Item 1A. Risk Factors
ITEM
1A. RISK FACTORS
An
investment in our common stock involves risks. You should carefully consider the risks described below, together with all of the other
information included in this Annual Report, as well as in our other filings with the SEC, in evaluating our business. If any of the following
risks actually occur, our business, financial condition, operating results and future prospects could be materially and adversely affected.
In that case, the trading price of our common stock may decline and you might lose all or part of your investment. The risks described
below, which are the risks we judge (rightly or wrongly) to be the most significant to investors, are not the only ones we face. Additional
risks that we currently do not judge to be among the “most significant” may also impair our business, financial condition,
operating results and prospects.
Risks
Related to Our Business
Various
factors raise substantial doubt about the Company’s ability to continue as a going concern.
The
Company has incurred significant losses since its inception, including a net loss of $6.3 million for the year ended December 31, 2024,
and has an accumulated deficit of $123.1 million as of December 31, 2024. These factors, among others, raise substantial doubt about
the Company’s ability to continue as a going concern. The Company’s continuation as a going concern is dependent upon its
ability to generate positive cash flows from operations and to secure additional sources of equity and/or debt financing. Despite the
Company’s intent to fund operations through equity and debt financing arrangements, there is no assurance that such financing will
be available on terms acceptable to the Company, if at all.
Our
independent auditors have included an explanatory paragraph in their audit report regarding the Company’s ability to continue as
a going concern. This going concern risk may materially limit our ability to raise additional funds through the issuance of new debt
or equity or may adversely affect the terms upon which such capital may be available. The inability to obtain sufficient financing on
acceptable terms could have a material adverse effect on the Company’s financial condition, results of operations, and business
prospects.
The
Company is actively pursuing strategies to mitigate these risks. However, there can be no assurance that these efforts will prove successful
or that the Company will achieve its intended financial stability. The failure to successfully address these going concern risks may
materially and adversely affect the Company’s business, financial condition, and results of operations. Investors should consider
the substantial risks and uncertainties inherent in the Company’s business before investing in the Company’s securities.
Any
failure to develop or maintain effective internal controls over financial reporting or difficulties encountered in implementing or improving
our internal controls over financial reporting could harm our operating results and prevent us from meeting our reporting obligations.
Effective
internal controls, particularly those related to financial reporting, are necessary for us to produce reliable financial reports. If we
cannot provide reliable financial reports, our business and operating results could be harmed, investors could lose confidence in our
reported financial information, and the trading price of our common stock could drop significantly. In addition, investors relying upon
this misinformation could make an uninformed investment decision, and we could be subject to sanctions or investigations by the SEC or
other regulatory authorities or to stockholder class action securities litigation.
In connection
with the audit of our financial statements as of and for the year ended December 31, 2024 (the “2024 audit”), our management
identified a material weakness in our internal control over financial reporting related to the lack of accounting department resources
and/or policies and procedures to ensure recording and disclosure of items in compliance with U.S. GAAP. This material weakness resulted
in adjustments to our prepaid expense accounts and recording short term notes receivable net of current expected credit losses in connection
with the 2024 audit. In response to the material weakness, we took a number of remediation steps to enhance our internal controls, including
implementing additional procedures and utilizing external consulting resources with experience and expertise in U.S. GAAP and public company
accounting and reporting requirements to assist management with its accounting and reporting of complex and/or non-recurring transactions
and related disclosures.
In connection with
the audit of our financial statements as of and for the year ended December 31, 2024 (the “2024 audit”), our management determined
that the material weakness identified in connection with the 2024 audit had not been fully remediated and resulted in adjustments to
the accounting treatment related to our prepaid expense accounts and recording short term
notes receivable net of current expected credit losses during the 2024 audit, which resulted in the late filing of the 2024 Annual
Report.
During
the year ended December 31, 2024 audit, we identified the lack of sufficient number of personnel within the accounting function to adequately
segregate duties, the Company did not have a designed and implemented effective Information Technology General Controls (“ITGC”)
related to access controls to financial accounting system, and the Company did not have formalized documentation of its processes and
controls that could be evaluated for proper design and implementation.
We intend
to continue to take steps to enhance our internal controls, including implementing additional internal procedures and utilizing well-established
external consulting resources with experience and expertise in U.S. GAAP and public company accounting and reporting requirements.
If we are unable to remediate the material weaknesses and achieve and maintain effective internal control over financial
reporting and effective disclosure controls, our business could be adversely affected.
Continued
uncertain economic conditions, including inflation and the risk of a global recession could impair our ability to forecast and may harm
our business, operating results, including our revenue growth and profitability, financial condition and cash flows.
While
U.S. inflation rates have come down substantially from their 2022 highs, the U.S. economy is still experiencing higher than target inflation
rates, and high levels of inflation persist in many countries around the world. Historically, we have not experienced significant inflation
risk in our business. The global economy suffers from slowing growth and elevated interest rates, and many economists are still unsure
whether a global recession may begin in the near future. If the global economy slows, our business would likely be adversely affected.
