展品99.2 爲創新癌症治療的未來,治癒患者並保留器官功能 2024年10月17日
法律披露本演示文稿包含前瞻性聲明,均在其整體上通過此警示聲明得到限制。 這裏包含的許多前瞻性聲明可通過使用前瞻性詞語如"可能","預期","相信","可能","期待","應該","計劃","打算","估計","將","潛在"和"正在進行"等詞語來識別,當然,並非所有的前瞻性聲明都包含這些識別詞語。 這些前瞻性聲明包括有關我們研究和開發計劃及目前和未來臨床前研究和臨床試驗的啓動、時間安排、進展、結果和成本的聲明,包括有關試驗啓動和完成的時間和相關的準備工作的時間段,試驗結果將何時可得以及我們的研究和開發計劃的聲明;有關我們期望通過bel-sar治療後患者生活質量改善以及對患者治療範式的改變的聲明;有關我們對於泌尿系統腫瘤領域中有效局部治療的高度未滿足醫療需求以保持器官功能的信念和期望的聲明;以及我們的產品候選品市場的規模和增長潛力以及我們服務於這些市場的能力的聲明。 除非另有說明,這些前瞻性聲明僅在本演示文稿的日期說法,我們沒有義務更新或修訂任何此類聲明以反映本演示文稿之後發生的事件和情況。 由於前瞻性聲明本質上會受到風險和不確定性影響,其中一部分難以預測或量化,有些超出我們的控制範圍,您不應該將這些前瞻性聲明視爲未來事件的預測。 有關這些及其他風險和不確定性以及其他重要因素的討論,其中任何因素可能導致我們的實際結果與前瞻性聲明所包含的結果有所不同,請參見我們最近一次年度報告的風險因素部分10-k和提交給美國證券交易委員會(SEC)的季度報告10-Q,以及我們隨後提交給SEC的其他文件中關於潛在風險、不確定性以及其他重要因素的討論,這些文件可在SEC的網站www.sec.gov上查看。 我們前瞻性聲明反映的事件和情況可能無法實現或發生,實際結果可能會大相徑庭,與前瞻性聲明中預測的結果可能存在實質性差異。 我們警告您不要過度依賴本演示文稿中包含的前瞻性聲明。 本演示文稿討論的產品候選品尚處於臨床前或臨床評估階段,並尚未獲得美國食品和藥物管理局(FDA)或任何其他監管機構的營銷批准。 在臨床研究報告完成前,此處展示的臨床試驗數據仍然可能會因臨床現場審計和其他審查過程的調整而發生變化。 對於這些產品候選品用於正在研究的用途的安全性或有效性,不作出任何保證。 本演示文稿不構成出售的要約或購買的邀約,也不得在未能在任何此類國家或其他管轄區根據任何該等國家或其他管轄區的證券法規定註冊或符合資格之前,在此等國家或其他管轄區內進行這些證券的出售。 2 2
泌尿外科腫瘤學的關鍵意見領袖參加今天的看漲 Neal Shore, MD, FACS Gary Steinberg, MD, Max Kates, MD Joe Jacob, MD, MCR Carolina Urologic Johns Hopkins Syracuse University FACS 研究中心 RUSH University 3 3
Aura領導參加今天的電話會議,參會者包括Sabine Brookman-Elisabet de los Pinos、Jill Hopkins、醫學博士Joseph McQuaid、董事Clinical May醫學博士、首席醫療官Development Urologic、治療領域高級副總裁、創始人兼首席執行官、研發總裁Oncology、頭腦泌尿生殖器腫瘤醫學。4 4
預測到2050年,由於人口老齡化,癌症病例將增加77%。在早期階段,需要保留、節約器官、治療方式改進的治療期權,以改善局部治療,從而國際化延緩疾病進程。世界衛生組織。全球癌症負擔增加,在服務需求不斷增加的情況下。2024年。可在:全球癌症負擔增加,在服務需求不斷增加的情況下獲得(who.int)[2024年10月1日訪問]。555
病毒樣藥物共軛物有潛力改變早期癌症治療 獨特的腫瘤選擇性 腫瘤和突變不可知 針對表達在超過100個細胞系中的關鍵受體分子 早期惡性腫瘤轉化階段 超過15個動物腫瘤模型 雙重機制 強效 靶向細胞毒性 和免疫每個VLP約200個細胞毒分子;激活;有潛力產生持久的抗腫瘤T細胞記憶 多個動物腫瘤模型中表現出皮克摩拉級的功效 安全性良好 多個早期局部癌症臨床數據 無與治療相關的SAE和無 • 脈絡膜黑色素瘤:陽性2期數據;3期正在進行的DLT在bel-sar 2期中報告 • NMIBC:陽性早期1期數據;1期正在進行脈絡膜黑色素瘤試驗DLt, 劑量限制性毒性;MOA,作用機制;NMIBC,非肌層侵襲性膀胱癌;SAE,嚴重不良事件;VLP,病毒樣顆粒。6 6
VLPs結合到巨噬細胞、樹突細胞和中性粒細胞上, 能夠通過TLR-4結合和NFk-β產生來刺激抗原呈遞細胞 反應性氧化物擾亂細胞膜和細胞器 AU-011具有一種新穎的雙重作用 腫瘤細胞膜的破壞 和通過壞死引起的促免疫細胞死亡導致T細胞激活和免疫介導的腫瘤細胞殺死 AU-011治療旨在對局部細胞產生細胞病 Release of DAMPs引發抑制細胞,減少免疫抑制 的抗腫瘤免疫環境並有助於抗腫瘤免疫 Kines RC等人。Int J Cancer。2016;138(4):901–11。 Kines RC等人。Mol Cancer Ther。2018;17(2):565–74。 Kines RC等人。Cancer Immunol Res。 2021;9:693–706。 DAMPs,損傷相關分子模式;HSPG,肝素硫酸蛋白多糖;VDC,病毒樣藥物結合物;VLP,病毒樣顆粒。 7
膀胱癌: 高醫療需求未得到滿足的器官保留治療是最常見的治療方法之一。傳統的膀胱癌治療方法普遍存在諸多不足,導致各種短期和長期風險。患者未能完成全程BCG治療的比例爲84%。 這也對患者的生活質量造成了相當大的影響。年患病例數超過600,000例, 多次經歷經膀胱腫瘤切除術的患者越來越多。由於全球範圍內BCG疫苗短缺,患者接受的疫苗次數也相應減少。疾病的進展/轉移可能導致患者需要膀胱切除術。2022年有614,298例被診斷爲膀胱癌,較2020年增長了7%。膀胱癌MIBC死亡率排名第13,其中25%爲MIBC,75%爲NMIBC。 每年膀胱癌治療的費用超過60億美元,NMIBC治療的年度花費佔比爲70-80%。 NMIBC患者中約有70-80%在治療後出現癌症復發。
High risk of recurrence and progression with current treatments for NMIBC Low grade – low & intermediate risk High risk papillary disease High risk CIS – BCG unresponsive Progression Adjuvant therapy Adjuvant therapy Adjuvant therapy Intravesical gene therapy 42–84% (Adstiladrin®) BCG TURBT BCG TURBT of low-grade Systemic immunotherapy IR patients (Keytruda®) Intravesical Intravesical develop chemotherapy Intravesical immunotherapy chemotherapy 4,5 recurrence recurrence recurrence (Anktiva®) Cystectomy (~80,000) (~20,000) (~4,000) a Each figure represents 1000 persons. 1. Holzbeierlein JM et al. J Urol. 2024;212(1):3–10. 2. Holzbeierlein JM et al. J Urol. 2024 Apr;211(4):533-538. 3. Internal Aura epidemiology of market size; data on file. 4. Shalata AT, et al. Cancers (Basel). 2022;14(20):5019. 5. van Rhijn BWG, et al. Eur Urol. 2009;56(3):430–42. BCG, Bacillus Calmette-Guérin; CIS, carcinoma in situ; IR, intermediate risk; NMIBC, non-muscle-invasive bladder cancer; TURBT, transurethral resection of bladder tumor. 9 1–3 Prevalence a Patients (US)
