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2/26/2025
Welcome to the Revolution Medicine's Q4 2024 Earnings Conference Call. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask a question during the session, you will need to press star 11 on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star 11 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 Acy. Please go ahead.
Thank you, and welcome everyone to our fourth quarter 2024 earnings call. Joining me on today's call are Dr. Mark Goldsmith, our Chairman and Chief Executive Officer, and Jack Anders, our Chief Financial Officer. Dr. Steve Kelsey, our President of Research and Development, and Dr. Wei Lin, our Chief Medical Officer, will join us for the Q&A portion of today's call. 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 at the U.S. Securities and Exchange Commission. This afternoon, we released financial results for the quarter ended December 31st, 2024, and recent corporate updates. The press release is available on the investor section of our website at revmed.com. With that, I'll turn the call over to Dr. Mark Goldsmith, Revolution Medicine's Chairman and Chief Executive Officer. Mark?
Thanks, Ryan. Good afternoon, and thank you for joining us. Today, I'll cover highlights of progress with our pioneering RAS on inhibitor pipeline and outline important priorities for 2025, as well as markers of progress we expect going forward as we pursue these priorities. Jack Anders will then summarize our financial results and provide a forward-looking financial view. Our mission at Revolution Medicines, one that we have pursued for much of our 10-year history, is to revolutionize treatment for patients with RAS-addicted cancers through the discovery, development, and delivery of innovative targeted medicines. This mission is anchored in three pillars, discovery, development, and delivery. First, our innovative clinical stage RAS-on inhibitors have shown our discovery capabilities to be among the most productive in the industry. Our extensive original research in RAS biology and advances in our technology platform have given us critical know-how and a deep pipeline of proprietary assets we expect will enable us to continue raising the bar for what's possible in treating patients with RAS-addicted cancers. Second, our first-rate development capabilities have advanced multiple assets through first-in-human studies and progressed our lead program into late-stage development. We will continue strengthening these capabilities as we move into additional registrational studies across our portfolio and across a number of tumor settings and lines of therapy. Third, we are preparing to deliver our novel therapies to patients by building strong commercialization capabilities in support of a successful launch subject to regulatory approval for Deraxon RACID. Supporting our mission is an ambitious strategic roadmap for maximizing the impact our RACID inhibitor portfolio can have for patients living with RACID-indicted cancers. And our commitment to this level of ambition is reinforced by our track record of productivity and successful execution. We've been pioneers in the RAS space. Scientific innovation within RevMed has resulted in the first three clinical stage Rason inhibitors, a Rason multi-selective inhibitor, a Rason G12C selective inhibitor, and a Rason G12D selective inhibitor, each with a unique and promising clinical profile. Last month, we introduced the international non-proprietary or generic names for these three compounds. each of which is centered on the shared phrase, on RASIB, that alludes to the novel RASON mechanism of action for this new class of compounds. Dyraxon RASIB, or RMC-6236, our groundbreaking multi-selective RASON inhibitor, Eliron RASIB, or RMC-6291, our distinguished G12C-selective covalent inhibitor, and Zoldon RASIB, or RMC-9805, our innovative G12D-selective covalent inhibitor. In 2024, we built on our record of execution. We made substantial progress in advancing this portfolio of RAS-focused investigational drugs. We reported compelling monotherapy clinical data with our first wave of RAS-on inhibitors, particularly duraxone RASib in pancreatic ductal adenocarcinoma, or PDAC, and non-small cell lung cancer, and zoldone RASib in PDAC. We also reported initial evidence of two promising combination strategies. First, we reported initial clinical proof of concept for the first-of-its-kind RAS inhibitor doublet with a combination of iliron RASib with duraxone RASib. These data are highly encouraging and increased our confidence in the innovative RAS doublet concept more broadly. We've already completed dose escalation on a second RASon inhibitor doublet, zoldon RASib, combined with duraxone RASib. We will study both racon inhibitor doublets further as potentially compelling options for patients, particularly as we move into earlier lines of treatment. Second, we reported early safety and tolerability data for both duraxone racib in combination with pembrolizumab and eliron racib in combination with pembrolizumab, observations that are highly encouraging and potentially enable a path to develop therapies for first-line metastatic non-small cell lung cancer. In addition, we also entered discovery and clinical collaborations designed to expand the range of treatment strategies we can bring to bear for patients with RAS-addicted cancers. Such collaborations enable us to explore a range of combinations with inhibitors of novel targets, exemplified by a PRMT5 inhibitor under our agreement with Tango, and novel approaches such as bispecific antibodies under our agreement with Athon Therapeutics. We also formed collaborations with leading industry academia translational research partners, such as the Breakthrough Cancer Organization, that presents a valuable opportunity to uncover new patient-centric scientific insights to further inform our ongoing commitment to transformative science. Last year, we also made progress in building the organizational capabilities needed for us to drive the next stage of our strategic plan. In particular, we deepened our late-stage clinical development presence by launching our first phase three registrational trial, reaching commercial scale manufacturing of Durexan RASIV, and strengthening our organizational capabilities in preparation for a potential first regulatory approval. And we formed select partnerships to help us fulfill our tireless commitment to patients as we prepare to deliver our novel therapies to patients broadly. For example, to ensure that we keep patient needs at the forefront As we advance these medicines, we now have a relationship with Pancreatic Cancer Action Network, or PANCAN, a distinguished organization devoted to improving the lives of people living with pancreatic cancer. And we ended 2024 in an exceptionally strong financial position, allowing us to continue our ambitious patient-centric strategy. 