EX-99.2 3 d818130dex992.htm EX-99.2 EX-99.2

展品99.2 为创新癌症治疗的未来,治愈患者并保留器官功能 2024年10月17日


法律披露本演示文稿包含前瞻性声明,均在其整体上通过此警示声明得到限制。 这里包含的许多前瞻性声明可通过使用前瞻性词语如"可能","预期","相信","可能","期待","应该","计划","打算","估计","将","潜在"和"正在进行"等词语来识别,当然,并非所有的前瞻性声明都包含这些识别词语。 这些前瞻性声明包括有关我们研究和开发计划及目前和未来临床前研究和临床试验的启动、时间安排、进展、结果和成本的声明,包括有关试验启动和完成的时间和相关的准备工作的时间段,试验结果将何时可得以及我们的研究和开发计划的声明;有关我们期望通过bel-sar治疗后患者生活质量改善以及对患者治疗范式的改变的声明;有关我们对于泌尿系统肿瘤领域中有效局部治疗的高度未满足医疗需求以保持器官功能的信念和期望的声明;以及我们的产品候选品市场的规模和增长潜力以及我们服务于这些市场的能力的声明。 除非另有说明,这些前瞻性声明仅在本演示文稿的日期说法,我们没有义务更新或修订任何此类声明以反映本演示文稿之后发生的事件和情况。 由于前瞻性声明本质上会受到风险和不确定性影响,其中一部分难以预测或量化,有些超出我们的控制范围,您不应该将这些前瞻性声明视为未来事件的预测。 有关这些及其他风险和不确定性以及其他重要因素的讨论,其中任何因素可能导致我们的实际结果与前瞻性声明所包含的结果有所不同,请参见我们最近一次年度报告的风险因素部分10-k和提交给美国证券交易委员会(SEC)的季度报告10-Q,以及我们随后提交给SEC的其他文件中关于潜在风险、不确定性以及其他重要因素的讨论,这些文件可在SEC的网站www.sec.gov上查看。 我们前瞻性声明反映的事件和情况可能无法实现或发生,实际结果可能会大相径庭,与前瞻性声明中预测的结果可能存在实质性差异。 我们警告您不要过度依赖本演示文稿中包含的前瞻性声明。 本演示文稿讨论的产品候选品尚处于临床前或临床评估阶段,并尚未获得美国食品和药物管理局(FDA)或任何其他监管机构的营销批准。 在临床研究报告完成前,此处展示的临床试验数据仍然可能会因临床现场审计和其他审查过程的调整而发生变化。 对于这些产品候选品用于正在研究的用途的安全性或有效性,不作出任何保证。 本演示文稿不构成出售的要约或购买的邀约,也不得在未能在任何此类国家或其他管辖区根据任何该等国家或其他管辖区的证券法规定注册或符合资格之前,在此等国家或其他管辖区内进行这些证券的出售。 2 2


泌尿外科肿瘤学的关键意见领袖参加今天的看涨 Neal Shore, MD, FACS Gary Steinberg, MD, Max Kates, MD Joe Jacob, MD, MCR Carolina Urologic Johns Hopkins Syracuse University FACS 研究中心 RUSH University 3 3


Aura领导参加今天的电话会议,参会者包括Sabine Brookman-Elisabet de los Pinos、Jill Hopkins、医学博士Joseph McQuaid、董事Clinical May医学博士、首席医疗官Development Urologic、治疗领域高级副总裁、创始人兼首席执行官、研发总裁Oncology、头脑泌尿生殖器肿瘤医学。4 4


预测到2050年,由于人口老龄化,癌症病例将增加77%。在早期阶段,需要保留、节约器官、治疗方式改进的治疗期权,以改善局部治疗,从而国际化延缓疾病进程。世界卫生组织。全球癌症负担增加,在服务需求不断增加的情况下。2024年。可在:全球癌症负担增加,在服务需求不断增加的情况下获得(who.int)[2024年10月1日访问]。555


病毒样药物共轭物有潜力改变早期癌症治疗 独特的肿瘤选择性 肿瘤和突变不可知 针对表达在超过100个细胞系中的关键受体分子 早期恶性肿瘤转化阶段 超过15个动物肿瘤模型 双重机制 强效 靶向细胞毒性 和免疫每个VLP约200个细胞毒分子;激活;有潜力产生持久的抗肿瘤T细胞记忆 多个动物肿瘤模型中表现出皮克摩拉级的功效 安全性良好 多个早期局部癌症临床数据 无与治疗相关的SAE和无 • 脉络膜黑色素瘤:阳性2期数据;3期正在进行的DLT在bel-sar 2期中报告 • NMIBC:阳性早期1期数据;1期正在进行脉络膜黑色素瘤试验DLt, 剂量限制性毒性;MOA,作用机制;NMIBC,非肌层侵袭性膀胱癌;SAE,严重不良事件;VLP,病毒样颗粒。6 6


