EX-99.2 3 srrk-20240603xex99d2.htm EX-99.2
Exhibit 99.2

GRAPHIC

PRESENTED BY: Phase 1 study (DRAGON) of SRK-181 (linavonkibart), a latent TGFβ1 inhibitor, combined with pembrolizumab in anti-PD1 resistant patients with advanced solid tumors: Updated results of expansion phase Ulka Vaishampayan1 , Randy F. Sweis2 , Deepak Kilari3 , Ahmad Tarhini4 , Justin F. Gainor5 , Minal Barve6 , Guru Sonpavde7 , Meredith Mckean8 , David Park9 , Sunil Babu10, Yawen Ju11, Lan Liu11 , Susan Henry11, Lu Gan11, Timothy A. Yap12 1University of Michigan, Ann Arbor, MI; 2University of Chicago, Chicago, IL; 3Medical College of Wisconsin, Milwaukee, WI; 4Moffitt Cancer Center Magnolia Campus, Tampa, FL; 5Massachusetts General Hospital Harvard Medical School, Boston, MA; 6Mary Crowley Cancer Research, Dallas, TX; 7AdventHealth Medical Group, Orlando, FL; 8Sarah Cannon Research Institute, Nashville, TN; 9St Jude Crosson Cancer Institute/Providence Medical Foundation, Fullerton, CA; 10Fort Wayne Medical Oncology and Hematology, Fort Wayne, IN; 11Scholar Rock, Inc., Cambridge, MA; 12The University of Texas MD Anderson Cancer Center, Houston, TX Ulka Vaishampayan, MD

GRAPHIC

PRESENTED BY: Mechanism of Action SRK-181, a Selective Anti-TGFβ1 Antibody, Overcomes CPIs Resistance 2 Ulka Vaishampayan, MD 1.Batlle E, et al. Immunity. 2019; 50(4):924-940. CPI, checkpoint inhibitor; GLP, good laboratory practice; MDSC, myeloid derived suppressor cells; TGFβ1, transforming growth factor beta-1.

GRAPHIC

PRESENTED BY: Phase 1 Clinical Trial Overview *Cohort Any Other was terminated early and HNSCC was added. ADA, anti drug antibody; BOR, best overall response; ccRCC, clear cell renal cell carcinoma; DCR, disease control rate; DoR, duration of response; ECOG, eastern cooperative oncology group; HNSCC, head and neck squamous cell carcinoma; MEL, melanoma; NSCLC, non-small cell lung cancer; ORR, objective response rate; OS, overall survival; PD, progressive disease; PD-1, programmed cell death protein 1; PD-L1, programmed cell death ligand 1; PD-(L)1, PD-1/PD-L1; PFS, progression-free survival; PK, Pharmacokinetic; q2w, every 2 weeks; q3w, every 3 weeks; RECIST, response evaluation criteria in solid tumors; UC, urothelial carcinoma. Ulka Vaishampayan, MD Part A1: SRK-181 Single Agent (80-3000 mg q3w/2000 mg q2w) All advanced solid tumor n=19 Part A2: SRK-181 + anti-PD-(L)1 (SRK-181: 240-2400mg q3w) Advanced solid tumor non-responders to prior anti-PD-(L)1 n= 15 Dose Escalation (3+3) Study Endpoints Primary: • Safety and tolerability Secondary: • Anti-tumor activity (BOR, ORR, DoR, and DCR) • PK and ADA Exploratory: • Biomarker • PFS, OS, etc. Part B: SRK-181 (1500mg q3w) + Pembrolizumab n=up to 40/cohort Dose Expansion Cohort HNSCC Cohort MEL Cohort UC Cohort NSCLC Cohort Any Other* Cohort ccRCC Key Eligibility Criteria • ≥18-year-old and ECOG 0-1 • Measurable disease per RECIST v1.1 • At least 1 prior line of anti-PD-1 antibody • Part B Cohort ccRCC and HNSCC: ▪ Must have had PD on the most recent prior anti-PD-1 • Part B Cohorts NSCLC, UC and MEL: ▪ Non-responders to all prior anti-PD-1

