H ig h ly p o te n t a n d s e le c tiv e R E T in h ib ito r, B L U -6 6 7, a c h ie v e s p ro o f o f c o n c e p t in A R R O W, a p h a s e 1 s tu d y o f a d v a n c e d, R E T-a lte re d s o lid tu m o rs Vivek Subbiah 1, atthew Taylor 2, Jessica Lin 3, imi Hu 1, Sai-Hong Ignatius Ou 4, arcia S. Brose 5, Elena Garralda 6, Corinne Clifford 7, ichael Palmer 7, eera Tugnait, 7 Erica Evans 7, Hongliang Shi 7, Beni Wolf 7, and Justin Gainor 3 1 Department of Investigational Cancer Therapeutics, The University of Texas D Anderson Cancer Center, Houston, United States; 2 The Knight Cancer Institute, Oregon Health & Science University, Portland, United States; 3 Department of edicine, assachusetts General Hospital, Boston, United States, 4 Chao Family Comprehensive Cancer Center, University of California Irvine edical Center, United States; 5 Abramson Cancer Center, University Of Pennsylvania, Philadelphia, United States; 6 Vall d Hebron Institute of Oncology, Vall d Hebron University Hospital, Barcelona, Spain; 7 Blueprint edicines Corporation, Cambridge, United States; NCT03037385 2018 Blueprint edicines Corporation 1
Disclosures I have the follow ing financial relationships to disclose: G rant/r esearch support from : B lueprint edicines C orporation Novartis International AG Bayer AG GlaxoSmithKline plc NanoCarrier Co. Ltd Vegenics Pty Ltd Northwest Biotherapeutics Boston Biomedical Inc Berg Incyte Corporation Fujifilm Holdings Corporation Pharmaar D3 Pfizer Inc ultivir Inc Amgen Inc AbbVie Inc Loxo Oncology F. Hoffmann-La Roche AG / Genentech Inc National Comprehensive Cancer Network National Cancer Institute-Cancer Therapy Evaluation Program BLU-667 is an investigational agent discovered and currently in development by Blueprint edicines Corporation (Blueprint edicines) 2
Receptor tyrosine kinase, REarranged during Transfection (RET) Normal RET signaling GDNF ligand GFRα1 TK1 TK2 RAS/RAF/EK/ERK RET Receptor Tyrosine Kinase Organ development and tissue homeostasis 3
Receptor tyrosine kinase, REarranged during Transfection (RET) Normal RET signaling Activating RET m utations* Oncogenic RET signaling GDNF ligand C620/C634 GFRα1 TK1 V804L/ Dimeric RET fu sio n s KIF5B-, CCDC6-,NCOA4, TRI-33- and more partners TK2 RET Proto-oncogene RAS/RAF/EK/ERK Organ development and tissue homeostasis Tumorigenesis 4
RET is a rare driver of multiple, diverse tumor types 1,2 Esophageal cancer Breast cancer edullary thyroid cancer >60% RET-mutations Papillary thyroid cancer ~10% RET-fusions Other tumor types 1% RET-altered elanoma Non-small cell lung cancer ~1-2% RET-fusions Colorectal cancer Leukemia 1. Drilon A et al. Nat Rev Clin Oncol. 2018;15:151-67 2.Kato S, et al. Clin Cancer Res 2017;23:1988-1997. 5
Patients with RET-alterations have not benefited from precision oncology P recision oncology Non-small cell lung cancer E G FR m utation ALK -fusion R O S -fusion Selective RTK inhibitors 1 Activity and off-target toxicity Typical ORR >60% Typical PFS >9 months Favorable tolerability KI, multikinase inhibitors; TC, medullary thyroid cancer; NSCLC, non-small cell lung cancer; ORR, overall response rate; PFS, progression-free survival; RTK, receptor tyrosine kinase 1. Herbst RS et al. Nature 2018; 553:446-54; 2. Drilon A et al. Nat Rev Clin Oncol. 2018;15:151-67. 6
