Viewray, Inc. · OTC:VRAYQ
Viewray — Investor Day (November 2022)
73 slides from Viewray's investor day presentation, Nov 17, 2022
Slide 1: Investor Day Nov. 17, 2022
INVESTOR DAY ViewRay NOV. 17 20 22 Exhibit 99.1
Slide 2: ViewRay
ViewRay NOV. 17 20 22
Slide 3: Investor Day
INVESTOR DAY ViewRay NOV. 17 20 22
Slide 4: Forward-looking statement
©2022 ViewRay Technologies, Inc. All rights reserved. 4 Forward-looking statement This presentation contains forward-looking statements within the meaning of Section 27A of the Private Securities Litigation Reform Act. Statements in this presentation that are not purely historical are forward-lookin
Slide 5: Agenda
5 • Welcome and overview Scott Drake, President and Chief Executive Officer • Commercial update Paul Ziegler, Chief Commercial Officer • Clinical update Martin Fuss, MD, Chief Medical Officer • KOL panel Dr. S. Hoffe, Dr. H. Nagar, Dr. J. Good, Paul Gearing Moderator: Hailey Austin, Director, Clinic
Slide 6: The difference is our people: vision, mission, values
©2022 ViewRay Technologies, Inc. All rights reserved. 6 T H E D I F F E R E N C E I S O U R P E O P L E OUR VISION OUR MISSION Treat and prove what others can’t. OUR VALUES We are re-envisioning radiation therapy to conquer cancer— because our lives depend on it. • Together • Accountability • Integr
Slide 7: The how: talent, clarity, culture, execution
Attract, retain, develop The best talent on the planet Strategic clarity Operate with strategic clarity Culture Live our shared values the HOW Execute As if lives depend on it because in our case indeed they do! Organizational and individual clarity—rigorous execution 7
Slide 8: Personalized and precise care
Personalized and Precise Care More and more consideration is given to quality of life beyond treatment and increased effort to mitigate side effects. Evolution from aggressive, invasive, blunt treatment to highly targeted, minimally invasive, personalized therapy. TRENDS CANCER CARE Surgery Radiatio
Slide 9: Dose vs. toxicity paradigm
©2022 ViewRay Technologies, Inc. All rights reserved. 9 Dose vs. toxicity paradigm Lower dose ~20-40 treatments Limited treatment options & higher toxicity Paradigm broken – ablative dose with low to no grade 3+ toxicity Conventional MRIdian® Paradigm shift is clear Ablative dose 5 or fewer treatmen
Slide 10: Customers' definition of clinical success
©2022 ViewRay Technologies, Inc. All rights reserved. 10 Customers’ definition of clinical success The MRIdian 5 Ablative dose 1 Tight margins 2 No fiducials 3 5 or fewer fractions 4 No to low grade 3+ toxicity 5 Among alternatives in the clinical landscape, we have found MRIdian’s evidence fits thi
Slide 11: Strategic pillars
Innovation Market awareness Clinical data Therapy adoption Customers & patients need to be aware that short course, highly effective therapy, with low levels of side effects is available TODAY! Our clinical, innovation, and awareness efforts lead current customers to expand their MRIdian footprint &
Slide 12: MRIdian – differentiated technology
©2022 ViewRay Technologies, Inc. All rights reserved. 12 MRgRT1 Conventional RT2,3 Diagnostic MRI imaging Daily adaptive workflow with unlimited re-optimization Parallel, collaborative workflow with remote access 3D, multiplanar tracking and automated beam control Integrated patient display Fits in
Slide 13: Focused clinical strategy
©2022 ViewRay Technologies, Inc. All rights reserved. 13 Brain FOCUSED Clinical strategy Tough-to-treat cancers Common cancers Pancreas Lung Breast Prostate 1
Slide 14: Focused disease sites: patient-centric roadmap
©2022 ViewRay Technologies, Inc. All rights reserved. 14 Focused disease sites Patient-centric roadmap Approved for external investor use only GOALS: - Local control - Extend survival - Short course treatment - Low to no toxicity Tough-to-treat cancers e.g., pancreas, ultra/central lung & brain Comm