VLPs结合到巨噬细胞、树突细胞和中性粒细胞上, 能够通过TLR-4结合和NFk-β产生来刺激抗原呈递细胞 反应性氧化物扰乱细胞膜和细胞器 AU-011具有一种新颖的双重作用 肿瘤细胞膜的破坏 和通过坏死引起的促免疫细胞死亡导致T细胞激活和免疫介导的肿瘤细胞杀死 AU-011治疗旨在对局部细胞产生细胞病 Release of DAMPs引发抑制细胞,减少免疫抑制 的抗肿瘤免疫环境并有助于抗肿瘤免疫 Kines RC等人。Int J Cancer。2016;138(4):901–11。 Kines RC等人。Mol Cancer Ther。2018;17(2):565–74。 Kines RC等人。Cancer Immunol Res。 2021;9:693–706。 DAMPs,损伤相关分子模式;HSPG,肝素硫酸蛋白多糖;VDC,病毒样药物结合物;VLP,病毒样颗粒。 7


膀胱癌: 高医疗需求未得到满足的器官保留治疗是最常见的治疗方法之一。传统的膀胱癌治疗方法普遍存在诸多不足,导致各种短期和长期风险。患者未能完成全程BCG治疗的比例为84%。 这也对患者的生活质量造成了相当大的影响。年患病例数超过600,000例, 多次经历经膀胱肿瘤切除术的患者越来越多。由于全球范围内BCG疫苗短缺,患者接受的疫苗次数也相应减少。疾病的进展/转移可能导致患者需要膀胱切除术。2022年有614,298例被诊断为膀胱癌,较2020年增长了7%。膀胱癌MIBC死亡率排名第13,其中25%为MIBC,75%为NMIBC。 每年膀胱癌治疗的费用超过60亿美元,NMIBC治疗的年度花费占比为70-80%。 NMIBC患者中约有70-80%在治疗后出现癌症复发。


High risk of recurrence and progression with current treatments for NMIBC Low grade – low & intermediate risk High risk papillary disease High risk CIS – BCG unresponsive Progression Adjuvant therapy Adjuvant therapy Adjuvant therapy Intravesical gene therapy 42–84% (Adstiladrin®) BCG TURBT BCG TURBT of low-grade Systemic immunotherapy IR patients (Keytruda®) Intravesical Intravesical develop chemotherapy Intravesical immunotherapy chemotherapy 4,5 recurrence recurrence recurrence (Anktiva®) Cystectomy (~80,000) (~20,000) (~4,000) a Each figure represents 1000 persons. 1. Holzbeierlein JM et al. J Urol. 2024;212(1):3–10. 2. Holzbeierlein JM et al. J Urol. 2024 Apr;211(4):533-538. 3. Internal Aura epidemiology of market size; data on file. 4. Shalata AT, et al. Cancers (Basel). 2022;14(20):5019. 5. van Rhijn BWG, et al. Eur Urol. 2009;56(3):430–42. BCG, Bacillus Calmette-Guérin; CIS, carcinoma in situ; IR, intermediate risk; NMIBC, non-muscle-invasive bladder cancer; TURBT, transurethral resection of bladder tumor. 9 1–3 Prevalence a Patients (US)


Treatment goals Focal treatment with direct tumor cell killing AU-011 as a potential front-line immune Stimulate broad anti-tumor T cell response ablative therapy in NMIBC Front-line early intervention for local disease AU-011 has a dual mechanism of Decreased treatment burden with favorable action and can potentially safety profile reduce the treatment burden Reduce risk of recurrence and progression Avoid TURBT/operating room NMIBC, non–muscle-invasive bladder cancer; TURBT, transurethral resection of bladder tumor. 10