Patients with RET-alterations have not benefited from precision oncology P recision oncology Current non-targeted paradigms for RET Non-small cell lung cancer NSCLC TC Refractory solid tumor E G FR m utation ALK -fusion R O S -fusion R E T- fusion R E T-m utation R E T- fusion Chemotherapy Immunotherapy ultikinase inhibitors ultikinase inhibitors No standard of care Selective RTK inhibitors 1 Activity and off-target toxicity Typical ORR >60% Typical PFS >9 months Favorable tolerability ultikinase Inhibitors 2 Activity and off-target toxicity NSCLC Typical ORR <30 % Typical PFS ~4.6 7.3 months TC Typical ORR 25-45% Typical PFS ~11-30 months KI have frequent dose reduction/interruption for treatment related toxicity KI, multikinase inhibitors; TC, medullary thyroid cancer; NSCLC, non-small cell lung cancer; ORR, overall response rate; PFS, progression-free survival; RTK, receptor tyrosine kinase 1. Herbst RS et al. Nature 2018; 553:446-54; 2. Drilon A et al. Nat Rev Clin Oncol. 2018;15:151-67. 7
BLU-667 was designed to treat RET-altered cancers Subnanomolar potency 1 ore Potent than KI Kinome selectivity for RET Less Active than BLU-667 ore Active than BLU-667 Variant Biochemical IC 50 (n) RET wildtype 0.4 RET V804L 0.3 RET V804 0.4 RET 0.4 CCDC6-RET 0.4 1. Subbiah V et al. Cancer Discovery April 15 2018 8 Kinome illustration reproduced courtesy of Cell Signaling Technology, Inc. (CSTI) ( www.cellsignal.com). The foregoing website is maintained by CSTI, and Blueprint edicines is not responsible for its content
Tum or volum e (m m 3 ) P ercentage reduction in D U S P 6/S P RY 4 vs vehicle BLU-667 potently inhibits RET-driven tumor growth K IF5B -R E T N S C LC patient-derived xenograft 1 P otent P athw ay inhibition 2250 0 1750 1500 R E T E K E R K D U S P 6 / S P RY 4 0-20 1250-40 1000 750-60 500 250 0 0 5 10 15 20 25 30 D ays after start of treatm ent Vehicle 3 mg/kg BID 10 mg/kg BID 30 mg/kg BID 60 mg/kg QD -80-100 BID, two times per day; QD, once daily 1. Subbiah V et al. Cancer Discovery April 15 2018 9
BLU-667 ARROW first-in-human study P a rt 1 : D o s e e s c a la tio n completed Opened arch 2017 P a rt 2 : D o s e e x p a n s io n enrolling NSCLC Failed prior kinase inhibitor Advanced RET-altered solid Tablets will go to US first tumors BOIN design BLU-667 orally QD continuous NCT03037385 TD NSCLC No prior kinase inhibitor edullary Thyroid Cancer Other RET-altered solid tumors K ey objectives TD, safety, pharmacokinetics, pharmacodynamics, anti-tumor activity BOIN, Bayesian optimal interval; TD, maximum tolerated dose 10
Demography and baseline characteristics P aram eter (N =53) P aram eter (N =53) Age, years; median (range) 56 (19-83) Sex, male; n (%) 30 (57) ECOG PS; n (%) 0 1 21 (40) 32 (60) etastatic disease; n (%) 50 (94) Tumor type; n (%) RET-alteration edullary thyroid cancer Non-small cell lung cancer Papillary thyroid cancer Retroperitoneal Paraganglioma Non-RET altered solid tumor 51 (96) 29 (55) 19 (36) 2 (4) 1 (2) 2 (4) Prior systemic therapy; n (%) ultikinase inhibitor; n (%) Chemotherapy; n (%) Immunotherapy; n (%) # of lines, median (range) 41 (77) 27 (51) 19 (36) 18 (34) 1 (0-8) ECOG PS, Eastern Cooperative Oncology Group performance score Data cut-off: April 6, 2018 11
Diverse RET genotypes enrolled 12
