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Jefferies Global Healthcare Conference June 2015
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Developing Novel Treatments For Serious Brain Diseases
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Clinical drug candidates
TPI 287 CRT 001
TPI 287 3rd generation taxane;
Brain-penetrable; well-tolerated
Encouraging ORR and OS signal in recurrent glioblastoma clinical trials
Clinical trials underway in secondary brain metastases
Oncology Neurology
TPI 287 Preclinical activity
observed in Alzheimer’s disease mouse model
Proof-of-concept clinical trials underway
CRT 001 Previously
marketed heart disease drug; potentially Phase 2 ready
Compelling preclinical activity in models of Alzheimer’s disease and Down syndrome
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Preclinical Phase 1 Phase 2
Oncology – TPI 287
Recurrent GBM (Avastin naive)
Recurrent GBM (Avastin exp.)
Breast cancer brain metastases (mono)
Secondary brain metastases (+radiation)
Neurology – TPI 287
Alzheimer’s disease
PSP/CBD
Oral formulation
Neurology – β1-ADR modulators
CRT 001 – cognitive impairment
Prodrug follow-ons – cognitive impairment
Pipeline
Update 4Q/15
Update 4Q/15
2016
2016
5
TPI 287 – Oncology
TPI 287 3rd generation taxane Mechanism identical to paclitaxel and
docetaxel Safety profile consistent with the class Readily penetrates the blood-brain barrier
Lead indication: recurrent GBM 53% ORR; 12.9 mo. OS w/Avastin
standard-of-care MTD not yet reached
Secondary brain metastases Phase 1 studies on-going +/- radiation
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GBM standard-of-care
Chinot et al., New Engl. J. Med. (2014); Gilbert et al., New Engl. J. Med. (2014) FDA Briefing Documents, ODAC March 2009 Rahman et al., Neuro-oncology (2014)
Recurrent Disease First Recurrence
Avastin (+/- other therapies)
PFS: 4 mo. OS: 7 – 9 mo.
Second Progression
Avastin (+ other therapies)
NovoTTF
PFS: 1.5 mo. OS: 3 – 4 mo.
Newly Diagnosed Front-line
Temodar Radiotherapy Surgery
PFS: 6 – 7 mo. OS: 16 – 17
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CB-017: TPI 287 in recurrent GBM
Avastin +
TPI 287 dose escalating
Avastin
+ TPI-287 (MTD)
Avastin
RANDOMIZE
Determine MTD Endpoints TBD
# US sites actively enrolling patients: 8
Avastin-naive
Recurrent GBM post TMZ + radiation
2 1
8
TPI 287 adverse event profile typical of taxanes
CB-017 adverse events as of April 17, 2015
Mild-moderate adverse events possibly associated with TPI 287 (n=16)
Peripheral neuropathy 12 (75%) Fatigue 5 (31%) Nausea 5 (31%) Neutropenia 5 (31%) Headache 3 (19%) Diarrhea 3 (19%) Lymphopenia 2 (13%) Alopecia 2 (13%) Back pain 2 (13%) Rhinorrhea 2 (13%)
G 3/4 adverse events regardless of causality (n=16)
Lymphopenia 1 (6%) Neutropenia 1 (6%) Fatigue 1 (6%) Seizure 1 (6%) Hypertriglyceridemia 1 (6%) Confusion 1 (6%) Dysphasia 1 (6%) Lymphopenia 1 (6%)
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CB-017: Updated response analysis June 3, 2015
17 patients evaluable for response per RANO evaluation criteria 9 objective responses (2 CR, 7 PR) → 53% ORR 7 stable disease → 94% disease control rate
months
Dos
e –
patie
nt #
PR
CR PR
PR PR
PR PR PR
CR SD
SD SD
SD SD
SD
PD SD
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RANO response in CB-017
T1 (enhancing)
FLAIR (non-enhancing)
Baseline Post 2 cycles
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TPI 287/Avastin beats Avastin monotherapy
CB-017 ReACT 2 BELOB CABARET BRAIN NCI ‘64E AVAREG
Regimen TPI 287 + Avastin
Avastin alone
Avastin alone
Avastin alone
Avastin alone
Avastin alone
Avastin alone
# patients 19 30 48 62 85 56 59
ORR 53% # 17% 38% 13% 26% 20% 26%
PFS (med) 5.5 mo. # 4.1 mo.** 3.0 mo. 4.0 mo.** 4.2 mo. 3.9 mo. N/A
OS (med) 12.9 mo.* 9.3 mo. 8.0 mo. 6.4 mo. 9.2 mo. 7.1 mo. 7.3 mo.
