Syndax Pharmaceuticals Q2 2025 Earnings Call Transcript

Quartr
Provided by Quartr
August 4, 2025

Key Takeaways

  • Positive Sentiment: Net product sales of Revuforge and Nykitmbo reached nearly $100 million in H1 2025, with Revuforge revenue up 43% QoQ to $28.6 million in Q2.
  • Positive Sentiment: Syndax is on track for profitability with a strong balance sheet of $518 million in cash and stable operating expenses guiding into the next few years.
  • Positive Sentiment: Revuforge has treated over 500 KMT2A patients since launch, is moving into earlier lines of therapy, and shows higher transplant and maintenance restart rates in the commercial setting.
  • Positive Sentiment: Nykitmbo generated $36.2 million in Q2 net revenue, yielding $9.4 million of profitable collaboration revenue for Syndax in its first full quarter.
  • Positive Sentiment: Several pipeline milestones are upcoming: an sNDA PDUFA date of October 25 2025 for NPM1 AML, frontline EVOLVE-2 trial enrollment underway, and Phase II study in IPF on track.
AI Generated. May Contain Errors.
Earnings Conference Call
Syndax Pharmaceuticals Q2 2025
00:00 / 00:00

There are 15 speakers on the call.

Operator

At this time, I would like to turn the call over to Sharon Clery, Head of Investor Relations at Syndax Pharmaceuticals.

Speaker 1

Great. Thank you, operator. Welcome, and thank you all for joining us today for a review of Syndax's second quarter twenty twenty five financial and operating results. I'm Sharon Clary and with me today to provide an update on the company's progress and discuss financial results are Michael Metzger, Chief Executive Officer Steve Kloster, Chief Commercial Officer Doctor. Nick Botwood, Head of R and D and Chief Medical Officer Keith Goldan, Chief Financial Officer.

Speaker 1

Also joining us on the call today for question and answer session are Doctor. Peter Ardentlik, Chief Scientific Officer and Doctor. Angeli Ganguly, Chief Strategy Officer. This call is accompanied by a slide deck that has been posted on the Investor page of the company's website. You can now turn to our forward looking statements on Slide two.

Speaker 1

Before we begin, I'd like to remind you that any statements made during this call that are not historical are considered to be forward looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by the statements as a result of various important factors, including those discussed in the Risk Factors section in the company's most recent quarterly report on Form 10 Q as well as other reports filed with the SEC. Any forward looking statements may represent our views as of today, 08/04/2025 only. A replay of this call will be available on the company's website, www.syndax.com, following its completion. And with that, I am pleased to turn the call over to Michael Metzger, Chief Executive Officer of Syndax.

Speaker 2

Thank you, Sharon, and good afternoon, and thank you all for joining us today. Starting with Slide three. 2025 has been a transformational period for Syndax marked by excellent commercial and pipeline execution. We are well positioned for rapid growth in the 2025 and beyond with its first two first and best in class therapies with a combined market opportunity exceeding $10,000,000,000 Revuforge and Nyktymbo sales are growing with nearly $100,000,000 in combined net product sales in the first half of the year, significantly exceeding expectations. Notably, Revuforge net revenue increased 43% quarter over quarter to $28,600,000 even with approximately onethree of patients pausing treatment to receive a stem cell transplant.

Speaker 2

Importantly, we are on the road to profitability with growing contributions from REBUFORGE and NYCTIMBO, a strong balance sheet and an operating expense base that will remain stable for the next few years while fully funding our strategic priorities. Looking to the future, our leadership in the menin space positions us to be first to the frontline and meaningfully expand the RevuForge franchise. We have a similarly compelling opportunity to bring Nyktymbo into earlier lines of therapy and additional patient populations. Turning to Slide four, let's dive into more detail on REVIVORGE, the first and only FDA approved treatment for relapsed or refractory acute leukemia with a KMT2A translocation. The continued growth reflects strong uptake, the high unmet medical need and physicians' enthusiasm for REVIVORGE.

Speaker 2

It is clear following the recent presentations at ASCO and EHA that REVUMENIB has a best in class profile with compelling activity across multiple genetic subtypes, including efficacy data in relapsedrefractory mutant NPM1 AML that surpass any other results seen in the field. The breadth and strength of our clinical data will be the key to our success in acute leukemia, a market that is efficacy driven given the severity of the disease. As we look ahead, the outlook is very promising with multiple drivers that will further solidify our leading position and ensure sustained growth for many years to come. I will briefly highlight those drivers and the team will provide additional details. First, patient identification and uptake has been strong.

Speaker 2

Since launch, we have already treated over five hundred patients with Revifort with approximately ninety percent of usage in KMT-2A patients. In just seven months, we have already reached a quarter of the two thousand patients diagnosed with relapsedrefractory KMT2A acute leukemia each year. Based on the robust activity we have seen in this population and physician excitement around the drug, we expect the total number of patients treated with REVIFORGE to grow materially in future quarters, particularly as it is the only approved therapy for these patients. Second, REVIVORGE is increasingly being used in earlier lines of therapy. Emerging claims data show that the use in KMT-2A as of this quarter is already being concentrated in the second line.

