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2019/12/23

SOTIO Arms Dendritic Cells for Immunotherapy Against Cancer

SOTIO has developed a method to generate autologous dendritic cells that express multiple tumor antigens on their surfaces to awaken oncology patients’ immune systems to attack the cancer. Radek Spisek, Ph.D., the company’s Global CEO, observed that cancer cells express many different tumor antigens. In their ongoing effort to elude detection by a patient’s immune system, those tumor cells shed some of their antigens. To counter this evasive strategy, SOTIO arms the patients’ dendritic cells, which Spisek describes as the immune system’s most important cells, with “multiple different tumor antigens,” he explained. “In case two of those antigens disappear from the tumor cell, or five of them, we still have many additional shots on goal. There are still additional targets for the immune response that can be explored and we believe that this is important,” he said. SOTIO is developing its dendritic cell platform for treatment of lung, prostate and ovarian cancers. The Czech company’s most advanced program targets prostate cancer and it expects to complete its Phase III registration trial in Europe and in the U.S. in 2020. Next up is a Phase III trial in ovarian cancer, which will take four years to complete. The company is also in discussions to design a potential registration trial for lung cancer patients. As part of an exclusive series spotlighting the insider perspectives of thought leaders on topics shaping the future of new medicines, WuXi AppTec Communications spoke with Spisek about his company’s technology and the challenges of developing new drugs for cancer. Spisek participated in the founding of SOTIO in 2010 as Chief Scientific Officer and was appointed Global CEO in March 2018. He received his Ph.D. in immunology from the 1st Faculty of Medicine of Charles University in Prague and is a professor at Charles University’s 2nd Faculty of Medicine. Spisek also worked at the Institute de Biologie of Université de Nantes in France and the Center for Immunology and Immune Diseases at Rockefeller University, New York. WuXi AppTec: Is your immunotherapy targeting early stage treatment of solid tumor cancers, including lung cancer? Radek Spisek: In our cancer immunotherapy program, we already have very intriguing data in ovarian cancer, and initial data in lung cancer, that show positive signs of efficacy in our ongoing clinical trials, especially in patients who are at the stage of either minimal residual disease or minimal tumor burden; or patients who are in remission after the standard of care chemotherapy and have low tumor burden. So, our approach seems to be best suited for patients who are diagnosed early, who have low tumor burden, where the immune system is still fully functional and when there is a great chance that successful immunotherapy might lead to induction of anti-tumor response and subsequently result in improvement of the prognosis of the patient. WuXi AppTec: How much progress has been made in lung cancer drug research over the past 10 to 20 years? Radek Spisek: There has been a revolution in the treatment of many solid tumors after the successful introduction with checkpoint inhibitors. They represent a novel class of treatments that exploit the immune system. The outcome is that you delete the immunosuppressive environment in the patients and you give the immune system a chance to get active, attack the tumor cells and eliminate them. Almost 10 years ago, the introduction of checkpoint inhibitors for the treatment of melanoma, then non-small cell lung cancer and then many other solid tumors really represented a change of paradigm, which for me now signals the addition of a new modality to the three classical modalities of radiotherapy, surgery and chemotherapy. Over the course of the past 10 years, checkpoint inhibitors have found their place in the standard of care treatment protocols, including those for lung cancer. It’s fascinating to see that they basically moved to a front-line treatment for lung cancer, and we now see many clinical trials where checkpoint inhibitors are tested as front-line treatments in head-to-head comparison with standard of care chemotherapy or in combination with chemotherapy. This decade-long process in the development of checkpoint inhibitors for lung cancer really resulted in the substantial improvement in the prognosis of the disease. To me this represents a revolution and rightly so was recognized with a Nobel Prize in 2018 for Jim Allison, of the MD Anderson Cancer at the University of Texas, and Tasuku Honjo, of Kyoto University. WuXi AppTec: How does SOTIO’s active cellular immunotherapy platform work in treatment of lung cancer? Radek Spisek: It falls into the category of active immunizations, so it means you are trying to actively induce anti-tumor action in the patient’s body. You are trying to get an anti-tumor immune response that recognizes the tumor cells and eliminates the tumor cells, prolonging survival of patients with lung cancer. There are many approaches that fall into this category of active immunization. What we are trying to explore is an approach based on dendritic cells. Dendritic cells are the most important cells in the human immune system. They are necessary for the induction of the immune response. What dendritic cells do very well is present tumor antigens on their surfaces, which become accessible to the effector cells of the immune system, especially T lymphocytes. When T lymphocytes see the tumor antigens on dendritic cells, the T lymphocytes get activated, they proliferate, they amplify and then they can recognize tumor cells that express these tumor antigens and kill them. In our clinical programs, we enroll patients into the clinical trial and then we artificially, in our cell therapy laboratories, generate hundreds of millions of dendritic cells from a particular cell subset in their blood. Patients go to a blood transfusion center and spend two to three hours there while we collect hundreds of millions of white blood cells from their peripheral blood. From these white blood cells, we generate hundreds of millions of dendritic cells within one week. There is one additional step we do in our laboratories and that is we introduce the tumor antigens into the dendritic cells. Our cell therapy laboratories are in Prague, Czech Republic and in Beijing, China. The tumor antigens are known to be present in lung cancer, and the outcome of their introduction is that the dendritic cells take up the tumor antigens and then they express them on the surface and this results in dendritic cells that are fully capable of inducing anti-tumor responses in the patient’s body. Next we freeze the dendritic cells in liquid nitrogen so they remain viable and when the patient comes to the hospital outpatient clinic, the physician takes up the frozen vial of the dendritic cells, thaws the cells and by a subcutaneous injection, injects the cells and they migrate in the body to the lymph nodes of the organ where they interact with the T lymphocytes. They activate the T lymphocytes, which do their job and kill the tumor cells. This a complicated process that we need to do for every patient involved in the trials. WuXi AppTec: How do you introduce the tumor antigens into the dendritic cells? Radek Spisek: This is a specific element of our program that is patent protected, but most of it has been presented and published in scientific journals. What we decided to do a long time ago and what will differentiate our approach from other ones is that the source of the tumor antigens is the tumor cells. We identified a mixture of two specific lung cancer cell lines that express many of the relevant antigens in lung cancer. We take the cell lines and kill them by a specific method called high hydrostatic pressure. This kills them but it also makes them express high levels of the tumor antigens. When they are killed, they are put together with the dendritic cells, which eat up or engulf the dead tumor cells – it’s called phagocytosis. Then they cleave the tumor cells to the individual tumor antigens and the tumor antigens are presented on the surface of the dendritic cells. This is what normally happens in vivo and we can make this process in vitro as well. WuXi AppTec: How is this different from the CAR-T cell immunotherapy? Radek Spisek: CAR-T cells are a totally different approach. They deal with the last component of this chain. I told you that we inject dendritic cells and we hope that in the patient’s body they activate T lymphocytes and the T lymphocytes then kill the tumor. The CAR-T cell industry does something that is very smart. They take the T lymphocytes, which are the last piece of the chain of immune reaction, and they genetically modify the T lymphocytes so they can specifically recognize a tumor antigen in the body. So, the outcome of the CAR-T cell production is hundreds of millions of T lymphocytes that when injected into the body go directly to the tumor and kill it. It’s cancer immunotherapy at a different level. The main difference is that we are using a response against multiple tumor antigens. Through our approach, we inject the dendritic cells into the patient. They express many tumor antigens – let’s say 25 different tumor antigens – and this results in the activation of the immune response against multiple targets on the tumor cell. I personally believe this is extremely important because then you have an immune response that fights many targets on the tumor cell. What very often happens in the development of the tumor is that the tumor tries to escape the immune response and one way the tumor tries to escape is it loses expression of some of its tumor antigens. If you only have a CAR-T cell active against one tumor antigen and that tumor antigen is gone – it’s not present on the tumor cell – the