Thank you. Welcome everybody to the webcast for Ascelia Pharma's Q4 report for 2020. I'm Magnus Corfitzen, CEO of Ascelia Pharma, and with me here today on this call, I have the entire executive team. We look forward to updating you on our progress in the quarterly report. Please turn to page number 2. We will be making certain forward-looking statements on this call. Please pay attention to this before moving to page number 3. Ascelia Pharma is focused on improving the life of people with rare oncology-related conditions by developing novel drugs to address unmet medical needs. We have two drugs in clinical development. Mangoral is in phase III, and we expect to complete the study in the second half this year. It will be the only product targeting an addressable market of $500 million-$600 million annually. Oncoral is being prepared for phase II in the treatment of gastric cancer based on encouraging results in phase I. We have a very strong and experienced team headquartered in Malmö, Sweden, a strong track record in late-stage drug development and commercialization. We have a solid financial position. In addition, we have built an extensive global network to help us bring our drug candidates to the patients who need it. Now please turn to page number four. Ascelia Pharma is in a transformative phase as we're moving from late-stage development into commercial stage. Our lead program, Mangoral, is expected to be launched in the U.S. at the end of 2022 or first half 2023, and we are highly engaged in the preparations. In the same timeframe, we expect that the phase II for Oncoral will be nearing completion. As part of our strategy, we might expand our portfolio with additional drug candidates that fit our orphan drug strategy where we can make significant benefit for patients. As you can appreciate, this is a truly exciting time for Ascelia Pharma. We see tremendous value creation potential as we progress. Now please move to slide number five. The Q4 has been a busy period. In October, we held a virtual capital markets day with a focus on the attractive commercial opportunity of Mangoral. We have done and continue to do a lot of commercial preparations. The findings led us to increase the addressable market to $500 million- $600 million annually in the U.S., Europe, and Japan. In November, we announced the information from European Medicines Agency that Mangoral is eligible for the centralized regulatory approval process. In December, we announced the result from a re-read study, which demonstrated that Mangoral was as effective as a liver-specific gadolinium agent in terms of visualization of focal liver lesions. The same endpoint as in SPARKLE, our global registration-enabling phase III study, which is ongoing. Carl will provide more information on this later on this call. In December, we announced that the U.S. Patent Office had accepted our patent filing for a second-generation version of Mangoral. This patent will run to at least 2040, and Julie will provide more information on this on this call as well. Shortly after the end of the quarter in early January, we presented our plan for Oncoral phase II development at the prominent group of leading oncologists who make up our advisory board. Please turn to page number 6. We'll now go into more depth on our pipeline, and I'd like to hand the word over to our Chief Medical Officer, Carl Bjartmar. Thank you, Magnus. I will now provide some more details on the clinical development of these two candidates. I will start with Mangoral, the contrast agent for liver MRIs. Please turn to page seven, slide seven. Contrast agents for liver MRI available today are all based on gadolinium, a heavy metal which is dosed intravenously. Gadolinium-based imaging drugs can be used in most patients but should not be given to patients with poor kidney function, since gadolinium is excreted through the kidneys and slow elimination can cause serious side effects. For that reason, regulatory authorities, for example, FDA in the U.S., have implemented restrictions for patients with impaired renal function. That is a very specific unmet medical need. This context is illustrated on the slide. Today, patients with normal kidney function, that's most patients, can receive gadolinium-based imaging drugs. However, patients with severely reduced kidney function lack an imaging drug today. In the future, tomorrow, this unmet need can be met by Mangoral. This is a specific target population, and it's approximately 4% of all patients requiring liver MRI. For these patients, Mangoral aims to be the standard of care. Importantly to note here is that Mangoral is the only liver-specific contrast agent in clinical development, so we are way ahead of any competition. Please go to slide eight. Our ongoing pivotal phase III study, SPARKLE, investigates efficacy and safety of Mangoral in target population with focal liver lesions and poor kidney function. As mentioned, the study is expected to be completed this year. As shown on the left, there is a strong clinical proof of concept through six individual phase I and II studies with very consistent results. These data were confirmed by an independent re-analysis by a blinded reader, which showed highly significant effects on the endpoints that are also used in our pivotal phase III study. The primary endpoint is lesion visualization based on the co-primary parameters lesion delineation and lesion contrast compared to background, which were both highly significant in the phase II program. The existing data also contains a direct comparison to gadolinium-based liver contrast agent, which showed similar effect on lesion visualization, and I will come back to that study. The right side of the slide illustrates the phase III design. The study, which