Karyopharm Therapeutics Q2 2025 Earnings Call Transcript

Quartr
Provided by Quartr
August 11, 2025

Key Takeaways

  • Negative Sentiment: The company faces a near-term debt maturity in October 2025, with existing liquidity expected to fund operations only into January 2026, and is exploring financing and strategic alternatives to enhance liquidity and maximize value.
  • Positive Sentiment: Completed new patient screening in the Phase III SENTRI trial for JAK-naive myelofibrosis, with top-line data anticipated in March 2026.
  • Positive Sentiment: Preliminary blinded safety data suggest the selinexor plus ruxolitinib combination may have lower rates of grade 3+ TEAEs—especially anemia and discontinuations—and improved tolerability versus historical ruxolitinib monotherapy.
  • Positive Sentiment: XPOVIO net product revenue for Q2 was $29.7 M, up 6% year-over-year, full-year 2025 guidance was raised to $110 M–$120 M, and royalty revenue grew 28%.
  • Neutral Sentiment: The company implemented a roughly 20% workforce reduction and cost-optimization initiative, expecting to save approximately $13 M annually beginning in 2026.
AI Generated. May Contain Errors.
Earnings Conference Call
Karyopharm Therapeutics Q2 2025
00:00 / 00:00

There are 10 speakers on the call.

Speaker 8

Good morning. My name is Luty, and I will be your conference operator today. At this time, I would like to welcome everyone to the Karyopharm Therapeutics second quarter 2025 financial results conference call. There will be a question and answer session to follow. Please be advised that this call is being recorded at the company's request. I would now like to turn the conference over to Brendan Strong, Senior Vice President, Investor Relations and Corporate Communications. Please go ahead.

Speaker 6

Good morning. Thank you for joining us on today's conference call to discuss Karyopharm's second quarter 2025 financial results and recent company progress. We issued a press release this morning detailing our financial results for the second quarter of 2025. This release, along with a slide presentation that we will reference during our call today, is available on our website. For today's call, as seen on slide two, I'm joined by Richard, Reshma, Sohanya, and Lori, who will provide an update on our results for the second quarter of 2025 and discuss recent clinical developments. Before we begin our formal comments, I'll remind you that various remarks we will make today constitute forward-looking statements for purposes of the Safe Harbor provisions under the Private Securities Litigation Reform Act of 1995, as outlined on slide three.

Speaker 6

Actual results may differ materially from those indicated by these forward-looking statements as a result of various important factors, including those discussed in the risk factor section of our most recent Form 10-Q or 10-K on file with the SEC and in other filings that we may make with the SEC in the future. Any forward-looking statements represent our views as of today only. While we may elect to update these forward-looking statements at some point in the future, we specifically disclaim any obligation to do so, even if our views change. Therefore, you should not rely on these forward-looking statements as representing our views as of any later date. I'll now turn the call over to Richard. Please turn to slide four.

Speaker 2

Thank you, Brendan, and thank you all for joining us today for Karyopharm's Q2 2025 earnings call. Before we begin, as outlined on slide five, I want to address a topic that is on the minds of our employees, our partners, and our investors. We are operating in a period of financial constraints with a near-term debt maturity in October. We are actively engaged with our lenders and advisors to enhance our liquidity and maximize value. Importantly, the fundamentals of our business remain strong, with a profitable multi-million commercial organization that provides us with a solid foundation that we can build on with two potentially transformative phase 3 readouts expected over the next 12 months. These trials target diseases where patients have few treatment options, and there is an opportunity to improve on existing therapies.

Speaker 2

Based on the strength of our data to date, we believe we have the potential to redefine the standard of care for these patients. This is the value that we are building toward and what drives our confidence in the long-term trajectory of the company. With that, let's get into our results for the quarter, where we delivered solid commercial results and made exciting progress towards enrolling our pivotal phase 3 trials in myelofibrosis and endometrial cancer. I am pleased to report that we expect to close new patient screening this week in our phase 3 SENTRY trial in patients with JAK inhibitor-naive myelofibrosis. This is a major milestone that is a result of many years of hard work and dedication from people throughout our organization, and I thank all of our teams. We greatly thank the patients and clinical trial sites that are participating in SENTRY.

Speaker 2

Importantly, SENTRY will be our first phase 3 trial readout where we utilize a lower dose of selinexor combined with antiemetics during the first two cycles of treatment to improve the tolerability of selinexor as we work to enhance the patient experience. Through our strong clinical trial execution, we are seeing the benefits of both of these factors in the preliminary blinded safety data that Reshma will review today. We are eagerly anticipating top-line data in March of 2026. Turning to slide six, completing enrollment in our phase 3 SENTRY trial is an important step on our over seven-year journey to demonstrate the role that XPO1 inhibition may play in patients with myelofibrosis. The phase 3 trial caps a growing body of evidence that has consistently demonstrated the potential for XPOVIO in myelofibrosis.

Speaker 2

We are optimistic about the potential for selinexor plus ruxolitinib to redefine the standard of care for patients living with this disease, and pending positive data, the transformational opportunity this represents for our organization. As outlined on slide 7, given the opportunity to improve the standard of care, leading KOLs, including Dr. John Mascarenhas from Mount Sinai, who is the Principal Investigator for SENTRY, continue to highlight the need for new treatment options for patients with myelofibrosis. The depth and durability of response that Dr. Mascarenhas mentioned in a recent interview with a patient advocacy organization plays to the strength of selinexor. Finally, as shown on slide 8, we estimate the peak revenue potential for selinexor in myelofibrosis is up to approximately $1 billion annually in the U.S. alone and believe that commercial uptake would be rapid.

