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Evaluate Pharma 52 Financial Summary Summary Statement of Operations (In thousands, except per share data) Three Months Ended March 31, 2015 Revenue $ Operating expenses 20,360 Other income (expenses) (210) Net loss $ (20,570) Net loss per share 1 $ (0.70) Condensed Balance Sheet Data (In thousands) March 31, 2015 Cash and cash equivalents $ 55,556 Total assets $ 59,627 Total stockholders equity $ 48,001 1 Based on 29.4 million weighted average common shares outstanding for the period ended March 31, 2015
I think the long acting local anesthetics have great promise in the future. General surgeon Source: Decision Resources Post Operative Pain Physician Research Initiative 2014 (N=30 qualitative interviews; N=184 quantitative survey) 10% 7% 5% 9% 6% 6% 5% 2% 7% 6% 7% 5% 3% 7% 3% 53% 60% 45% 62% 58% 58% 66% 44% 60% 60% 50% 41% 49% 47% 49% 37% 33% 49% 29% 36% 37% 28% 53% 34% 35% 43% 54% 48% 46% 48% 0% 20% 40% 60% 80% 100% Cesarean Section Cholecystectomy (outpatient) Arthroplasty knee (outpatient) Other non OR therapeutic procedures on musculoskeletal Treatment, fracture or dislocation of hip and femur (inpatient) Other fracture and dislocation procedure Repair of toe Arthroplasty shoulder Other therapeutic procedures on muscles and tendons Cholecystectomy (inpatient) Arthroplasty other than hip, knee, shoulder, or elbow Hernia (outpatient) Hip replacement, total and partial Hernia (inpatient) Arthroplasty knee (inpatient) Less frequently Same amount More frequently HTX 003 LONG ACTING BUPRENORPHINE FOR CHRONIC PAIN AND ADDICTION 49 30 Day Buprenorphine Comparison to Competitive Products in Development* RB Pharma is from US2013/0210853; Camurus data from US2013/0190341 Repeat Dose Model Therapeutic range *Prediction based on 15 mg dosed monthly 50 Excellent PK profile for once monthly dosing Cmax achieves steady state by second dose 51 Partnering Opportunity for Long Acting Buprenorphine Products Projected sales of products for opioid addiction to reach $3B by 2020 1 Recent deals for buprenorphine products show significant interest in the space: Titan license of Probuphine to Braeburn (12/17/2012) 6 month sub dermal implant for opioid addiction with NDA submitted $15.7M upfront, $180M milestones with double digit royalties Camarus license of CAM2038, long acting buprenorphine to Braeburn (11/20/2014) Phase 2 program for opioid addiction and pain, with exclusive rights for North America and option in Asia, Camurus retains ROW $20M upfront, $131M in milestones with mid teen royalty HTX 003 Target Product Profile 30 day zero order release of buprenorphine with single sub Q injection Low peak to trough variation allows for stable drug levels Administered by medical professional with very low potential for abuse by patients 1.
Adv Ther (2011) 28(9):776 788. POST OPERATIVE PAIN PROGRAM COMMERCIAL OPPORTUNITY 45 U.S. Post Operative Pain Market Source: Decision Resources, Post Operative Pain Pharmacor, May 2006; Decision Resources, Acute Pain, December 2012 Treatment options have remained stable over the past decade and new therapies are expected to be dominated by reformulations of existing molecules The total number of procedures is anticipated to increase 3% per year driven by aging population Unmet needs include longer acting local anesthetics, opioids with a more tolerable side effect profile and less addictive properties, and less invasive delivery mechanisms 2012 Post Op Pain Market (US only) 2021 Post Op Pain Market (US only) 2012 Total: $3.1B 2021 Total: $3.6B Strong opioid analgesics; 53% Simple analgesics; 11% Dual Acting Opioids; 9% Selective COX 2 inhibitors; 9% Local anesthetics; 9% Traditional NSAIDs; 9% Antiepileptic Drugs (AED); 1% Strong opioid analgesics; 51% Simple analgesics; 13% Dual Acting Opioids; 8% Selective COX 2 inhibitors; 5% Local anesthetics; 11% Traditional NSAIDs; 9% Antiepileptic Drugs (AED); 1% Novel Emerging Agents; 2% 46 72 hour Duration of Action Seen as Ideal by Physicians, With 48 hours Minimally Acceptable Ideal Duration of Efficacy for Long Acting Local Anesthetic Efficacy for Long Acting Local Anesthetic Source: Decision Resources Post Operative Pain Physician Research Initiative 2014 (N=30 qualitative interviews; N=184 quantitative survey) Minimally Acceptable Duration of 47 Across Procedures, Many MDs Expect the Use of Long Acting Local Anesthetics to Increase Use of Long Acting Local Anesthetics in the Future, by Procedure Percentage of physicians indicating how frequently they expect to use long acting local anesthetics in the future Minimizing opioid use by using long acting local anesthetics is the trend.
