Pharma Mar, S.A. (BME:PHM)
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Earnings Call: Q4 2022

Feb 28, 2023

Operator

Hello, and welcome to the PharmaMar Full Year 2022 Results Presentation Call. My name is Laura, and I will be your coordinator for today's event. Please note this call is being recorded, and for the duration of the call, your lines will be on listen only. However, you will have the opportunity to ask questions at the end of the call. This can be done by pressing star one on your telephone keypad to register your question. If you require assistance at any point, please press star zero and you will be connected to an operator. I will now hand you over to your host, José Luis Moreno, Director of Capital Markets and Investor Relations, to begin today's conference. Thank you.

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Thank you, Laura, and good morning to everyone. I'd like to welcome to all of you to our full 2022 results conference call. On the call with me today are Mr. Luis Mora, Managing Director of PharmaMar.

Luis Mora
Managing Director, PharmaMar

Hello.

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

María Luisa de Francia, Chief Financial Officer, and Pascal Besman, which is Vice President Strategic Development. Following our prepared remarks today, we will open the line for questions.

Before we start, I would like to remind you that today's conference call might include forward-looking statements regarding future events or the future financial and operating performance of our company. Such forward-looking statements are only predictions based on our current expectations, and actual results may vary from those projected. We disclaim any obligation to update any information provided herein, and we refer you to our safe harbor statement on our corporate presentation, which is available on our website together with the press release and the report of the results we released yesterday.

Last year, it was important year for the company because we achieved important goals, and we had an important advance in our development. I guess you had a chance to see our press release yesterday, so I'll not go through every little detail, but let me highlight the most important news from last year. In 2022, we saw the approval of lurbinectedin for commercialization for the treatment of small cell lung cancer in countries like South Korea, Qatar or Emirates. That adds, of course, to U.S., Australia or Singapore, where the drug has been approved already. As you know, one of our main targets with Zepzelca in the next future is to achieve approval in Europe and full approval in the U.S. In the meantime, we'll have more news about approvals and filings in other countries.

Talking about other developments, the two phase III trials that are ongoing with lurbinectedin for small cell lung cancer are currently recruiting. In the case of a trial in first line in combination with Tecentriq in small cell that our partner, Jazz, is doing together with Roche, they announced in January that recruitment will be completed this year. The LAGOON trial, which is our phase III for second line in small cell lung cancer using lurbinectedin as a monotherapy, is also progressing with its recruitment. It is worth mentioning that both trials will be fileable not only in U.S. and Europe, but also in other territories.

Also, last year, we reached an agreement with a company provider of the immunotherapy that will combine with Zepzelca for the phase III trial in mesothelioma that we expect to start later on this year. In 2022, we also advanced in the progress of other oncology molecules in our pipeline, and we had a new molecule, PM534, entering into clinical development in the phase I. We also did all the work and have ready to include another new molecule in the pipeline, which will happen later on this year. In other therapeutic areas like RNA interference, last year, we started another phase III trial with givosiran. Currently we have two phase IIIs ongoing with givosiran, one to demonstrate activity and another one to assess safety, which started in April last year.

Also, in RNA interference, last year, we started a phase II trial in macular degeneration with another molecule called SYL1801, which is worth highlighting the fact that is administered as eye drop solution for this indication. I will turn over now to María Luisa, who will give you more details about the financial results.

María Luisa de Francia
CFO, PharmaMar

Thank you, José Luis. Good morning, thank you all for joining this conference call about 2022 full year financial results. The main events that had an impact on the 2022 financial statement were as follows. Firstly, we will point out the new legislation applicable in France with respect to drugs marketed under the autorisation d'accès compassionnel early access program, which has resulted in significant discounts leading to the need for a provision of EUR 15.2 million. Units sold in France in 2022 were slightly higher than those sold in 2021. Secondly, in the last quarter of the year, after 15 years of Yondelis on the market, the generic product trabectedin began to be marketed in Europe. With the consequence pressure on prices and volumes. In 2022, the impact also felt has not yet been significant.