Speaker 2

We are very eager to bring this combination therapy to the market, pending the outcome of our data and future regulatory approvals. Now, I'd like to turn the call over to Reshma.

Speaker 1

Thank you, Richard. I will be sharing new blinded preliminary safety data with you today from our phase 3 SENTRY trial that may support the potential of the combination of selinexor plus ruxolitinib, which may have a similar, if not more favorable, safety profile than ruxolitinib alone. Before I get into the new data, let's review why we believe selinexor as an XPO-1 inhibitor is a rational mechanism to evaluate in patients with myelofibrosis, starting on slide 10. Selinexor prevents the nuclear export of various proteins and messenger RNA molecules, thus inhibiting both JAK and non-JAK pathways, the latter which includes the nuclear localization and activation of P53, an important tumor suppressor in myelofibrosis, given that approximately 95% of myelofibrosis patients are P53 wild type.

Speaker 1

As Richard indicated, we believe that the combination of selinexor plus ruxolitinib has the potential to establish a new treatment paradigm for myelofibrosis patients by addressing each of the four key pillars of this disease, as outlined on slide 11. While no assurances can be given, our confidence continues to strengthen as we receive and review additional data, including updated blinded safety data that I will be reviewing shortly. To set the stage, there has been a lack of new treatment options, given that JAK inhibitors are the only approved class of therapies. Ruxolitinib has been the standard of care for over 13 years. As the potential first combination therapy in myelofibrosis, selinexor plus ruxolitinib would be a convenient all-oral therapy that the myelofibrosis community has clearly indicated interest in adopting, given the rapid, deep, and durable spleen reductions in symptom improvement observed from the phase 1 study.

Speaker 1

Let's now focus on the four key hallmarks in myelofibrosis. First, spleen volume reduction. I think it is a very helpful reminder that only approximately one-third of patients achieve a spleen volume reduction of greater than 35% with ruxolitinib alone. Our phase 1 data suggests that the combination could more than double the SVR-35 rate, with durable responses also seen. Second is symptom improvement. Data from our phase 1 trial of selinexor in combination with ruxolitinib showed an average 18.5-point improvement in absolute TSS at week 24, which suggests this combination could provide a meaningful improvement over the 11 to 14-point improvement achieved by patients on ruxolitinib, as observed in the phase 3 MANIFEST-2 and TRANSFORM-1 trials. Third is hemoglobin stabilization and transfusion burden.

Speaker 1

The data that we presented in June at EHA show higher hemoglobin levels, lower transfusion burden, and much lower rates of all-grade and grade 3/4 anemia in myelofibrosis patients previously treated with JAK inhibitor therapies who were randomized to selinexor compared to the physician's choice arm, which included retreatment with the JAK inhibitor therapies, including ruxolitinib. Fourth is disease modification. There is minimal evidence of disease modification with JAK inhibitors. Data observed from selinexor monotherapy studies in a pretreated myelofibrosis population, as well as our phase 1 combination data in JAK inhibitor-naive myelofibrosis, suggest meaningful reductions in key cytokines that are critical to myelofibrosis pathogenesis, symptom development, and anemia, as well as improvements in bone marrow fibrosis, increases in erythroid progenitors, and mutational burden. Turning to slide 12, we are pleased that our phase 3 SENTRY trial will be closing new patient screening this week.

Speaker 1

Importantly, based upon an initial review of the baseline characteristics of the patients enrolled to date, they are representative of the intended patient population. One notable characteristic is the baseline TSS, which, when excluding fatigue, may ultimately be higher than other phase 3 trials, an important trend that may suggest that our trial could be well-positioned to report a greater improvement in absolute TSS. In this new era of combination therapies, there have been challenges demonstrating meaningful symptom improvement above and beyond ruxolitinib. Based upon learnings from other trials, we believe we have optimized SENTRY for success. First, we changed the co-primary endpoint of TSS50 to absolute TSS, a more sensitive method by which to detect meaningful symptom improvement above and beyond ruxolitinib. Second, we have excluded the fatigue domain in the primary analysis of absolute TSS in alignment with the U.S.

Speaker 1

FDA due to the difficulty in accurately assessing changes in this symptom. We are certainly not the first to exclude fatigue. In fact, both the pivotal trials that led to ruxolitinib and fedratinib approvals also excluded fatigue in their TSS50 analyses. It's also important to keep in mind that all of our studies have excluded fatigue in symptom analyses, including our phase 1 study evaluating the combination of selinexor and ruxolitinib, as well as MS035, which evaluated selinexor as a monotherapy in previously treated MS patients. Finally, absolute TSS in the phase 3 SENTRY trial will be analyzed using the mixed models repeated measure approach, or MMRM. This differs from our phase 1, which, given the limitations in sample size, could only evaluate the mean or average change at week 24. MMRM is viewed as a more sensitive and potentially more robust method by which to analyze absolute TSS.