Our
business and operations would suffer in the event of computer system failures, cyberattacks or a deficiency in our cybersecurity or a
natural disaster.
There
are growing risks related to the security, confidentiality and integrity of personal and corporate information stored and transmitted
electronically due to increasingly diverse and sophisticated threats to networks, systems and data security. Potential attacks span a
spectrum from attacks by criminal hackers, hacktivists, and nation state or state-sponsored actors, to employee malfeasance and human
or technological error.
Despite
the implementation of security measures, our internal computer systems, and those of third parties on which we rely (including our vendors,
contractors and other third-party partners who process information on our behalf or have access to our systems), are vulnerable to damage
from computer viruses, malware, ransomware, phishing attacks and other forms of social engineering, denial-of-service attacks, third
party or employee theft or misuse and other negligent actions, natural disasters, terrorism, war, telecommunication and electrical failures,
cyberattacks or cyber-intrusions over the internet, security incidents, disruptions, attachments to emails, persons inside our organization,
or persons with access to systems inside our organization. The risk of a security breach or disruption, particularly through cyberattacks
or cyber intrusion, including by computer hackers, foreign governments, and cyber terrorists, has generally increased as the number,
intensity and sophistication of attempted attacks and intrusions from around the world have increased. If such an event were to occur
and cause interruptions in our operations, it could result in a material disruption of our product development programs. To the extent
that any disruption or security breach was to result in a loss of or damage to our data or applications, or inappropriate disclosure
of confidential or proprietary information, we could incur material legal claims (including class claims) and liability, substantial
remediation costs, regulatory enforcement, liability under data protection laws, additional reporting requirements and damage to our
reputation, and the further development of our product lines could be delayed.
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Our
future growth may be limited.
Our
ability to achieve our expansion objectives and to manage our growth effectively depends upon a variety of factors, including our ability
to attract and retain skilled employees, to successfully position and market our product candidates when available, to protect our existing
intellectual property, to capitalize on the potential opportunities we are pursuing with third parties and to acquire sufficient funding
whether internally or externally. To accommodate growth and compete effectively, we will need cash to fund our operations, including
continuing our research and development efforts on our product candidates, develop additional procedures and controls and increase, train,
motivate and manage our workforce. There is no assurance that our personnel, systems, procedures and controls will be adequate to support
our potential future operations.
We
will need additional financing in order to grow our business.
From
time to time, in order to expand operations to meet customer demand, we will need to incur additional capital expenditures. These capital
expenditures are intended to be funded from third party sources, including the incurring of debt and/or the sale of additional equity
securities. In addition to requiring additional financing to fund capital expenditures, we may require additional financing to fund working
capital, research and development, sales and marketing, general and administrative expenditures and operating losses. The incurrence
of debt creates additional financial leverage and therefore an increase in the financial risk of our operations. The sale of additional
equity securities will be dilutive to the interests of current equity holders. In addition, there can be no assurance that such additional
financing, whether debt or equity, will be available to us or that it will be available on acceptable commercial terms. Any inability
to secure such additional financing on appropriate terms could have a materially adverse impact on our business, financial condition
and operating results.
Geopolitical
conditions, including direct or indirect acts of war or terrorism, could have an adverse effect on our operations and financial results.
Our
operations could be disrupted by geopolitical conditions, political and social instability, acts of war, terrorist activity or other
similar events. It is not possible to predict the broader consequences of current global conflicts, although such consequences can include
rising geopolitical tensions, rising regional instability, geopolitical shifts, cyberattacks or the disruption of energy exports for
the parties involved, neighboring parties, or supporting parties of these conflicts or their resulting sanctions. Such consequences could
materially adversely affect global trade, currency exchange rates, regional economies and the global economy. These situations remain
uncertain, and while it is difficult to predict the impact of any of the foregoing, these conflicts and actions taken in response to
these conflicts could increase our costs, disrupt our supply chain, reduce our sales and earnings, impair our ability to raise additional
capital when needed on acceptable terms, if at all, or otherwise adversely affect our business, financial condition, and results of operations.
We
are subject to litigation, which could result in significant expenses and negatively impact our business, financial condition, and results
of operations.
On
January 29, 2025, Lifesci Capital LC (“Lifesci”) filed a lawsuit against us in the United States District Court for the Southern
District of New York, alleging breach of contract and seeking damages in the amount of $503,483. We believe that no amount is owed to
Lifesci under the agreement at issue and are vigorously defending against the claims. However, litigation is inherently uncertain and
costly, and we cannot guarantee the outcome. An adverse result in this or other legal matters could materially impact our business, reputation,
financial condition, and results of operations.
Risks
related to regulatory approval
Even
if our development efforts are successful, we may not obtain regulatory approval for any of our product candidates in the United States
or other jurisdictions, which would prevent us from commercializing our product candidates. Even if we obtain regulatory approval for
our product candidates, any such approval may be subject to limitations, including with respect to the approved indications or patient
populations, which could impair our ability to successfully commercialize our product candidates.