CAR-T cell cannot do anything. It can’t see the tumor any more. What we have is a complex, robust immune response against multiple targets and in case two of those antigens disappear from the tumor cell or five of them we still have 20 shots on goal. There are still 20 targets for the immune response that can be explored and we believe that this is important. We see this benefit for patients in our lung cancer program and our ovarian cancer program. It’s a very significant benefit in terms of prolonging survival. WuXi AppTec: How are you applying your platform to the development of immunotherapies for prostate and ovarian cancer? Radek Spisek: We have a unique opportunity here. SOTIO started in 2010 and from the beginning we were funded by a very large Czech financial institution, called PPF Group. SOTIO is being built as a company that doesn’t want to be focused on a single program. We have been building for the past 10 years an oncology-focused company with a diversified portfolio of programs that all explore different arms of the immune system. At this stage we have six or seven programs at various stages of development. One program is focused on the dendritic cells and the dendritic cell platform has been optimized for lung cancer, ovarian cancer and prostate cancer. We have very interesting data from a Phase II program in ovarian cancer and in lung cancer where we see statistical significance of survival benefit in patients, which is the most important endpoint in oncology studies. This year we also brought to the clinic, after extensive preclinical work, a program where we have a molecule that very efficiently stimulates T lymphocytes and NK cells. It’s a molecule based on interleukin 15 (IL-15). We call it a superagonist of IL-15. This is now a very popular field in oncology research – proteins that can very efficiently activate those T cells, expand them and make them proliferate. This program is at the Phase I clinical trial stage. We are very close to bringing to the clinic one more program that is in the domain of antibody drug conjugates. We have a monoclonal antibody that recognizes tumor cells in gastric cancer and to this monoclonal antibody we attach a few molecules of a very toxic compound that kill the tumor cells. The idea of this approach is that the antibody brings those toxic molecules very specifically to the tumor cells that express the specific target for the antibody. The tumor cell then takes up the antibody, which releases the toxin and the toxin kills the tumor cell. We believe we may have a very interesting program for clinic trials in the next year and a half. SOTIO is looking for other portfolio programs and also doing minority investments into interesting biotech companies we want to cooperate with. WuXi AppTec: What are some of the other ways your cancer immunotherapy differs from other immunotherapies? Radek Spisek:  There is one more difference that is built into our clinical trials. We always incorporate long-term administration of the compound. In other words, our approach is not that the patient comes to the hospital and receives three shots of the vaccine and then that’s it. We have data that show it’s important to continuously boost the immune response. If you boost it once in four weeks, the tumor response goes down because it’s not very strong and it’s important to boost it again. We basically have in our clinical program one year of treatment for the patients where we continuously boost the immune response. It’s our belief, and it’s now supported by the data, that this long-term administration is important for the clinical efficacy of these approaches. WuXi AppTec:  What major challenges have you faced in developing your immunotherapies? What lessons have you learned that you can share with other CEOs? Radek Spisek: There’s an obvious answer to this one. What we are trying to do is very challenging with respect to the logistics of the process. Manufacturing and administering the cells is very complex – we have built a whole logistical system around it. The fact is we need to produce cells for each individual patient. In clinical medicine, people call this an autologous approach. For every single patient involved in your clinical program you need to generate a compound specific for that particular patient. This has significant logistical challenges. We need to have a network of blood transfusion centers where we collect the cells from patients. Then the cells need to make it from the blood transfusion unit to the SOTIO manufacturing site – one of the largest cell therapy facilities in Europe. And because we are working with living cells, we need to ship the cells within 30 hours to keep them alive, so we can work with them and modify them. Then at the end of the manufacturing process we need to get the cells to the hospital and back into patients’ bodies via subcutaneous injections. The major complication – and the major drawback – of these autologous therapies is the need to produce a specific cellular product for each individual patient. That’s the biggest challenge that we overcame. We have a very sophisticated network of fully functional blood transfusion units. We have very sophisticated software solutions for the logistics of cell shipment. We manufacture the cells in the Czech Republic then ship them and store them in facilities that are close to the clinical side. But this, of course, represents an additional cost of goods that complicates the process and makes it more expensive. WuXi AppTec: How will you maximize the value and benefit of your therapies for patients globally? Radek Spisek: If our clinical trial programs are successful and these cell therapies are approved, the vision of the company leadership and investors is to commercialize them – and we believe that can be done globally. We can already serve the U.S., the Europe and China with the existing process. We are doing a large, global prostate cancer clinical trial that includes sites in the U.S. and Europe. There are almost 1,200 patients enrolled in the trial and there has never been a single mistake in the logistics and the processing of the cells. We have also done all sorts of financial analyses that show us this program might be commercially viable if it gets on the market at a similar price point to other oncology products. WuXi AppTec: How soon will your immunotherapy reach the market? Radek Spisek: We will have the results of the prostate cancer trial in 2020. The next program, is in ovarian cancer. The timeline from the beginning of the registrational trial to the analysis of the results is four years from now. We now have two shots on goal: next year with prostate cancer and four years from now with ovarian cancer. We are still discussing the design of the potential registrational trial for the lung cancer program. WuXi AppTec: What are the top impediments for delivery of better medicines faster and cheaper for patients? Radek Spisek: The biggest issue is one that cannot be solved easily. In SOTIO we’ve been screening more than 300 new oncology programs a year. We are trying to identify oncology programs at the stage of preclinical studies and there are very few approaches, I think, that have a reasonable chance to make it to the market and be successful. This is not an impediment that is caused by the regulatory environment. It is also not caused by the lack of financial resources. It’s really the nature of oncology – of tumor cell biology. We are at the stage where many mechanisms of the tumor cell have been explored. There are many drugs out there and the prognoses of many cancers have improved significantly. And I think what we’ve seen over the past 10 years is there are a very limited number of programs that can be game changers. This is an inherent problem of oncology research at this stage. I see very few effective programs at the preclinical level that make me believe they can become new drugs in oncology. Then, of course, what I see from our experience is the financial need required for text book development in oncology. The cost per patient in clinical trials is increasing tremendously. I have seen a 30 percent to 40 percent increase in the clinical trial costs in the past five years. This is really getting to the point where many companies are struggling to find the financial resources to follow the clinical development program. For me, this is currently the biggest hurdle. You often hear people comment on the complicated regulatory environment in oncology. I don’t share this opinion. I think that regulators, especially the US Food and Drug Administration, are actually trying to create an environment that facilitates the approval of compounds that look promising at the stage of early clinical data. When the compounds look interesting, there are mechanisms to speed up development and accelerate approvals. But really, the financial burden of increasing clinical trial costs is currently the biggest hurdle in the development of new compounds. WuXi AppTec: What would be the one thing that has the most potential to lead a paradigm shift from treatment to cure in cancer? Radek Spisek: I am on the more skeptical side of this. From the 15 years of experience I have in oncology research, it’s very rare to see complete game changers that lead to a cure. I am more a believer in incremental improvements and in the combination of the different treatment modalities. This is what you see in most of the solid tumors. Incremental improvements in the prognosis of the disease come from introduction of new drugs that provide some benefit and then combining these novel treatments with pre-existing ones. This leads to a gradual improvement in the prognosis of the patients. I don’t expect to see a dramatic shift in the case of lung cancer that would result in 100 percent survival from the 20 percent survival you currently see in advanced patients. I doubt there will be a treatment like this.

