BeyondSpring, Inc. (NASDAQ: BYSI) Q1 2021 earnings call dated Jun. 16, 2021
Corporate Participants:
Ashley R. Robinson — Media & Investor Relations of LifeSci Advisors, LLC
Lan Huang — Co-founder, Chairman & Chief Executive Officer
Ramon Mohanlal — Executive Vice President, Research and Development, Chief Medical Officer
Rich Daly — Chief Operating Officer
Elizabeth Czerepak — Chief Financial Officer
Analysts:
Jason Gerberry — Bank of America — Analyst
Maury Raycroft — Jefferies LLC — Analyst
Andy Hsieh — William Blair — Analyst
Presentation:
Operator
Good morning, and welcome to BeyondSpring’s First Quarter 2021 Financial Results Conference Call. [Operator Instructions] Following management’s prepared remarks, we will hold a brief question-and-answer session. As a reminder, this call is being recorded today, June 16, 2021. I’ll now turn the call over to Ashley Robinson of LifeSci Advisors. Please go ahead.
Ashley R. Robinson — Media & Investor Relations of LifeSci Advisors, LLC
Thank you everyone for joining today’s call. I would like to advise listeners that comments made on today’s call may reflect forward-looking statements that are related to such matters as BeyondSpring’s clinical and preclinical research and development activities and results, regulatory and commercial plans, industry trends, market potential, collaborative initiatives and financial projections, among others. While management believes that its assumptions, expectations and projections are reasonable in view of the currently available information, you are cautioned not to place undue reliance on these forward-looking statements. The company’s actual results may differ materially from those discussed during the call for a variety of reasons, including those described in the forward-looking statements and risk factors section of the company’s 20-F and other filings with the SEC, which are available on the Investors section of BeyondSpring’s website.
Joining us on today’s call is Dr. Lan Huang, BeyondSpring’s Co-Founder, Chairman and Chief Executive Officer; Dr. Ramon Mohanlal, Executive Vice President, Research and Development and Chief Medical Officer; Richard Daly, Chief Operating Officer; and Elizabeth Czerepak, Chief Financial Officer. It’s now my pleasure to turn the call over to Dr. Lan Huang. Lan?
Lan Huang — Co-founder, Chairman & Chief Executive Officer
Thank you, Ashley. Hello, everyone, and thank you for joining today’s call. It has been a very short time since we last spoke with you on our comprehensive year-end earnings call. So I will keep today’s — I would like to take time to highlight the key activities and continued progress as we keep moving towards commercializing and developing our lead asset first-in-class agent, plinabulin as a pipeline in a drug for CIN prevention, non-small cell lung cancer and potentially many other cancer indications.
In this past quarter, US FDA filed our NDA filing, and we have an anticipated PDUFA date set with agency of November 30th this year. We were very pleased and grateful to receive priority review from the agency. Priority review is granted by FDA to applications that if approved would provide significant improvement in the effectiveness or safety of the treatment diagnosis or prevention of serious conditions when compared to the standard of care. We, of course, believe that plinabulin meets this definition and look forward now to our November PDUFA date.
As we wait our PDUFA date, we have made progress in developing plinabulin as a direct anti-cancer treatment agent in a global Phase 3 non-small cell lung cancer study or DUBLIN-3 and various checkpoint inhibitor combination studies in seven different cancers. In the coming months, we are looking forward to further validating plinabulin’s direct anti-cancer ability with top line overall survival data from our DUBLIN-3 study in non-small cell lung cancer. This Phase 3 registration trial being conducted globally in 60 clinical sites had finished enrollment of 559 patients. It is designed to evaluate plinabulin in combination with docetaxel in patients with second and third line non-small cell lung cancer with measurable lung lesion and EGFR wild-type, which is around 85% of western lung cancer patients. This is a severely unmet medical need indication as only four therapies approved with limited survival benefit and a severe side effects such as severe neutropenia in taxol-based therapies. This study has achieved two successful interim analysis. If a positive result in the study is achieved, we would anticipate seeking FDA approval and moving towards commercialization in this second indication for plinabulin.