We
are not permitted to market or promote or sell any of our product candidates before we receive regulatory approval from the FDA or comparable
foreign regulatory authorities, and we may never receive such regulatory approval for any of our product candidates. Securing marketing
approval requires the submission of extensive preclinical and clinical data and supporting information to regulatory authorities for
each therapeutic indication to establish the product candidate’s safety and efficacy for that indication. Securing marketing approval
also requires the submission of information about the product manufacturing process to, and inspection or remote regulatory assessment
of manufacturing facilities and clinical trial sites by, the regulatory authorities. If we do not receive approval from the FDA and comparable
foreign regulatory authorities for any of our product candidates, we will not be able to commercialize such product candidates in the
United States or in other jurisdictions. If significant delays in obtaining approval for and commercializing our product candidates occur
in any jurisdiction, our business, financial condition, results of operations, stock price and prospects will be materially harmed. Even
if our product candidates are approved, they may:
●
be subject to limitations on the
indicated uses or patient populations for which they may be marketed, distribution restrictions, or other conditions of approval;
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●
contain significant safety warnings,
including boxed warnings, contraindications, and precautions;
●
not be approved with label statements necessary or
desirable for successful commercialization; or
●
contain requirements for costly post-market testing
and surveillance, or other requirements, including the submission of a REMS to monitor the safety or efficacy of the products.
The
regulatory approval processes of the FDA and comparable foreign regulatory authorities are lengthy, time consuming and inherently unpredictable.
If we are not able to obtain, or experience delays in obtaining, required regulatory approvals, we will not be able to commercialize
our product candidates as expected, and our ability to generate revenue may be materially impaired.
The
time required to obtain approval by the FDA and comparable foreign regulatory authorities is unpredictable but typically takes many years
following the commencement of clinical trials and depends upon numerous factors, including the substantial discretion of the regulatory
authorities. In addition, approval policies, regulations, or the type and amount of clinical data necessary to gain approval may change
during the course of a product candidate’s clinical development and may vary among jurisdictions and there may be varying interpretations
of data obtained from preclinical studies or clinical trials, any of which may cause delays or limitations in the approval or a decision
not to approve an application. These regulatory requirements may require us to amend our clinical trial protocols, conduct additional
preclinical studies or clinical trials that may require regulatory or IRB approval, or otherwise cause delays in the approval or rejection
of an application. Any delay in obtaining or failure to obtain required approvals could materially adversely affect our ability to generate
revenue from the particular product candidate, which may materially harm our business, financial condition, results of operations, stock
price and prospects.
If
we experience delays in obtaining approval, if we fail to obtain approval of a product candidate or if the label for a product candidate
does not include the labeling claims necessary or desirable for the successful commercialization of that product candidate, the commercial
prospects for such product candidate may be harmed and our ability to generate revenues from that product candidate may be materially
impaired.
Changes
in product candidate manufacturing or formulation may result in additional costs or delay.
As
product candidates are developed through preclinical studies to later stage clinical trials towards approval and commercialization, it
is common that various aspects of the development program, such as manufacturing methods, facilities, equipment and formulation, are
altered along the way in an effort to optimize processes and results. Any of these changes could cause our product candidates to perform
differently and affect the results of planned clinical trials or other future clinical trials conducted with the altered materials. Such
changes may also require additional testing, or notification to, or approval by the FDA or a comparable foreign regulatory authority.
This could delay completion of clinical trials, require the conduct of bridging clinical trials or studies, require the repetition of
one or more clinical trials, increase clinical trial costs, delay approval of our product candidates and/or jeopardize our ability to
commence product sales and generate revenue.
Regulatory
approval by the FDA or comparable foreign regulatory authorities is limited to those specific indications and conditions for which approval
has been granted, and we may be subject to substantial fines, penalties, injunctions, or other enforcement actions, including criminal
actions, if we are determined to be promoting the use of our products for unapproved or “off label” uses, resulting in damage
to our reputation and business.
We
must comply with requirements concerning advertising and promotion for any product candidates for which we obtain marketing approval.
Promotional communications with respect to therapeutics are subject to a variety of legal and regulatory restrictions and continuing
review by the FDA, Department of Justice, Department of Health and Human Services’ Office of Inspector General, state attorneys
general, members of Congress, and the public. When the FDA or comparable foreign regulatory authorities issue regulatory approval for
a product candidate, the regulatory approval is limited to those specific uses and indications for which a product is approved. If we
are not able to obtain FDA approval for desired uses or indications for our product candidates, we may not market or promote them for
those indications and uses, referred to as off label uses, and our business, financial condition, results of operations, stock price
and prospects may be materially harmed. We also must sufficiently substantiate any claims that we make for our products, including claims
comparing our products to other companies’ products, and must abide by the FDA’s strict requirements regarding the content
of promotion and advertising.
