Nuvation Bio Q3 2026 Earnings Call Transcript

Nuvation Bio (NYSE:NUVB) reported third-quarter financial results on Wednesday. The transcript from the company’s third-quarter earnings call has been provided below.

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Summary

Nuvation Bio reported third-quarter 2026 revenue of $45 million, driven by strong growth in Ibtrosi, with net U.S. product revenue of $27.5 million, marking an 18% growth from the previous quarter.

The company is maintaining its leadership in the ROS1 TKI market, with Ibtrosi holding over 60% market share for first-line new patient starts and achieving significant milestones in patient treatment rates.

Safusitinib received FDA Fast Track designation for IDH1-mutant glioma, with promising Phase 2 study results showing a 52% objective response rate.

The company has a strong cash position of $663.4 million, supporting ongoing investments in their pipeline, including the drug-drug conjugate platform expected to update by year-end.

Management is optimistic about long-term growth driven by Ibtrosi’s market position and durability profile, and Safusitinib’s potential in glioma treatment.

Full Transcript

OPERATOR

Hello and welcome to Nuvation Bio’s Third Quarter 2026 Financial Results and Business Update Call. Today’s call is being recorded and a replay will be available on the company’s website. All participants are currently in a listen-only mode. A brief question-and-answer session will follow the prepared remarks. Now I’d like to turn the call over to J.R. DeVita, Vice President of Corporate Development and Investor Relations at Nuvation Bio. Please go ahead.

Robert (JR) DeVita (Executive Director, Corporate Development & Investor Relations)

Thank you and good afternoon, everyone. Earlier today we issued a press release summarizing our financial results for the quarter ending September 30, 2026 and provided a business update. The press release is available on the Investors section of our website at nuvationbio.com. Today’s call includes forward-looking statements, including statements about the therapeutic and commercial potential of Ibtrosi and Safusitinib, our development plans for taletrectinib, Safusitinib and our drug-drug conjugate platform, along with our plans for future updates from these programs, the components of our anticipated product revenue, our expected milestone payments and spending patterns, and our cash runway and profitability potential.

Because such statements deal with future events and are subject to many risks and uncertainties, actual results may differ materially from those in the forward-looking statements. For a full discussion of these risks and uncertainties, please review our Quarterly Report on Form 10-Q, which we filed with the U.S. Securities and Exchange Commission today. Joining me on today’s call are our Founder, President and Chief Executive Officer, Dr. David Hung, our Chief Commercial Officer, Colleen Sjogren, and our Chief Financial Officer, Philippe Sauvage. Now I’ll turn the call over to Dr. David Hung. David, please go ahead.

David Hung (Founder, President and CEO)

Thanks, J.R. Good afternoon, everyone, and thank you all for joining us today. I’m pleased to discuss the progress we made across our business. In the third quarter we generated $45 million in overall revenue driven by another quarter of strong Ibtrosi growth. Net U.S. Ibtrosi product revenue was $27.5 million, which represented 18% growth from the last quarter. Approximately 160 new patients started treatment with Ibtrosi, about 65% of which were in the first-line setting.

The commercial signals that matter most to our long-term thesis remain encouraging. Fifteen months into our U.S. launch, we continue to both build a growing base of patients on therapy and strengthen our position in the ROS1 market. Ibtrosi has reached an all-time high in its share of active patients receiving a ROS1 TKI and continues to lead in first line new patient starts with greater than 60% market share as of the end of the quarter. Our revenue growth reflects an expanding active treatment base driven by an increasing proportion of first-line patients that we believe can stay on therapy for years, as seen in our TRUST clinical studies.

IQVIA claims data from the third quarter demonstrated a 15% decline in total new patient starts across the ROS1 TKI market. This is further evidenced by a lower volume of ROS1-positive testing alerts from our laboratory data partners. We believe these observations suggest that at least part of the softness in our first-line new patient starts is a reflection of the overall flow of newly identified and treated patients rather than a loss of Ibtrosi’s competitive position.

Despite the market dynamics described, as of the end of the quarter we maintain our strong position as the leading ROS1 TKI in total active patients across all lines of therapy combined. ROS1-positive lung cancer is an ultra-rare disease and the number of new patients entering treatment can fluctuate from quarter to quarter. We do not believe one quarter provides sufficient data to establish an identifiable demand trend nor draw clear conclusions.

We are monitoring market activity and treatment patterns closely while maintaining our focus on the drivers we can influence: identifying patients earlier, educating physicians about appropriate testing, supporting biomarker-informed treatment decisions and increasing appropriate use of targeted therapy. We also are encouraged by how Ibtrosi’s launch compares with historical targeted lung cancer launches, particularly given the small ROS1 population and fragmented prescriber base. While we realize comparisons are nuanced due to differences in size of patient populations, cost of therapy and initially approved lines of therapy, we believe this is helpful to put Ibtrosi’s launch in context. For example, five quarters into the launches of Lorbrena and Alecensa for ALK-positive lung cancer, U.S. net revenues per SEC filings and financial reports were $25 million and $36 million, respectively.

As you know, Ibtrosi has already reached similar levels of sales in a more competitive market, despite ROS1 incidence being approximately half that of ALK. It is key to remember that the ALK-positive lung cancer market was not developed overnight. It took time for testing patterns, physician confidence, durability on treatment and long-term data to align behind the agents that ultimately became market leaders. Today, most fundamentally, our confidence begins with the clinical profile. In TKI-naive patients in TRUST-1, Ibtrosi demonstrated a 90% objective response rate, or ORR, 50 months of median duration of response, or DOR, and 50 months of median progression-free survival, or PFS. Its tolerability profile, including the unique absence of a CNS warning and precaution in the label, is another critical point of differentiation among brain-penetrant ROS1 TKIs.

And remember, these metrics are supported by median patient follow-up of 51 months in the TRUST-1 study. We believe these attributes can support physician confidence, sustained first-line adoption and meaningful time on therapy. This clinical profile is also one of the reasons we chose to develop Ibtrosi in the adjuvant setting. While we’re encouraged that enrollment is fully on track in this first-of-its-kind study for ROS1, if approved, this indication could expand the patient population Ibtrosi is able to address, and the data from Eli Lilly’s LIBRETTO study in RET-positive non-small cell lung cancer has given us even more confidence that we could reach a meaningful result in ROS1 sooner than we initially thought.

