Affimed NV (AFMD) 2021 Q3 法說會逐字稿

Thank you for standing by, and welcome to Affimed's Third Quarter 2021 Financial Results and Corporate Update Conference Call. (Operator Instructions) As a reminder, today's conference call is being recorded.

I'd now like to introduce your host for today's program, Alex Fudukidis, Head of Investor Relations. Please go ahead, sir.

Thank you, Jonathan. And thank you all for joining us today for third quarter 2021 results in operational update call. Before we begin, I'd like to remind everyone that we issued the relevant press release earlier today, and that it can be found on the Investor Relations section of our website.

On the call today, we have the following members of our management team. Dr. Adi Hoess, our Chief Executive Officer; Andreas Harstrick, our Chief Medical Officer; Arndt Schottelius, our Chief Scientific Officer; Wolfgang Fischer, our Chief Operating Officer; Ms. Denise Mueller, our Chief Business Officer and Angus Smith, our Chief Financial Officer. The whole team will be available for the Q&A session.

Before we start, I will quickly to go through the safe harbor statement. Today's discussion contains projections and forward-looking statements regarding future events. These statements represent our beliefs and assumptions only as of the date of this call. Except as required by law, we assume no obligation to update these forward-looking statements publicly or to update the reasons why actual results could differ materially from those anticipated in the forward-looking statements, even if new information becomes available in the future. These forward-looking statements are subject to risks and uncertainties, and actual results may differ materially from those expressed or implied in these statements due to various factors, including, but not limited to, those identified under the section entitled Risk Factors in our filings with the SEC and those identified under the section entitled Forward-Looking Statements in the press release that we issued today and filed with the SEC.

With that, I'll turn the call over to Adi. Adi?

Yes. Thank you, Alex, and good morning, everyone. Thanks indeed for joining our third quarter update call and I'm very pleased with the continued progress towards our goal of bringing new and innovative lifesaving medications to cancer patients who need them. Our pipeline positions us for several potential value creating milestones through the end of 2022.

Today, in addition to providing an update on our leading programs, where we'll spend a little bit of time to introduce you to AFM28, our most advanced preclinical IND-enabling data, which is expected to enter the clinic in 2022.

On Slide 3 of the presentation that we made available to accompany our call today, we summarize ultimate strategy for developing our internet selling engines. We introduced our 3-pronged development strategy to you about a year ago. As we said to you then, we believe this strategy allows us to explore different development approaches and thereby increasing the probability of success for each of our molecules. What we have learned to-date about the safety of our molecules is indeed supporting not just monotherapy but also combination approaches.

The first approach, where the patient's innate immune system is still functional in the involved development or innate cell engager molecules as monotherapy. Our combination therapy approach involves pursuing novel therapeutic combination, including combinations with NK cell therapy and other I-O to I-O therapy, such as checkpoint inhibitor. In the case of NK cell combinations, the combined cells create car light NK therapeutics that seek out and destroy tumors. An example of that is our investigator-sponsored clinical trial at MD Anderson Cancer Center.

On Slide 4, we are showing where we are with our leading innate cell engager, AFM13 and AFM24 and the recently added AFM28 in a nutshell. All 3 of these innate cell engagers bind to CD16A on natural killer cells and macrophages with high affinity and also binds on specific targets on cancer cells to bring the innate immune system to find against cancer. This slide shows our AFM13 innate cell engager targets CD30-positive lymphoma, AFM24, EGFR expressing solid tumors and AFM28, only as candidate, CD123-positive AML indications.

We are embarking on a broad development strategy for each of our molecules, which we believe will be the basis for continuous data flow from our pipeline over the next several quarters. Since we introduced you to our 3-pronged strategy, we've also made a lot of progress to support our strength. We have published clinical and preclinical data that make us quite confident about the path that we have set for our company.

Our goal in all of these efforts at Affimed is to bring innovative therapies to cancer patients who are often out of these options when it comes to managing their disease. These are very sick patients who frequently see their disease return after multiple lines of treatment. Very proud to have been able to offer these underserved and frequently without hope patients another opportunity to fight their disease. And as we have shown, for example, with AFM13 and in particular, in combination with natural killer cell.