GRAPHIC

PRESENTED BY: Preliminary Safety and Efficacy Phase 1 Dose Escalation Phase 4 Part A1 (n=19) Part A2 (n=15) • SRK-181 was well tolerated: No DLTs observed; no Grade 4 or 5 treatment-related AEs Safety Efficacy • Part A1, Single-Agent Dose Escalation ➢ All 3 ovarian cancer patients were stable beyond ~ 6-month cutoff • Part A2, Combination Treatment Dose Escalation ➢ 1 PR in anti-PD-1 resistant ccRCC patient ➢ 5 (33%) patients had SD for 4+ months o 1 HNSCC patient had a 29.4% tumor reduction PK • Exposure was similar between monotherapy and combination • Approximately dose proportional exposure over 240 mg q3w • Minimal to no accumulation was observed after multiple doses MAD/MTD • MAD: 3000mg q3w and 2000mg q2w for single SRK-181 and 2400mg q3w for SRK-181 in combination with anti-PD-1 • MTD not reached; recommended Part B dose at 1500 mg q3w or 1000 mg q2w Martin CJ, et al. Sci Transl Med. 2020;12:eaay8456. Yap T, et al. J ImmunoTherapy of Cancer 2022;10:doi: 10.1136/jitc-2022-SITC2022.0780. Ulka Vaishampayan, MD AE, adverse event; ccRCC, clear cell renal cell carcinoma; DLT, dose-limiting toxicity; HNSCC, head and neck squamous cell carcinoma; MAD, maximum administered dose; MTD, maximum tolerated does; PK, Pharmacokinetic; PD, progressive disease; PR, partial response; q2w, every 2 weeks; q3w, every 3 weeks; SD, stable disease. Data cut date: Apr 10, 2024

GRAPHIC

PRESENTED BY: Patient Demographics and Disposition Phase 1 Dose Expansion Phase 5 Ulka Vaishampayan, MD Category All# N 78 Age, median (range) 65y (32-81y) Gender, M, n (%) 56 (71.8) Prior Lines of Therapy, median (range) 3 (1-9) Number of Lines of Prior Anti-PD-(L)1, n (%) 1 2 3 4 48 (61.5) 23 (29.5) 6 (7.7) 1 (1.3) Best Response to Prior Anti-PD-(L)1, n (%) Partial Response Stable Disease Progressive Disease 1 (1.3) 40 (51.3) 37 (47.4) Disease Progressed from the Last Prior Anti-PD-1, n (%) 76 (97.4)* Category All Enrolled 78 On Study, n (%) 10 (12.8) Stopped Treatment, n (%) 68 (87.2) Reason for Completion/Discontinuation, n (%) Disease Progression Based on RECIST 1.1 Clinical Progression Adverse Event& Investigator Decision Withdrawal of Consent 40 (51.3) 6 (7.7) 17 (21.8) 1 (1.3) 4 (5.1) # Includes patients of 30 ccRCC, 11 HNSCC, 11 MEL, 11 UC, 11 NSCLC and 4 Any Other Cohorts. 1 HNSCC patient had best response of PR to prior anti-PD-(L)1. *2 MEL patients discontinued the last prior anti-PD-(L)1 due to other reason instead of disease progression. &10 patients (12.8%) discontinued from the study due to treatment-related AEs: rash maculo-popular and pneumonitis (2 patients), bullous pemphigoid, colitis, erythroderma, generalized erythematous rash, invasive squamous cell carcinoma, mucositis oral (1 patient each). AE, adverse event; ccRCC, clear cell renal cell carcinoma; HNSCC, head and neck squamous cell carcinoma; MEL, melanoma; NSCLC, non-small cell lung cancer; PD-1, programmed cell death protein 1; PD-L1, programmed cell death ligand 1; PD-(L)1, PD-1/PD-L1; RECIST, response evaluation criteria in solid tumors; UC, urothelial carcinoma. Data cut date: Apr 10, 2024

GRAPHIC

PRESENTED BY: Manageable Safety Profile Phase 1 Dose Expansion Phase 6 Ulka Vaishampayan, MD Treatment-Emergent AEs Related to SRK-181 or Anti-PD(L)1 Adverse Event All Grades (>5%) N=78 ≥Grade 3 N= 78 Rash# 25 (32.1%)* 10 (12.8%)* Pruritus 20 (25.6%)* 1 (1.3%)* Fatigue 16 (20.5%) 1 (1.3%) Diarrhoea 11 (14.1%) 0 (0%) Nausea 5 (6.4%) 1 (1.3%) ALT increased 4 (5.1%) 2 (2.6%) AST increased 4 (5.1%) 1 (1.3%) Arthralgia 4 (5.1%) 0 (0%) Vomiting 4 (5.1%) 0 (0%) • There was 1 treatment-related Grade 4 AE (Dermatitis exfoliative generalised) • There was no treatment-related Grade 5 AE • Treatment-related SAE >2% (2 patients) were Pemphigoid (irAE) #Rash includes rash, rash macular, rash maculo-papular, rash erythematous, and rash pruritic. *Treatment-related irAE. AE, adverse event; ALT, alanine aminotransferase; AST, aspartate aminotransferase; irAE, immune-related adverse event; PD-1, programmed cell death protein 1; PD-L1, programmed cell death ligand 1; PD-(L)1, PD-1/PD-L1; SAE, serious adverse event Data cut date: Apr 10, 2024

