In This Article:
Participants
David Delucia; Vice President, Corporate FP&A and Investor Relations; FibroGen Inc
Thane Wettig; Chief Executive Officer; FibroGen Inc
Juan Graham; Chief Financial Officer; FibroGen Inc
Andy Hsieh; Analyst; William Blair
Presentation
Operator
Good day and welcome to the FibroGen third-quarter 2024 earnings conference call. (Operator Instructions) Please note this event is being recorded.
I would now like to hand the call over to David Delucia, Vice President of Investor Relations. Please go ahead.
David Delucia
Good afternoon, everyone. Thank you for joining today to discuss our third-quarter 2024 financial and business results. I'm David Delucia, Vice President of Corporate FP&A and Investor Relations at FibroGen. Joining me on today's call are Thane Wettig, our Chief Executive Officer; Juan Graham, our Chief Financial Officer; and Chris Chung, our Senior Vice President of China Operations. Following out the pair of remarks, we will open the call to your questions. I would like to remind you that remarks made on today's call include forward-looking statements about FiberGen.
Such statements may include but are not limited to our collaborations with AstraZeneca and Astellas financial guidance. The initiation enrollment design conduct and results of clinical trials. Our regulatory strategies and potential regulatory results, our research and development activities, commercial results and results of operations, risks related to our business and certain other business matters. Each forward-looking statement is subject to risks and uncertainties that could cause actual results and events to differ materially from those projected.
In that statement, a more complete description of these and other material risks can be found in FibroGen's filings with the SEC including our most recent form 10-K and form 10-Q FiberGen does not undertake any obligation to update publicly any forward-looking statements whether as a result of new information, future events or otherwise, the press release reporting, our financial results and business update and a webcast of today's conference call can be found on the investors section of Fiber Gen's website at www.fibergen.com. With that, I would like to turn the call over to our CEO, Thane Wettig.
Thane Wettig
Thank you, Dave. Good afternoon, everyone and welcome to our third quarter, 2024 earnings call on today's call. I will highlight our current strategy for the company and the exciting opportunity for FG-3246 and FG-3180. Our first in class antibody drug conjugate targeting CD-46 and our PET imaging agent in metastatic castration-resistant prostate cancer.
I will also highlight the continued strong performance of Roxadustat in China and the potential for Roxadustat development for the treatment of anemia due to lower-risk myelodysplastic syndrome. Then Juan Graham, our CFO will review the financials after which we will open the call for your questions on slide 3. I would like to highlight the strategic strategic pillars for our company first advancing FG-3246 and FG-3180. And mCRPC remains a key priority.
In the second quarter of this year, we shared important data from two phase one studies highlighting the potential of FG-3246 as both monotherapy and in combination with enzalutamide, I'll provide a more detailed overview of where we are with the program and the upcoming 2025 catalysts in a moment. Second, Roxadustat continues to demonstrate very strong performance in China generating significant net revenue and positive cash flow with robust year over year revenue and volume growth.
Thanks to this impressive performance, we are reiterating our guidance of FibroGen's full year net product revenue under us GAAP to be between $135 million and $150 million and raising the bottom end of our full year guidance for juice at net sales in China to $330 million to $350 million.
In addition, we anticipate an approval decision from the China authorities in early 2025 for chemotherapy induced anemia, which if approved would represent a meaningful growth opportunity. On top of the substantial revenue generated by rosat and anemia associated with chronic kidney disease. If approved FiberGen will receive a $10 million milestone payment from our China partner AstraZeneca.
Third, we have a number of partnering opportunities for our remaining pipeline. Regaining the rights to Roxadustat from AstraZeneca in the US. And RoW excluding China and South Korea enables us to pursue internal or external development of certain indications with high end met need such as anemia in patients with lower-risk myelodysplastic syndromes.
Moreover, we continue to seek partnership opportunities for our early oncology pipeline of the Phase 1, ready FG-3165 an anti-Gal9 antibody and FG-3175 an anti-CCR8 antibody lastly due to our significant US cost reduction efforts and the wind down of the parem development program. Fiber exited the third quarter in a solid cash position with $160 million in cash, cash equivalents and accounts receivable assuming additional repatriation of cash from our China operations.
We expect our cash, cash equivalents and accounts receivable to fund operating plans into 2026 altogether. We are confident that our refined focus along with our strong foundation position us well to create value for shareholders now and in the future, I will now provide a brief overview of our FG-3246 and FG-3180 programs in mCRPC highlights the high end that need in late stage prostate cancer.
