Affimed NV (AFMD) 2021 Q2 法說會逐字稿

Good day, and welcome to Affimed's Second 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 conference call, Alex Fudukidis, Head of Investor Relations at Affimed. Please go ahead.

Thank you, Liz. I'd like to also welcome you all for joining us today for our second quarter 2021 results and 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; and Angus Smith, our Chief Financial Officer. The whole team will be available for the Q&A session.

Before we start, 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 the statements -- 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. And thanks a lot for joining in for our second quarter update call. Today, we're going to provide an update on our pipeline, discuss the program -- progress on our ongoing AFM13, AFM24 and AFM28 studies, and our plans for what promises to be an exciting period over the next few months for our company.

Before I do that, a quick summary of what we have accomplished so far. The clinical and preclinical data confirmed that our unique and innovative innate cell engagers are safe and has the potential to be effective in treating cancer patients, both as monotherapy, but also in combination either with natural killer cells or with checkpoint antibodies such as PD-1, maybe PD-L1. As we move the ongoing clinical trials forward, our efforts are now focusing on identifying and targeting indications where we believe our scientific discoveries will benefit patients by applying our 3-pronged approach: monotherapy, therapies in combination with natural killer cells and checkpoint inhibitors.

We're very happy to report that our pipeline remains on track for our registration-directed study of AFM13 monotherapy in relapsed/refractory peripheral T-cell lymphoma. We are recruiting well and on track to complete enrollment of this study in the first half of 2022, and we expect to be able to provide further guidance about timing for data as we get closer to the completion of enrollment.

In the investigator-sponsored clinical trial at MD Anderson Cancer Center, evaluating cord blood-derived natural killer cells precomplexed with AFM13, we have completed the dose escalation part of the study, with increasing doses. Indeed, there were 3 cohorts where we use either 10^6 cells per kilogram, 3 patients that received 10^7 cells per kilogram and 3 patients that received 10^8 cells per kilogram. We are currently enrolling additional patients at the highest dose of 10^8 cells per kilogram to gather robust data on safety and efficacy, what would form the basis for discussions with regulators about appropriate approval strategies. No dose-limiting toxicities have been observed during the dose escalation in any of the 3 cohorts, and we remain encouraged by the observed response rates. The next data update is planned for the fourth quarter at a major medical conference.

Regarding our efforts to take forward the combination of AFM13 with natural killer cells into a registration study, we have signed up a CDMO for the manufacturing of the NK cells and have generated additional data on cryopreserved natural killer cells precomplexed with AFM13. As we have shared with you over the past few months, we view this CAR-like NK characteristics of our innate cell engagers in combination with natural killer cells as a major advantage over monoclonal antibodies. The major difference being that when we look closer at the cell surface retention, our innate cell engagers won't fall off in combined therapy for a very long time, including days later, whereas monoclonal antibodies are not retained for very long. As a result, our research shows that it is not possible to generate a precomplexed product with monoclonal antibodies but with innate cell engagers only.

Moreover, our research demonstrate that the engagement of our innate cell engager molecules with natural killer cells activate the natural killer cells to kill tumor cells. In our collaboration with the Karolinska Institute, we found that AFM13 when compared to a monoclonal CD30 antibody mediated a more potent activation of natural killer cells leading to a significantly increased number of natural killer cells that exerted engagement with multiple target cells rendering these NK cell (inaudible) killers. This exciting data has been accepted for the poster presentation at the SITC Annual Meeting in November.

In our ongoing trial with MD Anderson, it is our goal to generate a strong data package that would support discussions with the FDA and other agencies regarding next steps for the program, including a potential registration-directed study.

Now let me turn over to AFM24, our EGFR-directed innate cell engager. For AFM24, we continue to execute our 3-pronged strategy of monotherapy, combination with natural killer cells and combination with a checkpoint inhibitor PD-L1. Our goal in this program is to evaluate a broad set of solid tumor indications in parallel, supported all by a strong biological rationale. We expect multiple inflection points this year, and plan to have multiple additional data readouts in 2022.