Treatment goals Focal treatment with direct tumor cell killing AU-011 as a potential front-line immune Stimulate broad anti-tumor T cell response ablative therapy in NMIBC Front-line early intervention for local disease AU-011 has a dual mechanism of Decreased treatment burden with favorable action and can potentially safety profile reduce the treatment burden Reduce risk of recurrence and progression Avoid TURBT/operating room NMIBC, non–muscle-invasive bladder cancer; TURBT, transurethral resection of bladder tumor. 10
In-office procedure Local cystoscopic AU-011 administration administration of drug Laser light with standard activation and activation may be cystoscopy needle <5 minutes <10 minutes total laser time optimized for the urology clinic <15 minutes total procedure time Local administration of AU-011 is aligned with current practice Familiar procedures for urologists in urology offices Bladder injections (e.g. botox) and laser application are commonly used No general anesthesia AU-011 treatment may be feasible for patients with contraindications for general anesthesia/TURBT (e.g., comorbidities) No requirement for additional safety precautions in drug handling No viral replication or shedding TURBT, transurethral resection of bladder tumor. 11
Phase 1 trial of AU-011 in bladder cancer Review of early data from non-light activated and light-activated NMIBC cohorts
Window of opportunity study: AU-011 administered between scheduled biopsy and standard TURBT Clinical response data up to 21 days; safety data up to 56 days Treatment phase: Feasibility and efficacy Follow-up phase: Safety Day 9 ± 1 (Cohort A) Day 1 Day 2 Day 56 ± 7 Day 14+7 (Cohort B+C) Cystoscopy + biopsy Cystoscopy Final cystoscopy End of follow-up AU-011 injection Laser light Standard of care: activation TURBT Pathology specimen Pathology specimen Final efficacy evaluation Final safety evaluation TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 13
Phase 1 trial of AU-011 for bladder cancer designed to evaluate safety, feasibility, and mechanism of action Single dose window of opportunity study in NMIBC all-comers Histopathological assessment completed at time of standard of care TURBT Part 1 (n=5) Part 2 (n=~10) AU-011 alone AU-011 + focal light activation Drug only Cohort A: Cohort B: Cohort C: (No light) Drug + light Drug + light Drug + light Total 100 µg Total 100 µg Total 200 µg Total 100 µg NMIBC (N~3) NMIBC (N=5) NMIBC (N=4) NMIBC (N=3) 200 µg at tumor base 50 µg at tumor base 50 µg at tumor base 100 µg at tumor base 50 µg within lamina propria 50 µg within lamina propria Completed Safety Review Board completed after each cohort. Patients followed for safety after TURBT to 56 days. 1 patient evaluable to date Open for enrollment Safety & dose- Feasibility of Focal distribution Focal Markers of Study objectives limiting toxicity technique of AU-011 necrosis immune activation NMIBC, non-muscle-invasive bladder cancer; MoA, mechanism of action; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 14
Patient population: AUA risk classification and grade at screening Drug + light: Patient A2 Drug + light: Patient B1 High-risk Drug + light: Patient A4 Drug only: Patient 3 Drug + light: Patient B3 Intermediate- Drug only: Patient 4 Drug + light: Patient B2 risk Drug + light: Patient A3 Drug + light: Patient C1 Drug only: Patient 1 Drug only : Patient 5 Low-risk Drug only: Patient 2 Drug + Light: Patient A1 High-grade Low-grade AUA, American Urological Association. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 15
