FPA144: A Therapeutic Monoclonal Antibody with Enhanced Antibody-Dependent Cell Killing for the Treatment of Fibroblast Growth Factor Receptor 2b Overexpressing Cancers Kristen Pierce, PhD
Disclosure Information AACR Annual Meeting 2016 Kristen Pierce I have the following financial relationships to disclose: Stockholder in: Five Prime Therapeutics Employee of: Five Prime Therapeutics - and - I will discuss the following off label use and/or investigational use in my presentation: Phase 1 Clinical Development of FPA144
FPA144 - A Humanized Monoclonal Antibody to FGFR2 Isoform b for Gastric Cancer FGF7 FGF10 Engineered for enhanced antibody-dependent cell-mediated cytotoxicity (ADCC) to increase natural killer (NK) cell recruitment Blocks Ligand Binding FGF22 FPA144: antibody specific to FGFR2b splice variant 3
FGF Receptors FGF Ligands FGFR Biology Classical FGFs 1 2 3 4 5 6 8 9 11 12 13 14 16 17 18 20 KGF Sub-family Hormonal FGFs 7 10 22 19 21 23 Klotho Klotho 1b 1c 2c 3b 3c 4 2b 1c 4 Blocked by FPA144 FGFR tyrosine kinase inhibitors indiscriminately block FGFRs 4
Both FGFR2 Amplification and FGFR2b Overexpression in Gastric Cancer Are Associated with Poor Prognosis Cumulative Survival FGFR2 gene amplification and FGFR2b protein overexpression are associated with lower survival in gastric cancer patients Most commonly found in patients with diffuse, poorly differentiated gastric cancer FGFR2 Gene Amplification FGFR2b Protein Over Expression FGFR2b IHC- (n=353) 4 4 4 FGFR2b IHC+ (n=9) Jung et al. 2009; FGFR2 FISH; P=0.012 Data are for all disease stages, including early Pathobiology 2015; 82:269-279 5
T u m o r V o lu m e (M e a n m m 3 S E M ) FPA144 Monotherapy is Effective in Preclinical Models OCUM-2M Gastric Cancer Xenograft 1 0 0 0 8 0 0 C o n tr o l 1 0 m g / k g F P A 1 4 4 1 m g / k g F P A 1 4 4 3 m g / k g F P A 1 4 4 1 0 m g / k g 6 0 0 4 0 0 2 0 0 0 0 1 0 2 0 3 0 D a y s S in c e T u m o r Im p la n ta tio n Cells courtesy of M. Yashiro, Osaka City University Graduate School of Medicine 6
FPA144 Treatment Recruits NK cells and Enhances ADCC in a Xenograft Model with Low FGFR2b Expression 4T1 Syngeneic Xenograft Model NKp46 DAPI FPA144 treatment leads to: Recruitment of NK and subsequent T cell infiltration into the tumors Upregulation of PD-L1 Saline FPA144 Regression of tumor growth Enhanced ADCC may be critical for activity in tumors with low and moderate expression of FGFR2b Poster: Powers,J Monday 8 am 4/18/2016 Abstract # 1407 Tumor size: 100 mm3 FPA144: 1 dose 10 mg/kg Tumors Harvested 1 Day Post FPA144 7
FPA144 Phase 1 Study Is Enrolling Selected Gastric Cancer Patients PART 1 Dose Escalation PART 2 Selected Gastric Patients Study Objectives PART 1A: Dose escalation in solid tumors PART 1B: Selected/ Unselected Gastric Cancer IHC 3+ FISH+ (n=30) IHC < 3+ Safety Objective response rate and duration Initiated November 2015 8
Patient Selection Strategy for Part 1B and Part 2 of Study FGFR2b Overexpression FGFR2 Amplification IHC Positive 3+ membrane staining in 10% of tumor FPR2-D proprietary anti-fgfr2b antibody Distinguishes FGFR2b and 2c Commercial antibodies less specific FISH Positive - FGFR2 probe: centromere probe 2 in 50 nuclei Commercially available probes Validated by LabCorp IHC provides information about heterogeneity that FISH does not IHC will be the primary assay used to identify FPA144 eligible patients CONFIDENTIAL 9