In 2022, Yondelis reached one of the commercial milestones set in the license agreement signed with J&J in 2001 for EUR 10 million. Finally, the decision to discontinue the diagnostic segment resulted in the recognition of a number of expenses and provisions amounting to some EUR 3.5 million-EUR 4 million. Thus, in the analysis of recurring revenues, we see a decrease of 5% compared to the previous year. As you know, these recurring revenues are made up of sales and royalties received from our partners. Yondelis sales in Europe were EUR 63.8 million. In 2021, they were EUR 69.4 million. Sales in Europe of Zepzelca under the authorization access compassionate program amounted to EUR 15.5 million, EUR 13.2 million in 2021.

This decline in sales was partially offset by an increase in royalties of 22% to EUR 50.3 million, of which EUR 46.9 million corresponds to Jazz Pharmaceuticals sales of Zepzelca in the United States, and by an increase in raw material sales to our partners for both Yondelis and Zepzelca for up 11.6% from EUR 19.2 million to EUR 21.4 million. In relation to non-recurring revenues, the main difference was due to the achievement in 2021 of a commercial milestone under the Jazz Pharmaceuticals agreement, which resulted in revenues of EUR 22 million, as well as to the amount recognized as revenues from those deferred incomes from the same agreement, which also was higher in 2021 by about EUR 10 million.

These differences were also partially offset by the achievement in 2022 of the milestone under the J&J license agreement for Yondelis in the mentioned amount of EUR 10 million. In terms of expenses, there was an increase in R&D expenses as a result of the up to four phase III trials ongoing in 2022. EUR 11.3 million more than the previous year or 16% higher. In marketing and general expenses, the return to international face-to-face meeting, congresses, and commercial actions have also led to a certain increase in expenses. Finally, as we mentioned at the beginning, the income statement is also affected by the discontinuation of diagnostic activity.

All of the above leads to an EBITDA of EUR 51.4 million compared to EUR 97.8 million in 2021, and a net result for the period amounting to EUR 49.4 million. Income taxes in 2022, +EUR 5.6 million , includes the activation of tax credit to be applied in the future, as well as the monetization of R&D deductions received in 2022. It's important to note that in 2022, operating activities generated cash of EUR 38.3 million. The net cash position at the end of the year amounts to EUR 192.8 million after deducting the EUR 39 million of total financial debt. This is 15% above the net cash at the end of 2021.

To summarize the financial part, I would like to highlight the generation of operating cash flows, even with growing R&D expenditure, with the consequence maintenance of cash levels and reduction of debt. I would like to end my intervention with a reference to ESG issues. As far as environmental concern, in 2022, the group has measured its carbon footprint, including scopes one, two, and three. In 2023, the group is planning to work on an emission reduction plan in accordance with the Science- Based Targets initiative standards. On the social side, I will briefly give some data on quality of employment. For instance, 98.8 of the contracts are permanent and all of our employees have a health insurance policy.

On diversity, we have employees of 15 different nationalities, and on equality, 60% of our employees are women with a weighted wage gap of 3.4%. Finally, regarding governance, I would add that 41% of our board members are independent, 33% are women, and also 47% of our senior management and management are women, too. Now, I pass the microphone to Luis Mora.

Luis Mora
Managing Director, PharmaMar

Thank you, María Luisa. Our pipeline, you can see the confirmation of our investment strategy in R&D, with a strong increase in the phase III planned for this year, 2023, and new molecules under development. Regarding Yondelis, after already 15 years in the market and maintaining an excellent market share of more than 30% in its label, close to 2022, we've done increases in sales, demonstrating that it's in a standard of care in subtypes of sarcoma. We have an excellent commercial network. In the last quarter, 2022, and María Luisa explained before, the generic trabectedin already appear impacting price in different European territories. According to the different regulations, the initial impact oscillates between 30%-50% higher reduction depending on the countries and the different distribution channels.

