Q4 2022 IGM Biosciences Inc Earnings Call

Speaker 1: I'll see you next time.

Speaker 2: Good day, everyone, and welcome to IGM Biosciences' fourth quarter and full year 2022 financial results and corporate update call. Today's call is being recorded. At this time, I would like to turn the call over to Fred Schwerzer, Chief Executive Officer of IGM. Fred Schwerzer, Chief Executive Officer of IGM.

Speaker 3: Thank you, operator, and thanks to all of you joining us on this call.

Speaker 3: On behalf of IGM, I'm joined today by Misfit Tahir, Chief Financial Officer.

Speaker 3: Dr. Chris Takamoto, Chief Medical Officer.

Speaker 3: Dr. Bruce Kight, Chief Scientific Officer, and Dr. Mary Beth Harler, President, IGM Autoimmunity and Inflammation.

Speaker 3: Please note that we will be making forward-looking statements on this call, including statements about IGM's plans, expectations and forecasts, and about future events.

Speaker 3: Actual results may differ materially as a result of various risks and uncertainties, including those discussed in the company's most recent annual report on Form 10-K as well as its other filings with the SEC.

Speaker 3: Any forward-looking statements represent IGM's view as of today, March 30, 2023 only, and the company disclaims any obligation to update these statements, except as required by law.

Speaker 3: Following this call, a replay will be available on the company's website, www.igmbio.com.

Speaker 3: like to start with a few introductory remarks, and then I will turn the call over to MSPSA to take you through our 2022 financial results.

Speaker 3: After MSPA's update, Chris will update you on clinical development of IGM 8444, our death receptor 5 agonist antibody.

Speaker 3: Next, Mary Beth will update you on our development plans for embotemab and autoimmune diseases.

Speaker 3: We will then turn it back over to Chris to discuss the true most recent product candidates in our oncology pipeline.

Speaker 3: IgM7354, our IgM-targeted immunostimulatory IL-15 cytokine, and IgM2644, our CD38xCD3 cell engager, a next-generation CD38 antibody for multiple myeloma.

Speaker 3: Looking back, 2022 was a transformational year for IGM.

Speaker 3: At the end of the first quarter, we entered into an important collaboration with Sanofi to develop novel IgM agonist antibodies to address three oncology targets and three autoimmune targets.

Speaker 3: Throughout the year, we also continued the clinical development of our death receptor 5 agonist antibody, IgM8444, particularly in combination with Fulfuri for the treatment of colorectal cancer.

Speaker 3: We're very pleased with the data we have seen from those clinical development efforts as we announced in January of this year.

Speaker 3: These data have provided the basis for our decision to immediately move into a randomized study of IGM 8444 in second line metastatic colorectal cancer in combination with Fulfuri and Bevacizumab, which is the standard of care in second line colorectal cancer.

Speaker 3: We are hopeful that this randomized study will show a significant improvement in progression-free survival relative to the standard of care chemotherapy control arm.

Speaker 3: As we announced today, we have now treated the first patient in this randomized study.

Speaker 3: We also made great progress during 2022 in developing our understanding of the potential role of our T cell engagers, such as in Votamab in treating autoimmune diseases.

Speaker 3: We are encouraged by the expanded safety and efficacy data for Envodumab at 100 milligrams that we have developed through our clinical studies in non-Hodgkin's lymphoma. And we believe that Envodumab's safety profile may be an important differentiating factor in the exciting new field of T cell engagers in autoimmune disease.

Speaker 3: Building on our success in 2022, we expect that 2023 will also be an important year for the expansion and validation of IGM's platform.

Speaker 3: Already this year, we have treated the first patients in our clinical study of IGM 7354, an IGM-targeted immunostimulatory IL-15 cytokine, which could be used for the treatment of patients with Fallon and hematologic malignancies.

Speaker 3: We are particularly excited about the potential to use IGM 7354 in combination with cellular therapies such as CAR-T and CAR-NK cells.

Speaker 3: We are also initiating studies of IgM2644, our CD38 by CD3 bispecific IgM antibody, which we hope will be a safe and more potent form of anti-CD38 therapy for multiple myeloma, including for patients who have previously been treated with daratumumab.

Speaker 3: At this point, I'd like to turn the call over to MSPSA to review our financial results for 2022.

Speaker 4: Thank you, Fred. In addition to the brief financial overview I will provide on the call today, you can read additional detail on our fourth quarter and year-end financial results and our press release issued prior to this call and in our 10K which was filed with the SEC.

Speaker 4: We are fortunate to be in a strong financial position. In the second quarter of 2022, we received an upfront payment of $150 million from Sanofi related to our collaboration agreement and raised gross proceeds of $230 million in a follow-on public equity offering. As a result, our cash and investments total $427.2 million.

Speaker 4: were $11.6 million and $49.7 million for the full year 2022.

Speaker 4: Collaboration revenues for the fourth quarter of 2022 were $0.4 million and $1.1 million for the full year 2022.

Speaker 4: Our net loss for the fourth quarter of 2022 was $52.6 million, or a loss of $1.19 per share.

Speaker 4: For the full year 2022, our net loss was $221.1 million, or a loss of $5.32 per share.

Speaker 4: Turning now to the financial guidance for 2023, we expect our full year 2023 GAAP operating expenses to be between $290 million and $300 million. This includes estimated non-cash stock-based compensation expense of approximately $50 million.

Speaker 4: For the full year 2023, we also expect to recognize approximately $3 million of collaboration revenue related to last year's upfront payment from Sanofi.

Speaker 4: Finally, we expect to end 2023 with a balance of approximately $200 million in cash and investments providing IGM with an expected cash runway into the second half of 2024.

Speaker 4: With that, I'll now turn the call over to Chris, our Chief Medical Officer.

Speaker 4: We are pleased to announce that we have now dosed more than 100 patients with IGM 8444 in our broad multi-indication, multi-combination phase 1 study. And we're very excited about the safety and clinical activity profile that we've seen to date in our combination with the standard full-fury chemotherapy regimen in colorectal cancer patients. For more information, visit our website at www.surgicalcannabis.com

In January , we shared our initial data from our Full Fury combination cohort, which is available in detail in our current corporate overview presentation.

To summarize, these data showed an encouraging safety profile that was broadly comparable to that expected from chemotherapy alone.

Specifically, no signs of drug-related clinically significant hepatotoxicity were observed. There's only grade 1 and grade 2 transient drug-related liver enzyme elevations were seen.

The substantial majority of our patients with metastatic colorectal cancer have been treated with 3 milligrams per kilogram of IgM 8444 in combination with full fury. And thus far, we have seen promising activity at that dose level with multiple confirmed responses even in patients who had previously progressed to a higher risk of COVID-19.

with Fulfuri plus bevacizumab, which is the current standard of care treatment for second line colorectal cancer.

I am pleased to announce today that we have now treated nearly 20 patients in combination with bevacizumab, and we've not seen any additional toxicity signals arising from the addition of bevacizumab to the combination.

These early safety and efficacy observations have encouraged us to proceed immediately into a randomized clinical study of Fulfurium bevacizumab plus or minus IgM8444 and second line colorectal cancer.

We are pleased to announce today that we have now dosed the first patient in this randomized clinical trial.

We're also excited to announce today that our analysis of the cell death biomarker, CasBase 3, in patients treated with IgM 8444 across multiple dose levels, both as monotherapy and in combination, showed a consistent increase post-treatment in 60 of 64 patients analyzed.

In addition, a dose-dependent increase was seen at the two highest dose levels tested of 3 and 10 milligrams per kilogram.

A summary of these data is available in our current corporate overview slide deck available on our website.

This biomarker signal has led us to add an additional 10 milligram per kilogram dose cohort to our randomized combination study.

This protocol is currently being amended to randomize patients to three groups, either 3 or 10 milligrams per kilogram of IgM8444 with fulfuri plus bevacizumab or standard of care chemotherapy alone.

Our primary endpoint for this study will be progression-free survival with overall survival and response rate as secondary endpoints.

We are exploring with the FDA potential randomized pathways to accelerated approval in accordance with their recently released guidance on this topic.

We also announced today that we are now treating patients in our fifth boronapant combination dose escalation cohort. To date there have not been any observed dose limiting toxicities in combination with boronapant.

We also announced today that we've treated the first patient in our IGM 8444 plus phenytoclax and azacytidine combination in subjects with acute myeloid leukemia.

Finally, we've also conducted extensive preclinical studies with other chemotherapeutic agents in combination with IgM 8444 in a variety of different cancer types.

We plan to clinically evaluate one or more of these chemotherapy combinations with IGM 8444 as our development program expands. At this point, I'd like to turn the call over to Mary Beth, our President of Autoimmunity and Inflammation.

interim clinical updates about the Invotimap NHL program.

about the Invotimap NHL program. Mary Beth.

Thank you, Chris.

As you mentioned, we are announcing some encouraging safety and clinical activity data for Invodumab, which we think could offer a compelling and differentiated profile in the exciting new area of T-cell engangers in autoimmune disease.

