October 2020 - Isofol
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Transcript of October 2020 - Isofol
© ISOFOL MEDICAL AB (publ)
Disclaimer
This company presentation of Isofol Medical AB (publ) (“Isofol”) has been prepared for advertisement purposes. It is not a prospectus and has not been prepared in accordance with the prospectus requirements in the Swedish Financial Instruments Trading Act (lagen (1991:980) om handel med finansiella instrument) or the European prospectus regulation (809/2004/EC) (the “Prospectus Regulations”). This company presentation is not subject to any registration or approval requirements under the Prospectus Regulations and has not been, and will not be, examined, approved or registered by the Swedish Financial Supervisory Authority or any financial supervisory authority or other supervisory body within the EU.
The company presentation may not be forwarded, reproduced or made available in or into any jurisdiction in which such publication or distribution would require any additional documentation to be prepared or registration effected or that any measures are taken in addition to those required under Swedish law or where it would be in conflict with any law or regulation in such jurisdiction. Persons who come into possession of this document are required to inform themselves about, and to observe, such restrictions.
The courts of Sweden shall have exclusive jurisdiction over any dispute arising out of or in connection with this document company presentation and the City Court of Gothenburg, Sweden, shall be the court of first instance.
2
© ISOFOL MEDICAL AB (publ)
Isofol at a glance
Developing arfolitixorin for the treatment of colorectal cancer
Headquarters in Gothenburg
Strategic CMC partnerships with Merck & Cie and Recipharm
Listed on NASDAQ First North Premier in Stockholm (ticker: ISOFOL)
* Holding as of July 31, 2020Source: Holdings.se, June 30 2020
Board and management with broad and long experience
Strategic commercial partnership with Solasia for the Japanese market
ShareholdersNumber of
sharesCapital/Votes
(%)
Avanza Pension 4 117 908 4,94%
Bengt Gustafsson 3 515 434 4,22%
Handelsbanken Fonder 3 393 412 4,07%
Futur Pension 3 295 229 3,95%
Alfred Berg Fonder* 2 719 717 3,26%
Swedbank Robur Fonder 2 413 791 2,90%
Fjärde AP-fonden 2 400 000 2,88%
Swedbank Försäkring 1 926 660 2,31%
Urus AB 1 866 664 2,24%
Rhenman Partners Asset Management AB
1 838 061 2,20%
10 largest shareholders 27 486 876 32,97%
Other owners 55 879 090 67,03%
TOTAL 83 365 966 100%
Number of shareholders approx. 4500
3
© ISOFOL MEDICAL AB (publ)
The arfolitixorin opportunity
Arfolitixorin
mCRC is a significant unmet medical need with no new treatment options for allcomers in over 16 years
[6R]-MTHF added to the cornerstone cytotoxic 5-FU more than doubles efficacy - arfolitixorin is [6R]-MTHF
Key Opinion Leaders active support in the development program
A $1B opportunity in 1st line mCRC only
Unprecedented low regulatory hurdle for approval in 1st line mCRC
Limited competition and few new drugs in development for 1st line mCRC, no branded products
4
© ISOFOL MEDICAL AB (publ)
Arfolitixorin - Significant Commercial Opportunity
6
Large Patient Population
AGENT study infirst-line mCRC
Limited competition
Straightforward adoptioninto Standard of Care
Premium pricing$mCRC Peak sales potential>$1B
© ISOFOL MEDICAL AB (publ)
Arfolitixorin - Aim to Increase Efficacy of current standard of care-the first pure form of [6R]-MTHF – the biological active substance
The Problem: 5-FU + [6R]-MTHF treatment with the pro-drug leucovorin 400 mg/m2
