This conference call transcript was computer generated and almost certianly contains errors. This transcript is provided for information purposes only.EarningsCall, LLC makes no representation about the accuracy of the aforementioned transcript, and you are cautioned not to place undue reliance on the information provided by the transcript.
spk17: Good day and thank you for standing by. Welcome to the Revolution Medicines Q2 2024 earnings conference call. At this time, our participants are in listen only mode. After the speaker's presentation, there will be a question and answer session. To ask a question during this session, you need to press star one one on your telephone. You would then hear an automated message advising your hand is raised. To withdraw your question, please press star 1-1 again. Please be advised that today's conference is being recorded. I would now like to hand the conference over to your first speaker today, Ryan Acey, Senior Vice President of Corporate Affairs. Please go ahead.
spk03: Thank you, and welcome everyone to the second quarter 2024 earnings call. Joining me on today's call are Dr. Mark Goldsmith, Revolution Medicines Chairman and Chief Executive Officer, and Jack Anders, our Chief Financial Officer. Dr. Steve Kelsey, our president of R&D, and Dr. Wei Lin, our chief medical officer, will join us for the Q&A portion of today's call. I'll note that certain statements we make during this call will be forward-looking because such statements deal with future events and are subject to many risks and uncertainties. Actual results may differ materially from those in the forward-looking statements. For a full discussion of these risks and uncertainties, please review our annual report on Form 10-K and our quarterly reports on Form 10-Q that are filed with the U.S. Securities and Exchange Commission This afternoon, we released financial results for the quarter ended June 30th, 2024, and recent corporate updates. This press release is available on the investor section of our website at resmed.com. With that, I'll turn the call over to Dr. Mark Goldsmith, Revolution Medicine's Chairman and CEO. Mark?
spk07: Thanks, Ryan. It's good to be with you this afternoon. Given our recent webcast in which we provided an update on our clinical progress in pancreatic cancer, we will keep our remarks relatively brief today. I'll share a quick summary of the data we presented last month, highlight recent progress we've made across the rest of our pipeline, and discuss several corporate updates. I'll then turn the call over to Jack, who will provide highlights of our financial results before we open the line for questions. We have made meaningful progress with our pioneering Rason inhibitor pipeline, notably preparing RMC6236, our Rason multi-selective inhibitor, to move into its first pivotal monotherapy studies in common difficult-to-treat cancers driven by oncogenic RAS variants. We kicked off the second half of the year with an important clinical milestone for RMC6236. We disclosed recent data from the RMC6236-001 trial, showing compelling preliminary progression-free survival and overall survival for patients with metastatic pancreatic cancer receiving RMC6236 monotherapy. These data have increased our confidence in the promise of this program and reinforce our commitment to initiate our first registrational study this year. I'll take a few minutes to walk through some of the key findings from the pancreatic cancer results we shared last month. The full detail of these results can be found on the investor section of our website at redmed.com. The data with a May 11th, 2024 cutoff date reflects patients with previously treated pancreatic cancer across the RMC6236 160 milligram to 300 milligram daily dose cohorts. The safety findings were promising. The most common adverse events are believed to be on target and associated with the inhibition of wild type RAS in normal tissue. Most adverse events were low grade. with approximately 22% of patients experiencing a grade three or higher treatment-related adverse event. The most common treatment-related adverse events observed were rash and gastrointestinal-related toxicities. There were no discontinuations due to treatment-related adverse events, and dose modifications of any kind occurred in only 28% of patients. The anti-tumor durability data were quite compelling as well. Historical progression-free survival benchmarks in pancreatic cancer are poor overall and deteriorate with advancing lines of therapy. In a progression-free survival analysis of second-line patients, which is consistent with the patient population we plan to evaluate in our phase three study, we observed an initial median progression-free survival of 8.1 months in patients with KRAS G12X tumors and 7.6 months in patients with RAS mutated tumors broadly. While these data continue to mature with longer patient follow-up, these preliminary findings compare favorably to standard of care in this patient population. We also showed an early interim look at overall survival in these patients. As of the cutoff date, the median overall survival had not been reached for patients with either KRAS G12X mutations or other RAS mutations, And importantly, the lower bound of the 95% confidence interval for the median overall survival estimate is above the standard of care benchmark for median overall survival in second-line metastatic pancreatic cancer. As we noted in July, while early overall survival estimates represent a relatively immature data set, in the context of the strong progression-free survival data, we believe these observations provide a meaningful complement to the overall efficacy story of RMC6236 in metastatic pancreatic cancer. We anticipate that these two