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Goldman Sachs 42nd Annual Global Healthcare Conference

Jun 8, 2021

Speaker 1

Thank you. Thank you everyone for joining this session at Goldman Sachs Global Healthcare Conference. This is the China Healthcare Analyst at Goldman. So this session is for Zai Lab. So today, we are very pleased to have the Head of BD from Zai Lab, Jonathan Wang to join this session to discuss with us the most updated progress in the BD and also the overall strategy of the SiLab.

Thank you, Jonathan, for joining us.

Speaker 2

Thank you, Ziyi. So,

Speaker 1

yes, we're going to start with some of the broad questions. I think in the past 6 months, we have seen major progression in the BB side. I think thanks to your and your team's great effort on getting all those assets in the past 6 months, we have seen 4 major deals coming in and the 4 major assets coming in. So let's start with the first one, which is the recent one. I think investors will be very interested to understand the progress you made on the KRAS G2 policy licensing from Eradi.

So first of all, would you please elaborate a little bit more about the rationale to get that asset? And particularly in China, what kind of commercial opportunity we'll be looking at for this asset?

Speaker 2

Yes, thanks for that question, Zvi. First of all, we're very excited about this collaboration with Mirati. KRAS has been a very hot target and also with the recent approval with Amgen's assets really satisfies the importance of KRAS in not only lung cancer treatment, but more broadly perhaps in some of the GI related tumors. The Meurati compound in our mind has the potential to being best cast. And also in China, there'd be an opportunity where we can move pretty quickly given the Amgen product is still not approved and also it's not even the clinic yet in China.

But from a strategic perspective, if I take a step back, if we look at our ZEISS portfolio, especially in lung, especially in the GI related tumors, I think we have built a very strong position, a leadership position with multiple assets that could be synergistic with each other. So if we look at lung, not only do we have the IO assets, the PD-onePD-one LAG-three, the tumor treating field recently had very encouraging data in lung. But if we look at our target therapy, precision medicine, we have a ROS1 with TurningPoint, a MET inhibitor. We also have the EGFR X120, which recently reported very encouraging data at ASCO. And now with this KRAS, we have a very long and broad portfolio that can address different mutations, different patient subpopulations.

So really we can create a lot of scale benefit, a lot of synergies whether it's in development stage or in commercial stage. And so this KRAS really completes that puzzle in addition to the opportunity that we may be able to combine it with our in house pipeline as well as potentially other pipeline assets that Mirati may explore on a global basis. So we're going to work with Mirati very closely. We're going to try to join as many of their global trials as possible, thereby trying to help them accelerate their timeline, but also hopefully bring this asset in monotherapy and combination therapies quicker to patients in China. So it's really strategic on many levels this collaboration.

Speaker 1

Yes, sure. Well, of course, it's going to be really strategically important to your lung cancer portfolio. But just one thing is that if you look at the prevalence rate of KRAS G12C in China compared to Western population based on some of the recent data, well, it looks like the province rate is a bit lower than in the Western population. What is your view on that? If we look at the commercial potential and we are paying 65,000,000 upfront plus near 300,000,000 milestone.

So how you actually look at the commercial potential here in China?

Speaker 2

Yes, that's a good observation. And based on literature, it does appear that the prevalence rate in China is lower than in the United States. So it's roughly about 4% or 5% of lung cancer and about 2% to 3% in colorectal. And however, you must caution that there has not been any clinical studies done in China. And because also there's no approved drugs on the market, the diagnose rate is obviously could potentially be a lot lower than what actually there may be.

So we could be one of the first KRAS to be put into clinical trials. Obviously, we'll know more from the study what the actual prevalence rate may be in China from our discussions with different KOLs. It does seem to be that there are a lot of patients with KRAS that could potentially join our trial and very quickly. So we'll find out more. But from a commercial perspective, it is still very large.

I mean, 4% or 5% of non small cell lung cancer in China on an absolute basis that is still a lot more than U. S. And Europe combined. So and then plus the colorectal patient population, it's still a pretty sizable commercial opportunity and given the late stage nature of this asset, given the potential to combine this with various other agents, given how hot KRAS is globally, we think it's a reasonable price to pay.

