Kura Oncology, Inc. Aktie

Good day, everyone. My name is Ryan, and I will be your conference operator today. At this time, I would like to welcome you to the Kura Oncology and Caspian Therapeutics Investors Call. [Operator Instructions]

At this time, I'd like to turn the call over to Greg Mann, Senior Vice President, Investor Relations and Corporate Affairs.

Good afternoon, and welcome to the Kura Oncology and Caspian Therapeutics Investor Call on KO-7246 in diabetes. We remind you that today's discussion will include forward-looking statements based on current expectations. Such statements represent management's judgment as of today and may involve risks and uncertainties that cause actual results to differ materially from expected response. Please refer to Kura's filings with the SEC, which are available from the SEC or on the Kura Oncology website for information concerning risk factors that could affect the company.

I'll now turn the call over to Dr. Troy Wilson, President and Chief Executive Officer of Kura Oncology and Executive Chairman of Caspian Therapeutics. Troy, please go ahead.

Thank you, Greg, and good afternoon, everyone. Today, we'll discuss why we created Caspian Therapeutics and how the KO-7246 data presented at EASD supporter plans to develop menin inhibitors in diabetes. Joining me on today's call are Dr. Francis Burrows, Kura's Chief Scientific Officer, who led our research into menin inhibitors in diabetes and who leads the team who discovered KO-7246; as well as Dr. Rob Spencer, Caspian President and Chief Operating Officer. Francis will review the science behind menin inhibition in diabetes, and Rob's going to discuss how Caspian intends to translate those findings into a clinical development program.

Caspian grew out of more than a decade of work in menin inhibition in Kura. We've pioneered menin inhibition and that experience gave us the scientific foundation to investigate whether this biology could help restore the body's own insulin producing capacity. As the data developed, we saw an opportunity that warranted a focused development effort as well as a dedicated investment. Diabetes require specialized capabilities and a development strategy tailored to metabolic disease. Caspian gives this program to dedicated leadership and financing, while Kura remains focused on its oncology business. Kura contributed KO-7246 related -- and related intellectual property and know-how to Caspian. The $50 million financing was led by BVF Partners with participation from the T1D Fund, Invus, Montanova, Eli Lilly and Company, Kura Oncology and other investors.

The proceeds are expected to support KO-7246 through IND-enabling development and initial clinical proof of concept as well as to support advancement of a second menin inhibitor candidate. Caspian can access Kura's research development and corporate capabilities through an intercompany services agreement. This gives Rob and his team access to established expertise in infrastructure while directing more of Caspian resources toward development. Caspian has responsibility for advancing the program with oversight from its Board of Directors. Kura retains approximately 50% ownership, giving Kura stockholders meaningful participation in potential future value. We believe this structure puts the program in a position to advance efficiently with capital aligned to a specific clinical objective. The scientific basis for the investment is the focus of today's call.

Francis, if you could please take us through the EASD slides.

Thank you, Troy. So our starting point is the loss of functional beta cell capacity in diabetes. Beta cells are the cells of the islets of the pancreas that make insulin. We're investigating whether we can help the body rebuild that insulin producing capacity by inhibiting a protein called menin. Menin controls expression of CDK inhibitor genes in beta cells, thus acting as a break on beta cell division. Studies of how the pancreas adapt to increased insulin demand such as during pregnancy suggests that menin inhibition can release that break and allow beta cells to multiply. We're investigating whether a drug can harness this natural capacity for adaptation to help restore insulin producing capacity in diabetes. KO-7246 is a potent, selective, oral menin inhibitor developed with metabolic disease in [ mind ].

At EASD, we reported data related to beta cell expansion, insulin production, launch sugar control and durability after treatment starts using mouse, rat and human models. And we also compared KO-7246 with other compounds to understand where its activity and selectivity differ. Next one, let's begin with the mouse model of type II diabetes. In this experiment, these animals have very, very high blood sugar when the treatment began. And as you can see in the light-blue line, semaglutide lowered it rapidly, but that affect weakened over time. With KO-7246 on the other hand, low sugar fell more gradually over 7 weeks, while insulin levels concomitantly increased shown on the right. That slower response is consistent with the process that takes time to build beta cell capacity.

Importantly, combining KO-7246 with semaglutide brought together both the rapid initial reduction in blood sugar and a sustained effect due to the menin inhibition despite increased insulin production. We observed no hypoglycemia that is abnormally low blood sugar in any KO-7246-treated mice, including in the combination group, where insulin levels reach quite high. That matters, the aim is to restore glucose control without driving blood sugar too low, and it's encouraging evidence of integrated physiologic regulation of menin in this model.

As they say, a picture is worth a thousand words. And I feel like this really captures the power of the approach of menin inhibition gap. After only 28 days of exposure, we can see that the islets the process containing the beta cells have grown substantially and are staying positive for insulin. Improved blood sugar control accompanied expansion of the insulin producing cell population.

Next one. We next studied rats given STZ, a chemical that destroys beta cells and causes severe insulin insufficiency. This model test whether generating new beta cells can restore blood sugar control, although it does not reproduce type 1 diabetes, autoimmune attack. The positive control exogenous insulin lowered blood sugar quickly. Once again, KO-7246 took longer, but a substantial effect developed over 8 weeks. Some animals responded strongly and others did not. Responders regained normal blood sugar control. In the same experiment, Icovamenib also known as BMF-219, did not reduce fasting blood glucose or increased beta cell mass under the conditions tested.

Let's take a closer look at this response in the next slide. This binary response, complete recovery in some animals and little or early in others, it's consistent with how KO-7246 is intended to work. It helps existing beta cells multiply. So there must be a sufficient surviving population to build upon. Our interpretation of the data is that animals with enough remaining beta cells could rebuild the insulin producing capacity needed to restore glucose control, while those with too few lack starting population needed for a meaningful response in this model.

Among the KO-7246 responders, islets recovered to between 40% and 90% of healthy control levels by day 56. In other words, partial recovery was enough to restore normal blood sugar control. This combination of tissue recovery and functional benefit clearly distinguish KO-7246 from Icovamenib experiment. We then stopped treatment in some of the animals for another month. And as you can see, in responders, blood sugar control was fully maintained.

Next slide. Stimulated C-peptide, a market of the body's own insulin production also remains significantly elevated after that month as shown in the chart here. No further treatment. But at the same time, very little cell division remained at this point. In other words, functional benefit persisted after active proliferation had ended, supporting the possibility that treatment can rebuild the insulin-producing capacity that continues working after drug withdrawal.

We then tested human islet micro issues, which contain the appropriate proportions of the different cell times found in a pancreatic islet. KO-7246, increased beta cell proliferation in multiple samples and the high glucose conditions that stress these cells and exist in diabetic patients, increasing the dose increase both beta cell proliferation and ultimately, the proportion of beta cells in the islets. KO-7246 selectively stimulate beta-cell proliferation without increasing proliferation of other cell types in these experiments.

The research compound harming [ ALDH1A ] inhibitor stimulated non-beta cells as well as beta cells, ultimately actually reducing the overall portion of beta cells. KO-7246, therefore, expanded the cell population that we want to restore without stimulating broader cell growth in the micro tissues. This selectivity matters because our goal is to rebuild the insulin-producing cell population without encouraging growth of surrounding cells. The results are consistent across complementary systems beta cell expansion with improved glucose control in rodent models of both type 1 and type 2 diabetes and selected beta-cell proliferation in human pilot micro tissues. The human finding strengthened the case that the underlying biology extends beyond mice and rats.

And finally, direct comparisons help explain KO-7246's pharmacologic profile, while both KO-7246 and Balomenib, another menin inhibitor being advanced in diabetes were indeed active against menin. KO-7246 was about 3x more potent than Balomenib in vitro and displayed superior antitumor activity at 1/4 of the dose in a menin independent mouse leukemia model. Icovamenib on the other hand, showed a different profile.

Although subscribed as a menin inhibitor, it did not measurably block menin MLL interaction in our assay and showed no efficacy in the menin-independent animal model even at 8x the dose of KO-7246. Instead, we observed robust inhibition of several kinases, including CDK9, a protein broadly involved in regulated protein synthesis, along with other kinases with reported growth in diabetes, such as C-kit and [ Label ]. These results do not support menin MLL inhibition as I cover managed mechanism, but do identify CDK9 as a distinct pharmacologic activity of this compact.

For K0-7246, the evidence connects potent menin inhibition with base cell expansion, improved glucose control and persistence after treatment starts. The consistency across mouse, rats and human models together with selected proliferation of beta cells gives us a strong scientific basis for development. The next step is to test whether these findings translating into safe meaningful improvement in patients own insulin production.

Rob will now describe how testing intends to build on these findings. Rob?

Thank you, Francis. So Caspian's initial development objective is to characterize the safety, tolerability and pharmacokinetic profile of K0-7246 for chronic administration and to assess its ability to improve endogenous insulin production in people with diabetes. The preclinical package gives us a strong rationale for that work and helps define what we need to learn by translating that into humans. We are advancing KO-7246 through IND-enabling studies to support our initial clinical program. The goals of the ongoing work are to establish the toxicology and exposure information that we need to support clinical dosing together with manufacturing and drug supply required for these studies. Our goal is an early clinical assessment that could inform both the potential of molecule and the design of subsequent studies.

But safety always comes first. So we need to understand how KO-7246 behaves in people and establish an appropriate basis for evaluating repeated dosing. The clinical program must ultimately establish the tolerability and exposure profile relevant to people with diabetes. Patient selection will be important. And as you heard from the preclinical data that Francis has presented at EASD, the biology suggests a residual beta cell capacity may be important, and the results in the STZ model reinforce that point. We are considering how baseline endogenous insulin production and the degree of insulin deficiency may help identify populations in which a treatment effect would be most informative.

We believe that both type 1 and type 2 diabetes are relevant to the broader opportunity. For the initial clinical assessment, we want to match the population to the mechanism and select measurements that can detect a meaningful change in function. For example, one key measure will be stimulated C-peptide, which helps us assess the body's insulin response to a defined challenge. We would interpret that alongside other measures and treatment requirements trending -- looking for trends over time, and those trends could help us to understand the magnitude and timing of the biological response, including glycemic control. For us, initial proof of concept is about establishing a satisfactory safety and exposure profile and looking for evidence the KO-7246 can improve the body's own insulin production. An encouraging signal would be an increase in stimulated C-peptide for baseline, whether during treatment or follow-up and we would assess that signal alongside the broader set of data. We have a defined scientific hypothesis and a program focused on testing this in the right way in people with diabetes.

Troy, I'll turn this back over to you.

Thank you, Rob. Thank you, Francis. The EASD findings explained why we believe this opportunity deserves dedicated development. KO-7246 combines potent selective menin inhibition with evidence of beta cell expansion and durable functional benefit in preclinical models. Caspian is building the leadership and the resources to investigate whether those findings can translate into a meaningful benefit for patients. For Kura stockholders, Caspian provides continued participation in that opportunity through its ownership position while enabling a development strategy focused on diabetes. For Caspian, the next priorities are completing the work needed for clinical entry and conducting the studies to establish initial proof of concept. We'll look forward to sharing progress with you as the program advances. We appreciate your interest, both Caspian and KO-7246.

With that, Ryan, we're happy to conclude the prepared remarks and then open it up for Q&A.

[Operator Instructions] Our first question will come from the line of Roger Song with Jefferies.

Excited to hear about this new development. And then mentioning some of the thesis and what to look for in the future. So the C-peptide levels that you're looking for, if you could provide some more color on how -- what would be a meaningful signal, whether to follow up or in the treatment?

Yes. Nabeel, thanks for the question. Rob, do you want to speak kind of in broad strokes, what might we be looking for in terms of the markers of activity?

Yes, absolutely. So I think what we're looking for is patient or enhancement of C-peptide levels as compared to baseline. And as I've mentioned, that would be over the course of the treatment period or during the follow-up period. So as you heard from Francis, we expect that this rebuilding of the beta cell pool will take time for that to occur and then for the treatment effect to demonstrate this increase in C-peptide.

Your next question will come from the line of Priyanka Grover with JPMorgan.

How do you think about KO-7246 in positioning it in the diabetes treatment landscape, especially with the possible combination use with GLP-1.

Yes. Priyanka, thanks for the question. Francis, maybe you can just talk a little bit about the scientific rationale and then Rob, if you could talk about potential future combination usage, but maybe Francis we'll start with you.

Sure. Yes. So certainly from our perspective, the mechanism that we're engaging here, which enables us to selectively increase beta cell mass is clearly very complementary with any current standard of care on the most basic level, GLP-1 agonist, for instance, will among its many other positive attributes, will improve the function of pancreatic beta cells. So combining that with increasing the number of pancreatic beta cells gives you a clear opportunity for synergy that we see in the animal models. We -- there are certain other activities of menin, which we don't talk about so much. One of those is upregulation of GLP-1 receptors. So I think that there's a strong basis for expecting that, that will translate in the human setting as well. And we -- this has certainly engendered a significant amount of interest among the producer of standard of care drugs and diabetes. Rob?

Sure. So I think, as you said, Francis, I think we see KO-7246 as being complementary to the existing standard of care, in particular, the GLP-1 receptor agonist rather than sort of acting like a typical glucose-lowering agent. As you probably can imagine that there is this unmet need to really have a therapy that can restore endogenous B-cell function and provide that physiologic insulin response. So we see this as being important and obviously, great to have in addition to GLP-1 agonist.

Your next question will come from the line of Li Watsek with Cantor Fitzgerald.

Just given the regenerative effect you've seen preclinically, what's the intended dosing paradigm in your clinical trials? Would it be chronic or maybe after a defined period?

That is, Li, that's the million-dollar question. Maybe I'll take a quick -- this is Troy. I'll take a quick stab at it, but then I'll invite Francis and Rob to comment. So preclinically, you get regeneration of the beta islet cells and restoration of function relatively rapidly. And as Francis showed you, you don't need full restoration. This isn't oncology. So we don't have to get to 100%. I would also say we and others have been treating cancer patients with menin inhibitors for years with no obvious issues with respect to metabolic tolerability.

So it's possible one could just keep this on board. And if there are insults to the beta cell mass you would -- they would repair it in situ. At the moment, that's why you have to do the preclinical talks and why you have to start with this sort of first-in-human studies. I think it's too early to say, do you do it continuously? Do you do it intermittently, what I think is pretty clear is you probably have a large therapeutic window with which to operate based on what we know about Ziftomenib and what Francis and his team have designed in KO-7246 as well as successor compounds. And the fun part will be figuring out is it one? Is it the other? Is it both? Is it different applications for different diseases. But Francis, anything you'd add to that?

Yes. I mean, so in the type 2 model, we quadruple beta-cell mass in 28 days. In the type 1 model, we essentially were able to get full 100% glucose control by basically increasing the beta cell mass from 20% to 40% or a little bit more. So the bars are not spectacularly high. There is no doubt that the rodent beta cells proliferate more readily and more quickly then we would expect the human-based sales to do. But if you extrapolate from the numbers in the ex vivo experiment with the islets that does turn out to be quite a lot of beta cells after a certain period of time. So we think that we will get there. The less you start out with the longer it will take to get to the finish line. So there may be variability in response time between individual patients depending on what their starting position was.

The next question will come from the line of Jason Zemansky with Bank of America.

Congrats on the good progress. I guess looking at development data, I believe there are 3 weeks of [indiscernible] A1c benefit lasting about 3 months of type 2 diabetes. I guess how does that shape the plan for 7246? I know you've mentioned chronic administration, what does the durability or suggest that maybe a short fixed force might work and said, and I guess beyond the in vivo potency, how does 7246 stand apart from the competitor moving forward as well?

Yes. Jason, your audio was breaking up a little bit there, but let me see if I can restate the question in 2 parts. So the first part, which I'm going to ask Francis to speak to is how does -- excuse me, 7246 and Balomenib like. And the second part is, given the relatively short course of treatment shown with Balomenib, how are we thinking about kind of intermittent dosing versus continuous dosing. If I'm reading the question back, and I'll ask Rob to speak to that. But Francis, maybe we start with just similarities and differences to Balomenib.

Yes. So we -- we are, as you know, are very active in menin chemistry front and any other compounds that are of interest, we synthesize and try and do a full workup of comparison as possible to understand where we stand. As I understand it, but menin inhibitor that was repurposed from AML. It's changed hands a couple of times. In our hands, as I say, it is a bonafide menin inhibitor that inhibits the menin KMT2A interaction in the biochemical assay. But in looking at menin dependent cells, we see about a fourfold difference that reflects the difference in the binding affinity in the biochem assay in the mice. It's getting twice a day, quite rapidly cleared. And again, you end up having to use about 4x much of it. So it looks pretty similar, absent comparisons of any other properties such as safety issues that we're not privy to -- it looks as though the 2 compounds are broadly comparable, but KO-7246 is a little bit more potent. Rob?

Yes. And I think as far as the clinical aspect of it, I think that's where, as you can appreciate, we have to really look at the exposure response to assess both the magnitude of the response, the onset. And then, as you said, looking at that duration of action post dosing. So I think we have to take all of that into consideration as well as patient population because we are looking at both type 1 and type 2 patients.

Yes. It's probably -- just to add to that, Jason, to both what Francis and Rob said. The intention, I think, is to start in healthy volunteers next year and really get a good understanding, as Rob said, of what is dose, what is exposure, what is initial tolerability. You really want to understand the drug-like properties of 7246 when you go into patients such that you do -- you understand as best you can, the experiment that you're running. So that's the way we're planning on approaching it. And I don't know that all that data is going to get disclosed as we go. I think -- we've kind of guided to data in late '28, possibly early '29, but that's the way we're going to go about it is you have a very, very good compound, but the more one can learn about the better we think we can position it in these patient populations.

Next up will be Charles Zhu with LifeSci Capital.

This is Peter Green on for Charles. A question for the team. How might this Phase I trial or future trials be designed to show 7246 is potential unique contribution to glycemic control as compared to other background therapies that patients might come in the trial on?

Yes, Peter, thanks for the question. Rob, do you want to -- can you share your thoughts to Peter?

Sure. Yes. I think what we've been looking at is that people would be on their standard of care during the course of the study and then looking at the comparison between that and being on treatment and obviously, looking at that from a dose response perspective. So as I've mentioned, C-peptide is going to be one of the main pillars that we're going to focus on. But beyond that, we'll also be looking at HbA1c and other markers as well looking for other improvements in glycemic control.

Yes. Peter, to what Rob was saying, we're not -- what we've heard from clinicians, from strategics, from folks who are knowledgeable in the space is. There really isn't another mechanism that anyone can name that selectively expands beta islet cells and drives increases in C-peptide without increasing the alpha cells or other cell types. So that is your kind of -- that is the critical proof of concept experiment. If you could do that with acceptable safety and tolerability, the view among the experts is you have something unique and pretty powerful. How you develop it then, I think is -- that's the much longer part of the question, but if we can demonstrate that and the preclinical data suggests that Caspian can, that you're going to be doing something that no one else today has been able to demonstrate. So there's been a lot of focus on that C-peptide and then related markers.

Yes. I think you would be maybe more to interpret the days or type 2 patients, type 1 patients. If you can significantly move the needle on any marker of glycemic control, I think you've got a feel that it has to be due to an increase in beta cell mass.

Yes. And as we've gone out now that the company is constituted and financed and there's Rob's building a team, folks have come forward with some pretty clever ideas on how to answer that question, which we're not going to share because it is a competitive space. But there's some interesting experiments in patient subtypes that one could do to try to get to this answer as quickly as possible. So that will -- more to come.

Excellent. And then if I may ask a follow-up, are there any incidental findings from the Ziftomenib experience demonstrating insulin control and perhaps diabetic patients that might have influenced the molecular design for the new compound or the development plan?

We wish, Peter, and that's the honest answer is, we wish. Two things. As you know, AML patients are frequently transfused. So that complicates your ability to gather the data and to interpret it. But I think more to the point, we've yet to meet a hematologist/oncologist who is really interested in doing exploratory work in diabetes.

Most of them are pretty focused on trying to extend and improve their patients' lives. So we really -- I don't think we've -- I don't -- the data may be there, but it isn't really the right patient population in which to ask the question. What I can tell you and folks know both our experience in AML, and we haven't shown the data yet, but we are at higher doses in patients who have GIST in combination with Imatinib is there isn't anything we're seeing from a safety perspective, a tolerability perspective that would preclude giving this chronically to diabetic patients.

And that's reassuring because at least one of the companies in this space has reported liver toxicity and some other observations, which in our experience, those -- that's not menin inhibition. That may be the fact that it's a covalent inhibitor, it's hitting other targets. Menin inhibition appears to be quite clean in a generalized patient population. So that's -- in contrast to the DRC 1 inhibitor that Francis mentioned, that's a big step in the right direction.

The next question will come from the line of Phil Nadeau with TD Cowen.

A question on the patient selection. Can you talk a little bit more about how you figure out who are the ideal patients in terms of residual beta cell capacity endogenous insulin production I guess, on a related note, in the recent data that came out from [indiscernible], do we know what patients were enrolled in that trial in terms of those parameters?

Phil, I'll take the second part of the question. I'll let Rob take the first part. The second -- the answer to the second part is no. We don't know. I think those observations are kind of directionally encouraging, but there's a lot there that wasn't shared in terms of patient selection. It may a bit early, but Rob, I'll let you whatever we can say about patient selection.

Yes, I think, obviously, as we said before, we're looking for some markers since we obviously can't due to a biopsy of a pancreas, we have to use the alternative, which is where we come back to the C-peptide because that tells us about endogenous insulin secretion. So we'll be looking for patients who demonstrate at least a reasonable amount of C-peptide that would suggest that they have enough beta cell mass to respond to KO-7246. So it's probably utilizing that tool to guide us going forward and obviously stratifying our patient population in the study, so we can understand people who perhaps have more or less C-peptide suggestive of differences in beta cell mass to start.

The next question will come from the line of Reni Benjamin with Citizens.

Congrats on the update. I guess 1 or 2 for us. Can you talk a little bit about the nonresponder animals and maybe what insights you may have learned as to why they aren't responding maybe outside of residual beta cell reserves or if that's pretty much the only thing that you've been able to find regarding those nonresponders. And as a follow-up, and I think it pertains more to [indiscernible], it's a little bit outside my therapeutic area of focus. But how do you think about these newly generated beta cells surviving kind of like the underlying autoimmune disease process that's leading to this issue? Do you think you'd have to somehow be thinking about combinations that prevail that autoimmune process as well for this to really work?

You want to comment, Francis?

Sure. Yes. Yes. So again, the second one, that's not going to go away. There are treatments for that, that the patients may be on while they're on trial. One thing I would say is that producing the beta cells endogenously while at a time in the pancreas has got to be less immunogenic than giving a bolus transplant on beta cells. That's, I think, a small advantage that we have there. What was the first part of the question?

The first one was, can we explain the nonresponder. Yes. Anything other than the lack of beta cell.

Yes, I'm going to say it in my opinion, I don't think there is. What -- there's not much we can do in the context of that therapy experiment where by the time you see the outcomes, the animals have sort of moved on, if you like. But what we did notice and one of the little highlight boxes that popped up that I used in the EASD talk whilst that there was a substantial amount of variability in the baseline glucose, FPG at day 0.

And you can just see that in the -- by looking at the control group. Similarly, when you look at the size of the islets, in insulted rats. So there was a wide variation 3, 4x between the largest amount of beta cell area and the smallest. So you could imagine in an animal that had a -- it was particularly well endowed with islets at the beginning to tolerate the STZ better and so on.

And you see how a lot of variability can creek in there. And indeed in the treatment groups, we did see in several places, the animals that failed to respond were the ones that had particularly high FPG at the beginning, which presumably reflects a relatively small base sell pool.

Beyond that, there is no real factors that we would bring in. And for me, the black and white nature of the response, it either worked perfectly or it did not work at all really speaks to a threshold. And if you like, a sliding doors moment early on in therapy, where you can either beat this thing or it's going to run away from you. If you look again in the details of the response, you'll see there are some rats that normalize their blood sugar levels in 2 weeks, but there are others that took 6 weeks. Again, I would assume that, that's because the ones took longer had a smaller starting point.

So that was my earlier comment about how we would expect perhaps different times to response for different patients that will reflect that. But there are a battery of tests that we could do to throw light on initial they sell mass above and beyond what Rob described. So we're confident that we can stay mostly within that range and/or that the first trial will give us clear guidance as to where the cutoffs might be.

[Operator Instructions] Next up will be Daniel Brims with Lake Street.

Back to eligible patients. If we look at looking at C-peptide that could be for patients later on after diagnosis with type 1 diabetes, the say, the long tail. In general, what do you think the window would be around onset of autoimmune destruction of the pancreas for patients to really have enough beta cells. And then as I said, probably after that, there's a long tail where you have some patients that continue to have enough over time, whereas others probably don't. But to grab that largest chunk, what do you think that window is around diagnosis and onset of type 1 diabetes?

Daniel, it's a good question. I'm going to -- I'm going to answer it and not answer it. I'll take a stab at it and then Rob can ignite any thoughts he has. I think let's do this step-wise. So step-wise, you want to have patients who are relatively stable. If they're rapidly declining, that's probably not good because it's going to make it difficult to compare relative to benchmarks.

If one gets a strong signal there, suggesting you move forward, then I think -- and this is where Caspian will endeavor to do it. It may ultimately there may need to be more resources, then you may go in combination with agents that help tamp down the autoimmunity, you may go on top of implants or X plants. I mean, there's a whole -- anytime you're dealing with beta cells, you could see how a menin inhibitor might play a role. For these first experiments, whether it is type 1 or type 2, you want them that part of the curve where they're relatively stable. And there are -- in talking to clinicians, we think those patient populations can be identified. You want to be careful. But in -- you're looking for that very strong signal that tells you this is -- this one is a much more significant investment. Rob, anything you'd add to that?

No. I think that's perfect. I think that people are finding with finding the battle on both sides, meaning you're looking at the destruction of the beta cells, but you're also looking at what remains of functional. So we can't obviously treat the patient population as being a single entity. It's going to be on an individual patient basis. So I think your point is well taken.

Your final question will come from the line of Roger Song with Jefferies.

This is Nabeel on again for Roger. I appreciate the additional questions. So I just wanted to ask, your lease also references other chronic metabolic diseases. If you could provide any color beyond T1D. T2D. If you're evaluating anything else? And is that also beta cell specific? And then -- or any color there would be great. And then if I could sneak one quick other one. What have you learned about the class? You guys have pioneered menin inhibition and AML understood on-target toxicities. You guys have a differentiated safety profile versus other means. If you could kind of share a bit more on how you designed KO-7246 for this chronic population?

Yes. Nabeel, since you're the last question asker, well, you get to sneak the 2 questions. Let me ask Francis just briefly to touch on your second question, which is what did we learn and how did we design 7246, I think you covered it in the prepared remarks, but Francis, maybe touch on it and then I'll hit Nabeel's first question.

Yes. So as you know, how well a drug works is a ratio of 2 things, how efficacious it is and how toxic it is. And we feel that the efficacy bar is a bit lower in diabetes than it is in AML, which is super aggressive disease where you've got to get every cell. On the other hand, diabetes patients are not nearly as sick as AML patients. And so clearly, we would view the tolerability bar as being somewhat higher.

So we really focused as you so kindly said, we are quite experienced at making menin inhibitors. So we had a large library of highly active compounds to choose from, and we were able to focus on the safety side for 7246. And what we did there was we completely dialed out any interaction with SIP system, any interaction with the hERG channel. And we also really kind of went the extra mile on the gene tox, which is a big delta between oncology and everything else.

We can sort of look the other way if things were a bit gene toxic in oncology, but not in this situation. So we did full GLP grade gene tox of both flavors. with this compound at millimolar concentrations that mimic the concentration it would achieve potentially in the lumen of the stunk.

So very, very high and found it to be completely clean. And these are really what we've focused on. Beyond that, we just wanted to make sure we had a nice clean, modern drug, which can be given once a day orally, which will block the target for the majority of the dosing interval, but be completely cleared by the time of the next dose. And that's fairly playing vanilla, but I think that's what we really wanted to have here.

Yes. And Nabeel, to your first question, yes, there are other indications, potential indications that the teams, the Kura and the Caspian teams working together, collaborating are evaluating. We can't tell you what they are, but menin is sort of hardwired into biology, right, which is what we're really doing is phenocopying with a small molecule, what nature in some circumstances does. So I think there's going to be some interesting applications. I'm reminded, when I first got involved in this, all we really thought about was KMT2A rearranged AML with menin. Now we have NPM1, we have FLT3.

You'll see other mutations at ASH. We have solid tumor applications. This whole field of epigenetic regulation, I think, is really ripe for drug development. And menin appears to be like the gift that just keeps on giving. So I'll close by thanking all of you on the call.

I want to thank our investors, including Eli Lilly Company, the T1D fund. Each -- this is the first beta cell regeneration investment that each of those organizations have made. I think that says a lot. We're really excited. Caspian is going to keep a relatively lower profile, but a lot of exciting things to come. For those of you who are following Kura, we will have an earnings call here before too long, where we'll give you an update on the third quarter and a lot of exciting developments to come. And in the meantime, please reach out to me, to Greg with any questions or any follow-up. With that, we appreciate everybody's time. We appreciate the questions, and we'll conclude the call. Thanks very much.

All right. Thank you, everyone, for joining us. My name is Frank Tang, and I'm with the Investment Banking division at Morgan Stanley. Thank you all for joining us today for the fireside chat with Kura Oncology. I am joined today by Chair and CEO, Troy Wilson; Chief Commercial Officer, Brian Powl; and Chief Financial Officer, Jennifer Fulk. Welcome, and great to have you all here today at our conference again.

When we sat down last year, Troy, we were talking ahead of your PDUFA date. A lot has changed. And for those less familiar with and new to Kura, can you give us an overview of where the company sits today as a commercial stage business, your pipeline and your priorities heading into the rest of 2026 and '27?

Sure. Yes. And thank you, Frank, to you and the Morgan Stanley team for the invitation. So it's been a year. What a difference a year makes. We are now a fully integrated research, development and commercial company. In the last quarter, we announced our second full quarter of sales for KOMZIFTI, which is our menin inhibitor approved in relapsed/refractory NPM1 mutant AML. We were really pleased to say that we took leadership of new patient starts in our second full quarter. That's pretty unusual. We continue to push the launch, and we have a large development program behind that initial approved indication. We have 2 Phase III trials ongoing in both the intensive chemotherapy and non-intensive chemotherapy settings with ziftomenib, which is KOMZIFTI. We also have trials underway to evaluate ziftomenib with both as a monotherapy and in combination really throughout the treatment continuum.

On the -- behind that, we have darlifarnib, which is our farnesyl transferase inhibitor. There, again, I think we've seen a lot of progress since we saw you last year. We are evaluating darlifarnib in a Phase Ib study in advanced kidney cancer in combination with cabozantinib, and we expect to start a combination of darlifarnib and daraxonrasib in pancreatic ductal adenocarcinoma next year. Darlifarnib is -- the way that we describe it is it's a therapeutic target and a molecule that really augments a lot of other targeted therapies. So we've got now 2 big drivers in the business. We're well capitalized and a lot of exciting things to come rest of this year and into next year.

That's great. Last year, you discussed KOMZIFTI's differentiated profile in the, kind of, the abstract now that you've launched and you've generated $9 million of sales and net product revenue in only your second quarter. And like you said, capturing the majority of new patients. What's driving that share capture? And how durable do you think it is?

Yes, Brian?

Yes, absolutely. Thanks, Frank, for the question. Yes. So as you said, we talked coming into the launch and for some time around the kind of the 4 pillars that we saw that differentiate KOMZIFTI from other competitors on the market. And those are the efficacy, the safety, tolerability, the combinability and compatibility with other agents and the simplicity of a once-daily 600-milligram dosing. That's what we're actually hearing back from physicians now that essentially KOMZIFTI has more simplicity to use, and it's just become -- we've seen quickly the preferred agent.

We talked about, as you said, $9.1 million in net revenue. We also had 115 new patient starts, 250 total prescriptions. And all of those metrics, which we think the new patient starts is the, kind of, the leading indicator, but they're all growing in the right direction, and we expect to see that to continue. So we're very pleased with where we are now, and we expect to see that continue to grow over time.

Great. And then physician-initiated combinations, particularly with ven and aza and FLT3 inhibitors are already running 40-ish percent of new patient starts. Even though you're only promoting monotherapy on the label, how do you read into that? What does that tell you about how the market is trending?

Yes. I think that early signal, especially the combination is a proof point that we've talked about, I think, is -- that talks about the combinability and the ease of use. Physicians have told us, well, of course, we're promoting to the label as a monotherapy. Physicians have told us that they want to be able to use menin inhibitors and KOMZIFTI in particular, in combination with their other standard of care agents. And we know that they're going to be trying to follow data on that. Our goal has been to present data and publish data to help to support their decision-making. We presented the ven/aza combination in the relapsed/refractory setting was published in Blood back in May of this year, which we think is also going to help patients or physicians make those choices.

And from a FLT3 perspective, which as you may remember, FLT3 mutations occur -- co-mutations with NPM1 occur about half of those NPM1 patients. So it's about 30% of the population is NPM1 mutant. Half of those are FLT3, and we're going to be presenting data coming up later this year on both combinations, both with gilteritinib and quizartinib. So we're building the data set to support the physician's decision on that going forward.

As you speak about that, the broad AML space remains large and competitive. Could you update us on how zifto is now positioned relative to other competitors across AML refractory and NPM1 mutant setting?

Sure, sure. So as you know, our approval is in the NPM1 population, which as we said, about 30% of the overall relapsed/refractory setting. We have a competitor in the market that also has an indication within the KMT2A population. That is an area that we're pursuing in combinations in our combination strategy that we move forward because we think that's the best way to use KOMZIFTI when we're treating those patients, given the profile of KOMZIFTI. We think that our -- I've had some conversations with some physicians recently that have told us the reason they're so excited about KOMZIFTI and using ziftomenib in multiple combinations and being able to build this substantially for the -- moving into the frontline is that it's rare that they've seen an agent that has the clinical activity with the good tolerability that oftentimes -- and of course, we know patients have side effects in leukemia, but they say it's such a well-tolerated agent that they want to be able to use it in the combinations as best they see fit.

So our data generation strategy in the relapsed/refractory setting is going to support that. But we also think that as we move into the frontline settings with our KOMET-017 studies that we'll be able to use the relapsed/refractory space as kind of a leading indicator for future success in that frontline opportunity, which has a much greater impact on patient outcomes and obviously, our revenue as well.

Just to add to that, Frank, I mean the total addressable market in the frontline is about 20x what it is in the relapsed/refractory setting. So I think what we're enthusiastic about is we're taking market leadership, right? We were second to market. We've taken market leadership in our approved indication. As Brian said, we have, we think, a superior agent in terms of tolerability, combinations, combinability to standard of care that allows physicians to drive efficacy. You're also seeing that pull through in our -- in the frontline data that we're showing from the ongoing Phase Ibs. This is all really giving physicians and patients experience as we work toward those significantly larger frontline indications.

Speaking of that, last year, you walked us through the 2 Phase III designs in frontline. Where does KOMET-017 enrollment stand today across the U.S. and worldwide? And how do you view the bar for success for your top line data in '28?

Sure. So there are -- we have 2 trials ongoing under a single protocol. You referenced it as KOMET-017. It has an intensive chemotherapy randomized Phase III, and it has a non-intensive chemotherapy Phase III. We put them together to make it easier for patients, for sites and for physicians. So when a patient presents at a clinical site, the physician and the care team can decide, do I put them on the intensive or the non-intensive regimen? We found that really works well with the sites. And enrollment is right where we would expect it to be. It's right in line with our projections.

We have guided to initial top line results in the intensive chemotherapy combination in 2028. In terms of the bar, in intensive chemotherapy, we have both an endpoint that we think is appropriate for accelerated approval and then a survival-based endpoint for full approval. So the accelerated approval endpoint is an endpoint called negative measurable residual disease at complete response, CR -- MRD-negative CR. The bogey there is about 44%. That's what chemotherapy will give you as measured in bone marrow. The data that we presented at the European Hematology Association meeting in June from the Phase Ib says we're running at about 59%, 55% to 59%. That's clinically meaningful. That's 20% greater than what chemo would give you alone.

We also then have an event-free survival, survival-based endpoint, which would come later. On the non-intensive side, the accelerated endpoint is complete response. You would expect a CR rate for ven/aza being about 60%. We'd like to do better than that. Again, clinically meaningfully better than that, 70% or more. And as Brian mentioned, we'll show data at the American Society of Hematology meeting, we hope later this year, where we give you an update on the ongoing Phase Ib study.

Importantly, we're running the largest Phase Ibs. Those are the trials that have informed the design and the execution of the Phase IIIs. We have more than 200 patients that we've treated across those different regimens. That's given us a lot of confidence in terms of are we seeing the right patients? Are we getting them on study, what to expect? So I think that's gone a long way toward derisking those 2 Phase IIIs. And everyone involved is very, very focused on enrolling those studies. And hopefully, we have positive top line results in '28.

Yes. Congrats on what you've shown at EHA and the derisking that it reads to 017. What other frontline combination data should investors be watching for, for the second half of this year?

Yes. I would say -- so we showed the frontline intensive chemotherapy data at EHA in Sweden. Let me just spend a moment on that because I think there's a development and a commercial consideration. From a development perspective, the OS rate at 12 months in that Phase Ib study was 94%. How do we think about that? What chemo alone would deliver in a 60-year and older population is about 45% to 55%. So you have 94% with the triplet versus 44% to 55%. So that's a good sign that you're driving clinical benefit for patients.

Equally importantly, you have patients who are staying on 12, 18, 24 months. And that really speaks to the commercial opportunity and the total addressable market in the front line. There are about 11,000 patients, we think, who are menin-eligible in frontline, it's about half of AML. If you can keep them on for 18 months, you're talking about a $7 billion to $10 billion market opportunity. So I think everything is tracking in the right direction.

Now to your question, we have the counterpart study, which is ziftomenib, venetoclax and azacitidine, that frontline Phase Ib. Hopefully, you'll see that later this year. The other frontline trial, Frank, that I would point people to is the one Brian mentioned, and that is ziftomenib and quizartinib in combination with intensive chemo in the NPM1, FLT3 co-mutated population. And as Brian said, the reason that's significant is 50% of your NPM1 patients have a FLT3 co-mutation. We've seen a lot of interest from clinicians to combine those 2 targeted therapies, a menin inhibitor and a FLT3 inhibitor. The competitors in the space have not yet shown data that they can successfully combine with FLT3 inhibitors. So this will be, I think, an important update for the field for menin inhibitors and for what we might be able to do for that very significant patient population.

That's great. That's helpful data set to provide physicians. Next, could you refresh us on your Kyowa Kirin partnership, how the development and U.S. commercial responsibilities are divided and how the economics affect you?

Sure. Jennifer?

Yes. So we've been -- we've had this partnership for a couple of years now. And at a high level, we -- Kura maintains development decision-making rights, and we share kind of the profits 50-50. We anticipate through the development of ziftomenib from here to top line results about $180 million of milestones. So within the U.S., we retain decision-making rights on development and commercial and then worldwide Kirin leads development, and we share in the profitability there.

Great overview. Moving on a little bit to the rest of your pipeline. Last year, we were talking about your early FTI program. Today, we can describe it as a second wholly owned franchise. Could you give us an overview of RCC, KRAS G12C data and near-term readouts and what investors should be watching for on darlifarnib and FTI?

Yes. Thanks for that. So maybe let's start with why should anybody care, right? As in leukemia, in solid tumors, increasingly, you see a push toward combination use and toward earlier lines of therapy. If you want to drive the best outcome for patients, it's unusual in these tumor types, kidney cancer and KRAS-driven tumors, monotherapy is not going to get you there. People -- let's take the kidney cancer side of the house first. You have immune -- you have checkpoint inhibitors, you have tyrosine kinase inhibitors and you have HIF-2 alpha. And we're seeing many, many combinations of those throughout the treatment continuum.

The challenge is we're still not curing patients. And so what we've heard is there's a desire for new mechanisms of action. There's a desire, in particular, for mechanisms of action that can augment those individual components. We showed data at both IKCS and KCRS this summer, which is darlifarnib plus cabozantinib. And long story short, darlifarnib can augment the activity of cabozantinib in patients whose disease has progressed on cabo. It can also augment activity of patients who are naive to cabo.

Cabo remains the largest tyrosine kinase inhibitor by market share. It's the leader. It is the backbone of a number of regimens. Our intent is to show that darlifarnib can make it better. That's attractive to clinicians because there is likely to be a tyrosine kinase inhibitor at some point in the treatment journey. And we're now at a point where if a patient's disease has failed those 3 therapies, physicians say, what am I going to do? And I think darlifarnib helps to fill that need.

We have an ongoing Phase Ib that's intended to select a dose of darlifarnib and to really help solidify that we're driving a clinical advantage over cabo alone. With that data, that data is expected. We'll give a data update probably second half of next year. Then we can decide where do we go. Do we go forward as the doublet, cabo/darli? And if so, is it second line or third line kidney? Or do -- and probably in parallel, do we consider a triplet, a triplet with HIF-2 alpha, a triplet perhaps with checkpoint inhibitor? We're working all that through now. Fortunately, darli is very combinable, very easy to use. I think we have a lot of confidence.

On the KRAS side, sort of a different setup, but the same theme. We've now seen daraxonrasib get approval in second-line PDAC, standing ovation at ASCO, well deserved. That's the good news. The bad news is the median overall survival is still 13 months for pancreatic cancer patients. We think we can do better. We did a proof-of-concept study combining darlifarnib with adagrasib in a selected population. This was the so-called KRAS G12C mutant population. And what we saw was an increased response rate, better durability in lung, in colorectal and in pancreatic patients. In particular, the pancreatic data was interesting because adagrasib alone has been reported to have about a 30% response rate.

The combination with darlifarnib, admittedly, it's small numbers, but we had 67% response rate. And that's what you would expect from the mechanism. So now what we're doing is saying, okay, we've learned that we can combine using adagrasib, let's now apply it to the newly approved daraxonrasib. And it's attractive to clinicians because, again, it's something that no one else is doing. People are bringing other RAS inhibitors forward and saying, how can we do better than daraxonrasib? But there's really only a couple of approaches, our farnesyl transferase inhibitor and maybe the PRMT5s that actually augment the clinical activity of daraxonrasib. So we're planning on starting a study in second-line PDAC next year. The hope would be that you can drive better clinical benefit than daraxonrasib alone. That's a very significant opportunity.

I think in addition, Frank, we could take either darax or other RAS inhibitors into other places. You could go into colorectal or into lung. We can't do everything. We won't even try. I think if we can drive value in a couple of key areas, pancreatic and colorectal, for example, along with what I described in kidney cancer, you've got a very significant franchise coming along. And importantly, we'll be in a position to make later-stage development decisions right around the time we're getting top line readouts on the AML program. So from a company building perspective, the 2 programs fit quite nicely together.

Yes. And it's great to see you guys continue to proceed with the combination strategy that you've been so successful with zifto as well.

Yes.

And you've also continued to advance your next-generation menin inhibitor, particularly in diabetes and cardiometabolic diseases. Could you update us on your NewCo strategy announcement?

Sure. Yes. So again, a lot has changed. We announced last week the successful formation and financing of a new company called Caspian Therapeutics.

Congratulations.

Thank you. The relationship is the Kura River empties into the Caspian Sea. So it's sort of continues our aquatic theme. Caspian is focused on the development of menin inhibitors in diabetes and metabolic disease. And we have -- we, Kura, Caspian have upcoming data at the EASD meeting in Milan at the end of September. And what you'll see there is we've done a lot of proof-of-concept studies with ziftomenib just to show that there's a there with menin inhibitors.

But Caspian is starting with a brand-new menin inhibitor. It's a new development candidate, a compound called 7246, and it was purpose-built for metabolic disease. So the pharmaceutical properties, the profile looks a little different than ziftomenib and the other menin inhibitors in oncology. And we are going to Caspian take it through a Phase Ia/Ib study, probably SAD/MAD in both healthy volunteers and patients with diabetes. There's an opportunity in type 2. There's an opportunity in type 1. There are other metabolic indications where either menin or menin and GLP-1 could be quite significant.