We think there is an important opportunity to bring forward a readily accessible therapy that offers deeper B-cell depletion than achievable with currently available anti-CD20 therapies.

Also, you may recall hearing about some recent, very encouraging data using CAR T cells for B-cell depletion in lupus.

We believe that Imvodimab may have clear advantages over CAR T therapies in autoimmune disease in terms of safety, cost, and logistics.

We announced today that as of our most recent data assessment, the incidence of cytokine release syndrome was 9% over all safety-evaluable patients treated with the 100-milligram titration dosing regimen in our phase one and phase two non-Hodgkin's lymphoma studies.

and it was 13% overall safety-evaluable patients treated with either 100 milligrams or 300 milligram titration dosing in these phase 1 and phase 2 lymphoma studies.

All cases of CRS seen in the 100 milligram and 300 milligram titration dose cohorts were grade one other than one grade two.

We also announced today, although the patient numbers are very small and additional patients currently on treatment may respond, as of the most recent data assessment, Invotimab has achieved a combined complete response rate of greater than 30% over all efficacy-evaluableone.

diffuse large B cell lymphoma or DLBCL patients in our phase 1 and phase 2 studies treated with the 100 milligram titration weekly dosing regimen.

Although the patient numbers are too small to make a statistical assessment, currently the response rate in DLBCL continues to be, appears, continues to appear to be lower at the 300 milligram dose.

As you may recall, we have previously announced that we have seen complete responses with invotemab in all four major NHL subtypes.

diffuse large B cell lymphoma, follicular lymphoma, mantle cell lymphoma, and marginal zone lymphoma.

While it is not possible to directly extrapolate these encouraging efficacy data in NHL to what we might observe in autoimmune disease, it's worth noting a couple of points.

First, CD20 is a well-established target in multiple autoimmune diseases. And secondly, the Invotemab data in NHL clearly demonstrates that Invotemab effectively depletes B cells, even rapidly growing lymphoma cells.

In combination with these strong signs of clinical activity, we believe that Infodimab's safety profile will be an important differentiating factor in the treatment of autoimmune diseases with T cell engagers. Together with the potential to more effectively deplete...

autoimmune diseases. We have also announced today that we plan to file IND applications in the second quarter to begin clinical testing of Embodomab in both severe systemic lupus erythematosus or SLE and in severe rheumatoid arthritis or RA.

We are also evaluating a variety of additional autoimmune diseases for a potential third IND application later this year. With that, I'll turn the call back over to Fred. Thank you, Mary Beth.

that we have seen with Envodimat at 100 milligrams in our non-Hodgkin's lymphoma clinical studies to date.

and we're excited to move forward aggressively in developing Envodimab for multiple autoimmune diseases. Given the relative size of the potential autoimmune markets and Envodimab's potential competitive advantage in autoimmune disease resulting from its safety profile,

We believe that the unmet medical needs and the commercial opportunities for invotemab in autoimmune diseases are substantially greater than those in non-Hodgkin's lymphoma, particularly those as monotherapy and relatively late lines of lymphoma treatment. As a result, we are announcing today...

that we are redirecting our clinical development efforts for Invotimab to autoimmune diseases.

and that we have decided to cease further monotherapy clinical development efforts for Envodumab in non-Hodgkin's lymphoma. We continue to believe that the safety and efficacy profile of Envodumab could position it well as a combination partner for the treatment of non-Hodgkin's lymphoma.

And we will be focusing our future efforts in NHL on evaluating combination opportunities and partnerships for Invotimap. With that I'd like to turn the call back to Chris to discuss our exciting early stage clinical development efforts in oncology.

Thank you, Fred. As we announced in January , we're excited to have initiated a clinical trial exploring the safety, efficacy, and pharmacodynamic activity of IgM 7354, an IgM targeted immunostimulatory IL-15 cytokine in the treatment of patients with solid tumors.

We are announcing today that we successfully dosed our first two patients with no drug-related safety issues. We believe that IgM 7354 has the potential to be used in combination with a broad range of other drugs which rely on CD8 positive cells or NK cells for their activity.

including combinations with CAR-T and CAR and K-cell. We are also announcing that the FDA has cleared our IND application for IgM-2644, a CD38 by CD3 IgM T-cell engager.

which allows us to commence a phase 1 dose escalation trial in patients with recurrent or refractory multiple myeloma.

This study will allow us to investigate the initial safety and efficacy of our next T-cell engaging IgM molecule.

Our ultimate clinical development goal for IgM 2644 is to establish it as a safe and more potent anti CD38 therapy, even for patients who have received prior daratumumab treatment.

We are very excited by the potential for IgM-2644 to provide the next generation form of an anti-CD8 therapy. As you may recall, in December of last year, we presented preclinical data at the 2022 ASH meeting showing that IgM-2644 achieved potent T cell directed...

In closing, I'd like to thank all of the employees of IGM for their work over the past year.

all of our principal investigators, their teams, and their institutions, and most importantly the patients and their families.

all of whom have made the progress we've described today possible.

We're very excited about the progress that we hope to make in 2023 towards our goal of bringing new and important treatments to patients.

We appreciate your interest in IGM and we look forward to keeping you all informed as to our progress.

With that operator, I'd like to open the call for questions. Thank you. As a reminder, to ask a question, please press star 1-1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1-1 again. Please stand by while we compile Q&A rosters.

Our first question is from Steven Willie with STIFL. Your line is open.

Yeah, good afternoon guys. Thanks for taking the questions.

Thanks for taking the questions. I guess there's a lot going on here.

The decision to add the 10 mg per kg dose to the randomized phase 2, can you maybe just.

Can you answer the question, I guess, as to whether or not you've conducted any dose expansion with the 10 make-per-cake dose in combination with Bev and Pulpiri before you're introing it into the randomized phase 2?

And then just any updated thoughts on when we might get a look at the remaining dose expansion patients. I guess those treated at the 3 mg per gig dose and any that you may have treated at the 10 mg per gig dose. And then Chris, would you like to take that one? Sure. Yeah. Thank you for the question. So the really the experience that we have with Ad questichan my question is is 80.

the biomarker data that we're sharing with you now that really showed this increase in plasma caspase 3 levels that continued to increase as we went from 3 to 10 milligrams per kilogram. And that was one of the major factors that...

led us to incorporate and make the decision to add 10 milligrams per kilogram to the randomized study. Plus we did get additional feedback from the FDA that was, again, very supportive of doing formal dose exploration and optimization in the study. So those were the things.

the new biomarker data that really prompted us to make this addition to the study.

Okay, and then I guess as a follow-up, does the addition of a third arm to the randomized phase two change your powering assumptions? And I know that you're kind of guiding to potentially having a conversation with FDA regarding an accelerated approval pathway. So should we think about patient enrollment then as kind of a moving...

the signal that we have seen in our single arm experience in combining 8444 with full fury. But it's also written so that when we can actually evaluate the impact of dose as well as looking at the primary endpoint which is going to be progression free survival.

And so we've left things somewhat open in terms of if we get a strong signal that allows us to pick a dose and also confirm the magnitude of the benefit over the control arm, there's the potential that we can...

either stop this early and initiate a more formal registrational trial, or alternatively, we could potentially, with regulatory feedback, expand this study to increase the number of patients on each of the arms and potentially use this as a randomized accelerated approval trial. So…

Those possibilities are all things that we are considering as we move forward.

Okay, and maybe just lastly, real quickly, I know obviously, in Vodimat, it's getting prioritized for AI disease, but maybe for Mary Beth, can you…

just kind of speak to, I guess, your interest in potentially looking at IGM 2644 in autoimmune disease as well. Yeah, no, absolutely. Thanks, Steve. As you know, we are thinking about...

our T-cell engager assets morph through a portfolio lens than individual opportunities. And we are very excited about how these assets may come together.

to afford multiple therapeutic approaches to treating B-cell and plasma cell mediated diseases. As we discussed, obviously CD20, a well-established target in autoimmune disease, CD38.

You know, some, there is a smaller but very interesting data set, particularly in the setting of diseases such as lupus to support the potential utility of CD8, CD38 targeting therapies. I think it is very important that we understand.

What the safety of our own CD38 by CD3 molecule looks like in multiple myeloma, as we've discussed, safety is clearly a very important consideration in the management of chronic diseases such as autoimmune disorders.

how this molecule could differentiate not only from, you know, invodumab but also other potential competitors in this space. So in summary, a lot of activity and we await that human data.

Great. Thanks for taking the questions.

Thanks, Dave. Thank you. One moment for our next question. One moment for our next question.

And our next question is from Greg Harrison with Bank of America. Your line is open.

Hey, good afternoon. Congrats on the progress and thanks for taking questions. First off, maybe could you give some additional color on the transition towards autoimmune indications from Vodumab? What was the decision process that led to the choice of lupus and RA and how broadly do you think?

and vodobam could be applied across autoimmune disease. Well, Mary Beth, I think that's probably a question for you. It's one we spend a lot of time thinking about, and it's very broad. So I'll leave you to go at it, Mary Beth. Indeed, and thank you for that question.