Our monotherapy dose escalation study is on track. Based on current data, cohorts 5 and 6 are pharmacologically active dose. Therefore, we have increased the size of cohort 5, patients are dosed at 320 milligrams; and cohort 6, patients are dosed at 480 milligrams to generate additional pharmacokinetic and pharmacodynamic data that we expect will aid our selection of the recommended Phase II dose. As of today, in each of the cohorts 5 and 6, 5 out of 6 patients are enrolled. It is important to mention that to date in patients that have already completed the DLT period in each cohort, no dose-limiting toxicities were observed.

So as just mentioned, we continue to see a good safety profile of AFM24. We confirm that we have not seen any of the classical EGFR-related side effects like acne form skin rash or mucositis. This is in line with the distinct mechanisms of action of AFM24, which is very different from the mode of action of EGFR pathway targeting antibodies like cetuximab or panitumumab. These findings also confirm the data from our pivotal toxicology studies in cynomolgus monkeys that indicated a different side effect profile for AFM24 versus rituximab. Infusion-related reactions remain the main side effect and are well manageable with symptomatic treatment and modifications of the infusion rate.

The ongoing dose escalation part includes patients with any EGFR-expressing solid tumors. When assessing antitumor activity at dose levels in the 320 milligram and 480 milligram cohort, we are encouraged to see that there were several patients on the study that experienced disease stabilization beyond 8 weeks and who are able to receive additional cycles. Biomarker analysis of the patients point to the activation of effector cells, shown by increasing expression of activation markers and a continuous secretion of cytokines. The supportive of this observation is a continuous occupancy of the CD16A receptor.

We are enrolling patients in the monotherapy study. And independent of the selection of our recommended Phase II dose, we plan to continue to increase the dose in nonselected patients to gather further insights into the exposure, effects relationship of AFM24 focusing on PD market and to confirm safety of AFM24 at even higher dose levels.

Important now to note is, in addition, in line with our guidance, we expect now to start enrollment of indication-specific patients in the expansion cohorts using single-agent AFM24 in the second half of 2021. These cohorts have been chosen based on a detailed analysis of the tumor biology, as we explained in the past, and will enrich for patients that we believe have a high likelihood to respond to single-agent AFM24. These expansion cohorts include -- will include renal cell carcinoma that failed standard of care, which includes TKIs and PD-1 targeted therapy. Second indication is non-small cell lung cancer, EGFR-mutant failing standard of care TKIs. And the third indication is colorectal cancer failing chemotherapy plus EGFR-targeted antibody. So we have selected 3 indications for the monotherapy study.

In addition, we are now in the final stages of the setup phase for our combination studies of AFM24 with both atezolizumab, studies called AFM24-102 and the autologous NK cell product SNK01, this study is called AFM24-103. We confirm our guidance that we expect both of these studies to start enrolling patients in 2021.

The tumor types we plan to study with the AFM24, atezo combination are as follows. Again, non-small cell lung cancer, in this case, EGFR wild-type failing chemo and PD-1 targeted therapy; gastric and GEJ cancer failing standard platinum-based chemo; and a basket of EGFR-expressing tumors comprising pancreatic, hepatocellular and biliary tract cancer, again failing standard of therapy for the respective disease.

Now the tumor types we plan to study in AFM24, SNK01 NK cell combination study are as follows. Again, non-small cell lung cancer, EGFR wildtype, squamous cell carcinoma of the head and neck failing chemo in PD-1 and colorectal cancer failing standard of care. The indications for each of the 3 studies have been selected carefully based on the biology of each tumor type. This approach allows us to investigate a broad set of solid tumors while also providing multiple shots on goal for the more prevalent tumor types such as non-small cell lung cancer and colorectal cancer.

In summary, we're very satisfied with the progress of the AFM24 program. The data show that AFM24 possesses a different mode of action compared to conventional EGFR-targeting antibody. We see pharmacological activity based on CD16A receptor binding and NK activation markers. At these pharmacologically active doses, we see no classical EGFR-related side effects like skin or mucosal toxicity. And in addition, we are seeing disease stabilization in these heavily pretreated patients at dose levels 320 milligram and 480 milligram.

