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Introducing a First-in-Class treatment for Non-Hodgkin LymphomaCarnegie Healthcare Conference, March 17, 2016Marco Renoldi, Chief Business Officer
Nordic Nanovector ASA Kjelsåsveien 168 B, 0884 Oslo, Norway - www.nordicnanovector.com
Forward-looking statements
This presentation may contain certain forward-looking statements and forecasts based on uncertainty, since they relate to events and depend on circumstances that
will occur in the future and which, by their nature, will have an impact on Nordic Nanovector’s business, financial condition and results of operations. The terms
“anticipates”, “assumes”, “believes”, “can”, “could”, “estimates”, “expects”, “forecasts”, “intends”, “may”, “might”, “plans”, “should”, “projects”, “will”, “would” or, in
each case, their negative, or other variations or comparable terminology are used to identify forward-looking statement. There are a number of factors that could cause
actual results and developments to differ materially from those expressed or implied in a forward-looking statement or affect the extent to which a particular projection
is realised. Factors that could cause these differences include, but are not limited to, implementation of Nordic Nanovector’s strategy and its ability to further grow,
risks associated with the development and/or approval of Nordic Nanovector’s products candidates, ongoing clinical trials and expected trial results, the ability to
commercialise Betalutin®, technology changes and new products in Nordic Nanovector’s potential market and industry, the ability to develop new products and enhance
existing products, the impact of competition, changes in general economy and industry conditions and legislative, regulatory and political factors.
No assurance can be given that such expectations will prove to have been correct. Nordic Nanovector disclaims any obligation to update or revise any forward-looking
statements, whether as a result of new information, future events or otherwise.
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Nordic Nanovector at a glance
• Focused on the development of treatments for haematological cancers• Leveraging the unique Antibody Radionuclide Conjugate (ARC) technology
• Pipeline led by Betalutin® for treating Non-Hodgkin Lymphoma (NHL)• Novel anti-CD37 ARC in Phase 1/2 clinical trials
• Promising efficacy with sustainable duration of response
• Confirmed favorable side effect profile
• Clear development pathway• New plan, introduced in October 2015, designed to enhance the chances of Betalutin® gaining
regulatory approval with a competitive product profile
• Corporate• Established in 2009, IPO in March 2015 (OSE: NANO)
• Cash end 2015: NOK 743 (USD 87.9m*); IPO proceeds NOK 575m (USD 68m*)
* US Dollar/Norwegian Krone 8.453
Betalutin®: the first-in-class antibody-radionuclide conjugate (ARC)
Tumor-seeking monoclonal anti-CD37 antibody + conjugated
radionuclide (Lu-177)
Specifically designed for the treatment of B-cell tumors
Effective therapeutic payload and multi-cell kill approach
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Betalutin® is specifically designed to treat NHL…
Multi-cell kill approach
• Prolonged irradiation of tumour cells within ~50-cell radius enables “multi-cell kill” effect, that destroys even malignant cells that do not express CD37 or have limited blood supply
• CD37 is a useful therapeutic target for novel therapies in NHL patients that have relapsed after CD20-based therapy
• Internalization of the antibody anchors the payload to the cancer cells, resulting in a prolonged irradiation of the cancer cell nucleus
• Beta-emitting particles with half-life (6.7 days) matching the antibody’s circulation time, long enough to ensure that tumour mass is irradiated
• Mean range of radiation treats ‘bulky’ tumors while limiting damage to health tissue
Lutetium-177:ideal therapeutic and safety properties
CD37: a validated target for B-cell NHL
ARC’s could deliver better treatment outcomes than immunotherapies (monoclonal antibodies or ADC’s), which rely on a single cell kill approach
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NHL, a family of different blood cancers, represents a significant unmet need
Sources: DataMonitor Pipeline Insight: Lymphomas, Multiple Myeloma and MyelodysplasticSyndromes DMHC2595/ Published 03/2010, National Cancer Institute at the National Institutes of Health, seer.cancer.gov/, annonc.oxfordjournals.org/content/19/3/570.full
B-cell NHL85%
Indolent lymphomas~41%
Aggressive lymphomas~59%
NHL
T-cell NHL15%
• Follicular lymphoma (~59%*)
• Small lymphocytic lymphoma
• MALT lymphoma
• Lymphoblastic lymphoma
• Lymphoplasmacytic lymphoma
• Diffuse large B-cell lymphoma (~61%**)
• Mantle cell lymphoma
• Burkitt lymphoma
• Primary mediastinal large B-cell lymphoma
NHL can be divided into several subtypes
• A cancer of the white blood cells (lymphocytes)/immune system
• 10th most common cancer: ~ 850,000 prevalent patients with B-cell NHL
• 66% of diagnosed patients age 55-74 years
• High mortality rate, despite available treatments
• Over $12B market opportunity by 2018
NHL represents a significant unmet need
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Betalutin®’s Unique Value Proposition is based on importantdifferentiating factors
1. Improved CR and DOR as single agent
2. Manageable haematological toxicity and minimal non-haematological toxicities
3. One-time therapy with simple administration schedule
4. Potential synergy from combination with antiCD20 moAB (rituximab) and withother immuno-oncology treatments
5. Improved quality of life
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In what NHL patients can Betalutin® fill the unmet medical need?
