Medivir presented updated clinical data at ESMO in September. The median time to progression of fostrox + Lenvima was established at 10.9 months, while the objective response rate was 24%. These are impressive results but based on a small sample (n=21). Furthermore, neutrophil and platelet count were comparatively stable with just a few grade 3 adverse events, meaning the dose could be kept for a majority of patients. In November, Medivir announced a supply and clinical trial agreement with Eisai, the producer of Lenvima. This collaboration makes sense because it reduces the cost of the upcoming phase IIb trial (as Lenvima will be free) and gives Medivir access to the experience Eisai has built up in liver cancer (HCC). Medivir plans to submit an IND for the phase IIb study in Q4 (allowing the study to begin in the US).

Birinapant is being developed in oncology under a licensing agreement with IGM Biosciences. In September, IGM communicated that it will focus entirely on immunology. Birinapant had been on hold since December 2023. IGM still has patients on study with birinapant and is discussing the future of the programme with Medivir. Unless room can be made for it in immunology, it will likely be returned to Medivir, which we think is the more probable scenario. We have, therefore, removed it from our valuation.

We have removed birinapant but also increased the forecast peak sales of fostrox in liver cancer. This results in a base case of SEK8 (SEK9). The agreement with Eisai means significant cost reductions, so the planned phase IIb study can now be funded by Medivir alone, if necessary. We estimate the cost of the trial decreases by slightly less than half. It also makes it more attractive for an Asian partner, who would have to pay an upfront payment and sponsor the Asian sites, which will now be cheaper. The next couple of months will show whether Medivir finds a partner.