From Zack's:
CVM: Confirmatory Study Clarity
05/21/2024
By John Vandermosten, CFA
NYSE:CVM
READ THE FULL CVM RESEARCH REPORT
First Quarter Fiscal Year 2024 Update
CEL-SCI Corporation (NYSE:CVM) reported its fiscal second quarter on May 15, 2024 with the submission of its Form 10-Q with the SEC and a press release on the following day. Since our previous update in mid-April, CEL-SCI reported that it had received a nod from the FDA on the design of a confirmatory study allowing it to proceed and announced a new director. Other highlights during the period include the grant of a waiver for pediatric requirements by the European Medicines Agency (EMA) and an article featuring CEL-SCI’s Ligand Epitope Antigen Presentation System (LEAPS) technology in Frontiers in Immunology.
Financial Review
CEL-SCI recognized no revenues for its fiscal second quarter ending March 31, 2023 and incurred operating expenses totaling $7.1 million during the three-month period. This resulted in a net loss available to common shareholders of ($7.2) million, or ($0.14) per share.
For the quarter ending March 31, 2023 versus the same prior year period:
? Expenses for research and development fell 24% to $4.6 million from $6.1 million. Lower Phase III study, employee stock compensation and miscellaneous costs contributed to the decrease;
? General and administrative expenses increased 17% to $2.4 million from $2.1 million on higher consulting fees, employee stock compensation and other miscellaneous expenses;
? Other non-operating items were $14,000 compared to ($8,000) in the prior year;
? Net interest expense of ($0.2) million compared with ($0.2) million was related to lease liabilities and was relatively constant;
? Net loss totaled ($6.7) million versus ($8.0) million or ($0.14) and ($0.18) per share, respectively.
As of March 31, 2024, cash and equivalents totaled $5.3 million. Cash burn for the three-month period amounted to approximately ($9.5) million, up from 2Q:23’s ($7.6) million. During the quarter, CEL-SCI closed on a gross $7.8 million in a common stock offering. CEL-SCI holds no debt on its balance sheet.
CEL-SCI Milestones
? EMA waiver for pediatric requirements – January 2024
? Commissioning of Multikine manufacturing facility – 2024
? Appointment of Mario Gobbo to Board of Directors – April 2024
? Feedback from various regulatory agencies - 2024
? Submission of license application to various agencies – 2024+
? Preparation for Multikine confirmatory trial - 2024
LEAPS Article Published in Frontiers in Immunology
Scientific journal Frontiers in Immunology published an article in its March 2024 issue on CEL-SCI’s LEAPS technology as reported in a March 19th press release. While there are approved treatments for rheumatoid arthritis (RA) including adalimumab and other TNF blockers and JAK inhibitors they do not balance adaptive immune homeostasis. These classes of drugs also present the risk of stimulating other disease. CEL-SCI’s CEL-4000 therapeutic vaccine may be able to treat RA while limiting negative side effects by promoting antigen-specific regulatory rather than inflammatory responses, thereby modulating the immunopathological course of RA. In CEL-SCI’s article entitled Current status of immunological therapies for rheumatoid arthritis with a focus on antigen-specific therapeutic vaccines, the authors discuss in-development and approved products for RA and preclinical data for CEL-4000. CEL-SCI’s candidate is able to redirect autoreactive pro-inflammatory memory T cells towards rebalancing the runaway immune/inflammatory responses that characterize it. The drug’s features require the use of more advanced trial design such as adaptive trials and the use of biomarkers for endpoints. The article concludes by asserting that an antigen-specific immunomodulating vaccine, such as CEL-4000, may deliver therapy for RA without weakening important immune defense mechanisms against microbial infections or cancer.
FDA Confirmatory Study Acceptance
On May 8th, CEL-SCI announced that its selection criteria for populating a confirmatory study and study design was cleared by the FDA. In a recent meeting, the agency indicated that the company may move forward with a confirmatory registration study of Multikine. These patients will be newly diagnosed with advanced primary head and neck cancer with no lymph node involvement (determined via PET scan) and with low PD-L1 tumor expression (determined via biopsy). Statistical analysis indicates that 212 subjects will be required to generate the confirmatory data and the FDA has given its blessing to this design. It will be a randomized controlled trial with two arms. The FDA has cleared the trial within the context of the unmet need for squamous cell head and neck cancer (SCCHN).
Based on a discussion of the path forward with the FDA which was included in a 29 page report, the agency responded in written notes accepting the eligibility criteria. It further acknowledged that the nonclinical data appears sufficient, the stratification factors appear reasonable and CEL-SCI’s approach for product specifications is acceptable. Furthermore, the FDA had no safety objections to further treatment of patients with Multikine.
Similar to the IT-MATTERS study, we anticipate that eligible individuals will have a diagnosis of untreated SCCHN, measurable tumor, normal immune function and no use of immunosuppressives in the previous year among other criteria. Based on the performance in the Phase III trial, further population characteristics for the confirmatory study will include patients with no lymph node involvement of the disease and low PD-L1 tumor expression.
The study design calls for a two arm, two stage, 1:1 randomized controlled trial. The first stage will examine pre-surgical response rates, which can be determined shortly after completion of enrollment. Stage two will assess overall survival (OS) as the primary endpoint. Histopathology biomarkers will also be measured.
In its confirmatory trial, CEL-SCI anticipates that it will need to surpass a hurdle of a 10% improvement in overall survival (OS) and produce a hazard ratio of 0.72 or less to merit approval. In the IT-MATTERS study, the target population achieved a 28.5% improvement in OS and produced a hazard ratio of 0.35.
Later sections in the report provided a summary of Multikine’s mechanism of action, emphasizing its ability to enable a local antitumor response to occur. A review of Multikine’s tumor histopathology was provided along with graphics showing pre-surgical response rates and overall survival for the various groupings of patients.
CEL-SCI’s report concluded with a management summary asserting that the FDA recognized an unmet neet for better therapies and is supportive of the confirmatory trial. It also noted the lack of other approved therapies for SCCHN and the lack of success for other immunotherapies in this indication. Details on timing and cost were not provided; however, we anticipate that the management team is in the planning stages for a new trial along with efforts in the other geographies where CEL-SCI seeks to obtain approval.
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