Relapsed NHL No standard therapy past second-line
Rituximab resistance Patients who have developed resistance to CD20-targeted antibody
Older patients Patients aged >65 years not able to tolerate some chemotherapies
Co-morbidities Some co-morbidities can impact tolerability of current treatments
Lack of response Patients with a poor response to first- or second-line treatment
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Positive clinical results support Betalutin®’s potential in NHL
Complete metabolic response (FDG PET/CT) at3 months in patient 007 with follicular lymphomaat dose level 20 MBq/kg
FDG PET CT: fluorodeoxyglucose positron emission tomography-computer tomography; FL: follicular lymphoma; MBq: megabecquerel
FDG PET/CT: fluorodeoxyglucose positron emission tomography-computer tomography; FL: follicular lymphoma; MBq: megabecquerel; SPECT: single-photon emission computerized tomography
Complete metabolic response (FDG PET/CT) at 6 months in patient 008 with follicular lymphoma at dose level 15 MBq/kg
This patient is still in complete remission This patient is still in complete remission
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Positive response data from Betalutin® Phase 1/2 study (LYMRIT 37-01) were presented at ICML 2015
1. Best Response Rate 2. One patient had confirmed transformed lymphoma at 3 months; this patient was excluded from Response Rate assessment (11 out of 12 patients evaluable for efficacy). MBq: megabecquerel, Kolstad A et al. ICML 2015; Abstract 287
Betalutin® achieved a 64% ORR with 36% CR rate1,2
012345678
SDPRCRORR
Nu
mb
er
of
pat
ien
ts
36%28%
64%
18%18%
PD
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
10MBq/Kg 20MBq/Kg 15MBq/Kg
ORR DLT
Betalutin® is effective across all dosages with 100% ORR at 20MBq/Kg
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Data from the same phase 1/2 study show Betalutin®’s duration of response is sustained
Tumor response assessed according to Cheson criteria 2007Kolstad A et al. ICML 2015; Abstract 287
• Median response duration not yet reached
• Response is still ongoing in 5/7 responders to Betalutin® treatment
Time (months)
10 MBq/kg b.w.
15 MBq/kg b.w.
20 MBq/kg b.w.
0 3 6 9 12 18 24
Not evaluated
Complete response
Partial response
Stable response
Progression
Time of progression
Durable responder
Continued response
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Betalutin® has the potential to be best in class vs. existing competition
3LFL
Ibritumomab tiuxetan(ORR: 74%, CR: 15%, DOR: 6,4 months)
Idelalisib(ORR: 54%, CR: 14%, DOR: 11,8 months)
Bendamustine(ORR: 75%, CR: 14%, DOR: 9,2 months)
ORR 70-75%CR 35-40%
DOR 9-12 months
Launched Products Clinical Efficacy Targets in Follicular Lymphoma
*ICML 2015 Sources: Scientific publications, publicly available information, please see prospectus for detailed sources
ORR 64%CR 36%
Median DOR not yet reached
Phase 1/2 Betalutin®Preliminary Results*
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Key 2015 deliverables have been achieved
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Understand the role of HH1 as pre-dosing
Completed Arm 2 in Phase 1/2
Amend Phase 1/2 study to enable higher, more effective doses
Protocol amendment approved in Austria, Sweden, Norway, Poland and UK*
Add sites in Phase 1/2 study to meet new timelines
Arms 3 and 4: 6 new sites qualified (10 total)Phase 2: 5 new sites qualified (19 total)
Accelerate patient enrollment in approved studies
Patient enrollment on track
Start study in a new NHL indication DLBCL protocol submitted and approved
Start dosimetry study in Germany Dosimetry study submitted and approved
Advance pre-clinical studies: chHH1 and CD20 upregulation
New compelling data presented at EANM and ASH
Betalutin® in FL
Betalutin® in DLBCL
Pipeline R&D
Nordic Nanovector is committed to invest in a broad development and discovery pipeline
Product candidate Discovery Preclinical Phase 1 Phase 2 Phase 3
DLBCL, ineligible for ASCT
FL, 3rd line
177Lu-chHH1 ARC
Affilutin1
DLBCL, conditioning
Indication
FL, 1st line
Multiple myeloma
Betalutin®
Betalutin®
Betalutin®
Other NHL Betalutin® + CD20
FL, 2nd line Betalutin® + CD20
Leukemia 177Lu-chHH1 ARC