Phase 1 trial of AU-011 for bladder cancer designed to evaluate safety, feasibility, and mechanism of action Single dose window of opportunity study in NMIBC all-comers Histopathological assessment completed at time of standard of care TURBT Part 1 (n=5) Part 2 (n~10) AU-011 alone AU-011 + focal light activation Dr Dru ug o g onl nly y Cohort A: Cohort B: Cohort C: ( (N No o l li ight ght) ) Drug + light Drug + light Drug + light T To ot ta al l 100 µ 100 µg g Total 100 µg Total 200 µg Total 100 µg NMIBC (N~3) N NM MI IBC BC ( (N N=5) =5) NMIBC (N=4) NMIBC (N=3) 200 µg at tumor base 50 µ 50 µg g a at t t tu um mo or r b ba as se e 50 µg at tumor base 100 µg at tumor base 50 µg within lamina propria 50 µg within lamina propria 50 µg within lamina propria Completed Safety Review Board completed after each cohort. Patients followed for safety after TURBT to 56 days. 1 patient evaluable Open for enrollment Safety & dose- Feasibility of Focal distribution Focal Markers of Study objectives limiting toxicity technique of AU-011 necrosis immune activation NMIBC, non-muscle-invasive bladder cancer; MoA, mechanism of action; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 16
Drug only without light activation (n=5) TURBT Drug only: Treatment schedule Pathology Total dose: 100 µg • 50 µg into base of tumor Day 2 Day 1 • 50 µg into lamina propria • Evidence of non-invasive • Urologist performs TURBT to urothelial carcinoma include injected lesion • Sample sent to central pathology • Injection of AU-011 performed within tumor (50 µg) and below for H&E and AU-011 staining tumor (lamina propria; 50 µg) H&E, hematoxylin and eosin; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 17
Drug only without light activation (n=5) Safety Data Event Grade Number of patients Adverse events (related to study drug) None None 0/5 Drug only: Adverse events (related to injection or laser procedure) Safety data 1 1/5 Hematuria • First in human in bladder – safety cohort as required by • No treatment emergent adverse events FDA related to study drug • No serious adverse events • No dose limiting toxicities ClinicalTrials.gov Identifier: NCT06007690; AU-011-301. FDA, Food and Drug Administration 18
Phase 1 trial of AU-011 for bladder cancer designed to evaluate safety, feasibility, and mechanism of action Single dose window of opportunity study in NMIBC all-comers Histopathological assessment completed at time of standard of care TURBT Part 1 (n=5) Part 2 (n~10) AU-011 alone AU-011 + focal light activation Drug only C Co oh ho ort rt A A: : Cohort C: C Co oh ho ort rt B B: : Cohort C: (No light) Dr Dru ug + g + l li ight ght Drug + light Drug + light Drug + light Drug + light Total 200 µg Total 100 µg Total 100 µg Total 200 µg Total 100 µg T To ot ta al l 100 µ 100 µg g N NMIB MIBC C ( (N N~ ~3) 3) NMIBC (N=5) N NM MI IBC BC ( (N N=4) =4) N NM MI IBC BC ( (N N=3) =3) 20 200 0 µ µg a g at t t tu um mo or b r ba as se e 50 µg at tumor base 50 µ 50 µg g a at t t tu um mo or r b ba as se e 10 100 0 µ µg a g at t t tu um mo or b r ba as se e 50 µg within lamina propria 5 50 0 µ µg g wi wit thi hin l n lam ami ina na pr pro opr pri ia a Completed Safety Review Board completed after each cohort. Patients followed for safety after TURBT to 56 days. 1 patient evaluable Open for enrollment Safety & dose- Feasibility of Focal distribution Focal Markers of Study objectives limiting toxicity technique of AU-011 necrosis immune activation NMIBC, non-muscle-invasive bladder cancer; MoA, mechanism of action; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 19