While
physicians may choose to prescribe products for uses that are not described in the product’s labeling and for uses that differ
from those tested in clinical trials and approved by the regulatory authorities, we are prohibited from marketing and promoting the products
for indications and uses that are not specifically approved by the FDA. These off label uses are common across medical specialties and
may constitute an appropriate treatment for some patients in varied circumstances. Regulatory authorities in the United States generally
do not restrict or regulate the behavior of physicians in their choice of treatment within the practice of medicine. Regulatory authorities
do, however, restrict communications by biopharmaceutical companies concerning off label use.
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If
we are found to have impermissibly promoted any of our product candidates, we may become subject to significant liability and government
fines. The FDA and other agencies actively enforce the laws and regulations regarding product promotion, particularly those prohibiting
the promotion of off label uses, and a company that is found to have improperly promoted a product may be subject to significant sanctions.
The federal government has levied large civil and criminal fines against companies for alleged improper promotion and has enjoined several
companies from engaging in off label promotion. The FDA has also requested that companies enter into consent decrees or permanent injunctions
under which specified promotional conduct is changed or curtailed.
In
the United States, engaging in the impermissible promotion of our products, following approval, for off label uses can also subject us
to false claims and other litigation under federal and state statutes. These include fraud and abuse and consumer protection laws, which
can lead to civil penalties, and criminal fines and agreements with governmental authorities that materially restrict the manner in which
we promote or distribute therapeutic products and conduct our business. These restrictions could include corporate integrity agreements
and non- or deferred prosecution agreements and could lead to exclusion from participation in federal and state healthcare programs,
and suspension and debarment from government contracts and refusal of orders under existing government contracts. These False Claims
Act lawsuits against manufacturers of drugs and biologics have increased significantly in volume and breadth. In addition, False Claims
Act lawsuits may expose manufacturers to follow-on claims by private payers based on fraudulent marketing practices. This growth in litigation
has increased the risk that a biopharmaceutical company will have to defend a false claims action, pay civil penalties, criminal fines
or restitution, agree to comply with burdensome reporting and compliance obligations, and be excluded from Medicare, Medicaid, or other
federal and state healthcare programs. If we do not lawfully promote our approved products, if any, we may become subject to such litigation
and, if we do not successfully defend against such actions, those actions may have a material adverse effect on our business, financial
condition, results of operations, stock price and prospects.
In
the United States, the promotion of biopharmaceutical products is subject to additional FDA requirements and restrictions on promotional
statements. If after one or more of our product candidates obtains marketing approval the FDA determines that our promotional activities
violate its regulations and policies pertaining to product promotion, it could request that we modify our promotional materials or subject
us to regulatory or other enforcement actions, including issuance of warning letters or untitled letters, suspension or withdrawal of
an approved product from the market, requests for recalls, payment of civil fines, disgorgement of money, imposition of operating restrictions,
injunctions or criminal prosecution, and other enforcement actions. Similarly, industry codes in foreign jurisdictions may prohibit companies
from engaging in certain promotional activities and regulatory agencies in various countries may enforce violations of such codes with
civil penalties. If we become subject to regulatory and enforcement actions our business, financial condition, results of operations,
stock price and prospects will be materially harmed.
Even
if our product candidates receive regulatory approval, we will be subject to ongoing obligations and continued regulatory review, which
may result in significant additional expense and limit how we manufacture and market our products.
Any
product candidate for which we obtain marketing approval will be subject to extensive and ongoing requirements of and review by the FDA
and comparable foreign regulatory authorities, including requirements related to the manufacturing processes, post approval clinical
data, labeling, packaging, distribution, adverse event reporting, shortage reporting, risk management plans, supply chain security, storage,
recordkeeping, export, import, advertising, marketing, and promotional activities for such product. These requirements further include
submissions of safety and other post-marketing information, including manufacturing deviations and reports, registration and listing
requirements, the payment of annual fees, continued compliance with current Good Manufacturing Practice, or cGMP, requirements relating
to manufacturing, quality control, quality assurance, and corresponding maintenance of records and documents, and good clinical practices,
or GCPs, for any clinical trials that we conduct post approval.
The
FDA and comparable foreign regulatory authorities will continue to closely monitor the safety profile of any product even after approval.
If the FDA or comparable foreign regulatory authorities become aware of new safety information after approval of any of our product candidates,
they may withdraw approval, issue public safety alerts, require labeling changes or establishment of a REMS or similar strategy, impose
significant restrictions on a product’s indicated uses or marketing, or impose ongoing requirements for potentially costly post
approval studies or post-market surveillance. Any such restrictions could limit sales of the product.
We
and any of our suppliers or collaborators, including our contract manufacturers, could be subject to periodic unannounced inspections
or remote regulatory assessments by the FDA to monitor and ensure compliance with cGMPs and other FDA regulatory requirements. Application
holders must further notify the FDA, and depending on the nature of the change, obtain FDA preapproval for product and manufacturing
changes.