OS-1 year 73% ^ 31% 26% 20%** 38% 33%** N/A
CB-017 results as of June 3, 2015; ReACT results from Q2/15 CLDX presentation; CABARET 31(15) May 20 Supp, 2013: 2017; AVF3708g and NCI 06-C-0064E data per FDA Briefing Documents, ODAC March 31, 2009; BELOB: Taal et al. Lancet Oncol. (2014); AVAREG: Brandes et al., Annals Oncol. (2014); N/R: not available; # n= 17; ^ n=11; * based upon occurrence of 37% of total events to date and 12.4 mo. median follow-up; ** estimate
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TPI 287 + Avastin beats ASCO rGBM Avastin comps
CB-017 ASCO #2004 ASCO #2005 ASCO #2012
TPI 287 + Avastin
Avastin alone
Avastin alone
Avastin alone
# patients 19 38 34 41
ORR 53% (n=17) 27% NR NR
Median OS 12.9 mo. 7.9 mo. 8.8 mo. 7.0 mo.
Source: CB-017 as of June 3, 2015; ASCO 2015 abstracts
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0%
25%
50%
75%
100%
0 2 4 6 8 10 12 14 16 18
months
CB-017 responders driving the OS median O
S pr
obab
ility
BRAIN trial CB-017
Avastin Avastin + CPT-11
Avastin + TPI 287
# patients 85 82 19
Med OS 9.2 mo. 8.7 mo. 12.9 mo. [95% CI 12.2 - NR]
Source: Friedman et al., JCO (2009)
Survival (mo.) Status Response Dose
(mg/m2)
16.3 + alive PR 140
15.3 + alive PR 140
15.1 deceased SD 140
12.9 deceased PR 140
12.6 + alive PR 160
12.6 deceased PD 150
12.4 + alive CR 160
12.2 deceased SD 150
7.6 deceased SD 170
6.9 + alive PR 170
6.9 + alive PR 180
6.6 deceased SD 170
5.5 + alive PR 180
5.2 deceased SD 160
4.1 + alive CR 170
4.1 + alive SD 180
2.8 + alive SD 180
0.5 + alive N/A 200
0.5 + alive N/A 200
Avastin + TPI 287 Avastin + CPT-11 Avastin alone
CB-017 as of June 3, 2015
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0%
25%
50%
75%
100%
0 2 4 6 8 10 12 14 16 18
months
CB-017 responders driving the OS median O
S pr
obab
ility
BRAIN trial CB-017
Avastin Avastin + CPT-11
Avastin + TPI 287
# patients 85 82 19
Med OS 9.2 mo. 8.7 mo. 12.9 mo. [95% CI 12.2 - NR]
SD CR, SD
PR, PR
CR
PR
PR PR
Source: Friedman et al., JCO (2009)
Survival (mo.) Status Response Dose
(mg/m2)
16.3 + alive PR 140
15.3 + alive PR 140
15.1 deceased SD 140
12.9 deceased PR 140
12.6 + alive PR 160
12.6 deceased PD 150
12.4 + alive CR 160
12.2 deceased SD 150
7.6 deceased SD 170
6.9 + alive PR 170
6.9 + alive PR 180
6.6 deceased SD 170
5.5 + alive PR 180
5.2 deceased SD 160
4.1 + alive CR 170
4.1 + alive SD 180
2.8 + alive SD 180
0.5 + alive N/A 200
0.5 + alive N/A 200
Avastin + TPI 287 Avastin + CPT-11 Avastin alone
PR
CB-017 as of June 3, 2015
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0%
25%
50%
75%
100%
0 2 4 6 8 10 12 14 16 18
CB-017: Objective responders living longer
CR and PR SD and PD # patients 9 8
# events 1 6
median not reached 12.2 mo [95% CI 6.6 - 12.6]
OS @ 9 mo. 100% 50%
OS @ 12 mo. 100% 50%
Surv
ival
pro
babi
lity
CR and PR
SD and PD
p = 0.007
months
CB-017 results as of June 3, 2015
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CB-017 Post-progression therapies – June 3, 2015
Treatment # Patients bevacizumab 9
CCNU 4
carboplatin 3
pembrolizumab 2
no treatment 2
BCNU 1
etoposide 1
NovoTTF 1
radiation 1
temozolomide 1
ipilumumab 1
ICN280/buparlisib 1
surgery 3
# Progressed # On-Study 14 5
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CB-017: TPI 287 in recurrent GBM
Avastin +
TPI 287 dose
escalating
Endpoints Primary: overall response rate Secondary: Safety, PFS, OS
# US sites actively enrolling patients: 11
Avastin-experienced
Avastin +
TPI 287 (expansion)
N=TBD
Recurrent GBM post TMZ
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CB-018: Response and stable disease observed
Dose Patient Best response Duration (mo.)