Taken together, the results reinforce our view that we are building a durable commercial franchise and that Ibtrosi has become the standard of care in ROS1-positive lung cancer. Quarterly new patient activity will not always move in a straight line, but our competitive positioning, growing active patient base and ability to reach more eligible patients provide a strong foundation for the years ahead. Moving to Safusitinib, we remain very excited about this program and its potential to become a key value driver for Nuvation Bio as we move to 2027 and beyond. In August, the FDA granted Fast Track designation to Safusitinib for the treatment of IDH1-mutant glioma. We view this as supportive external validation of both the unmet need in this disease and the potential development path for Safusitinib. Fast Track designation is intended to facilitate development and expedite review of therapies that may address serious conditions with unmet medical need, and we are pleased to have this designation as we continue to advance the program.

As a reminder, in July we announced updated long-term results from the Phase 2 J201 study in 27 patients with chemotherapy- and radiotherapy-naive grade 2 IDH1-mutant glioma with a median follow-up of 39 months. The centrally assessed ORR increased to 52% from 44% at 28 months of median follow-up. Median PFS had not yet been reached and the 36-month PFS rate was 79%. Responses in the study have continued to deepen and no new safety signals were observed.

With additional follow-up, we will present more detailed data beyond these top-line results at the Society for Neuro-Oncology Annual Meeting next week. As a result of this encouraging data set, we recently announced an enhanced development plan that allows us to address two key goals. First, our four studies together address all grades and risk groups within the broad IDH1-mutant glioma landscape. Second, two of these studies focus on patient groups with high unmet needs and no alternative treatment options and evaluate ORR as a primary endpoint, which will allow us to generate data quickly.

In fact, these two studies, in patients with grade 3 oligodendroglioma and in patients who have progressed following treatment with vorasidenib, also analyze tumor growth rate, or TGR, as a secondary endpoint, which may provide an even earlier signal of efficacy. This is a key difference from our other two pivotal randomized studies, which evaluate PFS as a primary endpoint and will not generate data until 2029 or later. As a reminder, these pivotal studies include Sigma, which is evaluating Safusitinib in patients with high-grade and high-risk astrocytoma, and a separate study in patients with grade 2 IDH1-mutant glioma.

Enrollment in the Sigma study, including the exploratory cohort, is on track, and we expect to be enrolling patients in all four studies in the coming months. We plan to provide more specific updates on enrollment and clarity around timing of data readouts next year. Finally, we also remain on track to provide an update on our drug-drug conjugate, or DDC, platform by the end of the year. This update will include additional detail about how we plan to move the program forward and into the clinic. We’re excited by the progress of this program and look forward to sharing more information soon.

Overall, the third quarter reinforced the long-term opportunity in front of us. Ibtrosi is now a commercial leader with a growing active patient base that is driven by an increasing number of new first-line patients and their long duration of treatment. Safusitinib continues to advance as a meaningful second franchise with potential data next year, and our DDC platform could contribute to future pipeline growth. With that, I’ll turn the call over to Colleen to provide a more detailed update on Ibtrosi’s commercial launch.

Colleen Sjogren (Chief Commercial Officer)

Thank you, David, and good afternoon, everyone. IPTROSI continues to strengthen its leadership in the ROS1 market with a launch trajectory that stands out against historical benchmarks. Just 15 months after launching, we have achieved approximately twice the cumulative patient starts of earlier-generation ROS1 TKI launches at comparable points in their commercialization based on our internal data and adjusted claims estimates. This is particularly meaningful in an ultra-rare disease with a broad and fragmented prescriber base.

We believe this performance is a testament to both IPTROSI’s differentiated clinical profile and the strength of an experienced commercial team that knows how to successfully launch targeted oncology therapies. In the third quarter, U.S. net product revenue grew 18% sequentially to approximately $27.5 million, despite an observed decline of about 15% in new patient starts across the overall ROS1 TKI market. This quarterly decline was observed in two distinct data sets, IQVIA data and the number of ROS1 NGS testing alerts from our contracted lab partners. This is the kind of fluctuation sometimes observed in ultra-rare disease, and we do not believe it is indicative of any trend.

In fact, it builds confidence that we continue to grow our active patient base and our sales in a down market. This growth was broad based across treatment settings, reflecting deepening physician confidence, expanding adoption, and sustained demand for IPTROSI. Our commercial execution continues to translate into significant market leadership, and this quarter we achieved an important milestone. IPTROSI is now the leading ROS1 TKI in total active patients across all lines of therapy combined.

This is based on IQVIA claims data. This is not simply a measure of new patient starts; it represents our share of all patients actively receiving a ROS1 TKI, including those who have initiated therapy years ago on earlier generations of ROS1 TKIs. Having achieved this leadership position just over a year post approval in a market with established therapies is particularly significant and reinforces both the strength of IPTROSI’s clinical profile and the success of our commercial execution.

We are also continuing to strengthen our first-line position. We established IPTROSI as the market leader in total active first-line patients through the end of the quarter, and today our share of first-line new patient starts is more than 60%. As David discussed, IPTROSI’s compelling efficacy, exceptional durability, and generally favorable tolerability profile continue to differentiate it in the first-line setting. Based on multiple advisory board meetings and one-on-one engagements, physicians continue to point to the strength of our clinical data, supporting our belief that IPTROSI’s durability is the benchmark against which other ROS1 therapies will be measured, especially given our mature patient follow-up. While our TRUST clinical studies were much longer than IPTROSI’s time in the market to date, we have observed a clear similarity between duration of therapy in the real world and durability in our clinical trials.

This is further evidence of why we believe IPTROSI can benefit patients for years. As the launch continues to mature, we are seeing a natural evolution in the ROS1 patient population. At launch, there was a pool of patients receiving earlier-generation ROS1 inhibitors who were candidates to switch therapies due to disease progression or tolerability. We have successfully captured many of these patients. As a result, the pool of patients immediately available to switch has become smaller, and future growth will increasingly be driven by newly diagnosed patients.

