ANNUAL REPORT UNDER SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
TRANSITION REPORT UNDER SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 |
(State or Other Jurisdiction of Incorporation or Organization) |
(IRS Employer Identification No.) | |
(Address of Principal Executive Offices) |
(Zip Code) |
Title of each class |
Trading Symbol(s) |
Name of each exchange on which registered | ||
☑ | Accelerated Filer | ☐ | ||||
Non- Accelerated Filer |
☐ | Smaller Reporting Company | ||||
Emerging Growth Company |
Page | ||||||
PART I |
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Item 1. |
Business | 7 | ||||
Item 1A. |
36 | |||||
Item 1B. |
71 | |||||
Item 2. |
71 | |||||
Item 3. |
71 | |||||
Item 4. |
72 | |||||
PART II |
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Item 5. |
Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity Securities | 73 | ||||
Item 6. |
74 | |||||
Item 7. |
Management’s Discussion and Analysis of Financial Condition and Results of Operations | 74 | ||||
Item 7A. |
88 | |||||
Item 8. |
89 | |||||
Item 9. |
Changes in and Disagreements with Accountants on Accounting and Financial Disclosures | 89 | ||||
Item 9A. |
89 | |||||
Item 9B. |
90 | |||||
PART III |
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Item 10. |
Directors, Executive Officers and Corporate Governance | 92 | ||||
Item 11. |
92 | |||||
Item 12. |
Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters | 92 | ||||
Item 13. |
92 | |||||
Item 14. |
93 | |||||
PART IV |
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Item 15. |
Exhibits and Financial Statement Schedules | 94 | ||||
Signatures | 100 | |||||
Financial Statements | F-1 |
• | our ability to raise substantial additional capital to fund our planned operations; |
• | estimates regarding our expenses, use of cash, timing of future cash needs and anticipated capital requirements; |
• | the development of our product candidates, including statements regarding the initiation, timing, progress and results of our preclinical clinical studies, clinical trials and research and development programs; |
• | our ability to advance our product candidates through various stages of development, especially through pivotal safety and efficacy trials; |
• | the risk that final trial data may not support interim analysis of the viability of our product candidates; |
• | our expectation regarding the safety and efficacy of our product candidates; |
• | the timing, scope or likelihood of regulatory filings and approvals from the U.S. Food and Drug Administration or equivalent foreign regulatory agencies for our product candidates and for which indications; |
• | our ability to license additional intellectual property relating to our product candidates from third parties and to comply with our existing license agreements; |
• | our ability to enter into partnerships or strategic collaboration agreements and our ability to achieve the results and potential benefits contemplated from relationships with collaborators; |
• | our ability to maintain and establish collaborations and licenses; |
• | our expectation of developments and projections relating to competition from other pharmaceutical and biotechnology companies or our industry; |
• | our estimates regarding the potential market opportunity for our product candidates; |
• | the anticipated rate and degree of commercial scope and potential, as well as market acceptance of our product candidates for any indication, if approved; |
• | the anticipated amount, timing and accounting of contract liability (formerly deferred revenue), milestones and other payments under licensing, collaboration or acquisition agreements, research and development costs and other expenses; |
• | our intellectual property position, including the strength and enforceability of our intellectual property rights; |
• | our ability to attract and retain qualified employees and key personnel; |
• | our expectations regarding the impact of the ongoing coronavirus disease 2019, or COVID-19, pandemic, included the expected duration of disruption and immediate and long-term impact and effect on our business and operations; |
• | the diversion of healthcare resources away from the conduct of clinical trials as a result of the ongoing COVID-19 pandemic, including the diversion of hospitals serving as our clinical trial sites and hospital staff and principal investigators supporting the conduct of our clinical trials; |
• | the interruption of key clinical trial activities, such as clinical trial site monitoring, due to limitations on travel, quarantines or social distancing protocols imposed or recommended by federal or state governments, employers and others in connection with the ongoing COVID-19 pandemic; and |
• | other risks and uncertainties, including those listed under Part I, Item 1A, “Risk Factors”. |
• | Our business, operations and clinical development plans and timelines could be adversely affected by the effects of health epidemics, including the COVID-19 pandemic, on the manufacturing, clinical trial and other business activities performed by us or by third parties with whom we conduct business, including our contract manufacturers, clinical research organizations, or CROs, shippers and others. |
• | We will require substantial additional financial resources to continue ongoing development of our product candidates and pursue our business objectives; if we are unable to obtain these additional resources when needed, we may be forced to delay or discontinue our planned operations, including clinical testing of our product candidates. |