Again, you know, the CD20 as a target in autoimmune disease, well established, and a very broad data set out there in the literature with respect to...

how various approaches to CD20 and B-cell depletion may look in the management of different B-cell and autoantibody mediated diseases.

As I think back to the conversations that were taking place, as our company contemplated the choice of continued investment in NHL versus beginning to invest in autoimmunity, you heard the key.

points of that rationale earlier, you know, in the presentation. Given the level of competition, given the change in the regulatory and therefore the commercial environment in the lymphoma space, right, the upside on the autoimmune front, again, given

from the University of Erlangen in September of 2022. Looking at an anti-CD19 CAR-T in five patients with severe lupus, that really catalyzed a deeper look at what is possible through deep B-cell depletion, right?

And we think that Imvodumab, which we believe will enable deeper B cell depletion than currently available anti-CD20s, because we are not dependent upon local complement and local NK cells. We know from our preclinical data.

that Invotemab will deplete in the spleen, in the lymph nodes, in the bone marrow, where reservoirs of pathogenic B cells can sometimes hide and basically continue to drive autoimmune disorders.

So our hope is that Invodumab will deliver that level of deep B cell depletion that was suggested by the CAR T data, but do so with an off-the-shelf product, with a better safety profile, clearly lower cost and fewer logistical effects.

consideration. So we're quite excited and moving quickly.

So I might add there that in terms of, you know, Greg, to your question, why lupus and RA as the first two indications and where might we go beyond that. Lupus, obviously, as Mary Beth mentioned, you've got the proof of concept with George Machette and that paper.

of real immune modulation, that's obviously a great place for us to start because we think we've got advantages over CD19 CAR-Ts there. RA is a place where we think we can get a signal very quickly in terms of biomarkers and so forth. But in terms of where we go after those two, I think you can think more broadly

First, any place where CD20 has shown signs of clinical activity or efficacy, those are good places. And any place across the entire landscape of autoimmune diseases where you've got auto-antibodies implicated in disease. And as was mentioned earlier, any place where you've got auto-antibodies implicated in disease is a great place to start.

That includes not just B cells that you might be able to take out with a CD20 T cell engager, but also B cells you might be able to take out with a CD38 or a combination of the two. So our landscape is just really, really broad here in terms of what we might be able to do.

with a portfolio of T cell engagers in autoimmune disease. And we think we're in a...

expect these initial studies in patients this year to inform on which development programs make the most sense for this particular mechanism. And I think for those of you who have been in the autoimmune space in the past, I think there has to be some quality evidence in to make sure that everyone understands theOKS of how physically the combined factors that users make decisions that turn and blamed the23 problem that we're dealing with in the system.

So there is, as Fred indicated, there is a very broad range of opportunities. And I will come back to his last remark, right? We not only have a very active molecule, but we think we've got a safety profile that will define the bar for this new class of therapies.

the biomarker data that you discussed looks encouraging. You're seeing it almost every patient. How would you expect that to correlate into a clinical response?

Chris, do you want to take that one? Yeah, no, great question, Greg. So, you know, obviously this is something that we're looking at very carefully. I think, though, when you first, when you think about, you know, Caspase 3, it's a cell death biomarker, it really is an indication of how well your agent is engaging the target and target pathway.

And so the most important information is that it's telling us that, you know, the signal of engagement in modulating the extrinsic apoptotic pathway is quite strong at 10 milligrams per kilogram. We're obviously looking at how this correlates with other clinical parameters, and again, the data are still very early, so we can't really draw any direct conclusions there. But...

Again, in terms of pharmacodynamic marker, we think it's very, very positive and very informative.

Thanks again for taking the questions and congrats again on all the progress.

And our next question is from Michael Schmidt with Guggenheim. Your line is open. Hey, guys. Thanks for taking my questions. I had two. Perhaps the one on 8444, you updated us on your combination arm with the rheupand as well, which seems to be progressing in dose escalation. Can you just remind us which types of patients are likely to respond to that particular combination? Just curious how you think about that. And then on CD20. I see many.

Obviously, a large commercial opportunity across a huge number of indications here. Does that shift in development strategy affect how you think about partnerships for this program that perhaps could maximize the opportunity if you have a large company on board for that? Thanks so much. Thanks. Thank you.

So, Chris, why don't you take the first question and I'll take the second one. Sure. Yeah, so with regards to the borinipant combination, so obviously we're in a dose escalation part of the study, and just to be clear, we're escalating the dose of borinipant in the study. And we're conducting this in patients with all different types of solid tumors. So let's say...

understanding of how a SMAC mimetic could obviously combine very well with a stimulator agonist of the extrinsic apoptotic pathway. And so we've seen, you know, activity in a range of different preclinical models.

I know Bruce, you want to comment a little bit to that in terms of where we think this is promising.

Yes, yes. Michael, thank you for the question. We have tested literally hundreds of different cell lines and patient samples in tumors, and we are, of course, always interested in any mechanism action type signals, but as well as prognostic indicators that might steer us.

But what is really exciting, as Chris mentioned, is we do see with the treatment of full-fury, particularly 5-FU and arena TCAN, you get the synergy, but you also get upregulation of DR5, which may combine well and...

set us up for success with 8444 treatment. Now, still having that, we'll, of course, have to do the studies, but the combination, the clinical studies to show where and when which patients result in the best therapy. But we, our preclinical data says that we're going to see a broad spectrum response.

in this and other indications. And I think with respect to the specific question of Berenapan, we think that that very much could be broadly applicable against...

a lot of different solid tumors and and hopefully with the combination of 8444 and borinapent, little or no additional toxicity and so there may be multiple combinations here that are possible going forward so very encouraging to as Michael as you know with those two

agents were hitting both the extrinsic apoptotic pathway and the intrinsic apoptotic pathway. We think that's a real...

important one-two punch that could be, if with no seeming additional toxicity, could be very, very helpful.

Right, I mean we clearly have quite a body of data showing that we have high safety in both of these and now pre-clinically we see again a series of animal models and in vitro where the combination with borinapent and intrinsic and 8444 intrinsic really combine well.

are...

Large in number, large in size, and could take a lot of money to pursue, but with a lot of potential upside at the end of the pathway.

So I think that strategically, finding a partner that was looking to join us to explore this really new opportunity of T-cell engagers and autoimmune disease would be a really good thing for us as a company. Now exactly what the timing of that is, we'll have to wait and see.

But long term, I think the opportunities are so large and so many different things we could do, so I think a partner would be a really good idea for that franchise, if you will.

Long term, I think the opportunities are so large and so many different things we could do, I think a partner would be a really good idea for that franchise, if you will. Great. Thanks so much.

Thank you. One moment for our next question. And our next question is from Roger Song with Jefferies. Your line is open. Great. Congrats on all the progress. Not long ago, aToro

across broad IGM pipeline. So maybe two quick clarifications from us. One is for

8444 DR5, as you are focused on the randomized trial for 3 meg and 10 meg, would you keep enjoying higher dose in your single arm study considering you may maybe just test the...

safety and PD marker and also If or when you will report additional data from the single arm they cloud and also for the

In Vodamap, I noticed when you talk about the lupus and RA, you used the nomenclature severe form of the disease. Just curious as you position your TCL in danger for autoimmune disease.

What is the real target population for each indication? It will be the last line of the therapy at the starting point, or you will potentially move into the early stage of the disease for those autoimmune disease. That's the two questions we have. Thank you.

Sure. Well, Chris, you want to take the first one and then hand off to Mary Beth to take the second one? Sure. So, Roger, your question was really about the dose of 8444 now that we're exploring 10 milligrams per kilogram in the randomized study. And as you're probably aware and we've talked about before in our monotherapy…

going up to 10 milligrams per kilogram in combination with full-fury chemotherapy. So there are really no safety issues there. But as we look across the program and the experience, particularly the preclinical experience, in terms of the efficacy and exposures that we're achieving that show activity.

in preclinical models, you know, we feel that 10 milligrams per kilogram is a good dose, and we don't feel that there's a strong need to explore higher doses. You know, it is something we would potentially leave open, but at least in our thinking today, we're really pleased with what we're seeing at 3 milligrams per kilogram. We want to get more experience in combination at 10 milligrams.

have not made a decision as to when and in what context we would produce additional monotherapy data. I think we're very focused on the randomized data. We're certainly not seeing anything in the monotherapy data that's inconsistent with what we've seen to date that would cause us to question our decision to move forward into a way of developing the tool.

into this randomized study. But at some point, we will present those data. We just haven't made a decision when, Roger. And Mary Beth, you want to go to the second question? Yeah, no, sure. Thanks, Roger, for the question. You're absolutely correct. We are focusing initially on severe SLE and severe RNA.

potential for disease modification through this approach as suggested by that CAR T data from George Shett. So thanks for the question.