Speaker 1

The co-primary endpoints in SENTRY are SVR-35 and absolute TSS, which are tested sequentially. Some of the key secondary and exploratory endpoints that will also be analyzed include progression-free survival, overall survival, hemoglobin stabilization, variant allele frequency reduction, improvement in bone marrow fibrosis, and changes in cytokine levels. Now let's review the encouraging preliminary blinded aggregate safety data from this trial. As these are preliminary data, please keep in mind that these data may not be reflective of the trial's actual top-line results. The data on slides 13 and 14 are from the first 61 patients that enrolled in the phase 3 portion of the SENTRY that have now been followed for a median of over 12 months. These patients were included in the successfully passed futility analysis conducted in the beginning of the year.

Speaker 1

While only members of the DSMB had access to the unblinded efficacy and safety data from these patients, we have continued to track the safety events over time and took a snapshot of the blinded safety data from these 61 patients on July 1, 2025, which continued to look favorable. Let's start by reviewing the adverse event summary on the left side of slide 13. The data on the 61 patients shown in the table include patients randomized to either the combination of selinexor plus ruxolitinib or ruxolitinib in a two-to-one ratio. Because these are blinded data, we do not know the rates by each arm. The second and third columns provide the treatment emergent adverse event summary, or TEAE summary, following a median follow-up of more than seven months or 12 months, respectively.

Speaker 1

What you see in this summary is that many of the adverse events occur early, with no meaningful increase in rates after the median of seven months of follow-up. In an effort to improve comparability, we then took our analysis one step further. Knowing that the 61 patients were randomized two-to-one, we used the historical data on ruxolitinib to extrapolate the preliminary safety data for the approximately 40 patients that received the combination, which is shown in the blue boxes on the right side of the slide. As you can see, the percentage of patients that have had at least one TEAE is approximately 97%, similar to what has been described for ruxolitinib. However, when we focus on the grade 3+ TEAE, the extrapolated data suggests that the rate may be slightly lower for patients on the combination versus ruxolitinib at approximately 53% and 57%, respectively.

Speaker 1

Looking at serious TEAEs, the extrapolated data suggests an even greater benefit for the combination therapy than ruxolitinib. Finally, the extrapolated rate of TEAEs leading to treatment discontinuation is only 5% to 7% for the combination, lower than the 6% to 11% range that has been historically reported for ruxolitinib, which we view as an encouraging observation. Let's turn to the individual treatment emergent adverse events, as shown on slide 14. We took the same approach with these data as the ones I just described on the prior slide. Starting on the left, you'll see the all-grade blinded safety data on these 61 patients with a median follow-up of more than seven months and again for more than 12 months. We also show two noteworthy grade 3/4 TEAEs at the bottom left, anemia and thrombocytopenia.

Speaker 1

Consistent with what I described on the prior slide, we see most TEAEs occurring within the first seven months of follow-up. Additional events are observed with the passage of time, resulting in the rates of TEAEs modestly increased at 12 months of follow-up. The number that excites me the most is the extrapolated rate of grade 3/4 anemia. At approximately 26%, the extrapolated rate of grade 3/4 anemia for the combination is meaningfully lower than the 37% historically reported for ruxolitinib. While the extrapolated rate of all-grade nausea is higher in the combination arm than ruxolitinib, the approximately 64% is substantially lower than the approximately 80% rate that we reported in the phase 1 portion of this trial. We have recently presented compelling cytokine data that could explain, in part, the efficacy observed with selinexor.

Speaker 1

In addition, slide 15 shows pictographs of bone marrows evaluated at baseline and at week 24 from a patient treated with the selinexor/ruxolitinib combination, and it's further evidence of the potential disease modification that selinexor may induce in patients with myelofibrosis. These data were first presented by Dr. Harris Ali at the International Congress on Myeloproliferative Neoplasms in October of 2024. This JAK inhibitor-naive myelofibrosis patient was treated with selinexor 60 milligrams and ruxolitinib 15 milligrams twice a day, as per the USPI. Due to cytopenias, the ruxolitinib dose was decreased to suboptimal ruxolitinib doses of 5 milligrams twice a day, starting in cycle two. The patient achieved an SVR-35 as early as week 12 and a TSS50 as early as week eight as a result of symptom reduction from a baseline of 42 points to 19.5 points at week eight.

Speaker 1

The efficacy observed in this patient can be explained in part by the meaningful change occurring in their bone marrow. Specifically, a 46% reduction in fiber density assessed by digital pathology was observed at week 24 compared to baseline samples, as was an approximately 200% increase in erythroid progenitors, which are precursors of mature red blood cells. While this is a single patient experience, the increase in erythroid progenitors could also explain the potentially lower grade 3/4 anemia rates with the combination as compared to historical ruxolitinib data, as I explained on the previous slide. We are very encouraged about these data and what it could mean for patients if we see something similar in the top-line results in the phase 3 SENTRY trial. Specifically, it could suggest a combination therapy that has a safety profile similar, if not potentially better, than standard of care ruxolitinib.

