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Good day, and welcome to the Seattle Genetics Business Update Conference Call. Today's conference is being recorded. At this time, I'd like to turn the conference over to Peggy Pinkston, Vice President of Investor Relations. Please go ahead, ma'am.
Thank you, operator, and good afternoon, everyone. I'd like to welcome all of you to Seattle Genetics' first quarter 2018 conference call. With me today are Clay Siegall, President and Chief Executive Officer; Todd Simpson, Chief Financial Officer; Jonathan Drachman, Chief Medical Officer and Executive Vice President, Research and Development; and Darren Cline, Executive Vice President, Commercial.
Following our prepared remarks today, we will open the line for questions. If we are unable to get to all of your questions, we will be available after the conclusion of the call. Today's conference call will include forward-looking statements regarding future events or the future financial and operating performance of the company, such as those, among others relating to the company's 2018 financial outlook including the anticipated second quarter ADCETRIS sales, and future revenues, costs and expenses, the company's potential to achieve anticipated regulatory and clinical milestones and expected timing thereof including data availability from ECHELON-2, as well as other planned and ongoing clinical trials, including enfortumab vedotin, tucatinib, tisotumab vedotin and ladiratuzumab vedotin.
Actual results or developments may differ materially from those projected or implied in these forward-looking statements. Factors that may cause such a difference include that the company may be delayed in its planned clinical trial initiations, the enrollment in and conduct of its clinical trials, obtaining data from clinical trials, planned regulatory submissions, and regulatory approvals in each case for a variety of reasons, including unexpected adverse events or regulatory discussions or actions and the inherent uncertainty associated with the pharmaceutical development and approval process. More information about the risk and uncertainties faced by Seattle Genetics is contained under the caption Risk Factors, included in the company's annual report on Form 10-K for the year ended December 31, 2017 filed with the Securities and Exchange Commission.
And with that, I'll turn the call over to Clay.
Thanks, Peg, and good afternoon, everyone. The first quarter of 2018 was extraordinary and provided us with powerful momentum towards our goal of building Seattle Genetics into a global oncology company. The approval of an ADCETRIS-based regimen in frontline Hodgkin lymphoma establishes a new standard of care option for Stage III and IV patients and the launch is off to a strong start.
We received breakthrough therapy designation from the FDA for enfortumab vedotin in metastatic urothelial cancer underscoring the strength of our data and the unmet medical need. And we completed the acquisition of Cascadian Therapeutics securing global rights to the late-stage breast cancer program tucatinib.
Today, I'll outline key activities with our lead programs. Darren will discuss our commercial progress and then Todd will discuss our first quarter financial results and provide some updated financial guidance. After that, Jonathan will highlight recent progress with our earlier stage pipeline.
On March 20th, we received FDA approval of ADCETRIS in combination with chemotherapy for the treatment of newly diagnosed patients with Stage III or IV classical Hodgkin lymphoma based on the successful outcome of the phase 3 ECHELON-1 clinical trial. This approval has the potential to be transformative for patients where the standard of care has not changed in more than four decades. FDA previously granted Breakthrough Therapy Designation for this setting. Approval came six weeks ahead of the FDA priority review action date of May 1 underscoring the importance of a new treatment option for patients in need.
Our first quarter sales of ADCETRIS in the U.S. and Canada were $95.4 million, a 36% increase over the first quarter of 2017. Based on the new label for ADCETRIS in frontline Hodgkin lymphoma the full year 2018 sales guidance we provided in February no longer reflects our outlook. While it is difficult to provide accurate annual guidance at this earlier juncture of the E-1 launch, we expect sales of ADCETRIS to be in the range of $105 million to $110 million for the second quarter of 2018. We look forward to providing further guidance as we monitor the dynamics and trajectory of our sales in frontline Hodgkin lymphoma.
Looking forward, we anticipate reporting additional key analyses from the E-1 trial to further inform the clinical community on patient outcomes from this large global study. Notably, at ASCO, we will present data on patients treated in North America. We believe these data are a useful indicator of what we would expect to see when ADCETRIS plus AVD is used in conjunction with North American standard of care.
In addition, we will report efficacy data from patients who received primary prophylaxis with G-CSF which were shown to optimize outcomes and reduce adverse events of the ADCETRIS plus AVD regimen. We believe another key driver of ADCETRIS growth in the future will be frontline peripheral T-cell lymphomas also referred to as mature T-cell lymphomas. This is a setting of our phase 3 ECHELON-2 trial. In the E-2 trial, we are evaluating PFS of ADCETRIS plus CHP compared to standard of care CHOP chemotherapy in newly diagnosed patients.
Approximately 4,000 patients are diagnosed annually in the U.S. with CD30-expressing PTCL. We expect to report data from the E-2 trial this year. Our clinical stage pipeline is an increasingly important part of Seattle Genetics. We believe our multiple and promising late stage programs will be a primary driver of future growth for the company and enable us to achieve our goal of bringing new medicines to people with cancer.
Our lead late-stage clinical program is enfortumab vedotin or EV, which we are co-developing with Astellas. Our initial focus with EV is in patients with locally advanced or metastatic urothelial cancer who have previously been treated with a checkpoint inhibitor or CPI. We recently received Breakthrough Therapy Designation from the FDA in this setting, an acknowledgement of our phase 1 data and the lack of available options for these patients. Updated data from the phase 1 clinical trial of EV will be presented in an oral session at ASCO in early June.
We are conducting a single-arm single-agent pivotal trial of EV known as EV-201 in urothelial cancer patients, who have previously received a CPI. The primary endpoint of the trial is confirmed objective response rate. Most patients in this setting have also been treated with cisplatin or carboplatin, two platinum-based chemotherapy agents commonly used in urothelial cancer. We are evaluating two CPI treated populations, platinum treated patients and those who have not received platinum.