We believe in the significant potential of AFM24, and with the planned expansion of the program, we're seeking to maximize this opportunity, addressing a broad set of major EGFR-expressing tumor indications. And this strategy will allow us to provide a continuous flow of data.

Now let me move to the third program, AFM28. For AFM28, we continue to advance the IND-enabling studies and have submitted an abstract with initial preclinical data for a major medical conference later this year. We plan to release information about the target and the indication once the abstract becomes available. We remain on track to submit the IND application in the first half of 2022, and our goal is to begin a clinical study in the second half of 2022. In addition to moving things forward in the clinic, we are continuing to publish data that supports our work. One such example is the recently published preclinical data that supported the IND filing -- IND application of our innate cell engager AFM24 in the journal mAbs.

Arndt, our CSO, will discuss the key takeaways from the publications. Arndt?

Thanks, Adi, and also from me a very warm welcome to everybody on the call. As introduced by Adi, I would like to summarize the key preclinical data for AFM24 described in the recent publication in the journal mAbs. In this paper, we demonstrate the high affinity binding of AFM24 to CD16A on natural killer cells and macrophages with strong binding values in the low nanomolar range. Importantly, AFM24 binds to CD16A on NK cells and macrophages with high affinity at a site that is distinct on binding of IgG such that high concentrations of polyclonal IgG results in a minimal, only twofold, reduction in binding affinity in contrast. Binding of an Fc-enhanced high-affinity anti-EGFR IgG antibody was significantly inhibited. These data again demonstrate the high surface retention of our ICE molecules to NK cells, enabling the earlier described precomplexing to NK cells with CAR-like NK cell properties, which are not possible with normal or Fc-enhanced antibodies.

We also show high affinity binding of AFM24 in the nanomolar range to various EGFR-expressing tumor cells. AFM24 demonstrated to be highly differentiated from marketed anti-EGFR antibodies with its ability to potently and effectively kill tumor cells through antibody-dependent cell-mediated cytotoxicity, or ADCC, or NK cells. Moreover, this ICE-mediated potent antibody-dependent cellular phagocytosis, or ADCP, via macrophages in vitro. AFM24 was also shown to be effective towards a variety of EGFR-expressing tumor cells, killing these regardless of their EGFR expression level and irrespective of their KRAS or BRAF mutational status. In addition, as AFM24 has a lower affinity for EGFR and binds to a different epitope than cetuximab, it exerts an over 1,000-fold lower inhibitory activity on EGFR signaling, further underscoring its highly differentiated mechanism of action.

Now in terms of in vivo data in tumor mouse models, we have published at AACR, this year's AACR, showing dose-dependent antitumor activity of AFM24 in combination with freshly isolated NK cells. This antitumor activity for AFM24 in combination with NK cells has now also been demonstrated with precomplex and cryopreserved NK cells in vitro and in vivo within one of our preclinical collaborations. This exciting data gives us confidence that the NK cell product we used in combination with AFM24 retains its potent antitumor activity after cryopreservation in vitro and in vivo.

Now coming to the toxicology studies. In cyno monkeys also described in the paper, AFM24 was well tolerated up to the highest dose of 75 mg per kg when administered once weekly for 28 days. Remarkably, skin and other cytotoxicities, which had been observed at these dose levels with cetuximab in comparable cyno monkey studies, were not observed here. Only transient elevation of interleukin-6 levels was detected at all dose levels, which returned to baseline after 24 hours. Moreover, an increase in circulating CD40 monocytes was observed after the first dose of AFM24, concurrent with a decrease of circulating NK cells with doses of greater or equal to 8 milligrams per kg, in our view showing the expected pharmacodynamic effect of this drug candidate.

Taken together, these results emphasize the promise of our bispecific innate cell engagers as an alternative cancer therapy and demonstrate the potential for AFM24 to effectively target tumors expressing various varying levels of EGFR regardless of their mutational status.

Happy to answer any questions you may have about this in our Q&A. And for now, 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 second quarter of 2021 with cash and cash equivalents of EUR 222.7 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 June 30, 2021, was EUR 17.3 million compared to EUR 15 million in the second quarter of 2020. Total revenue for the second quarter ended June 30, 2021, was EUR 9.7 million compared with EUR 2.9 million for the quarter ended June 30, 2020. Revenue for the second quarter of 2021 mainly comprised of collaboration revenue from Genentech and Roivant.