140 mg/m2
1 SD 4.1
2 PD -
3 PD -
160 mg/m2
1 CR 6.9 +
2 PD -
3 SD 2.8
170 mg/m2
1 SD 1.4 +
2 Not yet evaluated
3 Not yet evaluated
CR: complete response
SD: stable disease
PD: progressive disease
CB-018 (n=8)
CABARET (n=23)
Rahman et al. (n=42)
Median PFS 2.8 mo. (n=7) 1.8 mo. 1.4 mo.
Median OS 5.6 mo. 3.4 mo. 4.3 mo.
CB-018 results as of May 28, 2015; Hovey et al., #2003, ASCO 2015; Rahman et al., Neuro-Onc. 2014
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CB-018: Complete Response
6/6/14 first progression
9/19/14 second progression
10/15/14 baseline
12/4/14 post Cycle 1
T1
FLAIR
TMZ
Avastin
TPI 287
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TPI 287 clinical and regulatory timeline in GBM
2015 2016 2017 2018 1H 2H 1H 2H 1H 2H 1H 2H
CB-017 Phase 1 dose escalation
Phase 2 dose expansion
FDA meeting proposal
CB-018 Phase 1 dose escalation
Phase 2 dose expansion
Phase 3 pivotal
NDA filing
For potential accelerated approval
Follow-up
Follow-up
Meeting Proposal
Follow-up
Follow-up
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Glioblastoma
~ 23K malignant brain tumors/year; 48% GBM
No effective treatments in recurrent disease
$500 - $700M market opportunity
Secondary metastases to brain
~400K patients/year in the US
Radiation therapy and surgery only standards of care
$2 - $3B market opportunity
Pipeline market potential
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Form the spindles on which chromosomes pair and line up
Taxanes ↔ mitotic spindle mitotic catastrophe
Form the “tracks” for trafficking and distribution of cellular cargo
Two major roles of microtubules (MTs)
TPI 287 - Neurology
Taxanes ↔ axonal MTs restore disrupted axonal transport
Adapted from Brunden et al. Nature Rev. Drug Discovery (2009)
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“flame-shaped” NFTs Alzheimer’s disease
“globose” NFTs PSP
“Pick bodies” Pick’s disease
“filamentous” NFTs FTPD-17
Dickson, Brain Pathology (1999)
NFTs in tauopathy indications Alzheimer’s disease Myotonic dystrophy
Amyotrophic lateral sclerosis/parkinsonism–dementia complex * Niemann-Pick disease, type C Argyrophilic grain dementia * Non-Guamanian motor neuron disease with NFTs Corticobasal degeneration * Pick’s disease * Creutzfeldt-Jakob disease Postencephalitic parkinsonism Dementia pugilistica * Prion protein cerebral amyloid angiopathy Diffuse neurofibrillary tangles with calcification Progressive subcortical gliosisa * Down’s syndrome Progressive supranuclear palsy * Frontotemporal dementia with parkinsonism - chr. 17 * Subacute sclerosing panencephalitis Gerstmann-Straussler-Scheinker disease Tangle only dementia Hallervorden-Spatz disease * tau+ NFTs are the most predominant pathologic feature
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TPI 287 vs. other anti-tauopathy therapies
anti-tau antibodies
TPI 287
Infectious aberrant tau
Adapted from Brunden et al. Nature Rev. Drug Discovery (2009)
kinase inhibitors
Tangled clumps of Tau Proteins
Microtubule subunits fall apart
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TPI 287 in PS19: P-tau reductions with TPI 287
Defensor et al., Abst. 691.12, Society for Neuroscience 2014 Tangled clumps of tau Proteins
p-tau (AT8)
t-tau (Tau5)
0 1 3 mg/kg TPI 287
n=5 n=5 n=4
Microtubule subunits fall apart
26
TPI 287 in PS19 mice: Morris Water Maze
Escape latency – learning and memory improvements
Probe test – confirmation of spatial working memory improvements
Defensor et al., Abst. 691.12, Society for Neuroscience 2014
WT + TPI 0, 1, 3 mg/kg TPI 287 in PS19 vs. untreated WT
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TPI 287 tauopathy Phase 1 trials
#1 TPI 287 #2 CRT 001
