EX-99.2 3 d798681dex992.htm EX-99.2 EX-99.2

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Transforming Radiotherapy with Dismutase Mimetics November 2020 Exhibit 99.2


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Disclaimers and Forward-Looking Statements Certain information contained in this presentation and statements made orally during this presentation relates to or is based on studies, publications, surveys and other data obtained from third-party sources and Galera’s own internal estimates and research. While Galera believes these third-party sources to be reliable as of the date of this presentation, it has not independently verified, and makes no representation as to the adequacy, fairness, accuracy or completeness of, any information obtained from third-party sources. While Galera believes its internal research is reliable, such research has not been verified by any independent source. This presentation contains “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Forward-looking statements are neither historical facts nor assurances of future performance. Instead, they are based on our current beliefs, expectations and assumptions regarding the future of our business, future plans and strategies, our clinical results and other future conditions. All statements other than statements of historical facts contained in this presentation, including statements regarding future results of operations and financial position, business strategy, the safety, efficacy, regulatory and clinical progress, and therapeutic potential of current and prospective product candidates, plans and timing for the commencement of and the release of data from clinical trials, our plans to prepare for commercialization and a US launch, the anticipated direct and indirect impact of COVID-19 on Galera's business and operations, planned clinical trials and preclinical activities, potential product approvals and related commercial opportunity, current and prospective collaborations, and timing and likelihood of success, plans and objectives of management for future operations, are forward-looking statements. The words ”may,” “will,” “should,” “expect,” “plan,” “anticipate,” “could,” “intend,” “target,” “project,” “estimate,” “believe,” “predict,” “potential” or “continue” or the negative of these terms or other similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. The information in this presentation, including without limitation the forward-looking statements contained herein, represent our views as of the date of this presentation. Although we believe the expectations reflected in such forward-looking statements are reasonable, we can give no assurance that such expectations will prove to be correct. Accordingly, readers are cautioned not to place undue reliance on these forward-looking statements. Except as required by applicable law, we do not plan to publicly update or revise any forward-looking statements contained herein, whether as a result of any new information, future events, changed circumstances or otherwise. No representations or warranties (expressed or implied) are made about the accuracy of any such forward-looking statements. The forward-looking statements in this presentation involve risks and uncertainties that could cause actual results to differ materially from those reflected in such statements. Risks and uncertainties that may cause actual results to differ materially include uncertainties inherent in the drug development process and the regulatory approval process, our reliance on third parties over which we may not always have full control, and other important risks and uncertainties that are described in Galera’s Quarterly Report on Form 10-Q for the quarterly period ended September 30, 2020 filed with the U.S. Securities and Exchange Commission (SEC), Annual Report on Form 10-K for the year ended December 31, 2019 and Galera’s other filings with the SEC. New risk factors and uncertainties may emerge from time to time, and it is not possible to predict all risk factors and uncertainties. Whenever the Company uses the terms “transform radiotherapy” or “transforming radiotherapy” in this presentation, it is referring to its mission statement.


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Superoxide Dismutase Mimetics – Vision 1 Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment… Cancer. 2005;104:1129-1137 2 Begg AC, Stewart FA, Vens C. Strategies to improve radiotherapy with targeted drugs. Nat Rev Cancer. 2011;11:239-253 IMRT Intensity Modulated RT Potential to Reduce Toxicity Severe Oral Mucositis Head & Neck Cancer (SOM in HNC) Esophagitis NSC Lung Cancer (NSCLC) Normal tissue toxicity limits optimal radiotherapy treatment of tumor Phase 3 ROMAN Phase 2 Trial Potential to Increase Efficacy Pancreatic Cancer Locally Advanced (LAPC) Lung Cancer Locally Advanced (LANSCLC) Radiotherapy is SoC for many local tumors but need remains for greater efficacy Phase 1b/2a SBRT Combo Phase 1b/2a SBRT Combo SBRT Stereotactic Body RT Rapid elimination of Superoxide (O2) Increase H2O2 in tumors Over half of cancer patients receive radiotherapy as part of their care1, 2 Transforming Radiotherapy with Dismutase Mimetics