In-office procedure Local cystoscopic AU-011 administration administration of drug Laser light with standard activation and activation may be cystoscopy needle <5 minutes <10 minutes total laser time optimized for the urology clinic <15 minutes total procedure time Local administration of AU-011 is aligned with current practice Familiar procedures for urologists in urology offices Bladder injections (e.g. botox) and laser application are commonly used No general anesthesia AU-011 treatment may be feasible for patients with contraindications for general anesthesia/TURBT (e.g., comorbidities) No requirement for additional safety precautions in drug handling No viral replication or shedding TURBT, transurethral resection of bladder tumor. 11


Phase 1 trial of AU-011 in bladder cancer Review of early data from non-light activated and light-activated NMIBC cohorts


Window of opportunity study: AU-011 administered between scheduled biopsy and standard TURBT Clinical response data up to 21 days; safety data up to 56 days Treatment phase: Feasibility and efficacy Follow-up phase: Safety Day 9 ± 1 (Cohort A) Day 1 Day 2 Day 56 ± 7 Day 14+7 (Cohort B+C) Cystoscopy + biopsy Cystoscopy Final cystoscopy End of follow-up AU-011 injection Laser light Standard of care: activation TURBT Pathology specimen Pathology specimen Final efficacy evaluation Final safety evaluation TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 13


Phase 1 trial of AU-011 for bladder cancer designed to evaluate safety, feasibility, and mechanism of action Single dose window of opportunity study in NMIBC all-comers Histopathological assessment completed at time of standard of care TURBT Part 1 (n=5) Part 2 (n=~10) AU-011 alone AU-011 + focal light activation Drug only Cohort A: Cohort B: Cohort C: (No light) Drug + light Drug + light Drug + light Total 100 µg Total 100 µg Total 200 µg Total 100 µg NMIBC (N~3) NMIBC (N=5) NMIBC (N=4) NMIBC (N=3) 200 µg at tumor base 50 µg at tumor base 50 µg at tumor base 100 µg at tumor base 50 µg within lamina propria 50 µg within lamina propria Completed Safety Review Board completed after each cohort. Patients followed for safety after TURBT to 56 days. 1 patient evaluable to date Open for enrollment Safety & dose- Feasibility of Focal distribution Focal Markers of Study objectives limiting toxicity technique of AU-011 necrosis immune activation NMIBC, non-muscle-invasive bladder cancer; MoA, mechanism of action; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 14


Patient population: AUA risk classification and grade at screening Drug + light: Patient A2 Drug + light: Patient B1 High-risk Drug + light: Patient A4 Drug only: Patient 3 Drug + light: Patient B3 Intermediate- Drug only: Patient 4 Drug + light: Patient B2 risk Drug + light: Patient A3 Drug + light: Patient C1 Drug only: Patient 1 Drug only : Patient 5 Low-risk Drug only: Patient 2 Drug + Light: Patient A1 High-grade Low-grade AUA, American Urological Association. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 15


Phase 1 trial of AU-011 for bladder cancer designed to evaluate safety, feasibility, and mechanism of action Single dose window of opportunity study in NMIBC all-comers Histopathological assessment completed at time of standard of care TURBT Part 1 (n=5) Part 2 (n~10) AU-011 alone AU-011 + focal light activation Dr Dru ug o g onl nly y Cohort A: Cohort B: Cohort C: ( (N No o l li ight ght) ) Drug + light Drug + light Drug + light T To ot ta al l 100 µ 100 µg g Total 100 µg Total 200 µg Total 100 µg NMIBC (N~3) N NM MI IBC BC ( (N N=5) =5) NMIBC (N=4) NMIBC (N=3) 200 µg at tumor base 50 µ 50 µg g a at t t tu um mo or r b ba as se e 50 µg at tumor base 100 µg at tumor base 50 µg within lamina propria 50 µg within lamina propria 50 µg within lamina propria Completed Safety Review Board completed after each cohort. Patients followed for safety after TURBT to 56 days. 1 patient evaluable Open for enrollment Safety & dose- Feasibility of Focal distribution Focal Markers of Study objectives limiting toxicity technique of AU-011 necrosis immune activation NMIBC, non-muscle-invasive bladder cancer; MoA, mechanism of action; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 16


Drug only without light activation (n=5) TURBT Drug only: Treatment schedule Pathology Total dose: 100 µg • 50 µg into base of tumor Day 2 Day 1 • 50 µg into lamina propria • Evidence of non-invasive • Urologist performs TURBT to urothelial carcinoma include injected lesion • Sample sent to central pathology • Injection of AU-011 performed within tumor (50 µg) and below for H&E and AU-011 staining tumor (lamina propria; 50 µg) H&E, hematoxylin and eosin; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 17


