8/5/2026

speaker
Operator
Conference Operator

Good day, everyone. Welcome to B1 Medicine's Q2 2026 earnings call webcast. All lines have been placed on mute to prevent any background noise. After the speaker's remark, there will be a question and answer session. At this time, I would like to turn the call over to the company.

speaker
Dan Maller
Head of Investor Relations, B1 Medicines

Hello and welcome. Thank you for joining us today. I'm Dan Maller, Head of Investor Relations at B1 Medicines. Before we begin, please note that you can find additional materials, including a replay of today's webcast and presentation, on the Investor Relations section of our website, ir.b1medicines.com. I would like to remind all participants that during this call, you may make forward-looking statements regarding, among other things, the company's future prospects and business strategy. Actual results may differ materially from those indicated in the forward-looking statements as a result of various factors, including those risks discussed in our most recent periodic report filed with the SEC. Please also carefully review the forward-looking statements disclaimer in the slide deck that accompanies this presentation. Reconciliations between GAAP and non-GAAP financial measures discussed on this call are provided in the appendix to our presentation, which is posted to our Investor Relations website, along with our earnings release. All information in this presentation is as of the date of this presentation, and we undertake no duty to update such information unless required by law. Now turning to today's call, as outlined on slide three, John Oyler, our co-founder, chairman, and CEO, will provide a business update. Aaron Rosenberg, our CFO, will provide an update on our second quarter financial results and 2026 financial guidance. And Lai Wang, president and global head of R&D, will discuss our R&D and pipeline progress. We will then open the call to questions. Joining the team for the Q&A portion of the call will be Dr. Wu, President and Chief Operating Officer, Matt Shaulis, General Manager of North America, Mark Lanasa, Chief Medical Officer for Solid Tumors, and Amit Agarwal, Chief Medical Officer for Hematology. I'll now pass the call over to John. John?

