Good morning, everyone, and thank you for joining day three of the H.C. Wainwright twenty-sixth Annual Global Investment Conference 2024. My name is Daniel Smith, and I'm an H.C. Wainwright Equity Research Associate in Biotechnology. With that said, let me introduce our presenter for the session. I'd like to welcome Mr. Mark Rothera, President and CEO of Viracta Therapeutics, who are a clinical-stage oncology biotech. Viracta is traded on the Nasdaq under the ticker VIRX. The floor is yours. Thank you very much, Dan, and thank you, Wainwright, for the invitation this morning. Viracta's mission is to treat and prevent virus-associated cancers, and today I'm gonna focus on our lead late-stage asset, Nana-val, for EBV-associated cancer. During the course of my presentation, I may make forward-looking statements. Nana-val, as I said, is a late-stage asset. It's focused on EBV-associated cancers, and as you're going to hear in today's presentation, we have a potential route to a filing for an NDA in 2026. One of the things about EBV cancers, they're generally a lot worse than EBV-negative cancers, and you're gonna see that in a bit more detail in a minute. I think there's a very high unmet medical need here. Nana-val is an all-oral combination that's well-tolerated, that specifically targets and kills EBV cancer cells. It's a very novel MOA, and the great thing about this mechanism is that it can be applied across a whole range of EBV-associated cancer types, lymphomas, and solid tumors. What I'm also gonna share with you today is data from our ongoing phase II pivotal study in EBV-positive lymphomas from our lead indication, PTCL, showing compelling overall response rates of around 60% to 70%. That, combined with a recent meeting with the FDA, has opened up the possibility of an NDA filing in 2026. What is exciting about that is, this first indication is essentially a bridgehead into the market, opening up the possibility of multiple additional indications thereafter, both in lymphoma and in solid tumors. Roughly 2% of cancers worldwide are EBV-associated. Just to draw, you know, out that point a bit more, there are over three hundred thousand patients with cancer worldwide every year that are EBV-associated, and what we've done at Viracta is to focus our development program on three lymphoma subtypes: PTCL, DLBCL, and PTLD. You can see on the left there, the EBV positivity rates for those indications. We've also focused on NPC, nasopharyngeal carcinoma, and gastric cancer as two key solid tumors associated with EBV. There are many others beyond this, but that is our priority. This is why I joined Viracta, because when you look at survival for patients with EBV cancer. On the left, take PTCL as an example. In the dotted line, you can see those patients with EBV. In the black line, you can see those that are EBV negative. I f you have EBV PTCL, within about 12 month, seven out of 10 patients will die. Within around two years, nine out of 10 patients will die. This is a very aggressive cancer, and the same is true for EBV DLBCL. While it's a big area with lots of potential treatments, when you look at the EBV subpopulation, they do distinctly worse, and there is no targeted treatment today to address EBV cancer. So how do we do that? We have an all-oral combination of our proprietary nanatinostat and valganciclovir. Nanatinostat, in the presence of the latent EBV virus, which is in the cancer cell, kicks the latent EBV virus into its lytic cycle, and that enables the production of EBV protein kinase, shown in green in the middle. That converts the prodrug valganciclovir into its cytotoxic ganciclovir form, and ganciclovir causes both apoptosis and kills the virus. So we call that the kick-and-kill mechanism. It's a very neat mechanism that's very well documented. So how does this mechanism work in the clinic? I'm going to focus on our lead R/R lymphoma and our lead program in PTCL. W hat you see on this chart is the design of our ongoing pivotal phase 2 trial in relapsed and refractory EBV-positive lymphomas, with a focus on three key subtypes: PTCL, DLBCL, and PTLD. I t's a basket trial, and it's a Simon two-stage design, which is deliberately set up so that you have to pass a hurdle in stage one of 10 patients in each indication. If you pass that hurdle, you go to stage two for 21 patients in total, and if you pass the 21 patient hurdle, you can then go into the post stage two expansion phase. Also, between stage two and enrolling into the post stage two expansion, the goal is to meet with the FDA to discuss the route forward, and that's what we did for PTCL. PTCL has passed stage one, it's passed stage two. We are actively enrolling today in the post stage two expansion phase, and we've met with the FDA, so as I mentioned, you know, patients with PTCL have a very poor prognosis. If you have EBV, PTCL is even worse, and if you speak to opinion leaders today, you'll hear a lot of dissatisfaction, even with their first-line treatment, which is CHOP. 70% of patients are relapsed or refractory to first-line treatment, and once you get to second line, there is no standard of care for PTCL, let alone for EBV-associated PTCL. And so we think there's a real opportunity to set a new standard with Nana-val for EBV patients with PTCL in second line initially, and then ultimately help patients first line. I'm now going to share with you the data coming from stages one and two of the PTCL program, so that's twenty-one patients' worth of data. From a demographics point of view, they were predominantly White, with 80% of patients AITL, twenty percent PTCL-NOS. We had patients that had had a median of at least, you know, two prior therapies, with 50% of them having had one prior therapy and some having as many as three or more prior therapies. Around 70% to 75% of the patients were advanced with stages III and IV of cancer. Nana-val was generally well-tolerated. If you look at the treatment-related emergent adverse events, they were typically fatigue, nausea, decreased appetite, diarrhea, and decreased platelet count, but for the most part, manageable if not reversible. There was one case of grade five pancytopenia and sepsis. This patient had had at least three prior lines of treatment and had had HSCT, and as happens with patients who are very sick, in this case, this patient had advanced disease and bone marrow that was impacted. This is the only case of grade five adverse event out of 150 or more that we've treated so far in our lymphoma program. When it comes to efficacy, you'll see here a couple of different analyses. Firstly, we've looked at the total 21 patients. From an intent-to-treat perspective, we saw a 33% ORR, 41% efficacy-evaluable ORR. From a CRR perspective, we saw a 19% and 24% CRR for efficacy-evaluable, and the clinical benefit rate, which includes stable disease patients that have been stable for at least 16 weeks, was 48% and 59%. Now, if you look at those patients that were treated second-line, so having just failed