Drug only without light activation (n=5) Safety Data Event Grade Number of patients Adverse events (related to study drug) None None 0/5 Drug only: Adverse events (related to injection or laser procedure) Safety data 1 1/5 Hematuria • First in human in bladder – safety cohort as required by • No treatment emergent adverse events FDA related to study drug • No serious adverse events • No dose limiting toxicities ClinicalTrials.gov Identifier: NCT06007690; AU-011-301. FDA, Food and Drug Administration 18


Phase 1 trial of AU-011 for bladder cancer designed to evaluate safety, feasibility, and mechanism of action Single dose window of opportunity study in NMIBC all-comers Histopathological assessment completed at time of standard of care TURBT Part 1 (n=5) Part 2 (n~10) AU-011 alone AU-011 + focal light activation Drug only C Co oh ho ort rt A A: : Cohort C: C Co oh ho ort rt B B: : Cohort C: (No light) Dr Dru ug + g + l li ight ght Drug + light Drug + light Drug + light Drug + light Total 200 µg Total 100 µg Total 100 µg Total 200 µg Total 100 µg T To ot ta al l 100 µ 100 µg g N NMIB MIBC C ( (N N~ ~3) 3) NMIBC (N=5) N NM MI IBC BC ( (N N=4) =4) N NM MI IBC BC ( (N N=3) =3) 20 200 0 µ µg a g at t t tu um mo or b r ba as se e 50 µg at tumor base 50 µ 50 µg g a at t t tu um mo or r b ba as se e 10 100 0 µ µg a g at t t tu um mo or b r ba as se e 50 µg within lamina propria 5 50 0 µ µg g wi wit thi hin l n lam ami ina na pr pro opr pri ia a Completed Safety Review Board completed after each cohort. Patients followed for safety after TURBT to 56 days. 1 patient evaluable Open for enrollment Safety & dose- Feasibility of Focal distribution Focal Markers of Study objectives limiting toxicity technique of AU-011 necrosis immune activation NMIBC, non-muscle-invasive bladder cancer; MoA, mechanism of action; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 19


Cohort A–C: Single-dose drug with light activation (n=~10) TURBT Cohorts A–C: Single-dose drug with light activation Treatment schedule Pathology Cohort A: Day 9 ± 1 Cohort A: Day 1 Day 2 Day 3–7 Cohort B/C: Day 14+7 • 50 µg into base of tumor • 50 µg into lamina propria • Evidence of non-invasive • Urologist performs • Urologist performs TURBT urothelial carcinoma light activation with in area where tumor used Cohort B: 689 nm infrared to be present • Injection of AU-011 2 light (75 J/cm ) performed within and below • Sample sent to central • 100 µg into base of tumor tumor (Cohort A) and • ~5 min duration pathology for H&E and Cohort C: within tumor (Cohort B/C) immune staining • 200 µg into base of tumor H&E, hematoxylin and eosin; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 20


a Cohort A + B: Single-dose drug with light activation (n=7) Event Grade Number of patients Adverse events (related to study drug) Cohort A + B: Nocturia 1 1/7 Single-dose drug with Urinary urgency 1 1/7 light activation Adverse events (related to injection or laser procedure) 1 1/7 Hematuria Safety data 1 1/7 Urinary blood clots 1 1/7 Nocturia • No serious adverse events 1 1/7 Urinary urgency • No dose limiting toxicities Favorable safety profile: <10% of patients experienced Grade 1 TEAEs related to study drug; no Grade 2/3 adverse events related to study drug (n=12) A Compiled safety data includes all completed light-activated cohorts (A and B). Data cutoff date of September 9, 2024. TEAE, treatment-emergent adverse event. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 21