With that introduction, let me give you a quick update on our program. Jumping now to Slide 6. This shows a snapshot of where we are with AFM13. Our registration-directed study of AFM13 monotherapy in relapsed/refractory peripheral T-cell lymphoma is on track to complete enrollment in the first half of 2022, and we expect to provide guidance about timing for data as we get closer to the completion of enrollment.

We are also very pleased to share with you that the investigator-sponsored clinical trial at MD Anderson Cancer Center evaluating cold blood-derived natural killer cells pre complex with AFM13. It's going very well. As of October 31, a total of 18 patients have now been enrolled in the study, including 12 patients at the highest dose, where we use 10 to the 8 NK cells per kilogram body weight. We can confirm that no dose-limiting toxicities have been observed and we continue to be encouraged by the response rate.

To date, our key learnings are that the dosing regime is well tolerated and can drive robust antitumor responses in heavily pretreated patients. Our goal is to continue to gather robust data on safety and efficacy, and according the MD Anderson have submitted a protocol amendment to allow for an expansion of the study to treat up to 40 patients at the highest dose, now including Hodgkin Lymphoma patients and CD30-positive non-Hodgkin Lymphoma patients.

Finally, we plan to present updated data from the study at a company-sponsored event in mid-December and expect to provide additional details on the date and time for this event in the coming weeks. We're also very excited about our progress with AFM24, where we believe the execution of our 3-pronged strategy will allow for a continuous data flow of data over the course of the next several quarters.

Andreas, our Chief Medical Officer, will now tell you more about where we are with AFM24. Andreas?

Yes. Thank you, Adi, and good morning, good afternoon to all of you. It's my pleasure and my privilege to give you an overview of our development program with AFM24 and to review some of the recent progresses that we have made in this program.

If we move to Slide 8. This slide gives you an outline of the development strategy for AFM24. And as you see, it is a very comprehensive, very broad development approach. We expect to investigate AFM24 as a monotherapy and in combinations with either a PD-L1 inhibitor atezolizumab or with autologous NK cells in a total of 7 different integrations across 9 expansion cohorts. This broad approach is intended to deliver the highest probability of success for AFM24, those as single agent and as a combination partner.

On Slide 9, we demonstrate the process that we used to select indications and to maximize a probability of success. The selection of the indications for each studies was based on a very thorough and very comprehensive analysis that use the data of more than 10,000 patients across 144 tumor subtypes. And these were initially ranked based on 20 criteria but included, but are not limited to factors like EGF receptor expression, involvement and function of the innate immune system in the tumor microenvironments, but also looking at unmet medical need and potential paths to market.

If we can move to Slide 10, we show you the general concept that applies to all of our studies. All studies are based, as I said, a selection of indications that in the individual situation, we believe have the best chance of therapeutic success. The individual cohorts in each of these studies follow an optimized Simon 2-Stage design. This design provides us with an opportunity to make gated investment decisions.

In the first step, each cohort will recruit 12 to 18 patients after which we have a preplanned interim analysis. This interim analysis is associated with predefined success threshold. In the case of the individual success thresholds are met, we will recruit up to 40 patients in each cohort, and we believe that this number of patients will give us solid data to start conversations with regulatory agencies about registration strategies.

Furthermore, since these are open-label studies, we will have the opportunity for interim data readouts. With that said, let me update you on the development of AFM24 in our monotherapy study, which is shown on Slide 11. As you are all aware, the initial part is a dose escalations part in order to define the recommended Phase II dose. It is important to reiterate that the goal of the dose escalation part was to identify the pharmacologically active and safe dose of AFM24 as fast as possible. Therefore, in the dose escalation part, there was no selection of patients with tumors that are more likely to respond to single-agent as defined by our indication selection process.

Slide 12 shows you the recruitment status so far. Up to now, we have recruited 29 patients across 6 dose cohorts. As you can see, the study population covers a wide range of tumor indications with colorectal cancer harboring either RAS or RAF mutations being the most frequent tumor type. Also important to note that all these patients were heavily pretreated with a median number of previous therapies of 4 in a range of 2 to 8 previous therapies. All patients had exhausted all available treatment options for their given tumors.