• | Our plans to develop and commercialize non-viral and viral adoptive cellular therapies based on engineered cytokines and CAR T-cell as well as TCR therapies can be considered as new approaches to cancer treatment, the successful development of which is subject to significant challenges. |
• | Our current product candidates are based on novel technologies and are supported by limited clinical data and we cannot assure you that our current and planned clinical trials will produce data that supports regulatory approval of one or more of these product candidates. |
• | If we are unable to obtain the necessary U.S. or worldwide regulatory approvals to commercialize any product candidate, our business will suffer. |
• | Our product candidates are in various stages of clinical trials, which are very expensive and time-consuming. We cannot be certain when we will be able to submit a BLA to the FDA and any failure or delay in completing clinical trials for our product candidates could harm our business. |
• | Our cell-based and gene therapy immuno-oncology products rely on the availability of reagents, specialized equipment, and other specialty materials and infrastructure, which may not be available to us on acceptable terms or at all. For some of these reagents, equipment, and materials, we rely or may rely on sole source vendors or a limited number of vendors, which could impair our ability to manufacture and supply our products. |
• | Our immuno-oncology product candidates are based on a novel technology, which makes it difficult to predict the time and cost of product candidate development and subsequently obtaining regulatory approval. Currently, few gene therapy and cell therapy products have been approved in the United States and Europe. |
• | Our reliance on third parties to formulate and manufacture our product candidates exposes us to a number of risks that may delay the development, regulatory approval and commercialization of our products or result in higher product costs. |
• | If we are unable either to create sales, marketing and distribution capabilities or enter into agreements with third parties to perform these functions, we will be unable to commercialize our product candidates successfully. |
• | Our immuno-oncology product candidates may face competition in the future from biosimilars. |
• | If we or our licensors fail to adequately protect or enforce our intellectual property rights or secure rights to patents of others, the value of our intellectual property rights would diminish and our ability to successfully commercialize our products may be impaired. |
• | Our stock price has been, and may continue to be, volatile. |
• | We previously identified a material weakness in our internal control over financial reporting for the year ended December 31, 2019, which we believe has been fully remediated. If we have inadequately remediated this material weakness, or we otherwise fail to develop, implement and maintain an effective system of internal controls in future periods, our ability to report our financial condition or results of operations could be adversely affected and may result in material misstatements of our financial statements or could have a material adverse effect on our business and trading price of our securities. |
• | Building an end-to-end TCR solution targeting solid tumors. an end-to-end, scalable this end-to-end solution + T cells expressing third party (allogeneic) TCRs from a library, which we refer to as our Library TCR-T Approach and (ii) TCR+ T cells expressing recipient-derived (autologous) TCRs, which we refer to as our Personalized TCR-T Approach. We plan to expand our library of allogeneic TCRs from internal research and third parties that target mutated KRAS, TP53 and EGFR pan-cancer neoantigens as a key part of our commitment to advance clinical development for the treatment of patients whose solid tumors have driver mutations. |
• | Advancing our third generation CD19 CAR + T program. + T therapies may help address the manufacturing and economic challenges of other CAR+ T programs. Our CAR+ T program targeting CD19 on malignant B cells was initially developed in collaboration with MD Anderson in the United States and will be increasingly led by Eden BioCell in Greater China. |
• | Executing on the clinical trials of our Controlled IL-12 platform as both a monotherapy and in combination with immune checkpoint inhibitors. |
• | Delivering shareholder value through strategic business development and disciplined prioritization of our capital resources. in-house capabilities and technologies. |
• | Scalability |
• | Time to manufacture |
• | Expense of production |
• | Required lymphodepletion ex vivo pro-survival cytokines, such as naturally occurring (endogenous) IL-15, in the recipient prior to the administration of T cells. Lymphodepletion facilitates the sustained persistence of genetically modified T cells in the patient, but it exposes the patient to medical complications, raises expense, and limits the ability of the technology to be scaled as the administration of chemotherapy requires specialized centers. |
• | Toxicity |
• | Reduced costs. Sleeping Beauty |
• | Shortened manufacturing. Sleeping Beauty Sleeping Beauty + T cells expressing mbIL15 and a kill switch has been shortened to two days or less from gene transfer, including time to release the product for infusion. This reduction in time is primarily achieved through the elimination of in vitro |
• | Customizable therapies. Sleeping Beauty |
