Nektar Therapeutics Q2 2024 Earnings Call Transcript

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Provided by Quartr
August 8, 2024

Key Takeaways

  • Respegg (NKTR-214) is a first-in-class IL-2-based Treg agonist showing promising Phase 1b efficacy in moderate to severe atopic dermatitis and is being tested in two Phase 2b trials (400 atopic dermatitis patients and 84 alopecia areata patients) with top-line induction data expected mid-2025.
  • The Phase 2b atopic dermatitis study protocol was amended to extend maintenance dosing to 36 weeks (52 weeks total treatment) plus a one-year off-treatment follow-up to strengthen long-term safety and durability data for registration.
  • NKTR-165, an AI-designed TNFR2 agonist antibody, demonstrates selective monomeric activity on Tregs (with minimal binding to other immune cells) and is advancing through IND-enabling studies toward a mid-2025 first-in-human trial.
  • NKTR-255, the IL-15 oncology program, has shown consistent CAR T cell re-expansion and enhanced antitumor efficacy in three independent studies—including Stanford’s report of 67% 12-month relapse-free survival versus 38% in controls—and is positioned for Phase 3 dose selection and further cell therapy and checkpoint inhibitor combinations.
  • Nektar ended Q2 with $290.6 million in cash (no debt) and maintains a cash runway into Q3 2026 to fund multiple key value drivers, including Phase 2b Respegg readouts and the NKTR-165 and NKTR-255 programs.
AI Generated. May Contain Errors.
Earnings Conference Call
Nektar Therapeutics Q2 2024
00:00 / 00:00

Transcript Sections

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Operator

Good day, and thank you for standing by. Welcome to the Nektar Therapeutics Second Quarter 2024 Financial Results Conference Call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question-and-answer session. To ask a question during the session, you will need to press star one one on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star one one again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today, Vivian Wu. Please go ahead.

Vivian Wu
Vivian Wu
Head of Investor Relations at Nektar Therapeutics

Thank you, Crystal, and good afternoon, everyone. Thank you for joining us today. With us on the call are Howard Robin, our President and Chief Executive Officer, Dr. Jonathan Zalevsky, our Chief Research and Development Officer, Dr. Mary Tagliaferri, our Chief Medical Officer, and Sandra Gardiner, our Chief Financial Officer. On today's call, we expect to make forward-looking statements regarding our business, including statements regarding the therapeutic potential of and future development plans for drug candidates and research programs, the timing of the initiation of clinical studies, and the availability of clinical data for drug candidates, the timing and plans for future clinical data presentations, the formation, future development plans, or success of our collaboration agreements, financial guidance, and certain other statements regarding the future of our business.

Vivian Wu
Vivian Wu
Head of Investor Relations at Nektar Therapeutics

Because forward-looking statements relate to the future, they are subject to uncertainties and risks that are difficult to predict, many of which are outside of our control. Our actual results may differ materially from these statements. Important risks and uncertainties are set forth in our Form 10-Q that was filed on May 10, 2024, which is available at sec.gov. We are to take no obligation to update any of these forward-looking statements, whether as a result of new information, future developments, or otherwise. A webcast of this call will be available on the IR page of Nektar's website at nektar.com. With that said, I would like to hand the call over to our President and CEO, Howard Robin. Howard?

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

Thank you, Vivian, and thank you all for joining us today. We've made good progress in the second quarter towards our goal of building a highly promising, best-in-class pipeline focused on immunology and inflammation. In this quarter, we continue to make significant advancements with our lead program, rezpegaldesleukin or Rezpeg. Rezpeg is designed to both dampen the inflammatory response and simultaneously restore immune balance by directly expanding functional Treg cells and engaging multiple immunoregulatory pathways in patients with autoimmune disorders. Rezpeg has generated promising data, which supports its potential to become a highly differentiated novel treatment for immune disorders. These data include the phase I-B efficacy data in atopic dermatitis, which is the most common chronic inflammatory skin disease and is marked by dysregulation of the immune system and specifically excessive activation of autoreactive and inflammatory T cells.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