The Solution: 5-FU + Arfolitixorin 120 mg/m2 (120 mg/m2 [6R]-MTHF)
IV bolus push1-3 min
[6R]-MTHF essential for 5-FU anticancer effect
• With only up to 40% - 45% responding to current SOC in All-Commers
Strength of the arfolitixorin program:
• Hemisulfate guarantees stability
• Significantly higher intracellular tumor concentrations of [6R]-MTHF
• Significant higher inhibition of TS inhibition
• Use of 5-FU and arfolitixorin iv bolus push significantly inhibits TS
7
© ISOFOL MEDICAL AB (publ)
Arfolitixorin is a De-risked Opportunity- Phase III AGENT Study has a high probability of success with low regulatory hurdles for approval
● Significant Commercial Opportunity● Physicians understand and support the value proposition
● Established mechanism of action:● [6R]-MTHF role in potentiating 5-FU is well described in the literature1
● Arfolitixorin is the first pure form of [6R]-MTHF, require no activation and has the potential to help all patients treated with5-FU● FDA and EMA have granted approval to evaluate arfolitixorin in a first line 1st line pivotal registrational trial in mCRC setting, as an
improvement of established care based on:• Favorable safety profile with established MoA• Pre-clinical and clinical documentation
● Positive Clinical Data:● PK/PD data has demonstrated significantly increased [6R]-MTHF levels in Tumors from CRC patients vs SOC2
● Study 005 resulted in promising efficacy of 59% ORR in the ARFOX patient population after at least 16 weeks of treatment3
● Full CMC process in place:● ISOFOL and MERCK has spent over 15 years developing a manufacturing process and know-how together ● CMC and commercial scale manufacturing process has been completed and there will be no delays for clinical trials or commercial
launch
Source: 1. PV Danenberg et. al. Critical Reviews in Oncology/Haematology106 2016 118-131. 2. Y Wettergren et. al. Cancer Chemother Pharmacol. 2015 Jan;75(1):37-47. 3 Isofol data on file
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© ISOFOL MEDICAL AB (publ)
Colorectal cancer is the third most common cancer 1
11% of cancers discovered annually are colorectal cancer
COLORECTAL CANCER FACTSHEET
The 5-year survival rate for patients with stage 4 colorectal cancer falls to around 10%2
10%
GROWING INCIDENCE
The global burden of CRC is expected to increase by over 70% from 1,8 million 2018 cases to 3,1 million in 20401
>70%
Source: (1) GLOBOCAN 2018, Cancer Incidence and Mortality Worldwide. (2) GlobalData 2017
1.8m people are diagnosed with CRC each year globally11.8m
GLOBAL CRC MARKET
Total market size $bn 2018 to 20252
Colorectal cancer (CRC)- 3rd most common and 2nd deadliest cancer with a high unmet need
0,00,20,40,60,81,01,21,41,61,82,02,2
Lung Breast Colorectal Prostate Stomach Liver
Annu
algl
obal
inci
denc
e(m
illio
ns)
12% 12%11%
8%6%
5%
2018 2025
CAGR: ~3%
118.5
11
© ISOFOL MEDICAL AB (publ)
5-FU based chemotherapy will remain a cornerstone treatment in CRC
Metastatic CRC, spread
to distant organs
1st line 2nd line 3rd line
Localtumour
Tumour spread
to nearbylymph nodes
Source: (1) GlobalData 2017 12
© ISOFOL MEDICAL AB (publ)
[6R]-MTHF plays a vital role in improving the efficacy of 5-FU
TS-Tymidylate Synthase; 5-FU – 5 Fluorouracil
5-FU displaced due to [6R]-MTHF shortage
5-FU is an anti metabolite i.e. a false building block that out competes the natural TS substrate
Arfolitixorin is [6R]-MTHF 13
i.e. [6R]/MTHF
© ISOFOL MEDICAL AB (publ)
PK/PD data from Phase I/II study ISO-CC-002 demonstrate significantly increased MTHF levels in tumors from Colorectal Cancer patients treated with arfolitixorin vs Levoleucovorin