• | Potential improved safety profile. + T or CAR+ T therapies to engraft from low starting (infusion) numbers. We believe this reduced T cell dose may reduce the side effects caused by cytokine release syndrome, which is often experienced by patients receiving larger infusions of TCR+ T or CAR+ T cells. |
• | Potential to avoid lymphodepletion. of TCR- or CAR-expressing “younger” + T cells to signal via mbIL15 increases TCR or CAR persistence and has the potential to eliminate lymphodepletion as the T cells rely on their own source of this pro-survival cytokine rather than scavenging endogenous soluble IL-15 from the recipient. |
1. | Detecting and prioritizing neoantigens |
2. | Detecting and prioritizing TCRs be co-cultured with antigen presenting cells to efficiently identify the reactive T cells. One or more of the TCRs from individual reactive T cells are then sequenced. The TCRs are typically sequenced from TIL responding to the targeted neoantigens. |
3. | Manufacturing TCR + T cells Sleeping Beauty + T cells in clinically-sufficient numbers before they are released for administration into a patient. |
• | Subjects receiving Ad (Day 0, craniotomy) and 20 mg (Days 0 to 14) veledimex with unifocal disease (“Main” and “Expansion” n=20) administered low-dose corticosteroids showed mOS of 16.2 months (mean follow-up of 14.1 months); |
• | Subjects receiving Ad (Day 0, craniotomy) and 10 mg (Days 0 to 14) veledimex with 1 mg/kg or 3 mg/kg of nivolumab (n=6; 83% unifocal, 67% low dose steroids) showed mOS 16.9 months with mOS among all subjects (across both 10 mg and 20 mg veledimex dosing, n=21) of 9.8 months; |
• | Subjects receiving Ad (Day 0, craniotomy) and 20 mg (Days 0 to 14) veledimex with 350 mg/kg of cemiplimab have a mean a follow-up time of 6.5 months with mOS that has not been reached as of the data cut-off date; |
• | Most patients received low dose steroids, defined as <= 20 mg cumulative dosing of dexamethasone during veledimex administration; |
• | Serial MRIs show partial responses in each study (6 partial responses reported as of the data cut-off date); and |
• | Adverse reactions (in monotherapy and in combination) remained consistent with previously reported results, being predictable and promptly reversible upon discontinuation of veledimex, and there were no drug-related deaths reported as of the data cut-off date. |
• | Controlled IL-12 monotherapy was well-tolerated at the initial dose level (10 mg/day veledimex, BSA adjusted); |
• | Adverse Events (AEs) were similar to adult and older pediatric supratentorial brain tumor subjects in being mild to moderate and predominantly reversible upon withholding of veledimex doses; and |
• | Survival of the first subject dosed was within the historical reference range. |
• | completion of preclinical laboratory tests and animal studies according to Good Laboratory Practices, or GLPs, and applicable requirements for the humane use of laboratory animals or other applicable regulations; |
• | submission to the FDA of an Investigational New Drug Application, or IND, which must become effective before human clinical trials may begin; |
• | performance of adequate and well-controlled human clinical trials according to the FDA’s regulations commonly referred to as Good Clinical Practices, or GCPs, and any additional requirements for the protection of human research subjects and their health information, to establish the safety and efficacy of the proposed biological product for its intended use; |
• | preparation and submission to the FDA of a Biologics License Application, or BLA, for marketing approval that includes substantive evidence of safety, purity, and potency from results of nonclinical testing and clinical trials; |
• | satisfactory completion of one or more FDA inspections of the manufacturing facility or facilities where the biological product is produced to assess compliance with cGMP to assure that the facilities, methods and controls used in product manufacture are adequate to preserve the biological product’s identity, strength, quality and purity and, if applicable, the FDA’s current Good Tissue Practices, or GTPs, for the use of human cellular and tissue products; |
• | potential FDA audit of the nonclinical study and clinical trial sites that generated the data in support of the BLA; |
• | payment of user fees for FDA review of the BLA; and |
• | FDA acceptance, review and approval, or licensure, of the BLA, which might include review by an advisory committee, a panel typically consisting of independent clinicians and other experts who provide recommendations as to whether the application should be approved and under what conditions. |
• | Phase 1 |
• | Phase 2 |
• | Phase 3 |
• | The federal Anti-Kickback Statute, which regulates our business activities, including our marketing practices, educational programs, pricing policies, and relationships with healthcare providers or other entities, by prohibiting, among other things, soliciting, receiving, offering or paying remuneration, directly or indirectly, to induce, or in return for, either the referral of an individual or the purchase or recommendation of an item or service reimbursable under a federal healthcare program, such as the Medicare and Medicaid programs; |
• | Federal civil and criminal false claims laws, including the False Claims Act which permits a private individual acting as a “whistleblower” to bring actions on behalf of the federal government alleging violations of the False Claims Act, and civil monetary penalty laws, which prohibit, among other things, individuals or entities from knowingly presenting, or causing to be presented, claims for payment from Medicare, Medicaid, or other third-party payors that are false or fraudulent; |