Rezpeg is designed to address this root dysfunction, dysregulation, by proliferating regulatory T cells, which can act on multiple inflammatory pathways at once. Rezpeg is a first-in-class agent and the most clinically advanced program of its kind, targeting atopic dermatitis, which has traditionally focused on signal pathway antagonists. I'll let JZ talk more about this in a moment, but I'm proud to announce that we have an upcoming paper accepted in Nature Communications and a presentation at the EADV conference in September, which illustrate Rezpeg's mechanism. These publications will feature extensive biomarker analyses from our phase I-B studies in immune-driven skin-related disorders of atopic dermatitis and psoriasis. Rezpeg is advancing nicely in the two phase II-B studies that Nektar is conducting in atopic dermatitis and alopecia areata. Enrollment for both studies remains on track.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

The atopic dermatitis study is enrolling 400 patients throughout approximately 110 clinical investigator sites in the U.S., Canada, Europe, and Australia. Patients who are enrolling in this study are diagnosed with moderate to severe atopic dermatitis and are also biologic naive and have failed topical treatment options. Importantly, this is the identical patient population studied in the phase I-B study of rezpeg. JZ will talk more about this study design later in the call, and as I just stated, enrollment is on track for top-line data readout from the study's 16-week induction treatment stage in the first half of 2025. Data from the maintenance stage, which looks at maintenance dosing every 4 weeks and every 12 weeks, will be available towards the end of 2025 and early 2026.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

There's a high unmet need for distinctive new mechanisms to treat atopic dermatitis. With the extent and breadth of studies being conducted right now and the competition for patient recruitment, I am proud that we're achieving our enrollment goals. We believe that this is driven by a combination of the compelling Rezpeg phase I-B data presented at EADV 2023, and of course, the hard work of our clinical team. In the U.S., there are approximately 30 million people living with atopic dermatitis, and half of these patients are diagnosed with moderate to severe disease. It's estimated that under 10% of patients who could receive biologics today are actually receiving treatment. We believe that new mechanisms are the key to growing this market and that there's a high unmet medical need for novel treatment options.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

So we are excited that Rezpeg is poised to emerge as a highly differentiated potential treatment for these patients. Now, as you know, we have a second phase II study for Rezpeg that is enrolling 84 patients with alopecia areata. Enrollment for this study opened in March, and the enrollment also remains on track for this study. We're looking forward to top-line data from this trial in the middle of 2025, which is estimated to be a few months following the top-line readout from the phase II study in atopic dermatitis. We believe there's a significant potential for Rezpeg to help people with this devastating disease. Nearly 7 million people in the U.S. alone have or will develop alopecia areata.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

This disorder significantly affects the quality of life for patients, and the currently available JAK inhibitor therapies are not durable, have high relapse rates, and carry significant safety risks. Therefore, there's an urgent unmet medical need for these new therapies. On the preclinical side, we continue to advance NKTR-0165, our novel TNFR2 agonist antibody program. In June, we reported the first preclinical data on this program at EULAR. These data show that NKTR-0165 is a unique antibody with monomeric activity that selectively binds to TNFR2 on Tregs to enhance their immunoregulatory function. Given the importance of TNFR receptor two in certain autoimmune diseases, NKTR-0165 could potentially become a first-in-class treatment for autoimmune diseases such as multiple sclerosis, ulcerative colitis, lupus, and vitiligo. We're currently conducting IND-enabling studies with the goal of preparing for an IND submission in the middle of 2025.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

Next, I'd like to give you an update on NKTR-255, our IL-15 program in oncology. As you know, NKTR-255 is completing a study in large B-cell lymphoma, or LBCL, and Mary will be discussing this later in the call. In addition to the clinical study we're completing in LBCL, there are clinical studies ongoing for NKTR-255 being funded by our collaborators, Merck KGaA in bladder cancer and AbelZeta in non-small cell lung cancer. We also have an IST study ongoing at the Fred Hutchinson Cancer Center, and an IST that recently concluded at Stanford. Stanford University recently published data from their IST in the peer-reviewed Journal of the American Society of Hematology, Blood. The online manuscript has been posted and will be in print shortly.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

Stanford reported data that showed a doubling of recurrence-free survival at 12 months when NKTR-255 was combined with their investigational CD19/22 CAR T therapy, compared to historical controls with their investigational therapy alone. In addition to these studies, Mary will discuss more on the other studies for NKTR-255 and the strength of the data to support combination with cell therapies. As the data emerge this year, we believe that NKTR-255 can become an important component of cell therapy in cancer, and we continue to evaluate strategic partnership opportunities for this program. Before I hand the call over to JZ, I just want to say that Nektar remains in a strong financial position with a cash runway that extends into the third quarter of 2026, giving us more than a year's cash at the time of Respeg's top-line data readouts.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

With that, I'd like to hand the call over to JZ for an R&D discussion. JZ?