Efficacy data: Ta low-grade 4/5 low-grade target tumors demonstrate complete response to AU-011 c d Patient A1 Patient A3 Patient A4 Patient B2 Patient C1 Single Multiple Multiple Multiple Multiple (Multiple at TURBT) Screening diagnosis Ta low-grade Ta low-grade Ta low-grade (2024) Ta low-grade Ta low-grade Ta high-grade (2023) Screening AUA Intermediate Intermediate Intermediate Intermediate Low risk classification 100 µg 100 µg 100 µg 100 µg 200 µg AU-011 dose/delivery IT/IM IT/IM IT/IM IT IT Clinical complete response: - a Target tumor Clinical complete response: a 2/2 1/2 1/1 - - Non-target tumor (bladder b urothelial field effect ) e Immune response : pending Target tumor e Immune response : pending Non-target tumor pending Necrosis - Visual changes on cystoscopy - a b For purposes of this analysis, Clinical complete response defined as absence of tumor cells on histopathologic evaluation. Bladder urothelial field effect: absence of tumor cells in non-target lesions. C d Previously treated tumor demonstrated high-grade disease but pathology at time of treatment revealed low-grade disease in non-target tumor. Complete response (target tumor) based upon local e pathology with central review ongoing; immune response and necrosis evaluations pending central review. Immune response is defined by immunocyte infiltration on post-treatment histopathology. Cohorts A–C: AUA, American Urological Association; IM, intramural; IT, intratumoral; TURBT, transurethral resection of bladder tumor. 22 Clinicaltrials.gov identifier: NCT05483868; AU-011-102. Single-dose drug with light activation


• 100% (7/7) of target tumors showed infiltration of effector CD8+ T and CD4+ cells, as early as 7 days after laser activation Light-activated cohorts a (A + B): • 100% (7/7) of non-target tumors (in the five patients with available immune staining) showed T cell infiltration, supportive of a bladder urothelial field effect Strong evidence of immune-mediated • Focal eosinophilic infiltration was observed in 57% (4/7) target mechanism of action tumors and in 14% (1/7) non-target tumors, supportive of a local innate immune response to tumor necrosis b • Generation of lymphoid follicles was observed in 71% (5/7) target tumors, supportive of a local adaptive immune response AU-011 showed evidence of producing pro-immunogenic changes in situ that have the potential to bridge, activate, and enhance adaptive immunity, consistent with its expected MOA a b Patients for which biopsies were available. Organized aggregates of immune cells. MOA, mechanism of action Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 23


Complete clinical response visualized at time of TURBT confirmed with Patient A1 histopathologic evaluation 64-year-old Caucasian male Evidence of clinical complete response by Screening diagnosis: (2023) absence of tumor cells, as well as immune Immune • Single activation, after single dose treatment in first infiltrate • Ta low-grade <3 cm patient • No CIS Example of papillary carcinoma (Ta) Screening AUA risk classification: Low Necrosis 7 days Papillary urothelial after AU-011 Initial diagnosis: (2010) carcinoma treatment • Single • Ta low-grade <3 cm • No CIS • Low risk Post-treatment TURBT demonstrating necrosis, Prior TURBT: inflammatory infiltrate, and 2011; 2012; 2018 no residual carcinoma. Circled region shows area Prior adjuvant therapies: of necrosis; arrow indicates edge of inflammatory • MMC (2011) infiltrate. H&E stain • Tamoxifen (2016) Pre-injection bladder biopsy demonstrating low-grade • Gemcitabine (2018) papillary urothelial carcinoma; non-invasive CIS, carcinoma in situ; H&E, hematoxylin and eosin; MMC, mitomycin C; TURBT, transurethral resection of bladder tumor. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 24 Single-dose drug with light activation


Summary of pre-and-post treatment pathology: Single low-grade target lesion and two non-target lesions Patient A1 64-year-old Caucasian male Pre-treatment pathology Post-treatment pathology Target lesion: Clinical complete response Screening diagnosis: (2023) Local pathology: Central pathology: • Single • Ta low-grade <3 cm • Papillary urothelial carcinoma, non-invasive, low- • Negative for urothelial carcinoma • No CIS grade • Chronic inflammation • Muscularis propria not identified Screening AUA risk classification: Low Note – no central pathology Initial diagnosis: (2010) Non-target lesion A & B: Absence of tumor cells (2/2 lesions) • Single • Ta low-grade <3 cm Not applicable: Central pathology: • No CIS • Negative for urothelial carcinoma • No pre-treatment specimen obtained • Low risk • Chronic inflammation Prior TURBT: 2011; 2012; 2018 Prior adjuvant therapies: • MMC (2011) • Tamoxifen (2016) a • Gemcitabine (2018) Clinical complete response (target lesion) b Bladder urothelial field effect a b Clinical complete response identified on histopathologic evaluation. Bladder urothelial field effect: absence of tumor in non-target lesions. AUA, American Urological Association; CIS, carcinoma in situ; MMC, mitomycin C; TURBT, transurethral resection of bladder tumor. Cohort A: ClinicalTrials.gov Identifier: NCT06007690; AU-011-301. 25 Single-dose drug with light activation