• | The federal Health Insurance Portability and Accountability Act of 1996, or HIPAA, which created new federal civil and criminal statutes that prohibit, among other things, executing a scheme to defraud any healthcare benefit program or making false statements relating to healthcare matters; |
• | HIPAA, as amended by the Health Information Technology for Economic and Clinical Health Act of 2009, or HITECH, and their implementing regulations, which imposes certain requirements relating to the privacy, security and transmission of individually identifiable health information on entities and individuals subject to the law including certain healthcare providers, health plans, and healthcare clearinghouses, known as covered entities, as well as individuals and entities that perform services for them which involve the use, or disclosure of, individually identifiable health information, known as business associates as well as their covered subcontractors; |
• | Requirements to report annually to the Centers for Medicare & Medicaid Services, or CMS certain financial arrangements with physicians and teaching hospitals, as defined in the ACA and its implementing regulations, including reporting any “transfer of value” made or distributed to physicians (defined to include doctors, dentists, optometrists, podiatrists and chiropractors) and teaching hospitals, and reporting any ownership and investment interests held by physicians and their immediate family members and applicable group purchasing organizations during the preceding calendar year. Beginning in 2022, applicable manufacturers also will be required to report such information regarding its payments and other transfers of value to physician assistants, nurse practitioners, clinical nurse specialists, anesthesiologist assistants, certified registered nurse anesthetists and certified nurse midwives during the previous year; and |
• | State and foreign law equivalents of each of the above federal laws, such as anti-kickback and false claims laws which may apply to items or services reimbursed by any third-party payor, including commercial insurers; state laws that require pharmaceutical companies to comply with the industry’s voluntary compliance guidelines and the applicable compliance guidance promulgated by the federal government that otherwise restricts certain payments that may be made to healthcare providers and entities; state laws that require drug manufacturers to report information related to payments and other transfer of value to physicians and other healthcare providers and entities; state laws that require the reporting of information related to drug pricing; state and local laws that require the registration of pharmaceutical sales representatives; and state and foreign laws governing the privacy and security of health information in certain circumstances, many of which differ from each other in significant ways and often are not preempted by HIPAA, thus complicating compliance efforts. |
• | created an annual, nondeductible fee on any entity that manufactures or imports certain branded prescription drug agents or biologic agents, which is apportioned among these entities according to their market share in certain government healthcare programs; |
• | increased the rebates a manufacturer must pay under the Medicaid Drug Rebate Program to 23.1% and 13% of the average manufacturer price for branded and generic drugs, respectively; |
• | created a new Medicare Part D coverage gap discount program, in which manufacturers must now agree to offer 70% point-of-sale |
• | extended manufacturers’ Medicaid rebate liability to covered drugs dispensed to individuals who are enrolled in Medicaid managed care organizations, unless the drug is subject to discounts under the 340B drug discount program; |
• | created a new methodology by which rebates owed by manufacturers under the Medicaid Drug Rebate Program are calculated for drugs that are inhaled, infused, instilled, implanted or injected; |
• | expanded eligibility criteria for Medicaid programs by, among other things, allowing states to offer Medicaid coverage to additional individuals and by adding new mandatory eligibility categories for certain individuals with income at or below 133% of the federal poverty level, thereby potentially increasing manufacturers’ Medicaid rebate liability; |
• | expanded the entities eligible for discounts under the Public Health Service pharmaceutical pricing program; |
• | created a new requirement to annually report drug samples that certain manufacturers and authorized distributors provide to physicians; |
• | expanded healthcare fraud and abuse laws, including the False Claims Act and the federal Anti-Kickback Statute, new government investigative powers, and enhanced penalties for noncompliance; |
• | created new requirements under the federal Physician Payments Sunshine Act for drug manufacturers to annually report information related to payments and other transfers of value made to physicians and teaching hospitals as well as ownership or investment interests held by physicians and their immediate family members; |
• | created a Patient-Centered Outcomes Research Institute to oversee, identify priorities in, and conduct comparative clinical effectiveness research, along with funding for such research; |
• | established a Center for Medicare & Medicaid Innovation at CMS to test innovative payment and service delivery models to lower Medicare and Medicaid spending, potentially including prescription drug spending; and |