is a global study with 200 patients, has been agreed with FDA and EMA. As mentioned, the strategy is to repeat and confirm the phase II results using the same endpoints. Since there is no available contrast agent for patients with impaired renal function, the comparator will be unenhanced MRI, which is currently the standard of procedure for these patients. Finally, the follow-up for each patient is very short compared to most clinical studies. This simplifies the operational procedure and will also have a finalized study relatively sooner than a typical study of the same size. Go to next slide 9, please. As mentioned, we recently released the results of a blinded re-read study using the same endpoints and evaluation criteria as the ongoing phase III study, SPARKLE. This was an independent study where Mangoral was compared both directly against the gadolinium contrast agent, but also against MRI without the contrast enhancement. The key outcome was that Mangoral was as effective as gadolinium for visualization of focal liver lesions, where two out of three independent readers even reported higher scores for Mangoral. In addition, Mangoral MRI provided improved diagnostic efficacy compared to MRI without the contrast agent. This data will not only strengthen the data package to the regulatory authorities, it also supports our expectations of a positive outcome in the SPARKLE study. I will now turn over to the commercial outlook of Mangoral. Julie? Thank you, Carl. We are now on slide 10. I will share key highlights on the market opportunity for Mangoral and on our progress preparing for commercialization. In connection with our Capital Markets Day in October, we communicated an upgrade of our estimate of the addressable market for Mangoral to be between $500 million-$600 million in our key markets. Decision-makers understand the value that Mangoral provides, and our preparations for launch progress as planned, and we continue to see a strong case for building our own team in the U.S. In December, as Magnus mentioned, a patent was granted in the U.S. for our second-generation Mangoral, which provides patent protection until 2040. Please move to slide 11. As mentioned, the addressable market for Mangoral represents $500 million-$600 million annually, covering the U.S., EU, and Japan. This value is driven by a well-defined patient population. These are patients who have suspected liver cancer or metastasis and need a liver imaging for diagnosis or for ongoing treatment or monitoring, and they have severe kidney impairment. Our data on patients and procedures come from actual recorded medical procedures, real world data, which gives us a solid understanding of patients eligible for Mangoral and the number of imaging procedures for each patient per year. In terms of pricing and access, our analysis is based on extensive insights from payer and reimbursement experts in key markets. This gives us a solid understanding of the value proposition that Mangoral provides to the healthcare system and the pricing potential in each market. For these patients and these procedures, there is no competing drugs. As Carl talked about, the alternative to Mangoral is an unenhanced MRI, which, as Carl showed, does not provide an adequate image quality. Please move to slide 12. For the U.S., the attractiveness and clear path to market provides a strong case for commercializing Mangoral on our own, i.e., building a U.S. commercial affiliate. We already have strong relationships with key radiologists among our phase III clinical study investigators, and we also have partners among specialists and organizations within manufacturing and radiology. The target patient population for Mangoral has multiple health complications. The decision to use a contrast agent is centered around 2,000 radiologists who can be found at 400 hospitals. A sales team of 20 FTEs can reach priority decision-makers at launch. Building our own team in the U.S. allows us to create an attractive top line and retain profit and value in Ascelia. For other markets, the EU and Japan, we believe the most attractive opportunities are the next priority for Mangoral launch. In these markets, our strategy is to maximize the value by working with partners with existing local expertise and relationships with decision-makers. Please move to slide 13. In December 2020, we announced that the U.S. Patent Office issued a new patent covering our second-generation formulation of Mangoral. This second-generation formulation provides patent protection until 2040 in the U.S. A global patent application for our second-generation Oncoral was also filed, and decisions will follow in each market according to their national procedures. The second-generation formulation provides further value to the Oncoral franchise. This is an effervescent tablet where the first generation is two separate stick packs that are to be dissolved in water. The effervescent tablet formulation will further improve ease of use for patients and healthcare professionals. We can turn to slide 14 and go back to Carl and Oncoral. Thank you, Julie. I will now provide some more details on the Oncoral program. We can go to slide 16. The active substance of Oncoral is irinotecan, and irinotecan is an established chemotherapy with well-documented anticancer effects. It is currently used in several solid cancer indications, and it is approved for colorectal cancer and pancreatic cancer. In Japan, it is also approved for gastric cancer. Today, the administration is intravenous bolus infusion, typically every third week and typically high dose. Oncoral is a novel oral formulation of irinotecan. It is a tablet for daily dosing that could offer a valuable treatment option for cancer patients in the future, tomorrow. There