We helped to pull the syndicate together that included BVF, Invus, Montanova, Eli Lilly is an investor, the T1D Fund is an investor. So we're building an all-star team at Caspian to now really continue the journey and see what can menin inhibitors do for patients with diabetes and metabolic disease. It's -- we've separated it into Caspian because -- it allows us to focus to recruit more resources and to recruit a team that has experience in endocrinology and metabolic disease.

Rob Spencer is the President and Chief Operating Officer, and there will be additional hires to come. So it's -- I think it's -- we've gotten a lot of compliments that it's kind of a creative way to keep moving assets forward. Kura shareholders own approximately 50% of Caspian. So if Caspian is successful, the intent is that the employees and the shareholders of Kura will benefit.

That's great. Congratulations on that. Maybe moving over to the corporate side. You ended the quarter with significant cash, $519 million. And you guys have guided that roughly $180 million of anticipated milestones to come will fund AML programs through the first KOMET-017 top line in '28. Could you give us an overview of that runway and the balance? And what else does it cover?

Jennifer?

Yes. So that remains true. We've got cash runway we've talked about through top line results in 2028 for ziftomenib as well as funding the additional data sets that Troy and Brian were talking about that we're working on now. We've also -- and just to separate for darlifarnib, separate the 2 things. So one is the work that we're doing now both in kidney cancer and the additional look that we'll do in PDAC. We separate that from additional registration work that we'll look at next year. Our intent is to leverage the data to look at those opportunities that are most value and retain the strategic flexibility to pursue those value opportunities.

So a strong balance sheet in this environment. Super helpful.

We never have enough cash.

That's all the questions I had on the main topics. To close out, maybe I would love for you guys to leave us with the most important milestones and updates that you would like investors to focus on for the rest of the year and for the next 12 months.

Yes. Thanks for that. I would say continue to look at the launch, right? I cannot say enough good things about our commercial team, their execution, the ability to continue to drive leadership in the commercial setting with menin inhibitors. There's a lot of data coming out. We have 4 presentations that we expect here in the fourth quarter with ziftomenib, both as a monotherapy and in combination. That's important because those are proof points. Not everything we do with ziftomenib will be in a registration-directed setting. As Brian was saying, what we're hearing from clinicians is just show us data that it's safe, it's well tolerated, and it can drive better outcomes for patients.

So we're going to continue to put that out. We're going places that I don't think our competitors can or are going, such as FLT3 combinations. As we look to next year, we will start the darlifarnib PDAC study. We'll give an update on darlifarnib and cabozantinib in kidney cancer. You'll also see, Frank, milestone payments, as Jennifer mentioned, that are getting paid, and those are tied to enrollment goals in the ongoing Phase IIIs. So that's probably your best biomarker that the Phase IIIs are enrolling as expected.

At this point, it's really trying to drive ziftomenib as quickly as possible to take leadership in frontline AML and then to position darlifarnib right behind it to be able, as Jennifer said, to make larger registration-directed decisions probably late next year or early '28. It will be good timing. We've got $3 billion in peak sales that we've projected for zifto. I think if we're successful in kidney and PDAC with darli, you're probably in that same ZIP code. Not a lot of companies that have the potential to drive $6-plus billion in peak sales.

And we're clearly best-in-class on menin. We are only in class on FTIs, which is a good place to be because everybody wants to be in KRAS, right? Everybody is looking for an edge in KRAS. We can potentially make all of those KRAS inhibitors better. We're not going to do everything with our balance sheet, but we're going to position it such that it's clear darlifarnib can add value throughout the treatment continuum. We intend to keep the company well capitalized and just continue to execute on what we set out to do, research, development, commercial. There's a lot of good stuff coming rest of this year and on into next year. And before we know it, we'll be -- we'll have those top line results in AML.

Congrats on all the progress and a lot of exciting news coming up in the next 12 to 18 months.

Great. Thank you.

Thank you for joining us today.

Our pleasure. Thanks, Frank.

Good day, everyone. My name is Lenius, and I will be your conference operator today. At this time, I would like to welcome you to the Kura Oncology Second Quarter 2026 Financial Results Earnings Call. [Operator Instructions]

At this time, I would like to turn the call over to Greg Mann, Senior Vice President of Investor Relations and Corporate Affairs of Kura Oncology. Please go ahead.

Thank you, Lenius. Good afternoon, and welcome to Kura Oncology's Second Quarter 2026 Conference Call. Joining the call today are Dr. Troy Wilson, President and Chief Executive Officer; Brian Powl, Chief Commercial Officer; Dr. Mollie Leoni, Chief Medical Officer; and Tom Doyle, Senior Vice President, Finance and Accounting.

We remind you that today's discussion will include forward-looking statements based on current expectations. Such statements represent management's judgment as of today and may involve risks and uncertainties that cause actual results to differ materially from expected results. Please refer to Kura's filings with the SEC, which are available from the SEC or on the Kura Oncology website for information concerning risk factors that could affect the company.

With that, I'll turn the call over to Troy.

Thank you, Greg, and good afternoon, everyone. The second quarter marked another step forward in Kura's evolution as a commercial stage oncology company. KOMZIFTI moved into a leadership position in relapsed/refractory NPM1-mutant AML menin inhibitor market and new clinical data further strengthened our confidence in our strategy of building 2 differentiated growth franchises.

I'll start with KOMZIFTI. In only our second full quarter on the market, KOMZIFTI generated $9.1 million in net product revenue, exceeding our expectations and captured a majority of new patient starts in the relapsed/refractory NPM1-mutant AML menin inhibitor market. At this stage of the launch, new patient starts are the clearest leading indicator of commercial performance. They measure which therapy physicians are choosing today and they establish the base for future prescriptions and revenue. Achieving majority share of new patient starts in only our second full commercial quarter despite entering the market second is clear evidence physicians are differentiating within the menin inhibitor class.

In real-world AML practice, physicians choose therapies based on the total treatment profile, efficacy, predictable and manageable safety, dosing convenience, drug-drug interactions and increasingly, the potential to combine with existing treatment approaches. We believe KOMZIFTI's rapid adoption reflects the strength of that differentiated profile in the largest currently FDA-approved menin inhibitor opportunity. But the monotherapy launch is only the beginning. Our objective is to establish ziftomenib as a foundational therapy across AML by combining with multiple standards of care.

The long-term frontline data we reported at EHA demonstrated that ziftomenib combines cleanly with standard therapy, deepens responses and supports more durable outcomes. With nearly 100 patients and extended follow-up, KOMET-007 meaningfully increases our confidence in our frontline strategy. Mollie will discuss those data in more detail. Looking ahead, we expect multiple clinical updates in the second half of the year across monotherapy, combination therapy and multiple treatment settings.

Turning to darlifarnib. We now believe we have a second wholly owned strategic asset capable of creating significant value independent of our menin inhibitor franchise. across cabozantinib exposed and cabozantinib-naive renal cell carcinoma as well as in KRAS G12C mutated solid tumors, we've generated clinical evidence that darlifarnib has the potential to enhance the activity of targeted therapy backbones through a common biological mechanism while maintaining a manageable safety profile. Our strategy is straightforward, pair darlifarnib with established and emerging targeted therapies, allowing us to advance the program efficiently while preserving opportunities for future strategic collaboration.

Stepping back, Kura is substantially stronger than it was even just 1 quarter ago. We have established commercial leadership in new patient starts in relapsed/refractory NPM1-mutant AML, we have built one of the most mature and robust frontline menin inhibitor data sets in AML. We've advanced a wholly owned precision oncology platform beyond menin inhibition, and we've maintained the financial strength to execute through multiple value-creating milestones. Together, these assets position us to create value through commercial execution, pipeline expansion and disciplined capital deployment.

With that, I'll turn it over to Brian.

Thanks, Troy. In the second quarter, KOMZIFTI generated $9.1 million in net product revenue with approximately 115 new patient starts and more than 250 total prescriptions. Based on current prescription data, KOMZIFTI captured a majority share of new patient starts in the relapsed/refractory NPM1-mutant AML menin inhibitor market in only its second full quarter of launch. That's the headline for the quarter.

New patient starts are the clearest indicator of physician choice today and one of the strongest predictors of future commercial performance. The quality of the launch is evidenced across multiple metrics. Repeat prescribing continued to increase, adoption expanded across both academic and community treatment centers and new accounts continue to initiate menin inhibitor therapy with KOMZIFTI. Physician-initiated combination use with venetoclax and azacitidine and with FLT3 inhibitors in co-mutated patients represented approximately 40% of new patient starts.

And with more than 95% of covered lives and no label restrictions, physicians are confident to prescribe the therapy they believe is best for their patients. Physicians are increasingly choosing KOMZIFTI because of its differentiated profile, and we believe that profile is driving adoption. Our focus is simple, win every eligible patient. Every new patient creates the opportunity for repeat prescriptions and revenue. Our field force continues to execute at a high level, delivering consistent engagement with primary AML prescribers nationwide. We maintained engagement with more than 90% of our top priority AML accounts during the quarter while increasing the frequency of interactions with high-value treatment centers.

Despite being second to market, KOMZIFTI achieved majority share of new patients in only its second full commercial quarter. This is uncommon in oncology. We believe it reflects meaningful product differentiation, growing physician adoption of KOMZIFTI and exceptional commercial execution. Although we promote KOMZIFTI only for its approved monotherapy indication, physician-initiated combination use provides an early signal that clinicians see the product fitting naturally into future treatment paradigms.

We view the prescribing behavior as evidence of practical fit, which is strategically important as ziftomenib advances into FLT3 mutated disease and newly diagnosed AML, where combination therapies will define the largest opportunities. We believe the confidence physicians are showing today can extend KOMZIFTI's leadership into earlier lines and additional patient populations, ultimately positioning ziftomenib as a foundational therapy across AML.

For the balance of the year, our priorities are clear. Maintain leadership within the relapsed/refractory NPM1-mutant AML menin inhibitor market, continue to expand physician adoption by reinforcing the product attributes that physicians value most and deliver consistent quarter-over-quarter growth in new patient starts, total prescriptions and revenue. Our objective is straightforward, establish KOMZIFTI as the leading menin inhibitor today while building physician, payer and patient confidence to become a cornerstone therapy across AML tomorrow.

With that, I'll turn the call over to Mollie.

Thank you, Brian. The second quarter strengthened both of our precision oncology franchises. For ziftomenib, new clinical data increased our confidence in its potential to become a foundational therapy across AML. For darlifarnib, the data continued to support its potential as a broad and differentiated combination platform in solid tumors.

I'll begin with ziftomenib. Just before EHA, peer-reviewed results from the KOMET-007 relapsed/refractory ziftomenib plus venetoclax and azacitidine study were published in Blood. The regimen demonstrated meaningful activity in a heavily pretreated population, including patients previously treated with venetoclax. Impressively, among venetoclax-naive patients, the overall response rate was 87%. The CRc rate was 70% and median overall survival was not reached as of almost 11 months follow-up.

Turning to EHA. We presented long-term results from KOMET-007 evaluating ziftomenib plus 7+3 in 99 patients with newly diagnosed NPM1-mutant and/or KMT2A rearranged AML. Remission rates were high, responses were deep with a 96% ORR in relapsed/refractory NPM1-mutant AML. At 12 months, overall survival was 94% and median overall survival had not been reached after a median follow-up of 17.6 months. These results compare favorably with historical 12-month overall survival of 70% to 80% in younger fit patients and 45% to 55% in older adults who receive intensive chemotherapy alone.

Importantly, ziftomenib did not appear to add any meaningful myelosuppression to intensive chemotherapy. To our knowledge, this remains the largest frontline intensive chemotherapy data set reported for any menin inhibitor, making it a key indicator of the potential for the Phase III KOMET-017 program. Continuing to enhance that data pool, the pivotal trial KOMET-017, our one-stop shop design continues to accrue across the U.S., Europe and Asia. We continue to expect to report top line results for our intensive chemo ziftomenib trial in 2028, and our clinical data and operational execution gives us the confidence that we are well positioned to lead in frontline AML.

Our FLT3 combination program is also advancing. We expect preliminary clinical data later this year from ziftomenib plus gilteritinib in relapsed or refractory NPM1 and FLT3 mutated patients. In the second half of 2026, we also expect to provide combination data with 7+3 plus quizartinib. Additionally, there will be other updates, including long-term ven/aza data and an exploratory analysis evaluating ziftomenib activity in additional non-NPM1, non-KMT2A rearranged menin-dependent AML subtypes. Taken together, these studies aim to demonstrate ziftomenib's potential to combine effectively across multiple treatment approaches while maintaining the safety profile needed for long-term use in both relapsed and frontline AML.

Turning to darlifarnib, our second major strategic asset. Starting with renal cell carcinoma, we have reported powerful data in both cabozantinib exposed and cabozantinib-naive patients. In the cabozantinib exposed setting, darlifarnib plus cabo demonstrated a 44% objective response rate and a 94% disease control rate. Expected response rates in this patient population would be approximately 17% to 22%. The ability to generate responses when cabo had previously failed provides compelling clinical proof of mechanism.

The data in cabozantinib-naive patients was even more encouraging. In 34 patients with advanced clear cell renal cell carcinoma, objective response rates ranged from 33% to 50% across dose levels with a median progression-free survival of 13 months. For context, historical response rates in this setting range from 18% to 40% with median progression-free survival of approximately 6 to 11 months. The safety profile of the combination was manageable across doses tested. These data informed the dose combinations being evaluated in the randomized Phase Ib portion of FIT-001, which is comparing darlifarnib plus cabo with cabo alone in cabo-naive clear cell renal cell carcinoma.

The study is designed to select a recommended dose and inform a potential registrational strategy. We expect enrollment to complete in the first half of 2027 with initial data in the second half of the year. In addition, at ASCO, first-in-human data with darlifarnib plus adagrasib demonstrated tumor shrinkage in 77% of response evaluable patients with KRAS G12C mutated cancers. Activity was observed across tumor types and dose levels, resulting in an approximate doubling of the response rate expected with monotherapy adagrasib. This combination was also well tolerated. These results in both cabo and adagrasib combinations consistently and independently tell the story of darlifarnib's proposed mechanism of enhancing a targeted therapy backbone via a tolerable method of MAP kinase pathway inhibition.

We plan to initiate our darlifarnib platform study evaluating darlifarnib plus daraxonasib in second-line or later KRAS-mutant pancreatic cancer in the first half of 2027. Our priorities remain clear, execute our registrational studies, generate high-quality practice-informing clinical data and continue building 2 differentiated precision oncology franchises.

I'll now turn the call over to Tom to discuss our second quarter financial results.

Thank you, Mollie. I'm happy to provide a brief overview of our financial results for the second quarter of 2026. Our net product revenue from KOMZIFTI sales was $9.1 million compared to none for the second quarter of 2025. Collaboration revenue from our Kyowa Kirin partnership was $11.8 million compared to $15.3 million for the same period in 2025.

Research and development expenses were $61.9 million compared to $62.8 million for the second quarter of 2025. Selling, general and administrative expenses were $31.8 million compared to $25.2 million for the second quarter of 2025. Net loss for the second quarter of 2026 was $68.3 million compared to a net loss of $66.1 million for the second quarter of 2025. This includes noncash share-based compensation expense of $8.2 million compared to $6.9 million for the same period in 2025.

As of June 30, 2026, Kura had cash, cash equivalents and short-term investments of $519 million compared to $667.2 million as of December 31, 2025. We are maintaining our previously communicated guidance for collaboration revenue. We expect this to be $45 million to $55 million in 2026, $90 million to $110 million in 2027 and $90 million to $110 million in 2028. This revenue reflects noncash-based accounting recognition of performance obligations under our collaboration agreement with Kyowa Kirin.

Our current cash, cash equivalents and short-term investments as of June 30, together with anticipated payments of $180 million under our collaboration agreement with Kyowa Kirin are expected to fund our ziftomenib AML program through the first top line Phase III results from KOMET-017 anticipated in 2028.

With that, I'll turn the call back over to Troy.

Thank you, Tom. The second quarter demonstrates Kura is converting product differentiation into commercial leadership. KOMZIFTI is winning new patient starts in adult relapsed and refractory NPM1-mutant AML, while our clinical programs continue to expand ziftomenib towards the much larger frontline opportunity.

At the same time, darlifarnib is emerging as potentially differentiated precision combination platform with broad applicability across solid tumors. Together, these programs give us multiple independent drivers of long-term value creation, backed by the capital and execution to realize those opportunities.

With that, Lenius, we're ready to take questions.

[Operator Instructions] Your first question comes from the line of Jason Zemansky with Bank of America.

Congratulations on the great quarter. Two quick from me. Regarding the 115 new patient starts, can you help us separate how much of the sequential increase reflected growth in overall menin class penetration versus share gains from your competitor? And then secondarily, can you help us understand the emerging relationship among starts, refills and recognized revenue, including any inventory or gross to net effects in the quarter?

Thanks, Jason. Yes, I'll ask Brian to take each of those questions in turn.

Sure. Thanks, Jason, for the question. So yes, so as we've said, we're very pleased with that sequential growth over -- quarter-over-quarter. And I think what that represents, as we said, is continued execution on the team to penetrate into new accounts and extend for new patients. We -- our goal is to become the majority share -- the majority market leader in this space and this indication of new patient starts leading in only the second quarter summarizes that. I think what that shows is we're both taking share from competitors, but also having the opportunity to grow the market.

To your second question around kind of refills and dynamic kind of going that forward. I mean I think what you can see is in the results that we've shared, we've got a -- going from first quarter -- our first full quarter of launch into the second quarter, we demonstrated quarter-on-quarter growth of the new patient starts of about 35% and the TRx growth is actually about 60% growth quarter-over-quarter. So we're seeing repeat prescriptions. We're seeing new prescriptions. And I think we're able to see continued good growth. And there hasn't really been any inventory or stocking onetime events that really have contributed to that. But the story is really growth here.

Your next question comes from the line of Li Watsek with Cantor Fitzgerald.

Just curious, how do you expect KOMZIFTI's market leadership to evolve over time? And how much of that do you think is driven by combo use?

Brian, want to take this?

Sure. Thanks for that, Li. I think that we -- as we've said when we first launched, we said that we have a differentiated product profile that we think will be preferential for physicians. And we expected that we would deliver quarter-on-quarter growth throughout the year as well as becoming the market leader in the menin space in the NPM1-mutant population. We've achieved that market leadership, as we've shared here based on new patient starts already in the second quarter, with the growth in TRx, the growth in revenue, what we think is all kind of signs or kind of arrows are green. They're turning in the direction of growth here, and we think momentum is on our side to continue to evolve that.

We -- I know we've been asked questions around duration. Duration is something that will come over time, and that's something we'll be seeing over -- as we continue to grow. But the focus is getting all the new -- every new patient have the opportunity to get them on KOMZIFTI, and that's what we've achieved so far. And we continue to execute on that will enable us to get to that overall market leadership.

What about combination use?

Yes. And for combination use, yes, your question there. As we shared in the remarks, we have approximately 40% use in combination. That's consistent with where we were last quarter where we had obviously lower volume. So we're seeing that usage in combination growing. Obviously, the team is focused on promoting on label. But physicians see the choice and are looking to find ways to combine. We think that's a real growth opportunity for KOMZIFTI in the relapsed/refractory space because of the data that Mollie mentioned at the publication in Blood.

We'll be presenting new data in combination with FLT3 inhibitors, which, as you know, is approximately half of the NPM1-mutated market is co-mutated. So we'll be able to continue to develop that. We are seeing, as we said, kind of a split of both ven/aza combinations as well as FLT3 currently. But we think we're well positioned to continue that -- the data generation that will support physicians' choices to use KOMZIFTI.

Your next question comes from the line of Asthika Goonewardene with Leerink Partners.

My congrats for the growth this quarter. Just got a couple of quick hits on the inter-quarter dynamics here. Could you just maybe tell us a little bit about what your Tier 2 or preferred coverage was with KOMZIFTI? I'm sorry, can you hear me okay?

Yes.

Go ahead, Asthika.

Yes. Sorry. So the question was, can you tell us about your Tier 2 or your preferred coverage of KOMZIFTI? And for patients requiring a prior authorization, what proportion of those prior authorizations were converted? And then I have a quick follow-up.

Sure. Thanks, Asthika, for the question. So yes, so I didn't go into too much detail about our market access coverage, but I think it represents the continued success of the story. We have over 95% of lives now covered, and we have approximately 16 million lives are actually covered with a preferred status where patients have to step through KOMZIFTI before receiving other menin inhibitors. And I think what that translates into is the growth that we're seeing.

Prior authorizations have been -- it's a standard, I think, mechanism in oncology. And I think what's been very important for us is we have not seen any challenges for physicians to be able to access the KOMZIFTI for their patients. And I think that's reflected in the growth we've seen quarter-over-quarter.

And then the...

Yes, go ahead. You said, you got a quick follow-up.

Yes. Just on KOMET-017. So it looks like on ClinicalTrials.gov that you have all the sites active. So can you tell us when you expect to complete enrollment in the intensive chemo arm?

Mollie, would you like to take Asthika's question about 017?

Sure. Just to be clear, we'll have over 200 sites when all sites are active. So we're still in the process of activating them. But really, things have been going extremely well. So our guidance towards first data update and readout in 2028 remains fully on track.

Your next question comes from the line of Roger Song with Jefferies.

Congrats on the launch progress so far. This is Nabeel on for Roger. One from us. So on KOMET-017, you've mentioned the enrollment is running ahead of plan. Curious what's driving that? And how are you thinking about the value of being first to build that frontline data set in this class?

Mollie?

Well, ultimately, there's a few different factors. But 017 is successful because the design is actually so incredibly convenient for sites to use and for prescribers to put their patients on. Having both studies for intensive and non-intensive chemotherapy within the same trial so that you do one round of bureaucratic start-up activities and operational activities really does make a difference, and it makes it easy for any patient with a menin inhibitor dependent disease to have a place to go as soon as they walk into their physician's office.

And beyond that, the 007 data, the Phase I data that we continue to present at various conferences really just bolsters everyone's excitement. These patients are doing very well. The addition of menin inhibitor seems to not add any toxicity and probably is adding a good deal of benefit. So I think it's all-around excitement over the data we're showing and the structure of the trial that these patients are able to enroll in.

Your next question comes from the line of Charles Zhu with LifeSci Capital.

This is Peter Green on for Charles. Just actually a quick question on FTIs. It sounds like early or first half of 2027, launching a platform trial combining darlifarnib with daraxonasib you've committed to in PDAC. Wondering if your thinking has changed on potential other combinations. For example, we had talked about colorectal cancer with EGFR and G12D. And we're also seeing other combinations with RAS such as TRMT5 gaining in the competitive landscape. So just curious what your thoughts are there.

Yes. Thanks, Peter. Mollie, do you want to comment?

Sure. That's a very, very good question. So obviously, daraxonasib will be our first in the platform design. But the reason we did the platform design is so that we can explore all of these other combinations that make a lot of sense for patients and scientifically in parallel. So daraxonasib will be the first, but absolutely be looking for additional combinations in other indications and with other drugs.

Yes. And Peter, just to add to Mollie's comments, we see an opportunity to combine with daraxonasib in second-line PDAC. A lot of companies look to be steering into the frontline, perhaps trying to get there before a potential approval or maybe not to have to go head-to-head to be able to go against chemo. In our view, if we can replicate with daraxonasib, what we've seen with adagrasib, we think we can add clinical value to those second-line plus patients and hats off to the Revolution Medicines team for what they brought to patients. But I think it now gives us a platform on which to build through combinations, and you've mentioned some of them.

We're really looking, as Mollie said, to be selective. We're not -- we can't do everything, right? But we have a number of combinations under consideration that some of which require cooperative groups with other parties. And we'll provide more detail as it's appropriate.

And just a quick follow-up. Are there funds currently earmarked for this trial? And what are the expected costs?

Yes, there are funds, Peter. We haven't broken out the specific expense. I mean, at this point, we would plan for the Phase Ia. You want to confirm that you can -- that you have adequate safety and tolerability. If that looks good, then we'll reassess. We are at a point, you can probably hear it in the call where we have a wealth of opportunities that we could invest in. We're going to be -- we're going to continue to be very focused in our capital allocation. We think we now have awful leadership at least in new patient starts. We think soon in the other metrics with zifto, we want to [ position ] darli similarly. So all good things in time. We're fortunate with darli that this is still early development. So we're not talking about huge dollars relative to, for example, registration-enabling studies.

Your next question will come from the line of Salim Syed with Mizuho.

Congrats on the quarter, guys. I'll try to keep you back and get you back on track with a single question rule here. Appreciate it. So Troy, you guys are saying in the press release here, a majority share of new patient starts for relapsed/refractory NPM1. Syndax is also saying 60% or 2/3 of the business -- 2/3 of the NPM1 business is what they're seeing on their side. Obviously, both of these can't be true. So I'm just wondering where is it in the data that there's this confusion that both parties can claim majority share of new patient starts here?

Yes, Salim. So thanks for the question. And actually, as the operator indicated, we are allowing people to ask one follow-up. So feel free to ask a follow-up. But let me dispel the confusion. We've said we have 115 new patient starts. We're reading the competitor, both us and the competitor off of claims data. They had 250 new patient starts for the quarter and said approximately 40% of them were NPM1. So by my math, that's 100 and a 25% decline in new patient starts quarter-over-quarter, whereas we're growing 35% quarter-over-quarter.

They do have the KMT2A business. And I think when they're talking about -- there's -- we want to be very clear. We're talking only about NPM1. We're only speaking to NPM1. NPM1, ultimately, as you well know, is the much larger opportunity that includes potentially FLT3 and as we go out to the frontline. Not to take anything away from the KMT2A market, but that's 5% of AML. So I think you have to be clear about what question are we asking exactly. And back to something Brian said, Salim, whether it's NPS, whether it's TRx, whether it's net revenue, they're all growing, they're all strongly growing. I think that's a good sign.

Your next question will come from the line of Phil Nadeau with TD Cowen.

Now that you've had several quarters of commercial experience, I'm curious whether there's been any differences in the commercial experience with KOMZIFTI versus what we see in the clinical trials. Anything notable that physicians are pointing to? That's the first question. And then just a follow-up on the FLT3 combo data that we're going to see later this year. Can you give us some sense of what you're hoping to see from that data and what next steps could be?

Sure. Thanks, Phil, for the 2 questions. Brian, do you want to take the question on are we seeing things differently in the market versus maybe...

What we've seen...

Yes, versus the clinical experience.

Absolutely. Yes. Thanks for that question, Phil. And I'm happy to just kind of give a little bit of color there. But with the patients that have been kind of coming on to our studies, it's still a little bit early to see to kind of measure outcomes, as you know, but we've seen the uptake has been really supportive of the differentiation of KOMZIFTI as a new menin inhibitor in the market. The profile kind of the efficacy, safety, compatibility with other agents and the simplicity are what's leading to the increase in prescriptions, leading to the physician choice, and our team is executing clearly in order to get that.

I think as we continue to follow, we'll be tracking the duration story over time and getting an understanding of outcomes. But I think one indicator is that the combination use that we outlined shows you that physicians are very interested in using these therapies in combination. We were able to get the publication of the Blood -- Blood publication out quickly based on the feedback from physicians who really wanted to ensure they had the data available for them to make those decisions. So we'll continue to follow and we'll be, over time, be able to present that. But we're seeing consistency, I think, in the responses and the outline that we've gotten from the clinical data.

And speaking of combinations, Mollie, do you want to speak to the sort of what to expect from FLT3 and maybe thoughts around potential next steps?

Absolutely. So with regards to the FLT3 data that we're going to show you, both the combination in the relapsed/refractory setting with gilteritinib as well as in the frontline setting, the quadruplet with quizartinib, the first, second and third things you should be looking for is safety and the ability to combine. So the fact that we're actually able to show you these data, show you safe combination, show you safe dose escalation should be really important because as we've always said, AML is a combination game. It requires these combinations in order to successfully treat patients.

So really, you should be looking to see the safety and tolerability. But obviously, we'll also be showing you the associated efficacy. Some is evolving at this time. The quizartinib trial is still rather new, but it's enrolling so quickly. We want to share data with you as soon as we could. And we'll continue to update as everything evolves for next steps. I think that, that will be a topic that will be covered actually when we present the data.

[Operator Instructions] Your next question comes from the line of Etzer Darout with Barclays.

Can you guys hear me okay?

Yes, Etzer, we can hear you.

Great. Just a question, I guess, a little bit of a follow-up related question to the earlier questions around real world versus clinical use. Wondering more around the combination use that you've noted, the 40%. How much of that is in that relapsed/refractory NMP1 (sic) [ NPM1 ] patient, basically the on-label indication versus maybe even earlier line use or uses just in patient populations beyond what's currently on the label? Anything there would be helpful.

Yes. Thanks, Etzer, for that. The data that we reported is primarily in this relapsed/refractory population. It's not our indication, but in that population. Our goal is because we have KOMET-017 enrolling, I think we want to get any of those newly diagnosed patients to be put on those trials. But a lot of the dynamic that we've seen is that patients who are immediately refractory to frontline therapy may be preferentially treated in combination, and that's what I think physicians are using. So there's not really a big story in terms of dynamic outside of the population that we're treating.

Your next question comes from the line of Reni Benjamin with Citizens.

Congrats on the quarter. I guess, Troy, I'd love to understand a little bit more about the rationale behind the evaluation of zifto in these MEIS1 AML patients that are not NPM1 or KMT2A. How important is this in terms of market potential? Or is this just a nice to have? And as a follow-up, kind of on the heels of the [ TCRs ] and ASCO data and Tom's comments about the cash on hand to fund the zifto readouts. Can you talk about what might be the best strategy to fund the darlifarnib franchise? And what might be the best sort of collaboration structures that you'd be looking at?

Yes. Thanks, Ren. Two very different questions. Let me ask Mollie -- just a reminder for everyone, back when we were doing dose escalation, we did see activity, including a CR in a SETD2/RUNX1 patient. And that was kind of an important marker. But Mollie, maybe you can speak a little bit to the rationale for that study. Obviously, we can't go under the abstract. But Mollie, maybe you can speak to Ren's first question, and I'll take the second.

Yes. What you said is extraordinarily important. When we did the Phase Ia dose escalation, we saw activity outside of the places where you'd expect "to see it." And then from what we know from data that has been generated previously, up to 50% of AML probably has at least some form of MEIS1 expression high, meaning that it would probably be responsive to menin inhibition. So this is huge. If we can show you additional patient populations besides the NPM1 and the KMT2A, we really do think that we would be able to help up to 50% of AML patients, and we'll show you the data as to why we believe that.

And Ren, to your second question, just very quickly. At this point, our goal is to establish a registrational path in solid tumors for darlifarnib that provides meaningful clinical value and is differentiated from the competition. We think there's an opportunity in advanced renal cell carcinoma. Mollie spoke to that on her -- with her prepared comments. We think there's an opportunity on top of daraxonasib. Anything else, I think we have to be very thoughtful. We could make darlifarnib available to others. That would be an easy way to sort of expand the playing field.

Importantly, as we think about this, what you're picking up on now strategically is these 2 programs work together. So as we're moving toward initial top line results for ziftomenib in frontline AML in '28, that jives very nicely with the timing when you'd be making investment decisions for darlifarnib to be able to move it into a registrational setting. That's important in terms of building value for patients and shareholders. It's also interesting from a strategic perspective because now you have 2 potential blockbusters, one of which has hopefully a positive frontline data set, one or more and then a second one that's coming up behind it.

And as we indicated, the opportunity in renal cell and PDAC, either of those is on the same order as all of AML, right? So we really are -- I think we're really in a good position to have now 2 programs that are relatively close in time. And you see we're being very, very disciplined with our spend. Our R&D expense actually ticked down just slightly from last year. So we're going to continue to be very responsible stewards of capital and look to create value for shareholders.

Got it. So the funds on hand can get you to those registrational studies and then the timing will work out right with the zifto readout and moving this on to registrational studies.

Yes. I think -- we -- let me put it this way, Ren. Let me say it slightly differently. We look at all the options all the time. Personally, I don't know that doing a strategic collaboration on darli would necessarily be the right thing to do at this stage. There's a lot of value there, particularly if folks remember, we have what we believe will be the market-leading menin inhibitor throughout the AML treatment continuum.

And we've cited the $7 billion TAM. Look at our frontline data, like that's not -- that's a very reasonable TAM. We have -- we are the senior party in that collaboration. We book all U.S. sales. We control global development. We control U.S. commercial. Now Ren, you have a second asset sort of sliding in behind it. That's a pretty nice setup in terms of building value. So that's the way we think about it.

Your next question comes from the line of David Dai with UBS.

I also want to congrats on this great quarter. Just a quick question from me on the zifto and FLT3 combo. I'm just wondering how large do you believe this FLT3 and NPM1 co-mutated population could ultimately become within the broader zifto franchise? So I think you mentioned that there's 50% of AML patients have the FLT3/NPM1 co-mutation. But could you help us understand how big the market is in dollar amount?

Yes. Maybe I can take that, David. So just maybe take half a step back, just so everybody is clear, half of your NPM1 incident population has a co-mutation in FLT3. So if you really want to drive the greatest clinical benefit for patients, just as Mollie said, you're going to want to go to combinations. We know that's the future. Then there's another equally sized population. So FLT3 is 30% of AML. Half of that or 15% is overlapping with NPM1. The other half, David, are either with NPM1 wild-type or have other mutations.

To Mollie's point, I think it's reasonable to believe that a menin inhibitor certainly would be active in the co-mutated population. It may even be active in the wild-type -- the NPM1 wild-type, sort of let's stay tuned. We have said consistently, we see an opportunity to treat 50%, maybe more of AML patients throughout the treatment continuum. So when we go to that frontline setting, David, of right now, we've put a $7 billion TAM on it, $3 billion projected peak sales for us, all approvals, FLT3 is a portion of that. The big ones right now are KMT2A, NPM1 and let's see the FLT3 data, as Mollie said, a little later this year. Hopefully, that clarifies -- is the answer you're looking for.

[Operator Instructions] Our next question comes from the line of Daniel Brims at Lake Street.

Great quarter, guys. Just a quick question about what you're seeing as far as some kind of switching dynamic between the menin inhibitors. Obviously, it sounds like you guys can combine much more easily than your competitor. So just wondering if you're seeing patients starting there and then switching over to zifto as docs want to have better safety profile or be able to combine it with other things.

Yes. Thanks, Daniel. Brian, do you want to take Daniel's question?

Sure. Thanks, Daniel, for that. Yes, there is certainly a dynamic of switching. I think there are some physicians who see an opportunity to shift to KOMZIFTI. Our goal is to obviously optimize benefit for every patient. We're looking to both grow the market and take share from other products in the space. And I think what we're showing you is that we're doing both. By getting to the -- this majority share of the new patient starts within our second full quarter shows that we're able to get patients not just who may have been on another therapy, but we're bringing in new patients. And as the new patient flow comes forward, we're very happy to see the physicians are choosing KOMZIFTI based on all the things that I've outlined, our profile, their choice and the opportunity for things like combinations as well. So I think it's going to be a dynamic that will continue to evolve in this space. Thank you for that question.

Your final question today comes from the line of Peter Green at LifeSci Capital.

Just wondering if you could contrast the sales force experience at sites familiar with ziftomenib, perhaps they have had trials or investigators there versus sites that are unfamiliar with ziftomenib? And if there's -- what proportion of prescriptions are coming from trial investigators?

Yes. Peter, thanks actually for getting back in the queue and asking an additional question. I'm going to turn it over to Brian for just a second, but let me just comment. There isn't any one thing, right? The good news is like every -- the team is executing like everything is going in the right direction. And we're -- we were hopeful this was what we would see. I have to give great credit to Brian and his team. The physician engagement, the preferences we're seeing, the commercial execution is really top notch. But Brian, do you want to speak to any differences between people who haven't worked with it and those who have.

Of course. And thanks, Peter. Thanks, Troy, for the accolades to a great team. The team, as you said, has been executing even better than we could have expected. They're very experienced. They know a lot of these accounts because of their experience in hematology. And I would say that we're very pleased with where we're going, but we also haven't said that we penetrated every account. There's opportunity for growth, and we'll continue to see that opportunity. There are, of course, some sites that are more early adopters, those who've had experience, others are, as I've said, coming from experience with other menin inhibitors on other clinical trials, but then also those who haven't really had experience with menin inhibitors.

And I think the discussion with each of those groups may be slightly different than each other. So we have a great team that's able to engage and experience that. We're seeing growth everywhere. And I think that's what's been encouraging for us, and we're encouraged to see that momentum continue.

Thank you. There are no more questions at this time. I'd now like to turn the call over to Troy Wilson for closing remarks.

Thank you, Lenius. I want to thank you all once again. And in particular, I want to call out not only my team, everybody at Kura, but also the physicians and the care teams. At the end of the day, what we're trying to do is help patients. And I think the team is -- I couldn't be more proud. The team is making just tremendous progress. You hear it from the commercial setting, relapsed/refractory to the frontline execution to the data that you'll see later this year.

It's really just everybody working together on behalf of patients. We appreciate your interest. We appreciate your questions. We're going to be attending multiple conferences in September, and we look forward to seeing many of you there. In the meantime, if you have questions, you know how to find us, please reach out to Greg or me. Thank you all, and have a good evening.

Good day, everyone. My name is Stephen, and I will be your conference operator today. At this time, I'd like to welcome you to the Kura Oncology Investor Call to discuss updated results from the FIT-001 clinical trial evaluating darlifarnib in combination with cabozantinib in renal cell carcinoma. [Operator Instructions].

At this time, I'd like to turn the call over to Troy Wilson, President and Chief Executive Officer of Kura Oncology. Please go ahead, Dr. Wilson.

Good morning, everyone, and welcome to Kura Oncology's update. This morning, we're going to talk about darlifarnib in renal cell carcinoma, providing a clinical update from the KCRS symposium that was held in Boston. If we could please go to the next slide.

In today's presentation, we will be making forward-looking statements and we would refer you to both Kura Oncology website and the SEC's website for more information about risks, the risks and uncertainties of an investment in Kura Oncology. If we could please go to the next slide. We're delighted today to be joined by Dr. Ayanambakkam. Dr. Ayanambakkam is an Assistant Professor of Hematology Oncology at the University of Oklahoma Health Sciences Center. And he is the presenter at KCRS, and so he's going to take the opportunity today to walk through the slides a little bit more slowly and a little bit more better detail.

In addition, we're also joined, of course, by Dr. Mollie Leoni, Kura's Chief Medical Officer. If we could please go to the next slide.

So just before we get into the KCRS data, I just want to step back and recognize this is a really important time at Kura. We now have two major pillars in the company that are driving value for both patients and shareholders. On the left-hand side, with ziftomenib, it's really -- everything is going extremely well. The launch is going well. The enrollment in the Phase IIIs is going extremely well. we're looking toward a number of data updates that will help us to elaborate what we think ziftomenib can do both as monotherapy and in combination. Toward the goal of making it a broadly combinable AML backbone as a therapy for patients throughout the treatment continuum. So that's really a great story and one that just continues to move forward.

Today, we're going to focus on the right-hand side on the Darlifarnib program. And the darlifarnib program is exciting because it's really a different way of addressing cancer, using small molecule therapy. Darlifarnib is a mechanism-driven targeted therapy agnostic combination platform. We've shown you data with TKIs. We've shown you data with PI3 kinase inhibitors, and with KRAS inhibitors. There's really -- the way we think about it is darlifarnib is a drug that can enhance the clinical activity of other important targeted therapies, whether they be standards of care such as cabozantinib or they be investigational agents.

Today, we're going to talk about the Phase Ia data for cabozantinib in RCC. But just to remind you, the Phase Ib is underway, in addition, we are preparing for the Phase Ia escalation with daraxonrasib in second-line PDAC. We were excited to see that Daraxonrasib's NDA was submitted and hopefully, we'll be looking toward an approval later this year or early 2027. We'll be ready to add darlifarnib to that regimen to see if we can build on the clinical data that we showed you that we were able to do with Adagrasib.

So thinking more broadly, we're going to focus on what we can do on a go-it-alone basis. But darlifarnib offers a precision combination platform. And in that regard, Mollie showed you in our webinar at ASCO, we've started a combination platform study that gives us the ability to evaluate other potential combinations, combinations that we think can create value for patients and ultimately for current shareholders. If we can go to the next slide, please.

So the way we think about this very simply is it's about precision combinations, whether it's on the Ziftomenib side with things like venetoclax or gilteritinib, or whether it's now on the darlifarnib side with things like cabozantinib and daraxonrasib, we believe that by combining these targeted therapies and by enhancing their clinical activity, we can drive better outcomes for patients.

We can go to the next slide, please. Just to remind you, we've now shown you multiple examples where a farnesyl transferase inhibitor can enhance the activity of targeted therapy. And here, you can see in the headline, we're 3 for 3 -- so starting on the left-hand side of the slide, previously, at the IKCS Symposium earlier this year, we showed you that darlifarnib could enhance the activity of cabozantinib in patients who were TKI exposed and in particular, cabo exposed.

And we showed a 44% objective response rate versus what might expect from the benchmarks, which is there shown in green, 17% to 22%. Today's presentation is going to be different. We're going to shift from the cabo experienced to the cabo naive. We got some questions after the last presentation. And I think you're going to see that the activity continues to be quite encouraging. As we work rightward across the slide, the cabo example in renal cell carcinoma is just one. We've also shown whether it is in PIK3CA mutant head and neck with tipifarnib or it is in the KRASG12C mutated solid tumors where we combine darlifarnib and adagrasib. In each case, those blue bars, the activity of the combination the FTI combination is better than what one sees with the monotherapy comparator. So that's quite encouraging.

Now we have to ask ourselves the question of let's start to put the blocks in place that will support paths toward eventual registration. If we could please go to the next slide.

Another way of thinking about this is shown here on Slide 7, and this is just going to be an on-ramp to Dr. A's presentation. The way that we believe darlifarnib is working to enhance the activity of these targeted therapies is by blocking RHEB a farnesylated protein. One of RHEB's roles is to determine the localization of TORC1. So by blocking RHEB farnesylation, we prevent TORC1 from being where it needs to be. And that effectively provides a block on the signaling cascades that are downstream from the MAP kinase pathway on the left and the PI3 kinase pathway on the right.

When we add a targeted therapy that inhibits a node higher up in the pathway, whether that be a RAS inhibitor or in this case, a VEGF receptor TKI in combination with darlifarnib, we're effectively putting two blocks on the pathway. In the case of cabo, you've got to block at the receptor level, and you've got a block at the TORC1 level. And we think that's -- that's a big part of the base is why we're seeing enhanced activity relative to the monotherapy alone.

What I'll say is what we were pleasantly surprised by is that, that combination comes with acceptable safety and tolerability. And we've seen that now with FTIs, whether we combine them with TKIs, with RAS inhibitors or with PI3-kinase alpha inhibitors. We can actually dose these FTIs and maintain the dose of the targeted therapy.

And so we're able to provide a better block on the pathway and hopefully, that leads to better outcomes for our patients.

We could go to the next slide, with that, I'm going to turn it over to Dr. A and let him take you through the slides that were presented at the KCRS symposium. Dr. A?

Good morning. Thank you for letting us present the data again. My name is Adanma. I'm one of the GEMed-s and honored to present as part of the FIT-001 study group and the results of the FIT-001 study. Next slide, please. Here are my disclosures. Next slide, please. So we all are aware about the role of mTORC1 in renal cell carcinoma, especially in tumor growth angiogenesis and the limitations we've had with prior attempts at blocking the mTORC1 pathway. Darlifarnib is a potent next-generation farnesyl transferase inhibitor that blocks the farnesylation, which directly results in selective mTORC1 inhibition without the mTORC2 inhibition and thus bearing some selective toxicity.

At IKCS, earlier this year, we had talked about data about the safety and efficacy of darlifarnib in combination with cabozantinib where it had demonstrated an objective response rate of 44% with an impressive disease control rate of 94%. Next slide, please. So the FIT-001 study is a Phase I dose escalation, dose expansion study that's evaluating the combination of darlifarnib and cabozantinib in the locally advanced and metastatic RCC that has been refractory to prior lines of treatment, including immunotherapy multiple dose levels of darlifarnib and cabozantinib have been evaluated. And for the purpose of this discussion, we are talking about the safety data of what all patients with RCC in this study but also focusing on the efficacy data on cabozantinib naive clear cell RCC patients.

