10 short minutes about this company, Isofol. If I can get this to work. Here we go. We're basically an oncology-focused biotech company listed on Nasdaq here in Stockholm. I'm going to try and keep this quite simple for you as we only have 10 minutes, and I'll structure the talk in three key areas. First of all, what is the problem we are actually trying to solve at Isofol? Secondly, why is this worth solving, both from a humanitarian and an investor perspective? And thirdly, how can Isofol as a company actually make a difference here, and what are our prospects as a company? The underlying issue here is that patients treated for solid tumors typically respond inadequately to first-line standard therapies. Response rates are well below 50% for most solid tumors. As a matter of fact, the more lines of treatments patients have to pass through, the worse the outcomes get. This is clearly a main issue across solid tumors. Isofol has decided to focus on metastatic colorectal cancer as the first and lead indication, and others will then follow. This selection has been made simply because this is a combination of a large group of patients. It's actually 2 million cases yearly globally, about 1 million deaths globally, and it's the second-leading cause of cancer-related death. Our first and initial focus is metastatic disease, and the prognosis for these patients is unfortunately still dire. 86% of them are dead within five years of getting their diagnosis, despite all the innovation that is out there in pharma pipelines. Clearly, a main issue and something has to be done. There is a large area for improvement. Why then is it worth working on this specific issue? Well, we believe that working and improving outcomes in the first-line setting is actually where the greatest benefit can be achieved for the largest group of patients. About 90% of colorectal cancer patients get standard chemotherapy in first line. We're also stuck with this. It's the dominating therapy today, and everything points at this will be the fact also tomorrow. There is nothing basically in the pharma pipelines that will replace this first-line standard chemo. There is a lot going on here in colorectal cancer in general. Most of these treatments are intended to be used in later lines of treatment or as an add-on to the standard chemo backbone. From a humanitarian perspective, it's obvious that something has to be done in this field. From an investor perspective, this actually does translate into quite an interesting commercial opportunity, given what the market landscapes looks like. Again, we're talking about a large patient group, about 2 million cases annually of colorectal cancer. There's clearly a high need for better treatments. Competition in the field is limited. As I said, most initiatives and innovation is focused on later lines of treatment. Given the seriousness of this disease, the high mortality rates and so forth, there is a high willingness to pay for innovation also in first line, from the part of payers. Thirdly, how can we make a difference as a company in this field? We basically have a drug, arfolitixorin, designed to replace one of the standard components in the first-line chemo regimen. It's a new next-generation type of folate, basically. The mode of action is quite easy. I will jump straight to how it differentiates from today's standard of care. The drug used today is called leucovorin in most countries in the world. This is a prodrug that requires multi-step conversion before it gets to the active substance that actually can exert its efficacy in the tumors. The whole invention with arfolitixorin is that this is the active substance, the active metabolite from the start, bypassing that whole need for metabolic conversion. The drug is basically directly active. We have seen in preclinical and earlier clinical trials that this is translatable into improved outcomes in different forms. We are currently now in a phase I-B/II trial, combined phase one and two trial, and the data we have seen so far here is promising. I will give a flavor of the underlying package of evidence that we have to date. First of all, preclinically, we have seen two very interesting things. First of all, in various models, predominantly organoid models, that the efficacy of this drug compared to standard of care is consistently higher, regardless of which dose we give. Second finding is that there is a dose-response relationship. The more drug we give, the more the efficacy increases. This is actually quite unexpected and strongly differentiates arfolitixorin from today's folate. Folinic acid of today does not get better with increased doses. It basically plateaus at a quite early stage and stays like that. We have seen in years of experimenting out there in the clinics that nothing happens despite how much drug you give. It seems like the system gets saturated at a certain point. Clinically, we have also seen quite interesting data so far. First of all, when we resect and remove tumors, we have seen several-fold higher concentrations of the active substance after arfolitixorin as compared to after giving leucovorin. Very interesting. Obviously, we can change the tumor environment and make it more receptible to chemotherapies. Isofol has previously conducted a large phase III trial that actually did not meet its primary endpoint. We know why now, and that is because the doses used in that trial was extremely low, much lower than in the comparator standard of care arm, and there were also other issues with the dosing regimen. But what that study actually showed was that the drug is efficacious. There is no question that the drug is active. That is sort of already established in this case. All the learnings from that phase III program have now been incorporated in the new phase I-B/II trial that is currently ongoing. Spend a couple of minutes on that trial. This is basically what it looks like. We are right now in the first phase I-B, classic dose escalation trial. We are currently at the last, and hopefully final, highest dose level in the trial, 500 milligrams of arfolitixorin. We are moving on before year end to phase II, which is a much larger trial. We are looking at about 90 patients across Europe and Japan, and it is also randomized. We