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(1) EUSOM is a single-arm multi-center trial evaluating the safety of avasopasem in patients with HNC in Europe. (2) Phase 2a trial in patients with lung cancer building on avasopasem safety and tolerability findings from SOM trials in patients with HNC. (3) This first SBRT combination trial used GC4419 (avasopasem). Observations from this pilot trial have been used to guide development of GC4711 to assess anti-cancer efficacy in combination with SBRT. (4) Two stage trial with first stage to assess anti-cancer efficacy of SBRT +/- GC4711 and the second stage to assess anti-cancer efficacy of SBRT and checkpoint inhibitor +/- GC4711. Phase 1 Phase 2 Phase 3 1a1b 2a2b SOM in Head & Neck Cancer Esophagitis in NSCLC (2) SOM in Head & Neck Cancer (1) ROMAN avasopasem vs. placebo AESOP avasopasem single-arm EUSOM avasopasem single-arm Pancreatic Cancer (3) NSC Lung Cancer (4) LAPC Pilot GC4419 vs. placebo GRECO-1 GC4711 vs. placebo Pancreatic Cancer GRECO-2 GC4711 vs. placebo Topline Data 2H 2021 Topline Data 1H 2022 Topline Data 2H 2021 1 Year Follow-up 2H 2021 Initiate Trial 1H 2021 1st Stage Data 1H 2022 Topline Data 1H 2021 COVID-19 Critically Ill Patients COVID Pilot avasopasem vs. placebo Reducing RT Toxicity IMRT Combos Increasing RT Efficacy SBRT Combos Next Anticipated Milestone Clinical Stage Pipeline


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Investment Highlights Avasopasem GC4419 Reducing IMRT toxicity in patients with head & neck cancer Robust efficacy in randomized Phase 2b trial (n=223) Breakthrough therapy designation granted by FDA Single Phase 3 sufficient for registration (n450)   2nd Product GC4711 Increasing SBRT anti-cancer efficacy in patients Improved local control and overall survival in pilot LAPC trial (n=42) Preparing to initiate randomized Phase 2b trial in pancreatic cancer Randomized Phase 1/2 trial ongoing in NSCLC Planning US Launch Galera is building a commercial team for the US Launch 65,000 head & neck cancer patients diagnosed annually in the US 4,000 radiation oncologists in ~2,500 radiotherapy sites in US Galera’s quantitative market research reached ~5% of US Rad Oncs ~40 reps for the 4,000 radiation oncologists in U.S.


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Dismutase Technology


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O2 more damaging to normal cells than cancer cells Unique Technology Dismutase Mimetics Small Molecule Enzyme Mimetics Mimic human superoxide dismutase (SOD) enzymes Rapidly convert superoxide (O2) to hydrogen peroxide (H2O2) Shifts balance in normal & cancer cells from superoxide to hydrogen peroxide Avasopasem (GC4419) GC4711 H2O2 more toxic to cancer cells than normal cells


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Galera’s Dismutase Mimetics Native SOD Enzymes Native SOD Enzymes Overexpression reduces RT toxicity Large size, immunogenicity & short half-lives limit bioavailability Inactivation/inhibition by reactive oxygen species Small Molecule Mimetics Challenge: suitable small molecule dismutase mimetics Fast catalytic rates & high selectivity for superoxide Firmly hold manganese in macrocyclic ring Stable, safe & suitable for manufacturing Dismutase Mimetics Core Structure Pentaaza Macrocycles Small Molecule Dismutase Mimetics with Attractive Drug Characteristics Comparable to native SODs (2x107 molecules per sec) Interact with superoxide alone, not other reactive oxygen species Firmly hold Mn atom in macrocyclic ring Well-tolerated preclinically and clinically Efficient & cost-effective manufacturing process Speed Selectivity Stability Safety Synthesis


