It's a friendly session in H.C. Wainwright's 27th annual Global Investment Conference. My name is Eduardo Martinez, and I'm an Equity Research Associate here at H.C. Wainwright. It's my pleasure to introduce Mr. Robert Andrade, CFO of Fennec Pharmaceuticals.
Thank you, Eduardo, and thank you all who are here in attendance. I see some existing investors and some new investors, so thank you. I'm going to go through the standard corporate presentation. We have this on our website. As with any presentation, you'll see our safe harbor statement, so you can pull this presentation as well from our website. Let me tell you a little bit about Fennec if you don't know. We are a commercial-stage biotechnology company focused to improve the lives of patients with cancer. Specifically, we have one product. That product is FDA approved, and it is to reduce the risk of ototoxicity or hearing loss from those patients that receive a very prevalent and common chemotherapy known as cisplatin. Importantly, we received approval for PEDMARK in September of 2022, so we're just about on our third year here.
We like threes, so we have three consecutive quarters of revenue growth. We are up year over year for Q2 ending June 30th, 33%, which is the highest quarterly net product sales in the history of Fennec, nearly $10 million in quarterly sales. About a year ago, we rebuilt the commercial and medical organization and brought in new leadership. This new leadership was brought in to strengthen the execution and to increase our market presence as we augmented it not only from just pediatric patients that receive cisplatin, but also for those patients in the adolescent and young adult space that receive cisplatin, which we term as AYA. Now, we have the rights to PEDMARK, our only product globally. About a year ago, we partnered with Norgine, in which Norgine will commercialize PEDMARQSI, which is the European brand name for PEDMARK, in Europe, Australia, and New Zealand.
This was a deal that was done after EMA approval and MHRA approval in the UK. It included $43 million in upfront payments and over $200 million in sales and regulatory milestones. We have not received any yet, but we will be excited in the coming months to be in a position to start to receive some of those milestones. Norgine has successfully launched PEDMARQSI in the UK and in Germany, with additional EU rollouts coming in the next year. I mentioned global presence. We also conducted a trial in Japan. That Japanese trial was done with 25 patients. We expect results from that trial by the end of this year. To give you some perspective, Japan is about one-third of the size of Europe or one-third of the size of the U.S. from an incidence or patient population.
To repeat, for the UK or for the EU deal with Norgine, we received $43 million upfront and over $200 million in milestones. We have a great opportunity here. That's why we brought in new leadership. Over 20,000 patients are treated with cisplatin from one month of age to 39 years of age. 39 years of age is that cutoff in the adolescent and young adult population. We have a strong IP portfolio, including six U.S. Orange Book patents, plus seven years of U.S. market exclusivity under orphan drug designation, which takes us from approval plus seven years. Our patents are up to 2039. We have what's known as pediatric use and market authorization in Europe, which gives us 10 years of exclusivity. A little bit about cisplatin. Cisplatin is the chemotherapy. It's used across various tumors. It's been around for over 40 years.
In the non-metastatic patient arena, the survival rate is very, very high. It has a survival rate anywhere from 80% to 90%. On the right of the screen, you can see some of the common tumors, especially for childhood cancers. When you move up into the AYA regime, you have additional tumors, including the germ cell set, which includes testicular. You have head and neck, ovarian, and breast. Prior to PEDMARK, if you took cisplatin and you had hearing loss, this was your only choice: hearing aids or cochlear ear implants, both very, very invasive, suboptimal. What PEDMARK does is it prevents the hearing loss. It's to avoid hearing aids or cochlear ear implants. Prior to PEDMARK, approximately half of those patients would be eligible for hearing aids as a result of their hearing loss. This is a little bit about the mechanism of cisplatin. Cisplatin is given IV.
It goes systemic. It attacks the tumor. After it attacks the tumor, there is excess cisplatin that is in your system and can eventually get into your cochlea or into your ear and cause a stress with those hair cells in your ear that enable all of us here to hear. The cochlea of an individual is effectively the same from one month of age to 80 months of age, and those hair cells cannot restore. Unfortunately, as a result of that cisplatin-induced ototoxicity, you have hearing aids, cochlear ear implants, or the inability for your hearing. About 40% to 80% of adults who receive cisplatin have CIO, and greater than 50% of children. That's the real need for the opportunity for PEDMARK. It can occur as early as that first cycle. You administer PEDMARQSI each time you administer cisplatin. When you finish the cisplatin regimen, you finish PEDMARQSI.
If you utilize PEDMARQSI after your cisplatin, it's likely too late. The damage is done. It cannot restore your hair cells within the cochlea. I'm sure one can appreciate and sympathize and maybe empathize with dealing with hearing loss at any age, but in particular at young ages. You can see here the chart of being held back a grade, 37% versus 3%, having issues or challenges with reading, math, attention, poor reported school functioning. We've had cases of patients who have a job that specifically relies on hearing, i.e., a pilot, and going through cisplatin and the importance of being able to hear thereafter. Until PEDMARQSI, there was nothing else to add. I think I've gone over this, but hearing aids, cochlear ear implants, speech rehabilitation, that was it. You live the rest of your life with that inability to have the most effective hearing possible.