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

Thank you, Howard. I'd like to begin with Rezpeg. This program is the most advanced IL-2 Treg mechanism in the field. We believe there are major opportunities in both atopic dermatitis and alopecia areata that Rezpeg could potentially address. Our phase I-B Rezpeg data in atopic dermatitis demonstrated dose-dependent efficacy and encouraging durability observed long after patients completed the 12-week induction period. In fact, for both patient-reported outcome and physician-assessed endpoints, we observed the same trends: rapid onset of effect, dose dependence, and long durability of control. The rapid onset of action and the type of extended disease control after the end of dosing rivals or outperformed that of dupilumab or JAK inhibitors. These promising data have us and KOLs very enthusiastic about the potential for long-lasting responses and infrequent maintenance dosing with Rezpeg in atopic dermatitis.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

Our phase II-B study in atopic dermatitis is enrolling roughly 400 patients with three different regimens of Rezpeg versus placebo, evaluated over a 16-week induction period. After the induction period, patients that meet a threshold to advance from induction to maintenance will be re-randomized into one of two maintenance regimens at their original dose level to receive that dose level on either a once-a-month or once every 3-month regimen. To best position our program for registration, we've recently amended the protocol to extend the time on treatment during the maintenance portion of this study. The maintenance portion of the phase II-B study was originally designed as a 26-week treatment period, but we have now extended that to 36 weeks, which will in total provide 52 weeks of treatment duration for patients in the study.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

This will strengthen the robustness of our data set with long-term exposure in this disease setting and increase the number of patients in our safety analysis to support registrational trial work following this phase II study. We also extended the off-treatment follow-up to be a 1-year period that begins upon the conclusion of the 52-week treatment period, in order to allow us to evaluate the potential remittive effect of Rezpeg in patients after 1 year of treatment. As Howard stated, we still anticipate top-line data from the 16-week induction period of this phase II-B study in the first half of 2025, and data from the 36-week maintenance period of the study will be available towards the end of 2025 or early 2026. Now, turning to alopecia areata, which is a dermal disease localized to hair follicles.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

In this disease, the patient's immune system attacks the hair follicle, disrupting its normal ability to keep and grow hair, leading to hair loss. We believe there is strong rationale for Rezpeg in this indication, based on the role of Tregs on the underlying pathology of this disease. Normal hair follicles exist in a state of immune privilege. So in other words, there are essentially no immune cells, no MHC expression, and minimal immune system components inside the hair follicle. We know this exclusion of the immune system is needed to maintain healthy, long-lived, and continuously functioning stem cells to grow hair during our lifespans. In people with alopecia areata, there is a breakdown of the immune privilege in the hair follicle, infiltration of the immune system, inflammation, and all this leads to hair loss and eventually complete baldness.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

Biologically speaking, Rezpeg, through its central pathway of Treg rescue, is uniquely poised to address the diversity of immunopathology, providing broad potential for targeting and treating alopecia areata, as well as other dermal diseases. In published preclinical studies, both in vitro and in mice implanted with human alopecia skin samples, the studies have shown that Tregs are essential for restoring and maintaining immune privilege, and therefore, a novel therapeutic strategy for the treatment of this disease. Consequently, we believe the Treg mechanism of Rezpeg can restore immune privilege and could provide durable disease control. There is a high unmet need in this patient population for tolerable treatment options with durable responses that currently available treatments like JAK inhibitors cannot provide. We believe there is an opportunity for Rezpeg to become a novel and potentially game-changing biologic therapy in alopecia areata.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

The phase II-B study is well underway and plans to recruit 84 patients with severe to very severe disease that will be randomized to Rezpeg or placebo. Patients will be treated for a period of 36 weeks and observed up to 60 weeks in total. Our primary endpoint for this study is mean % improvement in SALT, or the Severity of Alopecia Tool, at week 36. We will also be looking at a number of other secondary endpoints, including the proportion of patients that were observed to have varying degrees of improvement in SALT score. We are well underway with enrolling patients into this study, and we expect top-line data near the middle of 2025, a few months following the top-line data readout from our atopic dermatitis study. Now, turning to NKTR-0165, our TNFR2 agonist antibody.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