2025 will be an important year for RevNet as we advance our strategy, aiming to maximize the impact we can have for patients with RAS-addicted cancers. I'd like to outline the highest current priorities that we anticipate could drive significant company transformation and value creation, and to identify some of the markers of progress to follow. Our first priority is to execute pivotal trials with Draxon RAS and monotherapy in patients with previously treated metastatic pancreatic cancer and non-small cell lung cancer. For the global phase three resolute 302 randomized controlled trial currently underway in patients with second line metastatic PDAC, enrollment is an important measure of progress. So far, we have seen very strong interest among patients and investigators with highly encouraging enrollment at the initial U.S. investigation centers, and we are actively opening new U.S. sites in line with our plan. With regulatory clearances in the EU and Japan in hand, we are also activating ex-US sites to support the global strategy. We currently anticipate substantially completing enrollment in the trial this year to enable an expected data readout in 2026. For non-small cell lung cancer, I'm pleased to confirm that activation of investigational sites is now ongoing in the phase three RESOLVE-301 randomized control trial, comparing duraxone RACIB to docetaxel in patients with previously treated metastatic RAS tumors. Our second priority is to advance Deraxon RASib into earlier-line randomized pivotal trials in patients with PDAC. We expect to initiate a trial in first-line metastatic disease, comparing a reference arm of patients treated by chemotherapy to two investigational arms, one with patients treated with Deraxon RASib monotherapy and one with patients treated with duraxanracib plus chemotherapy. Based on single-agent data and preliminary chemotherapy combination data, we are optimistic that both treatment arms containing duraxanracib have the potential to become important therapeutic options for patients living with metastatic pancreatic cancer. We plan to finalize the trial design later this year when we have sufficient safety and tolerability data from the currently ongoing duraxanracib plus chemotherapy safety cohorts. Of course, we'll need to align with the relevant regulatory authorities, including the US FDA, before we can initiate the global randomized case-free trial in patients with first-line metastatic PDAC. As a further step in our ambition to serve patients with earlier stage disease, I'm also very happy to share that we are actively designing a registrational trial with Deraxon RACIB as an adjuvant treatment, patients with resectable pancreatic cancer who have undergone surgery and perioperative therapy, often including chemotherapy. This population constitutes approximately 15% of newly diagnosed pancreatic cancer cases in the US each year. We expect to move quickly on developing this program in parallel with our work to finalize the pivotal trial in first-line metastatic disease mentioned earlier. We anticipate that both of these pivotal trials will be initiated in the second half of this year. Our third priority is to generate sufficient data to inform development priorities for the mutant selective inhibitors, Eliron RASIB and Zoldon RASIB, and prepare to initiate one or more pivotal trials, either as monotherapy or in a drug combination, and a number of options are under consideration. For example, we continue development of Zoldon RASIB, our innovative Rason G12D selective inhibitor for which the first in human clinical data including a favorable tolerability profile and encouraging anti-tumor activity in RAS G12d PDAC were reported at the triple meeting last quarter. A key marker of progress against this priority is generating additional clinical data that helps to qualify and prioritize these options, and we expect to share additional clinical safety and anti-tumor activity on this exciting compound in the second quarter of 2025. Another example is our ongoing efforts to identify and advance rational combination strategies with our Rasson inhibitors. We are data-driven in prioritizing among multiple combination options for advancing into earlier lines of therapy. As noted earlier, we have already provided initial encouraging safety and tolerability data for both Durexon Rassib and Eliron Rassib in combination with Pembrolizumab, thereby enabling potential combination paths to pivotal studies in first-line metastatic non-small-cell lung cancer where pembrolizumab is the global standard of care. We also provided initial encouraging data on the combination of aliron racib with daraxan racib in KRAS G12C colorectal cancer that provide initial validation of this innovative approach. We are actively enrolling and evaluating this racon inhibitor doublet in combination with pembrolizumab. That is, as a triplet regimen, in KRAS G12C non-cell lung cancer as a potential chemotherapy sparing first-line treatment. And a trial evaluating a doublet of zoldonracib with daraxanracib is currently in an expansion phase across a range of solid tumors at the anticipated single agent recommended phase two dose for each agent. We plan to evaluate emerging data for multiple ongoing studies to help us prioritize among the range of potential monotherapy and combination clinical development plan options. Based on this work, we expect to initiate one or more pivotal combination trials in 2026 that incorporate either Elir on RASIB or Zold on RASIB, likely based on a Rason inhibitor doublet, and anticipate sharing clinical data supporting these plans in the second or third quarter of this year. Our fourth priority is to regress our earlier stage pipeline, including advancing next-generation innovations from our highly productive discovery organization. In particular, we currently expect to advance RMC5127, a Rathon G12V selective inhibitor, to a clinic-ready stage this year. This will enable initiation of a first-in-human dose escalation phase one clinical trial in 2026 and a subsequent evaluation of a Rasson inhibitor doublet with Derax on Rassus. Based on a highly productive virtuous cycle between the preclinical and clinical sciences enabled uniquely by our platform and pipeline, we are