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2019/12/16

Refuge Biotechnologies: Developing “Smart Cells” to Fight Cancer Inside the Human Body

Cell therapy is an emerging treatment with great potential because, unlike small molecules, cells are dynamic. They can migrate, proliferate, differentiate, and respond to their environment both in vitro and in vivo. Cell therapy company Refuge Biotechnologies, based in Menlo Park, CA is leveraging gene engineering technologies known as CRISPR interference (CRISPRi) and CRISPR activation (CRISPRa) to develop therapeutic cells that are programmed to make decisions inside the patient’s body. This commitment is aptly summarized by the company’s mission statement: Designing Intelligent Cell Therapies to Fight Cancer. Refuge’s platform connects cell membrane receptors to CRISPR a/i systems, creating a genetically programmable switch that can control multiple gene expressions. Refuge is seeking to enable the integration of multiple therapies into a single type of therapeutic cells, one that combines greater efficacy with fewer side effects. Refuge’s technology enables cells to sense their surroundings and conditionally activate or repress multiple genes when they encounter specific external antigens. In particular, with receptor-dCas, immune cells can now be engineered to conditionally turn on/off certain genes, such as PD-1, to generate more potent CAR-T immune cells when it senses the presence of a tumor cell. Leading Refuge’s research programs is CEO and Co-founder Dr. Bing Wang. Dr. Wang co-founded the company following nearly a decade of life science investment banking experience. He most recently served as director of healthcare investment banking at Barclays Capital. Dr. Wang, a cancer survivor who is passionate about bringing forth “smarter” medicines that will transform cancer care, earned a B.S. in Applied Physics from Columbia University, an MBA from Columbia Business School, and a Ph.D. in Electrical Engineering from Princeton University. WuXi AppTec communications asked Dr. Wang to explain how Refuge’s unique cell therapy platform can fight cancer in vivo and the future benefits of and challenges in developing cell therapies. WuXi AppTec: How has cell therapy research progressed over the past 10 years? Do you anticipate a wave of new approvals coming over the next five to 10 years? Dr. Bing Wang: Absolutely, the expectation is that cell therapies will become much more prominent as a treatment modality across many diseases over the next five to ten years. There has been an immense amount of progress in the cell therapy field over the last decade building on original research into using cells to treat diseases, especially as the Novartis and Kite/Gilead products have come to the forefront to treat hematological malignancies. At Refuge, we are building on this progress and hope to further apply the cell therapy modality with other mechanisms to make cell therapies more effective in oncology and beyond. WuXi AppTec: What kinds of diseases are targeted with cell therapies? Dr. Bing Wang: Recently, cell therapies have been most prominently linked to oncology, but there is a wide range of applications for which cell therapies can be targeted, including regenerative medicine, rare diseases, and metabolic and cardiovascular diseases. Refuge initially focused on furthering cell therapy efficacy in solid tumors, but now we are exploring the potential ways to utilize the Refuge platform beyond oncology indications. WuXi AppTec: What scientific advances are needed to make cell therapies more effective? Dr. Bing Wang: As research progresses further into how cell therapies work and act within the tumor microenvironment, it is expected that better control over these mechanisms will improve the efficacy of cell therapies. Refuge is uniquely positioned to be able to tackle these issues together as its platform technology has the ability to target multiple pathways that underpin these mechanisms at the same time by modulating multiple genes simultaneously in addition to a cell therapy itself, such as CAR-T. This effectively designs an intelligent cell that is fitter and can react to its environment. WuXi AppTec: Will cell therapies ever be commonplace? If so, how soon? Dr. Bing Wang: At the current rate of advancement across various cell therapy fields, it would be expected that cell therapies would become much more common in the clinic and industry. Within the next five to ten years, cell therapies could likely become a common treatment modality in addition to traditional small molecule medicines and antibody-based therapies. WuXi AppTec: What are the risks and limitations of cell therapies? Dr. Bing Wang: As with all medical treatments, there are safety and efficacy risks that need to be managed for cell therapies. With further use in the clinic, as we have seen with the evolution of therapy management in dealing with CRS (Cytokine Release Syndrome), many of the risks can be effectively managed so that patients can really benefit from curative cell therapies. For current cell therapy products on the market, the obvious limitation today is that they are only indicated in hematological malignancies. There are various challenges for getting CAR-T (cell surface chimeric antigen receptor) therapy to perform better in solid tumors, including improving the ability to have CAR-T get into the tumor microenvironment and improving the persistence and fitness of CAR-T therapy cells, which many research and development institutions, including Refuge Biotech, are working towards solving. The field of oncology presents a highly complex range of biology and manifestations that