We believe this dynamic, combined with our entrenched commercial leadership, provides a strong foundation for sustained long-term growth, and while new treatment options are entering the market, our leadership remains strong as IPTROSI continues to be the only brain-penetrant treatment option without a CNS warning and precaution in its label. To date, we have not observed a material impact on IPTROSI’s overall active patient share with recent market entrants, and our data suggests that early uptake of a new competitor is largely concentrated in later lines of therapy with no off-label use in TKI-naive patients.

Beyond our growing market leadership, we are also encouraged by the opportunity to expand the overall ROS1 TKI market. Claims data show that the number of patients actively receiving a ROS1 TKI increased materially year over year following IPTROSI’s launch. Even with a market pullback this past quarter, we believe this growth demonstrates the potential to expand the population receiving a ROS1 TKI, and we see an even more substantial opportunity ahead through earlier identification of ROS1 fusions and increased adoption of targeted therapies in place of chemotherapy with or without immunotherapy.

However, we see two key barriers remaining along the testing-to-treatment journey. First, limited awareness that DNA-based testing alone may miss ROS1 fusions, and second, the urgency to initiate treatment before molecular testing results are available, potentially leading patients to receive chemotherapy or immunotherapy instead of a targeted therapy. We have focused commercial initiatives underway to help drive the shift in testing and treatment decision behavior, which we believe are key sources of long-term growth for IPTROSI. For example, through our quality-based initiatives we are addressing critical gaps in patient care, from significantly improving NGS testing rates at key community oncology practices to ensuring patients receive optimal care with appropriate targeted therapies. We are also assessing testing lab alert data to prioritize relevant physician outreach and advancing network collaborations to strengthen molecular testing and treatment decisions.

Additionally, we are also investing in field training, coordinated omnichannel marketing, and AI-enabled approaches to make HCP engagements more targeted and timely. We know this may take time, but patients deserve it and our focus is always on increasing the rate of diagnosis and displacing inadequate treatment options. At the institutional level, we continue to strengthen access and pathway positioning. For example, one major community pathway recently reinforced the position of IPTROSI as its primary first- and second-line ROS1 TKI treatment choice. Along with focused contracting initiatives and tailored strategies across academic centers, IDNs, and community practices, this reduces practical barriers to access. These efforts require close, appropriate coordination among Sales, Market Access, Marketing, and Medical, and I’m incredibly proud of how our experienced teams are executing cross-functionally.

What gives me confidence in the long-term success of IPTROSI is the combination of strong clinical differentiation, an established and growing market position, and a commercial team that understands both the opportunities and the work required to capture them. We have built a strong foundation over the first 15 months, and we remain focused on translating that leadership into sustainable long-term growth and bringing the potential benefits of IPTROSI to more appropriate patients.

With that, I’m going to turn the call over to Philippe.

Philippe Sauvage (Chief Financial Officer)

Thanks, Colleen, and good afternoon, everyone. For detailed third quarter 2026 financial results, please refer to our earnings press release which is available on our website. I will highlight a few key points from the quarter. For the third quarter of 2026, total revenue was $45 million, including $27.5 million in IPTROSI net U.S. product revenue and $17.5 million in collaboration and license revenue. For the first nine months of 2026, we generated $159.9 million in total revenue.

This included $69.2 million in IPTROSI net U.S. product revenue and $90.7 million in collaboration and license revenue. The commercial dynamics David and Colleen discussed are consistent with our view of how this market would and will develop as behaviors change. The later-line pretreated ROS1 population represented an important but finite opportunity early in the launch. The long-term growth driver now becomes first-line adoption and the accumulation of patients who can remain on therapy for multiple years. David mentioned the trajectory of precedent launches in the ALK-positive lung cancer space.

These precedents tell us a few things, first and foremost that IPTROSI’s launch is in line with prior rare lung oncology launches on a population-adjusted basis, but also that it takes time for the first-line patients on therapy to build a durable revenue base. This is why we continue to be excited by IPTROSI’s potential. Our access strategy continues to be effective. Gross-to-net deductions were approximately 30% in the third quarter. We expect gross-to-net to remain generally stable as our payout mix and contracting mature. The remainder of our revenue was generated through collaboration and license agreements. We continue to receive royalty revenue from Innovent Biologics in China and Nippon Kayaku in Japan. The China and Japan launches are progressing ahead of our expectations, and we continue to view our ex-U.S. partnerships as a growing component of the broader IPTROSI portfolio. In fact, $7.7 million of our total revenue for the quarter was driven by milestone and royalty payments from these partnerships. We are also working closely with ASI, our partner for Europe and other select territories. We expect potential approval in Europe in the first half of next year, which will trigger an approximately $30 million milestone payment to Nuvation Bio.

On the expense side, we continue to invest in the business and our programs, resulting in total operating expenses of $75.2 million for the quarter. R&D expenses were $32.7 million for the quarter and $98.4 million for the first nine months of 2026, primarily reflecting investment in the TRUST and sapuzedinib clinical development programs as well as preparation for future development activities. SG&A expenses were $42.6 million for the quarter and $123.5 million for the first nine months of 2026, primarily driven by support for the commercialization of IPTROSI.

While we always expect small quarter-on-quarter fluctuations in our spend, we do not expect material changes to our general spending patterns for the remainder of the year, as a rise of R&D spend on sapuzedinib is compensated by gradual reduction of the spend on the TRUST program over time. It is also exciting to highlight that for the first time, IPTROSI is now on a quarterly revenue run rate relative to launch-related expenses that represents a self-sustaining commercial program on a standalone basis. Our goal has always been for IPTROSI to be a driver of future profitability, and we view this as a first step on the journey of IPTROSI being able to finance all of our spending activity.

Turning to the balance sheet, we had cash, cash equivalents, and marketable securities of $663.4 million as of September 30, 2026, which now includes all proceeds from our convertible debt offerings this summer. This solid cash position gives us the confidence to continue investing in our future, driven by our pipeline of exciting assets. Importantly, our approach to capital allocation has not changed. We remain disciplined. We will continue investing behind IPTROSI, advancing sapuzedinib, and progressing our DDC platform through a position of strength.