Of note, the cabozantinib 60-milligram and darlifarnib 8 and 5-milligram cohorts were limited to just cabozantinib naive patients in comparison to others, which had a mixed bag of both cabozantinib refractory and naive patients. Next slide, please. Baseline characteristics of our study. As of May of 2026, we had about 72 patients enrolled in the study, predominantly clear cell in 80% of these patients Important to note that these patients were heavily pretreated with about 50% of these patients having had more than two prior lines of treatment.

And of note, at least 67% of these patients had a prior I-O plus TKI combination. 38% had prior cabozantinib in any line and 17% had a prior HIF 2-alpha inhibitor. Next slide, please. When we look at the safety and the totality data, it is an extension of what we had previously seen at the IKCS, where the combination seems to be safe, tolerable with very acceptable side effect profiles.

As we would expect, we did see some side effects that we all are aware of in terms of the TKI era, especially cabozantinib induced diarrhea nausea, stomatitis and Hand-Foot syndrome. Important to note, they were predominantly less than Grade 3 and significant greatly or higher events with TKIs were not significantly different from what we have seen previously.

Of note, we did have treatment-emergent adverse events of any grade in 90% related to Darlifarnib and 96% related to cabozantinib. Grade 3 or higher were 58% and 57%, with 76% in the overall group. Important to note that serious treatment emergent adverse events were minimal, less than 20% in both groups.

Of note, the most significant difference in treatment-emergent adverse event was neutropenia of integrated at 47% and Grade 3 of 38%. And -- most of this neutropenia was initially during the initial DLT period where growth factor support was not allowed during this process.

Next slide, please. Now when we come to the antitumor activity, we want to limit our analysis to just the cabozantinib naive patient population. And here, it's important to note that in this cabo-naive cohort, about 47% of these patients had a prior TKI, including lenvatinib. We had encouraging antitumor activity with objective responses ranging from 33% to 50%.

Of note, the Darlifarnib 5-milligram cohort plus 60 milligrams of cabozantinib had an injectable response rate of 50%. And disease control rate was acceptable with 83% to 100% among all groups. -- and clinical benefit rate was about 70% in that target group of 5-milligram darlifarnib plus 60-milligrams cabozantinib and 58% in the group that had darlifarnib about 8 milligrams and cabozantinib at 60 mg.

Next slide, please. Here is our waterfall plot that's looking at the objective response rates at various dose levels of darlifarnib and cabozantinib. And what's important to highlight over here is that even at the lower dose levels of darlifarnib 3 milligrams, of 5 and 8 milligrams, we had some significant responses and also in both the cabozantinib 40-milligram and 6-milligram cohort in this cabo-naive population.

Next slide, please. What is also important to understand was that these -- the benefits that we had seen with these objective response rates were durable. -- and they were evaluated across all the combination dose levels. Median progression-free survival was 13 months in these cabo-naive clear cell RCC patients with 6-month PFS probably at 74% and 9-month PFS probably at 60%.

Next slide, please. Here is a swimmers plot that's telling us about the durability of these responses, but also important to note that more than half of these patients currently are on treatment at the time for the data cutoff. So hopefully, our progression-free survival continues to increase. We also should note that most of these AEs that we had seen the Grade 3 neutropenia was manageable with dose modifications, including dose reductions and dose interruptions and it tells us that despite these AE profiles, this is a safe, tolerable profile that we're able to manage without significant adverse events.

Next slide, please. We'd like to highlight a couple of examples of patient scenarios, and this is patient scenario #1, which includes a 66-year-old meal with clear cell RCC diagnosed in 2023, who had double immune checkpoint inhibitors with nivolumab and ipilimumab as a frontline response who started darlifarnib at 5 milligrams and 60 milligrams in January as of data cutoff at May 2026, it continues to have a response and is ongoing on treatment.

And as you can see, pretty earlier on in the disease course that week 8 he had a partial response. And what is impressive is that this partial response continues to be maintained at week 48, and we see ongoing reduction in tumor lesions even at week 24, which is impressive. Next slide, please.

Now not only is darlifarnib effective in the TKI-naive patient population where we know cabozantinib is a good drug to use. Importantly, it is also effective in a patient cohort that has had TKI prior exposure as well. Here is an example of a patient who's had prior zanzalintinib plus nivolumab, This is frontline treatment when he was diagnosed with RCC in 2022, had a partial response and then discontinued due to radiographic progression.

He started darlifarnib at the lower dose at 3 milligrams and cabozantinib at a 60 milligrams in October of 2025. And again, was able to see a partial response at week 8, through week 24 and an ongoing disease response at week 24 as well from a 33% tumor shrinkage to a 54% tumor shrinkage.

Next slide, please. In conclusion, with long-term follow-up, this combination of darlifarnib and cabozantinib has a demonstrated durable and encouraging anti-tumor activity in both the cabozantinib-naive and the cabozantinib exposed patients -- in this study, we've shown an objective response rate of 33% to 50% in the cabozantinib-naive population with a median progression-free survival of 13 months.

This combination was well tolerated with a safety profile that was manageable with those modifications, including interruptions and reductions in both the cabozantinib and darlifarnib. Neutropenia was successfully managed. And in the ongoing Phase Ib expansion phase, we do recognize this and allow G-CSF support to avoid dose modifications for the Darlifarnib if feasible.

These data support the continued development of darlifarnib in this space, along with a combination, cabozantinib and VEGF-TKI. Currently, the FIT-001 Phase Ib portion of the study is enrolling.

Next slide, please. In the expansion phase, we are testing two dose levels of darlifarnib at 5 milligrams and 8 milligrams. The study is randomized in a 1:1:1 fashion to either darlifarnib 5 plus cabo 60 versus darlifarnib at 8 milligrams plus cabo 60 versus cabozantinib 60 milligrams monotherapy. Given the efficacy of darlifarnib combinations in a prior cabo expose population, we do allow those patients who enroll on the cabozantinib monotherapy population of cohort to be enrolled in a subsequent cohort of combination darlifarnib and cabozantinib.

Next slide, please. With this, I'll hand it over to Dr. Leoni for further comment. Thank you.

Thank you, Dr. A. I would say the basis for our excitement is clear as we move to those patient outcomes. So thank you very much for presenting them. So the next slide, please.

When looking at our renal cell carcinoma program, what you have seen is a new mechanism of action that can help reshape the RCC landscape. We have shown you that darlifarnib can safely and tolerably enhance the clinical activity of cabozantinib. Because of the impressive results thus far, we are currently in dose optimization as described by Dr. A in our Phase Ib trial where we randomized to the 5- or 8-milligram darli dose and to a mono cabo dose that allows crossover upon progression. This will be the basis for future registrational trials.

We plan to share these data with you in the second half of 2027. These data easily support initial registration into the second or third-line advanced RCC space but future combinations that could be explored in our platform trial design that is currently being developed or of interest to bring this combination to patients even earlier in their treatment journey and provide improved outcomes. If we go to the next slide.

Important to remember, our combination data significantly outperformed what you would expect of cabo as a monotherapy in second line as showed on this slide. And more importantly, the combination showed these improvements in a safe and tolerable manner. This new mechanism not only holds the ability to enhance activity of the TKI, but also to overcome prior resistance. A new TKI partner that can enhance activity for these patients is a valuable addition to the treatment landscape.

Moving to the next slide. So the next question is, of course, now what? What is the registrational path? As we allow our data to mature and as the shifting landscape of RCC therapy evolves, there is a clear path to market in the third line plus RCC, as is evidenced by our data versus the current third line benchmarks shown here. We could bring a new mechanism of action to this space of high unmet need that has a differentiated profile, including improved PFS and as our data mature and the landscape becomes clear, we will, of course, be looking to move into earlier lines through even broader combinations.

This new mechanism of action that can broadly enhance TKI effectiveness is an important addition for patients and prescribers, and we look forward to sharing more data with you next year.

And with that, I will hand it over to Troy.

Thank you, Mollie. If we could please go to the next slide. So I think with today's presentation from KCRS, in combination with the data that we showed you from ASCO and a little bit earlier this year, the data that we showed you from my IKCS, you can see why we're so encouraged about the opportunity with darlifarnib .

Darlifarnib is a drug candidate that has the potential to improve the clinical activity of many other targeted therapies. And here, we've shown you we have both preclinical and in now many cases, clinical data evidencing that we can drive better outcomes for patients potentially by doing rational combinations with darlifarnib whether that be in the KRAS space on the left-hand side or potentially TKIs in the upper right or PI3 kinase inhibitors, really a very large number of potential patients we could benefit this -- we say this isn't another KRAS inhibitor. This isn't another TKI.

It's a drug that cannot only make one member of the class better, could potentially make multiple members of these classes better.

With that, if we could go to the next slide, Slide 28. In the specific context of kidney cancer, what we've shown you today is we think there's certainly a meaningful opportunity in third line plus. There may be an opportunity as well in second line plus. We haven't made the decision yet as to exactly what the design of the registration-enabling trial will look like. But because of the improvements in therapy for these renal cell carcinoma patients. We're now seeing more patients in the third line plus setting. That's a quite significant opportunity at $2 billion a year.

In the second-line setting, potentially looking at a total market opportunity of up to $6 billion a year. And one of the reasons that we started with cabozantinib, of course, is as we look at the TKI landscape, cabozantinib remains the market leader. And what we're hearing from physicians is there's a desire to improve on those outcomes, whether it be in the cabo-naive or the cabo experienced population.

So we'll provide more information. As Mollie indicated, we're looking toward full enrollment in the Phase Ib, and we'll continue to elaborate where we're going to take darlifarnib. But if we just focus initially in the addressable market for RCC, we think the future for darlifarnib is quite bright.

If we go to the next slide, please. I just want to recap where we started, which is it's an exciting time at Kura. Ziftomenib continues to gain momentum as the market leader in relapsed/refractory NPM1-mutant AML patients.

We really see a path to where we will be have market leadership throughout the treatment continuum, not only in NPM1-mutant but as well in other mutations. We're looking forward to providing additional data for you later this year.

On the darlifarnib side, it's -- this program continues now to pick up momentum. So the Phase Ib study is underway with cabozantinib. We'll be starting the Phase Ia with daraxonrasib early next year. And I think you're going to see us look to be selective and provide additional opportunities to provide value creation for patients, better outcomes and potentially for our shareholders.

And the company remains in a very strong cash position with $580 million in cash as well as $180 million in anticipated collaboration payments coming in the relatively near term from our partners at Kyowa Kirin. If we could go to the next slide. With that, that concludes the prepared remarks, and we're happy to turn it over now for a Q&A session.

[Operator Instructions]. Our first question will come from Charles Zhu with a LifeSci Capital.

Excellent. Great. Good morning, everyone, and thank you for putting out your data and for hosting this event. Two questions from me. One, -- could you perhaps elaborate a bit more on the specific prior treatment history for your patients here? And where I'm getting at is that you talked about how many pages have had prior TKI, including cabo.

Can you also talk about how many patients may have had prior lenvatinib, given some of the existing clinical data out there that strongly suggests that cabo has possibly wildly different outcomes depending on if patients have seen prior IO-IO, axitinib or lenvatinib and so forth.

And my second question, of course, is how would you position or contextualize your data relative to some of the TKI plus HIF 2-alpha as well as lenvatinib plus everolimus data out there.

Great, Charles. Thanks for the questions. Let me ask the first one. Your first question is on the prior treatment history. Dr. A or Mollie, do one or both of you want to take Charles' first question?

Yes, sure, I can. So for the overall patient cohort, we have about 72 patients that were enrolled in this study. And in that grew about 67% of them had prior TKI, and that was TKI at any line, including frontline I-O plus TKI. And if you factor in the patients who've had just cabozantinib that's around 38% of these patients -- so the analysis has been split into two parts.

The first analysis that was presented at IKCS earlier this year were patients who had prior cabozantinib and the efficacy that was presented recently is now was efficacy in patients who are cabo-naive. So in this cabo-naive population, 47% of these patients had prior TKI, including lenvatinib but obviously, not all in lenvatinib. I don't have the exact rate of how many was lenvatinib, but there's a sizable portion here that was exposed to TKI, including lenvatinib.

We do not have a lot of patients on lenvatinib plus belzutifan, if that's the direct question because it is a regimen that's been recently approved. But interestingly, we do have patients of those who have been on lenvatinib plus belzutifan and also belzutifan monotherapy.

About 88% of patients on this trial have had prior belzutifan exposure too, and we've seen the response. Now it's interesting to look at the recent Cabo length trial that look at cabozantinib versus lenvatinib prolimus, the lenvatinib prolimus seems to be doing better. But everolimus is also a harder drug to tolerate and that probably is coming from both mTORC1 and mTORC2 inhibition, whereas darlifarnib with a selective MTORC1 inhibition does not seem to have that same efficacy -- sorry same toxicity profile with the same efficacy being retain.

We do not see the same side effect that we see with everolimus as in worsening stomatitis or any of the significant pneumonitis or diarrhea or rash that we have seen with everolimus with darli. So it seems to be a better and more tolerable drug. But again, with limited data thus far, we will need to see what the future data holds.

Mollie, did you want to take Charles, the second question, which is how do we think about positioning that's relative to TKI, HIF 2-alpha or Charles, I think you called out specifically lenvatinib ever align us, as Dr. A was saying. Mollie you want to comment?

Well, first, I want to remind that this isn't just a cabozantinib combination. This particular darlifarnib activity can be seen in any TKI combination. So we think that, yes, we can enhance the activity of cabo, but we can also enchance the activity of lenvatinib, axitinib, any of the others.

So where do we see ourselves being positioned? We see a definite third line play. However, I think as we watch the field settled down a little bit with all the HIF 2-alpha data that's coming out, and the kind of tinkering of different combinations being added together, we can see an earlier play as well. And I also foresee us going into more of these broader combinations.

We are starting a platform trial, which will allow to evaluate even broader combinations on earlier combinations in these patients. So we look forward to sharing that data with you. But ultimately, this is a new mechanism of action we're introducing into this space. So we really look forward to being able to bring it as early and as broadly as we possibly can.

Our next question will come from Li Watsek with Cantor Fitzgerald.

Thanks for the update. I just wanted to follow up on the second line development strategy versus the HIF 2 just given this combination now set a new benchmark in second line, we're seeing on the next-gen HIF-2 that seems to deliver even longer PFS benefit and maybe Dr. A can comment on this as well.

Just given the data you've seen so far, where do you think Darli plus cabo can fit in the second and third-line RCC. And then how are you thinking about potentially combining with or perhaps sequencing after the HIF-2 class for initial target patient population?

Mollie, you want to start? And then maybe you could turn it over to Dr. A.

Yes. So as we said, the field really is changing a lot. -- and HIF-2 alpha will bring a lot of efficacy for these patients, and we're excited for that. We're introducing a brand-new mechanism and then help to even augment the activity that's being seen with these HIF-2 alpha combinations. So really anywhere you're seeing a TKI brought into a line of therapy, we can easily be a partner for that TKI bringing even more efficacy preventing resistance, et cetera. in that combination.

I foresee us starting the easy access into the third line and then obviously broadening out into the second line and ultimately going with an I-O combination in the front line. Again, reminding you that we have started a platform trial that will enable us to really explore all of these things in parallel rather than in sequence. But Dr. A, I'd love to throw it over to you.

Yes. I think it's definitely exciting. I think it's good to have all these options from an oncology standpoint and also a patient standpoint. But I think there are a few caveats to remember here.

We know that belzutifan is now approved in the adjuvant setting. So that means that many patients are going to be getting belzutifan and they're going to be belzutifan exposed. We also know that there's a subgroup of patients who don't tolerate belzutifan neither due to significant anemia or hypoxia and we as a community are trying to figure out how to manage that. But it is promising that in patients who are responding well to belzutifan seem to be durable responses.

But when we talk to the frontline setting, a significant portion of these patients are either going to have pembrolizumab lenvatinib combinations upfront. And if they had lenvatinib combination upfront, they are not going to be eligible for lenvatinib plus belzutifan and we also know that the frontline registrational trial, which has a preliminary result out that it's not positive when they combine lenvatinib and belzutifan is interesting.

So that combination of TKI plus HIF-2 alpha is important relevant, but it doesn't seem to have reached the frontline space as of yet. So maybe there is another combination that we need to look at for the holy grail of triplet therapy in the frontline setting. And maybe FDI is one opportunity there that's definitely worth evaluating.

But I think this space is wide open in terms of what we are going to do in the second line or the third line. So in patients who have not seen lenvatinib plus belzutifan. We know that that's a good combination. It works. It has a good PFS and OS benefit, not OS spending OS benefit. But in those patients, post-lenvatinib plus belzutifan what we use in the third-line setting that is important and tivozanib or axitinib and single agents have really not had great responses.

So maybe the goal is to move from a synergistic combination approach in the frontline to a combination approach in the second line and maybe third line. So Darlifarnib in combination with like Mollie and Troy pointed out, any TKI is probably a good option post belzutifan exposure, whether that's belzutifan monotherapy or belzutifan, pembrolizumab or lenvatinib belzutifan.

We do have some patients in [indiscernible] who have responded to it despite being on lenvatinib and belzutifan before, and I do personally have that experience as well on this trial. So we'll need to wait for more mature data to be confident that all patients post lenvatinib belzutifan will respond to this combination. But this is a new mechanism of action.

So there's no reason to believe that they won't and we have not seen any signals that tells us that they want. So whether this is a sequence before or after that combination approach is yet to be decided by the company, but also will be informed by the data that we generated this expansion phase.

I might just -- before we go to the next question, I might just add one more comment, Li to your question and for everyone on the line. We have here go-it-alone strategies with both cabozantinib and daraxonrasib and PDAC.

One of the reasons we articulated the platform study is just as Mollie said, we're anticipating additional combinations. And we can't speak to specific discussions, but I would look forward to that in the months to come, that may provide us with even more options to be able to move darlifarnib forward, whether that is as a doublet as a triplet, I would say stay tuned.

What is clear, as Mollie said, is this combination, we think, really is compelling in the third line. We look at it relative to the competitors pretty clear that, that would be a place we could go. We'd love to move it even earlier.

Second line, we just want to make sure we do the right combination. And as Dr. A said, there's a number of things we can be looking at. So look for us to clarify that. Part of that will come from our own data. Part of that will come from the potential for additional combinations. I just want to add -- I just wanted to add that thought. We can go on to the next question.

Our next question will come from the line of Roger Song with Jefferies.

This is Nabeel on for Roger. Congrats on the data. Just maybe one quick one on the neutropenia management. So as mentioned at the DLT period, the support of care being permitted. I was just curious what percent of patients require any growth factor support, dose interruptions and reductions. And were there any cases of febrile neutropenia or infection or any discontinuation due to neutropenia ?

Dr. A, do you want to take that?

Yes. I think this is something that we are learning as we go because we don't usually see neutropenia as a significant AE for RCC treatment. So in the initial phases of this trial during the DLT period,G-CSF was not allowed. So these patients had to have dose interruptions of the darlifarnib and cabozantinib. But as we have treated more patients, we know this is a Darlifarnib-related effect. Most of our patients have been managed with just dose interruptions with challenges, the same dose or at a lower dose, and they have tolerated it well.

It seems to be an effect that happens early on. So patients either get neutropenia upfront. And if they do, then they modified the darlifarnib doses modified or they never get neutropenia. So it's not accumulative proxy that we're seeing, but it's a signal that happens earlier on.

And even despite these dose reductions, we've seen ongoing responses. For example, there is a patient of mine who had Grade-4 neutropenia and neutropenic fever was admitted with sepsis in the hospital and hence had to hold darlifarnib, but that he was rechallenged with darlifarnib at a lower dose and currently he is on that darlifarnib combination for more than a year now. So dose reductions seem to be affected.

But as we've moved on into the expansion phase, we realized that toxicity. So now patients that are allowed to have G-CSF support. So we're seeing neutropenia pop in, we are supplementing them with G-CSF and we've been able to avoid dose modifications or dose reductions.

So it does seem to be one of the easier to manage side effect. About 38% of patients had great or higher neutropenia, but neutropenia fortunately is not very symptomatic. So yes, there have been cases of neutropenic fever. I think this is something that we are recognizing. But with G-CSF support, it doesn't seem to be a major hindrance to treatment at this point.

Our next question will come from Salim Syed with Mizuho.

Great. Congrats on the data, guys. Just one -- another one from us on the potential second line strategy here. Troy, you kind of spoke about maybe you've been doing some sort of doublet. I know kind of like the initial commentary was maybe going towards triple. Just curious what the thoughts are from yourself or Mollie or Dr. A here on cabozantinib plus darli, just given that CAS is already doing 15 months median PFS as a monotherapy in the ARC-20 study, and we'll get obviously some more data for that. prior to ESMO.

But what are your thoughts here on the doublet casdatifin plus darlifarnib second line? Is that an option?

I'm happy to take that and maybe ask Mollie to comment, Salim. It's a good question. Because HIF-2 alpha doesn't work through the MAP kinase pathway, you wouldn't necessarily expect additivity or synergy in a combination with darli. Were you to do the triplet with a TKI, HIF-2 alpha and darli, that could be quite interesting. But just mechanistically, we wouldn't necessarily expect darli to enhance the activity of HIF-2 alpha, the way that we're seeing it enhanced the activity of both cabo clinically and multiple TKIs preclinically. Mollie, do you want to comment?

Yes, absolutely. So I agree with you. The casdatifan is impressive, but it's impressive as long as you're not the patient that is progressing after 13 to 15 months. So until there's a cure, we have to keep augmenting these combinations and getting patients into deeper remissions or overall remissions. So agree with Troy, this is a TKI combination, darlifarnib a TKI drug. But bringing that TKI new mechanism into other combinations is extremely important.

And we are going to show through our platform trial that we are able to combine with these. So we will start to do something eventually where we show that we can be combined with a HIF-2 alpha along with the TKI can be combined with I/O along with the TKI. So it's really a story where we want to continue to augment the efficacy of these various combination products.

Okay. Got it. And just to -- yes, Salim, just to build on that one more thought, and Dr. A can comment on this as well. Interestingly, we've seen activity even at the starting dose of darlifarnib in lower doses of cabo. People may remember, if you look at the data, we initially dose escalated at 40 milligrams of cabo and that was on the recommendation.

At that time, that, that was the combination dose. As we advance through that, you saw the combination was well tolerated. So we then went to the 60-milligram dose, but you still see meaningful activity at those lower doses of both darli and cabo.

So that could help to make a TKI regimen better tolerated. -- and help to drive sustained activity. Dr. Adanma, I don't know if you want to add anything to the thoughts or just Salim's question?

No. I think it's a very valid point of when we have successful drugs, we're always looking at how to improve their efficacy by being synergistic and we have tried this in RCC for quite some time, and it's that elusive frontline triplet option that we still haven't established like iconic COSMIC,all those trials looking at IO doublets and TKIs have not broken through. And we now have this upcoming result that will probably be reported by Dr. Chaudhary maybe at ESMO, where the combination of pembrolizumab lenvatinib plus 2 alpha did not seem to make a difference in the front line compared to a very strong pembrolizumab lenvatinib.

So whether our hypothesis that triplet is better than a doublet is always going to be true is a question that remains to be answered and it would be nice to test out all these newer mechanisms of actions like darlifarnib, but I think the toxicity profile is uniquely different. We do not see any overlapping toxicity with darlifarnib and HIF-2 alpha inhibition. Maybe anemia could be one example, but anemia is multifactorial and I do think that's an on-target side effect of darlifarnib is more the neutropenia with darlifarnib that we've seen.

So theoretically, darlifarnib any HIF-2 alpha could be combined with our synergistic toxicity, but we have to look at what the synergistic efficacy of both of them are, and I'll be surprised if there is any synergy. Again, not knowing what the data is just from a hypothesis standpoint, like Troy pointed out. But it is a tolerable drug.

It does not seem to be super hard to tolerate or we've not had to have those reductions with cabozantinib pretty up currently, we've been able to treat these patients with cabozantinib at 60 milligrams. Now cabozantinib is not an easy drug to tolerate and many patients do have dose reduction. So in this trial, first went from the cabo-40 to the Cabo-60, I was one of those patient advocates who thought this would be a harder regimen to tolerate, but I'm happy to announce that I've been wrong about it.

And most patients tolerate the Capa-60 have not had significant toxicities from what we would normally see. So I don't think that this is a an easy drug to tolerate. But we have to be careful when we are adding them on without data, and that's where the their platform trial is going to be important where you have really small steps of information and how you move this darlifarnib drug combination.

In this wide open space of RCC, where there's no other drug that's inhibiting the final cell trans mechanism is important.

Our next question will come from Asthika Goonewardene with Leerink Partners.

Maybe one for Dr. A here, please. So Dr. A, among the 47% of the cabo-naive patients who had seen prior VEGF-TKI -- can you tell us a bit about what proportion had discontinued prior to TKI either due to best response progressive disease or due to treatment -- subsequent treatment resistance. I'm just wondering -- how does that inform your view on how darli resensitizes patients versus if the patient had originally discontinued therapy due to toxicity. And then I have a quick follow-up.

Yes. I don't have the exact numbers for you as to how many patients had stopped due to a side effect of a TKI versus progression. But -- the protocol does include patients or specified with patients should have had progression of disease prior to enrollment. They don't allow patients who just been on a break to go back on the cabo.

Now I personally have enrolled quite a bit to this trial. And I do have my own share of patients who've been on cabozantinib and progress and then gone on the study and then have had a response. So there are specific patient examples that I can cite where patients have been on cabozantinib 40 milligrams, a year or 2 into treatment with progression of disease that have gone on this trial combination and have responded.

There are also patients who have gone from an IO doublet to go, but most of the patients, about 67%, if I remember right, had an IO/TKI approach at some point during the course of the treatment. Not all of them just immediately prior, but there is a good portion of patients who had a prior TKI as their immediate prior line before they came to the Cabozantinib and darlifarnib drug. So there does seem to be some ongoing sensitivity despite cabo.

What I hear from a position standpoint, I think is the more important or relevant data point here is not the efficacy signals that we're seeing in the cabozantinib population. -- but the efficacy signals that we saw in the cabozantinib exposed population that was presented at IKCS earlier this year in Paris. In that group of cabozantinib exposed patients, objective response rates were about 40%. -- disease control rates were about 90%. So this is a drug combination that works.

And in that cohort, a majority of them, more than 50%, I don't know the exact numbers, we can look at it and get it back if it's not listed in the publication. A majority of those patients added TKI as a prior line of therapy before they came on the cabo and the darlifarnib. So there does seem to be some efficacy signal here telling us that there is some resensitization happening to the -- now whether that's all just resensitization to the TKI, whether there is a company synergistic efficacy of the FTI inhibition is something that we don't know.

But we also know that FTI monotherapy really hasn't moved the needle too much. So I do think it's a combination, and I'm assuming that there's some resensitization to the TKI time that's happening, but we don't have that answer yet.

Got it. That's encouraging. And then it's good to hear that you're able to manage neutropenia now in patients by doing G-CSF. I'm just wondering if you can talk to us a little bit about the number of patients who you managed this way following the dose escalation work, what proportion of them did you avoid dosing down darli or were you able to even avoid dose and down darli completely by giving G-CSF.

So it's important to understand that the dose expansion phases in its initial enrollment period. It hasn't been a year or 2 since dose expansion started right compared to the dose escalation, which has been a while. So I don't know the exact numbers again, but most -- like my patients on the trial, we have not had to dose reduce on the darlifarnib due to neutropenia, there have been other scenarios where cabozantinib has been dose reduced.

But so far on the expansion phase, I have not gone down on the dose of the darlifarnib have just been able to use G-CSF, so for example, I have previously talked about a patient who had these grade 4 neutropenia, hospitalization and then went on rechallenge with a dose reduction of the darlifarnib -- in that patient, we did synthetically add G_CSF along with the dose reduction, and he's been tolerating it well now for about 9 or 10 months since rechallenged, and we've not had to dose reduce further.

So it does seem to be an all or none phenomenon where some patients get it, some patients don't. And in those patients who get it, we've been able to get a way without dose modifications as of yet, but it's pretty early. And I don't know how these are going to change.

Because if you look at the cabozantinib-naive population, median PFS is around 15 months. So I think that as patients stay on the darlifarnib longer, we might accomplish some of these neutropenias, but it's also encoring to know that there's no cumulative toxicity as the longer they stay in the darlifarnib with the neutropenia gets worse.

I wanted to add a little bit to that is that very rarely do we see a darlifarnib dose reduction rather than a darlifarnib plus interruption. -- and the darlifarnib dose interruptions are really with this sufficient to allow the neutropenia to recover.

Our next question will come from Jason Zemansky with Bank of America.

Congrats on the great progress -- maybe to connect some of the dots recognizing this is somewhat speculative at this point. But based on what you've seen thus far from darli's emerging profile, where do you think the ideal setting in RCC is for the FTI? And then given how entrenched and fragmented the first and second line markets are, is there a potential to leapfrog some of the emerging novel regimens by simply adding on to one of the more established combinations.

Dr. A, do you want to share some of the questions or comments you've maybe got from your colleagues at the KCRS about their thoughts how to use this if they could, setting aside Kura's designs, maybe speak to a little bit of the commentary you received in it .

Yes. I think -- It's along the lines of what we expect and anticipate. So we are seeing data that tells us that this combination is doing better than what we would with just cabozantinib monotherapy. Now cabozantinib was that gold standard second-line treatment, but then we've also had multiple trials needed, whether it was the levantinib everolimus trial or the leventanib belzutifan trial, which had cabozantinib as a competitor. Dr. Chaudhary who chaired the KCRS meeting in Boston and who is the person who introduced cabozantinib and so on.

His comment specifically was well, this seems to be doing better than cabozantinib, why are you not doing a frontline trial with that. So I -- personally, we as physicians do think that this is a regimen that's worth exploring in the frontline space. right? and adding it on to an existing regimen seems like the best strategy, whether that's pembro lenvatinib or nivo cabo or pembro axitinib.

Now obviously, we know the response rates are better for pembro lenvatinib and nivo cabo. So maybe that's a scenario that we need to think about. So we've had discussions before internally in our meetings as to we're curious to see what Kura is going to do with this track too.

And I do think it's going to be very easy to enroll patients in the frontline setting to this, too. I -- for example, I as a Phase I physician will have no qualms against offering this to a patient in the naive setting.

Now I do believe that it needs to be combined with the TKI because I think there's some synergy like we have seen but I don't believe that it has to be cabozantinib. I do think it can be any TKI, whether it's cabo, whether it's lenvatinib, whether it Sanza, we don't know what the efficacy signals of each of them are.

So assuming that the basket trial that they're talking about shows that it's safe and effective with all these combination approaches.

I think a drug like darlifarnib could be one of those drugs that can combine with any upfront treatment strategy without marrying into a specific frontline treatment, it doesn't need to be tied in with lenvatinib tied in with cabozantinib. I can be IO-TKI plus darlifarnib. That's the way I would design a trial, if I will give all the resources I want to do. But again, easier said than done and like everyone else, eager to see what Kura will do to this combination.

[Operator Instructions]. Our next question will come from Phil Nadeau with Cowen

Two follow-ups from us. So first, in terms of the baseline characteristics of the patient in this study, any notable differences between these patients and the precedent cabozantinib second line trial that you highlighted on the comparison slide, -- anything that would bias the patients either more likely or less likely to respond to cabo. That's first.

And then second, in terms of the pivotal study, the first pivotal, I guess, what exactly are you debating? Is it just the patient population that could be enrolled as well as the dose in third line, but you're committed to going forward with the cabo combo or is there a scenario where you actually wait for the results from your platform study and perhaps move a different cabo forward into the first pivotal.

Yes. Thanks, Phil, for the questions. Mollie, do you want to speak to Phil's question about the baseline characteristics relative to the comparator trials that we highlighted.

Absolutely. So we attempted to show you the closest apples-to-apples comparisons that we could for what you would expect cabo to do in a second-line setting. However, really our patients were really in a third line plus -- so that's your biggest difference between the groups is that we actually are showing you patients that are somewhat less pretreated.

So really, our results been are even more outstanding, in my opinion, compared to what we would expect to see with these patients that are receiving cabo alone.

And Phil, maybe I can take your second question. We're deliberately sort of not yet articulating that registration-enabling design. And as in any case, right, what are we weighing off? We're weighing off the unmet need. We're weighing off the commercial opportunity the competitive landscape, cost and time.

As Mollie indicated, we've gone in a relatively short period of time from FTI as being either I'll be harsh, irrelevant or an KRAS inhibitor to something that could broadly combine with TKIs in RCC, and I think can really positively impact the evolving KRAS space. So we want to make sure that when we do this, we're doing it with all the available information. There are a number of combinations we can take forward.

We want to make sure we think about and carefully consider the overall development plan. We won't be able to do everything. So we have to be selective you do hear us wanting to move dearly as quickly as we can earlier in the treatment setting. But we also want to ensure that we give it the very best shot to get that first registration.

So just look for us to provide more clarity, either later this year or early next year. And to your question about dose, -- the great thing is either 5 or 8, both look to be pretty good. So I think I think we're in a good spot as far as that's concerned or project optimists, we do need to make sure that we do the right experiment, right?

The FDA is looking for for the proper project Optimist design, and that's what the Phase Ib does, then we'll be able to, I think, again, later this year, early next year, articulate a registration-enabling design. I hope that helps.

Our next question will come from Reni Benjamin with Citizens.

Congrats on the data. Maybe just two for us. Are there any patterns that are starting to develop the patients you think are most likely to benefit from this combination? Or in this study, are there any biomarker analyses that you guys are conducting that might help in identifying those patients. And just as a follow-up, maybe for Dr. A.

Looking ahead, is there any additional data from the ongoing randomized Phase Ib study that would be kind of most important for you as a practicing physician? Or is that really more for the company and you'd be more interested in really the registrational pivotal study path.

Sure. Thanks, Ren, for the questions. Mollie, do you want to take the question about biomarkers and patients most likely to benefit.

Sure. I mean, it's a great question. It's early. Let us continue on with our Phase Ib work, we'll have a good pool of more homogenous patients that will be able to help us potentially answer that question more. But again, these are some questions that occasionally don't get answered for a very long time, but we hope to be able to gain more information from that to help guide maybe it's earlier line patients, maybe it's patients that haven't seen TKIs, maybe it is patients that have. So let us continue to generate that data, and then we'll share it with you.

And Dr. A, for you, anything in particular you're looking for from the Phase Ib to Reni's second question? Or are you really excited to -- and Ren I'm reframing your question. excited to sort of move into that next combination or a pivotal design?

I think we're all excited to see where this drug goes. We've had experience with it. It's been an easy drug to manage in clinic and patients have stayed on it for a long time. Two things that we are all waiting to see is one, durability of response. So in the KCRS presentation, where we had a PFS of 13 months, about 50% of these patients are still on treatment. So we know that we don't have long-term follow-up yet.

And hopefully, we can see a better PFS and a longer durability. Like 6-month PFS was around 74%, 9 months was around 60%, if I remember, right? So -- it does seem to be durable when we're seeing these responses, and that's what the long follow-up will show. The second thing that's going to be important is that this Phase Ib expansion will be randomized.

So it's randomizing to cabozantinib monotherapy at 60 milligrams, which we all know is a good drug. And that will tell us what the combination is doing in terms of incremental benefit, and that animization is also stratified based on a prior TKI exposure. So instead of looking at it by saying this cohort of patients at this or that, I think we'll have prospective randomized data, which is always stronger.

But we all hope and believe that this will be something that's promising and how you combine it or take it forward in the next line setting is going to be important. And I am not a firm believe that it has to be cabo. I think it can be any TKI and probably a multi-kinase inhibitor is the one that Kura should target. Now whether that's cabo, cabo like, [indiscernible] or any of the other agents that have been investigated in this field is up for debate and it opens up the opportunities in the basket trial.

So I'm optimistic that the trial will be relevant and significant and that the addition of the cabo to the darli, whether it's 5 or 8 will have some meaningful improvement in outcomes. And then hopefully, by that time this data is the basket trial data out, which tells us the safety of combining it with everything else, and then Kura have a good headache of trying to figure out which trial combination they need to take forward with -- it will be interesting times.

And our last question will come from David Dai with UBS.

Just a quick one. Thinking about the potential other combinations in addition to Cabo and RAS inhibitors maybe wondering if you can tease some of the potential combination strategies or interesting MOAs you're currently evaluating.

Yes, David. That's a good question to end on, actually. This will be kind of my concluding comments. So we'd like to benefit as many patients as we can in RCC. As Dr. A mentioned, there's a rationale to combine with any of the TKI containing regimens. Should -- it would be great if we could do something akin to what we're doing in AML with ziftomenib, where as you look toward the end of the year, you're going to see combinations with venetoclax in azacitidine with FLT3 inhibitors, with other regimens like LDAC would be great to do that in the RCC space.

In the KRAS space, we've committed to moving forward with resorb because, obviously, that's the second line standard of care. Interestingly, a number of these companies are now pivoting and going to front line. These are other RAS companies. We're not doing that. We actually think we can build upon the strong data with Daraxonrasib and potentially make it even better. That puts us in an attractive place, I think, in this evolving KRAS landscape.

But there, again, we can combine with the mutant selective inhibitors. We can combine with the PAN inhibitors, and we can likely do it in each of the major tumor types. This is going to require a meaningful development spend, but I think the opportunity there is -- there hasn't been a molecule like an FTI before, one that actually can work well in a solid tumor space like RCC that, as we indicated, is a $6 billion market opportunity in the second line and then the RAS space, which is just on fire. So it's an exciting time. It's a high-class problem that we have to make these development decisions, but look for us to articulate that through the rest of the year.

With that, I know we're a few minutes over. I want to thank everyone for your listening to us and participating. I particularly want to thank Dr. A for being so generous with his time both at KCRS and in this webinar. We will be releasing earnings here in the next sort of -- within the next couple of weeks and look forward to talking to you all then. Until then, happy Monday, and enjoy the rest of your day. Thanks very much.

Good day, everyone. My name is Stefan, and I'll be your conference operator today. At this time, I'd like to welcome you to Kura Oncology's investor call to discuss the long-term results of ziftomenib and 7+3 in newly diagnosed AML. [Operator Instructions]

At this time, I'd like to turn the call over to Troy Wilson, President and Chief Executive Officer of Kura Oncology. Please go ahead, Dr. Wilson.

Thank you, Stefan. Good morning, everyone. We're coming to you from Stockholm, Sweden, the European Hematology Association meeting, and we're delighted to share with you the latest update from our frontline results of ziftomenib with 7+3.

If we could please go to the next slide. In today's presentation, we're going to be making forward-looking statements. So of course, we'll refer you to our website and the SEC's website for more information about Kura Oncology and the risks and uncertainties of an investment in the company.

Take us to the next slide, please. It was just a couple of weeks ago that we came to you from ASCO where we brought you an update on our darlifarnib program. We're really at a point now where we're executing across the company. The KOMZIFTI launch is going very well. We have robust new patient starts and early momentum. Today is part of our effort to help provide data and talk about how we think we can advance ziftomenib to achieve our goal of addressing up to 50% of AML patients. And this is the next in a number of important readouts around the program.

If we can please go to the next slide. I'm joined this morning by 2 other participants, Dr. Amer Zeidan. Dr. Zeidan is Professor of Medicine at Yale Cancer Center as well as Dr. Mollie Leoni, who, of course, is the Chief Medical Officer of Kura Oncology.

We can go to the next slide, please. The agenda for today is Mollie is going to spend just a moment or 2 on the results that were published in blood on the combination of ziftomenib and venetoclax/azacitidine in the relapsed/refractory NPM1-mutant AML setting. Dr. Zeidan will take us through the presentation at EHA, where he'll discuss the long-term results for ziftomenib and the 7+3 combination in the newly diagnosed NPM1 and KMT2A populations. And then Mollie is going to take over and relate the results from the 007 trial that Dr. Zeidan is discussing to how you should think about our ongoing KOMET-017 study in frontline AML.

If we could go to the next slide. And with that, I'll turn it over to Mollie. Mollie?

Thank you, Troy. So now that ziftomenib or KOMZIFTI is approved as a monotherapy, Kura has been dedicated to generating data in the combination setting. To this end, we have a robust development program that has the ability to benefit patients with menin-dependent AML across the treatment continuum. Next slide. In today's presentation, we will be discussing 2 important pieces of the continuum, the combination of ziftomenib with venetoclax and azacitidine in the relapsed/refractory setting and the combination of ziftomenib with 7+3 in the frontline setting. Both of these data sets come out of the KOMET-007 trial. The sample sizes have been robust and able to support and inform the KOMET-017 registrational trial that is evaluating ziftomenib in newly diagnosed patients. While frontline data and their applicability in the KOMET-017 trial are a primary focus of today's presentation, we wanted to begin with an important update in relapsed/refractory setting.

If we go to the next slide. The important results of ziftomenib in combination with ven/aza in the relapsed/refractory setting have recently been published in blood. Moving to the next slide. And the results are very important to patients with relapsed/refractory NPM1 mutant AML. This study enrolled patients that were heavily pretreated, many of whom had already received venetoclax-based therapies. In the venetoclax-experienced patient population, where we would expect minimal patient benefit, we saw a 48% ORR with 24% achieving a CRc of significant durability.

Importantly, we saw in patients that were ven-naive an 87% ORR with 70% of patients reaching a CRc with a meaningful duration that appears to have also translated into survival for these patients as the median OS has not been reached. These data are remarkable when we consider the poor ORR and OS expected for these patients. These deep and durable responses exceeding what one would expect with ven/aza alone in this relapsed/refractory setting with a well-tolerated combination regimen speaks volumes with regards to the importance of menin inhibition early in the treatment paradigm.

And with that, I will pass it over to Dr. Zeidan, who will discuss the data surrounding zifto's use in the frontline setting.

Thank you so much, Dr. Leoni. So I'm going to be talking about the combination in the frontline setting with ziftomenib. This is the presentation we will be doing in EHA meeting this weekend. Next slide, please. So these are my disclosures, including consulting for Kura and Kyowa. So as you just heard, ziftomenib is an oral menin inhibitor that is given once a day that has been already approved as a potent selective inhibitor in the relapsed/refractory setting for patients who have refractory leukemia, acute myeloid leukemia with NPM1 mutations.

But at the same time, it has shown promising preclinical activity in combination with standard of care therapies that we have been using for AML for a long time, including intensive chemotherapy with 7+3. And as you just heard with aza and ven. So the KOMET-007 has been exploring these combinations in a large ongoing international study that includes dose escalations as well as dose expansions, both in the frontline setting as well as in the refractory relapse setting for both subsets of leukemias that have been shown to benefit from menin inhibition, primarily NPM1 and KMT2-arranged leukemia.

Next slide, please. So the focus of the presentation in EHA this year is going to be on the frontline combination with intensive chemo 7+3, and this is in patients who are deemed to be fit to receive intensive chemotherapy by their physician. So the way the trial was conducted is that we have 2 separate cohorts, one for NPM1 and one for KMT2A rearranged leukemias. Both of those underwent a dose escalation starting with a 200 milligram, 400 milligram and then 600 milligram of ziftomenib in combination with 7+3 in the dose escalation phase that went subsequently into a dose expansion phase using the optimal dose, which was determined to be 600 milligrams of ziftomenib.

And what we are presenting in the meeting is all the patients who have been enrolled on both the dose escalation and the dose expansion part of the study that have received the optimal dose, the 600 milligram, which I would note is the dose that's also being tested in the randomized registrational Phase III trial that you will hear about later in this meeting. So here, you can see the patients who were enrolled in terms of their disposition. We are presenting data in 99 patients, which I believe is the largest experience in the frontline setting reported to date of any menin inhibitor in combination with intensive chemotherapy.

49 patients had NPM1 mutations and 50 patients had KMT2 translocations. You can see that at the time of this data cutoff, which was April 10, 2026, the median follow-up at that point was 17.6 months for NPM1 and 11 months for KMT translocation. And at the time of the cutoff, 90% of the patients with NPM1 and 62% of the patients with KMT2A patients were still on study either on treatment phase or in the survival follow-up phase of the study.

Next, please. So these are the baseline characteristics. I would note for the NPM1 mutation, and I think this is important as you interpret the results that the dose escalation part of this study required patients who had NPM1 mutation to also have what we call factors that make them adverse risk. So they had to be either older than 60 or they had what we call therapy-related AML or they had adverse cytogenetics. All of these predict worse outcomes. So those were the patients who were treated in the dose escalation part. But once we have gone to the dose expansion part of the NPM1 mutation patients, it was open for all newcomers.