With a pKa of 8.1, bupivacaine is very sensitive to reduced pH Acidic Environment Shifts the Balance to Ionized Form Unable to Penetrate Nerve Cell Membrane Local anesthetic nerve penetration model adapted from Becker and Reed, Anesth Prog 53:98 109 2006 BUPH + BUPN + H + BUPH + BUPN + H + Nerve Cell Membrane HTX 011 Phase 1 Single Ascending Dose Study Cohort 1 100 mg HTX 011 (5 active:1 placebo) Min 7 day Observation Safety PK evaluation Min 7 day Observation Safety PK evaluation Randomized, Single Blind, Placebo Controlled 3 Single Rising Dose Cohorts 144 hr pharmacokinetic pharmacodynamic assessments Cohort 2 200 mg HTX 011 (5 active:1 placebo) Cohort 3 400 mg HTX 011 (5 active:1 placebo) 35 Design 36 Plasma Concentrations of Bupivacaine Observed with HTX 011 0 100 200 300 400 500 600 0 24 48 72 96 120 144 Hours HTX 011 100 mg HTX 011 200 mg HTX 011 400 mg 37 HTX 011 Provides Longer Duration of Bupivacaine Release without a Large Initial Peak * Exparel data extracted from FDA Clin Pharm review 38 Mechanical Detection Threshold Using von Frey Fibers *Combined placebo data from all cohorts 39 *Combined placebo data from all cohorts Pharmacodynamic Effects of HTX 011 Correlate with Pharmacokinetic Profile 40 Safety No serious adverse events or premature discontinuations No clinically relevant ECG changes No clinically relevant laboratory changes Only adverse events considered possibly related to drug were associated with the subcutaneous administration of the product: mild redness and bruising at some injection sites 41 Summary Initial Phase 1 experience validates target product profile for HTX 011 Desired pharmacokinetic profile for both bupivacaine and meloxicam achieved Strong pharmacodynamic activity that correlated with pharmacokinetic profile observed Rapid on set of action without a large, potentially negative initial peak 2 3 days of stable bupivacaine plasma levels correlated to 2 3 days of anesthetic effects All three doses were well tolerated Phase 1 results support immediate advancement into Phase 2 42 Next Steps for Post Operative Pain Program SAD evaluation to complete in 1Q15 Quickly initiate Phase 2 studies 2Q15 Bunionectomy study scheduled to start late 2Q Completing toxicology for nerve block and orthopedic indications to allow expansion of program 43 Phase 3 Trial of Exparel in Bunionectomy Michael Golf, et. al.
Study #1; All studies used the post operative pain model in pigs from Castle et al, 2013 EPJ Pig Post Operative Pain Model (n=4 pigs, except at 120 hrs for Study #2: preliminary results from 2 animals) 2. Study #2 compared expected human dose of Biochronomer bupivacaine/meloxicam formulation to the human dose of EXPAREL (40% smaller incision used with EXPAREL) 31 32 HTX 011 Shows Durable Response in Sciatic Nerve Block Model in Pigs 33 Local Anesthetics Exist in a Balance Between Water Soluble and Lipid Soluble Forms Local anesthetics have pKa values 7.4, so at normal physiologic pH of 7.4, the majority of molecules exist as the water soluble quaternary salt not able to penetrate nerve cell membrane Water Soluble Ionized Form Lipid Soluble Un Ionized Form Local anesthetic nerve penetration model adapted from Becker and Reed, Anesth Prog 53:98 109 2006 BUPH + BUPN + H + BUPH + BUPN + H + Nerve Cell Membrane 34 Local Anesthetics Exist in a Balance Between Water Soluble and Lipid Soluble Forms The acidic environment associated with inflammation shifts the balance further to the left, resulting in far less drug penetrating the nerve membrane and reduced anesthetic effects.