On Slide 13, we provide a summary of the patients that were treated at the 480 milligram cohort. Of note, 4 out of 6 patients are still receiving therapy with AFM24 as they are deriving clinical benefit according to the assessment of the treating physicians. 2 patients have shown stable disease beyond 3 months and continue treatment. Of specific note, patient 5, while classified with progressive disease, has experienced a meaningful clinical benefit and also continues on treatment. We plan to submit detailed data from the dose escalation for a presentation at a medical conference in the first half of 2022.

Moving on, we are pleased to announce that we have determined that 480 milligrams is a safe and pharmacodynamically active dose and will be our recommended Phase II dose for weekly administration.

As outlined in Slide 14, this decision is based on a comprehensive review of safety, pharmacokinetic exposure and pharmacodynamic data, including CD16A receptor occupancy on peripheral NK cells. A supportive pharmacodynamic data, we have also measured a permit of serum cytokines and markers of immune cell activation, which exhibit continuous activation of NK cells at doses of greater than 160 milligrams. From a safety perspective, no dose-limiting toxicities were observed at either 320 or 480 milligrams. In the next 2 slides, we share the data on the pharmacokinetics and the receptor occupancy that has reported the recommended Phase II dose decision.

On Slide 15, you'll see the PK profiles of all dose cohorts. As shown on the left side, we observed a proportionality of dose and exposure at doses of 320 and 480 milligrams, which indicates that we achieve saturation of target mediated elimination by EGFR, meaning that EGFR receptors at these doses are likely saturated. In the graph of the right side, you also see that the trust levels that we are reaching with 320 and 480 milligrams shown in green and blue bots are comparable to the cetuximab trough levels at the marketed cetuximab dose indicated as a gray shaded area.

If we move to Slide 16, we review here the data that we have obtained with CD16 receptor occupancy. And I will take a minute to walk you through the slide. On the left graph, you see the measured CD16A receptor occupancy on circulating NK cells. As you can see that we initially see an increase in CD16A occupancy with increasing doses, which plateaus at 480 milligrams, indicating a saturation of CD16A in the periphery.

Now the important question is how does this translate into the tumor and how is this correlated to activity? On the right, you see 2 curves from our in vitro studies. The blue curve is tumor cell killing by NK cells in the presence of AFM24. The red curve is CD16A receptor occupation. As you can see, maximum tumor cell killing is achieved as dose ranges that are associated with relatively modest CD16A occupancy.

It is important to note though that when we speak about relative receptor binding, let's say, of 10%, this does not mean that we have only activated 10% of NK cells. Every NK cell has bound AFM24, but on the individual cell level, there is a 10% occupation of available receptors, which already translates into maximum cytotoxicity. Now the vertical line here indicates the drug level of AFM24, which we expect in the tumor at a dose of 480 milligrams.

For this calculation, we have taken a very conservative assumption, which is that AFM24 concentrations in tumor tissue will be 200 fold lower than in circulating blood. But as you can see that even under these very conservative assumptions, 480 milligrams results in a CD16A occupancy in the tumor that is sufficient for maximum and NK cell activation.

In summary, as stated on Slide 17, our decision for 400 milligram as a recommended Phase II doses based on the good safety profile and the PK and PD data that I just showed. As next steps, we plan to open the expansion cohorts at 480 milligrams to explore antitumor activity in 3 selected indications. In parallel, we also plan to continue dose escalation of AFM24 to 720 milligrams. The court is currently open for patient enrollment, together additional safety data and provides the basis for alternative scheduling like a once every 2 or once every 3 application of AFM24.

If we now turn to the 2 combination studies, namely the combination with NKGen's autologous NK cell AFM24-103 and the combination study with atezolizumab, AFM24-102. For both of these trials, the starting dose of AFM24 will be 160 milligrams, followed by those escalation steps through which we will assess safety and identify a recommended Phase II dose for the combination. These recommended Phase II doses will then be used in the dose expansion phases, which, as I described will follow a Simon 2-Stage design in 5 of the 6 cohorts with interim analysis after 12 to 18 patients and the ability to enroll up to 40 patients.