And what this resulted in is that the median age of the patients who had NPM1 mutations in this study was 60 years old. So half of them were older than 60 basically. While the KMT2-arranged patients were slightly younger with a median age of 43, we have slight predominance of females on this. And some of the patients, as you can see here, had co-mutations as is expected in this setting, including a small number of patients who had FLT3. The FLT3 patients who had those mutations were generally considered to be too low to receive in terms of their variable allele frequency to receive a FLT3 inhibitor or had a FLT3-TKD.

Next, please. So these are the -- an overview of the side effect profile. What you can see here is the treatment-emergent adverse events that occurred in 30% or more of all patients. This does not really add much in terms of the safety beyond what we have seen in previous presentations from the study. Primarily, most patients will experience treatment-emergent adverse events because this is given in combination with intensive chemotherapy and the safety profile is very well recognized in this setting. So I think the primary conclusion from this data set is that it does not seem that the addition of ziftomenib to 7+3 is causing additional toxicities. What we are primarily seeing here is count suppression in the form of thrombocytopenia and neutropenia as well as febrile neutropenias, some GI side effects in the form of diarrhea, some pruritus. However, again, all of these are within what you typically expect with no new or unexpected adverse events with the longer-term follow-up of this patient cohort.

Next, please. This slide on the safety front is looking at the severe treatment-emergent adverse events defined as Grade 3 or higher that occurred in at least 10% of patients. And again, the same focus being count suppression, which is primarily driven by the intensive chemotherapy that's given to those patients as well as a small incidence of other things such as pruritus and GI side effects.

I think what is important to note is that the treatment adverse events of interest such as differentiation syndrome and QTC prolongation occurred in a small number of patients, for example, differentiation syndrome occurred only as a Grade 3 in 4 patients. There were no Grade 4 or Grade 5. All of these DS events completely resolved with protocol mitigated interventions and 3 of them were actually able to continue on ziftomenib therapy. And the same thing for QTC prolongation. There were 3 cases that were Grade 3 that were assessed by the investigators and there were no Grade 4 or higher and all of them resolved and the patients were able to continue on therapy.

Next, please. So I think here, we are seeing, in my opinion, the most impressive data of this presentation in the next 2 slides, focusing on the responses and the survival data. So I'm going to present the data kind of looking at each cohort separately because I think there's important differences between these patients that are important to note. So I would start by the complete response, which is really understood in the context of intensive chemotherapy to be one of the most important endpoints to achieve in this setting.

And what you can see in NPM1 mutated patients out of a relatively large sample size for a Phase II trial of 49 patients, we are seeing a stable CR rate of 94%. This number actually over the previous 3 presentations we had of this data set, not only has been in this range, but actually went up, indicating the stability of the CR rate, which again is, I think, one of the highest we have ever seen in the context of intensive chemotherapy for any acute leukemia patient subset. And again, most of those were full CRs, meaning you have complete count recovery. The MRD negativity, which is another indication of the depth of the response was observed using local assessment in the vast majority of patients for the NPM1, it was observed in 85%.

I will be talking about the central MRD negativity, which is we are presenting for the first time in this presentation in the next slide. And I would also observe that the median time to CR MRD negativity was quick at 1.5 months. When you look at the KMT2A, again, those patients generally have a more severe disease. They are generally expected to have worse outcomes than the NPM1 and this is -- reflects what we see. But at the same time, I think those outcomes compare favorably to what we typically expect with 7+3. For example, the complete response rate was 82%, the complete -- the composite CR was 90%. And again, the CR -- MRD negative CR was the majority of patients at 86%, and it was observed to occur relatively quickly with a median time to MRD negative CR of 0.9 months.

Next, please. Here is the central molecular MRD negativity. And this is important because MRD negativity locally has been assayed by different methods, including flow cytometry and genetic studies, but also it was done locally by different centers. So here, the advantage is you are using one highly sensitive genetic test that's done in a central lab, giving you, I think, a lot of confidence in the findings. And here, what you can see is that the MRD negative composite CR was also quite high, as you can see. And we looked at it at 2 different thresholds using 0.1%, 1 in 1,000, which was observed in 79% of patients. And again, this is only in NPM1 mutated patients where MRD negative CR has been really, I think, shown to be a surrogate for long-term outcomes, including EFS and OS.

For using the threshold of 0.01% or 1 in 10,000, it was observed in 56% of patients. And again, those MRD negativity results were obtained relatively quickly with a median time of around 2.2 months. So by the second cycle, by the end of consolidation 1, which is generally has been considered the most important endpoint time for the MRD negativity, all of those patients who have achieved MRD negativity have already reached by the end of the second cycle of intensive chemo, which is usually the end of the first cycle of consolidation therapy.

Next, please. And concurrent with the safety profile that I think was impressive and the fact that we think one of the problems of adding drugs to intensive chemotherapy in general has been the concern about additional myelosuppression, which can translate into adverse events. One of the -- I think one of the most reassuring aspects of this particular combination is that it does not seem to add additional myelosuppression. And this is here reflected by the time to count recovery with a neutrophil count of more than 1 and a platelet count of more than 100, which constitute the CR. You can see that the time -- median time to count recovery for both was around 28 days, which is what we generally see with 7+3 itself. So that suggested that the myelosuppression is not being worsened by the addition of ziftomenib to intensive chemotherapy.

Next, please. So these are swimmer plots that demonstrate the durability of the response. So it's not only a very high rate of complete responses, but those CRs appear to be durable, as you can see in this figure. So with the median follow-up of 17.6 months, the median duration of the CR, and this is for the NPM1 mutated patient cohort, was not reached. At 12 months, 80% of patients were still in CR, 10 patients underwent transplant of the NPM1 mutated patients.

And most of those patients were able to continue on maintenance, which was allowed in the protocol in which ziftomenib again was started on day 8 and was continued throughout and the protocol allowed the patients to go into maintenance either post transplant if their physician elected to go to transplant or after the completion of consolidation chemo. So most patients were able to proceed to the maintenance phase, 31 patients were able to do that. 8 of them were after -- on study transplant. And only 8 patients discontinued at any point due to relapsed or refractory disease with a very low rate of discontinuation due to adverse events, only 4 patients, one of them only was ziftomenib related.

Next, please. In the KMT2A rearranged leukemia, again, we see here the durability of the responses, noting again that this patient subset have a higher-risk disease and generally, not only they have a lower chance of achieving responses with 7+3, but generally, their durations are lower. So I think when you look at the data in combination with ziftomenib, you can see that these data are exciting. Here with a median follow-up of 11 months, median duration of CR was 12 months. Most of those patients have undergone transplant, again, reflecting the belief by the physicians that those patients are at high risk of kind of adverse outcomes and relapse. So this is why most of those patients are being geared toward transplant in general whenever possible. And many of those patients continued on ziftomenib maintenance primarily after the transplant performance. 10 patients discontinued due to relapsed or refractory disease and 7 due to adverse events. Only 2 of them were ziftomenib related.

Next, please. So I think, in my opinion, this is the most important slide in this presentation. If I was going to show one slide summary of what I think is most exciting, this would be the one. So this is what you can see here is the overall survival curve in NPM1 mutated patients. You can see a very nice, almost straight line with the survival. Of course, here after a median follow-up of 17.6 months, the median overall survival was not reached. At 12 months, the overall survival rate was an impressive 94%. And I would add here one of the things that we also monitor when we give patients intensive chemotherapy is what I call induction mortality or early mortality, which is the chance of dying in the first 60 days from complication.

This was very low at 2%, which again is extraordinary low. Remembering, again, that this is a large international study. Those patients were treated in many centers. This was not only one highly specialized single center. So I think to see such a low induction mortality is quite impressive. And the other point I would make also is that those patients, as I mentioned at the beginning, those are older and higher risk than your average patient because of the patients who were included in the dose escalation part of the study, in particular.

The median age was 60. So when you try to compare historically generally in terms of the CR rates, in terms of the durability of the CR as well as the overall survival rate, I think these numbers compare very favorably. And at the same time, this is combined with good safety where time to count recovery is only 28 days and the risk of adverse events is generally along the lines of what you expected with 7+3 itself. And as you can see, most of those patients are still alive and continued on study, and we will continue to follow these data until maturity on the longer run.

Next, please. So these are similar data for the KMT2-arranged patient subset. Again, the outcomes here look a little bit worse than the NPM1, but this reflects the higher risk nature of this particular entity of acute leukemia. Still here with a follow-up of 11 months, the median OS was not reached. And 60-day mortality was still good at 4% and 62% of those patients were still on study either on the treatment or on the follow-up phase of the study and the 12-month survival was 71%.

Next, please. So I think in conclusion, in this analysis from the KOMET-001 study, which, as I mentioned at the beginning, I believe to be the largest data set of intensive chemotherapy treated patients who received it in combination with a menin inhibitor that has been presented to date, the combination was very well tolerated with a safety profile that is consistent with previous reports and also doesn't seem to be significantly different than 7+3 by itself, in particular, when it comes to lack of additional myelosuppression, quick time to count recovery. And I think the adverse events of special interest, in particular, differentiation syndrome seems to be very largely mitigated.

This is one of the advantages of giving a combination of chemotherapy along with the menin inhibitor, not only to enhance the synergistic activity and the efficacy, but also it mitigates the risk of the differentiation syndrome. Beyond the safety, I think the clinical results are extremely exciting, in particular, the NPM1 cohort with a CR rate of 94% and a CR that is very durable. The median duration has not been reached and 80% are still -- of those in CR were still in CR at 12 months, but also the median OS not reached and OS at 94% for NPM1 patients at 12 months. And similarly, for KMT2A, a high rate of complete remission of 82% with a median CR duration and median OS that were not reached. So I think all of these data support the ongoing registrational Phase III trial, KOMET-017 for the intensive chemotherapy part of it that combines ziftomenib with 7+3 against randomization to 7+3 by itself. With that, I think this is the last slide. Thank you.

Thank you. And every time I see those data, I get more excited and more confident in our ongoing frontline registrational trial, the KOMET-017 trial. And I want to highlight that the experience with KOMET-007 has been able to inform the development of this important registrational KOMET-017 trial with that. The basics of KOMET-017, the trial was designed to generate clinically and registrationally relevant data for global markets.

The trial contains 2 large independently and conservatively powered Phase III studies, which have the ability to detect clinically meaningful benefit for patients. We are enrolling across North America, Europe and Asia Pacific with the intention of generating a geographically diverse data set pertinent to all major commercial markets. However, our trial sites have a limited focus on markets that potentially have significant differences in their treatment paradigm, thus reducing potential risks to 017 that could manifest via differences in clinical practice or supportive care.

This multiregional clinical site footprint will support commercial readiness by building investigator experience and familiarity globally. Our ultimate goal with the design of KOMET-017 was to optimize for speed, but just as importantly, for regulatory and scientific credibility, statistical probability of success and commercial relevance. KOMET-007 data are instrumental in facilitating this design.

If we go to the next slide. So first and foremost, the safety and tolerability emerging from the KOMET-007 trial is reassuring for the conduct of KOMET-017. The overall safety profile for ziftomenib in combination with 7+3 is consistent with that seen with the 7+3 backbone. The rate of differentiation syndrome, a known risk when administering a differentiating agent like ziftomenib is considerably decreased compared with monotherapy rates. The events have been readily resolved with supportive treatment.

QT prolongation was seen infrequently in the trial. When events were detected, they each had causes likely unrelated to ziftomenib therapy that were resolved so that treatment could continue. The ziftomenib therapy -- the concurrent use of zifto with 7+3 does not result in delayed count recoveries for these patients. Neutrophils and platelets returned to normal ranges within 28 days of treatment initiation, indicating no additive myelosuppression with 7+3. And finally, the addition of zifto to this backbone regimen does not adversely affect induction-related mortality rates. This totality of data from the KOMET-007 trial supports and recommends the ongoing registrational KOMET-017 trial.

Going to the next slide. Even more striking is the efficacy we are seeing that more than recommends continued momentum in the KOMET-017. Here, I am focusing on the NPM1 mutant solely because they will make up the majority of patients enrolled into the registrational trial. However, as you can see in Dr. Zeidan's presentation, the same apparent benefits and outcome measures are seen with the KMT2A patient population. Starting with the CR rate, we are seeing even our older patients having a 90% to 100% complete response rate, far exceeding the expected benchmarks of 56% to 88% for this patient population.

The 7+3 portion of KOMET-017 was designed to have an accelerated approval endpoint of CR MRD negativity in the bone marrow. The reference for this in NPM1 patients is 44%. We saw 56% of our patients achieved this bone marrow MRD negativity, which again supports the design of KOMET-017. And the most important of outcomes is the overall survival. MRD-negative CR is expected to predict an improvement in overall survival. Our median OS has not been reached for NPM1 mutant patients, but at 12 months, 94% of the NPM1 mutant patients are alive in sharp contrast with historical numbers ranging from 45% to 80% in these age groups. Again, this supports and recommends continuance of the KOMET-017 registrational trial as designed.

If we go to the next slide. What we have seen with the KOMET-007 trial gives us great confidence in KOMET-017. But with KOMET-017, we have put additional measures in place. Important among them is central MRD testing. Having a central method in place improves reliability and maintains regulatory standards. With local MRD testing, there are multiple laboratories performing different types of tests with the likelihood of creating site-to-site variability and making comparison difficult. With central MRD samples are tested at a single lab with the same test, allowing uniform assessment in accordance with regulatory requirements.

Moving to the next slide. Assessing the MRD in this uniform way allows us to translate these deep molecular responses we have been seeing into an accelerated path towards value creation in frontline NPM1 AML. As a reminder, MRD-negative CR is the co-primary endpoint for accelerated approval in the 017 trial. As data has grown in the field, MRD negativity has consistently emerged as a predictor of long-term outcomes. The bone marrow MRD negativity we are seeing in 007 compares favorably with historical benchmarks. And these data that we believe are predictive of outcomes in 017 are clinically meaningful and appropriate to support FDA accelerated approval.

Moving to the next slide. As Dr. Zeidan was referencing, ultimately, it's this slide that tells the story better than any of us actually can, an OS survival curve for AML that extends at this level over a 24-month period. I don't know what other endpoints could actually matter more than that. The median EFS and OS have not been reached. The 12-month OS is superior to 7+3 alone. These data all tell you that menin inhibition is an important part of the treatment paradigm and that treating early with the combination appears to have a positive benefit risk balance that we will continue to explore, not only in the relapsed/refractory setting as we showed you in combination with ven/aza, but also for newly diagnosed patients.

And with that, I will pass it back to Troy.

Thank you, Mollie. We could go to the next slide, please. So this is part of our initiative with the launch underway in the relapsed/refractory NPM1 setting, as we've guided, we think that total addressable market opportunity in the U.S. is $350 million to $400 million. As both Dr. Zeidan and Dr. Leoni mentioned, the goal is go earlier, go in combination, and you can see that as we work our way up the curve. Ultimately, and I think the data support this, we're optimistic that if the KOMET-017 studies are successful, we could be poised to achieve a much more significant U.S. total addressable market of up to $7 billion. And I think you can see why we say that now. The goal is get these patients into response and then keep them on continuation therapy. Many of those NPM1 patients, in fact, did not go to transplant. They're just remaining on zifto cycle after cycle.

We go to the next slide, please. So where we are today? Again, a couple of weeks ago, we talked about darlifarnib. This week, we're talking about ziftomenib on the left-hand side. The launch is going well. We have robust momentum and gaining market share. And we are firmly focused on continuing to advance ziftomenib through a variety of different combinations to address up to the 50% of AML patients that we think could benefit. The 007 results, although they are Phase Ib results, we think that they support a best-in-class profile among menin inhibitors and that they continue to derisk the ongoing Phase III registrational studies. Both Dr. Zeidan and Dr. Leoni said it well. The survival data sort of speaks for itself. And we're very excited. The enrollment in the 017 studies is going very well. We're hopeful that with this data, it will only accelerate, and we remain committed to transforming the standard of care for patients with acute leukemia.

Next slide. And with that, that concludes our prepared remarks, and we'll now go to a question-and-answer session. Stefan?

[Operator Instructions] Our first question will come from Li Watsek with Cantor Fitzgerald.

Very impressive OS data. And I guess just given the impressive durability of the response and OS rate, what is your best estimate for duration of therapy in the frontline setting?

Mollie, would you like to -- I don't know if we can answer that question, but we would like to try.

I mean it's certainly still evolving. You'd see that it's going to be at worst about 24 months is what it looks like at this point. These patients are, in general, very successful on treatment, getting into a response and then staying on treatment with the monotherapy once they're in their response. So we don't have the exact answer yet because thankfully, for these patients, their treatment is still ongoing, and we're still able to follow them to get additional information.

Great. And let me just clarify, those of you who want to ask a question, if you'd like to ask a question and follow-up question, please feel free. We're going to limit it to just one question and one follow-up. But -- you're welcome to get back in the queue, but going forward, one and one is fine.

Stefan, next question.

Our next question will come from Jason Zemansky from Bank of America.

Okay. We'll move on from Jason in the meantime. We'll move on to Phil Nadeau from TD Cowen.

Congrats on the data. We have a question on the MRD negativity rates. What level of MRD negativity is correlated with survival? Is it the lowest threshold that you presented or the second threshold? And then kind of as a follow-up to that, how is MRD negativity going to be used to decide on the treatment plan for patients? So which patients would go to transplant, which ones would be more amenable to maintenance therapy without transplant. We're curious to hear your thoughts on that.

Mollie, do you want to start with that?

Yes, sure. So we showed you multiple treatment -- multiple MRD cutoff points because it would allow you to compare it to maybe the local values. And that's why we showed you the less sensitive and the more sensitive values. We ultimately -- obviously, the lower -- the more sensitive you go, the more predictive things generally tend to be. However, more data is going to come out over the next year or so that are going to show you probably even at less sensitive levels, even that the MRD negativity is quite predictive of survival in these patients. But I would offer it over to Dr. Zeidan to give his opinion on how this is going to influence treatment in the coming months.

Yes, I agree. So I think the more sensitive the test and kind of the deeper the response, we believe, is correlating with kind of longer-term outcomes. I think when it comes to how people are influenced, there has been generally with NPM1 kind of AML, a general practice that if the patient is still MRD positive beyond the first consolidation cycle or subsequently turns from negative to positive, the standard approach has been in patients who are otherwise a transplant candidate is to consider transplantation. There is a separate question about whether these patients need to receive a treatment that can convert into negativity to -- before they proceed to transplant. But I think that reflects the field belief and supports the clinical observation that MRD positivity beyond 2 cycles generally correlates with poor outcomes. And I think certainly, this is influenced in terms of how we kind of counsel and treat these patients.

And Phil, so maybe I'll just add a thought or 2. We wanted to be really clear and break this down because we see a lot of numbers for MRD negativity getting discussed. The treatment decisions are based on the local values. But ultimately, to support an application for accelerated approval, the FDA requires the central testing with that level of rigor that Mollie described. So that's why we're breaking it down for you. Both of them look to be quite clinically meaningful. But when one is thinking about are you going to meet the bar for an accelerated approval, you really need to be now talking about the central values. So hopefully, that will provide some clarity as we look at the menin inhibitor field continue to evolve in the front line.

Okay. And now we'll circle back to Jason Zemansky with Bank of America.

Apologies for the technical difficulties, but congrats on the great progress. I guess this is somewhat theoretical. But given what you've seen from that Kaplan-Meier curve, how much do you think you could realistically address the 1 and 5-year survival rates? And is this sufficient to support widespread use?

Dr. Zeidan, do you want to speak to that?

Yes. So I think we know with acute myeloid leukemia in general is that most patients who relapse generally tend to do so in the first 3 years, and the risk is highest in the first year, goes down a little bit in the second year and then a little bit lower in the third year. So we have patients who can still relapse after 5 years or after 3 years, but the number goes down significantly. Historically, some people used to use 5 years, but I would say 3 years is a pretty good indicator if the patient is cured or not.

So I think based on how this curve is looking, we showed the 12 months as a 94%, but because of the 17-month median follow-up, after the 12 months, there's some degree of [ sensing ]. So I think -- but when you look at the curve, it looks still quite good up to 24 months. So my estimation is that if this trend continues and especially those patients are still ongoing ziftomenib maintenance therapy, my expectation is that this continues. And I would add to that, I think Troy touched on this, is in patients who are older than 60, generally, there has been an ongoing discussion in the field about whether those patients should be transplanted because although they have NPM1, they tend to have worse outcomes.

And I think it was quite impressive to me, the very high rate of CR on this trial, 100%. I mean you cannot get any better than that with the menin inhibitor combination with 7+3, but also the favorable -- as you could see, the average survival and the CR rate is much lower in those patients with 7+3 by itself. So it's clear to me that combination is adding benefit in terms of the durability and the overall survival. I think in another year or so, we'll have a much better sense about the durability, but all the early indicators are going in the right direction in my assessment.

Great. And if I could follow up with a quick one. But to what extent is this data extrapolable to the KOMET-007 data of the ven/aza combination?

Mollie, do you want to speak to that?

So as we've discussed in the past, I believe, we will be showing you an update on the KOMET-007 ven/aza frontline as well in coming months because we think it's important for you to be able to see that translatability as well. But we have just as much confidence in the ven/aza data as we do in the 7+3 data. This just happened to be more mature and available for sharing. But I think you should assume that you're going to see us similarly excited about that data.

Sure. And maybe, Jason, just one more comment for you and the audience. Before we started these studies, we heard from all quarters, sort of a desire to move from 7+3 to ven/aza. And what has been interesting is the 7+3 enrollment has remained very robust throughout the Phase I and now into the Phase III. And I think Dr. Zeidan spoke to it, this combination of ziftomenib and 7+3 provides a really compelling option for patients, particularly those who may -- you may not need to go to transplant. So that's one of the things that has us excited about running the 2 studies as one protocol in 017, patients and their physicians can elect intensive chemo. They can elect ven/aza. They have the option to do either. And I think we're confident that each of these 2 independent cohorts are going to show meaningful clinical benefit for patients. It's great to give those patients options.

So if we can go to the next question.

Our next question will come from Salim Syed with Mizuho.

Great. Can you guys hear me okay?

We can, Salim. Yes.

Okay. Congrats on the data. Just one for us on the safety side of this, Troy. On the QTC prolongation, I know they -- as mentioned is unrelated, but just curious how those patients were managed with zifto paused in those cases and similarly on the differentiation syndrome for the 4 cases, what exactly was the mitigation protocol that was implemented here?

Sure. Mollie or Dr. Zeidan, whichever one of you wants to take that, leave it to you.

I can start and then Dr. Zeidan can fill in. For the QT cases, they were all clearly attributable to other underlying issues such as concomitant medications or electrolyte imbalances. And once those were corrected or dose adjusted, these patients were able to remain on ziftomenib therapy without any additional issues. The differentiation syndrome, we've developed that method of treatment and intervention over many years now. And so it does result in an interruption of therapy, although it probably doesn't need to in the combination setting. And again, these are all just Grade 3 and easily resolved with supportive care and these patients were able to continue on treatment. But Dr. Zeidan, you...

Yes. So I'll over my own also personal experience as I have treated quite a number of patients on this protocol. And I think some of that also speaks to the experience of the investigator in terms of like working with these drugs. I think in some sites where there might not necessarily be a lot of familiarity with ziftomenib, sometimes the initial reflects would be to stop the investigational drug when there's QTC prolongation.

But I think to Mollie's point and has been my own experience is that almost always there are other reasons such as low magnesium, low potassium. So we tend to correct these. We -- often in the context of intensive chemotherapy, we use a number of other drugs, in particular, antibiotics and antifungals. And all of these -- some of them can have QTC prolongation. So I actually always tell my team when we face the situation is that don't stop all drugs at the same time because this is what usually happens that they stop the IP and the antibiotics and it becomes tough to exactly know what's causing things.

So I tend to stop the antibiotic first for 2, 3 days and then see what happens with the QTC. And I can tell you when we did that, generally, the QTC would have normalized without stopping the ziftomenib. But I think sometimes it gets confusing when people stop the drugs at the same time. But my -- again, there were no Grade 4s. There were -- everybody was -- for me, since you are able to restart all the patients back on the drug without QTC prolongation, that's also empiric proof that it probably has not been caused by the drug itself.

And without dose adjustment.

Yes.

Our next question will come from Roger Song with Jefferies.

Congrats on this impressive survival data. This is Nabeel on for Roger. Just one from us. So we did see triplet therapy at ASCO with gilteritinib -- sorry, quizartinib necessitating dose reductions. How do you compare your menin inhibitor safety profile with regards to heme tox? And then anything else we should keep in mind for combos?

Mollie, do you want to take that?

Sure. But I also -- I'm going to then ask Dr. Zeidan to comment because he has some very definite feelings on this topic. I think the data shows you itself that we're not adding any hem tox. So we don't have to sit there and interrupt our therapy to allow counts to recover. We don't have to change doses to allow counts to recover. When the patients are solely on the ziftomenib therapy after their consolidation, they don't have to have a dose adjustment. They're not having thrombocytopenia or neutropenia issues. So we do not believe that we are having any additive myelosuppressive effects with this addition of ziftomenib. But again, I really welcome Dr. Zeidan to comment as well.

No, I fully agree with this. And actually, one of the fun things in my opinion, when you do the randomized Phase III trials is when you don't have a very good sense of which patient is getting what is because everybody is recovering very quickly, this is always very exciting. But I think in this particular context as someone who have given 7+3 with FLT3 inhibitors all the time because these are approved treatments, you could see that the time to count recovery is generally upwards of 35 days before you get like the ANC and the platelets.

So you could easily see that the drug is adding some degree of myelosuppression, which is not the situation with ziftomenib. With ziftomenib, it starts on day 8 and actually continues -- you don't stop it, like I don't know if you are aware of this, but with the FLT3 inhibitors, most of them, they only are given from day 8 through day 21. We have to hold them because if you keep going with them, the patient count recovery will even take longer. So here, you are able to continue throughout without interruptions and still the patients are recovering within 28 days. So I think in my opinion, this is the best empiric proof that you have in terms of the count recovery.

But I would add one of the functional consequences of prolonged time to count recovery and additive myelosuppression, why we hit it is because it leads to infections, bleeding and inpatient induction mortality. And again, on all of these fronts, the combination is doing very well. To have only 2%, 1 patient out of 49 in the NPM1 die within first 40 -- within the first 60 days. And again, remember, the median age of those patients was 60. Half of your patients were older than 60. And to get intensive chemo, only have 1 death out of 49 and no increased significant risk of like severe infections. I think all of this speaks to the lack of additive myelosuppression and the tolerability of the combination.

Our next question will come from Jonathan Chang with Leerink Partners.

Dr. Zeidan, can you discuss your experience with ziftomenib in the commercial setting? How are you using the drug currently? And how do these recent results potentially impact that?

Yes. So I think the drug certainly has a safety profile that has been very good. Primarily, my use has been in the context of the clinical trial because the drug has just been recently approved. But my own experience has been similar to the clinical trial experience, in particular, in terms of how relatively easy it is to give it as a monotherapy. I would make the point that all of these -- that the patients after going into the intensive chemo, whether it's in induction and consolidation, they are going to monotherapy on this particular trial, the 007 drug and 007 trial.

And this is a setting in which you can really see the isolated part of the kind of what is resulting from the drug itself compared to when you are giving it with 7+3. And in that context, I can tell you most of the patients are tolerating it quite well, not only lack of severe toxicity, but sometimes we see what I call chronic low-grade toxicities that are not severe, but they are taken a toll on the patient life that they have to discontinue. And that's not something we see with ziftomenib. Patients are able to continue on it. And again, in the setting of maintenance therapy where the chronic use is going to be even much longer than the refractory relapse setting, I think this becomes very important.

Our next question will come from Charles Zhu with LifeSci Capital.

This is Peter on for Charles. Just thinking about the patients who have relapsed on this trial, what therapies are they getting after? Are any of them getting menin now that a couple are approved in these settings? And is there any role for menin inhibitors actually after relapse on frontline menin combinations?

Mollie or Dr. Zeidan, if one of you wants to take it.

I can say from the overall study perspective, we are certainly tracking that. And it's something that we have seen even within the 007 trial, where we had both frontline and relapsed/refractory patients that patients that may be relapsed after the frontline therapy even in the same trial then went on to our relapsed/refractory ven/aza, which also obviously included a menin inhibitor. But I think Dr. Zeidan's experience with his own patients would probably be more pertinent.

Yes. So I would say, historically, when you had a patient relapse after 7+3, we historically have used other intensive chemos such as FLAG-IDA. But with -- once venetoclax became available, although aza-ven is not approved as a refractory relapsed regimen, it has become very widely used as a salvage regimen after intensive chemotherapy in the case of relapse, in particular, for patients with NPM1 or IDH, which are thought to be subsets that are quite sensitive to venetoclax.

So the practical question became is what do you do with menin inhibitors in that setting? And I think this is where the blood data that Dr. Leoni showed at the very beginning is very relevant because right now, if you have a patient who relapses after 7+3, your question is, do I give a menin inhibitor or do I give aza-ven. And you can just give all 3 together where you are getting kind of, I think, encouraging results. And you can do that indefinitely for patients who are on -- who are candidates for transplant or you can use it as a bridge to get to transplant and then subsequently continue some form of maintenance.

Now to the second part of your question, I think, about what do you do if the patient has got a menin inhibitor as part of their frontline treatment. This is going to be primarily a clinical trial question because these drugs are not approved as combination of frontline intensive chemo yet. I think we are going to collect data from this trial and other trials and understand the issue of the sequencing and whether there are certain mutations that are predictive of responses to certain drugs. But I think this is something that still needs time to be answered.

Our next question will come from Etzer Darout with Barclays.

Congrats on this data update. Just given a meaningful proportion of patients proceed to transplant, particularly in KMT2A, how should we think about the relative contribution of ziftomenib versus transplant and driving the durability in OS outcomes you're seeing? And then would this be something that the Phase III KOMET-017 would allow to isolate to get a better understanding of the contributions?

I actually think you've answered your own question. We don't know for sure exactly what the contribution is with the post-transplant maintenance. And if it influences the outcomes, we think it does. But that's what the 017 trial is specifically designed to look at. That's why there are 3 arms in the trial so that you can look at the effects of post-consolidation maintenance as well. So you have the one arm of patients who are receiving ziftomenib during induction consolidation and post-consolidation maintenance and that consolidation can be transplant or chemo.

You have the patients that are getting zifto through induction consolidation followed by placebo during that post-consolidation maintenance and you're getting patients that are getting placebo throughout. So we really did design it to be able to answer that question. But so far, we think that it's adding to the equation. And really when you have a drug that's not bringing on additional toxicities even with incremental benefit, it becomes worthwhile to keep the patient on. And Dr. Zeidan, would -- could you please also?

Yes. So I'll add my clinical perspective actually not only to the KM2 but also to the NPM1 because I think this is also relevant to some of those patients. So I think it's very important to remember that with KMT2-arrange leukemia, the vast majority of patients would still relapse post transplant. So transplant is not something that you do and then you are all set. Most patients are still relapsing and dying from their leukemia. So it's the community and the patients are really in need of something that would improve their survival beyond.

Now I think like when you approach these therapies, and I'll tell you, for example, if the trial is positive and the drug is available. And I would tell you many people are already probably using this off-label. We are trying to give something post transplant for these patients that has any chance of success because we know that their outcomes are poor even with transplant. So if you have a drug that is easy to take, that does not add to the myelosuppression that's once a day and it's approved in that setting, I think there is going to be a lot of interest to use it. Now in terms of the NPM1, I wanted to add that part because NPM1, again, it sort of has a favorable risk disease, but still a significant number of those patients who relapsed in particular among older patients, patients who are older than 60.

And there is still controversy in the field in terms of recommending transplant in older patients. Some centers still recommend transplant, especially in the lack of -- or in the presence of MRD positivity. But one of the things that patients find extremely, I think, intriguing about this combination as well as the doctors is the potential to be able to get rid of the need for transplant even for older patients. I think something that Troy alluded to is that we only had 10 patients who went to transplant in the context of NPM1. I can't recall the age difference, but I suspect some of them were older patients because, again, this is where we tend to think of transplant for patients. And I think if you have a drug that will improve the outcomes by adding it to consolidation, induction and maintenance post chemo, I think there will be a lot of interest in moving away from transplant completely.

Our next question will come from David Dai with UBS.

Congrats on the data as well. So you mentioned that the MRD negativity is favorable compared to historical 7+3. Maybe just can you clarify how the baseline characteristics for the patients and transplantation rates in KOMET-007 compares to the historical 7+3 cohorts?

David, I'm sorry, I'm not sure I understand. Can you ask the question again? I'm not sure -- you're asking how do the baseline characteristics and the transplant rates that we're seeing in 007 relate to historical precedent? Is that the question?

That's right. Yes. Just any thoughts on how the baseline characteristics of your KOMET-007 study compares to the historical 7+3 treatments in the real world?

Yes. And let me -- I think, David, the key slide is the slide that breaks down the CR rates by age. You've heard Dr. Zeidan speak to it. You've heard Mollie speak to it. Typically, you see a disconnect between the younger patients and the older patients. The older patients have much worse outcomes. Here, I mean, it's very early days. These are small numbers. But I think that's what you -- and Dr. Zeidan cited is you have 100% CR rate at patients older than age 60. So that jumps out at you.

You're seeing lower rates of transplant because we have the ability to keep these patients on continuation therapy. It's difficult. We've really made an effort to try to break down the various components of what all of you should be comparing and to give you appropriate references because we get this question regularly. We can't parse the data too much further. But I think you've heard this consistently, you're seeing great benefit in both younger and older patients, no additive toxicity, possibly the ability to prevent transplant. I mean everything is sort of going in the right direction. So I hope that answers the question.

Well, this was our last question for today. So I'd now like to turn the call over to Troy Wilson for any closing remarks.

Great. Thank you, Stefan, and thank you all for joining the call today. We're just -- we're absolutely thrilled with this data. It's another step toward our goal of improving outcomes for patients with acute leukemia. I want to thank Dr. Zeidan for being so gracious with his time today. I want to thank my team, and I want to thank all of you for your questions. We're available. Most of our team is at EHA, but we're available if you have additional questions. And so you can reach out to Greg or me. And we hope this was helpful and look forward to the next time. So thanks very much. We'll adjourn the call.

Good day, everyone. My name is Megan, and I will be your conference operator today. At this time, I would like to welcome you to the Kura Oncology Investor Call to discuss recent clinical data and the company's updated development strategy for darlifarnib. [Operator Instructions]

At this time, I would like to turn the call over to Troy Wilson, President and Chief Executive Officer of Kura Oncology. Please go ahead, Dr. Wilson.

Thank you, Megan. Welcome, everyone. It's a pleasure to come to you today and share the darlifarnib clinical results from ASCO as well as our strategy and next steps for the program.

If we can go to the next slide. In today's presentation, we're going to be making forward-looking statements. We would refer you to the -- to our website and to the SEC's website for more information about Kura Oncology and risks and uncertainties relating to an investment in the company.

Next slide, please. Today's participants include where Dr. David Hong, from MD Anderson Cancer Center. We're delighted to have him here today as well as my colleagues, Dr. Mollie Leoni, our Chief Medical Officer, and Dr. Francis Burrows, our Chief Scientific Officer.

Next slide. This is an exciting time for Kura Oncology in addition to the substantial momentum that we're making in our -- with our ziftomenib program, both in the commercial marketplace as well as in the clinic. We're now in a position where darlifarnib is moving into a position that's quite exciting. And that's really the purpose of today's sessions to share with you the data some translational data and thoughts around strategies and next steps.

Next slide, please. At Kura, 1 of our key focus for the company is on a concept we call precision combinations. And that is the idea that patients will do better, drive better outcomes through use in combinations.

And if we can please go to Slide 6. Sorry, if we can go forward to the next slide, please. One more, please. Thank you.

So here, some of the challenges of developing an effective companion therapeutic to enhance clinical activity. This is really the opportunity and the challenge with darlifarnib. This is not a new concept. People have been trying to develop combination therapies, particularly against targets on the MAP kinase and PI3 kinase pathways for quite some time. Some of the requirements are, of course, that the targets have to be druggable. They have to be selective. Often, these combinations are limited by toxicity. We've seen this with various combinations. Sometimes those toxicities prohibit actually being able to reach doses where you can drive maximum activity. Similarly, there are pharmacokinetic or pharmodynamic interactions that can limit dosing.

We go to the next slide, please. That's what we think we've addressed here with darlifarnib. We have a companion therapeutic. We've now demonstrated in multiple settings that we're going to walk through today the ability to combine and the ability to suppress this pathway signaling and enhance activity. With that, we think there's really a significant opportunity for patients and potentially for Kura's shareholders.

Next slide. So darlifarnib is our next-generation farnesyl transferase inhibitor. As many of you know, we've been working on this program for a number of years. And this compound is really as optimized as 1 could be. Importantly, not to take anything away from others. We're not working on another tyrosine kinase inhibitor, another KRAS inhibitor, we're developing an approach with darlifarnib where we think we can enhance the clinical activity across multiple targeted therapies and multiple settings. And in that, we think FTIs represent a mechanism-driven, targeted therapy-agnostic combination platform approach. So it's quite different, we, think, complementary and really positions us quite favorably relative to these rapidly evolving landscape.

Next slide, please. So here, this pathway diagram, really several key points. First of all, we've shown you now 3 different examples where darlifarnib is able to enhance the activity of a targeted therapy. Working from left to right, we have that adagrasib, which the data we'll show you today. A few weeks ago, we showed you the combination data with cabozantinib, and last year, we showed you combination data of tipifarnib plus alpelisib. In each case, we've been able to see an enhancement of clinical activity.

The common mechanism of action here is blocking RHEB PAR insulation. RHEB is responsible for the localization of TORC1. So by darlifarnib blocking the farnesyl transferase, that's able to attenuate pathway signaling, MAP kinase pathway signaling and PI3 kinase signaling. This gives us opportunities both within each of these classes. As you'll see, we think this approach can apply to adagrasib as well as other KRAS inhibitors. It gives us opportunities to go it alone, it also gives us opportunities to collaborate with others.

So it's quite an extensive menu, and you'll -- this is why we wanted to give you the strategy update to help you understand our proposal for a platform study, which will really help us to evaluate these different combinations efficiently.

Next slide, please. The opportunity for patients is really quite significant, just working our way around the circle here at the top, you have the indications that are relevant for the tyrosine kinase inhibitors, kidney cancer as well as neuroendocrine tumors. We have, of course, the PI3-kinase alpha mutant tumors in the lower right. And then really what will be the focus of today's presentation, the KRAS mutant tumors, pancreatic, colorectal and non-small cell lung. These are significant numbers. And we have now, as you'll see a little later in the presentation, clinical proof-of-concept data in a number of these indications.

We won't -- Kura won't be able to prosecute all of these on our own. We will, however, be able to advance some of them on our own, and we think to work with others to really be able to do what's best for patients.

Next slide, please. With that, I'm going to turn it over to Dr. David Hong and let him walk you through the data that was presented this weekend at ASCO. Dr. Hong?

Hey, guys, I don't know who's on the other line, but I'm sure I've met many of you talking about KRAS in general. I'm going to walk you through the combination that we've now started looking at with adagrasib. I'm very familiar with adagrasib. I help lead a number of other combinations of adagrasib.

Next slide, please. This was a closure presentation that we presented in ASCO.

Next slide, please. Yes. Okay. So really 3 dose levels from 3, 5 and 8. We really didn't feel like 8 was going to be able to be advanced further, but I think you'll see from the data on 3 and 5 that those doses also show some significant activity.

Next slide, please. So this is the overall demographic profile of the patients, there are 15 patients at the 3 milligram darlifarnib and at 15, as you know, adagrasib was set up 100% standard of care dosing. And then pretty much given distribution here. Most patients with good ECOG and really 3 tumor types that we're looking at non-small cell lung, PDAC and colorectal, you can see the distribution.

Next slide, please. Typical of most Phase I trials. These patients had lots and lots of prior therapy. As you can see here, the majority of these patients had 2 or more -- many of them had prior either sotorasib or adagrasib, which is now the standard care in non-small cell lung and to some extent and also colorectal, and also had other investigational agents such as daraxonrasib and divarasib and smaller inhibitors.

Next slide, please. And you can see here the distribution of tumor types, PDAC, non-small cell lung, and colorectal. Some of you may know KRAS G12C PDAC is a much harder subset of patients to identify. It's probably less than 5% of all PDAC. And you can see here that the majority of patients who had prior G12C were non-small and colorectal, which, as you know, there are 2 drugs approved in both areas. The majority of these patients got either sotorasib or adagrasib.

Next slide, please. Yes, these are the adverse events. Pretty much it to compare that to like adagrasib especially the diarrhea, nausea, really no significant add-on toxicities, clearly, there's no rash as we see with daraxonrasib and the overall neutropenia, anemia that is probably associated with darlifarnib, we rarely see that with adagrasib, looks like pretty much no significant synergistic toxicities noted here.

Next slide, please. But this is what is really, really, really interesting. And there's still small numbers. I'm going to be honest with you. But if you look at these numbers, look at the number of patients, particularly in the pancreatic subset. As you recall, both adagrasib and sotorasib, the response rates are not -- in the -- for sotorasib because I ran that trial is in the low 20s. And adagrasib maybe low 30s. This is like -- it's 60-some percent with darlifarnib here in the pancreatic setting. And every 1 of these patients are having some kind of tumor shrinkage. That is significant. I don't -- you don't know until you obviously add another maybe 10, 15 patients here. But that, that I don't think that's something that we can dismiss and that's what was really intriguing about this combination.

Next slide, please. And again, you can see here, especially in the pancreatic subset. These are not just like one and done responses. They are ongoing. And so it tells me that this may definitely be something that plays out and not only in responses but also PFS and possibly overall survival.

Next slide, please. And you can see the spider plot, again, looks good.

Next slide, please. And overall, again, 67% response in pancreatic. Non-small cell lung, the overall subset is 50%, but in the naive was also 67%. If you recall, adagrasib was probably in the high 30s to low -- sorry, mid-40s subsets. So there is something going on here. And especially with -- also colorectal cancer, you're seeing a 29% response rate. Remember, with sotorasib is -- it's literally in the single digits but adagrasib may be a little bit higher, like 11%, 12%, but the fact that 29% is -- could tell you that there is something there.

I really think that the colorectal subset I think you would see significant increase in response if we would add an EGFR inhibitor, which, as many of you know, is 1 of the reasons that single-agent RAS inhibitors don't seem to respond. But there's something about blocking red and row that definitely adds, if not, additivity maybe even synergy. Next slide, please.

So this is an example of just a really nice, nice response. Fifth-line treatment, somebody who's had non-small cell lung, cisplatin, gemcitabine and durva, went on to see second-line docetaxel and then got sotorasib, progressed, got third-line cisplatin, pemetrexed and then got vinorelbine and then went on darlifarnib and adagrasib and had this amazing response. Next slide, please.

So against all small numbers, but I do think that there is something, a definite signal here, in all 3 given. And particularly PDAC, I just -- I've not seen a combination where you're seeing things like that to date. Next slide, please.

Okay. I mean, here's -- let me give you -- the reason I've been interested in this combination. In fact, I had approached -- I mean I was running this trial since -- my first trial, by the way, ever was tipifarnib many, many years ago. And I -- at that time, we didn't have NGS. And we -- I tried putting patients with KRAS hotspot and they weren't responding. But many years afterwards, Kura picked this up and realized in patients with HRAS, we could induce responses.

But in addition to this, which I think is really important, there have been several really prominent investigators, including Channing Der, who's a good friend of mine, 1 of the godfathers of RAS, who would argue to you that the combination -- the next iteration of RAS is really combinations. And what they've seen is that there are certain key molecules downstream that may significantly combine AXL, ERK, MYC and [indiscernible]. And right now, there's not a good, real, clean AXL inhibitor. There are not really good MYC inhibitors and the ERK inhibitors have been tried in the past, but they were just too toxic. And so the fact that this thing appears to have a strong signal really validates that preclinical data that Channing Der and others have generated.

Next slide. I think that's my -- that's the end of my presentation.

Thank you, Dr. Hong. Francis?

