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Jennifer Dao Phan Gaëlle Datchoua Emmanuel Gomez UEI2 Scientific communication Workshop February 11 & 12, 2010 
Safe Harbor ,[object Object],[object Object]
Product:   Sipuleucel-T (Provenge®) Laboratory:  Dendreon Indication:  asymptomatic metastatic Androgen Independent Prostate Cancer  Agent:  autologous dendritic cells Launch on market:  expected for mid-2010
A short review of advanced prostate cancer ,[object Object],[object Object],[object Object]
Summary for Prostate Cancer epidemiology Jemal et al.  CA Cancer J Clin. 2009;225-249. Commun Oncol 2007;4:447–452  15% Metastatic disease Prostate cancer Initial diagnosis 85 % localized early disease 60-70% Localized disease 30-40% Relapse disease ~ 18-36 months
Diagnosis of advanced prostate cancer Gleason’s score PSA doubling time Residual testosteronemia > 50 ng/mL Digital Rectal Examination+Biopsy Blood test Research of  metastases
http://www.stjohn.org/InnerPage.aspx?PageID=1446 Histological grading of Prostate Cancer ,[object Object],[object Object],[object Object],1. Small, uniform  glands 2. More stroma between glands 3. Distincly infiltrate  margins 4. Irregular masses  of neoplastic glands 5. Only occasional  gland formation Gleason’s grade 2-4 Well differenciated 5-7 Intermediate 8-10 Poorly differentiated Gleason’s score
Prostatic Specific Antigen doubling time (PSA DT)  ,[object Object],[object Object],[object Object],[object Object],Adaptated from:J Clin Oncol 23;2005:4975–9
Freedland SJ, Humphreys EB, Mangold LA, et al. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy.  JAMA . 2005;294:433-439.  Pound CR, Partin AW, Eisenberger MA, et al. Natural history of progression after PSA elevation following radical prostatectomy.  JAMA . 1999;281:1591-1597. Gleason’s Score + PSA DT = predictive for PCa outcome
Asymptomatic metastatic PCa : no approved therapies in European guidelines A gap for brand new treatment strategies? Asymptomatic metastatic PCa: a medical unmet need Adaptated from : Nature Reviews Cancer  2 , 389-396 (May 2002)   Progrès en Urologie (2008), Suppl. 7, S343–S348   Commun Oncol 2007;4:447–452
Focus on Provenge® (APC-8015, Sipuleucel-T) ,[object Object],[object Object]
What is Provenge® and how does it work ? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Main protagonists ,[object Object],[object Object],[object Object],[object Object]
Provenge®, the lead A.C.I. candidate of Dendreon ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
How do APCs and antigen-specific T cells find each other? ,[object Object],[object Object],[object Object],BLC SLC ELC T zone stromal cell (producing CCL21)
Antigen Presentation to T Cells (BARAS, LICHTMAN, Cellular and Molecular Immunology, Saunders ed., 5e ed., 2003) Secondary lymphoid organs Peripheral tissues Th1/Th2 pathway Macrophage/ B cell activation Cytotoxic effect against targeted cells
How to break the tolerance CD 4 – CD8 LFA - 3 ICAM – 1(=CD54) CD 40 B7 (CD80 and CD86) LFA - 1 CD 2 CD 40 L -S–S - CD 28 T-Cell Antigen Presenting Cells MHC peptide Complexe, I or II -S– S - TCR - CD 3 Peptide
Flow Chart ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Patient management  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
APCs and fusion protein ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Quality control of final product ,[object Object],[object Object],[object Object],[object Object],[object Object],- Swain, S. L., M. Croft, C. Dubey, L. Haynes, P. Rogers, X. Zhang, L. M. Bradley. 1996.  From naive to memory T cells .  Immunol. Rev.   150 : 143 - The Journal of Immunology , 2000, 164: 1705-1712.  Functional Maturation of Adult Mouse Resting Microglia into an APC Is Promoted by Granulocyte-Macrophage Colony-Stimulating Factor and Interaction with Th1 Cells  Francesca Aloisi et al
Clinical Trials and Publications
Clinical development program of Sipuleucel-T
Randomized Placebo Controlled Trial Overall Survival  D9901
APC Activation Correlates with Survival D9901 and D9902
The Innate Immune System also engaged ,[object Object],[object Object],[object Object],[object Object],[object Object]
T-cell Mediated Immune Response Week 0 to Week 8, Study D9901
Cytokine Signature of Activated T cells observed in Sipuleucel-T after first priming dose ,[object Object],[object Object],[object Object],pg/nL
Randomized Phase 3 IMPACT Trial (9902B) (Immunotherapy Prostate AdenoCarcinoma Treatment) Primary endpoint: Overall survival Secondary endpoint: Time to objective disease progression