14
Significantly higher Methylene THF ([6R]-MTHF) concentrations in colorectal tumor after two equimolar dose
levels of arfolitixorin or L-LV, all dosages (analysis of variance; P < 0.01)
Methylene THF ([6R]-MTHF) levels in colorectal tumor
Con
c (p
mol
/g)
0
2000
4000
6000
8000
10000
Arfolitixorin 60mg/m2
Levoleucovorin 60mg/m2
Arfolitixorin 200mg/m2
Levoleucovorin200 mg/m2
n=32
© ISOFOL MEDICAL AB (publ)
Gene expression studies indicate that arfolitixorin has the potential to increase Progression Free Survival (PFS) in metastatic Colorectal Cancer (mCRC) patients
Background Low expression of the ABCC3 gene has been linked to
poor conversion of leucovorin into [6R]-MTHF and associated with potentially worse clinical outcome
Source: ASCO 2018, Isofol Data on file
PFS is dependent on ABCC3 expression High ABCC3 expression: 11,4 months Low ABCC3 expression: 6.7 months
Hypothesis 75% of patients with low expression of ABCC3 do not optimally
benefit from LV optimization of 5-FU efficacy and correlates with worse PFS vis-à-vis high gene expression
GENE EXPRESSION DATA based on validated method
∆ = 4.7
Fig. 1 & 2. Kaplan-Meier Curves showing PFS when patients with synchronous mCRC were categorised based on ABCC3 expression
High ABCC3 in 25% of pts
Low ABCC3 in 75% of pts
N=144; p:0.0002Quartiles
ABCC3 expression levels and PFSin patients treated with 5-FU/LV regimens
Results from the phase III AGENT study will confirm the Hypothesis that arfolitixorin substitution of leucovorin results in significant better efficacy, with those with low gene expression having the most benefit
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© ISOFOL MEDICAL AB (publ)
2. Arfolitixorin generates significantly higher [6R]-MTHF levels in patients tumors
1. [6R]-MTHF is critical for 5-FU’s mode of action
[6R]-MTHF in cancer treatment ABCC3 expression and PFS
3. Arfolitixorin could rescue up to ~ 75% of all mCRC patients treated with 5-FU unable to convert LV
(improved Progression Free Survival PFS 11.4 vs 6.7 months)
Arfolitixorin – a novel drug for improving response and survival in mCRC patients- Arfolitixorin could improve ORR and PFS by potentiating 5-FU cytotoxicity
Based upon solid preclinical data, early clinical data, a favorable safety profile and a well understood MoA –FDA and EMA have endorsed the ongoing Phase 3 trial to form the basis for a future market registration
Methylene THF ([6R]-MTHF) levels in colorectal tumor tissue
High ABCC3 in 25% of pts
Low ABCC3 in 75% of pts
N=144; p:0.0002Quartiles
Source: ASCO 2018, Isofol Data on file
antimetabolite
5-FU TS-substrateout-competed
arfolitixorin([6R]-MTHF)
Thymidine synthetaseinhibition
persistent thymidine shortage
persistent DNAsynthesis arrest
tumor cell death through apoptosis
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© ISOFOL MEDICAL AB (publ)
Clinical Development Program and Accelerated Developmentresulted in a shortened route to market- Due to strong support from regulatory authorities
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© ISOFOL MEDICAL AB (publ)
Target Product Profilearfolitixorin Minimal acceptable results Ideal Results
Primary Product IndicationFor the treatment of
1st line mCRC in combination with 5-FU
For the treatment of advanced colorectal cancer in combination with 5-FU
Patient Population 1st line mCRC 1st line mCRC
ORR (%) >55% - >10% improvement compared to current SOC
>60% - >15% improvement compared to current SOC
PFS (months)*>11,8 months –
>1,8 months improvement compared to current SOC
>12,5 months –>2,5 months improvement compared to current SOC
