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NovoCure Limited

nvcr · NASDAQ Healthcare
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Ticker nvcr
Exchange NASDAQ
Sector Healthcare
Industry Medical - Instruments & Supplies
Employees 1488
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FY2020 Annual Report · NovoCure Limited
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2020

2020 business highlights

3

FDA-APPROVED  
INDICATIONS

18,000+

PATIENTS TREATED  
GLOBALLY1

$494M $132M $843M

IN 2020 GLOBAL 
NET REVENUES

IN 2020 
R&D INVESTMENTS

CASH   
ON HAND2

5

185+

INDICATIONS IN 
LATE-STAGE DEVELOPMENT

ISSUED PATENTS AND PENDING  
PATENT APPLICATIONS GLOBALLY

1. as of December 31, 2020

2. cash, cash equivalents and short-term investments as of December 31, 2020

William Doyle, Executive Chairman

Asaf Danziger, CEO

a letter from our Chairman and CEO

Dear fellow shareholders, 

We entered 2020 focused on a clear set of priorities: to 
drive commercial adoption of our innovative therapy for the 
treatment of glioblastoma multiforme (“GBM”) and malignant 
pleural mesothelioma (“MPM”); to advance our clinical trials 
across multiple solid tumor indications; and to optimize the 
delivery of Tumor Treating Fields (“TTFields”) through product 
innovation – all with the goal of extending survival in some of 
the most aggressive forms of cancer. 

We are proud to have made notable progress on all fronts 
last year, despite the challenges caused by COVID-19. 
We opened clinical trials and initiated new clinical trial 
collaborations. We received regulatory approval for Optune® 
in China and Optune Lua™ in Europe. With positive decisions 
to establish national coverage for Optune in Israel, Germany 
and Switzerland, we secured broad reimbursement for GBM 
in all of our active markets. And perhaps most importantly, 
we have now treated nearly 20,000 patients globally.

We believe we are in a virtuous cycle of innovation and 
execution, as our commercial business generates the 
financial strength to invest in innovation intended to unlock 
the full potential of the TTFields platform and fuel the future 
growth of our company. As we reflect on 2020 and look 
ahead with optimism, we believe we are only beginning.  

a self-reinforcing cycle of execution and innovation

Our performance last year underscores the resilience of our 
organization. Despite the complexities caused by COVID-19, 
our GBM business delivered a record $494 million in global 
net revenues in 2020, a 41% increase from the prior year. 
This growth was driven by a 17% year-over-year increase 
in the number of active patients on therapy and improving 
reimbursement rates in our active markets. We ended the 
year with more than 3,400 active patients on therapy. 

We invested a record $132 million in research and 
development in 2020, representing 67% growth versus 2019, 
including $54 million to advance clinical programs. The 
TTFields platform offers opportunities for broad applicability 
across solid tumor cancer indications, for use together with 
other effective oncology treatments and for technological 
enhancements to therapy delivery systems. Given our 
clear organic growth opportunities, we are committed to 
advancing our TTFields science and technology. 

Notwithstanding increased investments in clinical and 
product development, Novocure was profitable throughout 
2020, with nearly $20 million in annual net income and $115 

million in Adjusted EBITDA1. In November, we closed a $575 
million convertible bond offering and a $150 million revolving 
credit facility, resulting in nearly $850 million in cash–on-
hand. Our capital structure and improved profitability position 
us well for a period of significant innovation and growth. 

current development programs offer an opportunity  
for transformative growth

We are focused on advancing a comprehensive clinical 
development strategy to further extend survival in our 
approved indications and to establish the safety and efficacy 
of TTFields in new indications together with existing and 
emerging standard-of-care therapies. Last year, we launched 
three new clinical trials, expanding our development  
pipeline to seven actively enrolling trials targeting more than 
2,900 patients.  

In December 2020, we enrolled the first patient in our post-
marketing TRIDENT trial in newly diagnosed GBM. TRIDENT 
will determine the potential survival benefit of initiating 
Optune plus temozolomide concurrent with radiation 
therapy. The study is designed to detect an extension in 
overall survival of approximately 6 months, representing our 
commitment to further improving outcomes for  
GBM patients. 

Our four ongoing phase 3 pivotal trials create the potential 
to make our therapy available to many more cancer patients. 
If approved, these indications could increase our potential 
market opportunity by twenty fold.

Our four ongoing phase 3 pivotal 
trials create the potential to make our 
therapy available to many more cancer 
patients. If approved, these indications 
could increase our potential market 
opportunity by twenty fold.

Our LUNAR trial is testing the effectiveness of TTFields as a 
second-line treatment for primary non-small cell lung cancer 
(“NSCLC”). In April, we announced that LUNAR’s pre-specified 
interim analysis concluded with a favorable recommendation 
to continue accrual with no new safety signals noted. The 
Data Monitoring Committee recommended a reduced 
sample size and reduced time to follow-up. We believe these 
recommendations support the potential for TTFields to make 

a significant difference in treatment outcomes for patients 
with NSCLC. In 2021, we plan to expand our thoracic cancer 
program into first-line NSCLC through a clinical collaboration 
with MSD (a tradename of Merck & Co.). The KEYNOTE B-36 
trial to study TTFields together with the anti-PD-1 therapy 
KEYTRUDA will launch later this year. We are also studying 
the effect of TTFields on brain metastases from NSCLC in our 
phase 3 pivotal METIS trial.