measures, progression-free survival and overall survival, will be dual primary endpoints in our planned phase three study. Additional metrics and more detail regarding these data can be found on our website. Given the strength of these data and based on initial feedback from the Food and Drug Administration, including alignment around high-level study design and the selection of 300 milligrams as our go-forward dose for pancreatic cancer, we plan to initiate our first global, registrational Phase III study this year. This Phase III study, called RASALUTE302, will evaluate RMC6236 as a second-line therapy for patients with metastatic pancreatic cancer. Of course, while we are excited to initiate this study shortly on behalf of patients, Our ambitions for RMC6236 go well beyond second-line pancreatic cancer as we explore or plan to explore other tumor types and earlier lines of therapy. Data from the non-small cell lung cancer portion of the RMC6236 monotherapy study continue to mature. In the fourth quarter, we expect to provide updated safety and anti-tumor activity, including durability data, and to initiate a second registrational study evaluating RMC6236 monotherapy for patients with previously treated non-small cell lung cancer. The strength of the data we've presented also enhances our commitment to expand the reach of RMC6236 into earlier lines of therapy, including first-line metastatic, locally advanced unresectable, and resectable disease. Exploratory studies evaluating RMC6236 in combination with current standard of care chemotherapy in first-line pancreatic cancer and colorectal cancer are currently enrolling and will yield important insights that should inform dosing paradigms for potential first-line registrational paths. This area remains a significant focus for RevMed. Another important combination study in progress is evaluating RMC6236 with pembrolizumab, with or without chemotherapy, in patients with advanced RAS-mutated non-small cell lung cancer. We expect to report initial data for this combination in the fourth quarter of 2024. While there is substantial focus and investment in RMC6236 as our most advanced RAS-on inhibitor in the clinic, we also continue to prioritize investment in qualifying our first two RAS-on mutant selective inhibitors RMC6291, our G12C selective inhibitor, and RMC9805, our G12D selective inhibitor, for late-stage development. First, we continue to make progress in our combination studies with the goal of moving RMC6291 into early lines of therapy for patients with RAS G12C tumors. The RAS-on inhibitor doublet of RMC6291 in combination with RMC6236 in patients with KRAS G12C solid tumors, primarily non-small cell lung cancer, is a vanguard study of this sort of combination regimen. This study is ongoing and we expect to share initial data in the fourth quarter of this year. Another combination approach with KRAS G12C non-small cell lung cancer is RMC6291 with pembrolizumab with or without chemotherapy. A study of this combination is ongoing and we anticipate disclosing initial data for RMC6291 with pembrolizumab in the first half of 2025. Second, the first in human monotherapy study of RMC9805, a Rason G12 Deselective Inhibitor, continues to enroll well. Dose optimization is ongoing, and we are on track to share initial safety, tolerability, and antitumor activity in the fourth quarter. Overall, we have a busy and exciting road ahead with the anticipated initiation of two RMC6236 monotherapy registrational studies, a number of important exploratory combination study data updates, and additional data maturation that may validate the potential to advance two clinical stage RAS on mutant selective inhibitors into late stage development. In addition to advancing our studies, we are also preparing the organization for the next phase of growth. We are pleased to announce that we have appointed Frank Clyburn to our board of directors. Frank is a distinguished commercial pharmaceutical leader who brings a wealth of experience to help Revolution Medicines advance toward late-stage clinical development and pre-launch commercial readiness. Notably, he was instrumental in building Merck's modern oncology business, leading the successful global launch and commercialization of Merck's Keytruda to create the dominant immuno-oncology franchise. His insights and experience will be invaluable as we move forward. We've also made several strategic leadership hires across medical affairs, research and development, program management, and corporate affairs to help scale our organization as we move closer to becoming a fully integrated commercial organization. In particular, I'd like to highlight two individuals who have joined RevMed's senior leadership team. First, Ryan Acy, who is hosting today's call, brings extensive business experience in the biopharmaceutical industry to his new role as our senior vice president for corporate affairs. Second, Dr. Mary Pinder-Shank has joined the organization as our senior vice president and head of medical affairs. In addition to being a well-respected board-certified medical oncologist, Dr. Pindershank brings extensive US and global medical affairs leadership experience to RevMed. I'm highly confident in the strength of our team and the collective depth and breadth of experience we can apply to this transformative stage of the company. We continue to build the capabilities needed to drive the long-term sustainable growth of our business. This team, along with our robust pipeline of innovative programs and one of the most productive drug discovery organizations in the industry, position us well for what lies ahead. Now I'd like to turn the call over to Jack Anders, our Chief Financial Officer, to provide a financial update. Jack?