Incidence of Grade III/IV AEs (%)
Similar frequency to current SOC Similar frequency to current SOC
To improve efficacy
● with no additional toxicity
● by a proven concept
● no change in clinical practice required for use
● Low hurdles for incorporation into current treatment practice
Arfolitixorin promises
Arfolitixorin has the potential to optimize 5-FU based treatment efficacy
* FDA requires a positive trend in PFS as the lowest hurdle
19
© ISOFOL MEDICAL AB (publ)
ISO-CC-005 – Phase I/IIa dose defining studySafety and dose finding with extension cohorts
Dose finding part; MTD & RP2D
Patients (n=62)mCRC 1st to 5th line
MTD and RP2D
Primary Endpoint
Secondary Endpoints2020ARF/ARFOX/ARFIRI +/- BevacizumabmCRC
ORR @ 8wObjective response rate
Patients (n=43)mCRC 1st line
ARFOX or ARFIRI (120mg/m2)mCRC
Safety2020
ORR @ 8w
Primary Endpoint
Secondary Endpoints
Objective response rate
Final results(Expected)
Safety extension cohorts 1 & 2 Treatment/Efficacy(followed 16 weeks and beyond with CT)
1st line Cohorts 1 & 2 (31 patients)
SafetyTo date, no safety issues related to the use of arfolitixorin have been raised at the dose of 120 mg/m2
Overall Response Rate (ORR)
ARFOX 59%ARFIRI 50%
Final results(Expected)
Results 1st-5th line (62 patients)
Dose FindingMaximal Tolerated DoseRecommended Phase 2 Dose
120 mg/m2 arfolitixorinWas the selected dose
SafetyTo date, no safety issues related to the use of arfolitixorin have been
raised at any tested dose
Recommended Phase 2 Dose
Source: Isofol data on file20
© ISOFOL MEDICAL AB (publ)
55% Overall Response Rate (≥-30%) in 31 first line patients in ISO-CC-005 (Cohort I & II)- Results 16 weeks and beyond of treatment with 120 mg/m2 Arfolitixorin + 5-FU + irinotecan or oxaliplatin (ARFIRI/ARFOX)
Source: Isofol Data on file
17 out of 31 patients had partial response, PR (≥-30%)
ORR according to RECIST 1.1
PD (≥20%)
PR (≥-30%)
ARFOX 59%ARFIRI 50%
0,00% 0,00% 0,00% 0,00%
-5,63%
-11,54%-14,71% -16,00%
-29,69%-34,02%
-36,67% -37,18%
-44,00%-46,22%
-50,00%
-57,00% -57,45% -57,69%
-63,64% -64,15%-67,35% -68,00%
-73,77% -75,53%-79,59%
-84,71%-90,00%
-80,00%
-70,00%
-60,00%
-50,00%
-40,00%
-30,00%
-20,00%
-10,00%
0,00%
10,00%
20,00%
30,00%
40,00%
#1 1
20 m
g AR
FOX
#2 1
20 m
g AR
FOX
#20
120
mg
ARFO
X
#21
120
mg
ARFO
X
#22
120
mg
ARFI
RI
#4 1
20 m
g AR
FIR
I
#5 1
20 m
g AR
FIR
I
#6 1
20 m
g AR
FIR
I
#30
120
mg
ARFI
RI
#7 1
20 m
g AR
FOX
#28
120
mg
ARFO
X
#33
120
mg
ARFI
RI
#3 1
20 m
g AR
FOX
#9 1
20 m
g AR
FIR
I
#11
120
mg
ARFI
RI
#8 1
20 m
g AR
FOX
#10
120
mg
ARFO
X
#32
120
mg
ARFI
RI
#15
120
mg
ARFO
X
#13
120
mg
ARFO
X
#35
120
mg
ARFO
X
#34
120
mg
ARFO
X
#18
120
mg
ARFI
RI
#19
120
mg
ARFO
X
#17
120
mg
ARFI
RI
#36
120
mg
ARFO
X
#12
120
mg
ARFI
RI
#39
120
mg
ARFI
RI
#25
120
mg
ARFO
X
#26
120
mg
ARFO
X
#16
120
mg
ARFI
RI
% CHANGE OF TUMOUR SIZE FROM BASELINE
*
*
*
*
SD19 mts*
PR21 mts
pCR15 mts*
• 1 Patient (#9) with SD followed for 19 months and censored at study end.
• 1 Patient (#18) with PR resected and reached pCR after surgery at 15 months.
• 1 (#16) Patient with PR + resection was followed for 21 months until PD.
* Received bevacizumab after 8 weeks** Received panitumumab after 8 weeks+ 13 Confirmed responses according to RECIST 1.1
++ + +++ ++ +++ +
**
*
*
*
*
Extension cohort I & II (ORR beyond 8 weeks – 31 patients) of ISO-CC-005 - ARFOX/ARFIRI
+
21
© ISOFOL MEDICAL AB (publ)
ORR The ORR for Arfolitixorin in the ISO-CC-005 (ARFOX/ARFIRI) trial is higher compared to the commonly used chemotherapy combinations in all-comer patient populations and is in line with the target readout from the ongoing Phase 3 AGENT study.