We expect to complete enrollment in the first group of patients before the end of the third quarter of this year positioning us for data in the first half of 2019. This represents a potential expedited pathway to registration in patients who have already received both platinum and a CPI.
In addition, we and Astellas plan to expand the program and continue enrolling patients with urothelial cancer who have received a CPI but not a platinum agent. We believe data from this separate subgroup of patients could potentially serve as the basis for a second-labelled indication.
Complementing our single-agent strategy, we are conducting a phase 1b trial of EV in combination with pembrolizumab for first or second-line metastatic urothelial cancer. This could serve to provide data on EV in an earlier line of therapy and allow us to further understand the potential value of combining ADCs with CPIs.
Lastly in mid-2018, we and Astellas plan to initiate a phase 3 trial of EV in the post CPI setting. This study called EV-301 will enroll approximately 550 patients and is intended to serve as the confirmatory trial and support global approvals. The primary endpoint will be overall survival. Our next late-stage program is tucatinib which recently entered our pipeline through the acquisition of Cascadian Therapeutics. Tucatinib is an oral, small molecule tyrosine kinase inhibitor, or TKI, that is highly selective for HER2. We believe tucatinib has the potential to be a best-in-class TKI based on its tolerability profile and its potential in patients with HER2-positive metastatic breast cancer.
We are evaluating tucatinib versus placebo each in combination with capecitabine and trastuzumab in a randomized pivotal trial called HER2CLIMB for patients with HER2-positive metastatic breast cancer with or without brain metastasis. The primary endpoint is progression free survival. The trial is intended to support applications for approval in the United States and European Union as well as in the rest of the world.
Despite major treatment advances, there remains a high unmet need and no standard of care exists for third-line HER2-positive metastatic breast cancer and management of brain metastasis. Patient accrual in HER2CLIMB has been robust and is expected to be completed in 2019.
In addition to the initial registration pathway in the third-line setting, tucatinib may have a role in earlier lines of metastatic breast cancer as part of a combination regimen such as with T-DM1, as well as in other HER2 positive solid tumors such as metastatic colorectal cancer. We are currently evaluating the potential for a broader development plan with tucatinib.
Tucatinib expands our breast cancer portfolio alongside the ladiratuzumab vedotin, or LV. LV is an ADC for metastatic triple negative breast cancer. We are conducting multiple phase 2 clinical trials with LV both as a monotherapy and in combination with CPI.
Lastly, with tisotumab vedotin, or TV, we and our partner Genmab are on track to initiate a pivotal phase 2 single-arm, single-agent trial for women with advanced cervical cancer in the first half of this year. Target enrollment is 100 patients and the primary endpoint is confirmed objective response rate. The trial is intended to support regulatory submission under the FDA's accelerated approval regulations.
In addition, we expect to initiate a phase 2 trial later in 2018, evaluating TV in combination regimens for first-line cervical cancer. We also believe that TV may have applications across other solid tumor types based on data from a phase 1 dose escalation trial. We plan to initiate a phase 2 basket trial that will enroll multiple solid tumor types that express tissue factor.
As an update matter, based on a thorough review of our portfolio, we've decided to no longer develop 19A and our clinical stage PBD based ADCs. This decision allows us to focus resources on our most promising programs.
As I said in my opening, 2018 is off to a great start, and the first quarter marked several significant accomplishments. ADCETRIS together with our later stage EV, tucatinib, TV and LV programs strongly position us to address unmet medical needs across both hematologic malignancies and solid tumors.
At this point, I'll turn the call over to Darren to discuss our Commercial activities. Darren?
Thanks, Clay. ADCETRIS net sales were $95.4 million in the first quarter, up 14% over the fourth quarter of 2017. This is the highest sequential quarter-to-quarter growth since 2014. Net sales increased 36% compared to the first quarter of 2017.
There were two main contributors to the growth in the first quarter. First, we began promoting ADCETRIS plus AVD chemotherapy for frontline treatment of patients with stage three 3 and 4 Hodgkin lymphoma following FDA approval on March 20. This approval was based on the phase 3 ECHELON-1 trial which was presented at ASH last December and simultaneously published in The New England Journal of Medicine. And second, we continue to see adoption of ADCETRIS for the treatment of primary cutaneous ALCL in CD30-expressing mycosis fungoides, following FDA approval for this indication in November of last year.
The commercial team was ready for the early FDA approval of ADCETRIS plus AVD and immediately began promotion. Initial launch metrics are encouraging. Our expanded sales force has already reached a significant portion of target physicians and over 150 new community based accounts ordered ADCETRIS since March 1. Utilization in the community setting where the majority of frontline Hodgkin lymphoma patients are treated has been very positive. A regimen that eliminates bleomycin, and has the potential to increase long-term disease-free survival appeals to both patients and oncologists. Our goal is to ensure treating physicians are familiar with the frontline data, so that they are prepared to offer it to the appropriate newly diagnosed patients. This incident population is treated for up to 12 cycles or about six months.
I'm pleased with the way the commercial team has executed on the launch of ADCETRIS in frontline Hodgkin lymphoma, doctors and patients are enthusiastic about the regimen and reimbursement to the label is going very well. I look forward to sharing more details about the launch in future quarters.
I will now turn the call over to Todd to discuss our financial results.
Thanks, Darren, and thanks to everyone for joining us on the call this afternoon. We ended the first quarter in a strong financial position, while accomplishing a lot with ADCETRIS and across our pipeline. We also closed the acquisition of Cascadian, completed an equity financing and entered into new technology and licensing deals. Several of these transactions during the quarter were not reflected in our prior guidance, causing our expenses to exceed consensus. But these activities are intended to drive our future growth.