What are we here for? We're here to change the standard of care for CIO prevention. We are the first and only approved agent for the prevention of hearing loss of any form or fashion, but we are specific for cisplatin administration. Through two phase III trials, including one published in the New England Journal of Medicine, it was shown to have approximately a 50% reduction in hearing loss when you had PEDMARQSI administered with cisplatin. We're the only company of its kind, and we have a very, very unique formulation, which is further supported by our patent portfolio for PEDMARQSI. Talk a little bit about the global opportunity. In the U.S., we received approval for PEDMARK for those patients greater than one month of age with localized and non-metastatic solid tumors receiving cisplatin. That was received in September of 2022.
Post-approval, we received what is called NCCN Clinical Practice Guidelines with a 2A endorsement for the adolescent and young adult population. In the EU and the UK, I talked about PEDMARQSI. That's the branded name of PEDMARK. We received that approval in June of 2023 in the EU and in the UK shortly thereafter. PEDMARQSI is now launched in the UK and in Germany with our partner, Norgine. I touched a little bit about NCCN 2A recommendation, AYA, and I'll tell you a little bit about the market opportunity in some subsequent slides. Why this is so important to our company is because it enables that opportunity to present to patients ages 15 to 39. AYA patients, adolescent and young adult patients, now have that opportunity to prevent the hearing loss when they're administered cisplatin. Here's a little breakdown of the pediatric market.
You can see in the U.S., that box on the lower end is the addressable market for PEDMARK. A little over 2,000 cisplatin-treated patients in the U.S. Some of the top tumor types include neuroblastoma, CNS, and osteosarcoma. Similar type of a market size in the EU. Again, this is for non-metastatic solid tumors that are administered cisplatin. This market is highly concentrated. The top 200 centers do 80% of the pediatric administration of cisplatin. The good news is it's very, very high survival rates, greater than 80%. Touching a little bit about the AYA market, the AYA market is 20,000 cisplatin-treated patients per year, so nearly 10 times the size of the pediatric market. Some of the common tumor types include testicular, germ cell, head and neck, and breast. Converse to the pediatric landscape, the AYA landscape is spread out, largely done by these community centers.
Adolescent and young adult patients prefer to stay closer to home to get treated. You can see roughly 4,000 community centers do 80% of the patients across the U.S. I mentioned a little bit about our dynamic team. We've brought in a new CEO. We've brought in a new Chief Medical Officer, Chief Operating Officer, Chief Commercial Officer with a real cross-functional focus. We have an organization that has 38 employees, of which 22 to 23 of them are customer-facing each day. We have some great, great momentum and dialed in and focused on the execution. How are we focused on that? Creating awareness, creating education, having a successful administration, thus adoption, and access. What is access? Reimbursement. We have been very successful on the reimbursement front with over 80% reimbursement success, including large plans like Cigna, United, Blue Cross Blue Shield.
Some of these key activities are ones you would see in every commercial organization, but really, it starts and ends with the patients and their advocates. We have incredible, we built some incredible relationships with KOLs. They are the best form of marketing that a company can have in terms of actual real use and seeing the real results. We've also had partnerships with audiologists. As I mentioned, frequently, by the time it gets to an audiologist, if you didn't utilize PEDMARK, it's too late. The hearing is already done. We can partner with audiologists early on. Hopefully, they can communicate the opportunity of PEDMARQSI to prevent that hearing loss. We have what's called our Fennec HEARS program, and this has become more and more prevalent as we moved into the adolescent and young adult market. This provides full education and financial support, patient support.
We work with patients and their providers to make sure that reimbursement is successful, administration is successful. We answer any questions as it relates to the product itself. We've been able to really rebuild this program as we've rebuilt the company, not just from a pediatric-focused company, but from a pediatric plus an AYA-focused company. I'll spend a little bit of time on our financials. We were pleased to report our third quarter of consecutive growth in net product sales, achieving the highest quarter ever of nearly $10 million. What's important there? That was on a quarterly basis. What's important there is from a cash flow break-even perspective, we are right around turning the corner there. In order to get to cash flow break-even on a normalized cash OpEx expense over the year, we have to achieve greater than $9 million in net product sales. We're right there.
We spend more money in the first half of the year than we do in the second. If you look at it, our total cash OpEx for the year is roughly $35 million. We spent $20 million in the first half. We'll spend only $15 million in the second half and look forward to the quarters to come as it relates to cash generation. We have $19 million in cash and cash equivalents, and we have $19,500 in convertible debt. That convertible debt is in the money today. The strike price is just a little under $8 per share. We've had some great institutional ownership, including some of those companies listed here: Southpoint Capital, Sphera Funds Management. You can see on the right, there is a picture of us when we were on the NASDAQ for the launch.
I was very, very excited and pleased that we just had the closing bell. We just did the closing bell of the NASDAQ on Friday in support of Childhood Cancer Month. What I'm wearing here today, we had patients and their families really, really resonate. Patients that took PEDMARQSI and that can hear today because of that opportunity to have PEDMARQSI. With that, I'll close and take any questions.