TNFR2 is highly expressed on Tregs, myeloid suppressor cells, regulatory B cells, neuronal cells, and others. In Tregs, TNFR2 agonism has been shown to potentiate the effector function, suppressive functions, and maintenance of Treg lineage stability, especially in non-lymphoid tissue compartments. Genetic studies show that if TNFR2 is absent, the phenotypic effect is autoimmunity, as well as other conditions that resemble FoxP3 loss of function. In contrast, its presence and activation of its signaling has been associated with immunoregulatory function and tissue protection effects. The TNFR2 agonist program is built upon many years of Treg experience that we've gained from studying Rezpeg. Rezpeg is an IL-2 receptor pathway agonist, drives JAK-STAT signaling in Tregs, which is critical to drive Treg proliferation and function in primary and secondary lymphoid organs.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

TNFR2 is the most abundant TNF superfamily member expressed on Tregs and the key activator of NF-kappa B, which also controls the FOXP3 protein expression and is critical to maintain Treg function, especially in non-lymphoid organs. Thus, with the Rezpeg and TNFR2 agonist programs, Nektar's pipeline provides target rationale for both lymphoid and non-lymphoid Tregs, and this is why we are so excited about NKTR-0165. As Howard mentioned, we presented the first preclinical data for this program at EULAR in June of this year. In the presentation, we demonstrated several novel and innovative properties of the antibodies that we discovered and are developing. Firstly, the TNFR2 agonists we discovered came from AI-based de novo design, and consequently, they provide novel TNFR2 binding and cell signaling properties.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

One example of that novelty is a demonstration that these antibodies are able to signal through the TNFR2 multimeric receptor as single-arm, monovalent antibodies. This is a very novel effect for a TNFR2 agonistic antibody. We grafted these into a regular bivalent antibody format, in NKTR-0165, and demonstrated the very high specificity of this antibody for binding and signaling through TNFR2 on Tregs, with little to no binding and signaling in conventional T cells and NK cells or monocytes. NKTR-0165 also drove Treg proliferation, upregulation of FoxP3, and other activation markers in primary human Tregs. Importantly, NKTR-0165 drove these effects as a single agent, without need for CD3 ligation, co-stimulation, cytokine, or mitogen support.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

We also studied NKTR-0165 in a human TNFR2 knock-in mouse and used that model to confirm the Treg selective PK/PD profile of the antibody, and also demonstrated single-agent efficacy in a mouse model of KLH DTH, established in the same TNFR2 knock-in mouse strain. We are very excited with the unique and differentiated profile of the antibodies that were discovered, and we are rapidly advancing NKTR-0165 into the clinic. We expect to initiate first-in-human studies in the middle of 2025. Examples of indications that could be addressed include multiple sclerosis, mucosal immunology conditions, such as ulcerative colitis and GI or other oral mucosal diseases, lupus, and even dermal autoimmune diseases like vitiligo.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

We note the growing interest for a novel and selective TNFR2 agonist like NKTR-0165, and as we move forward with our IND-enabling studies, we will continue to be open to the opportunity of working with companies that have interest in these areas to strategize on the best path forward. With that, I'll hand the call over to Mary to discuss NKTR-255. Mary?

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

Thank you, JZ. And finally, turning to our IL-15-based oncology program, NKTR-255. We believe the IL-15-based mechanism of action has promising potential in combination, particularly with cell therapies. While autologous CAR T-cell therapy transformed the management of patients with large B-cell lymphoma after the first cellular therapies were approved, clinical responses were not durable, and roughly 60% of patients receiving CAR T-cell therapy for large B-cell lymphoma eventually progressed. In 2017, the NCI and Kite, and months later, the Fred Hutch group, published data showing that high serum IL-15 levels were associated with a higher Cmax and AUC of CAR T cells, both factors correlated with responses in lymphoma. Thus, our initial development strategy aimed to improve the long-term efficacy of CAR T-cell products with the administration of exogenous IL-15, given the wealth of data about this cytokine's importance. Dr.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