In
addition, later discovery of previously unknown adverse events or that the product is less effective than previously thought or other
problems with our products, manufacturers or manufacturing processes, or failure to comply with regulatory requirements both before and
after approval, may yield various negative results, including:
●
restrictions on manufacturing, distribution,
or marketing of such products;
●
restrictions on the labeling, including required additional
warnings, such as black boxed warnings, contraindications, precautions, and restrictions on the approved indication or use;
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●
modifications to promotional pieces;
●
issuance of corrective information;
●
requirements to conduct post-marketing studies or other
clinical trials;
●
clinical holds or termination of clinical trials;
●
requirements to establish or modify a REMS or similar
strategy;
●
changes to the way the product candidate is administered;
●
liability for harm caused to patients or subjects;
●
reputational harm;
●
the product becoming less competitive;
●
warning, untitled, or cyber letters;
●
suspension of marketing or withdrawal of the products
from the market;
●
regulatory authority issuance of safety alerts, Dear
Healthcare Provider letters, press releases, or other communications containing warnings or other safety information about the product
candidate;
●
refusal to approve pending applications or supplements
to approved applications that we submit;
●
recalls of products;
●
fines, restitution or disgorgement of profits or revenues;
●
suspension or withdrawal of marketing approvals;
●
refusal to permit the import or export of our products;
●
product seizure or detention;
●
FDA debarment, suspension and debarment from government
procurement and non-procurement programs, and refusal of orders under existing government contracts, exclusion from federal healthcare
programs, consent decrees, corporate integrity agreements, or non- or deferred prosecution agreements; or
●
injunctions, the imposition of civil penalties, criminal
fines, or imprisonment.
Any
of these events could prevent us from achieving or maintaining market acceptance of the particular product candidate, if approved, or
could substantially increase the costs and expenses of commercializing such product, which in turn could delay or prevent us from generating
significant revenues from its marketing and sale. Any of these events could further have other material and adverse effects on our operations
and business and could adversely impact our business, financial condition, results of operations, stock price and prospects.
The
FDA’s policies or those of comparable foreign regulatory authorities may change and additional government regulations may be enacted
that could prevent, limit or delay regulatory approval of our product candidates, limit the marketability of our product candidates,
or impose additional regulatory obligations on us. Changes in medical practice and standard of care may also impact the marketability
of our product candidates.
If
we are slow or unable to adapt to changes in existing requirements, standards of care, or the adoption of new requirements or policies,
or if we are not able to maintain regulatory compliance, we may lose any marketing approval that we may have obtained and be subject
to regulatory enforcement action.
Should
any of the above actions take place, we could be prevented from or significantly delayed in achieving profitability. Further, the cost
of compliance with post approval regulations may have a negative effect on our operations and business and could adversely impact our
business, financial condition, results of operations, stock price and prospects.
Risks
related to commercialization
We
face significant competition from other biopharmaceutical and biotechnology companies, academic institutions, government agencies, and
other research organizations, which may result in others discovering, developing or commercializing products more quickly or marketing
them more successfully than us. If their product candidates are shown to be safer or more effective than ours, our commercial opportunity
may be reduced or eliminated.
The
development and commercialization of cancer immunotherapy products is characterized by rapidly advancing technologies, intense competition
and a strong emphasis on proprietary rights. We face competition with respect to our current product candidates, and will face competition
with respect to any product candidates that we may seek to develop or commercialize in the future, from major biopharmaceutical companies,
specialty biopharmaceutical companies, and biotechnology companies worldwide. There are a number of large biopharmaceutical and biotechnology
companies that currently market and sell products or are pursuing the development of products for the treatment of solid tumors, including
oncolytic immunotherapy and cancer vaccine approaches. Potential competitors also include academic institutions, government agencies,
and other public and private research organizations that conduct research, seek patent protection, and establish collaborative arrangements
for research, development, manufacturing, and commercialization.
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While
our product candidates are intended to be used in combination with other drugs with different mechanisms of action, if and when marketed
they will still compete with a number of drugs that are currently marketed or in development that also target cancer. To compete effectively
with these drugs, our product candidates will need to demonstrate advantages in clinical efficacy and safety compared to these competitors
when used alone or in combination with other drugs.
Our
commercial opportunities could be reduced or eliminated if our competitors develop and commercialize products that are safer, more effective,
have fewer or less severe side effects, are easier to administer or are less expensive alone or in combination with other therapies than
any products that we may develop alone or in combination with other therapies. Our competitors also may obtain FDA or comparable foreign
regulatory authority approval for their products more rapidly than we may obtain approval for ours, which could result in our competitors
establishing a strong market position before we are able to enter the market. Further, depending on the specific competing product, earlier
approval of a competitor’s products could block us from receiving approval and could require that we change our development strategy.
In addition, our ability to compete may be affected in many cases by insurers or other third-party payors coverage decisions or third-party
intellectual property rights that another may allege are violated by our product candidates.
