NovoCure
Annual Report 2018

Plain-text annual report

from day one forward N O V O C U R E 2 0 1 8 A N N U A L R E P O R T 1 For an interactive version of our annual report, please visit 2018.novocure.com. NOVOCURE 2018 ANNUAL REPORT a global oncology company with a proprietary platform 2 5 FDA-APPROVED INDICATIONS INDICATIONS IN LATE-STAGE PIPELINE 140+ ISSUED PATENTS GLOBALLY $248M NET REVENUES FY 2018 40% $246M REVENUE GROWTH 2018 COMPARED TO 2017 CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS In 2018, we made a commitment to put into words our vision, mission and values. Our 2018 report focuses on our mission and values that support our overarching patient-forward vision to make a difference in cancer. The words are new, but the sentiments – who we are as a company and the mission we are striving to achieve – have been the foundation of Novocure from day one and will continue to unify us as we move forward. Together with our patients, we strive to extend survival in some of the most aggressive forms of cancer by developing and commercializing our innovative therapy. 333 NOVOCURE 2018 ANNUAL REPORT TOTAL PERSCRIPTIONS 23% 2018 VS. 2017 2,808 5,060 2,383 $248,069 4,119 1,834 $177,026 1,091 2016 2017 2018 (USD in thousands) $82,888 2017 2016 2018 In the United States, total prescriptions grew more than 20 percent in 2018 compared to the prior year. We continue to focus the tremendous efforts of our sales and marketing teams on increasing oncologists’ confidence and comfort describing our clinical benefits to patients and on increasing adoption in the community setting, particularly among radiation oncologists. In the U.S., we also rolled out several direct-to-patient initiatives, including groundbreaking Facebook Live programs, an expanded patient ambassador program, and an updated direct-to-patient campaign highlighting Optune’s long- term survival and quality-of-life data. 2016 2017 2018 We are grateful for the trust and confidence of our patients, prescribers and shareholders. I am particularly grateful for the dedication and hard work of my Novocure colleagues who make our progress possible. Driving commercial adoption of Optune Optune is proven to provide quality, long-term survival for patients with newly diagnosed GBM. Since our first FDA approval, we have made significant investments to establish our commercial infrastructure around the world. To date, we have treated more than 10,000 GBM patients and have posted 16 consecutive quarters of active patient growth since the initial presentation of our EF-14 trial data in newly diagnosed GBM. In 2018, prescriptions for patients with newly diagnosed GBM grew 40 percent year-over-year. 4,119 2,808 “Today, we are a global oncology company with two FDA-approved indications, a third indication under FDA review and four additional phase 3 clinical programs.” 2016 2017 TOTAL ACTIVE PATIENTS 5,060 2,383 $248,069 4,119 30% 2018 VS. 2017 2,808 1,834 1,091 $177,026 In EMEA, we focused primarily on the German market. We were also active in Austria, Switzerland and Israel. Total prescriptions grew 14 percent in 2018 compared to the prior year. Notably, net revenues grew more than 70 percent year-over-year, driven by a meaningful improvement in the reimbursement approval rate of individual claims in Germany and by national reimbursement in Austria. In January 2019, we announced receipt of national reimbursement in Sweden. Our commercial launch in Sweden is underway. $82,888 2016 2017 2018 2016 2017 2018 2016 2017 2018 (USD in thousands) 5,060 TOTAL OPERATING REVENUE 2,383 $248,069 1,834 40% 2018 VS. 2017 1,091 $177,026 $82,888 2018 2016 2017 2018 2016 2017 2018 (USD in thousands) 2018 was our first full year of commercial activity in Japan. We signed contracts with more than 100 hospitals to provide Optune; we filled 162 prescriptions and delivered more than $6.3 million in net revenues. We remain enthusiastic about the opportunity to grow adoption of Optune in this key market. In September 2018, we announced a strategic collaboration with Zai Lab including a license agreement for Tumor Treating Fields in Greater China and a clinical development cooperation agreement. Zai Lab shares our patient-forward vision and our business values. Zai hit the ground running and already has begun to treat GBM patients in Hong Kong. As we enter 2019, we believe there is significant opportunity for further growth in our GBM business across geographies. Our teams continue to focus on driving adoption through physician education, clinical research and, where permitted, direct-to-patient outreach. We know there are many more patients who can benefit from Optune than are currently on therapy. 5 dear fellow shareholders, Bill Doyle, Executive Chairman Cancer, the second leading cause of death worldwide, presents one of the principal healthcare challenges of our time. Novocure was founded in 2000 to develop Tumor Treating Fields, a new approach to treating cancer that targets the electrical properties of proteins to kill dividing cancer cells. Today, we are a global oncology company with two FDA-approved indications, a third indication under FDA review and four additional phase 3 clinical programs. At Novocure, delivering better outcomes for patients with some of the most aggressive forms of cancer drives our work each day. 2018 was a particularly productive year We entered 2018 with two clear priorities: first, to drive commercial adoption of Optune for the treatment of glioblastoma (GBM); and second, to advance our clinical pipeline. We finished the year with growth in our GBM business globally and tangible progress in our clinical development programs. Highlights included presenting our STELLAR data in malignant pleural mesothelioma (MPM), enrolling the first patient in our phase 3 pivotal PANOVA-3 trial for pancreatic cancer, signing our collaboration agreement with Zai Labs to bring Tumor Treating Fields to China, receiving national reimbursement in Sweden, and finishing the year with almost $250 million in annual revenue. 