Speaker 1

Given that both grade 3/4 anemia and thrombocytopenia are the same, if not better, than ruxolitinib alone, it could also suggest decreased blood draws for the patient and reduced monitoring burden for physicians and healthcare staff. I would also like to provide an update on our phase 2 SENTRY 2 trial, where we are evaluating selinexor as a monotherapy in JAK inhibitor-naive myelofibrosis patients with moderate thrombocytopenia. Enrollment in this trial has been slower than anticipated, given that the vast majority of sites enrolling on SENTRY 2 are also enrolling patients into SENTRY, and we have asked sites to prioritize enrollment on SENTRY. In addition, patients with platelet counts between 50,000 and 100,000 represent only 10% to 15% of all JAK inhibitor-naive myelofibrosis.

Speaker 1

Now that SENTRY enrollment is completing, we plan on expanding the enrollment criteria to include all patients with platelet counts above 50,000, pending they meet all other eligibility criteria. This should increase the number of patients that can participate in this trial. Our prior plan was to report preliminary data on a subset of patients from SENTRY 2 in the first half of this year. Given the enrollment challenges and the changes we are making to the enrollment criteria, we now plan to report top-line data from all patients that we enroll in the 60 milligram cohort of this trial in 2026. Now let's shift our focus to endometrial cancer, where P53 wild type is such an important biomarker.

Speaker 1

As seen on slide 17, patients with both MMR proficient and TP53 wild type tumors make up approximately 50% of all advanced or recurrent endometrial cancer cases, representing a very sizable group. Enrollment in the EXPORT ECO-4-2 trial is progressing steadily, as seen on slide 18, and we continue to expect to report top-line data in the middle of 2026. I remain encouraged with the potential of selinexor to achieve clinically meaningful outcomes in the maintenance setting for patients with P53 wild type endometrial cancer. Lastly, our phase 3 EMN29 SPD trial is outlined on slide 20. This trial aims to demonstrate the potential of an all-oral triplet treatment option for multiple myeloma patients that could also benefit those undergoing pre and post T-cell engaging therapies. We expect to report top-line data from this event-driven trial in the first half of 2026. I will now turn the call to Sohanya.

Speaker 4

Thank you, Reshma. On slide 22, I will discuss our commercial highlights for Q2 2025. XPOVIO Net Product Revenue was $29.7 million this quarter, up 6% from the second quarter of 2024. Demand for XPOVIO was consistent in the second quarter of 2025 versus the second quarter of 2024, with the community setting continuing to drive approximately 60% of total U.S. sales. As we all know, the multiple myeloma market is highly competitive and is becoming more competitive each year. Within this market, XPOVIO is positioned in the community as a flexible therapy with a differentiated mechanism of action, oral convenient option following treatment with an anti-CD38 therapy, as well as in patients who cannot access or fail a T-cell engaging therapy. In the academic setting, XPOVIO is being increasingly used before and following T-cell therapies.

Speaker 4

Taking our results for the first half of the year into account, including the atypical level of returns in the first quarter of this year, we expect Net Product Revenue for full year 2025 will be in the range of $110 to $120 million. Finally, we continue to expand global patient access for selinexor and are now approved in various indications in 50 countries. This is translating into growth in royalty revenue from Menarini Group, Antengene Therapeutics Limited, and other international partners. Royalty revenue increased 28% to $1.6 million in the second quarter of 2025 compared to the second quarter of 2024, reflecting increased global demand for XPOVIO and NEXPOVIO. With data from our phase 3 SENTRY trial in sight, our commercial team is preparing for a very rapid launch in myelofibrosis, if approved.

Speaker 4

As outlined on slide 23, we continue to believe that our peak annual revenue opportunity in the U.S. alone is up to approximately $1 billion, with additional royalty and milestone revenue globally. As you think about this opportunity, keep in mind that the average real-world duration for the current standard of care is approximately 13 months. Given the data we have reported to date, we believe we may have an opportunity to extend this further when ruxolitinib is combined with selinexor. On slide 24, we outline why we believe we're well-positioned for a rapid launch in myelofibrosis pending positive data and approval. As we've shared previously, 75% of the physicians that we surveyed say that they intend to adopt a combination therapy in myelofibrosis if one becomes available. If selinexor is approved in combination with ruxolitinib, we could be the first combination therapy on the market.

Speaker 4

We would be an all-oral therapy, which makes adoption much easier, especially in the community setting. On this point, there's an 80% overlap in the community between myelofibrosis and multiple myeloma prescribers that our organization is already calling on, which enables us to drive a rapid launch and minimizes the upfront investment required for the launch. Finally, in endometrial cancer, as shown on slide 25, we continue to believe that we have a significant opportunity in the P53 wild type and PMMR patient population, which represents approximately 50% of advanced or recurrent endometrial cancer patients. Similar to what I outlined for myelofibrosis, there is a large overlap between the potential community-based oncologists caring for endometrial cancer patients and those we're already engaging with. Now, I'll turn the call over to Lori.

Speaker 3

Good morning, everyone, and thank you, Sohanya. Turning to our financials, since we issued a press release earlier today with the full financial results, I will focus on the highlights and reviewing our guidance for 2025 on slide 27. Total revenue for the second quarter of 2025 was $37.9 million compared to $42.8 million for the second quarter of 2024. The decline was primarily attributable to $6 million of non-recurring license-related revenue from our partners recognized during the second quarter of 2024. U.S. XPOVIO Net Product Revenue for the second quarter of 2025 was $29.7 million compared to $28 million for the second quarter of 2024. As expected, the rate of product returns this quarter reverted to historic levels following the atypical increase reported in the first quarter of this year.

