Biovest International is seeking a strategic partner to further develop BiovaxID, its personalized active immunotherapy for follicular lymphoma. BiovaxID targets the unique tumor-specific antigen on malignant B-cells. Clinical trials have shown BiovaxID improves outcomes for follicular lymphoma patients, including extending time to disease progression. Biovest proposes further clinical development of BiovaxID in two indications: as a monotherapy for advanced stage low tumor burden follicular lymphoma, and in combination with other immunotherapies for relapsed rituximab-refractory follicular lymphoma.
Chair William K. Oh, MD, Neeraj Agarwal, MD, Matthew R. Smith, MD, PhD, and Evan Y. Yu, MD, prepared useful Practice Aids pertaining to prostate cancer for this CME activity titled "Mapping the Pathways to Better Patient Outcomes in Prostate Cancer: Personal Insights and Guidance From the Patient CaseBook." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/3bJ932h. CME credit will be available until March 17, 2021.
Robert Z. Orlowski, MD, PhD, prepared useful practice aids pertaining to multiple myeloma management for this CME/CNE activity titled "Driving Change in Multiple Myeloma: Updates on Novel Agent Classes and Next-Generation Therapeutics." For the full presentation, monograph, complete CME/CNE information, and to apply for credit, please visit us at http://bit.ly/2SPKaZZ. CME/CNE credit will be available until August 7, 2020.
Sagar Lonial, MD, FACP, Shaji Kumar, MD, Robert Z. Orlowski, MD, PhD, and Nina Shah, MD, prepared useful practice aids pertaining to multiple myeloma for this CME/MOC activity titled "How I Think, How I Treat: Understanding Innovation in Multiple Myeloma—New Models for Attacking Disease Across the Clinical Spectrum". For the full presentation, complete CME/MOC information, and to apply for credit, please visit us at https://bit.ly/30sAs5I. CME/MOC credit will be available until July 16, 2021.
Chair William K. Oh, MD, Neeraj Agarwal, MD, Matthew R. Smith, MD, PhD, and Evan Y. Yu, MD, prepared useful Practice Aids pertaining to prostate cancer for this CME activity titled "Mapping the Pathways to Better Patient Outcomes in Prostate Cancer: Personal Insights and Guidance From the Patient CaseBook." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/3bJ932h. CME credit will be available until March 17, 2021.
Robert Z. Orlowski, MD, PhD, prepared useful practice aids pertaining to multiple myeloma management for this CME/CNE activity titled "Driving Change in Multiple Myeloma: Updates on Novel Agent Classes and Next-Generation Therapeutics." For the full presentation, monograph, complete CME/CNE information, and to apply for credit, please visit us at http://bit.ly/2SPKaZZ. CME/CNE credit will be available until August 7, 2020.
Sagar Lonial, MD, FACP, Shaji Kumar, MD, Robert Z. Orlowski, MD, PhD, and Nina Shah, MD, prepared useful practice aids pertaining to multiple myeloma for this CME/MOC activity titled "How I Think, How I Treat: Understanding Innovation in Multiple Myeloma—New Models for Attacking Disease Across the Clinical Spectrum". For the full presentation, complete CME/MOC information, and to apply for credit, please visit us at https://bit.ly/30sAs5I. CME/MOC credit will be available until July 16, 2021.