speaker
John Oyler
Co-founder, Chairman and CEO

Thank you, Dan, and welcome, everyone. Q2 was a very strong quarter across every dimension of our business. From a financial perspective, we achieved 1.7 billion in total revenues and $2.05 in gap earnings per ADS. This represents growth of 30% and 144% compared to the prior year, respectively. Brukinza, our foundational BTK inhibitor, continues to exceed our high expectations in the marketplace. More than six and a half years after its initial launch, Brukinza is seeing its highest level of sustained new patient starts, showing favorable early trends in duration of therapy, and it's showing strong growth across all five approved indications. On the back of these strong results, we're raising our 2026 guidance ranges for revenue and gap operating income by $300 million and $250 million, respectively. And Aaron will detail this later. As impressive as our financial performance was in the quarter, our pipeline progress was equally significant. Thank you for joining us. Mangrove is yet another example of the growing body of evidence supporting Brukinza as the foundational BTK inhibitor. We're excited about Mangrove for two key reasons. The first is because it represents the first chemo-free treatment option for patients with frontline mantle cell. And secondly, because when you see the data, we believe the efficacy will speak for itself. We're confident that this Brukinza-based chemo-free regimen has the potential to become the future standard of care for the roughly 21,000 new patients diagnosed with MCL each year in the major markets. Global submissions are planned for the second half of 2026, and we're looking forward to sharing the full data at an upcoming medical meeting. Let's now turn to Brukinza's commercial performance. In Q2, Brookins' global revenues reached over $1.2 billion, representing growth of 31% year-over-year. Brookins is the number one BTK inhibitor both in the U.S. and globally, and it has the broadest label of any BTKI, with approvals in five B-cell malignancies. We often talk about Brukinza in the context of CLL and with good reason. But it is important to remember that Brukinza is a very important option for patients with other B-cell malignancies, including MCL, Waldenstrom's, marginal zone, and follicular lymphoma. Brukinza is now treated more than 300,000 patients across 80-plus markets. But market share alone doesn't tell the full story. The reason we're winning is scientific. And that story has three chapters. Differentiated design, differentiated clinical outcomes, and differentiated real-world evidence. At B1, we're committed to generating and sharing the evidence needed to fully characterize our medicines for the patients and physicians that we serve. On the left side of this slide, you can see the highlights of the breadth of Phase III data generated for Brukinza as a single agent. Here you can see Brickenza has reported the most Phase III data of any single agent BTK. The right side illustrates the substantial body of data currently being generated in combination, where you can see that Brickenza has the most reported and ongoing Phase III data of any BTKI agent. This slide demonstrates the scale of Brukinza's development plan compared to the more curated efforts of our peers. In addition to Mangrove, Brukinza has four more potentially market-expanding Phase 3 readouts in the next three years. A major wave of data is coming that will extend Brukinza's evidence base and its label well into the future. One quick reminder of why Brukinza performs the way it does. From day one, Brukinza was designed to deliver complete and sustained PTK inhibition through its potency and its PK profile. Our hypothesis was simple. Continuous PTK coverage would translate into a superior therapeutic profile. and over a decade of clinical and real world evidence has really borne that out. And that's what the next few slides show. Let me remind you now that Brukinza is the only BTK inhibitor that has demonstrated PFS superiority versus Ibrutinib in a head-to-head randomized trial. In Alpine, Brukinza delivered a hazard ratio of 0.69, and that separation has been sustained to a median follow-up of 42.5 months. In Elevate RR, Acala showed early separation from Ibrutinib, but that separation was not sustained. The curves crossed, and the final hazard ratio was 1. And in Bruin 314, Perto reported a hazard ratio of 0.845. Put simply, there was very little differentiation between the two arms, with 48 PFS events reported for PERTO versus 50 for Ibrutinib. And with respect to tolerability, PERTO showed numerically more discontinuations due to AEs than ibrutinib, whereas both Brukinza and Acala each showed markedly fewer discontinuations than ibrutinib in their respective head-to-head trials. When comparing AFib rates of next-generation BTK inhibitors across studies, it's important to understand the protocol differences that may affect patient selection and event reporting. As you can see on the left, both Brukinza and Akala studies in frontline CLL used highly similar eligibility criteria and AFib reporting. In contrast, the PERTO studies utilized more restrictive eligibility criteria that may have resulted in a fitter study population, and they also incorporated sponsor adjudication of AFib events. As a reminder, AFib events and rates are known to rise substantially with age. In a large study of more than 17,000 adults in U.S. primary care clinics, the absolute prevalence of AFib was nearly 4% higher among those aged 70 to 74 as compared to 65 to 69. So factoring for this level of age difference in studies really matters. Despite the differences in inclusion criteria, which may have led to roughly half the percentage of patients above the age of 75 in Bruin 313 and a four-year lower median age in the PERTO studies, and despite the differences in AFib reporting methods, AFib rates were generally similar in the active treatment arms across studies. Interestingly, if we applied the more restrictive Bruin 313 and 314 eligibility criteria to the Sequoia population, 15 of the highest risk patients would have been excluded from the Brukinza arm. And in fact, those 15 patients had roughly twice the rate of serious grade 3 or higher infections and more than twice the rate of deaths due to AEs compared to the overall study. This analysis underscores the extent to which differences in protocol inclusion criteria may play a key role in the clinical narrative. Although some have suggested that PERTO may be well-suited for use in older patients due to lower AFib risk and improved tolerability, It is the least studied BTK inhibitor in that population. It lacks relevant long-term data with only 28 months of follow-up, and the narrative about being more tolerable and having less AFib are not supported by the data. The totality of evidence continues to support Brickenza's best-in-class profile. One of the key lessons we've recently learned in CLL trials is that long-term follow-up matters. Many regimens can appear highly effective in the first three years, but that's not enough time to understand their true durability. This slide shows the reported landmark PFS at years three through six across the respective frontline CLL phase three trials for the frontline treatment regimens. Recognizing the limitations of cross-trial comparisons, a few items jump out. One, the landmark PFS rates for Brukinza are higher and continue to diverge over time compared to the other two continuous BTKIs. In fact, in year six, the delta between the landmark PFS rates reaches 12%, which is equivalent of one in eight patients not progressing. 2. There's an even more pronounced delta between Brukinza's landmark PFS and that of VO. In year 6, there's a delta of 21%, or roughly 1 in 5 patients. While the all-comer story is compelling, the high-risk story is even more striking. It raises important questions about the use of the current fixed duration regimens in high risk patients, which I want to point out represent the majority of CLL patients. This is not a small patient subgroup. This slide shows how the current fixed duration treatments perform relative to the foundational in unmutated IGHV patients, those with the highest unmet medical need. Brookinsa remains durable, 84% landmark PFS at year 3 and 70% at year 6. In contrast, VO drops from 82% at year 3 to just 42% at year 6, a 40-point collapse. and AV Amplify, based on the limited data disclosed to date, shows just 69% at year three, which is of course lower than VO at a similar time point. There's a few important takeaways from this slide. First, While we're big believers in the promise of fixed duration, the existing Venn-based treatments are not a compelling option for higher-risk patients where foundational Brukinza has generated the best-in-class data. Second, long-term follow-up is critical in CLL. As you can see on this slide, many regimens look promising at three years, but by six years the outcomes can diverge meaningfully, especially in high-risk patients. And that's why we've consistently prioritized long-term follow-up in our studies and why we believe six-year data provide a more complete picture of treatment durability. It's also why we're concerned when conclusions reached on regimens based on only three years of data or less are made. We've been very surprised that some studies have not continued to report longer-term follow-up data because years three to six are critical to evaluate the true long-term benefit of any CLL therapy. Patient outcomes are at stake. The durability advantage that we're seeing in the clinical data for foundational Brukinza is increasingly being reinforced Thank you for joining us. In this patient population, Brickenza reported statistically significant 24% and 36% reduction in the risk of death compared to those treated with Acala and Ibrutinib, respectively. 24% and 36%. As you can imagine, this dataset generated significant interest from physicians at ASCO, given both its size and the importance of these findings to the real-world US Medicare population. The study has since been published in a peer-reviewed journal. And importantly, this is now one of several large real-world analyses showing a consistent advantage for Brukinza, including a recent study of claims data from 17,000 frontline CLL patients, which also reported improved survival and treatment durability for Brukinza versus Acala. Stepping back. B1 is the only company in the world with foundational medicines across the three mechanisms of action for B-cell malignancies. Brukinza, our foundational BTK inhibitor, Bacalzi, our recently approved next generation, potentially best-in-class BCL2 inhibitor, and Tachybrutideg, our potentially first and best-in-class BTK degrader. Only B1 is equipped to provide the best-in-class therapies as monotherapy or in combination for every CLL patient and other lymphomas regardless of their stage of disease, risk status, or treatment preference. I've spoken about how 2026 is an inflection year for our solid tumor pipeline, and we presented data this quarter that supports our confidence in moving our CDK4 inhibitor, our B7H4 ADC, and our GPC341BB bispecific antibody into registrational trials. Looking forward to ASMO, we'll be sharing similar proof-of-concept data sets for two more potentially best-in-class medicines, our PRMT5 inhibitor and our CEA-ADC. It's an incredibly exciting time for our company, for our portfolio, and for our pipeline. And with that, I'll hand it over to Aaron for the financial results.