spk19: Thank you, Mark. We ended the second quarter of 2024 with $1.59 billion in cash and investments. This compares to $1.7 billion at the end of Q1. The decrease in cash and investments during the second quarter was primarily due to net loss for the quarter. Turned into expenses, R&D expenses for the second quarter of 2024 were $134.9 million compared to $98.0 million for the second quarter of 2023. The increase in R&D expenses was primarily due to increases in clinical trial expenses for our first wave of RAS on inhibitors, preclinical portfolio expenses, personnel-related expenses associated with additional headcount, and stock-based compensation expense. G&A expenses for the second quarter of 2024 were $21.7 million compared to $14.6 million for the second quarter of 2023. The increase in G&A expenses was primarily due to increases in personnel-related expenses associated with additional headcount, commercial preparation activities, and stock-based compensation expense. Net loss for the second quarter of 2024 was $133.2 million compared to $98.3 million for the second quarter of 2023. As previously disclosed on July 15th, we have updated our 2024 financial guidance and expect full year 2024 GAAP net loss to be between $560 million and $600 million. which includes estimated non-cash stock-based compensation expense of between $70 million and $80 million. That concludes the financial update. I'll now turn the call back over to Mark.
spk07: Thank you, Jack. Revolution Medicines entered the second half of the year by fulfilling one of many important clinical milestones for our organization. We are well capitalized and remain focused on delivering key data and actions to advance RMC6236 into its first registration studies while evaluating several opportunities to move into earlier lines of treatment for patients living with RAS-addicted cancers. We are also laying the groundwork to move our first two RAS on mutant selective inhibitors into late stage development. This important work and the progress we've made would not be possible without the support of our patients and caregivers, clinical investigators, scientific and business collaborators, advisors, shareholders, and the tireless efforts of RedMed employees on behalf of patients. This concludes our prepared remarks for today, and I'll now turn the call over to the operator for the Q&A session.
spk17: Thank you. At this time, we will conduct a question and answer session. As a reminder, to ask a question during this session, you need to press star 1 1 on your telephone and wait for your name to be announced. To withdraw your question, please press star 1 1 again. We ask that you please limit your questions to one question and one follow-up.
spk08: Please stand by while I compile the Q&A roster. Our first question comes from Mark Fromm from TD Cowan.
spk17: Please go ahead.
spk18: Yes, thanks for taking my questions. Let me just start off. When you think about the PFSA that you released in pancreatic cancer the other day, You know, it looks a little bit better than what was achieved kind of with the G12C inhibitors in that subpopulation of pancreatic patients. Do you think that similar gap should kind of be expected when we look at monotherapy data in other settings where we have mature G12C inhibitor data, whether that's lung cancer or ultimately some other settings like colorectal cancer, or is just the biology just way too different across tumors?
spk07: Thanks, Mark. Appreciate your question. I think at this point, given that data will be rolling out, you know, in coming months and over the next year, I think it's best just to let the data speak for themselves. There's obviously, there are many differences in the subtle aspects of biology comparing one tumor type to another.
spk10: Whether or not that nets out in any particular direction, I think, can just be determined empirically.
spk18: Okay, thanks. And then maybe thinking about first line in pancreatic cancer, how much more data do you need to gather to kind of know what the plan is there rather than just saying you want to do it, whether it's monotherapy? Do you need a fair amount of combo data with chemo or even with the G12D inhibitor to just kind of figure out what the design looks like to move to first line?