CytoDyn is a biotechnology company developing innovative treatments for multiple therapeutic indications based on leronlimab, a novel humanized monoclonal antibody targeting the CCR5 receptor. CCR5 appears to play a key role in the ability of HIV to enter and infect healthy T-cells. The CCR5 receptor also appears to be implicated in tumor metastasis and in immune-mediated illnesses, such as GvHD and NASH. CytoDyn has successfully completed a Phase 3 pivotal trial with leronlimab in combination with standard anti-retroviral therapies in HIV-infected treatment-experienced patients. CytoDyn plans to seek FDA approval for leronlimab in combination therapy and plans to complete the filing of a Biologics License Application (BLA) in the first quarter of 2020 for that indication. CytoDyn is also conducting a Phase 3 investigative trial with leronlimab as a once-weekly monotherapy for HIV-infected patients and plans to initiate a registration-directed study of leronlimab monotherapy indication, which if successful, could support a label extension. Clinical results to date from multiple trials have shown that leronlimab can significantly reduce viral burden in people infected with HIV with no reported drug-related serious adverse events (SAEs). Moreover, results from a Phase 2b clinical trial demonstrated that leronlimab monotherapy can prevent viral escape in HIV-infected patients, with some patients on leronlimab monotherapy remaining virally suppressed for more than five years. CytoDyn is also conducting a Phase 2 trial to evaluate leronlimab for the prevention of GvHD and a Phase 1b/2 clinical trial with leronlimab in metastatic triple-negative breast cancer. More information is at www.cytodyn.com.
Roy F. Chemaly, MD, MPH, FIDSA, FACP, and Genovefa Papanicolaou, MD, prepared useful Practice Aids pertaining to cytomegalovirus for this CME activity titled "Managing CMV in the New Era of Antiviral Therapy: Practical Considerations in the HCT Setting." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2EUH2GI. CME credit will be available until March 25, 2020.
What next for prevention of pneumococcal disease in light of serotype replacement? Is there a pathway to licensure for novel pneumococcal vaccines?
https://www.meningitis.org/mrf-conference-2017
CytoDyn is a biotechnology company developing innovative treatments for multiple therapeutic indications based on leronlimab, a novel humanized monoclonal antibody targeting the CCR5 receptor. CCR5 appears to play a key role in the ability of HIV to enter and infect healthy T-cells. The CCR5 receptor also appears to be implicated in tumor metastasis and in immune-mediated illnesses, such as GvHD and NASH. CytoDyn has successfully completed a Phase 3 pivotal trial with leronlimab in combination with standard anti-retroviral therapies in HIV-infected treatment-experienced patients. CytoDyn plans to seek FDA approval for leronlimab in combination therapy and plans to complete the filing of a Biologics License Application (BLA) in the first quarter of 2020 for that indication. CytoDyn is also conducting a Phase 3 investigative trial with leronlimab as a once-weekly monotherapy for HIV-infected patients and plans to initiate a registration-directed study of leronlimab monotherapy indication, which if successful, could support a label extension. Clinical results to date from multiple trials have shown that leronlimab can significantly reduce viral burden in people infected with HIV with no reported drug-related serious adverse events (SAEs). Moreover, results from a Phase 2b clinical trial demonstrated that leronlimab monotherapy can prevent viral escape in HIV-infected patients, with some patients on leronlimab monotherapy remaining virally suppressed for more than five years. CytoDyn is also conducting a Phase 2 trial to evaluate leronlimab for the prevention of GvHD and a Phase 1b/2 clinical trial with leronlimab in metastatic triple-negative breast cancer. More information is at www.cytodyn.com.
Roy F. Chemaly, MD, MPH, FIDSA, FACP, and Genovefa Papanicolaou, MD, prepared useful Practice Aids pertaining to cytomegalovirus for this CME activity titled "Managing CMV in the New Era of Antiviral Therapy: Practical Considerations in the HCT Setting." For the full presentation, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2EUH2GI. CME credit will be available until March 25, 2020.
What next for prevention of pneumococcal disease in light of serotype replacement? Is there a pathway to licensure for novel pneumococcal vaccines?
https://www.meningitis.org/mrf-conference-2017
2. Opportunity Overview
2
Biovest International, Inc.