Cohort A–C: Single-dose drug with light activation (n=~10) TURBT Cohorts A–C: Single-dose drug with light activation Treatment schedule Pathology Cohort A: Day 9 ± 1 Cohort A: Day 1 Day 2 Day 3–7 Cohort B/C: Day 14+7 • 50 µg into base of tumor • 50 µg into lamina propria • Evidence of non-invasive • Urologist performs • Urologist performs TURBT urothelial carcinoma light activation with in area where tumor used Cohort B: 689 nm infrared to be present • Injection of AU-011 2 light (75 J/cm ) performed within and below • Sample sent to central • 100 µg into base of tumor tumor (Cohort A) and • ~5 min duration pathology for H&E and Cohort C: within tumor (Cohort B/C) immune staining • 200 µg into base of tumor H&E, hematoxylin and eosin; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 20
a Cohort A + B: Single-dose drug with light activation (n=7) Event Grade Number of patients Adverse events (related to study drug) Cohort A + B: Nocturia 1 1/7 Single-dose drug with Urinary urgency 1 1/7 light activation Adverse events (related to injection or laser procedure) 1 1/7 Hematuria Safety data 1 1/7 Urinary blood clots 1 1/7 Nocturia • No serious adverse events 1 1/7 Urinary urgency • No dose limiting toxicities Favorable safety profile: <10% of patients experienced Grade 1 TEAEs related to study drug; no Grade 2/3 adverse events related to study drug (n=12) A Compiled safety data includes all completed light-activated cohorts (A and B). Data cutoff date of September 9, 2024. TEAE, treatment-emergent adverse event. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 21
Efficacy data: Ta low-grade 4/5 low-grade target tumors demonstrate complete response to AU-011 c d Patient A1 Patient A3 Patient A4 Patient B2 Patient C1 Single Multiple Multiple Multiple Multiple (Multiple at TURBT) Screening diagnosis Ta low-grade Ta low-grade Ta low-grade (2024) Ta low-grade Ta low-grade Ta high-grade (2023) Screening AUA Intermediate Intermediate Intermediate Intermediate Low risk classification 100 µg 100 µg 100 µg 100 µg 200 µg AU-011 dose/delivery IT/IM IT/IM IT/IM IT IT Clinical complete response: - a Target tumor Clinical complete response: a 2/2 1/2 1/1 - - Non-target tumor (bladder b urothelial field effect ) e Immune response : pending Target tumor e Immune response : pending Non-target tumor pending Necrosis - Visual changes on cystoscopy - a b For purposes of this analysis, Clinical complete response defined as absence of tumor cells on histopathologic evaluation. Bladder urothelial field effect: absence of tumor cells in non-target lesions. C d Previously treated tumor demonstrated high-grade disease but pathology at time of treatment revealed low-grade disease in non-target tumor. Complete response (target tumor) based upon local e pathology with central review ongoing; immune response and necrosis evaluations pending central review. Immune response is defined by immunocyte infiltration on post-treatment histopathology. Cohorts A–C: AUA, American Urological Association; IM, intramural; IT, intratumoral; TURBT, transurethral resection of bladder tumor. 22 Clinicaltrials.gov identifier: NCT05483868; AU-011-102. Single-dose drug with light activation
• 100% (7/7) of target tumors showed infiltration of effector CD8+ T and CD4+ cells, as early as 7 days after laser activation Light-activated cohorts a (A + B): • 100% (7/7) of non-target tumors (in the five patients with available immune staining) showed T cell infiltration, supportive of a bladder urothelial field effect Strong evidence of immune-mediated • Focal eosinophilic infiltration was observed in 57% (4/7) target mechanism of action tumors and in 14% (1/7) non-target tumors, supportive of a local innate immune response to tumor necrosis b • Generation of lymphoid follicles was observed in 71% (5/7) target tumors, supportive of a local adaptive immune response AU-011 showed evidence of producing pro-immunogenic changes in situ that have the potential to bridge, activate, and enhance adaptive immunity, consistent with its expected MOA a b Patients for which biopsies were available. Organized aggregates of immune cells. MOA, mechanism of action Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 23