spk07: Yeah, I mean, I think we said before, and I know you and I talked about that the monotherapy RMC6236, I think, already qualifies to be included in such a trial. And really the question is around how to play with chemotherapy. What role should that play? Should that be an arm in the study? And if so, efficacy question. RMC6636 clearly is a broad-based inhibitor of RAS. It's by design. It's generally well-tolerated and safe, but it does have some side effects. Chemotherapy is typically replete with side effects, and so when you put those two together, we need to have confidence going into the study, going into a registration study that that combination will not blow up for patients. So that's really what we're doing is trying to figure that out. There are many combinations, as you point out, that we could pursue. I wouldn't consider RMC 9805 specifically part of that determination for 6236 going into frontline. It's its own entity, and how we'll deal with that we'll describe over time as we reveal data about that interesting compound.
spk08: Okay, thanks a lot.
spk17: Thank you. One moment for our next question. Our next question comes from Michael Schmidt from Guggenheim. Please go ahead.
spk21: Hey, thanks for taking my questions. I had one on the potential phase three study in second line non-small cell lung cancer for 6236. I mean, one would think that the easiest or the simplest design would just be a one-to-one randomization compared to dosetaxel. But I'm just curious, there may be a scenario where Cresati has full FDA approval in G12C positive patients at some point in the future and based on the CRISPR-12 study. And I was just wondering, To what degree that might factor into the potential trial design? Would you, for example, allow Cresati in the control arm for G12C-positive patients, assuming that the trial obviously would include those patients, or is that something that is not, you know, not feasible in your opinion?
spk07: Thanks, Michael. Good to hear from you. Maybe I'll just say something brief about it, and then if either Steve or Weiwa said something, we can do that. Maybe my general comment is G12C is clearly the most complicated part of the lung cancer trial for RMC6236. There are subtleties associated with that, as you just alluded to. We've not described our plan yet for lung cancer. We put forth sort of a prototype last October, but we've not laid that out. getting out a little bit of our skis to commit today. But whether there are any principles that Steve or Wayne wants to add to that, feel free to.
spk05: I think the only thing I want to add is that I think it will end up being a consideration from the FDA. If they were to prove Cresati, do they believe that 1.6-month PSS improvement, if that's Cresati, in addition to docetaxel. And that would dictate whether Prasadi is required to be the comparator or docetaxel is to be acceptable. So I think that would be a regulatory review issue.
spk21: Okay. Okay. Thank you. And then, yeah, I'm very curious about the combination of 6236 with 6291, where I think you committed to presenting data later in the fourth quarter and Yeah, I just want to understand a little bit better what types of patients are involved in this study. Are these predominantly second-line or later patients or perhaps some treatmentized patients included there as well? And what efficacy bar are you looking for to potentially advance that dual combination into more registration-directed studies?
spk07: Okay, so the first question is,
spk05: So the patients that are eligible is any patient with a T12C previously treated tumor. Predominantly so far we'll be enrolling T12C patients who have a lung cancer or a colorectal cancer just given the predominance of those tumor types or I think if you look at 100 patients with solid tumor T12C mutations, 70 of them will probably be lung cancer and the other 20 will be colorectal cancer and low.
spk07: And so that second line plus, given that they have to have been previously treated with low G12C. And then your second question was, what's the efficacy bar? Yeah. Well, it's a fairly subtle topic here. You know, really to compare two things and prove that they're different requires a randomized control trial with hundreds of patients. So there's not going to be a number that's going to come out of this that will allow us to declare victory at that level, of course. What we're looking for, though, is can we see some level of differentiation that's qualitatively informative? And what that is will emerge over time. We'll see what we see, and we'll communicate it at that time. But there's not a preset response rate
spk21: Okay, great. Thank you.
spk08: Thank you.
spk17: One moment for our next question. Our next question comes from Eric Joseph from J.P. Morgan. Please go ahead.
spk02: All right. Thanks for taking the questions. I'm hoping you could just help us level set expectations into the Phase I phase. non-small cell lung cancer update in fourth quarter in terms of patient numbers. You know, just kind of drafting from the update that we saw in July in pancreatic, should we expect a similar ramp up in the number of evaluable patients across doses 160 to 300 milligrams? And then just as a follow-up in pancreatic cancer, Mark, I guess how should we be thinking about sort of additional updates either kind of within the data set that you presented in July, perhaps at medical meetings, or sort of follow-on updates as that trial matures. Thank you.