• | created a licensure framework for follow on biologic products. |
• | continue to undertake clinical trials for product candidates; |
• | scale-up the formulation and manufacturing of our product candidates; |
• | seek regulatory approvals for product candidates; |
• | work with regulatory authorities to identify and address program-related inquiries; |
• | implement additional internal systems and infrastructure; and |
• | hire additional personnel. |
• | obtaining regulatory approval from the FDA and other regulatory authorities that have very limited experience with the commercial development of genetically modified and/or unmodified T-cell therapies for cancer; |
• | identifying and manufacturing appropriate TCRs from patient and from third parties that can be administered to a patient; |
• | developing and deploying consistent and reliable processes for engineering a patient’s and/or donor’s T-cells ex vivo T-cells back into the patient; |
• | possibly conditioning patients with chemotherapy in conjunction with delivering each of the potential products, which may increase the risk of adverse side effects of the potential products; |
• | educating medical personnel regarding the potential side effect profile of each of the potential products, such as the potential adverse side effects related to cytokine release; |
• | addressing any competing technological and market developments; |
• | developing processes for the safe administration of these potential products, including long-term follow-up for all patients who receive the potential products; |
• | sourcing additional clinical and, if approved, commercial supplies for the materials used to manufacture and process the potential products; |
• | developing a manufacturing process and distribution network with a cost of goods that allows for an attractive return on investment; |
• | establishing sales and marketing capabilities after obtaining any regulatory approval to gain market acceptance; |
• | developing therapies for types of cancers beyond those addressed by the current potential products; |
• | maintaining and defending the intellectual property rights relating to any products we develop; |
• | and not infringing the intellectual property rights, in particular, the patent rights, of third parties, including competitors, such as those developing T-cell therapies. |
• | developing drugs and biopharmaceuticals; |
• | undertaking preclinical testing and human clinical trials; |
• | obtaining FDA and other regulatory approvals of drugs and biopharmaceuticals; |
• | formulating and manufacturing drugs and biopharmaceuticals; and |
• | launching, marketing, and selling drugs and biopharmaceuticals. |
• | the scope of rights granted under the applicable license agreement and other interpretation-related issues; |
• | whether and the extent to which our technology and processes, and the technology and processes of PGEN, MD Anderson, the NCI and our other licensors, infringe intellectual property of the licensor that is not subject to the applicable license agreement; |
• | our right to sublicense patent and other rights to third parties pursuant to our relationships with our licensors and partners; |
• | whether we are complying with our diligence obligations with respect to the use of the licensed technology in relation to our development and commercialization of our potential products under the MD Anderson License, the License Agreement with PGEN and our patent license agreement with the NCI; |
• | whether or not our partners are complying with all of their obligations to support our programs under licenses and research and development agreements; and |
• | the allocation of ownership of inventions and know-how resulting from the joint creation or use of intellectual property by our licensors and by us. |
• | Additional nonclinical data requests by regulatory agencies; |
• | Unforeseen safety issues; |
• | Determination of dosing issues; |
• | Lack of effectiveness during clinical trials; |
• | Slower than expected rates of patient recruitment and enrollment; |
• | Inability to monitor patients adequately during or after treatment; |
• | Inability or unwillingness of medical investigators to follow our clinical protocols; and |
• | Regulatory determinations to temporarily or permanently cease enrollment for other reasons not related to patient safety. |
• | Continuing to undertake preclinical development and clinical trials; |
• | Participating in regulatory approval processes; |
• | Formulating and manufacturing products; and |
• | Conducting sales and marketing activities. |
• | Decreased demand for our product candidates; |
• | Injury to our reputation; |
• | Withdrawal of clinical trial participants; |
• | Withdrawal of prior governmental approvals; |
• | Costs of related litigation; |
• | Substantial monetary awards to patients; |
• | Product recalls; |
• | Loss of revenue; and |
• | The inability to commercialize our product candidates. |
• | Delay commercialization of, and our ability to derive product revenues from, our product candidates; |
• | Impose costly procedures on us; and |
• | Diminish any competitive advantages that we may otherwise enjoy. |
• | regulatory authorities may withdraw approvals of such product; |
• | regulatory authorities may require additional warnings on the label; |
• | we may be required to create a risk evaluation and mitigation strategy plan, which could include a medication guide outlining the risks of such side effects for distribution to patients, a communication plan for healthcare providers, and/or other elements to assure safe use; |