Great, thanks for the comment. Maybe just a quick follow-up, maybe clarification for Fred. So what I meant is for the additional single arm data from the combination, also from the combination you have been doing now the monotherapy data. I believe that the answer is similar, you haven't decided when you will present for the next generation.

we'll be presenting our initial single-armed data on the Venetoclax combination, but we have not made a decision, you know, on when those data disclosures might happen, where we're still all in progress on all of those studies right now. Thank you.

That's it on that. Thank you. Thank you. One moment for our next question. Our next question is from Joel Beatty with Baird. Your line is open.

Great, thanks for taking the questions. The first one is on the DR5 randomized study. How would you define success from that study?

I think we'll certainly know it when we see it, but I'm going to leave it to Chris to talk more about what we've got in mind.

So, thanks, Joel. Yeah, so, you know, the study is designed with PFS as the primary endpoint. Obviously, we will be also looking at response rate and overall survival. The reason why we're really focusing on PFS, though, is that one wasn't blind while we did that kind of study, which I thought was pretty XYZneron,

That's much more strongly correlated with overall survival and at least in the eyes of the FDA is much more...

an endpoint which is, you know, has a much higher track record in terms of actually being a registration, potential registration endpoint. And as we start to think about now randomized data supporting accelerated approval, that's really what has led us to design the study in the current way.

In terms of what the success looked like, again, we don't, I never like to give really specific targets, but we, you know, our expectation is that if you look at historical second line colorectal cancer data, we'll call FURY control arms for large randomized studies. The PFS tends to be five, six months or so in those studies and things in the not too distant past. So those, that kind of gives you a floor of what we.

Thanks for all those details. Also, on the same agent, now that you're focusing more on the 10 milligram dose, is there a risk of seeing some of the liver issues that we're seeing with other agents targeting the target? What I would say is, again, based on our monotherapy...

you know, our expectation is that that would not be an issue, and it hasn't been, and we don't expect it to be an issue in the future. Yeah, and we dosed, as we said, three patients in combination with Fall Fury, didn't see anything there. We have dosed some patients in combination with Berenipan and X per keg 2 and did not see any signal there.

we're not expecting to see a safety signal, a liver, a hepatotoxicity signal, but I guess that's why you do the study.

a safety signal, a liver, I've had a toxicity signal, but I guess that's why you do the study, but not expecting it.

Great, thank you. Thank you. One moment for our next question. And our next question is from Noah Eisenberg with JP Morgan. Your line is open. Bless the everything.

Hi guys, this is Noah on for Eric. Thanks for taking our question. Just kind of looking at the second line randomized trial for 8444. I'm noticing that you're stratifying by KRAS status.

So based on that, we're wondering, is there any synergistic potential between DR5 activation and EGFR inhibition, and to what extent are you interested in evaluating EGFR combos or KRAS inhibitor combinations as part of the DEV's development strategy? Thank you.

So maybe I can start, you know, obviously the colorectal cancer space, you know, there are, you know, we're starting to see molecular profiling obviously have a big treatment impact on different treatment options. But one of the things that's been very clear to us, at least pre-clinically and also thus far in the clinic, is that...

Through our mechanism, we think we should work well in a variety of different molecular subtypes. So KRAS wild type, KRAS mutant, we expect and what we're seeing so far, again small numbers, and we'll obviously look at this further, but we don't expect to see really any differences in terms of just we expect to be active in all those subpopulations.

You know, that being said, as we think about really having a maximal impact on this disease and where do we go? If we can confirm the signal and then where else do we go? We would obviously be open to exploring, you know, other combinations in the space as we start to broaden the program. But at least the development and plans now is to...

to try and go more broadly across different molecular subtypes. I don't know, Bruce, there was kind of a mechanistic question there that maybe you can address. Yeah, no, it's a very good question. It's certainly an active area of research. We, as Chris mentioned, we haven't seen differences due to KRAS positive or negative, but likely we'd work in both. But the opportunity to combine is still a good opportunity. We're investigating pre-clinically.

Thank you. Thank you. One moment for our next question. And our next question is from Brian Abrams with RBC Capital Markets. Your line is open. Hey guys, thanks. It's Leo on for Brian . I'm just clouding Jason.

get to doses where we'll have more activity and you know where's the preclinical data steering you in terms of what doses you want to reach what tumor types might might be most active and do you think you can also target low PD1 expressing cells or is your strategy still going to be enriched and then I had maybe a follow-up on 2644 as well

Chris, you want to take that question? Yeah. So, obviously, one of the things we do when we start a Phase 1 study is we, based on the preclinical data, make estimations of where we think an efficacious exposure level is. And obviously, for safety reasons and things, in a dose escalation study, you generally start low and escalate.

But, you know, I will say that... So, in terms of our expectation going into the study, you know, we would have thought that maybe in, you know, dose cohort three or four, we would be sort of entering the range that we saw clear actions in preclinical models. But, you know, I think the other factors that, you know, IL-15 is...

is a potent agonist, and we've shown certainly our molecules have been able to hit the target. So the safety, we think, is good, but we're also, through our biomarkers, looking at pharmacodynamic effects even at the lowest dose levels. And I think we're off to a good start, and we'll have more to talk about.

DCMA, GPR, C5D. How are you thinking about how 2644 is going to play in the space and the advantages that you might have over some of the other offerings? Maybe I'll start with that and then let Chris take over. But we see 2644 as...

pretty different, at least the way we're intending to develop it, as hopefully quite differentiated from those other bi-specifics. We would like to see this as a next generation CD38 molecule, and so we would like to, assuming safety and efficacy, we'd like to randomize against Dara as fast as we can in order to show that...

We can potentially work better than Dara and some of those patients who've maybe seen Dara previously and then maybe eventually moving up. So the focus here for 2644 is a, hopefully, a next-generation CD38. Chris, you want to add to that? Yeah, and, you know, it is a crowded space with bi-specifics, but about 10 or 12 of those are all BCMA, CD3.

BCMA antigen and things and so it's not necessarily clear you'd want to use the BCMA targeting Bi-specific before you would use a CAR T cell or that you could use it afterwards. So the fact CD38 Bi-specific there are many fewer out there There are a handful of other targets and multiple myelomas for bi-specifics too, but it's not anywhere near as crowded as BCMA. So we

at this point.

Thanks for the answers.

Thank you. One moment, please, for our next question. And our last question is from Aasdika Goodwarden with Truist. Your line is open. Hi, guys. Thanks for taking my question and appreciate all the colors provided today.

So, Chris, I have a couple questions for you here. On your slide where you have the CAPTCH-3 increase, what was the on-treatment…when was the on-treatment measurement made at which cycle? Perhaps you can tell us that. And then do you expect the change in baseline to increase with subsequent cycles? And then related to that…

You have four patients that you've profiled, or five patients that you've profiled, including four with PRs, and then one went on to cure this surgery. What's the level of increase in Cas8-3 that you noted in those profile patients? And then I got a couple of follow-ups.

Sure, yeah, no, thanks for the question. So, just to be clear on our biomarker slide, you know, what we're doing, so these are normalized data, so not surprisingly, Caspase III levels in the plasma, you know, can vary highly at baseline from our patients. So, what we've done is taken the pretreatment sample, normalized that.

to one and then showed the relative change. And actually the data that we're showing you here, so we monitor the...

Caspase levels during the first cycle, second cycle, and what we're actually showing here is actually the maximum change that we see in the Caspase-3 levels in patients who are on study. Now, that could vary somewhat at different time points, although we do tend to see a very immediate rise in the Caspase-3 levels with...

Oh yeah, yeah, and then how their relative fold increase in caspase. Yeah, so we have those data we've looked at things in terms of you know those patients that have shown seem to see clinical benefits and things And again, it's just small numbers that we really you know can't draw any conclusions so that we don't really have anything

to share with you right now, although, obviously, we're going to be looking at this pharmacodynamic biomarker and correlating that with all different sort of other clinical endpoints in the study, particularly as we move forward. Got it. Okay. And then, Chris, I mean, the slide with the biomarker does suggest that there's 17 patients or so who have been treated at the same time.

three makes the case dose. Yeah, yeah. So the answer to the last part of your question is no, it's actually different. So the data that we're showing you here is a combination of the monotherapy dose escalation patients, which were in all tumor types, as well as patients that were in the full theory combination arm. And we previously disclosed that we only treated three patients with 10 milligrams for

with full theory. But that being said, you know, one of the things obviously that is a key question is, you know, how much, particularly for the combination patients, how much of this biomarker change is being driven by our 8444 molecule and how much is being driven just by chemotherapy. And, you know, what we'll say again with small numbers but when we look at this in our data.

data to share with you to really address that question. Great, thanks for the call there, Chris. Fred, I got one last for you. You said, at some point, I'm using air quotes here for presenting data from the phase one study on the different cohorts. Can I tease you to say, in terms of the data that you're presenting, can I tease you to

at least one of them in some point this year? On what are you talking about, the Envoto Map Study? No, 8444. 8444. Oh, oh. I'm being really honest in saying we have not made a decision when we would do that.

and we'll turn to that question that you've asked shortly, I think. Excellent. Thanks, guys. I really appreciate the questions. Okay, thank you.