In addition, resistance to immunotherapy is a severe unmet medical need, and we believe plinabulin may have a potential synergistic anti-cancer effect when combined with checkpoint inhibitors. First, our mission of developing plinabulin as a treatment in oncology is supported by the compelling data our scientific team presented at the recently concluded ASCO conference. At ASCO, we presented Phase 1 data that showed plinabulin in combination with nivolumab and ipilimumab at 46% ORR in 13 patients with PD-1 one PD-L1 naive or resistant tumors in second line and beyond in small cell lung cancer. Additionally, the data showed that plinabulin combination was able to re-sensitize tumors that had progressed on prior PD-1 or PD-L1 inhibitors in third line small cell lung cancer with 43% of ORR. The three PR patients in PD-1 resistant patient population had tumor reduction over 50% and the long duration of treatment was one patient treated for 18 months.
Second, we had initiated an investigator-initiated Phase 1b/2 trial evaluating the safety and tolerability and efficacy of plinabulin in triple combination with both PD-1 or PD-L1 antibody and radiation therapy in seven advanced cancers, who failed PD-1 and PD-L1 inhibitors at MD Anderson. The first patient was dosed in non-small cell lung cancer who failed Keytruda in early June.
I’m very proud of our team as they tirelessly execute on this program. All of us are committed to raising the standard of care for cancer patients in the largest global market with first-in-class treatments. We now draw closer than ever to achieving this mission and look forward to advancing plinabulin and realizing upon our many opportunities to succeed.
I will now turn the call over to Dr. Ramon Mohanlal for a very important announcement of our upcoming R&D Day event. Ramon?
Ramon Mohanlal — Executive Vice President, Research and Development, Chief Medical Officer
Thank you, Lan. I’m very pleased to announce that we will be hosting an R&D Day planned for Friday of next week, June 25 at 8:00 AM where we will be sharing with you our anti-cancer development strategy for plinabulin. Our event will feature presentations from Dr. Steven Lin, PI [Phonetic] for the immune combination study from MD Anderson; and Dr. Trevor Feinstein, our DUBLIN-3 study PI from the Peyton Cancer Center. Our team will also present a more detailed overview of our program. Plinabulin is a first-in-class agent with a unique mechanism of action with selective binding to tubulin and therefore, releasing the broad immune defense protein, GEF-H1. This novel mechanism of action has been greatly de-risked through strong animal data and strong with preliminary efficacy data in small cell lung cancer patients that was recently presented at ASCO. Later on, this mechanism of action has also been published in peer reviewed journal.
Of course, we are known as a company that developed an innovative CIN approach with combining non-G-CSF agent for plinabulin with GSF, and we are very happy with the data. We now increasingly would like to direct our attention through the anti-cancer applications of plinabulin. And at R&D Day, we will outline the company’s anti-cancer strategy that will focus on these key areas. Number one, reversal of resistance to IO therapies. Number two, reversal of cold tumors, which currently are not candidate for IO treatment into hot tumors, which we expect will become candidate for IO therapy. Number 3, prevention of immune-related adverse event, which can occur in approximately 40% of patients and Grade 3/4 of these events can lead to permanent discontinuation of this IO agent. We will share more about this at R&D Day, and I would like to encourage you to attend that event.
With that, I will now turn the call over to Rich who will discuss our commercial and partnership strategy. Rich?
Rich Daly — Chief Operating Officer
Thank you, Ramon. Our pre-launch activities and preparations for a commercial launch into the CIN market are building with our PDUFA date clearly set for November. Over the next several months, our seasoned commercial leadership team is preparing to deliver a fully integrated market preparation and launch program to support a successful launch of plinabulin in the early 2022 complete with elements, such as driving awareness of the unmet medical need or we call the neutropenia vulnerability gap, continuing our large account outreach, preparing for NCCN guidelines submission; KOL development; speaker mobilization; key stakeholder outreach, including patient groups and federal, state and local legislative initiatives; medical symposium education, publications, targeted advisory boards and finalizing our patient support services to ensure broad access at launch.
