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Tuesday, March 02 2021 - 08:39
AsiaNet
INOVIO Announces Positive Results from REVEAL 1, a Phase 3 Pivotal Trial Evaluating VGX-3100, its DNA-based HPV Immunotherapy for the Treatment of High-grade Precancerous Cervical Dysplasia Caused by HPV-16 and/or HPV-18
PLYMOUTH MEETING, Pa., March 2, 2021 /PRNewswire-AsiaNet/ --

-- Trial achieved primary and secondary efficacy endpoints among all evaluable 
subjects in the Phase 3 multi-center, randomized, double-blind, 
placebo-controlled trial

-- VGX-3100 is the first DNA medicine to achieve efficacy endpoints in a Phase 
3 clinical trial

-- INOVIO also continues to partner with QIAGEN to develop a pre-treatment 
predictive biomarker with the goal of identifying women expected to respond to 
VGX-3100

INOVIO, (NASDAQ:INO), a biotechnology company focused on bringing to market 
precisely designed DNA medicines to treat and protect people from infectious 
diseases, cancer and HPV-associated diseases, today announced it met primary 
and secondary endpoints among all evaluable subjects for the REVEAL 1 trial. 
This trial is one of two ongoing pivotal, randomized, double-blind, 
multi-center, placebo-controlled, Phase 3 trials (REVEAL 1 and REVEAL 2) 
evaluating the safety, tolerability and efficacy of VGX-3100 to treat 
HPV-16/18-associated cervical high-grade squamous intraepithelial lesions 
(HSIL) using the company's proprietary CELLECTRA(R) 5PSP device. 

The trial protocol-defined modified intention to treat (mITT) population 
(N=193) includes all subjects with endpoint data. For the primary endpoint of 
histopathological regression of HSIL combined with virologic clearance of 
HPV-16 and/or HPV-18 at week 36, the percentage of responders was 23.7% 
(31/131) in the treatment group, versus 11.3% (7/62) in the placebo group 
(p=0.022; 12.4% difference in percentage, 95%CI: 0.4,22.5), thus achieving 
statistical significance. All secondary efficacy endpoints were achieved. These 
endpoints were: a) regression of cervical HSIL to normal tissue combined with 
HPV-16/18 viral clearance, b) regression of cervical HSIL alone, c) regression 
of cervical HSIL to normal tissue, and d) HPV-16/18 viral clearance alone. 

The trial protocol-defined intention to treat (ITT) population (N=201) includes 
all randomized subjects regardless of availability of endpoint data and defines 
those without endpoint data as non-responders. There were eight such subjects 
(seven in the treatment group, one in the placebo group). Including subjects 
with missing endpoint data, the percentage of subjects meeting the primary 
endpoint was 22.5% (31/138) in the treatment group, versus 11.1% (7/63) in the 
placebo group (p=0.029; 11.4% difference in percentage, 95%CI: -0.4,21.2), 
which was not statistically significant. All secondary endpoints were achieved 
except for regression of cervical HSIL alone (12.8% difference in percentage, 
95%CI: -0.6,24.5). The reasons for missing endpoint data were: one subject was 
randomized but was never dosed, one withdrawal due to pregnancy, one withdrawal 
due to administration error, one withdrawal due to post-administration pain, 
one loss of follow-up due to COVID19-related travel restrictions, and three 
losses to follow up due to undetermined reasons. A pre-specified per-protocol 
(PP) analysis will also be performed upon trial completion.

There were no treatment-related serious adverse events and most adverse events 
were self-resolving and were considered to be mild to moderate, consistent with 
earlier clinical trials.

REVEAL 1 and REVEAL 2 are designed to assess and confirm the safety, 
tolerability, and efficacy of VGX-3100. INOVIO will continue to follow subjects 
in REVEAL 1 for safety and durability of response for 18 months following the 
last administration and REVEAL 2 is currently enrolling subjects. INOVIO 
expects to present REVEAL 1 findings at a scientific meeting this year.

Dr. J. Joseph Kim, President and CEO of INOVIO, said, "INOVIO is very proud to 
advance VGX-3100 as the first DNA medicine to achieve efficacy endpoints in a 
Phase 3 clinical trial in all evaluable subjects. We expect VGX-3100, if 
approved, to be an important therapeutic option for those impacted by 
HPV-16-/18-related disease. The REVEAL 1 efficacy and safety data also 
represent an important proof-of-platform for INOVIO's DNA medicines.

Dr. Mark Einstein, MD, MS, FACS, FACOG, Principal Coordinating Investigator for 
the REVEAL 1 trial, said, "There is a very significant need for a non-surgical 
therapeutic for young women suffering from HPV-associated cervical dysplasia.  
These results are very encouraging and show that we are headed in the right 
direction."

Dr. Prakash Bhuyan, MD, PhD, Senior Vice President and Head of HPV Therapeutic 
Clinical Development at INOVIO, said, "We thank the investigators, site 
personnel, and patients who made this research possible. We are excited to be 
developing a new therapeutic designed to advance women's health. Through our 
ongoing partnership with QIAGEN, we also plan to develop complementary a 
biomarker diagnostic test that would enable practitioners to more effectively 
identify women expected to respond to VGX-3100."