Speaker 1

Got it. Thank you for the color. And also I think investor might be interested to understand the clinical pass rate here in China for that one because we do think that Mirati's asset, the KRAS retriatelse could actually be the first one, well, if well, not first, but like probably the first three to get to the market if the clinical pathway, clinical strategy is right. So any preliminary thoughts here? You're going to do a bridging study in China or join their global trials?

What's going to be the most efficient way to do that?

Speaker 2

Yes. So I think Mirati has, if I remember correctly, guided or have stated in public that in the second half of this year, they will be filing their NDA in the U. S. For the late lines in monotherapy in lung cancer. So that certainly if that is the case and given their breakthrough therapy designation, that would really help us to potentially accelerate the pathway in China.

Now we just signed the deal. So we need to discuss more with Mirati. We also need to have more dialogues with the Chinese CDE and NPA. So until then, it is bit too premature to really say what the regulatory pathway is. But if I look at other products that we have successfully put onto the market, there is a range of possibilities from potentially an accelerated approval, leveraging their global data and maybe some PK data to perhaps maybe conducting a bridging study.

So there are various obviously addresses a very large unmet medical need here in China. So we think that there may be a case for acceleration.

Speaker 1

Got it. Got it. Well, just a small question on that is, we read about the data coming from Mirati's assets and we talked to some of the physicians. So some might show a bit concerns on the QT prolongation in a small percentage of patients. So when you are doing all those due diligence on the assets, is that risk any flag to you?

Speaker 2

Yes. So we noted that as well and we talked to many KOLs in the U. S. And also in China. First of all, the grade 3 or above QT prolongation is about 3%.

And if we look at that number, there are actually quite a few other approved tachytherapy products on the market also with similar range of QT prolongation as a percentage of patients in their clinical trials. One example is Tagrisso. So Tagrisso has a QT prolongation 3 grade 3 or above about 2.2%. That has certainly not stopped Tagrisso being a very strong drug also in the lung area. And when we talk to KOLs, they know that this is very manageable, it's short lived, it's not sustaining.

Based on the Mirati data, there is no arrhythmia currently observed. So we think it's a manageable issue. And then if I look more generally at the AE profile of the drug compared to Amgen's products currently approved, I mean, Amgen's product actually has a label warning with their interstitial lung disease, which had fatal cases. And from a treatment discontinuation rate, theirs is about 9% versus the Mirati drug, which is about 7%. So looking at totality, look, I don't want to say which one is better based on safety.

There are pros and cons with each, but we certainly believe that the QT prolongation is manageable based on other drugs and based on KOL comments specifically with alagrassib.

Speaker 1

Got it. Well, that's really useful. Probably we can touch on another asset here in the pipeline. Well, it's probably not in the pipeline, but a new indication is for the tumor treating field Optune. So we have seen really positive interim readout earlier this year in April.

What should be how should we look at the data and what kind of potentially be the readout process from the positive development from lung cancer to other solid tumors that the tumor treating field is starting? Because I think we are going to have ovarian cancers, liver cancers, pancreatic cancers coming for data readouts. So what's your view here?

Speaker 2

Yes, we're certainly very excited by the recent developments with TTF. And I must also say that neither us nor Novocure has actually seen the data. This is from the DMC and their recommendation to change the protocol has also been endorsed by the U. S. FDA as well.

So we're patiently away for that much shortened trial now and when that data probably comes out sometime next year. But that is certainly very exciting for lung cancer patients and for TGVF as a franchise. To your point, there are many other important readouts coming up. The first one is probably going to be in liver cancer, which is going to probably sometime later this quarter, very soon actually imminently. And then you're going to have ovarian cancer interim readout for that pivotal trial as well in the second half of this year.

Our own gastric cancer should finish enrollment by the end of this year as well this local study in China. The important thing is now if this does work in lung and it's already approved in GBM obviously as well as in mesothelioma. Therefore, this has been approved outside of GBM in the chest cavity first with mesothelioma and now potentially with non small cell lung cancer. And then you look at in combination with the TTF stator in various other solid tumors in Phase II trials, for example, in pancreatic, in ovarian cancer, all of them care, then you're looking at a product that across different tumor types, in Phase II, in Phase III, all seems to be working, that gives you a much greater confidence in the potential of this product working in some of these other indications, would have pivotal data readouts coming up. We believe this is very revolutionary.