Thank you. And I would now like to turn the conference back to Fred Schwartz, Chief Executive Officer, for the closing remarks. Well, I'd like to thank you all for joining us on today's call, and we greatly appreciate your support. Thank you. And this concludes today's conference call. Thank you for participating. You may now disconnect. Thank a lot.

I.

Good day, everyone, and welcome to IGM Biosciences' fourth quarter and full year 2022 Financial Results and Corporate Update Call. Today's call is being recorded. At this time, I would like to turn the call over to Fred Schwerzer, Chief Executive Officer of IGM. Fred Schwerzer, Chief Executive Officer of IGM.

Thank you, operator, and thanks to all of you joining us on this call.

On behalf of IGM, I'm joined today by MSPTAHIR, Chief Financial Officer, Dr. Chris Takamoto, Chief Medical Officer,

Dr. Bruce Kight, Chief Scientific Officer, and Dr. Mary Beth Harler, President, IGM Autoimmunity and Inflammation.

Please note that we will be making forward-looking statements on this call, including statements about IGM's plans, expectations and forecasts, and about future events.

Actual results may differ materially as a result of various risks and uncertainties, including those discussed in the company's most recent annual report on Form 10-K as well as its other filings with the SEC.

Any forward-looking statements represent IGM's view as of today, March 30, 2023 only, and the company disclaims any obligation to update these statements, except as required by law. Following this call, a replay will be available on the company's website.

www.igmbio.com. I would like to start with a few introductory remarks, and then I will turn the call over to MISPA to take you through our 2022 financial results. After MISPA's update, Chris will update you on clinical development of IGM-8 for the next year. And then we'll move on to the next slide.

product candidates in our oncology pipeline.

IgM7354, our IgM-targeted immunostimulatory IL-15 cytokine, and IgM2644, our CD38 by CD3 T-cell engager, a next-generation CD38 antibody for multiple myeloma. Welcome back. 2022 was a transformational year for our...

IGM 8444, particularly in combination with Fulfuri for the treatment of colorectal cancer.

We're very pleased with the data we have seen from those clinical development efforts as we announced in January of this year. These data have provided the basis for our decision to immediately move into a randomized study of IgM8444 in second-line metastatic colorectal cancer in combination with Fulfuri and bevacizumab.

which is the standard of care in second-line colorectal cancer. We are hopeful that this randomized study will show a significant improvement in progression-free survival relative to the standard of care chemotherapy control arm. As we announced today, we have now treated the first patient in this randomized study. We also made great progress during 2022 in developing our understanding of the potential role

Building on our success in 2022, we expect that 2023 will also be an important year for the expansion and validation of IGM's platform.

Already this year, we have treated the first patients in our clinical study of IGM 7354, an IGM-targeted immunostimulatory IL-15 cytokine, which could be used for the treatment of patients with Fallon and hematologic malignancies.

We are particularly excited about the potential to use IGM 7354 in combination with cellular therapies such as CAR-T and CAR-NK cells.

We are also initiating studies of IgM-2644, our CD38 by CD3 bispecific IgM antibody, which we hope will be a safe and more potent form of anti-CD38 therapy for multiple myeloma, including for patients who have previously been treated with daratumumab. We also plan to file investigational new drug applications.

overview I will provide on the call today. You can read additional detail on our fourth quarter and year-end financial results in our press release issued prior to this call and in our 10K, which was filed with the SEC.

We are fortunate to be in a strong financial position. In the second quarter of 2022, we received an upfront payment of $150 million from Sanofi related to our collaboration agreement and raised gross proceeds of $230 million in a follow-on public equity offering. As a result …

our cash and investments total $427.2 million as of December 31, 2022. In the fourth quarter, our research and development expenses were $45 million.

For the full year 2022, R&D expenses were $179.3 million. General and administrative expenses for the fourth quarter of 2022 were $11.6 million and $49.7 million for the full year 2022.

Collaboration revenues for the fourth quarter of 2022 were $0.4 million and $1.1 million for the full year of 2022.

Our net loss for the fourth quarter of 2022 was $52.6 million, or a loss of $1.19 per share. For the full year 2022, our net loss was $221.1 million, or a loss of $5.32 per share.

Turning now to the financial guidance for 2023, we expect our full year 2023 gap operating expenses to be between $290 million and $300 million. This includes estimated non-cash stock-based compensation expense of approximately $50 million. For the full year 2023, we expect our full year 2023 to be between $200 million and $300 million.

We also expect to recognize approximately $3 million of collaboration revenue related to last year's upfront payment from Sanofi. Finally, we expect to end 2023 with a balance of approximately $200 million in cash and investments, providing IGM with an expected cash runway into the second half of 2024.

With that, I'll now turn the call over to Chris, our Chief Medical Officer. Thank you, Ms. Spaff. As Fred mentioned, 2022 was a very important year for the clinical development of IGM 8444. I am pleased to announce that we have now dosed more than 100 patients with IGM 8444 in our broad, multi-indication, multi-combination Phase 1 study.

And we're very excited about the safety and clinical activity profile that we've seen to date in our combination with the standard full fury chemotherapy regimen in colorectal cancer patients. In January , we shared our initial data from our full fury combination cohort, which is available in detail in our current corporate overview presentation.

To summarize, these data showed an encouraging safety profile that was broadly comparable to that expected from chemotherapy alone. Specifically, no signs of drug-related clinically significant hepatotoxicity were observed. There's only grade one and grade two transient drug-related liver enzyme elevations were seen. The substantial majority of our patients with metastatic colorectal cancer have been treated with three milligrams per kilogram.

These data have encouraged us to start treating patients with Fulfuri plus bevacizumab, which is the current standard of care treatment for second-line colorectal cancer.

I am pleased to announce today that we have now treated nearly 20 patients in combination with bevacizumab, and we've not seen any additional toxicity signals arising from the addition of bevacizumab to the combination. These early safety and efficacy observations have encouraged us to proceed immediately into a randomized...

today that our analysis of the cell death biomarker, caspase-3, in patients treated with IgM 8444 across multiple dose levels, both as monotherapy and in combination, showed a consistent increase in post-treatment in 60 of 64 patients analyzed.

In addition, a dose-dependent increase was seen at the two highest dose levels tested of 3 and 10 milligrams per kilogram. A summary of these data is available in our current corporate overview slide deck available on our website. This biomarker signal has led us to add an additional 10 milligram per kilogram dose cohort.

to our randomized combination study. This protocol is currently being amended to randomize patients to three groups, either 3 or 10 milligrams per kilogram of IgM-8444 with fulfuri plus bevacizumab or standard of care chemotherapy alone. Our primary endpoint for this study will be progression-free survival with overall survival and response

To date, there have not been any observed docilinear toxicities in combination with bertapam

We also announced today that we've treated the first patient in our IgM 8444 plus panetoclax and azacytidine combination in subjects with acute myeloid leukemia. Finally, we've also conducted extensive preclinical studies with other chemotherapeutic agents in combination with IgM 80...

Beth, our President of Autoimmunity and Inflammation. Mary Beth will be leading our clinical development efforts for Invodumab in autoimmune diseases. And as the clinical development in autoimmune diseases will be our focus going forward, she will be sharing today's interim clinical updates about the Invodumab NHL program.

and inflammation. Mary Beth will be leading our clinical development efforts for Invotimab in autoimmune diseases, and as the clinical development in autoimmune diseases will be our focus going forward, she will be sharing today's interim clinical updates about the Invotimab NHL program. Mary Beth.

Thank you, Chris. As you mentioned, we are announcing some encouraging safety and clinical activity data for Invodumab, which we think could offer a compelling and differentiated profile in the exciting new area of T cell engagers in autoimmune disease. We think there is an important opportunity to bring forward a readily accessible therapy that offers deeper B cell depletion than achievable with currently available anti-CD20 therapies. Also, anything related to vector

You may recall hearing about some recent, very encouraging data using CAR T cells for B-cell depletion in lupus. We believe that invotimab may have clear advantages over CAR T therapies in autoimmune disease in terms of safety, cost, and logistics. We announced today that, as of our most recent data assessment, the incidence of cytokine release syndrome was 9% over all safety-evaluable patients treated with the 100 mg titration dosing regimen.

in our phase one and phase two non-Hodgkin's lymphoma studies. And it was 13% overall safety-evaluable patients treated with either 100 milligrams or 300 milligram titration dosing in these phase one and phase two lymphoma studies. All cases of CRS seen in the 100 milligrams and 300 milligrams.

response rate of greater than 30% over all efficacy-evaluable diffuse large B cell lymphoma or DLBCL patients in our phase 1 and phase 2 studies treated with the 100 milligram titration weekly dosing regimen.

Although the patient numbers are too small to make a statistical assessment, currently the response rate in DLBCL continues to be, appears, continues to appear to be lower at the 300 milligram dose.