Today I'll summarize our financial results for the first quarter as well as provide some revisions to our financial outlook for the year as a result of the events in the quarter. Total revenues in the first quarter of 2018 were $141 million. This included record ADCETRIS net sales in the U.S. and Canada of $95 million.
As Clay mentioned, we are guiding for second quarter ADCETRIS net sales of $105 million to $110 million. We are very early in the launch and as we gain more experience with ADCETRIS in the frontline settings we will provide further updates. Royalty revenues in the first quarter of 2018 were $16 million compared to $17 million in the first quarter of 2017.
Beginning in 2018 and in accordance with the new accounting standards for revenue recognition we now report royalty revenues in the same quarter of direct sales by Takeda. If not for this change, we would have reported total royalties of $23 million in the first quarter, reflecting strong year-over-year sales growth by Takeda in its territory. Collaboration revenues were $30 million in the first quarter of 2018, driven by amounts earned under our ADC collaboration with Takeda, and our ADC deals.
This included an $8 million milestone payment from AbbVie. To date, we've generated approximately $400 million from our ADC collaborations, primarily from upfront in milestone payments.
There are now three ADCs in late stage development using our technology, one by each of Roche, AbbVie and GSK. Under these deals, we are entitled to receive substantial milestones and single-digit royalties on sales of ADCs that use our technology.
R&D expenses increased to $153 million in the first quarter of 2018. The increase reflects higher investment in TV, LV and in the rest of our pipeline. As a result, of the recent acquisition of Cascadian, we are increasing our expectations for 2018 R&D expenses to now be in the range of $530 million to $580 million. This factors in the ongoing cost of tucatinib development, as well as expenses in the first quarter related to upfront payments under our recent collaboration agreements with Pieris and PharmaMar.
SG&A expenses increased to $66 million in the first quarter of 2018. This increase reflects transaction costs associated with the acquisition of Cascadian and increased commercial costs to support the launch of ADCETRIS in frontline Hodgkin lymphoma. We are updating our guidance for total SG&A expenses for the year in 2018 to now be in the range of $220 million to $240 million. For both R&D and SG&A expenses, first quarter results reflect one-time items that are not expected to continue but are included in our guidance for the year. For R&D, this includes $35 million in business development related costs and for SG&A, it includes $15 million in costs associated with the Cascadian acquisition.
We ended the first quarter with $400 million in cash and investments. During the first quarter, we completed equity financing, raising $658 million in net proceeds. This was primarily used to fund the acquisition of Cascadian for $614 million. Not included in our cash position is $180 million related to our common stock holdings in Immunomedics and Unum. We marked these shares to market and as a result, we reported a non-cash charge of $90 million during the first quarter.
And with that, I'll turn the call over to Jonathan.
Thanks, Todd. Today I'll highlight some of the exciting technologies and programs in our earlier stage pipeline. Many of our recent advances were featured at the AACR Annual Meeting earlier this month in nine separate presentations.
Our scientists continued to perform ground-breaking research and provide many exciting preclinical programs to fuel our pipeline. There are three themes from these presentations, as well as other publications. First, we continue our leadership in the field of ADCs through the development of novel payloads, linkers and antibody technologies. Our latest program to advance into the clinic SGN-CD48A is an example. It uses our second-generation MMAE drug linker, which our preclinical research shows to have a wide therapeutic index due to increased chemical stability, reduced hydrophobicity and greater number of drugs per antibody.
Second, we're generating data that support the potential for ADCs to be a preferred partner for checkpoint inhibitors due to targeted cell-killing and immunogenic cell death. Ongoing combination clinical trials are evaluating CPIs with ADCETRIS, EV and LV. And third, we have a growing pipeline of proprietary and innovative immuno-oncology programs that are differentiated and target critical elements of the tumor microenvironment.
Some highlights from AACR include the following. Our new technologies were described in two presentations. We reported preclinical data on a new proprietary payload referred to as NAMPT inhibitors which may have an enhanced therapeutic window. In addition, we presented our masked antibody technology, a novel approach to producing antibodies that selectively bind their target when activated within the tumor microenvironment. This technology can be applied to targets with potentially problematic normal tissue expression for future development.
Also at AACR, we presented preclinical data with three of our auristatin ADCs, ADCETRIS, ladiratuzumab vedotin and SGN-CD48A. Including in combination with checkpoint inhibitors, these data demonstrate additional mechanisms of action including the ability of ADCs to cause immunogenic cell death and support the clinical trials being conducted across our ADC portfolio in combination with CPI.
And finally, we made two presentations on our non-ADC portfolio. First, we reported an encouraging biomarker data demonstrating inhibition of few population with the novel immuno-oncology agent SGN-2FF at the first dose level of our phase 1 trial in patients with solid tumors. And second, we presented preclinical data with SEA-BCMA which employs our sugar-engineered antibody technology to enhance ADCC. We plan to advance SEA-BCMA into a phase 1 trial for multiple myeloma this year.
It's a remarkable time in the field of oncology with unprecedented advances for patients and novel therapies for submission. Seattle Genetics is strongly positioned to harness its leadership in ADCs, its expertise in targets and antibodies and its focus on developing innovative new medicines for people with cancer.
With that, I'll turn the call back over to Clay.
Thanks, Jonathan. I'll close with a short summary of key milestones expected over the remainder of 2018. They include reporting data from the ADCETRIS phase 3 ECHELON-2 trial, completing enrollment in the EV pivotal trial, EV-201 in urothelial cancer patients who have previously been treated with a platinum and a CPI, continuing to enroll the HER2CLIMB trial of tucatinib in metastatic breast cancer and initiating the pivotal trial of TV in cervical cancer.
At this point, we will open the line for Q&A. Operator, please open the call for questions.
Thank you. And we'll take our first question from Cory Kasimov with JPMorgan.