speaker
Aaron Rosenberg
Chief Financial Officer

Our second quarter financial results reflect strong execution and a durable and healthy underlying business as we invest with discipline to support growth over the long term. Starting with our commercial performance, we delivered another strong quarter across the portfolio with continued broad-based growth. Total revenue for the quarter was $1.7 billion, representing 30% growth compared to the prior year. U.S. Perkinsa sales totaled $893 million, representing growth of 31%, which exceeded expectations due to several underlying factors. Despite the competitive environment, in Q2, we saw the highest level of sustained new patient starts since Brukinza's launch. Prescribers increasingly selected Brukinza for their patients, given the totality of evidence for efficacy and durability supported by the clinical data and their real-world experience. We also continue to see meaningful growth from indications beyond CLL, which speaks to the breadth of the Brukinza label and the diversification of the franchise. And while duration of therapy remains immature for Brukinza, the data suggests favorable duration relative to historical benchmarks. This makes sense given the unprecedented long-term data seen with Sequoia, as well as recently published real-world studies that reinforce statistically significant advantages for Brukinza in time to discontinuation relative to both acalabrutinib and ibrutinib. And finally, patient adherence has also improved, potentially linked to the launch of the tablet formulation late last year, which reduced both pill size and burden. High adherence rates are important for patient outcomes, and we are pleased to see this progress. These factors are not unique to the U.S., and we expect they will support durable, long-term global demand growth for Brukinza. Beyond Brukinza, Tevimbra generated $229 million in global sales. representing 18% growth versus the prior period. Tevimbra maintained its market leadership in China in the face of steep competition. Our global launches are also gaining traction, and this is ahead of the potential catalyst associated with the approval of Tevimbra in combination with Zahira and chemotherapy for patients with first-line HER2-positive GEA. Our Amgen in-license portfolio also delivered $157 million in revenue, growing 25% year-over-year. Next, I'd like to highlight the broad-based nature of growth across geographies. The U.S. remained our largest market, contributing approximately $899 million in revenue during the quarter and growing 31% year-over-year. China contributed approximately $500 million in revenue and grew 17% year-over-year, demonstrating continued strength across our commercial portfolio while maintaining market leadership for both Tevimbra and Brukinza. Note that foreign exchange contributed 7% of reported growth given year-over-year renminbi strengthening. Europe continues to be an important growth driver for the company, generating approximately $208 million in revenue and growing 37% year-over-year. We also continue to see strong momentum across our rest of world markets, where revenue more than doubled to approximately $73 million. Key markets, such as Japan and Brazil, are making contributions that are increasingly meaningful at the enterprise level. Turning to the Gap P&L. Gross profit was $1.5 billion with gross margin of just under 90%, benefiting from mix as well as productivity improvements for both Brukinza and Tovembra. Operating expenses totaled $1.2 billion, representing 13% growth, reflecting advancement of key clinical programs and continued investment to support commercial growth. We continue to demonstrate the scalability of our model in the quarter, with income from operations growing to $325 million. and finally net income totaled $237 million. This includes the previously disclosed tax audit settlement which had an approximate $60 million impact. GAAP diluted earnings per ADS were $2.05 compared with $0.84 in the prior period. Now turning to our adjusted results with a full reconciliation provided in the appendix of our results presentation. Adjusted income from operations increased to $503 million, representing growth of more than 80% year-over-year. Adjusted net income increased to $444 million, while adjusted diluted earnings per ADS increased to $3.84, compared with $2.25 a year ago. Cash generations continues to build momentum, with free cash flow doubling from the prior year period to 435 million. Turning to our updated full-year outlook, which reflects the strong first half performance and confidence in the trajectory of our business. We are raising our revenue outlook by 300 million to a range of 6.6 to 6.8 billion. This increase reflects the continued strength we are seeing across the portfolio, led by Brukinza's performance in the U.S., ongoing global expansion, and continued contributions from the broader commercial portfolio. We continue to expect gross margin to remain in the high 80% range. We're investing in both commercial execution and pipeline advancement with a modest increase in operating expenses to an updated range of $4.8 to $5 billion. Including those investments, the strength of the business translates to the bottom line. with a guidance raise in 2026 operating income by $250 million across the range. We now expect GAAP operating income of $1 billion to $1.1 billion and non-GAAP operating income of $1.7 to $1.8 billion. Other underlying assumptions remain unchanged. Overall, this updated outlook reflects the strong performance we've delivered year to date and our confidence in continued execution for the remainder of the year. As we have now rounded the first half of the year, and while staying away from providing detailed guidance, I'd like to provide some perspectives as you update your models and begin thinking beyond this year. Our 2026 outlook provides confidence in the durability of our commercial business, including the prospects for continued Brukinza growth despite the competitive environment. And as you see in our implied operating expense guidance for the second half of the year, we are investing to realize the full potential of our pipeline that we believe will drive sustainable long-term value for shareholders and the potential to address multiple unmet need for patients. Thank you so much for joining us. We look forward to providing our next financial update in November with Q3 results. And with that, I'll now pass the presentation over to Lot.