As you may recall, we have previously announced that we have seen complete responses with Invodumab in all four major NHL subtypes.

diffuse large B-cell lymphoma, follicular lymphoma, mantle cell lymphoma, and marginal zone lymphoma. While it is not possible to directly extrapolate these encouraging efficacy data in NHL to what we might observe in autoimmune disease.

it's worth noting a couple of points. First, CD20 is a well-established target in multiple autoimmune diseases. Secondly, the Invotimab data in NHL clearly demonstrate that Invotimab effectively depletes B cells, even rapidly growing lymphoma cells.

In combination with these strong signs of clinical activity, we believe that Infodimab's safety profile will be an important differentiating factor in the treatment of autoimmune diseases with T cell engagers.

together with the potential to more effectively deplete pathogenic B cells deep within tissues that may be refractory to current therapies.

We believe there are significant unmet medical needs and commercial opportunities that Invotimab may address across a range of autoimmune diseases. We have also announced today that we plan to file IND applications in the second quarter to begin clinical testing of Invotimab in both severe systemic lupus erythematosus or SLE.

and in severe rheumatoid arthritis or RA. We are also evaluating a variety of additional autoimmune diseases for a potential third IND application later this year. With that, I'll turn the call back over to Fred.

severe rheumatoid arthritis or RA. We are also evaluating a variety of additional autoimmune diseases for a potential third IND application later this year. With that, I'll turn the call back over to Fred. Thank you, Mary Beth.

We are pleased with the safety and clinical activity profile that we have seen within Botomat at 100 milligrams in our non-Hodgkin's lymphoma clinical studies to date.

and we're excited to move forward aggressively in developing Imvodumab for multiple autoimmune diseases. Given the relative size of the potential autoimmune markets and Imvodumab's potential competitive advantage in autoimmune disease resulting from its safety profile, we believe that the unmet medical needs and the commercial opportunities for...

to autoimmune diseases, and that we have decided to cease further monotherapy clinical development efforts for invotumab in non-Hodgkin's lymphoma.

We continue to believe that the safety and efficacy profile of Envodimab could position it well as a combination partner for the treatment of non-Hodgkin's lymphoma.

And we will be focusing our future efforts in NHL on evaluating combination opportunities and partnerships for Envodimab. With that, I'd like to turn the call back to Chris to discuss our exciting early-stage clinical development efforts in oncology. Thank you, Fred. As we announced in January , we're excited to have initiated a clinical trial exploring the safety, efficacy, and assumptions of scientificFOOSE in the Jenny

has the potential to be used in combination with a broad range of other drugs which rely on CD8-positive cells or NK cells for their activity, including combinations with CAR-T and CAR-NK cells. We are also announcing that the FDA has cleared our IND application for IgM-2644, a CD38 by CD3-

IgM T-cell engager, which allows us to commence a phase 1 dose escalation trial in patients with recurrent or refractory multiple myeloma. This study will allow us to investigate the initial safety and efficacy of our next T-cell engaging IgM molecule.

Our ultimate clinical development goal for IGM-2644 is to establish it as a safe and more potent anti-CD38 therapy, even for patients who have received prior daratumumab treatment. We are very excited by the potential for IGM-2644 to provide the next generation form of an anti-CD8 therapy.

As you may recall, in December of last year, we presented preclinical data at the 2022 ASH meeting, showing that IgM2644 achieved potent T-cell-directed cellular cytotoxicity in multiple myeloma patient samples and in daratumab-resistant cell lines with minimal cytokine release. With that, I'd like to turn the call back over to Fred.

recall in December of last year we presented preclinical data at the 2022 ASH meeting showing that IgM 2644 achieved potent T cell-directed cellular cytotoxicity in multiple myeloma patient samples and in daratumab-resistant cell lines with minimal cytokine release. With that I'd like to turn the call back over to Fred.

Thank you, Chris. In closing, I'd like to thank all of the employees of IGM for their work over the past year, all of our principal investigators, their teams and their institutions, and most importantly, the patients and their families, all of whom have made the progress we've described today possible. We're very excited about the progress that we hope to make in 2023 towards our goal of bringing new and important treatments to patients.

We appreciate your interest in IGM and we look forward to keeping you all informed as to our progress. With that operator, I'd like to open the call for questions. Thank you. As a reminder, to ask a question, please press star 1-1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1-1 again. Please stand by while we compile Q&A rosters. Our first question is from Steven Willey with Stifel.

Just any updated thoughts on when we might get a look at the remaining dose expansion patients. I guess those treated at the three megaparct dose and any that you may have treated at the 10 megaparct dose.

Chris, would you like to take that one? Sure, yeah. Steve, thank you for the question. So, really, the experience that we have with 8444 at 10 milligrams per kilogram, is there where, you know, we explored a number of patients during the monotherapy dose escalation. Meaninged, parts of a coworkers' family were both mental health workers, and mental health workers, members of care workers with mental health deficits that could not move on to

And then when we started to combine with full theory, we did the expansion at three milligrams per kilogram, although we did treat three patients at 10 milligrams per kilogram with full theory. But it was really the biomarker data that we're sharing with you now that really showed this increase in plasma caspase-3 levels that continued to increase as we went from three....

to 10 milligrams per kilogram. And that was one of the major factors that led us to incorporate and make the decision to add 10 milligrams per kilogram to the randomized study. Plus, we did get additional feedback from the FDA that was, again, very supportive of doing formal dose exploration and optimization in the study. So those were the things.

the new biomarker data that really prompted us to make this addition to the study. Okay. Then, I guess as a follow-up, does the addition of the third arm to the randomized phase two change your powering assumptions? No, it doesn't.

I know that you're kind of guiding to potentially having a conversation with FDA regarding an accelerated approval pathway. So should we think about patient enrollment then as kind of a moving target? Yeah. So this study is built with a certain degree of flexibility. And again, the study is really designed to confirm the signal that we have seen in our single arm experience in combining 8444 with Pulpuri.

but it's also written so that when we can actually evaluate the impact of dose as well as looking at the primary endpoint, which is going to be progression-free survival. And so we've left things somewhat open in terms of, if we get a strong signal that allows us to pick a dose and also confirm the magnitude of the benefit over the control arm, there's the potential that we can...

either stop this early and initiate a more formal registrational trial, or alternatively, we could potentially, with regulatory feedback, expand this study to increase the number of patients on each of the arms and potentially use this as a randomized accelerated approval trial. So those possibilities are all things that we are considering as we move forward. Okay, and maybe just lastly real quickly, I know obviously, Envodimat is getting prioritized.

assets more through a portfolio lens than individual opportunities. And we are very excited about how these assets may come together to afford multiple therapeutic approaches to treating B-cell and plasma cell mediated diseases.

As we discussed, obviously, CD20, a well-established target in autoimmune disease, CD38. There is a smaller but very interesting dataset, particularly in the setting of diseases such as lupus, to support the potential utility of CD8.

CD38 targeting therapies. I think it is very important that we understand what the safety of our own CD38 by CD3 molecule looks like in multiple myeloma. As we've discussed, safety is clearly a very important consideration in the management of chronic diseases such as autoimmune disease.

but also other potential competitors in this space. So in summary, a lot of activity and we await that human data.

Great, thanks for taking the questions. Thanks, Dave. Thank you. One moment for our next question.

And our next question is from Greg Harrison with Bank of America. Your line is open. Hey, good afternoon. Congrats on the progress and thanks for taking the questions. First off, maybe could you give some additional color on the transition towards autoimmune indications from Votamab? What was the decision process that led to

the choice of lupus and RA and how broadly do you think Imvodibam could be applied across autoimmune disease? Well Mary Beth, I think that's probably a question for you. It's one we spend a lot of time thinking about and it's very broad. So I'll leave you to go at it Mary Beth. Indeed and thank you for that question.

Again, you know, the CD20 as a target in autoimmune disease, well established, and a very broad data set out there in the literature with respect to how various approaches to CD20 and B cell depletion may look in the management of different B cell and auto antibody mediated diseases. You know, as I think back to the conversations that were taking place.

You know, as our company contemplated the choice of continued investment in NHL, you know, versus beginning to invest in autoimmunity, you heard the key points of that rationale earlier in the presentation. Given the level of competition, given the change in the regulatory and therefore the commercial environment.

in the lymphoma space, right? The upside on the autoimmune front. Again, given that this is a well-characterized target and one that could absolutely benefit from deeper B cell depletion, those are the things that really got us excited. If you have not seen the publication from George Sheth et al.

from the University of Erlangen in September of 2022. Looking at an anti-CD19 CAR-T in five patients with severe lupus, that really catalyzed a deeper look at what is possible through deep B-cell depletion, right?