Cameron Turtle from Fred Hutch completed preclinical experiments showing that NKTR-255 enhanced the in vivo persistence and antitumor efficacy of CD19-directed CAR T cells in a dose-dependent manner. As predicted, mice treated with the CAR T cell NKTR-255 combination maintained significantly higher CAR T cell peak levels and continued tumor suppression, translating into durable efficacy. Following Dr. Turtle's published results in Blood Advances, we all shared a strong conviction that NKTR-255 could lead to re-expansion of CAR T cells when dosed in patients to enhance efficacy. Fred Hutch began an IST to evaluate NKTR-255 as an adjuvant treatment to CAR T cells to improve the complete response rate in patients with large B-cell lymphoma. Doctors Crystal Mackall and Lori Muffly also evaluated NKTR-255 to enhance the efficacy of Stanford's proprietary CD19/22 CAR T cell for B-cell acute lymphoblastic leukemia. Stanford's data was published in Blood last month.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

Compared to Stanford's control group, previously treated with the CAR T cell therapy, NKTR-255, when added to the CD19/22 CAR T cell therapy, increased the 12-month relapse-free survival from 38% to 67%. The median RFS for the CAR T cell-only cohort was 3.9 months, and for the cohort treated with NKTR-255 and the proprietary CAR T cell therapy, it has not been reached with over 14.4 months of follow-up. So why does NKTR-255 work? We've now confirmed in patients the re-expansion of CAR T cells following NKTR-255 that we saw pre-clinically. In the Stanford study, we observed re-expansion of the CAR T cells in the CNS following NKTR-255 administration.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

At Fred Hutch, where they're combining NKTR-255 with Breyanzi in patients with large B-cell lymphoma, we have confirmed re-expansion of the CAR T cells after NKTR-255 as well, leading to a second peak and increase in AUC. An additional observation from Stanford suggests that NKTR-255 also influences lymphocyte trafficking to diseased tissues. As you know, we've been running our own trial, where we've enrolled 15 patients with large B-cell lymphoma. In this study, NKTR-255 is administered after autologous CD19 CAR T-cell therapy. We are concluding treatment of the patients randomized in our study, and we have now observed in a third trial the same re-expansion phenomenon of CAR T cells following NKTR-255 treatment in these patients, and we look forward to presenting the full data set from this study at a future medical meeting. This compounding effect has the potential to extend beyond CAR T cell therapies.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

We continue to collaborate with AbelZeta, a leading cell therapy company, to evaluate NKTR-255 in combination with their tumor-infiltrating lymphocytes, or TILs, in an ongoing phase I clinical trial in patients with advanced non-small cell lung cancer who do not respond to anti-PD-1 therapy. Lastly, we are continuing to work with Merck KGaA, who is conducting the phase II Javelin Bladder MEDLEY study, which is evaluating NKTR-255 in combination with Bavencio. Merck is projecting the first potential PFS analysis from this study around the end of this year. As a reminder, there are three separate combinations being evaluated in this study, each being compared separately to the Bavencio monotherapy arm. With that, I will turn the call over to Sandra for a review of our financial guidance. Sandra?

Sandra Gardiner
Sandra Gardiner
CFO at Nektar Therapeutics

Thank you, Mary, and good afternoon, everyone. We ended the second quarter with $290.6 million in cash and investments, with no debt on our balance sheet. Our financial position remains strong, and we still plan to end 2024 with $200 million-$225 million in cash and investments. Our cash runway extends into the third quarter of 2026, which will take us through several key data milestones, including top-line data for both our phase II-B rezpeg studies. I'll now briefly review our quarterly financials and reiterate our financial guidance for 2024. Our revenue was $23.5 million for the second quarter of 2024.

Sandra Gardiner
Sandra Gardiner
CFO at Nektar Therapeutics

We still expect our revenue for the full year to be between $75 million and $85 million, which includes $55 million-$65 million in non-cash royalties and $20 million-$25 million in product sales. For the second half of the year, we expect the remaining revenue to be weighted more heavily towards the fourth quarter. R&D expense for the second quarter of 2024 was $29.7 million, and we still anticipate full year R&D expense to range between $120 million and $130 million. G&A expense for the second quarter of 2024 was $20.5 million. We continue to expect G&A expense for the full year to be between $70 million and $75 million. Lastly, our 2024 non-cash interest expense remains unchanged and is expected to be between $20 million and $25 million.