Abbreviations: 5-FU: 5-fluorouracil; anti-EGFR: anti-epidermal growth factor receptor; ARFOX: : infusional 5-FU,Arfolitixorin, oxaliplatin; ARFIRI: : infusional 5-FU,Arfolitixorin, irinetocan; FOLFIRI: infusional 5-FU, l-leucovorin, irinetocan; FOLFOX: infusional 5-FU, l-leucovorin, oxaliplatin; BV: bevacizumab; CTX: cetuximab; ORR: overall/objective response rate; PFS: progression free survival; PMAB: panitumumab; SOC: standard of care; LV: leucovorin; mCRC: metastatic colorectal cancerSource: [1] Giuliani and Bonetti (2018) First-line therapies in metastatic colorectal cancer: integrating clinical benefit with the costs of drugs. International Journal of Colorectal Disease
Syneos Health analysis of average ORR based on pivotal Phase III trials considered in a recentmeta-analysis/review by Giuliani & Bonetti [1] compared to ISO-CC-005 patients with poor prognostic factors
20,0%
27,0%
45,0%
59,0%
40,0%
50,0%
0,0%
10,0%
20,0%
30,0%
40,0%
50,0%
60,0%
70,0%
5FU/LV capacitabine FOLFOX ARFOX FOLFIRI ARFIRI
005 Data
Historical controls
22
© ISOFOL MEDICAL AB (publ)
AGENT study – Ongoing global Phase 3 study designStudy summary:
Study sites
43US, Canada
34
IndicationFirst line treatment
Randomized controlled study
mCRC
mFOLFOX-6 + Bevacizumab**
ORRObjective response rate
Primary Endpoint
PFS, DORProgression-free survivalDuration of Response
Key Secondary Endpoints
H12022
Final results
EuropeJapan
*ARFOX (Arfolitixorin + 5-FU + Oxaliplatin) + bevacizumab**mFOLFOX-6 (Leucovorin + 5-FU + Oxaliplatin) + bevacizumab
Australia
4
2
ARFOX + Bevacizumab*
440 patientsmFOLFOX-6 + Bevacizumab**
Interim analysis around year-end 2020 – Adaptive design330 patients observed for 16 weeks - event driven
Additionallysites in Japan and Australia are planned to be initiated+
DSMBrecommendation
Possible sample size increase with 220
Coordinating Principal Investigator:
Prof Joseph Tabernero, MD, PhD
Prof Heinz-Josef Lenz, MD, PhD
H22021
Final results
* As of August 2020
23
660 patients
© ISOFOL MEDICAL AB (publ)
Regulatory requirement for marketing approval of arfolitixorin:
FDA & EMA, TGA (Aus) and PMDA (Jpn)
● Primary Objective: Response Rate, at least 10% increase above SOC
● Secondary Objective: Positive trend in PFS and DOR
● Safety: No deterioration in OS, at least maintained risk/benefit ratio
● Required sample size: 440 patients
Interim Analysis
● Basis for adaptive design● When patient number 330 has been observed for at least 16 weeks (end 2020) the DSMB will review safety
and efficacy (ORR and trend in PFS) and recommend based on outcomes;
AGENT study – with Adaptive Design, a De-Risked Program
1.Stop recruitment at 440 patientsCarry on observing the 440 patients
2.Sample size increase to 660 patientsIncrease sample size to 660 patients to
reach statistical significance on PFS
24
© ISOFOL MEDICAL AB (publ)
Strong support from leading CRC KOL’sProf. Heinz Josef Lenz – Keck School of Medicine,
University of Southern California, USA
Professor Lenz has supported the AGENT study for theinitiation of the project. He is also chairman for ourinternational advisory board. During our last adboard, hegave his strong support for our project and helped infacilitating the connections with the leading KOL networkinternationally.
Professor Tabernero, is the coordinating PI for the AGENTtrial and as previous chairman for ESMO he is also one ofthe leading KOL’s worldwide. Prof. Tabernero recentlypublished a very positive review on the arfolitixorinopportunity (attached) and has been a strong supporter ofour program for several years back. He is also part of ourinternational advisory board.
Prof Joseph Tabernero - Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
Prof. Sebastian Stintzing - CharitéUniversitätsmedizin Berlin, Berlin, Germany
Professor Yoshino is the leading colorectal KOL in Japan.When presented to the AGENT trial and arfolitixorin a bitmore than a year ago, he immediately realized theimportance of the molecule and agreed to be PI in Japan, heis also part of our international adboard. Prof Yoshino waspivotal for the success in discussions with PMDA and a verystrong supporter of the study design and endpoints.