On Slide 18, you see the design of C-102 study, where we combine AFM24 with atezolizumab. In this trial, we will focus on non-small cell lung cancer, gastric cancer and hepatobiliary pancreatic cancer, all areas of very significant unmet medical need. The cohorts in non-small cell lung cancer and gastric cancer follow the described Simon 2-Stage design. The third cohort that can include hepatocellular cancer, biliary tract cancer and pancreatic cancer is designed as a signal identifying basket cohort with descriptive statistics.

If we move to Slide 18. Here, we show the design of our study 24-103, combination of AFM24 with adoptive NK cell transfer. This study will focus on non-small cell lung cancer, colorectal cancer and head and neck cancer. We will lose this innovative approach in these indications where patient's endogenous NK cell numbers are dysfunctional or only existing sufficient numbers has a good opportunity to show activity.

In contrast to the 101 study, where we also evaluate CRC but require previous treatment with EGFR antibodies, and thus will most likely exclusively recruit the CRC patients with KRAS wild-type. The CRC cohort in 103 were focused mainly on patients with KRAS mutations. Finally, on AFM24, you may have seen the presentation at the most recent triple meeting, where we showed that AFM24 enhances cytotoxicity against EGFR positive tumor cells when combined with SNK101, the autologous NK cell product. The addition of AFM24 to autologous SNK101 cells improved cell killing when compared to NK cells alone in EGFR positive tumor cell lines regardless of EGFR mutational status.

To summarize on Slide 19, the status of the AFM24 program, we are very excited that we can now embark on a broad development program in several indications with significant unmet medical need. These studies as shown, will generate a continuous flow of data in 2022 and beyond.

With that, I will turn the call over to my colleague, Arndt Schottelius, who will present our novel fully owned ICE AFM28. Arndt, please?

Thank you, Andreas. And also for me, good morning, good day, everybody. Warm welcome to the call. I'm really excited to introduce AFM28 to all of you, which is our newest addition to our portfolio.

As shown on Slide 21, we recently announced our newest innate cell engager AFM28, which is designed to bind CD123 and established targets in myeloid malignancies. We chose CD123 as it is almost universally expressed on leukemic blasts and leukemic stem cells in patients with AML both at diagnosis and at relapse and independently of cytogenetic risk.

AFM28 is being developed for the treatment of patients with acute myeloid leukemia. We believe that AFM28 could be the key to novel treatment approaches that can fulfill several unmet needs. I would like to spend a few minutes to explain this and layout why we are so excited about adding AFM28 to the arsenal against leukemia. AML is the most common form of adult acute leukemia, more than 40,000 patients are diagnosed with this disease every year in the 7 major markets. The outcomes have remained very poor and treatment options are generally limited, particularly for relapsed or refractory disease.

And as shown on Slide 22, in AML, most patients become refractory to standard induction treatment or relapse within 1 year. Only 1 of 3 patients is alive after 1 year once they become relapse or refractory. And after 5 years, it is only 1 out of 10 patients. It is obvious that new drugs are needed that reduce the high rates of relapse or prolong the time to relapse by inducing deeper responses and by eradicating measurable residual disease or MRD.

In addition, for patients who have relapsed or are refractory to standard treatment, alternative options to induce remissions that are long-lasting are urgently needed. This all needs to be achieved for a patient population that is elderly. Note that over 80% of patients are over 60 years old and can often not tolerate treatments associated with toxicity. So these new approaches not only need to be more effective. They also need to be safer.

Recent data have demonstrated that natural killer cell-based innate immunotherapy is emerging. It's a promising treatment option in AML based on the demonstrated susceptibility of leukemic blasts for NK cell killing and clinical activity of allogeneic NK cell therapy and relapsed/refractory disease. Also, these treatments are remarkably well tolerated. Yet, these approaches rely on the cell's natural ability to recognize leukemic cells. So these cells are not specifically targeted against the tumor.

Immune evasion from NK cell killing is a well-known phenomenon and escape of leukemic stem cells and AML has been described, so to effectively deplete leukemic cells, including leukemic stem cells, a targeted approach, in addition to natural cytotoxicity, has the potential to induce more frequent and deeper responses.

We believe these statements are also supported by the data that we have generated with AFM13 in combination with NK cells. We designed AFM28 to be differentiated versus available therapy and to bring a truly novel approach to the treatment of AML.