01 Biovest Overview
§ Biovest is seeking a strategic partner to take on further clinical and commercial development
of BiovaxID
§ Biovest currently holds 93.7% interest in worldwide rights to BiovaxID
§ Majority shareholders hold 6.3% royalty
§ Clinical program calls for $15-30m in further development between 2015-2020 in order to
unlock multiple $350m - $1bn+ indications including Low Tumor Bulk and Relapsed
Refractory Follicular Lymphoma
§ Support of leading investigators and research institutions including MD Anderson, Penn
Abramson, Moffitt and Leiden
§ Cost of manufacturing reduced from more $500k to less than $50k in last 18 months –
substantial additional reduction possible
3. Engaging the Immune System to Fundamentally Change Cancer
Treatment
3
Biovest International, Inc.
01 Biovest Overview
§ Founded on the premise that training the immune system to recognize tumor-specific
mutations can lead to long-term disease modification and control
§ 15+ years of clinical development demonstrating ability of vaccination against tumor-specific
antigens to delay or to prevent relapse / disease progression in incurable B-cell lymphomas
§ Clinical program under design to seek approval in US for use in Low Tumor Bulk and in
Relapsed Rituximab Refractory Follicular Lymphoma
§ Automated manufacturing and quality assurance processes that enable delivery of patient-
specific, tumor-specific therapeutics with commercially attractive margins
§ Technology transfer team with leading expertise in the development of highly-automated
manufacturing and quality systems for the production of personalized biologics
§ 35,000 ft2 facility in Minneapolis with current capacity of approx. 500 vaccines per year
4. Indolent B-Cell Lymphomas Are Largely Incurable
4
Biovest International, Inc.
01 Biovest Overview
DEATH
Induction
Therapy
R-CHOP
B-R
R-CVP, etc.
2nd Induction
Therapy
… Nth Induction
Therapy
Transplant
and Disease Progression
B-R, R-CHOP
2nd Line
Therapies
Clinical Trials,
High-dose Chemotherapy,
Transplant, etc.
1st Line: R-CHOP,
B-R, R-CVP, etc. –
highly successful at
generating CR
(60-85%)
2nd Line: Alternative
1st Line therapies –
similarly successful at
generating CR
R-Refractory: Idelalisib,
immunotherapy clinical trials
involving checkpoint inhibitors
(e.g. PD-1), lenalidomide, &c.
Origin: Single
Malignant B-Cell
Tumor Formation:
Induction-resistant
cells already present
Induction-Resistant
Cells Persist:
Remission ≠ “Cured”
– rather, “minimal
residual disease”
Induction-Resistant
Cells Proliferate:
Induction-regimens
prove increasingly
ineffective in
controlling disease
progression
Transplant & Disease Progression
Clinical Trials, High-Dose Chemotherapy,
Transplant, etc.
Disease Progression
Overview
§ Anti-CD20 mAb rituximab in conjunction with
chemotherapy has demonstrated prolonged
DFS and, in some settings, OS and has
become standard first line therapy – R-chemo
is not, however, curative
§ Originating cells resistant to R-chemo persist
through multiple rounds of cytoreductive
therapy, eventually leading to disseminated or
transformed disease and death
§ Immunotherapies hold unique promise for
promoting long-term disease control
Low Tumor Bulk: Watch &
Wait, Radioimmunotherapy
Follicular Lymphoma
§ Most common indolent b-cell lymphoma
§ US Incidence: 15,000 – 20,000 per year
§ US Prevalence: Approx. 150,000
§ Median Survival: 10-13 Years
§ Age of Onset: 60’s
5. Indolent B-Cell Lymphomas Are Uniquely Suited to Treatment
Via Active Immunotherapy
5
Biovest International, Inc.