• | we could be sued and held liable for harm caused to patients; and |
• | our reputation may suffer. |
• | We may be unable to identify manufacturers on acceptable terms or at all because the number of potential manufacturers is limited and the FDA must approve any replacement contractor. This approval would require new testing and compliance inspections. In addition, a new manufacturer would have to be educated in, or develop substantially equivalent processes for, production of our products after receipt of FDA approval, if any. |
• | Our third-party manufacturers might be unable to formulate and manufacture our products in the volume and of the quality required to meet our clinical needs and commercial needs, if any. |
• | Our future contract manufacturers may not perform as agreed or may not remain in the contract manufacturing business for the time required to supply our clinical trials or to successfully produce, store, and distribute our products. |
• | Biopharmaceutical manufacturers are subject to ongoing periodic unannounced inspection by the FDA, the Drug Enforcement Administration and corresponding state and foreign agencies to ensure strict compliance with current good manufacturing practices, or cGMP, and other government regulations and corresponding foreign standards. We do not have control over third-party manufacturers’ compliance with these regulations and standards. |
• | If any third-party manufacturer makes improvements in the manufacturing process for our products, we may not own, or may have to share, the intellectual property rights to the innovation. |
• | Further third-party manufacturers may encounter difficulties in achieving volume production, quality control, and quality assurance and also may experience shortages in qualified personnel and obtaining materials for our product candidates, including delays or shortages due to limited supply or capacity of production facilities as a result of the recent COVID-19 pandemic. |
• | Our third-party manufacturers may not be able to comply with cGMP regulations or similar regulatory requirements outside the United States. Our failure, or the failure of our third-party manufacturers, to comply with applicable regulations could result in sanctions being imposed on us, including clinical holds, fines, injunctions, civil penalties, delays, suspension or withdrawal of approvals, license revocation, seizures or recalls of products, operating restrictions and criminal prosecutions, any of which could significantly and adversely affect supplies of our products. |
• | Litigation involving patients taking our product; |
• | Restrictions on such products, manufacturers or manufacturing processes; |
• | Restrictions on the labeling or marketing of a product; |
• | Restrictions on product distribution or use; |
• | Requirements to conduct post-marketing studies or clinical trials; |
• | Warning letters; |
• | Withdrawal of the products from the market; |
• | Refusal to approve pending applications or supplements to approved applications that we submit; |
• | Recall of products; |
• | Fines, restitution or disgorgement of profits or revenues; |
• | Suspension or withdrawal of marketing approvals; |
• | Damage to relationships with existing and potential collaborators; |
• | Unfavorable press coverage and damage to our reputation; |
• | Refusal to permit the import or export of our products; |
• | Product seizure; or |
• | Injunctions or the imposition of civil or criminal penalties. |
• | Developing drugs and biopharmaceuticals; |
• | Undertaking preclinical testing and human clinical trials; |
• | Obtaining FDA and other regulatory approvals of drugs and biopharmaceuticals; |
• | Formulating and manufacturing drugs and biopharmaceuticals; and |
• | Launching, marketing, and selling drugs and biopharmaceuticals. |
• | Perceptions by members of the healthcare community, including physicians, about the safety and effectiveness of our products; |
• | Pharmacological benefit and cost-effectiveness of our products relative to competing products; |
• | Availability of coverage and adequate reimbursement for our products from government or other third-party payors; |
• | Effectiveness of marketing and distribution efforts by us and our licensees and distributors, if any; and |
• | The price at which we sell our products. |
• | Created an annual, nondeductible fee on any entity that manufactures or imports certain branded prescription drugs and biologic agents, apportioned among these entities according to their market share in certain government healthcare programs; |
• | Increased the statutory minimum rebates a manufacturer must pay under the Medicaid Drug Rebate Program to 23.1% and 13% of the average manufacturer price for most branded and generic drugs, respectively; |
• | Created a new Medicare Part D coverage gap discount program, in which manufacturers must now agree to offer 70% point-of-sale |
• | Extended manufacturers’ Medicaid rebate liability to covered drugs dispensed to individuals who are enrolled in Medicaid managed care organizations; |
• | Created new methodologies by which rebates owed by manufacturers under the Medicaid Drug Rebate Program are calculated for drugs that are inhaled, infused, instilled, implanted or injected, and for drugs that are line extensions; |
• | Expanded eligibility criteria for Medicaid programs by, among other things, allowing states to offer Medicaid coverage to additional individuals with income at or below 133% of the Federal Poverty Level, thereby potentially increasing both the volume of sales and manufacturers’ Medicaid rebate liability; |