4 phase 2 pilot milestones PANOVA data (1st cohort) 2016 PANOVA data (2nd cohort) INNOVATE data HEPANOVA data gastric trial data STELLAR data TODAY LUNAR interim analysis FDA approval for MPM METIS data final EF-14 data Phase 3 pivotal or registration milestones anticipated milestones 2022 INNOVATE-3 interim analysis LUNAR final data PANOVA-3 interim analysis potential to significantly expand total addressable market = 5,000 cases diagnosed annually in the U.S. Glioblastoma (GBM) Non-small cell lung cancer Mesothelioma (MPM) Pancreatic cancer Brain metastases from non-small cell lung cancer Ovarian cancer GBM Today ~1 Year ~3 Years ~5 Years NOVOCURE 2018 ANNUAL REPORT Advancing the pipeline Tumor Treating Fields is a physics-based therapy that is broadly applicable to solid tumor cancers. The application of electric fields to attract and repel charged proteins during cell division has demonstrated an effect in every cancer cell line tested. The mechanism of action is independent of genotype, phenotype or micro- environment. It only requires the appropriate placement of transducer arrays to create electric fields tuned to specific frequencies within targeted cancer cells. Since our initial public offering in 2015, we have presented successful phase 2 pilot data in multiple solid tumor indications. These clinical milestones have created the foundation for a drumbeat of late-stage clinical and regulatory milestones expected over the next three years. In 2018, we presented data from our STELLAR registration trial studying Tumor Treating Fields in unresectable MPM. Patients who received Tumor Treating Fields with pemetrexed and cisplatin or carboplatin experienced a median overall survival of 18.2 months. As expected, there was no increase in systemic toxicity when Tumor Treating Fields was added to the standard of care chemotherapy regimen. MPM is one of the most aggressive forms of cancer. There has not been significant progress in treating MPM since the approval of pemetrexed more than 15 years ago. Our STELLAR data have been submitted to the FDA for marketing approval under the Humanitarian Device Exemption (HDE) pathway provided by our Humanitarian Use Device (HUD) designation. We are in constructive, ongoing discussions with the FDA and hope to receive approval for MPM in 2019. We continue to enroll patients in our phase 3 pivotal trials in brain metastases, non-small cell lung cancer and pancreatic cancer, and initiated our phase 3 pivotal trial in ovarian cancer in March 2019. We are also recruiting a phase 2 pilot trial in liver cancer and are working with Zai Lab to initiate a phase 2 pilot trial in gastric cancer in China. We continue to perform basic research on Tumor Treating Fields as do members of the independent scientific community. In 2018, we developed significant new insights that may enable us to further improve efficacy beyond what we have seen in our trials, to date. A post-hoc analysis of the EF-14 data showed that more time on Optune predicted increased survival of GBM patients. In 2018, a separate post-hoc analysis showed that higher levels of energy (mW/cm3) at the tumor bed predicted increased survival of GBM patients, independent of time on therapy. For Optune, dose density can now be defined as time on therapy times the energy delivered, the cumulative energy delivered. With this knowledge, our engineering efforts are now geared toward Optune system improvements to improve efficacy and extend survival. We have developed novel mapping algorithms to optimize treatment planning and our teams are working to incorporate these algorithms into a second generation NovoTAL system. We are also working to develop second generation transducer arrays to improve patient comfort and convenience and to maximize the energy delivered to the tumor bed and surrounding tissues. Creating shareholder value Novocure is a high-growth oncology company with significant growth opportunities remaining in GBM and in much more prevalent cancers. Our balance sheet is strong. We ended 2018 with $246 million cash, cash equivalents and short-term investments on hand, and largely have been able to fund our investments in additional indications and Optune system technology improvements with cash flow from the GBM business. While GBM alone provides an important opportunity for Novocure to improve patient outcomes and grow revenue, it represents the tip of iceberg for the company. We believe the total potential addressable market for Optune in additional cancer indications is exponentially larger than the opportunity we see today in GBM. We believe our extensive IP portfolio and our extended cash runway provide the stability and flexibility to execute our core strategies. Investing in our people and culture From the day Professor Yoram Palti founded Novocure in 2000, we have maintained an encompassing effort to ensure every employee shares his patient-forward vision. Now, as a 600-plus-person organization, we have recommitted to ensure a shared focus on our core mission to extend survival in some of the most aggressive forms of cancer by developing and commercializing Tumor Treating Fields – to extend life without interfering with quality of life. Looking ahead, I am enthusiastic and energized about our opportunities as we work to accomplish our mission. Thank you for your continued support. Bill Doyle, Executive Chairman 6 7 from day one f rward NOVOCURE 2018 ANNUAL REPORT – innovation Our founders created a different way to fight cancer. We channel that founding spirit into our science, business and patient relationships to deliver innovative and proven solutions designed to advance cancer care. – focus We dream big. But we also know that in order to achieve our aspirations, we must be intentional every day in how we spend our time, energy and resources. – drive Patients and their families are the heart of our mission. Our passion for making a difference in the lives of cancer patients fuels us in our day-to-day work and guides us in our decision-making. – courage It takes courage to innovate. We stand alongside our patients and stand up for them by challenging the status quo. – trust Our patients trust us as an integral part of their cancer care team. We trust ourselves and our colleagues to act with integrity and accountability as we use our individual strengths to work together efficiently and effectively in pursuit of our patient-forward mission. – empathy Confronting cancer is physically, mentally and emotionally challenging. We put ourselves in the shoes of our patients, their families, health care providers, researchers and our colleagues as we strive to change the way cancer is treated. 