Sandra Gardiner
Sandra Gardiner
CFO at Nektar Therapeutics

In Q2, we recorded $13.3 million in non-cash impairment charges for our real estate obligations due to the continuous decline of the San Francisco life sciences and office real estate markets. Our net loss for the second quarter of 2024 was $52.4 million, or $0.25 basic and diluted loss per share. Excluding the $13.3 million in non-cash impairment charges, net loss on a non-GAAP basis was $39.1 million, or $0.19 basic and diluted loss per share. As I mentioned earlier, we still plan to end 2024 with $200 million-$225 million in cash and a runway that extends into the third quarter of 2026. With that, I'll now open the call for questions. Crystal?

Operator

Thank you. As a reminder, to ask a question, please press star one one on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. In the interest of time, we do ask that you please limit yourselves to one question at this time. Please stand by while we compile the Q&A roster. And our first question will come from Jay Olsen from Oppenheimer. Your line is open.

Jay Olson
Jay Olson
Biotechnology Equity Research Analyst at Oppenheimer

Oh, hey, congrats on all the progress, and thank you for taking our question. That NKTR-255 data in collaboration with Stanford looks great. Can you talk about the next steps and if there's potential synergy for NKTR-255 with CAR T for autoimmune diseases? Thank you.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

JZ, do you want to take that call, that question?

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

Sure, yeah. So, thanks, Jay, for the question. So I'll start off and maybe, Mary, you can add also a little bit of color onto that. But I think that study with Stanford was a very important study, Jay, for us, because it was the first time that treatment was evaluated very close to the time of administration of the CAR. Like, there was just a short offset of a couple of weeks after the CAR was delivered, before NKTR-255 was treated. And we observed some very exciting findings that were published by the Stanford group. Those included changes in the cellularity, changes in the migration, including into one patient that had a CNS disease, with a really large amount of CAR moving into the CNS, really impacting positively that patient.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

Then, of course, the duration of effect, as Mary described, in terms of the real extent of efficacy that was observed relative to what's known historically for that CAR, where durability of the effect wanes. Mary, maybe if you could talk medically about adding some more of the context and how it fits together with the other studies that are ongoing.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

... Yeah. Hi, Jay, this is Mary. You know, what we were really excited about is in three different studies now, we wanted to look at the safety, the feasibility, and the efficacy, so we could hone in on the recommended phase III dose. And across all three studies, we have not seen a dose-limiting toxicity. We see a consistent safety profile that's highly favorable to patients, and as you can imagine, that's remarkable when you're combining a drug with CAR T-cell treatments. It's also feasible to not only dose this drug in the adjuvant setting right after patients receive CAR T-cells, but they continue to receive NKTR-255 every three weeks, which is also highly favorable to patients.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

And when we think about next steps and where we can go, I believe with the combination and aggregate of the data from the 3 trials, we have identified our recommended phase III dose. The other thing, you know, that, the other place where we're developing the drug, as I mentioned, is in combination with TIL therapy. And as you know, right now, Iovance combines their TIL therapy with high-dose IL-2, and that's really, you know, fraught with error because there are... It's very difficult to tolerate high-dose IL-2. Patients have to be in the inpatient setting to receive high-dose IL-2. And currently, in the area of non-small cell lung cancer, patients who actually received TILs and high-dose IL-2 in a very small study of roughly patients, you know, there were 2 deaths in that trial conducted by Dr.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

Scott Antonia and published in Nature. And so I think that the opportunities here are very broad, in the area of cellular therapy, both with autologous and allogeneic and CAR T-cells as well as TILs. And then again, you know, we're awaiting the data in combination with the checkpoint inhibitor, and, you know, if the data prove to be compelling and strong, there's, you know, an additional indication for combining with checkpoint inhibitors.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

I would add to that that of course we've shifted over to, you know, immune disease and inflammation, but clearly we have data with IL-15 that demonstrates how its potential, how there's a great potential for it to be used in combination with cell therapies. And I think that's gonna—that may very well play an important role on the future of cell therapy. So we're talking to a number of companies, and I do think we can find an important collaboration there.

Jay Olson
Jay Olson
Biotechnology Equity Research Analyst at Oppenheimer

Super helpful. Thank you so much.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

Jay, this is JZ. Your other question about autoimmune disease, it's a really good question. It's a kind of a theoretical question at this time, but based on what we saw in the data and were published at Stanford, as Mary described, which from a totality of both safety as well as pharmacodynamic effects, would make it feasible to also add this in the setting of autoimmune disease, CAR cell therapy use. You know, we're focused on oncology now, but theoretically, first principles, it should be possible.