excited about other promising next generation preclinical programs that will continue to be areas of investment for us to sustain our innovation pipeline beyond the current development stage assets. Finally, we are growing our commercial and operational capabilities and increasing pre-commercial activities in support of a potential launch. We've experienced and talented executives leading our commercial and medical affairs teams, and these groups have already begun expanding our visibility in key settings, including clinical conferences to reach leading oncology practitioners. It is clear that our presence and growing leadership role are being felt. We continue to expand key aspects of our organization to support a commercial launch by adding top talents, including our U.S. field teams. We expect to continue to partner with translational and clinical experts and leading patient advocacy organizations to complement our internal capabilities. We are resourcing our efforts to ensure that we have the best strategy, tactics, operational capabilities, and people to bring Durexone RACIB with urgency to patients with previously treated metastatic PDAC through a successful launch pending regulatory approvals. We see the U.S. as a core foundation and an important driver of potential long-term shareholder value. We are committed to retaining control of U.S. commercial rights as a main element of our current strategy. We also continue exploring strategies for serving patients outside the U.S., potentially including partnership opportunities to help us determine the best approach to ensure global access. We're excited about the continuing momentum and remarkable opportunity we have in front of us and look forward to reporting on markers of progress as we advance programs throughout the year. I'll now turn the call over to Jack Anders, our CFO, to summarize our fourth quarter financial results and forward-looking guidance. Jack?
Thanks, Mark. We ended the fourth quarter of 2024 with $2.3 billion in cash and investments, which includes $823 million in net proceeds from our upsized equity offering last December. We project that our cash and investment balance can fund planned operations into the second half of 2027 based on our current operating plan. This operating plan has been updated to reflect anticipated increased spend resulting from our growing confidence in the advancement of our clinical development programs. Turning to expenses, R&D expenses for the fourth quarter of 2024 were $188.1 million compared to $148.5 million for the fourth quarter of 2023. Please note the prior year quarter included $13.1 million in wind-down costs associated with the EQRx acquisitions. The increase in R&D expenses was primarily due to increases in clinical trial-related expenses and personnel-related expenses associated with additional headcount. G&A expenses for the fourth quarter of 2024 were $28.2 million compared to $32.2 million for the fourth quarter of 2023. The decrease in G&A expenses was due to $13.8 million in EQRx wind-down costs in the prior year quarter. Excluding these non-recurring EQRX costs, G&A expenses increased in the fourth quarter of 2024, which was primarily due to increases in commercial preparation activities and personnel-related expenses associated with additional headcount. Net loss for the fourth quarter of 2024 was $194.6 million, compared to $161.5 million for the fourth quarter of 2023. Please note, net loss for the prior year quarter included a total of $26.9 million in EQRX wind-down costs. The increase in net loss was due to higher operating expenses, as described earlier. Full year 2024 financial results are available in our corresponding press release and also in our Form 10-K that was filed with the SEC this afternoon. Turning to financial guidance for 2025, we expect full-year gap net loss to be between $840 and $900 million, which includes estimated non-cash stock-based compensation expense of $115 to $130 million. The increase in expected gap net loss for 2025 as a result of increased expenses associated with the progression and expansion of our clinical development programs. In particular, the multiple ongoing and planned registrational studies we have outlined as priorities. We also expect higher expenses in 2025 as a result of increased commercial preparation efforts as we continue to build and expand our organizational capabilities in preparation for becoming a commercial stage company. That concludes the financial portion. I'll now turn the call back over to Mark.
Thank you, Jack. In 2024, we continue to deliver compelling clinical observations and to build on our track record of effective execution. We have begun 2025 with the talent, capabilities, and financial capital to fuel our vision to create an industry-leading targeted medicines franchise for patients with RAS-addicted cancers and to fulfill our responsibilities to patients investors, and employees. The foundation we've established sets us up for long-term, sustainable growth in support of our aim to revolutionize treatment for patients with RAS-addicted cancers. With that, I'll turn the call over to the operator for the Q&A portion of the call.
Thank you. At this time, we will conduct the question and answer session. Each participant is encouraged to ask one question and a follow-up. As a reminder, to ask a question, you will 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. Our first question comes from the line of Ellie Murley of UBS. Your line is now open.
Hi, guys. It's Sam on for Ellie. Thanks for taking our question. I guess, can you walk us through the decision to move forward with the two phase three studies in the earlier line PDAC? And I guess, specifically, what gives you conviction on the phase three in the adjuvant setting? And can you talk a little bit about the role of RAS in this earlier line setting?
Yeah, thanks very much for your question. I think based on the data that we've already reported in pancreatic cancer, the monotherapy data, I think we have strong conviction that we ought to try to own the entire PDAC space and will continue doing so as the year progresses. The adjuvant is basically a study of patients who will have had their disease resected and represents an important opportunity to provide very significant long-term clinical impact for those patients. And the proof of concept that supports pursuing that particular indication is already provided by the second line and third line rational and appropriate things for us to pursue and will further our goal of completely owning the PDAC space with this content.