8 9 “Innovation plays a role in the work we do here daily. It plays a role in every single aspect of the business.” NOVOCURE 2018 ANNUAL REPORT “Innovation plays a role in the work we do here daily,” she said. “It plays a role in every single aspect of the business. Being stagnant is not an option.” For Katia, innovation begins with an idea and then develops by including others and incorporating their feedback. “I really value the input of the team, even when we disagree on the approach,” she said. “We always try to do what’s best for our patients. For me, innovation and creativity has a lot to do with the conversations with the team and including people in the decision-making.” A big-picture thinker, Katia also uses innovation in her personal life as a mother of three sons. For example, she said, as her children grow, she finds new ways to spend quality time together and thinks deeply about how to effectively communicate. Her son, Matt, 22, likes to talk while riding in the car, so Katia uses that time to connect. With her stepson, Kyle, 24, she had to learn how to understand him and help him learn how to express himself. When he was younger, she would play games with him or buy his favorite food and they would prepare it together. Today, she makes a point to ask him about things that interest him. Katia and her youngest son, Lukas, 14, go to the gym together and once a week to his favorite coffee shop. During that time, she asks about his life, what he’s learning at school, and what teachers he likes or dislikes. “I cannot approach a subject in the same way twice,” she said of being a parent. “I have to approach it differently and creatively.” When it comes to innovating at Novocure, she said she feels comfortable expressing her ideas partly because Novocure’s leadership team encourages employees to do so. She also feels that her management team trusts her to follow through on her commitments and knows that if she needs help, she will ask for it. Since adjusting to her new role within Novocure, Katia feels excited about the positive impact her projects can have on her colleagues and on the company. She also looks forward to Novocure’s future. “All of us want to be a part of these next chapters of Novocure,” she said. Katia Felix, Associate Director of Global Strategic Development innovation Katia Felix is not afraid to share her ideas. Throughout her career, she has paved a way for herself often by bringing her ideas to the table. Recently, she expressed to some members of Novocure’s management team that she felt there was a need to develop career paths for employees and to strengthen Novocure’s training program to ensure that the company is retaining the talented people it attracts. “I think that our employees are our greatest assets,” Katia said. “If we treat them well, they will treat our patients well, and we all gain with that. That has always been my mantra.” The sharing of that idea contributed to a promotion for Katia in 2018 – she’s now Novocure’s Associate Director of Global Strategic Development. Novocure’s management team created the role for Katia to better utilize her skills and strengths. One of her current initiatives is the development of career paths and training programs for employees who work in Revenue Operations and Health Policy. “I’m not afraid of presenting ideas, even if it means I am going to have to improve … if it means that I am the one that has to change so that other changes can happen, so be it,” she said. With her latest promotion, came a big change. Katia went from managing a large team to managing no one and collaborating more with people from other departments. Along with being excited about her new role, she said, it was also difficult to let go of her former responsibilities. It took her time to decompress and refocus in her new position. “I felt lost for about a month,” she said, adding that she questioned whether she made the right decision. “But then I started focusing on the difference I could make in the lives of my colleagues if I worked very hard on the projects that we identified.” Katia said interacting with her colleagues is one of her favorite aspects of working at Novocure. She also enjoys breaking ground as an innovative company. Since joining the company in 2013, she has seen the company grow and change in many ways. 10 11 focus From a young age, Dario Garcia-Carrecedo has understood the importance of the parts that equal the whole. As a 12-year-old boy growing up in Oviedo, Spain, he would often checkout animal books from the library and visit his grandmother in the countryside to identify creatures and observe them in their natural habitats. In high school, he became interested in molecular biology and was fascinated by how the cell works. When settling on a career path in college, Dario wanted to do something that he could apply to society, so he chose oncology. Upon completing his doctorate in Molecular Biology and Biochemistry from the University of Oviedo, he moved to the United States in 2008 after receiving a grant to work as an associate research scientist studying head and neck and pancreatic cancers at Columbia University in New York. In 2015, he received a Medical Affairs Fellowship at Novocure. As a fellow, he learned about the business and supported the Medical Affairs department, which reviews materials for medical and scientific accuracy, creates medical and scientific content, and monitors the competitive landscape. After his one-year contract, he was hired as a Manager, and has since been promoted