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8-K - FORM 8-K - HERON THERAPEUTICS, INC. /DE/d234176d8k.htm
Company Overview
OTCQB: APPA.PK
September 2011
Exhibit 99.1


Legal Disclaimer
September 2011
©
2011. A.P. Pharma, Inc. All rights reserved.
2
This presentation contains "forward-looking statements" as defined by the Private
Securities Litigation Reform Act of 1995.  These forward-looking statements
involve risks and uncertainties, including uncertainties associated with timely
development, approval, launch and acceptance of new products, satisfactory
completion of clinical studies, establishment of new corporate alliances, progress
in research and development programs and other risks and uncertainties identified
in the Company's filings with the Securities and Exchange Commission.  Actual
results may differ materially from the results expected in our forward looking
statements.  We caution investors that forward-looking statements reflect our
analysis only on their stated date.  We do not intend to update them except as
required by law.


Company:
A.P. Pharma, Inc.
Ticker:
OTCQB: APPA.PK
Stock Price:
$0.25 (9/16/11)
Market Capitalization:
$98.1 million
1
Cash:
$23.6
million
2
Debt:
$1.5 million
3
Stock Summary
September 2011
©
2011. A.P. Pharma, Inc. All rights reserved.
3
1
Based on 392.5 million as-converted common shares assuming the full conversion of
convertible debt outstanding or subject to purchase rights, and 80 million warrants; not
including options and 4M warrants with an exercise price of $0.88/share
2
Pro forma as of June 30, 2011 including net proceeds from July 1, 2011 PIPE funding
3
As of June 30, 2011


John B. Whelan
President, CEO & CFO
Raven Biotechnologies
Eos Biotechnology
Hewlett Packard/Agilent
Michael A. Adam,
Ph.D.
Senior Vice President &
Chief Operating Officer
Spectrum Pharmaceuticals
Pfizer
Bristol-Myers Squibb
John Barr, Ph.D.
Senior Vice President,
Research and Development
Cortech
Kristin Ficks
Head of Commercial Operations
Gemini Healthcare
Celgene
Eisai/MGI Pharma
Management
September 2011
©
2011. A.P. Pharma, Inc. All rights reserved.
4


A.P. Pharma Highlights
©
2011. A.P. Pharma, Inc. All rights reserved.
5
Lead product candidate, APF530, is long-acting, injectable
product for chemotherapy-induced nausea and vomiting (CINV)
Incorporates
widely
used
5HT3
anatgonist
-
granisetron
(Kytril
®
)
5-day delivery profile
Reduces both acute-
and delayed-onset CINV with single injection
APF530
shown
to
be
non-inferior
to
market
leader
Aloxi
®
1,341-patient, randomized, controlled, Phase 3 study
Presented at ASCO 2009
Company is addressing issues raised in Complete Response
Letter
End-of-review meetings held in 1Q 2011
Resubmission planned for 1H 2012
APF530 targets a $900 million market opportunity in US alone
Could be second, long-acting, injectable product on market
A.P. Pharma has pipeline of additional products based on its
Biochronomer™
drug delivery technology
September 2011


Product Pipeline
Product
Candidate
Potential
Indication
Drug
Target
Duration
Preclinical
Phase 1
Phase 2
Phase 3
NDA
APF530
Chemotherapy-
induced nausea
and vomiting
Granisetron
5 days
APF112
Post-surgical
pain relief
(opiate-sparing)
Mepivacaine
3 days
APF580
Sustained pain
relief
Buprenorphine
7 days
APF328
Post-surgical
pain and
inflammation
(orthopedic
surgery)
Meloxicam
Up to two
weeks
APF505
Chronic pain
and
inflammation
(osteoarthritis)
Meloxicam
Up to six
weeks
All leverage same polymer technology used in APF530
6
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


APF530 Milestones 2011 -
2012
1Q 2012
2Q 2012
2H 2012
7
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011
Complete validation activities
FDA approval decision
Complete thorough QT and
metabolism study
Complete human factors study
Complete CMC activities
Resubmit APF530 NDA


Clinical Summary
8
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


APF530 Pivotal Phase 3 Study Overview
Randomized, controlled, multi-center study
1,341 patients in primary efficacy population
Two doses of APF530 (5 mg and 10 mg granisetron)
compared to the approved dose of Aloxi
Patients stratified by type of chemotherapy regimen
(moderately or highly emetogenic)
Primary end point compared complete response between
groups in both the acute (day 1) and delayed (days 2-5)
phase
Complete response defined as no emesis and no rescue medications
A ±15% margin was used to establish non-inferiority
9
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