Yeah, that makes a lot of sense. That's really helpful. And then I guess just a quick follow-up. Can you just touch on how the frequency of RAS mutations might differ in the adjuvant setting versus maybe like the advanced or metastatic disease and how you're thinking about the overall opportunity there?
different representation of RAS drivers than all other patients, which is essentially almost all pancreatic cancer patients have a RAS driver. And so there's no reason to believe that those patients would behave any differently in response to direxone racin.
Thank you so much.
Thank you. Our next question. will come from the line of Eric Joseph of JPMorgan. Your line is now open.
Thank you. Thanks for taking the questions. The proposed pivotal study in the adjuvant setting is also interesting to us and expansive to what we've generally thought about as being in scope in pancreatic cancer. You noted, Mark, that resectable PDAC is about 15% of overall cases, if I heard that correctly. Has this been a static metric? I wonder if you see this proportion sort of expanding at all with perhaps early detection initiatives. And then, you know, as it relates to the pivotal study, how should we be thinking about the regulatory bar that would need to be satisfied for registration? You know, is it PFSOS? It would be great to hear your thoughts there. Thank you.
Yeah. Hi, Eric. Thanks for your question. I don't think that we can comment today on the second part of the question, since we really haven't engaged with regulatory authorities at the moment. So that will have to be something that we address in the future. But on the first question, I think I'll ask Dr. Wade Landau, Chief Medical Officer, to comment on the estimated proportion of total PDAC cases that are currently considered receptable and whether that could evolve over time.
Thanks, Mark. It's a great question. I think in the short term, we don't expect the number to change because that detection is largely driven by whether there's any screening. Unlike breast cancer, colorectal cancer, there's no mammography or colonoscopy, and there's no pending test evaluating patients with pancreatic cancer. Now, with blood tests for CTNA and so on, That's a much more long-term to be established before it becomes standard care. That's why we don't, probably in the short term, we don't see that number change.
Yeah, and if I could just add to that, of course there are efforts underway to try to develop such screening tools that are largely based on circulating tumor DNA. And to the extent that we can show further benefit to patients who are diagnosed earlier in their disease, or future events to occur. And, of course, the possibility of even clearing a tumor to the point of cures becomes credible in the context of resectable disease. And so if it becomes possible to diagnose patients much earlier, then the possibility of even greater impact, as you point out, becomes much higher. But at the moment, we just have to focus on the patients who are diagnosed, and they do represent a significant fraction
Okay, great. Thanks for taking the questions. I appreciate the color.
Thank you. Our next question comes from the line of Mark Fromm of TD Cohen. Your line is now open.
Thanks for taking my questions. I wanted to start just to follow up on the question about adjuvant design. You know, pancreatic docs also talk about borderline resectable disease, not just resectable. And then there's also, you know, within resectable, some patients get Whipple procedures, others don't get Whipples. Would you be looking to go after all surgeries or just kind of certain subsets there? Because, you know, there are some varying outcomes depending on which one you fall in. And then similarly, with the current trial in late-line disease, you have this hierarchical analysis based on different RAS mutations. Would you also do that and enroll broadly, or is that kind of introducing too much risk when you're moving lines, different subsets, and different mutations in there?
Thanks, Mark. Is the second question also relating to resectable, or was that referring to?
Well, it's adjuvant, but both first line and adjuvant for that second part of it.
I see.
Yeah. So, first question regarding the patient population. So, first of all, I just want to caveat by saying that we have not had any health authority interactions. So, the final design is still pending those interactions. But we would certainly like to offer Drax and Rassif as a new standard care for patients, to the broadest patient population possible. So, that would really... including as many patients that have had resection of their primary disease and then have any type of perioperative disease, typically chemotherapy, and that defined as broadly as possible. Now, I think the final design is still pending health interaction, but that's our goal is to define the largest population where we believe drugs on RASFib can really benefit. And then the second question about the mutation specifically, this is kind of, it's piggyback on Mark's early comment. We do believe that RAS is the cancer-initiating driver mutation. And so, first of all, I think the preference is, as far as we know, it's fairly consistent throughout the lines of therapy. And then in the active setting or the early disease setting, our approach in developing duroxin RAS is similar in the metastatic setting, which is we aspire to cover as many patients that's actually eligible for our trial, and then that's including a potential for a whole-comer approach to the entire population of pain-pathic cancer patients.
Okay, that's really helpful. And then maybe just a more strategic view, Mark, just based on how you balance with But all of these different combinations, also monotherapy opportunities to move forward into earlier lines, just how do you balance, you know, moving quickly versus making sure you don't end up having to run too many redundant trials or setting bars that then make it difficult to get the best option for patients over the long term?