Prof. Takayuki Yoshino - National Cancer Center Hospital East, Chiba, Japan
Professor Stintzing participated in our recent oncologyseminar in Stockholm and is also both an investigator andadboard member. His message during the seminar is thatArfolitixorin is a unique opportunity in 1st line mCRCwhere there have been no improvements for a decade. Healso strongly supports our endpoints in the AGENT trial.He also clearly stated the importance of the AGENT trialas a physician. Link to presentation
25
© ISOFOL MEDICAL AB (publ)
Blockbuster potential in Colorectal Cancer alone
~ $1Bin annual market potential only in the 1st line treatment setting
in the 7MM
1.8mGlobal colorectal cancer (CRC)
incidence
>370kAnnual mCRC drug treated patient
pool in 1st-3rd treatment line
Source: GLOBOCAN 2018, Cancer Incidence and Mortality Worldwide.;GlobalData 2017; GlobalData Colorectal Cancer: Competitive landscapeto 2026; Deallus Market research and forecast model 2018.
27
© ISOFOL MEDICAL AB (publ)
Primary market research in 7 major markets (7MM) + South Korea- Healthcare professionals (HCPs) view on arfolitixorin TPP
0% 20% 40% 60% 80% 100%
Asia
EU
US
Global
Minor Importance Significant Improvement Very significant Improvement
HCP opinion on arfolitixorin significance
HCPs were excited about arfolit ixorin, 74% of HCPs indicated it offered a s ignif icant or very s ignif icant
improvement vs. current treatment options
Region 1 2 3 4 5 6 7 8 9 10
Global
US
EU
Asia
Very excitingNot exciting
Source: Deallus Market research and forecast model 2018
A total of 34 physicians were interviewed (N=34 (US: 12, EU: 16, Asia: 6). Study performed by Deallus Consulting for Isofol Medical.
28
© ISOFOL MEDICAL AB (publ)
Arfolitixorin could see market share of 50%, 42% and 31% in the US, Asia and EU respectively within the 1L mCRC setting
Source: Deallus Market research and forecast model 2018
A total of 34 physicians were interviewed (N=34 (US: 12, EU: 16, Asia: 6). Study performed by Deallus Consulting for Isofol Medical.
31%40%
31%24%25%
50%
33%
20%29% 31%
26%20%
47%42% 40% 40%
0%
10%
20%
30%
40%
50%
60%
Adjuvant 1L mCRC 2L mCRC 3L mCRC
Arfolitixorin MS (%) by Region & Line of Therapy
Global US EU Asia
• Arfolitixorin market share data is based on HCP willing to prescribe among all drug treated patients in each line of therapy
• Willingness to prescribe Arfolitixorin is greatest in the US (50% in 1LmCRC), followed by Asia (42% in 1L mCRC) and lowest in the EU (31% in 1L mCRC)
29
© ISOFOL MEDICAL AB (publ)Source: GLOBOCAN 2018, Cancer Incidence and Mortality Worldwide.;GlobalData 2017; GlobalData Colorectal Cancer: Competitive landscapeto 2026; Deallus Market research and forecast model 2018.
Arfolitixorin target patient populations and estimated market share- A large number of drug treated mCRC patients in 1st to 3rd line is expected to be treated with arfolitixorin
mCRC treated patient pool 7MM
372 000
US: 50%
22 500 Arfolitixorin market share 1st line
26 700 15 600About 65 000
mCRC patients eligible for arfolitixorintreatment in 1st line in the 7MM
EU531%
Japan42%
~ 9 months Average treatment length
Arfolitixorin market potential 1st line
16 000 Additional market share for arfolitixorin in 2nd-3rd line
24 000 19 000
Annual mCRC drug treated patient pool independent of 1st-3rd
treatment line
Arfolitixorin peak market share in 1st
line mCRC
About 60 000additional mCRC patients eligible for arfolitixorin
treatment in 2nd to 3rd line in the 7MM
>$1Bin annual market potential only in the 1st line treatment setting in the 7MM
30
© ISOFOL MEDICAL AB (publ)Source: GlobalData 2017
Colorectal cancer market 2015 – 2025 (7MM)- Arfolitixorin expected to be used in 1st – 3rd line with peak market sales >$1B
VEGF inhibitorsAvastin, Zaltrap, Cyramza
1st and 2nd line Target population: 100%
CRC market 2025 - ~$3B
EGFR inhibitors Erbitux & Vectibix
1st and 2nd lineTarget population: ~40%
CRC market 2023 - ~$2B
PD1/PD-L1 inhibitorsKeytruda & Optivo
1st and 2nd lineTarget population: 4%
CRC market 2025 - ~$1B
Novel 3rd line drugsLonsurf & Stirvaga
3rd and 4th lineTarget population: 100%
CRC market 2025 - ~$500M
Arfolitixorin – Novel TS inhibition1st line trial (possible extension to 2nd and 3rd)
Target population: 100%
CRC market 2026 > $1B in first line alone
Approved drugs
Clinical development
31
© ISOFOL MEDICAL AB (publ)
GlobalData CRC report 2018 – 2028 for 8MM- Arfolitixorin is presented as one of the most promising pipeline drugs in the new CRC report by GlobalData
● Global sales in 2028 estimated to be 8,1BUSD in 8MM with anCAGR of 2,4% from 2018. China has the highest growth rate,CAGR 4,8%.