Study Results Part 1A and Part 1B Part 1A (Advanced Solid Tumors) Part 1B (Gastric Cancer) Dose (mg/kg) No. of Patients Tumor Types Mean Exposure (weeks)* Dose (mg/kg) No. of Patients Tumor Types Mean Exposure (weeks)* 0.3 3 1 4 Breast, Colon, Neuroendocrine Colon, Lung, Gallbladder, Submandibular 24.2 13.1 3 3 Bladder, Colon, Gastric 13.6 3 1 Gastric 14.0 6 3 2 Colon, Gastric 3.5 6 1 Gastric 6.3 10 3 Colon, Gastric, Peritoneal 4.2 10* 6 Gastric 2.5 15 3 Bile Duct, Esophageal, Pancreatic 4.2 Total 19 12 Tumor Types 10.6 Total 8 All Gastric 4.4 * 2 of 6 patients in the 10 mg/kg cohort did not meet the criteria for FGFR2b overexpression (IHC-) As of the data cut off of 10/29/15 CONFIDENTIAL 10
Study Results Safety Summary Parts 1A and 1B As of the data cut-off of October 29 th, 2015: No dose- limiting toxicities in the dose escalation portion of the study Maximally tolerated dose not reached No on-study deaths 4 serious adverse events (SAEs) (across 2 subjects) reported, but none were treatment-related No treatment related hyperphosphatemia CONFIDENTIAL 11
Study Results Radiographic Response and Decreased FDG PET Uptake in a Subject with Urothelial Bladder Cancer (UBC) Some evidence for a role of FGFs/ FGFRs in bladder cancer Patient dosed with FPA144 at 3 mg/kg every two weeks and continues on study as of April 1, 2016 (day 353) Patient has moderate overexpression of FGFR2b without FGFR2 amplification Screening (Day -5) Cycle 8 Day 15 (Day 213) Ureter Kidney Ureter Kidney Ureter Kidney Ureter Kidney FGFR2b Staining 12
% Change Sum of Longest Diameters (SLD) Study Results Preliminary Radiographic Responses in FGFR2b-selected Gastric Cancer Patients in Part 1B Tumor Responses in Selected Part 1B Patients Treated with FPA144 50 40 30 20 10 0-10 0 20 40 60 80 100 120 140-20 -30-40 Days Post 1 st FPA144 Dose Partial Response in Patient Treated with 6 mg/kg FPA144 Screening (Day -14) Cycle 4 Day 1 (Day 83) Tumor responses were assessed with the use of RECIST 1.1 Data as of 1/15/2016 Additional data to be presented at ASCO 13
Summary FPA144 is an FGFR2b- specific antibody that FivePrime glycoengineered for enhanced ADCC (Abstract #1407) Leads to recruitment of Natural Killer (NK) and T cells into the tumor and inhibition of tumor growth in vivo Drives both innate and adaptive immune responses In ongoing Phase 1 testing FPA144 has been well tolerated with no dose limiting toxicities and no hyperphosphatemia Patient enrollment in selected gastric cancer patients continues at 15 mg/ kg, the highest dose tested There has been one confirmed partial response in a urothelial bladder cancer patient treated with 3 mg/ kg FPA144. This patient has moderate FGFR2b expression Of 6 selected gastric cancer patients treated in part 1B as of January 15, 2016, there were 2 partial responses (1 confirmed), 3 stable diseases and 1 progressive disease 14
Acknowledgements Patients and Clinicians participating in the FPA144-001 clinical trial The FivePrime FPA144 team Dr. M Yashiro, Osaka City University Graduate School of Medicine for the OCUM- 2M Cells 15