01 Biovest Overview
§ The B-cell receptor (“idiotype” or “Id”) of malignant B-cell clones represents a unique tumor-
specific marker that is ideally suited to targeting via active immunotherapy
§ Id vaccination seeks to build a cohort of T-cells that are
activated against the breadth of malignant clonal
populations (tumor heterogeneity), thereby providing
long-term immune-surveillance and disease-control
§ Multiple programs have sought to explore the potential uses
of Id as a tumor-specific antigen for use in therapeutic
vaccination - taken together, these point to potential
efficacy in patients who have the ability to mount an immune
response, and who have been immunized against the proper clonal populations
§ BiovaxID (dasiprotimut-t: Id-KLH + GM-CSF) is the only such program that has demonstrated
an ability to prolong remission duration in a multi-center, prospective, randomized, double-
blind, active-controlled clinical trial
§ BiovaxID is the only program in advanced stage follicular lymphoma that has an associated
patient population in continuous first complete remission (30% of Phase 2 at > 15 years)
6. BiovaxID Clinical Study Summary: 3 Studies With > 15 Years Of
Follow Up Demonstrate Safety and Efficacy
6
Biovest International, Inc.
01 Biovest Overview
Study Phase Indication Subjects Results
NCI T93-1064
9/1996 – 3/2010
Phase 2
Single Arm
Open Label
Follicular Lymphoma
First Complete
Remission following
PACE chemotherapy
N = 25 Median DFS: 62.5 mos
Median OS: Not Reached
Survival @ 165.7 mos: 80%
No vaccine-related toxicities
NCI-1033
6/2000 – 8/2005 (Open)
Phase 2
Single Arm
Open Label
Mantle Cell Lymphoma
Following EPOCH-R
induction
N = 24 Median PFS: 24.1 mos
SAE: 1 (4%)
BV301
1/2000 – 2/2012
Phase 3
Multi-Center, Double
Blind, Randomized,
Active Control
Follicular Lymphoma
First Complete
Remission following
PACE chemotherapy
Active N = 118
Control N = 59
ê in Risk of Relapse: 42% (HR: .58)
Median DFS: +15.4 mos vs. active control
(46.0 vs. 30.6)
Grade 4 SAE: 6 (3.3%)
7. BiovaxID Clinical Study Summary (Cont’d)
Notes:
§ BiovaxID (dasiprotimut-T) has demonstrated efficacy in reducing the risk of relapse (42%, P3 FL) and in extending
tumor remission duration (15.4 months, P3 FL), both vs. active control
§ 30% of patients who received vaccine in P2 FL trial remain tumor-free with no additional therapy (15+ years)
§ 73% of patients in Phase 2 FL showed induced cellular complete remission, no circulating malignant cells were
detectable by PCR. (Nature Medicine)
§ Anti-tumor memory T-cell persistence measured 2.5 years post-vaccination
7
Biovest International, Inc.
01 Biovest Overview
Disease Free Survival (P3 FL) 15-year Remission (P2 FL) GM-CSF OS Biomarker (P2 MCL)
8. BiovaxID Has An Extensively Documented Mechanism of Action
8
Biovest International, Inc.
01 Biovest Overview
9. Clinical Development
9
Biovest International, Inc.
01 Biovest Overview
§ Biovest is seeking to further develop BiovaxID in Follicular Lymphoma indications with low
degrees of competition and high degrees of unmet medical need
§ Clear path with FDA toward registration for use as a monotherapy in treatment naïve patients
with low tumor bulk, and in combination with immunotherapies for relapsed patients who are
refractory to rituximab
§ 2 primary studies proposed
– 1. Idiotype vaccine versus watchful-waiting for advanced stage low tumor burden follicular lymphoma
• N = 250 (150 v 100)
• 26 month treatment protocol, 1 year accrual
– 2. Idiotype vaccine plus Idelalisib versus Id vaccine plus PD-1 (nivolumab) vs Idelalisib for relapsed
Rituxan refractory follicular lymphoma
• N = 270 (90 v 90 vs 90)
• 26 month treatment protocol, 1 year accrual
10. Clinical Development Rationale: Id Vaccine in Advanced Stage
Low Tumor Bulk Follicular Lymphoma
10
Biovest International, Inc.