Thanks, Troy. Hello, everybody. I'm here today to give you a little bit of the highlights of our translational work with darlifarnib in combination with RAS inhibitors. This work was recently published in Cancer Research. So I'm just going to touch on a few of the highlights here. Here's the pathway diagram again, as Troy showed you, the reason why RAS is such a big dog in oncology is that it drives signaling down both from MAP kinase and the PI3K-AKT pathways, but its control of MAP kinase is much stronger than on the other side. And the red mTORC node is downstream of both of those.

And what I hope you can appreciate from these charts here is that in all 3 major RAS-driven solid tumor types, RAS inhibitor monotherapy fails to either completely suppress mTORC1 activity, as you see here with adagrasib in the non-small cell lung cancer model, or if we move on to a better RAS inhibitor, daraxonrasib in CRC or PDAC. In this case, you do get a nice suppression, but it does not last, and under continuous exposure conditions, we see a pretty robust bounce back of the mTORC1 activity. But in all 3 cases, this can be rescued by combining the RAS inhibitor with the darlifarnib to suppress mTORC activity over a longer period of time. Next slide.

When we started this work probably about 4 years ago now, there was only a few RAS inhibitors in the clinic, the first few G12C and other selective compounds. Now, clearly, there is a really growing field here. But we've looked at all 3 of these classes. Mutant-selected G12C or G12D or pan-RAS or pan-KRAS. And with all classes, we're able to get robust enhancement through blockade of the RHEB/mTORC node. So we think that this is going to be a broadly applicable combination approach. Next slide.

As I mentioned that the early work was all in non-small cell lung cancer G12C mutant and we modeled that in combination with adagrasib or divarasib, another similar RAS inhibitor. And what I hope you can appreciate from this is that irrespective of how active the RAS monotherapy was on its own, we were able to enhance it. So on the left-hand side of the chart, you see models that were pretty refractory, but you throw in darlifarnib on top of that, and we can at least slow tumor growth.

On the right-hand side, you see models that -- where you get regressions on the monotherapy, but we can deepen those regressions and extend their duration. Most excitingly, perhaps, in the middle there, you see a number of moderately responsive models, which, when we add in the darlifarnib, we can move from progressive disease to some pretty deep regression. So we think that we shouldn't need to do any kind of patient selection to take these trials forward.

On the right, there's some data with daraxonrasib in a CRC panel. Again, this is a slightly more challenging tumor type for RAS inhibitors and the daraxonrasib is only able to generate best tumor stasis on its own. But again, we see across the range of activities that by adding in the FTI, we can enhance the activity and get some pretty decent regressions in some models. Next slide.

As we've been talking about and the reason we're all here is that RAS inhibitor clinical development, it's really taken off. And even when we started this work, we anticipated that we were going to be recruiting a lot of patients to our trials who had already seen a RAS inhibitor before. So we thought we would model that and it worked out quite well. As you can see here, this is a non-small cell lung cancer model, which does respond for a while to either adagrasib with a stasis or daraxonrasib with regressions, but it only lasts for a few weeks and then the tumor starts to progress.

If we add darlifarnib at this moment, next, we can recover tumor control and induce deep regressions in these relapsing tumors. And indeed, next one, it doesn't look that different from if we did the combination upfront. So that's giving us -- gave us at that time, some optimism that we were perhaps not going to see huge differences in the types of responses in patients who are KRAS inhibitor-naive versus those who are experienced, receiving that class of drugs. And I think our clinical data have confirmed that.

We see a similar situation in the colorectal model on the next slide. In this case, we've compared it to the G12D mutants. So we look at the RAS G12D selective compound MRTX1133 and also daraxonrasib on the right, and both of these do very nicely. They induce good regressions for a solid month. But at that time, the tumor control dissipates and the tumor starts to grow again. If we add darlifarnib at that time, we can recover the regressions and one more, please. You can see that the outcomes are not that different from upfront combo.

So what we concluded from this work on the next slide is that we could see enhancement of activity of all the classes of RAS inhibitors we looked at. We've looked at a total of 7 or 8 now in various models. And we see that whether they work well or less well in a decent panel of preclinical CDX and PDX models, the combination is able to induce regressions even in these preclinical models where there has been previous exposure and progression on either mutant selective or pan-RAS inhibitor monotherapy. So we feel that this preclinical data supports evaluating darlifarnib with both pan-RAS and mutant-selective inhibitors. And as such, darli represents a mechanism-driven, RAS inhibitor-agnostic combination platform with potentially very broad applicability. Thank you.

So what have we seen thus far? We have seen preclinical data that has translated to clinical data across the combination partners and indications. We have seen a mechanism-driven, targeted-therapy-agnostic combination platform. Next slide.

Across 3 different combination partners and 5 different tumor types so far, we have shown you that the combination consistently outperforms what you would expect with backbone therapy. Let me emphasize, we would not expect darlifarnib to have more than minimal to no monotherapy activity in these settings. So what does that mean? It means that darlifarnib is able to augment the activity of these targeted agents. And based upon the preclinical data we know that this mechanism can augment more than cabo in renal cell carcinoma, more than alpelisib in PIK3CA mutant head and neck, more than pancreatic, non-small cell and colorectal in combination with adagrasib. This truly is a mechanism-driven, targeted-therapy-agnostic combination platform, and we can consistently make good therapies better for patients. Next slide.

And the number of patients that could potentially benefit is extraordinary, likely with more to come, one therapy that can improve outcomes across PDAC, CRC, non-small cell lung cancer, breast cancer, head and neck cancer, neuroendocrine tumors and renal cell carcinoma so far. Next slide.

So how do we get this drug to patients? What are the next steps? So for renal cell carcinoma, we are currently enrolling our Phase Ib that is evaluating darlifarnib in combination with one of the commercially available VEGF-TKIs, namely cabozantinib. We anticipate having these data that confirm the recommended Phase II dose as well as continue to support the overall hypothesis in 2027. We are also preparing for a registrational path with the same combination that would at least allow for a third-line registration and likely second-line plus that can be initiated in 2028. From there, we can expand to the frontline. Darlifarnib is easily combinable, making triplet regimens the likely and best next step for patients. Wherever the TKI can go, be it in combination with HIF-2 alpha or IO therapy, darlifarnib can follow and augment the activity. Next slide.

And with regards to KRAS-driven tumors, we are currently operationalizing our platform trial that will allow evaluation of darlifarnib in combination with any pan-KRAS, pan-RAS or KRAS-mutant selective agents. Our first cohort in the trial will be a combination with daraxonrasib in pancreatic cancer, anticipated to initiate in early 2027. From there, we will continue to build on this mechanism-driven, targeted-therapy-agnostic combination platform and move towards a registrational path in second-line plus KRAS-driven tumors, and ultimately to the front line as we look to improve patient outcomes. Next slide.

Exploring these combinations and indications through a platform study allows us to evaluate outcomes in parallel rather than sequentially and overall demonstrates the broad applicability of this mTORC1 inhibition. The design is flexible and both approved investigational therapies could be evaluated, making way for the ability to collaborate with multiple partners. If new and interesting possibilities become available, they can be evaluated in the same trial. Each combination and indication can be individually evaluated for milestones that will result in a graduation to the next phase of development. As I said, daraxonrasib and PDAC will be among the first combinations evaluated. However, colorectal cancer, possibly in combination with EGFR inhibitors as well, and other indications are subsequent opportunities that need to be explored. This trial will allow us to demonstrate the vast applicability of this mechanism to enhancing the targeted therapies already available. And I look forward to being able to share these data as we progress.

With that, I'll turn it back to Troy.

Thank you, Mollie. We can go to the next slide, please. As Mollie mentioned, our initial focus is going to be in third-line plus kidney, the potential to go earlier as well as third-line plus PDAC. These are significant opportunities. We talk about ziftomenib as being a multibillion-dollar opportunity in AML. These large solid tumors, there's just, unfortunately, so many patients who are in need. So we really see this as a meaningful opportunity for the company and for shareholders. We've also prioritized, as Mollie mentioned, combinations with agents that are either available in standard of care in the case of cabozantinib, or that everyone anticipates will very shortly be the standard of care in the case of daraxonrasib in PDAC. So we are open to additional combinations as the science and the development plans and the interest from potential collaborators guide us. Next slide, please.

And just to summarize it again, a whole set of milestones for ziftomenib. We really are going to be the market leader in not only relapsed/refractory NPM1-mutant AML, but we think we've got the opportunity to dominate the front-line setting. And now with darlifarnib, we have a completely separate wholly-owned asset where there's going to be a lot going on. There's been a lot of inbound interest. Everyone wants to be involved. Everyone wants to do the best for patients. I think everybody recognizes the need for these precision combinations, and we think we're in a very good spot.

So if we can go to the next slide, we're happy to at this point end the prepared remarks and open it up for questions. Before we do, I will just say, Dr. Hong was very generous to share his time with us. He has a hard stop at the top of the hour. So we would ask you if you have questions for him to please prioritize those. We'll get to as many questions as we can. [Operator Instructions]

But with that, Megan, we're happy to open it up to Q&A.

[Operator Instructions] Our first question will come from Li Watsek with Cantor Fitzgerald.

I guess for pancreatic cancer, how should we think about the translatability of the G12C data that you've seen to the G12V and D and other RAS isoforms?

Francis, do you want to give that a short answer?

Yes, yes, yes. As I said, we see the same kind of patterns with all of the different classes of RAS inhibitors. The pan-RAS are more active than the mutant-selective in most models and it will be in part because of resistance mediated by the wild-type RAS. But nonetheless, in -- even with daraxonrasib, which is an awesome compound, it takes a lot to get a standing ovation at ASCO and that's a truly great compound. Even with that compound, it is able to suppress the mTORC pathway, but you need 10x as much drug to achieve that as you do to suppress the MAP kinase pathway. So our goal is to combine with the FTI and enable us to get at those more resistant cells.

One thing we all know about PDAC is that it has the fibrotic TME, which retards drug access and really has made PDAC a drug graveyard for decades now. So we feel that in order to get most efficient and as efficient as it needs to be suppression of the pathway throughout these pancreatic tumors, you are going to need a combination like this.

Thanks, Francis.

I can comment?

Yes. Dr. Hong, please.

So history often does not repeat but it rhymes. I'm serious. So if you look at the BRAF story, right, BRAF plus cetuximab in colorectal that translated into what we -- as Scott presented, like the first time the BREAKWATER study, right? It's going to -- it's translated into G12C with cetuximab. Likewise, I think what's going to happen is you're seeing in pancreatic, possibly and also colorectal and non-small cell lung this combination, which in C it's less of a leap and even RAF to KRAS that you're going to likely have the same kind of mechanism in D, V, whatever, pan-RAS, whatever. I think that's just the reality of the situation. And I am a big fan of Mark Twain.

Our next question will come from Jason Zemansky with Bank of America.

Congrats on the data. Maybe a quick one for Dr. Hong. Obviously, the efficacy looks pretty potent. Just curious about the safety dynamics. Do you think the thrombocytopenia is going to be an issue at all? And are there ways to mitigate it especially as you explore some of those higher doses?

Yes. No, I'm not worried about thrombocytopenia. We don't get worried about thrombocytopenia until patients' platelets get below 10,000. But most of these patients and with darlifarnib, the vast majority of the time, we would just hold it for a couple of days and bring the patient back and it would come back. And I just -- thrombocytopenia is not an issue. Neutropenia, as you know, we have ways to mitigate that. So -- and even now Nplate is actually approved in patients with low platelets. I don't -- it's not like -- it's not a quality of life issue, right? Like you get -- you have a platelet of 50,000 and people aren't like worried about nausea, vomiting or anything like that. It's -- so I'm not too worried. And there's no -- and the good thing is that there's really no overlap with daraxonrasib, none of the -- I mean there are some small percentage of these patients who get cytopenias, but the vast majority don't. And I don't see where we're going to have troubles combining these drugs. The overlap in toxicity at all is very minimal, maybe some GI. But even then, it's -- I think it's going to be manageable.

Our next question will come from Charles Zhu with LifeSci Capital.

I know Charles.

Charles, please unmute your line and ask your question. Not a problem. We can come back to Charles. The next question will be Jonathan Chang from Leerink Partners.

What settings in pancreatic cancer are you expecting to evaluate the darlifarnib plus daraxonrasib combination in?

Mollie, do you want to take that?

Sure. We're initially going to start in the second-line plus area. Obviously, easiest to always see the signal in that relapsed recurrent setting. And then as our plan shows you with the potential for the platform trial, if we see what we expect to see, we can have it graduate to the next level towards a registrational program and then obviously start branching out further into earlier line of therapy.

Next question, we will check on Charles Zhu with LifeSci Capital. Charles Zhu, if you could unmute your line and ask your question, please.

Charles is having a problem with his mic.

Not a problem. We will move on to the next question. Erik Lavington with Mizuho.

So very curious about your thoughts on rationale and biology, if darlifarnib is kind of in your upfront, right, data, it kind of looks like you are getting breakout mutations. And I'm just curious if there's some underlying biology that might explain that if you have data on the mutation landscape through time to explain that or to tease that out? And wouldn't that kind of point to bringing darlifarnib in earlier as early as possible to prevent RAS mutations.

Yes. Erik, maybe I can take that question. There's a lot going on in these pathways in these tumor types. I think we have to balance the biology that you're seeing with the ability to run the study. At the moment, we're talking about Phase I dose escalation and then potentially expansions. So we'll start there. Our goal would be to move as quickly as the data supports to earlier lines. We really think of this as a potent means of attenuating pathway signaling, as Francis mentioned, through both MAP kinase and PI3 kinase. The tumor is always going to be looking for other ways to get around it. But I think Dr. Hong said it nicely. This is a very potent way of adding to inhibitors at the top of the pathway. And we do see patients that their disease is failing therapy, but we'll move as quickly as we can.

Your next question will come from Phil Nadeau with TD Cowen.

Congrats on the data. Just 2 follow-up from us. So first, you said second-line in pancreatic cancer, what do you define as second-line? Is that post chemo? Or will you allow patients who have had daraxonrasib monotherapy experience before? That's first.

And then second, in terms of the adagrasib dosing, you mentioned 400 milligrams is what's moving forward. We're under the impression that in some indications, 600 milligrams BID is standard. What's the rationale for using 400?

Mollie, do you want to take those 2?

Sure. So as we get the trial started, we will be looking kind of at an all-comer patient population in that recurrent metastatic setting. So it will be a second-line plus trial for the dose escalation where, yes, we would consider them having failed front-line chemo to define them as now being eligible for trial. In those initial dose escalation cohorts, we would also allow prior daraxonrasib exposure, just as we've done in pretty much all of our other trials. So we really do think it proves the point and proves the mechanism to see -- to be able to see those responses.

With regards to adagrasib, there's a lot of debate right now as to what the appropriate dose is, and BMS is actually performing studies in both 400 milligrams and 600 milligrams in order to satisfy some regulatory requirements. A great deal of their combinations right now are at the 400-milligram dose, and it does seem to still be very effective dose for these patients. But Dr. Hong, do you have any additional comments on that?

Yes. Daraxonrasib is a very good drug. I mean, I was -- I led the Phase I on that thing. But it's not a cure. I don't know about you, but if you're a pancreatic cancer patient in the second-line after chemo, which it won't be approved for a while, if it does get approved, which I think it will. But you want something better. So if you -- if I was a pancreatic cancer patient who finished FOLFIRINOX, and somebody said, hey, I have daraxonrasib plus a new drug that's going to make this better, I'd enroll. I don't think that we'll have trouble finding patients, if that's your question.

Your next question will come from Charles Zhu with LifeSci Capital.

This is Peter on for Charles. Just wondering how do you feel that FTI plus daraxonrasib could be positioned against daraxonrasib plus KRAS-mutant selective inhibitors?

Mollie, do you want to take that or Dr. Hong? I don't know that they're mutually exclusive. I think we need to do everything we can.

Right now, like, for example, probably the one that's most ahead right now is zoldonrasib. They're trying to, I think, Revolution Medicines is trying to position zoldon plus dexon in the front-line setting, right? They've already announced that they're doing that trial. And we'll see how it goes. I think ultimately, like pancreatic cancer, 5 years from now is going to be a lot like treated like non-small cell lung. You're going to have KRAS, but you may have like KRAS plus MTAP loss. People are going to try to position themselves for that. We're going to try to position -- if you talk to any pancreatic doc, you saw that in the PR on daraxonrasib, they don't like chemotherapy and they don't want to give chemotherapy. And so if this darlifarnib plus whatever looks amazing in the second-line, I mean, I definitely think it's going to have a likelihood that it could position itself in the front-line.

And then so you could have possibly zoldon -- you could combine this with zoldon. Ideally, they can't obviously combine dex. I mean I'm not sure I'm not -- maybe they'll come out with some data that I haven't seen, but they can't combine the daraxonrasib with EGFR. So right now, at some point in colorectal, they're going to try to combine zoldon plus EGFR. And then what if -- if this thing augments that, holy cow, you can also combine it with that. I mean there's just so many different reiterations as to how it's going to pan out. But I think in the pancreatic space, everybody is going to try to push chemo out of the picture at some point. And this could be one of those situations where you either have a D inhibitor or the pandexon-RAS inhibitor, whatever in the frontline setting.

And Peter, just to add on to Dr. Hong's comments. This is part of the motivation for the platform study. We're getting approached, as you can imagine, by folks with all manner of targeted therapy looking to do combinations, we're not going to be able to do it all. We'd like to do the ones that make the most sense for patients and ideally not have regimens competing with each other. But there's a clear opportunity, we think, in pancreatic to test this combo. There are -- Dr. Hong was alluding to it, there are combinations in colorectal that we look to pursue. Stay tuned throughout this year and early next year. I think we'll have much more to say about that.

I have to go, guys. Thank you.

Thank you, Dr. Hong. We appreciate your time.

I'm just going to say, I'm excited. I'm very excited with this combo. So please support them so I can do this combo. Thank you. Bye.

We appreciate your time. Thanks, Dr. Hong.

[Operator Instructions] Your next question will come from Reni Benjamin with Citizens.

Congrats on the progress. I guess since Dr. Hong has gone. Troy, maybe you can answer this. You talked about how darlifarnib is broadly applicable through a variety of these indications and combinations. How important is it to have additional combination agents on top of the KRAS inhibitors? And maybe just as a follow-up, I think Dr. Hong had mentioned EGFR on top of KRAS. I'd love to kind of get your thoughts as to how you're thinking about it.

And as a follow-up, I probably missed it in the poster, but how many patients remain on treatment? And kind of what's the median duration of response? And any comments on resensitization of patients who are refractory to KRAS monotherapy?

Mollie, do you want to take that second question first, and then I can address Ren's sort of broader question?

Yes. So a good amount of the patients still remain on treatment as of the time of this data cut. Almost all of the pancreatic, all but one, are still on treatment and 37% of patients overall are on treatment. So they're doing very, very well. So not just deep responses, but actually durable responses. And we are seeing -- these are small numbers.

So my statistician would kill me if I gave you true median duration of responses because they're so unstable to actually estimate. But for non-small cell, we have seen about at 8 months. PDAC is still evolving in 4 months. So these are still evolving numbers, but they're already starting to exceed what we would expect from the background therapy alone. So stay tuned. We'll discuss more as we get more data.

Yes, Ren, to your first question, I mean, there's no accident that, that second box in the platform study is darlifarnib plus compound A in colorectal. There is a clear need. I think we all recognize it's likely to be a triplet. One of the advantages you have with darli is it combines nicely with EGFR inhibitors. There was a trial run with tipifarnib and Tarceva, for example, was run in the wrong patient population, but there was good safety and tolerability. Part of this is we're juggling kind of what we can do internally with the folks who are approaching us. And -- but colorectal is of high interest, both for mutant-selective inhibitors and for pan inhibitors. We'd like to find a way to move darlifarnib further along in that area for sure.

Your next question will come from Daniel Brims with Lake Street.

Just curious what you saw or didn't see in the 8 mg dose that you decided not to push that forward?

Sure. Mollie, do you want to take that?

Yes, sure. Obviously, every protocol has its defined toxicity limits. And while we didn't see any drug-drug interaction between the 2 molecules, as we got into the higher doses, we did start to see some overlap of the neutropenia. And that was simply -- we reached a level that we didn't think the benefit outweighed the risk enough to keep pushing it forward. But overall, it wasn't any different safety profile. It was just we felt that 3 and 5 were the more tolerable options and still efficacious.

And Dan, as a reminder to everyone, you don't mitigate toxicities in a Phase Ia dose escalation. You're -- the whole goal is actually to understand the tolerability profile. So as Dr. Hong indicated, I mean, many of these are clinical values, and they can be mitigated as we go forward. But for the dose escalation, that wasn't possible. And as Mollie said, it didn't -- the benefit/risk didn't justify going forward at 8. But either 3 or 5, as you can see, are very active. It is going to be -- the only one tolerability or toxicity that I think we have to watch for is neutropenia. We've now been able to combine FTIs with cabozantinib, with alpelisib. Previously, J&J combined with both chemo and a couple of targeted therapies. There's a very broad combinability. You do have to watch for neutropenia.

There are no more questions at this time. I'd now like to turn the call over to Troy Wilson for closing remarks.

Yes. Thank you, Megan, and thanks, everyone, for joining the call today. We're at a really exciting inflection point with this darlifarnib program. Apologies that we couldn't corral Dr. Hong for longer. He had patient obligations, which obviously have to take priority. You can hear from his comments the enthusiasm around both the daraxonrasib combination and other combinations. He's been a tireless advocate for this program. So it sounds like a number of you have relations with him and would invite you to engage with him as you will.

We will come back to you in about a week with another update back on our ziftomenib program and the front-line AML results out of EHA. That will be one to pay attention to. Those results, I think, are very encouraging for the potential for ziftomenib to drive clinical benefit in a front-line setting. And Mollie will walk you through what that data means for the ongoing intensive chemotherapy arm in the KOMET-017 study. So we look forward to talking to you again then. If anyone has additional questions, you can reach out to me or Greg, and we're happy to get back to you. We appreciate your time. We appreciate your interest. And with that, we'll conclude the call. Thanks, everyone.

[Audio Gap] BofA Health Care Conference in very [ thirsty ] Las Vegas. My name is Jason Zemansky. I'm one of the SMID cap analyst here at BofA, and I'm very pleased to have with us on stage, Kura. Troy Wilson, CEO; and Brian Powl. Thank you so much for joining us.

Thank you, Jason.

Thank you.

Maybe to start it broadly for those who aren't familiar with the Kura story, could you please provide a brief overview of zifto and darli?

Sure. Yes. So on the 1 side, you have ziftomenib, or commercial name KOMZIFTI. We have approval in the relapsed/refractory NPM1-mutant setting. Our goal is to be the market leader to drive sustainable quarter-over-quarter growth there. We have, I think, the largest most comprehensive Phase III development program in both the intensive and nonintensive frontline setting. We'll be giving a data update on that here in a few weeks. And then we have extensive studies, looking at different combinations to really be able to advance the standard of care and get ziftomenib throughout the treatment continuum in AML.

We're also studying ziftomenib in gastrointestinal stromal tumors or GIST. We're making good progress in dose escalation, probably not looking at a day to update until next year, but definitely some potential there as well as investigating other solid tumors.

Shifting to the darlifarnib side, darlifarnib is really trying to address the problem of innate or required resistance to targeted therapies. We have a data coming out at ASCO looking at darlifarnib in combination with adagrasib, the KRAS G12C inhibitor that's approved. And that will be the third installment of an FTI plus targeted therapy. The first being in PIK3CA mutant head and neck, the second being in renal cell carcinoma. That's a really interesting opportunity. FTI is potentially combined with and can enhance targeted therapies in kidney cancer, breast, lung, colorectal and pancreatic. So there's quite a significant opportunity. We're going to have a poster presentation on May 30 and an Investor event June 3 to really give a strategy update on that program. So each of those 2 programs, Jason, I think, drives value for cancer patients. I'll just remind everybody, the ziftomenib-AML program is in a partnership with Kyowa Kirin and fully funded through to initial top line results. That gives us a significant running room and really the ability to maximize both ziftomenib and darlifarnib for patients.

Thanks, Troy. You've -- let's focus initially on ziftomenib. You framed sort of the key driver here in the market as physician preference. So I'm curious, what has initial feedback been like from prescribers and treatment centers on Ziftomenib.

Sure. Brian, do you want to take that?

Sure. Yes. Thanks. And we announced in our earnings just yesterday, which I think is a good proxy for how physicians are responding. So yesterday, we reported $5.8 million in net revenue for the first full quarter of launch. This equates to coming from 85 new patient starts. And of the patients in this population of the NPM1-mutated population, that equates to about 40% of the new patient starts among the menin inhibitor class. That's a great start for us. I think what that shows is the profile of KOMZIFTI is competitive. Physicians see it as a compelling choice for them. And of those patients, one more stat just to share with you. Of those patients that started about 40% of those were actually treated in combination, which is off-label, outside of our approved indication, but based on physician choice were used in combination with either ven/aza or in combination with the FLT3 inhibitor gilteritinib.

You've flagged the administration profile as being a major source of differentiation and its combined ability as well, which you sort of alluded to in the previous answer here. But any sense that these are starting to resonate? Is it something else you think that's getting physicians excited?

I think what this has shown us is that physicians are getting excited and they have a choice, right? I think before we came to the market, there was 1 choice available for a menin inhibitor. And you're starting to see uptake in a lot of centers, both those who are experienced with KOMZIFTI in ziftomenib, in our trials, but also those who are experienced with other menin inhibitors. And it's really the profile, the balance of the efficacy, the safety, combinability and the convenience of once-daily dosing, in a very complex patient population, puts KOMZIFTI in a potentially favorable position that we think will help us get to leading the market share coming out of that first year.

You mentioned a good point is that a lot of your prescribers participated in the clinical studies. So in terms of how do you reach new prescribers? And I think from a maybe broader perspective, what about the community prescribers that maybe are less familiar with some of the more nuanced profiles of both assets?

Sure. So I think that in the treatment of relapsed/refractory AML, largely the treatment is happening in the academic centers, right? So it's probably 85% to 90% of those patients are going to be treated where that -- these are sick patients, they tend to go to those academic centers. So the decisions are being made are really more focused right now at the academic centers. And these are kind of those tertiary -- the large tertiary centers. I think from our objective to reach those patients, we have our current sales force, which is out in the field engaging with those physicians. But we also have our partner, Kyowa Kirin, who has their field force also spending a percentage of their time also raising awareness and focusing. So it allows us to get breadth and depth to educate on the differentiation. And that's what we're starting to see already kind of in this first launch -- first full quarter of launch, strong uptake. We expect to extend that even more centers as the launch progresses this year.

Yes. And I might -- Jason I might just add to that. We were actually pleasantly surprised by the extent of combination use, spontaneous combination use, as Brian mentioned. A lot of these academic physicians are very sophisticated and they're really experimentalist. Almost every patient history is different. And so they're up on the literature, they're talking to one another all the time. And I think it speaks to KOMZIFTI or ziftomenib's profile that they can combine it. They can use once a day. It has a very benign safety and tolerability profile. That's allowing them to really find the best solution each patient. This is very much in the relapsed/refractory setting kind of a bespoke treatment that the physician does for each of his or her patients. And KOMZIFTI, although we're promoting that, we're really promoting the monotherapy, it gives them that flexibility and that ability to find just the right solution. So I think it's giving us a real momentum and real potential to continue to not only take market share, but ultimately grow the market in this relapsed/refractory NPM1 setting.

We -- sometimes we talk about leading indicators of how well launch is going. Is the combination percentage, is that kind of what you would point to as being something investors should focus on? Or Is there another sort of indicator that would help indicate that everything is resonating and the trajectory is inflecting well?

I would say the 2 things that would account for that to kind of show some of that lead -- those leading indicators. One is the new patient starts. The number of new patient starts are much more rapid than even we expected. We knew we would be able to come out strong, but 40% of those new patient starts in the first full quarter is a strong start, couple that with the combination use of the physicians choosing to use KOMZIFTI in combination, those also will lead to potentially -- it's finding the right patient to be treated potentially in the earlier lines of therapy rather than salvage lines of therapy, and they potentially may get a longer benefit because they're earlier in their treatment course. And in combination, there may be a benefit that the physician sees to add KOMZIFTI and then potentially treat longer and get a better benefit for those patients.

You might also add the access and the payer preferences. I think those are also good leading indicators.

Yes, I think that that's -- to add to that point. We did also share that we have -- over 93% of covered lives are now on policy and on plan for our payers. So we've largely in that first [ quarters and a half ] essentially since we got our approval, have very good coverage that is at parity. We do have a number of plans. I think we have 10 plans that have actually put favorable positioning of KOMZIFTI either step edits or tiered formularies where they prefer KOMZIFTI over other therapies in this space. It equates to about 12 million lives right now.

Lots of good leading indicators.

Absolutely.

Given how relatively small the patient population is and the level of high unmet need, how quickly do you think it will take for menins to reach that peak penetration in the relapsed/refractory setting? And then could we potentially see KOMZIFTI taking measurable share of the, what you call -- what you've estimated as a $300 million to $400 million market opportunity?

Yes. So I think that -- as we've shared before, as you said, it's a $350 million to $400 million market, we think in that relapsed/refractory NPM1-mutated setting. This -- the market dynamics for those patients is that there are several options already available to them, ven/aza, FLT3 are co-mutated, other therapies that need to be able to penetrate in. So what we're trying to do is build out grow the market for menin inhibitors and show that menins are the preferred treatment choice for those patients but also then ultimately become the market leader in this space. we feel confident that there's going -- it may be a slower growth in areas where there's no options available for those patients. But ultimately, we think we'll be able to get to become that leading class share in the menin class by the end of the year.

In terms of making ziftomenib foundational across all of AML. I mean you've talked about a very comprehensive first-line development program moving forward. But there's certainly more menins coming up the pipeline. What does it take? And what does sort of the time lines look like?

Yes. There are 3 or 4 menin inhibitors Jason, that are in active clinical development. I would say us J&J and Syndax, we're all in registrational studies of some sort. There is a -- the Dainippon Sumitomo compound is quite a ways back. They have a dose in KMT2A, they don't yet have a dose in NPM1. One of the challenges for subsequent drug developers in AML is as you see triplets getting approved, and that's why we're sprinting as fast as we can to the front line, the next company coming along has to run its investigational triplet against an approved triplet. And unfortunately, for Astellas, we saw just recently, just a few weeks ago, they did not have a successful trial when they were in the triplet of gilteritinib 7+3 versus midostaurin 7+3. That was a 700-and-something patient trial, but not enough to ultimately deliver the survival-based end point. So I think you're going to find the AML development limiting. There are other options for menin inhibitors in solid tumors, potentially in diabetes, we may see later entrants going elsewhere. Our goal is to be the market leader throughout the treatment continuum in AML. We've been -- we were there first. We were in menin first. And continue to drive leadership not only in AML, but in solid tumors, diabetes and elsewhere.

Got it. Let's talk about some of the specific catalysts near term. The KOMET-007 study, we'll see first half of 2026. It's the update in intensive chemotherapy. What -- how would you frame the outcome? And what should investors be looking for?

Right. So we just yesterday announced the abstract was published for that study. For everybody's benefit, this is Ziftomenib plus intensive chemotherapy in both NPM1 mutant and KMT2A-rearranged patients. This is a data update from the 007 study that we've had ongoing. The last update we gave was at EHA 2025. So we're now a year on from that. And it also forms the basis for the KOMET-017 registrational study that's being run in the same populations. What are you looking for? You're looking for high rates of CR, you're looking for high rates of MRD negativity, you're looking for extended durability. Each of those will be important. And you can see from the abstract, the CR rate for NPM1, I think, is 96%. The MRD negativity is 80%. The median patient has been on something like 17 months. And fortunately, for the NPM1 population, there -- we can't -- we don't yet have a duration of response. So I think that bodes well. It's -- the study is ongoing. One of the interesting learnings, Jason, from intensive chemotherapy is we believed, and I think the dogma was before any of us had started that in the intensive setting, you'd maybe get patients on a menin inhibitor for 1 or 2 cycles and you'd lose them to transplant. Interestingly, when you look at the 007 data, that's not what you're seeing in the NPM1 patients, you do see the KMT2A patients going to transplant because that's really where -- what they need to do. But if an NPM1-mutant patient is -- has an MRD-negative CR transplant is contraindicated. The mortality risk doesn't outweigh the clinical benefit. As a result, you have these patients and you look at swim lanes, and they're all just on ziftomenib cycle after cycle, that's important from really improving the standard of care. It's also important from a commercial perspective. 18 months of therapy is, if you take the incident patient population of 11,000 patients, that's a $10 billion opportunity. Now we'd look to take just a portion of that. But I think we're starting to see -- the difference between ziftomenib and all everything that's come before is these patients can stay on for 18 cycles or longer. We've not seen that with chemo, with venetoclax, with other targeted therapies due to tolerability concerns. Everything you asked, Brian, about those attributes, combinability, convenience, cost, safety, those become even more important as we're thinking about the frontline population in that continuation therapy setting.

Great. Let's extend this a little bit further. You have the KOMET-008 update coming up. How much of a driver can this be just given how common you see a FLT3 mutation with a menin mutation?

FLT3 is 1/3 of and it's half of the NPM1, the patient population, their co-mutations. There are 3 FLT3 inhibitors out there. We're actually working with 2 of them. we have the 008 study ongoing with gilteritinib in the relapsed/refractory setting and a study with quizartinib in the frontline setting. In preclinical models, Jason, that combination is curative. And I think the update that you referred to, the 008 update, we're expecting at the end of the year at a major medical meeting. That will be important because if you can improve on both a FLT3 inhibitor and a menin inhibitor as monotherapy by putting them together, nearly half of your NPM1 mutant patients are going to have that genotype. So in terms of both creating a solution that's best for them and giving physicians choice and then market leadership, we're well ahead of the competition on pioneering these combinations with FLT3 inhibitors. So I think that will be a meaningful update.

Got it. You referenced the KOMET-017 programs as these are the frontline settings. Can you give us your expectations on enrollment time lines? What's the status look like, especially now that, as you mentioned earlier, we have multiple menins advancing?

Yes, happy to. So we made a deliberate decision a number of years ago to combine the 2 Phase III studies into 1 protocol, and that is KOMET-017. We call it the one-stop shop. As a result, it's easier for sites, they activate on protocol. Any patient that presents at their clinic has a space in either the intensive or non-intensive study. It's one budget, it's one sort of stand up, and we're essentially standing up 2 Phase IIIs at the same time. Enrollment has been brisk. I think we've demonstrated with 007 and 008, the 007 update that we talked about is nearly 100 patients in the relapsed/refractory setting. So enrollment is going very well. We're well ahead of the competition by a year, maybe 2 in the intensive chemotherapy setting. I'm not aware that our competitors have yet started their trials or started enrollment. In the nonintensive the ven/aza combo, that's there, everybody is working together. But by combining the 2 studies together, Jason, we were able to attract many of the leading sites in Europe, in the U.S. and in Asia Pac. And that does 2 things, right? These are many of the leading practitioners in AML. They're also our customer base. And part of this is winning hearts and minds, if they're having good experience in the 017 studies, we know that's going to read through into the commercial landscape. So we're taking kind of a whole holistic approach that very much commercial and development working in partnership.

Great. You mentioned earlier, there's opportunities outside of AML, GIST being one of them, diabetes, there's cardiometabolic indications as well. Why does a menin make sense in this population?

Yes. So menin is an epigenetic modifier, right? So menin acts by regulating gene expression of other downstream genes. In AML, these are genes involved in either in differentiation or in leukemogenesis. In GIST, menin regulates KIT expression. So you have a KIT inhibitor that blocks catalytic activity, and you have a menin inhibitor that blocks KIT transcription. In diabetes, menin regulates the CDKs in pancreatic beta islet cells. It actually -- by blocking menin, you take brakes off the CDKs and you get selective proliferation of pancreatic beta islet cells. So it's context-dependent but it also gives you a sort of the Swiss Army knife of therapeutic targets.

You have discussed a potential $7 billion opportunity for the menin. I mean what are some of your key assumptions here? And time lines in terms of getting to that potential?

Yes. Very simply, in the U.S., you have -- we think half of AML patients are going to be eligible for menin therapy. And very simply, that's FLT3, NPM1 and KMT2A. There are likely additional mutations as well, but let's just keep it simple. That's 50% of all of AML. There's 22,000 patients a year diagnosed with AML. So let's 10,000 patients to make the math easy. If you could keep those patients on therapy for 12 months. You're talking about $5 billion. If you can keep them on for 1.5 years, as I said, it's $10 billion. We're being -- I think we're being conservative in saying, you're going to get a stacking year-over-year, but $7 billion peak sales for the class seems very reasonable. How do you get there? You need, of course, to get the patients on drugs and then to keep them on for many cycles. But that's why I think the 007 update from EHA will be so illustrative because that's as close to both the Phase III study and the real-world population of what one would expect as you're going to get at this stage. All indications are, Jason, I mean, what you'd like is to delay the onset of disease recurrence. The drugs are very good at eliminating the leukemia. The problem is the leukemia comes back. And in -- for example, in the intensive chemotherapy setting, 60% of patients recur within 2 to 3 years. That's what you're trying to prevent. So by having a therapy on board with the patient that's very well tolerated, you can prevent that recurrence, you can delay the time to transplant. Have we seen this before, yes, in myeloma right? This is exactly -- it's the multidrug regimens that both allowed to get disease remission and then to extend that. And we've seen dramatic transformation of the landscape in myeloma. The hope is this is the beginning of the same thing in AML.

Got it. Well, let's shift gears to darlifarnib. Obviously, the FTI class has been a focus of development for some time. Why do you think agents like tipifarnib fell short? And I guess, where is the confidence that darli can deliver?

Yes. So we needed 3 things for FTIs to work. you needed an understanding of how to use them because they're not like a kinase inhibitor. They block farnesylation of different therapeutic targets. So you need to understand the biology. You need next-generation sequencing to be able to find patients. And Jason, most importantly, you need the other targeted therapies. And FTI on its own is really not effective at driving responses except in something like HRAS-mutant tumors. And that was really Chapter 1 with -- or maybe Chapter 2 with tipifarnib in HRAS-mutant solid tumors. What Francis Burrows, Shivani Malik and our translational team figured out is, if you can assault a tumor with a targeted therapy, TKI, a KRAS inhibitor, you can actually make that tumor cell then dependent on an FTI. The FTI is working by blocking a protein called RHEB, Ras homolog in brain. RHEB localizes a protein called TORC1 or complex called TORC1. TORC1 sits right at the bottom of the MAP kinase and the PI3 kinase pathways. So everything I've just mentioned, TKIs, PI3 kinase inhibitors, KRAS inhibitors, they all ultimately signal through those pathways. It's like turning the [ stop clock ] at the bottom of the cascade, you get a very effective block. The question is now, can you safely combine, and we've shown twice, we can. You'll see the adagrasib data here shortly. And can you enhance the activity. This is just to be clear with everybody. This is not a new problem, right? People have been trying to find companion therapeutics since I've been in this industry. We've tried AKT. We tried MEC, we tried SOS1, we've tried SHP2, nothing's really worked. FTIs may actually be the solution. I think the data that you're going to see at ASCO will be very illustrative of what we can do in KRAS-driven tumors.

Got it. Why does it make sense to start in RCC? I mean you've shown promising preclinical efficacy in tumors like NSCLC, colorectal, HNSCC?

Yes. So this is where you have to take the science and you have to overlay it with the business realities. So one needs to be able to have a clear path to get to the market where you have only 1 investigational agent. So I mean, you can do novel, novel combinations. But from a development perspective, those are much more difficult, right? How do you show the contribution of individual components. As an alternative, if you go on the back of cabozantinib, cabozantinib is the accepted standard of care in second-line renal cell carcinoma. It continues to grow market share. It has other applications. That's well established. You then build on that and you have to show what can darlifarnib do to add to cabo. It's just simpler from a development, regulatory and commercial perspective. You could do a similar thing. There will be a KRAS inhibitor here approved relatively shortly, we think, in pancreatic, going on the back of that just greatly simplifies your development in regulatory as well as your commercial strategy. Then you can start to get more creative, if you want, you can add other novel agents. But I think you need to, Jason, have your base case and then your upside cases. That's where we translate the research and the early development to how do we think about being good fiduciaries and making choices. Ultimately, FTIs can go a lot of places, you have to prioritize. And we'll talk more about the strategy at our Investor Analyst Event on June 3. That will be after the ASCO data is presented, but we're going to have a very well-known KOL in the KRAS space. And we'll explain kind of the background. We'll go through the clinical data with adagrasib and then we'll talk about the next steps and what's the development and commercial strategy going forward. I think that will -- and the KOL will be able to add valuable perspective on why a companion therapeutic, why an FTI, why darlifarnib?

Got it. you reported some fairly encouraging numbers last month at IKCS, ORRs of 44%, DORs of 94%. Obviously, it's still early, but where does that translate in terms of overall benefit in these later line settings? And is there a compelling enough case do you think where you can move not only second line, but first?

I think so. I think at this point, Jason, we feel confident we have a play in third line based on the data we have today. I'll just remind everybody, we are conducting a Phase Ib study in combination with -- darlifarnib in combination with cabozantinib, we're investigating a 5- and 8-milligram dose of darli with a 60-milligram dose of cabo. We're doing a third arm of cabo monotherapy where patients who progress on cabo and then roll over into the combination, and we can further test this hypothesis that we can rescue them by adding darlifarnib. Based on what we have today, the KOLs are telling us, we've got a clear shot in third line. you'd like to obviously go earlier. We need to get -- we need to finish the Phase Ib and understand, it's a second-line strategy, the doublet on top of cabo or do we consider a triplet. Let's -- we'll hold that thought. The tolerability, what we hear from the physicians, and I think saw it in the darlifarnib is extremely well tolerated. The only real AE we see is neutropenia. We didn't make any effort to try to mitigate that in the dose escalation because you want to see toxicity. Now in the Phase Ib, we allow the physicians to use G-CSF. So that will be mitigated. I think there is an opportunity to combine in the front line. Something we hear from physicians is as they're considering these combinations of IO, TKI and HIF-2 alpha, if a patient's disease progresses on those 3, what else are you going to give them? You're going to give them some subset of that? Not ideally. So that physicians are really attracted to the idea of a novel mechanism of action coming into renal cell carcinoma. Now we have to sort of figure out what's the development plan year 1, 3, 5 and onward? And you'll see us elaborate that throughout the rest of this year.

Wonderful. Exciting year. Thank you so much, Troy. And Brian.

Thank you, Jason.

Thank you.

Good day, everyone. My name is Leila, and I will be your conference operator today. At this time, I would like to welcome you to the Kura Oncology First Quarter 2026 Financial Results Earnings Call. [Operator Instructions]

At this time, I would like to turn the call over to Greg Mann, SVP of Investor Relations and Corporate Affairs of Kura Oncology. Please go ahead.

Thank you, Leila. Good afternoon, and welcome to Kura Oncology's First Quarter 2026 Conference Call. Joining the call today are Dr. Troy Wilson, President and Chief Executive Officer; Brian Powl, Chief Commercial Officer; Dr. Mollie Leoni, Chief Medical Officer; and Tom Doyle, Senior Vice President, Finance and Accounting.

We remind you that today's discussion will include forward-looking statements based on current expectations. Such statements represent management's judgment as of today and may involve risks and uncertainties that cause actual results to differ materially from expected results. Please refer to Kura's filings with the SEC, which are available from the SEC or on the Kura Oncology website for information concerning risk factors that could affect the company.

With that, I'll call the call over to Troy.

Thank you, Greg. Good afternoon, everyone. Kura's at an inflection point. What we've been building over the last several years is now showing up clearly in the clinic, in the market and in the way physicians are making treatment decisions. Our first commercial launch is off to a strong start. Our Phase III programs are ahead of plan. And over the next 12 to 24 months, we expect a steady flow of data that we believe will define leadership in the menin inhibitor class. Most importantly, we're executing with focus, discipline and a very clear strategy.

Let me start with KOMZIFTI. In our first full quarter of launch, we generated $5.8 million in net product revenue ahead of expectations. But what matters more to us is what's underneath those numbers. We're seeing repeat prescriptions. We're seeing broad uptake and use expand across treatment centers. We're seeing increasing payer preference and we're seeing early instances of physicians switching patients from other menin inhibitors to KOMZIFTI.