Certain
of the companies with which we are competing or may compete in the future have significantly greater financial resources and expertise
in research and development, manufacturing, preclinical testing, conducting clinical trials, obtaining regulatory approvals, and marketing
approved products than we do. Mergers and acquisitions in the biopharmaceutical and biotechnology industries may result in even more
resources being concentrated among a smaller number of our competitors. Early stage companies may also prove to be significant competitors,
particularly through collaborative arrangements with large and established companies. These third parties compete with us in recruiting
and retaining qualified scientific and management personnel and establishing clinical trial sites and patient registration for clinical
trials, as well as in developing or acquiring technologies complementary to, or necessary for, our programs. If we are unable to successfully
compete with these companies our business, financial condition, results of operations, stock price and prospects may be materially harmed.
If
we are unable to establish effective marketing, sales and distribution capabilities or enter into agreements with third parties to market
and sell our product candidates, if they are approved, the revenues that we generate may be limited and we may never become profitable.
If
and when our product candidates receive marketing approval, we intend to commercialize our product candidates on our own in the United
States and potentially with pharmaceutical or biotechnology partners in other geographies. In order to commercialize our products, we
must continue to build our marketing, sales, and distribution capabilities or make arrangements with third parties to perform these services,
and we may not be successful in doing so. We have incurred and we expect we will continue to incur expenses prior to product launch or
even approval in order to recruit a sales force and develop a marketing and sales infrastructure. If a commercial launch is delayed as
a result of FDA or comparable foreign regulatory authority requirements or other reasons, we would incur these expenses prior to being
able to realize any revenue from sales of our product candidates. Our sales force and marketing teams may not be successful in commercializing
our product candidates. This may be costly, and our investment would be lost if we cannot retain or reposition our sales and marketing
personnel.
We
may also or alternatively decide to collaborate with third-party marketing and sales organizations to commercialize any approved product
candidates in the United States, in which event, our ability to generate product revenues may be limited. To the extent we rely on third
parties to commercialize any products for which we obtain regulatory approval, we may receive less revenues than if we commercialized
these products ourselves, which could materially harm our prospects. In addition, we would have less control over the sales efforts of
any other third parties involved in our commercialization efforts, and could be held liable if they failed to comply with applicable
legal or regulatory requirements.
We
have no prior experience in the marketing, sale, and distribution of biopharmaceutical products, and there are significant risks involved
in building, managing, growing and operating a commercial infrastructure. The establishment and development of commercial capabilities,
including compliance plans, to market any products we may develop is, and will continue to be expensive and time consuming and could
delay any product launch, and we may not be able to successfully develop this capability. We have and will continue to compete with other
biopharmaceutical and biotechnology companies, including oncology-focused companies, to recruit, hire, train, manage, and retain marketing
and sales personnel, which is expensive and time consuming and could delay any product launch. Developing our sales capabilities may
also divert resources and management attention away from product development.
In
the event we are unable to develop an effective marketing and sales infrastructure, we may not be able to commercialize our product candidates
in the United States or elsewhere in an effective manner, which could limit our ability to generate product revenues and materially harm
our business, financial condition, results of operations, stock price and prospects. Factors that may inhibit our efforts to commercialize
our product candidates include:
●
the inability to recruit, train,
manage, and retain adequate numbers of effective sales and marketing personnel;
●
the inability of sales personnel to obtain access to
physicians or persuade adequate numbers of physicians to prescribe our product candidates;
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●
our inability to effectively oversee
a geographically dispersed sales and marketing team;
●
the costs associated with training sales and marketing
personnel on legal and regulatory compliance matters and monitoring their actions;
●
an inability to secure adequate coverage and reimbursement
by government and private health plans;
●
the clinical indications for which the products are
approved and the claims that we may make for the products;
●
limitations or warnings, including distribution or
use restrictions, contained in the products’ approved labeling;
●
any distribution and use restrictions imposed by the
FDA or comparable foreign regulatory authorities or to which we agree as part of a mandatory REMS or voluntary risk management plan;
●
third-party intellectual property rights that another
may allege are violated by our product candidates;
●
liability for sales or marketing personnel who fail
to comply with the applicable legal and regulatory requirements;
●
the lack of complementary products to be offered by
sales personnel, which may put us at a competitive disadvantage relative to companies with more extensive product lines; and
●
unforeseen costs and expenses associated with creating
an independent sales and marketing organization or engaging a contract sales organization.
As
we continue to evolve from a company primarily involved in research and development to a company also expected to be involved in commercialization,
we may encounter difficulties in managing our growth and expanding our operations successfully.
We
anticipate that, as our operations expand and, assuming that our development, testing, studies and trials are successful, we will need
to expand our internal manufacturing, marketing and sales capabilities. Managing our future growth will impose significant added responsibilities
on members of our management team and will be time consuming and costly. We must be able to manage our development efforts effectively;
manage our clinical trials effectively; hire, train and integrate additional management, development, administrative and sales and marketing
personnel; and improve managerial, development, operational and finance systems, all of which may impose a strain on our administrative
and operational infrastructure.
Our
product candidates are based on a novel approach to the treatment of cancer, which makes it difficult to predict the time and cost of
product candidate development.