H&E CD3 Patient A1: AU-011 focal distribution, necrosis, and positive immune staining (target lesion) CD4 CD8 Post-treatment No central pathology read available for pre-treatment; block lost at site. Cohort A: H&E, hematoxylin and eosin.Clinicaltrials.gov identifier: NCT05483868; AU-011-102 26 Single-dose drug with light activation


Complete clinical response visualized at time of TURBT confirmed with Patient A3 histopathologic evaluation 72-year-old Hispanic male Screening diagnosis: (2024) • Multiple AU-011 • Ta low-grade (<3 cm) injection • No CIS Screening AUA risk classification: Intermediate Initial diagnosis: (2019) Biopsy • Ta high-grade <3 cm • No CIS • Intermediate risk Prior TURBT: • 2019, 2020 (x2), 2021 (x2), 2023 Prior adjuvant therapies: • BCG induction and maintenance (2020-2021) Pre-injection/pre-biopsy appearance of Post-injection edema and tumor on office cystoscopy ecchymosis at injection site AUA, American Urological Association; BCG, Bacillus Calmette-Guerin; CIS, carcinoma in situ; TURBT, transurethral resection of bladder tumor. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 27 Single-dose drug with light activation


Summary of pre-and-post treatment pathology: Single low-grade target lesion and two non-target lesions Patient A3 Pre-treatment pathology Post-treatment pathology 72-year-old Hispanic male Target lesion: Clinical complete response Screening diagnosis: (2024) Central pathology: Central pathology: • Multiple • Low-grade papillary urothelial carcinoma, non-invasive • Negative for urothelial carcinoma • Ta low-grade (<3 cm) • Acute and Chronic inflammation • No CIS Non-target lesion A and B: absence of tumor cells (A) / immune cell infiltration (B) Screening AUA risk classification: Intermediate LESION A LESION A Initial diagnosis: (2019) Central pathology: Not applicable: Pre-treatment biopsy not completed • Negative for urothelial carcinoma • Ta high-grade <3 cm • Chronic inflammation • No CIS • Intermediate risk LESION B LESION B Prior TURBT: Not applicable: Central pathology: • 2019, 2020 (x2), 2021 (x2), 2023 Pre-treatment biopsy not completed • Papillary urothelial carcinoma; non-invasive Prior adjuvant therapies: • Low-grade • BCG induction and maintenance • Additional findings: Cystitis cystica et glandularis (2020-2021) a Clinical complete response (target lesion) b Bladder urothelial field effect a b Clinical complete response identified on histopathologic evaluation. Bladder urothelial field effect: absence of tumor in non-target lesions. AUA, American Urological Association; BCG, Bacillus Calmette-Guerin; CIS, carcinoma in situ; TURBT, transurethral resection of bladder tumor. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 28 Single-dose drug with light activation


Patient A3: AU-011 focal distribution, necrosis, and positive immune staining (target lesion) H&E CD3 CD4 CD8 Pre-treatment Post-treatment H&E, hematoxylin and eosin. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 29 Single-dose drug with light activation


H&E: Pre-treatment CD4: Pre-treatment Patient A3: Post-treatment generation of secondary lymphoid follicles and increase in CD3, CD4, and CD8 infiltration CD4: Post-treatment H&E: Post-treatment H&E, hematoxylin and eosin. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 30 Single-dose drug with light activation


Efficacy data: Ta high-grade 3/3 high-grade tumors demonstrated immune response to AU-011 Patient A2 Patient B1 Patient B3 Single Single Multiple Screening diagnosis Ta high-grade Ta high-grade Ta high-grade Screening AUA High Intermediate High risk classification AU-011 dose/ 100 µg 100 µg 100 µg delivery IT/IM IT IT a Clinical complete response: Target tumor - - - Clinical complete response: Non-target NA - NA a b tumor (bladder urothelial field effect ) c Immune response : Target tumor c Immune response : Non-target tumor NA NA Necrosis - - - Tumor Visually Tumor Visually Visual changes on cystoscopy - Smaller Smaller a b Clinical complete response defined as absence of tumor cells on histopathologic evaluation. Bladder urothelial field effect: absence of tumor cells in non-target lesions. c Immune response is defined by immunocyte infiltration on post-treatment histopathology Cohorts A + B: AUA, American Urological Association; BCG, Bacillus Calmette-Guerin; CIS, carcinoma in situ; IM, intramural; IT, intratumoral; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 31 Single-dose drug with light activation