are still being discovered and understood today. It is likely that there are unknown limitations that will cap the ability to have a single solution for all cancers, so combination therapy across cell therapies and other treatments may still be needed. WuXi AppTec: What cell therapies are you developing? Dr. Bing Wang: Our mission at Refuge Biotech is to “Design Intelligent Cell Therapies To Fight Cancer” based on Stanley Qi’s original research in CRISPR interference and activation to allow cells to make decisions in vivo. When the cell therapy comes in contact with a tumor, different genes within the T cell are expressed to react and enhance the attack against cancer cells. To do this, we are leveraging a synthetic biology circuit that combines cell surface signaling with specific multiplexed gene modulation through use of a deactivated CRISPR system. This capability enables us to combine many different cancer therapeutic mechanisms in a single therapy. As it relates to our initial clinical developments, we are applying known cancer biology, combining CAR-Ts against targets such as HER2, among others, with simultaneous modulation of genes responsible for various pathways involved in cancer pathogenesis. This includes checkpoint genes as well as targets in various other co-immunostimulatory and co-immunoinhibitory pathways. Our lead pipeline asset is a HER2 CAR-T plus PD-1 knockdown system for various solid tumor indications. We are also developing various additional pipeline assets focused on other CAR-T targets, with modulation of different genetic target combinations derived through intensive bioinformatics analysis to treat a wide range of cancers. Additional oncology indications will be disclosed in due course. WuXi AppTec: How does your approach differ from other cell therapy companies? Dr. Bing Wang: Our technology platform connects cell membrane receptors to CRISPR interference / activation to facilitate inducible gene modulation of multiple genes simultaneously with cell therapies such as CAR-T therapy. CRISPR interference / activation is very different from standard gene editing technology, such as standard CRISPR, Talens and Zinc fingers, etc., in which there is no cutting of the genome. The CRISPR is “deactivated” to mute the cleavage site while maintaining all the gene targeting specificity through short guide RNA (sgRNA). At the same time a transcription that either down-regulates or up-regulates gene expression is combined to the deactivated CRISPR, so that the cell therapy can use the GPS mechanism of the CRISPR to pinpoint a targeted strand of DNA and switch that gene on or off to varying degrees. This structure is tethered to the cell surface so that it is released only in response to engagement of tumor antigen through activation of a CAR-T on the T-cell surface. On release, the structure travels to the cell nucleus guided by sgRNA to effect specific gene modulation, where gene targeting can be multiplexed through adding multiple sgRNAs. Most DNA editing technologies snip out genes entirely and have an all-or-none effect, but we are able to control gene modulation and up-or-down-regulate multiple gene expressions at different levels. This will be important in combination therapy situations where you may not want to completely knockout endogenous genes since doing so can lead to long term permanent changes to the genome after tumor cells disappear. The advantages of our platform consist of no cutting of genetic material, the ability to multiplex gene modulation through the addition of more sgRNAs, and the capability to simultaneously versus sequentially enhance this process, thereby providing better efficiency for manufacturing. Comparable editing technologies need to be more careful with concurrent edits due to potential translocation and genotoxicity risks, which are irrelevant issues for our technology. By effectively being able to combine multiple cancer treatment modalities together, the Refuge platform will be able to provide better efficacy in the treatment of various cancers while simultaneously achieving a better safety profile. WuXi AppTec: What are your major regulatory and commercial challenges? What lessons have you learned? Dr. Bing Wang: We have a very novel approach to treating cancer that effectively incorporates synthetic biology, cell therapy and gene engineering. Therefore, familiarizing health authorities and regulatory bodies with our technology is essential, especially before we increase the complexity by using multiplexed targets. In parallel, we need to be diligent in manufacturing, as it is central to development and commercialization, alongside impeccable planning. WuXi AppTec: The drug industry is already under enormous pressure in Congress to hold down prices.  And as with other, new medicines, prices for some cell therapies seem to generate “sticker-shock” among patients. What are ways can we make new cell therapies more accessible to patients especially in these times? Dr. Bing Wang: As with any new and complex class of treatments, we must find ways make them effective and ensure patients can access them. One key element to consider is manufacturing. The complexity of manufacturing and delivering cell-based therapies, compared to traditional biologics and small molecules, leads to higher costs. Cell therapies require greater precision and regulatory inspections to ensure quality grade practices, and we face a shortage of capacity in GMP-grade manufacturing facilities to support new cell-based products coming to market. But as more products advance toward the market, the resulting growth in manufacturing capacity and other innovations may help reduce cost.