Complete clinical response visualized at time of TURBT confirmed with Patient A1 histopathologic evaluation 64-year-old Caucasian male Evidence of clinical complete response by Screening diagnosis: (2023) absence of tumor cells, as well as immune Immune • Single activation, after single dose treatment in first infiltrate • Ta low-grade <3 cm patient • No CIS Example of papillary carcinoma (Ta) Screening AUA risk classification: Low Necrosis 7 days Papillary urothelial after AU-011 Initial diagnosis: (2010) carcinoma treatment • Single • Ta low-grade <3 cm • No CIS • Low risk Post-treatment TURBT demonstrating necrosis, Prior TURBT: inflammatory infiltrate, and 2011; 2012; 2018 no residual carcinoma. Circled region shows area Prior adjuvant therapies: of necrosis; arrow indicates edge of inflammatory • MMC (2011) infiltrate. H&E stain • Tamoxifen (2016) Pre-injection bladder biopsy demonstrating low-grade • Gemcitabine (2018) papillary urothelial carcinoma; non-invasive CIS, carcinoma in situ; H&E, hematoxylin and eosin; MMC, mitomycin C; TURBT, transurethral resection of bladder tumor. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 24 Single-dose drug with light activation
Summary of pre-and-post treatment pathology: Single low-grade target lesion and two non-target lesions Patient A1 64-year-old Caucasian male Pre-treatment pathology Post-treatment pathology Target lesion: Clinical complete response Screening diagnosis: (2023) Local pathology: Central pathology: • Single • Ta low-grade <3 cm • Papillary urothelial carcinoma, non-invasive, low- • Negative for urothelial carcinoma • No CIS grade • Chronic inflammation • Muscularis propria not identified Screening AUA risk classification: Low Note – no central pathology Initial diagnosis: (2010) Non-target lesion A & B: Absence of tumor cells (2/2 lesions) • Single • Ta low-grade <3 cm Not applicable: Central pathology: • No CIS • Negative for urothelial carcinoma • No pre-treatment specimen obtained • Low risk • Chronic inflammation Prior TURBT: 2011; 2012; 2018 Prior adjuvant therapies: • MMC (2011) • Tamoxifen (2016) a • Gemcitabine (2018) Clinical complete response (target lesion) b Bladder urothelial field effect a b Clinical complete response identified on histopathologic evaluation. Bladder urothelial field effect: absence of tumor in non-target lesions. AUA, American Urological Association; CIS, carcinoma in situ; MMC, mitomycin C; TURBT, transurethral resection of bladder tumor. Cohort A: ClinicalTrials.gov Identifier: NCT06007690; AU-011-301. 25 Single-dose drug with light activation
H&E CD3 Patient A1: AU-011 focal distribution, necrosis, and positive immune staining (target lesion) CD4 CD8 Post-treatment No central pathology read available for pre-treatment; block lost at site. Cohort A: H&E, hematoxylin and eosin.Clinicaltrials.gov identifier: NCT05483868; AU-011-102 26 Single-dose drug with light activation
Complete clinical response visualized at time of TURBT confirmed with Patient A3 histopathologic evaluation 72-year-old Hispanic male Screening diagnosis: (2024) • Multiple AU-011 • Ta low-grade (<3 cm) injection • No CIS Screening AUA risk classification: Intermediate Initial diagnosis: (2019) Biopsy • Ta high-grade <3 cm • No CIS • Intermediate risk Prior TURBT: • 2019, 2020 (x2), 2021 (x2), 2023 Prior adjuvant therapies: • BCG induction and maintenance (2020-2021) Pre-injection/pre-biopsy appearance of Post-injection edema and tumor on office cystoscopy ecchymosis at injection site AUA, American Urological Association; BCG, Bacillus Calmette-Guerin; CIS, carcinoma in situ; TURBT, transurethral resection of bladder tumor. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 27 Single-dose drug with light activation