are several potential advantages of oral daily dosing. Most important, efficacy. It is well known that many cancer types have suboptimal treatment outcomes today. An oral daily dosing may improve efficacy through a favorable pharmacokinetic and pharmacodynamic profile based on more constant, even therapeutic plasma levels of the active substance. There are both non-clinical and clinical data supporting this concept. There is tolerability or safety. Intravenous dosing of chemotherapy is frequently associated with severe side effects, for example, gastrointestinal and hematological side effects. An oral daily dosing has the potential for improved tolerability by avoiding high plasma levels and by offering dosing flexibility. In addition, there's convenience and cost. It's more convenient and cost-effective to take a tablet at home than going into a hospital and prepare for intravenous administration. Please go to slide 16. Yeah, this is an example of improved outcome, in this case, overall survival with a more frequent dosing. These are patients with metastatic breast cancer, where overall survival was improved from 20% with dosing every third week, irinotecan intravenously, high dose, to 32% with weekly dosing with a slightly lower dose. This is, if you will, a proof of principle. Go to the next slide, 17 please. The concept of frequent low-dose administration is called metronomic dosing. The figure to the left illustrates a simulation model comparing levels of the active substance, SN-38, after irinotecan intravenous dosing every third week, that's the gray line, and oral Oncoral dosed daily, that's the yellow line. Over a three-week cycle, the exposure or area under the curve is comparable, although the plasma peaks associated with toxicity are avoided by daily dosing. Approximately one-third of the side effects observed after intravenous dosing are reported as severe or even life-threatening, grade 3 or 4. Metronomic dosing may not only reduce peak-related toxicity but also brings the possibility to adjust the dosing quickly if adverse events should occur. Our own Oncoral phase I results show that Oncoral was well-tolerated overall and importantly, the hematological toxicities were mild to moderate, grade 1 or grade 2. In addition, our phase I data with Oncoral indicated activity or stable disease even in patients that previously progressed on irinotecan given intravenously. That is encouraging. We can go to the next slide, 17 please. 18, sorry. 18, yeah. Yeah, this program is supported by a high-profile advisory board. We have Professor Tabernero from Barcelona, Spain, former president of ESMO, Professor Ajani from University of Texas, Professor Van Cutsem from Belgium. We have Professor Jeff Evans from the University of Glasgow. Here there is a joint view that Oncoral will be an important treatment option for cancer patients in the future. Can go to the next slide 19. Now we are preparing for the phase II study, and the objectives of the phase II study are several. First of all, to establish a clinical proof of concept in metastatic gastric cancer. Gastric cancer is chosen partly because of strategic reasons. There is potential for orphan drug designation in gastric cancer, and the clinical guidelines and clinical data support efficacy of irinotecan in gastric cancer. Subsequently, there is potential for label expansion into other solid tumor indications. Another objective is to generate compelling phase II data for further development, potentially with a partner. The study is a randomized, controlled, multicenter, multinational study comparing Oncoral on top of standard of care with standard of care alone. The primary endpoint is typical for a phase II study in oncology, progression-free survival. There's a battery of secondary endpoints, response rate, PK safety, and overall survival. This will include approximately 100 patients. We anticipate the study to start the second half of this year, 2021, and the duration into 2024. Thank you. On to Julie, slide 20. Again, to reiterate our position to pursue gastric cancer in our phase II study. Gastric cancer represents an attractive opportunity because there's a large unmet medical need and because there's a value potential for Ascelia Pharma. Today, irinotecan is approved in colorectal cancer and pancreatic cancer, but in gastric cancer, irinotecan is not approved. As Carl showed, there's a potential for improved patient outcomes with a daily dosing. Gastric cancer is the third most frequent cause of death in cancer. It represents a $3 billion-$4 billion market today, and there's an opportunity for an orphan drug indication and value in the U.S. and Europe. In the future, there may be opportunities to expand our indications into other areas, either colorectal or pancreatic or new indications. With this, we'll move to slide 21. Thank you, Julie. Then jumping directly to page 22. The development in earnings compared to the corresponding periods last year is the same as we have discussed in previous calls. The increased loss year-over-year, both for the quarter alone and for the full year, is as expected and reflects the continued progress and the spend on the clinical development program for Mangoral. It also reflects that we are ramping up on our commercial preparations. We now turn to page 23. The key message here is, as also said on previous calls, is that we continue to stand with a solid cash position. The cash position will take us into 2022, consequently, beyond the clinical milestone, the top line phase III data from SPARKLE, our phase III study, which we expect to present in the second half of this year. With that, I'll leave the word over to Magnus. On slide 24. Thank you, Christian. I'd like to end this quarterly update with