to Senior Manager and Associate Director of Medical Affairs. In Dario’s role today, focus is essential to doing his job well. “Focus to me means to direct the attention at what is important, and what’s important, are our patients,” Dario said. The Medical Affairs team supports other parts of the business and receives a high volume of requests to review materials, many of which are time sensitive. In order to focus effectively, Dario said, he also has to prioritize. “It’s almost like making a to-do list and just having everything organized. Keeping the focus on the things that need priority, but without forgetting about other things you have on your to-do list, getting to them when the time is necessary,” Dario said of his strategy for focus. His experience of working in laboratories has translated to his work at Novocure. Focus is also important in his role because he often reviews or creates materials that are distributed to patients and health care providers or at scientific congresses, and those materials need to be accurate. “Focus to me means to direct the attention at what is important, and what’s important, are our patients.” NOVOCURE 2018 ANNUAL REPORT Dario Garcia-Carrecedo, Associate Director of Medical Affairs “In the laboratory, you have to be very meticulous, focused and organized,” Dario said, adding that a lack of focus in a lab could result in having to repeat an experiment. “In order to be scientifically accurate, prioritize and meet all of your deadlines, you have to be able to direct your attention.” In his current role, Dario leads a team and often imparts his approach of focus and prioritization to his colleagues. “I enjoy the fact that I can influence others on my team by sharing the ways I see things,” he said. “I think that’s very powerful, and I feel very lucky.” Growing with the organization has helped Dario to prioritize his workflow. “I’ve been more involved in conversations that are cross- functional,” he said. “I’m able to see a bigger picture than when I first arrived here. I am able to see which things need to get out first.” Dario also sees how his work plays a role in the bigger picture of Novocure’s mission. For example, during the first few months of his fellowship, he helped develop the materials that are used to train physicians to become certified prescribers of Novocure’s cancer treatment. Those materials have been used to certify hundreds of physicians who have prescribed Novocure’s therapy to thousands of patients. “It always feels good,” he said of making a difference at Novocure. “The moment I joined Novocure, I realized that everything we do has an impact on our patients.” 12 13 drive In 2008, Roman Pass moved from his home Finland to Switzerland for an opportunity to play floorball with only his sport bag and hockey sticks. He knew no one in Switzerland, nor did he speak German. He had played floorball – a type of indoor hockey – for more than 10 years at the time, and had an opportunity to play in Switzerland and to live somewhere new. He always foresaw himself moving away from Finland, where he emigrated to from Estonia with his mother and brother as a young child. Playing the sport provided only a small amount of money, and he needed a full-time job. Without knowing the local language, finding employment proved to be a challenge. He recalled being paid 1,000 Swiss francs when he arrived by the team, spending the money within several days, and eating pasta with tomato sauce for two weeks straight. “First year I was totally without a job,” Roman said. “I was just getting paid from the club, just pocket money every month. It was kind of a dark time.” Roman felt a world away from home – isolated and lonely, as he embarked on this new chapter of his life. Many times, he thought about giving up. “I think the most horrible part is the loneliness,” he said. “It’s easier to give up. It’s harder to say ‘I will not give up. I will fight for it.’” Roman reminded himself that it would get better with every day that passed. A year after moving, he secured a job working as a warehouse operator for a sporting goods company. He started to make friends. Over the course of three years, he learned German and began to feel confident enough to speak it. Then he felt ready to grow professionally. In 2013, he learned about an open position as a warehouse operator at Novocure in Root, Switzerland, and became intrigued by the company’s story. Roman saw the position as an opportunity to build something from the ground up. His first task was to design the inside of the warehouse. He traveled to Novocure’s U.S. Operations NOVOCURE 2018 ANNUAL REPORT “For me, it’s not just a job. I want to do my best every day, to show my managers and everybody else that I want to grow with the company. So I’m still not done. I have a lot to reach.” Center in Portsmouth, New Hampshire, to see how the warehouse was structured there and to learn from his colleagues. After two years, Roman transitioned to a new role as an Order Administrator to try something new. “I am a person who sets goals,” he said. “And I want to be there in two years and in five years. I definitely want to build a career and go as far as I can.” In Roman’s current role, he manages patient-related shipments to and from the warehouse in Root. He coordinates with Novocure’s Device Support Specialists in Europe to ensure that patients receive the therapy on time. “For me, it’s not just a job,” he said. “I want to do my best every day, to show my managers and everybody else that I want to grow with the company. So I’m still not done. I have a lot to reach.” He aims to motivate his colleagues and build connection by keeping a positive attitude and making a point to connect with people face to face or over the phone, when possible, instead of via email. He finds meaning in the work he does at Novocure and feels that he is making a difference along with the company. “I have never regretted it,” he said of his decision to join Novocure. Roman has lived in Switzerland for more than 10 years. He still plays and coaches floorball for the same team, and teaches fitness classes at a local gym. The struggle of his early days in Switzerland is somewhat a distant memory, yet still fresh as a reminder of the drive he exemplified to create this life for himself. He recalled the moment he knew he had made it through the hardest days of his journey of starting over somewhere new. “It starts to feel like home,” Roman said. “Then you know you are in the right place.” 