Research and development expense for the second quarter of 2021 was EUR 21.8 million compared to EUR 11.7 million for the second 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 as well as an increase in costs associated with our other early-stage programs and infrastructure and an increase in share-based payment expense.

General and administrative expenses for the second quarter of 2021 increased by 109% to EUR 5.4 million from EUR 2.6 million in the second quarter ended June 30, 2020. The increase relates largely to higher personnel expenses, higher premiums for our directors and officers liability insurance, higher consulting expenses and increased share-based payment expenses.

Net finance costs for the quarter ended June 30, 2021, increased by 63% from EUR 1 million in the quarter ended June 30, 2020, to EUR 1.6 million during the second quarter of 2021. The increase is largely due to foreign exchange losses related to assets denominated in U.S. dollars as a result of the weakening of the U.S. dollar against the euro during the quarter.

Net loss for the quarter ended June 30, 2021, was EUR 18.8 million or EUR 0.16 per common share compared with a net loss of EUR 12.2 million or EUR 0.16 per common share for the quarter ended June 30, 2020. The weighted number of common shares outstanding for the quarter ended June 30, 2021, was 119.6 million.

I will now turn the call back to Adi for closing remarks. Adi?

Thanks a lot, Angus. As just explained, our company is making significant strides forward by advancing science and demonstrating that our innate cell engagers can play a leading role in enabling innate immune cells to identify and eliminate cancer cells. Now for AFM13, our strategy -- development strategy allows us to target a broad set of CD30-positive lymphoma, indeed including various types of non-Hodgkin and Hodgkin lymphoma. We're very excited about the potential and market opportunity for AFM13 in these indications. And we will have additional data for the NK cell combination study by the end of the year. For AFM24, we are now executing a strategy that we believe gives us the highest probability of success. We have reached active dose levels in our dose escalation study, and we'll now use this to initiate this 3-pronged development approach in parallel, indeed, across a broad set of solid tumor indications. We expect that these 3 studies will generate a continuous flow of data.

Finally, we are executing on our preclinical pipeline to bring additional product candidates into the clinic. Our development progress for AFM28 is indicative of our ability to further expand our pipeline by leveraging the unique ROCK platform, and we're working on additional early candidates from the platform.

Many, many people have contributed to bring our innovative therapies to patients who need additional options in their fight to cancer. These include patients and their families who entrust us with the lives of their loved ones, our employees and the investors who, over the years, have supported our efforts. As always, I'm very thankful for the trust you put into our efforts. Thank you.

We're now ready to take any questions that you may have. Operator?

(Operator Instructions)

Our first question comes from Daina Graybosch with SVB Leerink.

Two for me on AFM24. The first is, I believe you mentioned, and I just want to confirm, that you saw stable disease in several patients beyond 8 weeks. And in that same sentence, you mentioned that you're recruiting any EGFR-expressing solid tumors. I'm wondering if you could clarify whether you saw the stable disease in patients that had more EGFR expression. Was there any correlation with that? Or even if you could tell us of these patients recruited at cohort 5 and 6, what proportion of them did have high EGFR, and which ended up with low EGFR? That's the first question.

And the second question is, can you confirm how you ultimately will select the dose, given you haven't hit any dose-limiting toxicity? Can you -- will you be going off pharmacodynamic activation in periphery? What gives you confidence that that will track with your activity in the tumor? Will you be going off of occupancy of CD16 or EGFR? Or will you continue to try to dose as high as possible? How you do understand your highest tolerable growth?

Thank you, Daina. I have to check if Andreas is still on the phone. Andreas, could you follow the questions and...

Hello.

Okay. Very good, Andreas.

Yes. I'm on the phone. I have to apologize, I'm in rural Italy. So if I break up at some point, it's just due to technology reasons, but I try to stay as long as I can. So let's start with the second part of your question first, and Arndt also chime in. So as we always said, the selection of our recommended Phase II dose will be based on pharmacodynamic markers. As Arndt mentioned, our mechanism of action is completely different from EGFR pathway targeting agents like cetuximab or other TKIs. So we were not expecting to see any dose-limiting toxicity like skin or mucosa. And what we're in fact seeing clinically is really reconfirming this assumption. So IRRs remain the side effect, which are well manageable, but we are not seeing any skin toxicity and mucosal toxicity.