Summary of pre-and-post treatment pathology: Single low-grade target lesion and two non-target lesions Patient A3 Pre-treatment pathology Post-treatment pathology 72-year-old Hispanic male Target lesion: Clinical complete response Screening diagnosis: (2024) Central pathology: Central pathology: • Multiple • Low-grade papillary urothelial carcinoma, non-invasive • Negative for urothelial carcinoma • Ta low-grade (<3 cm) • Acute and Chronic inflammation • No CIS Non-target lesion A and B: absence of tumor cells (A) / immune cell infiltration (B) Screening AUA risk classification: Intermediate LESION A LESION A Initial diagnosis: (2019) Central pathology: Not applicable: Pre-treatment biopsy not completed • Negative for urothelial carcinoma • Ta high-grade <3 cm • Chronic inflammation • No CIS • Intermediate risk LESION B LESION B Prior TURBT: Not applicable: Central pathology: • 2019, 2020 (x2), 2021 (x2), 2023 Pre-treatment biopsy not completed • Papillary urothelial carcinoma; non-invasive Prior adjuvant therapies: • Low-grade • BCG induction and maintenance • Additional findings: Cystitis cystica et glandularis (2020-2021) a Clinical complete response (target lesion) b Bladder urothelial field effect a b Clinical complete response identified on histopathologic evaluation. Bladder urothelial field effect: absence of tumor in non-target lesions. AUA, American Urological Association; BCG, Bacillus Calmette-Guerin; CIS, carcinoma in situ; TURBT, transurethral resection of bladder tumor. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 28 Single-dose drug with light activation
Patient A3: AU-011 focal distribution, necrosis, and positive immune staining (target lesion) H&E CD3 CD4 CD8 Pre-treatment Post-treatment H&E, hematoxylin and eosin. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 29 Single-dose drug with light activation
H&E: Pre-treatment CD4: Pre-treatment Patient A3: Post-treatment generation of secondary lymphoid follicles and increase in CD3, CD4, and CD8 infiltration CD4: Post-treatment H&E: Post-treatment H&E, hematoxylin and eosin. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 30 Single-dose drug with light activation
Efficacy data: Ta high-grade 3/3 high-grade tumors demonstrated immune response to AU-011 Patient A2 Patient B1 Patient B3 Single Single Multiple Screening diagnosis Ta high-grade Ta high-grade Ta high-grade Screening AUA High Intermediate High risk classification AU-011 dose/ 100 µg 100 µg 100 µg delivery IT/IM IT IT a Clinical complete response: Target tumor - - - Clinical complete response: Non-target NA - NA a b tumor (bladder urothelial field effect ) c Immune response : Target tumor c Immune response : Non-target tumor NA NA Necrosis - - - Tumor Visually Tumor Visually Visual changes on cystoscopy - Smaller Smaller a b Clinical complete response defined as absence of tumor cells on histopathologic evaluation. Bladder urothelial field effect: absence of tumor cells in non-target lesions. c Immune response is defined by immunocyte infiltration on post-treatment histopathology Cohorts A + B: AUA, American Urological Association; BCG, Bacillus Calmette-Guerin; CIS, carcinoma in situ; IM, intramural; IT, intratumoral; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 31 Single-dose drug with light activation
Summary