We think this is really a new modality, which is coming up that could be really a truly a platform. And the unique thing about it, it's so safe that you can combine TTF almost with anything with PD-one, with chemotherapy, etcetera. So we think it could be really a backbone therapy for many different types of all kind of patient populations as monotherapy or as combination therapy.

Speaker 1

Got it. Got it. That's very interesting. So as we mentioned at the beginning of the session, as Xylep's will be really active this year on the BD side. So now we have already built a very strong pipeline for lung cancer and now we also have a pretty strong pipeline for gastric cancers.

And historically, like with PARP inhibitors also with the Optune for ovarian cancer, we also have women cancers. So going forward, I just want to understand a bit more about your BD strategy. What kind of areas you well, in oncology or outside oncology will be looking at? Particularly, earlier this year, we did another round of financing. So I think CellFX now is sitting on a very strong cash position.

So any new strategy will bring up to the company and any new areas you will be targeting?

Speaker 2

Yes. Thanks for that question. Since the inception for the last 6, 7 years, our BD strategy have always evolved as well. I think we have been under Samantha's leadership, we have really been a pioneer being the sort of go to partner, the partner choice for many of our Western companies. And initially, it's really about China market access, how to bring these products quicker to China.

But that has really evolved more to about how we can work collaboratively like in the case of Mirati, like argenx where we can help them accelerate some of their global trials. We can do some innovative trials ourselves in China. So and we're going to continue to evolve. I think there are 3 disease areas, which we have really built a very strong presence in, namely in oncology. And within oncology, we have sort of 4 or 5 disease strongholds like lung, like GI, like hematology, women's oncology and brain tumor, for example.

And then now we have EFCA, for example, and that in itself is a pipeline product opportunity. All of a sudden, we have a very strong presence in severe autoimmune diseases, coupled with our own obviously IL-seventeen. So in areas where we are strong in, we're going to continue to make them stronger like in lung, like in GI with KRAS, with the colorman asset, etcetera. But then in other areas like what we did with EFCAR, like what we did with the Regeneron 1979 asset, we can also very quickly, we have demonstrated ability to get something in an area which we haven't had presence before, but because of these type of anchor assets very quickly build up presence to demonstrate to our partner that we're capable of doing that. So there probably will be other areas outside of what we have historically been active in.

We could build positions there too. And then beyond that, if I take a step back, the company strategy is really to be a global biopharmaceutical company focusing on innovation. So I think in addition to these regional rights collaborations, a part of our BD strategy inevitably would also be about how we can help the company accelerate its path to be a global important player. So I think we're always very open minded. It's not just licensing.

We're open to a lot of creative deal structures. So let's see where that takes us. Our BD team is also getting stronger as well. I think we've been doing a lot of deals as you mentioned over the last 12 months and our current BD pipeline looks as promising as ever too. So we're very encouraged and excited about the future going

Speaker 1

forward. Got it. Well, on the BD side, we probably have a more broader question is that we see increasing number of pharma companies, biotech companies in China to get into the space, right? So everyone looking at global assets, since there's a huge gap in China versus in the U. S, in Europe, in terms of pipeline.

So have you seen the competition actually is increasing and triggering some potentially higher price for some of the high quality assets and you are facing more intensive competition for some of the assets when you are looking for assets that can strengthen your pipeline? Or what will be some of it let's say you're going to do a perfect pitch, What will be the key message you're going to deliver to potential partners to win the deals?

Speaker 2

Yes, it's a good question. Look, it's there's no doubt that there's more companies in general, given the capital, given the growing market, there's more companies whether to do discovery or to do licensing that's sort of popping up here in China. You sort of first let's look at the results. I think since we went public for the last 3 years, the deals that we've been doing, both the quantity as well as the quality, not only the quality of the asset, but the quality of the partners is just increasing. And I think what's important is at Zai, we are very consistent.