Speaker 3

As a result, the gross to net provisions for XPOVIO in the second quarter were 26.8%, down from the 45% that we reported in the first quarter of this year and down from 29.3% in the second quarter of 2024. The year-over-year decline was primarily driven by mix and lower 340B discounts in the second quarter of 2025. We expect our gross to net provisions will remain relatively consistent with Q2 2025 for the remainder of the year. R&D expenses for the second quarter of 2025 were $32.8 million, down 15% when compared to $38.4 million for the second quarter of 2024. The decrease was due to a reduction in headcount and contractors related to our cost optimization initiative, combined with lower clinical trial and related costs, primarily from our phase 3 clinical trial in multiple myeloma.

Speaker 3

SG&A expenses for the second quarter of 2025 were $28.5 million, down 8% when compared to $31.1 million for the second quarter of 2024. The decrease was primarily due to the realization of previously implemented cost reduction initiatives. Interest expense was $11.2 million in the second quarter of 2025, up from $8.9 million in the second quarter of 2024. As a reminder, we announced a refinancing in the second quarter of 2024 that raised interest expense. However, there was only a partial quarter impact in the second quarter of 2024. Last year's refinancing also resulted in a $44.7 million gain on the extinguishment of debt in the second quarter of 2024. Other expense was $2.2 million in the second quarter of 2025 compared to $14.3 million of other income in the second quarter of 2024.

Speaker 3

These amounts were attributable to recurring non-cash fair value remeasurements of embedded derivatives and liability-classified common stock warrants related to the refinancing transactions in the second quarter of 2024. We reported a net loss of $37.3 million, or $4.32 per share on a GAAP basis. This figure includes $11.2 million in interest expense related to our debt instruments, as well as approximately $2 million in non-cash losses from the remeasurement of embedded derivatives and liability-classified common stock warrants. Our net loss from operations was $24.5 million for the second quarter of 2025. This operating result reflects the performance of our core business during the quarter. From an earnings per share perspective, our GAAP EPS includes both interest expense and marked-to-market impact of the warrant and derivative remeasurements. We continue to be very diligent in allocating our resources and pipeline prioritization.

Speaker 3

We announced a roughly 20% reduction in our workforce in early July. You will start to see the financial impact of these actions when we report our results for the fourth quarter of this year. In 2026, we expect these actions will lower our annual spend by approximately $13 million. We exited the second quarter of 2025 with cash, cash equivalents, restricted cash, and investments of $52 million compared to $109.1 million as of December 31, 2024. Based on our current operating plans, our guidance for the full year of 2025 is as follows: total revenue of $140 to $155 million, consisting of U.S. XPOVIO Net Product Revenue and license, royalty, and milestone revenue expected to be earned from our partners, primarily Menarini Group and Antengene Therapeutics Limited. U.S. XPOVIO Net Product Revenue to be in the range of $110 to $120 million.

Speaker 3

R&D and SG&A expenses to be in the range of $240 to $250 million. Finally, we expect our existing liquidity, including the revenue we expect to generate from XPOVIO Net Product sales, as well as revenue generated from our license agreements, will be sufficient to fund our planned operations to the October 15 maturity of our senior convertible notes. Excluding the remaining $24.5 million 2025 notes maturity and $25 million minimum liquidity covenant, we expect that our liquidity is sufficient to fund our planned operations into January 2026. As we address this, we are working closely with our advisors, including Centerview Partners, to explore potential financing and strategic alternatives to enhance liquidity and maximize value. I will now turn the call back to Richard for some final thoughts.

Speaker 2

Thank you, Lori. Turning to slide 29, we continue to believe that myelofibrosis and endometrial cancer, depending on the data from our ongoing phase 3 clinical trials, are both game-changing opportunities for patients and our organization, with the myelofibrosis opportunity alone representing up to a potential $1 billion in peak annual revenue in the U.S. alone. To deliver on these opportunities, we are working with urgency and discipline to address our liquidity while keeping our focus squarely on the opportunity in front of us to bring meaningful, much-needed innovation to patients and generate significant value. I'd like to thank our employees, our partners, and our investors for their continued support and belief in our potential. We look forward to updating you on our progress in the coming months, and I would now like to ask the operator to open the call up to the Q&A portion of today's call. Operator?

Speaker 8

Thank you. Ladies and gentlemen, we will now begin the question and answer session. To ask a question, you may press star followed by the number one on your telephone keypad. If you're using a speakerphone, please pick up your headset before pressing the keys. To withdraw your question, please press star two. We ask that you please limit yourself to one question and one follow-up. With that, our first question comes from the line of Ted Tenthoff with Piper Sandler. Please go ahead.

Speaker 7

Great. Thank you so much for taking my question. I guess my biggest question has to do really two, if I may. First, just on myelofibrosis, you know, everything seems to be pointing in the right direction. What's your biggest worry about that potential readout? Is it JAK by doing better? Is there what could be kind of the snake hiding in the bushes or the grass or whatever that could surprise us? The second question is just with really three big readouts next year with myelofibrosis, the XPOVIO MMO through one trial, and also endometrial. How are you planning on sort of prepping and being ready for all of those data readouts at the same time? Is that going to cause any problems just in terms of processing everything? Thanks so much.