AU-011 demonstrated a favorable safety profile with robust clinical and immunological response in early data readout of ‘all-comers’ NMIBC patients Tumor shrinkage Favorable Rapid Immune Development and clinical safety profile activation plan response Only Grade 1 Drug-Related 100% of patients showed Continued development of Positive early data show 4/5 Adverse Events Reported in immune cell infiltration in AU-011 with planned phase 1 patients with low-grade disease <10% of Patients target and trial expansion to test additional had a complete clinical non-target lesions doses and treatment regimen No drug-related grade 2 or response higher AEs; no SAEs or DLTs Single low-dose of AU-011 In parallel, prepare for a Focal treatment with no Immune-mediated MOA showed multiple clinical phase 2 trial to further systemic adverse events and bladder urothelial complete responses in evaluate bel-sar’s clinical observed as of data cutoff field effect target and non-target activity and durability of tumors response AE, adverse event; DLT, dose-limiting toxicity; DOR, duration of response; MOA, mechanism of action; NMIBC, non-muscle-invasive bladder cancer; SAE, serious adverse event. ClinicalTrials.gov Identifier: NCT06007690; AU-011-301. 33
Appendix
Anti-tumor immunity: Treating beyond the target Preclinical development
Evidence of secondary (activated) follicles in tumor stroma supportive of local adaptive immune response Where does AU-011 fit in the cancer immunity cycle and the TME sub-cycle? Photoactivation of AU-011 generates ROS, resulting in necrotic cell death of tumor cells bound by AU-011. This releases tumor neoantigens and DAMPs, Depletion of tumor-resident driving a robust immunosuppressive cell types such as TAMs, immunogenic response and MDSC, iDC etc. (shown pre-clinically; not yet kickstarting the cancer shown in clinic), relieves tumor immunity cycle. immunosuppression, enabling an effective anti-tumor response Modified from: Mellman I, et al. Immunity. 2023;56(10):2188–205. APC, antigen-presenting cell; CTL, cytotoxic T lymphocyte; DAMPs, damage-associated molecular patterns; iDC, immature dendritic cell; MDSC, myeloid-derived suppressor cell; ROS, reactive oxygen species; TAM, tumor-associated macrophage; TLS, tertiary lymphoid structures; TME, tumor microenvironment. 36
Role of CD4+ and CD8+ T-cells at time of treatment and time of tumor rechallenge in the TC-1 syngeneic murine tumor model Depletion at the time of treatment Depletion at the time of rechallenge Implant TC-1 Implant TC-1 Rechallenge with 3 3 Tumor volume: 50mm Tumor volume: 50mm tumor cells tumor cells TC-1 tumor cells Day: -100 -93 -90 -87 +10 -1 0 +1 +3 +17 Day: 0 7 9 10 11 13 20 100 100 100 Isotype Naïve 80 80 Isotype anti-CD4 anti-CD4 anti-CD8 60 60 anti-CD8 40 40 20 20 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 ▲▲▲▲ Day post tumor Days post tumor ▲▲▲▲▲ challenge * * * implantation Intravenous AU-011 NIR treatment Depleting or matched isotype Kines RC, et al. Cancer Immunol Res. 2021;9(6):693–706. NIR, near-infrared. 37 Percent survival Percent survival
Tumor growth Syngeneic mouse tumor bladder model • MB49 model in C57BL/6 mice 1400 Control • N = 8–10/group Robust pre-clinical anti-PD-1 1200 AU-011 Anti-PD-1 anti-PD-1 + AU-011 1000 activity in bladder • Mouse equivalent of pembrolizumab • 100 µg administered 3 times every 3 days (IP) 800 cancer both as a 600 AU-011 AU-011 single dose • 100 µg as a single dose (IV) 400 2 single agent and in • All groups treated with NIR (50 J/cm ) 200 All animals that survived the first treatment were rechallenged combination with 0 and survival was evaluated up to 100 days after rechallenge 0 7 14 21 28 35 42 Days post tumor-implantation checkpoint inhibitors Survival Survival after rechallenge AU-011 treatment impacts 100 100 primary and distant tumors, overall survival, and induction of 80 80 durable immunological memory Control 60 60 anti-PD-1 • Treatment resulted in complete Control (naive) AU-011 AU-011 response and prevented tumor growth anti-PD-1 + AU-011 40 40 anti-PD-1 + AU-011 after rechallenge 20 20 • Data supports potential prevention of metastatic disease 0 0 0 25 50 75 100 0 25 50 75 100 Day post-treatment Days post-challenge Kines RC, et al. Cancer Immunol Res. 2021;9:693–706. IP, intraperitoneal; IV, intravenous; NIR, near-infrared. 38 3 Tumor volume, mm (mean±SEM) Survival, % Survival, %