That tells us something important. This is not just a class story anymore. Physicians are starting to differentiate based on product profile and we believe KOMZIFTI is standing out. We see that differentiation coming from a combination of compelling efficacy, a predictable safety profile, simple and convenient dosing and potential for broad combinability. In real-world practice, these things matter and they're driving how physicians choose therapy. It's early, but based on what we're seeing, we believe KOMZIFTI is well positioned to emerge as a leader in the treatment of adult patients with relapsed or refractory NPM1 mutant in AML.

At the same time, we're not building this as a single indication product. Our focus is to expand ziftomenib across the AML treatment continuum and establish it as a backbone therapy in combination. This year, we expect to generate multiple data readouts to support that strategy, including updated data from our 7+3 combination in newly diagnosed AML at EHA, publication of our venetoclax/azacitidine combination and initial data from our gilteritinib combination in relapsed and refractory AML patients with NPM1 and FLT3 co-mutations.

Taken together, these data sets are designed to answer a simple question. Can KOMZIFTI be used broadly, safely and effectively in combination across AML? Based on what we've seen so far, we believe the answer will be yes.

In parallel, our frontline Phase III program, KOMET-017, is progressing ahead of plan with strong enrollment for both studies across leading global science. Our one-stop shop design is doing exactly what we intended, accelerating execution without compromising rigor.

Beyond AML, we continue to build a broader pipeline with meaningful upside. Darlifarnib is a good example. The data we've generated, reinforced its mechanism and potential to overcome resistance to targeted therapies. We'll have additional combination data this year, including in KRAS G12C mutated cancers, where we think there's an opportunity to open up new treatment approaches across large solid tumor indications.

So when we step back, we think Kura is in a very strong position. We have a commercial product beginning to gain -- that is gaining traction and beginning to differentiate in the real world. We have a pipeline with multiple anticipated near-term clinical catalysts that can expand that opportunity significantly, and we have the balance sheet to execute our strategy and reach key value-creating milestones.

The menin inhibitor class in AML is still early. The next year or 2 will determine how it evolves and who leads. Based on what we're seeing today in the clinic and in the market, we're confident in our ability to play a leading role in shaping that future.

With that, I'll turn it over to Brian.

Thanks, Troy. We're very encouraged by KOMZIFTI's performance in the first full quarter of launch. And although we're pleased by the first quarter results, we're even more encouraged by the underlying trends driving that revenue.

Our early momentum reflects 3 core strengths: strong preparation and experienced commercial team and most importantly, a clearly differentiated product profile defined by efficacy, safety, combinability and convenient dosing.

Our commercial strategy is focused on 3 priorities: drive broad awareness of KOMZIFTI's differentiated profile, deliver strong and consistent quarter-over-quarter growth and established leadership in relapsed or refractory NPM1 mutant AML, a $350 million to $400 million market opportunity.

In the first quarter, we generated $5.8 million in net product revenue with 85 new patient starts and nearly 160 total prescriptions. Patients were treated across approximately 60 activated accounts, including ziftomenib trial sites, other menin experience centers and accounts new to menin inhibitors.

More importantly, we are seeing clear signs of growing physician adoption. First, repeat prescriptions and expanding use across treatment settings indicate growing physician confidence with KOMZIFTI in real-world practice.

Second, following our approval, we have observed physicians switching patients from other menin inhibitors to KOMZIFTI. Although still early, this is a meaningful signal that physicians are making active treatment decisions based on the product profile.

Third, we are aware of early physician-initiated use of KOMZIFTI in combination with commonly used agents, including venetoclax azacitidine and with gilteritinib and FLT3 co-mutated patients. This physician-initiated use reinforces our belief that ziftomenib has potential to be a highly combinable backbone for use across AML patient populations.

Feedback from physicians, pharmacists and nurses consistently highlights the practical advantages of KOMZIFTI, particularly as dosing simplicity and convenience for patients which we believe are important factors in real-world treatment decisions when monotherapy efficacy is viewed as similar.

Collectively, these dynamics point to a clear conclusion. Increasingly, physicians, pharmacists and nurses are selecting KOMZIFTI, which offers strong efficacy with a well-characterized and manageable safety profile and convenient once-daily dosing compatible with concomitant therapies, what we describe as efficacy without compromise.

Turning to access. We secured coverage at parity or better for more than 93% of covered lives with no label restrictions. Achieving this level of access, this early in launch, particularly as a second to market therapy reflects the strong payer recognition of KOMZIFTI's value. We're also seeing favorable formulary positioning and step edit dynamics. I'm thrilled to report more than 10 plans covering more than 12 million lives has placed KOMZIFTI in a favorable policy position. These decisions reflect payer recognition of KOMZIFTI's differentiated profile and the predictability of its cost in managing patients in this setting.

Operationally, execution remains strong. Time from prescription to patient receipt is approximately 3 days, ensuring rapid access to therapy. And our field teams in collaboration with Kyowa Kirin are driving strong engagement across both academic and community settings.

Looking at the bigger picture, the combination of repeat prescriptions broad access, payer preferences, expanding real-world use and early instances of switching gives us confidence that KOMZIFTI is not just participating in the mein inhibitor class, but is increasingly defining its leadership position in the NPM1 market. The success we are seeing in this initial monotherapy setting is an important first step and reflects our foundational advantage of delivering strong efficacy with a predictable safety profile and convenient dosing that, in our view, represents efficacy without compromise. Importantly, this early momentum lays the foundation for our next phase of growth as we expanded the combination in frontline settings.

I'll now turn it over to Mollie.

Thank you, Brian. In 2026, we expect a continued steady cadence of clinically meaningful data for ziftomenib and darlifarnib. Our strategy for ziftomenib is focused on 1 clear objective, establishing it as a highly active and broadly combinable backbone therapy across the AML treatment landscape, supported by our registrational clinical programs, spanning multiple lines of therapy and patient populations.

As treatment paradigms evolve, physicians are increasingly looking for therapies that can be safely and effectively combined with existing standards of care and ziftomenib is specifically designed to address that need.

At the upcoming EHA meeting in June, we plan to present updated data from ziftomenib in combination with 7+3 in newly diagnosed NPM1 mutant and KMT2A rearranged AML. This updated data set will include extended follow-up with a median of approximately 16 months, including treatment course and response durability.

We also expect to publish data showcasing venetoclax and azacitidine in combination with ziftomenib in relapsed or refractory NPM1 mutant AML. These data expand upon our presentation at ASH 2025, where we reported a striking 70% composite CR rate in patients without prior venetoclax exposure. This is an important regimen as ven/aza remains a widely used standard of care.

In parallel, we are advancing combinations with FLT3 inhibitors. As a reminder, FLT3 mutations occur in approximately 1/3 of AML patients and notably half of NPM1 mutant patients have FLT3 co-mutations. We anticipate preliminary data in the second half of the year from ziftomenib in combination with gilteritinib and relapsed or refractory NPM1 mutant FLT3-mutated AML. We are also evaluating ziftomenib in combination with quizartinib in the newly diagnosed setting.

As a whole, these data are building a consistent picture. Ziftomenib can be integrated across multiple treatment approaches without compromising safety or activity in clinical studies, an attribute we believe, will be essential for long-term use in both relapsed and frontline settings.

Turning to our frontline development program. Our KOMET-017 trial is an innovative one-stop shop design, which enables simultaneous enrollment into 2 independent Phase III trials at each activated site. This streamlined approach is a meaningful differentiator and operational advantage, allowing us to accelerate enrollment while maintaining rigorous study, design and execution. We are very pleased with the progress to date. Site activation and enrollment are ahead of projections with strong participation from leading academic centers across the U.S., Europe and Asia. This level of engagement reflects both the clinical interest in menin inhibition and the confidence investigators have in ziftomenib's profile, particularly its potential to be combined with standard frontline regimens.

Beyond AML, we continue to explore the broader opportunity of menin inhibition. Our study evaluating ziftomenib plus imatinib in GIST is progressing well, and we hope to provide updates when appropriate. In addition, we are evaluating the role of menin inhibition in other solid tumors.

And turning to darlifarnib, which also continues to make important progress. Recent data presented at the International Kidney Cancer Symposium provided clear proof of mechanism, demonstrating activity in cabozantinib pretreated clear cell renal cell carcinoma, a setting where clinicians would not typically expect to reinduce responses with the same TKI after progression. These findings support the role of the REV mTORC1 resistance pathway and reinforce potential for darlifarnib to restore sensitivity to targeted therapies. Enrollment in the Phase Ib portion of the darlifarnib plus cabozantinib trial is now underway. In addition, we intend to present an update on the full Phase Ia data set later this year.

We see combinations of FTIs and KRAS inhibitors with a potential next advance for patients. At ASCO, we will present preliminary data evaluating darlifarnib plus adagrasib and KRAS G12C mutated solid tumors, and we look forward to discussing that data at a virtual event on June 3.

I'm incredibly proud of our teams at Kura for the disciplined focused execution behind these programs. Their cross-functional commitment and operational excellence are helping translate our strategy into meaningful clinical progress for patients.

And with that, I'll turn the call over to Tom for financial updates.

Thank you, Mollie. I'm happy to provide a brief overview of our financial results for the first quarter of 2026.

Our net product revenue from KOMZIFTI sales was $5.8 million compared to none in the first quarter of 2025.

Collaboration revenue from our Kyowa Kirin partnership was $12.5 million compared to $14.1 million for the same period in 2025.

Research and development expenses were $65.3 million compared to $56 million for the first quarter of 2025. The increase was driven by ziftomenib combination trials, including the start of enrollment in our KOMET-017 trials in the second half of 2025.

Selling, general and administrative expenses were $31.6 million compared to $22.8 million for the first quarter of 2025. This increase was driven by the commercial launch of KOMZIFTI.

Net loss for the first quarter of 2026 was $73.3 million compared to a net loss of $57.4 million for the first quarter of 2025. This includes noncash share-based compensation expense of $8.4 million compared to $7.8 million for the same period in 2025.

As of March 31, 2026, Kura had cash, cash equivalents and short-term investments of $580.8 million compared to $667.2 million as of December 31, 2025.

We are maintaining our previously communicated guidance for collaboration. We expect this to be $45 million to $55 million in 2026, $90 million to $110 million in 2027 and $90 million to $110 million in 2028. This revenue reflects noncash based accounting recognition of performance obligations under our collaboration agreement with Kyowa Kirin.

Current cash, cash equivalents and short-term investments as of March 31, 2026, together with anticipated payments of $180 million under our collaboration agreement with Kyowa Kirin are expected to fund our ziftomenib AML program through the first top line Phase III results from KOMET-017 anticipated in 2028.

With that, I'll turn the call back over to Troy.

Thank you, Tom. As I said at the outset, the company is firing on all cylinders. Our first commercial launch is off to a strong start. Our Phase III programs are ahead of plan and we expect a strong cadence of data over the next 12 to 24 months that will further define leadership for ziftomenib and the menin inhibitor class.

With that, we'll conclude our prepared comments and we're happy to Leila to open the call up for questions.

[Operator Instructions] Our first question will come from Li Watsek with Cantor.

This is Dan Bronder on for Li Watsek. Congrats on the update and the commercial launch. Can you give us some color on how we should think about the duration of treatment with KOMZIFTI early on, given that it sounds like you have patients on monotherapy as well as some that might be receiving combination? Greatly appreciated.

Sure, Dan. Thanks for the question. Let me ask Brian if he can speak to them.

Sure. Thanks, Dan, for the question. I think it is difficult at this point to really give too much detail on duration of treatment because we have 1 full quarter. We've reiterated before that our expectation is to get around 6 months of treatment.

What I can say is that we're very pleased, of course, with the number of new patient starts. We think that's really the measurement at this early in the launch to measure how well we're doing. And I think the 85 new patient starts us up well. What we need to do is really track for several quarters to get a better sense of that.

Your next question will come from Peter Green with LifeSci Capital.

This is Peter on for Charles. Congrats on the results team. You mentioned a few times the frontline opportunity and also strong enrollment in KOMET-017. And in light of -- sorry, EHA abstracts today. I have a question there. I'm noticing from last year that complete response rates across both NPM1 mutant and KMT to rearrange AML, that's in the front line for zifto in combination with 7+3. I'm Noticing those CR rates are increasing. I'm also noticing that CR MRD negativity is an NPM1 occurring potentially out to 43 weeks in some patients. So I guess with all of that said, what have you learned from KOMET-007 about the dose profile in the front line, especially over longer-term use? Is there some response deepening? Happening? Or is this just kind of an artifact of increasing -- of including kind of less adverse risk patients?

So I think we've learned foremost that we're using it correctly. And that doing it with a staggered start and a start that enables patients to continue to remain on without having to interrupt or lower dose or discontinue for adverse events is a really powerful way to keep these patients both in a response, have that response deepen over time and have these patients be able to continue into some sort of continuation treatment, whether that be post-transplant or post consolidation. We continue to gather more data, and we continue to be extremely encouraged that the way we've designed 007, the data we continue to gather from 007 helps us to really reinforce that we've correctly designed 017, so that we can expect great outcomes for these patients in the front line as well.

Yes. Peter, this is Troy. Just to add to Mollie's comments, I agree with everything she said. One of the things you'll see at EHA is really this is probably the most mature set of data in the front line and it's really a story of durability and clinical benefit for patients. The data will be updated at the presentation, but response rate, MRD negativity are important. We'll really draw people's attention as well, as Mollie said, to the durability. We're really -- this is -- this data is pretty unprecedented and I think very encouraging from the promise of menin inhibitors and the 017 study, as she said.

Your next question will come from Jonathan Chang with Leerink Partners.

On the KOMZIFTI launch, can you provide more color on what you're seeing in terms of initial combination use and instances of switching from other menin inhibitors? How common is combination use in switching?

Yes. Thanks for that question, Jonathan. Yes. So what I can share about the combination use for this, of course, as you know, our promotional teams, our commercial teams are focusing on promoting on label as a monotherapy, but physicians are choosing to use in combination. The data we're seeing so far is that it's about -- probably about 40% of patients are getting -- using KOMZIFTI combination, either with ven/aza or in those FLT3 co-mutated also with gilteritinib. So that's what we're seeing early on. I think that getting to the expectation of how those patients will do is something will follow.

And regarding your question around switching, that is something that we -- as I said, we observed, especially as 2 products that became available. It just kind of drove where physicians are choosing to use KOMZIFTI based on the profile. I think that's going to be probably less of a trend than the combination use that we expect to go forward. But nevertheless, it does demonstrate the strength of the KOMZIFTI profile and really, I think, supports the strong initial early momentum we've had in this first quarter of launch.

Your next question will come from Etzer Darout with Barclays.

Just a follow-up on a question. Maybe you could comment on the primary reason patients have been switching from other menin inhibitors. I'm not sure how much data point you've gotten at this point, but just wondered if it's something you could comment on?

Yes. I don't think I can -- thanks for the question, Etzer. I don't think I can go into the detail of each patient that switched really. It's probably more at a high level. We're seeing that physicians now they have a choice between multiple menin inhibitors and there have been physicians chose to switch those patients from another menin inhibitor to give them the opportunity to benefit from KOMZIFTI. So it could be based on the profile. Based on whatever the decision the physician feels. Based on if its efficacy, the safety profile, the simplicity of use, all of those things are what we've heard has resonated from a number of physicians.

Yes, Etzer, just to jump in for a second and build on that. I mean the switching is, to some extent, what we expected. I don't -- I agree with Brian. I don't think it's probably the most significant aspect. What we draw your attention to is, as Brian said in his prepared remarks, the new patient starts. The other menin inhibitor had approximately 130 new patient starts. We've had 85 in our first full quarter. That's about 40%. Given that the story prior to this was kind of a winner take all, we think we've got really strong momentum to be able to take leading market share in NPM1. You are going to see some switching. I mean, as we've said, we think we have a superior overall profile, but where we really think you're going to see it is in the new patient -- increased new patient starts again, use in combination, although that's not our labeled indication, that's physician discretion. Those are some of the elements we draw folks' attention to.

Your next question will come from Reni Benjamin with Citizens.

Congrats on the progress. Maybe just sticking with the new patient starts. I guess, any other or additional color you can provide, anything regarding gross to net dynamics? And when you talk about the 157 total prescriptions, are these -- are the scripts typically like 1 month on average, are they 3 months on average? Can you give us some sort of details there. And just if I can throw 1 more in regarding the commercialization, you said 60 activated accounts. Brian, what's kind of the total number of accounts that you're targeting? Just to give us a sense as to where we are in the cycle.

Yes, sure. So thanks for the question, Reni. So with regards to these new patient starts, the color we're seeing, and I shared a little bit, these are the relapsed/refractory patients to kind of fit across -- we're seeing it across accounts that are either KOMZIFTI trial sites. We're seeing it from those who have experience with other menin inhibitors as well as those who haven't had any experience. What we're seeing is a very strong start this early on that we're able to get, as Troy mentioned, 40% of the kind of new patient starts in this first quarter alone gives us a lot of confidence that there are patients out there who may benefit from KOMZIFTI, and we're very pleased with the opportunity we have to move forward with that at this point in time. We do say, and as I mentioned in the remarks, we're going to continue to see quarter-on-quarter growth. We'll continue to go deeper into other accounts and ultimately become the market leader in this space based on that menin class share. So we're very encouraged by the start right now. We look forward to that in the future.

And Reni, the scripts are 1 month, right? These are 1 month scripts.

Got it. And the gross to net dynamics?

Thanks, Reni, for that question. Those are within normal ranges, so in that 20% to 30% range.

Your next question will come from Roger Song with Jefferies.

This is Nabeel on for Roger. I'm encouraged to hear on the open label, the combo use at 40% in combination. So I'm just kind of curious if you could give us color on how this looks in academic and community settings? And then as we get more data, the ven/aza publication and then the second half data with the FLT3 combo, how do we expect this to sort of evolve? And does the KOMZIFTI have any advantage here?

Yes. So I mean, I think that as we said, this is -- the combination use is not what we're promoting actively, but it's based on a lot of the data. I think that in the remarks that as we've shared here, Mollie's remarks around the combination use. This really shows that we have a potential to become that strong leader, both in the relapse/refractory, but in the front line setting. The data that we'll be presenting in the publication with ven/aza, will be coming, as we said, in the first half of the year. We think that will help to draw momentum. Of course, our objective is to submit that to NCCN guidelines, but we can't determine whether or not that will be incorporated. But we have heard feedback from physicians that the publication of the data are very important for them. So we'll see that plus the potential unique combination to be able to combine with the FLT3 inhibitor, I think also gives us a strong avenue to build strength in a market where there's 50% of the NPM1 patients who have a FLT3 co-mutation, which may be unique to KOMZIFTI's profile to be able to do.

Your next question will come from Phil Nadeau with TD Cowen.

Congrats on the progress. In regards to the frontline data that's going to be at EHA, we're curious to get your most recent thoughts as to what measures you think investigators and physicians are going to look to you when thinking of adopting the menin ins in the front line. Do you think ultimately the most powerful data will be the durability of the response? Could it be progressing to transplant, ultimately, overall survival? I guess in your conversations what are physicians evaluating most prominently as they think about moving the menin ins forward?

Sure. I actually think it's a combination of all of those things you said. Ultimately, survival is the primary endpoint. You want these patients to live. There's some ability to get to curative intent with transplant, and we want to be able to expand patients' ability to get to curative intent. So the durability, I think, is going to be your best prognostic indicator for our ability to increase the survival. And I think the MRD negativity is going to be what actually predicts the durability as well. So all of them are extremely important. We're seeing extremely high response rates. You'd expect to see maybe 70% to 80% of patients having a complete response to 7+3, and we're seeing things in the high 90s. You'd expect to see about 45% of patients have MRD negativity in the bone marrow, and we're seeing that in the 80s. So again, I think that all signs are pointing to these patients having really strong, really deep responses and a great chance of having an effect on survival overall.

Your next question will come from Salim Syed with Mizuho.

Great. Congrats on the quarter, guys. Just 1 for us on that 40% number, Troy. Could you maybe comment on the cadence through the quarter? Is that something that is also representative of your exit NBRx share for NPM1? Or was it higher kind of coming out of the quarter? And similarly, I guess, is that similar to the dynamics you're seeing for this current quarter?

Yes. Salim, I mean we're talking about small numbers. Our goal here is to be the market leader in relapsed/refractory NPM1, that's 51% or more. I think you're going to see us push that as high as we can. There's -- as you can -- as you know, I mean, you've been doing this a long time. There's a lot of variability, week-to-week, month-to-month. What I think we're really encouraged by is we're second to market behind another product that's been on the market now for 15 months, and we've taken 40% of new patient starts in the first full quarter. That's what we set out to do. That's just the beginning. I think we're very optimistic. You're hearing it whether it's in the performance of the field force and the commercial team, whether it's the EHA abstract, this -- ziftomenib or KOMZIFTI in the commercial setting has a real opportunity. So look for us to build on that, as Brian said, I think we're just getting started. We're still learning. We're still educating. This is the first step, but I think a very, very encouraging first step.

[Operator Instructions] Our next question will come from David Dai with UBS.

Congrats on the quarter. So a few questions from me. One is on the $5.8 million revenue. How much of that is inventory stocking? And then how should we think about the combo use could extend the duration of therapy beyond the 6 months on monotherapy? And then lastly, do you think the patients will actually continue to use menin inhibitors beyond progression?

So just a reminder to everybody. David, I'm going to -- I don't mean to single you out, but we're trying to limit people to 1 question. So there isn't any meaningful stock in. I mean this is -- you can see this in the numbers. But Brian, maybe you can speak to durably -- the question on durability of combo?

Yes. I mean I think that, as I said earlier, David, I think duration of treatment is something we'll be seeing over time. It's difficult to say within a first full quarter of how much that duration is used. Our expectation is that patients who are on therapy in combination will likely have a longer duration. But we need a little more time to play that out because you need to understand which type of patients are getting on therapy. Is it more second line versus third or fourth line or something. Those are the things that we're tracking. We're pleased with where we're heading now. But I could ask if we could get a couple more quarters under our belt to get a better sense on what that durability could be. But we would reiterate that our -- we believe that this overall market opportunity in the relapsed/refractory setting still remains around that $350 million to $400 million.

Yes, David, what I might add to that is we were not surprised to see some spontaneous combination usage. I think we were pleasantly surprised to see physicians choosing to combine with gilteritinib, given that we're not even planning to present that data until sort of towards the end of the year. But given the overall profile, the combinability of zifto, it's nice that physicians have that option for their patients, and we're starting to see that kind of work its way into the commercial setting. That's very gratifying. It's not anything we're promoting, but it is nice to see.

Your next question will come from Daniel Brims with Lake Street.

Congratulations on the strong launch. For ASCO, I was just curious, will we be seeing any monotherapy data there or just combination data for darlifarnib with adagrasib?

Yes. So we've actually previously presented the monotherapy data last year. And to give you an idea of the really wide therapeutic window that we have with the monotherapy, balancing both efficacy and safety so that we'll be able to do an extensive amount of combinations over time. At the ASCO presentation, you're going to see it in combination with the KRAS inhibitor adagrasib. You will see dose escalation data, and you will see it across multiple time types, including non-small cell lung, PDAC and colorectal cancer. And we're very excited to be able to share this with you, kind of our third installment of the REV mTORC inhibition pathway that is helping to overcome adaptive and innate resistance for these patients with suffering from cancer.

Your next question will come from Peter Green with LifeSci Capital.

This is Peter again on for Charles. Just wondering, you mentioned that the KOMET-017 trials is going -- ahead of schedule. Just wondering if there's any more details on that, what you're hearing from investigators? And then remind me, does that change any guidance for potential future readouts?

Yes. Maybe Mollie can speak to anything we're hearing, Peter, and then I can address your question about guidance. Mollie?

All we hear is excitement. Excitement for new sites to get up and running, the regions to get up and running. I can tell you that participation both in the U.S., Europe and Asia is extremely strong and has come to that level of strength very, very quickly. So I would say 007 was a great indicator of how quickly we could enroll 200 patients into a Phase I trial. The Phase III is going incredibly well, and it's really well predicted by that enrollment rate we saw in 007.

And on the guidance question, Peter, we haven't changed anything at this point. We've guided to the initial top line results from the first -- from the intensive chemotherapy combo in 2028. We haven't been more specific. We might tighten that up as we get closer. I will highlight, we're significantly ahead as far as we can tell the competition in that setting. But even in the ven/aza setting, which is the other side of 017, we're -- the team is making just incredible progress. And really credit to Mollie for combining these 2 Phase IIIs into a single protocol, since that every time we activate a clinical site, we're getting 2 Phase III starts for the price of one. And so you're going to -- I think you're going to see that continue to get pulled through. The excitement has just been helpful. We did an investigator meeting recently, and it was incredibly well attended and well received. So onward we go.

There are no more questions at this time. I'd now like to turn the call over to Troy Wilson for closing remarks.

Thank you, Leila, and thank you all for joining us today. We're encouraged by the early performance of the KOMZIFTI launch, the momentum we're seeing across our clinical programs, the clarity of our strategy moving forward. With continued commercial execution, multiple clinical catalysts and including EHA and ASCO and a strong financial position, we believe, Kura's well positioned to drive meaningful impact for patients and to create long-term value. We look forward to updating you again soon and to engaging with many of you at our upcoming investor event later this month. Thank you all once again, and we'll adjourn.

Good day, everyone. My name is Jenny, and I will be your conference operator today. At this time, I would like to welcome you to Kura Oncology's 2026 IKCS Investor Event. [Operator Instructions]

At this time, I'd like to turn the call over to Troy Wilson, President and Chief Executive Officer of Kura Oncology. Please go ahead, Dr. Wilson.

Thank you, Jenny. Hello, everyone. Today, we're delighted to share with you some updates that were presented at the International Kidney Cancer Symposium that's being held over the next couple of days in Paris, France. This relates to our the ongoing study evaluating darlifarnib and cabozantinib in patients with kidney cancer.

If we can go to the next slide, please. In today's presentation, we're going to be making forward-looking statements. I would refer you both to our filings and our website, our SEC filings on our website for more information about Kura Oncology and the risks and uncertainties of an investment at this time.

I'm joined on today's call by 2 participants. Dr. Adanma Ayanambakkam is Assistant Professor of Hematology Oncology and Medical Director of the Genitourinary Medical Oncology Research at Oklahoma Health Sciences Center. And also joining us today is Dr. Mollie Leoni, Kura's Chief Medical Officer.

Both of them are going to be presenting slides through this presentation. This is an incredibly exciting and dynamic time at Kura. We are squarely focused on the launch of our first commercial product, KOMZIFTI, which was approved just last year in relapsed/refractory NPM1 mutant AML. We're looking forward to giving an update on how the launch is going at our earnings call next month.

We're also broadening out the opportunity with ziftomenib or KOMZIFTI as it's known commercially to be able to treat up to 50% of AML patients. What we're here to talk about today is one of our pipeline programs. And we have a thesis at Kura that cancer is best treated in combination. And we'll talk more about that today. But as you'll see with both our menin inhibitors and our Farnesyl transferase inhibitors, we're advancing innovative therapies that I think have the potential to combine with other agents to really drive better outcomes for people with cancer.

If we can please go to the next slide. So we call these precision combinations. And if we can go to the next slide, on the left-hand side, you can see the combinations that we're undertaking with ziftomenib. Many of these are familiar to you. We're, of course, evaluating ziftomenib in acute myeloid leukemia, both in the relapsed/refractory and in the newly diagnosed setting.

Importantly, we'll be giving an update on the intensive chemotherapy combination in newly diagnosed patients middle of this year. We're looking toward a publication with the non-intensive chemotherapy combination to be published a little bit later this year. And then finally, we'll give an update on the FLT3 combination specifically with gilteritinib in the relapsed/refractory setting.

Our view is and always has been, while menin inhibitors offer tremendous promise, we want to move them forward and move them into combination as quickly as we can. Continuing that theme, we've got ziftomenib in GIST, and we're looking forward potentially to an update next year for that program. On the right-hand side, if we can go to the next slide, we're going to focus today on our pipeline program, darlifarnib, which is just now beginning to come into its own. And specifically, as you know, we're evaluating darlifarnib in 2 contexts.

Today, we're going to talk about the data combining darlifarnib with cabozantinib, which, of course, is an anti-VEGF receptor inhibitor. A little bit later this year, we're looking forward to sharing with you the darlifarnib data in combination with adagrasib, which, of course, is a KRAS G12C mutant specific inhibitor. And there, we'll be showing you data in lung, colorectal and pancreatic cancer. This idea of precision combinations is not new, but we think it's really the right way to go.

Cancers use a number of different mechanisms to be able to grow and evade and metastasize everything from genomic instability, inducing angiogenesis, avoiding immune destruction. And our view is -- and our focus is to develop therapeutic agents that can combine with other therapies.

If we go to the next slide, That's, in fact, what we've seen in renal cell carcinoma, the evolution of treatments in kidney cancer. And Dr. A is going to speak to this as he goes through the data slides. But initially, the first approvals were with classical immunotherapy, then we saw a wave of tyrosine kinase inhibitors as well as mTOR inhibitors.

Now increasingly, we're seeing doublets and triplets. And that's, in fact, where we anticipate darlifarnib will go ultimately is in combination, but we think it's important to demonstrate the mechanism of action and validate that as well as to get a sense of what is the safety, tolerability and activity as we think forward.

Mollie will be able to speak to this as she goes through our strategy building on this initial data. So if we go to the next slide, darlifarnib, as all of you know, is our next-generation farnesyl transferase inhibitor. We've been working on farnesyl transferase really since the inception of the company. Darlifarnib is as good as it gets as far as a farnesyl transferase inhibitor is concerned, extremely potent, has great safety and tolerability.

We took everything we knew about tipifarnib and we optimized it. And we're really delighted. We did share some early data from the Phase Ia study late last year. This is now an update of that data. And ideally, we'll provide yet another update here in kidney cancer a bit later this year.

If we go to the next slide, these are the last couple of slides before I turn it over to Dr. A. What's the rationale here? Well, we know that cabozantinib and other tyrosine kinase inhibitor therapies block various signaling pathways. And in particular, they block VEGF receptor, but they also block PDGFRs, they block other targets as well.

TKIs have become a mainstay of treatment in kidney cancer. They're used throughout the treatment continuum. The challenge is once TKI therapy fails a patient, the treatment either with the same TKI or another TKI or really any subsequent treatment is reduced. So there's a significant need to be able to either drive deeper, better responses or ideally to resensitize patients to treatment with these TKIs.

If we go to the next slide, that's really where darlifarnib comes in. So darlifarnib acts in this context in renal cell carcinoma by blocking a protein called RHEB. RHEB is Ras homolog expressed in brain. And the significance of RHEB is that RHEB controls the transport of TORC1. TORC1 is one of the two TOR complexes that sit at the bottom of the MAPK kinase pathway. And when you defarnesylate RHEB, RHEB can no longer get TORC1 to where it needs to be.

So what that does effectively is it provides a second complementary block on the signaling pathway. And each of the targets that these TKIs are targeting are signaling through these signal pathways. So one has the ability -- if we can go to the next slide, once we introduce a combination, for example, of cabozantinib and darlifarnib, one can see you're blocking at the receptor level, you're also blocking down much further in the pathway. And the consequence, as we've seen both preclinically and clinically is you get less angiogenesis and tumor death.

We've validated this. We have presentations available on our website and that have been put in the published literature on the mechanism of action and preclinical data with various combinations. I think it's important to generalize these results. What we're going to show you today is the specific combination of cabozantinib and darlifarnib. But what we've seen, at least preclinically is that these results are generalizable to any tyrosine kinase inhibitor.

And as we talked about, we've been quite encouraged by the safety, the tolerability and the clinical activity that you're about to see. If we go to the next slide, I'm going to turn it over to Dr. A to walk us through the slides. These slides were presented by Dr. Zakharia in a poster presentation at IKCS, but Dr. A is kind enough to present the slides and put them in the appropriate context. Dr. A, I'll turn it over to you.

Thank you. Good morning, everyone. My name is Adanma Ayanambakkam. I'm a GU Medical Oncologist at the University of Oklahoma. And on behalf of the FIT1 team, I'm happy to present the data and give you a perspective on how things are moving along in this trial.

Next slide, please. Briefly, disclosures all pertaining to research or consulting and advisory roles. Next slide, please. So the FIT-001 trial is a Phase Iab dose escalation dose expansion study, and that evaluated both darlifarnib monotherapy and darlifarnib monotherapy plus cabozantinib. Now the darlifarnib monotherapy, the dose escalation cohort was not in renal cell carcinoma. It was in predominantly KRAS-mutated tumors. And what we found was that it was an efficacious drug and also safe and the recommended dose for expansion was around 8 to 10 milligrams.

We moved on to the dose escalation trial, and then this was when we combined it with cabozantinib and evaluated renal cell carcinoma patients. So this is the portion of the study that we're talking about today. And in order to evaluate the safety, we started off at a lower dose of cabozantinib at 40 milligrams, which is a lot more tolerable, but not as efficacious as the recommended dose, which is cabozantinib at 60 milligrams.

So the study started at darlifarnib at 3 milligrams, escalated to 5, 8 in addition to cabozantinib 40 milligram. And when that was considered safe and we did not meet our DLTs, we moved ahead to the second part of the study, which looked at the ideal dose of cabozantinib, which is 60 milligrams in combination again with escalating doses of darlifarnib to 3, 5 and 8. Currently, the study has moved on to the expansion phase where cabozantinib at 60 milligrams is being evaluated with darlifarnib at 5 and 8 milligrams.

Next slide, please. In the dose escalation, our patients were a mixture of patients who are cabozantinib naive and cabozantinib resistant. But for this talk and the poster that's being presented by Dr. Zakharia at IKCS, it was focused on those patients who had been cabo exposed. All these patients had prior line of cabozantinib or some TKI during their course. About 67% of patients had exposures to other TKIs apart from cabozantinib and almost 56% or half of the patients had cabozantinib as their immediate prior line of therapy and all had progressed on cabozantinib.

So about 56% were what we would consider cabozantinib refractory, a total sample size of around 18, a small population, but still an important population to evaluate, pretty evenly distributed from all the different cohorts, but important to highlight that a predominant portion of this study includes patients, about 15 or the 18 patients had cabozantinib at 40 milligrams, not at 60 milligrams.

Next slide, please. Overall, the safety profile was pretty consistent and tolerable. And for the safety profile, we look at the whole dose escalation patients, not just the cabozantinib refractory patients. Here, what we found was that darlifarnib was a pretty tolerable and safe regimen. Now if you look at any grade TRAEs, the most common ones were neutropenia, fatigue and diarrhea. But for the grade 3 or more TRAEs from darlifarnib, neutropenia and anemia were by far the most common.

Now it's important to understand that while neutropenia has increased, it is an expected event from farnesyl transferase inhibition, and it is also something that's easier to manage. So in comparison to the other side effects from cabozantinib, which are discussed elsewhere in the poster, what we are showing here is that darlifarnib did not add to the toxicity profile of cabozantinib and neutropenia, anemia and thrombocytopenia, while our TRAEs are usually asymptomatic to the patient's perspective. So it did not lead to any significant deterioration in quality of life, which is very important in this patient population.

Next slide, please. Overall, darlifarnib was well tolerated. There were obviously some dose reductions predominantly due to cytopenias, predominantly in neutropenia. There were interruptions in about 60% of patients, but most of them were able to continue on it. 13% had to dose reduce the darlifarnib. A good portion were able to go back without any discontinuation in their -- or dose reduction in the darlifarnib.

Overall, the number of patients who needed discontinuation of darlifarnib was around 6 patients, so 4 out of the 70, so a pretty good number. In comparison, cabozantinib needed dose reduction in about 26%. Cabozantinib needed to be interrupted in about 70%. And to put it in context, other trials that have looked at cabozantinib like the recent LITESPARK-011 trial or the CONTACT-03 trial that had cabozantinib as the control arm had about dose interruption in about 90% to 100% of these patients.

We know cabozantinib longer duration is toxic and can have some AEs. So within that context, I think this is pretty reassuring in terms of the tolerability of darlifarnib and how we are able to manage the AEs that arise from it.

Next slide, please. The clinical activity is pretty encouraging. What we noticed was that in these 16 patients, about 15 of them had disease control rates, so a disease control rate of about 94%. But what was even more promising is that the objective response rate in this population was around 44%. So to put it in perspective, these are patients who had prior line of cabozantinib, about 60%, 56% to be precise, had cabozantinib as their immediate prior line and had progressed on cabozantinib.

And even among those patients, we had a good amount of response, 4 out of the 7 responders who had cabozantinib as immediate prior line of treatment had an objective response rate on this study. So in that context, pretty promising objective response rates of 44%.

Next slide, please. What is even more interesting is that the objective responses that were seen on the study seems to be seen along multiple doses of the darlifarnib. You can see darlifarnib at 3 milligrams also having significant partial responses and darlifarnib at 5 and 8 also following. Now what's also important to understand is that most of these patients were on cabozantinib 40 milligram as depicted by those poker dot bars and very few patients as in the solid bars were patients who had cabozantinib at 60 milligrams.

Why this is important is that we know cabozantinib 60 milligrams has a better objective response rate than the 40 milligram. And it's interesting to see that this combination in a cabozantinib pretreated or cabozantinib refractory population still has considerable responses at the lower dose of cabozantinib at 40 milligrams, which is also the more easier to tolerate dose of the cabozantinib.

Next slide, please. Duration of response is still evolving. We don't have a long-term follow-up as of yet, but it's important to note that many of these patients continue to respond. We have a follow-up of around 50, 56 weeks for the longest patient in this cohort. The responses do seem to be durable, but we will need to wait to see how durable these responses are in the long term. But what we are seeing is there is slow evolution of disease that goes from stable disease to partial response, some people with partial response pretty earlier on in the disease course.

And what we have not identified is a long duration of stable disease before we see a response. At most, most patients had a partial response by the 8- to 10-week mark around the first couple of scans. But important to note that so far, the responses do seem to be durable, but long follow-up is required.

Next slide, please. We'll highlight a couple of different patient vignettes for us to put this in perspective. This is an 80-year-old patient with TSL RCC diagnosed in 2022, starts frontline treatment with nivolumab and cabozantinib with a best objective response of stable disease was on this treatment from around 2023 to 2025. Our initial study treatment was on June of 2025. So about 3 years after he was on nivolumab and cabozantinib. Get started on cabozantinib 40 milligrams and darlifarnib at 8 milligrams. And at week 8, he did have a partial response. He had 36% reduction at 8 weeks, and these responses seem to be durable. And his last scan at 16 weeks shows a partial response with a RECIST score of 32%. So patient continues to remain on treatment, and this highlights that despite progression on cabozantinib as prior line of treatment, patients continue to respond at the lower dose of cabozantinib without significant side effects.

Next slide, please. This, I think, is a little bit more relevant to the ongoing discussion. And here, again, another younger patient, 53-year-old female diagnosed in 2021, get started on frontline immune checkpoint inhibition doublets with nivolumab and ipilimumab, progresses to nivolumab and cabozantinib, and this was done before we knew that IO beyond progression is not meaningful.

And importantly, this patient also had HIF inhibition with Belzutifan, the FDA approved HIF-2 alpha inhibitor, and she subsequently started study treatment in October 2024. What's important is that in this heavily pretreated patient population, prior IO doublet, prior cabozantinib and prior HIF-2 alpha inhibition, the darlifarnib at the lower dose of 3 milligrams and the cabozantinib at a lower dose of 40 milligrams PR, about 38% reduction at week 8 and continues to evolve with a 53% reduction at week 48, indicating an ongoing response in this heavily pretreated population. So pretty promising responses, pretty good safety profile that has got us excited about this novel combination.

Next slide, please. This is a little bit exploratory. We always thought not to make cross-trial comparisons, but in oncology, we always end up making cross-trial comparisons, and this is one such scenario, not to highlight the superiority of any such regimen, but to highlight the tolerability and the safety profile of these different regimens. There has been Phase II trials looking at lenvatinib–-everolimus showing that they had better outcomes. There was a recent LenCabo trial that was presented at ESMO last year that looked at len–va-everolimus in a randomized manner. And importantly, the control arm of that trial was cabozantinib, in a cabozantinib-naive patient population.

In that trial, what they did show was that cabozantinib objective response rate in a naive patient population was around 40%, and it was inferior to the superior objective response rate of lenvatinib–-everolimus. So making big jumps, it's interesting to see that the combination has an objective response rate of 44% in a cabozantinib refractory population compared to cabozantinib monotherapy of 40% and odd responses in a naive population. But what's important to understand is that the safety profile seems to be a lot more tolerable.

I would want to focus your attention on the second column, which is lenvatinib– plus everolimus and mTOR inhibition combination doublet with TKI and the darlifarnib combination to look at the different safety profiles. And what we are not seeing here is an increasing toxicity profile from the combination. We are definitely not seeing a significant amount of pneumonitis, arthralgia and other side effects that we see with everolimus. And so as demonstrated in the preclinical rationale, the selective mTOR1 modulation via the RHEB pathway does seem to avoid certain side effects that we don't want while still retaining the efficacy that we want.

Next slide, please. So overall, I think it is a very good combination that has a proven safety and tolerability profile. We will need to wait for longer follow-up to evaluate the durability of the responses, but it's important to highlight that even in this heavily pretreated population, in this population of patients who are cabozantinib refractory, we had an impressive objective response rate of 44% with a disease control rate of about 94%.

The study is now actively enrolling in the expansion phase, which is looking at cabozantinib naive patients in combination, and we're excited to see how the study will fit in the evolving landscape for RCC. Next slide, please.Thank you.

All right. Thank you, Dr. A. And with that, I want to discuss the company's next steps. So these data are spectacular, and we have to ask ourselves what's next. We are currently in our dose refining Phase Ib. It is a randomized trial enrolling into 2 different darli doses, the 5 and 8 milligram as well as the cabo monotherapy arm, where upon progression, patients can then roll over on to the darli combination. These patients will have seen IO, but be cabo-naive and with no more than 3 priors. Endpoints will include response rate, durability and of course, safety.

Going to the next slide. These data encourage us to move forward exploring second-line plus and demonstrate a novel mechanism to add to the RCC armamentarium. We are currently enrolling into this randomized Phase Ib and expect to be able to share data next year. We are excited to be exploring an option for the IO refractory patient population. There are limited options for patients that have progressed on IO-HIF-2 alpha combinations and adding darli to these combination backbones provides new options for patients.

We recognize that the field is appropriately moving to combination approaches in the advanced setting. As HIF-2 alpha continue to move towards the front line, we believe darli combinations offer a potentially new way to address disease after failure of HIF-2 alpha. We believe that darlifarnib and cabozantinib have the potential as a combination to establish a new standard in IO refractory second-line plus clear cell renal cell carcinoma.

And with that, I will turn it over to Troy.

Thanks, Mollie. Please go to the next slide. So as Mollie said, we're really pleased with this data. This is just the first of multiple data updates on our precision combinations. You can see them laid out here. It's going to be an eventful year. And from our perspective F, which we couldn't be happier. We have a strong launch. We have outstanding execution on the Phase IIIs, and we have a lot of upcoming clinical data of these precision combinations that will help us figure out how do we position them in order to achieve the best outcomes for patients.

In particular, I'll draw your attention to -- this is the kidney cancer side of the darlifarnib story. We expect to present to you the KRAS side of the story here before too long in the context of an upcoming major medical meeting.

So with that, if we can go to the next slide. We're happy at this point, Jenny, to turn it over and open it up for questions and answers.

[Operator Instructions]

Our first question comes from Charles Zhu with LifeSci Capital.

Congrats on the data. Recognizing that these data are from about 4.5 months ago and not that many patients were evaluable at 60-milligram cabo combinations. Could you talk about the decision to expand at some of these 60-milligram cabo combinations, maybe what you've seen? And is there a potential to see enrichment in response rates as you treat patients at these higher doses and potentially introduce prophylactic G-CSF?

Yes, [indiscernible], thanks for the question. I'm going to ask Mollie to speak. You have a couple of subparts in there, but Mollie can take the question.

Yes. I just want to remind you that what we're showing you here are the patients that had already seen cabozantinib therapy. So it is not the full data set. And by the time we got to the 60-milligram portion of that dose escalation, we were not enrolling patients that had seen cabo previously. So that's why you see less data at the 5 and 8, the 60-milligram combination doses. But when we present the updated Phase Ib data a little bit later this year, you'll see the full patient profile. So you'll see all the patients that were treated, and it will be clear to you why we think that the 60-milligram dose with either 5 or 8 milligrams of darli makes the most sense.

