[Translation] Zephyrus II: A phase III, randomized, double-blind, placebo-controlled study evaluating the efficacy and safety of pamrevlumab in the treatment of idiopathic pulmonary fibrosis (IPF)

本研究的总体目的是与安慰剂对比，在特发性肺纤维化患者中评价Pamrevlumab的有效性和安全性。

[Translation]

The overall objective of this study was to evaluate the efficacy and safety of pamrevlumab compared with placebo in patients with idiopathic pulmonary fibrosis.

Start Date11 Nov 2022

Sponsor / Collaborator

FibroGen (China) Medical Technology Development Co. Ltd.

CTR20212110 / TerminatedPhase 3

一项Pamrevlumab（FG-3019）或安慰剂联合全身性皮质类固醇治疗杜氏肌营养不良非卧床受试者的III 期、随机、双盲试验

[Translation] A Phase III, Randomized, Double-Blind Trial of Pamrevlumab (FG-3019) or Placebo Plus Systemic Corticosteroids in Ambulatory Subjects with Duchenne Muscular Dystrophy

评价Pamrevlumab与安慰剂相比，联合全身性皮质类固醇，每两周给药一次，治疗杜氏肌营养不良非卧床受试者（6岁至<12岁）的疗效和安全性。

[Translation]

To evaluate the efficacy and safety of pamrevlumab compared with placebo, given every two weeks in combination with systemic corticosteroids, in ambulatory participants (6 years to <12 years) with Duchenne muscular dystrophy.

Start Date22 Dec 2021

Sponsor / Collaborator

FibroGen (China) Medical Technology Development Co. Ltd.

[+2]

CTR20212108 / TerminatedPhase 3

一项在卧床杜氏肌营养不良（DMD）受试者中研究Pamrevlumab（FG-3019）或安慰剂联合全身性皮质类固醇治疗的III 期、随机、双盲试验

[Translation] A phase III, randomized, double-blind trial of pamrevlumab (FG-3019) or placebo combined with systemic corticosteroids in ambulatory subjects with Duchenne muscular dystrophy (DMD)

评价pamrevlumab相比安慰剂联合全身性皮质类固醇治疗杜氏肌营养不良受试者（卧床、年龄12岁及以上）的有效性和安全性。

[Translation]

To evaluate the efficacy and safety of pamrevlumab compared with placebo plus systemic corticosteroids in participants (ambulatory, aged 12 years and older) with Duchenne muscular dystrophy.

Start Date09 Dec 2021

Sponsor / Collaborator

FibroGen (China) Medical Technology Development Co. Ltd.

[+2]

100 Clinical Results associated with Pamrevlumab

100 Translational Medicine associated with Pamrevlumab

100 Patents (Medical) associated with Pamrevlumab

Literatures (Medical) associated with Pamrevlumab

01 Sep 2024·CURRENT OPINION IN PULMONARY MEDICINE

Evidence from recent clinical trials in fibrotic interstitial lung diseases

Review

Author: Valenzuela, Claudia ; Cottin, Vincent

Purpose of review:

Idiopathic pulmonary fibrosis (IPF) is the prototype of fibrosing interstitial lung diseases. It is mirrored by progressive pulmonary fibrosis (PPF), an umbrella term which characterizes disease behavior of various fibrotic interstitial lung diseases with irreversible progression, accounting for loss of lung function, exercise intolerance and respiratory failure leading to early mortality. Pirfenidone and nintedanib halve the decline in lung function but do not halt disease progression.

Recent findings:

Since the publication in 2014 of pivotal pirfenidone and nintedanib studies, a number of clinical trials were conducted, many of them did not reach their primary endpoints. In IPF, promising phase 2 trials were followed by large phase 3 trials that did not confirm a favorable efficacy to tolerability favorable profile, including those with ziritaxestat, an autotaxin-1 inhibitor, zinpentraxin-alpha (human recombinant pentraxin-2), and the monoclonal antibody pamrevlumab targeting connective tissue growth factor. Nevertheless, newer compounds that hold promise are currently being evaluated in phase 3 or phase 2b randomized controlled trials, including: nerandomilast, a preferential phosphodiesterase 4B inhibitor; admilparant, a lysophosphatidic acid receptor antagonist; inhaled treprostinil, a prostacyclin agonist; and bexotegrast, a dual-selective inhibitor of αvβ6 and αvβ1 integrins. Nerandomilast, admilparant, inhaled treprostinil, and inhaled AP01 (pirfenidone), are currently studied in patients with PPF.

Summary:

Despite recent frustrating negative results, there is a growing portfolio of candidate drugs developed in both IPF and PPF.

06 Aug 2024·JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION

Pamrevlumab for Idiopathic Pulmonary Fibrosis

Article

Importance:

Current treatments for idiopathic pulmonary fibrosis slow the rate of lung function decline, but may be associated with adverse events that affect medication adherence. In phase 2 trials, pamrevlumab (a fully human monoclonal antibody that binds to and inhibits connective tissue growth factor activity) attenuated the progression of idiopathic pulmonary fibrosis without substantial adverse events.

Objective:

To assess the efficacy and safety of pamrevlumab for patients with idiopathic pulmonary fibrosis.