Biomarker Development

In the course of the REVEAL 1 and REVEAL 2 clinical trials, INOVIO continues to 
pursue development of a pre-treatment RNA-based biomarker blood test which 
could be used to identify prospective VGX-3100 patients who would be most 
likely to respond to the immunotherapy. INOVIO believes this will be an 
important element of VGX-3100 product and market development. 

INOVIO announced in February that it is continuing its partnership with QIAGEN 
to co-develop an in-vitro diagnostic based on RNA sequencing technology to 
guide clinical decision-making for the use of VGX-3100 in cervical HSIL. This 
technology had previously been employed in a post-hoc assessment of VGX-3100 
Phase 2 data by INOVIO, in which 85% of VGX-3100 treated subjects who had the 
biomarker experienced regression of HPV-16- and/or HPV-18-associated cervical 
HSIL.

VGX-3100 REVEAL 1 Phase 3 Cervical Dysplasia Trial Design & Highlights

    -- Trial participants included 201 women, 18 years of age or older, who 
       have histologically-confirmed cervical HSIL associated with HPV-16 
       and/or HPV-18, but who were otherwise healthy. 
       (ClinicalTrials.gov Identifier: NCT03185013) 

    -- Participants received either VGX-3100 or placebo at 0, 4 and 12 weeks 
       (randomized 2:1). 

    -- Trial had 90% statistical power (two-sided 0.05 alpha-level) for the 
       evaluation of the primary endpoint 

    -- Results are based on the demonstration of having no evidence of HSIL 
       associated with HPV-16 and/or HPV-18 from cervical biopsy samples and 
       non-detectability of HPV-16 and/or HPV-18 using the cobas(R) HPV test 
       from ThinPrep samples, at approximately 6 months following VGX-3100 or 
       placebo administration. 

    -- Based upon blinded aggregate data, the overall safety findings have 
       been consistent with previously reported trials and considered 
       generally safe and well tolerated. 

    -- Data will continue to be collected until the end of the trial (week 
       88).

About High Grade Cervical Dysplasia (Cervical HSIL)

Cervical HSIL is the pre-cancerous condition of the cervix that immediately 
precedes the development of invasive cervical cancer. Cervical HSIL is caused 
by persistent infection with high risk-HPV, including HPV-16 and HPV-18, which 
collectively confer the highest risk for cervical HSIL development and cervical 
cancer development. Estimates of the incidence rate of cervical HSIL over 
recent years have indicated that up to 195,000 cases are diagnosed in the U.S. 
annually.

About VGX-3100

VGX-3100 is a DNA medicine in clinical trials for the treatment of three 
HPV-16-/18-related disease states – cervical dysplasia, vulvar dysplasia and 
anal dysplasia. The cervical dysplasia program is in late Phase 3 clinical 
trials (REVEAL 1 and REVEAL 2). VGX-3100 is designed to utilize the patient's 
own immune system to clear HPV-16/18 virus and HPV-16-/18-associated high-grade 
precancerous lesions with the aim of reducing the risk of cancer.

About INOVIO's DNA Medicines Platform

INOVIO has 15 DNA medicine clinical programs currently in development focused 
on HPV-associated diseases, cancer, and infectious diseases, including 
coronaviruses associated with COVID-19 and MERS for which programs are being 
developed with funding support from the U.S. Department of Defense and the 
Coalition for Epidemic Preparedness Innovations (CEPI). DNA medicines are 
composed of optimized DNA plasmids, which are small circles of double-stranded 
DNA that are synthesized or reorganized by a computer sequencing technology and 
designed to produce a specific immune response in the body.

INOVIO's DNA medicines deliver optimized plasmids directly into cells 
intramuscularly or intradermally using INOVIO's proprietary hand-held smart 
device called CELLECTRA(R). The CELLECTRA device uses a brief electrical pulse 
to reversibly open small pores in the cell to allow the plasmids to enter, 
overcoming a key limitation of other DNA and other nucleic acid approaches, 
such as mRNA. Once inside the cell, the DNA plasmids enable the cell to produce 
the targeted antigen. The antigen is processed naturally in the cell and 
triggers the desired T cell and antibody-mediated immune responses. 
Administration with the CELLECTRA device is designed to ensure that the DNA 
medicine is efficiently delivered directly into the body's cells, where it can 
go to work to drive an immune response. INOVIO's DNA medicines do not interfere 
with or change in any way an individual's own DNA. The advantages of INOVIO's 
DNA medicine platform are how fast DNA medicines can be designed and 
manufactured; the stability of the products, which do not require freezing in 
storage and transport; and the robust immune response, safety profile, and 
tolerability that have been observed in clinical trials.

With more than 3,000 patients receiving INOVIO investigational DNA medicines in 
more than 7,000 applications across a range of clinical trials, INOVIO has a 
strong track record of rapidly generating DNA medicine candidates with 
potential to meet urgent global health needs.