14 Roman Pass, Order Administrator 15 courage For Noam Zaradez, courage means many things. He has his master’s degree in Philosophy and is pursuing a doctorate in Qualitative Research. When he speaks about courage, his thoughts are refreshingly complex yet still somehow light. In 2007, Noam joined Novocure as a Device Support Specialist (DSS), a role that provides technical support and a face-to-face relationship with glioblastoma patients who receive Novocure’s cancer treatment. Noam said interacting with patients who face a life-threatening disease can evoke emotions of sadness, fear and grief in DSSs. “For me, courage as a DSS is to be able to handle tough and complex situations regarding our patients, and also within our team, to be able to communicate those experiences – to be able to talk freely about our feelings, fears and stress,” he said. “As a team, we need to share those experiences.” Noam realized the importance of processing and sharing challenging emotions when his team grew and he became a manager. In 2016, he was promoted to a DSS Regional Manager and Care Coordinator. Prior to becoming a manager, he dealt with difficult emotions and stress on his own, mostly by finding comfort in being with his family at the end of the day and learning to appreciate every day. “Then I realized that it’s not only me anymore,” he said. “I also have responsibility to the others, to my team.” In 2018, he initiated a mental health program for DSSs in Israel – a monthly, two-hour group therapy session. During the sessions, he said, his team starts to open up and share before even sitting down. They move the table and face each other, seated in a circle so there are no barriers between. NOVOCURE 2018 ANNUAL REPORT “We have to have courage to do things that have never been done before.” Bringing the idea to management took courage on Noam’s part. The program is the first of its kind at Novocure. Noam also suggested to leadership for the group’s therapist to conduct workshops at a DSS conference in Rome last year. The workshops were well-received, and a DSS manager in Germany initiated a therapy program for her team as well after attending. “We have to have courage to do things that have never been done before,” Noam said. Participating in group therapy together has helped to unify his team, creating a sense of team spirit. They are more willing to volunteer and help each other when a team member needs it. As a manager of a team, Noam aims to create an open, sincere and free working relationship with his colleagues. “It’s really empowering us,” Noam said. “In this way, we can work on our strength as employees, on our resilience, to be able to keep the dynamic relationships with our patients. I am so proud of my team.” Noam also uses physical activity as a way to alleviate stress and process his emotions. He enjoys long-distance running, cycling, swimming, surfing and dancing. “Running long distances is like taking out all of the things that stay inside your soul and dealing with it,” he said. “For me, it’s like meditation.” Noam also views courage as being flexible and having the ability to work through the unknown. In group therapy, he and his team learn about accepting oneself and emotions as they come and noticing when they are reacting to those emotions. They learn how to watch their emotions and let them pass. Noam said it is important that DSSs take care of their mental health because of the ongoing interactions they have with patients and caregivers. DSSs have to be compassionate, positive and sensitive when they work with patients, who are confronting a devastating diagnosis. “There is a lot of responsibility on our shoulders,” he said. “It is our responsibility to go with them through this path and to give them a hand and to guide them during this process.” 16 16 17 Noam Zaradez, DSS Regional Manager and Care Coordinator trust DeEtta Ard-McDonald has learned the importance of trust throughout her 30-year marriage to her husband, Everett. DeEtta and Everett met when she was 15 and he was 16 at a festival in East Chicago, Indiana. They had a mutual friend and Everett asked for DeEtta’s phone number. She wasn’t allowed to date until she turned 16, so they spoke on the phone every day for a few months, developing a friendship first. She liked that he was smart, funny, thoughtful and easy to talk to. When they began dating, he’d drive to her home from a neighboring town about 30 minutes away and they would spend time together a few hours a week. Together, they attended Indiana University. They married when she was 27 and had two children, Maxx, 29, and Jade, 27. DeEtta said Everett has never given her a reason not to trust him. Having trust with Everett makes her feel secure. “In my marriage, I had to trust that my husband was doing the best thing for our family to move us forward and reach our goals, and he had to trust me to do the same,” she said. DeEtta views trust as the foundation of all relationships. “To me, trust means transparency, open communication, support, encouragement and just wanting to be the best for the other person in that relationship,” she said. NOVOCURE 2018 ANNUAL REPORT Earlier in her career, DeEtta worked as a pharmacy technician. She transitioned to a career in sales when her two children were young after Everett, who also works in sales, suggested it. Her first sales role was a flexible, part- time position that enabled her to spend more time with her kids. As her children grew older, she moved back into full-time work. She enjoys sales because of the flexibility and because she has the chance to interact with different people every day. DeEtta considers trust