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Dismutase Mimetics Reduce Radiation Toxicities Thompson, et al., Free Radical Research, 44(5):529-540, 2010 Galera internal data Mice given GC4403 or placebo before lethal Total Body Irradiation (8.5 Gy) 100% of 40mg/kg GC4403 mice survived; 100% of control mice died Intestinal mucositis was main cause of death Reduce Radiation Mucositis Lethal dose of Total Body Irradiation (8.5 Gy) to mice 100% death on control, 100% survival with 40mg/kg Main cause of death was intestinal mucositis


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Dismutase Mimetics Increase Anti-Cancer Efficacy with High Fraction-Dose RT in Preclinical Models RT with Biological Equivalent Doses Days Post Treatment Days Post Treatment Days Post Treatment Days Post Treatment SBRT Stereotactic Body Radiation Therapy Courtesy of M Story (UTSW) Vehicle Increase Radiotherapy Efficacy Focal irradiation of human tumor xenografts (H1299 NSCLC) in mice RT anti-cancer synergy of GC4419 increases with bigger RT fractions Bigger fraction à More O2 à More H2O2 Also demonstrated with human pancreatic cancer xenografts


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…Increasing Anti-Cancer Efficacy via H2O2 Sishc et al, AACR, 2018 Sishc, et al, AACR Pancreatic Cancer, 2019 Larger RT fraction à more O2 Dismutase Mimetics à more H2O2 • PANC-1 PDAC xenograft Genetically modified H1299CAT – with doxycycline-inducible catalase Tumor tissue H2O2 reduced when doxycycline added, losing the synergy


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Reducing Toxicity of IMRT – Clinical Data (Intensity Modulated Radiotherapy)


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GT-201: 223-Patient Randomized Phase 2b OM Trial Supportive trial to the ROMAN Phase 3 for the NDA Anderson et al, JCO, 2019 Ulcers Requires a liquid diet Ulcers Unable to eat or drink Ulcers Able to eat a solid diet No ulcers Erythema and soreness 3 4 2 1 SEVERE WHO Grading Scale Randomize (1:1:1) GC4419 90mg x 7 weeks GC4419 30mg x 7 weeks Placebo x 7 weeks Treatment Avasopasem (GC4419) 90mg, 30mg, or placebo 60 minute IV infusion, Mon-Fri. Ending <60 mins pre-RT Population Patients with HNC Locally-advanced, squamous cell Eligible for SoC – 7 weeks IMRT + cisplatin Stratification Factors Tumor HPV Status: positive or negative Cisplatin Schedule: q3wks or weekly Endpoints Primary – Reduction in median duration of SOM – WHO Grades 3 & 4 Secondary – Reduction in incidence and severity of SOM at pre-specified timepoints Exploratory – Time to SOM onset Tumor outcomes (2 year follow-up) Locoregional control, distant mets, PFS, OS Trial Design


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Consistent Efficacy Across All SOM Parameters And consistent dose response: 90mg > 30mg Primary endpoint was duration - defined as # days from 1st occurrence of grade 3 or 4 SOM until the 1st event of grade 2 or less (there being no subsequent grade 3 or 4 events.) *Secondary endpoints (incidence and severity ) have nominal p values compared to placebo ITT = Intent-To-Treat population (n=223) DURATION 92% Reduction in median days of SOM 90 mg vs. Placebo p=0.024 INCIDENCE 34% Reduction through all RT 90 mg vs. Placebo p=0.009* SEVERITY 47% Reduction in Incidence of Grade 4 OM 90 mg vs. Placebo p=0.045*