first-line treatment, we saw a 60% ORR, 67% efficacy-evaluable rate ORR, and then for CRR, we saw a 30% to 33% rate, and then the clinical benefit rate of 80% to 89%. So clearly, there's an advantage to treating patients with this very aggressive cancer as quickly as you can, and these data are very consistent with our prior phase Ib/II study data. When you look at the swimmer plot, you can see that the responses were prompt at around eight weeks when you see the first scans, the green dots being CRs, the yellow dots PRs, the blue dots SDs, and they were durable, with median duration of response not yet reached, and seven patients still ongoing at the time of cutoff of this data, and when you look at the 10 patients that were second line, you can see again that the median duration has not yet been reached, with five patients still ongoing at the time of data cutoff, and two of these patients transitioned to hematopoietic stem cell therapy. The one at the top, for example, was thought by the investigator to be a complete response, but later on, seemed to have missed complete response by one millimeter, and was moved on to HSCT, and now has been in response for over 16 months. So just to underline the point that I made at the beginning, this is a very, very aggressive cancer. Patients, you know, drop out very rapidly, and what we've seen from this study is if you treat second line, you're really gonna give these patients the very best chance to respond. And that's very much the goal now we have in mind as we move forward, is how to really give these patients the best option to respond and for as long as possible by treating second line. From a path forward, I think we have a very clear path now. We had a meeting with the FDA, where we could discuss the data and the path forward, and really, two key messages came out from those discussions. One, if we want to apply for an accelerated approval, we really need a compelling overall response rate. Secondly, we would need a randomized control study in addition to the ongoing open label, single-arm study that is well advanced. If you couple that with the data that we've seen from NAVAL-1, where we saw in second line a 60% to 70% ORR in the second line patients, we think this kind of develops this into a very clear path forward. So what we're gonna do with NAVAL-1 is undertake, in this stage two expansion, an interim analysis when we get to 40 second-line patients enrolled, supported by the overall analysis of patients enrolled at that time. And also initiate a randomized control study of 120 patients in second line, that will be... Our goal is to make sure it is well underway by the time this comes to review. So this sets out for potential NDA submission in 2026 and provides the first opportunity for access to Nana-val to patients with EBV cancer. And just to situate the data that I've shared with you, what you can see in this slide is the Nana-val data that I've just presented, juxtaposed against three other treatments that have had accelerated approval in the past, for PTCL. Remember, the data that you're seeing for those other three assets are not EBV positive specific. They're to treat both EBV positive and negative patients, and as we know, EBV negative patients tend to do better. I'm just gonna say a couple of words about DLBCL. I showed this curve at the beginning, but if you have EBV DLBCL, you generally do a lot worse than those that are EBV negative. This is due to the fact that EBV conveys, for these DLBCL patients, distinct biological features and mutational landscape. The World Health Organization classifies EBV DLBCL as a distinct subtype. What EBV does is it inhibits apoptosis and downregulates the innate immune system, so these patients generally do a lot worse. And if you look at our prior study, the 201 study, in the nine efficacy-evaluable patients, we had a 67% overall response rate and a 33% complete response rate. And if you look at the swimmer plot, at the time of cutoff last year, the median duration of response had not yet been reached. And two patients at that time were converted onto single-patient INDs, and they both have been on treatment for around five years now. So what does that mean in terms of milestones moving forward? I n Q4 of this year, what we're looking to do is to present additional data from the stage two expansion cohort of PTCL, including both second line and further line patients' efficacy and safety data. In H1 of 2025, we wanna also share additional data coming out of that PTCL stage two expansion cohort on the way to what we hope will be then the interim analysis in 2026, setting up for a potential NDA filing in 2026. We're also planning to meet with the FDA in the H1 of next year to align with them on the design of the randomized control study and initiate enrollment into that study in the H2. Finally, for DLBCL, we're looking to share data from stage one of the NAVAL-1 study in the H1 of next year. Now, given our resources, we've taken the decision for the solid tumor program to pause that program once we've determined the recommended phase 2 dose. Put all our eggs in the lymphoma basket, and then, you know, pursue that solid tumor program again, either when we have financing or partnership in place. In addition, we did a reduction in force of 23%, which we announced in August, so perhaps a few words about the solid tumor program. We're very excited about this program. We are in the end stage of the dose-ranging work. We previously presented five dose levels worth of data and showed that we were getting partial responses. We then decided to up the dose further by implementing a split daily dosing strategy, so augmenting the dose further by going from four days a week of nanatinostat to seven days a week, and we've now completed enrollment of dose levels six and seven, and we're on track for a recommended phase 2 dose in Q4 of this year. So as I say, we're very excited about this program, and we're open to, you know, getting that back up and running once we have either financing or partnership in place. So to summarize, we have, with Nana-val, a late-stage asset. We have a clear path forward to potential regulatory NDA filing in 2026. It's an area of very significant unmet need. We've shown how quickly PTCL patients progress. We have a well-tolerated all-oral combination with a novel mechanism of action that not only applies in our lead indication, PTCL, but has the potential to apply across a range of different lymphoma and solid tumor types, making this potentially a very significant commercial opportunity. And as you can see, you know, 2% of cancers worldwide, 2% of patients with cancer worldwide are affected, and so our hope and goal is this can make a real difference to patients across the world in the coming years. Thank you very much. I wanna thank Mr. Rothera for the presentation, and I think we have time for a question or two. No? Okay. Thank you again, Mr. Rothera. Thank you.
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