Slide 15: Market awareness, clinical research, advocacy
Market awareness Patient awareness Clinical research Advocacy interests Outstanding pancreatic data demonstrating 53%, 2-year survival on MRIdian. PanCAN patient support staff refers patients to MRIdian centers. MIRAGE phase 3 RCT data from UCLA demonstrated a significant reduction in GU toxicity. U
Slide 16: Therapy adoption: MRIdian vs. market
©2022 ViewRay Technologies, Inc. All rights reserved. 16 Therapy adoption MRIdian vs. market MRIdian vs. market 300 250 86% 13% patients per year Throughput SBRT adoption shorter course treatment 1/3 MRIdian customers have already reinvested, or are looking to reinvest in add’l MRIdian systems nearl
Slide 17: MRIdian SMART reducing patient disruption
©2022 ViewRay Technologies, Inc. All rights reserved. 17 MRIdian SMART Reducing patient disruption Conventional RT (45 fractions) Week 1 Week 9 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 SUN MON TUE WED THR FRI SAT x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x
Slide 18: MRIdian SMART reducing patient disruption
©2022 ViewRay Technologies, Inc. All rights reserved. 18 MRIdian SMART Reducing patient disruption MRIdian SMART (<5 fractions) Conventional RT (45 fractions) Week 1 Week 9 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 SUN MON TUE WED THR FRI SAT SUN MON TUE WED THR FRI SAT x x x x x x x x x x x
Slide 19: MRIdian SMART reducing patient disruption
©2022 ViewRay Technologies, Inc. All rights reserved. 19 MRIdian SMART Reducing patient disruption Week 1 Week 9 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Patients get back to what matters most… - back t
Slide 20: MRIdian market adoption
20 93% patients treated since 2014 CAGR 58 systems installed around the world* MRIdian systems in planning or currently being installed MRIdian 80~ MARKET Adoption *FY ‘22 18
Slide 21: Accelerating revenue growth
21 Accelerating revenue growth • 2020 – 2022 top 10% of Med Tech growth • >2x business in the next 3 years >30% CAGR 2020 - 2022 2023 - 2025 ~32% CAGR
Slide 22: Positioned well for next phase of growth
©2022 ViewRay Technologies, Inc. All rights reserved. 22 Positioned well for next phase of growth Tailwinds Headwinds • Incredible patient impact • Innovation + clinical pipeline • Strong commercial backlog + interest • Durable revenue growth • P&L Leverage • Supply chain • A/R timing
Slide 23: Delivering growth and value 2023-2025
©2022 ViewRay Technologies, Inc. All rights reserved. 23 MSD>30% Delivering growth & value ’23 – ‘25 >30% Revenue growth Strong sales growth exceeding Med Tech sector Margin expansion Healthy gross margin expansion of >2,000 bps Meaningful leverage Significantly faster sales growth than operating ex
Slide 24: KCM Spot
KCM Spot 24
Slide 25: Commercial
VIEW RAY Commercial 25
Slide 26: Commercial execution: strategic pillars
26 Commercial execution Innovation Market awareness Clinical data Therapy adoption STRATEGIC PILLARS Drive therapy adoption to create competition & accelerate demand Differentiation ‒ See, Shape, Strike ‒ Voice of customer ‒ Innovation realized Advocacy ‒ Physicians ‒ Administrators ‒ Patients Value
Slide 27: Global patient opportunity
©2022 ViewRay Technologies, Inc. All rights reserved. 27 Global patient opportunity 2M 9.5M 19M treated patients addressable patients new diagnoses 50% of cancer patients will receive radiation therapy at some point during the course of their treatment. Global cancer diagnosis Newly diagnosed patien
Slide 28: Global market opportunity: TAM, SAM, target market