We also continue to evaluate business development opportunities only where we see the potential to generate compelling returns and create long-term shareholder value. Based on our internal revenue projections and the current operating plan for all of our programs, we continue to believe we have sufficient capital to reach profitability. I’ll now turn it back to David for closing remarks.

David Hung (Founder, President and CEO)

Thanks, Philippe. This quarter reinforces what we are building at Nuvation Bio. A commercial program with the potential to redefine the treatment of advanced ROS1 positive lung cancer, a second program that continues to gain momentum in IDH1 mutant glioma, and a pipeline platform that we believe can support future growth. We recognize that changing treatment behavior in targeted oncology takes time, but we are confident in the fundamentals. Nabtrosia has a differentiated label, a growing active patient base and a durability and tolerability profile we believe are necessary to support long-term adoption.

At the same time, Zafu Sitinib is advancing through a comprehensive development plan in an area of significant unmet need. I am proud of the progress our team continues to make and grateful to our employees, investigators, partners and shareholders and to the patients and families who place their trust in us. I’ll now ask the operator to open the line for questions.

OPERATOR

Thank you. At this time we will begin the question and answer session. Please limit yourself to one question and one follow-up. To ask a question, please press Star 1 on your telephone keypad. To withdraw your question, press Star 1 again. Please hold while we compile the Q and A roster. Your first question comes from the line of Farzeen Haque with Jefferies. Your line is open. Please go ahead.

Farzeen Haque (Analyst at Jefferies)

Hi everyone. Thanks for taking my question. First on glioma, are you providing any color on the enrollment for the two cohorts, the oligodendroglioma and the post VORA patients, and when we could potentially get the ORR readout in 20?

David Hung (Founder, President and CEO)

Hi Farzeen. We haven’t yet provided color on that, but we will probably be doing that in the future. Time.

Farzeen Haque (Analyst at Jefferies)

Got it. And then on Ibtrosy, the October sales are looking in line with prior months, but with the new patient starts holding up and the first-line patient base is accumulating, how should we think about the 4Q revenues despite the broader ROS1 market decline that you’re seeing? Is 108 million consensus the right area to think about for the year?

Philippe Sauvage (Chief Financial Officer)

Yeah, I think there’s lumpiness in this last quarter, so I think that we don’t really look at that as a trend of any sort. So we anticipate growth continuing at around the same point as we’ve seen in the past.

Farzeen Haque (Analyst at Jefferies)

Great. Thank you for taking a question.

OPERATOR

Your next question comes from the line of Gregory Ranza with Truist Securities. Your line is open. Please go ahead.

Aneesh (Analyst at Truist Securities)

Hi guys, it’s Aneesh on for Greg. Congrats on the progress this quarter and for taking our questions. We wanted to know within the first-line opportunity, how are you seeing Ibtrossi compete with repotrectinib and what is driving physician choice? And is the bigger remaining opportunity taking share from other TKIs or earlier ROS1 testing and conversion from chemo-IO? Thanks so much.

David Hung (Founder, President and CEO)

Okay, well, that’s a lot of questions, but I think we’re doing very well against repo. As you know, we are not only market leader, but we are also, in the first year of our launch, we’ve sold twice as much drug as all other ROS1 agents combined. So we’ve done extremely well against our competitors. We think the market’s going to grow by a couple of ways. Number one, we do believe that we will take care from other TKIs given if you look at our efficacy, which has not been matched, our safety profile.

As we mentioned, we are the only ROS1 TKI that penetrates the brain, that does not have a CNS or warnings and precautions. So that’s unique. So we think we will continue to take market share from other TKIs, but we also do think that we will grow the market because good drugs grow markets. And we saw that happen with ALK, we saw that with EGFR, and we think that’s going to happen in ROS1. We do anticipate increasing testing for ROS1, but we also anticipate other changes in practice that are now supported by NCCN guidelines, namely reduction of IO chemo use and using a precision ROS1 TKI for a precision mutation like ROS1.

So we do think that will continue to grow the market. Colleen?

Colleen Sjogren (Chief Commercial Officer)

Yeah, I want to add on to that, too. Thanks for the question. It’s a good one. So when you look at Ibtrosy right now, what is really remarkable, looking at the team’s achievement, Ibtrosy right now has the largest number of patients actively receiving a ROS1 TKI. Now, that’s across all lines of therapy combined. And to your question, that’s including patients who started in prior periods on therapies available for years. So this is distinct just from being number one in new starts.

So reaching this position in just 15 months after launch, that reflects both new patient adoption and patients continuing treatment. So we think that’s really important. And I’d like to just address quickly what you said about testing. We see this as one of the most meaningful opportunities. So when we look at the two care gaps that matter most, we’re looking at this idea that DNA-only testing can definitely miss some of these ROS1 fusions and then the other part of it is these treatment decisions beginning sometimes before molecular testing results are even back and available. So we’re hyper focused on improving comprehensive testing that’s including appropriate RNA-based methods.

We’re also very focused on helping practices incorporate molecular results into their treatment decisions. So these changes do take time. We know that this team has been in ultra-rare disease before but they definitely can improve care and expand the appropriate targeted treatment for these patients.

David Hung (Founder, President and CEO)

And I want to add one more comment to Colleen’s comment. So if you look at the duration of response in the first-line setting for it’s 50 months. That’s, you know, if you look at repotrectinib, their DOR is around 36 months. So that’s a pretty significant difference in how long patients will be on therapy. That contributes to more patients being on therapy. But on top of that I mentioned that we are the only ROS1 TKI without a CNS warnings precautions.

If you look at our median time of follow-up with the Ibtrosy data so far it’s 51 months. We’re not talking about 14 months of follow-up. We’ve had well over four years of follow-up. And you know that adverse events accumulate with time. In spite of a 51-month follow-up we have right now no CNS warnings or precautions on label. We have a very, very low incidence of adverse events. We think that that combined with the efficacy leads to a growing pool of patients on therapy which will contribute to the revenue stacking that we’ve talked about from day one.