1. Collaboration with AffibodyARC: antibody -radionuclide conjugate; ASCT: autologous stem cell transplant; chHH1: chimeric HH1 antibody; DLBCL: diffuse large B-cell lymphoma; FL: follicular lymphoma; NHL: non-Hodgkin lymphoma
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1. Obtain Betalutin®’s approval in 3L (and subsequently 2L) Follicular Lymphoma
2. Expand indication in DLBCL as soon as possible
3. Selectively extend the Company’s pipeline around core expertise (ARC/ADC, haematology-oncology) to embrace innovative technologies and de-risk the company
4. Independently commercialize Betalutin® and follow-on compounds in major markets
5. Opportunistically consider partnerships to leverage position of strength
Our strategic imperatives are focused on maximizing shareholders’ value
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2
3
4
5
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Betalutin®’s clinical development plan in FL is designed to maximize efficacy
* Dose decision based on safety data and Safety Review Board’s recommendation 16
Lymrit 37-01 – Phase 1/2 trial
20MBq(+ HH1 50mg)
N=310MBq
(- HH1 R0)N=1
15MBq(+ HH1 50mg)
N=6
10MBq(+ HH1 50mg)
N=3Arm 1
Phase 1
Arm 2
Phase 2
15MBq(+ HH1 50mg)
N=9
15MBq(- HH1 R0)
N=3 to 6
15MBq(- HH1)
N=2
15MBq(+ HH1 125mg/m2)
N=3 to 6
17.5MBq or20MBq*
(- HH1 – R0)N=3 to 6
10MBq(- HH1)
N=3 to 6
17.5MBq or20MBq*
(+ HH1 125mg/m2)N=3 to 6
17.5MBq*(+ HH1 50mg)
N=3
Arm 3
Arm 4
PARADIGME dose decision: Q1 2017
First Patient: 2H 2017
Dose TBDN=85
Last Patient: 2H 2018
Regulatory submission: 1H 2019
Discontinued
MBq = Megabecquerel(radioactivity measurement unit)HH1 = CD37 B-cell seeking antibodyR0 = rituximab predosing on day 0n= Number of patients
Pivotal Phase 2 trial
Betalutin® is also being investigated in relapsed, ASCT-ineligible, DLBCL
* Dose decision based on safety data and Safety Review Board’s recommendation
Lymrit 37-05 – Phase 1
Phase 2 dose decision: 2H2017
Pivotal Phase 2 trial
First Patient: 2H 2018
Single armDose TBDN=70-90
Last Patient: 2H 2019
Regulatory submission: 2H 2020
Protocol design pending SAB and regulatory validation
n = 3-18Day -14: rituximabDay 0: HH1 125mg/m2
Day 0: Betalutin*
10MBq/kg(HH1 125mg/m2)
15MBq/kg*(HH1 125mg/m2)
20 or 17.5MBq/kg*(HH1 125mg/m2)
3+3
3+3
3+3
Several combinatorial approaches to be explored (CAR-T, check -
point inhibitors, BCL - inhibitor)
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Preclinical data suggest potential synergy from combination of Betalutin® with rituximab
• Treatment with rituximab-containing regimens can result in disappearance of the CD20 antigen expression, leading to reduced clinical effect
• CD20 antigen levels are upregulated after treatment with Betalutin®, increasing binding of rituximab to NHL cells
• The efficacy of rituximab is boosted by a combination of effects after treatment withBetalutin®
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Survival of SCID mice intravenously injected with Rec-1 Mantel celllymphoma cells is increased by the Betalutin® + rituximabcombination (ASH poster, 2015)
Chimeric HH1 opens up new opportunities for frontline treatment of B-cell malignancies
• Similar internalisation and selectivity to human lymphoid tissues as the HH1 antibody
• Higher Antibody Dependent Cellular Cytotoxicity (ADCC)
• Less immunogenic, enabling safer repeated use
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SCID mice with MCL xenografts treated 2/wk. with 100 mg chHH1, 100 mgHH1 or 100 ml of NaCl for 4 weeks (black arrows). After 180 days 100 % ofthe mice treated with chHH1 were still alive, vs. 70 % with HH1. (EANMabstract, 2015)
Nordic Nanovector holds a solid cash position
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Key milestones
• Initiate DLBCL clinical program
• Start arm 3 and 4 in Phase 1/2 FL study 1Q 2016
• First patient treated in DLBCL Phase 1 study 2Q 2016
• Dose selection for pivotal Phase 2 / PARADIGME 1Q 2017
• Dose selection for DLBCL pivotal trial 2H 2017
• PARADIGME enrollment completed 2H 2018
• First regulatory submission for 3L FL 1H 2019
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Nordic Nanovector ASA
Kjelsåsveien 168 B, 0884 Oslo, Norway
www.nordicnanovector.com
IR contact: [email protected]
Thank you for your attention!