Summary


AU-011 demonstrated a favorable safety profile with robust clinical and immunological response in early data readout of ‘all-comers’ NMIBC patients Tumor shrinkage Favorable Rapid Immune Development and clinical safety profile activation plan response Only Grade 1 Drug-Related 100% of patients showed Continued development of Positive early data show 4/5 Adverse Events Reported in immune cell infiltration in AU-011 with planned phase 1 patients with low-grade disease <10% of Patients target and trial expansion to test additional had a complete clinical non-target lesions doses and treatment regimen No drug-related grade 2 or response higher AEs; no SAEs or DLTs Single low-dose of AU-011 In parallel, prepare for a Focal treatment with no Immune-mediated MOA showed multiple clinical phase 2 trial to further systemic adverse events and bladder urothelial complete responses in evaluate bel-sar’s clinical observed as of data cutoff field effect target and non-target activity and durability of tumors response AE, adverse event; DLT, dose-limiting toxicity; DOR, duration of response; MOA, mechanism of action; NMIBC, non-muscle-invasive bladder cancer; SAE, serious adverse event. ClinicalTrials.gov Identifier: NCT06007690; AU-011-301. 33


Appendix


Anti-tumor immunity: Treating beyond the target Preclinical development


Evidence of secondary (activated) follicles in tumor stroma supportive of local adaptive immune response Where does AU-011 fit in the cancer immunity cycle and the TME sub-cycle? Photoactivation of AU-011 generates ROS, resulting in necrotic cell death of tumor cells bound by AU-011. This releases tumor neoantigens and DAMPs, Depletion of tumor-resident driving a robust immunosuppressive cell types such as TAMs, immunogenic response and MDSC, iDC etc. (shown pre-clinically; not yet kickstarting the cancer shown in clinic), relieves tumor immunity cycle. immunosuppression, enabling an effective anti-tumor response Modified from: Mellman I, et al. Immunity. 2023;56(10):2188–205. APC, antigen-presenting cell; CTL, cytotoxic T lymphocyte; DAMPs, damage-associated molecular patterns; iDC, immature dendritic cell; MDSC, myeloid-derived suppressor cell; ROS, reactive oxygen species; TAM, tumor-associated macrophage; TLS, tertiary lymphoid structures; TME, tumor microenvironment. 36


Role of CD4+ and CD8+ T-cells at time of treatment and time of tumor rechallenge in the TC-1 syngeneic murine tumor model Depletion at the time of treatment Depletion at the time of rechallenge Implant TC-1 Implant TC-1 Rechallenge with 3 3 Tumor volume: 50mm Tumor volume: 50mm tumor cells tumor cells TC-1 tumor cells Day: -100 -93 -90 -87 +10 -1 0 +1 +3 +17 Day: 0 7 9 10 11 13 20 100 100 100 Isotype Naïve 80 80 Isotype anti-CD4 anti-CD4 anti-CD8 60 60 anti-CD8 40 40 20 20 0 10 20 30 40 50 60 70 80 90 100 0 10 20 30 40 50 60 70 80 90 100 ▲▲▲▲ Day post tumor Days post tumor ▲▲▲▲▲ challenge * * * implantation Intravenous AU-011 NIR treatment Depleting or matched isotype Kines RC, et al. Cancer Immunol Res. 2021;9(6):693–706. NIR, near-infrared. 37 Percent survival Percent survival


Tumor growth Syngeneic mouse tumor bladder model • MB49 model in C57BL/6 mice 1400 Control • N = 8–10/group Robust pre-clinical anti-PD-1 1200 AU-011 Anti-PD-1 anti-PD-1 + AU-011 1000 activity in bladder • Mouse equivalent of pembrolizumab • 100 µg administered 3 times every 3 days (IP) 800 cancer both as a 600 AU-011 AU-011 single dose • 100 µg as a single dose (IV) 400 2 single agent and in • All groups treated with NIR (50 J/cm ) 200 All animals that survived the first treatment were rechallenged combination with 0 and survival was evaluated up to 100 days after rechallenge 0 7 14 21 28 35 42 Days post tumor-implantation checkpoint inhibitors Survival Survival after rechallenge AU-011 treatment impacts 100 100 primary and distant tumors, overall survival, and induction of 80 80 durable immunological memory Control 60 60 anti-PD-1 • Treatment resulted in complete Control (naive) AU-011 AU-011 response and prevented tumor growth anti-PD-1 + AU-011 40 40 anti-PD-1 + AU-011 after rechallenge 20 20 • Data supports potential prevention of metastatic disease 0 0 0 25 50 75 100 0 25 50 75 100 Day post-treatment Days post-challenge Kines RC, et al. Cancer Immunol Res. 2021;9:693–706. IP, intraperitoneal; IV, intravenous; NIR, near-infrared. 38 3 Tumor volume, mm (mean±SEM) Survival, % Survival, %