As we said in terms of pharmacodynamic markers, we have a whole array of parameters that we look at. The most leading parameters are markers of the activation of circulating NK cells as well as the occupancy of the CD16A receptor where we see values that are well above those values needed for experimental activity in vitro and in vivo. So we feel very confident that we are currently working at pharmacodynamically active doses. And this is our doses that we will take forward into Phase II testing both as a single agent as well as in combinations. Irrespective of this, we may escalate 1 or 2 additional dose steps just to confirm that we have very good safety profile, a very good safety, but not necessarily to use these higher doses for further evaluation of clinical activity.

In terms of EGFR expressions, we are collecting the data. Again, for the highest dose levels, we have not all data in-house. For the lower dose levels, we could not see any correlation between the degree of EGFR expression and any of the clinical parameters. But again, the data for the 2 highest dose levels in terms of EGFR quantification are still pending.

Our next question comes from Maury Raycroft with Jefferies.

Congrats on the progress. Also, one question on AFM24. You mentioned additional inflection points for the program by the end of the year. Just wondering if you can recap what those inflection points are.

Yes. So the -- as we've mentioned, we are now planning to start the dose expansion cohorts. So that's an important milestone. And we've also mentioned that there are 2 additional studies that are being initiated. The one is the combination study with natural killer cells and the other one is the study with atezolizumab. So these are 3 very important inflection points in our mind. And in addition, we can provide updates as we proceed with the dose escalation study. You have heard from Andreas that we have expanded the cohorts 5 and 6 to include more patients. Those data will be collected and analyzed. And once available, we plan to share this data with you.

Got it. That's helpful.

Maury?

Yes. I'm still here. And just wondering if you're saying anything additional about any more specifics on the activation markers and cytokine secretion that you're seeing; you're providing any more specifics there.

Arndt?

Yes. Thanks, Maury. Good question. At this point, not specifically we would like to share that. I mean we have said, just to repeat maybe what Andreas already said, we look at activation and exhaustion markers on circulating NK cells. We look at infiltration of the cells in some of the biopsies we have. We will look at the cytokine levels. And of course, as we have reported, in addition to exposure, so PK parameters also at receptor occupancy. And we will share that in more detail once all the data, as Adi also mentioned, will be collected together and then we'll also share the specific markers used.

Got it. Okay. And then also wanted to ask about the AFM13 plus NK cell combo. Can you say if you have responses at the highest dose at this point? And how many patients total at the highest dose are planned for the study?

So we haven't disclosed any such details for the time being as we are preparing for a presentation later in the year as outlined, so that we can see the composite. But in short, what the plan has been is that we have in each cohort initially 3 patients, and a cohort is always a certain number of NK cells, which is increased by a factor of 10 when the safety is warranted. And as I said, it's 10^6 cells per kilogram. We moved to 10^7 and 10^8. In these patients, we haven't seen any dose-limiting toxicities or any other side effect, so it appears quite safe. And overall, what I can say here is that we're also very encouraged by the responses that we're seeing after the first assessment. Currently, additional patients are treated. So we have continued to enroll patients -- or MD Anderson has continued to enroll patients at the highest dose cohort and that's currently ongoing.

Got it. Okay. That's helpful. And then my last question, and then I'll hop in the queue. In the prepared remarks, you said the program, the AFM13 plus NK cell combo program would be robust and could enable discussions with regulators for approval strategies. Just wondering if you think you'll have enough data by year-end '21 to enable these discussions?

In terms of timing, we've been -- we will let you know as soon as we have such data [to manage] T-cell. We're dependent on MD Anderson to enroll these patients. And so I would say that we have to wait for a little while before we can confirm any of these next activities. This is an important activity, but as we feel it's not the only very important activity. The other one is that we can proceed with the NK cells and its manufacturing. And I was sharing to news today that we have made good progress on this front as well. First, we're now working with the CDMO for the manufacturing of the cord blood-derived NK cells, and we have generated first data of a cryopreserved AFM13 precomplexed NK cells and determined its activity in preclinical experiment.