So we do think that the number of patients on Ibtrosy will continue to grow especially because of our long duration of response and our really excellent tolerability.

Aneesh (Analyst at Truist Securities)

Thanks so much. Thanks so much.

OPERATOR

Your next question comes from the line of Jeff Meacham with Citi.

Jeff Meacham (Analyst at Citi)

Great. Thanks guys. Thanks for taking the question. Congrats on the quarter. Had a couple questions. One for Ibtrosy, maybe just it’d be helpful to walk through in the US the nuances between the community and academic setting. Are there any differences there? And then as your partners prepare for a launch in China and in Japan in that market are there anything that anything you would call out as differences that may, you know, help the launch and adoption.

I’m just trying to think of the comparisons to the US and then I have a follow-up.

David Hung (Founder, President and CEO)

Sure. So in the community we do see lower rates of testing than in many academic centers. So I think that will improve over time, but I would say that community is still not getting as much testing done as academicians are. On top of that, we do think that there is probably more IO chemo use in the community setting than there is in academia. So I think those are two of the most important differences. When we look at China and Japan, those launches have actually exceeded our expectations.

And part of that is because testing is actually remarkably high in China and Japan. And in China, you know, you get in trouble for not ordering NGS on a lung cancer patient in 2026. I wish I could say that for the US that’s not the case, but I would say that the testing rates in China, Japan are excellent and probably contribute to the reason that those launches have actually exceeded our expectations.

Jeff Meacham (Analyst at Citi)

Okay, and then just on safu, with the expansion of the SGMA study, maybe just talk a little bit about what that means for the standard of care across the different European countries. I’m just trying to think of variations in the standard of care among the different new European countries and what that could do to some of your comps or maybe enrollment kind of timelines.

David Hung (Founder, President and CEO)

Yeah, I don’t think it’s going to really change among the countries. You know, the things that all the patients have to have failed to get onto the SGMA study are all pretty standard. I don’t think that’s going to contribute to any role variation. I think that this is a pretty uniform patient population. We anticipate it being, you know, pretty standard across all the countries. You know, we are trying to find countries where there are different standards of care in which VORA is not available to do a study against placebo, because that’s not possible in countries that do have VORA.

But I would say for the SGMA countries, the standards of care are pretty standardized across all of them and we don’t anticipate any real problems from a clinical trial standpoint.

Jeff Meacham (Analyst at Citi)

Awesome. Okay, thanks.

OPERATOR

Your next question comes from the line of Lee Watsack with Cantor Fitzgerald. Your line is open. Please go ahead.

Lee Watsack (Analyst at Cantor Fitzgerald)

Hey guys, thanks for taking my questions. Maybe just on SAPU readout, which of the endpoints could we potentially get in 2027 and what would be impressive, you know, outcomes either in legal or post VORA settings. And then on Ibtrosy, just wondering, you know, what the reason might be behind the sequential decline of the new patient starts for the overall market. Thanks.

David Hung (Founder, President and CEO)

Okay, let me answer your first question first. So with regard to SAPU readout, we previously said that we expect at least 20 patients to be enrolled this year in the grade three oligodendroglioma study. So that means by June of 2027 we will have somewhere between six and nine month follow-up on at least those 20 patients or more will be enrolled more than that. So, you know, in general, if you look at how long it takes to get a response on sacitab, we would say those responses we see are generally in the range of between six months and 12 months.

So we would expect a number of those patients to have objective responses. We are also initiating these post voricitinib study. This study is different because there are a lot of patients now who can put on VORA in the thousands. And we know from the VORA Indigo data that about a quarter of them progress on VORA within about a year. So given the fact that VORA is now pushing almost two years since launch, we would expect there to be well over a thousand patients that would be available that would be progressing under VORA.

And we believe that it would be very easy to identify patients progressing on VORA because they’re progressing clearly. The opportunity to see responses there is even greater. We believe that the bar to beat is in the range of 20%. We know that. We know from Chimerix, as an example, their approval was based on 50 patients in their trial with 11 responses, about a 22% response rate. We know that other glioma fit trials have been in the range of about 70, 75 patients or so.

So we think that somewhere in the neighborhood of 50 patients at a 20% response rate gives you a data set that would be pretty compelling to FDA if you’re responsible, you know, if you in an unmet need and certainly grade three oligodendroglioma and post VORA failure are two indications where there is absolutely nothing available to these patients. So we think that’s a wide open opportunity.

Colleen Sjogren (Chief Commercial Officer)

You want me to take the— Yeah, so your second question on Ibtrosy and the slowdown. So a couple things, you know,

Philippe Sauvage (Chief Financial Officer)

In my experience and the team’s experience, this is really the volatility that you expect in an ultra-rare market. Even when we look across at other TKIs in the lung space, you know, you saw a sharp decline in EGFR and ALK in Q2 over Q1 and then it bounces back. You know, we can never attribute sort of a slowdown to one single cause, but the evidence that we do see here points in one direction. So the IQVIA data shows, you know, lower overall market status.

We talked about that 15% pullback that we see, and that aligns naturally with what we saw in our lab. Partner alerts moved the same way. So approximately 25% decline there. So, you know, the good news in this, in the market that’s pulling back, Ibtrosy still maintained more than 60% share of first-line new patient starts, while reaching, by the way, the leading position in total active ROS1 TKI patients. So, you know, this is very consistent with a smaller market flow than a broad deterioration in our competitive position. So additional quarters will show, you know, and we expect that that will show that the market volume will also normalize.

David Hung (Founder, President and CEO)

And Lee, just because we’ve heard some confusion over our clinical trials and what endpoints are being used and when the readouts, well let me just reiterate that for everyone. So there’s four trials. The SIGMA study is a PFS readout that’s going to be long, that’s going to read out in 2029 or so, and against vorasidenib that’s going to also be a PFS readout. However, two of our studies are response-rate studies. The grade 3 oligodendroglioma is a response-rate study which we believe we will have data on starting probably mid next year.

And the post-vorasidenib study is a response-rate study which we will also start to have responses in 2027. So we would expect that. So while we cannot tell you exactly when the response will occur, we feel very confident given our data that we will see responses, that we think that 2027 will be the beginnings of a number of responses that will hopefully go into a filing package for those indications.