Hey. Good afternoon, guys. Thanks for taking the questions. I guess, my first one on ADCETRIS, nice quarter for the product and I wanted to follow-up on Darren's comment regarding the E-1 approval, that the E-1 approval on March 20 was a contributing factor to the step-up in sequential growth you saw. That's pretty impressive given how little time there was left at the end of the quarter at the time of approval. So I'm curious if you're seeing some sort of warehousing effect with docs holding patients for the anticipated launch of this drug?
So, Cory, thank you for the question. Places don't really warehouse our drug at all. These are drop shift and use as needed. What it more reflects I think is that our data came out at ASH and that was in December. And we published simultaneously in the New England Journal and doctors started seeing this. And while it wasn't on label yet, but anybody that potentially had pulmonary insufficiency or things like that, docs have to consider things not using bleomycin in certain patients. So I think that there might have been some use there although not in a huge way until we approved it. Darren, you want to make any additional comment?
Yeah. Cory, we had been in the field. We expanded our sales force as I stated in the last call to 90 sales representatives and we were ready. They had been deployed. We did see a little bit of use, as Clay alluded to, post ASH and post the New England Journal publication, but nothing of significant note until right at approval. We were ready to execute and we have. You might be referring to, did physicians hold on to patients or what have you. I did not get a sense that they did that. And so we're really pleased with the uptick so far, particularly in the community as I alluded to and we're off to a great start.
Okay. Yeah, and I wasn't referring to, hanging on to patients, not warehousing the drug. And then one follow-up question, and again with the understanding it's only been a month since you got the E-1 approval, but I'm curious if you can talk a little bit more about the response you've seen in these early days from payers. Has there been any pushback in terms of access? And are you aware of doctors trying to get Stage IIb patients onto treatment?
Yeah. So thanks, Cory. We feel that there's a very strong alignment with payers, right now, in our label, for sure. And that's what we're promoting to our label. As far as your question on other stages, Stage IIb is treated very similar to Stage III and IV and our label is in Stage III and IV. And so certainly, we've heard of questions from some docs, but that's really where we are now. It's pretty early in the game. Darren, do you want to add to that?
Yeah. I think Stage III/IV, Cory, will absolutely align with the label. No issues there. And I think it's too early on the IIbs to see how that plays out, but we're focused strictly on within the III/IV label and docs are very, very pleased with a new treatment now. They haven't had one in 40 years, and ADCETRIS plus AVD in Stage III/IV is really, really exciting to both patients and their physicians.
Okay. Great. Thanks for taking the questions. I'll hop back in queue, and good all-around quarter.
Thanks.
And we'll take our next question from Geoff Meacham with Barclays.
Hey, guys. This is Jason jumping on for Geoff. Thanks so much for taking the question, and congratulations on a great quarter. Just as a follow up for ADCETRIS, I'm curious. You mentioned that the response has been overwhelmingly positive. Has there been any pushback from docs who, I guess, are more used to bleomycin and kind of what are your expectations for kind of moving these population over to the E-1 label?
So it's a good question. Thank you for that. Doctors have been leaning on a bleo regimen called ABVD for 41 years. And largely this has been a chemotherapy success story. It really changed the lives and improved the lives of patients. What we do is take it up a notch further. We have now gotten rid of the toxic effects that are in bleomycin by not using bleomycin. And at the same time, this was the first time that any regimen – and there's been at least 10 different trials looking to get rid of bleomycin – the first time anyone shown a higher level of long-term disease-free survival.
So we did the two accomplishments we wanted to do, get rid of bleo and improve the outcome on patients. But as you mentioned doctors have been using ABVD for a long time and over four decades. And so they don't all just on day one change and say okay, we're just going to drop everything. That's not the way docs work. But I could tell you that since March 1, we've had 150 new accounts coming on board which is a lot.
And as we talked to docs and we hear from them, docs are excited about this. They've all had experiences, not all but a lot of them I should say, have had experiences where they see the toxic side of bleomycin and a really bad result. And docs hate treating patients with a drug that actually hurts the patient more than helps the patient at times. And so they're really excited to have this new regimen to work on. And I think that with time, it's just going to continue to grow and grow and grow as our field staff is out there talking about the data. I just think we're in a really good position and, Darren, you may want to add something to that?
Yeah. I think the evolution of the brand over six years, we started relapse refractory and we've gone to consolidation post-transplant. And now in the frontline setting, there's a new audience of physicians now that will be treating patients that haven't used ADCETRIS in the past. So our mission is to go out and educate them on the data. And that will take some time for some of those that you referred to that will be a little bit later in the adoption curve.
Also another key piece of this patient population, the Frontline Stage III/IV, is it's a younger patient population and they seek information and we have things in place. They are able to educate patients. And I think what you also see is patients coming in and talking about this option with their physician. So we feel over the long haul the data really, really stands on its own. Physicians have been waiting for it, patients haven't. So we couldn't be more excited about the future.
Jonathan, you have a comment as well?
Yeah. I haven't heard anything from any physicians about missing bleomycin or wishing that they could continue to use ABVD for their patients. So I don't think that's going to be an issue at all. In fact for decades, they've been trying to minimize or eliminate bleomycin.
Awesome. Thank you so much for the color and just as a quick follow-up, what is your expectation for guidelines and how those will change and kind of what that impact is going to be?
That is a second question, but not a quick question. So I'll try to give you a quick answer and we'll let someone else ask questions as well, so everyone gets a turn here. We are in guidelines already in Stage III and IV. So that's really good. I think that when you are tumbled to the most important part as we put out more data like the North American data at ASCO and those get published, absolutely those kind of data will be brought to guidelines and guidelines likes to see publications and more data and we're going to be doing that and I think that can only help us and not hurt us. I would encourage you to go to ASCO and look at our North American data. We're pretty darn excited about it.
Great. Thanks so much.
