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Two, three years in the past, CytomX Therapeutics (NASDAQ:CTMX) was on the cusp of greatness. It had three issues going for it. First, it had a novel, conditionally activated Antibody Drug Conjugate (ADC) platform that might be used to focus on beforehand undruggable proteins. Second, it had main (on-paper) partnerships with a number of huge pharma firms. Third, there was early information exhibiting indicators of efficacy of lead candidate Praluzatamab ravtansine (CX-2009) in TNBC and HR+/HER2- breast most cancers sufferers.
The platform works utilizing a masking/unmasking course of the place part of the ADC latches on to a protease when it’s current in or close to the tumor microenvironment, however avoids that very same protease when it’s current in wholesome cells. These are proteins which had been beforehand undruggable as a result of they had been current in each tumor and wholesome cells. This platform produced appreciable curiosity in huge pharma, with Pfizer, AbbVie, BMS, Astellas and Amgen partnering with this small firm. To prime all of it, the corporate produced sturdy section 1 information at ASCO 2021 which confirmed encouraging anti-cancer exercise, together with a number of partial responses in closely pretreated superior tumors, and an appropriate toxicity profile. Part 2 information from each CX-2009 in breast most cancers and CX-2029 in superior squamous non-small cell lung most cancers and head and neck squamous cell carcinoma had been due in a couple of months, and traders had been on the lookout for a windfall.
Nevertheless, by early 2022, the corporate was in tatters, following section 2 information readout from these candidates. The inventory has been on a downward slide ever since, and hasn’t recovered.
Interim section 2 information for CX-2029 was revealed in December 2021. Information confirmed an goal response charge of 18.8% and a illness management charge of 87.5% charge in lung most cancers sufferers. For head and neck most cancers sufferers, the figures had been, respectively, 4% and 56%.
ORR Is the sum of full responses and partial responses, divided by the overall variety of sufferers, expressed in proportion. DCR is a broader measure, together with not solely CR and PR but additionally sufferers with steady illness, i.e. the place the tumor is neither shrinking nor progressing. It’s easy arithmetic to see that when the DCR is excessive however the ORR is low, much more sufferers are getting SD than PR or CR. This might not have been so unhealthy if the CR+PR charge was not less than in an appropriate zone. Nevertheless, the trial noticed no CRs and the following couple of PRs:
Trial information (CTMX web site)
This was a disappointment.
6 months later, CTMX introduced information from CX2009 in breast most cancers. Information was poor as soon as once more. Whereas there was some optimistic in HR/HER2- breast most cancers, there was nothing good in TNBC. Here is the information:
- CTMX stated the examine met the first endpoint of goal response charge of larger than 10% in HR+/HER2-non-amplified breast most cancers.
- Nevertheless, in arm B of the examine, the target response charge was lower than 10% in sufferers with superior triple-negative breast most cancers.
- Subsequently, CTMX stated enrollment in arms B and C of the examine will likely be discontinued.
- The examine confirmed a scientific profit charge of 40% and the sufferers confirmed a median progression-free survival of two.6 months.
- CTMX CEO Sean McCarthy additionally stated that the corporate doesn’t plan to additional advance the praluzatamab ravtansine program alone because of present market situations and can search a companion.
A number of analyst corporations downgraded the inventory. CTMX lower its workforce by 40%. Most sadly for the corporate, in March this yr, AbbVie lower itself free from the CX2029 deal it had struck with CTMX in 2016. The inventory went right into a stoop.
It’s only within the final 6 months that CTMX is exhibiting some indicators of restoration. These developments stem from CytomyX’s authentic prowess as a number one developer of conditionally activated antibodies, a management that was marred by its personal poor trial information, in addition to by earlier points with its BMS and PFE collabs (outdated information, mentioned in my earlier protection, and doubtless not associated to any free ends in CTMX know-how). These collaborations present that, though CTMX did not do its personal trial properly, there may be persistent curiosity in its conditional activation know-how, and that the know-how has worth.
In November, Regeneron signed a $2bn, $30mn upfront take care of CTMX to mix CTMX’s conditional activation know-how with Regeneron’s Veloci-Bi bispecific antibody growth platform. The settlement requires CTMX to collaborate with Regeneron to determine and validate conditionally energetic bispecific antibodies, whereafter Regeneron will take over preclinical and scientific work. The collaboration places CTMX in a really early stage R&D stage place, the place it demonstrated its talents earlier.
The businesses stated this know-how has the potential to reduce off-target results for these next-generation T-cell partaking therapies, probably addressing tumor sorts which have traditionally been unresponsive to immunotherapy.
In January, Moderna signed a take care of CTMX to collaborate and develop mRNA-based therapies for oncology and non-oncology situations. CTMX obtained an upfront fee of $35M, together with $5M of pre-paid analysis funding, and is eligible to stand up to about $1.2B in future growth, regulatory and business milestone funds.
In January, the corporate additionally obtained a $5mn milestone fee from Astellas after getting the primary scientific candidate underneath their Probody T-Cell Partaking Bispecific (TCB) settlement. In the identical quarter, Bristol Myers Squibb additionally superior their partnered Anti-CTLA-4 non-fucosylated Probody®, BMS-986288, from Part 1 to Part 2 scientific trial.
These developments helped the inventory spruce up just a little. These confirmed that regardless of its fall from grace, CTMX nonetheless had respectable technological prowess, and that their conditional activation platform nonetheless had worth. The important thing downside, although, is that this worth must be demonstrated not less than as soon as in a registrational scientific trial. Whether or not BMS does it or another companion, or whether or not CTMX does it themselves is moot. However for the corporate to unlock its worth, such a proof of idea – not proof by way of collabs however by way of trials – is critical.
Financials
CTMX has a market cap of $111mn and a money stability of $204mn, a uncommon prevalence which once more demonstrates the validity of my opinion. Analysis and growth bills decreased by $9.4 million in the course of the three months ended March 31, 2023 to $21.2 million, whereas basic and administrative bills decreased by $2.6 million in the course of the three months ending March 31, 2023 to $8.0 million. At that charge, they’re funded for 5-6 quarters.
Dangers
Lack of a proof of idea regardless of being available in the market for 15 years is their key limitation. Money is, surprisingly, not an issue proper now. The small market cap, coupled with low volatility, could create some downside for traders.
Bottomline
CTMX continues to be a inventory to look at. The BMS section 2 trial could ship proof of idea finally. I’ll stick with the sidelines till that occurs. Some years in the past, I purchased some shares at round $5/share and was capable of promote out at a small revenue. As is my technique, I retained some shares, however received out in January final yr at a small loss.