Our next question comes from Nick Abbott with Wells Fargo.

Rural Italy sounds delightful, I have to say. Just starting off maybe on AFM13. You mentioned the CDMO, Adi. Is this using cord blood from MD Anderson? Obviously, I know that you've licensed the technology from them, but are you restricted to where the cord blood cells come from, which bank they come from?

So yes, we have a license to the entire technology, and this would also include indeed any work on cryopreservation that's being conducted by MD Anderson. In terms of cord blood cells, we're not restricted to any specific source. So we can source this from MD Anderson, but also independent places. And -- so in essence, that's how we are set up. Is there a specific reason why you're asking?

No. Not at all. No. So I'm just thinking if you are going to be -- I don't -- we don't know where the CDMO is, but if you're going to have a CDMO in Germany, for example, and shipping cord blood from MD Anderson wouldn't be as convenient as sourcing it from somewhere in Germany.

Yes. Yes. No, it's an international CDMO. So that has footprint all over the world. So it's obviously one of the very experienced one. That was important to us, again, a CDMO that has already worked and developed NK cell products. So we're tapping into a specific know-how already with this choice. And at the moment, our focus is to work with the site in the U.S.

Okay. Great. And then just on AFM24, and terrific now to finally get all the details of those expansion cohorts. One thing that struck me in the monotherapy, there's not a KRAS-mutated colorectal cohort. The NK combo would appear to allow for KRAS-mutated colorectal. But did you consider -- is there a reason why there isn't a KRAS-mutated cohort? Obviously, it couldn't be EGFR-pretreated, and that's probably the reason but I thought I'd ask.

Andreas, can you hop out here?

Yes. This a good pick. As we said, our selection on the expansion cohorts are based on a pretty thorough analysis of the underlying tumor biology and the makeup of the different players of the innate immune system. When we look specifically at KRAS-mutated colorectal cancer, it is not due to the KRAS mutation but there appears to be a coincidence that many KRAS-mutated colorectal cancers have very limited NK cell numbers and then some other factors that indicated to us that KRAS-mutated colorectal cancer would be one of these indications where the patient would need support of an external NK cell source, and that's the reason why they ended up basically in Study 103. We believe that once you are able to supply these KRAS-mutant colorectal cancers with NK cells and with an appropriate engager, that you could see innate immune system in the best position to work against this very difficult to treat tumors.

(Operator Instructions)

Our next question comes from Yale Jen with Laidlaw.

The first question is that for the AFM13 plus the cord blood NK cell, which that -- according to clinical trial data that you have was that you expect to include about 30 patients. Is this target still -- or do you anticipate or how has any modification on that? And would that potentially could be a critical mass for potential sort of registration discussion with FDA?

Andreas, you may want to take that.

Yes. The first thing I can confirm is that the protocol is written in a way that we, in fact, can recruit somewhere between 30 and 40 patients at a recommended dose level. This could be a mixture of Hodgkin's and non-Hodgkin's CD30-expressing lymphomas. Again, whether this mass or this number will be sufficient for any registration package, of course, will depend on the effect level. And definitely, the study will allow us probably even earlier than going up to the full recruitment to engage in discussions with FDA. And I think during these discussions, we will learn what kind of patient numbers they're expecting. So I think it's a robust study. It will give you a pretty good data set. It will enable us also to look at different biologies within the CD30-expressing lymphoma space. Everything else will really depend on our initial discussions with FDA.

Great. That's very helpful. And maybe just a quick follow-up on this, which is, is the data anticipated reporting at ASH or other venues?

Again, the disclosure policy is mainly driven by MD Anderson. Our expectation is that they will submit some of the data for ASH.

Okay. Great. And maybe one general question for the AFM24. You have the monotherapy as well as the combo, specifically with NK cell combo. I noticed that the renal cell carcinoma was only monotherapy but not on the combo. Is there any reason behind that? Or maybe more specific reason behind that?