And we'll take our next question from Kennen MacKay with RBC Capital Markets.
Hey, thanks for taking the questions. Actually Clay and the whole rest of the team, was going to congratulate you on getting added NCCN Guidelines just last week, so that's terrific to see. And I just had a question on that, I had wondered about the amendment through NCC (sic) [NCCN] Guidelines to do a PET scan after two cycles and restage these patients. And just wondering how we should be thinking about the average number of ADCETRIS cycles that patients are getting, can you help us understand how many patients after two cycles in a scan would do well dwell one through four and getting four more cycles versus five and switching to other therapies? Potentially starting with other therapies I should say.
Yeah. So thank you for the question. Jonathan, would you like to opine on this?
Sure Kennen. So the whole idea of doing the PET scans after cycle 2 is really driven by the rapport approach to try to get rid of bleomycin early and it isn't really applicable to the A+ AVD regimen at all. So I think that it's now becoming more of a standard of care particularly in patients who aren't using A plus AVD, because it's an indication that the treatment is not working, if the PET scan is positive, and they should switch to something else or try to get rid of bleomycin early, but that that really isn't relevant to our setting, and there's no data regarding stopping ADCETRIS at any point in the regimen.
So I'll add to that.
Got you.
Our expectation here is a little different than the expectations that we had coming into relapse/refractory patients. In our trial, we averaged about eight doses of ADCETRIS, and those were every third week. And when you do that in a relapse/refractory patients in a trial, you need to get out into the real world of treating doctors. There is a lot of things that happen, and some patients get on, go to CR pretty quickly when it's transplant. And we get four cycles and it was a total success, but we were averaging about 6 to 6.5 cycles in those patient population.
This is a different population. This isn't a frontline setting with a curative intent. And so patients should be getting their 12 doses and the doses are they get two a month, so at every second week. And we think we're going to get a high percentage of patients to actually stay on and get their full cycles, because this is upfront with curative intent. It's not patients that have been treated and failed other things. So a little bit different, I'm not sure you were asking about that, but it occurred to me and Jonathan has another comment.
Yeah, just one more thing, there will be an abstract at ASCO on the – looking at the effect of the PET – the cycle to PET scan in the ECHELON-1 trial. And we reported in The New England Journal article on the actual differences in PET negativity. This will also address outcomes for those patients based on whether they were PET negative or PET positive and I think that will be informative to physicians.
Got you.
Yeah. We're looking forward and excited about that presentation.
Thank you very much, both Jonathan and Clay and congrats on the guideline addition. And one other I guess follow-up question there. It seems like in all Stage III/IV classic Hodgkin, there is a NCCN category 2B rack, but in patients without any neuropathy, it was a 2A recommendation. I guess, can you help us understand at baseline, what percentage these patients have, any neuropathy where it could be sort of a 2B versus don't have any whether it would be a 2A. And then I guess, moving on from that, is there any sort of additional data? Then you talked about presenting some of the data at ASCO from the North American experience which remembering back to the ASH data had looked much more impressive both from an efficacy as well as a safety perspective than the rest of the world experience? Is that something that could maybe help move this recommendation again all the way up to a 2A? Thank you.
Okay. So...
Sure. Go ahead, Jonathan.
Okay. We'll just start with a very few patients who are – these are generally younger patients and untreated, will have neuropathy at baseline. So I don't think that's a major issue. You're right. Their hazard ratio was very different for North America on that as shown in the publication and the presentation, and we'll have a lot more data on that. I think it's important for physicians to understand that there are some regional differences potentially in the way patients are treated and we think that will be an instructive presentation.
Yeah. Kennen, maybe one other note on...
Looking forward to it. Thanks again for the questions.
And we'll take our next question from Adnan Butt with Guggenheim Securities.
Thanks and congrats on the strong quarter. I have to ask at this time are you able to shed some light on what you think as assumptions for your second quarter guidance number for ADCETRIS?
Sure. Todd?
Yeah. Thanks for the question. So as I think you heard on the call already we're very early in the launch. We just got label right at the end of March. So we're starting to collect some market data and we're launching – launch trajectories and we're trying to do the best we can to provide a little bit of color on kind of how we think this is going right now, but recognize this is really early and we just really need to have a little bit more time to study what's going on and I think as we do that we'll be in a position to provide a little bit more color on how we think this is going to go. But for right now we want to hold our guidance for just Q2.
Sure, Todd. But then in the second quarter, can you say how much if any frontline sales you are expecting?
We don't break that down, Adnan. We've never broken down the different categories because now this is our fifth label and we've also said that we do get some off label use based on guidelines which include for instance B-cell lymphoma, CD35 B-cell lymphoma. So there's a lot of pieces and parts to this and we just don't provide that level of guidance. But keep in mind in this quarter, we went up from a quarter-to-quarter from the fourth quarter to the first quarter. We went up 14% which was the largest quarter-over-quarter sequential gain in four years, okay. And we're guiding to another pretty large sequential gain that could be close to another record kind of quarter in gain on a quarter-to-quarter sequential basis.
So we're thinking about this really, I mean, this is really great. We're out there, docs are employing this. We have a lot of new docs ordering, a lot of docs have ordered in the past order. We're helping patients. We're moving upstream, but as you asked the question earlier, it is a regimen ABVD that's been used for 41 years. So our sales people are out there, they're doing a great job in educating. We will build this market. We're excited about it.
But as Todd said, it's really – it's hard to provide accurate guidance now to why we withdrew our guidance for the year, and just giving a quarter now because it's super important for us to be accurate and reliable when we give our guidance. And so we will at our soonest possible time where we feel comfortable we'll come back with more guidance and go back to annual guidance, but we're just suspending it for a short period of time while we learn a lot.