We consistently bring not 1, not 2, sometimes multiple good assets every single year and with different types of partners as well. So we may lose one deal, we may lose to one or but so far we really haven't. But we may lose one one day, right? But at a sort of macro level, we have been very, very consistent as the go to kind of the ideal partner. And under some under Samantha's leadership across the entire spectrum of different functions for a pharmaceutical company from the sort of preclinical development stage, that's where we really can help the partner accelerate things and we've demonstrated we'll be able to do that.

On the regulatory side, I think we're second to none. We've been able to do things where many people just haven't been able to, we've been a pioneer in fact and even going faster than our original communications to Wall Street, to our partners. And on the commercial side, we are building a very strong team under William's leadership that is about 700 to 800 people now and is doing quite well for the product that has been launched. So we have many success case stories and successful track records. Ultimately, it's about trust.

We've been able to instill that trust in potential partners. We have been reinforcing these trust in existing collaborations. For example, Turning Point that is a collaboration we've been able to expand after just 6 months to go to a second asset. So I think we've just been very consistent and we have been able to deliver on our promises. And in a country where even though the reform is progressing rapidly, it's still relatively new market to many companies.

So the last thing they want is to really worry about China. They want a partner who can really help and make sure they don't want to worry about the data that's produced, whether it's in compliance, whether commercially there's any issues. There could be a lot of things that can go wrong, right? So for their lead asset, for their best asset, they want to put it in the right hands. And I think at Zai, we have demonstrated that.

I think that is ultimately the most important aspect.

Speaker 1

Got it. Well, one thing we have noticed that we are pushing forward some of the in house discovery assets into clinical stage. So now we have CDC-seven, we have CDC-forty seven, we could call the 18.2, those two assets are highlighted in AACR this year and also we have IL-seventeen, right? So I think every single year, we're probably going to see more assets moving. It's more like in house developed.

So within Synab, how you guys are going to balance the resources in terms of BD, which is still contributing a lot of pipeline now and also the in house discovery, which is going to potentially be more like future growth drivers. So how actually you're going to balance that? And in terms of picking the right target to for drug discovery and development, so what was the rationale of picking some of the targets and what's the strategy behind?

Speaker 2

Yes. That's a good question. Look, I think it's actually more synergistic. The 2 really complements and helps each other. So certainly when we look at our licensing opportunities, our early stage team, discovery preclinical team really helps us to look deeply into the preclinical profile of the different compounds molecules.

And then similarly because of our understanding of the disease pathways, for example, with the PARP inhibitor in sort of the VDR space with many precision medicines that we have in IO, we have in those spaces. We have better idea or more know how in picking the right targets, in picking the right molecules in our own discovery efforts too. So I think they actually complement each other. And from a resource perspective, I think for now, it's definitely still going to be more collaboration. We have 3 in house programs that's currently in the clinic.

We have over a dozen actually much more of that through licensing that's in various states of development or commercialization. I think over time that shift may change a bit more. I don't know if it will ever be fifty-fifty or it may actually tip the other way. We don't have a specific goal. It's really when we look at whether in house or licensing, we evaluate whether the compound has the potential to be globally sort of relevant being globally 1st or best in class and have differentiation.

If we think we can do that, then we'll probably do it ourselves. But if we think there are compounds like the Mirati KRAS, G12C that's looking very promising very late stage, then we want to work with the best partners there. So I think it's really a case by case. We are taking a portfolio view approach to assembling our sort of diverse programs. But whatever we do, obviously, there will have to be synergies as well.

So likely, with our own discovery efforts, it will be areas that's sort of adjacent to or sort of similar to clinical programs we already have.

Speaker 1

Got it. Well, probably we're going to switch to gear for a bit down to the commercialization part because this is actually a rare capability that a biotech company with a relatively short history can actually do it because in China now we only feel there's a small bunch of biotech companies can actually build a decent commercial infrastructure. So what about the commercial strategy now compared to some of the established pharma in China and also compared to multinational in China. I think PARP inhibitor, such as probably one of the good example, right? We're trying to hear more about that because you're already competing the number one oncology franchise from multinational players, which is Merck plus AstraZeneca and Derusha upcoming as number 1 domestic oncology powerhouse, I mean, Hongwei and China, also one of the big tech company, Beijing in the market.