As we show on Slide 23, AFM28 binds with high affinity to both CD123 and CD16A, and no such molecule currently exists to our knowledge. It thereby strongly activate NK cells, inducing ADCC and through binding to CD123 causes depletion of leukemic glass and leukemic stem cells. We will be presenting preclinical data for AFM28 at ASH and plan to submit an IND in application in the first half of 2022 and to start a clinical study in the second half of 2022.

With that, I'll hand the call over to Angus to review the financials. Angus?

Thank you, Arndt. Affimed's consolidated financial statements have been prepared in accordance with IFRS as issued by the International Accounting Standard Board or IASB. The consolidated financial statements are presented in euros, which is the company's functional and presentation currency. Therefore, all financial numbers that I will present in this call unless otherwise noted will be in euros.

We ended the third quarter of 2021 with cash and cash equivalents of EUR 198.7 million compared to EUR 146.9 million on December 31, 2020. Based on our current operating plan and assumptions, we anticipate that our cash and cash equivalents will support operations into the second half of 2023.

Net cash used in operating activities for the quarter ended September 30, 2021 was EUR 25.6 million compared to EUR 3.6 million in the third quarter of 2020. Total revenue for the third quarter ended September 30, 2021 was EUR 8.7 million compared to EUR 10.5 million for the quarter ended September 30, 2020.

Revenue for the third quarter of 2021, mainly comprised of collaboration revenue from Genentech and Roivant. Research and development expenses for the third quarter of 2021 was EUR 20.6 million compared to EUR 10.1 million for the third quarter of 2020. The increase in R&D expenses compared to the same period last year were driven primarily by increased expenses for AFM24, including costs for the production of clinical trial material, an increase in costs associated with other early-stage programs and infrastructure and an increase in share-based payment expense.

General and administrative expenses for the third quarter of 2021 were EUR 6.8 million compared to EUR 3.5 million in the quarter ended September 30, 2020. The increase relates largely to higher personnel expenses, higher premiums for insurance, higher consulting expenses and increased share-based payments. Net finance income for the quarter ended September 30, 2021 was EUR 1.5 million compared to net finance loss of EUR 3.1 million in the quarter ended September 30, 2020.

Net finance income loss is largely due to foreign exchange gains or losses related to assets denominated in U.S. dollars as a result of currency fluctuations between the U.S. dollar and the euro. Net loss for the quarter ended September 30, 2021 was EUR 17.1 million or $0.14 per common share compared with a net loss of EUR 6 million or $0.07 per common share for the quarter ended September 30, 2020. The weighted number of common shares outstanding for the quarter ended September 30, 2021 was $119.8 million.

With that, I'll turn the call back to Adi for closing remarks. Adi?

Thank you, Angus. As you have heard now, we have made continuous progress with our 2 lead programs, AFM13 and 24. And soon, we plan to have a -- innate cell engager that Arndt presented called AFM28 in the clinic.

As we now look ahead, as shown on Slide 24, we expect the rest of this year and 2022 will be busy as we have numerous clinical trials from which we expect to report data. We expect the key milestones are as follows: for AFM13 we will host an investor event in December, where we plan to provide a data update on our ongoing trial in combination with natural killer cells.

In addition to our AFM30 monotherapy in peripheral T-cell lymphoma, we expect to complete enrollment in our registration-directed study in the first half of next year. We've broadly explained where we stand with AFM24 and for monotherapy, we are now planning to open the expansion cohorts before the end of this year. And we submit an abstract with data from the dose escalation for presentation at a medic conference in the first half of 2022. And then as we move forward with the expansion cohort to report initial data in 2022.

We have set up 2 additional studies for AFM24 in combination either with natural killer cells or with anti PD-L1 atezolizumab. We are expecting to complete the first dose escalation cohort in each study during the first half of 2022, start with the dose cohort expansion. If safety is favorable and thereby also be able to provide updates as we progress. For AFM28, a very new candidate that we carefully selected in order to address the high medical needs.

After now the ASH update, our next milestones are the planned R&D submissions in the first half of 2022 and subsequently, the initiation of clinical studies we're planning again, as explained before, to do this in monotherapy and all with combinations in particular, in combination with natural killer cells. We are preparing the company to meet these opportunities and look forward to bringing innovative medicines to patients that need them.