● Avastin will maintain leadership despite introduction of biosimilarswith decreased sales from 2,4BUSD in 2018 to 1,5BUSD in 2028
● Arfolitixorin is perceived as one of the most promising pipelinedrugs in CRC together with encorafenib (Braftovi).
● In US, EU and Japan, Global Data rate the launch of arfolitixorinas one of few events with major impact on the market.
● In the rating of the most important events the expected launch ofarfolitixorin in 2023 is expected to have a significant impact of themarket and perceived as a future leading brand.
Avastin
Clinical attributes
Low High
Com
mer
cial
att
ribut
es
High
Low
Pipeline candidates
Marketed drugs
Zaltrap
Cyramza
ArfolitixorinOpdivo + Yervoy
Keytruda
Erbitux
VectibixGRANITE-001
TS-1
LonsurfNapabucasin
Stivarga
Tucatinib
Vitrakvi
Note: Adapted from ”Figure 3: Competitive Assessment of the Late-Stage CRC Pipeline Agents” from GlobalData April 2020 CRC report.Bubble size represents approximate peak-year sales extimates for recently approved and late-stage pipeline drugs for the treatment of CRC.
Mektovi + Braftovi
Tafinlar + Mekinist
Isofol’s drug candidateArfolitixorin
32
© ISOFOL MEDICAL AB (publ)
Arfolitixorin is the only drug in late stage to improve SoC for all-comers
3rd-line or greater1st-line 2nd-line 3rd-line
Novel Immuno CRC Agent~4% of patients
Stat inh + SoCNo threat to Arfolitixorin
B-Raf/MEK inh10% of patients
Line extension projectsSmall fraction of fragile
patients
ARFOX vs mFOLFOX6+ bevAGENT
Very few late stage development projects in 1st or 2nd Line mCRC• IO projects targets 4% of patient population• Line extension project in a very small patient population• 2nd line projects in niche patient populations or on top of SoC
Arfolitixorin only drug in late stage to improve SoC and target all-comers
Current Phase III development landscape for mCRC Competitive analysis performed by Deallus Consulting
Source: Adapted from Oncology Resources Group , ONCrg Pipelines Strategies 2019. Deallus Primary Market research 2018
33
© ISOFOL MEDICAL AB (publ)
Breakthrough license agreement entered with Solasia Pharma K.K. to develop and commercialize arfolitixorin in Japan
Securing the Japanese market – the 2nd largest market for arfolitixorin
Strong validation from a specialized innovative oncology partner
Significant deal value – ~ USD 100 million as upfront and milestone payments
Tiered royalties on net sales in solid double-digit figures
Additional indications will be evaluated jointly by Solasia Pharma K.K. and Isofol
Solasia’s proven capabilities to develop and commercialize oncology treatments in Japan and other Asian markets as well as their commitment to cancer patients make them the ideal partner to support our development and commercialization
efforts in Japan
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Route to the market – Commercial plan
Active business development reach out to secure commercial partnerFocus on global partnering deal for RoW
Solid commercial forecast model established● Favorable competitive environment
● Pricing and market access analysis
● Commercial uptake analysis
Partnering● Japanese partner agreement secured August 2020
● Market preparations are initiated
Global commercial plan in development● Partnership with Syneos Health to support in commercialization
● Medical affairs activities initiated in major markets and medical communication platform
● Establishment of a Global commercial plan including life cycle management plans
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© ISOFOL MEDICAL AB (publ)Source: (1) GLOBOCAN 2018, Cancer Incidence and Mortality Worldwide. (2)GlobalData 2019, (3) Deallus Consulting December 2014, (4) Datamonitor gastriccamcer treatment tree Sruvery 2016, (5) Monocl Strategy Servoces Analysis 2016
Life cycle management - additional indications- Arfolitixorin can be used anywhere 5-FU is used and as rescue therapy after High Dose Methotrexate Treatment (HDMTX)
Pancreatic Cancer
Head & Neck Cancer
Gastric Cancer