speaker
Lai Wang
President and Global Head of R&D

Thank you, Aaron. Hello, everyone. Thank you for joining us today. Across our portfolio, we'll continue to deliver meaningful progress. Starting with hematology, John already highlighted the positive readout from the mangrove study in treatment-naive mental cell lymphoma. Bokinsa plus rituximab has the potential to redefine frontline treatment and become the first chemo-free regimen for these patients. We achieved our first FDA approval in relaxed refractory mental cell lymphoma. Moving on to the celestial 301 study update. The ZANU-SORO regimen did not reach statistical superiority in the UMRD analysis versus the VIO regimen. The IDMC recommended the study continue toward its primary regulatory endpoint of progression-free survival. While the UMRD comparison was an interesting scientific question, UMRD superiority represented a very high bar given the historical high UMRD rates associated with VO regimen. Importantly, UMRD rates do not consistently predict PFS outcomes when comparing different MOAs, such as BTK inhibitor versus anti-CD20 antibody. For example, in CLR17, despite 26% lower UMRD rates than VO, the Ibutinib venetoclax regimen demonstrated comparable PFS outcomes as VO. As a result, If a BTK inhibitor plus BCR2 inhibitor combination achieves similar UMRD rates as VO, it should translate into better PFS than VO. Given the high UMRD rates and exceptional durability observed with the Xanusolone regimen in Study 101, we remain highly confident in achieving the PFS endpoint. Next, our BTK-degrader, Tecabutidec, continues to advance through potentially-registrational Phase II studies, while our Phase III Cadence 304 study against PROTO remains on track. Together, these programs support our ambition to lead the next generation of CRP in B-cell malignancies. In solid tumors, Tevambra reached another important milestone with FDA acceptance and the priority review of our HER2-positive GA application. We also made regulatory progress in China with the CDC accepting submissions for both Tevambra and Zahara. Beyond Tevambra, we'll continue to advance a diversified and increasingly innovative pipeline. Our CDK4 inhibitor has begun phase 3 development in breast cancer. Our GPC-3-4-B-B bispecific recently completed enrollment in a potentially China-registration-enabling HCC cohort. We also remain on track to initiate a phase 3 study in second-line HCC before year-end. In addition, our PMT-5 inhibitor received FDA orphan drug designation for pancreatic cancer, and we initiated clinical development of our PD-1, VEGF, CTA-4 tri-specific. The milestones from the last quarter are a reflection of more than strong execution. They demonstrated the power of focused R&D strategy. We concentrate our investments in disease areas where we can establish leadership, building disease franchises rather than stand-alone products. Supporting that strategy is a growing technology toolkit, from degraders and novel payload ADCs to cell therapies and T-cell engagers. Because we're not tied to any single modality, we can pair the right biology with the right therapeutic approach. The result is a pipeline designed not just to be broad, but to be sustainable. As our innovation engine matures, we are creating depth within each priority disease area, with multiple assets and mechanisms working together. That depth opens the door to proprietary combinations from within our own portfolio, driving differentiation and maximizing the value of our innovation investments. As we discussed on the previous slide, our innovation engine is generating a growing number of high-quality opportunities across the portfolio. Historically, our solid tumor pipeline was heavily weighted toward immuno-oncology. The CDK4 inhibitor marked the beginning of a new chapter, one defined by more diversified mechanisms, broader modalities, and a sharper focus on specific tumor types. Today, that evolution is clearly visible. We now have five solar tumor programs that have achieved the clinical proof concept and are advancing toward pivotal development. Remarkably, each is on track to progress from first in human studies to pivotal stage in approximately two and a half years. Our CDK4 inhibitor is already enrolled in Phase 3. The B74 ADC is expected to enter a pivotal study in ovarian cancer by year-end. For GPC3 from BB, we complete enrollment of the China Restoration Intended Expansion Cohort with approximately 100 patients in just two and a half months. You heard it right, it's only two and a half months. Under-scoring our ability to execute at an exceptional speed. Based on this momentum, we also expect to initiate a Phase III study in second line HCC by year-end. In parallel, our CADC and PMT5 inhibitor have achieved the proof concept and are advancing toward registration-enabling development. Taken together, these programs demonstrate a repeatable model built on differentiated science, disciplined portfolio strategy, and strong clinical execution. As multiple internally discovered assets advance into late-stage development, we are creating a growing number of value inflection points. Now, let's take a closer look at some of the assets we highlighted at OSCO. Starting with our CDK4 inhibitor, the data continue to be highly encouraging and are consistent with our scientific hypothesis. At OSCO, we report a potentially best-in-class profile, combining promising efficacy with differentiated hematological safety. At the phase 3 dose, BGB43395 achieved an objective response rate of around 70% in combination with letrozole in first-line HR-positive HER2-negative metastatic breast cancer. Safety remains a key point of differentiation. At 400 mg, The overall neutropenia rate was just 21%, with no graceful or higher events. This compares favorably with both a thermocyclic and approved CDK4-6 inhibitors, where severe neutropenia remains a meaningful clinical challenge. Together, these findings provide strong support for our ongoing Phase III program, which is enrolling rapidly. They also create opportunities for novel combinations across our portfolio, including with our CDK2 degrader, BCR2 inhibitor, and Cas6 inhibitor. Turning to our GPC-3 4-on-BB program, BGB-B2033 continues to demonstrate what could be a breakthrough profile in HCC, combining strong monocyte P activity with a highly favorable safety profile. At ASCO, we reported objective response rate of over 30% in second-line plus HCC, comparable to current first-line combination regimens and well above what was reported with available TKIs in the post-IO setting. Safety remains a key differentiator, enabled by our unique FormBP approach. This profile supports development in earlier lines. were approximately 70 patients have already been enrolled in combination with Tevambra and Bevacuzumab. Development momentum also remains strong. We completed enrollment in a potentially China registration enabling expansion cohort in post-IO, post-TKI HCC. In parallel, we are engaging with global regulatory authorities to explore accelerated approval pathways in Second Line Plus HDC based on the comparing efficacy and the safety profile observed to date. Turning to our B74 ADC, BGC9074. At ASCO, we present the data that supports its potential to become a leading program in ovarian cancer. The key differentiator is safety. At 6 mg per kilo, treatment-related grade 3 or higher adverse events were approximately 26%, less than half the rates reported for other ADCs in development for first-line ovarian cancer without biomarker selection. This profile is particularly attractive in the maintenance setting, where long-term tolerability is critical. We also reported encouraging efficacy, including activity that appears independent of B74 expression, supporting an all-common development strategy. Based on this data, we plan to initiate a Phase III study in first-line maintenance of brain cancer before the end of 2026, while continuing to expand the opportunity to endometrial cancer and TMBC. Taken together, C9074 combines competitive efficacy with potentially best-in-class tolerability, positioning it as the leading B7H4 ADC. We're excited for ASMO, where we have 12 extracts accepted, including one rapid oral presentation and nine posters. Highlights include our GPC3-4-on-BB bispecific Phase I dose optimization data, the first disclosure of Phase I proof concept data for our PMT-5 inhibitor with a focus on non-small cell lung cancer and the initial evidence of clinical meaningful brain activity, and the initial proof concept data for CADC that underscores its compelling first-in-class potential in non-small cell lung cancer. Together, this presentation highlights the strengths and the breadth of our innovation engine. We have covered most of the milestones already. I will just call out a few items on this slide. We remain on track for a potential Accelerated Approval submission of TECA in Reliance Refractory CLL by the end of this year, further expanding our CLL franchise in B-cell malignancies. In addition, we plan to start TECA Songlong Fixed-Servation Combination Phase III development in Reliance Refractory CLL in 2027. In solid tumors, we expect to initiate pivotal studies for both our GPC341BP bispecific in sec-line prostate HCC and our B7H4 ADC in first-line maintenance of vein cancer before year-end. Looking further ahead, both our PMT5 inhibitor and the CADC are positioned to enter phase 3 development in 2027. I will now turn it back to John.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks so much Lai, and we'll now open the call to Q&A. Please limit the number of questions to ensure we have time to hear from as many attendees as possible. Operator, please go ahead.