Now on behalf of the entire team, I would like to once again express my gratitude to everybody who is contributing to these efforts. We are now ready to take any questions that you may have. Operator?

(Operator Instructions) Our first question comes from the line of Daina Michelle Graybosch from SVB Leerink.

Just looking at the data that you presented on AFM24, maybe a 2 part question. Can you remind us why you think these 3 planned expansion cohorts will be most amenable to single-agent activity? So the CRC KRAS wild-type, the EGFR-mut lung and RCC. And then it is, I guess, those tumor types where you did see the stable disease or that patient with progressive disease that continues on treatment. Can you share anything more about those patients? Do they have a high EGFR expression, were they refractory to other EGFR targeted therapies?

Thanks, Daina. I'll hand this over to Andreas, please.

So let's start with probably the second question or second part first. So the patients that we have treated on 480 milligrams. We have these 2 patients with EGFR mutant non-small cell lung cancer and our colorectal cancer patients. Important to note, we fixed or we decided which combination or which tumor types will go into which of the studies prior to seeing the data.

And as I said, this decision was really driven on this comprehensive analysis that we showed where we looked at the data from more than 10,000 patients. And then really looking at biology of the innate immune system activating and inhibiting factors NK cell biology.

So what we see now here on Slide 6, again, very small one on the core 6, very small patient numbers. Is a little bit maybe an early confirmation of our selection process, if you look at the colorectal cancer patients, wild-type patient number one, this would be a patient who would have qualified for the expansion cohort, patient #3, EGFR mutant, non-small cell and other patients that would have qualified in patient 5, again, EGFR mutant would be in the patients that would have qualified, or the other 2 patients, 2 and 4, where we have a follow-up data, patient 6 is very early in this treatment would have not qualified for the expansion cohort as monotherapy. So again, the sequence was different. So we look at the biology first and then decided, which are the most likely cohorts or most likely tumor types that can respond. Again, with this very small data set, there seems to be a trend that exactly these tumors really do quite well on each -- on AFM24 monotherapy.

Now we have measured EGFR across our cohorts, most patients have moderate to high expression. I do not have individual patient numbers or data, but I would expect us to EGFR mutant non-small cell lung cancer patients have rather high expression of EGFR receptor. As a requirement, they needed to exhaust all previous lines of therapy. So all of these patients have been pretreated and have become resistant to EGFR targeting therapies, whether it's TKIs or antibodies.

Our next question comes from the line of Maury Raycroft from Jefferies.

Congrats on the updates. I had a question on AFM24 too. For that one, you showed a lot of helpful PK and PD data. I'm wondering if you can tie it together with what you're seeing in the 6 patients at 480 mgs, particularly in respect to antitumor activity as you approach steady state. And if you can talk more about what you're seeing on cytokines and NK cell activation markers as exposure increases?

I can take the first part, and let me hand over to Arndt regarding the cytokines. So as you see, these patients are treated at the 480 milligrams. So this is the dose level where we achieve dose proportionality. So we have basically saturated EGFR binding. As we showed, we also achieved CD16A receptor occupancy and then correlating figures in the tumor that according to our experiments are sufficient to maximum activation of the tumor residing NK cells. We have not broken down these data on an individual patient level yet, but this is something that we will have to do in the future. And Arndt maybe you can talk..

And maybe I can talk -- yes, on the NK side, yes. Yes, sure. Happy to do so. So you noted, Maury, we didn't share that data because we want to disclose that as discussed at an upcoming conference in '22. What we see, what I can share with you in terms of the cytokines, to give you an example, interferon gamma, [TNF alpha] important for NK activation at doses at or above 160. When we look at the steady state levels, we see a steady increase. We didn't see a real difference between 320 and 480, but we see that it clearly was rising above 160 in making the point again that this is clearly pharmacologically active. In terms of the activation markers, similarly, we want to share that data when it's also a little bit more matured, but the same trend that we see at doses above 160. We saw an increase of those activation markets, again, showing that we have consistent NK cell activation. Hopefully, that helps with your question.