Consistency Across Phase 3 Studies *Unadjusted Cox model & log rank  **Cox model adjusted for PSA and LDH
Keep an eye on … Group Sipuleucel-T n / N (%) Placebo n / N (%) Odds Ratio (95% CI) p-value  All Subjects All CVA’s 18 /461 (3.9%) 6/231 (2.6%) 1.52 (0.596, 3.892) 0.510 Deaths attributed to CVAs 7 / 461 (1.5%)  2 / 231 (0.9%) 1.76 (0.364, 8.566)  0.725  AIPC (Proposed Indication) All CVA’s 17 / 345 (4.9%) 3 / 172 (1.7%) 2.92 (0.84, 10) 0.092 Deaths attributed to CVAs 7 / 345 (2.0%) 2 / 172 (1.2%) 1.76 (0.36, 8.6) 0.724 ADPC (P-11) All CVA’s 1 / 116 (0.9%) 3 / 59 (5.1%) 0.16 (0.016, 1.596) 0.112 Deaths attributed to CVAs 0 0 --- ---
PROTECT (P11): PROVENGE Treatment and Early Cancer Treatment.  Ongoing Phase 3 trial with enrollment completed
Open Trials (Phase II) - AIPC  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Open Trials (Phase II & IIIB) – ADPC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Challenges for Provenge® ,[object Object],[object Object]
Sipuleucel-T (Provenge ® )   production and delivery PROVENGE® (sipuleucel-T) Cellular, Tissue, and Gene Therapies  Advisory Committee Meeting March 29, 2007 The Mattson Jack Group, Cancer Metric Database 2009 COMPLETE COURSE OF THERAPY: 3 CYCLES 100 000 patients in USA with metastatic AIPC in 2010 100 000 X 3 = 300 000 doses to prepare and to deliver on time How will Dendreon make it? Day 1  Leukapheresis Apheresis Center Day 2-3 Manufacturing Dendreon’s facility Day 3-4 Infusion Doctor’s Office
Advance Planning System (APS) ,[object Object],[object Object],[object Object],[object Object]
Track patients sample through process using barcode ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Exemple of a workstation to manufacture Provenge
Exemple of a workstation to manufacture Provenge
Transportation ,[object Object],[object Object],[object Object],[object Object]
Manufacturing sites location SDI, PCa Patient Population 2006
Product Follow-Up
Regulatory aspects
Patents ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Regulatory Strategy in US ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
www.caretolive.com/research FDA Decision on Provenge: Who’s who, who’s connected ?
Regulatory framework in Europe (1) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Regulatory framework in Europe (2)
Regulation 1394/2007: Consequences ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Best option for Dendreon in Europe ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dendreon ,[object Object],[object Object],[object Object]
Targeting cancer, transforming lives™
Dendreon Corporation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dendreon website Dendreon’s pipeline (1) Sipuleucel- T  (PROVENGE) Mature autologous DCs obtained via leukapheresis procedure Treatment of metastatic androgen- independent prostate cancer (AIPC).   Phase 3 Lapuleucel-T (NEUVENGE) Targets the  HER2/neu  Ag. Same process as sipuleucel-T. The treatment of breast, ovarian and colorectal solid tumors Phase 2 Preclinical Program: CA-9 and CEA ,[object Object],[object Object],[object Object],[object Object],Preclinic
Dendreon’s pipeline (2)
Sales and income 2009 THOMSON REUTERS When and How will they make Money ? Millions US$
Financial analysis (stock price)
Wholesale  price of Provenge® ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
US sales projection (2011-2019)
EU sales projection (2011-2019)
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What’s next for Dendreon ? ,[object Object],[object Object]
Best option for Dendreon in Europe ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Any idea?… ,[object Object],[object Object],[object Object]
Thanks for your attention! Any question?

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Provenge (Sipuleucel T)

  • 1. Jennifer Dao Phan Gaëlle Datchoua Emmanuel Gomez UEI2 Scientific communication Workshop February 11 & 12, 2010 
  • 2.
  • 3. Product: Sipuleucel-T (Provenge®) Laboratory: Dendreon Indication: asymptomatic metastatic Androgen Independent Prostate Cancer Agent: autologous dendritic cells Launch on market: expected for mid-2010
  • 4.
  • 5. Summary for Prostate Cancer epidemiology Jemal et al. CA Cancer J Clin. 2009;225-249. Commun Oncol 2007;4:447–452 15% Metastatic disease Prostate cancer Initial diagnosis 85 % localized early disease 60-70% Localized disease 30-40% Relapse disease ~ 18-36 months
  • 6. Diagnosis of advanced prostate cancer Gleason’s score PSA doubling time Residual testosteronemia > 50 ng/mL Digital Rectal Examination+Biopsy Blood test Research of metastases
  • 7.