Patient A1: Single-dose drug with light activation Immunohistochemistry Target lesion Non-target lesion A Non-target lesion B Stain Pre-treatment Post-treatment Pre-treatment Post-treatment Pre-treatment Post-treatment NA Absent NA Absent NA Absent AU-011 NA Present NA Absent NA Absent Necrosis NA NA NA NA NA NA Intratumoral NA Moderate NA Moderate NA Moderate Stromal CD3 NA NA NA Mild NA Mild Benign urothelial NA Marked NA Marked NA Marked Lymphoid follicle NA NA NA NA NA NA Intratumoral NA Moderate NA Moderate NA Moderate Stromal CD4 NA NA NA Absent NA Absent Benign urothelial NA Marked NA Marked NA Marked Lymphoid follicle NA NA NA NA NA NA Intratumoral Mild Mild Mild NA NA NA Stromal CD8 NA NA NA NA Mild Mild Benign urothelial NA Moderate NA Moderate NA Moderate Lymphoid follicle NA NA NA NA NA NA Intratumoral NA Marked NA Moderate NA Moderate Stromal CD45 NA NA NA Mild NA Mild Benign urothelial NA Marked NA Marked NA Marked Lymphoid follicle NA, not applicable. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 39


Patient A3: Single-dose drug with light activation Immunohistochemistry Target lesion (biopsy) Target lesion (TURBT) Non-target lesion A Non-target lesion B Post- Post- Post- Post- Stain Pre-treatment Pre-treatment Pre-treatment Pre-treatment treatment treatment treatment treatment Absent Present Absent Absent NA Absent NA Absent AU-011 Absent Absent Absent Present NA Absent NA Absent Necrosis Mild NA Mild NA NA NA NA Mild Intratumoral Mild Moderate Mild Moderate NA Mild NA Mild Stromal CD3 Mild Mild Mild Mild NA Mild NA Mild Benign urothelial NA Marked NA Marked NA NA NA NA Lymphoid follicle Absent NA Absent NA NA NA NA Absent Intratumoral Mild Moderate Mild Moderate NA Mild NA Mild Stromal CD4 Absent Mild Absent Mild NA Absent NA Mild Benign urothelial NA Marked NA Marked NA NA NA NA Lymphoid follicle Mild NA Mild NA NA NA NA Mild Intratumoral Mild Mild Mild Mild NA Mild NA Mild Stromal CD8 Mild Mild Mild Mild NA Mild NA Mild Benign urothelial NA Mild NA Mild NA NA NA NA Lymphoid follicle NA Mild NA Mild NA NA NA Mild Intratumoral Mild Moderate Mild Moderate Moderate Moderate NA NA Stromal CD45 Mild Mild Mild Mild NA Mild NA Mild Benign urothelial NA Marked NA Marked NA NA NA NA Lymphoid follicle NA, not applicable; TURBT, transurethral resection of bladder tumor. Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 40


Secondary (activated) lymphoid follicle: Patient A3 Capable of generating tissue-specific, adaptive immune responses 72-year-old Hispanic male Screening diagnosis: (2024) • Multiple • Ta low-grade (<3 cm) • No CIS • Secondary lymphoid follicles form ectopically at sites of Screening AUA risk classification: Intermediate chronic inflammation and antigenic stimulation Initial diagnosis: (2019) • Ta high-grade <3 cm • Lymphoid follicles are widely • No CIS • Intermediate risk reported in colorectal and ovarian carcinoma, suggestive Prior TURBT: of ongoing B-cell expansion and • 2019, 2020 (x2), 2021 (x2), 2023 a favorable prognosis Prior adjuvant therapies: • BCG induction and maintenance (2020-2021) AUA, American Urological Association; BCG, Bacillus Calmette-Guerin; CIS, carcinoma in situ; TURBT, transurethral resection of bladder tumor. Cohort A: Clinicaltrials.gov identifier: NCT05483868; AU-011-102. 41 Single-dose drug with light activation