Dose escalation results D ose (m g Q D ) aximum Tolerated Dose 400 mg QD # E valuable (N =49) D ose lim iting toxicity 30 1 None 60 6 None 100 5 Alanine transaminase increased (1) 12 None 41 of 53 patients rem ain on treatm ent (m edian 3.9 m onths [range: 0.3 11.5]) 53 41 11 400 10 600 4 Tumor lysis syndrome (1) Hypertension (1) Asthenia (1) Hypertension (1) Hyponatremia (1) Hypertension (1) 8 Progressive Disease 1 unrelated AE 1 related AE ( ALT) 1 non-com pliance 1 unrelated death ALT, alanine aminotransferase Data cut-off: April 6, 2018 13
BLU-667 mean plasma concentration (ng/ml) Percentage reduction in DUSP6 and SPRY4 vs Baseline Dose-dependent exposure and RET pathway inhibition 10000 S teady-state P harm acokinetics Tum or P harm acodynam ics 100 1000 Brain IC 90 75 50 R E T E K E R K D U S P 6 / S P RY 4 100 Plasma IC 90 25 0-25 10-50 -75 1 0 5 10 15 20 25 Time (h) -100 30 mg QD 60 mg QD 100 mg QD mg QD mg QD 400 mg QD 600 mg QD 14
60 60 100 100 60 60 60 60 100 60 100 60 % reduction in CD21 % reduction in CD21 Dose-dependent decline in TC tumor markers C arcinoem bryonic antigen (C E A) C alcitonin 25 25 0 0-25 -25-50 -50-75 -75-100 -100 60 mg QD 100 mg QD mg QD mg QD Data cut-off: April 6, 2018 15
Serum arker (% Baseline) Reduction in Tumor (%) Potent activity against highly invasive RET-mutant TC Baseline onth 4 120% 100% 80% 60% 40% 20% Calcitonin CEA Tumor 0% -50% 0 30 1 60 2 90 3 120 4 1505 180 6 210 7 240 8 270 9 10 onth BLU-667 60 mg 100 mg 190 mg mg mg dose 10% 0% -10% -20% -30% -40% 16 27-year-old male; RET L629-D361 Del; initiated at 60 mg; ongoing at 400 mg with confirmed PR
ct DNA (% Baseline) Reduction in Tumor Potent activity against KIF5B-RET NSCLC post chemotherapy Baseline onth 4 FISH KIF5B 10p11.22 Breakpoint FUSION RET 10q11.21 100% 80% 60% 40% 20% TP53 ctdna KIF5B ctdna Tumor 0% -10% -20% -30% KIF5B Exons 1-15 Chr10:32315000 RET Exons 12-20 Chr10:43610000 0% BLU-667 mg Dose 0 30 1 602 90 3 120 4 150 5 180 6 210 7 240 8 270 9 onth mg -40% 17 37-year-old female; ongoing at 400 mg with confirmed PR Subbiah V et al. Cancer Discovery April 15 2018
Potent activity against KIF5B-RET NSCLC post-vandetinib+everolimus Baseline First Assessment (onth 2) 74-year-old male; initiated at mg; ongoing at 400 mg; PR at month 5 pending confirmation 18 Subbiah V et al. Cancer Discovery April 15 2018
Activity against KIF5B-RET NSCLC brain metastases Baseline First assessment (onth 2) 69-year-old male; initiated at 400 mg; ongoing at month 4 19 Images courtesy of Drs of Gainor, J and Lin, J of GH
aximum Reduction from Baseline (%) KIF5B C634R V804 KIF5B CCDC6 EN2B RET FISH+ CCDC6 KIF5B 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 V388A/C634R KIF5B L629-D681 Del KIF5B KIF5B CCDC6 RET In/Del E632_I638 Del KIF5B KIAA1468 CCDC6 CCDC6 BLU-667 has broad anti-tumor activity against RET-altered cancers 30 20 PD 10 0-10 -20-30 -40-50 -60-70 -80-90 IC B est R esponse IC IC E valuable P atients (N =40) n, (% ) CR* 1 (3) PR** 17 (43) SD 20 (50) PD 2 (5) IC * confirmed ** 10 confirmed, 7 pending confirmation I IC C C IC IC Non-small cell lung cancer edullary thyroid cancer Papillary thyroid cancer IC I I I C IC SD PR C, prior chemotherapy; CR, complete response; I, prior immunotherapy;, prior KI therapy; KI, multikinase inhibitor; PD, progressive disease; PR, partial response; SD, stable disease Data cut-off: April 6, 2018 20