Speaker 2

Yeah, thanks, Ted. A couple of great questions. I'll take the second one first. That's a great opportunity that we're excited about to have three big readouts in front of us and to be getting ready for potentially positive data across all those readouts, which is what we're super excited about as an organization. Obviously, you know, building on the foundation of multiple myeloma, I think that's something which is kind of our bread and butter. Organizations are really ready for it. Myelofibrosis is a key area for us, obviously, and you've heard us talk, and we talked again today, that, you know, there's significant overlap in the prescriber base. To be able to build on our foundation, leverage our commercial capabilities, and get out and start being able to get ready for myelofibrosis and ultimately launching it, you know, pending positive data, I think we're well ready for it.

Speaker 2

You know, endometrial cancer, kind of largely the same. There's a lot of overlap because a number of these patients, both in myelofibrosis and endometrial cancer, are seen in the community. Our organization, our payer capabilities, our medical affairs capabilities, our commercial capabilities all have a lot of synergy to be able to bring both myelofibrosis and endometrial cancer to the patients rapidly. That's a good problem that we're excited about. The organization already is starting to work on getting ready for myelofibrosis, obviously, as our next potentially transformative opportunity. We're looking forward to updating more in the future. For the second part of the question, I'll turn that over to Reshma. Can I talk with you about MF? You know, we talk about our biggest worry.

Speaker 2

I think there's just, you know, broadly, I'll say it's just a high level of excitement, really a high level of excitement that we're building on the foundation that's being put in place with ruxolitinib. To be able to potentially combine with the standard of care and create a new standard of care for patients, obviously, is very exciting for us, especially, you know, given that that's an all-oral with two already approved medications. I'll let Reshma maybe share with you what her biggest worry is with regards to looking at the phase 3 readout with the selinexor and ruxolitinib.

Speaker 3

Yeah, thanks, Richard, and thanks, Ted, for the question. It's interesting, worry. I'm not sure I would couch it in those words. As Richard was mentioning, we've been exploring myelofibrosis for so many years, I mean, seven plus years, both with preclinical data, obviously teasing apart the mechanism. We've got multiple clinical data sets. We've got a phase one study evaluating the combination in this relevant patient population of JAK inhibitor-naive myelofibrosis. I have to say, I like what we've got. We've shown some very, very compelling SVR data, SVR-35 at week 24 that more than doubles what we've observed with historical ruxolitinib that leads to SVR rates in only approximately a third of all patients, even with symptom improvement. I'll admit, symptom improvement has been the Achilles heel of so many phase 3 trials.

Speaker 3

With that said, I like the data that we've observed to date, both from a TSS50 standpoint, but also an absolute TSS, that latter, which shows an 18.5 point improvement at week 24 relative to baseline. I always contextualize that with some of the monotherapy data that also shows some very compelling TSS data as well. Beyond that, SVR and TSS are only two of the key hallmarks that we evaluate in myelofibrosis. I really am quite encouraged by the disease modification data, both with the cytokines as well as bone marrow fibrosis, obviously the impact on hemoglobin stabilization, this really intriguing observation that we're also including improving the safety, especially the grade 3/4 anemia rates relative to historical control.

Speaker 3

I think, when I step back, the phase 3 is going to be the phase 3, but I think going into that phase 3, I really, again, like what we see in that the combination really can meaningfully improve on not only the key endpoints of SVR-35 and absolute TSS, but all of the areas that obviously are very relevant to the patient as well as their physician.

Speaker 7

That's very helpful. I share your enthusiasm. Looking forward to the data readouts. Thanks so much.

Speaker 2

Thank you, Ted.

Speaker 8

Your next question comes from the line of Colleen Coosey with Baird. Please go ahead.

Operator

Great. Good morning. Thanks for taking our questions. Helpful update on the baseline characteristics for the pivotal MF combo study. You spoke to higher TSS at baseline. Can you talk about that a little bit more and how you think that'll impact your results? Specifically, have you seen a ceiling effect with other trials?

Speaker 3

Yeah, thanks, Colleen. Great question. Some of the data, especially when we look at historical trials in this JAK inhibitor-naive myelofibrosis, does suggest whether you're looking at TSS50 or absolute TSS, that the higher the baseline, the more likely you're going to see that meaningful outcome, either a 50% improvement or that proportion of patients who can achieve that 50% improvement, or overall that average reduction in that mean TSS at week 24 relative to baseline. The higher you can push it, the more likely, again, you can achieve a meaningful outcome. These are just preliminary characteristics. We have not enrolled all of our patients. Ultimately, when we complete enrollment, we'll take a snapshot of where that baseline TSS is. I'm really encouraged where the evolution has been within this phase 3 trial, i.e., pushing to higher baseline TSS. Yeah, excited to see where we are right now.

Operator

Great. One quick follow-up if I can. You touched on this a little bit, but can you just further explain the rationale again for why you think you're seeing the lower rates of grade 3/4 anemia with the combination? How important do you think that will be for physicians and, you know, potential uptake of the combination?