to be important to the work she does at Novocure. She joined Novocure in 2015 as a Territory Manager on the U.S. Business Team. In her role, she is responsible for sales and account management- related activities in South Chicago. Her job entails establishing and maintaining relationships with health care providers. In order to do that effectively, she has to earn their trust. “Trust with providers is built by being reliable, by being resourceful, and just by letting my providers know that I am there to support them so they can better support their patients,” she said. When establishing a relationship with a new provider, DeEtta focuses on the data supporting Novocure’s cancer treatment in glioblastoma. If they have prior misperceptions regarding the treatment, she does her best to educate them and gives them time to trust that she is providing them with accurate information. She knows that she’s earned a provider’s trust when they become more open and begin reaching out. “That’s a great feeling,” she said. “That’s what keeps me going.” DeEtta also finds trust to be an important part of her interactions with her teammates. They confide in each other regarding their challenges and know that the information will not be shared outside of the conversation without permission. She also feels that Novocure’s leadership team is transparent with its colleagues. “We have to let each segment of the organization do what they do, and we have to trust that they’re doing what’s best for the organization as a whole,” she said. “We have to trust that leadership is going to take us in the direction we need to go.” Ultimately, for DeEtta, valuing trust goes back to the patients who are the heart of Novocure’s mission. “I value trust because we’re providing a therapy for patients with a devastating diagnosis,” DeEtta said. “They need to know we are doing the best we can to help them.” DeEtta Ard-McDonald, Territory Manager, South Chicago 18 18 “Trust with providers is built by being reliable, by being resourceful, and just by letting my providers know that I am there to support them so they can better support their patients.” 19 NOVOCURE 2018 ANNUAL REPORT “This is not just a number,” he said. “This is a person who has a family, they have feelings, they have friends, and they have brain cancer. When you have a reason for your argument and you feel strongly about it, it’s really hard to stop someone like that.” Syed has felt a strong connection to Novocure’s patient- forward mission since joining the company in 2015. In order to empathize with patients, he said, one has to try to understand what they are going through. “I think that’s probably the most important factor of the whole business, to really empathize with the patient,” he said. Syed also practices empathy with his colleagues, health care providers and insurers. “Empathy is one of those things that you don’t just pick and choose when you want to use it,” he said. “You have it and use it. You have to be respectful to whoever you’re talking to and that goes a long way.” For Syed, his job is much more than a paycheck. He loves having the opportunity to help patients gain access to Novocure’s cancer treatment. “Not every patient’s case is going to go that way, but they all have the possibility of turning out that way,” he said. “The opportunity I have to help somebody else is what keeps me motivated.” “I think that’s probably the most important factor of the whole business, to really empathize with the patient.” empathy In 2012, Syed Ali was leading his college baseball team as pitcher in a matchup against one of their rivals in Florida when he tore two muscles in the rotator cuff of his shoulder. In what may have been one throw, he lost his ability to play the game he loved and what had become a large part of his identity. “It kind of felt like everything that I cared about, everything that had led me to that point, was gone,” he said. Recovering from his injury was a physical and mental challenge. Physically, he had to do basic exercises every day to help the injury heal and to regain his strength. Mentally, he couldn’t play the sport that had become such a big part of his life. He missed the rest of the season and postponed graduation by one year so that he could finish his collegiate baseball career. Many of his friends were graduating that year, and he was supposed to be on the stage with them. As Syed recovered from his injury, he refocused on his academics. He also turned his attention toward other areas of his life where he could improve, like being a good teammate and being a good listener. He realized during this time that baseball was a small part of who he was and that he had much more to offer. He returned to play for a fifth year of college with a new perspective and had one of his best seasons, breaking all of his personal records and making all-conference teams. “I look back on it, and it was one of the best things that ever happened to me,” he said. During his fifth year, Syed recalled a time when a friend and teammate was struggling with baseball and his personal life. Syed listened and shared his story and feelings from his journey the year prior. His friend went on to turn around his season and improve his grades. “That was empathy right there, just being able to come down to my friend’s level and talk to him about a similar situation that I went through,” he said. “It made me feel good to help him, and it made him feel like there was not only hope for him, but that there was plenty of light in the tunnel.” Empathy is one of Syed’s greatest strengths. A Case Manager at Novocure in Portsmouth, New Hampshire, Syed works with insurers to help facilitate coverage approvals for patients prescribed Novocure’s cancer treatment. Syed keeps the patient at heart during his interactions with insurers. 