Prior Therapy BLU-667 has durable activity and high response rate in RET-altered NSCLC IC I C C IC IC IC C IC IC IC C IC I C IC B est R esponse Treatment Duration (days) E valuable P atients (N=14); n (%) CR 0 PR* 7 (50) SD 5 (36) PD 2 (14) * 5 confirmed, 2 pending confirmation 1 29 57 85 113 141 169 197 225 253 281 309 337 365 KIF5B KIAA1468 CCDC6 RET FISH+ Treatment duration: edian 3.9 months Range 0.4 11.4 months 13/19 (68%) on treatment Data cut-off: April 6, 2018 21
Prior Therapy BLU-667 has durable activity and high response rate in RET-altered TC C IC I I I I B est R esponse 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 8.00 9.00 10.00 11.00 12.00 13.00 Treatment Duration (days) E valuable P atients; (N =25) N (% ) CR* 1 (4) PR** 9 (36) SD 15 (60) PD 0 *confirmed;**5 confirmed,4 pending confirmation 1 29 57 85 113 141 169 197 225 253 281 309 337 365 L629-D361 Del V388A/C634R C634R RET In/Del E632_1638 Del Other RET V804 Treatment duration: edian 4.7 months Range 0.5 11.5 months 25/29 (86%) on treatment Data cut-off: April 6, 2018 22
BLU-667 is well tolerated Treatment-emergent Adverse Events 10% per CTCAE (30-400 mg Safety Population, N=49) Adverse event, n (% ) G rade 1 G rade 2 G rade 3 G rade 4/5 Constipation 10 (20) 2 (4) 0 0 ALT increased 10 (20) 0 1 (2) 0 AST increased 8 (16) 2 (4) 0 0 Hypertension 2 (4) 2 (4) 4 (8) 0 Fatigue 5 (10) 1 (2) 1 (2) 0 Edema peripheral 6 (12) 1 (2) 0 0 Diarrhea 4 (8) 1 (2) 1 (2) 0 Blood creatinine increased 6 (12) 0 0 0 Hyperphosphatemia 4 (8) 2 (4) 0 0 Headache 5 (10) 1 (2) 0 0 Leukopenia 5 (10) 0 0 0 Neutropenia 2 (4) 1 (2) 2 (4) 0 White blood cell decreased 2 (4) 2 (4) 1 (2) 0 Insomnia 5 (10) 0 0 0 Cough 3 (6) 2 (4) 0 0 AE, adverse event; ALP, alkaline phosphatase; ALT, analine aminotransferase; AST, aspartate aminotransferase; CTCAE, common terminology criteria for adverse events Data cut-off: April 6, 2018 ost adverse events were Grade 1 8 (16%) patients had Grade 3 treatment-related AE No Grade 4/5 treatment-related AEs 23
Conclusions BLU-667 delivers: Potent RET pathway inhibition with favorable tolerability Broad anti-tumor activity regardless of RET genotype, indication and prior therapy High preliminary response rates and durable activity ORR: RET-fusion NSCLC 50% ORR: RET-mutant TC 40% ORR: RET-fusions and mutations (NSCLC, TC and PTC) 45% 41 of 51 RET-altered patients remain on treatment ARROW dose escalation data validate BLU-667 as a promising precision therapy for RET-altered cancers ARROW dose expansion is open and enrolling globally BLU-667 manuscript published today in Cancer Discovery Foundational preclinical work and clinical translation Data cut-off: April 6, 2018 24
Acknowledgements We thank the participating patients, their families, all study coinvestigators, and research co-ordinators at the following institutions: Department of Investigational Cancer Therapeutics, The University of Texas D Anderson Cancer Center, Houston, United States The Knight Cancer Institute Oregon Health & Science University Portland, United States Department of edicine, assachusetts General Hospital Cancer Center, Boston, United States Chao Family Comprehensive Cancer Center University of California Irvine edical Center, United States Abramson Cancer Center, University Of Pennsylvania, United States Vall d Hebron Institute of Oncology Vall d Hebron University Hospital, Barcelona, Spain 25