And we think that Imvodimab, which we believe will enable deeper B cell depletion than currently available anti-CD20s, because we are not dependent upon local complement and local NK cells, we know from our preclinical data that Imvodimab will deplete.

in the spleen, in the lymph nodes, in the bone marrow, where reservoirs of pathogenic B cells can sometimes hide and basically continue to drive autoimmune disorders. So our hope is that Invodumab will deliver that level of deep B cell depletion that was suggested by the CAR-T data.

but do so with an off-the-shelf product, with a better safety profile, clearly lower cost and fewer logistical considerations. So we're quite excited and moving quickly. So I might add there that in terms of, you know, Greg, to your question, why lupus and RA as the first two indications and where might we go beyond that, is that you're right in the middle of a Councillor's argument about why lupus haveline

lupus obviously as Mary Beth mentioned you've got the proof of concept with George Shett and that paper of real immune modulation that's obviously a great place for us to start because we think we've got advantages over CD19 CAR-Ts there. RA is a place where we think we can get a signal very quickly in terms of biomarkers and so forth.

But in terms of where we go after those two, I think you can think more broadly, first, any place where CD20 has shown signs of clinical activity or efficacy. Those are good places. And any place across the entire landscape of autoimmune diseases where you've got autoantibodies implicated in disease. And as was mentioned earlier, that includes not just...

B cells that you might be able to take out with a CD20 T cell engager, but also B cells you might be able to take out with a CD38 or a combination of the two. So our landscape is just really, really broad here in terms of what we might be able to do with a portfolio of T cell engagers in autoimmune disease.

And we think we're in a, we have the potential to be in a real leadership position here. And we think our safety is perhaps the most important differentiating factor. Mary Beth, did you want to add to that? Yeah, no, thank you. I think, you know, those are absolutely critical comments, right? We expect these initial studies in patients this year to inform on which development programs may be needed.

are currently going in autoimmune disease. We could even contemplate perhaps, you know, where the FCRNs are going. So there is, as Fred indicated, there is a very broad range of opportunities. And I will come back to his last remark, right? You know, we not only have a very active molecule, but we think we've got a safety profile forelli we've got you in the living room so it doesn't

on 8444, the biomarker data that you discussed looks encouraging. You're seeing it in almost every patient. How would you expect that to correlate into a clinical response? Chris, do you want to take that one? Yeah, no, great question, Greg. So, you know, obviously, this is something that we're looking at very carefully.

the signal of engagement in modulating the extrinsic apoptotic pathway is quite strong at 10 milligrams per kilogram. We're obviously looking at how this correlates with other clinical parameters and again, the data are still very early so we can't really draw any direct conclusions there. But...

Again, in terms of pharmacodynamic marker, we think it's very, very positive and very informative. Great. That's helpful. Thanks again for taking the questions, and congrats again on all the progress. Thank you. Thank you. One moment for our next question. And our next question is from Michael Schmidt with Guggenheim. Your line is open.

Hey, guys. Thanks for taking my questions. I had two. Perhaps the one on 8444, you know, you updated us on your combination arm with the Rooney-Panda, as well, which seems to be progressing in dose escalation. Could you just remind us, you know, which types of patients are likely to respond to that particular combination? I'm just curious how you think about that. And then on CD20...

Obviously, a large commercial opportunity across a huge number of indications here. Does that shift in development strategy affect how you think about partnerships for this program that perhaps could maximize the opportunity if you have a large company on board for that? Thanks so much. Chris, why don't you take the first question and I'll take the second one. Someone says, can someone in front of the staff give an update about what the ones already

Yeah, so with regards to the borinapant combination, so, you know, obviously we're in a dose escalation part of the study, and just to be clear, we're escalating the dose of borinapant in the study. And we're conducting this in patients with all different types of solid tumors. So it's a standard solid tumor phase one dose escalation study.

that is continuing to go on. In terms of where we might take this, again, our strong interest in borinapant in this combination was really built on the preclinical models that showed strong synergy as well as the scientific mechanistic understanding of how a SMAC memetic could obviously combine very well with a stimulator agonist of the extrinsic apoptotic pathway.

And so we've seen, you know, activity in a range of different preclinical models. I know, Bruce, you want to comment a little bit to that in terms of, you know, where we think this is promising. Yes, yes. Michael, thank you for the question. I mean, we have tested literally hundreds of different cell lines and patient samples in tumors, and we are, of course, always interested in any mechanism action type signals, but as well as prognostic indicators that might steer us.

to show where and when which patients result in the best therapy. But we, our preclinical data says that we're gonna see a broad spectrum response in this and other indications. And I think with respect to the specific question of borinopin, we think that that very much could be broadly applicable against a lot of different solid tumors and...

hopefully with the combination of 8444 and Berenipan, little or no additional toxicity. And so there may be multiple combinations here that are possible going forward. So, very encouraging to, as Michael, as you know, with those two agents, we're hitting both the extrinsic apoptotic pathway and the intrinsic apoptotic pathway. And we think that's a real...

important one-two punch that could be, if with no seeming additional toxicity, could be very, very helpful. Right, I mean we clearly have quite a body of data showing that we have high safety in both of these and now pre-clinically we see again a series of animal models and in vitro.

where the combination with Berenepam intrinsic and 8444 intrinsic really combine well. And thanks for your question about strategic partnerships for Invotimab, and I might expand it out to say Invotimab and our T cell engagers for autoimmune perhaps more broadly. As you say, the opportunities there are large in number, large in size, and could take a lot of money to pursue.

but with a lot of potential upside at the end of the pathway. So I think that strategically finding a partner that was looking to join us to explore this really new opportunity of T cell engagers and autoimmune disease.

would be a really good thing for us as a company. Now, exactly what the timing of that is, we'll have to wait and see, but long term, I think the opportunities are so large and so many different things we could do, I think a partner would be a really good idea for that franchise, if you will. Great, thanks so much. Thank you, one moment for our next question.

And our next question is from Roger Song with Jefferies. Your line is open. Great. Congrats on all the progress across broad IGM pipeline. So maybe two quick clarifications from us. One is for 8444 DR5. More points you get for ZXSyn. wrote me ask.

As you are focused on the randomized trial for 3-meg and 10-meg, would you keep enjoying higher dose in your single-arm study, considering you may maybe just test the...

safety and PD marker and also For when you will report additional data from the single arm they cloud and also for the

In Vodamap, I noticed when you talk about the lupus in RA, we use the nomenclature severe form of the disease. Just curious, as you position your TCL engager for autoimmune disease, what is the real target population for each indication?

it will be the last line of the therapy at the starting point, or you will potentially move into the early stage of the disease for those autoimmune disease. That's two questions we have. Thank you. Sure. Well, Chris, you want to take the first one and then hand off to Mary Beth to take the second one.

Sure. So, Roger, your question was really about the dose of 8444 now that we're exploring 10 milligrams per kilogram in the randomized study. And as you're probably aware and we've talked about before, in our monotherapy part of the study, we went as high as 10 milligrams per kilogram, but we did not go higher. There were no any safety signals that arose. We didn't define dose-limiting toxicities or a maximum tolerated dose. And that was also true going up to 10 milligrams per kilogram in combination.

with full-fury chemotherapy. So there are really no safety issues there. But as we look across the program and the experience, particularly the preclinical experience, in terms of the efficacy and exposures that we're achieving that show activity in preclinical models, we feel that 10 milligrams per kilogram is a good dose, and we don't feel that there's a strong need to explore higher doses. You know, it is something we would potentially leave open, but at least in our thinking today, we're really pleased with what we're seeing at 3 milligrams per kilogram.

certainly not seen anything in the monotherapy data that's inconsistent with what we've seen to date that it would cause us to question our decision to move forward into this randomized study. But at some point we will present those data. We just haven't made a decision when Roger.

And Mary Beth, you want to go to the second question? Yeah, no, sure. Thanks, Roger, for the question. You're absolutely correct. We are focusing initially on severe SLE and severe RA. Our intention is to establish initial safety and activity in those populations and then move into the

So thanks for the question. Great. Thanks for the comment. Maybe just a quick follow-up, maybe clarification for Fred. So what I meant is for the additional single arm data from the combination, also from the combination, you have been doing the monotherapy data. But I believe that the answer is similar. You haven't decided yet.

well predicted. Yeah, we have not decided. At some point, we'll be presenting additional single-arm data on the Fofuri combination. At some point, we'll be presenting our initial single-arm data on the borinapent combination. And at some point, we'll be presenting our initial single-arm data on the Venetoclax combination.

but we have not made a decision on when those data disclosures might happen where we're still all in progress on all of those studies right now. Excellent. Thank you, Fred. That's it for now. Thank you. Thank you. One moment for our next question. Okay.

And our next question is from Joel Beatty with Baird. Your line is open. Great. Thanks for taking the questions. The first one is on the DR5 randomized study. How would you define success from that study?