GRAPHIC

PRESENTED BY: Efficacy in Cohort MEL Clinical Responses in Anti-PD-1 Non-responders 7 Ulka Vaishampayan, MD Efficacy Intent To Treat N=11 ORR 3 (27.3%) Confirmed CR 1 (9.1%) Confirmed PR 1 (9.1%) mDoR (Months) 4.9 (1.8, 7.1) DCR 8 (72.7%) • Median lines of prior cancer therapy: 3 (range 1 – 7) ➢ All have SD or PD as BOR to the last prior anti-PD-1 ➢ 9 (82%) had PD from the last prior anti-PD-1 BOR, best overall response; CR, complete response; DCR, disease control rate; mDoR, median duration of response; MEL, melanoma; ORR, objective response rate; PD, progressive disease; PD-1, programmed cell death protein 1; PR, partial response. Pt#1 Pt#1: Screening Axillary lymph node 17.5 mm Pt#1: C3 Axillary lymph node 10.1 mm Pt#1 Data cut date: Apr 10, 2024

GRAPHIC

PRESENTED BY: Efficacy in Cohort UC Clinical Responses in Anti-PD-1 Non-responders 8 Ulka Vaishampayan, MD Efficacy Intent To Treat N=11 ORR 1 (9.1%) Confirmed PR 1 (9.1%) mDoR (Months) 12.9 (12.9, 12.9) DCR 5 (45.5%) • Median lines of prior cancer therapy: 4 (range 2 – 5) ➢ All have SD or PD as BOR to the last prior anti-PD-1 ➢ All had PD from the last prior anti-PD-1 Pt#1 BOR, best overall response; DCR, disease control rate; mDoR, median duration of response; ORR, objective response rate; PD, progressive disease; PD-1, programmed cell death protein 1; PR, partial response; SD, stable disease; UC, urothelial carcinoma. Pt#1: Screening Lung nodule 59 mm Pt#1: C26 Lung nodule 41.1 mm Pt#1 Data cut date: Apr 10, 2024

GRAPHIC

PRESENTED BY: Efficacy in Cohort HNSCC Clinical Responses in Heavily Pre-treated and Anti-PD-1 Resistant Patients 9 Ulka Vaishampayan, MD Efficacy Intent To Treat N=11 ORR 2 (18.2%) Confirmed PR 1 (9.1%) mDoR (Months) 2.2+ (0.1, 4.3+) DCR 4 (36.4%) Pt#1: Screening Lung nodule 16 mm Pt#1: C3 Lung nodule 0 mm BOR, best overall response; DCR, disease control rate; HNSCC, head and neck squamous cell carcinoma; mDoR, median duration of response; ORR, objective response rate; PD, progressive disease; PD-1, programmed cell death protein 1; PR, partial response; SD, stable disease. Pt#1 Pt#1 • Median lines of prior cancer therapy: 3 (range 1 – 7) ➢ 10 (91%) have SD or PD as BOR to the last prior anti-PD-1 ➢ All had PD from the last prior anti-PD-1 Data cut date: Apr 10, 2024

GRAPHIC

PRESENTED BY: Efficacy in Cohort ccRCC Clinical Responses in Heavily Pre-treated and Anti-PD-1 Resistant Patients Ulka Vaishampayan, MD Efficacy Intent To Treat N=30 ORR 7 (23.3%) Confirmed PR 6 (20%) mDoR (Months) 7.7+ (2.5+, 20.9+) DCR 17 (56.7%) • IMDC score: intermediate 67%; poor 30% • Median lines of prior cancer therapy: 2 (range 1 – 9) ➢ 29 (97%) received at least 1 prior anti-PD-1 and TKI ➢ All had SD or PD as BOR to the last prior anti-PD-1 ➢ All had PD from the last prior anti-PD-1 Pt#1 Pt#1: Screening Lymph node 21.5 mm Pt#1: C8 Lymph node 5 mm BOR, best overall response; DCR, disease control rate; IMDC, International Metastatic Renal Cell Carcinoma Database Consortium; mDoR, median duration of response; ORR, objective response rate; PD, progressive disease; PD-1, programmed cell death protein 1; PR, partial response; SD, stable disease; TKI, tyrosine kinase inhibitor. Pt#1 Data cut date: Apr 10, 2024