Jay Olson
Jay Olson
Biotechnology Equity Research Analyst at Oppenheimer

Okay, great. Really impressive data. Thank you again.

Operator

Thank you. Our next question will come from Chris Shibutani from Goldman Sachs. Your line is open.

Analyst at Goldman Sachs

Hi, this is Kevin on for Chris. Thanks for taking our question and congrats on the progress. Just wanted to focus on alopecia there. So, just for housekeeping, I know that you know, enrollment is on track and there's the primary completion is the same on clinicaltrials.gov, but just wondering about the timeline to mid-2025 versus first half. And then also, you know, understanding the value proposition there versus JAK inhibitors, which are approved, it makes sense with the safety profile. How are you talking about efficacy? Are you going to want or need to match the efficacy of JAK inhibitors in alopecia? Thanks.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

Why don't I let Mary answer your question on that?

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

Yep. Thank you, Howard and Kevin. Yes, you know, we started the alopecia areata study in March, and you know, we are on track, and we do—we will have top-line data based on our enrollment today in mid-2025. And I think, you know, you ask a great question, is you know, which is what does success looks like in alopecia areata and what's the bar for us? And you know, as you know, JAK inhibitors are efficacious for alopecia areata. And you know, the clinical trials that were conducted had a SALT endpoint at 36 weeks of treatment. And before I go into the efficacy data, you know, there are two main issues that the dermatologists share with us.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

One is, you know, there's absolutely no durability of effect with a JAK inhibitor, and patients immediately start to lose their hair when they stop taking the JAK inhibitor, and that hair loss is very rapid. The second, of course, is that 80% of patients who have alopecia areata are younger than age 40, and nobody really knows what kind of risks, you know, a JAK inhibitor would pose. Obviously, you know, the black box warnings are for, you know, serious heart-related events like heart attacks and stroke and blood clots and thrombosis and cancer and serious infections. So there is just a general, you know, worry about exposing a patient to a JAK inhibitor for their entire life. So those are the problem statements.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

In terms of efficacy, we believe similar efficacy to, say, baricitinib would establish a differentiated compound because, one, we don't have an association, you know, certainly with our 600 patients we've treated to date, with these serious side effects. And number two, we believe based on the phase I-B in atopic dermatitis, that there's a potential for remittive effect or a maintenance regimen that, you know, wouldn't be daily, like you see with a JAK inhibitor, but rather we could potentially dose patients after a 36-week induction period with a frequency that's longer than every 2 weeks in the maintenance phase.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

You know, we've spoken a lot to doctors about even, you know, an induction time period, and, you know, their belief is, you know, it doesn't even matter if it takes these patients a year to grow their hair back. If you actually have a, a biologic that they, you know, that would provide a remittive benefit and not be associated with so many side effects, that would be critically important. And then specifically for the phase III trials with baricitinib, you know, the, the SALT change at 36 weeks was less than 10% for placebo, which makes it nice. You can run smaller trial size studies because the placebo effect is low, is approximately 30% for the low dose of baricitinib, the 2 milligram per day dose, and about 49%, um, SALT reduction for the high dose of 4 milligrams.

Analyst at Goldman Sachs

Great. Thank you.

Operator

Thank you. Our next question will come from Roger Song from Jefferies. Your line is open.

Analyst at Jefferies

Hi, this is Kombi on for Roger. Can you provide us an update on your litigation with Lilly?

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

Yeah, sure. Look, we're still having discussions with Lilly, as you know, and as you can see from the excellent phase data. Clearly a mathematical mistake was made, and the data is somewhat compelling after we corrected for that math error that we discovered. We're still having discussions with Lilly. We had a mediation. The court has ordered us to continue mediation, and we expect to do that in the near future. So obviously, I can't spend a lot of time. I can't discuss in detail an ongoing litigation, but I can say that we firmly believe that we've been harmed by their behavior, and consequently, we will continue mediation with them.

Operator

Thank you. Our next question will come from Andy Hsieh, from William Blair. Your line is now open.

Andy Hsieh
Andy Hsieh
Biotechnology Equity Research Analyst at William Blair

Hi, thanks for taking our question. So the Blood paper is pretty intriguing. I'm curious about your interpretation of the historical controls, just, you know, given the non-randomized nature of the study. There's some, you know, kind of push and pulls regarding baseline patient characteristics. It seems like, you know, the historical control might be a little bit more heavily pretreated, the dosing is a little bit lower. So I'm just curious, just kind of looking at the baseline characteristic, how would you characterize the similarities and differences? How alike are those two populations? Thank you.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

Mary, could you... It's a good question, Mary. Could you give some insight into the Stanford historical controls?