Specifically, we plan for a dedicated and focused team for the US market. Importantly, we will have a field reimbursement liaison team supported by a patient services hub in place to ensure effective reimbursement from day one to provide support for both providers and patients. We believe this extensive commercial strategy will position us well with successive launch plinabulin combination therapy to capture long-term commercial success. We look forward to updating you on our progress with our pre-launch activities over the coming months. In China, we are taking a parallel path having dedicated and focused commercial team build-out and partnerships’ discussions with potential synergistic commercial partners.
I’ll now turn the call over to Elizabeth to provide the financial update. Elizabeth?
Elizabeth Czerepak — Chief Financial Officer
Thanks, Rich. I’ll now briefly discuss our first quarter 2021 financial results. For a greater detail to these results, I refer you to our press release issued this morning and to our 6-K filing, both of which can be accessed under the Investors section of our website. With that, I will now highlight some of the key financial results.
R&D expenses in the first quarter of 2021 were $11.3 million compared to $13.7 million in the same period last year. The decrease of $2.4 million was primarily due to a decrease in clinical trial expenses and non-cash stock-based compensation, which was partially offset by an increase in manufacturing costs and costs related to the plinabulin regulatory filings. G&A expenses were $6.4 million in the first quarter of 2021 compared to $2.9 million for the same quarter of 2020. The $3.5 million increase was primarily due to higher personnel costs and non-cash stock-based compensation, as well as pre-commercialization activities for plinabulin.
Net loss in the first quarter of 2021 was $17.0 million compared to $16.1 million for the same period last year. Our cash balance at the end of Q1 was $90.6 million, which we believe will be sufficient to support our ongoing clinical programs over the next year, including our immune oncology pipeline and to prepare for the potential launch of plinabulin in CIN in early 2022.
With that, I’ll now turn the call back over to Lan to conclude. Lan?
Lan Huang — Co-founder, Chairman & Chief Executive Officer
Thank you, Elizabeth. We have had an extremely productive period and everyone inside the company fueled the momentum as our vision of commercializing plinabulin and expanding our indications comes closer. From treating chemotherapy side effects to treating cancer directly, plinabulin is truly a pipeline in a drug with its encouraging data showing efficacy in many indications. Plinabulin could be a game changer in cancer treatment by combining with checkpoint inhibitors. We intend to capture this value for shareholders and continue advancing our programs through clinical testing and into potential commercialization as novel cancer treatment options in the months and years ahead. Finally, I would like to thank the patients, our dedicated team, our shareholders and our partners for their continued support as we work towards improving the current standard of care for cancer patients worldwide. This concludes our prepared remarks today.
I will now ask the operator to begin our Q&A session. Operator?
Questions and Answers:
Operator
Thank you. At this time, we’ll be conducting a question-and-answer session. [Operator Instructions] Our first question comes from the line of Jason Gerberry with Bank of America. Please proceed with your question.
Jason Gerberry — Bank of America — Analyst
Hi, guys. Good morning. Thanks for taking my questions. Two for me. Just your confidence level that plinabulin will have an FDA advisory committee, I know that so far they have not asked or requested that an Adcom be scheduled, but given that it is a new mechanism of action, which is a typical trigger for convening a panel, curious if you can share your thoughts on maybe why an Adcom wouldn’t be necessary in this particular instance.
And then, my second question is just as you look at the data generated with the triple plinabulin plus IO/IO in tumors that have progressed beyond PD-1 therapy in the small cell lung context. What are your thoughts about looking at this combination in non-small cell lung? Obviously, a bigger market opportunity. And I assume you’re going to want to wait till you see the DUBLIN results before making any investment decisions, but just sort of curious your outlook there for the utility in non-small cell lung cancer. Thanks.