Design, Setting, and Participants:

Phase 3 randomized clinical trial including 356 patients aged 40 to 85 years with idiopathic pulmonary fibrosis who were not receiving antifibrotic treatment with nintedanib or pirfenidone at enrollment. Patients were recruited from 117 sites in 9 countries between July 18, 2019, and July 29, 2022; the last follow-up encounter occurred on August 28, 2023.

Interventions:

Pamrevlumab (30 mg/kg administered intravenously every 3 weeks; n = 181) or placebo (n = 175) for 48 weeks.

Main Outcomes and Measures:

The primary outcome was absolute change in forced vital capacity (FVC) from baseline to week 48. There were 5 secondary outcomes (including time to disease progression, which was defined as a decline of ≥10% in predicted FVC or death). The exploratory outcomes included patient-reported symptoms. Adverse events were reported.

Results:

Among 356 patients (mean age, 70.5 years; 258 [72.5%] were men; 221 [62.1%] were White), 277 (77.8%) completed the trial. There was no significant between-group difference for absolute change in FVC from baseline to week 48 (least-squares mean, −260 mL [95% CI, −350 to −170 mL] in the pamrevlumab group vs −330 mL [95% CI, −430 to −230 mL] in the placebo group; mean between-group difference, 70 mL [95% CI, −60 to 190 mL], P = .29). There were no significant between-group differences in any of the secondary outcomes or in the patient-reported outcomes. In the pamrevlumab group, there were 160 patients (88.4%) with treatment-related adverse events and 51 patients (28.2%) with serious adverse events vs 151 (86.3%) and 60 (34.3%), respectively, in the placebo group. During the study, 23 patients died in each group (12.7% in the pamrevlumab group vs 13.1% in the placebo group).

Conclusions and Relevance:

Among patients with idiopathic pulmonary fibrosis treated with pamrevlumab or placebo, there was no statistically significant between-group difference for the primary outcome of absolute change in FVC from baseline to week 48.

Trial Registration:

ClinicalTrials.gov Identifier: NCT03955146

02 Dec 2023·Expert opinion on biological therapy

An up-to-date review of approved and emerging antibody therapies for idiopathic pulmonary fibrosis

Review

Author: Sgalla, Giacomo ; Richeldi, Luca ; Simonetti, Jacopo

INTRODUCTION:

The use of pirfenidone and nintedanib in treating Idiopathic Pulmonary Fibrosis (IPF) has shown significant slowing down of the progressive functional decline in these patients. In recent times, antibody-based therapies with precise molecular targets have also been explored as alternative treatments to IPF.

AREAS COVERED:

This review aims to summarize the available updates regarding monoclonal antibodies that have been tested in IPF. The drugs describedare developed to antagonize inflammation,immunity pathways and fibrogenesis. Currently, the anti-CTGF pamrevlumab has demonstrated a significant reduction in functional decline as compared to placebo and is undergoing the last stages of phase 3 trial.

EXPERT OPINION:

Although antibody-based therapies for IPF have had unsatisfactory results in most trials in the last few years, the pursuit of therapeutic development in this field should continue to deliver a more personalized treatment approach in the future, which is currently not available with existing treatment options. However, several molecules are still under study and some have shown encouraging results in the early phases of clinical trials. Future investigations need to be more carefully designed and valid predictive markers of response to treatment should be used to enhance the effectiveness of future trials.

107

News (Medical) associated with Pamrevlumab

06 Aug 2024

·www.globenewswire.com

FibroGen Reports Second Quarter 2024 Financial Results and Provides Business Update