©2022 ViewRay Technologies, Inc. All rights reserved. 28 SAM 3,700 Centers / 10,460 Linacs TM 3,250 Centers / 9,200 Linacs TAM 7,900 Centers / 14,250 Linacs Global market opportunity Total addressable market MRIdian competes for 95% of centers/linacs Service addressable market Targeting 2+ vault cen
Slide 29: 10 year anniversary of innovation
10YEAR ANNIVERSARY of INNOVATION MRIdian Linac FDA clearance MRIdian SmartVISION & HSMLC FDA clearance MRIdian A3i FDA clearance 2021 DEC 2019 FEB 2017 FEB MRIdian Cobalt FDA clearance 2012 FEB 29
Slide 30: MRIdian SMART: See, Shape, Strike
©2022 ViewRay Technologies, Inc. All rights reserved. 30 MRIdian SMART Stereotactic MR-guided Adaptive Radiotherapy SHAPE STRIKE SEE SEE SHAPE STRIKE High-value MRI On-table adaptive re- planning Real-time, 3D tissue tracking and automated beam control
Slide 31: Newest innovation in MRgRT, 4th generation
©2022 ViewRay Technologies, Inc. All rights reserved. 31 • Streamlined on-table adaptive workflow • Expanded clinical utility Newest innovation in MRgRT …intelligently CONTOURING ADAPTING BEAM GATING Auto- Auto- Auto- 4TH GEN
Slide 32: MRIdian A3i and BrainTx
©2022 ViewRay Technologies, Inc. All rights reserved. 32 MRIdian A3i and BrainTx™ Parallel, collaborative, remote workflow BrainTx™ Integrated patient displayMultiplanar, 3D tissue tracking and beam gating
Slide 33: 58 systems installed, 27K patients treated
©2022 ViewRay Technologies, Inc. All rights reserved. 33 20172012 2020 20212019 1. Internal and historical company data 2. MRIdian usage data as of 7.1.2022 • Today 58 systems installed globally* • ~1/3 of MRIdian customers have already reinvested, or are looking to reinvest in add’l MRIdian systems
Slide 34: Therapy adoption drives growth
©2022 ViewRay Technologies, Inc. All rights reserved. 34 Therapy adoption drives growth Successful programs drive competition, expansion & reinvestment 58 programs globally* 80 systems in planning or installation ~ Y1 Y2 Y3 Y4 Y5 Y6 Y7 Y8 Y9 Y10 Annual service revenue x2 x2x2 10YR replacement *FY ‘2
Slide 35: Clinical strategy
> VIEW RAY Clinical strategy 35
Slide 36: Focused clinical strategy
©2022 ViewRay Technologies, Inc. All rights reserved. 36 Brain Lung Pancreas Breast Prostate FOCUSED Clinical strategy Tough-to-treat cancers Common cancers 34
Slide 37: Radiation therapy considerations
©2022 ViewRay Technologies, Inc. All rights reserved. 37 Radiation therapy considerations Often resulting in insufficient doses for long term benefit Safely deliver radiation dose while minimizing side effects Tolerance of healthy tissue dictates radiation dose Do no harm!
Slide 38: Safety is top of mind
©2022 ViewRay Technologies, Inc. All rights reserved. 38 J Med Phys, 2011;36:192-197J Gastrointest Oncol 2014;5(3):236-246 Safety is top of mind
Slide 39: Radiation therapy limitations
©2022 ViewRay Technologies, Inc. All rights reserved. 39 Radiation therapy limitations • Patient anatomy changes from day to day — shape and size of tumor and surrounding organs • Intra-fraction motion — during treatment respiratory motion and changes in filling status Motion management
Slide 40: Planning target volume: concept and limitations
©2022 ViewRay Technologies, Inc. All rights reserved. 40 Planning Target Volume: concept and limitations OAR 1 Target OAR 2 Prostate RT Pancreas RT
Slide 41: Planning target volume: concept and limitations
©2022 ViewRay Technologies, Inc. All rights reserved. 41 OAR 1 Target OAR 2 Prostate RT Typical margins 3-5 mm Pancreas RT Planning Target Volume: concept and limitations
Slide 42: Planning target volume: concept and limitations
©2022 ViewRay Technologies, Inc. All rights reserved. 42 OAR 1 Planning Target Volume: concept and limitations Target OAR 2 Prostate RT Typical margins 3-5 mm Pancreas RT OAR Target
Slide 43: Planning target volume: concept and limitations