Lan Huang — Co-founder, Chairman & Chief Executive Officer
Yes. Thanks. Jason. This is Lan. Let me answer the first question regarding what our confidence regarding the Adcom. And then second question, I think the triple IO to be extrapolated or later to have studies potentially in non-small cell lung cancer. I will give this baton to Ramon to answer as he is clinical brain behind all the study designs. So for the no Adcom meeting, we did have in this letter from FDA saying very specifically there is no Adcom had planned at this moment. We think that probably that’s due to two very positive elements during the two-month review. Number one is FDA inspection did happen in our New York office in the beginning of May. And we do not have any 483 [Phonetic] after the inspection.
And then secondly is, we also had a large AOM meeting with FDA. So AOM meeting is orientation meeting for NDA applications from FDA side. They usually are given to agents, which had breakthrough designation and also have like orphan disease and which are truly helping with unmet needs. So that meeting had huge support from the FDA side. They have almost 40 clinical leaders in CMC and preclinical, all of those experts coming to the call. And we had a pretty nice meeting there. So potentially they were happy with what they hear. And another thing, I think, we add to the confidence potentially no Adcom is as you see from our earlier press release, we did show that agency-based endpoints such as the prevention of febrile neutropenia is correlated to the reduction of clinical outcome, such as the incidence and duration and severity of febrile neutropenia and also hospitalization. So that is the key element, which we think gives FDA and also later for the clinical community confidence that the combination of plinabulin adding GSF is providing meaningful and very clinical meaningful benefit for patients compared to the standard of care have pegfilgrastim alone in preventing CIN, which does lift standard of care for the first time in the last 30 years. Does this answer your question?
Jason Gerberry — Bank of America — Analyst
Yeah, definitely. Thank you so much for the thoughtful answer.
Lan Huang — Co-founder, Chairman & Chief Executive Officer
Thank you. So I’m going to give the second question to Ramon.
Ramon Mohanlal — Executive Vice President, Research and Development, Chief Medical Officer
Yes. Thank you, Lan. Yes, certainly. The goal is indeed together now with plinabulin what you call proof-of-concept evidence that it works in specific IO combination and then, the next step will be that we move these combinations into first line. So moving into non-small cell lung cancer is certainly the plan as one of the next steps. There are two big IO combination strategies currently employed. We have the Merck approach with PD-1 inhibitor combining that with chemo and that also is approved, of course, for first line non-small cell lung cancer. And we see an excellent opportunity for plinabulin to be added to that regimen. To therefore get better survival benefit, they are also — and that’s the — those are important points we are making. Plinabulin not only adds to the overall survival benefit, but also prevents important side effect with chemo of course that this neutropenia and with IO agents that this immune related events. Plinabulin therefore is very uniquely positioned to not only increase overall survival, but also prevent both neutropenia and immune-related events. The
Other big IO triple strategy that’s being employed is by BMS where they combine two different IO agents, PD-1 inhibitor, nivolumab with ipi. There is no chemo in the mix. However, there are much more immune-related AEs. There again plinabulin is very well positioned to both increase the overall survival, but also to reduce the immune-related AEs. So we start here with small cell lung cancers, yes. But then, the next step will be, we will move into first line to non-small cell and other cancer types and adding plinabulin to these different triple combos that are currently employed by the various big pharma. Thank you.
Jason Gerberry — Bank of America — Analyst
Got it. Great. So yeah, I look forward to R&D Day next week to maybe, if you can a little bit more of a clarity around the pathway, would that be next steps and sort of the clinical pathway would be helpful to learn more about. Thanks.
Lan Huang — Co-founder, Chairman & Chief Executive Officer
Thank you, Jason, for your support.
Operator
Thank you. Our next question comes from the line of Maury Raycroft with Jefferies. Please proceed with your question.
Maury Raycroft — Jefferies LLC — Analyst
Hi, good morning everyone. Congrats on the progress. Thanks for taking my questions. First question is just for Phase 3 DUBLIN. If you can provide any specifics on where you’re at in respect to reaching the 439 events needed for the final analysis. And you’ve guided to top line data midyear, but do you think this will be more of an August or September update?