Let me let me switch tax and ask a pipeline question please. It's for enfortumab, can you just clarify the timelines for the platinum exposed versus non-exposed patients? And is that the same phase 2 pivotal that you're talking about? And then when – which one reads out? When they read out please?
Sure. So what we announced at this – in this call is that we will be done with enrollment of urothelial patients that have seen both platinums and CPIs by the third quarter, okay. So some time through now and the end of third quarter, we'll complete enrollment that what we need for that to our study which is intended for registration. And I'll remind you we recently got Breakthrough Therapy Designation for EV. What has come to attention is that there really is a large amount of patients that have seen both platinum and checkpoints. It's a much smaller amount of patients that have not and the playing field is changing.
And Jonathan could comment a little bit on the playing field in urothelial cancer, but we think by putting together a data package on the third line, if you will, that have seen both platinum and checkpoints and there's really no other option for the patients, that's the quickest way that we could get to registration. While we continue to enroll to the patients that have just had checkpoints and were ineligible for platinum which is we were viewing as a separate population.
And Jonathan, you want to give a little bit more color to that?
Sure. It's just – it's a rapidly changing area with checkpoint inhibitor coming in relapsed refractory patients and now moving up the frontline and there's combinations. And so because of the way it's been introduced, most patients at this point have seen one of the two platinum compounds, either cisplatin or if they're ineligible for that, they get carboplatin. So what we're seeing is that the majority of our patients have been exposed to the checkpoint inhibitors and one of the platinum compounds. And that enrollment is going so well. We don't want to hold up anything. We want to move as quickly as possible to finish that off and get it submitted.
As things are changing and people are starting to look at using checkpoint inhibitors without platinum, there's an increasing number of patients that will be coming and we'll be able to enroll those and then have another submission.
Okay. Understood. Thank you.
And we'll take our next question from Salveen Richter with Goldman Sachs.
Thanks for taking my questions. I mean, you'd mentioned earlier that there are over 150 community-based accounts that have ordered ADCETRIS. Could you just put this in context in terms of the community oncologists that you have targeted to date?
Sure. Thank you for the question. And I'll let Darren give you some more color here, but I'll start by saying that in the frontline setting, it's probably something about three quarters of patients are treating at the community setting. So it's different than the later stages where in the past before ADCETRIS, I mean you'd get a ABVD and then there wasn't really anything else approved and docs would throw some chemotherapy that wasn't approved to that patients and they didn't know what to do and they had to call the cancer centers like the Memorial Sloan-Ketterings or MD Anderson's and saying I don't know what to do. That's where we started in 2011 with our approval saying, okay, here's an option there. This is very different. This is in frontline where the regular doctors want to keep their patients and have a high chance to use a well-tolerated regimen and get a long-term disease-free survival and cure because in Hodgkin lymphoma you can get that. Darren, you want to talk a little about community and what this represents?
Yeah. I mean, Salveen, it's – as Clay said three-quarters of the patients are diagnosed in the community. There is roughly 7,000 or so community individual physicians throughout the country, but they are around group practices, academics and then large community settings. We've been in the six years, six-and-half years ADCETRIS has been on the market.
I've been calling on majority of the academics and a lot of the community. But now over time have branched now into some of these other community accounts. And again, these are new community physicians that are currently ordering and we anticipate to see more as we continue to reach into these new customers and tell the story about ADCETRIS and Hodgkin lymphoma and we'll continue to update on our progress as we move forward.
Great, thank you. And then just with regard to TV and tucatinib, could you just provide us some timelines for when we might see the pivotal data sets?
Well, with TV, I could tell you that we are going to start the registration study in the first half of this year. So that means in the next few months. And we're working closely with our partners at Genmab on that. And I was recently over in Utrecht which is where they're based and I visited their site which is outside of Amsterdam. They've been here in Seattle.
So we have a really great collaboration going on with Genmab. And so we haven't given – until you start a study and give it to enrollment, we're not going to give you when this is going to be completed. But we're going to be starting the pivotal study in only 100 patients, cervical cancer patients, with a readout of objective response rate.
And so we think this could go and get accrued very rapidly and then it's very fast to get the data on this. So we think this is a not too distant opportunity for us with TV. You asked about tucatinib, and I'm really excited about this. This is why we went ahead and acquired Cascadian. The HER2CLIMB trial is accruing in a robust fashion. And I can tell you that I'm going to be disappointed if we don't expand pretty dramatically different ways we're interrogating tucatinib to help cancer patients, because there's a lot of different data that was out there generated in trials such as in combination with T-DM1 or such as what's ongoing in colorectal carcinoma. And so there's a lot going on right now with tucatinib that has been going on. And I think we're well-positioned to look at this and consider expanding this program. We're not going to outline the specifics of what we're doing now, but we'll certainly be – I think it was obvious. We'll be expanding this program.
Well, thank you.
And we'll take our next question from Tazeen Ahmad with Bank of America.
Hi. Thanks for taking my questions. Maybe one about the results for the quarter. Can you just remind us how many days in the quarter you were promoting the full-label for ADCETRIS? And then, in terms of trying to get expansion you talked about getting a second expanded label. And also I wanted to get your thoughts, Clay, on whether or not you think it's useful to run a study in Stage I/II patients as well.
Okay. So let's do these one at a time. So as far as how many days were we out there promoting to it, our approval was on the 20 and I believe there were six business days...
Selling days, I believe so.
...selling days there because the rest were weekends. So we were promoting starting on April 20. We did not, I mean...
At March 20.
...at March 20, sorry. We started promoting that day because we had trained and were positioned and everyone was out in the field. So we didn't waste an hour. And so every business day since March 20 through the end of the quarter, we were out there promoting this.