And maybe one other question on the AFM13 plus on cord-blood NK cell combo study. Just wondering if you can talk more about expectations on durability for this upcoming update? And also just checking if you have plans to move this study over to sponsorship at Affimed at some point?

Andreas, can you take the question, please?

Yes. So what you see or what you realize is when you compare to the status that we have basically by the middle of the year, June or so, we have added a very significant number of patients over the last couple of months. So I would say that for the highest dose cohort, time to progression or duration of response data will be quite immature in December as many of these patients have recently started treatment within the last 3, 4 months. So of course, on the lower doses, we have a longer follow-up. But again, this will not be the therapeutic doses that we will move into our expansion cohort and will use subsequently. Now in terms of sponsorship, we have not decided. As we always said, we are working on with several CDMOs to transfer the production process. We are in the process of doing that, and we'll provide updates as we have more concrete data to share.

Our next question comes from the line of Kripa Devarakonda from Truist Securities.

Congrats on all the progress. I have a follow-up question on the AFM13 cord-blood NK cell combo. Can you talk a little bit about the decision to expand into both HL and NHL patients, what should we expect the split to be should -- are you looking to enroll more NHL patients? And maybe talk a little bit about how this if at all this changes your strategy in what to focus on, whether it's HL or NHL.

I'll again have Andreas answering your question, Andreas?

Yes. So as you know, CD30 is a target that is expressed on Hodgkin's, but also on non-Hodgkin's lymphoma like T-cell lymphoma or subset of CD30-positive B-cell lymphomas. So currently, we are following, if you will, a 2-pronged approach. So clearly, our main indication or the first indication, I would say, it will be Hodgkin's lymphoma, where we have the wealth of data and where we have seen this very impressive responses already in the first 4 patients. So this is the study at least now designed that it will recruit 30 Hodgkin patients at the recommended Phase II dose, which we believe gives us good data set to move on with Hodgkin's on the registration path.

Now the second part is a little bit opportunistic. Again, there's also a very significant medical need and then peripheral T-cell lymphomas and in diffuse large B-cell lymphomas. So we thought that we at least should explore NK cell-based AFM13 based combinations in these diseases that could potentially result in a second or a second and a third development pathway. So this is really broadening the indications. But for now, Hodgkin will be our lead indication where we will try to move ahead was full steam.

And just a follow-up question on the AFM24, the data that you presented. You've been dose escalating for a while, but have you seen any indication, especially with the lower doses where patients have been treated for a longer period of time, the deepening of responses?

We have -- yes, yes. We have occasionally seen some disease stabilization at the lower doses. But again, according to our data, the maximum pharmacokinetic pharmacodynamic active or activity was set in around 160 to 320 with 480 being our selected dose, right now. So these are really anecdotal observations. As we said, out of our 480 milligram cohort, 4 of 6 patients are still on treatment. I think this is will be interesting to cohort to watch whether we do see a deepening of responses.

Our next question comes from the line of Nick Abbott from Wells Fargo.

Thank you for all the detail on AFM24. First question is on AFM28, can you speak to why CD133 in the context of CD3, CD33 engage you built for (inaudible) compare CD123 to CD33 and NHL to T-cells in this application in AML?

Yes. We're happy to take this question, Arndt?

Yes, happy, happy to do that. Nick, yes, we -- I think we already also provided some background information. As you rightly said, (inaudible) has this CD33, I think a very valid target, of course, in combination with a CD3, the T-cell engager. Why are we -- why have we selected, maybe let me speak about or reiterate CD123. One is, it is very broadly expressed on the leukemic blasts. It's also expressed equally leukemic stem cells and importantly not unhealthy stem cells. So we have a very high selectivity.

We've also followed our approach in selecting this when we look at, in a way, the programs that have been out there, like an Fc-enhanced CD123 target antibody that was -- comes from kind of, Johnson & Johnson, a while ago, talacotuzumab that was not continued because as an Fc-enhanced antibody without the additional mechanisms of actions that we believe we add in terms of also the efficacy in terms of the, let's say, tuning engineering with the molecule, we see a great potential to address that medical need.

