs54. Surufatinib plus Tuoyi showed encouraging antitumor activity in patients with advanced solid tumors, especially in neuroendocrine neoplasms (NENs) patients. A Phase II study is already enrolling patients in eight solid tumor indications in China.
In addition, we have expanded our global collaboration with Innovent and, in July 2020, started a Phase I study to evaluate the safety and efficacy of Tyvyt (PD-1) in combination with surufatinib. In May 2020, we further entered into a global clinical collaboration agreement to evaluate combining surufatinib with BeiGene's anti-PD-1 antibody, tislelizumab, for the treatment of various solid tumor cancers in the United States.