Company implementing significant cost reduction plan in the U.S. due to results in late-stage pamrevlumab pancreatic cancer trials, including a reduction of U.S. workforce by approximately 75%Focus R&D investment on FG-3246 and PET46, a first-in-class anti-CD46 antibody-drug conjugate and companion PET imaging agent for metastatic castration-resistant prostate cancer (mCRPC) Presented compelling preliminary data from dose escalation portion of Phase 1b/2 investigator-sponsored study of FG-3246, in combination with enzalutamide, in patients with mCRPC at the 2024 American Society of Clinical Oncology Annual Meeting Topline results from Phase 2 portion of the study expected in 1H 2025 Anticipate initiation of Phase 2 monotherapy dose optimization study of FG-3246 in mCRPC in 1Q 2025Second quarter net revenue growth of 14% year over year, driven by strong performance of roxadustat in China, with robust year over year volume growth of 33% Raising full year net product revenue guidance to $135 million to $150 million, representing full year total roxadustat net sales in China1 between $320 million to $350 million Cash, cash equivalents and accounts receivable balance of $147.1 million; cash runway projected into 2026 SAN FRANCISCO, Aug. 06, 2024 (GLOBE NEWSWIRE) -- FibroGen, Inc. (NASDAQ: FGEN) today reported financial results for the second quarter 2024 and provided an update on the company’s recent developments. “While we are disappointed with the results from the pamrevlumab pancreatic cancer trials, we continue to be very excited about the prospects of FG-3246 and PET46, our CD46 targeted antibody-drug conjugate and companion PET imaging agent. We have released compelling Phase 1 data on FG-3246 as a monotherapy and in combination with enzalutamide in metastatic castration-resistant prostate cancer. In addition, roxadustat continues its strong momentum in China, exceeding $92 million in net sales in the second quarter,” said Thane Wettig, Chief Executive Officer, FibroGen. “Looking ahead, we expect topline data from the Phase 2 portion of the FG-3246 + enzalutamide combination study in mCRPC in the first half of 2025 and plan on initiating our Phase 2 monotherapy study in mCRPC in the first quarter of 2025 with a more focused and streamlined organization. I would like to express my deepest gratitude to our FibroGen colleagues who have dedicated so much of their time and energy for the prospect of bringing much needed therapies to some of the most challenging and deadly diseases affecting humanity.” Recent Developments and Key Events of Second Quarter 2024: Implementing significant cost reduction plan in the U.S. Headcount in the U.S. will be reduced by approximately 75%. Focusing R&D investment on FG-3246 and PET46, a first-in-class antibody-drug conjugate and companion PET imaging agent for mCRPC.Announced positive interim results from the dose escalation portion of the investigator-sponsored Phase 1b/2 study conducted by the University of California San Francisco of FG-3246 (FOR46), a potential first-in-class anti-CD46 antibody drug conjugate (ADC) with a MMAE-containing payload, in combination with enzalutamide in patients with metastatic castration resistant prostate cancer (mCRPC) at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting. The presentation included data from 17 biomarker unselected patients in the dose escalation portion of the trial. Over 70% of the patients in the study received at least two prior ARSIs, which included prior enzalutamide treatment.The primary endpoint was determination of the maximally tolerated dose (MTD) of FG-3246 in combination with enzalutamide. The MTD was established at 2.1 mg/kg ABW, with primary G-CSF prophylaxis, in combination with enzalutamide 160 mg/day. The combination treatment demonstrated an encouraging preliminary estimate of median radiographic progression free survival (rPFS) of 10.2 months with prostate-specific antigen (PSA) declines observed in 71% (12/17) of evaluable patients. Additional data from a total of 56 biomarker unselected and heavily pre-treated patients in a Phase 1 monotherapy study of FG-3246 in mCRPC reported. Efficacy analysis (includes adenocarcinoma patients receiving doses ≥ 1.2 mg/kg): The median radiographic progression free survival (rPFS) in this patient population was 8.7 months.For RECIST evaluable patients, 20% met the criteria of a partial response, or measurable tumor reduction in size of ≥ 30%, with a median duration of response of 7.5 months.PSA reductions of ≥ 50% were observed in 36% of PSA evaluable patients. Safety analysis: The most frequent adverse events were consistent with other MMAE-based antibody drug conjugates and included infusion-related reactions, fatigue, weight loss, neutropenia, and peripheral neuropathy. Reported topline results from the pamrevlumab arm of PanCAN Precision Promise Phase 2/3 adaptive platform trial for the treatment of metastatic pancreatic ductal adenocarcinoma (mPDAC), in which the trial did not meet the primary endpoint.Reported topline results from the LAPIS Phase 3 study of pamrevlumab in patients with locally advanced, unresectable pancreatic cancer (LAPC), in which the