20 21 21 Syed Ali, Case Manager selected financials Cash flow from the glioblastoma business is funding increased investments in R&D global net revenues (USD in millions) $300,000 IN USD MILLIONS $248,017 $177,026 $248M FULL YE AR 2018 NET REVENUES $248M $82,888 $10,359 $15,490 $33,087 NET REVENUES FY 2018 >40% REVENUE GROWTH 2018 COMPARED TO 2017 2013 2014 2015 2016 2017 2018 U.S. net revenues EMEA net revenues Japan net revenues China upfront licensing fee See Novocure’s Form 8-K filed on or around Jan. 7, 2019 for additional detail 2016 2017 2018 $250 $250,000 $200,000 $200 $150,000 $100,000 $150 $50,000 $100 $0 $50 0 ($50) ($100) ($150) ($2) 98% NET CASH USED IN OPERATING ACTIVITIES A 98% DECREASE FROM 2016 INCLUDING $51M INVESTMENT IN RESEARCH AND DEVELOPMENT CASH, CASH EQUIVALENTS AND SHORT-TERM INVESTMENTS 269.4 245.9 219.6 183.3 Our balance sheet is strong global net revenues (USD in millions) 2015 2016 22 $300,000 $250,000 $200,000 $150,000 $100,000 $50,000 $0 2017 2018 $248,017 $248M FULL YE AR 2018 NET REVENUES $177,026 $82,888 $10,359 $15,490 $33,087 >40% REVENUE GROWTH 2018 COMPARED TO 2017 2013 2014 2015 2016 2017 2018 U.S. net revenues EMEA net revenues Japan net revenues China upfront licensing fee See Novocure’s Form 8-K filed on or around Jan. 7, 2019 for additional detail NOVOCURE 2018 ANNUAL REPORT Year ended December 31, 2018 2017 2016 2015 $ 248,069 $ 177,026 $ 82,888 $ 33,087 80,048 – 168,021 50,574 77,663 73,456 201,693 (33,672) (12,270) (45,942) (17,617) (63,559) (0.69) $ $ 55,609 – 121,417 38,103 63,528 59,114 160,745 (39,328) (9,169) (48,497) (13,165) (61,662) (0.70) $ $ 39,870 6,412 36,606 41,467 59,449 51,007 151,923 (115,317) (6,147) (121,464) (10,381) (131,845) (1.54) $ $ 20,610 – 12,477 43,748 38,861 33,864 116,473 (103,996) (3,151) (107,147) 4,434 (111,581) (3.67) $ $ December 31, 2018 2017 2016 2015 $ 140,622 $ 78,592 $ 99,780 $ 119,423 105,256 339,793 256,809 64,560 162,974 112,259 104,719 265,298 194,932 50,202 101,532 113,564 119,854 282,081 224,991 36,882 102,854 142,345 150,001 307,336 265,277 28,627 27,889 250,820 consolidated statement of operations U.S. dollars in thousands Net revenues Cost of revenues Impairment of field equipment Gross profit Research, development and clinical trials Sales and marketing General and administrative Total Operating expenses Operating income (loss) Financial income (expenses), net Income (loss) before income taxes Income taxes Net income (loss) Basic and diluted net income (loss) per ordinary share consolidated balance sheet U.S. dollars in thousands Cash and cash equivalents Short-term investments Total assets Working capital Current liabilities Long - term liabilities Total shareholders' equity condensed cash flow U.S. dollars in thousands 2018 2017 2016 2015 Net cash provided by (used in) operating activities Net cash provided by (used in) investing activities Net cash provided by (used in) financing activities Effect of exchange rate differences on cash and cash equivalents Net increase (decrease) in cash, cash equivalents and restricted cash $ (1,865) $ (33,134) $ (107,592) $ (99,884) (5,493) 69,369 27 8,628 5,168 8 12,996 (115,269) 75,124 276,989 10 – 62,038 (19,330) (19,462) (61,836) 23 ”With annual revenues appoaching $250 million, five indications in our late-stage pipeline and a strong balance sheet, we believe we are well-positioned to deliver significant long- term shareholder value.” — Wilco Groenhuysen, Chief Financial Officer leadership corporate officers and executive leadership William F. Doyle Executive Chairman Asaf Danziger Chief Executive Officer Mike Ambrogi Chief Operating Officer Wilco Groenhuysen Chief Financial Officer Eilon Kirson, M.D., Ph.D. Chief Science Officer and Head of Research and Development Todd Longsworth General Counsel Yoram Palti, M.D., Ph.D. Founder Pritesh Shah Chief Commercial Officer 2424 24 board of directors William F. Doyle Executive Chairman Asaf Danziger Chief Executive Officer William Burkoth Jeryl Hilleman David T. Hung Kinyip Gabriel Leung Martin J. Madden Sherilyn D. McCoy Charles G. Phillips III William A. Vernon NOVOCURE 2018 ANNUAL REPORT market price of and dividends on the registrants’ common equity and related stockholder matters The following performance graph is being furnished as part of this annual report and shall not be deemed “filed” with the SEC or incorporated by reference into any of our filings under the Securities Act of 1933, as amended (the “Securities Act”), or the Exchange Act, whether made before or after the date hereof and irrespective of any general incorporation language in any such filing. The following graph shows the total shareholder return of an investment of $100 in cash at market close on October 2, 2015 (the first day of trading of our ordinary shares) through December 31, 2018 for (1) our ordinary shares, (2) the Russell 2000 Index, and (3) the Nasdaq Biotechnology Index. Pursuant to applicable SEC rules, all values assume reinvestment of the full amount of all dividends; however, no dividends have been declared on our ordinary shares to date. The shareholder return shown on the graph below is not necessarily indicative of future performance, and we do not make or endorse any predictions as to future stockholder returns. comparison of 39 month cumulative total return COMPARISON OF CUMULATIVE TOTAL RETURN Among NovoCure Ltd, the Russell 2000 Index, and the NASDAQ Biotechnology Index $ 140 $ 120 $ 100 $ 80 $ 60 $ 40 $ 20 $ 0 10/2/2015 NovoCure Ltd $ 350 $ 300 $ 250 $ 200 $ 150 $ 100 $ 50 12/31/2015 03/31/2016 06/30/2016 09/30/2016 12/31/2016 $ 0 10/2/15 NASDAQ Biotechnology Index 6/16 12/15 3/16 9/16 Russell 2000 Index 3/17 12/16 6/17 NovoCure Ltd Russell 2000 NASDAQ Biotechnology 12/17 9/17 3/18 Assumes $100 invested on October 2, 2015 Assumes dividend reinvested Fiscal year ending December 31, 2015 6/18 9/18 12/18 *100 invested on 10/2/15 in stock or 9/30/15 in index, including reinvestment of dividends. Fiscal year ending December 31. Copyright© 2019 Russell Investment Group. All rights reserved. COMPARISON OF CUMULATIVE TOTAL RETURN cumulative total return summary Among Novocure Ltd, the Russell 2000 Index, and the Nasdaq Biotechnology Index NovoCure Ltd Russell 2000 $ 140 $ 120 $ 100 $ 80 $ 60 $ 40 $ 20 $ 0 10/2/2015 NASDAQ Biotechnology 10/2/15 12/15 3/16 6/16 9/16 12/16 3/17 6/17 9/17 