Lan Huang — Co-founder, Chairman & Chief Executive Officer
So, probably I can. This is Lan. I can answer this quick question. So as of now, we did reach — and these will 439 death events, which is the final analysis criteria. So we’re still cleaning the data. No analysis has been done yet. So I think we guided market that it’s midyear because when you do the cleaning to make sure the raw data is same in the EDC system that is that extensive process and also there is additional sensitive analysis. So we’re still guiding as midyear.
Maury Raycroft — Jefferies LLC — Analyst
Got it. Okay. And then, I’m also — sorry, go ahead.
Lan Huang — Co-founder, Chairman & Chief Executive Officer
I said thank you.
Maury Raycroft — Jefferies LLC — Analyst
Okay. And then, the other question was also related to Phase 3 DUBLIN. Just wondering if there’s anything additional you can say on the patient baseline characteristics at this point, including proportion of patients who are PD-1 failure patients and how baseline characteristics factor into your efficacy expectations, or is this something we can learn more about at your R&D event — Day event next week?
Lan Huang — Co-founder, Chairman & Chief Executive Officer
First is I think our R&D next week will be very comprehensive. So we are going to go into details into the designs and also primary and secondary endpoint to the DUBLIN-3 Study. So I think that’s the right platform to review the details. And then, secondly for the baseline characteristics, they all are balanced. So we are selecting the measurable lune lesion patients, which is the mechanism enriched population pre-specifically. And secondly, this is in the EGFR wild-type, which is 85% of the non-small cell lung cancer. This is much larger than the EGFR-mutant or the ROS or AOK mutation population. And this is the — very, very sick patients as you know that placebo, the TKI agents that’s not even work as well as docetaxel in this EGFR wild-type patient population. So we do stratify patient who had previous PD-1 or PD-L1 experience, so those arms balanced, but we have a limited percentage in those patients in this study.
Maury Raycroft — Jefferies LLC — Analyst
Okay. That’s helpful. And likewise, looking forward to the R&D Day event next week. Thanks for taking my questions.
Lan Huang — Co-founder, Chairman & Chief Executive Officer
Thank you for your insightful questions.
Operator
Thank you. [Operator Instructions] Our next question comes from the line of Andy Hsieh with William Blair. Please proceed with your question.
Andy Hsieh — William Blair — Analyst
Great. Thanks for taking my questions, and congratulations on all the regulatory milestones that you’ve achieved in the past six to nine months. So, my question has to do with kind of the regulatory sentiment. So the question is that the basis of the question had to do with during the COVID pandemic, I think NCCN was really aggressive in terms of updating guidelines regarding management of CIN patients. I’m just wondering through the breakthrough designation discussions with the FDA priority review, has the agency bring up kind of that factor or that benefit that plinabulin can provide, especially maybe in the US, where we’re probably, kind of, 60% over, but I guess on a global level where we’re still very much in the pandemic.
Lan Huang — Co-founder, Chairman & Chief Executive Officer
Thanks for this great question. Let me probably start the first half of the answer. Now I’m going to give the baton to Rich who actually also has done a lot of market research to see how this NCCN guideline update is going to affect the market reach for the plinabulin anti-CSF combination. So first is I think FDA is kind of independent from the NCCN guideline members. But as you see, we did get breakthrough, right. This is for the unmet clinical needs and also to raise the standard of care. So that’s the two criteria for the breakthrough. And secondly, we are also grateful, but yet to give a priority review. That’s another help in a way supported from FDA saying that this is a truly unmet medical need. We like to have this expedited [Phonetic] review time, so that if the drug is proven to be effective, it want to get to the market as soon as possible, right. So that’s the backdrop. So, probably, I can give the baton to Rich to talk about how this NCCN guideline update is affecting how patients — how doctors are using CSF and later our market penetration potential.
Rich Daly — Chief Operating Officer
Great. Thanks, Lan. And thanks, Andy, for the question. So with the NCCN guideline change last March, we’ve seen the physicians actually begin to go deeper into the intermediate risk category and our ongoing discussions with the KOL community, many of whom are deeply engaged with NCCN indicate that they do not believe that the NCCN will revert back to the guide — the old guidelines, which is high risk only anytime soon. So, they believe that this is ongoing, mostly a couple of factors. One, there is a belief that patients or people, the community in general will need boosters in the long run.