©2022 ViewRay Technologies, Inc. All rights reserved. 43 OAR Target OAR 1 Target OAR 2 Prostate RT Typical margins 3-5 mm Pancreas RT Planning Target Volume: concept and limitations
Slide 44: Planning target volume: concept and limitations
©2022 ViewRay Technologies, Inc. All rights reserved. 44 OAR cTarget OAR 1 Target OAR 2 Prostate RT Typical margins 3-5 mm Pancreas RT Typical margins 5-15 mm Planning Target Volume: concept and limitations
Slide 45: Motion management in an ideal world
©2022 ViewRay Technologies, Inc. All rights reserved. 45 Motion management Radiation therapy In an ideal world Optimal assessment of the position of the tumor and organ risk immediately prior to radiation dose delivery Ability to adjust original dose plan if changes were observed Continuously tracki
Slide 46: Diagnostic-quality MR imaging (See)
©2022 ViewRay Technologies, Inc. All rights reserved. 46 Diagnostic-quality MR imaging Optimal imaging of target and organs at risk prior to RT SEE MRIdian® Ref: https://doi.org/10.1186/s13014-021-01758-w
Slide 47: Diagnostic-quality MR imaging (See)
©2022 ViewRay Technologies, Inc. All rights reserved. 47 Diagnostic-quality MR imaging Optimal imaging of target and organs at risk prior to RT SEE MRIdian® Ref: sciencedirect.com/science/article/abs/pii/S1055320721000491
Slide 48: Precise and personalized adaptation (Shape)
©2022 ViewRay Technologies, Inc. All rights reserved. 48 Precise and personalized Adaptation of original treatment plan when medically necessary SHAPE MRIdian® Initial plan Predicted dose Adapted plan
Slide 49: The MRI controls the beam (Strike)
©2022 ViewRay Technologies, Inc. All rights reserved. 49 The MRI controls the beam Real-time, 3D tissue tracking and automated beam control STRIKE MRIdian®
Slide 50: The MRIdian difference
50 • Allows clinicians to fundamentally re- think radiation therapy • Provides opportunity for radiation dose escalation without increasing the risk for normal tissue toxicity • Enables ablative, shortened treatment courses (SBRT at BED10=>100 Gy) The MRIdian difference MRIdian overcomes the limitat
Slide 51: ASTRO 2022 Phase II: SMART pancreas
51 Clinical trial results ASTRO 2022 Phase II: SMART pancreas (tough-to-treat cancer)
Slide 52: SMART pancreas Phase II results
52 Phase II, single arm, multi-center, international, n=136 Study design Ablative SMART therapy (50 Gy in 5 fractions, BED10=100 Gy) Treatment method Primary: 90-day grade 3 or higher toxicity, hypothesis <16% Secondary: 2-year survival, distant recurrence free survival, quality of live Endpoints 01
Slide 53: Tough-to-treat: pancreas and lung
©2022 ViewRay Technologies, Inc. All rights reserved. 53 Pancreas Lung Tough-to-treat Goal: extend survival LAP-ABLATE to prove MRIdian SMART extends survival LAP 07 Standard RT dose 15 months median survival for non-ablative RT + chemo vs ~16 month with chemo alone SMART pancreas Ablative dose Low
Slide 54: ASTRO 2022 Phase III: MIRAGE prostate
54 Clinical trial results ASTRO 2022 Phase III: MIRAGE prostate (common cancer)
Slide 55: MIRAGE prostate Phase III results
55 Phase III, randomized, single- institution Study design CBCT-guided vs MR-guided SBRT Treatment method Primary: 90-day grade 2 or higher GU and GI toxicity Secondary: biochemical control (PSA control), OS, QOL Endpoints 01 02 03 MRI-guidance leads to a significant reduction in acute physician-sco
Slide 56: More common cancers: prostate and breast
©2022 ViewRay Technologies, Inc. All rights reserved. 56 More common cancers Goal: enhance quality of life FORT & SHORTER To move intact prostate SBRT to 2 fx and reduce the post-op treatment schedule without increasing toxicity Mostly long-course treatment (28-45 fx) Standard dose SBRT (36.25 Gy) s
Slide 57: KOL panel
VIEW RAY KOL panel 57
Slide 58: Thought leaders