GRAPHIC

PRESENTED BY: Proof of Mechanism SRK-181 and Pembrolizumab Treatment Creates a Proinflammatory Microenvironment 11 • SRK-181 and pembrolizumab increase CD8+ T-cells infiltration into tumors across multiple tumor types • CD8+ T-cell were activated (CD8+GrmB+) in responding patients across multiple cohorts • The number of CD8+GrmB+ cells correlates with tumor shrinkage Ulka Vaishampayan, MD 0.0 0.1 0.2 0.3 -100 -50 0 50 %CD8+GrmB+/total Best Target Lesion SOD Percent Change SRK-181 and Pembrolizumab Increased CD8+ Infiltration CD8+ Cytotoxic T-cells were Activated in Responding Patients Line indicates cutoff that defines infiltrated status. Data generated from available paired biopsies that were evaluated using a chromogenic assay. Data generated from available paired biopsies that were evaluated using a multiplex fluorescent assay. Data generated from available post treatment biopsies that were evaluated using a multiplex fluorescent assay. ccRCC, clear cell renal cell carcinoma; CD, cluster of differentiation; GrmB, Granzyme B; HNSCC, head and neck squamous cell carcinoma; NSCLC, non-small cell lung cancer; PD, progressive disease; PR, partial response; SD, stable disease; UC, urothelial carcinoma. Data cut date: Apr 10, 2024

GRAPHIC

PRESENTED BY: Biomarker Data May Inform Patient Selection Strategy Baseline CD8+ T-cell Infiltration Status and Baseline Treg Levels Suggest a Higher Chance of Clinical Response 12 Ulka Vaishampayan, MD • Baseline data was available from 14 patients and 10 were infiltrated • If enrollment had been limited to patients who were infiltrated at baseline: ➢ ORR is increased from 23.3% (7/30) to 40% (4/10) ➢ mDoR is improved from 7.7 months to 9.3 months ccRCC, clear cell renal cell carcinoma; CD, cluster of differentiation; mDoR, median duration of response; Foxp3, forkhead box p3; ORR, objective response rate; TGFβ1, transforming growth factor beta-1; Treg, T regulatory cells • Baseline data was available from 11 patients and 6 had elevated Treg levels • If enrollment had been limited to patients with elevated Treg at baseline ➢ ORR is increased from 23.3% (7/30) to 50% (3/6) ➢ mDoR is improved from 7.7 months to 9.8 months Baseline CD8+ Infiltration Status Suggest a Higher Chance of Response in ccRCC Patients Elevated Baseline Treg (CD4+Foxp3+) Levels within Tumor Compartment Suggest a Higher Chance of Response in ccRCC Patients *1 patient progressed prior to 1st scan, so not represented on spider plot. Data cut date: Apr 10, 2024

GRAPHIC

PRESENTED BY: Summary 13 Ulka Vaishampayan, MD • ORR 23.3% in ccRCC, 18.2% in HNSCC, 27.3% in MEL, including 1 CR, and 9.1% in UC • mDoR were 7.7+m in ccRCC, 2.2+m in HNSCC, 4.9m in MEL and 12.9m in UC AE, adverse event; ccRCC, clear cell renal cell carcinoma; CD, cluster of differentiation; CR, complete response; HNSCC, head and neck squamous cell carcinoma; mDoR, median duration of response; MEL, melanoma; ORR, objective response rate; PD, progressive disease; PR, partial response; SAE, serious adverse events; SD, stable disease; Treg, T regulatory cells; UC, urothelial carcinoma. Objective evidence of anti-tumor activity across multiple cancer types with duration of response up to 20+ months • Combination was associated with enhanced proinflammatory microenvironment with activation of CD8+ T-cells in responding patients across multiple cohorts and the number of activated T-cells correlating with tumor shrinkage • In baseline CD8+ T-cells infiltrated ccRCC patients, ORR increases from 23.3% to 40% with mDoR improving from 7.7 months to 9.3 months • In baseline Treg elevated ccRCC patients, ORR increases from 23.3% to 50% with mDoR improving from 7.7 months to 9.8 months Biomarker findings establish proof of mechanism and inform potential patient selection strategy • Treatment-related AEs were primarily skin toxicities with 1 Grade 4 skin event; no Grade 5 event • Treatment-related G3+ AEs ≥ 5% were rash only and treatment-related SAE ≥ 2% were pemphigoid only Safety profile with the combination of SRK-181 and pembrolizumab was manageable

GRAPHIC

PRESENTED BY: Conclusion 14 Ulka Vaishampayan, MD TGFβ1, transforming growth factor beta-1. • Anti-tumor activity in anti-PD1 resistant patients across multiple cancer types establishes proof-of-concept for SRK-181, a selective latent TGFβ1 inhibitor • Biomarker results establish proof of mechanism and inform potential patient selection strategy in ccRCC • These data warrant further investigation of SRK-181

GRAPHIC

PRESENTED BY: 15 Ulka Vaishampayan, MD The authors thank the participating patients, their families, the study centers, and investigators for their contributions to the study. This study was sponsored by Scholar Rock. THANK YOU FOR YOUR ATTENTION