APF530 Phase 3 Study Design
Cycle 1
Cycles
2 to 4
Patient Stratification
(n = 1,341)
Moderately Emetogenic
(n = 634)
Highly Emetogenic
(n = 707)
10
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011
Aloxi
APF530
(5mg)
APF530
(10mg)
Aloxi
APF530
(5mg)
APF530
(10mg)
APF530
(5mg)
APF530
(10mg)
APF530
(5mg)
APF530
(10mg)


Primary Efficacy Results: Complete Response
Patients Receiving Moderately Emetogenic Chemotherapy
11
©
2011. A.P. Pharma, Inc. All rights reserved.
Acute
Delayed
APF530 5mg
APF530 10mg
Acute
Delayed
Acute
Delayed
Difference in Complete Response
APF530-Aloxi (97.5% CI)
-15
-10
-5
0
5
10
15
September 2011
75
74.8
76.9
57.7
51.4
59.0


Primary Efficacy Results: Complete Response
Difference in Complete Response
APF530-Aloxi (98.33% CI)
Acute
Acute
Delayed
Delayed
APF530 5mg
APF530 10mg
Patients Receiving Highly Emetogenic Chemotherapy
12
©
2011. A.P. Pharma, Inc. All rights reserved.
Acute
Delayed
September 2011
80.7
77.7
81.3
66.4
64.6
68.3


Safety Summary
* >90% of injection site reactions were reported as mild; one patient discontinued due to
injection site reaction
Reported in Cycle 1
13
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011
Nervous System
Bruising
Erythema (redness)
Nodule (lump)
Pain
Injection Site*
Headache
Serious Adverse Events
Discontinued Due to Adverse Event
Frequent Adverse Events
Constipation
Nausea
Diarrhea
Abdominal pain
Gastrointestinal disorders
APF530 5 mg
APF530 10 mg
N
%
N
%
N
%
1
1
0.2
0.2
0
1
0
0
0
0
0
0.2
62
56
49
21
13.4
12.1
10.6
4.5
72
60
44
13
15.4
12.8
9.4
2.8
62
41
39
28
13.4
8.9
8.4
6.0
31
6.7
47
10.0
45
9.7
78
33
22
16
16.8
7.1
4.7
3.4
93
51
50
33
19.9
10.9
10.7
7.1
41
14
3
5
8.9
3.0
0.6
1.1
Placebo (NaCl)
Aloxi 0.25 mg


APF530’s Efficacy with Difficult Chemo Regimens
14
©
2011. A.P. Pharma, Inc. All rights reserved.
Treatment
Chemotherapeutic Regimen
APF530 10 mg
Aloxi 0.25 mg
Moderately
Emetogenic
Acute
Cyclophosphamide/Doxorubicin
70.7%
65.7%
All other regimens
84.4%
85.0%
Delayed
Cyclophosphamide/Doxorubicin
47.4%
46.3%
All other regimens
72.9%
70.0%
Highly
Emetogenic
Acute
Cisplatin regimens
81.1%
75.5%
Carboplatin/Paclitaxel
85.4%
89.8%
All other regimens
75.4%
67.6%
Delayed
Cisplatin regimens
66.0%
60.4%
Carboplatin/Paclitaxel
70.8%
71.4%
All other regimens
65.2%
57.4%
September 2011


APF530’s Sustained Efficacy in Cycles 2-4
©
2011. A.P. Pharma, Inc. All rights reserved.
15
* Sakai et al (Annals of Oncology, Vol. 19 Sept. 2008)
Complete Response Rates for Delayed-onset CINV in Patients Receiving
Highly Emetogenic Chemotherapy
351
315
254
117
100%
90%
72%
33%
240
169
129
94
100%
70%
54%
39%
N =
% of Cycle 1
APF530 10mg
Aloxi 0.75mg*
September 2011


Summary of APF530 Phase 3 Results
Non-inferiority to Aloxi was demonstrated
For both acute-
and delayed-onset CINV
With both moderately and highly emetogenic chemotherapy
APF530 was safe and well-tolerated
Incidence of adverse events comparable to Aloxi
High response rates were observed in difficult
chemotherapy regimens
A high level of efficacy was maintained through multiple
cycles of chemotherapy
16
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