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

Yes. So really importantly, Andy, so first of all, I just want to talk a little bit about the person who conducted this trial. You know, Crystal Mackall is the founding director of the Stanford Center for Cancer Cell Therapy, and she's really, you know, one of the godmothers of, you know, cell therapy. And if you look at, Crystal's Nature paper, she actually had dosed 17 patients, you know, not 8, that are used as the control patients in for this study. So she actually selected patients that had comparable baseline characteristic traits to be matched with the patients of this second study. So you can imagine, you know, with her academic background and her vast experience with treating ALL patients, she was very, very mindful of these baseline characteristic traits as well as burden of disease.

Mary Tagliaferri
Mary Tagliaferri
CMO at Nektar Therapeutics

So she very carefully actually selected the control group, which is a subset of the total number of patients she originally reported upon in Nature.

Andy Hsieh
Andy Hsieh
Biotechnology Equity Research Analyst at William Blair

That's helpful. Thank you.

Operator

Thank you. As a reminder, to ask a question, please press star one, one. Again, to ask a question, that's star one, one. One moment for our next question, please. Our next question will come from Arthur He from H.C. Wainwright. Your line is open.

Arthur He
Arthur He
Equity Research VP at H.C. Wainwright

Hey, good afternoon, Howard team. I just had a quick question on the 165. Obviously, it's very interesting preclinical data. But maybe, JZ, could you give us more color on the one six five, the binding to the Tregs receptor, but not the other ones on the CD4 T cell or monocyte? Because we know the TNFR2 also expressed on those two cells. Just curious about the mechanism there. Thanks.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

Mm-hmm. Sure. Thanks, Arthur. Thanks for the question. Yeah, so, so one of the things that we found is that our antibody definitely has some form of conformational selectivity in terms of the epitope that it recognizes. And in that EULAR poster, there was a panel that showed binding to two different forms of TNFR2. So you know that TNFR2, primarily, it's a transmembrane receptor, like as, you know, TNF receptor, but it can also be shed by ectodomain shedding through normal metalloproteases. ADAM17 cleaves TNFR2, and then that liberates a shed form that can circulate in the blood. And so we tested the binding of our antibody to the surface receptor and to the shed form, and the antibody bound the surface receptor much, much higher affinity, much more greatly, and it barely interacted with the shed form.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

So it indicates to us that there's a conformational, you know, specificity or conformational component to the binding. And to assess that, we're actually doing a lot of biophysical studies right now. First of all, we're mapping the epitope and the paratope of the antibody, so those experiments are ongoing. And we're also doing structural modeling using, you know, some of the structural approaches that you could do computationally to assess the epitope. And then we aim to put all that together. We might even possibly go as far as solving the crystal structure of the antibody. But our hypothesis, you know, right now is that it's very conformational, and that's why we see cellular selectivity, because while you're right, the receptors express on multiple cell types, its function is not the same on multiple cell types.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

Also, the TRAF components that signal intracellularly are also not the same across those cell types, and we think that's the reason. But yeah, we're very excited 'cause that's. It's not like a typical finding, as you can imagine, for an antibody, which is why we think this is such an innovative molecule.

Arthur He
Arthur He
Equity Research VP at H.C. Wainwright

Oh, great. Thanks.

Jonathan Zalevsky
Jonathan Zalevsky
Chief Research and Development Officer at Nektar Therapeutics

Sure.

Operator

Thank you. I am showing no further questions on the phone lines, and I'd like to turn the conference back over to Howard Robin for any closing remarks.

Howard Robin
Howard Robin
CEO at Nektar Therapeutics

Okay, well, thank you everyone for joining us today, and as you can see, we're making excellent progress in our strategic plan to focus Nektar's efforts on immunology and inflammation, and we're advancing multiple novel and innovative therapies in and towards the clinic. So I want to thank all of our employees for their hard work, and I want to thank our investors for their continued support. Please stay tuned. Thanks for joining us today.

Operator

Thank you. This concludes today's conference call. Thank you for your participation. You may now disconnect. Everyone, have a wonderful day.

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