So you are really competing with those number ones in the market. So what is the performance how's the performance look like now? And how you guys are actually to defend yourself in the commercial side from those major competitors?

Speaker 2

Yes. I think, first, we have been doing pretty well. I think we sort of in Hong Kong, we did very well, as you know. And then when we launched in China earlier last year, we were under some handicap from a commercial infrastructure perspective given Linkparser already on the NRDL and Linkparser is launched sort of I think 18 months or something like that ahead of us in Mainland China. So that gave them edge because we were on self pay.

Nevertheless, we did pretty decent, I think, in that 1st year for sale being handicapped. We were able to successfully get onto the NRDL at the end of last year to be eligible to the reimbursement from March of this year. And so far what we're seeing is very encouraging. We were able to list the product on to a lot of hospitals. We actually listed in the most number of hospitals compared to other oncology products that got NRDL reimbursed.

So it's just really showing the execution of our team. Our team overall is about 700 to 800 people. So in a very short span of time, we're able to under William's leadership to build a pretty sizable commercial team and many of them come from very good backgrounds. Many of them launched several products including Tagrisso and others with William when he was at the Head of oncology BU at AstraZeneca. So I think the execution we'll see more of that.

But I think fundamentally a lot of it is also to the product itself. That's why we have a lot of pride in the pipeline that we have assembled. There is real differentiation in Niraparib compared to other PARP inhibitors. It is the only PUP inhibitor that is approved and validated that can address the all comer patient population that does not need a diagnostic test in the similar to last year, we should be eligible for an ideal reimbursement negotiation later this year for the first line setting as well. But this product has both on efficacy, on safety, on convenience, a lot of differentiating factors compared to Lynparza.

And Beijing and unraised PARP inhibitor are still just approved in the 3rd line in the gBRCA setting. So I think it's really the competition is between us and Lynparza and we're pretty confident we can gain shares and we have built a pretty good commercial team under with them leadership with the differentiating assets. So we're pretty confident.

Speaker 1

Got it. So beyond oncology space, now you've got Apgar, right, to really get into the autoimmune diseases there. So in China, one of the questions we always have is that, we have been looking at the market for many years, well, but still for most of the autoimmune drugs, even like HUMIRA, like AMBRO, they didn't do very well in China, right? So, I'm trying to get your thoughts on that. Do you actually envision there's going to be an inflection point for the Alto New market in China?

So or what's going to be your strategy to get EVGAARD into China, while some other the ultimately new disease drugs might not doing that well? So I try to understand a bit more about that strategy.

Speaker 2

Sure. Sure. So first of all, historically the TNF Alpha for example hasn't really done that well. There's probably a lot of legacy issues. And more recently for example Dupixent is actually doing not so bad.

It's also addressing diseases, autoimmune diseases that address pretty large patient populations being more mild to moderate kind of diseases. When we picked EFCAR as really our anchor asset to go into this space, we did a lot of various KOL and experts primary research. This product addresses many different types of severe autoimmune diseases and many of them have very deadly consequences. And also many of these diseases patients go seek care at a very limited number of hospitals, highly concentration of them. And then even by the way still even though GNG for example is actually on the rare disease list in China, there's still about over 200,000 patients.

So it's not small by any means. But the features that I described, the relevant to efgart actually makes it more like an oncology product, in that there's concentration, in that it can be very deadly. That is huge unmet medical need with very limited treatment options currently. And so we believe this is the perfect product to use to build around a commercial team that can be very similar to our oncology commercial team to really fully maximize the potential of FGI. And by the way, FGI is actually touching a lot of sort of hospital departments that we are already in, for example, in hematology, where this product is being developed in ITP and CIDP, also neurology for the leading case in gMG has some synergies with our Optune product as well because the hospitals where neurology is strong, Optune OpTune also is very strong.

So there are synergies, there are relevance with oncology, it's very severe. I think if any product can proceed, this should be the one.

Speaker 1

Got it. Got it. Well, a bit more also about the talent, because I think as the better company in China now, you are building a full fledged platform. So talent is definitely being very critical to you guys. So could you please update us on how many headcounts you have in the clinical team now, discovery team, commercial, you mentioned about 700 to 800, right?