With regards to your safety-related question, now that we're done with the dose-limiting toxicity portion of the trial, meaning we're done with kind of the initial dose finding and safety portion, we'll be able to do prophylactic treatment. So we will be able to use G-CSF or give the transfusion, et cetera, in order to mitigate these events. So I expect patients to be able to stay on at least as long, if not longer, and again, continue to have an easier time on treatment because we'll be able to use prophylaxis.

Our next question comes from Jonathan Chang with Leerink Partners.

Maybe for Dr. Ayanambakkam, where do you envision darlifarnib fitting into the RCC treatment landscape? And how has that changed with HIF-2 alpha inhibitors?

Yes. Thanks for the question. I think it's an important question, and it's something that's very promising from a treating kidney cancer doc because now we have a lot of options. But I think the landscape is evolving and it's evolving really quickly, and we're going to change how we do stuff over the next few years. We have seen in the LITESPARK-022 trial that looked at adjuvant therapy with HIF inhibition, pembrolizumab plus belzutifan. We know that there are frontline trials looking at IO combination with HIF-2 inhibition. There's also a triplet approach IO plus TKI plus HIF2 alpha inhibitors in the frontline setting.

Triplet therapy in frontline kidney cancer has been an elusive strategy. This is not the first time we've tried it, but we've not had success before. Maybe things will change and we will move on to combination therapies. But as of now, I would argue that there is a combination therapy that's recommended in the frontline setting. And 2 important trials have looked at combination therapy against the best TKI second line that we had, which is cabozantinib, which is LITESPARK-011 and also the LenCabo trial.

The LenCabo looked at lenvatinib-everolimus versus cabozantinib. The other trial, lenvatinib and belzutifan looked at cabozantinib as the control arm. In both of the trials, objective responses with cabozantinib was around 40%, median PFS was around 10 months or odd. The CONTACT-03 trial, which had cabozantinib in the control arm, all these 3 trials are cabozantinib at 60 milligrams. So they're very strong control arms.

And all of them objective response of 40%, PFS of 10 months, showing that a combination approach is probably better. But as more people start using pembrolizumab and lenvatinib upfront, maybe with another HIF-2 alpha depending on how that other trial pans out. And as people start using lenvatinib-belzutifan more, it begs the question of what other options there are. We know that the mTOR pathway is an important pathway to inhibit an important pathway that adds to mechanism resistance.

So I see this as being a doublet strategy for second line and above whether this combination is sequenced before lenvatinib, belzutifan or after lenvatinib, belzutifan depends on if the patient has had HIF alpha inhibition before or not. And it will be interesting to see. But this is probably in subsequent or in sequence with the combination with HIF-2 alpha.

Our next question comes from Etzer Darout with Barclays.

Congrats on the data. Just given what we've seen here from an efficacy safety standpoint, maybe your view around the mechanism translating into sort of the KRAS update on both efficacy and safety, if you could comment on that?

Mollie, do you want to take that?

Sure. I mean, for us, just as well as our PIK3CA data that we presented last year now, I believe it was. This is showing that the mechanism is what we say it is. This inhibiting the ability of RHEB to activate mTOR is really shutting down that additional pathway that cancer uses to evade treatment with targeted therapies, including KRAS inhibition.

So I think you should take away from this that mechanism of action, we have once again shown you evidence of its activity in this particular combination in PIK3CA, and we'll be moving forward into that KRAS inhibitor, where we think that you'll take away the same message that this works. This is an appropriate combination partner to help get rid of some of the acquired or the acquired resistance mechanisms that these cancers use to abate.

Our next question comes from Daniel Bronder with Cantor Fitzgerald.

This is Daniel Bronder on for Li Watsek. Could you elaborate on the 10 patients of the 18 that you had noticed had disease progression on prior cabo? And what were the reasons the other patients discontinued cabo and whether or not you see responses across the whole spectrum of prior cabo exposure?

So just in answering the last part of your question first, yes, we see responses across the continuum of how and when and where they've received cabozantinib previously. So for the patients that -- especially in the 40-milligram group, they either came off for progressive disease or potentially intolerance. And that makes sense with why they would want to come back on in the 40-milligram combination because that's usually how they reexpose these patients to cabo after they've previously seen it.

But I think the most important piece to recognize is that of the 7 responders, all of them had progressive disease on their cabo. And 4 of those 7 had come directly on to our trial from cabo therapy, so from a cabo failure and we're able to have their responses rescued from use of darli as well. And their best response on their prior cabo was only stable disease. So we were able to actually not only get them out of a progression, but move them into a response using a combination where the monotherapy was not able to even get them into a response originally.

Our next question comes from Erik Lavington with Mizuho Securities.

Erik on for Salim. Congrats on the progress. Recognizing it's really early days yet, just curious about the dosing of darlifarnib, if you have any interest or capacity in protocol to look at dosage above 8 milligrams. Your thoughts on that?

Sure. So we did a monotherapy dose escalation in addition to these combination dose escalations. The cabo 1 of what you're seeing right now. In the monotherapy dose escalation, as we've previously described, 10 milligrams appeared to be really the maximally tolerated dose, but you have a very wide therapeutic window with anywhere from 3 to 10 producing efficacy in expected patient populations and being safe enough to keep patients on.

So we would be able to increase the dosing between that 3 and 10 milligrams in any combination that we're looking at. That's probably the escalation pattern we would look at. But here, we felt that the 8 milligrams offered the appropriate safety and efficacy and really moving to 10 milligrams would have only increased the toxicity. And so that's why we're moving forward with the 5 and 8.

Yes. Erik, just to add to Mollie's comments, I mentioned that darlifarnib is a next-generation FTI, and that really is kind of on 3 axes. One is significantly greater potency relative to tipifarnib. Tipifarnib was dosed at 600 milligrams twice a day. And one really needed to be at that dose in order to see activity in HRAS mutant solid tumors.

As Mollie indicated, here, we have obviously a much more potent compound beginning with activity at 3 milligrams, but we also interestingly have this window between 3 and 10, probably 3 and 8, where we can balance safety, tolerability and activity. So it gives us a lot more flexibility, and it's also once-daily dosing versus the twice daily dosing of tipifarnib. It really is an ideal set of properties for these precision combinations, whether it's cabozantinib, adagrasib as you'll see for other TKIs and KRAS PI3 kinase inhibitors in the future.

Our next question comes from Jason Zemansky from Bank of America Securities. We will come back to Jason.

Our next question comes from Roger Song with Jefferies.

This is Nabeel on for Roger. Congrats on the data updates. So curious on the treatment durations, we still have a couple of patients on therapy. How are we interpreting durability at this stage?

Yes. It's a great question. It's still early, but you saw that there's patients that have been on even in this subset of the Phase I that we're showing you for getting close to a year. So it's an evolving story with the patients still on. And I think that it will be nice for you to get a broader picture when we show you the additional Phase Ib data in coming weeks where you'll be able to see even more patients, even more patient stories and even more of the durability story.

Our next question comes from Roger Song with Jefferies. Apologies that is Jason Zemansky with Bank of America.

Congrats on the progress. Maybe just a quick follow-up to Mollie regarding the mechanism, but appreciating RCC is just one indication of a broader strategy. Has the data set changed your outlook about which indications to pursue next? Are there any read-throughs to other solid tumors here that make them more attractive indications?

So what it does reassure me is that we can do this with any of the compounds that we can really -- it's more than just indication, it's really the combination partner. So anywhere cabo can go, we can go. Anywhere lenva can go, we can go. And then I would generalize that also to the KRAS inhibitors and the PIK3CA inhibitors. So that's really your landscape. Wherever those particular compounds can go, we can make them better. And that's why we'll continue to evaluate potential options and pick the right one to get this to patients as quickly as we can.

Yes. And Jason, just to add to Mollie's comment, again, you should be seeing the KRAS data, hopefully here before too long. I think that after we show you that, we may be in a better position to talk about the balance between going fast and getting to registration versus going broad. If anything, this data reinforces that there's a significant opportunity here in solid tumors. We are actively working through what's the right development strategy for Kura, both alone and in collaboration with others. And we'll be in a position kind of as the year goes on, I think, to speak more to that.

[Operator Instructions]

Our next question comes from Phil Nadeau with TD Cowen.

Congrats on the data. We wanted to follow up on the activity in the refractory patients. So it seems like based on our math, approximately 4 out of 10 patients who were refractory to cabo had a response. That's a very similar response rate to the 3 of 8 roughly who were refractory to cabo. Is that analysis correct that you're relatively seeing the same efficacy across those 2 populations? And if so, I guess our question is, for the next trial, you're looking at cabo-naive patients, why not continue in cabo refractory given the pretty strong efficacy there?

What we do think is that this combination gets the cabo exposed up to what you'd expect to see with cabo monotherapy in the naive patient population. I think that actually more of the patients were refractory than maybe your calculations are taking into account, like I said, of the 7 responders, all of them were refractory to cabo at the time of coming on the trial.

And as for our Phase Ib trial, it's part of the reason we're doing the cabo monotherapy arm is one to establish a good baseline in this patient population that has this ever-evolving landscape. So we want to see what our patients look like now today with HIF-2 alpha IO, et cetera. But having that rollover potential really allows us to continue to demonstrate the mechanism of being able to save or induce responses in patients that progress on the monotherapy. So we'll still be able to see additional data in that regard. But just to get the clearest signal, we wanted to make it so that we cabo-naive patients.

There are no more questions at this time. I'd now like to turn the call over to Troy Wilson for closing remarks.

Great. Thank you, Jenny, and thank you to everyone who participated in the call today. We will look forward to our -- the next time we talk to you, I think, will be our earnings call in early May. I look forward to that. If in the meantime, you have any questions, feel free to reach out either to Greg or me. And we appreciate it. We hope everyone enjoys the Friday and the weekend. And with that, we'll adjourn the call. Thanks very much.

Hello again, everyone. My name is Etzer Darout, senior biotech analyst at Barclays. It's my pleasure to welcome Kura Oncology to our next fireside chat. With me this morning, I have Troy Wilson, President and Chief Executive Officer; and Brian Powl, Chief Commercial Officer.

Just maybe just to get us started, Troy, if maybe you can just make some introductory remarks for the team, and then we'll go into a Q&A.

Yes. Thanks, Etzer. Thank you to you and Barclays for inviting us to attend the conference. It's always terrific. So as folks probably know, Kura is now a commercial stage fully integrated biopharma focused on developing targeted therapies for both liquid tumors and solid tumors. We have sort of 3 priorities this year that we're going to -- I'm sure we're going to talk about in your Q&A. But the first is to drive the launch of our marketed product, KOMZIFTI to majority market share. The second is we have, I think, the broadest and most aggressive development plan for ziftomenib, which -- or KOMZIFTI throughout the treatment continuum, most notably the front line. And then we have a pipeline of therapies to come that at this point, I think, are just a really attractive call option, and we'll move those forward. Company is very well capitalized, and 2026 is going to be an exciting year.

Great. And maybe just again, given the recent launch of KOMZIFTI, can you just maybe kind of comment on at least what you're observing so far, the feedback that you're getting from KOLs on that sort of initial ramp. And then we'll obviously ask a little bit more around that. Sure. Brian, do you want to take that?

Brian, you wanna take that?

Yes, happy to. Thanks, for the question. So KOMZIFTI, as we know, was approved back in November of last year. We've had a very successful launch so far. We've really built the messaging and the focus of our discussions with KOLs and prescribers around really 4 points of differentiation for KOMZIFTI. One, we have built on a strong base of efficacy in the relapsed/refractory NPM1-mutant space. The safety profile for KOMZIFTI is viewed by KOLs as differentiated and really meaningful for those -- for the physicians and the patients.

Third, the combinability of KOMZIFTI with concomitant medications, the ability not to have to change a lot of your dosing is important. And then finally, the simplicity of once-daily dosing is also something that's resonated. The feedback we've heard so far has been very positive. KOLs are seeing that there is an opportunity to bring KOMZIFTI into the market, and we believe that we'll be able to achieve that majority market share based on -- in this space.

Great. And as you think about 2026, what do you sort of see as the puts and takes to adoption of KOMZIFTI?

Yes. I think it really starts back to the profile. We think that there's opportunity that this is a market where the population of patients are coming in as they progress from their prior line of therapy. We think the opportunity to get patients on KOMZIFTI as a monotherapy really is at that point of decision-making. We see that working for us well so far.

In the longer term, we also see the ability, while it's not within our label, a lot of the physicians want to combine with other standard therapies. And within the NPM1 space, patients have other options. They may be able to get things like venetoclax/azacitidine. If they're co-mutated with FLT3, there's an opportunity for them to get gilteritinib. And we're hearing that there may be opportunity to rather than sequence a menin inhibitor after those therapies to potentially combine. So that's one of the areas that we see as an opportunity.

Great. And are you observing any friction points, if you will, I guess, similar experience to other companies potentially in the space around center logistics, prior authorizations, comfort positions, DS monitoring. Anything that you'd want to highlight?

I would say the one thing I'd like to highlight is we haven't really seen a lot of friction so far. In fact, one of the things that's been quite compelling for us is the rapid uptake from payers to put KOMZIFTI onto their policies has been almost more of an upside surprise. We've had over 80% of private payers have put us on policy in the first 90 days, and that's well ahead of benchmarks. So we've seen a lot of open access for KOMZIFTI to go forward. Haven't really seen any major barriers. It's more than just you got to have the patients that come forward. It's an incident market where patients will be considered for KOMZIFTI, and that's what we're going to be working towards with our field teams.

Great. And obviously, the longer-term plan is to move into earlier line settings, particularly the frontline AML setting and several menin inhibitors moving forward in clinical trials to evaluate their drugs in frontline settings. What do you view as a key differentiator for you as you're working to execute your plans around KOMET-017, which is your frontline trial?

Yes. So I think it's sort of 2 pillars, if you will, Etzer. One is the properties of ziftomenib and the other is the manner in which we're executing on the trials. On the properties of ziftomenib, it goes back to something that Brian was saying. Oftentimes, investors are hearing it's all about efficacy, efficacy, efficacy. That's true. But if we -- with the, I think, the differentiated safety, combinability, convenience, you can drive better activity. You can drive better efficacy, whether that's in the relapsed/refractory setting or the frontline setting. You can see that from our frontline data. I would put it up against any of our competitors. We're going to give a data update on the 7+3 frontline Phase Ib. And I think, again, you're going to see that pull through. That's on the molecule side.

On the execution side, a number of years ago, we made a deliberate decision to put the 2 Phase IIIs under a single protocol. And we did that because when we went out and we talked to clinical sites in the U.S. and Europe, they said to us, we said, look, you're going to have multiple sponsors. How can we win your love. And what they said was put both trials in one protocol. It's easier, it's simpler to get up and running. It's on 1 IRB. You're standing up really trial. And most importantly, Etzer, any patient who walks in the door can come on 1 of those 2 trials. So as a result, we are rapidly activating. We're going to have up to 200 sites globally. We're rapidly activating. We've got many of kind of the premier sites in the U.S., Europe and Asia Pac. And I think we're just going to outexecute everybody else. We haven't really totaled it, but we've enrolled at this point, 350 patients in the Phase I studies to date with 30 sites. So now the goal is 1,300 and like the game is on.

Right. Great. And in the Fit AML patient population, you're evaluating combination with 7+3 in both NMP1 and KMT2 patients. I guess what does the biology tell us about where conviction can lie in either both of those patient populations? And I guess, ultimately, how could that translate into durable responses and outcomes for those KMT1 patients and NMP1 -- KMT2A and NMP1 patients?

Yes. Good question. So the -- the biology that you're addressing in frontline is you are trying to get patients to MRD negativity. Why is that so important? You can have 5% leukemic blast counts and be at a CR. If I have 5% leukemic blast counts, you still have full-blown leukemia, right? But if you're MRD negative, as measured in bone marrow, which is the accelerated endpoint for the 017 FIT study, you don't have leukemia down to the limit of detection. There is a very strong meta-analysis that we and the [ Impact ] consortium use to convince the agency to allow MRD negativity as an accelerated endpoint. And that's the association between MRD negativity and survival.

So the biology, as you asked about it, is you use the combination of intensive chemo and zifto to drive the MRD negativity down and then you use zifto in continuation therapy to maintain those patients ideally in an MRD-negative state. You called out the 2 genotypes. Let me just spend a moment on each of them. What we're seeing in FIT much to our surprise is that the NPM1 patients, in general, are not going to transplant. And the reason for that is pretty simple. If you're MRD negative CR as an NPM1 patient, transplant is contraindicated. If you're -- the KMT2A patients are going to transplant because that disease is different, it's more aggressive. It has an 8-month EFS versus a 22-month EFS for NPM1. But you -- what we are seeing is we're driving patients, KMT2A patients to transplant and then putting them back on zifto on the other side.

And when we think about MRD negativity and want to sort of understand the bar for success here. Can you give us a sense of the expectations around MRD negativity in the control arm?

Yes. So that's -- let's be clear. There is the MRD negativity assessment that the site makes that's typically done in plasma or in blood. And there's the MRD negativity assessment that you're doing that's centrally confirmed. And those numbers are different. The site numbers are typically higher. The benchmark for intensive chemotherapy in MRD negativity rates in bone marrow after 2 cycles for NPM1 is about 45%. 45% of patients are MRD negative after 2 cycles. Our goal is to demonstrate a rate of MRD negativity using, again, a high-sensitivity assay in bone marrow that's clinically meaningful above that. That's typically 10% to 15%. When we show you the update middle of this year on the intensive chemotherapy combo, look for that rate of MRD negativity that is assessed in bone marrow. The local assessments will always be higher, but the FDA wants to see the central assessment in both the control arm and the active arm.

Great. And then in the unfit population, maybe also your sense around bar for success when you think about CR and overall survival.

Yes. So the bar for success in the unfit population, this is the venetoclax/azacitidine combination. And we're there, we're only enrolling NPM1. You're in the range of about 60% CR rate in NPM1 and your OS is about 22 months for the NPM1 population. So that's what you're -- for both of those, either accelerated or full endpoint, those are the benchmarks you're looking to exceed.

Great. And you've highlighted a couple of updates from other zifto studies, KOMET-007, we'll get an update in the first half of 2026, 008 in the second half of 2026. Maybe starting with the 007 update where you presented some data at ASH. Maybe help us to understand what additional data we would get in the first half of this year. And then again, what should investors be focused on as those data sets are rolled out?

Yes. Thanks. There's actually 3 updates. Maybe I can just clarify. So we're going to present a publication that was really a continuation of the data you mentioned at ASH. That's venetoclax/ azacitidine, ziftomenib in the relapsed/refractory NPM1 setting. The significance there, particularly when you put zifto on top of ven/aza, your ORR goes to almost 80%. So to Brian's point, that's not going to be within the label, but we heard very clearly from clinicians get this data out, like we want to be educated. The physicians want to use these drugs in combination.

So you'll see that probably around midyear. We don't control publication timing. That's -- that will be a peer-reviewed publication. There will be a frontline update. What I would look for there is the sort of the median patients had been on the Phase Ib frontline study last year for about 5 or 6 months. This is now a year later. So that means your median patient will have been on almost 18 months. The significance of that is if you -- thinking about the frontline opportunity, if you can -- you have 10,000 patients, if you can keep them on therapy for 18 months, that is a $10 billion market. So investors should be paying attention to that. You're still going to want to see a positive Phase III, but these Phase Ibs are so large and robust, they'll go a long way to derisking it. The last data set is the one you mentioned that is the ziftomenib gilteritinib combo in relapsed/refractory NPM1 FLT3 co-mutated patients.

I'll just remind folks, that's half of your NPM1 population in every line of therapy. We have already said we were successfully able to dose escalate and get into an expansion with no DLTs, you're going to see that data back to the point that Brian was making, right now, there's -- what we hear is physicians will sequence FLT3 NPM1 co-mutated patients through gilt and then give them a menin inhibitor because gilt has a survival advantage. It went through a randomized trial. If you can give them data that says, don't do that, actually give the 2 together, you'll drive a better outcome, we think that will be very informative. Look for that data around the end of the year.

And what sort of data will kind of help us inform us, if you will, on sort of whether or not these patients are seeing a better outcome of the combination?

So the CR rate for gilt in that setting is less than 20%. The CR rate for zifto is 21%. The CR rate for our competitor is, I think, 23% you want to see a CR rate that is meaningfully better than those numbers and good durability. If you see that, I think you're in good shape. I'll also remind you, Etzer, that we're also evaluating quizartinib plus zifto in the frontline setting. That study is still in dose escalation. But to date, we've had no trouble at all combining with either of the 2 marketed FLT3 inhibitors.

Great. And then TOMET-015 study ongoing in GIST. Maybe if you can just comment on that study and perhaps where you are in dose escalation?

Yes. So what you're referring to is the study to assess imatinib plus ziftomenib in recurrent metastatic GIST. These are patients who have failed imatinib. The significance here is menin controls the transcription of KIT. So by combining a menin inhibitor and a KIT inhibitor, you're attacking KIT from 2 different directions. You're blocking the catalytic activity and you're blocking the transcriptional activity. What we've seen preclinically is we can resensitize KIT failures to almost any KIT inhibitor. If we're successful, this is the first novel MOA in GIST since the advent of KIT inhibitors, right? Believe that's like 25 years ago. So that's a big deal.

I think we all appreciate from Cogent, from GSK, how big that GIST market could be. We're currently in dose escalation. I think we're encouraged by what we're seeing. We're at doses now that are higher than the AML doses, and it's going well. I think, Etzer, you're probably looking at a data update next year. We want to have enough data that we can come forward and really have a conversation about where we go from here.

Maybe we can spend the last few minutes on darlafarnib. A couple of programs there, KRAS G12C mutant solid tumors, RCC. Maybe just first on the KRAS mutant program, what -- how much data, again, could we see across the different KRAS mutant types? And we can have some follow-up questions on that.

Yes. So we are in that study, combining adagrasib, the KRAS G12C mutant selective inhibitor and darlafarnib. We're evaluating it in patients with non-small cell lung, colorectal and pancreatic cancer. Many of those patients have actually already seen a KRAS inhibitor. You're going to see Etzer, between the -- well, actually, this is just the escalation. You'll see 30 to 40 patients. It's a meaningful data set.

And when you think about sort of the KRAS space, there's always been a lot of focus around PDAC. But is there a particular histology that you think could be more meaningful than others? Or just maybe where sort of the benchmarks line and be able to sort of come ahead of those benchmarks?

Yes. Our goal is -- maybe just to frame the problem, and it's a common problem in both RCC and KRAS. Resistance is the problem, right? So even with all of the successes that we've seen, it's not like we're curing patients, right? Half of them respond off those half most of them eventually relapse. What you're doing with darlafarnib is you're blocking a major resistance mechanism. To your question, what we'd like to show with this data is we're bringing forward a novel mechanism of action that is broadly combinable and whether you have a mutant selective, a pan-selective, you're going to want to combine with darli. What are people doing right now? They're combining with cetuximab, right? They're going back 20, 30 years because they're trying to overcome resistance. So that's really going to be the focus. You'll see us articulate a development plan. Is it pancreatic? Is it colorectal, doublets or triplets.

Look for us to do that a little later. At this point, I think we want to get everybody saying, yes, that's obviously an MOA. I would want to combine with these KRAS inhibitors.

And I think to your point around sort of KRAS cancers and then the inevitable escape mechanisms that develop, right, to be able to keep patients on longer, durability matters. So I guess, is there another data set later on that could be more telling in terms of whether or not you're seeing the durability associated with being able to stop that resistance mechanism? Or could we get that type of update at this first?

I mean the hope is -- so whether we're talking about RCC or KRAS, what you're looking for is if a patient had adagrasib and progressed, a physician wouldn't normally think to put the patient back on adagrasib, right? Same thing with cabozantinib. So if we can show you examples of patients where we've been able to put the patient back into response, the only thing we've done is to add darlafarnib that's pretty interesting in terms of overcoming the resistance mechanism.

Part of the reason we're just now much more mature and disciplined. Part of the reason we've waited to show this data is you want to give your responses time to confirm. You want to have enough durability data that you can say something meaningful. It's still a Phase Ia, but we're also using that data in confidential conversations with a number of the players in the KRAS and RCC space because everybody has the same problem, right? And just to go to RCC for a second, there's a view that we're going to see a triplet of HIF-2 alpha TKI-IO go to frontline. If a patient fails that, you've just exhausted the 3 mechanisms in RCC. What do you do, right? And we're hearing a lot of enthusiasm if we can introduce a new mechanism of action that resensitizes patients to one or more of those MOAs, that's a big deal. The second-line opportunity is going to look different and is going to continue to be quite significant in RCC. So lots of exciting data to come in the darli program.

Great. And with combinations, particularly with KRAS, I think the question around safety always comes up just given sort of the KRAS historically being a problematic molecule to combine with. Maybe your thinking around like what sorts of safety signals should we be looking out for? What's problematic? What is reasonable to assume from a manageable safety perspective?

So I can say this, right? And folks who have followed this story for a while have heard me say this. I always talk about safety and tolerability because if you can't combine, you can't drive efficacy. The fact, Etzer, that we can combine at a full dose with cabo, alpelisib and adagrasib, full dose of each of them, full dose of darli kind of tells you everything you need to know. Do we -- the only AEs we see are on mechanism myelosuppression, which you're not going to address in a dose escalation because you want to see the tox, but you just give supportive care, you give G-CSF, for example, for the neutropenia, and you can address that quite meaningfully.

The beautiful thing about FTIs is this is why I keep pushing this mechanism. We have 5,000 patients worth of data, right? The safety profile is as good as it gets. It's better than cetuximab, for example, no disrespect, right? The -- I think people will be very pleasantly surprised. We hear from the clinicians in the RCC study. The remark at how well tolerated the cabo/darli combo is relative to other things they've seen. And I think that's going to allow us to drive interesting activity.

Right. So we're up on our time. Troy, Brian, thank you so much for your participation, and thank you to our listeners, and then we'll be back shortly with our next session.

Thanks Etzer.

Thank you.

Good day, everyone. My name is Abigail, and I will be your conference operator today. At this time, I would like to welcome you to the Kura Oncology's Q4 and FY 2025 Financial Results Earnings Call. [Operator Instructions] At this time, I would like to turn the call over to Greg Mann, SVP of Investor Relations and Corporate Affairs of Kura Oncology. Please go ahead.

Thank you, Abigail. Good morning, and welcome to Kura Oncology's Fourth Quarter 2020 Conference Call. Joining the call today are Dr. Troy Wilson, President and Chief Executive Officer; Brian Powl, Chief Commercial Officer; Dr. Mollie Leoni, Chief Medical Officer; and Tom Doyle, Senior Vice President, Finance and Accounting. We remind you that today's call will include forward-looking statements based on current expectations. Such statements represent management's judgment as of today and may involve risks and uncertainties that cause actual results to differ materially from expected results. Please refer to Kura's filings with the SEC, which are available from the SEC or on the Kura Oncology website for information concerning risk factors that could affect the company.

With that, I'll turn the call over to Troy.

Thank you, Greg, and good morning, everyone. 2025 was a defining year for Kura, marked by FDA approval of KOMZIFTI and initiation of a successful commercial launch. As we enter 2026, our priorities are clear: execute commercially, move aggressively into frontline AML and combinations and build long-term leadership in men and inhibition while advancing a data-rich pipeline. KOMZIFTI generated $2.1 million in net product revenue in the final weeks of 2025. Although it's early, the launch is off to a strong start.

Feedback from physicians, pharmacists and payers has been consistent. KOMZIFTI delivers meaningful efficacy with differentiated safety, simplicity and combinability with concomitant medications in medically complex AML patients that matters. We believe leadership in relapsed and refractory NPM1 mutant AML will be determined by preference, not by who enters the market first. Importantly, KOMZIFTI is now listed in the FDA's Orange Book with patent protection through July 2044. That runway strengthens the long-term value of the franchise, particularly as we expand into frontline AML and combination settings.

Our strategy extends well beyond the initial approval. Enrollment is underway in our pivotal KOMET 017 frontline trials and 2026 will bring important data in both the frontline and relapsed/refractory settings. We're positioned Ziptomenib as a foundational combination partner in AML, including with FLT3 inhibitors and standard backbone regimens across relapsed/refractory and frontline nail we estimate the total U.S. opportunity at approximately $7 billion. Beyond AML, we're advancing a focused solid tumor strategy -- our ziftomenib combination with imatinib in gastrointestinal stromal tumors, or GIST, is progressing in dose escalation and our next-generation menin programs are advancing.

Darlifarnib, our furnace transferase inhibitor is designed to address resistance mechanisms across multiple oncogenic pathways. It's combination flexibility, including with cabozantinib, KRAS inhibitors and PI3 kinase inhibitors gives it potential to impact more than 200,000 patients annually in the U.S. We expect multiple clinical ups this year. In short, we're executing commercially, expanding development of ziftimenib across the AML treatment continuum and advancing a pipeline with meaningful catalysts in 2026.

WillWith that, I'll turn it over to Brian.

Thank you, Troy. Good morning. Our commercial objectives for KOMZIFTI are straightforward, establish clear differentiation in the menin inhibitor class, delivered strong quarter-over-quarter growth and achieve leading class share in relapsed/refractory NPM1 mutant AML. The early launch is exceeding expectations. I could not be happier with the execution of our world-class team who have been laser-focused on delivering a strong launch. Prescription trends are strong and the quality feedback has been consistent and encouraging.

Positions, both academic and community-based consistently KOMZIFTI clinical activity and ease of use. Once-daily dosing and lack of required azole dose adjustments are meaningful advantages in real-world AML practice, institutional pharmacists firmly echoed this in complex patients on multiple medications, safety and predictability drive confidence. We also hear clearly that the safety profile matters. KOMZIFTI carries a single boxed warning for differentiation syndrome compared to multiple box warnings for a competitor. That difference is resonating. Importantly, KOMZIFTI was added to the NCCN guidelines as a category 2a recommendation within a week of Kura's submission.

That rapid decision reflects enthusiasm and strong alignment among clinical thought leaders. Operational execution has been strong. KOMZIFTI was shipped within days of approval, and our experienced sales force brings an average of more than 20 years of industry experience and deep hematology expertise. The team was trained and fully deployed and in partnership with [indiscernible] is targeting more than 4,000 hematology professionals. Our message is simple. NPM1 mutations are now actionable and KOMZIFTI offers a differentiated profile.

Access has been a major strength and highlights a powerful leading indicator early in the launch. We engage payers covering approximately 90% of insured lives prior to approval. Within 90 days, approximately 84% of private payers had established coverage aligned with the label and without additional restrictions. That speed of coverage surpasses both industry benchmarks and our internal expectations. We're also thrilled to report that certain Blue plans are now requiring patients to go on KOMZIFTI before allowing coverage for the other approvement in inhibitor.

It's our understanding that their decision to implement this stat was based on the efficacy, safety and predictable price per patient. Step editing is uncommon in oncology. We view this as a meaningful independent validation of KOMZIFTI's profile and competitive advantage as the class evolves. KOMZIFTI is distributed through a focused network of specialty distributors and pharmacies through CuraRxConnect the average time for prescription to payer decision is 2 days. Patients are getting rapid access. We estimate the initial U.S. market for NPM1 mutated relapsed/refractory AML at approximately $350 million to $400 million annually. This is our starting point.

On top of our enthusiasm about our early launch, we strongly believe that long-term leadership across the AML continuum will be determined by breadth. By who can combine effectively with ven/aza 7+3 and FLT3 inhibitors and take the lead in frontline disease. KOMZIFTI it's profile, particularly at safety, combinability and simplicity position us to maximize the efficacy benefit across settings and drive class leadership. In the near term, we'll remain focused on quarter-over-quarter growth net revenue and new patient starts. Over time, we anticipate providing additional metrics to track progress.

I'll now turn it over to Mollie to discuss our pipeline.

Thank you, Brian. FDA approval in relapsed refractory NPM1 mutant AML was a major milestone, and it's just the beginning. We are building a durable expanding franchise backed by the most comprehensive development strategy. Our will is clear, makes Zipametib a foundational therapy across AML. We are executing the most comprehensive development strategy in the category. We expect to deliver multiple updates this year across key programs at major medical meetings supported by an expanding publication plan. Relapse rates in AML remain high, up to 70% within 3 years.

We believe deeper and more durable outcomes require moving effective therapies earlier in treatment. This drives our first to frontline strategy. We are rapidly advancing our registrational COVID-17 program in newly diagnosed AML, which will recruit patients at approximately 200 global sites. The program includes 2 independently powered trials, intensive and nonintensive chemotherapies, each designed to support potential U.S. accelerated approval and full approval.

Data from the Phase I KOMET-007 trial support this strategy in newly diagnosed patients treated with 7+3 or venisomenib, we observed high CR rates and deep MRD negativity Importantly, the addition of zitamenib did not meaningfully delay platelet or neutral account recovery in either combination. We expect to present updated intensive chemotherapy data from KOMET-007 in the first half of 2026. In parallel, we are preparing a manuscript detailing is implemented in combination with [indiscernible] in the relapsed/refractory NPM1 mutant AML setting.

Data last December showed encouraging safety, tolerability and clinical activity in this population. The combination was generally well tolerated without additive toxicity and meaningfully improved overall response rate composite CRE and overall survival relative to ziptamenobolone. We view this as an important component of our strategy. and we believe it has the potential to significantly improve outcomes in patients with relapsed/refractory NPM1 mutant AML. FLT3 co mutations present another significant opportunity and 1 we are well ahead of competitors.

We are evaluating zitimedibin combination with gilteritinib in the relapsed/refractory setting and with quizartinib in the frontline setting. If we can demonstrate the ability to combine with FLT3 inhibitors, we believe that will be a key differentiator Outside AML, KOMET-015 is evaluating cytomatinib in patients with advanced GIST. Dose escalation continues without dose-limiting toxicities in a broad range of doses. We remain very encouraged and plan to provide an update when appropriate.

Turning to darlafarnib. We are advancing this FTI in combinations to address resistance biology across solid tumors. We announced today the initiation of the Phase Ib dose expansion of FIT 001 with cabozantinib in advanced renal cell carcinoma. The Phase Ib portion comprises of randomization into 3 arms in line with project Optimis, including on cabozantinib monotherapy arm. This third arm provides a controlled benchmark and enables us to evaluate the combination in patients who are not responding to or just beginning to fail cabozatinib therapy. Phase Ia dose escalation data from FIT 001 showed encouraging safety and tolerability as well as antitumor activity, including in patients previously treated with cabozantinib.

Updated data will be presented in the second half of the year. We also plan to present preliminary data from our Phase Ia study evaluating darlifarnib with adagrasib in patients with KRAS G12C mutated lung, colorectal and pancreatic cancers in the first half of 2026. Finally, our menin inhibitor programs continue to advance, including preclinical work in solid tumors, as well as diabetes and cardio metabolic indications. In summary, we are working to move zitiminib earlier in the AML treatment paradigm, expanding our combination strategies and advancing a second growth pillar with the FTI platform with multiple catalysts this year.

And with that, I'll turn it over to Tom for a financial update.

Thank you, Mollie. I'm happy to provide a brief overview of our financial results for the fourth quarter of 2025. As we preannounced in January, our net product revenue from KOMZIFTI sales was $2.1 million compared to none for the fourth quarter of 2024. The first commercial sale triggered a $135 million milestone payment under our collaboration agreement with [indiscernible]. Collaboration revenue from our [indiscernible] partnership was $15.2 million compared to $53.9 million for the same period in 2024.

Research and development expenses were $64.4 million compared to $52.3 million for the fourth quarter of 2024. The increase was driven by zitomentid combination trials, including the start of enrollment in our KOMET-017 trial in 2025. Sales, general and administrative expenses were $39.1 million compared to $24.1 million for the fourth quarter of 2024. The increase was driven by the commercial launch of KOMZIFTI. Net loss for the fourth quarter of was $8 million compared to a net loss of $19.2 million for the fourth quarter of 2024. This includes noncash share-based compensation expense of $11.3 million compared to $8.6 million for the same period in 2024.

As of December 31, 2025, car at cash, cash equivalents and short-term investments of $667.2 million compared to $727.4 million as of December 31, 2024. Our $667.2 million balance at the end of 2025 reflects fourth quarter 2025 receipts of $195 million for the first commercial sale of KOMZIFTI and KOMET-017 enrollment milestone payments. Kura is providing guidance for collaboration revenue, which reflects noncash-based accounting recognition of performance obligations under our collaboration agreement with [indiscernible]. We expect this to be $45 million to $55 million in 2026, $90 million to $110 million in 2027 and $90 million to $110 million in 2028.

Current cash, cash equivalents and short-term investments as of December 31, 2025, together with anticipated milestones of $180 million under our collaboration agreement with [indiscernible] are expected to fund our Zetomented AML program through the first top line Phase III results from KOMET-017 anticipated in 2028.

With that, I turn the call back over to Troy.

Thank you, Tom. Kura enters 2026 with strong momentum. We have a launched product, which is performing well. We have the broadest frontline AML development strategy underway. We have multiple data readouts ahead and we have a second platform advancing in solid tumors. Our priorities are clear: accelerate uptake of KOMZIFTI in relapsed refractory NPM1 mutant AML and delivered strong quarter-over-quarter product revenue growth, advance and execute on our first to frontline strategy, generate and publish combination data, which guides treatment decisions and deliver clinical updates across our FTI platform.

2026 will be a year of execution, expansion and data. We're building a durable franchise in AML and a broader oncology pipeline with both breadth and depth. Everything is moving forward commercially, clinically and operationally and we're focused on converting that momentum into long-term value for patients and shareholders.

With that, Abigail, we'll conclude and open the call for questions.

[Operator Instructions] Our first question comes from Lee Watsek with Cantor Fitzgerald.

Congrats on the progress. Maybe a commercial question for Brian. You made a very interesting comment about step editing that some peers may require to use concept before the competitor product. I just wonder if you can give us a little bit more information about that. What percentage of payers have implemented the stock through policy and any specific feedback you can share from peers regarding [indiscernible] ?

Yes. Thanks, Lee, for the question. I'm going to -- just to remind everyone, we're going to try to limit to 1 question per analyst so that we can get through everyone. But Brian, I'll let you -- there's 2 or 3 questions tucked in there. I'll sort of let you speak to them.

Right. Thanks. And thanks, Lee, for the question. Yes. Yes, as we shared in the remarks, I think -- we think that this news of a step at it in required from some payers that's just come forward is a powerful leading indicator that supports kind of our overall assertion about KOMZIFTI being differentiated. I will say that our team -- the market access team has done a phenomenal job securing access and working with payers so broadly to get this access so early. What I can kind of share around the step edit and as you know what that recommend, the recommendation from some of these payers is that a patient should -- would be recommended to receive KOMZIFTI before receiving any other menin inhibitor.

Our understanding is the basis of that is built on a report from a group called IPD analytics. It's an independent consulting firm who is influential to many payers. And their recent reports of the relapsed refractory market in evaluating comset, recommended the step that for adult patients with relapsed/refractory and PM1 mutant AML. We know that there are some payers that have started to implement that, as I shared.

The biggest driver from what we can understand from this -- from the consulting summary from IPD, is that really, the 4 pillars we talked about around the differentiation of Comfy stood out, particularly because of the predictability of the cost. If you look at the -- based on their assessment, the annual WACC for KOMZIFTI in this setting is about just under $600,000 a year. But with our competitor MET inhibitor because of the different dosing schemes and SKUs that come forward, it comes up to almost $1 million a year. And I think that's where we see they're driving the difference when you also add in the safety profile, the combinability and the predictability of that.

So I can't really give you an overview of how many plans there are a handful, and we can't predict how many other plans may do this in the future, but it's encouraging for us as we look to become the class leader here in the NPM1 space.

Your next question comes from Roger Song from Jefferies question.

I should congrats for the update. And then the very encouraging early launch Signal. So the stablity certainly very interesting, maybe just given the excess is very rapid and broad, can you comment on the patient demand side versus the revenue generation, if any thing you can comment on the trend for the rest of the year? That would be helpful.

Yes. Thanks, Roger. I'm happy to do that. So we haven't we're not going to be giving you guidance specifically on the trend. What we can tell you is that the launches, as I said, has been off to a very strong start. We are seeing patient demand the feedback we've heard from physicians has echoed back the differentiation pillars that we've talked about, payers, physicians and pharmacists have all kind of given us similar feedback.

So what we anticipate and as we get into our next quarter, we'll start to see a little bit more data, we'll be able to share around new patient starts of things. I can tell you that the demand has been strong and that we've been pleased with the direction that the launch has gone so far.

Our next question comes from Jonathan Chang with Leerink Partners.

This is Albert Austin on for Jonathan Chen. Congratulations on all your progress. So my question is what do you see as the biggest hurdle now for KOMZIFTI to gain market share in 2026. Now is it just prescribers inertia or something else?

Yes, sure. Sure. Thanks, Albert, for that. Yes, I mean, I think that we're -- what we anticipate with the NPM1 market, this is a market that is really going to be driven on new patients coming forward and kind of incident patients as they're diagnosed into -- or progress into the second, third, fourth line setting. So it really will come down for us as to getting those patients into our queue. One of the part -- I think 1 element of this market that's a bit unpredictable for us as you as you well know, is that we're approved in a monotherapy setting, and that's where our teams are going to be promoting.

But we do -- we've heard a lot from physicians that they're looking to use menin inhibitors and KOMZIFTI in combination. That will be 1 of the questions for us to understand is how that uptake comes out in the combination setting. That will be something we'll be able to see coming forward in the future. But we don't see -- the payer hurdles have been really nonexistent. We're really pleased with how quickly our uptake has been getting on policies. So we don't really see any major hurdles other than just getting those incident patients onto therapy.

Albert, this is Troy. I might just add a comment or 2 to Brian's response. This is why we've laid out in our milestones for 2026 the significance of the publication in relapsed refractory NPM1 mutant AML with ven/aza that Mollie mentioned, as well as the combination with gilteritinib. As Brian mentioned, this is a very different market than KMT2A. We're obviously going to have the sales team promoting on label with monotherapy -- but what's clear, and I think we'll continue to be clear, is the ability to combine the ability to drive better outcomes for patients is ultimately going to be of great value.

And what we see, it's why we feel confident that we're going to take leadership not only of the NPM mutant class, but ultimately, of the much larger opportunity because it's going to be about combinations and the attributes that Brian mentioned that were highlighted in the IPD Analytics report, those become ever more important as you move into combinations. Just to make an example, we're well ahead of the competition in terms of combining with inhibitors. As you know, that's half of the NPM1 population. So it's an important part of our leadership strategy.

Your next question comes from Salim Syed with Mizuho Securities.

Congrats on the progress. Just 1 for us on the 50% that you noted here, Troy, the market feedback suggests you get up to 50% of AML patients here trying to -- just what is the assumptions that you put in from these doctors when you're kind of doing your market feedback work? And is it just based on the existing data? Or is there something that you're still planning to get to sort of get to that leading the leading share, I think, as you put it?

Yes. And Salim, I take from your question, you're referring to the relapsed refractories segment. Is that your question point the market feedback Yes, I'll ask Brian to speak to that. Thanks for the clarification, Brian?

Yes. No, absolutely. And. And we've gotten feedback as we -- both from physicians, but we do physician market research as well -- and it's interesting, we've had -- we basically provide the profiles of the products. It's blinded. We don't ask them which company, they don't know who's asking the questions. And of those, we found that have had familiarity with the men in class the profile that we've outlined seem has come back to be the preferred profile, both across efficacy, safety, the simplicity, combinability, compatibility of working with other agents. So those are -- the feedback we've heard is that gives us the confidence that as we build into this market, we'll have an opportunity to become that market leader and take the delete share in the mid in class.

Yes. And I'll just add to that. Salim just add to that. I mean at this point, we're not really talking about FLT3 in terms of doing the market research. This is really focused on the monotherapy -- but 1 of the differences between this market and the KMT2A market is, obviously, if you have a FLT3 mutation, gilteritinib has a survival advantage. And so it's reasonable to assume a menin inhibitor is going to be sequenced after Gilt.