Speaker 3

Yeah, it's a really, really intriguing observation. I really do think that it's probably due to the disease modification that is occurring with selinexor plus ruxolitinib. We've touched upon some really compelling cytokine data. This was back at EHA in June when we looked at selinexor as a monotherapy in that previously treated population. What those data suggested is that it's decreasing key cytokines that are involved in all aspects of anemia, specifically hepcidin and ferritin, et cetera, right? You see decreases in those rates, obviously, or potentially could be translating to lower grade 3/4 anemia. I'm really liking what we see from the very preliminary data coming out of the bone marrow fibrosis too, a really marked decrease in that reticulin density.

Speaker 3

It suggests that you're clearing out that marrow and potentially allowing for some repopulation of those key cells that ultimately can produce erythrocytes and lead to higher hemoglobin. That also could not only lead to efficacy, i.e., higher hemoglobin, but also potentially translate to lower grade 3/4 rates. Early days, right? These are just hypothesis-generating data. I love the fact that we see these clinical outcomes married with these disease modification data that, again, can explain both the efficacy and safety aspects that we see in our trials.

Operator

Great. Thanks for taking our questions.

Speaker 2

Thank you, Colleen.

Speaker 8

Your next question comes from the line of Peter Lawson with Barclays. Please go ahead.

Speaker 7

Great. Thanks so much. Thanks for the updates. As we think about revenues and kind of the drivers, what was the contribution on those misses of volume pricing versus inventory? How should we think about that for the rest of the year? I have a follow-up.

Speaker 2

Yeah, thanks, Peter. Yeah, inventory was relatively consistent across the periods. I think, as Sohanya shared, there's a balance. We saw an improvement in the GTN. That's something that we obviously talked to last quarter when we had this one-time returns issue. Overall, we also have seen demand be relatively consistent. That's kind of the balance in the drivers.

Speaker 7

Great. Thank you. There's that early blinded safety data that looks really encouraging for lower grade 3/4 anemia and discontinuation rates versus ruxolitinib alone. How confident are you that those kind of backing out of data sets will hold once it's unblinded?

Speaker 3

It's a good question. Peter, I always say, I wish I had that perfect crystal ball. Sometimes crystal balls can be fuzzy. With that said, I like the evolution that we've seen in these blinded safety data. We've taken a couple of snapshots. We've taken advantage of these 61 patients. They, again, were included as part of that futility analysis that the Data Safety Monitoring Board evaluated earlier this year. With approximately six months of follow-up, we see a really nice evolution in that safety profile, especially when we extrapolate with historical ruxolitinib. When we continue to follow those patients and took an updated snapshot as of July 1st, we really see a similar kind of trend. Yes, numerically, we do see increases in some of these rates of AEs, whether it's all grade or grade 3+, but a really nice compared to historical ruxolitinib.

Speaker 3

I think one of the key things, when I do these extrapolations, or I should say we as a team do these extrapolations, is that historical ruxolitinib safety data has been relatively consistent, right? When we look at the manifest phase 3 trial versus the comfort, they span more than a decade. Yet, again, it's interesting to see that ruxolitinib safety data, by and large, is very consistent. It allows us, or it gives us a little bit more confidence when we extrapolate to what the combination is likely going to see as relatively stable. Ultimately, we'll need to just see what the phase 3 data demonstrates. Again, encouraged by this preliminary observation.

Speaker 7

Great. Thank you so much.

Speaker 2

Thank you, Peter.

Speaker 8

Your next question comes from the line of Maureen Ravcroft with Jefferies. Please go ahead.

Speaker 9

Hi. This is Amy from Maureen. Thank you for taking our questions and congrats on the quarter. I have two questions, one on the endometrial, the other on the SENTRY 2 study. For the endometrial phase 3, can you talk about the enrollment progress so far and what % of the target has already been enrolled? For the SENTRY 2, could you help us understand how the protocol amendment would help with the enrollment of the study considering the phase 3 SENTRY and this original SENTRY 2 are not in the same population? What is the bar for success now for this amended study? What do you plan to show in the top line? How should we contextualize the data with the new population? Thanks.

Speaker 3

Yeah, thanks, Amy. I'll take the first one. For endometrial cancer, enrollment is very steady, right? This is a unique study in that it's a biomarker-driven maintenance study. What we are seeing right now and aiming to complete is what we call the top of the funnel, i.e., the number of patients who have submitted samples to Foundation Medicine for assessment of their P53 status. We see nice flows of samples into that bucket and anticipate top-line results in the middle of 2026. Again, very encouraged by the progress made to date. We have not released any target enrollment as of today, so we're not giving out any numbers. We're confident with what we are seeing at the top of the funnel, as well as the subsequent randomization, that we are going to hit top-line results in the middle of 2026. In terms of SENTRY 2, another good question.

Speaker 3

Let me just back up for a minute. SENTRY 2 was also looking at that JAK inhibitor-naive myelofibrosis patient population. We're evaluating selinexor as a monotherapy in a single-arm cohort in this population. Now, keep in mind that the population had been different and still is different than our combination trial, SENTRY, the ongoing phase 3, largely based upon their platelet count. SENTRY 2 is just enrolling patients who have baseline platelet counts between 50 and 100. SENTRY is enrolling patients with 100 and above. What we plan to do, this hasn't occurred yet, but what we plan to do is to amend the trial to allow all patients with baseline platelet counts of 50 all the way, there's no limit, to enroll as part of this trial.