There
can be no assurance that any development problems we experience in the future will not cause significant delays or unanticipated costs,
or that such development problems can be solved. Should we encounter development problems, including unfavorable preclinical or clinical
trial results, the FDA and foreign regulatory authorities may refuse to approve our product candidates, or may require additional information,
tests, or trials, which could significantly delay product development and significantly increase our development costs. Moreover, even
if we are able to provide the requested information or trials to the FDA, there would be no guarantee that the FDA would accept them
or approve our product candidates. We may also experience delays in developing a sustainable, reproducible and scalable manufacturing
process, or developing or qualifying and validating product release assays, other testing and manufacturing methods, and our equipment
and facilities in a timely manner, which may prevent us from completing our clinical trials or commercializing our product candidates
on a timely or profitable basis, if at all.
In
addition, the clinical trial requirements of the FDA and comparable foreign regulatory authorities and the criteria these regulators
use to determine the safety and efficacy of a product candidate vary substantially according to the type, complexity, novelty and intended
use and market of the potential products. The FDA and comparable foreign regulatory authorities have limited experience with the approval
of oncolytic immunotherapies. Limited immunotherapies have received FDA approval to date. Any product candidates that are approved may
be subject to extensive post approval regulatory requirements, including requirements pertaining to manufacturing, distribution, and
promotion. We may need to devote significant time and resources to compliance with these requirements.
If
our product candidates do not achieve broad market acceptance, the revenues that we generate from their sales may be limited, and we
may never become profitable.
We
have never commercialized a product candidate for any indication. Even if our product candidates are approved by the appropriate regulatory
authorities for marketing and sale, they may not gain acceptance among physicians, patients, third-party payors, and others in the medical
community. If any product candidates for which we obtain regulatory approval do not gain an adequate level of market acceptance, we could
be prevented from or significantly delayed in achieving profitability.
Additionally,
efforts to educate the medical community and third party payors on the benefits of our product candidates may require significant resources
and may not be successful. If any of our product candidates is approved but does not achieve an adequate level of market acceptance,
we could be prevented from or significantly delayed in achieving profitability.
18
The
degree of market acceptance of any of our product candidates will depend on a number of factors, some of which are out of our control,
including the following:
●
the efficacy of our product
candidates in combination with marketed checkpoint blockade drugs;
●
the commercial success of the checkpoint blockade
drugs with which our products are co-administered;
●
the prevalence and severity of adverse events
associated with our product candidates or those products with which they are co-administered;
●
the clinical indications for which the products
are approved and the approved claims that we may make for the products;
●
limitations or warnings contained in the product’s
FDA-approved labeling or those of comparable foreign regulatory authorities, including potential limitations or warnings for our
product candidates that may be more restrictive than other competitive products;
●
changes in the standard of care for the targeted
indications for our product candidates, which could reduce the marketing impact of any claims that we could make following FDA approval
or approval by comparable foreign regulatory authorities, if obtained;
●
the relative convenience and ease of administration
of our product candidates by direct injection into tumors, a less common method for the administration of oncology therapies than
systemic administration, which may result in slower adoption of our therapies;
●
the relative convenience and ease of administration
of any products with which our product candidates are co-administered;
●
the cost of treatment compared with the economic
and clinical benefit of alternative treatments or therapies;
●
the availability of adequate coverage or reimbursement
by third parties, such as insurance companies and other healthcare payors, and by government healthcare programs, including Medicare
and Medicaid;
●
the price concessions required by third party
payors to obtain coverage;
●
the extent and strength of our marketing and
distribution of our product candidates;
●
the safety, efficacy, and other potential
advantages over, and availability of, alternative treatments already used or that may later be approved;
●
distribution and use restrictions imposed
by the FDA or comparable foreign regulatory authorities with respect to our product candidates or to which we agree as part of a
REMS or voluntary risk management plan;
●
the timing of market introduction of our product
candidates, as well as competitive products;
●
our ability to offer our product candidates
for sale at competitive prices;
●
the willingness of the target patient population
to try new therapies and of physicians to prescribe these therapies;
●
the extent and strength of our manufacturing
operations and our third-party manufacturer and supplier support;
●
the actions of companies that market any products
with which our product candidates are co-administered;
●
the approval of other new products;
●
adverse publicity about our product candidates
or any products with which they are co-administered, or favorable publicity about competitive products; and
●
potential product liability claims.
The
successful commercialization of our product candidates, if approved, will depend in part on the extent to which government authorities
and health insurers establish adequate reimbursement levels and pricing policies.
Sales
of any approved drug candidate will depend in part on the availability of coverage and reimbursement from third-party payers such as
government insurance programs, including, but not limited to, Medicare and Medicaid, private health insurers, health maintenance organizations
and other health care related organizations, who are increasingly challenging the price of medical products and services. Accordingly,
coverage and reimbursement may be uncertain. Adoption of any drug by the medical community may be limited if third-party payers will
not offer adequate formulary coverage. Additionally, significant uncertainty exists as to the reimbursement status of newly-approved
drugs. Cost control initiatives may decrease coverage and payment levels for any drug and, in turn, the price that we will be able to
charge and/or the volume of our sales. We are unable to predict all changes to the coverage or reimbursement methodologies that will
be applied by private or government payers. Any denial of private or government payer coverage or inadequate reimbursement could harm
our business and reduce our revenue.