speaker
Operator
Conference Operator

If you would like to ask a question, please use the raise hand icon, which can be found at the bottom of the webinar application. When you are called upon, please unmute your line and ask your question. We will now take a minute for the queue to assemble. Your first question comes from the line of Yanan Zhu with Wells Fargo. Please unmute your audio and ask your question.

speaker
Yanan Zhu

Great. Thanks for taking our questions and congrats on a beat and raise quarter. Could you provide more color on the growth of Brickenza sales? And specifically, I was wondering if you can quantify how much of the growth is coming from indications outside CLL versus CLL itself? And within CLL, do you see any impact from the Akala van launch? and how do you think the dynamics could evolve in the next couple of quarters from that perspective? And also very quickly, Celestial 301, any color on the HR of the two arms? Sounds like it could be similar at this stage, but any color would be helpful. Thank you.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks. So I think we kind of got three sub questions in there. Maybe I will start and give a quick answer, you know, related to your question on Acala plus Venn. Then we can jump to Aaron and he can answer your general Brickenza question. And we can come to Celestial with Amit. So, you know, let me just start, you know, I think right now we're not seeing much impact from the AV Amplify in the U.S. You know, it's early. It's hard to say how it'll evolve. And if Amit has extra detail on that, he can add it when he jumps to Celestial. So with that, Aaron, do you want to talk more broadly about where growth's coming from?