We have two ongoing phase 3 pivotal trials in our abdominal 
cancer program. INNOVATE-3 is testing the effectiveness of 
TTFields in patients with platinum-resistant ovarian cancer. 
PANOVA-3 tests the effectiveness of TTFields in patients with 
unresectable, locally-advanced pancreatic cancer. Almost all 
patients diagnosed with these cancers face a poor prognosis. 

We recently completed a phase 2 pilot trial in liver cancer, 
the HEPANOVA trial, and are enrolling patients in EF-31, a 
phase 2 pilot study in gastric cancer in partnership with Zai 
Lab. The data generated from these studies are intended 
to inform the design of phase 3 pivotal trials and create the 
potential to expand our late-stage pipeline into additional 
indications.

we believe we are only beginning to unlock the  
potential of the TTFields platform

Beyond our clinical development, we believe there is 
considerable opportunity to extend survival through product 
innovation. Our product development teams remain focused 
on delivering innovations to increase TTFields dose and to 
improve patient usability. Our teams continue to evaluate 
opportunities to optimize the TTFields generator, design next 
generation arrays, and create new patient-centered software 
intended to support larger populations in multiple indications.

Our belief that the TTFields mechanism of action is broadly 
applicable to solid tumor cancers is supported by a scientific 
rationale grounded in more than 20 years of research. In 
addition to its anti-mitotic effect, TTFields has been shown 
in vitro to inhibit DNA damage repair, to induce autophagy 
and to induce immunogenic cell death, among other 
downstream effects. 

Our platform therapy is intended principally for use together 
with other standard-of-care treatments. There is a growing 
body of evidence that supports TTFields’ broad applicability 
with other therapies, including radiation therapy, and certain 
chemotherapies and immunotherapies. 

We continue to see signals of broadening interest in our 
therapy among external researchers and clinicians. Last year, 
TTFields was cited in over 1,600 scientific publications and 

82 publications were authored about our therapy. 31 active 
investigator-sponsored trials are anticipated to further refine 
our understanding of TTFields’ optimal use in the clinic. 
These external efforts build upon and enrich the TTFields 
ecosystem and serve to advance our patient-forward mission. 

Last year, TTFields was cited in over 
1,600 scientific publications and 82 
publications were authored about our 
therapy. 31 active investigator-sponsored 
trials are anticipated to further refine our 
understanding of TTFields’ optimal use in 
the clinic. 

striving to make a difference

We started Novocure with the novel insight that electric 
fields can be harnessed to disrupt cancer cell division. Two 
decades later, our mission remains clear. We strive to extend 
survival in some of the most aggressive forms of cancer 
through the development and commercialization of TTFields. 

Over the last year, we learned firsthand that life can change 
dramatically overnight. We worked most of the year under 
extraordinary conditions, adapting many times to the 
challenges and seeking opportunities before us. We never 
lost sight of our aspiration to make a difference in cancer. As 
we look forward, we see an opportunity to make a difference 
in the lives of many more people diagnosed with some of the 
most aggressive and prevalent solid tumor cancers. Through 
the experience of the past year, our resolve and passion have 
only increased, and we feel even more motivated to move 
forward on our mission. 

Thank you for your continued support. 

Asaf Danziger, 
CEO

William Doyle,  
Executive Chairman

1. 

Adjusted EBITDA is a non-U.S. GAAP measurement of 
earnings before interest, taxes, depreciation, amortization and 
share-based compensation. Reconciliations of non-GAAP 
financial measures to GAAP financial measures are included in 

our Form 8-K filed with the SEC on April 29, 2021.

2020 ESG highlights

PATIENTS THAT QUALIFIED FOR 
OUT-OF-POCKET EXPENSE FOR 
OUR THERAPY OF LESS THAN 

$500

 PER YEAR

8% 

OF OPTUNE DEMAND WAS 
MET IN THE FORM OF FREE 
THERAPY PROVIDED BY US 
TO PATIENTS, INCLUDING 
THOSE WITHOUT 
INSURANCE 

100%

OF PATIENTS WERE VERY 
SATISFIED OR SATISFIED 
WITH NOVOCURE1

87% 

OF OUR EMPLOYEES ARE 
ENGAGED, MORE THAN 
14% POINTS ABOVE THE 
GLOBAL NORM2

ROLLING 12 MONTH 
TURNOVER RATE OF 

9%3

COMPARED WITH 
INDUSTRY AVERAGE OF 
NEARLY 16%4

66%

OF ELIGIBLE EMPLOYEES 
PARTICIPATED IN OUR 
EMPLOYEE SHARE PURCHASE 
PROGRAM VS. 30% AVERAGE 
GLOBAL PARTICIPATION FOR 
COMPARABLE PLANS   

OVER

30

OVER

15

NATIONALITIES REPRESENTED 
WITHIN OUR WORKPLACE

LANGUAGES SPOKEN WITHIN 
OUR WORKFORCE

1. 