Indeed, also with those approaches talacotuzumab, the occasional complete responses were seen, where we are specifically excited is in the prospect, of course, testing monotherapy but then very quickly combining AFM28 with allogeneic NK cells, why? Because we know in AML for a myeloid disease, in case of the macrophages will not be fully at least fully functional or not functional.

So adding, in a way, you could say, the payload or mechanism of action with allogeneic NK cell transfer, we see a very high property of success to getting to those deep responses that we're looking at, which is this very high medical need to really get to also minimal residual disease negative patients. Hopefully, that kind of addresses your question, Nick.

Yes. And I think, I guess the point of NK cells, T-cell emphasizes the safety advantage you feel there is whether NK cell versus a T-cell engager?

Yes, absolutely. I -- that is an important point. We have now seen consistently across our innate cell engagers, excellent safety profile. I mean, some of the early IRS that we have seen very well manageable schedule pretreatments. So NK cells are just by the nature of their biology, very effective but much safer than T-cells. Again, I think we know the principle by now, it's not only the cytokine storm, but it's also really the -- in a way, autoimmune effects that we see where T-cells once unleashed. But just not selective in, kind of, targeting for attacking the tumor versus healthy [T-cell] NK cells very well distinguished. Clearly, thus a very much better sector profile. And as I laid out, I think when you look at the very elderly patient population that we have frail patients that will not tolerate some of them high dose chemotherapy. We see this as a very differentiated good profile with an NK cell engagement.

And then maybe just last one for me. In solid tumors, obviously, with AFM24, you've described very eloquently, the 3-pronged strategy. You've already elucidate to an NK cell combo. So for AFM28, at least 2 prongs. Is there a 3-pronged strategy, do you think that's applicable for AFM28 myeloid disease?

Happy also for Adi or Andreas to jump in. We have currently also publicly said, we want to make the combination with allogeneic NK cells a priority because of the reasons that I've been giving, there may be cases for also the kind of, third pillar. That's not something that we have fully thought through and would update accordingly as we move on with our plans.

Our next question comes from the line of Brad Canino from Stifel.

Just quickly, on the protocol amendment for AFM13 NK, was that driven by MD Anderson or by your team? And if you could talk more about the reason behind that and then I'm also interested in the breakdown of the 6 AFM24 patients you had at the 480 mg cohort. You highlighted how 3 of these would have been eligible for the monotherapy expansion cohort, but they had 4 to 7 prior lines of therapy, it looks like in the expansion cohort, should we expect this number of prior lines of therapy or will you be looking for patients that may be earlier at 1 or 2 prior lines?

I guess Andreas that's question for you.

Yes. Yes. So let's start with the amendment of the protocol. I think important to iterate, we have a very good, very close working relationship with MD analyst. And so I would say it was basically a joint effort joint decision. Initially, the protocol was only designed to evaluate safety. So it was a pure Phase I safety protocol. But then I would say, even for us, a little bit unexpectedly, we saw this really significant anti-tumor activity already at the lower dose levels. And so we immediately developed the desire to gather more efficacy data and to basically put this compound on a development path. So we use the existing protocol to allow for more patients at the recommended Phase II, which will give us a sufficient number of patients to really have a good, solid estimation of efficacy in Hodgkin's lymphoma. And as we always said, will provide us the basis to engage with health care with regulators for the most appropriate and the fastest path towards approval. So this was a joint decision, and it was really driven by our enthusiasm both MD Anderson, our enthusiasm about the data that we were seeing.

Now in terms of the expansion cohorts in study 101, yes, you are right. These patients are heavily pretreated. And I think taking this into account, seeing this degree of activity in late line, at least for us, is really very encouraging. Whether there will be less pretreated patients in the expansion cohort, it's a little bit hard to say the expansion cohorts still require that patients have exhausted all available treatment options for their respective diseases. So I would say, we will see the majority of patients with 3 to 4 lines of previous therapy. Again, we are here in an area of a very significant unmet medical need, which generates a higher bar. But on the other hand, we believe also sets the scene for a potential accelerated approval process. If you can show a robust and reproducible activity in patients that have no treatment alternatives left.

(Operator Instructions) And this does conclude the question-and-answer session as well as today's Affimed's third quarter update call. Thank you, ladies and gentlemen, for your participation. You may now disconnect. Good day.