You asked about Stage I and II. And let's go to that one. So there are quite a number of studies, I don't remember, it's five or six different trials and we're supporting these with grant dollars and these are investigator or consortium trials that are looking at Stage I and II. There was in fact one of these trials which came out of Memorial Sloan Kettering was presented – the data was presented at ASH 2017 and was presented by the lead doc, Anita Kumar. And she gave a resoundingly beautiful presentation showing how effective ADCETRIS AVD was in the Stage I and II patients that they were looking at. And every one of these trials is a little bit different, but the data that she presented on behalf of her consortium was outstanding.
And I have to think with these five or six trials that are going on in different consortiums and with the data coming out that especially after the first dataset which was so powerful, that at some point we have a decent chance to get in guidelines in earlier stages of Hodgkin lymphoma based on the preponderance of the work that's ongoing right now. So I don't know if that was your exact question. And then you asked one more thing on expansion of label. And, Tazeen, can you ask that again? I don't remember what you were asking.
Yeah. No, it's related to that. So perhaps over time and maybe that's in the near-term, you can get included in compendia based on the studies that have been completed in Stage I/II. But I guess in your mind how important is it to have an actual label for Stage I/II, given that physicians are often known to use off-label within oncology?
Right. Well, first of all, judging based on being on the market for many years now with ADCETRIS, physicians do use ADCETRIS off-label and that happens and we know it. And we try to track it as best as we can. It's hard to track perfectly, but it's not something we report on. But we are aware of that from physicians. And looking at Stage I and II, I can't say now it's so early whether there will be off-label use in those stages. I have to think that I'd be surprised if there was none, and that docs do – as you know oncology docs do tend to use this depending on the patient, depending on the situation.
And I think that what Darren said is a lot of young people get Hodgkin lymphoma and they're very tech savvy and they read about not using bleomycin and the side effects of bleomycin. And they go in and they ask their doctors about it. We really heard that from our salespeople that patients come in and say, hey, I am diagnosed with Hodgkin lymphoma. I read about this. What about this? And they talk about the options. So it's kind of interesting to have them selling it to themself based on not wanting to use bleomycin and getting an increased long-term disease-free survival, so the data supports itself.
I don't see the company right now, and I don't want to say permanently. Right now I don't see us doing a corporate study in Stage I and II. I think it would be a very long study and take a lot of patients to do, both in terms of number of patients and my patience to do. And I think that we're better off right now funding through grants, consortiums and docs doing investigator-sponsored trials and group studies and the ROI on funding those types of events based on what we've done historically such as in cutaneous T-cell lymphoma is so high.
So a very high ROI taking a drug like ADCETRIS. And when doctors come to us, say, hey we want to do all these exploratory work and with the grants that we're giving, it's a pittance of dollars compared to what a corporate trial costs. So it's very cost effective and really gets ADCETRIS out there into a lot of doctors' hands in Stage I and II. And the more doctors that want to touch it in Stage I and II, they're going to get used to this. They're going to get used to not using bleomycin and that's a good thing.
Hey, Tazeen...
Okay.
...this is Todd. I wanted to add one more, I guess, piece of color. When you think about the growth that we saw in the first quarter in the March 20 approval date, I think it's important to factor in a couple of growth drivers for the quarter. Certainly, the approval was one of them and the work that Darren and his team were able to do from a promotional aspect once we got approval. But I think, as you also know, the data were presented at ASH. There was a New England Journal of Medicine publication on the result. So the data were out there early.
But the other growth driver in the quarter was Darren and his team had a full quarter to work with the ALCANZA label in cutaneous T-cell lymphoma. So, there were a number of good things that happened during the quarter. They didn't just happen on March 20.
Yeah. Thanks for that color. And then maybe if I can ask a pipeline question. You're expecting the HER2CLIMB trial to complete enrollment in 2019. So, I guess, in best guess, when do you think, Clay, we could see a readout on that study?
Well, it's a trial that is enrolling great, like I said, and we have not given a specific date on the readout of it, but we have said that we'll complete enrollment in 2019. And that's looking very good based on the enrollment that we are seeing right down the accrual that we're seeing right now. So I understand your question, but I think we haven't yet given specifics on this, and when to read out.
But we're really bullish on this. We think that tucatinib is a very active and effective HER2 TKI, but without the side effects that you see in some other – in the other two HER2 TKIs that are on the market, and probably because it hits HER2 TKI very strongly, but it hits EGFR very, very weakly. I wouldn't call it zero but much weaker than the other ones and that's where you get the rash and the diarrhea, and these toxicities that you get are – we think largely due to hitting the EGFR TKI.
So this is just a more specific TKI to HER2. And we think that that may change the paradigm of the safety profile. But also, if it's – with that added safety, patients can stay on this drug longer and it may result in even better efficacy because patients could stay on. So we think we really like this program and we're working hard on it.
Okay. Thanks very much.
And we'll take our next question from Boris Peaker with Cowen.
Great. Thanks for squeezing me in. I'll just throw one question out there and maybe this is for Darren. Just curious what are you seeing in terms of adoption of checkpoint inhibitor in Hodgkin's lymphoma and kind of what is your strategy to work with that landscape?
Well, Darren can certainly answer that, we don't track. I mean that's not our product checkpoint inhibitors. So you're asking about you know what's the adoption there, largely they're used after ADCETRIS, I mean that's really how they're employed by doctors in there. So we're pleased they're there, it's an option for patients. But going into front-line and getting more long-term disease-free survivals and we think which will result in more cures. Hopefully, we're not treating people as much in the later – late stages of Hodgkin lymphoma. Additionally, we have this trial that's ongoing in collaboration with Bristol-Myers Squibb called CHECKMATE 812, and it's in patients that have relapsed. And that's an ongoing study of ADCETRIS plus nivolumab versus ADCETRIS alone and which is based on strong, strong data that we reported at ASH last year on the combination of ADCETRIS and nivolumab in relapsed patients. So incredibly strong data, we're pretty fired up about those data.