Patient A1: Single-dose drug with light activation Immunohistochemistry Target lesion Non-target lesion A Non-target lesion B Stain Pre-treatment Post-treatment Pre-treatment Post-treatment Pre-treatment Post-treatment NA Absent NA Absent NA Absent AU-011 NA Present NA Absent NA Absent Necrosis NA NA NA NA NA NA Intratumoral NA Moderate NA Moderate NA Moderate Stromal CD3 NA NA NA Mild NA Mild Benign urothelial NA Marked NA Marked NA Marked Lymphoid follicle NA NA NA NA NA NA Intratumoral NA Moderate NA Moderate NA Moderate Stromal CD4 NA NA NA Absent NA Absent Benign urothelial NA Marked NA Marked NA Marked Lymphoid follicle NA NA NA NA NA NA Intratumoral Mild Mild Mild NA NA NA Stromal CD8 NA NA NA NA Mild Mild Benign urothelial NA Moderate NA Moderate NA Moderate Lymphoid follicle NA NA NA NA NA NA Intratumoral NA Marked NA Moderate NA Moderate Stromal CD45 NA NA NA Mild NA Mild Benign urothelial NA Marked NA Marked NA Marked Lymphoid follicle NA, not applicable. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 39
Patient A3: Single-dose drug with light activation Immunohistochemistry Target lesion (biopsy) Target lesion (TURBT) Non-target lesion A Non-target lesion B Post- Post- Post- Post- Stain Pre-treatment Pre-treatment Pre-treatment Pre-treatment treatment treatment treatment treatment Absent Present Absent Absent NA Absent NA Absent AU-011 Absent Absent Absent Present NA Absent NA Absent Necrosis Mild NA Mild NA NA NA NA Mild Intratumoral Mild Moderate Mild Moderate NA Mild NA Mild Stromal CD3 Mild Mild Mild Mild NA Mild NA Mild Benign urothelial NA Marked NA Marked NA NA NA NA Lymphoid follicle Absent NA Absent NA NA NA NA Absent Intratumoral Mild Moderate Mild Moderate NA Mild NA Mild Stromal CD4 Absent Mild Absent Mild NA Absent NA Mild Benign urothelial NA Marked NA Marked NA NA NA NA Lymphoid follicle Mild NA Mild NA NA NA NA Mild Intratumoral Mild Mild Mild Mild NA Mild NA Mild Stromal CD8 Mild Mild Mild Mild NA Mild NA Mild Benign urothelial NA Mild NA Mild NA NA NA NA Lymphoid follicle NA Mild NA Mild NA NA NA Mild Intratumoral Mild Moderate Mild Moderate Moderate Moderate NA NA Stromal CD45 Mild Mild Mild Mild NA Mild NA Mild Benign urothelial NA Marked NA Marked NA NA NA NA Lymphoid follicle NA, not applicable; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 40
Secondary (activated) lymphoid follicle: Patient A3 Capable of generating tissue-specific, adaptive immune responses 72-year-old Hispanic male Screening diagnosis: (2024) • Multiple • Ta low-grade (<3 cm) • No CIS • Secondary lymphoid follicles form ectopically at sites of Screening AUA risk classification: Intermediate chronic inflammation and antigenic stimulation Initial diagnosis: (2019) • Ta high-grade <3 cm • Lymphoid follicles are widely • No CIS • Intermediate risk reported in colorectal and ovarian carcinoma, suggestive Prior TURBT: of ongoing B-cell expansion and • 2019, 2020 (x2), 2021 (x2), 2023 a favorable prognosis Prior adjuvant therapies: • BCG induction and maintenance (2020-2021) AUA, American Urological Association; BCG, Bacillus Calmette-Guerin; CIS, carcinoma in situ; TURBT, transurethral resection of bladder tumor. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 41 Single-dose drug with light activation