(oral) Rolapitant?? (IV) 2017 2018 2019 fosaprepitant patent expiry palonosetron patent expiry 27 SUSTOL would be the first and only injectable 5 HT 3 indicated for acute and delayed CINV in both MEC and HEC favored by more than 50% of oncologists Attribute Favor IV Aloxi (1 2) No Preference (3) Favor SUSTOL (4 5) Avg. (N=66) Effective for prevention of delayed CINV in assoc. with HEC 3.65 Is long acting, with an extended PK profile 3.62 Provides consistently durable efficacy for over 5 full days 3.53 Effective for prevention of delayed CINV in assoc. with MEC 3.48 Has low rates of breakthrough CINV 3.47 Minimizes amount of rescue medication required 3.44 Demonstrates sustained efficacy over multiple chemo cycles 3.44 Effective for prevention of acute CINV in assoc. with HEC 3.32 Well tolerated, with a low risk of side effects 3.32 Effective for prevention of acute CINV in assoc. with MEC 3.27 MD PMR Q29: Please rate the extent to which you favor SUSTOL versus IV Aloxi (palonosetron) on each of the following attributes using a 5 point scale, where 1= Strongly favor IV Aloxi (palonosetron) over SUSTOL and 5 = Strongly favor SUSTOL over IV Aloxi (palonosetron) [SS] HEC Regimens Represent a Significant Market Opportunity for SUSTOL and HTX 019 Source: IntrinsiQ data from July 2012 June 2013 HEC Regimens Account For ~20% (500K) of Palonosetron Administrations Of All HEC Administrations, ~20% Are Given Without Concomitant IV 5 HT 3 Inconsistent With Clinical Guidelines 497,256 1,463,558 451,490 111,696 200,000 400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 HEC MEC LEC Minimal 200,000 400,000 600,000 800,000 1,000,000 1,200,000 Annual HEC administrations Untreated with IV 5HT3 Treated with generic IV 5HT3 Treated with Aloxi 317,915 188,988 497,256 28 POST OPERATIVE PAIN PROGRAM 30 Heron Post Operative Pain Program Target Product Profile for Best in Class Product: An injectable pain therapeutic that utilizes proprietary Biochronomer polymer based drug delivery platform technology Designed to deliver both bupivacaine (anesthetic) and meloxicam (anti inflammatory) evenly over 2 3 days without a large initial peak HTX 011 builds on other innovations in the category and has best in class potential Introducing HTX 011: Maximal pain relief that lasts for 2 3 days Maximal reduction of opioid use Maximal reduction of length of hospital stay Elimination of dose limiting peak of bupivacaine Easy to use for a large variety of procedures Does not require refrigeration or special handling 31 HTX 011 Significantly Superior to EXPAREL at 24 72 Hours 1.
IV EMEND based on polysorbate 80 free formulation Leverage a highly synergistic CINV portfolio to maximize return on investment ~600 practices account for ~90% of both Aloxi and IV EMEND use in clinic segment SUSTOL targeted practices are the highest users of IV EMEND Highly leveraged cost effective commercial footprint 3 3 25 Heron has the opportunity to establish a long term, dominant position in a CINV market that has over 3.6M penetrable units Q2'13 Q4'13 Injectable Drugs for the Prevention of CINV Number of Package Units Sold by Quarter ALOXI ANZEMET KYTRIL KYTRIL Generic (GRANISETRON) ZOFRAN ZOFRAN Generic (ONDANSETRON) EMEND 800,000 0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 Q2'06 Q4'06 Q2'07 Q4'07 Q2'08 Q4'08 Q2'09 Q4'09 Q2'10 Q4'10 Q2'11 Q4'11 Q2'12 Q4'12 Aloxi EMEND Data is Package Units; Ondansetron units reflect only 2 mg/ml and 32mg/50 ml strength sizes 26 New branded, injectable agents will be well positioned to gain significant share as current market leaders (Aloxi, EMEND) lose patent protection Candidate Class Indication Sponsor Possible Launch AKYNZEO Oral FDC combines netupitant (NK 1 ) with palonosetron (5HT 3 ) Prevention of CINV in MEC/HEC Eisai / Helsinn Launched Q4 2014 Generic palonosetron IV 5 HT 3 MEC acute delayed CINV HEC acute CINV TBD (multiple) Oct 13, 2015 Ongoing litigation Rolapitant Oral / IV NK 1 Prevention of delayed onset CINV in MEC/HEC (to be used in combination with 5 HT 3 ) Tesaro Oral mid 2015 IV Q3 2016 Generic fosaprepitant IV NK 1 Prevention of CINV in MEC/HEC (to be used in combination with 5 HT 3 ) TBD (multiple) Q1 2019 2014 2015 2016 AKYNZEO (oral) Rolapitant??