In some countries, the access system changed, starting new offers to tenders, and we will see what is the evolution through 2023. It is important to highlight the important development plan with lurbinectedin with two phase IIIs in the small cell lung cancer in first line and second line treatment with trials underway. Three new cancer screening for mesothelioma or synovial sarcoma, and in the last quarter of the year, we plan to start consider two ovarian cancer trials. This aside, Pascal will review more details. In 2022, we reached important agreement with a company that is going to collaborate in the mesothelioma trial, and we hope to start around the summer of this year.

Regarding Sylentis, two phase III and one phase II and advancing according to plan in under development. The recruitment is ongoing, and we will see the result data when it's coming. We expect it in early next year, probably we will have the result data. In phases I and II, we have trabectedin and PM534, and also in this third quarter, a new compound, PM54, we will start the phase I. Finally, with Aplidin, with plitidepsin, we are initiating a phase II trial in immunosuppressive patients with SARS-CoV-2. As you can see, this is an ambitious development program that will certainly bring new treatment option for the patient and new opportunities for PharmaMar. Now, Pascal will review more details in some clinical trials. Pascal?

Pascal Besman
VP of Strategic Development, PharmaMar

Thank you, Luis, and hello to all. I'm gonna give you some details on our current and near future phase III trials. In addition to the combination pivotal trial with atezolizumab in first-line maintenance therapy, which is ongoing by Jazz in partnership with Roche, I have three PharmaMar-led trials to share with you. First of all, the LAGOON trial. This is a three-arm trial of lurbinectedin monotherapy at the 3.2 mg approved dose versus a combination with irinotecan, versus the control arm of either oral or intravenous topotecan or irinotecan, where the primary endpoint will be arm A versus arm C with 90% power to deliver a hazard ratio of 0.8. It's important to know that there is a statistical plan such that either arm can both lead to a potential approval or only one.

The order will be arm A versus C, which is the primary analysis, followed by B versus C. There are four learnings and new pieces of information that led to this trial where we've made some tweaks that we think increase our odds of success I will share with you. Number one, the FDA requested that we make sure that 70% of the patients have prior IO. This reflects the population of the United States and is very helpful to us because whereas there is no data that we are aware of that shows synergy or additive benefit from IO and topotecan or irinotecan, we have plenty of such data with lurbinectedin and IO, some of which of course has led to the combination trial you are already aware of.

The second tweak we have done in this case is, unlike our prior trial, we are requesting brain scans to make sure that all of the brain mets are stable or tapering doses. This was our worst subset in the prior trial with a hazard ratio of 1.3. We think that can help that as well. The third tweak we've made is no prior GCSF. If you recall from our basket trial, the use of GCSF was not mandated for primary prophylaxis, and therefore the secondary use was only 20%. By having forced GCSF on all patients in prior trial, we were basically helping the control arm.

Lastly, and perhaps in my opinion at least, most worthwhile to think about is that this is the first trial where the regulators have allowed oral topotecan instead of IV. Oral is more used because it's more tolerable, and despite having been approved in a non-inferior trial, it is numerically inferior. Most importantly, IV topotecan as your control arm introduces patient selection bias, because with a 92-year-old person coming in on their walker, you're not enrolling them as a physician into a trial with a 50% chance of IV topotecan. We think the addition of oral will mean that some lower performance status patients will be admitted into the trial, which will help us. With this trial and the first-line maintenance trial, you can see that we're not just happy in second-line small cell treating patients, we want to change the treatment paradigm.

Let me move on to mesothelioma. This is another aggressive thoracic malignancy with a long latency period caused by an external stimulus, in this case, asbestos. The treatment paradigm has had very slow progress. The only real change has been the recent addition of nivo-ipi in both U.S. and E.U. into the front-line setting. The patient numbers are smaller than small cell and dominated here by Europe. Looking at our trial now, this is based on ESMO 2019 monotherapy data and what we have seen of the addition and synergistic benefit of IO in multiple datasets. Because of the recent approval of nivo-ipi in certain territories, this is a trial that will be prior to one platinum, and there we will stratify for those who have had IO versus those who have not.