speaker
Aaron Rosenberg
Chief Financial Officer

Thank you. So We really saw Brukinza growth and really for the rest of our portfolio driven by strong growth and demand across all of our regions. We spent some time talking about our U.S. business, and at the last quarter, we talked about the strength that we saw coming out of April and May, and obviously, that's continued into our second quarter performance. I highlighted in my preparer remark three core areas. The first, we are achieving our highest level of new patient starts since launch, so we're really pleased to see the uptake in the marketplace. This is driven by strength in CLL. As well as our non-CLL indications. So we really do see that durable growth across all indications. You talked a bit about sort of context. I mean, if you look at just prevalence across the five approved indications, there's about a third of the total prevalence in those non-CLL indications. and we're punching a little bit above our weight in those areas because we actually have really strong share in those indications. The other piece that we had talked about was duration of therapy and that continues to be highly constructive yet immature. This is reinforced by real-world data. We talked about the study in 10,000 Medicare patients that were recently published and this was really noteworthy with Brukinza showing meaningful Long-term benefits on discontinuation of therapy versus acalabrutinib and ibrutinib. In fact, Brukinza did not meet the median time to discontinuation in this data cut. and what we're really pleased about is how this relates directly to patient outcomes and experience and this is what you see in our overall demand growth. As a result of data such as this, we have updated our internal planning assumptions to reflect longer duration of therapy and overall the business is just performing exceptionally well. So Amit, will you take the next question?

speaker
Amit Agarwal
Chief Medical Officer, Hematology

Yeah, thank you Aaron. I think the question was about Amplify and I think John mentioned this in his remarks but Long-term outcomes are very important in CLM. As we've seen, there is a huge difference between what happens with patients between years three and six. And for AV, we only have the three-year data. We don't have long-term data. And what we've seen from that data is the lowest rate of UMRD, as well as landmark PFS, even among the WEN-based regimens. So while it is hard to say what will happen with this data set in six years, We do have other data sets that look better than AV at the three-year mark with the longer follow-up, including VEN-O and VEN-I. And when we look at these data, they really highlight some of the challenges that are seen with the current VEN-based fixed duration regimens. Now, in particular, when we look at that unmutated IGHV patient population, which represents a majority of the frontline CLL patients, There's a clear distinction between the results from Brookinsa and other Venn-based combinations. For example, at six years, Brookinsa shows 70% PFS, whereas the fixed-duration Venn-based regiments show PFS in the low 40s. We're talking about a 30% difference in the PFS. This really matters. Now, when we couple this with the fact that there are safety issues and some of the Venn-based regiments have serious infection rates of 20% to 30%, including fatal infections. And the fact that almost half of the progression events are deaths, not even allowing patients an opportunity for retreatment, it is clear that these patients are really not being served well with Venn-based regimens. And the fact that Brukinza is the treatment of choice makes a lot of sense. Now, maybe I'll quickly address the celestial question around the hazard ratio. So as Lai mentioned in his prepared remarks, This was an IDMC event where the IDMC reviewed the data for the UMRD, and B1 remains unblinded to the data, so we do not have the details of the hazard ratio. But having said that, again, we remain very confident in the PFS endpoint and our ability to show superiority for ZS over B1 for the primary regulatory endpoint, which is PFS. With that, I'll turn it back to John.

speaker
John Oyler
Co-founder, Chairman and CEO

Yeah, thank you so much, Amit. And can we have another question, please, operator?

speaker
Operator
Conference Operator

Your next question comes from the line of Rennie Benjamin with Citizens. Please unmute your audio and ask your question.

speaker
Rennie Benjamin

Hey, good morning, guys. Thanks for taking the questions and congratulations on an outstanding quarter. That's my question, mainly has to do with the mangrove study. Can you maybe provide some early physician feedback regarding the results you've disclosed? Any sort of thoughts on the study, not including a rituximab maintenance arm and kind of how they're viewing the data? And how do the physicians kind of interpret this relative to the echo regimen, which has already been approved? Thanks.

speaker
John Oyler
Co-founder, Chairman and CEO

Sure. Thank you so much for the question. You know, again, we haven't disclosed that much data on this yet, but I think I'm it. This is back in your wheelhouse.

speaker
Amit Agarwal
Chief Medical Officer, Hematology

Thank you, John, and thank you for the question, Randy. So really, I think we're all very excited about the mangrove results. And really what mangrove has let us do is it's another great example of how Brookins' differentiated profile leads to really meaningful advantage for patients. So from a design perspective, one of the important differences for mangrove compared to some of the other studies is that mangrove was designed to test a chemo-free regimen in that frontline MCL setting. and show for the first time that it actually is better than the standard of care chemotherapy regimens. The other BTK inhibitors, as you mentioned, ECHO being one example, have really added the BTK inhibitor to that chemotherapy regimen and so they're more add-on rather than replacement designs. and Mangrove for the first time showed that a chemo-free regimen of ZR was superior to BR with a hazard ratio of 0.57 in favor of the ZR arm. And these results themselves are really unprecedented in terms of thinking about that chemo-free regimen. We've talked about the OS data being immature, but I think when you see that data, it will really sort of tell an important story there and when we shared these results with physicians, KOLs, experts who treat MCL, they're really excited about this data. I think they really understand the impact that this can have, the fact that the chemo-free regimen really is going to allow for patients to avoid some of the toxicities that are seen with chemotherapy, avoid the rituximab infusion. Actually, there is a high level of interest in understanding what this rituximab maintenance-free regimen would also look like. And so overall, we've received very positive feedback from the MSIL community so far.