HTX 019 is polysorbate 80 free and may avoid some of these adverse reactions. Product should receive a unique J code and compete directly with EMEND IV (fosaprepitant) Rapid development utilizing the 505(b)(2) registration pathway is anticipated to achieve NDA submission in 2H2016 based on bioequivalence (to be discussed with FDA) 1. LA Norris, et al. 2010 COMMUNITY ONCOLOGY; Polysorbate 80 hypersensitivity reactions: a renewed call to action 1 1 CINV FRANCHISE COMMERCIAL OPPORTUNITY 24 Commercial Opportunity Summary Market Heron has the opportunity to establish a long term, dominant position in a CINV market targeting 3.6M units of IV 5 HT 3 and NK 1 annually The NK 1 market grew 10% YOY in 2013 with significant opportunity for increased penetration into MEC regimens Competitive Landscape New branded, injectable agents will be well positioned to gain significant share as current market leaders (Aloxi, EMEND) lose patent protection SUSTOL positioned to be the only branded injectable 5 HT on the market following Aloxi s patent expiry in 2015 HTX 019 anticipated to be similarly positioned following EMEND s patent expiry in 2019 Go To Market Strategies Differentiate SUSTOL and HTX 019 clinically to drive uptake SUSTOL targeted to be the first and only injectable 5 HT indicated for the prevention of acute and delayed CINV in both MEC and HEC HTX 019 has potential to differentiate vs.
NK receptor antagonists are recommended to be used in combination with 5 HT 3 receptor antagonists for prevention of CINV Primary Composition of Matter patent protection of aprepitant expired April 2015 Secondary patent on polymorpic form not relevant to intravenous formulation The other commercially available IV NK 1 receptor antagonist contains polysorbate 80, which has been shown to cause infusion site reactions, hypersensitivity and other reactions in some patients .
All subjects will receive dexamethasone 12 mg IV on day 1 and 8 mg PO BID on days 2 4 2. All subjects will be allowed to receive rescue medications as required at the discretion of their treating physician HEC agents as defined in the 2011 ASCO CINV guidelines. Superiority design assuming a CR rate of 65% in the control (ondansetron) arm, a binary endpoint (CR or no CR), a 2 sided alpha = 0.05 to test 65% vs 75%; for 90% power you need 880 evaluable patients 15 16 New SUSTOL Study Strategically Designed Based on Previous Results ^^Average Complete Response rate improvement adding NK 1 RA to 5 HT 3 RA and Dexamethasone is ~15 20% in the delayed HEC Poll Bigelli; Cancer, 97:12, 3090, 2003 Projection of what would happen with a 20% increased response by addition of fosaprepitant to Sustol + Dex Projected Response with addition of NK 1 ^^ Study powered to show 10% difference: 65% vs 75% APF530 + Dex + Fosaprepitant APF530+Dex Ondansetron + Dex + Fosaprepitant Ondansetron + Dex Standard of Care Phase 3 Study HEC Study 67% 65% 45% Study powered for a 10% difference between arms 20% difference is expected with the addition of fosaprepitant, 75% 87% 0 10 20 30 40 50 60 70 80 90 100 17 HEC Study Update Enrollment closed end of March 2015, with over 900 patients enrolled NDA resubmission at mid year 2015 FDA has previously indicated that a positive outcome from this study would be sufficient to obtain delayed HEC indication 18 SUSTOL Has the Potential to be the Next Generation 5 HT 3 Receptor Antagonist 5 HT 3 RAs 1 st generation 2 nd generation 3 rd generation Products ondansetron granisetron palonosetron SUSTOL Duration of action Short acting ~ 8 hr half life Longer acting ~40 hr half life Long acting PK profile 5 7 days Indications Prevention of CINV in emetogenic chemo including high dose cisplatin MEC acute delayed CINV HEC acute CINV MEC acute delayed CINV HEC acute delayed CINV* *Obtaining