spk07: Yeah, thanks, Eric. Nice to talk with you. On the second question of PDAC, I think we've made a pretty clear commitment
spk10: We have a meaningful update, but we've not been able to share a specific timeline or setting in which that will happen. So I don't think we have anything to add to that today. With regard to the lung cancer data, it's hard really to go into that level of forecasting what we'll communicate.
spk07: You know, I think generally speaking, we're going to be in the ballpark with the kinds of numbers that we've enrolled previously for pancreatic cancer, but the analysis will just have to speak for itself, you know, at the time.
spk02: Okay, thanks. Maybe just one follow-up in lung cancer, if I could, just picking up on a prior question about the phase three strategy. It sounds sort of like one that you're contemplating as an integrated trial where G12C patients can go on to either a G12C or can be compared to a G12C inhibitor or a taxane. I just wonder operationally, is there sort of a scenario where you conduct two phase three trials, one in sort of G12X minus C and then another in G12, another that's focused in G12C patients? Thank you.
spk07: Well, yeah, there are a lot of possible scenarios. I don't think I can give any hints today about what the scenario is that we'll pursue. I think that's best done at the time that we share the data and describe it. I think that Wade's comment earlier was more one of concept. If that's an FDA, ultimately that's an FDA question. What will they treat as the standard of care? And would CRISATI, if it's approved, be declared as the standard of care for G12C patients or just launch several treatments that are acceptable, in which case dose of taxes would be a good comparator. That's a topic really for discussion with the FDA. It's not so much that we're considering A, B, or C, but just as a concept, that's how one would have to think about it.
spk10: And also, I think the other factor that would go into that is the timing as to if Grisali gets approved, when does it get approved relative to that study?
spk02: Okay. Got it. Appreciate the color, and thanks for taking the questions.
spk17: Thank you. One moment for our next question. Our next question comes from Jonathan Chang from Learing Partners. Please go ahead.
spk12: Hi, guys. Thanks for taking the question. Given that there are multiple data updates now expected in 4Q, how should we be thinking about the cadence and venue of these disclosures? Will it happen sequentially? Do you have an order in mind, or could these be bundled together in a combined way? Thank you.
spk10: Yeah, thanks, Jonathan. The answer to your question is yes.
spk07: So you gave a list of possibilities, and that is... I think we won't be able to provide more clarity. We're glad that we can give you at least narrow it down to a quarter. That's a step forward, but beyond that, we'll save the format for the right moment.
spk08: Understood. Thank you. Thank you. One moment for our next question. Our next question comes from Chris Shubitani from Goldman Sachs.
spk20: Please go ahead. Thank you very much. I know that, Mark, you and the team had a discussion of the data, but perhaps if you could just, for the purposes of this audience at this point, for the second line PDAC readout, thinking about dropouts and censorship, is the level of censorship in an expected range? Is there something that might have accounted in some idiosyncratic way, potentially, investigation site or trial or any aspect of treatment of the patients? And then how should we think about this as possibly being relevant at all as we think about the larger phase three multi-institutional trial. Thanks.
spk07: Yeah, thanks, Chris. Nice to talk to you. Thanks for the question. Yeah, there was some censorship that went, some censoring that went on in both the PFS and OS analyses, and maybe Wei can address both of your questions. What type of censorship was it? Was it unusual? Did it indicate anything? And...
spk05: There were nothing unusual about the sensorine. The sensorine was just standard sensorine due to the fact that some patients were enrolled later than other patients, and at the time of the data cutoff, they have not had a progression event. And so that's the reason for the sensorine that you saw for the patients that have occurred throughout both the CAPMAR curve for the PFS and OS. As we follow through and have later data cut with more maturity to the data, many of those sensors will move out and hopefully even beyond the median PFS assessment. And furthermore, if they have a PFS event, then obviously that sensor will move. In terms of translation to the ultimate recreational trial, in a, because in a, early line study, we can observe the data in real time and we can cut the data continuously and so you do see an early data cut which we presented with some censoring due to the maturity lack thereof of the data. In a setting of a retribution trial, this would no longer be an issue because it would be a pre-specified be used to date at which time we read out the study. And so we would not be looking at the data in real time and we'll be not presenting data in an immature state as we have in this case. So we're not expecting these. And so at that time, the PFS and OS, when we do read out, will be a fairly safe recommendation for final analysis. So I don't think there's any sort of
spk10: If I could just add one point to the first part of the question, which is those patients who were censored because they had started on the trial more recently. We did look at those patients, at their profiles.