If you can demonstrate as Mollie indicated that you can safely combine and that, that's beneficial to the patient, that's going to ultimately drive kind of a next leg within that relaxed refractory segment. We're not really yet there with the physicians because we obviously have to do that with data. But that's what gives us the encouragement. Today, it's monotherapy tomorrow, it's the combination with ven/aza, the day or 2 after tomorrow, it's the FLT3 combination and it just builds 1 after the other.

Your next question comes from Reni Benjamin with JMP Securities.

Congratulations on the early launch and hopefully it's going well for 2026. You talked a little bit -- Mollie talked a little bit about the combination of bazartinib and gilteritinib and the FLT3 opportunity. Can you talk a little bit about what you're hoping to see in your FLT3 data? And how important is kind of maximizing the opportunity when we're thinking about the potential $7 billion TAM for zifto?

Yes. Thanks for that question. So the most important thing you can see when you look at our combination data is going to be safety, safety indicating that you actually can combine. And obviously, after that, to improve upon the agents in isolation. So as I said, we'll be presenting our relapsed/refractory gilteritinib data towards the end of the year. We will be presenting both the dose escalation and the expansion, which should tell you that we were able to combine the drug successfully and safely for these patients.

With the front line, we are in the process of dose escalation with quizartinib, a combination was famed plus 7. And again, that continues to advance -- so overall, we expect to be able to show you not just the fact that we can combine, but that we can improve upon the outcomes of these drugs in isolation.

Yes. And Ren, just to build on Mollie's comments, we've seen commentary recently from Astellas that have identified gilteritinib as 1 of their blockbusters 1 of the 5 sort of emerging blockbusters. They have a frontline trial that's was conducted with HOVON that is expected to read out any day now. As we said, FLT3 is 1/3 of all of AML patients. It's hard to imagine you can have a market leadership strategy without including FLT3.

That's why we're combining with both quizartinib and gilteritinib you will see us over the next quarter or 2 move more aggressively into the 3 frontline setting because that -- we haven't really yet broken it out, but that will be -- it's a major driver in that $7 billion TAM ultimately as you look across all lines of therapy.

Your next question comes from Charles Zhu with LifeSci Capital.

Congrats on all the progress. I'll ask one on a slightly different topic regarding FTIs. We had a lot of updates from the recent ASCO GU conference, particularly in renal cell carcinoma and some of the emerging HIF2 alpha or emerging an approved HIF2 alpha inhibitors in that space. Maybe could you help contextualize your upcoming second half data for Daly plus cabo, not only within the current standard of care, but also amongst the potential emerging standard of care as well?

Sure. Yes. We're following that data very closely as well, and it's looking very good for patients. In fact, I think as you're referring to, it's looking so good that it probably will end up moving up in line in line of therapy for these patients. We, as we announced, have just started our Phase Ib which is a randomized Phase Ib so that we can both contend with project optimist, but also set some baseline data for ourselves with cabozantinib in this particular line of therapy.

And we will be able to also see if patients that are randomized to the cabo monotherapy can cross over and successfully either gain or regain responses when you combine it with darlifarnib, which I think is an important demonstration of our mechanism of action. We do think that our data as progress as they are, and we have limited follow-up time compared to some of these other studies are still competitive with a lot of these data that are being presented, and we look forward to sharing that updated information with you.

But what we do think is again, that these good outcomes for patients alphas we'll move them earlier in lines of therapy. So you'll see them in the front line. And ultimately, it can open a rather big vacuous space in the second line. that we could then jump right into with this cabo-dalafarnib combination.

Your next question comes from Jason Zemansky with BofA.

Congrats on the progress. Brian, I was hoping you could share some of the early feedback from your prescribers that are new to come if maybe that haven't been associated with any of your clinical programs or at least minimally associated. We recognize this is a small community, and it's early days, but maybe for those, especially I participated in a trial associated with your rival or don't have a large AML population, how has the product profile resonated?

Yes. Thanks for that question, Jason. And I'd speak to it both from physicians we've heard from, but I'd also point to pharmacists like the pharmacists that are -- have maybe not been involved so much with treating the patients outside of the trials. The feedback that we've heard has really -- they recognize that there are -- there's multiple menin inhibitors available the efficacy we've heard seems to be table stakes essentially.

I think both products have similar efficacy. What really does outline is the questions around how to manage QT understanding what monitoring for QT prolongation means versus edits the not just having to monitor, but to understand the potential implication of a higher risk of cardiac issues has come back from us as well as -- I mean, even the simplicity of treating patients once a day without having to do a lot of dose modifications based on the complexity of other therapies they have. So we've heard that.

I mean I think what we know is that, of course, a lot of probably early scripts are going to be those for people who've had a lot of experience with us. But we have received feedback from physicians who are new to the men in class, and we've been spending our time educating them around comp. So we're as we said, it's early days, but we're pleased with what we're hearing so far and it seems to be consistent from what we've heard from those who do have experience.

[Operator Instructions] Our next question comes from Etzer Darout with Barclays.

I'd like to ask about KOMET-008, guided to showing data in combination with gilteritinib in the second half of this year. Can you remind us where you stand with regards to the combination of Zip to with flag IDA and with the low-dose coterbine?

Sure. No. As you said, we have been guiding to release the gilteritinib data because -- in large part, we think that is very informative to physicians and how to treat DeBlase refractory NPM1 mutant co-mutated with FLT3 as well. but also within that study are our flag IDA combination, which sees mostly second-line patients and our LDAC combination, which allows for an easy combination with zippimetit that gives time for this differentiating agent to really take effect while keeping disease control simultaneously.

So we haven't guided to when we'll be releasing that data. But I do think that it will be we'll do it pieces at a time to keep the information coming and also be writing a publication. But again, we haven't guided as to when those additional cohorts will be shared.

Your next question comes from Phil Nadeau with TD Cowen.

It was great to see the team this week in Boston. We have 1 commercial question. I think you suggested that the relapsed refractory NPM1 market is about $300 million to $400 million. in revenue. We're curious to hear how quickly you think the menin class can penetrate the market. It seems like the value proposition is pretty clear today. But we're wondering if there's any gating like combo therapy data, in particular, that could be necessary to fully penetrate the opportunity?

Great. Thanks, Phil, and thanks again for seeing you. Good to see you yesterday. Yes. The -- as we've said, this TAM of $350 million to $400 million is kind of representing that relapsed/refractory space. We think because of the dynamics of the NPM1 population, where physicians have previously had choices for their patients to either get ven/aza or a FLT3 inhibitor for those who are co-mutated we anticipate early on, there will probably be more of the -- kind of the relapsed refractory in the third or fourth line setting. Combinations will help to drive that into the second line where you'd be able to see more patients get therapy and benefit earlier.

Our expectation is that there'll be a lot of -- as we said, there's a lot of use likely in the -- as a monotherapy, but the physicians are very excited about using in combination. It's not something we can promote on actively, but we will educate based on publications around like the ven/aza publication that we plan to publish in the -- with -- based on KOMET-007. So what we anticipate is that there will be a ramp-up based on incident patients coming forward, probably starting more in the in the third, fourth line, but we will see and we are starting to see those second line patients as well. We'll need a little bit of time to really get an understanding as to how the how companies being used in combination relative to monotherapy.

Your next question comes from David Dai with UBS.

On the quarter. Just 1 question on the duration of therapy. So I understand it's early innings, but any thoughts on duration of therapy or cost so far. And as you are thinking about combination with ven/aza or gueritinib, how do you think the duration of therapy call evolve over time?

Great. Thanks, David, for that question. Obviously, we're sharing 5 weeks of data. We can't really give you a lot of detail around duration of therapy at this point. Our expectation is that patients will be able to get therapy for up to -- we think an average of 6 months, our label suggests that patients are treated for up to 6 months to maximize the depth of their response. And for those patients who do get a response, we've seen duration of therapy of 5 months duration of response of 5 months and oftentimes it takes 3 months or so then to get that response to achieve the response.

So we think that we'll get to -- we're not seeing any signs yet because it's too early to see -- we are seeing repeat prescriptions but it's too early to talk through any duration right now. To your question around FLT3 inhibitors, I think that any combination is expected to give a longer duration of treatment than you would expect as a monotherapy.

There are no more questions at this time. I'd now like to turn the call over to Troy Wilson for closing remarks.

Thank you, Abigail. Thanks, everyone, for joining the call today, and thanks for all the questions. We will see many of you next week in Miami at the various events and conferences. If you have any additional questions, please reach out to Greg or me. And we wish all of you good morning and a good rest of the day. Thanks, again.

Good day, everyone. My name is Abigail, and I will be your conference operator today. At this time, I would like to welcome you to the Kura ASH 2025 Update Call. [Operator Instructions]

At this time, I would like to turn the call over to Troy Wilson, President and CEO of Kura Oncology. Dr. Wilson. Please go ahead.

Thank you, Abigail, and good afternoon, everyone. Welcome to our ASH 2025 analyst and investor event. This is -- this has been a big day, and it's been a great conference for menin inhibitors in acute leukemia. If we can go to the next slide.

We're going to be making certain forward-looking statements today in the presentation. And I would just refer you either to our website or to the SEC's website for more information about Kura Oncology and about the risks and certain investment in the company.

If we can go to Slide 3. Here, you can see the agenda. Today, we're going to be reviewing the data that was actually just presented in the oral session here at ASH. That is ziftomenib combination with azacitidine and venetoclax both in the newly diagnosed NPM1 mutant AML setting as well as in the relapse and refractory NPM1 mutant and KMT2A rearranged AML setting.

We're going to aim to have prepared comments approximately half an hour. That should leave us plenty of time for Q&A. So if we can go to the next slide. It's really my pleasure to welcome and to thank the 2 key opinion leaders that we have on today's call. Dr. Wang is the Chief of Leukemia Service as well as Professor of Oncology at Roswell Park, and Dr. Zeidan is the Chief of Hematologic Malignancies and the Director of Hematology and Early Therapeutics Research as well as Associate Professor of Medicine at Yale.

Each of them are intimately familiar with ziftomenib and, I think, can really speak to the data that we're going to go through today. We're, of course, thrilled because this is the first ASH where ziftomenib is now approved and the branded name is, of course, KOMZIFTI, available as 200-milligram capsules. For Kura Oncology and our partners at Kyowa Kirin, this has really been a very exciting ASH.

The feedback has been extremely positive. Physicians, caregivers, patients, the entire community are thrilled to have another option available for patients. And it's our goal, as you'll see today, to build on this initial approval in the monotherapy setting, and continue to evaluate ziftomenib in combination with various standards of care.

If we can go to the next slide. We'll talk about this, but we like to frame the opportunity for KOMZIFTI as one is evaluating this data really around 4 pillars, and they're shown here: efficacy, safety, compatibility and simplicity.

We'll touch on each of these in turn in the data, both in the frontline and in the relapsed/refractory setting. We think this combination of these 4 features really provides a compelling option to physicians as they think about how best to treat their patients with AML. And we'll touch on these, I'm sure in the prepared remarks, and in our answers to your questions.

So if we can go to the next slide. It's my pleasure to turn it over to Dr. Zeidan, who's going to take us through the ziftomenib and ven/aza data in the newly diagnosed NPM1 mutant population. Dr. Zeidan?

Yes, thank you so much. So it's my pleasure to be here today. So I'm going to preview the data that was actually just presented this morning about the combination of ziftomenib with venetoclax and azacitidine in newly diagnosed NPM1 mutated acute myeloid leukemia from the ongoing Phase Ib trial on behalf of my colleagues.

Next slide, please. So this is overall schema of the trial. There was a dose escalation, as many of you are familiar of ziftomenib in combination with ven/aza in the refractory relapse patient population, and we have settled on 600-milligram daily of ziftomenib as a dose to go forward.

And this what was tested in the frontline setting in patients who are newly diagnosed with acute myeloid leukemia who were mutated for NPM1. So here, ziftomenib was started on cycle 1 day 8 is -- was given as a standard for 7 days, and venetoclax was given as per the label continuously with interruptions of venetoclax based on the bone marrow clearance by the end of cycle 1, and then adjustment based on the blood count recovery.

The primary endpoint of this study was complete response as well as assessment for adverse events, and we observed a number of secondary end points focusing on duration of response, other important clinical responses as well as MRD readings from this trial. This is the first presentation of data in the frontline setting.

Next, please. So here, you can see the study flow for the patients who were enrolled. We had a total of 40 patients who are included in this data cutoff as of September 2025. Of those 40 patients, all of them are safety evaluable and 37 were efficacy evaluable.

As you can see, the median follow-up on the study was 26 months. And at the time of the data cutoff, 70% were still on study and 55% were still receiving ziftomenib. Of the patients that discontinued 16, you can see are the causes of discontinuation, but the discontinuation due to death on study was only on 4 patients, which aligns with what was seen with aza/ven as without a third agent. 5 patients went to transplant, and subsequently, 3 of them went to maintenance with ziftomenib.

Next, please. Here are the baseline characteristics of this patient population, and this is very typical for older unfit patient population. So the median age of this group was 75 years old. We have as old as 93-year old going on this study. 53% of those patients were females primarily white patient population. And there, as common concomitant mutations, including FLT3 and IDH2 as you can see here.

Next, please. So these are the most commonly seen adverse events that were seen in 25% or more that, as you can see here, can be categorized by ziftomenib-related as well as all treatment-related adverse events. This is basically very similar to what we would expect with aza/ven doublet. The most common side effects are in the form of GI adverse events such as nausea vomiting, some diarrhea and the blood count suppression, neutropenia, leukopenia and some incidence of liver enzyme abnormalities.

However, again, those are very common in patients with AML who undergo aza/ven therapy. And once you look at the 3 ziftomenib-related adverse events as designated by the investigator, again, most of these were in line of the previous experience with ziftomenib.

Next, please. Here, we are focusing on the Grade 3 and higher treatment emergent adverse events that occurred in 10% of more. Again, mostly blood count suppression in the form of neutropenia, thrombocytopenia and leukopenia, which are very common in patients with acute myeloid leukemia getting treatment as well as febrile neutropenia and very rarely cases of sepsis.

Importantly, differentiation syndrome was very rare, occurred only on one patient out of the 40 and it was Grade 2 and successfully treated and the patient was able to continue on ziftomenib or resume ziftomenib. And there was also one case of QTC prolongation that occurred in the setting of concomitant electrolyte abnormality and other medication. And again, this is a very common situation that we see in patients with acute myeloid leukemia because of the low magnesium, low potassium, other antifungal drugs to see some QTC prolongation.

Next, please. In terms of the efficacy, this is an overall view of the efficacy, evaluable patient population, the 37 patients who are efficacy evaluated at the 600-milligram dose. And you can see that the CR rate, which is the most important readout from this trial was very high at 73%. And when you look at CR plus CRH, the total was 78%. And when you look at the overall response rate, it was 89%. The composite CR was 86% and the median term to first CRC in weeks was 3.4 weeks so [Technical Difficulty] the first response.

Next, please. Importantly, the MRD in this trial was assisted both centrally as well as locally, using a very sensitive assay to the level of 0.005%. And we looked at 2 thresholds. Both of them, I think, showed very favorable results with the MRD negative rate being 68% when you look at the threshold of 0.1%. And when you look at 0.01%, it was 44%. And you can see very clearly that the patients who were able to stay on treatment had deepening MRD responses where by the fourth cycle, almost all patients, 100% achieved a very deep level of MRD negativity, which we think correlates well with long-term outcomes.

Next, please. This is a study that is still ongoing and the data continues to mature. So for that reason, the median follow-up is 26 weeks. The median duration of complete response was the median OS duration or the median overall survival was not reached either. As I mentioned earlier, some patients with this disease will go to transplant, 5 patients did go to transplant, and 3 of them continue to receive subsequent ziftomenib maintenance. And at the time of this cutoff, 68% of patients were alive and still on study.

Next, please. Importantly, each time when we add a drug to aza/ven , we think about additional myelosuppression and delayed count recovery because this can cause problems in terms of infection and bleeding. But the good news in this trial is that the addition of ziftomenib to aza and ven did not seem to prolong recovery of neutrophil count and platelet count beyond what has been the historical experience with ven/aza. You can see here by 2 cutoffs that the median time to ANC recovery to more than 500 was 36 days and platelet count more than 50, 24 days. When we look at the higher thresholds of ANC of 1, it was 37 days and more than 100 of platelets, it was 30 days. And again, these are in line of aza/ven doublet therapy.

Next, please. So in conclusion, this is the first readout of the frontline NPM1-mutated older patient population on the KOMET-007 receiving the triplet of ziftomenib at 600-milligram daily and combined with aza/ven, and we are seeing high rates of CR. Almost 73% of patients achieving CR, 86% achieving composite CR ,68% achieving molecularly defined MRD negativity, deepening MRD responses over time as the patients continue on trial and the median duration of the complete response and the median overall survival was not reached.

Importantly, the addition of ziftomenib to aza and ven did not seem to worsen the safety profile of aza/ven. The myelosuppression was in line with what we typically see with the doublet. The time to count recovery was also in line and adverse events of special interest such as differentiation and investigator-assist QTC, were very limited and generally well managed.

So taken together, I think this data speaks very well for advancement of this combination to the registrational approach in the randomized ongoing Phase III trial, KOMET-017 that will this combination against aza/ven and hopefully, will lead to the approval of this combination in the frontline setting. Thank you so much.

Thank you very much. This is Eunice Wang, and I'm pleased to present the results of ziftomenib in combination with venetoclax and azacitidine in the relapsed/refractory NMP1 or KMT rearranged acute myeloid leukemia. This is an updated Phase Ia/b safety and clinical activity results from the KOMET-007 study.

So as shown here, this is an ongoing Phase I combination study. We previously presented data with the Phase I dose escalation, which established ziftomenib dose of 600 milligrams as the dose to move into Phase Ib dose expansion and recommended Phase II dosing.

For this trial, patients were enrolled on ziftomenib following then aza. Ziftomenib was started on day 8 and administered continuously thereafter. The primary endpoints of the study were similar to the ones described by Dr. Zeidan, primarily CR and adverse events. And secondary endpoints, we're looking at other clinical endpoints of efficacy, including MRD-negative disease and duration of remission.

Shown here are the dispositions of the 83 patients who are enrolled and treated with the combination of ziftomenib 600 milligrams and ven/aza. There were 51 patients with NMP1 mutant relapsed/refractory AML and 32 patients with KMT2A rearranged relapsed/refractory AML.

There were a couple of patients on the NPM1 cohort who did not have a response assessed at the time of the data cut, so we present data here on response evaluable [indiscernible] patients encompassing 48 NMP1 mutant and 32 KMT rearranged patients. Shown here are the baseline patient characteristics of these relapsed/refractory AML patients. As we would expect in adult patients with AML, the median age of patients enrolled in the study was in the mid-60 range.

The ECOG performance status was anywhere from 0 to 2 and about 24% or 29% of our patients had co-mutations in FLT3, again, as would be expected in our NPM1 mutant cohort. Of note, patients had a median of one prior therapy with up to 4 and these included the prior allogeneic stem cell transplantation, almost 20% of patients, the overwhelming majority, 58% of patients had received prior venetoclax-based therapy and 10% of patients had even received prior menin inhibitor therapies.

The median follow-up for these patients was 25 weeks or approximately 6 months and there are currently 25% of patients that remain on treatment. The safety and tolerability of ziftomenib combined with venetoclax azacitidine in the relapsed/refractory AML population was very favorable.

As you can see here on the right-hand side, zifto-related treatment-emergent adverse events were uncommon. You have nausea, vomiting, diarrhea, which is consistent with any oral chemotherapy administration and you have very low rates of cytopenias, anywhere from 10% to 15% that were attributed to the chemotherapy drug. There was about a 13% or 15% incidence of pruritus, but the majority of these were low grade and easily manageable with supportive medications.

Of note, ziftomenib-related adverse events of interest included QTC prolongation and differentiation syndrome. There was no ziftomenib-related QTC prolongation reported with the combination of ziftomenib 600 milligrams combined with venetoclax azacitidine. Only 2 patients discontinued therapy due to zifto-related adverse events of sepsis and stomatitis. And there was only one patient who developed differentiation syndrome.

This was an NMP1 mutant patient who developed Grade 3 differentiation syndrome, which was successfully mitigated with protocol-specified interventions. And the patient was subsequently able to resume ziftomenib therapy after this occurrence. You can see here again thrombocytopenia, neutropenia, leukopenia and anemia were under 10%. And the rate of sepsis in these pretreated relapsed/refractory AML patients attributed to ziftomenib was only 5%.

The clinical activity of ziftomenib with venetoclax azacitidine in relapsed/refractory AML patients was impressive. In this heavily pretreated patients, the CR rate was 27% in NMP1 mutant patients, 6% in KMT rearranged patients, but in patients who achieved some sort of clinical remission, the numbers were 48% or almost half of NMP1 mutant patients and 28% of patients with KMT rearrangements.

You can see here that MRD negativity rates were 60% in the NMP1 mutant patients, 43% in the KMT rearranged patients. And overall, the response rates were 2/3 of NMP1 mutant patients and 41% of KMT rearranged patients. Of note, 58% of these patients treated with this combination had a history of prior venetoclax exposure.

So when we took a specific look to examine the activity level in patients with and without prior venetoclax exposure. As you can see here in patients who had received no prior venetoclax therapy, i.e., for example, patients who had received prior 7+3 induction chemotherapy and then relapsed. We noted very high overall response rates and NMP1 patients of 83% and 70% in KMT rearranged patients.

CR rates were 44% in NPM1 mutant patients and 20% of KMT to be arranged and MRD negativity in NMP1 patients was over half of patients. Patients who had received prior venetoclax did still have responses, but these responses were less than those who had not received prior BCLA inhibitor therapy.

For NMP1 mutant patients follow up of 27.4 weeks, the median duration of a CRC response was 39.9 weeks. Then venetoclax-naive patients had the same response, 39.9 weeks and 14 NPM1 mutant patients were able to undergo allogeneic stem cell transplantation with 5 of these individuals continuing on to ziftomenib maintenance. The median overall survival for NMP1 mutant patients in the relapsed/refractory NMP1 setting was 54.9 weeks.

Patients with relapsed/refractory KMT rearranged, acute leukemia also had benefit from this combination. The median duration of CRC in these patients was 12.4 weeks and 2 KMT rearranged patients were able to undergo subsequent allogeneic stem cell transplantation followed by ziftomenib maintenance in both of these individuals.

The median overall survival in these relapsed/refractory patients was 21.1 weeks. Similar to the upfront data presented by Dr. Zeidan, we see here that times to neutrophil and platelet recovery with the combination of ziftomenib ven/aza, were comparable to those for ven/aza backbone therapy alone and shown here ranging anywhere from 27 to 36 to 45 days.

So in conclusion, in the ongoing KOMET-007 study, ziftomenib 600 milligrams once daily, combined with venetoclax azacitidine was well tolerated in patients with relapsed/refractory NMP1 mutant and KMT rearranged leukemia. There were very low rates of zifto-related myelosuppression. There was no appreciable ziftomenib-related QTC prolongation reported in any patients and only one case of differentiation syndrome in a patient with NMP1 mutant disease was reported and was successfully mitigated with protocol-specific measures.

There is evidence of encouraging clinical activity demonstrated in this patient population, particularly in patients with prior venetoclax exposure and more prominently in patients without prior venetoclax exposure. As you can see here, 2/3 of patients with NPM1 mutant disease achieved an overall response with therapy with a median duration of response of 40 weeks. Venetoclax-naive patients had an overall response rate of 83%, 70% of which was CRC, then exposed patients still benefited with 48% overall response rates and 28% CRC.

And in the KMT rearranged population, the overall response was still an impressive 41% with the 28% CRC and a median duration of response of over 12 weeks. Taken together, these data support further investigation of ziftomenib-based combination therapies in relapsed/refractory NMP1 mutant and KMT rearranged acute leukemia patients.

At this point, we'll turn it over to Mollie Leoni, our Chief Medical Officer, to give some comments on next steps and conclusions. Mollie?

Yes. Thank you so much. So we are extraordinarily excited to be approved in the relapsed/refractory monotherapy setting, we were able to offer new hope for patients. We now remain committed to developing KOMZIFTI in the combination setting. And as we presented, the combination yields high rates of response and better activity than either the doublet or zifto alone.

In fact, there are some evidence of potentially enhanced activity with the backbone in the relapsed/refractory then naive patients. In addition, the combination was well tolerated with no meaningful added toxicity and no increased burden in administration. Combinations have low rates of DS, no additive myelosuppression and no zifto-related QTC prolongation.

We have a robust and comprehensive clinical development plan that is producing significant data with other combinations such as quizartinib, gilteritinib, FLAG-IDA and LDAC. We will continue to generate these data and publish potentially paving the way for future NCCN guideline submissions.

All of this supports our confidence in our registrational KOMET-017 trial in the newly diagnosed patients, which we are showing here on this slide.

As you can see, this trial encompasses 2 different independently powered trials on the left for our non-intensive chemotherapy patients and on the right for intensive chemotherapy patients. On the left, for non-intensive patients will be randomized to either ziftomenib or placebo with the venetoclax-azacitabine backbone and the outcomes we are looking at are complete response is an accelerated approval point and overall survival for full approval.

In addition, on the right is our intensive chemotherapy option. And here, we have 3 arms that the patient could be randomized to. One involving the administration of ziftomenib throughout induction and consolidation and into the post consolidation maintenance space, one where we discontinued ziftomenib at the time of the post-consolidation maintenance phase and one where they received placebo throughout.

This will allow us to really evaluate the contribution of ziftomenib to the post-consolidation phase. The endpoints under of interest here are CR MRD negativity and EFS that we will be continuing to measure. So the opportunity is significant and meaningful in this frontline where we hope to prevent more patients from becoming relapsed and refractory. And our goal is to be the first approved menin inhibitor in the newly diagnosed setting, and our team is laser-focused on execution.

With that, I should turn it back.

Yes. With that, that concludes our prepared remarks, and we're now going to turn to a question-and-answer session. [Operator Instructions] So with that, operator, we are prepared to now move to questions.

[Operator Instructions] Our first question comes from the line of Li Watsek with Cantor Fitzgerald.

[Technical Difficulty].

Li, we're not able to hear your question. I don't know if you're dialing in, but your question is breaking up.

Our next question will come from Roger Song with Jefferies.

Can you hear me?

We can hear you, Roger. Thank you.

Excellent. Okay. Congrats for the data. Yes, I will limit my question to one. Troy, maybe the KOL as well. So as we start to see more data in the frontline and then with a different combination, can you help us to further compare the efficacy kind of level particularly for the depth of the efficacy, maybe the durability of the efficacy.

Do you start to see some different among all the menin inhibitor? Because we definitely heard the comments saying, "Yes, it's -- we no longer call this a menin party because every menin inhibitor may be different."

Sure, Roger. And I'm actually going to -- I'm actually going to turn it over to Mollie for that. I mean just with the caveat that these are -- it's difficult to do cross-trial comparisons. We're not comparing head-to-head.

But that being said, I think what you're asking is if we can look at MRD negativity and durability. So maybe I can ask Mollie, if she can speak to that to get us started.

Sure. So obviously, the backbone alone, especially in the frontline, does provide a good amount of responses for these patients. But it is not curative. And it is how do we judge whether we're making a difference by adding something on an addition. We think our best marker for that is MRD negativity. And that's why we chose to present MRD negativity using a central assay.

And as you can see, we did it at 2 different cut points. One, which would be the more traditional point one where you see flow and things like that at the local level come around. And the more conservative cut point of 0.01, which is favored by the FDA. So when we did that, let's say, just looking at the point one, the more conventional site level cut, we see a 68% MRD negativity rate.

Now if I look at other trials like Beat AML, we were seeing more like a 31% MRD negativity rate in that -- in a similar cut point. So we do think that there's reason to believe that we are adding significant benefit as our differentiated menin inhibitor, if you will, since we aren't all part of the same menin party anymore.

And then again, when we go down to the even more stringent cut point of 0.01, we saw the 44% MRD negativity rate. And realistically, it was more like 60% because there were 4 additional patients who buy 0.001, missed the cutoff. And so obviously, with even running the assay again, probably would have hit that cutoff. So we're very encouraged that we are seeing evidence via MRD that our responses are of greater depth than we've previously seen, which would hopefully translate into longer durability and ultimately better overall survival.

Our next question comes from Jonathan Chang with Leerink Partners.

I'm curious to get your thoughts on the PARADIGM study results presented at ASH and how that impacts your thinking on the development strategy for zifto?

Great. Jonathan, thanks for the question. Again, let me let Mollie lead off with that, and then we can go from there.

I'm so happy for Amir Fathi and his data was beautiful. I don't know that it's necessarily a representative of the patient population we are enrolling as it does tend to include -- well exclude most of the NPM1s as well as include much more of the high-risk patients. So I'd really like to turn it over to our KOLs to hear how they would -- they feel that this data might influence their practice. We could start with Eunice.

Sure. So I think the PARADIGM is an incredibly important study. It was very much anticipated and the results were beautifully presented by Dr. Fathi, however there are some significant caveats with the study. It's a randomized Phase II study, and they screened over 300 patients, but only were able to enroll about 50% of that population onto their studies. So it leads you to a question which patients did not get enrolled upon the study and the reasons why and whether the physicians that were enrolling the patients decided to move forward with one treatment versus another.

The other point of contention is that NMP1 mutant patients which is the primary population that we're looking at with ziftomenib were excluded from the trial unless they were 60 years and above. Third, the NMP1 mutant and IDH2 patient population was much enhanced in the patients that received the venetoclax azacitidine with about double the number of NMP1 IDH1 mutant patients treated with ven/aza as opposed to those treated with standard induction chemotherapy.

So that, again, introduces a bias because we know that patients with NMP1 and IDH2 mutations tend to have favorable outcomes with a less intensive regimen. And lastly, the patients that have NMP1 tend to be in the intermediate risk category and 76% of the patients enrolled on the PARADIGM study had adverse carrier type. So again, it's not relevant for the patient population that we receive KOMZIFTI. Dr. Zeidan?

Yes, I think I agree with all of this. And again, while this is an important study, I'm not quite sure it changes much in terms of what we were already doing. I think the general practice, if you are treating with aza/ven is to go to transplant if you are trying to go for a cure. So I think the main decision continues about are you trying to cure patient or is a patient potentially curable without transplant?

In my opinion, the addition of a third agent to whether intensive chemo was 7+3 or to aza/ven could offer the opportunity to change the natural history of the disease without necessarily going to transplant. And I would also note -- and again, I give the Kura team a lot of credit for this, is that having 2 protocols and under -- or having 2 studies in the same protocol offers the patients to be able to go on the study whether the doctor thought they were intensive chemo candidates or not.

So they don't have to go to another study just because they are deemed to be intensive chemo candidate or not. But I do not foresee the PARADIGM study to have like a meaningful impact on our ability to conduct the study.

Your next question comes from the line of Charles Zhu with LifeSci Capital.

This is Peter Green on for Charles. Congrats on the data. Really great to see the thesis potentially start to play out of, honestly, frankly, really nice safety in combination and potentially even better safety than for monotherapy, if do. So congrats again.

Just wondering if these data give you any line of sight or any confidence into a potential frontline label as KOMET-017 begins to read out in the future and whether there's any read-through from the first label in monotherapy relapsed/refractory setting, whether potentially a lot of the language around inclusion criteria and monitoring criteria might stay through or whether if you can show an even safer profile in the combination here, whether that's kind of grounds for negotiation for potentially even a less stringent label.

Thanks, Peter, for the question. and agree with you on your interpretation, particularly around the differentiation syndrome that it gets better in combination, right? As well, it gets better, I think, as the community generally gets experience with these agents.

We see that kind of across the board. But let me let Mollie start off by answering your question about maybe how this reads into the ongoing Phase III trials and what that differentiated label might look like, Mollie?

Sure. So the 007 trial has been enormously helpful in how we've designed and planned for the 017 trial. So all of these results continue to support us moving forward. They tell us we've made correct assumptions. They help us understand the likelihood of success. And I think every time we look at the data, we are more excited, but I think your second point is very important.

Having a randomized study with a placebo control is going to absolutely be able to impact the safety and the labeling for KOMZIFTI. Ultimately, it's very difficult to interpret a single-arm trial. And thus, the FDA is always going to take a more conservative route and attribute things to the investigational agent even if they might be due to the underlying disease alone or to the concomitantly administered medications.

So having a randomized controlled trial with that data to be able to show for example, a lack of QTC prolongation with ziftomenib therapy will be extremely important and will absolutely be useful in amending the label and making it so that patients really do have the ability to make an informed decision about their treatment options.

Our next question comes from the line of Etzer Darout with Barclays.

This is a question that goes back to the earlier presentation. Just curious about the relevance and impact of the updated ELN guidelines on MRD negativity on maybe the field and sort of future plans, particularly again in these first-line AML settings?

Thanks, Etzer, for the question. Mollie, do you want to...

Sure. I mean we're obviously waiting -- they may have been published today. I guess that might be why you're asking firstly. We're waiting to see them come out. We're not sure how generalizable all of that data will be because they -- it was largely PCR, we're focusing on NGS and various time points of when these measurements are taken. So I don't know how much cross read there will be but we will continue to evaluate now that's come out. But I'd absolutely turn it over to Dr. Zeidan to see his thoughts as well.

No, I agree. I think the paper needs to come out so that we kind of clearly discuss this particular aspect. But I personally feel very comfortable with the frontline results both in the intensive and the non-intensive chemo in terms of the CR rate being 73% in terms of the MRD negativity using very sensitive assays being very deep.

So I do not have any concerns about how does that translate when you compare it by other techniques, whether it's PCR or flu. One point I just want to highlight quickly kind of Mollie mentioned is that the MRD negativity seems to deepen with time. So by the fourth cycle, for the aza/ven cohort, actually all the patients who got 4 cycles basically became MRD negative. And this is very important because this speaks to the importance of adding a drug where the patients are able to stay on therapy. You don't want to have a drug that causes a lot of myelosuppression that patients fall off the drug and the trial.

So I think this, in my opinion, could differentiate ziftomenib from some of the other drugs that are other menin inhibitors that could add additional myelosuppression. So I don't think the issue of the MRD is going to be a problem. Of course, MRD is more relevant in terms of a regulatory front to the intensive chemo front because this is where it's going to be used for accelerated endpoint.

But we know that in the non-intensive setting, there is a good correlation between MRD negativity and survival. In the VIALE-A, the MRD negativity was around 30% to 35%. So I do think we are seeing some differentiation in a 40-patient sample size. So clearly, we have to wait for the randomized data, but I think everything looks promising from what has been presented. I don't know if Dr. Wang wants...

No, I completely agree. And the VIALE-A data took 7 cycles or more for the majority of patients to achieve the same amount of MRD negativity that we're starting to see by cycle 4 with the triplet combination.

Next question will come from Hunter Hurley with Guggenheim.

And again, congrats on the data. Again, this is Hunter Hurley on for Brad Canino from Guggenheim. Just wanted to kind of as a segue for this MRD conversation. And I guess, how we're kind of using this in combination. Have you reported anything on reductions for this combination as I didn't really see that in the presentation?

And as we're kind of thinking about this with treatment long term for this combination, what are your kind of expectations for the regimen as far as like durability, long-term usage? And then in combination, are you planning on keeping ziftomenib on indefinitely or potentially reducing ven/aza? And how is this kind of combination going to look over time?

Yes. So Hunter, let me just ask -- so you actually asked 3 questions. So we're trying to keep people limited to one. But let me just ask a question back in return. You mentioned reductions. Are you specifically asking about the rate of dose reduction? Is that what you're asking?

That's correct.

Okay. Let me ask Mollie speak to that, and then we can kind of go from there.

Yes. I think one of the best ways to be able to look at that in our data is to look at our swim lanes. We -- well, not necessarily the dose reductions, the dose continuation, which was the second half of your question, where we can see that we started zifto and we continue it from cycle 1, day 8 on, while the backbone might be modified to lesser days or lesser doses depending on covenantly administered medications, the zifto remains.

With regards to ziftomenib reductions, we're really not seeing very many at all. I'm hard-pressed to think of more than 1 or 2 that have been seen. And most often, even with our monotherapy, we see a return back to the initial dose even after an initial interruption or reduction.

So we're really not seeing a requirement for the ziftomenib to be changed in order for these patients to successfully remain on the treatment regimen. And as we will see, we'll see the data play out in both 007 and then ultimately 017 to see what effect that has on the backbone therapies as well because we know that physicians are trying to modify and make sure that these patients are not overly myelosuppressed and once they -- especially once they've reached response. And so we'll be watching the ven/aza dosing a lot over the coming months. But so far, I would really direct you towards those swim lanes to see how it's being handled currently.

And I think Dr. Zeidan wants to add a few thoughts.

Yes. I just want to add like my own personal experience as someone who has treated many patients on both of the 007 trial as well as 008 trial. And many of those patients are actually able to continue on the drug in my own hands. I don't believe we have reduced anybody in terms of the dose. And I think from discussion with patients, this is one of the easier drugs to give in terms of being -- especially in the maintenance setting, where you are giving it without other drugs.

So you have a very good sense of what is actually related to the drug and what is not related to the drug. And it's really very easy for most patients to be on. This is, again, very important because I do believe strongly that patients need to be on the drug especially in the frontline setting for as long as possible to try to minimize the chance of the leukemia relapsing. So I think my own experience kind of goes in line with what Mollie has mentioned in terms of the overall trial.

So I just wanted to mention just if I could throw in that, this is in contrast to what we see with some revumenib HMA and venetoclax combination. So for data presented with the combination of oral decitabine with revumenib and HMA that the SAVE trial that was presented yesterday, they noted that there was a 48% incidence of Grade 4 febrile neutropenia, 24% thrombocytopenia and 19% neutropenia.

So they had significantly Grade 3, Grade 4 neutropenias with that triplet combination of revumenib, venetoclax and HMA. Similarly, if you look at the BEAT AML trial in newly diagnosed older unfit patients, they had significant cytopenias with delay of subsequent cycles of that triplet for 40 or 50 days.

That neutropenia cytopenia incidence is not present with the combination of zifto. I also want to point out that the QTC prolongation and the need for dose adjustment of revumenib with azoles and concomitant medications may also impact on the ability to give revumenib long term, particularly elderly individuals with concomitant meds, cardiac issues, et cetera.

And as we mentioned, the durability and the overall survival of these patients in the newly diagnosed as well as refractory setting is really highly dependent on patients being able to take it in the long term for months or even years.

So Hunter, I limited you to one question, but you got 3 answers. So if you do want to follow up, we're happy to take the next -- your other 2 questions, but I want to make sure we give everyone at least a chance to ask one question. But happy to have you jump back in the queue, and we can speak to, if there's an additional question you have. Let's go on to the next.

Your next question comes from the line of Reni Benjamin with JMP Securities.

Congratulations on the data. There's a lot of talk looking at co-mutations like FLT3. Can you talk a little bit about the percentages of NPM1 patients that are FLT3? And can you talk about the importance of zifto being able to combine with some of these FLT3 inhibitors?

Sure. I mean, I can start us, Ren. FLT3, I think, is estimated at 25% to 30% of AML patients, and it's about half of your NPM1 population. So it's a significant population. It's of the same order of magnitude as NPM1. But I'll let Mollie get us started. That's data actually that everyone, I think, as Mollie will say, maybe we can look forward to next year. But Mollie, over to you.

That's exactly right. We'll be presenting our FLT3 data next year. And keep in mind, we're generating data both with gilteritinib, which is known to cost prolonged QTC, as well as quizartinib, which actually has a black box warning for having a different mechanism of QTC prolongation.

And so far, we have yet to show the data. But obviously, if we are continuing to escalate and go through with our expansions, it's probably going well. I would draw your attention to the combination of revumenib plus gilteritinib where we saw dose-limiting toxicities at every dose level tested. And I believe the vast majority were QTC prolongations.

So obviously, in combination, the safety profiles of these different drugs are going to play out with the ability to use them. And I think that the FLT3 inhibitors, in particular, are going to be difficult for some of our competitors to combine with.

I think -- Yes. I just want to add quickly that I think that the quadruplet frontline combination that's ongoing now with the quizartinib and ziftomenib plus 7 and 3, I think, would be very important because one of the kind of main questions in the field is what do you give these patients? Do you give them a menin inhibitor with 7+3 or do you give them a FLT3 inhibitor?

And I think currently, most people are giving FLT3 inhibitors because this is where we have the survival advantage. But having good data with the quadruplet, I clearly will open, hopefully, the ability to use menin inhibitors in the frontline sitting intensive chemo FLT3 positive setting with the communication with NPM1.

And Ren, just to add to that, we often get -- the ziftomenib label is limited to NPM1-mutated relapsed/refractory AML adults. We do -- we're doing many, many trials, evaluating ziftomenib in various combinations. We're promoting specifically on label, but we often get the question of how to use combinations, how to think about sequencing.

And as Dr. Wang commented in her presentation with ven/aza, there's interesting data on sort of how you use these agents and in what sequence. We think the same thing will be true in the FLT3 case. What our responsibility is to generate robust data where we're talking about tens of patients, not sort of -- more than single digit, really to give our collaborators, the physician experts, the data that they need to make the determination of how best to use these menin inhibitors. So you're going to -- again, that's 2026 goal and objective, but I think that will be an exciting next chapter.

Our next question -- your next question comes from the line of Salim Syed with Mizuho Security.

This is Erik on for Salim. Congrats on the data. So my question is on the combinations with menin inhibitor, particularly with zifto other than ven/aza or 7+3. Just wondering, assuming -- I'm assuming, and correct me if I'm wrong, that those 2 combinations will likely take up the majority of usage. I'm just wondering if for these other combinations like what portion of the AML population do you think that they would be used? And this is about like [indiscernible] the FLT3s and all of that stuff.

Mollie?

Yes. No, you're correct. At least right now, the 7+3 and the ven/aza are dominating the frontline space and times will change. More therapies will come out and be approved, more targeted therapies. And so it will continue to evolve. A lot of the data that we've been generating that I think you're referring to is in the relapsed/refractory setting.

And that is data with FLAG-IDA, that is with gilteritinib, that is with low-dose cytarabine. And it is so that physicians have the optionality because not all patients can handle ven/aza, not all patients can handle 7+3. Unless they're relapsed/refractory, they really need to have multiple options depending on what they've previously seen.

So our plan is to obviously generate as much data as we possibly can, robust data. I don't -- we generally don't tend to present our data until we have really good patient pool to be able to make some calls off of. And so that's what we'll continue to do. And like we said earlier, we will be presenting a lot of these data in the 2026 time frame.

So I'm going to just jump in here, Abigail, because Li Watsek, who was up first couldn't ask her question. She e-mailed it to us, so I'm just going to ask it on her behalf. She said, may I ask in the real-world study at ASH, it seems as though doctors like to use menin inhibitors in combination with venetoclax. Can Dr. Wang and Dr. Zeidan talk about potential real-world adoption of zifto and the combinations with the venetoclax based on the safety profile. Dr. Wang, maybe I'll start with you.

So since the approval of ziftomenib, I've received a lot of calls from colleagues and other physicians, clinicians asking about, for example, should they use ziftomenib? Or should they use revumenib, for example, for an NMP1 mutant relapsed/refractory patient? And out call as should we -- is it combinable? Can we use it in the post-transplant setting, which would be preferable?

And I feel that for a lot of practical reasons, we are recommending potentially that ziftomenib has certain advantages. It is easily combinable with venetoclax and even azoles because those drugs may have a predisposition to prolong the QTC. There's no dose adjustment with azoles in a patient with baseline neutropenia. There's no concern -- less concern about the risk of significant QTC prolongation in a patient that has concomitant cardiac meds or in the relapse setting maybe on some immunosuppressive meds, again, that can cause interactions. It's a once-a-day dosing.

So that also is preferred by patients. And in combination with ven, we have seen actually a decrease in the ven/aza combinations of differentiation syndrome to be concerned about and having it really be 1 or 2 patients among 50. So I think in the real-world setting, as these drugs start to populate out into clinical practice, I think we are going to see greater adoption, ziftomenib particularly in combinations because of those reasons.

I think that revumenib has been largely adopted by providers because they had no other option. But moving forward and discussing some of these features with people in the real world, almost all of the colleagues that have asked have said that those are valid concerns. And this is also a drug that my patient may be taking for weeks, months, and those are things that my practice or my providers may not want to be seeing the patient and adjusting the medicines on a daily basis. Dr. Zeidan?