delayed HEC dependent on results of ongoing SUSTOL trial SUSTOL REGULATORY STATUS 20 SUSTOL NDA Status NDA resubmitted in September 2012 CMC: correction of PAI issues and revision of one in vitro release method Requirement for Human Factors Validation Study with commercial product Re analysis of the existing Phase 3 study using the ASCO 2011 guidelines for categorization of MEC and HEC Received Complete Response Letter March 2013 raising three main issues: 21 How We Are Addressing the CRL Chemistry, Manufacturing, and Controls Sites with PAI issues have been eliminated from the supply chain, with work transferred to a well established site with no PAI issues Transition is complete, with secondary benefit of improvement in the COGS New in vitro release method has been developed and validated Multiple validation batches of finished product have now been completed Human Factors Validation Study Successfully completed Re analysis of Phase 3 using new ASCO 2011 Guidelines Re analysis complete Complete dataset and programs supplied to FDA and found acceptable NDA resubmission expected mid year 2015 22 HTX 019: Aprepitant IV HTX 019 is a proprietary IV formulation of aprepitant, an NK 1 receptor antagonist.
Not statistically significant. Highlighted HEC regimens were considered HEC in both protocol specified Hesketh and 2011 ASCO Guidelines 12 1 13 Response Rates With Chemotherapy Classified as HEC by Both Hesketh and 2011 ASCO* Cisplatin, carmustine, dacarbazine, dactinomycin, mechlorethamine, streptozotocin SUSTOL reflects 9 11% greater response rate in the most emetogenic chemotherapy 14 A Delayed HEC Indication Would Provide Clear Differentiation in an Important Segment of the CINV Market 1 IntrinsiQ data from July 2012 June 2013 14 HEC regimens account for ~20% (500K) of palonosetron administrations This is the same segment of the CINV market where NK receptor antagonists are extensively used Distribution of Aloxi Sales HEC Minimal LEC MEC 1 1 15 Phase 3 MAGIC Study 900 patients received HEC randomized 1:1 Ondansetron 0.15 mg/kg IV (up to 16 mg IV) d 1 + fosaprepitant 150 mg IV d 1 + DEX + placebo SC d1 APF530 500 mg SC d 1 + fosaprepitant 150 mg IV d 1 + DEX + placebo IV d 1 Cycle 1 1.
Rapid development utilizing the 505(b)(2) registration pathway is anticipated to achieve NDA submission in 2H2016 6 5 Day Profile: APF530 Pharmacokinetics Granisetron is released rapidly following injection of APF530 and continues to be released for 5 days, providing long acting coverage for CINV Data from patent application 20120258164 for transdermal granisetron 0 5 10 15 20 0 24 48 72 96 120 144 168 Time after Dosing (h) All subjects (n= 18) mean SEM Minimum therapeutic concentration of granisetron 7 SUSTOL Pivotal Phase 3 Study Overview Randomized, controlled, multi center study 1,341 patients in primary efficacy population Two doses of APF530 (5 mg and 10 mg granisetron) compared to the approved dose of Aloxi (results from 10 mg dose group presented) Patients stratified by type of chemotherapy regimen: MEC or HEC Primary end point compared complete response between groups in both the acute (day 1) and delayed (days 2 5) phase Complete response defined as no emesis and no rescue medications 15% margin used to establish non inferiority 8 Primary Efficacy Results: Complete Response Patients Receiving Moderately Emetogenic Chemotherapy + Acute Delayed APF530 10mg Acute Delayed Difference in Complete Response APF530 Aloxi (97.5% CI) 15 10 5 0 5 10 15 9 Primary Efficacy Results: Complete Response Patients Receiving Highly Emetogenic Chemotherapy Difference in Complete Response APF530 Aloxi (98.33% CI) 15 10 5 0 5 10 15 Acute Delayed APF530 10mg Acute Delayed + 10 Safety Summary 1 Safety results with the 5 mg dose of APF530 studied in