OPERATOR

Your next question comes from the line of Leonid Timoshev with RBC Capital Markets. Your line is open. Please go ahead.

Xander (Analyst at RBC Capital Markets)

Hi, thanks for taking our questions. This is Xander on for Leo. So I know you touched on a little bit of this already, but I guess when looking at the post-Vora setting, are there any precedents or comps that you can point to that would be helpful when we think about reusing a mechanism while moving down in treatment line, kind of how we can think about framing responses there. Thanks.

David Hung (Founder, President and CEO)

To question why we believe that we will have responses in the post-Vora setting? Oh, okay. I mean, first of all, if you look at our response rate, it’s significantly higher than Vora’s. I mean, you know, more than double the Vora response rate. So clearly, you know, we have just more responses. But number two, if you look at the kinds of patients we’re treating, we have responses in sicker, more advanced types of glioma than Vora has. It’s always harder to treat the more advanced, the harder ones, than the easier ones.

So given the fact that we have high-grade responses when Vora has zero, and given the fact that we had more than double the low-grade response to Vora, and given the fact that there’s always some overlap in the spectrum that gliomas have between low and high grade, we would certainly expect to have responses in post-Vora failures. I think our data are pretty compelling in that regard. On top of that, we made the point previously that our adverse events are different. Vora’s primary adverse event is liver function test abnormalities. Ours are immune-type reactions, things that we believe indicate an increased immune activity—things like skin hyperpigmentation, arthritis, rash, hair loss. These are things that we believe are consistent with an immune mechanism. And if you look at our responses that we’ve seen so far in all of our studies, as I mentioned, it can take 6 to 12 months to see a response.

That sounds an awful lot like immuno-oncology. If you look at our responses when we get them, they’re really durable. If you look at our GBM, that patient’s tumor has been gone for three and a half years. A high-grade, grade 4 astrocytoma gone for three and a half years. Those are immune-type reactions that we think completely differentiate us from Vora. So just given our efficacy that we’ve seen so far and the kinds of adverse events we’ve seen and the durability of our responses, we would certainly anticipate that we would see responses.

Xander (Analyst at RBC Capital Markets)

Great. Thanks for taking the question. I really appreciate it.

OPERATOR

Your next question comes from the line of Priyanka Grover with J.P. Morgan. Your line is open. Please go ahead.

Priyanka Grover (Analyst at J.P. Morgan)

Hi guys. Thanks for taking my question. So, on the persistence trends on the front line, second line, what have you seen throughout the quarter? Basically, are discontinuation rates still tracking with what was shown in the clinical trials? Thanks.

Philippe Sauvage (Chief Financial Officer)

Hey, Priyanka. So when we look—yes. So when we look at treatment-related adverse events in the first line and second line, TKI-naive, we are tracking very closely. So when you look at launch through September, our TRAEs are tracking very closely to what we saw in our TRUST trials. So that’s been consistent since launch. And generally speaking, to your point, Priyanka, we’ve not seen anything different from what we’ve seen in a clinical trial in terms of patients staying on therapy, the time they stay on therapy, and all of these things.

Not anything different so far. Obviously the clinical trial we had more than 50 months observation. Here we’ve launched only 15 months. So, you know, we cannot say for the future. But it’s clear that so far we’ve seen it tracking exactly the clinical trial. So really no difference there, which is very reassuring for the long-term potential of that market, of course.

Colleen Sjogren (Chief Commercial Officer)

And one thing, maybe I’ll add on to that, Priyanka. So keep in mind that many of the patients who started early in our launch on Abtrozy, they had received prior ROS1 therapies. So in progression, that more heavily pretreated population has been an important driver of where we saw those discontinuations. But to Philippe’s point, we monitor discontinuations by not only line of therapy but cause—so not just in aggregate. And our adverse event-related discontinuations have, in fact, remained low and consistent with the trials.

OPERATOR

Your next question comes from the line of Yaron Werber with TD Cowen. Your line is open. Please go ahead.

Stephen (Analyst at TD Cowen)

Good afternoon, thanks for taking our question. This is Stephen on for Yaron. One from us on SAFU. Are we inferring correctly that you might expect the grade 3 oligodendroglioma study to be the faster readout versus the post-Vora? And then maybe a follow-up on the tumor growth rate: how would FDA acceptance of that endpoint change the timing on the path to market? And could we potentially hear an update around the growth rate before the ORR data come out?

David Hung (Founder, President and CEO)

So I don’t know which will be faster. You know, I think that we feel pretty confident that the grade 3 oligo study will be positive because we’ve seen great responses there. I think post-Vora we also, as I mentioned, we have so much higher, you know, more than double the objective response rate than Vora in the low-grade setting and have significant high-grade response where Vora’s are zero. So I just think the spectrum of activity is so different between SAFU and Vora.

I feel bullish on that study as well. I can’t tell you which will read out faster. I think that, you know, the Vora study should accrue faster because there’s more patients. But we started accruing the grade 3 oligo study months ago. So then again, you know, will they really be different? I don’t know. Tumor growth rate we think is a really important endpoint. Now it’s not accepted yet by FDA, but I think it makes the point that you can’t have a response—a tumor that’s growing can’t shrink—without changing its slope. And that’s just a no-brainer. So when we change the tumor growth rate from positive to negative, it’s hard to ignore. And, you know, we’re going to assemble data to show how well that correlates with ultimate response.

But we do think that when you change a tumor that’s growing with a positive slope to one that has a negative slope, certainly the patient’s going to feel a lot better about that, as is his doctor, and I would imagine so would the FDA. Now, whether or not they’ll accept that at this point, we have no idea. We’re not assuming that. We’re still assuming they’ll take response rate, but we will present those data with our objective responses to form a package.

I think it will be important in the future because I think that is where this field should head, because I do think that you can’t get a response without changing that tumor growth rate.