And also how do you feel like the competition for the talents now in the China market? We understand there are numerous new biotechs that emerge, right? They are also competing for those talents. They rank level above some of the entry level staffs. So what's your take on that?

Speaker 2

Yes. So first of all, on the people side, we have actually about 1400 maybe approaching 1500 FTEs. Obviously, we have presence in the U. S. On both the East and West Coast, but the vast majority of those people are still in Mainland China.

And then if I split between the major functions, commercial is about 700 to 800. The clinical development operation team is probably around about 500 and maybe a bit more than that now. And then various other functions like manufacturer as well, we have some people there. So we have been good at attracting talent. We have been doing a great job in trying to retain talent.

I'm sure a lot of people or other companies want to steal some of our people away from us. But I think on the Samantha's leadership on the sort of financial incentive side, pretty much the majority of our employees have equity ownership in the company and are well compensated. But more importantly, I think as I, we have really built a culture around sort of the U. S. Biotech kind of culture, really results driven execution oriented.

So people really feel a sense of achievement and getting things done. And then also very importantly, we have a great pipeline. I think whether it's the development colleagues, whether it's the commercial sales team, they all want to work with differentiated product, they want to work with good programs. So I think it's really a reinforcing kind of cyclical positive circle that sort of you have good products that attracts good people when the good people are happy and then they are able to whether discovery or partnership bringing more better products. So that's why actually the turnover rate at Zai, I think is probably the lowest in the industry despite the fact that probably more men want to, as I mentioned, grab a lot of talent from Xi, but we've been able to retain, we've been able to continue to attract and even attract, as you saw in some of these recent announcements, some of these global leading people like Alan Stellner, who was Head of Oncology for solid tumors at Genentech Globally.

So we'll continue to build our presence both in China, our infrastructure as well as the with the ultimate ambition of being a global company that is primarily based in China.

Speaker 1

Got it. Well, since you already mentioned about the talent recruitment in the U. S. And also the global part of your story. So lastly, we would like to touch upon your global strategy.

So now you've got in house projects and also you've got potential, the ambition to get some of the global rights for some potential future assets. And how you will look at the global strategy play out for Silap as a company? Now you're pretty much building everything in the pipeline licensing model, right? In the future, in terms of the resource allocation, in terms of the talent recruitment, in terms of the assets, how the global strategy will be like?

Speaker 2

Yes. So, it takes different stages and phases, I think, first of all. At Zai, we've always been operating at a very fast pace and speed. So I think you may have seen our corporate deck is like every 3 year, there's a significant evolution in the company's trajectory. So we are hoping in the next 3 years, we will be a much stronger company from a global perspective.

And we've been sort of going on that trajectory step by step, first, the inclusion of very strong talent both globally as well as still continuously here in China. So talent is very important. And then the pipeline out through now we have from a discovery from our in house efforts, we have assets with global rights and we're going to continue to advance those and bring other preclinical assets to the clinic. And then we're going to also try to sort of boost those efforts, obviously, with business development to also have global rights programs both inorganically as well as organically. So I think all of these are going to happen at the same time.

We also are going to take advantage of the fact that being a China based global company, there are certain diseases and certain indications where we may have an advantage to develop for the world in sort of solid tumors, in sort of, for example, infectious diseases, in autoimmune diseases, which as you know are very prevalent here in China. So I think there are many angles that we're doing and we've taken a lot of different approaches. But the vision is very clear. We want to be a global company. We want to be a company like Takeda and Daiichi Sankyo's because there's a very strong tailwind here and we want to take advantage of that.

But also very importantly, we want to build this leadership position in China and bring good therapies to Chinese patients. And then hopefully very soon we can do that for the global patient population as well.

Speaker 1

Great. I think our time is up and thank you very much, Jonathan, for your sharing. And we're definitely looking forward to more deals, more clinical progress readouts from Zai Lab. Looking forward to that. Thank you.

Speaker 2

Thank you. It's always a pleasure talking with AZ. Thank you.

Speaker 1

Yes. Thank you. Thank you, Jonathan.

Speaker 2

Bye bye.

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