separate arm of the phase 3 study are not included 2 90% of injection site reactions were reported as mild; one patient discontinued due to injection site reaction Cycle 1 Safety Results APF530 10 mg 1 Aloxi 0.25 mg N % N % Drug Related Serious Adverse Events 0 0 0 0 Discontinued Due to Adverse Event 1 0.2 0 0 Frequent Adverse Events Gastrointestinal Disorders Constipation Diarrhea Abdominal pain 72 44 13 15.4 9.4 2.8 62 39 28 13.4 8.4 6.0 Nervous System Headache 47 10.0 45 9.7 Injection Site 2 Placebo (NaCl) Bruising Erythema (redness) Nodule (lump) Pain 93 51 50 33 19.91 0.9 10.7 7.1 41 14 3 5 8.9 3.0 0.6 1.1 11 FDA Requested ASCO 2011 Reanalysis Improves Difference Between SUSTOL and Aloxi in HEC Patients Protocol Specified HEC Population ASCO 2011 Guideline HEC Population Acute Delayed Acute Delayed 12 CR Rates by Treatment Chemotherapeutic Regimen APF530 10 mg Aloxi 0.25 mg Moderately Emetogenic Acute Cyclophosphamide/Doxorubicin 70.7% 65.7% All other regimens 84.4% 85.0% Delayed Cyclophosphamide/Doxorubicin 47.4% 46.3% All other regimens 72.9% 70.0% Highly Emetogenic Acute Cisplatin regimens 81.1% 75.5% Carboplatin/Paclitaxel 85.4% 89.8% All other regimens 75.4% 67.6% Delayed Cisplatin regimens 66.0% 60.4% Carboplatin/Paclitaxel 70.8% 71.4% All other regimens 65.2% 57.4% Largest Differences Between Arms is Seen With Most Difficult Chemo Regimens 1 Data from post hoc analysis.
Designed to obtain delayed onset CINV indication in patients receiving HEC. No injectable 5 HT 3 agents currently approved for prevention of delayed onset CINV after HEC HTX 019 is a proprietary intravenous (IV) formulation of aprepitant, an NK 1 receptor antagonist and is distinguished from the only IV NK 1 receptor antagonist presently approved in the U.S. in that it does not contain polysorbate 80, which may cause infusion site reactions, hypersensitivity or other adverse reactions in some patients.
Actual results may differ materially from the results anticipated in our forward looking statements. We caution investors that forward looking statements reflect our analysis only on their stated date. We do not intend to update them except as required by law. 3 Status of Development Programs Preclinical Phase 1 Phase 2 Phase 3 NDA Intravenous NK 1 for CINV CINV: Acute and Delayed Onset after MEC, and Acute Onset after HEC SUSTOL (APF530) SUSTOL (APF530) HTX 019 HTX 011 CINV: Delayed Onset after HEC Will be evaluated in soft tissue, nerve block, and orthopedic indications Bupivacaine + meloxicam for post operative pain HTX 003 30 Day Buprenorphine for chronic pain and addiction 505(b)(2) registration pathway should lead to NDA filing 2H2016 CINV FRANCHISE 5 CINV Highlights SUSTOL (granisetron injection, extended release), is a long acting, injectable product for the prevention of chemotherapy induced nausea and vomiting (CINV) 1,341 patient, randomized, controlled, Phase 3 study demonstrated activity in acute and delayed onset CINV after moderately emetogenic chemotherapy (MEC), and acute onset CINV after highly emetogenic chemotherapy (HEC) MAGIC: Enrollment of over 900 patients completed March.
Company Update May 2015 Exhibit 99.1 2 Legal Disclaimer This presentation contains forward looking statements as defined by the Private Securities Litigation Reform Act of 1995. These forward looking statements involve risks and uncertainties, including uncertainties associated with the development, regulatory approval, manufacture, launch and acceptance of new products, completion of clinical studies and the results thereof, the ability to establish strategic alliances and/or acquire desirable assets, progress in research and development programs and other risks and uncertainties identified in the Company's filings with the Securities and Exchange Commission.