Yeah, well, that's a, you know, that's a hard question. That's what we grapple with every day, you know, in our strategic considerations. I think our primary motivation here is to serve patients, and that means moving swiftly. When we have something that we think will move the needle for patients, we really need to do so. Given also the competitive environment from a business point of view, there's not a lot of opportunity for us to pause things and wait and see what we might offer that's better in place of that. I think we just have to move. tells us what to prioritize, we'll use that information in making those prioritization decisions. But there could be certainly circumstances where we can't make such a decision, but we wouldn't hold off on pursuing a Phase III registration trial because that would leave patients unserved and or it would leave opportunities and try to beat the bar ourselves rather than chasing someone else. And given our current position, I think it's ours to lose. If we don't pursue these things, we will be setting ourselves up for a different scenario. We'd rather be first at the table where we can't be. So it's a challenging topic. but we have to work in real time because for patients, this is a pressing matter.
It's not something that they can wait years for us to sort out.
Thank you. Our next question will come from the line of Michael Schmidt of Guggenheim. Your line is now open.
Hey, thanks for taking my questions and congrats on all the progress. I had a follow-up on your first line metastatic pancreatic cancer strategy. So, It sounds like you've now committed to doing a single three arm trial there for registration as opposed to two separate trials. How much more phase one work needs to be done with the chemotherapy combination before initiating the study? And will you be able to share some of that data perhaps later this year, be it as a monotherapy perhaps in first line or in combination? And secondly, What are your latest thoughts on how to incorporate salt and rasset into your pancreatic cancer registration strategy, perhaps relative to the retcon rasset? Thanks so much.
Thank you, Michael. So the first question is, are we continuing evaluation of chemotherapy combination to support that third arm in the trial? And the answer to that is straightforward. Yes, we're doing that work now. We've collected some data, but... We need more. And it mainly has to do with what regimen we select to move forward with. And that's primarily around safety. It's really not at this stage about primarily driven by efficacy because we already have confidence in the efficacy based on the monotherapy second, third lines data that we've already shared. So this is really just about safety and making sure that We can assure high enough relative dose intensity during treatments that there aren't long breaks. As you may know, even both forms, major forms of chemotherapy in pancreatic cancer, often incur the liability of a grade three or higher And that's not ideal, particularly for a targeted therapy where as continuous coverage as possible is likely to have the greatest efficacy in the long run. So we just want to choose the best regimen and regimens to go forward with, and we need some more data to drive that. But it still is our intention in 2025 to initiate that trial.
So we're moving as quickly as we can to support that decision. The second question is zolomracid.
Do you want to comment away on zolomracid and pancreatic cancer and how we think about that relative to direct zolomracid?
Sure. Zolomracid, as you know, G12B has a problem rate of about 40% of pancreatic cancer. So it's the most common RAS mutation or specific mutation in general that's a driver of pancreatic cancer. So we had shared earlier FACE-1 data showing that it's a highly active agent. We're actually following on those results, looking for the durability of these activities. And then I think our initial thinking is it will probably end up being a separate registration trial with a standalone registration path. And we're currently evaluating a combination with Draxon RASIF, as a potential RAS on doublet, a best-in-class option that could be substantially improved upon by the hormonal therapy, as well as the chemotherapy plus standard care with psilocybin.
So those are potentially two options we could really develop. Thank you.
Thank you. Our next question comes from the line of Ben Burnett of Stifel. Your line is now open.
Great, thank you. First, just want to add another quick question on Zoldan Arasib. I guess, is there any more color you can provide on the data update being contemplated in the second quarter? Specifically, what are the key learnings that you hope to glean from these data?
Yeah, hi, Ben. Thanks for your question. We don't have any more color to provide on that today. We do intend to provide additional data on zoldonracib in the second quarter of this year, and I think we'll just have to wait until those data are available.
Okay, understood. And if I can maybe go back to sort of a previous question on the frontline metastatic pancreatic cancer. You know, it feels like there's been some debate as to the combinability of doxonracib with chemo. Sounds like you guys are pretty confident that there is some combinability potential here, given the design that you're proposing. in the frontline metastatic cancer setting. But I guess the question is, like, what are the overlapping talk signals that one should be concerned with when thinking about doxoracib and the data that's been provided thus far with the various chemos being contemplated?
Yeah, Ben, let me just clarify, though. I don't know that there's been a debate about the combinability. That really, I think, is that statement's been made a number of times, but I haven't heard that debate. Really, the topic that we raised earlier this year is the one that I alluded to in one of the earlier questions, which is that chemotherapy alone is a very difficult thing for pancreatic cancer patients to go through because the disease is so aggressive, the chemotherapy has to be aggressive to go with it. And that chemotherapy already today drives substantial side effects, adverse events, the drug for some period of time and or hospitalization. And that in and of itself, just for the chemotherapy, the standard care chemotherapy alone, could have implications for the ultimate efficacy of a combination of chemotherapy with duraxone or acid or with any other targeted agent, to be honest. So that's really the issue that we've raised. We haven't, not sure that there really has been any meaningful public debate about whether or not they are combinable. And so I don't think we have anything to add to that because that hasn't really been the core issue. Of course, we're evaluating that now, and we're optimistic that we can develop a regimen that combines them, but we're keeping in mind this fundamental issue that the
So that's the context for that.
Thank you.
Our next question comes from Laura Prendergast of Freeman James. Your line is now open.