Tripple Negative Breast CancerAdjuvant treatment setting• Almost 120 000 annual
Stage II/III patient treatments with 5-FU/LV in 7MM
Colorectal Cancer
Large cancer populations in which the current 5-FU/LV or capecitabine treatments can be optimized. Only for gastric and pancreatic cancer, the annual number of 5-FU/LV treated patients are about 63 000 in the 7MM
Suggested additional label expansions in combination with 5-FU Additional label expansions in HDMTX indications
Osteosarcoma
Burkitt’s Lymphoma PCNSLPrimary central nervous system lymphoma
About 33 000 patients in the 7MM are estimated to be treated with HDMTX followed by rescue therapy with reduced folates (LV/LLV)
ALLAcute Lymphoblastic Leukemia
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Commercial grade manufacturing process in place
ACTIVE PHARMACEUTICAL INGREDIENT
arfolitixorin
Production technology patented by Merck
Use patents by Isofol
First large scale GMP batch completed and released summer 2017
First validation batch manufactured in February 2020
IP & SUPPLY AGREEMENTS WITH MERCK & CIE VALID AT LEAST UNTIL 2038
FINAL DRUG PRODUCT
LARGE SCALE DRUG MANUFACTURING SECURED
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Patent Type Region Expiry Status Patent holder
[6R]-MTHF Substance / Formulation USA 2037 Granted
Europe, Japan, China, etc. 2034 Granted in several regions including
Europe, Japan & China
MTHF Formulation USA 2029 Granted
Europe, Japan, Canada, etc. 2024 Granted
New clinical discovery Clinical treatment, dosage regimen
US, Europe, Japan, Canada, etc. 2038 Granted in US and Japan pending in
other regions
New clinical discovery Clinical treatment,dosage regimen
US, Europe, Japan, Canada, etc. 2038 Patent pending
New clinical discovery Gene Expression US, Europe, Canada and Australia 2035 Granted in US, pending in other regions
New clinical discovery Biomarker in blood US, Europe, Japan,Canada, etc. 2038 Granted in US, pending in other regions
New clinical discovery Clinical treatment, dosage regimen
US, Europe, Japan,Canada, etc. 2039 Patent pending
Intellectual property overview of main patents
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ManagementJarl Ulf Jungnelius, MD
CEO
Sven Erickson, PhDChief Commercial Officer
Gustaf Albèrt, MSCChief Financial Officer, Vice CEO
Roger Tell, MD, PhDChief Medical OfficerChief Scientific Officer
Pär-Ola Mannefred, MBAChairman of the Board
Experience as aBoard memberand investments
Magnus Björsne, PhD, MBABoard Member
Paula BoultbeeBoard Member
Alain Herrera, MD, PhDBoard Member
Anna Belfrage, MBABoard Member
Bob Marchesani, MBABoard Member
Board of directors
Aram Mangasarian, PhD, MBABoard Member
Experienced Leadership
Over 20 years experiencein the biotechnology industry
Over 20 years of oncologycommercialization
Over 20 years of oncologysales & marketing
Over 20 years of oncology drug development experience
Over 20 years of businessdevelopment
Over 20 years of oncology drug development experience
Board certified Oncologist
Exclusive experience asa Board member with financial background
PhD in Experimental Oncology fromThe Karolinska Institute.
Master of Science in Economics andInternational Accounting and Auditing
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The arfolitixorin opportunity
Arfolitixorin
mCRC is a significant unmet medical need with no new treatment options for allcomers in over 16 years
[6R]-MTHF added to the cornerstone cytotoxic 5-FU more than doubles efficacy - arfolitixorin is [6R]-MTHF
Key Opinion Leaders active support in the development program
A $1B opportunity in 1st line mCRC only
Unprecedented low regulatory hurdle for approval in 1st line mCRC
Limited competition and few new drugs in development for 1st line mCRC, no branded products
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Isofol Medical AB (publ)
Biotech CenterArvid Wallgrens Backe 20SE-413 46 Göteborg, Sweden
Isofol Medical AB (publ)
Biotech CenterArvid Wallgrens Backe 20SE-413 46 Göteborg, Sweden
© Isofol Medical AB (publ) Company presentation, October 2020. ISO-44, rev4