trial did not meet the primary endpoint. Upcoming Milestones: Roxadustat Expect approval decision for roxadustat in chemotherapy-induced anemia (CIA) in China in the second half of 2024. If approved, FibroGen will receive a $10 million milestone payment from AstraZeneca. Oncology Pipeline Topline results from the Phase 2 portion of the investigator-sponsored Phase 1b/2 study conducted by the University of California San Francisco of FG-3246 in combination with enzalutamide in patients with mCRPC expected in 1H 2025.Anticipate initiation of Phase 2 monotherapy dose optimization study of FG-3246 in mCRPC in 1Q 2025. China: Second quarter FibroGen net product revenue under U.S. GAAP from the sale of roxadustat in China was $49.6 million compared to $23.9 million in the first quarter of 2023, an increase of 108% year over year.Second quarter total roxadustat net sales in China1 by FibroGen and the distribution entity jointly owned by FibroGen and AstraZeneca (JDE) was $92.3 million, compared to $76.4 million in the second quarter of 2023, an increase of 21% year over year, driven by a 33% increase in volume.Roxadustat continues to be the number one brand based on value share in the anemia of CKD market in China.For 2024, FibroGen’s expected full year net product revenue under U.S. GAAP is raised to a range between $135 million to $150 million, representing expected full year roxadustat net sales in China1 by FibroGen and the JDE of $320 million to $350 million, due to continued strong performance in China. Financial: Total revenue for the second quarter of 2024 was $50.6 million, as compared to $44.3 million for the second quarter of 2023, an increase of 14% year over year. Total revenue increase was driven by strong performance of roxadustat in China and changes in net product revenue assumptions under U.S. GAAP.Net loss for the second quarter of 2024 was $15.5 million, or $0.16 net loss per basic and diluted share, compared to a net loss of $87.7 million, or $0.90 net loss per basic and diluted share one year ago.At June 30, 2024, FibroGen reported $147.1 million in cash, cash equivalents and accounts receivable.We expect our cash, cash equivalents and accounts receivable to be sufficient to fund our operating plans into 2026. Conference Call and Webcast Details FibroGen management will host a conference call and webcast today, Tuesday, August 6, 2024, at 5:00 PM Eastern Time to discuss financial results and provide a business update. Interested parties may access the conference call by dialing 1-877-300-8521 (in the U.S.) or 1-412-317-6026 (outside the U.S.). The call will be available via webcast by clicking here or on the “Events and Presentation” page on the FibroGen website. About RoxadustatRoxadustat, an oral medication, is the first in a new class of medicines comprising HIF-PH inhibitors that promote erythropoiesis, or red blood cell production, through increased endogenous production of erythropoietin, improved iron absorption and mobilization, and downregulation of hepcidin. Roxadustat is in clinical development for chemotherapy-induced anemia (CIA) and a Supplemental New Drug Application (sNDA) has been accepted by the China Health Authority. Roxadustat is approved in China, Europe, Japan, and numerous other countries for the treatment of anemia of CKD in adult patients on dialysis (DD) and not on dialysis (NDD). Several other licensing applications for roxadustat have been submitted by partners, Astellas and AstraZeneca, to regulatory authorities across the globe, and are currently under review. Astellas and FibroGen are collaborating on the development and commercialization of roxadustat for the potential treatment of anemia in territories including Japan, Europe, Turkey, Russia, and the Commonwealth of Independent States, the Middle East, and South Africa. AstraZeneca and FibroGen continue to collaborate on the development and commercialization of roxadustat in China. About FibroGen FibroGen, Inc. is a biopharmaceutical company focused on accelerating the development of novel therapies at the frontiers of cancer biology. Roxadustat (爱瑞卓®, EVRENZOTM) is currently approved in China, Europe, Japan, and numerous other countries for the treatment of anemia in chronic kidney disease (CKD) patients on dialysis and not on dialysis. Roxadustat is in clinical development for chemotherapy-induced anemia (CIA) and a Supplemental New Drug Application (sNDA) has been accepted for review by the China Health Authority. FG-3246 (also known as FOR46), a first-in-class antibody-drug conjugate (ADC) targeting CD46 is in development for the treatment of metastatic castration-resistant prostate cancer. This program also includes the development of an associated CD46-targeted PET biomarker. In addition, FibroGen has expanded its research and development portfolio to include two immuno-oncology product candidates for the treatment of solid tumors. For more information, please visit www.fibrogen.com. Forward-Looking Statements This release contains forward-looking statements regarding FibroGen’s strategy, future plans and prospects, including statements regarding its commercial products and clinical programs and those