Regulatory Status and Strategy
17
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


APF530 NDA Status
Submitted NDA in May 2009
Received Complete Response Letter in March 2010
FDA raised issues in three main areas:
Dosing system
Two-syringe system
Chemistry, Manufacturing, and Controls (CMC)
Sterilization
Characterization
Clinical/statistical
Specific studies
Presentation of data
Held end-of-review meetings with FDA in 1Q 2011
Implementing plan to resubmit NDA in 1H 2012
18
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


Outcome of FDA Meetings
Dosing System
Changed to single-syringe system
Single glass syringe for storage and administration
Smaller needle: switch from 1”
x 16 gauge to 5/8”
x 18 gauge thin-wall
Enhanced dosing instructions
Overall, simpler and more convenient
Non-clinical human factors study planned
Chemistry, Manufacturing, and Controls
Changed from bulk to terminal irradiation
Additional specifications and assays for raw materials, polymer and drug
product
Clinical/Statistical
Thorough QT study –
Initiated in August 2011
Metabolism study
Revised presentation format for Phase 3 data
No additional clinical efficacy studies requested
19
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


Commercial Opportunity
20
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


U.S. Market Opportunity for APF530
More than 7 million cycles of chemotherapy administered
each year
~27% are highly emetogenic
~46% are moderately emetogenic
Significant unmet medical need for additional therapies to
address delayed-onset CINV
5HT3 antagonists are standard-of-care for CINV
Recommended in treatment guidelines –
NCCN, ASCO, ONS
An injectable 5HT3 antagonist is co-administered with more than 90% of
moderately and highly emetogenic regimens
APF530 targets a $900
million market opportunity in the
US alone
In 2010, there were 5.14 million vials of injectable 5HT3 antagonists
administered for CINV
The average selling price for market leader Aloxi is $179
Sources: Company-sponsored survey and analysis and Wolters Kluwer
21
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


1
Generation 5HT3 Antagonists Study Results
©
2011. A.P. Pharma, Inc. All rights reserved.
22
Moderately
Emetogenic
Chemotherapy
-
Ondansetron
Gralla
Eisenberg
50%
34%
Highly Emetogenic Chemotherapy
Ondansetron
Granisetron
Aapro
Emend Label Studies
Emend
Label
Saito
25%
43%
52%
43%
33%
40%
Average Overall Complete Response* rates
*Overall Complete Response defined as no emesis and no rescue
medications during 0 to 120 hours following chemotherapy
September 2011
st
Moderately Emetogenic Chemotherapy ~ 42%
Highly Emetogenic Chemotherapy ~ 39%
Overall Complete Response rates by study:


Aloxi Study Results
©
2011. A.P. Pharma, Inc. All rights reserved.
23
Moderately Emetogenic Chemotherapy
Eisenberg
Gralla
Grunberg
Hajdenberg
APPA Ph 3
46%
69%
59%
59%
52%
Highly Emetogenic Chemotherapy
Aapro
APPA Ph 3
41%
62%
Average Overall Complete Response rates
Moderately Emetogenic Chemotherapy ~ 57%
Highly Emetogenic Chemotherapy ~ 51%
Overall Complete Response rates by study:
September 2011


Antiemetic Treatment Patterns
September 2011
©
2011. A.P. Pharma, Inc. All rights reserved.
24
Most chemotherapy patients will undergo 4 to 15 cycles of
chemotherapy
Doctors prefer to administer antiemetics on-site for
moderately and highly emetogenic chemotherapy
Patient compliance is a significant concern
Average cost per CINV event ranges from $4,000 to $5,300
Issues controlling CINV typically appear during the first few
cycles
If the initial prevention regimen is not effective, drugs are
added and/or changed to address CINV in subsequent
cycles
No long-acting injectable alternative to Aloxi is available to prevent
delayed-onset CINV


LOGO

 

CINV Market Dynamics

Injectable Drugs for the Prevention of CINV

Number of Package Units Sold by Quarter

800,000

700,000

600,000

500,000

400,000

300,000

200,000

100,000

0

Q2’06 Q3’06 Q4’06 Q1’07 Q2’07 Q3’07 Q4’07 Q1’08 Q2’08 Q3’08 Q4’08 Q1’09 Q2’09 Q3’09 Q4’09 Q1’10 Q2’10 Q3’10 Q4’10 Q1’11 Q2’11

ALOXI ANZEMET KYTRIL KYTRIL Generic (GRANISETRON) ZOFRAN ZOFRAN Generic (ONDANSETRON) EMEND

* US Oncology data added starting Q1’09.