  • 8.
  • 9. Freedland SJ, Humphreys EB, Mangold LA, et al. Risk of prostate cancer-specific mortality following biochemical recurrence after radical prostatectomy. JAMA . 2005;294:433-439. Pound CR, Partin AW, Eisenberger MA, et al. Natural history of progression after PSA elevation following radical prostatectomy. JAMA . 1999;281:1591-1597. Gleason’s Score + PSA DT = predictive for PCa outcome
  • 10. Asymptomatic metastatic PCa : no approved therapies in European guidelines A gap for brand new treatment strategies? Asymptomatic metastatic PCa: a medical unmet need Adaptated from : Nature Reviews Cancer 2 , 389-396 (May 2002) Progrès en Urologie (2008), Suppl. 7, S343–S348 Commun Oncol 2007;4:447–452
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  • 17. Antigen Presentation to T Cells (BARAS, LICHTMAN, Cellular and Molecular Immunology, Saunders ed., 5e ed., 2003) Secondary lymphoid organs Peripheral tissues Th1/Th2 pathway Macrophage/ B cell activation Cytotoxic effect against targeted cells
  • 18. How to break the tolerance CD 4 – CD8 LFA - 3 ICAM – 1(=CD54) CD 40 B7 (CD80 and CD86) LFA - 1 CD 2 CD 40 L -S–S - CD 28 T-Cell Antigen Presenting Cells MHC peptide Complexe, I or II -S– S - TCR - CD 3 Peptide
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  • 22.
  • 23. Clinical Trials and Publications
  • 24. Clinical development program of Sipuleucel-T
  • 25. Randomized Placebo Controlled Trial Overall Survival D9901
  • 26. APC Activation Correlates with Survival D9901 and D9902
  • 27.
  • 28. T-cell Mediated Immune Response Week 0 to Week 8, Study D9901
  • 29.
  • 30. Randomized Phase 3 IMPACT Trial (9902B) (Immunotherapy Prostate AdenoCarcinoma Treatment) Primary endpoint: Overall survival Secondary endpoint: Time to objective disease progression
  • 31. Consistency Across Phase 3 Studies *Unadjusted Cox model & log rank **Cox model adjusted for PSA and LDH
  • 32. Keep an eye on … Group Sipuleucel-T n / N (%) Placebo n / N (%) Odds Ratio (95% CI) p-value All Subjects All CVA’s 18 /461 (3.9%) 6/231 (2.6%) 1.52 (0.596, 3.892) 0.510 Deaths attributed to CVAs 7 / 461 (1.5%) 2 / 231 (0.9%) 1.76 (0.364, 8.566) 0.725 AIPC (Proposed Indication) All CVA’s 17 / 345 (4.9%) 3 / 172 (1.7%) 2.92 (0.84, 10) 0.092 Deaths attributed to CVAs 7 / 345 (2.0%) 2 / 172 (1.2%) 1.76 (0.36, 8.6) 0.724 ADPC (P-11) All CVA’s 1 / 116 (0.9%) 3 / 59 (5.1%) 0.16 (0.016, 1.596) 0.112 Deaths attributed to CVAs 0 0 --- ---
  • 33. PROTECT (P11): PROVENGE Treatment and Early Cancer Treatment. Ongoing Phase 3 trial with enrollment completed
  • 34.
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  • 38. Sipuleucel-T (Provenge ® ) production and delivery PROVENGE® (sipuleucel-T) Cellular, Tissue, and Gene Therapies Advisory Committee Meeting March 29, 2007 The Mattson Jack Group, Cancer Metric Database 2009 COMPLETE COURSE OF THERAPY: 3 CYCLES 100 000 patients in USA with metastatic AIPC in 2010 100 000 X 3 = 300 000 doses to prepare and to deliver on time How will Dendreon make it? Day 1 Leukapheresis Apheresis Center Day 2-3 Manufacturing Dendreon’s facility Day 3-4 Infusion Doctor’s Office
  • 39.
  • 40.
  • 41. Exemple of a workstation to manufacture Provenge
  • 42. Exemple of a workstation to manufacture Provenge
  • 43.
  • 44. Manufacturing sites location SDI, PCa Patient Population 2006
  • 47.
  • 48.
  • 49. www.caretolive.com/research FDA Decision on Provenge: Who’s who, who’s connected ?
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  • 59.
  • 60. Sales and income 2009 THOMSON REUTERS When and How will they make Money ? Millions US$
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  • 63. US sales projection (2011-2019)
  • 64. EU sales projection (2011-2019)
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  • 69.
  • 70. Thanks for your attention! Any question?