of its collaboration partners Fortis and UCSF. These forward-looking statements include, but are not limited to, statements regarding the efficacy, safety, and potential clinical or commercial success of FibroGen products and product candidates, statements under the caption “Upcoming Milestones”, statements regarding the expectation that cash, cash equivalents and accounts receivable will be sufficient to fund FibroGen’s operating plans into 2026, and statements about FibroGen’s plans and objectives. These forward-looking statements are typically identified by use of terms such as “may,” “will”, “should,” “on track,” “could,” “expect,” “plan,” “anticipate,” “believe,” “estimate,” “predict,” “potential,” “continue” and similar words, although some forward-looking statements are expressed differently. FibroGen’s actual results may differ materially from those indicated in these forward-looking statements due to risks and uncertainties related to the continued progress and timing of its various programs, including the enrollment and results from ongoing and potential future clinical trials, and other matters that are described in FibroGen’s Annual Report on Form 10-K for the fiscal year ended December 31, 2023, and our Quarterly Report on Form 10-Q for the quarter ended June 30, 2024, each as filed with the Securities and Exchange Commission (SEC), including the risk factors set forth therein. Investors are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date of this release, and FibroGen undertakes no obligation to update any forward-looking statement in this press release, except as required by law. ________________________1 Total roxadustat net sales in China includes sales made by the distribution entity as well as FibroGen China’s direct sales, each to its own distributors. The distribution entity jointly owned by AstraZeneca and FibroGen is not consolidated into FibroGen’s financial statements. Condensed Consolidated Balance Sheets(In thousands) June 30, 2024 December 31, 2023 (Unaudited) (1) Assets Current assets: Cash and cash equivalents$140,714 $113,688 Short-term investments - 121,898 Accounts receivable, net 6,412 12,553 Inventory 25,397 41,565 Prepaid expenses and other current assets 36,936 41,855 Total current assets 209,459 331,559 Restricted time deposits 1,658 1,658 Property and equipment, net 10,917 13,126 Equity method investment in unconsolidated variable interest entity 6,912 5,290 Operating lease right-of-use assets 61,212 68,093 Other assets 3,045 3,803 Total assets$293,203 $423,529 Liabilities, stockholders’ equity and non-controlling interests Current liabilities: Accounts payable$9,938 $17,960 Accrued and other liabilities 113,574 172,891 Deferred revenue 9,546 12,740 Operating lease liabilities, current 15,531 14,077 Total current liabilities 148,589 217,668 Product development obligations 17,397 17,763 Deferred revenue, net of current 131,192 157,555 Operating lease liabilities, non-current 58,376 66,537 Senior secured term loan facilities, non-current 72,478 71,934 Liability related to sale of future revenues, non-current 54,532 51,413 Other long-term liabilities 1,012 2,858 Total liabilities 483,576 585,728 Redeemable non-controlling interests 21,480 21,480 Total stockholders’ deficit attributable to FibroGen (232,340) (204,166)Nonredeemable non-controlling interests 20,487 20,487 Total deficit (211,853) (183,679)Total liabilities, redeemable non-controlling interests and deficit$293,203 $423,529 (1) The condensed consolidated balance sheet amounts at December 31, 2023 are derived from audited financial statements. Condensed Consolidated Statements of Operations(In thousands, except per share data) Three Months Ended June 30, Six Months Ended June 30, 2024 2023 2024 2023 (Unaudited) Revenue: License revenue $— $1,000 $— $7,000 Development and other revenue 269 5,158 1,147 9,050 Product revenue, net 49,643 23,889 80,181 48,049 Drug product revenue, net 729 14,272 25,216 16,381 Total revenue 50,641 44,319 106,544 80,480 Operating costs and expenses: Cost of goods sold 5,178 5,708 30,931 9,199 Research and development 34,106 95,478 72,498 169,964 Selling, general and administrative 22,276 31,181 45,097 65,455 Total operating costs and expenses 61,560 132,367 148,526 244,618 Loss from operations (10,919) (88,048) (41,982) (164,138) Interest and other, net: Interest expense (4,783) (3,069) (9,779) (5,441)Interest income and other income (expenses), net (1,281) 2,652 1,289 3,687 Total interest and other, net (6,064) (417) (8,490) (1,754) Loss before income taxes (16,983) (88,465) (50,472) (165,892)Benefit from income taxes (262) (235) (229) (161)Investment income in unconsolidated variable interest entity 1,177 550 1,766 1,346 Net loss $(15,544) $(87,680) $(48,477) $(164,385) Net loss per share - basic and diluted $(0.16) $(0.90) $(0.49) $(1.71) Weighted average number of common shares used to calculate net loss per share - basic and diluted 99,835 97,729 99,408 96,218 For Investor Inquiries:David DeLucia, CFAVice President of Corporate FP&A / Investor Relationsir@fibrogen.com For Media Inquiries:Simon MillerVice President, Marketing and Corporate Communicationsmedia@fibrogen.com