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Safety Summary – Rand. Phase 2b Trial Safety Profile of Both Avasopasem (GC4419) Doses Comparable to Placebo Avasopasem (GC4419) was well tolerated at both doses Most frequent AE’s are those expected with SoC cisplatin – RT regimen Most Frequent AEs (any grade) Placebo (n=72) 30 mg GC4419 (n=73) 90 mg GC4419 (n=72) Lymphopenia 89% 92% 88% Nausea 75% 68% 82% Fatigue 69% 60% 65% Oropharyngeal pain 64% 63% 61% Constipation 53% 59% 64% Radiation skin injury 47% 51% 53% Vomiting 47% 52% 49% Dysgeusia (taste) 49% 55% 43% Dysphagia 43% 42% 47% Weight decreased 35% 40% 44% Oral candidiasis 29% 45% 43% Leukopenia 39% 37% 39% % Anderson et al, JCO, 2019


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GT-301: The ROMAN Trial - Phase 3 Confirmatory Trial Enrolling Reduction in Oral Mucositis with Avasopasem Manganese (GC4419) Ulcers Requires a liquid diet Ulcers Unable to eat or drink Ulcers Able to eat a solid diet No ulcers Erythema and soreness 3 4 2 1 SEVERE WHO Grading Scale Randomize (3:2) GC4419 90mg x 7 weeks Placebo x 7 weeks Treatment Avasopasem (GC4419) 90mg or placebo 60 minute IV infusion, Mon-Fri Ending <60 mins pre-RT Population Patients with Head & Neck Cancer Locally-advanced, squamous cell Eligible for SoC – 7 weeks IMRT + cisplatin Stratification Factors Surgery Status: post-op or definitive Cisplatin Schedule: q3wks or weekly Endpoints Primary – Reduction in incidence of SOM – WHO Grades 3 & 4 Secondary – Reductions in severity of SOM and number of days of SOM experienced Tumor outcomes1 – LRC, DM-free, PFS, OS Trial Design (n450 pts)   1 LRC = locoregional control, DM-free = free of distant mets, PFS = Progression-Free Survival, OS = Overall Survival


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Increasing SBRT Efficacy – Clinical Data (Stereotactic Radiotherapy)


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Pilot Phase 1/2 in Pancreatic Cancer: SBRT +/- GC4419 1LO-ET = Late-Onset Efficacy-Toxicity (Jin IH, Liu S, Thall PF, Yuan Y. J Am Stat Assoc 2014;109:525-36) SBRT = stereotactic body radiation therapy, LA = Locally-Advanced, BR = Borderline Resectable ORR = Overall Response Rate, LRC = Locoregional Failure, DM = Distant Metastases, PFS = Progression-Free Survival, OS = Overall Survival R Inoperable LA or BR Pancreatic Cancer after ~6 months of induction Chemo SBRT + GC4419 x 5 doses SBRT + Placebo x 5 doses GC4419 90mg IV over 60min Surgical Evaluation Resection If possible N=11 N=8 2018–2019 Limited to LA/unresectable >1 Year Follow-Up SBRT GC4419 Pilot Double-blind, Placebo-controlled, Randomized Trial Patients with Locally Advanced Pancreatic Cancer (LAPC) post ~6 mos chemo Optimal SBRT fraction selected based on 90-day safety/efficacy (LO-ET 1) Tumor outcome measures: ORR, LRC, DM, Resectability, PFS, OS 90 90 90 90 90 GC4419 SBRT Single-center Stage N=24 N=18 N=13 N=10 2020 (Jan–June) Included borderline resectable 3–6 Months Follow-Up Multicenter Stage Total


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Baseline Characteristics (n=42) ECOG = Eastern Cooperative Oncology Group Performance Status Criteria CA 19-9 = Carbohydrate Antigen 19-9 is a tumor marker for pancreatic cancer Placebo (n=18) Avasopasem (n=24) Median age (range), yrs 68 (48–82) 72 (41–83) Male/Female 7/11 16/8 Borderline resectable/Locally advanced 2/16 7/17 ECOG Performance status 0/1/2 9/9/0 12/11/1 Prior chemo, duration median (range), wks 21.9 (12.0–36.3) 17.9 (9.1–67.1) CA19-9 at randomization, median (range) 26.25 (0.5–2186) 28.5 (0.3–70) Smokers/Nonsmokers 3/15 2/22