Hey, guys. I was wondering if you could provide a little bit more colorectal cancer data disclosure cadence. You know, should we be expecting any chemo combo data, EGFR inhibitor combo, doublet data this year? And then just, you know, any guidance on if or when there will be a registrational path for colorectal cancer, and then maybe, you know, beyond the big 3K RAS-driven tumors as well?
Yeah. Hi, Laura. Thanks for your question. We don't have any guidance provided yet on next disclosures about colorectal cancer. We, of course, are studying colorectal cancer. In fact, just in December, we disclosed data from a study of the combination a G12C inhibitor and really had no other options, and we showed significant activity from the combination of Euleronracid with Draxonracid, so that was just six weeks ago or two months ago. But we don't have any guidance to provide. We continue to study this. There are a variety of different combination strategies that might prove to be interesting, and we're evaluating them, and I think when we have information that starts to
point to future strategies, we'll share that.
Great. Thank you.
Thank you. Our next question comes from the line of Kelly Shi of Jefferies. Your line is now open.
Hey, guys. This is Clara. I'm for Kelly. Thanks for taking our questions. So, for the phase one study in PDAC, As of the last update, the median overall survival was so immature at the upper 2D. So just wondering, do you have any plans to update the overall survival data this year?
Yeah. Hi, Clara. Thanks for your question. Yes. What we showed before was two different ways of looking at the data. One was from an aggregate 14.5 months. When we took just the subset of that, that was the 300 milligram sort of subset, if you will, that particular dose cohort, because those patients had been enrolled more recently than had the patients with the earlier doses, that those curves were not very mature. And so we didn't have an estimate of OS per se, but we did have information regarding the six-month OS, which was quite high, depending on which subset you looked at. It was in the 97% to 100% range, which I think provided a pretty good look about what's going to come as these data mature. But of course, we didn't have those data. So those do continue to mature. And I'm sure at one point, at some point, we will have an estimate of that We don't have that today, and we don't have any information to share, but I would imagine at some point we'll share that information.
We don't have a specific plan around it right now.
Thank you. Appreciate it. Thank you.
Our next question comes from the line of Chris Shibutani of Goldman Sachs. Your line is now open.
Hi. This is Kevin on for Chris. Thanks for taking our questions. I just wanted to clarify on the first-line lung opportunity. You noted that you're exploring the potential for a chemotherapy-free triplet combination here. Just in terms of your priorities here, would you potentially also pursue a non-G12C frontline indication, or do you still have plans to explore that? And then for the triplet, could that be one of the updates that we could expect in the second quarter or third quarter of this year? Thanks.
Thanks, Kevin. I think we have Steve Kelsey, our president of R&D. Maybe he could comment on how we think about the first line of lung cancer. Certainly, there are kind of multiple subsets, as you alluded to. Essentially, G12C has now been defined as sort of a disease in and of itself, and then there's everything other than G12C.
Maybe Steve could comment on that.
Sure. We definitely divide the world of RAS mutant lung cancer into distinct sets depending on the type of RAS mutation. And I think that now G12C mutant lung cancer has established itself as a completely separate disease, probably requiring a G12C selective inhibitor. So right now, because we are acquiring and have presented preliminary data on the combination of a neuron RACID with Deraxon RACID in G12C mutant cancers, we would plan to move that chemo-free triplet into the G12C lung cancer space. And then the Deraxon RACID would be prioritized for all other RAS mutant lung cancer without a G12C mutation, which is about probably somewhere in the region of 17 to 18% of all non-small cell lung cancer right now. So I think that addresses your first question. Can you remind me of your second question?
Well, just following up on that, so does that mean that… Oh, data, data, yeah.
Will we release… I don't think we've specifically guided with regards to when the data that justifies those clinical trials will be put together in a complete package. I mean, we are releasing data in tranches as we accumulate that data. We've already, I think, tried to persuade you that our Rason inhibitors are combinable with Pembrolizumab, which of course is a fairly significant step on the road to starting first-line trials in non-small cell lung cancer. It's an almost absolute prerequisite now for the starting trials in first-line non-small cell lung cancer. And not only can we combine our Rason inhibitors with Pembrolizumab without incurring additional toxicity. But we can combine them at what we believe to be the full recommended phase three dose. We don't have to take a haircut on the dose in order to combine with pembrolizumab like some of the other RAS inhibitors have had to do. So ultimately, we are, as you know, still aggressively enrolling the combination of the lirum racib and Drexel racib in both colorectal cancer and non-cell cell lung cancer and waiting for the sort of durability to mature. As soon as that has matured, then we can tell you about it. But of course, because it's durability data, I can't really give you a timeline for the maturation of that data. And of course, just behind that data set will be the combination of zolder acid with durexomer acid, in RAS mutant tumors as well. That's a little bit behind, and again, I don't have any guidance on when we can report that. But as soon as we have the trials, the trial designs ready for public disclosure, we will also have the supporting data ready for public disclosure.
Great. That's really helpful. Thanks. I'll hop back into Q. Thank you.
Our next question comes from the line of Jay Olson of Oppenheimer. Your line is now open.