Clinical ResultPhase 1Drug ApprovalASCOLicense out/in

01 Aug 2024

·www.globenewswire.com

FibroGen Announces Topline Results from Two Late-Stage Pamrevlumab Pancreatic Cancer Studies and Provides Corporate Update

Pamrevlumab arm of the Precision PromiseSM study in metastatic pancreatic cancer, sponsored and conducted by the Pancreatic Cancer Action Network (PanCAN), did not meet the primary endpoint of overall survival as determined by the protocol pre-specified Bayesian statistical analysis LAPIS study in locally advanced, unresectable pancreatic cancer, sponsored by FibroGen, did not meet the primary endpoint of overall survival Pamrevlumab was generally safe and well tolerated across both studies, with no clinically meaningful difference in overall safety vs. control arms Company to implement immediate and significant cost reduction plan in the U.S. Terminate pamrevlumab research and development (R&D) investment and expeditiously wind down remaining obligations Reduce U.S. workforce by approximately 75% July 30, 2024 -- FibroGen, Inc. (NASDAQ: FGEN) today announced topline results from two late-stage trials evaluating the efficacy and safety of pamrevlumab in patients with pancreatic cancer and a corporate update. The pamrevlumab experimental arm in PanCAN’s Precision Promise Phase 2/3 adaptive platform trial compared treatment with pamrevlumab combined with gemcitabine + nab-paclitaxel to gemcitabine + nab-paclitaxel alone for treatment in first line (1L) and second line (2L) patients with metastatic pancreatic ductal adenocarcinoma (mPDAC). The pamrevlumab arm of the study did not meet the primary endpoint of overall survival as determined by the protocol pre-specified Bayesian statistical analysis. The Phase 3 LAPIS trial compared treatment with pamrevlumab combined with gemcitabine + nab-paclitaxel or FOLFIRINOX to placebo combined with gemcitabine + nab-paclitaxel or FOLFIRINOX for the treatment of locally advanced, unresectable pancreatic cancer (LAPC). The study did not meet the primary endpoint of overall survival. “We are deeply disappointed that the pamrevlumab arm in the Precision Promise trial and the LAPIS trial did not meet the primary endpoint of overall survival,” said Thane Wettig, Chief Executive Officer, FibroGen. “We were hopeful that pamrevlumab could bring meaningful innovation to pancreatic cancer patients in desperate need of new therapies. FibroGen would like to thank the patients, their families and the clinical trial investigators and teams for their dedication to participating in these studies. I would also like to express my deepest gratitude to our FibroGen colleagues who have dedicated so much of their time and energy for the prospect of bringing much needed therapies to some of the most challenging and deadly diseases affecting humanity.” Based upon the results of the late-stage pamrevlumab trials in pancreatic cancer, the Company plans to implement an immediate and significant cost reduction plan in the U.S. The pamrevlumab development program will be terminated and the Company plans to expeditiously wind down any remaining pamrevlumab obligations. As a result of the cost reduction plan, headcount in the U.S. will be reduced by approximately 75%. FibroGen’s collaboration agreement with AstraZeneca for roxadustat in China, where roxadustat is the market leader by brand value share in the chronic kidney disease (CKD) anemia category, as well as FibroGen’s collaboration agreement with Astellas for roxadustat in the E.U., Japan, and other territories, remain in place. Given both 1L and 2L pamrevlumab treatment groups graduated into Stage 2 of PanCAN’s Precision Promise study, the hazard ratio for the primary overall survival (OS) analysis assumed a common hazard ratio to estimate a single treatment effect for both 1L and 2L pamrevlumab patients combined compared to patients treated with gemcitabine + nab-paclitaxel. In addition, the pre-specified Bayesian model utilized a hierarchical model that included the borrowing of data from the mFOLFIRINOX control arm to the gemcitabine + nab-paclitaxel control arm for the primary efficacy analysis. The pre-specified primary efficacy analysis was performed in a modified intention-to-treat (mITT) population that included only subjects who initiated treatment. The mITT population in the pamrevlumab arm was comprised of a total of 102 patients in the 1L treatment group and 111 patients in the 2L treatment group and the gemcitabine + nab-paclitaxel control arm was comprised of a total of 34 patients in the 1L treatment group and 36 patients in the 2L treatment group. Primary OS Analysis as Determined by Pre-Specified Bayesian Statistical Analysis (mITT Population) Bayesian Model Common Hazard Ratio (HR)Posterior ProbabilityMedianMean (SD)95% CIPr(HR Primary Efficacy Analysis1.1701.184 (0.175)(0.882, 1.563)0.13977 LAPIS Efficacy Results The study did not meet the primary endpoint of overall survival (stratified log-rank p-value=0.55). Median overall survival of 17.3 months was observed in the pamrevlumab combined with gemcitabine + nab-paclitaxel or FOLFIRINOX arm compared to median overall survival of 17.9 months in the control arm of placebo combined with gemcitabine + nab-paclitaxel or FOLFIRINOX (HR: 1.08; 95% CI – 0.83 to 1.41). The preliminary safety analyses across both studies indicate that the safety profile of pamrevlumab combined with gemcitabine + nab-paclitaxel or FOLFIRINOX was generally well tolerated with an acceptable safety profile in pancreatic cancer patients. No clinically meaningful differences in treatment emergent adverse events were seen between the treatment arms. PanCAN’s Precision Promise adaptive platform trial (NCT04229004) is a U.S.-based, seamless Phase 2/3 study sponsored by PanCAN that enrolled patients in 24 sites nationwide. The multi-arm study consists of experimental treatment arms and two comparator arms: gemcitabine + nab-paclitaxel and mFOLFIRINOX. The pamrevlumab experimental arm enrolled 102 patients with mPDAC in first line (1L) and 111 patients with mPDAC in second line (2L). Both 1L and 2L patients received pamrevlumab in combination with gemcitabine and nab-paclitaxel. The final analysis was based upon the data collected up to 12 months after the last patient initiated treatment. The LAPIS study is a global Phase 3, randomized, double-blind trial to evaluate the efficacy and safety of neoadjuvant treatment with pamrevlumab or placebo in combination with either gemcitabine + nab-paclitaxel or FOLFIRINOX in the treatment of participants with locally advanced, unresectable pancreatic cancer (LAPC). The study enrolled 284 patients, who were randomized at a 1:1 ratio to receive either pamrevlumab or placebo, in combination with either gemcitabine + nab-paclitaxel or FOLFIRINOX. All patients were dosed up to six cycles of treatment and patients who completed study treatment were evaluated for surgical exploration for possible R0 or R1 resection. Participants who were ineligible for surgical exploration continued to receive treatment as per standard of care (SOC) for each institution. Pamrevlumab is a potential first-in-class anti-CTGF fully human monoclonal antibody being developed by FibroGen to inhibit the activity of connective tissue growth factor (CTGF). Pamrevlumab is in clinical development for the treatment of metastatic pancreatic cancer and locally advanced unresectable pancreatic cancer (LAPC). The U.S. Food and Drug Administration has granted Orphan Drug Designation for the treatment of patients with pancreatic ductal adenocarcinoma (PDAC), and Fast Track designation to pamrevlumab for the treatment of patients with LAPC. Pamrevlumab is an investigational drug and not approved for marketing by any regulatory authority. For information about our pamrevlumab studies please visit www.clinicaltrials.gov. FibroGen, Inc. is a biopharmaceutical company focused on accelerating the development of novel therapies at the frontiers of cancer biology. Roxadustat (爱瑞卓®, EVRENZOTM) is currently approved in China, Europe, Japan, and numerous other countries for the treatment of anemia in chronic kidney disease (CKD) patients on dialysis and not on dialysis. Roxadustat is in clinical development for chemotherapy-induced anemia (CIA) and a Supplemental New Drug Application (sNDA) has been accepted for review by the China Health Authority. FG-3246 (also known as FOR46), a first-in-class antibody-drug conjugate (ADC) targeting CD46 is in development for the treatment of metastatic castration-resistant prostate cancer. This program also includes the development of an associated CD46-targeted PET biomarker. In addition, FibroGen has expanded its research and development portfolio to include two immuno-oncology product candidates for the treatment of solid tumors. For more information, please visit www.fibrogen.com. The content above comes from the network. if any infringement, please contact us to modify.

