Pembrolizumab in Metastatic Melanoma
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1 Clinical Immune Monitoring and Biomarker Data of Tavo Monotherapy Compared to Tavo with Pembrolizumab in Metastatic Melanoma Supports the Rationale for Combination Therapy Alain Algazi 1, Katy K. Tsai 1, Donna Bannavong 2, Victoria Shainsky 2, Reneta Talia 2, Erica Browning 2, Christopher G. Twitty 2, Jean Campbell 2, Sharron Gargosky 2, Robert H. Pierce 2, Mai H. Le 2, Carmen Ballesteros-Merino 3, Carlo B. Bifulco 3, Bernard A. Fox 3, Mark Faries 4, Manuel Molina 5, Shailender Bhatia 6, Sanjiv Agarwala 7, Karl Lewis 8, Robert Andtbacka 9 and Adil Daud 1. 1 University of California San Francisco, San Francisco, CA; 2 OncoSec Medical Incorporated, San Diego, CA; 3 Earle A. Chiles Research Institute at Providence Portland Medical Center Portland, OR; 4 John Wayne, Los Angeles, CA; 5 Lakeland Health Medical Center, Lakeland, FL; 6 University of Washington, Seattle, WA; 7 St. Luke s Cancer Center, Bethlehem, PA; 8 University of Colorado Cancer Center, Aurora, CO, 9 Huntsman Cancer Institute, Utah
2 Disclosure 2 I have the following potential conflict(s) of interest to report. I participate in research funded by: Acerta AstraZeneca Bristol Myers Squibb Dynavax Genentech Incyte Medimmune Merck Novartis OncoSec I serve as an unpaid advisor to OncoSec Medical Incorporated
3 Both clinical trials are in patients with metastatic melanoma with accessible lesions OMS-I100 Phase 2 2 Centers Multi Multi OMS-I102 Therapy IT-tavo-EP IT-tavo-EP / pembrolizumab IT-tavo-EP D1, 5, 8 or D1, 8, 15 Q6w or q90d IT-tavo-EP D1, 5, 8 q6w pembrolizumab 200 mg IV q3 weeks Patients Metastatic melanoma Metastatic melanoma predicted to be PD-1 non responders Efficacy Endpoint ORR by modified skin RECIST ORR by RECIST v1.1 3
4 Clinical Trial Designs No selection for PD-1 hi CTLA-4 hi IT-tavo-EP D 1, 5, 8 90 Days IT-tavo-EP D 1, 8, 15 OMS-I100 6 Weeks IT-tavo-EP D 1, 5, 8 OMS-I102 6 Weeks Selection for PD-1 hi CTLA-4 hi Pembrolizumab D1, 22 6
5 tavokinogene telseplasmid (tavo; pil-12) delivery by electroporation Interleukin-12 (IL-12) is a potent, well-characterized pro-inflammatory cytokine Intratumoral delivery of IL-12 stimulates a safe but powerful immune response 1 Injection of tavokinogene telseplasmid (tavo) 2 Intratumoral electroporation delivers tavo into the cells 3 IL-12 is expressed and secreted 4 Local inflammation and T cell education 5 Systemic anti-tumor immune response 7
6 Patient demographics were similar between the trials Age (years) OMS-I100 tavo monotherapy OMS-I102 tavo + pembro combination N / mean (SD) N=51/ 66.7 (11/2) N=23 / 65.5 (12.2) Median, min max 65.0, 44, 89 67, 39, 91 Sex - Male / Female 33 (64.7%) / 18 (35.3%) 13 (56.5%) / 10 (43.5%) Stage at enrollment Stage III b and IIIc 29 (56.8 %) 14 (60.9%) Stage IV M1a and M1b 19 (36.3%) 4 (17.4%) Stage M 1c 3 (5.9%) 5 (21.7%) Prior checkpoint inhibitors apd actla BRAF Mutant 17 (33.3%) 7 (30.4%) Unknown, not tested 34 (66.7%) 16 (59.6%) 8
7 Less than 10% Treatment Emergent Serious AE reported to date in monotherapy or in combination Preferred Term OMS-I100 tavo monotherapy N=51 Patients reporting any TESAE 5 (9.8%) 2 (8.7%) Coronary Artery Disorder Non ST- elevation myocardial infarction 0 1 (4.3%) Infections and infestations Cellulitis 1 (2.0%)* 1 (4.3%)* Musculoskeletal and connective tissue disorder Rhabdomyolysis 1 (2.0%) 0 Nervous System Disorder Cerebrovascular accident Dizziness 1 (2.0%) 1 (2.0%) Respiratory, thoracic, and mediastinal disorder Pulmonary embolism 1 (2.0%) 0 OMS-I102 tavo + pembro combination N= *possibly related 9
8 Clinical relevant responses BORR OMS-I100 Tavo D monotherapy N=26 OMS-I100 Tavo D 6 weeks monotherapy N=20 OMS-I102 # Tavo + pembro Combination in predicted apd-1 non responders N=22 BORR (CR + PR)* 9 (34.6%) 5 (25%) 11 (50%) DCR (CR + PR +SD)* 18 (69.2%) 13 (65.0%) 13 (59.0%) CR 5 (19.2%) 0 9 (41.0%) PR 4 (15.4%) 5 (25.0%) 2 (9.0%) SD 9 (34.6%) 8 (40.0%) 2 (9.0%) PD 8 (30.8%) 7 (35.0%) 9 (41.0%) # OMS-I102 patients were selected based on biomarker data, thus the PISCES /Keynote 695 trial to address the patient populations *OMS-I100 was modified skin RECIST and OMS-I102 RECIST with one pseudo progression. RECISTv1.1 BORR was 42.9% 10