our focus on 2021. The clinical development of Mangoral is highly important for us. This work continues full speed despite some COVID-19 impact, as previously communicated, and we continue to work with investigators and consultants to make this study a success and are adapting to the circumstances to ensure patient medical staff, employees, and everybody else are safe. We continue our preparations for Mangoral commercialization, have many activities ongoing to enable us to detail and implement the value-maximizing strategy as outlined by Julie. Another important activity this year is our preparations for the Oncoral phase II study, which we expect and hope to start in the second half of this year. This was our final slide, and we'd be happy to take any questions. Thank you. Ladies and gentlemen, if you wish to ask a question, please press zero one on your telephone keypad now. That is zero one to register for a question. I have a question from the line of Ludvig Svensson from RedEye. Please go ahead. All right. Ascelia team, thank you for a nice presentation. My first question is related to the patent covering the new formulation of Mangoral. Could you elaborate on your strategy here on how you will use this asset to prolong exclusivity on the market? Thank you. Yeah, we have not communicated our exact strategies, but this is really a testimony of a successful lifecycle management strategy. Of course, this is an opportunity to maximize the exclusivity on markets and globally also some of the markets that may not be in the first priorities. That is what we have communicated so far. We will communicate further on the strategies for launching with the second generation at a later stage. All right. Thank you. Thank you, Julie. My second question, and this might of course be hard for you to answer, but nevertheless of interest for investors, of course. How is the recruitment to the SPARKLE trial progressing? Is the recruitment paced what you had expected? Obviously, any information would be helpful. Yes, as you know, Ludvig, we don't provide details on this. Our strategy is to communicate first patient in and last patient in, and not details in between there. The reason is that recruitment is never linear in a clinical study. If you give a certain number at a certain time point, there will be extrapolation and speculation, and that's not in anyone's interest. Having said that, and I think you expected that answer, but I'll try to answer. We have a challenge with COVID, and everyone knows that. In spite of that, we're taking every measure we can to mitigate the impact on SPARKLE, and we are in the process of opening sites. As you may have seen on clinicaltrials.gov, we now have 20 sites open, and we are in the process of opening new sites. We expect that to contribute to the recruitment. As we are currently, we believe we are on track for finalizing the study this year as we have communicated. That's what I can say today. Should that change for any reason, and that could be COVID related, for example, that will be communicated. We are not there. We still expect to finalize the studies this year. I hope that answered the question. It is a difficult question because, as I said, we don't communicate the details during the study. Absolutely. Thank you for that answer, Carl. That was everything for me. Thank you for the presentation. Thank you. Thank you. Thank you, Ludvig. I remind you that if you want to ask a question, please press zero one on your telephone keypad now. Our next question comes from the line of Dan Akschuti from Pareto Securities. Please go ahead. Thank you for taking my question and thank you for the great presentation. I just have a question on the phase II of Oncoral and what kind of learnings could you take also from your U.S. peer company, Athenex, which is advancing oral paclitaxel. What was surprising for me to see in several similar studies that PFS actually is, there is an improvement in progression-free survival, but the improvement in overall survival is even better, which is kind of the opposite of what you usually see, is there is an effect on PFS, but maybe less on overall survival and how this affects your phase II design plans and maybe also beyond that. It's a good question but the study is designed and the sample size and power is based on progression-free survival. We're still collecting overall survival, and there is an adaptive element into the study. We can sort of switch the endpoints, if you will, based on interim analysis, if we would wish to do that. I still think that progression-free survival is the conventional and best-suited primary endpoint for a phase II study, given the purpose of establishing a proof of concept in advanced gastric cancer. You can always argue here, but as I said, we're collecting both endpoints, of course, progression-free survival and overall survival. Okay, thank you. Again, Dan, thanks for the question, and I think your point goes very well to support the rationale that Carl explained some data on here, and there's a lot more available. That more frequent dosing of anticancer agents is, in many cases, leading to better treatment outcomes. Again, that supports the rationale for Oncoral. Thank you. As a final reminder, if you would like to ask a question please press zero one on your telephone keypad now. There are no further questions at this time. Please go ahead, speakers. Yep. Thank you everybody for listening in. We'll be happy to update you on the fourth quarter of 2020. We are super excited about 2021, which will be yet another transformative year for Ascelia Pharma as we progress towards making our drug candidates available for patients. Thank you, everybody. Have a good day.
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