About INOVIO

INOVIO is a biotechnology company focused on rapidly bringing to market 
precisely designed DNA medicines to treat and protect people from infectious 
diseases, cancer, and diseases associated with HPV. INOVIO is the first and 
only company to have clinically demonstrated that a DNA medicine can be 
delivered directly into cells in the body via a proprietary smart device to 
produce a robust and tolerable immune response. INOVIO's lead immunotherapy 
candidate, VGX-3100, currently in Phase 3 trials for precancerous cervical 
dysplasia, cleared high-risk HPV-16 and/or HPV-18 in a Phase 2b clinical trial. 
High-risk HPV is responsible for 70% of cervical cancer, 91% of anal cancer, 
and 69% of vulvar cancer. Also in development are programs targeting 
HPV-related cancers and a rare HPV-related disease, recurrent respiratory 
papillomatosis (RRP); non-HPV-related cancers glioblastoma multiforme (GBM) and 
prostate cancer; as well as infectious disease DNA vaccine development programs 
in coronaviruses associated with COVID-19 diseases and MERS, Lassa fever, 
Ebola, and HIV. Partners and collaborators include Advaccine, ApolloBio 
Corporation, AstraZeneca, The Bill & Melinda Gates Foundation, Coalition for 
Epidemic Preparedness Innovations (CEPI), Defense Advanced Research Projects 
Agency (DARPA)/Joint Program Executive Office for Chemical, Biological, 
Radiological and Nuclear Defense (JPEO-CBRND)/Department of Defense (DoD), HIV 
Vaccines Trial Network, International Vaccine Institute (IVI), Kaneka 
Eurogentec, Medical CBRN Defense Consortium (MCDC), National Cancer Institute, 
National Institutes of Health, National Institute of Allergy and Infectious 
Diseases, Ology Bioservices, the Parker Institute for Cancer Immunotherapy, 
Plumbline Life Sciences, Regeneron, Richter-Helm BioLogics, Thermo Fisher 
Scientific, University of Pennsylvania, Walter Reed Army Institute of Research, 
and The Wistar Institute. INOVIO also is a proud recipient of 2020 Women on 
Boards "W" designation recognizing companies with more than 20% women on their 
board of directors. For more information, visit www.inovio.com.

CONTACTS:

Investors: Ben Matone, +1 484-362-0076, ben.matone@inovio.com 
Media: Jeff Richardson, +1 267-440-4211, jrichardson@inovio.com

This press release contains certain forward-looking statements relating to our 
business, including our plans to develop VGX-3100 for HPV-16/18-associated 
cervical high-grade squamous intraepithelial lesions, plans to present clinical 
data at an upcoming scientific meeting, the advantages and potential benefits 
of our DNA medicines platform, as well as VGX-3100 and our other product 
candidates, and our expectations regarding our research and development 
programs, including our plans for a collaboration with QIAGEN to develop an 
in-vitro diagnostic to guide clinical decision making for the use of VGX-3100. 
Actual events or results may differ from the expectations set forth herein as a 
result of a number of factors, including uncertainties inherent in preclinical 
studies, clinical trials, product development programs and commercialization 
activities and outcomes, our ability to secure sufficient manufacturing 
capacity to mass produce our product candidates, the availability of funding to 
support continuing research and studies in an effort to prove safety and 
efficacy of electroporation technology as a delivery mechanism or develop 
viable DNA medicines, our ability to support our pipeline of DNA medicine 
product candidates, the ability of our collaborators to attain development and 
commercial milestones for products we license and product sales that will 
enable us to receive future payments and royalties, the adequacy of our capital 
resources, the availability or potential availability of alternative therapies 
or treatments for the conditions targeted by us or our collaborators, including 
alternatives that may be more efficacious or cost effective than any therapy or 
treatment that we and our collaborators hope to develop, issues involving 
product liability, issues involving patents and whether they or licenses to 
them will provide us with meaningful protection from others using the covered 
technologies, whether such proprietary rights are enforceable or defensible or 
infringe or allegedly infringe on rights of others or can withstand claims of 
invalidity and whether we can finance or devote other significant resources 
that may be necessary to prosecute, protect or defend them, the level of 
corporate expenditures, assessments of our technology by potential corporate or 
other partners or collaborators, capital market conditions, the impact of 
government healthcare proposals and other factors set forth in our Annual 
Report on Form 10-K for the year ended December 31, 2020 and other filings we 
make from time to time with the Securities and Exchange Commission. There can 
be no assurance that any product candidate in our pipeline will be successfully 
developed, manufactured or commercialized, that final results of clinical 
trials will be supportive of regulatory approvals required to market products, 
or that any of the forward-looking information provided herein will be proven 
accurate. Forward-looking statements speak only as of the date of this release, 
and we undertake no obligation to update or revise these statements, except as 
may be required by law.

SOURCE INOVIO Pharmaceuticals, Inc.
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