It will be a monotherapy versus a combo therapy with atezolizumab versus the control arm, which is dealer's choice gemcitabine or vinorelbine with an overall survival primary endpoint. We're finalizing the protocol and expecting to have our first patient in this summer. The last indication is leiomyosarcoma, which we are hoping to start also in the first half of this year. Let me start with the rationale for this. We have seen data that's been published for Yondelis in this indication with a very strong overall survival. We've had in the public domain some data from lurbinectedin in this indication, some published, presented last year at CTOS, and yet we also have more that is not yet public domain that we are aware of.

We know that lurbinectedin synergized with doxorubicin from multiple prior trials. That's why we want to test it in this trial in combination in the front line versus doxorubicin. I'll show you the protocol momentarily. Do bear in mind that we are unparalleled in the land of sarcoma treatment from our 20+ years of experience with Yondelis trials and commercial. We know the centers, the doctors, the patient associations, the reimbursement channels. We feel very confident that this is a trial we can win on. As for the business case, leiomyosarcoma is 50% of soft tissue sarcoma. Half of that is metastatic. The treatment target market in EU 5 is around 2,000. We think we can get a good chunk of market share.

Furthermore, we expect to see six or more cycles, much more than in small cell, as this is a first-line trial. Y ou can do the math that this may be somewhere around the EUR 30 million European indication for us. In the U.S., because of the IP, the opportunity will be more limited and shorter. Given in Europe that the 10-year orphan clock has not been triggered yet, we could have eight years or so, in our opinion, to see this business case bear out. Now for the trial design here. This is a phase II/III adaptive design. We will have two different dosing regimens in the part II-B versus standard of care doxorubicin.

An interim analysis will then be held to pick the better dose, and then the primary endpoint will be PFS by independent review of the 80 patients in the phase II-B and the 120 into part three, so 200 in the analysis. This will have 60 sites over Western Europe and the U.S. only, where we have the sarcoma experience. We hope to get data back end of 2026. With that, I will turn it back to José Luis for further comments and to take your questions. Thank you.

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Thank you, Pascal. After hearing about all these projects, 2023 is definitely going to be a very busy year for us. Firstly, we expect to hear about new approvals and submissions of lurbi in different countries. In regard to the drug development and particularly development with lurbinectedin, as Pascal just mentioned, we expect to start the phase III trial for mesothelioma and a phase III trial in other indications like leiomyosarcoma. In regard to both of the phase III trials for small cell lung cancer, LAGOON and IMforte, both are currently ongoing. They will continue recruiting. In the case of IMforte, our partner, Jazz, announced in January, as we just mentioned, they expect to finish recruitment later this year.

Also, with lurbinectedin, we expect to finish this year the phase II trial in combination with irinotecan for small cell lung cancer. About other molecules in our pipeline, in 2023, we expect further developments with PM534 and PM14 and also expect to have a new molecule, as we've mentioned, PM54, which wi ll get into clinical development during the first half of this year.

Finally, as Luis mentioned, in RNA interference, we expect to conclude this year the two phase III trials that we have currently ongoing for dry eye. We hope all these developments will lead us to achieve our goals in the sure future. After this year, we expect to see more important news like data in those two phase III trials in RNA that I just mentioned. Perhaps some more license agreements in this indication and others. IMforte , the trial will be still ongoing in 2024 and might start generating some news afterwards. The other trials in phase III, like LAGOON, might start generating some news in 2025. All in all, a very busy and exciting couple of years ahead of us.

With a strong balance sheet and cash position, which will allow us to finance our developments. With this, we conclude our speech today, and we open the line to questions. Laura?

Operator

Thank you very much. Ladies and gentlemen, as a reminder, if you would like to ask questions, please press star one on your telephone keypad. Thank you. We'll now take our first question from Ami Fadia at Needham and Company. Your line is open. Please go ahead.

Eason Lee
Biotech Equity Research Associate, Needham and Company

Hi. Good morning. This is Eason Lee for Ami . Thanks for taking our questions. Maybe a couple here. First, on the phase II update for lurbi plus irinotecan, I guess any chance this could support maybe , you know, an sNDA in the U.S. or a submission in Europe?