Source: Wolters Kluwer

Usage in CINV estimated based on vial size

September 2011 © 2011. A.P. Pharma, Inc. All rights reserved.

a.p.pharma

25


Aloxi Market Performance
September 2011
©
2011. A.P. Pharma, Inc. All rights reserved.
26
Zofran went
generic
Pricing
Average Selling Price = $179
Medicare Reimbursement = $189
Wholesale
Acquisition
Cost
~
$300
-
$330
Orange Book Patent Exclusivity
One patent expires April 2015
Three patents expire January 2024


CINV Market Dynamics: Conclusions
Aloxi has gained market share over last 3 years despite
availability of generics for acute-onset CINV
From 48% in 2008 to 56% in 2Q 2011
Kytril was widely used prior to Zofran
®
going generic
High physician acceptance of granisetron
Aloxi dipped 30% when Zofran went generic but then
regained 100% of its lost share two quarters later
NK1 antagonists typically are only used as an adjunct to
5HT3 antatgonists
Injectable Emend
®
units sold less than 10% of injectable units sold for
CINV prevention
27
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


Competitive Landscape
September 2011
©
2011. A.P. Pharma, Inc. All rights reserved.
28
APF530 would be one of two injectable products approved
for preventing delayed-onset CINV
5HT3 antagonists are standard-of-care
1   generation products have limited effectiveness in preventing
delayed-
onset CINV
Patients continue to experience CINV despite currently available
products
Most chemotherapy patients will undergo 4 to 15 cycles of chemotherapy
Large Phase III study supporting APF530’s use
Non-inferior efficacy to Aloxi
Similar safety profile to granisetron and Aloxi
High response rates were observed in difficult chemotherapy regimens
A high level of efficacy was maintained through multiple cycles of
chemotherapy
st


APF530 Commercialization Strategy
A.P. Pharma owns worldwide rights to APF530
APF530 can be commercialized with a compact
commercial infrastructure targeting oncologists
Company to evaluate partnering opportunities before and
after FDA approval
29
©
2011. A.P. Pharma, Inc. All rights reserved.
September 2011


Financial Summary
September 2011
©
2011. A.P. Pharma, Inc. All rights reserved.
30
Completed $24MM PIPE in July 2011
Current resources expected to fund company into 2013
Summary Statement of Operations
(In thousands, except per share data)
Six Months Ended
June 30, 2011
Revenue
$      646
Operating expenses
3,501
Other
income
(expenses)
1
(496)
Net loss
$ (3,351)
Net
loss
per
share
2
$   (0.08)
Condensed Balance Sheet Data
(In thousands)
June 30, 2011
Dec 31, 2010
Cash and cash equivalents
$ 21,331
3
$ 2,109
Working capital
$ 18,626  
$    941
Total assets
$ 22,121
$ 2,911
Total stockholders’
equity
$ 18,892
$ 1,316
1
Includes discontinued operations
2
Based on 40.1 million weighted average common shares outstanding
3
Includes $20.3 million in advance proceeds received in June 2011


A.P. Pharma Highlights
©
2011. A.P. Pharma, Inc. All rights reserved.
31
Lead product candidate, APF530, is long-acting, injectable
product for chemotherapy-induced nausea and vomiting (CINV)
Incorporates
widely
used
5HT3
antagonist
-
granisetron
(Kytril
®
)
5-day delivery profile
Reduces both acute-
and delayed-onset CINV with single injection
APF530 shown
to
be
non-inferior
to
market
leader
Aloxi
®
1,341-patient, randomized, controlled, Phase 3 study
Presented at ASCO 2009
Company is addressing issues raised in Complete Response
Letter
End-of-review meetings held in 1Q 2011
Resubmission planned for 1H 2012
APF530 targets a $900 million market opportunity in US alone
Could be second, long-acting, injectable product on market
A.P. Pharma has pipeline of additional products based on its
Biochronomer™
drug delivery technology


Thank You
A.P. Pharma, Inc.
OTCQB: APPA.PK
September 2011
©
2011. A.P. Pharma, Inc. All rights reserved.
32