spk07: into those cohorts and is forced to be censored at a certain point in time.
spk20: Thank you. That's reassuring clarification. Appreciate it.
spk08: Thank you. One moment for our next questions. Our next question comes from Eliana Merrill from UBS.
spk17: Please go ahead.
spk04: Hi, this is Elliot Bosco. I'm for Ellie Merrill, UBS. First one, what's your view on what would be a competitive PFS data for the upcoming 6236 non-small cell lung cancer update? In particular, could you clarify what would be competitive when thinking about both crass and non-crass targeted therapies?
spk10: Yeah, Elliot, thanks for your question. I mean, it's pretty straightforward.
spk07: We think that the first thing we have to do is make sure that we clear the standard care bar. or in the midst of gathering and analyzing data, it's very hard to separate then our view of those data from that. We, of course, have target product profiles that are internal and proprietary, but nonetheless, for a conversation like this, I think it's really a tricky question at this stage. So the best thing to do is to wait and see. We do have experience, of course, with RAS inhibitors as to what they previously considered sufficient, and investors have had opinions about that, and everybody's had an opinion about it.
spk10: And we'll present ours in the context of the data that we have and everybody . Okay.
spk04: And then just one more. For the ongoing 6236 monotherapy and combo studies in colorectal cancer, could you provide a sense of when we might see data? Is that likely to be a 2025 event?
spk10: Yeah, we haven't provided any guidance on timing for that, so I'm hesitant to just do it off the cuff here.
spk07: I think the one concept that I think Steve has communicated a number of times and Wei has as well is that we consider colorectal cancer to be primarily a combination strategy play. That's been the history of essentially forever, and it will be as well. So that's more the horizon to be thinking about Not to say we may not present some monotherapy data, but we do believe that fundamentally the biology of colorectal cancer requires.
spk08: Okay. Thanks for taking the question. Sure. Thank you. One moment for our next question.
spk17: Our next question comes from Alec Stranahan from Bank of America. Please go ahead.
spk13: Hey, guys. Thanks for taking our questions. First one from us, just from the nested trial design in RASalute 302, any signals you'd highlight from either your phase one or preclinical work for the activity of 6236, specifically in the G13X, the G61X, and especially the RAS wild type patients? Would you view these as maybe higher hanging fruit from a mechanistic perspective? I know you saw some preclinical activity in the RAS wild type in your nature paper earlier this year.
spk10: Yeah, maybe Steve wants to comment on that, but non-G12X versus G12X, and I would think about that in the nesting. Yeah, well, I would think about it in the nesting is that the proposal is that if it isn't G12, it isn't in the inner core as we describe it,
spk06: whether that is based on firm data or whether it is based on more of a conceptual approach to the whole disease and the concept of rats driving the disease I think is something that we don't really know yet. I mean the assessment of any of our compounds, including IMC6236, in RAS mutations outside of the G12 mutations was a somewhat later event. And therefore, the emergence of data in those mutations is going to be somewhat behind the main body of data on which we base our decision making. And so we're a little less confident there. I think it's more about confidence than it is about science and medicine. And no doubt that will evolve So I'd love to be able to give you a proper scientific answer to the question, but at the moment we are unable to do that.
spk07: And I would just add to that that in the data we presented, we did show the overall RAS mutated group, and the PFS value for that was 7.6 months. So if there are differences that we haven't yet developed clarity around, they don't seem to compromise, you know, looking at the whole group. You know, and also keeping in mind that 85% of pancreatic cancer is attributable to a RAS G12X mutation, so the majority of the disease that we're trying to treat here is still in the core population, but we'd like to offer something more broadly than that if it's justified.
spk13: Got it. That makes sense. And then one more, if I may. obviously launching and supporting your ongoing and planned studies is a top priority. But in terms of capital allocation, next 12 months or so, how do you plan to move forward with the earlier Wave 2 pipeline in order to realize the ultimate potential of the Rasson approach? Thanks.