Philippe Sauvage (Chief Financial Officer)

And maybe another point to keep in mind. We’re not talking—David, you say that often—we’re not talking about the blinded study. So you can see response rate over time, and it doesn’t necessarily mean you have to wait for a certain time to read out like we would do for PFS. This is response rate that we are monitoring over time. So as we accumulate patients in both of those studies, we will have a better view of the response rates, and we will know where the slope is taking us, to David’s point about the tumor growth rates, which will give a lot of confidence to us that if the shape of that curve is changing, we will eventually get the kind of response we are hoping for. And that’s really important too.

Stephen (Analyst at TD Cowen)

Makes sense. Thank you very much.

OPERATOR

Your next question comes from the line of Michael Yee with UBS. Your line is open. Please go ahead.

Matt (Analyst at UBS)

Hey guys, this is Matt on for Mike. Thank you for taking your questions and congrats on a nice quarter. Could you talk maybe for the grade 2 low-grade, low-risk study? Do you expect the control arm of that study to perform similarly to the original Vora study? Are there anything in the patient population to think about that might not be the same? Any thoughts? That would be great. Thank you so much.

David Hung (Founder, President and CEO)

I do think it would be similar. So I—we’re not inventing any new wheels here. We’re just trying to use a better drug to get the same, you know, to get better results. That’s—we expect the trial to be very similar.

OPERATOR

Your next question comes from the line of Mayank Mamthani with B. Riley, your line is open. Please go ahead.

Mayank Mamthani (Analyst at B. Riley)

Hi Mike, I’m from Mayank. Thanks for taking our questions and congrats on the share gains this quarter. So you had a slide showing or comparing IBTrosy to La Rena and Alicenta, both of which grew about fivefold from their fifth quarter as first four-line patients accumulated. What gives you confidence that Ibtrosy follows that same curve? And also on SAFU for next week, what should we focus on for the four SLO posters? Thank you. Yeah, so as Kali had mentioned, if you look at the sales in the first five quarters of Wabrena and Elsenza, they’re in the range of 26 to 30-something million and we’re smack dab in that range despite the fact that ROS1 incidence is half about. So in spite of being half the incidence, we’re still generating about the same amount of sales. So we think that’s, you know, pretty good. And they still grew that market fivefold more beyond that. And we think that given our trajectory we should, you know, we’re comparing quite favorably to the ALK launches.

So we think that we’re actually doing pretty well.

David Hung (Founder, President and CEO)

And the other thing which is very reassuring that Colleen was mentioning earlier, right, is that this has been, to your point, a very steady and important growth over time, but not necessarily like every quarter higher on new patient start. You know, Colleen was mentioning that earlier. If you look at the new patient start in ALK, Q2 was down 19% versus Q1. So you do see in that rare space some fluctuation. But despite those fluctuations, the trend is clearly up in that space and has been up for a very long time.

And because of the extremely long duration of our response and the very high selectivity of Ibiptrosi, we believe we’re going to see exactly the same thing, which is a general trend going up and going up for a very long time. Even if you could have fluctuation on new patient start one quarter to the next, those things happen. Let me make another point. So if you look at the DORs of at least the alectinib, you know, it’s much, much shorter than our 50-month DOR.

And Lorbrena didn’t at the time even know that the ground data will ultimately give them a seven-year PFS. But if you look at our duration, you’re not going to even see that per year. So we’re only 15 months—15 months out—you’re not even going to see the stacking from Josie for another full stacking for another three plus years, right. So the fact that we’re already matching the out launches at half the epidemiology incidence and we haven’t even gotten to the stacking, suggests to us that we’re going to do really well.

Oh, we haven’t—we’re gonna—you’re gonna see more data on depth and durability of responses. We can’t give you a lot more color than that, but you’re going to see more detail on the depth and durability of the responses that we presented before.

OPERATOR

Your next question comes from the line of Robert Burns with H.C. Wainwright. Your line is open. Please go ahead.

Robert Burns (Analyst at H.C. Wainwright)

Hey guys, congrats on the quarter. Two questions for me, if I may. So obviously we saw updated data from the AROS1 trial at ESMO this year and GHK is planning to file an sNDA in the coming months for the Samson in the frontline setting. So considering that as well as the launch dynamics that you’re now seeing within the frontline setting for Etrosi, I wanted to get your thoughts on the potential impact of the Zitzamtenib’s potential approval in the front line setting on Trozzie’s future revenue potential in the front line.

And then switching over to Vora. Obviously, you know, considering the fact that we’re going to see data from the phase 2 trials in 2027 which could potentially support FDA approval, I want to get your thoughts as to how you’re thinking about the build-out—whether you’ll have to build out your commercial team further to launch it in the CNS indications that you’re pursuing in 2028.

David Hung (Founder, President and CEO)

Let me take the first question. I’ll turn to Colleen for a second. So, you know, the bottom line is we have a 50-month DOR in the first-line setting. We have not seen anything from the daytro on what their duration of response will be in the first-line setting. So I would just say that, you know, it’s going to be pretty hard to beat a 90% response rate and the 50-month DOR. As we’ve mentioned, except for Lorbrena, there are no drugs in the history of oncology that have been able to better a 50-month DOR of Atrosi.

So I would say that, you know, we don’t know how their label will look. When their second-line label came out there were some surprises. Zendaycho had CNS warnings and precautions which no one had expected. If you look at their adverse events even now, 42% peripheral edema—something that’s very noticeable to patients—CNS warnings and precautions, shortness of breath, 4% grade 3 shortness of breath. These are things that I think are going to make it more challenging to continue using drug in the first-line setting where, you know, if you want to get to a 15-month DOR, you’re going to have to have a pretty tolerable drug.

With 51 months of follow-up we’ve shown an extremely tolerable profile for Emtrosy, but after only 14 months of follow-up for Z, as I mentioned, they already are up to 42% BRA and 25% CNS toxicity, plus all the other things I’ve mentioned. So, you know, I think the data will come out when the data come out and right now we think that we are the bottom feet and I think it’s going to be hard to match. Colleen, I’ll let you turn.