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Safety – Grade 3+ Adverse Events (All Causes) AE = adverse event; GI = gastrointestinal . Placebo (n=18) Avasopasem (n=24) Acute Adverse Events (up to 90 days post SBRT) Patients with acute Grade 3+ AEs* 4 (22%) 6 (25%) Grade 3 acute GI toxicity** 2 (11%) 2 (8%) Late Adverse Events (91 days–1 year post SBRT) Patients with late Grade 3+ AEs 5 (28%) 7 (29%) *Only 1 patient > Gr. 3 (aspiration pneumonia, hypoxia & atrial fibrillation, resolved with supplemental O2, antibiotics & beta blocker) **No bleeding ulcers by 12-week endoscopy, no GI toxicity > Grade 3


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Best Response from Baseline Tumor in SBRT Field (n=42) Waterfall plot through August 24, 2020; follow-up ongoing 1 Partial response per modified RECIST (Response Evaluation Criteria in Solid Tumors)  SBRT + GC4419 NE SBRT + Placebo PR1 or better: 8 out of 24 patients on GC4419 (33%) PR1 or better: 3 out of 18 patients on placebo (17%) R0 R0 R0 R0 R0 R0 R1 RO R1 = Surgical resection (R0 = clear margins). = Surgical resection (R1 = tumor at margins). NE = not evaluable.


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Patients Who Underwent Resection Post SBRT Surgical Decision Based on Multiple Factors (n=7) LA/BR = locally advanced or borderline resectable; pCR/pNR/pPR = pathological complete, near, or partial response; R0/R1 = resectable results: R0 = clear margins, R1 = positive microscopic margins; SBRT = stereotactic body radiation therapy Treatment SBRT Arm Initial Tumor Staging LA or BR Margins Post Resection R0/R1 Histopath Analysis Post Resection Avasopasem (n=5) LA   R0   pCR   BR R0   pPR BR R0   pPR BR R0   pPR LA   R0   pPR  Placebo (n=2) BR R0   pPR LA   R1 pNR No significant perioperative complications after SBRT for all 7 patients


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SBRT + GC4419 Demonstrated Better Preliminary Outcomes Than SBRT + PBO Data through August 24, 2020; follow-up ongoing Exhibited Better Local Control Exhibited Less Failures Inside & Outside RT Field Response within SBRT Field = % of patients with partial response or better per Modified RECIST; Successful Surgery = % of patients with R0 margins post resection Failure within SBRT Field = % of patients with locoregional failure; Failure outside SBRT Field = % of patients with distant metastases


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Encouraging Survival in All Patients (data as of Aug 24, 2020) Kaplan-Meier Analysis by Treatment (ITT, n=42) AVA = GC4419 or Avasopasem Note: Resected patients (n=7) censored at time of surgery for PFS (5 on GC4419 arm) Overall Survival (OS) Progression-Free Survival (PFS) Log Rank P value = 0.0643, HR = 0.4 Log Rank P value = 0.29, HR = 0.6 N=42


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Efficacy Endpoints in Patients Followed for >1 Year (n=19, ITT) HR = Hazard ratio; LRC = locoregional control; OS = overall survival, PFS = progression-free survival, TDM = time to distant metastases. Best Response Rate Medians (Weeks From SBRT) HR=0.4; P (log-rank): 0.068 HR=0.3; P (log-rank): 0.046 HR=0.4; P (log-rank): 0.078 HR=0.1; P (log-rank): 0.051 Not Reached Not Reached


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Encouraging Survival in Patients Followed for >1 Year Kaplan-Meier Analysis by Treatment (ITT, n=19) AVA = GC4419 or Avasopasem Log Rank P value = 0.0463, HR = 0.3 Log Rank P value = 0.078, HR = 0.4 Overall Survival (OS) Progression-Free Survival (PFS) N=19