Speaker 3

Now that we are opening up that baseline platelet cap, we do anticipate that the enrollment is going to pick up relative to what we've seen to date. In terms of the bar, because the amendment has not been issued yet, we don't see any difference in the bar. We do anticipate that the majority of the patients enrolled as part of the 60 mg cohort are still going to be that moderate thrombocytopenic population, 50 to 100. This is a very high net need small population at approximately 14%. Because there's not really effective therapies for that population, that bar is anywhere above 25%, right? 25% to 30% relative to historical controls of approximately 15%.

Speaker 8

Okay, thank you.

Speaker 2

Thank you, Amy.

Speaker 8

Your next question comes from the line of Brian Abrams with RBC Capital Markets. Please go ahead.

Speaker 5

Hey, good morning, guys. Thanks for taking my questions. I guess maybe asking the safety question a little bit of a different way. I'm curious, like, what's your view as to what the potential reasons why you're seeing this possible overall difference in tolerability when you kind of look at those extrapolated safety rates versus the phase one? Is there anything you can tell us about the use of antiemetics in the study, whether patients are continuing to use them or stopping after those first two mandatory cycles? My second question is, there's been some recent changes in FDA leadership at CEDER, and I'm curious if you've had any updated communications with the agency since your alignment on the new coprimary endpoints for the phase 3 and your level of confidence that their position on what's going to be required remains the same as your prior feedback. Thanks.

Speaker 3

Thanks, Brian, for the question. It really is a very nice evolution, both to historical ruxolitinib, but as you mentioned, also to the phase one data. Arguably, I think some of the greatest benefit is around those GI toxicities. It's very well known with selinexor. What we see in our phase 3 extrapolated data is a really nice improvement, both with that nausea as well as vomiting. In that phase one, yes, we saw 80% of the patients experience any grade nausea, approximately 50% of the patients experiencing any grade vomiting. What we are now potentially seeing in our phase 3 is a reduction in both the nausea and vomiting from 80% to 64%, even vomiting from 50% to now, you know, close to what you see and expect with historical ruxolitinib around 10-12%. I think you hit the hammer on the head. Why do we see this?

Speaker 3

I think it's really because of all of the antiemetics. In our phase one, antiemetic usage was not consistent. There were many patients, unfortunately, who did not take dual antiemetics. There were quite a few patients who only took one. There were some patients who didn't take any. In our phase 3, we've really tightened that requirement. Virtually all of those patients, above 90%, are taking those dual antiemetics for the first two cycles, and then if optional, thereafter. I think it's because of those required dual antiemetics we see this improvement in nausea. The real, really nice improvement is, again, in that vomiting, about from 50% all the way down to 10%. A really nice improvement not only to the phase one, but again, also relative to historical ruxolitinib. In terms of the FDA, lots of evolution going on with the FDA, as we all know.

Speaker 3

With that said, no additional feedback. We got that feedback back in the third quarter of 2024 around the endpoint change and have not gotten any additional feedback. Because everything is so documented, we feel confident in the position that the FDA will ultimately take on our phase 3 when we meet with them, hopefully next year.

Speaker 2

Brian, I think, just to add to that, I think when we look at the agency, we feel really positive about the evolutions and how they're focused on accelerating access to meaningful cures, treatments, and diagnostics. A couple months back, we participated in a really valuable CEO listening tour with the commissioner and really appreciate the interactions and the evolution. We continue to look forward to working positively with them to bring new medicines to patients.

Speaker 5

Really helpful. Thank you.

Speaker 2

Thanks.

Speaker 8

Your next question comes from the line of Jonathan Chang with Leerink Partners. Please go ahead.

Speaker 5

Hi, guys. Thanks for taking my question. Can you discuss the scenarios being explored to enhance liquidity and maximize value? What existing and/or potential exposure opportunities are being considered in these scenarios? Thank you.

Speaker 2

Yeah, thanks, Jonathan. I mean, on that side, there's really nothing more to add on this point beyond what we've stated in our 8K in July and what we shared today in the press release and our 10Q. As we've stated, we are exploring a full range of financing and strategic alternatives that are going to enable us to extend our cash runway or enhance liquidity and maximize value. We have engaged Centerview Partners, which, as you know, is a real leader in this area to help us through this. We don't intend to discuss or disclose any further developments unless and until our board has approved a real specific action or otherwise determines that further disclosure is appropriate. That's kind of where we are now, continuing to work on it, obviously, as we move forward. Obviously, with XPOVIO, it encompasses the totality of XPOVIO.

Speaker 5

Got it. Understood. Thanks for taking the question.

Speaker 2

Thanks, Jonathan.

Speaker 8

I'm showing no further questions at this time. I would like to turn it back to Richard Paulson for closing remarks.

Speaker 2

Thanks, operator. I think, as you heard today, our organization is very focused on delivering on the opportunities in front of us. As we've stated, we're working with real urgency and with discipline to address our liquidity and keeping our focus squarely on the opportunities we have in front of us, which is why we do what we do every day, and that's to bring meaningful, much-needed innovation to patients and to generate significant value. Once again, I'd like to thank our employees, our partners, our investors for the continued support and the belief in our potential. Thank you for joining the call today.

Speaker 8

Thank you, presenters. Ladies and gentlemen, this concludes today's conference call. Thank you all for joining. You may now disconnect.

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