spk10: So we – thanks for that question. I mean, we define Wave 1 Rasson inhibitors as being the
spk07: and then we have lots of other inhibitors behind that. We haven't formally called them away to, but I think that would be a natural progression. And we have not declared any sort of public guidance about what, where, when, and how. There's so much to chew on with the first three assets, both as monotherapy, combinations, multiple lines of therapy, multiple tumor types, that that's a lot of a story for people to digest. And we've allocated capital largely accordingly. Not that there is no money spent on other things, but really the drivers of our spending are just what we've identified as the Wave 1 assets. And within that, most of that is actually RMC 6236. So all I can say is stay tuned. This is a company with an Any organization could move forward in parallel. We've done some prioritizing, but we keep a very close eye on that productive earlier pipeline creation, and we'll move things forward as they make sense. And by the way, we also want to understand how those first three assets perform in order to understand where the gaps are. And that's not something that's just a matter of defining it preclinically, but we want to see in the clinic where the gaps are
spk10: be learning as we go. Appreciate the color. Thank you.
spk08: Thank you.
spk17: One moment for our next question. Our next question comes from Peter Lawson from Barclays. Please go ahead.
spk16: Hi, good afternoon. This is Alex on for Peter. Thanks for taking our questions. Just had one on the combination data with PEMBRO in lung cancer in the second half for 6236. So I understand that, you know, safety data for the combination is going to help you inform your strategy in the first line metastatic setting. I'm wondering if that data would also enable potential studies in earlier lines of therapy in lung cancer, like the adjuvant setting, for example. And if that's something that's also of interest for RevMed, thank you.
spk07: Yeah, thanks a lot, Alex. I think Dr. Lin can answer that question.
spk05: Yeah, I think absolutely we have thought about this, and I think you're absolutely correct. I think the current regimen of chemo plus chemotherapy is used both in the first line as well as the actual perioperative setting. So by stopping the safety and Thank you. One moment for our next question.
spk08: Our next question comes from Kelly Shi from Jefferies.
spk17: Please go ahead.
spk01: Thank you for taking my questions. So for the G12D data in fourth quarter, what tumor types would be included in this first data disclosure? And also for the 6236 PEMBRO combo in lung, for the data disclosure, do we expect only second lung class settings? Thank you.
spk07: I didn't quite understand the first question. Did somebody catch exactly what was being asked? Tumor types. I'm sorry, I just didn't hear that word. Yeah, I mean, it's a G12D solid tumors study, so it will have a mix of G12D solid tumors. G12D is most common in gastrointestinal tumors, although it does appear in lung cancer and others, but less frequently. my knowledge, the representation in the study is sort of the representation in the world. And those tumors are nasty tumors, no matter what type they are, so they're going to show up for targeted therapy because it's available.
spk10: So I think it'll be a mix.
spk07: And then the second question about 6 and 3-6 in non-small cell lung cancer was whether those patients are all previously treated or not, or are they second line and later, or are their first line
spk05: Yeah, so the trial design says that in initial dose escalation, we previously treated an expansion, and once we established a safe and tolerable dose, after dose escalation, we expanded to the first concept.
spk09: Thank you.
spk08: Thank you. One moment for our next question.
spk17: Our next question comes from Jay Olson from Oppenheimer. Please go ahead.
spk14: Jay Olson Well, hey, congrats on all the progress, and shout out to Ryan Acy. It's great to reconnect. We were curious about any long-term plans for combination studies and specifically accommodation of your molecules with ADCs, and then I had a follow-up question.
spk07: Yeah, I mean, there are a lot of possibilities. It's almost infinite. And if we're successful in establishing RMC6236 as a backbone targeted therapy, we would imagine a lot of things will be combined, both things that we prioritize, things that investigators prioritize, and things that who knows who else ultimately decides to study, things that are done outside of the context of the company.
spk10: We have no plans as close today relating to ADCs.
spk07: And, you know, I think we'll want to keep watching the ADC space and to see which compounds emerge as potentially being complementary and having probability profiles that justify wanting to combine 6236 with it.
spk10: So we're open to it. We're interested.
spk09: No plans as close today.
spk14: Great. Thank you. And then as a follow-up, for your internal combinations, are you planning to formulate any fixed-dose combinations?
spk07: You know, that's possible at some point. You know, there are a lot of combinations that we're talking about. We really have to establish, you know, the doses first before you create those combinations. You have to allow for step-downs for dose modifications, which create We also have some compounds that are QD, some compounds that are BID. So those aren't exactly amenable to fixed dose combination. So I don't know that that's going to be a major part of our commercial strategy, but our team certainly has it on their radar and will move when it makes sense to do something like that, when it really is going to add convenience and not just add robustness.