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2019/12/02

RAPT Therapeutics Sees “Charged” Lung Cancer Tumors as Inviting Targets for Lead Drug FLX475

Lung cancer remains a stubborn disease to treat. Even cutting-edge immuno-therapies have had limited success. Brian Wong, CEO of South San Francisco-based RAPT Therapeutics, believes that the company’s lead drug, FLX475, has potential to overcome the scientific challenges in treating this disease. RAPT’S proprietary discovery platform has identified certain tumors in which the abundance of regulatory T (Treg) cells are likely to be a key cause of immune suppression. RAPT refers to these tumors as “charged” because of their expression of high levels of C-C motif chemokine receptor 4 (CCR4) ligands, Treg  cells and CD8 positive effector cells. These charged tumors include tumor types such as non-small cell lung cancer. RAPT’s approach is designed to enable selective restoration of the immune response within tumors without systemically depleting Treg cells or broadly suppressing the immune system. Dr. Wong is leading RAPT’s programs. He joined RAPT Therapeutics in 2015, bringing more than 15 years of experience leading research and translational medicine organizations. Most recently, he served as Senior Vice President, Research, and Head of Immuno-Oncology at Five Prime Therapeutics, where he led the discovery of novel therapeutics in cancer and inflammation. Prior to Five Prime, Dr. Wong served as Director of Research in the Inflammation Disease Biology Area at Roche Palo Alto from 2005 to 2009. From 2000 to 2005, he held various leadership roles at Rigel Pharmaceuticals, where he identified and developed clinical candidates for allergic, autoimmune and respiratory disorders, including Tavalisse™. Dr. Wong received his M.D. from the Weill Cornell Medical College and his Ph.D. in Immunology from Rockefeller University. WuXi AppTec: What is your opinion about the challenges of early diagnosis of lung cancer? Are there any specific biomarkers? Dr. Brian Wong: The biggest challenges in the early diagnosis of lung cancer are determining which people to screen, and developing methods that can reliably diagnose the disease at a stage when it is still curable, or at least improve overall survival. Finding the right biomarkers to identify and select patients who will best respond to specific immunotherapies is a constantly evolving area. PD-L1 expression and tumor mutational burden are among the most extensively studied and investigated, but are by no means perfect. Through extensive computational analysis of cancer genetic signatures, we have identified tumor types characterized by high levels of effector cells, Treg cells, and CCR4 ligands as being tumors we believe have a higher chance of responding to our drug candidate (FLX475), which targets CCR4 and Treg cell recruitment. We call these “charged” tumors, and non-small cell lung cancer is one of those “charged” tumor types. WuXi App Tec: What are the hot targets in the field of drug development for lung cancer? Dr. Brian Wong: Relevant to immuno-oncology, the anti-PD-(L)1 antibody therapies have revolutionized lung cancer therapy and have become key treatment options for a subset of patients. However, it is clear that a majority of patients do not respond to these therapies, likely due to immune-resistance mechanisms such as Treg cells, which act to suppress the immune response. At RAPT we are developing a novel oral small molecule that is designed to specifically target Treg cells associated with the tumor while not triggering widespread immune suppression, which has historically plagued the field. WuXi App Tec: What treatment modalities show the most potential? Are there any with the potential to treat early stage disease? Dr. Brian Wong: Immunotherapies are showing new potential in the treatment of lung cancer, both as monotherapies as well as in combination with different treatment modalities, including other novel immuno-oncology agents and chemotherapy. With that said, there is still room for significant improvement in this therapeutic area since still only a minority of lung cancer patients are benefiting from checkpoint inhibitors. WuXi AppTec: How is your drug different from existing lung cancer treatments? Is it a new approach? Dr. Brian Wong: We are developing FLX475, our lead drug candidate targeting CCR4, for the treatment of a broad range of “charged” tumors. These “charged” tumors are characterized by high levels of effector cells, Treg cells, and CCR4 ligands, the target for our immunotherapy. “Charged” tumor types include lung cancer and other cancer types we believe are most likely to respond to FLX475. In cancer, the secretion of certain chemokines from tumor cells and tumor-resident immune cells is responsible for recruitment of immunosuppressive Treg cells to tumor sites. Treg cells represent a dominant pathway for downregulating the immune response, and thus may limit the effectiveness of currently available therapies such as checkpoint inhibitors. Therefore, blocking the migration of Treg cells has the potential to restore naturally occurring antitumor immunity as well as to synergize with a variety of both conventional and immune-based therapies, such as radiation, chemotherapy, checkpoint inhibitors, immune stimulators and adoptive T cell therapy. We believe that the inhibition of CCR4 has the potential to bring therapeutic benefit to lung cancer patients (among other tumors) in a manner similar to other immuno-oncology therapies that have been shown to be effective against multiple tumor types, while also potentially deepening or broadening clinical responses to these therapies. The company is conducting a Phase 1/2 study of FLX475 in patients with advanced cancer. The Phase 1 portion of the study will examine the safety and determine the Phase 2 dose of FLX475, both as a monotherapy and in combination with pembrolizumab. The Phase 2 portion will examine the efficacy of FLX475 both as monotherapy and in combination with pembrolizumab in selected types of cancer.   WuXi AppTec: What is the specific mechanism of action? Dr. Brian Wong: FLX475 is an orally-available small molecule drug that blocks the CCR4 receptor on regulatory T cells and thus stops their ability to be recruited into tumors. By cutting off the supply of suppressive regulatory T cells to the tumor microenvironment, FLX475 is predicted to then shift the CD8 effector T cell to regulatory T cell balance toward the anti-tumor effector cells which should promote the eradication of tumor cells. FLX475 could be used either as monotherapy, or in combination with other therapies that can be limited by regulatory T cells such as checkpoint inhibitors, CAR-T cells, vaccines, chemotherapy, and radiation therapy. WuXi AppTec:  How did you choose to focus on lung cancer? It has been a very difficult disease to treat. Dr. Brian Wong: Through our analysis of many types of cancer we identified specific tumors that appear to be much more likely to express high levels of CCR4 ligands and to have high numbers of regulatory T cells and effector CD8 T cells, which we believe have a higher chance of responding to FLX475. Non-small cell lung cancer (NSCLC), both adenocarcinoma and squamous subtypes, came up as being among the most “charged” tumor types in our analysis. WuXi AppTec: Other than participating in clinical trials how have patients been involved in the development of your drug? Dr. Brian Wong: We have incorporated our profiling of cancer patient genetic data to come up with the “charged” tumor profile, which has indicated that NSCLC patients may be more likely to respond to FLX475. So patient data have certainly helped shape our overall development plan. WuXi AppTec: What major challenges have you faced in trying to bring a new drug for lung cancer to patients? Dr. Brian Wong: It is a highly competitive field, with many clinical trials ongoing using all kinds of agents, both novel and follow-on. We see these dynamics as good for patients as it means that the industry is focusing on the unmet needs of this patient population, but it also can mean many clinical trials are recruiting the same types of patients. WuXi AppTec: What lessons have you learned during the development process? Dr. Brian Wong: It is crucial to engage with investigators early on in the process and to communicate the science behind your drug candidate. Patient selection and enrichment strategy as well as a comprehensive biomarker program are critical in increasing the probability of success. WuXi AppTec: What other drug candidates do you have in the pipeline? Dr. Brian Wong: For cancer we are developing inhibitors of general control nonderepressible 2 (GCN2) and hematopoietic kinase 1 (HPK1), both of which limit the immune systems’ ability to recognize and eliminate tumor cells. These programs are in the discovery stage. We are also developing a second CCR4 antagonist called RPT193 as an oral treatment for a broad array of allergic disorders. WuXi AppTec:  What are the top three major impediments in our delivery of “better” medicines “faster” and “better” to patients? Dr. Brian Wong: First, identifying novel targets to meaningfully improve clinical outcomes. Second would be the identification of patient populations or subpopulations that have an increased probability of responding to these novel mechanisms of action, and the third impediment is the high number of clinical trials competing for the limited numbers of patients who actually participate in clinical trials. WuXi AppTec: For lung cancer, what would be the one thing that would have the greatest potential to lead a paradigm shift “from treatment to cure?” Dr. Brian Wong: Finding the right combinations of therapies that can both directly kill tumor cells while unleashing the full capacity of the immune system to develop, expand, and maintain an effective anti-tumor immune response.