12/17 3/18 6/18 9/18 12/18 100.00 122.32 79.21 63.84 46.72 42.94 44.31 94.64 108.59 110.50 119.26 171.23 286.65 183.15 100.00 103.59 102.02 105.89 115.47 125.67 128.77 131.94 139.42 144.07 143.95 155.11 160.66 128.21 100.00 111.62 10/31/2015 89.57 86.95 95.87 89.13 97.75 11/30/2015 103.18 112.36 106.14 104.85 107.67 119.92 96.28 12/31/2015 Novocure Limited NASDAQ Biotechnology Index Russell 2000 Index Assumes $100 invested on October 2, 2015 Assumes dividend reinvested Fiscal year ending December 31, 2015 Indications For Use Optune is intended as a treatment for adult patients (22 years of age or older) with histologically-confirmed glioblastoma multiforme (GBM). Optune with temozolomide is indicated for the treatment of adult patients with newly diagnosed, supratentorial glioblastoma following maximal debulking surgery and completion of radiation therapy together with concomitant standard of care chemotherapy. For the treatment of recurrent GBM, Optune is indicated following histologically-or radiologically-confirmed recurrence in the supratentorial region of the brain after receiving chemotherapy. The device is intended to be used as a monotherapy, and is intended as an alternative to standard medical therapy for GBM after surgical and radiation options have been exhausted. Summary of Important Safety Information Contraindications Do not use Optune if you have an active implanted medical device, a skull defect (such as, missing bone with no replacement), or bullet fragments. Use of Optune together with implanted electronic devices has not been tested and may theoretically lead to malfunctioning of the implanted device. Use of Optune together with skull defects or bullet fragments has not been tested and may possibly lead to tissue damage or render Optune ineffective. Do not use Optune if you are known to be sensitive to conductive hydrogels. In this case, skin contact with the gel used with Optune may commonly cause increased redness and itching, and rarely may even lead to severe allergic reactions such as shock and respiratory failure. Warnings and Precautions Use Optune only after receiving training from qualified personnel, such as your doctor, a nurse, or other medical personnel who have completed a training course given by Novocure (the device manufacturer). Do not use Optune if you are pregnant, you think you might be pregnant or are trying to get pregnant. It is not known if Optune is safe or effective in these populations. The most common (≥10%) adverse events involving Optune in combination with temozolomide were low blood platelet count, nausea, constipation, vomiting, fatigue, scalp irritation from device use, headache, convulsions, and depression. All servicing procedures must be performed by qualified and trained personnel. Do not use any parts that do not come with the Optune Treatment Kit, or that were not sent to you by the device manufacturer or given to you by your doctor. Do not wet the device or transducer arrays. If you have an underlying serious skin condition on the scalp, discuss with your doctor whether this may prevent or temporarily interfere with Optune treatment. Please visit www.optune.com/safety to see the Optune Instructions for Use (IFU), for complete information regarding the device’s indications, contraindications, warnings, and precautions. 25 NOVOCURE 2018 ANNUAL REPORT looking ahead living our mission and values Since the early days of Novocure, when Tumor Treating Fields was a theory not yet a therapy, our mission has been clear. We are striving to improve survival in some of the most aggressive forms of cancer by developing and commercializing our innovative therapy. At Novocure, the patient has been at the center of what we do, from day one. Developing and commercializing Tumor Treating Fields required that we create an innovative and evolving business that supports the patient, from device support specialists to care coordinators to shipping clerks. When we receive a prescription, it triggers this system, and our important work of supporting our patients begins. We support thousands of patients in the same way around the globe. We have the potential to support hundreds of thousands of patients as we continue to develop our therapy in indications outside of glioblastoma. Some companies need to remind employees why they work there. That is not the case at Novocure. Our mission is understood. Our values define who we are – as people first – then as a company. As we grow across countries and continents, we will ensure that our commitment to our mission and our values remains strong. We believe our values, the core traits that we share, will help us to achieve our mission. As we look toward the future, it can be helpful at times to reflect on where we came from. Novocure began with an idea that led to a culture of innovation. Bringing the idea to fruition required a microscopic level of focus, focus that becomes more and more intricate and important as we grow. We needed the drive to fight a fight that no one else would fight for us, and the courage to get up again and stand up for what we believe in after getting knocked down. As we began to grow across the world, we had to trust our colleagues to have our patients’ best interest at heart. From day one, we had to have empathy for our patients – who may be facing the greatest challenge of their lives – empathy for our colleagues and health care providers, and even empathy for those who disagree with us. I am proud to say that as a part of Novocure, this is who I am. I am proud to lead a company of employees with outstanding character who do the most challenging work, who create their own path rather than following one that already exists. As we grow, there may be times of uncertainty on the best way forward. In those moments, we will use our vision, mission and values as a compass to help chart our way. Thank you for being a part of our journey. Asaf Danziger, CEO 2626 27 Second Floor No. 4 The Forum Grenville Street St. Helier, Jersey, JE2 4UF www.novocure.com 

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