Yes. The answer is, again, it's based on the analysis of biology and the setup of the different players of the innate immune system. Clear cell carcinoma, renal cell carcinoma, we know already since (inaudible) time that this is a tumor where the immune system can exert some tumor control. When we specifically looked at the players in the innate immune system, we found that RCC is a good candidate that could benefit from monotherapy. So our first step here is to test monotherapy AFM24. We believe that several important pieces are in place in RCC that an innate cell engager could work as a monotherapy. Of course, if we should see good data that would not preclude that at some point, we may add combination with an NK cell or PD-1. But again, for the first evaluation RCC looks (inaudible) tumors where monotherapy could be quite beneficial for these patients.

Okay. Great. And maybe the last question, which is a housekeeping one. In the second quarter of this year, the R&D expenditure as well as revenue has increased, particularly R&D expenditure increased quite significantly compared to the prior quarter. So should we -- for modeling purposes, should we anticipate the second quarter R&D expenditure will be something more as a base moving -- going forward for -- at least for the remaining of the year?

Yes. Thanks, Yale. So I mean a couple of comments there. I mean, one, we haven't provided specific guidance on our expenses, but we have provided guidance on our cash runway. And what we've said is that we expect our existing cash, which is about a little over EUR 220 million, will last us into the second half of 2023. So if you do the math on that, again, that's kind of 8 to 10 quarters out. That implies a cash burn in the low-to mid-20s, excluding any impact of additional proceeds from loans or milestones, et cetera. So just doing -- based on that math, you can assume that the expenditure level that you're seeing in Q2 of this year is probably more relevant as we go forward than expenses you've seen in previous quarters, in particular in the second quarter of last year.

But having said that, we do expect that R&D expense will be lumpy, right. This quarter, we've had, as I said on the call, we had an increase in AFM24. A lot of that's associated with production of clinical trial material for our ongoing study and upcoming studies. We've also had ramp-ups in our earlier-stage programs like AFM28 and AFM32. And when it comes to CMC investments, those can be a little bit lumpy. But long story short, fair to assume that the R&D expenditure this quarter is probably more in line with where we'll be in the future than where we've been in the past.

We have a follow-up question from the line of Nick Abbott with Wells Fargo.

Great. Just going back to the AFM24 trial. I believe that currently the trial is being conducted at 4 sites in the U.S., U.K. and Spain, and Adi you mentioned a U.S. CDMO. So can you talk maybe a little bit about the -- for the 3 expansion cohorts, how many sites that you expect to be running those trials at and whether they're going to be international or all in the U.S.? And will this be a Simon sort of 2-stage design for each of the cohorts?

Okay. Yes, thanks for this question. Nick, I'll have either Wolfgang or Andreas jump in here, if they can.

Yes, I can. So for the expansion cohorts of the monotherapy trial, we are looking to increase the number of sites from 4 that we are currently having probably to somewhere between 10 and 15, 16 sites. It will continue to be a mixture of U.S. site, international sites. And you mentioned, currently we have in Europe. We will add a couple of sites in Southeast Asia, mainly Korea, especially to recruit EGFR-mutant patients.

Now the same is true for the PD-1, PD-L1 study where we will have also a mixture of U.S. and ex U.S. sites. Study 103, the SNK01 study will initially be a U.S.-only study with up to 4 sites for the initial part and then expanding to couple of more sites. But currently the plans for this specific study are to be a U.S.-only study.

Now in terms of the study design, all studies are designed according to Simon 2-Stage principles. We will have an initial phase with a defined number of patients, of course, as we are enrolling different disease types. The go, no-go criteria will vary by disease type and then also the definition of response rate of interest will be a little bit different. But in general, as I said, this would be Simon 2-Stage designs with initial cohort of probably around 12 to 15 patients looking at a predefined success criteria and then having the ability to enroll up to 30 to 35 patients per cohort to verify the initial assumption of the Simon 2-Stage design.

And that concludes today's question-and-answer session. Ladies and gentlemen, thank you for participating in Affimed's Second Quarter 2021 Financial Results and Corporate Update Conference Call. This concludes the program, and you may now disconnect. Everyone, have a great day.