There are approximately 290,000 men diagnosed with prostate cancer each year in the US. These are 665,000 drug treatable patients where the cancer is metastasized and become castrate resistant, resulting in a grim five year survival rate of approximately 30%.
There remains a significant opportunity for new treatments that can extend survival for these men. FG-3246 could be this new treatment option. Turn to slide 6, FG-3246 is a potential first in class ADC and development for mCRPC with a novel antibody YS-5 which binds to a tumor selective epitope of CD-46, CD-46 and the specific CD-46 epitope have several distinguishing features. CD-46 is up regulated during tumor genesis and helps tumors evade complement dependent cytotoxicity.
The CD-46 epitope is highly expressed in mCRPC tissues with lower interpatient variability and higher median expression compared with PSMA as depicted in the graph. In the lower right hand portion of the slide, its expression is upregulated and the progression from localized castration, sensitive prostate cancer to metastatic castration, resistant prostate cancer and further overexpressed following treatment with androgen signaling inhibitors and the CD-46 epitope is also overexpressed in colorectal cancer and other solid tumors.
A companion PET imaging agent, FG-3180 utilizes the same targeting antibody as FG-3246 and is also under clinical development in pre clinical studies. The PET imaging agent has demonstrated specific targeting of an uptake by CD-46 positive tumor cells.
Slide 7, highlights the importance of the companion PET imaging agent. FG-3180 to the development pathway for FG-3246. We believe that having a patient selection file marker would not only allow us to better enrich the patient population in the Phase 3, portion of the clinical development program. It would also enable differentiation of FG-3246 in the prostate cancer treatment landscape.
In addition, FG-3180 could represent an important commercial opportunity as a companion diagnostic to FG-3246. Slide 8, recaps the pipeline results from the Phase 1, monotherapy study and the Phase 1, B portion of the investigator-sponsoredstudy of FG-3246. In combination with enzalutamide, both of which were reported in the second quarter of 2024.
The completed monotherapy study included a total of 56 mCRPC patients who were biomarker unselected and were heavily pre treated, receiving a meeting of five lines of therapy. Prior to FG-3246 in the efficacy of valuable population of 40 patients. We observed a median radiographic progression free survival of 8.7 months. Overall response rate of 20% confirmed by Resis 1.1 and PSA reductions of greater than 50% and 36% of patients.
Adverse events were consistent with those observed with other MMAE based ADC therapies. The manuscript describing the phase one monotherapy trial has been submitted and we anticipate acceptance and publication in the coming months following our recent discussion with the FDA. Regarding the FG-3246 development program, we are preparing to initiate the Phase 2, monotherapy trial of FG-3246 in the first quarter of 2025.
Interim results of the Phase 1b portion of the investigator-sponsored combination study with Enzalutamide that is currently being conducted at UCSF were reported at Asco in June of this year. These interim results included data on 17 biomarker unselected patients. 70% of which were pretreated with at least two prior ARSIs. In addition to establishing the phase two dose of FG-3246 the is also demonstrated an encouraging preliminary estimate of RPFS of 10.2 months with PSA declines observed in 71% of the valuable patients.
The trial remains on track for top line results in the first half of 2025. And we will also include CD-46 expression data on patients screened with FG-3180 our pet bar marker during the Phase 2, portion of the IST on Slide 9, we depict the comparison of the initial results from the monotherapy trial and heavily pretreated patients and the combination trial that show an impressive RPFS versus the existing FDA approved standard of care in the mCRPC setting.
While we cannot make direct comparisons to these trials, due to differences in things such as study design and previous treatments, we are encouraged by these RPFS results. Moving to Slide 10, we would like to share the Phase 2, dose optimization trial design. Based on our discussion with the FDA, we plan to enroll 75 patients across three dose levels to determine the optimal dose for Phase 3, based on efficacy safety and PK parameters.
It is important to note that FG-3180 will also be a part of the study as we seek to demonstrate the correlation between CD-46 expression and response to the ADC in the all commerce population. One other important design element is the primary prophylaxis with GCSF to mitigate adverse events associated with neutropenia, commonly seen with ADCs containing an MMAE payload.
The addition of GCSF may enable a better tolerated and more consistent treatment thereby extending duration of therapy with FG-3246 and potentially enhancing efficacy measures such as RPFS on Slide 11. We highlight the recent and ongoing studies for FG-3246, NFG-3180. As I mentioned earlier, we are expecting additional data for FG-3180.