• | Expanded the entities eligible for discounts under the Public Health Service pharmaceutical pricing program; |
• | Created a new requirement to annually report drug samples that certain manufacturers and authorized distributors provide to physicians; |
• | Expanded healthcare fraud and abuse laws, including the False Claims Act and the federal Anti-Kickback Statute, new government investigative powers, and enhanced penalties for noncompliance; |
• | Created a licensure framework for follow-on biologic products; |
• | Created new requirements under the federal Physician Payments Sunshine Act for certain drug manufacturers to annually report information related to payments and other transfers of value made to physicians, as defined by such law, and teaching hospitals as well as ownership or investment interests held by physicians and their immediate family members; |
• | Created a Patient-Centered Outcomes Research Institute to oversee, identify priorities in, and conduct comparative clinical effectiveness research, along with funding for such research; and |
• | Established a Center for Medicare & Medicaid Innovation at the Centers for Medicare & Medicaid Services, or CMS, to test innovative payment and service delivery models to lower Medicare and Medicaid spending, potentially including prescription drug spending. |
• | The federal Anti-Kickback Statute, which regulates our business activities, including our marketing practices, educational programs, pricing policies, and relationships with healthcare providers or other |
entities, by prohibiting, among other things, soliciting, receiving, offering or paying remuneration, directly or indirectly, to induce, or in return for, either the referral of an individual or the purchase or recommendation of an item or service reimbursable under a federal healthcare program, such as the Medicare and Medicaid programs; |
• | Federal civil and criminal false claims laws, including the False Claims Act which permits a private individual acting as a “whistleblower” to bring actions on behalf of the federal government alleging violations of the False Claims Act, and civil monetary penalty laws, which prohibit, among other things, individuals or entities from knowingly presenting, or causing to be presented, claims for payment from Medicare, Medicaid, or other third-party payors that are false or fraudulent; |
• | The federal Health Insurance Portability and Accountability Act of 1996, or HIPAA, which created new federal civil and criminal statutes that prohibit, among other things, executing a scheme to defraud any healthcare benefit program or making false statements relating to healthcare matters; |
• | HIPAA, as amended by the Health Information Technology for Economic and Clinical Health Act of 2009, or HITECH, and their implementing regulations, which imposes certain requirements relating to the privacy, security and transmission of individually identifiable health information on entities and individuals subject to the law including certain healthcare providers, health plans, and healthcare clearinghouses, known as covered entities, as well as individuals and entities that perform services for them which involve the use, or disclosure of, individually identifiable health information, known as business associates and their subcontractors that use, disclose or otherwise process individually identifiable health information; |
• | Requirements under the Physician Payments Sunshine Act to report annually to CMS certain financial arrangements with physicians, (defined to include doctors, dentists, optometrists, podiatrists and chiropractors) and teaching hospitals, as defined in the ACA and its implementing regulations, including reporting any “transfer of value” made or distributed to teaching hospitals, and physicians, as defined by such law and reporting any ownership and investment interests held by physicians and their immediate family members and applicable group purchasing organizations during the preceding calendar year, which will be expanded beginning in 2022, to require applicable manufacturers to report such information regarding its relationships with physician assistants, nurse practitioners, clinical nurse specialists, anesthesiologist assistants, certified registered nurse anesthetists and certified nurse midwives during the previous year; and |
• | State and foreign law equivalents of each of the above federal laws, such as anti-kickback and false claims laws which may apply to items or services reimbursed by any third-party payor, including commercial insurers; state laws that require pharmaceutical companies to comply with the industry’s voluntary compliance guidelines and the applicable compliance guidance promulgated by the federal government that otherwise restricts certain payments that may be made to healthcare providers and entities; state laws that require drug manufacturers to report information related to payments and other transfer of value to physicians and other healthcare providers and entities; state laws that require the reporting of information related to drug pricing; state and local laws that require the registration of pharmaceutical sales representatives; and state and foreign laws governing the privacy and security of health information in certain circumstances, many of which differ from each other in significant ways and often are not preempted by HIPAA, thus complicating compliance efforts. |
• | The degree and range of protection any patents will afford us against competitors, including whether third parties will find ways to invalidate or otherwise circumvent our patents; |