©2022 ViewRay Technologies, Inc. All rights reserved. 58 Thought leaders James Good, MD, PhD Clinical Director of Stereotactic Radiotherapy GenesisCare Sarah Hoffe, MD Section Head, GI Radiation Oncology Director of Radiation Oncology Virtual Reality/Innovation Moffitt Himanshu Nagar, MD Assistant P
Slide 59: ViewRay | Visibly Better
VIEW RAY |VISIBLY BETTER’
Slide 60: Financial outlook
VIEW RAY Financial outlook 60
Slide 61: Delivering growth and value 2023-2025
©2022 ViewRay Technologies, Inc. All rights reserved. 61 MSD>30% Delivering growth & value ’23 – ‘25 >30% Revenue growth Strong sales growth exceeding Med Tech sector Margin expansion Healthy gross margin expansion of >2,000 bps Meaningful leverage Significantly faster sales growth than operating ex
Slide 62: Revenue growth >30% CAGR
©2022 ViewRay Technologies, Inc. All rights reserved. 62 0 75 150 225 300 2020 2021 2022 2023 2024 2025 (i n m ill io ns ) REVENUE Growth >30% CAGR • 7x the RT market from ’20 – ’22 • Top tier Med Tech growth to ’25 • >2x business in the next 3 years 59
Slide 63: Power of the installed base
63 $12M revenue cycles 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Service contracts run for the life of the system – which is typically 10 years At that point we begin a replacement cycle with the sale of a new system and start the cycle all over again begin replacement cycleinitial system s
Slide 64: Gross margin drivers
©2022 ViewRay Technologies, Inc. All rights reserved. 64 Gross margin drivers Revenue growth • Top tier growth • Full utilization of infrastructure Cost down • Process & design enhancement • Insourcing of key parts and components Service efficiency • Improved FSE ratio • Geographic density • Remote
Slide 65: Gross margin targets
©2022 ViewRay Technologies, Inc. All rights reserved. 65 Gross margin 2020 2021 2022 2023 2024 2025 finalSales drop through Service efficiency Cost down 2025 System gross margin • Top tier market growth • Leveraging overhead • Cost down - ~$1mm/system savings Service gross margin • Deliver & capture
Slide 66: Gross margin - system
©2022 ViewRay Technologies, Inc. All rights reserved. 66 Gross margin - system 2020 2021 2022 2023 2024 2025 final2025 >1,500 bps improvement >2,000 bps improvement System gross margin • Top tier market growth • Leveraging overhead • Cost down - ~$1mm/system savings Service gross margin • Deliver &
Slide 67: Gross margin - service
©2022 ViewRay Technologies, Inc. All rights reserved. 67 Gross margin - service 2020 2021 2022 2023 2024 2025 final2025 >1,500 bps improvement >2,000 bps improvement System gross margin • Top tier market growth • Leveraging overhead • Cost down - ~$1mm/system savings Service gross margin • Deliver &
Slide 68: Meaningful operating leverage
©2022 ViewRay Technologies, Inc. All rights reserved. 68 Meaningful operating leverage R&D: • Talent in place to continue strong pace of innovation • Nonrecurring engineering uptick in 2023 to drive cost down project S&M: • Sales force positioned to support higher volumes • Incremental investments t
Slide 69: Growth model
©2022 ViewRay Technologies, Inc. All rights reserved. 69 Growth model Revenue growth • Large underpenetrated TAM • Top tier growth - >30% Margin expansion • Achieve >30% margin (>2,000 bps cumulative expansion) • Leverage on existing overhead • Service efficiency from greater geographic density and
Slide 70: Beyond 2025
©2022 ViewRay Technologies, Inc. All rights reserved. 70 Beyond 2025 • Early innings of TAM penetration • Reaching key milestones on unit economics • On the cusp of replacement cycle 67
Slide 71: More patients, more proof, more promise
More patients More proof More promise 71
Slide 72: Q & A
72 Q & A Email questions to investors@viewray.com
Slide 73: ViewRay | Visibly Better
VIEW RAY |VISIBLY BETTER’