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2019/11/21

SQZ Biotech’s Unique Technology Squeezes Cells to Transform Them into Therapeutics

SQZ Biotechnologies’ technology platform aims to tap into cells to create the next generation of commercially viable therapeutics with the potential to have an impact treating a broad range of diseases. Unlike current gene and cell therapies, which use viruses to engineer cells for therapeutic purposes, the company’s Cell Squeeze® platform disrupts the membranes of cells to deliver materials that arm them to treat diseases. The company recently received approval from the US Food and Drug Administration (FDA) to begin clinical trials of a cell therapy aimed at activating patients’ immune systems to attack solid tumors caused by human papilloma virus (HPV) infection. SQZ founder and CEO Armon Sharei, Ph.D., explained, “What we have been starting with is this mechanism around antigen presentation. What we do is take PBMCs (peripheral blood mononuclear cells) from the patient’s blood and use the SQZ platform to load them with tumor antigens. We are starting with HPV positive tumors.” The cells, loaded with HPV positive tumor antigens, are injected back into patients, activating the immune system’s killer T cells to attack the cancer. The clinical trials will test the therapeutic cells as a monotherapy and in combination with Roche’s checkpoint inhibitor. SQZ is working with Roche in a collaboration to develop antigen presenting cells to treat cancer. In discussing SQZ’s technology, Sharei observed, “I’m excited about the platform. We think it can overcome a lot of the fundamental issues in the cell therapy field and potentially create a whole host of new products that can make a big impact for people.” As part of an exclusive series spotlighting the insider perspectives of thought leaders on topics shaping the future of new medicines, WuXi AppTec Communications spoke with Sharei about his company’s technology and the challenges facing cell and gene therapies. Sharei founded SQZ Biotechnologies in 2013 and has served as the CEO since January 2015. He earned his B.S. from Stanford University and Ph.D. in Chemical Engineering from the Massachusetts Institute of Technology. WuXi AppTec: How has research in gene and cell therapies progressed over the past 20 years? Do you anticipate a wave of new approvals coming over the next 5 to 10 years? Armon Sharei: Gene and cell therapies have advanced by leaps and bounds over the past 20 years and really have started to show the impact people were hoping to see with these concepts. If you think about historically what we’ve done with therapeutics, we had small molecules and then we had biologics. Gene therapies have the potential to be a quantum leap above that relative to what has existed so far, and that is with things like CAR-Ts (chimeric antigen receptor T-cells). With the adoption of some of these AAV (adeno-associated virus) therapies we are starting to see differences in patients that are just a huge delta relative to what was done before in those fields. CAR-Ts having north of a 70 percent response rate in patients who really had no chance of survival at that point is really dramatic. It’s very different from when you have a chemotherapy or targeted therapy come out and give patients a month of extra time versus this, which works to actually completely change your biology, potentially allowing patients to go into remission. When it comes to the next 5 to 10 years that’s where I would start to distinguish the gene therapy and cell therapy definitions a little bit differently. For therapeutics that use viruses—a lot of the gene therapies today administer a virus in vivo—that’s an area that we work less on, but from what I can tell it looks like people have really started to figure it out in a way that’s going to be therapeutically meaningful quickly in the next 5 to 10 years across a few indications. That’s amplified by companies like Novartis and Roche going into this field. After a period of refinement and development, these virus-based therapies are coming into their own and most of their applications are in these rarer genetic disorders. Now for cell therapies I would say we’re still very much at the beginning of what’s possible. Comparatively speaking, injecting a virus in vivo can do an interesting set of things beyond what a biologic could do. But a cell can do more things, by far, than a virus can do. With these cell therapies right now, due to a lack of tools, people use viruses to engineer them. That’s why this whole category of cell and gene therapies has been blurry because so much has relied on viruses to get this far. CAR-Ts, for example, are made with viruses. But ultimately what you can do with a cell is not restricted to genetic change, and I think that’s exemplified by what we’re doing at SQZ. Our platform lets us go after much more diverse biologies within cells, like the program we have partnered with Roche. We don’t make any genetic changes to these cells. We deliver, in this case, peptide materials that leverage these cells’ physiological systems and induce immune responses. Those immune responses have shown a lot of potential pre-clinically and we’re very optimistic about what they’re going to do in the clinic. In contrast to gene therapies, we’re at a point where you are going to see these cell therapies become more commonplace and accepted, and useful across diseases. We’re going to start to see more interesting things happening over the next few years, but it’s going to be decades until cell therapies really reach the height of their impact because I think they can apply to so many more diseases and patients. WuXi AppTec: When you are referring to viruses, you’re talking about the delivery systems, correct? Armon Sharei: Yes, exactly. At the end of the day, for these applications, it comes down to what can you make a cell do; and viruses are pretty limited in what kind of cargo they can bring in and also what kind of cell type they can transduce. But if you are relieved of those constraints, there is a much broader range of what you can do. What illustrates that is most AAV vector gene therapies are being used for relatively rare genetic diseases. WuXi AppTec: What scientific advances are needed to make these therapies more effective?  Armon Sharei: On the viral gene therapy side, one of the biggest things right now is repeat dosing and pre-existing immunity. That is something where people are trying to figure out how to shut down those immune responses against these viral vectors so that you can enable repeat dosing. That has been a challenge so far. In the context of cell therapies, it goes back to those elements we were talking about where right now people are really limited in what they can engineer. Improvements in cell engineering are really going to drive that big differentiation down the line. That’s where you need these newer technology platforms, which can alter many different functions within cells to create these therapeutics. Now to layer on top of that, I would say the challenge is manufacturing. Right now manufacturing for both gene therapy and cell therapy, and particularly for cell therapies, can be really impractical in the sense that it is quite expensive and, from a patient perspective, takes too long. If you are a cancer patient on your last legs, you don’t have a month to just wait for your cell therapy to be prepared. With the SQZ system, for example, our manufacturing process for our program that’s already in the clinic now is under 24 hours. So it is by far faster and more cost effective than what people have been able to achieve so far with cell therapies. And I think these kinds of manufacturing improvements are going to really determine the accessibility of these therapies down the line. A final point on the cell therapies is safety. Right now within cancer there is significant tolerance for safety challenges. CAR-Ts are not safe-based products. They tend to have significant side effects that are currently manageable, but they are still substantial. You can’t tolerate those kinds of side effects as you go into earlier lines of treatment in cancer, or if you go into indications that are not going to be terminal for the patient. Going back to cell engineering, that is the main advance needed. As you can access different biologies, you can start to create therapies that can be really effective, but also are a lot safer because they stay closer to natural physiology in how they work and don’t inadvertently trigger a host of other responses that drive toxicity. WuXi AppTec: Will cell therapies ever be commonplace? Will they become more commonplace than small molecules and biologics? Armon Sharei: I think cell therapies can be a much more rational biological approach to many diseases because you are using a complex biological machine to go and create your treatment as opposed to a relatively simplistic small molecule or biologic. That being said, it will always be easier to swallow a pill than to get an infusion of a cell therapy. So for our more serious diseases cell therapies can become commonplace and will usher in a new era where you