Number two, cancer patients are among the most immunocompromised patients we have. Obviously, we intentionally immunocompromised them with chemotherapy. And so, they need added protection in this kind of an environment. So, the guidelines appear to be with us for — these updated guidelines is going to be with us for quite some time. And the physicians are getting quite comfortable with it as are the payers. So we see obviously the addressable market has grown by more than 100% because of these updated guidelines. The high-risk patients represent 35% of the patient population, and intermediate risk represents 37%. So we think this bodes well for the opportunity because plinabulin is the only drug that can actually raise the standard of care in CIN. So we’re pretty excited about the opportunity to help out and improve the standard of care. So we believe this is a great opportunity for us for the providers and for the patients as well. Thanks.
Andy Hsieh — William Blair — Analyst
Oh, great. And maybe just a follow-up, Rich, so — well and also Elizabeth. So from a modeling standpoint, how do you think about the ramp? Rich, in your prepared remarks, you did talk about if you’re kind of building an integrated infrastructure here in the United States. So how should we kind of think about that SG&A build maybe basically from now to PDUFA and maybe from PDUFA to launch?
Rich Daly — Chief Operating Officer
Yes. Great question. So we have a three-fold through pre-launch approach, and we talked about this before. We’re talking about addressing this, driving the awareness of this neutropenia vulnerability gaps, day one to day seven, eight, nine. So this is where plinabulin has its effect and it’s the perfect partner for G-CSF. With 1.4 million units of G-CSF being used and this base is growing over time because of obviously this NCCN situation and the opportunity to improve the standard of care. So addressing this neutropenia vulnerability gap and being the perfect partner for CSF because of a really good opportunity.
And then, positioning the plinabulin with the key decision makers and payers in large accounts, anyone affected by contracting we can actually talk to now. And so, we are out talking to them right now, making them aware of the potential that the drug does in fact have and then activating these key accounts, making sure that they know who BeyondSpring is. They know that the drug is in fact coming and then being prepared for broad access availability and access for patients, so making sure that our systems are up and running. So as we think about the infrastructure build, we’re well on our way. We’re really confident we have the ability because of the — as Lan mentioned, a deeply seasoned commercial team that has done this many times before. And we think about our SG&A ramp, we will be hiring our sales — identifying our sales team and only hiring them after we have a guaranteed approval and because it’s difficult to launch a product during the holiday season, that’s why we refer to launching this in the first quarter. We don’t want to just be — have the physicians distracted by the holiday. It’s not good for the product. It’s not good for the company and certainly not good for patient care. We want to make sure that we bring the product to market when we can attract the attention of the physician and get their full attention, and that’s generally after the holidays. So that’s what we’ll be doing.
So with that, I’ll turn it over to Elizabeth for any additional comments.
Elizabeth Czerepak — Chief Financial Officer
Yes, thank you. And I just want to continue to assure everyone that we are making all of the plans to make sure that the company is well funded during this time period of pre-launch, as well as preparing for the launch and you’ll note in our statements that we’ve just filed that we are sufficiently funded for the next year. However, that said, we are always evaluating options for getting other funding into the company. And our preference at this point is some form of non-dilutive financing to just boost the balance sheet as well as at the right time to consider partnerships.
Andy Hsieh — William Blair — Analyst
Okay. Thank you very much for answering all my questions.
Lan Huang — Co-founder, Chairman & Chief Executive Officer
Thank you, Andy, for your continued support.
Operator
Thank you. Ladies and gentlemen, this concludes our question-and-answer session. I’ll turn the floor back to Dr. Huang for any final comments.
Lan Huang — Co-founder, Chairman & Chief Executive Officer
Thank you again to everyone for joining us for the call today. We’re very proud of our accomplishment and look forward to speaking with you again on our R&D Day on June the 25th, next Friday. Thank you.
Operator
[Operator Closing Remarks]