Luis Mora
Managing Director, PharmaMar

No. The trial is ongoing. We expected to finalize the trial this year and the recruitment. Probably in the last quarter of this year, we have the data. We will see depending of the results. Remember, it's a single arm trial in combination with irinotecan, and then we will see. It's difficult to answer, why answer this question after when we have the data.

Eason Lee
Biotech Equity Research Associate, Needham and Company

Okay. Got it. Got it. Then, maybe, I guess, you know, you talked in the past kind of thoughts around, you know, in-licensing, you know, assets to leverage, kind of, your marketing sales force. Maybe remind us again of, you know, the type of assets that you think best fit in your portfolio. Then, kinda curious if you've seen an evolution in the market for such assets, you know, at present versus say, you know, 2021, 2022. Thank you.

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Yeah. We continue to screen the market and to have conversations with several options. The assets where we want to incorporate in our pipeline in the sales network is for solid or hematological tumors. The level of the peak sales, potential peak sales between EUR 70 million to EUR 120 million. This is the level of the asset we search in the market. It is. I mean, it's not a lot of options today in the market, some options more. The activity is not a stop, obviously. It's continuous. We have today several options. We had in the past some conversations and obviously this is the deal. Two parts need to agree. We hope in 2023 or 2024, we finally achieve some licensing in.

Eason Lee
Biotech Equity Research Associate, Needham and Company

Great. Thank you very much.

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Thank you.

Operator

Thank you. We'll now take our next question from Christian Glennie at Stifel. Your line is open. Please go ahead.

Christian Glennie
Pharma, Biotech, and Medtech Analyst, Stifel

Hi, guys. Good afternoon. Thanks for taking the questions. To kick off with, just a few, sort of on the financials and the modeling side for 2023. I didn't fully catch what you seem to be implying from the generics, to Yondelis in Europe. What should we be implying in terms of erosion of sales, potentially in 2023? Is there an expectation that there may be some U.S. generics coming in 2023 on Yondelis?

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

No, not in U.S.A. We don't expect it in the short term, generics in U.S.A. The major impact is here in Europe. I explained before that the impact that, according to legislation of different countries, there's a reduction price between 30% to 50%, which is automatically. In some countries, not in all countries, the market access channel change is just through tenders. Like Italy, in Spain, not yet, but little by little as when the generic more the discounts is played in this game, okay? From the price. Then we will see. We will see through this 2023 what we'll see the real impact. I repeat, the price impact between 30% to 50% depends on the country. It's automatic. Okay?

Christian Glennie
Pharma, Biotech, and Medtech Analyst, Stifel

Okay, thanks. That's helpful. Then on Zepzelca and the royalties they reported. Obviously, we'll see what number Jazz comes up with sort of overnight, but it, you know, implies maybe sales of around about sort of $275 million. At this point, there's no mention of potential milestones, commercial milestones on those U.S. sales. Is that just a timing thing, or s hould we assume that you haven't hit the next threshold?

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Well, we can mention nothing about the Jazz sales or if the milestone are coming. Okay. The royalty growth is a good signal. The Zepzelca is a good level of sales in U.S.A., and the royalties you remember we announced come from high teens to 30%, depend of the level of sales. If it's growing, if you put a jump the other scale of royalties, this is good because it's a signal, it's in parallel with a good level of sales Zepzelca in U.S.A. Okay.

Christian Glennie
Pharma, Biotech, and Medtech Analyst, Stifel

Okay. We may still have end up with a milestone being paid potentially f or 2022.

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

We can comment more. If you want to see more about the Zepzelca sales, you say ask Jazz. It's not our market. Okay?

Christian Glennie
Pharma, Biotech, and Medtech Analyst, Stifel

Okay. Then just finally on R&D, what should we be expecting for 2023? Is it a similar increase? Obviously, you've got the same trials are ongoing. You're gonna start mesothelioma. What should we be expecting for R&D?