In
addition, both the federal and state governments in the United States and foreign governments continue to propose and pass new legislation,
regulations, and policies affecting coverage and reimbursement rates, which are designed to contain or reduce the cost of health care.
Further federal and state proposals and healthcare reforms are likely, which could limit the prices that can be charged for the product
candidates that we develop and may further limit our commercial opportunity. For example, the Inflation Reduction Act of 2022, or IRA,
includes several measures intended to lower the cost of prescription drugs and related healthcare reforms, including limits on price
increases, inflation and non-compliance penalties, and subjecting an escalating number of drugs to annual maximum fair price negotiations
with CMS. We cannot be sure whether additional legislation related to the IRA will be issued or enacted, or what impact, if any, such
changes will have on the profitability of any of our drug candidates, if approved for commercial use, in the future. There also may be
future changes unrelated to the IRA that result in reductions in potential coverage and reimbursement levels for our product candidates,
if approved and commercialized, and we cannot predict the scope of any future changes or the impact that those changes would have on
our operations. Similarly, several states have established prescription drug affordability boards that set upper payment limits (maximum
prices that can be charged for specific drugs) for select high-cost drugs. We cannot be sure whether additional state legislation related
to price caps will be enacted, or what impact, if any, such changes will have on the profitability of any of our drug candidates, if
approved for commercial use, in the future.
19
If
future reimbursement for approved product candidates, if any, is substantially less than we project, or rebate and/or discount, or fees
and obligations associated with them are substantially greater than we expect, our future net revenue and profitability could be materially
diminished.
The
size of the potential market for our product candidates is difficult to estimate and, if any of our assumptions are inaccurate, the actual
markets for our product candidates may be smaller than our estimates.
The
potential market opportunities for our product candidates are difficult to estimate and will depend in large part on the drugs with which
our product candidates are co-administered and the success of competing therapies and therapeutic approaches. Our estimates of the potential
market opportunities are predicated on many assumptions, which may include industry knowledge and publications, third-party research
reports, and surveys of clinics. Although we believe that our internal assumptions are reasonable, these assumptions involve the exercise
of significant judgment on the part of our management, are inherently uncertain, and their reasonableness has not been assessed by an
independent source. If any of the assumptions proves to be inaccurate, the actual markets for our product candidates could be smaller
than our estimates of the potential market opportunities.
Risks
Related to the Ownership of Our Securities
We
have a large number of authorized but unissued shares of our common stock which will dilute existing ownership positions when issued.
At
December 31, 2024, our authorized capital stock consists of 225 million shares of common stock, of which approximately 224.3 million
remain available for issuance, including shares of common stock issuable upon the exercise of outstanding derivative securities. Our
management will continue to have broad discretion to issue shares of our common stock in a range of transactions, including capital-raising
transactions, mergers, acquisitions and other transactions, without obtaining stockholder approval, unless stockholder approval is required
under law or the rules of Nasdaq or any other trading market on which our common stock may be listed. If our management determines it
be appropriate to issue shares of our common stock from the large pool of authorized but unissued shares for any purpose in the future
and is not required to obtain stockholder approval, your ownership position would be diluted without your further ability to vote on
that transaction.
Our
common stock may be affected by limited trading volume and price fluctuations, which could adversely impact the value of our common stock.
Our
common stock has experienced, and is likely to experience in the future, significant price and volume fluctuations, which could adversely
affect the market prices of our common stock without regard to our operating performance. In addition, we believe that factors such as
quarterly fluctuations in our financial results and changes in the overall economy or the condition of the financial markets could cause
the market prices of our common stock and warrants to fluctuate substantially. These fluctuations may also cause short sellers to periodically
enter the market in the belief that we will have poor results in the future. We cannot predict the actions of market participants and,
therefore, can offer no assurances that the market for our common stock and warrants will be stable or appreciate over time.
We
may need, but be unable, to obtain additional funding on satisfactory terms, which could dilute our stockholders or impose burdensome
financial restrictions on our business.
We
have relied upon cash from financing activities, and, in the future, we hope to rely on revenues generated from operations to fund the
cash requirements of our activities. However, there can be no assurance that we will be able to generate any significant cash from our
operating activities in the future. Future financing may not be available on a timely basis, in sufficient amounts or on terms acceptable
to us, if at all. Any debt financing or other financing of securities senior to the common stock will likely include financial and other
covenants that will restrict our financing and/or operational flexibility. Any failure to comply with these covenants would have a material
adverse effect on our business, prospects, financial condition and results of operations because we could lose our existing sources of
funding, and our ability to secure new sources of funding could be impaired.