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Hazard Ratios on all Efficacy endpoints appear to favor GC4419 arm Comparison of Mature (n=19) and All Patients (n=42) – as of August 24, 2020 Comparison of Hazard Ratios (95% Confidence Intervals) Initial Stage Pts (n=19) All Patients (n=42) Overall Survival (OS) 0.3 (0.09-1.05) 0.4 (0.12-1.11) Progression-Free Survival (PFS) 0.4 (0.15-1.14) 0.6 (0.23-1.56) Loco-Regional Control (LRC) 0.1 (0.01-1.37) 0.2 (0.02-2.22) Time to Distant Mets (TDM) 0.4 (0.11-1.13) 0.4 (0.13-1.29)


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Pancreatic Cancer Population in US 1 2019 SEER Data 2Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors, Rawla P et al. World J Oncol. 2019 Feb; 10(1): 10–27 GRECO = Galera Radiotherapy Efficacy Cancer Optimization Metastatic Regional Local Not Known GRECO-2 Double-Blind Placebo-controlled Randomized trial Annual new cases 460,000 Globally1 57,000 in US2 9-13% 5-year Survival 5-Year Survival is ~10% 1/6th get attempted surgical resection 1/3rd get chemotherapy upfront then some considered for SBRT Half at diagnosis are beyond locoregional control and receive chemotherapy, with some getting RT as palliation to primary


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GRECO-1 for Lung Cancer SBRT +/- GC4711 *SBRT dose is 10-12 Gy x 5, determined by SBRT Planning. GRECO = Galera Radiotherapy Efficacy Cancer Optimization, NSCLC = Non-Small Cell Lung Cancer; ECOG PS = Eastern Cooperative Group Performance Status SBRT GC4711 Combo Trial Double-blind, Placebo-controlled, Randomized Trial after Short Phase 1 NSCLC Locally Advanced – Previously untreated (1st line) Objectives: Safety (reducing Pneumonitis), ORR, LRC, DM, PFS, OS Stage 1 to access SBRT +/- GC4711; Stage 2 SBRT + Checkpoint Inhibitor +/- GC4711 1st–line NSCLC Centrally located or Large Tumors ECOG PS 0-3 Phase 1 (n=5 pts) R SBRT + GC4711 x 5 SBRT + Placebo x 5 Randomized Phase 2 (n66 pts)   SBRT + GC4711 x 5 30 Day Safety SRC Review 100 100 100 100 100 GC4711 SBRT 100 100 100 100 100 GC4711 SBRT GC4711 100 mg IV in 15min SBRT 10-12 Gy* x 5 1st Stage: GC4711 100 mg IV in 15min SBRT 10-12 Gy* x 5


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Commercial Considerations


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Large Commercial Opportunity Addressing Clear Unmet Need Severe Oral Mucositis & Esophagitis 1 Medicare Claims Analysis by Galera in 2019 2Hypothetical Product X for SOM with a similar profile to avasopasem Phase 2b results 3NCI or RTOG grading scales, 4Galera Market Research (150 Radiation Oncologists), Rad Oncs = Radiation Oncologists, SOM = Severe Oral Mucositis Patients with OM incur ~$32,000 more in medical expenses in first 6 months from start of RT Current approaches inadequate – while frequently used, only 1 in 5 believe they are useful SOM common and costly ~$32,000 ~65k new cases/year in US 2/3rd get IMRT & cisplatin as standard-of-care à 70% get SOM 20-30% get Grade 4 No approved drug Rad Oncs report severe oral mucositis is most burdensome side effect of HNC RT treatment Severe Oral Mucositis Head & Neck Cancer 42k HNC Pts Galera’s quantitative market research to date includes ~5% of US radiation oncologists Supports significant, rapid uptake2 220 Rad Oncs in market research 5% of Rad Oncs Targeted salesforce In U.S. Focused commercial infrastructure ~2,500 RT sites in US ~60% of patients are treated in ~500 centers1 ~40 reps for the 4,000 radiation oncologists in U.S. ~40 Reps ~50k NSCLC patients treated with IMRT, 50% get ≥ Grade 2 esophagitis3 à inability to swallow, severe pain, ulceration, bleeding & hospitalization SOM efficacy seen by radiation oncologists as supportive for esophagitis4 Esophagitis in Lung Cancer 50k NSCLC Pts