Oh, hey. Congrats on the progress, and thank you for the update. For the study of daraxanracib in the adjuvant setting for resectable PDAC, how are you thinking about the dosing duration, and could that be guided by ctDNA? And then I have a follow-up question on non-small cell lung cancer.
You know, I think it's just a little bit early for us to get into the details of trial design since, as we indicated, we're now committed to working on the trial design. You know, those are obviously questions that we'll be addressing, but they are core elements of the trial design. So I would say hold that question, and we ought to be addressing it in due course.
Okay, understood. And then in non-small cell lung cancer, are you interested in earlier lines of therapy like the adjuvant setting or even neoadjuvant? And can you just talk about what your strategy might be there?
Well, I can answer the first part of your question.
Yes, we're very interested. I mean, we obviously have a very rich pipeline that's going to be very relevant to RAS, the RAS mutants. in all lines of treatment. And you've heard about, from Steve just a moment ago, about strategy around first line. And I think we've just shown with our disclosure about our intention to pursue an adjuvant trial in cancer that we're committed to moving to these earlier lines. We don't have specificity around that right now. It's a little hard to explain a strategy until we have it well articulated, well thought through. And the pancreatic cancer is just a little bit ahead of lung cancer because it really has taken off and the unmet need is so substantial and urgent that we're in a better position really to push things in all directions there. But you'll hear about lung cancer over time as we're able to do so. Our second line, third line, a non-small cell lung cancer study, as we expected to do in the first quarter of this year, but we're there now, and that's happening. So that's the first step in the right direction, and as we develop both data and then the strategy that supports the data for various earlier lines, we will share that.
Thank you.
Our next question comes from the line of Joe Catanzaro of Piper Sandler. Your line is now open.
Great. Thanks so much for taking my question. Maybe one quick one from me as it relates to your comment, Mark, that chemo alone and frontline PDAC is an aggressive regimen. So for the frontline chemo combo, are you thinking that you'll design the regimen as just continuous combination therapy until progression? Or is there potential to use an induction maintenance idea? and maybe what the pros and cons of each approach could be. Thanks.
Thanks for your question, Joe. I think Wei can comment on that question.
Yeah. Again, because we have not had the regular interactions, I think right now we do not have the final studies I think what we're doing right now in the exploratory studies in evaluating the combinations, really combining, adding drexongracid to the current standard care chemotherapy, either genobraxen or Folfironox. I think as we've discussed earlier, our primary goal is really to protect the dose and intensity of drexongracid because we think that's going to deliver the maximum chemical benefit for patients. And so one way or the other, the final regimen that we develop will move into the first-line setting. So other than that, I think maybe it's too early to share.
Yeah, maybe if I could add a little bit to that. You know, we do expect that one arm of that trial will be monotherapy, direxone or acid. And so there really isn't. benefiting from it. You know, with the chemotherapy added, it does raise the question whether there's an initial phase and then a follow-up phase of whether you call that induction and maintenance or not. You know, it doesn't matter so much. That's just nomenclature. But currently, pancreatic cancer patients, first-line pancreatic cancer patients, typically try to pursue four to six cycles of chemotherapy, but many patients don't make it through four to six cycles of chemotherapy, either because they can't tolerate it and so they stop, or because their disease progresses and they stop. And so that's just something to keep in mind, is we want to make sure that patients actually get through their initial period, whatever that is, because the potential for having long-term benefit from duraxone or acid is implied by or suggested by the data from the previously treated Again, we come back to the notion that, you know, based on the history of that disease and how it's treated and the fact that we're now moving from sort of a generalized chemotherapy attempt to just kill cells to a more biologically driven disease-modifying kind of strategy, will think of that combination arm as the Draxon-Raciv arm to which we've added some chemotherapy as opposed to the chemotherapy arm to which we've added some Draxon-Raciv. And that's conceptually a very important thing to think about and may or may not conform to the nomenclature we were using
the most appropriate strategy.
Okay, got it. That's helpful. That's all for me. Thanks.
Thank you. Our next question comes from the line of Alex Stronahan of Think of America. Your line is now open.
Hey, guys. This is Matthew on for Alex. Thanks for taking our questions. Maybe a first quick one from us. I think in 3Q you mentioned that you expect to disclose data from the I know you had safety tolerability data in December. Just curious if there were any updates planned still for 1Q or whether the next updates would come in the mutant selector inhibitor update in 2Q or 3Q.
Okay. I was processing your question, and I realize now what you're alluding to. We actually moved that update from Q1 of 2021. sure if we were going to be able to do that, which is why we alerted folks that might come in 2025, but it actually came in 2024. And it was primarily and it is primarily a safety assessment. The issue with efficacy is that the patients who were treated, the vast majority of those patients were actually previously treated patients who had already experienced pembrolizumab So there really wasn't much potential for them to get a new boost of anti-tumor activity by retreating them with pembrolizumab. And so looking at efficacy in that context, if you're thinking about it as additive pembrol plus duraxone racid, what you'd really just be seeing is the duraxone racid activity. This contrasts with where it would actually be used, which is in first-line patients who have not seen duraxone racid or pembrolizumab before.
for assessing efficacy.
Makes sense. And then maybe a quick one on how you think about entertaining potential collaboration opportunities with the RACTS on RACIF or any of your other assets.