Colleen Sjogren (Chief Commercial Officer)

Yeah, sure. I’ll add a little bit on to that. I mean, first of all, you know we expect competition to evolve and I just want to reemphasize, when you look at the accomplishments of what my team has done across—cross-functionally—marketing, market access, sales, medical affairs—when you look at what they have accomplished in 15 months as a fourth entry into the ROS1 market, it’s just remarkable. And what brings us a lot of confidence in the future is that KOLs—our top thought leaders—consistently cite our durability and our data maturity as key differentiators. So as David said, with many describing our approximately 50-month median duration of response supported then by our 51 months of median follow up, it just has created a benchmark for them. So combined with our favorable tolerability profile, this just reinforces physician confidence and I would say particularly in the first-line setting.

So we will continue competing. What I believe is most important is on the totality of evidence and on our execution rather than, you know, assuming any market share is permanent. We are ready for competition and we feel well positioned.

Philippe Sauvage (Chief Financial Officer)

And Robert, to your structured point about launching in glioma, obviously there are lots of things that we will not have to redo. We can leverage fully our commercial organization as it is. The only difference is different calling points, so we potentially need to add some reps, but when you think about day one, that’s about 17 reps. So you’re not talking about a huge team. Glioma is treated in a certain number of centers which is rather limited because obviously it’s brain cancer—you don’t treat that everywhere.

So we are thinking about a relatively limited commercial team that will be able to fully exploit all of the synergy we have by being already a fully commercial organization. When you think about OPEX management, all that we have to support Salesforce today, all market access, etc., all of this will be leveraged. So it’s an addition because of different calling points but a relatively small addition.

Robert Burns (Analyst at H.C. Wainwright)

Awesome. Thanks guys and congrats again.

OPERATOR

Your next question comes from the line of Sylvan Turkan with Citizens JMP. Your line is open. Please go ahead.

Josh Wurman (Analyst at Citizens JMP)

Hey, this is Josh Wurman on for Sylvan Turkan, and thanks for taking my question and congrats on the update today. Maybe just on the variability in the ROS1 diagnoses—how consistent has that, I guess, 3,000 annual diagnoses been year over year? And is the variability year to year, or is it more quarter to quarter, I guess? And then additionally, maybe could you speak to some of the relevant updates in glioma at ESMO? Thanks.

David Hung (Founder, President and CEO)

Okay, so let me be clear. We were never talking about any data that suggests that the epidemiology is off. There is a large amount of literature that supports roughly 2% incidence of non-small cell lung cancer being ROS1-positive. But we were talking about just that when you have a rare indication like ROS1, quarter to quarter there could be lumpiness—things could change. We’ve seen this. If you look at ALK scripts they vary just as much. Just recently I believe that one of the quarters showed a 50% reduction in ALK scripts in the quarter.

We’ve seen that in other orphan indications. So we don’t believe that the overall epidemiology of ROS1 is off. We just believe that from quarter to quarter, when you have a rare indication, you may see some lumpiness and you may have quarters that are down, quarters that are up. But overall it will equilibrate to roughly 2% of all lung cancer new patients properly identified can fluctuate from one quarter to the next. And that’s what happened, as we said, in all Kira’s everywhere really.

But the trend and the epidemiology stands, which to your point means that it’s a quarter-to-quarter fluctuation, not a whether you have changed.

Josh Wurman (Analyst at Citizens JMP)

Great, thanks.

David Hung (Founder, President and CEO)

In the landscape—yeah, I don’t think there’s anything in glioma that’s really changed. In fact, it really further highlights how special SAFU is, because there were actually no data for any agent that had shown results that are as compelling in our opinion as SAPU. So, you know, nothing that we can identify in the landscape. We do think that SAPU is the most promising drug being called IGUAMA today. And so we are excited about this program. And to add to that, another point we made in the past is that because we are going to develop SAP with markets where VORA is not available, it’s going to be very, very hard for anyone in the future to develop anything in IDH1 within Glomar without comparing to an active comparator which will be either us or VORAS time. So not only have we not seen very much other development going on in that space, but any future development in that space will be much more difficult because they will have to compare to an active comparator and we know it’s much harder to do and much longer.

Josh Wurman (Analyst at Citizens JMP)

Great, thank you.

OPERATOR

Your last question comes from the line of Boris Peaker with Jones Research. Your line is open. Please go ahead.

Boris Peaker (Analyst at Jones Research)

Great, thanks for squeezing me in. Just two questions on Ebtrozy. Can you comment on the gross-to-net adjustments this quarter and how that is trending? And the second question on the Sigma trial—I’m just curious, in post chemo-radiation sometimes you see pseudoprogression which could complicate the modified RANO assessment. So I’m just curious, what steps are you—with a centralized blinded independent committee—taking to adjudicate for true progression versus maybe treatment-related inflammation or pseudoprogression?

Philippe Sauvage (Chief Financial Officer)

Thank you for your questions. I’ll start with the GTN. So pretty much stable this quarter, like it has been in past quarters. As I mentioned in previous calls, the next time you’re going to see our GTN—I’m sorry, can you hear me? Yeah. So next time we’re going to see an evolution of our GTN will be at the time of our next price increase because of inflation impact and things of that nature. But it’s been very stable throughout the year, and we think we really stabilized around these 30% gross-to-net.

That’s where we are and that we believe we’re going to stay until the end of the year. And I’ll let David comment on the second question.

David Hung (Founder, President and CEO)

You know, this study has been compared against placebo with a blinded independent committee review. So I think that there will be significant differences between the two populations, but the comparator is placebo. So I think that’s the control and I don’t know how else to comment on that. It’s a controlled study. We think that’s—

Boris Peaker (Analyst at Jones Research)

I was just worried that even on a placebo, just the radiation itself could cause pseudoprogression.

David Hung (Founder, President and CEO)

Well, but they’re—they’re gonna both—this will be in both arms, though, right? The difference will be the drug. And just given the results we’ve seen so far in our SAFI studies, we think the drug will be a significant difference.

Boris Peaker (Analyst at Jones Research)

Okay, great. Well, thanks. Take my questions.

OPERATOR

There are no further questions at this time. I will now turn the call back to David for closing remarks.

David Hung (Founder, President and CEO)

We want to thank you all for your support, and we look forward to updating you on our next call. Thanks so much.

OPERATOR

This concludes today’s call. Thank you for attending. You may now disconnect.

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