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1 2019 SEER Data 2Epidemiology of Pancreatic Cancer: Global Trends, Etiology and Risk Factors, Rawla P et al. World J Oncol. 2019 Feb; 10(1): 10–27. 3Acta Oncologica, 2015; 54: 979–985 4Suker M., Beumer B.R., Sadot E., Marthey L., Faris J.E., Mellon E.A. The Lancet Oncology. 2016;17(6):801–810. 5NCCN = National Comprehensive Cancer Network-2019 Unmet Medical Need with Limited Treatment Options Pancreatic Cancer Lethal Common Cancer Increasing Number of Pancreatic Cancer Patients Diagnosed Each Year Annually, 57,000 newly diagnosed in US1 and 460,000 globally2 It is the most lethal common cancer: 5-year survival 9-13%1,2 Over 30% present with locally advanced unresectable or borderline resectable (18,000 in US)2 Novel Therapies Needed First Line Treatment is Induction Chemotherapy for Over 80% of Patients2 FOLFIRINOX or Gemcitabine/Abraxane most commonly used3 60% of patients fail induction therapy within 12 months4 60% on FOLFIRINOX develop Grade 3-5 toxicity4 SBRT is Accepted Tx Option SBRT Use is increasingly used for locoregional control (by NCCN and others)5 1st or 2nd line option after 4-5 months of chemotherapy for locally advanced cancer For loco-regional recurrence after surgical resection For some patients with metastatic disease for palliative control of local disease


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GRECO-1 Trial: GC4711 + SBRT Combination in NSC Lung Cancer Globocan & US SEER Data* Decision Resources Group (DRG) Primary Market Research, Oct 2020 12,120 Central Tumor ≤ 3cm 15,430 Central Tumor > 3cm NSCLC Non-Small Cell Lung Cancer (NSCLC) Leading cause of cancer death in US – 142,670 deaths in 2019* SBRT commonly used for smaller peripheral tumors Lung toxicity limits use in larger (>3cm) or centrally-located tumors GC4711 GC4711 – SBRT Clinical Candidate Same mechanism of action as avasopasem (GC4419), with IV & oral forms Novel chemical entity with IP through 2036 Completed 14-day Phase 1 in healthy volunteers: 15-minute infusion 14,600 Peripheral Tumor > 3cm 175,000 NSCLC (US*) 102,000 Stage I, II, III 55,100 Node-negative 2,500,000 NSCLC (World*)


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COVID-19 Trial


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Superoxide plays important role in Late Stages of COVID-19 Infection ARDS à Shock Building Cytokine Storm Superoxide plays an important role in the hyperinflammatory stage and in hypotensive sepsis/shock COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal Hasan K. Siddiqi, MD, MSCR, Mandeep R. Mehra, MD, MSc Published:March 20, 2020 DOI:https://doi.org/10.1016/j.healun.2020.03.012 Classification of COVID-19 disease states and potential therapeutic targets. The figure illustrates 3 escalating phases of COVID-19 disease progression, with associated signs, symptoms, and potential phase-specific therapies. ARDS, acute respiratory distress syndrome; CRP, C-reactive protein; JAK, janus kinase; LDH, lactate dehydrogenase; NT-proBNP, N-terminal pro B-type natriuretic peptide; SIRS, systemic inflammatory response syndrome; GM-CSF, Granulocyte Macrophage Colony Stimulating Factor.