01 Biovest Overview
§ As many as 85% (12,750-17,000 per year) of follicular lymphoma patients present with
advanced (stage 3-4) disease
§ Of these, a large number (40-50%; 5,100-8,500 per year) are asymptomatic and carry
comparably low tumor bulk
§ Owing to the relative toxicities of R-Chemo – rituximab is B-cell depletive and profoundly
immunosuppressive – these patients currently undergo observation (“Watchful Waiting” or
“Watch & Wait”) until disease progression (2-3 years)
§ Due to the toxicities mentioned above and to the relatively late-age of presentation of
follicular lymphoma (mid-60’s), a non-toxic therapy that can substantially prolong the time to
disease progression is highly desirable
§ Additionally, the development of an anti-tumor T-cell cohort prior to B-cell depletion may
improve the efficacy of B-cell depletive cytoreductive therapy
11. Low-Grade
"Watch-and-
Wait"
Follicular
Lymphoma
LN Biopsy
Vacc Mfg.
-3
Randomization
9 month (+6 vaccine)
Response
Assessment
(CR/PR/SD)
+ IR
-2 -1 0 1 2 3 4 6 11 23
Month Study
Completion
CR/PR/SD
Continues Vaccination
on Months 11,13,15,17
19,21,23 until Study End or
Progression
Immune Response Assessment
Endpoints:
Anti-tumor cytokine response,
Anti-Id antibody responses
Vac month 0, +6, +12 months vs
Pre-Vaccine Baseline
Dasiprotimut-T Biovest
(Id-KLH + GM-CSF) monthly
Primary Endpoint:
PFS
(HR reduction of
50% )
Observation Only
Proposed Clinical Trial Protocol
11
Biovest International, Inc.
01 Biovest Overview
Idiotype Vaccine v Watchful-Waiting for Advanced Stage Low Tumor Burden Follicular Lymphoma
12. Clinical Development Rationale: Id Vaccine Plus Idelalisib vs Id
Vaccine Plus Nivolumab vs Idelalisib in Relapsed Rituxan
Refractory Follicular Lymphoma
12
Biovest International, Inc.
01 Biovest Overview
§ Of the patients who present with advanced (stage 3-4) follicular lymphoma (12,750 – 17,000
per year; prevalence of 80,000 – 120,000), the great majority will receive Rituxan-containing
induction (and potentially maintenance) courses until the failure of R-therapy (3-6 years)
§ The failure of R-therapy has traditionally portended increasingly aggressive disease with
progressively more toxic and invasive therapeutic regimens such as chemotherapy and stem
cell transplant – there is no generally accepted standard of care in this setting
§ A new generation of immunopotentiating agents (e.g. imid, PI3Kδ, PD-1) have the potential to
give patients less toxic options in R-refractory settings while potentially jump-starting
immune function
§ These agents are unlikely to provide long-term disease control absent an ability to stimulate
tumor-specific immune surveillance
§ Id-vaccination’s differentiated and highly-complementary mechanism, induction agent
sparing mechanism of action and relative safety make it an ideal potential combination
partner for the range of emerging immunotherapies
13. Proposed Clinical Trial Protocol
13
Biovest International, Inc.
01 Biovest Overview
Three-arm Das-T/Idelalisib//PD-1 Combination Clinical Trial (Das-T+Idelalisib vs Das-T+PD1 vs Idelalisib)
14. Low Tumor Bulk & Relapsed Refractory Follicular Lymphoma
14
Biovest International, Inc.
01 Biovest Overview
Low Tumor Bulk Follicular Lymphoma Relapsed Rituxan Refractory Follicular Lymphoma
Metric Low High
US Population 320,000,000
NHL Incidence (per 100K)
NHL Incidence
19.6
62,720
21.1
67,520
FL % of NHL
FL Incidence
25%
15,680
33%
22,282
% Stage 3-4
Stage 3-4 Incidence
75%
11,760
85%
18,939
% LTB / Asymptomatic
LTB / Asymptomatic Incidence
35%
4,116
50%
9,470
Metric Low High
US Population 320,000,000
NHL Incidence (per 100K)
NHL Incidence
19.6
62,720
21.1
67,520
FL % of NHL
FL Incidence
25%
15,680
33%
22,282
% Stage 3-4
Stage 3-4 Incidence
75%
11,760
85%
18,939
Time to R-Failure
Life Expectancy
3 yrs.