can treat terminal illnesses with few side effects. They will be the most meaningful therapeutic modality. But when you can take a pill to ease your joint pain you’ll probably do that over a cell therapy. WuXi AppTec: How far away are we from that day? Armon Sharei: I think we are over a decade away from (cell therapy) being that commonplace. Over the next 10 years people are going to have to show that future world is possible. By taking the dramatic progress made already in cell therapies and starting to implement cell therapies across more diseases, in a safer way, with much faster manufacturing, that will be the tipping point which can lead to a proliferation of cell therapies across many disease areas. It will take a while to get there, but it will be a very interesting world when we do get there. WuXi AppTec: What are the risks and limitations of these therapies? Armon Sharei: For gene therapies, which you are delivering with viruses, the limitations are that there are not that many diseases that will ultimately be addressed by that kind of the therapeutic strategy. There are some very serious diseases that relate to a genetic deficiency, but there are many diseases that are not rooted in that kind of cause. Gene therapy will certainly have an impact for patients who really need it, but it’s not going to be a huge proportion of the population. For cell therapies, the limitations right now are those points we talked about. They are limited in what diseases they can be used for, there are safety issues, and it’s very impractical to administer them. And as we improve on methods of how to engineer these cells and have new platforms that can engineer a much broader range of function in a quick and practical way, you will start to see significant change, which makes this a lot more accessible. WuXi AppTec: How does your cell therapy work and what diseases are you targeting? Armon Sharei: Our company is built around this platform where we have shown that by squeezing cells at high speeds in a microfluidic channel you can disrupt their membranes and enable the delivery of all kinds of different materials. This has really opened up the doors as far as what cell types you can use and what you can engineer about them while implementing a simple, rapid, and cost-effective manufacturing format. We think this can ultimately be used as the basis for creating many different cell therapies. Our goal for the company is to create that next wave of much more impactful cell therapies. What we have been starting with is a mechanism around antigen presentation. We take PBMCs (peripheral blood mononuclear cells) from the patient’s blood and use the SQZ platform to load them with tumor antigens. We are starting with HPV (human papilloma virus) positive tumors. When we load these cells with the tumor antigens, what they’re going to do once we inject them in vivo is present those antigen components on their surface. That will activate the patient’s own endogenous CD8 T cells, which are the killer T cells, and they will proliferate and try to destroy the tumor. It’s really a mechanism of trying to tell the immune system what to target in the context of cancer. If we can show success in these HPV positive tumors, it should be pretty plug and play to then implement this for many different tumor types. And the manufacturing time for our Phase I trial is under 24 hours for creating the product, so it’s by far faster than what people currently do. WuXi AppTec: How would you contrast your approach with that of others attempting to create cell therapies? Armon Sharei: Our platform can address virtually any cell type and deliver any materials to alter its function. And we can do this all without otherwise causing undesirable changes to the cell function. It has broadened our ability to go after many different biologies and concepts that others can’t implement. So the contrast I would say right now is that a lot of the field of cell therapy in oncology has been focused on CAR-Ts, which thus far have been limited to B cell malignancies (i.e. specific blood cancers) and haven’t been able to translate effectively to other tumor types. Also they are associated with significant toxicity issues. In our case, we are from the beginning going into these solid tumors, which are HPV positive tumors, and based on the mechanism we’re pursuing we would expect a much better safety profile; certainly have a much faster manufacturing time; and know that it will be much simpler to implement in other tumor types relative to the mechanisms that the CAR-Ts have pursued. WuXi AppTec: Will your technology be able to treat early stage cancer? Armon Sharei: In principle, yes. Our trial is starting with later stage cancer, but the mechanism is very applicable to early stage cancers, and because we expect it to be a lot safer, it would be quite desirable to implement it in earlier stages. Whereas some of the systems that exist today for cell therapies you would not want to treat early stage cancers because the toxicity issues would be difficult to make it justifiable. But we should be able to go in earlier as well as in a broader range of cancer types. WuXi AppTec: What major regulatory and commercial challenges do you face, now that you have begun clinical development? Armon Sharei: We have had productive interactions with the FDA, and from a regulatory perspective I think we all recognize that this is a newer field and everybody is learning as we go. We have a strong case. Given the simplicity of our platform, and given the types of mechanisms we go after–and our expectations for it being safer than what’s out there–we haven’t had challenges per se from the regulatory side. There is a challenge because it’s a new field–and relatively unknown–and the regulators and companies like ourselves are trying to be thoughtful, deliberative, and creative about how we approach it. On the commercial front, because we’ve solved a lot of the manufacturing problems, we can make cell therapy much more feasible, much more broadly implementable, and it should be successful in trials. I think the main challenge is going to end up being that no one has been able to implement a broad cell therapy commercially right now. That’s going to be interesting because this is going to end up being different from a biologic. Our first program uses autologous cells. You need to think about implementation at a really broad scale, tracking individual patient material and the manufacturing chain, and scheduling the patient follow-up visits. It is more complex than a biologic or a small molecule, but ultimately we believe our approach is a lot more tractable than what people do today in cell therapy. WuXi AppTec: As with other new medicines, the prices for some gene and cell therapies generate “sticker-shock” among patients. Will gene therapies be widely accessible for patients? What changes are needed to ensure universal accessibility to these potential disease cures? Armon Sharei: It’s a great debate that’s going on right now. We’re in favor of outcome-based pricing because these new modalities, like the gene therapies and the cell therapies, should have an impact that is disproportionate to what a small molecule or biologic could have achieved. That would be the justification for the added cost. In the end, if you are actually making these new modalities do what they are capable of, it should actually be a net benefit and cost-savings to society because you’re treating or potentially curing diseases that previously would result in much less desirable personal and economic outcomes. When we are used to paying for a treatment that is going to prolong your life for a month or two and be really expensive, that is one mindset. But when you’re talking about a treatment that could potentially cure the disease, that is a very different proposition. Ultimately, I think there will be a solution to pricing that recognizes the impacts of these therapies and has an economic incentive to continue to create them. WuXi AppTec: Have you determined how you are going to value your therapy? Armon Sharei: We have not. It will be determined by how much of an impact we’re having. Obviously there have been certain precedents set by where CAR-Ts have been priced, but we want to see what our cell therapy does in the clinic and how truly differentiated it is before trying to figure out pricing. WuXi AppTec: In general, what are the top 3 impediments to delivery of better medicines, faster and cheaper to patients?  Armon Sharei: In our context, the biggest impediments are the breadth of biology people can access today. It has been limited and we feel platforms like ours can overcome this. That will make a big difference. The manufacturing and turn-around time involved with our field right now are problems, and if we can resolve those it will really make these (cell therapies) much more accessible. And then finally—this actually goes to your point on pricing and incentives—we do need a more rational incentive and pricing structure that motivates the right kinds of innovation and demotivates the much more incremental or repetitive pieces that might encourage inefficiencies in the system.