speaker
John Oyler
Co-founder, Chairman and CEO

Yeah, thanks, Amit. I just want to reiterate that the response I've had is wonderful. So thank you so much, operator. Could we have the next question, please?

speaker
Operator
Conference Operator

Your next question comes from the line of Michael Schmeidt with Guggenheim. Please unmute your audio and ask your question.

speaker
Michael Schmeidt

Hey, good morning. Thanks for taking my questions. I had one on the BTK degrader program, sticking with hematology. Maybe comment a bit about how you're tracking towards completing the first registration study in reluptofractory CLL. What is the efficacy bar in this setting, especially in context of a single arm study? and longer term, how do you see the DEGRADER program position relative to other programs, specifically the Norex Roche program? Thanks so much.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks, Michael. Nice to hear your voice. I think that AMID is very popular this morning. So please, can you jump into that?

speaker
Amit Agarwal
Chief Medical Officer, Hematology

Yes. Thank you, John. So as Lai mentioned in his remarks, you know, if we remain on track and if the data supports this, We're looking forward to that AA submission in Q4 of this year. Now, I'll remind folks that the FDA has previously granted FAST-TRACK designation for tachypneurotic for adult patients with relapsed refractory CLL. will receive at least two prior lines of therapy, including a BTK and BCL2 inhibitor. And in the context of what we've seen so far from our phase one data, across different patient populations, we've seen very encouraging both response rates as well as the durability of those responses. And we think that this is a profile which is compelling. And when we think about previous accelerated approvals, We think that the profile really, you know, supports accelerated approval in that context. Now, in addition to this, we also have important phase three studies, which are executing very well. Particularly, I would call out a head-to-head comparison of tacobrutidec versus pertabrutinib, the non-covalent BTK inhibitor. This study is enrolling very well, and we are very excited to share those results when they're available. And in addition to this, Lai mentioned the Tachybrutidec plus Syndrotoclax relapsed refractory study that we also plan to initiate early next year. So overall, I think, you know, this really reflects our growing confidence in the program and our ability to execute on a sort of profile which is going to allow Tachybrutidec to become a foundational asset in CLL along with the rest of our portfolio.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks Amit. And operator, we're ready for another question.

speaker
Operator
Conference Operator

Your next question comes from the line of Etzer Darut with Barclays. Please unmute your audio and ask your question.

speaker
Etzer Darut

Great. Thanks for taking the question and congrats on the update today. Maybe another one on mangrove, if you can maybe talk about when we could See an additional data cut here and any sort of potential presentations we may see around that. And then secondly, and maybe one for like around the pipeline, just curious around the Cat6 design elements and the potential to put, you know, combined maybe with the CDK4 selective program or other Thank you so much for the question. Let's start with Amit and jump to live.

speaker
Amit Agarwal
Chief Medical Officer, Hematology

Yeah, I think the question about mangrove was really just when are we presenting the data. And I think, you know, as you mentioned, John, we are very excited to present this at an upcoming Congress. So we'll hopefully share the details very soon. Lai?

speaker
Lai Wang
President and Global Head of R&D

Yeah, in terms for the Cas6, this molecule was designed to be more selective for Cas6, trying to spare in the Cas7. This is a main differentiation versus Pfizer's Cas6 program. We believe this can potentially lead into less hematological toxicities. So far we certainly, starting from last year, we had this program enter and connect to initiate the first in human study in breast cancer. While the design there used to be combined with our CDK4 inhibitor, but certainly in our pipeline there are many other potential molecules which we can combine with Cas6 in the breast cancer. But in addition to that, I think it was just last month, we also initiated our second Phase 1 study. This one is to exploring this Cas6 molecule in AML. We have seen quite a bit interesting preclinical translational data about Cas6 in AML, and we're certainly looking forward to seeing this molecule, how it does in AML.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks so much, gentlemen, and back to the operator for another question.

speaker
Operator
Conference Operator

Your next question comes from the line of Yaron Werber with T.D. Cohen. You may unmute your mic and ask your question.

speaker
T.D. Cohen

Great. Congrats on a really nice quarter. Question, PRMT5 is a really important target, and you're the lead, essentially, with the brain penetrant molecule. So it sounds like you're going to have data in lung cancer and asthma. Can you give us a sense what we might be able to see because you're moving that into phase three next year? And I think also pancreatic cancer achieved POC. Is there any chance we might see some of that data at ESMO or is that going to be in the next meeting? And is that moving to phase three next year as well? Thank you.

speaker
John Oyler
Co-founder, Chairman and CEO

Hi, Yaron. Thanks for the great question. And Mark, why don't you speak to that since you're closest to the detail?

speaker
Mark Lanasa
Chief Medical Officer, Solid Tumors

Thank you, Jeroen. We're very excited about our PRNT5 program and look forward to the initial disclosure that's upcoming at ESMO. Our molecule entered the clinic in the first quarter of 25, so this is our initial disclosure and therefore will include the monotherapy phase 1A dose escalation data. But we'll also include a significant number of patients who have been enrolled in expansion phases. Because our molecule is designed to be CNS penetrant, we have had an emphasis on enrolling patients with non-small cell lung cancer. As you heard from live, we'll share some data showing that we have early evidence of clinically meaningful CNS coverage. But we will share data across tumor types, inclusive of non-small cell lung cancer, pancreatic cancer, and other tumor types. Again, while we have an emphasis on lung cancer, we intend to have a broad development plan for this molecule.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks so much, Mark. And back for another question, please.