10 yrs.
6 yrs.
13 yrs.
15. BiovaxID Benefits From Multiple Layers of Market Protection
§ Proprietary Cell Line: exclusive worldwide rights to BiovaxID hybridoma cell line (K6H6) necessary
for production of patient-specific, tumor-specific B-cell lymphoma Id
§ Proprietary Manufacturing: patent-protected bioreactor and purification instrumentation necessary
for the cost-effective production of patient-specific active immunotherapies
§ Proprietary Quality Control: highly-automated manufacturing and quality control processes that
ensure cGMP quality, scalability and cost-efficiency
§ Time-to-Market: extended time-to-market for any potentially competitive therapeutic; any new
product would require 7-10 years of clinical development
§ Orphan Protection: BiovaxID has obtained orphan drug status for multiple indications in the US
and in the EU – including both follicular lymphoma and mantle cell lymphoma
§ No Competition in Mechanism of Action: Id-vaccination synergizes with induction agents and is
induction regimen-sparing (e.g. rituximab)
15
Biovest International, Inc.
01 Biovest Overview
16. Automated Manufacturing & Streamlined Logistics Make
BiovaxID Convenient for Physicians and for Patients
16
Biovest International, Inc.
01 Biovest Overview
§ Standard biopsy è subcutaneous injection
§ Two (2) months from biopsy to vaccine
availability
§ Standard logistics for biologics – 72 hours
for delivery of biopsy to plant; several
months of Id-KLH (conjugated Ab) storage
life post-production
§ Single biopsy yields virtual lifetime supply
of vaccine
§ Current care schedule is vaccination in
months 1, 2, 3, 4, 6 – boosters under
evaluation
§ Automated manufacturing and QC ensure
scalable cGMP compliant production of
patient-specific therapeutic
> 10x reduction in cost of production achieved in last 18 mos ( > $500K to < $50K) –
clear path toward further cost optimization
17. § Volker Diehl, M.D., Ph.D. (University of Cologne, Germany)
§ Prof. J.H. Veelken, M.D., Ph.D. (Leiden University Medical Center, Netherlands)
§ Alf Lindberg, M.D., Ph.D. (EVP, Head of R&D Sanofi Pasteur – Ret.)
§ Dayton Reardan, Ph.D., (Regulatory: FDA)
§ Anne Tomalin, BA, BSc (OptumInsight)
§ Adriaan Fruijtier (Regulatory: EU)
Scientific Advisory Board
Supported By Leaders in Lymphoma Care, Active Immunotherapy and Bioinformatics
§ Larry Kwak, M.D., Ph.D. (M.D. Anderson)
§ Sattva Neelapu, M.D. (M.D. Anderson)
§ Stephen Schuster, M.D. (University of Pennsylvania)
§ Eduardo Sotomayor, M.D. (Moffitt Cancer Center)
§ Joshua Brody, M.D. (Mount Sinai Hospital)
§ Brian Athey, Ph.D. (University of Michigan)
§ David States, M.D., Ph.D. (Bioinformatics)
§ Gilbert Omenn, MD, Ph.D. (University of Michigan, Bioinformatics)
§ Neil Berinstein, M.D. (University of Toronto)
§ James Mulé, Ph.D . (Moffitt Cancer Center)
§ Lindy Durrant, Ph.D. (University of Nottingham)
Clinical
Active
Immuno-
therapy
Bio-
informatics
Regulatory
17
Biovest International, Inc.
01 Biovest Overview
EU