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Well, I explained before, it's a very busy year. The pipeline is plenty of phase III with Zepzelca, with Sylentis , et cetera. Obviously the every new drug is coming to phase I, et cetera. The increase of R&D will be clear. The level of increase we will see depend on the new. You know very well is very linked to the number of patients we enroll, the number of countries, centers included in these trials. In principle, we can expect it to increase like this year if you compare with the last year, the past year, 2021. Okay.

Christian Glennie
Pharma, Biotech, and Medtech Analyst, Stifel

Okay. Thank you.

Operator

All right. We'll take our next question from Joseph Hedden at Rx Securities. Your line is open. Please go ahead.

Joseph Hedden
Biotech Equity Analyst, Rx Securities

Good afternoon. Thanks for taking my questions. Just firstly, on the Q4 royalty number for lurbinectedin, can you confirm if that contains any adjustments that you had to make after Jazz reported its Q3 sales?

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

I t's not any adjustment. This is our forecast, about the royalties. We don't have exactly Q4. We don't expect a big deviations of that. Okay.

Joseph Hedden
Biotech Equity Analyst, Rx Securities

Okay. I mean, you have to make adjustments after Jazz reports its actual numbers, presumably, and these are accounted for in the next quarter's royalty line. Were there any , you know, that were related to Q3 in there, or is it purely the Q4 royalty forecast?

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

It's not a material adjustment.

Joseph Hedden
Biotech Equity Analyst, Rx Securities

Okay. Fine. That's great. Thanks. On the ATU program, you mentioned a slight increase in the number of patients in that this year. Is there any scope for further increase of patient numbers in this program or do you think it's pretty level now? Also, you know, on the price, we know that the price has come way down there due to French regulations. Is that settled now or will there be further discounts?

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Well, in 2022, the number of patients treated in France, if I remember, is about 700 patients. Okay? Is about 7%- 8% more than the previous year. The price is flat, but the previous year, many of the patients were treated under ATU, autorisation temporaire d’utilisation . In July 2021, changed the law for autorisation d'accès compassionnel. Many patients was a carryover, and some patients was already included in ATU. With this impact in the level of discounts more in December 2021.

T he level of discounts apply under this new legislation are linked with two variables. One is the level of sales, and two, depend on the number of patients treated is in the loop. Okay? Based on that, the calculation, internal calculation from about 50%, a little more than 50% than the sales. Okay? This is the law. Now the company send the information to the French authorities, and we expect that they come with a credit note. The price is flat from 2019, 2020.

Joseph Hedden
Biotech Equity Analyst, Rx Securities

Okay. That's great. Thanks. Just on Yondelis, obviously generic competition coming in there in Q4. Is this gonna impact the size of your oncology sales force? Are there gonna be any meaningful cuts there this year?

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Well, our sales force and medical affairs and different areas in the next work. Now they have a lot of work, not only for Yondelis, and it's different in different countries. I mean, it's not the same in Germany than Spain, or same Italy than France. It's not like Netherlands than Belgium. The generic impact is in different manner. The second one, the activity for to prepare with the market for the next compounds are coming for the Zepzelca, et cetera. They started to work in 2023. The other important reason is if we want to achieve an agreement for licensing, we need the sales force. It makes sense to have licensing without sales force. What we don't will increase is the SPs in the sales force and the new capability. Okay?

Joseph Hedden
Biotech Equity Analyst, Rx Securities

Okay. Okay. Great. Thanks. Just to follow up on that, in terms of your business development efforts, is there anything more to say on that front in the new year?

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Well, we are big activity. I can confirm. Big activity, many contracts, screen the market. We have always in the table assets for analyze, we will maintain this activity because it's our important goal for us, and we want to have a new asset, not only one, not only two, as soon as the better. We will see. I can't say more. Okay?

Joseph Hedden
Biotech Equity Analyst, Rx Securities

Okay. Last one for me, just on that R&D slide that you showed where it's good to see that you're expanding the phase III indications now. That's great. I noticed the one that you didn't go into further detail on was ovarian cancer, phase III. Can you just describe how your plans there are different from the CORAIL trial that you've already conducted with lurbinectedin?