spk14: Great. Thanks for taking the questions.
spk17: Thank you. One moment for our next question. Our next question comes from Laura Prendergast from Raymond James. Please go ahead.
spk15: Hey, guys. Congrats on the progress. I was curious. Some KOLs did note that, you know, the deepening of response over time seen with the PDAC patients was, you know, interesting to them and I actually refer to that as a phenomenon. Do you think this could be due to the unique mechanism of action of the drug, and do you think it's going to translate to other indications or other RAS inhibitors? Any color there would be helpful.
spk07: Thank you, Laura. That's an interesting question.
spk10: Who wants to take that question?
spk06: The observation that the response is even over time, is much more evident in pancreatic cancer than it appears to be in non-surgical lung cancer, which are the two diseases with which we have the most experience right now with RNC 6236. And so, having said that, it's clearly more obvious with RNC 6236 than it is with chemotherapy. I think it may be a combination of both the mechanism of action of the drug, which could include a multitude of different effects on both the tumor cells themselves and the immune microenvironment, and possibly also the particular biology and histology of pancreatic cancer, which traditionally is a very large mixture or a pleiotropic mixture of different cell types, sometimes of which the dominant one is the epithelial tumor cell itself, and sometimes it isn't. It's a minority component of a mishmash of immune cells and fibrotic cells and a whole lot of other things. So you can imagine that if your tumor is is a very mixed histology and there's a lot of things going on, it may take quite some time for that remodeling to occur such that when you look at it with a very crude imaging, a very crude imaging modality like CT scanning, which let's face it has been around for about 50 years, then it could take some time for the observations that we that we apply to that to take effect. And superimposed on top of that, of course, is the dichotomization of response versus lack of response. You know, a patient can go from 0% tumor reduction to 31% tumor reduction, and they're called a response. If they go from 29% tumor reduction to 29.5% tumor reduction, they're not a response. And so the deepening of responses over time is really, in our data set, has only been applied to the dichotomous conversion of patients from lack of response to response and from a response to a response with a higher percentage of chin reduction. But in fact, this is happening in the linear continuum in all patients, irrespective of whether they qualify for RESS's response or not. The answer is we don't know, but I suspect it's a 50-50 mixture of the biology of pancreatic cancer and the mechanism of action of the drug, and it isn't quite as obvious in lung cancer, which makes me say that.
spk15: That's really helpful. Thanks, Brother Culley.
spk17: Thank you. One moment for our next question. Our next question comes from Joe Cantazzaro from Piper Sandler. Please go ahead.
spk11: Hey, thanks for taking my question. I had a quick one here on 6236 and combinability with pembrolizumab, and maybe even with other combination approaches you're looking at, and it primarily relates to 6236-mediated rash. When you look at historical data sets for other MAP kinase pathway inhibitors that also see rash, is there anything there that informs how the addition of pembrolizumab and or chemotherapy could impact or not the rate and severity of, of rash when you start combining. Thanks.
spk10: Yeah, I'm seeing shaking heads here. I don't think that we think there is much of a connection there.
spk07: Um, you know, the effect on rash of the mechanism of rash probably due to direct effects on, on, uh, you know, the epidermal cells.
spk10: And, um,
spk05: Yeah, I think the immune-mediated type of rash are slightly different than the type of rash that we observe more commonly. Ours is more predominantly acne-informed and then purely responsive to antibiotic treatment. So that's quite different than the macular-capillary that are more commonly here. It's always a mix, but I'm talking about what's actually more predominant and I think the whether you're talking about BRAF inhibitor, NET inhibitor, HFR inhibitor, or RAS inhibitors, actin form tends to be dip-down in form. So if that only combined the two, it may be true-true, but you're probably going to see each creating its own type of rash, but my past experience did not indicate combining the two mutually enhance their respective rash.
spk08: Okay, thanks. That's helpful. Thanks for taking the question.
spk17: Thank you. I am showing no further questions at this time. I will now turn it over to Mark Goldsmith for closing remarks.
spk07: Thank you, Operator, and thank you to everyone for participating today and for your continued support of Revolution Medicines.
spk17: Thank you for your participation in today's conference. This does conclude the program. You may now disconnect.
Disclaimer