Primary endpoint: safety
Three dose cohorts randomized to placebo 8:3 (n=33)
Secondary endpoints: early efficacy, tau levels in CSF, MR imaging
Funding from CBD Solutions
Primary endpoint: safety
Three dose cohorts randomized to placebo 8:3 (n=33)
Secondary endpoints: early efficacy, tau levels in CSF
Funding from the AD Foundation
3 dose cohorts: 2, 7, 20 mg/m2 every 3 weeks
“Pure” tauopathies
Progressive Supranuclear Palsy Corticobasal Degeneration
Alzheimer’s Disease
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CRT 001 - Neurology
Xamoterol Approved in the 1980’s in select
European territories for the treatment of cardiovascular disease
Clinical data from over 3,500 patients available in over 70 research publications
Intellectual property filed by Stanford University covering:
• methods for enhancing learning and memory with CRT 001
• composition of matter for back-up compounds and analogues
Potentially Phase 2 ready
β1 adrenergic receptor partial agonist
29
Adrenergic receptor signaling in the brain
Bondareff, W., et al., Alzheimer Dis Assoc Disord, 1987; Tejani-Butt, et al. Brain Res, 1993; Murchison et al., Cell. 2004
Multi-receptor neurotransmitter pathway distinct from cholinergic system Critical role in learning and memory retrieval Significantly impaired in Alzheimer's disease and other CNS diseases
Noradrenaline
α1A,B,D α2A,B,C β1,2,3 receptors
cAMP
Long-term memory gene expression
30
CRT 001 enhances social recognition Alz mouse
Social learning Both normal and APP mice respond equally to the introduction
of Intruder A
Social recognition Normal mice have heightened interest in new Intruder B vs.
prior Intruder A
However, APP mice do not recognize Intruder A and show equally high interest in A and B
APP mice treated with CRT 001 display enhanced recognition of Intruder A without losing interest in Intruder B
inte
rest
leve
l
normal APP
normal APP APP w/ CRT 001
Coutellier et al., Annals of Clinical and Translational Neurology (2014)
Intruder A is removed from the cage Intruder A is reintroduced or new Intruder B is
introduced...
inte
rest
leve
l
31
Oncology – TPI 287 CB-017 Phase 1/2 Recurrent GBM: Avastin-naïve Update 4Q/15
CB-018 Phase 2 Recurrent GBM: Avastin-experienced Update 4Q/15
IST Phase 1 Lung/breast cancer brain mets w/FSRT Update 2H/15
IST Phase 1/2 Breast cancer brain mets (mono) Update 2015
Expected milestones
Neurology – TPI 287 and CRT 001 IST Phase 1 TPI 287 in Alzheimer’s disease Interim data 2016
IST Phase 1 TPI 287 in PSP/CBD Interim data 2016
CRT 001 Clinical development plan Finalized 2H/15
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Management
George Farmer, PhD – Chief Executive Officer
Synta Pharma, Canaccord, Wachovia, DuPont, MSKCC, UCSF, Columbia Univ.
Don Picker, PhD – Chief Operating Officer
Johnson Matthey, Tapestry Pharma, Genta, LXR Biotech, Synergy Pharma, Univ. Washington, SUNY Albany
Sandra Silberman, MD, PhD – Consultant (Chief Medical Officer)
Pfizer, Novartis, Eisai, Tapestry Pharma, Dana Farber, Johns Hopkins Univ., Cornell Univ.
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Novel approaches for treatment of serious brain diseases
TPI 287: 3rd generation brain-penetrable taxane
Efficacy observed in Phase 1 and 2 GBM clinical trials
Preclinical data provides proof-of-concept for ongoing tauopathy Phase 1 studies
CRT 001: beta1 adrenergic receptor partial agonist
Preclinical data supports proof-of-concept for treatment of cognitive impairment
Potentially Phase 2-ready supported by deep regulatory history
Catalyst-rich over 2015-16
Conservative cash management model
Summary
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CorticeBiosciences.com