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2019/11/08

Avalon Venture’s Jay Lichter Discusses COI, Community of Innovation, a Different Way for Drug Discovery and Development

By Rich Soll, Senior Advisor, Strategic Initiatives, WuXi AppTec (@richsollwx) and WuXi AppTec Content Team Tucked away in the life science corridor of San Diego’s famed Torrey Pines Road is an unconventional incubator with an unconventional name, COI Pharmaceuticals. This facility is not really a pharmaceutical company but rather a Community of Innovation, according to its CEO, Jay Lichter. Established in 2013, COI is a fully integrated incubator that streamlines its operations through shared key resources including finance, planning, facility and more. Unlike most incubators, this is not a real estate play but rather is part of the Avalon Ventures’ investment portfolio, where Lichter is a Managing Director responsible for life science related investments. Lichter perceived it as a pragmatic way of operating various small businesses. Lichter brings an unusual combination of business acumen and deep scientific/technical knowledge together, resulting in licensing or merger/acquisition deals valued in excess of $3B. He started 25 companies; for example, he was a co-founder of Sequana Therapeutics and Synthorx (a synthetic biology company whose genetic alphabet expanded to six base pairs makes novel protein therapeutics with improved pharmacological properties). He also led investments in Sitari, Calporta, Otonomy, Aratana and Fortis amongst many others. A hands-on executive leader with more than 25 years of experience, he holds more than 300 patents (issued or application). His investment and management style and that of his senior staff is “operational capital,” meaning that he invests in companies, his team runs the companies, and he keeps track of them daily. In a recent discussion with Rich Soll and the WuXi AppTec Content Team, Lichter identified his main motivation: pushing the frontiers of technology to satisfy unmet medical needs. Most of Lichter’s startups are first in mechanism, “no me too’s.” This philosophy is partly inspired by his own experience with a balance disorder and hearing loss, which connected directly to the funding of Otonomy, a company that pioneered new treatment options to patients with otic (ear) disorders whose therapy is now in Phase 3. “There’s certain risk with first in mechanism,” Lichter admitted. “How is the FDA going to go, how to set up clinical trials necessarily, whether or not your approach is going to have efficacy with a successful safety profile when you finally get to the clinic… (But) when you do win, you’re going to get it at a premium for that particular molecule because nobody else is doing it. Anybody else is years behind you.” However, Lichter stressed that investing considerations are not solely based on good science. Given the extensive experiences of Avalon and its expertise, the portfolio companies are required to have a specific financial picture of the amount of money they need to put in over the life of the startup, which highlights the importance of running a business. “There are plenty of things where it is great science but terrible business. I’m not doing it. So that business piece is super important,” Lichter said. “I’m making investment decisions and coaching people on business strategy.” All Avalon portfolio life science companies stay in COI for further discoveries and development; there are 12 companies currently. When the company grows up and has a full-time management team, it leaves the incubator. This usually happens when a Series B get raised and when its own dedicated team is needed. Otonomy did, Synthorx did, and a few others are going on that path. COI’s pipeline is as abundant as its portfolio. “We have Avelas in Phase 3 for breast cancer treatment during surgery, a bunch of companies in the clinic testing new molecules, and companies that are manufacturing right now, promising a near future to be in the clinic,” Lichter continued. “In addition, one healthcare IT company with monthly revenue growth by 20% and two companies going to be acquired. We’re excited by that.” When looking into the Intellectual Property within all the funded companies, a third of it is homemade and two-thirds come from universities. GlaxoSmithKline (GSK) installed a unique early-stage partnership model with Avalon Ventures in 2013, with a goal of 10 investments. They have formed eight companies incubated by COI as part of that partnership. These included Iron Horse Therapeutics, whose focus is on amyotrophic lateral sclerosis, PDI Therapeutics, an immune-oncology company, and Sitari. On September 11, 2019, GSK announced it would acquire Sitari Pharmaceuticals for its transglutaminase 2 (TG2) small molecule program for the treatment of celiac disease, where TG2 is thought to play multi-factorial role in autoimmune response to the disease as well as catalyzing a reaction with dietary gluten peptides that drive pathogenesis of the disease. The acquisition occurred six years after Sitari’s founding and $10M in Series A financing. “Our batting average for delivering clinical candidates is about 60-70%, which is not only quite remarkable for a first-in-class molecule, it is higher than industry average,” stated Lichter. “Part of it is that we make sure we have all the assets and reagents needed, hope for a little luck, and good contractors like WuXi AppTec to make sure that experiments get done right.” Lichter was a big fan of virtual companies before it became popular. “We were outsourcing a lot of stuff; if there was a key complex biological asset, we kept that in house, Lichter stated. “With Fortis we raised $28 million yet had no full-time employees; everything was outsourced. We could not do that fifteen years ago.” WuXi AppTec has had a long-time partnership with Avalon’s portfolio companies. In the development of these startups, WuXi AppTec enabled COI through manufacturing, general chemistry, process, PK and other kinds of capabilities. Lichter viewed it as a privilege of keeping small teams and working on multiple projects. According to him, it helps companies put emphasis on innovation and plan, rather than the size of chemical libraries. Lichter’s senior team has seen more than 1500 proposals over the last 5 years. To be considered for entrance into COI, an entrepreneur’s proposal must have innovative science that addresses an unmet medical need, possess a clear regulatory and clinical strategy to the market, and the product must be disruptive rather than incremental in terms of benefit to the patients. Lichter also commented on innovation impediments or barriers to delivering medicines faster and cheaper to patients. “You can get some grant money and small capital from friends and family. Identify a target. Make your laboratory-based antibody and you can even engineer it a little bit. Get to your final form without a lot of money. Then it’s minimally nine months and five million dollars, often more, to have it made and manufactured. In today’s funding world that’s really difficult,” said Lichter. “This is an industry-wide hurdle.” As a seasoned former researcher, he also wished to see improved manufacturing technologies. “If there was a machine that I could take a cell or a group of cells from a clonal population with novel antibody in it, and in two weeks out pops enough GMP materials, I could run my first Phase 1. That would change a lot of things. You’d see a lot more of these things in the clinic quickly,” he said. Lichter concluded with the following: “There are already many cancers that can be treated and cured, and that number will increase dramatically,” said Lichter. “It will be like infections. Until you first started to understand what antibiotics were, people would die quickly from infections. Now there’s therapy and the vast majority of people who get infections don’t die. And I think in cancer you’re going to see the same thing in the next ten to twenty years.”

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