Yes.
I mean, we certainly are both entertaining and actually engaged in collaborations. There have been many years of preclinical collaborations that have been underway and continue and have published papers and so on. And there are actually active clinical collaborations. We've mentioned, for example, that Tango Therapeutics will conduct a study of their PRNT5 inhibitor with one or several of our RAS inhibitors, including direxone acid. And we would imagine that that range of combinations will be expanded over time.
Thank you.
Our next question comes from the line of Ami Fadiya of Needham & Company. Your line is now open.
Hi, this is Guna. I'm for Ami. Thank you for taking our question. On SOLD and RACF, what additional data do you need to see that will give you confidence to initiate the typical combination trials? And with any of these updates, do you include data from other indications such as GAT-STRIK and CRC?
Unfortunately, we can't hear you very well, so we're not sure what those two questions were. Could you repeat that? And maybe if we could get the volume adjusted up, that would be helpful.
Oh, sorry. I was asking what additional data do you need to see for Zoldan RASIV that would give you confidence to initiate the typical combination trials? And would any of these updates include data from other indications such as gastric and CRC?
Okay, so the question is really about typical trials of Zoldan RASIV in combination contexts. We are currently evaluating Zoldanracib in combination with Daraxanracib, which we think is justified by the previous observations that Elironracib plus Daraxanracib delivered compelling differentiated initial evidence of anti-tumor activity. And so we believe that same concept may hold for Zoldanracib and we're evaluating it. We're also evaluating Zoldanracib in combination with other other agents, other standard of care agents that would be appropriate for lung cancer or for colorectal cancer or for pancreatic cancer. So, I think we have to generate that information. We've indicated that this is a high priority for this year. The work, much of that work is already underway. We expect to share some additional clinical data on Zoldanracid mid-year, and we expect
to develop at least one pivotal trial concept based on a new selective inhibitor, which could as well be a solvam or acid for 2026 and beyond.
Okay, thank you.
Thank you. Our next question comes from the line of Peter Lawson of Barclays. Your line is now open.
Hey, good afternoon. This is Alex on for Peter. Thanks for taking my question. I joined late, so sorry if this was addressed already. But how are you thinking about completion of the second line PDUX study and potential approval? And how could that impact, if that could impact the control arm in your first line trial and the ability to show an OIS benefit?
Yes. Yes, thanks for your question.
There's always a downside to anything that has an upside, so rapidly completing that trial does create new barriers for a different trial. That doesn't stop us, though. We want to move forward as quickly as possible to complete that trial, and it is a very important opportunity for us to demonstrate an OS benefit from Durexon RACID, which we believe is a credible thing based on the data that we've shown so far. There's broad interest in this study. You're now talking about the 302, a resolute study. There's broad interest in that study by patients and investigators. The currently active sites, enrolling sites, are enrolling quite actively. We're very pleased with the progress there. We're also opening new sites in the U.S. according to our plan, consistent with our plan, and we're opening sites in the U.S. right now. We do expect and are highly confident that we can complete enrollment of this study in 2025. There may be some stragglers from countries outside the U.S. that could roll over into 2026, but largely, we do expect to complete enrollment, and that trial was here, and we're moving as fast as we possibly can. As you point out, it does put pressure on that first-line trial, and frankly, we think it'll put pressure on every future first-line trial, that's sort of part of the, you know, part of the intention here is to deliver changes in treatment benefit for patients that moves the needle. That's what we want to achieve. But we are fighting ourselves a little bit on this, which means getting to an answer on our final trial design for the first-line trial as quickly as possible is important to do. We feel that urgency, and we currently expect to be able to do so to initiate the trial, you know, by the end of this year.
Okay, thank you. And do you see any potential for an accelerated approval of some sort, you know, based on PFS in the first line setting?
Yeah, that's a question probably best addressed to regulators.
You know, I think that there is a widespread belief and understanding that the FDA is not wild about accelerated approval in pancreatic cancer for a number of reasons. one of which is that the OS readout doesn't come that long after the PFS readout, and so they're not particularly enthusiastic about giving somebody an approval and then finding out a month later that it does or doesn't meet the OS bar, just to exaggerate a little bit. So I think generally speaking, we don't assume that there's an accelerated approval path based on PFS. On the other hand, there hasn't really been a drug that's moved the needle based on PFS really ever, you know, in any meaningful way. And our ambition is to be able to deliver such data that will be determined by what the data show. But based on the phase one, two data we've shown so far, we're encouraged by that possibility and how a regulatory body might look at those results, we don't, we of course can't predict. We designed the trial really around the OS, which means that it's overpowered for PFS. And the timing of the analyses, the first analysis, is actually driven by the number of OS events. And so it's an OS event-driven trial. But it is possible to achieve subsequent assessment of the data with a greater chance of achieving the OS at that point. What happens in that interim period, I think we'll just have to leave dangling because that's not really entirely up to us.
In fact, it's not really up to us very much at all.
Thank you.
I am showing no further questions at this time, so I would like to turn it back to management for closing remarks.
Thank you, operator, and thank you to everyone for participating today and for your continued support of Revolution Medicines.
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