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Phase 2 Pilot Trial of Avasopasem in Patients with COVID-19 Randomized Placebo-Controlled Trial in Patients with Critical Illness (n=50) SSC = Standard Supportive Care, SOFA = Sequential Organ Failure Assessment Salvemini, et al, Br J Pharmacology, 2001; Macarthur, et al, Crit Care Med, 2003; Cuzzocrea, et al, Crit Care Med, 2004; Ndengele, et al, Shock, 2005 GC4419 For COVID-19 Double-blind, Placebo-controlled, Randomized Trial Superoxide plays a central role in pathophysiology of acute respiratory distress syndrome (ARDS) Causes endothelial cell damage, increased microvascular permeability, peroxynitrite (ONOO-) Galera’s dismutase mimetics inhibited these effects in animal ARDS models Randomize (1:1) Avasopasem 90mg x 7 days BID + SSC PBO + Standard Supportive Care (SSC) Active Regimen Avasopasem 90mg 3 hr IV infusion BID x 7d Patients COVID-19 test + critical phase respiratory failure Stratification Age < 60 or > 60 years Sites Multi-center Primary 28-day mortality (overall survival) Secondary Safety of avasopasem in COVID patients Ventilator weaning Vent-free days in hospital ICU-free days Catecholamine support, BP <65mmHg SOFA scores


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Appendix


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Oral Mucositis in HNC – Large Unmet Medical Need SOM and Head & Neck Cancer Can Have Devastating Complications ~65,000 new HNC patients in US/Year ~65% get IMRT & cisplatin as standard-of-care ~70% of patients get SOM (can’t eat) ~20-30% get Grade 4 (can’t eat or drink) No approved drug available Treatment Approach Recommended for HNC OM due to RT? Basic oral care ✔ Anti-microbials, coating agents, anesthetics, & analgesics (0.2% morphine mouthwash) ✔ Anti-inflammatories, benzydamine ? Low level laser & other light therapy ? Cryotherapy for 5-FU chemotherapy O Natural & other agents O Current Treatments 42,000 receive IMRT WHO Grading Scale Ulcers Requires a liquid diet Ulcers Unable to eat or drink Ulcers Able to eat a solid diet No ulcers Erythema and soreness 3 4 2 1 SEVERE Dehydration & Malnutrition Often requiring PEG tube feeding Pain Often severe pain requiring opioids Treatment interruption Each week of treatment delay decreases tumor control by >10% Increased economic burden OM Dx à ~$32,000 in additional medical expenses in first 6 months from RT start MASCC / ISOO Guidelines for HNC OM


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Efficacy Parameters Better on 90mg arm Compared to Placebo Swimmers plot: each patient who developed at least one SOM episode is represented by a row Grade 4 Grade 3 90 mg GC4419 34% Less Incidence SOM 47% Less Grade 4 OM 92% Shorter Duration SOM Delayed Onset of SOM PLACEBO Arm (45 of 74 Pts had ≥1 visit with SOM) 90MG Avasopasem (GC4419) Arm (35 of 76 Pts had ≥1 visit with SOM)


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Tumor Outcomes Maintained - 2 year follow-up Final ITT Analysis OS = Overall Survival, PFS = Progression-Free Survival, LRC = LocoRegional Control, DMF = Free of Distant Metastases


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RT-related Mucositis Beyond Head and Neck Cancer 1Galera Market Research (150 Radiation Oncologists) 2 NCI or RTOG grading scales Market Research Question Patients with Other Conditions1 Given the demonstrated ability of Product X to prevent radiation-induced toxicities in the oral mucosa, please indicate how you might use (maximum %) Product X for the following radiation associated conditions? Mucositis of Esophagus Radiotherapy-related Esophagitis in Lung Cancer SOM efficacy seen by radiation oncologists as supportive for esophagitis1 ~50,000 lung cancer patients are treated with RT, 50% get ≥ Grade 2 esophagitis2 Effects: inability to swallow, severe pain, ulceration, bleeding & hospitalization Compendial Listing Phase 2 to support Compendial Listing post-Approval for SOM Single-arm Phase 2a trial in 60 patients w/ locally-advanced lung cancers Standard IMRT to ≥ 5 cm of esophagus (30 fractions, 2Gy/day x5 for 6 weeks) Post approval for SOM in HNC, plan to seek compendial listing in U.S.