are testing different doses of arfolitixorin versus standard of care. In this trial, we will get a confirmation, perhaps not statistically significant due to the small sample size, but still we will see the efficacy delta numerically between our drug and standard of care. Extremely interesting to see the outcome of phase II. We have already seen promising data coming out of phase one. Only a small number of patients, I have to admit that, but still quite interesting. First of all, no safety issues in the doses given to date. All patients actually showed tumor shrinkage, so total tumor burden decreased in all patients included in the trial. We did not expect this, actually. Thirdly, about half of the patients included until that interim readout were unexpectedly taken out of the study for tumor resection. This was actually an exclusion criteria. If the patients were well enough to be operated, that is the route they should go. They should not enter the trial. Here we were surprised to see that after a couple of cycles of treatment, the tumor characteristics changed to an extent that resection was all of a sudden possible. Very interesting. This readout was made earlier this year, and we are hoping to be able to come with another second interim readout, during this fall ahead of the total top-line data that is coming out later. We are, of course, looking forward to that quite a lot. Question then, do we do this alone as a small Swedish biotech company? The answer is no. We are surrounded by a strong network of clinical experts across the world. We handpick the leading experts really to work with us on this journey. We also have a number of commercial partnerships in place with a Japanese pharma company who are responsible for development and commercialization in Japan. We have Merck, German Merck, who are manufacturing the drug substance, and we also have secured CMC and large scale manufacturing with Recipharm already. Finally then, what does the commercial opportunity look like here? First of all, the market for colorectal cancer treatments is growing, expected to amount to about $17 billion by 2030, growing year by year as you can see. For us, our market research show that we should be able to get actually a blockbuster status in this market, so about $1 billion in the U.S. alone. Then to that, we can add other regions, obviously, and also other potential follow-on indications, first in the adjuvant and neoadjuvant space in colorectal cancer, but then other solid tumors where 5-FU- based chemotherapies are also standard first-line therapies. Just to sum it up in a slightly different way than I started, we are working in an area where the unmet medical need is extreme, I would say. Again, 85% or 86% even, of patients are dead within five years of getting their diagnosis. Simply not acceptable. The need for something better here is obvious. Secondly, I believe we have a high potential drug candidate. arfolitixorin has potential, and despite being in phase I now, has already a platform of evidence that is unusual for a drug at this early stage. Thirdly, yes, it is possible also to make money if one like on this opportunity. The market is large, and the share that the arfolitixorin should be able to capture according to our research is significant. I think I will stop there and give time for some questions. Do you have any questions in the room? I will start. I have got one here. What market penetration are you assuming to reach the blockbuster potential? Yeah, so that depends how you measure market penetration. If it is in the total drugs used, these patients receive about five different drugs in the first line setting. So we have measured that against our key competitor, which is leucovorin or today's folinic acid. And we believe a quite conservative estimate, what is behind that blockbuster potential I mentioned, is about 50%-60% market share in that segment. I see. I know that recruitment had been a bit slower than you had hoped, but if you want to talk us through the actions that you took to resolve that issue and you feel confident now that it is sort of full speed ahead. Sure. Yeah. So that is true for us as for many biotechs. Exactly. Enrollment and recruitment in the trials is rarely as swift as we would. As one you would wish, yeah. Yes, exactly. We started out with one key hospital, Charité in Berlin, as our strategic partner. That is also where the clinical trial was taking place initially. We have struggled with enrollment pace and as a result of that, expanded to several other clinics. We are now adding another clinic in Germany to the trial to speed up the final part of phase I-B. Then for phase II, it is really going to be a dramatic increase. We are looking now at at least 15 hospitals in four different countries in Europe and Japan, so five countries in total. Everything points that that will have a huge impact on the recruitment pace. Yeah. Yeah. People are always interested about the financial status. How would you say that the financial status of Isofol is right now? Good for now. Good for now. Absolutely. Isn't that always the answer. Yeah. As a listed company, we generally don't guide on the actual runway and the forecast from that regard. What we have said is that the funding in our hands at the moment will definitely take us to a meaningful readout of this trial. This trial. Yeah. Coming back to pricing, leucovorin is very cheap. Do you see any problems in convincing users to pay a whole lot more for your drug? Not if we are significantly better. That was obviously a key concern all along, and that is also why we invested quite a lot of energy, and money for that matter, into market research, talking to U.S. payers, what they would be willing to pay for a drug like this, given a certain efficacy benefit over today's standard of care. If we can show a clinically meaningful efficacy benefit, they would easily be willing to pay about 10 times the price of generic leucovorin at the minimum. This is research done by an external company called Back Bay, who did this in late 2024 for us. We expect that to still hold true. That sounds comforting. Indeed. I think we will end on that comforting note. Thank you so much, Petter. Thank you.
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