speaker
Operator
Conference Operator

Your next question comes from the line of Jessica Fye with J.P. Morgan. Please unmute your audio and ask your question.

speaker
Jessica Fye

Hey guys, good morning. Thanks for taking my question. Maybe one for Aaron and one for Mark. On the guidance increase, can you just walk through what changed most materially relative to your expectations when you last updated guidance last quarter? And then for Mark, on the CEA ADC for lung cancer, can you talk in broad strokes about the phase three you envision running for that product next year? Thank you.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks, Jessica. Please, Aaron and Mark.

speaker
Aaron Rosenberg
Chief Financial Officer

Sure. And I'll be fairly brief, and thanks for the question, Jess. I covered, I think, many of the factors that were driving performance for the quarter. The ones I highlighted are all areas of strength for Brukinza, whether it be the level of new patient starts we're seeing, the strength across all indications, and and certainly improvements in our understanding of duration of therapy and how that's manifest in demand. All these are areas of strength for the business and candidly ahead of our expectations at the beginning of the year. We're really pleased to see this. Ultimately, this means impact for patients and we look forward to continue to growing the franchise as we move forward.

speaker
Mark Lanasa
Chief Medical Officer, Solid Tumors

Thanks, Jess. Regarding the CEA ADC, as I mentioned for PRMT5, again, we're very excited to make our initial data disclosure at the upcoming ESMO. Because this is the first disclosure, this will include the phase one dose escalation data as well as the expansion data. We do have a first in class proof of concept in non-small cell lung cancer. And we think that these data compare favorably to other investigational ADCs in the non-small cell lung cancer space. Based on these data, we want to leverage our lead mover advantage so the initial registration opportunities will be in a later line setting, but we're actively working to generate evidence in an earlier line setting given the strength of data that's emerging.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks so much. Another question, please.

speaker
Operator
Conference Operator

Your next question comes from the line of Fazal Khurshid with Jefferies. Please unmute your audio and ask your question.

speaker
Fazal Khurshid

Hello, this is Inan Shan for Fezzel. Just give a little more detail on your PRMT5 and RAS strategy. Would the phase three for the PRMT5 lung cancer study be a combo or mono? And could you provide any further details on your RAS-on inhibitor? Thank you.

speaker
John Oyler
Co-founder, Chairman and CEO

So Mark, I think that's back to you.

speaker
Mark Lanasa
Chief Medical Officer, Solid Tumors

Thank you very much for the question. RAS inhibition has proven itself to be a very important therapeutic modality, not only in pancreatic cancer, but also in non-small cell lung cancer. We're deeply committed to innovation in that space. We have a highly potent RAS-on inhibitor that will enter the clinic prior to the end of this year. Similar to our PRNT5 molecule, this molecule was designed to be CNS penetrant, and therefore we're particularly excited about the opportunities for that molecule in non-small cell lung cancer. We are certainly aware and excited about the data when a Rason inhibitor is combined with a PRNT5 inhibitor in MTAP-deleted pancreatic cancer. We will be looking to generate evidence in that regard as swiftly as possible. And then going back to RAS, we have additional RAS targeting molecules that we're advancing, including a KRAS targeting degrader, as well as a RAS on ADC, where a RAS on inhibitor will be the payload for the molecule.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks so much. And back to the operator for one more question.

speaker
Operator
Conference Operator

Your last question comes from the line of Gregory Renzo with Truist Securities. Please unmute your audio and ask your question.

speaker
spk09

Great. Thank you and good morning, John and team. Congrats on the quarter and thanks for taking my question. John, maybe one for Aaron. And just as we look across the portfolio, when it comes to the Amgen portfolio, Aaron mentioned the growth of 25% or so. Just curious how we should be thinking about its contribution. It continuously outperforms expectations, certainly some nice growth there. But where do you see the portfolio going and how should we be framing the contributor to the top line? Thanks so much.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks for the question, Aaron. Why don't you wrap up Q&A and we'll close.

speaker
Aaron Rosenberg
Chief Financial Officer

Sure. Thanks for the question. We're obviously very pleased with the performance of our IMGEM portfolio this year and really since the inception of this important collaboration. So this is a franchise with great assets. We're on the verge of launching our opportunity within Delta in the marketplace. I did touch on the last quarter by a similar competition that's coming. For XGIVA, we'll share more on that evolution as our understanding of the situation evolves. That's not a near-term impact, but it's certainly something that could influence performance as we move beyond this year. We'll share more details of that as our understanding of the situation comes to light. Thank you.

speaker
John Oyler
Co-founder, Chairman and CEO

Thanks so much, Aaron. In closing, I just want to share that we believe the company has never been better positioned. The commercial engine is really delivering. The pipeline's at an inflection point. The global organization is executing at a very high level. Thank you so much for joining us. Thank you all for joining us and being part of things. Have a wonderful rest of the day.

Disclaimer

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