9 What is the mechanism of the immune responses observed?
10 W 6 : S c r e e n ( C D 3 - C D C D N K C e l l s ) Upregulation of innate immune mediators in the periphery of responding patients after monotherapy Serum Analysis PBMC Flow Analysis W 6 : S c r e e n ( C D 3 - C D C D N K C e l l s ) s p o n d e r e s p o n d e r p < s p o n d e r e s p o n d e r 12
11 M e l a n o m a S c o r e M e l a n o m a S c o r e Intratumoral tavo triggers adaptive resistance which is enhanced with anti-pd-1 combination IT-tavo-EP p = IT-tavo-EP + pembro p < P r e P o s t 0 P r e P o s t 16
12 Significant increase of proliferating partially exhausted CD8 + T cells with combination therapy IT-tavo-EP NS IT-tavo-EP + pembro p < % Ki-67 + (PD-1 + T Cells) % Ki-67 + (PD-1 + T Cells) Pre Post 0 Pre Post 17
13 log10 P-value log10 P-value Combination increases post-treatment intratumoral expression of NanoString immune-based gene set IT-tavo-EP IT-tavo-EP + pembro All Patients (Combo) Higher Pre-Treatment Higher Post-Treatment Higher Pre-Treatment Higher Post-Treatment Th1/Anti-tumor genes Th2/Tumor promoting genes Th1/Anti-tumor genes Th2/Tumor promoting genes P= P=0.01 P=0.05 P= Log2 Fold Change Log2 Fold Change 18
14 log10 P-value log10 P-value log10 P-value log10 P-value Treatment-related increased Th1/anti-tumor-related gene expression pronounced in responders IT-tavo-EP IT-tavo-EP Non-Responders + pembro (Combo) Higher Pre-Treatment Higher Post-Treatment Higher Pre-Treatment Higher Post-Treatment Th1/Anti-tumor genes Th2/Tumor promoting genes Th1/Anti-tumor genes Th2/Tumor promoting genes Non-Responders 0.01 P= P=0.01 P=0.05 P= Higher Pre-Treatment Higher Post-Treatment Log2 Fold Change Th1/Anti-tumor genes Th2/Tumor promoting genes Higher Pre-Treatment Higher Post-Treatment Log2 Fold Change Responders (Combo) Th1/Anti-tumor genes Th2/Tumor promoting genes Responders 0.01 P= P=0.01 P=0.05 P= Log2 Fold Change Log2 Fold Change
15 Count Count Combination therapy significantly increases IFN-g responsive genes in the tumor microenvironment 100 IFNg 15-Gene Signature All Samples Screen vs. Post-Treatment IT-tavo-EP 102 All Samples IT-tavo-EP Screen vs. + Cycle pembro * * * * * * * * Pre-Treatment Post-Treatment p < CXCL10 CXCL9 IDO1 IFNG STAT1 CCL5 GZMK 10 Pre-Treatment Post-Treatment p < CXCL10 CXCL9 IDO1 IFNG STAT1 CCL5 GZMK 20
16 Conclusions Clinically IT-tavo-EP is well tolerated (<10% SAE) alone and in combination with pembrolizumab BORR % with IT-tavo-EP alone Clinically meaningful response rate in predicted non-responders to apd-1 was 50% with IT-tavo-EP + pembrolizumab Immunologically Systemic innate responses with IT-tavo-EP but combination drives the frequency of pectl Increase of adaptive resistance with IT-tavo-EP is augmented with combination therapy Increased intratumoral Th1/IFN-g gene expression is augmented with combination therapy IT-tavo-EP promotes innate and adaptive cellular responses, triggering adaptive resistance and a partially exhausted immune response that pembrolizumab is able to reinvigorate leading to increased efficacy 21
17 Acknowledgements The patients and their families! UCSF Ari Oglesby Kristine Winters Lawrence Chen Oncosec Tu Diep Punit Dhillon Toshimi Takamura Merck Judith Liao Scot Ebbinghaus 22
8 of 21 (38.1%) Achieved RECIST v1.1 Durable Complete Response (CR) in Predicted Anti-PD-1 Non-Responder Melanoma Patients at 24 Weeks
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