And just to clarify, thanks for the detailed explanation, Clay. I just wanted to know in terms of duration of treatment, are you seeing any impact on the number of cycles because now you have another option after ADCETRIS that the physicians didn't have or is there really no impact on the duration of treatment in relapsed/refractory patients?
Yeah, Boris, we're – as Clay alluded to in the relapsed setting, where the CPIs are approved, ADCETRIS is first and physicians really haven't – it hasn't impacted their approach to treatment and around duration, duration is held steady at around six in the relapsed setting.
Great. Thank you very much for taking my questions and congratulations...
You're welcome.
...on the excellent quarter.
Thanks.
Thank you.
And we'll take our next question from Mara Goldstein with Cantor Fitzgerald.
Thanks very much, I appreciate it. Just two items on tucatinib. There have been some other studies, ISTs I believe, underway, with tucatinib one and which is MOUNTAINEER, which might have some interim data and is that still anticipated?
And the second is if I could just go back to the ADCETRIS in the community setting, do you think now that you're seeing this influx of physicians in the communities setting that hadn't been really previously using ADCETRIS, that these docs will be essentially keeping more of relapsed patients in the community rather than referring them out?
So first of all, thank you for the question on tucatinib and yes, I mean, there are some ISTs. I imagine as you look to the future, there will be more and MOUNTAINEER is – I think that's the colorectal cancer IST, and yes that's still operational. And we look forward to at some point the data being presented absolutely. We are certainly in contact with the physicians that are working on these programs and I don't want to tell you anything in specific about this, but we're very excited about what's going on with tucatinib outside of breast cancer – outside of HER2 breast cancer. There's other areas of HER2 positivity such as colorectal cancer which were pretty exciting, soon you'll hear more about that looking to the future.
And you asked about a question which is about the community docs and with the influx of community docs in the frontline, will they use ADCETRIS more in the later lines because they become more comfortable using it. Darren, you want to make a quick comment?
Yeah. I think they will keep the patients. I think that's what you were referring to and not to send them to an academic setting. We've seen this transition in 6.5 years. So we will continue to see that.
Okay. Thank you very much. Appreciate it.
And we'll take our next question from Yatin Suneja with SunTrust.
Hey, guys. Congrats on good quarter. Just a couple of questions. Maybe we'll start with tucatinib, I mean, looks like there will be a presentation at ASCO looking at the retrospective pool analysis. Could you tell us what we should be anticipating from that presentation?
Well, the titles are now out, but the data – the abstracts are now out and the data is not out. So you can see the title but any more than that, we really need to present this at the conference by the presenter. So I don't feel that we should be talking about the specifics of what we're going to be presenting there.
But we're really excited that tucatinib will be represented at the ASCO event. We have quite a lot, I don't know exactly maybe 10 or so presentations at ASCO across our pipeline. So we're really looking forward to ASCO being a big event for us. And you know historically – all of you know that historically ASH has been our big event and we've been doing a lot of focus there, but I would say that ASH and ASCO are going to be both our big events now. And so we're transforming a little bit, becoming a multi-product company and doing both hem and solid tumor, so go ASCO and go ASH.
Great. And may be just two quick question. The first one is, were there any changes to inventory level in Q2? And the second one just a little broader question. Now that you have approval in the frontline setting, frontline HL or Hodgkin setting, I think probably the biggest indication of the currently approved indications that you have and we acknowledge it early days, how are you looking at the profitability? I mean any high level comment on when and how quickly you might achieve that?
Sure. As far as inventory levels we have – we've been manufacturing this for years and we have great inventory on it and we keep the right amount. I don't think we saw any – there was not people storing it in some channel if you are asking at all, this is – it's a drug that people dropship, they order, they get the number of vials they need. They treat the patients, when they need to re-treat the patients, whether it's a frontline or a later-line of patients, they reorder it in two weeks or reorder in three weeks, they get it the next day, and they get it a couple of days ahead of when the patients come in and it's on-time delivery. There's really no stocking of this, if you're asking, so that didn't get affected.
Now the other thing you asked us about profitability now that we're in frontline, and thank you for the question. We want to be profitable, we expect to be profitable and we certainly could be profitable now based on our revenue if we skinny down everything and didn't do what we're doing. But we have a vision that we could make Seattle Genetics into a much more powerful big expansive company and helping a lot more patients and have two, three, four, five drugs on the market, and really become one of the success stories in biotech like you see with other companies, like Biogen and Gilead and Celgene and – we aspire to doing things like that and becoming a really valuable, important company for cancer patients. And we think we have the nucleus to do it. We have the pipeline to do it. So it doesn't feel like it's the right time to pull off the gas pedal and make being profitable our top priority even though we want to be profitable at the earliest possible time. We're investing in some late stage products. And we're no longer ADCETRIS and a bunch of early stage products, we're now multiple late stage products across oncology and we're really excited about this. I think we have a great future.
Got it. Thank you so much.
And we'll take our next question from Andy Hsieh with William Blair.
Yeah, thanks for squeezing me in. Just one quick one on E-2. I believe Clay provided update maybe couple of quarters ago about potentially moving this to a landmark study, any sort of update on that?
Yeah, I never mentioned that we were moving it to a landmark. I said that the events were coming slower than we thought and we were going to be connecting with regulators. And the questions I got from analysts were it couldn't become a landmark study, and I said it could – that's one of the options. So I just wanted to be clear as that, and I'm not saying you're inferring that I said that, but it is an option there but not the only option. Absolutely, we are confident with our discussions with regulators and our guidance is that we will have the data this year. So that is unchanged.
Great. Thank you. Thank you.
And there are no more phone questions at this time.
Okay. Thank you, operator. Thanks everybody for joining us this afternoon. Have a good evening.
And that concludes today's presentation. Thank you for your participation. You may now disconnect.