Clinical ResultOrphan DrugLicense out/inFast Track

31 Jul 2024

·www.fiercebiotech.com

FibroGen lays off 75% of US staff as cancer drug flunks 2 more trials

Investors sent FibroGen's stock down 45% to $0.57 in premarket trading. FibroGen is radically restructuring its business, laying off 75% of its U.S. staff and stopping investment in its lead candidate in response to the failure of two late-phase pancreatic cancer clinical trials.One year ago, FibroGen laid off 104 employees, around one-third of its U.S. workforce, after the failure of pamrevlumab in two phase 3 trials. Work on two pancreatic cancer studies continued. At a Goldman Sachs event in June, FibroGen CEO Thane Wettig framed the cancer readouts as a pivot point for the biotech—either hit the endpoints and file for approval or miss and be forced to restructure.The company revealed yesterday that both trials missed their primary endpoints, and Wettig swiftly followed through on his vow to reshape the business for a post-pamrevlumab future. It means that FibroGen is implementing an immediate and significant cost-reduction plan in the U.S.The plan entails the termination of investment in pamrevlumab R&D and a 75% reduction in FibroGen’s U.S. workforce. Including ex-U.S. employees, FibroGen had 486 staffers at the end of last year. FibroGen also plans to “expeditiously wind down any remaining pamrevlumab obligations.” That rapid retreat from pamrevlumab reflects the results of two studies that dealt the killer blow to the anti-CTGF antibody. Called a hot prospect in 2017 on the back of midphase idiopathic pulmonary fibrosis (IPF) data, the candidate floundered once it reached pivotal trials. Failures in IPF and Duchenne muscular dystrophy precipitated last year’s layoffs and left pamrevlumab with two shots at redemption.The Pancreatic Cancer Action Network (PanCAN) was studying pamrevlumab in metastatic pancreatic cancer. In parallel, FibroGen was running a trial in locally advanced, unresectable pancreatic cancer. The phase 2/3 PanCAN trial cleared an interim assessment, which showed the study had at least a 35% chance of success, but ultimately found pamrevlumab had no significant effect on overall survival (OS).FibroGen’s phase 3 trial in another pancreatic cancer population reported a median OS of 17.3 months in people who received pamrevlumab on top of a chemotherapy regimen. Median OS in patients who got placebo plus chemotherapy was 17.9 months.William Blair analysts said yesterday that they believed “investors had exceedingly low expectations for pamrevlumab in pancreatic cancer” going into the readout because of the candidate’s failures in other indications and the industrywide history of struggles to improve outcomes in the solid tumor. Even so, investors sent the stock down 45% to $0.57 in premarket trading. The failure of pamrevlumab leaves FibroGen focused on a clutch of earlier-stage candidates that it has in-licensed. FG-3246, a CD46-directed antibody-drug conjugate, is the most advanced pipeline prospect, with a phase 1/2 trial set to start this year.William Blair analysts said “investor inbounds on FibroGen have increased markedly following the recent M&A activities in the ADC field and competitive top-line data releases.” However, the analysts cautioned that FG-3246 is the only pipeline candidate currently in the clinic, and a potentially registrational-enabling study is still “several years from initiation.”

Phase 3Clinical ResultADC

100 Deals associated with Pamrevlumab

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R&D Status

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Indication	Highest Phase	Country/Location	Organization	Date
Muscular Dystrophy, Duchenne	Phase 3	US	FibroGen, Inc.	10 Aug 2020
Muscular Dystrophy, Duchenne	Phase 3	CN	FibroGen, Inc.	10 Aug 2020
Muscular Dystrophy, Duchenne	Phase 3	AU	FibroGen, Inc.	10 Aug 2020
Muscular Dystrophy, Duchenne	Phase 3	AT	FibroGen, Inc.	10 Aug 2020
Muscular Dystrophy, Duchenne	Phase 3	BE	FibroGen, Inc.	10 Aug 2020
Muscular Dystrophy, Duchenne	Phase 3	CA	FibroGen, Inc.	10 Aug 2020
Muscular Dystrophy, Duchenne	Phase 3	CZ	FibroGen, Inc.	10 Aug 2020
Muscular Dystrophy, Duchenne	Phase 3	FR	FibroGen, Inc.	10 Aug 2020
Muscular Dystrophy, Duchenne	Phase 3	IL	FibroGen, Inc.	10 Aug 2020
Muscular Dystrophy, Duchenne	Phase 3	IT	FibroGen, Inc.	10 Aug 2020