Our PET imaging agent for multiple studies being run at UCSF including the phase one imaging development study which was recently upsized as well as the combination trial with Enzalutamide slide 12 shows the recent and upcoming catalysts for the FG-3246 program. As mentioned earlier, we had a productive meeting with the FDA regarding the FG-3246 development pathway and received guidance for the Phase 2, trial design highlighted a few slides earlier.
In addition, IND submissions for FG-3246 and FG-3180 are planned this quarter and next quarter respectively. We have potential value inflection points in the near term with the anticipated initiation of the Phase 2, dose optimization study in mCRPC in the first quarter of 2025. And the top line results from the Phase 2, portion of the combination study with Enzalutamide which are expected in the first half of 2025.
To summarize on Slide 13, FG-3246 targets. A novel epitope on prostate cancer cells with first in class potential it has already demonstrated promising efficacy signals with an acceptable safety profile both in monotherapy and combination settings. We are excited for the upcoming milestones and look forward to updating you on the program as the studies progress moving now to Slide 15, Roxadustat for anemia of chronic kidney disease continues its robust performance in China.
Third quarter, total reduced at net sales in China by fiber and the distribution entity jointly owned by FiberGen and AstraZeneca totaled $96.6 million compared to $77.1 million. In the third quarter of 2023 an increase of 25% driven by an increase in volume of 34%.
FibroGen's portion of -- debt net product revenue in China was $46.2 million for the third quarter on a US GAAP basis compared to $29.4 million in the third quarter of 2023. An increase of 57% moving to Slide 16, Roxadustat continued its category leadership and brand value share in China maintaining a 45% share in the most recent three month period ending in August of 2024.
The potential approval of the chemotherapy induced anemia indication early next year would provide an important new treatment alternative for patients with CIA. Be a meaningful addition to the Roxadustat business in China and would trigger a $10 million milestone payment from AstraZeneca.
Given that there have been several generic applications filed and two applications approved in China. I would like to reiterate that the impact of a generic approval and launch in China is meaningfully different than in the US. Generic players face lead time and execution risk of market adoption after approval as they need to be admitted into individual hospital formularies, one listing at a time.
Therefore, originator products do not experience a meaningful deterioration in revenue until they are subjected to volume based purchasing, which only occurs after at least four generic products are approved and the government includes the originator in the BVP process. Even then originator products in China have historically maintained a stream of net product revenues and profits after generics enter the market. Despite the expiration of our composition of matter patents in June of this year, we do not expect meaningful deterioration of the rocks two step business in the near term.
In addition to the exceptional performance of Roxadustat in China this quarter, Roxadustat penetration in Europe continues to increase, showing quarter over quarter growth. We expect this growth to continue given the fact that Roxadustat is reimbursed in all EU five countries is the only hip PHI indicated in the EU for the treatment of anemia of CKD in both non-dialysis and dialysis patients and has exclusivity until 2036 position.
It positioning it for continued growth and hip market leadership over the next decade plus now to slide, 17, we announced earlier this year that we regained all us and rusted rights from AstraZeneca with the exception of South Korea, while the China Collaboration Agreement remains in place, regaining the rights to Roxadustat in the US allows us to pursue Roxadustat development opportunities with potential partners or on our own. In indications such as anemia associated with lower-risk myelodysplastic syndromes.
Slide 18, highlights the unmet need and the potential for Roxadustat in patients with anemia associated with lower risk MDS. There is a lack of effective second line and beyond treatments. Given the currently available therapies are effective in approximately 50% of patients. In addition, there are no oral options available or in late stage development, which could be a meaningful differentiator for Roxadustat and potentially translate into significant commercial opportunity.
Moving on to Slide 19, in late 2023 subgroup analysis from the Phase 3, Matterhorn study of roxadustat and patients with anemia of lower risk mds were presented at the American Society of Hematology annual meeting and patients with anemia associated with lower risk MDS who entered the trial with a higher transfusion burden vat demonstrated a meaningful difference in transfusion independence versus placebo results that are highly similar to the pivotal trials for two recently approved therapies for anemia associated with lower risk MDS.
Based on these results. We believe that Roxadustat represents an important potential therapy for patients with anemia associated with lower risk MDS. Therefore, we are currently evaluating options for Roxadustat to determine the best path for continued development. With the aim of realizing additional value for Roxadustat in this high value indication.
I will now turn the call over to Juan to discuss the company's financials. Juan?