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Yeah. In ovarian cancer, we are still considering. This trial, potential trial was born because we haven't. We know very well the ovarian cancer in Europe. Several competitive groups in gynecological oncology and key opinion leaders approach us. Because the patients relapse to PARP inhibitors, they have a poor prognosis and not a lot of options for treatment. We conducted a phase I, II in the past. Well combined, very well combination, very good combination, lurbinectedin plus paclitaxel. Several patients entered in this trial, and with the encouraging results. Based on that, based on the medical needs, based on the mechanism of action of this combination, we start to work with these key opinion leaders and competitive groups to design this trial.

Now it's advanced. The protocol is on more or less finished in contact with these groups. We expected, if all goes well, to start this trial at the end of this year. Okay?

Joseph Hedden
Biotech Equity Analyst, Rx Securities

Okay. That's great.

Luis Mora
Managing Director, PharmaMar

This is start of this trial.

Joseph Hedden
Biotech Equity Analyst, Rx Securities

Brilliant. Thanks. Thanks very much.

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Thank you, Joe.

Operator

Thank you. We'll take our next question from Álvaro Lenze at Alantra Equities. Your line is open. Please go ahead.

Álvaro Lenze
Equity Research Analyst, Alantra Equities

Hi. Thanks for taking my questions. Most of them have already been asked and answered. Just some clarification. I don't know if you commented on this during the prepared remarks, but the increasing in general and administrative expenses in Q4 seems a bit higher than we expected. Is this for preparation for any additional marketing efforts in some countries? Or is this just one-off item that we should not assume going forward? My second question would be regarding Zepzelca in the current setting of second-line small cell lung cancer. What is the rate of the growth rate that we should expect in the U.S. from the royalties before there is an extension to first-line or something like that?

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Maria?

María Luisa de Francia
CFO, PharmaMar

Yeah. Alvaro, in regard to general and administrative expense, they are affected by Genomica liquidation or the starting of the closing, the process of the closing of the company. That's why it's a bit higher than past year.

Álvaro Lenze
Equity Research Analyst, Alantra Equities

Could you please quantify how much could that have been in Q4?

María Luisa de Francia
CFO, PharmaMar

Not exactly now, no. I am sorry, no. I don't have number here, but not exactly.

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Regarding the second question, well, you know we can't to say any number about the Jazz market and the Jazz space. Okay? That's it. Sorry that I can't to explain more.

Álvaro Lenze
Equity Research Analyst, Alantra Equities

Okay, thank you very much.

Operator

Thank you. Now over to you, José. Questions over at your end. Thank you.

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

Thank you, Laura. We had a few questions, written questions by email in regards to the NEPTUNO trial. The close of the trial, Luis, and, you know, about recruitment, recruited patients and available patients, if you could just give more detail on that?

Luis Mora
Managing Director, PharmaMar

Okay. Thank you, Pepe. Well, the two trial, as you remember, was designed for a particular population. Population in the hospitalization patients, moderate COVID-19, need the oxygen, et cetera, et cetera, so on and so forth. Across of the pandemic, we observe this pathology of patients decreased dramatically. This population, I don't refer in severe or in the patients admitted in the hospital. I refer this special population, what's included in the protocol. We have stopped it, and that we announced recently, for the lack of recruitment, lack of patients. The evolution of the pandemic is linked with this level of recruitment. We closed the trial with 205 patients, evaluable patients. The total of patients randomized was about 15%, 20% more higher than that, but evaluable patient was 205.

In the primary analysis, in the top line, when we announced in the press release, was a clear positive trending favor of plitidepsin. The final data is still under analysis and screening that today we will publish in a scientific publication, obviously. Okay.

José Luis Moreno
Director of Capital Markets and Investor Relations, PharmaMar

All right. Thank you. Laura, with this, we finish the round of questions.

Operator

Thank you. This concludes today's call. Thank you for your participation. Stay safe. You may now disconnect.

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