Clinical Result

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT03941093 (LAPIS, CTgov)	Phase 3	Pancreatic carcinoma non-resectable	284	FOLFIRINOX+Nab-paclitaxel+Pamrevlumab+Gemcitabine (Pamrevlumab + Gemcitabine/Nab-paclitaxel or FOLFIRINOX)	rzxjerppfv(uyrptlgpbi) = pcmxkbfivg cwsiohgsnl (wmzuwumqdq, zggljlxdze - bybolmyblx) View more	-	05 Nov 2024
				Placebo+Nab-paclitaxel+Gemcitabine (Placebo + Gemcitabine/Nab-paclitaxel or FOLFIRINOX)	rzxjerppfv(uyrptlgpbi) = pwhlawmhfg cwsiohgsnl (wmzuwumqdq, vszhhdmfvd - lvlqgpguzb) View more
NCT04632940 (LELANTOS-2, CTgov)	Phase 3	Muscular Dystrophy, Duchenne	73	Corticosteroids+Pamrevlumab (Pamrevlumab)	owlqcroyns(ibkofsesbc) = hfepzavrbt mevudzoyyd (rmvruyzefe, ystszwxtmi - mygsxjgmcr) View more	-	26 Aug 2024
				Placebo (Placebo)	owlqcroyns(ibkofsesbc) = yxietxbipg mevudzoyyd (rmvruyzefe, sumotisccx - zshoxgxxbg) View more
NCT04419558 (CTgov)	Phase 3	Idiopathic Pulmonary Fibrosis	372	Pamrevlumab (Pamrevlumab)	eeifkfezuu(nslniikedb) = dsncbvcfun rxdvcpgwfs (itltxitcvy, upmyllyodc - ddhuuocdls) View more	-	12 Aug 2024
				Placebo (Placebo)	eeifkfezuu(nslniikedb) = cttcmdttjt rxdvcpgwfs (itltxitcvy, ylbjwuiqxr - lyqbztnjua) View more
NCT03955146 (ZEPHYRUS-1, Pubmed)	Phase 3	Idiopathic Pulmonary Fibrosis	356	Pamrevlumab 30 mg/kg	ouvzevhheq(ovozxvenjv) = wrzwdyxagp mfqcgyrqxo (zcwkenvuoo, -350 to -170)	Negative	19 May 2024
				Placebo	ouvzevhheq(ovozxvenjv) = dvsueovdlm mfqcgyrqxo (zcwkenvuoo, -430 to -230)
NCT04371666 (LELANTOS-1, CTgov)	Phase 3	Muscular Dystrophy, Duchenne	98	Corticosteroids+Pamrevlumab (Pamrevlumab)	hlorgxkkhd(yexpjoosdk) = pfaqypzjfe oqphsnqmqa (dlqrvkdmcn, zgixymbhxs - dscytjehme) View more	-	12 Mar 2024
				Placebo (Placebo)	hlorgxkkhd(yexpjoosdk) = fgqhvpydqp oqphsnqmqa (dlqrvkdmcn, xxywnowpzp - doxzuugnny) View more
NCT04632940 (LELANTOS-2, Biospace) Manual	Phase 3	Muscular Dystrophy, Duchenne	73	Pamrevlumab	lfddijrlfv(fkljyqdzzd): difference(point) = -0.528 (95% CI, -2.308 to 1.251), P-Value = 0.5553	Negative	23 Aug 2023
				Placebo
NCT02210559 (CTgov)	Phase 1/2	Pancreatic carcinoma non-resectable	37	Nab-paclitaxel+Pamrevlumab+Gemcitabine (Arm A: Gemcitabine Plus Nab-paclitaxel + Pamrevlumab (G/NP+P))	oqksgbdiwh(lftnaafvjx) = wsjdvlpraa uehivtqktf (cmuwdnpfrn, wyluhynznd - wzixrdoekn) View more	-	02 Mar 2023
				Nab-paclitaxel+Gemcitabine (Arm B: Gemcitabine Plus Nab-paclitaxel (G/NP))	oqksgbdiwh(lftnaafvjx) = rtumxdzzij uehivtqktf (cmuwdnpfrn, tunhuaghlt - eqthiboegw) View more
NCT04432298 (CTgov)	Phase 2	COVID-19	22	Pamrevlumab (Pamrevlumab)	icnzwixmrz(idnmswsvap) = tdknnxwbmy myrevbbuwy (eitmeanlyy, hqciwpssvm - pgaufrnphm) View more	-	18 Jul 2022
				Placebo (Placebo)	icnzwixmrz(idnmswsvap) = pjrxlogrcy myrevbbuwy (eitmeanlyy, uzwwgzrjoe - jnmntdsxzn) View more
NCT02606136 (MISSION, CTgov)	Phase 2	Muscular Dystrophy, Duchenne	21	Pamrevlumab	ugrjyvnrlo(zdcqvlezdh) = csvyblydav ndejzrzfdn (ttwubjiadr, temwpcxkdq - dmqqnoiewj) View more	-	30 Dec 2021
NCT01890265 (PRAISE, CTgov)	Phase 2	Idiopathic Pulmonary Fibrosis	160	Pamrevlumab (Pamrevlumab)	qjehqkesoy(mcjvalinxv) = urxgjynihs dptdlhxwjm (xaftcsajtz, rdgbkqpdby - eycrfpwlqx) View more	-	04 Sep 2020
				Placebo (Placebo)	qjehqkesoy(mcjvalinxv) = bewfonneud dptdlhxwjm (xaftcsajtz, sbbzqnpwjr - crxbqjinjv) View more

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