I think we'll certainly know it when we see it, but I'm going to leave it to Chris to talk more about what we've got in mind. So thanks, Joel. Yeah, so, you know, the study is designed with the PFS as the primary endpoint. Obviously, we will be also looking at the...

response rate and overall survival. The reason why we're really focusing on PFS, though, is that one, that's much more strongly correlated with overall survival, and at least in the eyes of the FDA, is much more......

an endpoint which has a much higher track record in terms of actually being a potential registration one point. And as we start to think about now randomized data supporting accelerated approval, that's really what has led us to design the study in the current way. In terms of what the success looked like, again, we don't, I never like to give real quotes, but I think we need to put some Commanding

So that kind of gives you a floor of what we think where we need to be better and where we expect to be substantially better. But that's kind of the thinking that has gone into the design of the trial. Yeah, I mean, we really are looking for, hopefully, a significant improvement.

on PFS over control here, something that's clinically meaningful. Got it, okay, sounds great. Thanks for all those details. And then also on the same agent, now that you're focusing more on the 10 milligram dose, is there a risk of seeing some of the liver issues that we're seeing with other agents targeting the target?

So what I would say is, again, based on our monotherapy experience, we did not see any dose-related issues. We didn't see any issues around treatment-related liver toxicity in general, and we certainly didn't see anything that emerged at higher doses. So our expectation is that that would not be an issue, and it hasn't been, and we don't expect it to be an issue in the future.

Yeah, and we dosed, as we said, three patients in combination with Fulfuri, didn't see anything there. We have dosed some patients in combination with Berenipanta and 10-Mix-per-Kig-2 and did not see any signal there. So we're not expecting to see a safety signal, a liver, a hepatotoxicity signal, but I guess that's why you do the study, but not expecting it. Great. Thank you. One moment for our next question.

And our next question is from Noah Eisenberg with JP Morgan. Your line is open. Hi, guys. This is Noah on for Eric. Thanks for taking our question. Just kind of looking at the second line randomized trial for 8444, noticing that you're stratifying by KRAS status. So based on that, we're wondering, is there any synergistic potential between DR5 activation and EGFR inhibition and to it?

And to what extent are you interested in evaluating EGFR combos or KRAS inhibitor combinations as part of the DEVS development strategy? Thank you. So maybe I can start. Obviously the colorectal cancer space, we're starting to see molecular profiling obviously have a big treatment impact.

we expect and what we're seeing so far, again, small numbers, and we'll obviously look at this further, but we don't expect to see really any differences in terms of just we expect to be active in all those subpopulations. That being said, as we think about really having a maximal impact on this disease and where do we go, if we can confirm the signal and then where else do we go, we would obviously be open to it.

of research. As Chris mentioned, we haven't seen differences due to KRAS positive or negative, but likely we'd work in both. But the opportunity to combine is still a good opportunity. We're integrating pre-clinically.

as Chris mentioned, we haven't seen differences due to KRAS positive or negative, but it could likely we'd work in both. But the opportunity to combine is still a good opportunity. We're investigating pre-clinically. Thank you.

Thank you. One moment for our next question. And our next question is from Brian Abrams with RBC Capital Markets. Your line is open. Hey, guys. Thanks. It's Leo on for Brian . I had maybe a couple on the pipeline. So maybe starting with 7354, can you talk about, you know, given the initial Clean Safety data there in two patients, is this a dose you think could be active? And then I guess when do you think we may get to doses where we'll have?

more activity and you know, where's the preclinical data steering you in terms of what doses you want to reach what tumor types might be most active and do you think you can also target low PD one expressing cells or is your strategy still going to be enriched and then I had a follow up on twenty six forty four as well.

Chris, you want to take that question? Yeah. So, obviously, one of the things we do when we start a Phase 1 study is we, based on the preclinical data, make estimations of where we think an efficacious exposure level is. And obviously, for safety reasons and things, in a dose escalation study, you generally start low and escalate. But I will say that in terms of our expectations going…

So, you know, the safety, we think, is good, but, you know, we're also, through our biomarkers, looking at pharmacodynamic effects even at the lowest dose levels. And, you know, I think we're off to a good start, and we'll have more to talk about in the future about this. But, you know, there is certainly the potential that we could start...

seeing evidence that we're hitting the target even at the lowest dose levels in the study. Got it. Thanks. And then maybe one on 2644. You know, obviously, there's a few different five specifics in multiple myeloma now, DCMA, GPR, C5D. How are you thinking about how 2644 is going to play in this space and the advantages that you might have over some of the other offerings? Maybe I'll start with that and then let Chris take over.

We see 2644 as pretty different, at least the way we're intending to develop it, as hopefully quite differentiated from those other biosecifics. We would like to see this as a next generation CD38 molecule. And so we would like to, assuming safety and efficacy, we'd like to randomize against Dara as fast as we can in order to show that we can potentially work better than Dara in some of those patients who may be seeing Dara previously and then maybe eventually moving up.

The focus here for 2644 is a hopefully a next generation CD38. Chris, you want to add to that? Yeah, and you know, it is a crowded space with bispecifics, but about 10 or 12 of those are all BCMA, CD3 bispecifics, and then you have the BCMA CAR T cells coming into this space. And I can tell you that, you know, the fact that we're not a BCMA bispecific is actually an important differentiating factor. Obviously, there's been reported cases of resistance to...

to CAR T-cell therapy in multiple myeloma through loss of the BCMA antigen and things. And so it's not necessarily clear you'd want to use the BCMA-targeting bispecific before you would use a CAR T-cell or that you could use it afterwards. So the fact that CD38 bispecifics, there are many fewer out there. There are a handful of other targets in multiple myelomas for bispecifics, too, but it's not anywhere near as crowded as BCMA. So we think there's a way to differentiate there. And then Fred has already outlined a major tenet to our strategy here, and that is to really think about this as potentially the best CD38-targeting agent in this class.

So that's really kind of driving our strategic thinking at this point. Got it. Thanks a lot of sense. Thanks for the answers. Thank you. One moment, please, for our next question. And our last question is from Aasika Goodwarden with Truist. Your line is open. Hi guys, thanks for taking my question. And I appreciate all the colors provided today. Great. So, Chris, I have a couple of questions for you here. On your slide where you have the CAPTES 3 increase,

What was the on-treatment measurement made at which cycle, perhaps you can tell us that, and then do you expect the change in baseline to increase with subsequent cycles? And then, related to that, you have four patients that you profile, or five patients that you profile, including four with PRs, and then one went on to cure this surgery. What's the level of increase in Cas8-3 that you noted in those profile patients? And then I got a couple of follow-ups. Sure, yeah, no, thanks for the question. So just to be clear on our biomarker slide, you know, what we're—

that we see in the Caspase 3 levels in patients who are on study. Now, you know, that could vary somewhat at different time points, although we do tend to see a very immediate rise in the Caspase 3 levels with treatment. So it's something that's very consistent that we're seeing across our patients. But, you know, there is some noise to the timing of this, but in general it goes up in essentially all of the patients that are on treatment.

And I don't feel that we looked at those specific patients and how their relative fold increase in caspase. Yeah, so we have those data. We've looked at things in terms of those patients that I've shown seem to see clinical benefits and things. And again, it's just small numbers, so we really can't draw any conclusions. We don't really have anything to share with you right now, although obviously we're going to be looking at this.

this pharmacodynamic biomarker and correlating that with all different sort of other clinical endpoints in the study, particularly as we move forward. Got it. Okay. And then, Chris, the slide with the biomarker suggests that there's 17 patients or so who have been treated at 10 milligrams per gig. Could you maybe give us some color on that, about how many of those patients had colorectal cancer? Or if you can't tell us that, was the distribution similar, the percent of colorectal cancer patients, was the distribution similar to that seen as a three-mix per gig?

Yeah, yeah, so the answer to the last part of your question is no, it's actually different. So the data that we're showing you here is a combination of the monotherapy dose escalation patients, which were in all tumor types, as well as patients that were in the full FURIE combination arm. And we previously disclosed that we only treated three patients at 10 milligrams per kilogram in combination with full FURIE, and only one of those was a colorectal cancer patient. And because of the expansion at three milligrams per kilogram with full FURIE, the majority of patients that we're showing you with these biomarker changes.

in the 3 milligram per kilogram cohort are actually colorectal cancer patients that are being treated in combination with full theory. But that being said, one of the things, obviously, that is a key question is, you know, how much, particularly for the combination patients, how much of this biomarker change is being driven by our 8444 molecule and how much is being driven just by chemotherapy. And, you know, we'll say, again, with small numbers, but when we look at this in our data set, we don't see much of an effect of full theory chemotherapy on this marker, so we think...

at least one of them in some point this year? On what are you talking about, the Envoto Map study? No, 8444. 8444. Oh, oh. I'm being really honest in saying we have not made a decision.

and running and these new biomarker data, that that's really been our focus. And we'll turn to that question that you've asked shortly, I think. Excellent. Thanks, guys. I really appreciate the questions. Okay. Thank you. Thank you.

And I would now like to turn the conference back to Fred Schwerzer, Chief Executive Officer, for the closing remarks. Well, I'd like to thank you all for joining us on today's call, and we greatly appreciate your support. Thank you.

And this concludes today's conference call. Thank you for participating. You may now disconnect. The otherWinds