• | If and when patents will be issued; |
• | Whether or not others will obtain patents claiming subject matter related to or relevant to our product candidates; or |
• | Whether we will need to initiate litigation or administrative proceedings that may be costly whether we win or lose. |
• | Price and volume fluctuations in the overall stock market; |
• | Changes in operating results and performance and stock market valuations of other biopharmaceutical companies generally, or those that develop and commercialize cancer drugs in particular; |
• | Market conditions or trends in our industry or the economy as a whole; |
• | Preclinical studies or clinical trial results; |
• | Public concern as to the safety of drugs developed by us or others; |
• | The financial or operational projections we may provide to the public, any changes in these projections or our failure to meet these projections; |
• | Comments by securities analysts or changes in financial estimates or ratings by any securities analysts who follow our common stock, our failure to meet these estimates or failure of those analysts to initiate or maintain coverage of our common stock; |
• | The public’s response to press releases or other public announcements by us or third parties, including our filings with the SEC, as well as announcements of the status of development of our products, announcements of technological innovations or new therapeutic products by us or our competitors, announcements regarding collaborative agreements and other announcements relating to product development, litigation and intellectual property impacting us or our business; |
• | Government regulation; |
• | FDA determinations on the approval of a product candidate BLA submission; |
• | The sustainability of an active trading market for our common stock; |
• | Future sales of our common stock by us, our executive officers, directors and significant stockholders; |
• | Announcements of mergers or acquisition transactions; |
• | Our inclusion or deletion from certain stock indices; |
• | Developments in patent or other proprietary rights; |
• | Changes in reimbursement policies; |
• | Announcements of medical innovations or new products by our competitors; |
• | Announcements of changes in our senior management or directors; |
• | General economic, industry, political and market conditions, including, but not limited to, the ongoing impact of the COVID 19 pandemic; |
• | Other events or factors, including those resulting from war, incidents of terrorism, natural disasters or responses to these events; and |
• | Changes in accounting principles. |
• | Delaying, deferring or preventing a change in control; |
• | Impeding a merger, consolidation, takeover or other business combination involving us; or |
• | Discouraging a potential acquirer from making a tender offer or otherwise attempting to obtain control of us. |
• | continue to undertake clinical trials for product candidates; |
• | seek regulatory approvals for product candidates; |
• | work with regulatory authorities to identify and address program-related inquiries; |
• | implement additional internal systems and infrastructure; |
• | hire additional personnel; and |
• | scale-up the formulation and manufacturing of our product candidates. |
Clinical Phase |
Estimated Completion Period | |
Phase 1 |
1 - 2 years | |
Phase 2 |
2 - 3 years | |
Phase 3 |
2 - 4 years |
• | The number of clinical sites included in the trials; |
• | The length of time required to enroll suitable patients; |
• | The number of patients that ultimately participate in the trials; |
• | The duration of patient follow-up to ensure the absence of long-term product-related adverse events; and |
• | The efficacy and safety profile of the product. |
Year Ended December 31, |
||||||||||||||||
2020 |
2019 |
Change |
||||||||||||||
($ in thousands) |
||||||||||||||||
Research and development |
$ | 52,696 | $ | 38,331 | $ | 14,365 | 37 | % |
Year ended December 31, |
||||||||||||||||
2020 |
2019 |
Change |
||||||||||||||
($ in thousands) |
||||||||||||||||
General and administrative |
$ | 27,665 | $ | 19,527 | $ | 8,138 | 42 | % |
Year ended December 31, |
||||||||||||||||
2020 |
2019 |
Change |
||||||||||||||
($ in thousands) |
||||||||||||||||
Other income |
$ | 385 | $ | 813 | $ | (428 | ) | -53 | % | |||||||
Non-cash inducement warrant expense |
— | (60,751 | ) | 60,751 | -100 | % | ||||||||||
|
|
|
|
|
|
|||||||||||
Total |
$ | 385 | $ | (59,938 | ) | $ | 60,323 | |||||||||
|
|
|
|
|
|
Year ended December 31, |
||||||||||||||||
2019 |
2018 |
Change |
||||||||||||||
($ in thousands) |
||||||||||||||||
Collaboration revenue |
$ | — | $ | 146 | $ | (146 | ) | -100 | % |
Year ended December 31, |
||||||||||||||||
2019 |
2018 |
Change |
||||||||||||||
($ in thousands) |
||||||||||||||||
Research and development |
$ | 38,331 | $ | 34,124 | $ | 4,207 | 12 | % |
Year ended December 31, |
||||||||||||||||
2019 |
2018 |
Change |
||||||||||||||
($ in thousands) |
||||||||||||||||
General and administrative |
$ | 19,527 | $ | 19,918 | $ | (391 | ) | -2 | % |
Year ended December 31, |
||||||||||||||||
2019 |
2018 |
Change |
||||||||||||||
($ in thousands) |
||||||||||||||||
Other income (expense), net |
$ | 813 | $ | 631 | $ | 182 | 29 | % | ||||||||
Non-cash inducement warrant expense |
(60,751 | ) | — | (60,751 | ) | 100 | % | |||||||||
Change in fair value of derivative liabilities |
— | 158 | (158 | ) | -100 | % | ||||||||||
|
|
|
|
|
|
|||||||||||
Total |
$ | (59,938 | ) | $ | 789 | $ | (60,727 | ) | ||||||||
|
|
|
|
|
|