2. 

3. 

4. 

based on 2020 patient survey results

based on 2021 employee survey with an 88% response rate conducted by  
an independent third party

as of December 31, 2020

based on the Radford U.S. Life Sciences Trends Report for Q4 2020

comparison of 15 month cumulative total return*

cumulative total return summary

The graph below matches NovoCure Ltd’s cumulative 5-Year total shareholder return on common stock 
with the cumulative total returns of the Russell 2000 index and the NASDAQ Biotechnology index. The 
graph tracks the performance of a $100 investment in our common stock and in each index (with the 
reinvestment of all dividends) from 12/31/2015 to 12/31/2020.

The stock price performance included in this graph 
is not necessarily indicative of future stock price 
performance.

Among NovoCure Ltd, the Russell 2000 Index  and the NASDAQ Biotechnology Index

$ 500

NovoCure 
Ltd

Russell 
2000

NASDAQ 
Biotechnology

$ 450

$ 800

$ 400

$ 700

$ 350

$ 600

$ 300

$ 250

$ 500

$ 200

$ 400

$ 150

$ 300

$ 100

$ 50
$ 200

$ 0
$ 100

10/2/15

$ 0

12/15

12/15

100.00

100.00

100.00

12/16

35.11

121.31

78.65

12/17

90.34

139.08

95.67

12/15

12/16

12/17

12/18

12/19

12/18

149.73

123.76

87.19

12/16

12/17

12/18

12/19

12/20

NovoCure Ltd

Russell 2000

NASDAQ Biotechnology

12/19

376.88

155.35

109.08

NovoCure Ltd

*$100 invested on 12/31/15 in stock or index, including reinvestment of dividends. 
Fiscal year ending December 31. Copyright© 2021 Russell Investment Group. All rights reserved.

NASDAQ Biotechnology

Russell 2000

approved indications

warnings and precautions

Optune is intended as a treatment for adult patients 
(22 years of age or older) with histologically-confirmed 
glioblastoma multiforme (GBM).

Optune can only be prescribed by a healthcare provider 
that has completed the required certification training 
provided by Novocure®.

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.

important safety information

contraindications

Do not use Optune in patients with GBM with an 
implanted medical device, a skull defect (such 
as, missing bone with no replacement), or bullet 
fragments. 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.

Use of Optune for GBM together with implanted 
electronic devices has not been tested and may lead to 
malfunctioning of the implanted device.

Do not use Optune for GBM in patients known to be 
sensitive to conductive hydrogels. Skin contact with the 
gel used with Optune may commonly cause increased 
redness and itching, and may rarely lead to severe 
allergic reactions such as shock and respiratory failure.

The most common (≥10%) adverse events involving 
Optune in combination with chemotherapy in 
patients with GBM were thrombocytopenia, nausea, 
constipation, vomiting, fatigue, convulsions, and 
depression.

The most common (≥10%) adverse events related to 
Optune treatment alone in patients with GBM were 
medical device site reaction and headache. Other 
less common adverse reactions were malaise, muscle 
twitching, and falls related to carrying the device.

If the patient has an underlying serious skin condition 
on the treated area, evaluate whether this may prevent 
or temporarily interfere with Optune treatment.

Do not prescribe Optune for patients that are pregnant, 
you think might be pregnant or are trying to get 
pregnant, as the safety and effectiveness of Optune in 
these populations have not been established.

forward-looking statements

In addition to historical facts or statements of current 
condition, this report may contain forward-looking 
statements. Forward-looking statements provide 
Novocure’s current expectations or forecasts of future 
events. These may include statements regarding 
anticipated scientific progress on its research programs, 
clinical trial progress, development of potential 
products, interpretation of clinical results, prospects 
for regulatory approval, manufacturing development 
and capabilities, market prospects for its products, 
coverage, collections from third-party payers and other 
statements regarding matters that are not historical 

12/20

773.88

186.36

137.90

facts. You may identify some of these forward-looking 
statements by the use of words in the statements such 
as “anticipate,” “estimate,” “expect,” “project,” “intend,” 
“plan,” “believe” or other words and terms of similar 
meaning. Novocure’s performance and financial 
results could differ materially from those reflected 
in these forward-looking statements due to general 
financial, economic, environmental, regulatory and 
political conditions as well as issues arising from the 
COVID-19 pandemic and other more specific risks 
and uncertainties facing Novocure such as those 
set forth in its Annual Report on Form 10-K filed on 
February 25, 2021 with the U.S. Securities and Exchange 
Commission. Given these risks and uncertainties, 
any or all of these forward-looking statements may 
prove to be incorrect. Therefore, you should not rely 
on any such factors or forward-looking statements. 
Furthermore, Novocure does not intend to update 
publicly any forward-looking statement, except as 
required by law. Any forward-looking statements herein 
speak only as of the date hereof. The Private Securities 
Litigation Reform Act of 1995 permits this discussion.

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No. 4 The Forum
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novocure.com