Speaker 2

This trend is especially important in oncology because as patients are treated earlier, they generally have a higher response rate, a longer duration of response and a higher chance of proceeding to a potentially curative stem cell transplant. Thus, as reviforge is used earlier, we expect to see an increase in the average time on drug for all patients. We also expect to see a high rate of patients proceeding to transplant a higher rate of patients proceeding to transplant than was observed in our pivotal trial, which on average enrolled a later line patient population. In fact, early indicators suggest that we are already seeing a meaningfully higher transplant rate in the commercial setting. Third, as the group of patients receiving reviforge post transplant increases, it should substantially increase the overall duration of therapy.

Speaker 2

Notably, prescribing physicians tell us they plan to restart patients on reviforge post transplant for one to two years. Given the high risk of recurrence, both patients and physicians tell us they are eager to restart the therapy that induce remission, especially when the drug has an excellent tolerability profile. These three drivers position Reviforce to transform care for KMT2A patients from an acute treatment paradigm with survival measured in a few months to a more chronic disease with the potential to extend survival from months to years. Importantly, relapsedrefractory KMT2A acute leukemia is just the first opportunity for REVIVORGE. In the near term, we anticipate both the inclusion of REVIVORGE in the clinical treatment guidelines and the approval of our supplemental new drug application or sNDA in relapsedrefractory mutant NPM1 AML.

Speaker 2

The anticipated approval of our sNDA, which was recently granted priority review and assigned a PDUFA action date of 10/25/2025, would expand our addressable population to over 6,000 patients across both genetic subtypes and increase the relapsedrefractory market opportunity for REVIVORGE in The U. S. To $2,000,000,000 Importantly, REVIVORGE is positioned to become the first and only MEND inhibitor with a label that expands to mutant NPM1 and KMT2A translocated patients, both adults and children. Based on resounding KOL feedback, the expected breadth of our label will be a major competitive advantage. Looking to the future, we will further extend our leadership into the frontline setting, a U.

Speaker 2

S. Market opportunity exceeding $5,000,000,000 Enrollment is already ongoing in our frontline trial for patients unfit to receive intensive chemotherapy, and start up activities are well underway to initiate our trials in patients able to receive intensive chemotherapy. With Revuforge's best in class profile and a multiyear start into the market versus potential me too competitors, we will maintain our dominant position in this multibillion dollar market opportunity. Shifting gears to Slide five to Nictimbo, our first in class therapy for chronic graft versus host disease or GVHD. I am pleased to highlight a very successful first full quarter for sales with our partner, Insight, reporting $36,200,000 in net revenue.

Speaker 2

This is up significantly from $13,600,000 in the first two months of the launch in Q1. The $50,000,000 in net revenue generated in the first five months of the launch underscores the substantial opportunity in chronic GVHD. Importantly, Nictimbo is already profitable to Syndax with our 50% share of the Nictimbo product contribution amounting to $9,400,000 for the second quarter. As sales continue to ramp, the cash flow contributions to Syndax from Niktymbo will only grow in significance, with initial Niktymbo sales tracking with the early benchmark set by Rezarok, another product approved in the third line chronic GVHD setting, now annualizing at more than $500,000,000 in The U. S.

Speaker 2

Within three years of its launch. We are confident that Nyktymbo will be a critical component of our success for many years to come. Finally, before I hand the call over to the team, I would like to highlight that we also strengthened our leadership team this quarter with the addition of Doctor. Nick Botwood as Head of R and D and Chief Medical Officer. Nick is a medical oncologist by training with over twenty five years of experience leading the development and global commercialization of novel oncology medicines, including blockbuster drugs such as Opdivo and Yervoy during his time at BMS.

Speaker 2

I would also like to thank Bill Murray for his seven years of service on our Board and congratulate him on his new role as CEO of Incyte, our partner for Niktymbo. Bill has been an invaluable member of our Board as we developed and launched both drugs, and we look forward to working closely with him and the Incyte team as we continue to unlock Niktympo's value. And with that, I will turn the

Speaker 3

call over to Steve to discuss our commercial progress in more detail. Steve? Thank you, Michael. Let's dive right into our commercial updates on REVUFORGE and NIKTIMBO, starting with REVUFORGE on Slide six. As Michael said, the launch is going very well with net revenue for the second quarter increasing 43% quarter over quarter to nearly $29,000,000 and $56,000,000 generated over the first seven months of the launch.

Speaker 3

These impressive results are driven by multiple factors, including a high unmet patient need, a robust stream of new patient starts over the quarter, expanding breadth and depth of prescribing, excellent formulary coverage and a product in RevuForge that is delivering for patients. Physicians are observing excellent activity in clinical practice. RevuForge is rapidly becoming a standard of care in our indicated population. Over 1,300 prescriptions for Revuforge have been written for more than 500 patients from launch through the June. Just midway through the year, we have already penetrated twenty five percent of the annual 2,000 patient incidents and are on track to penetrate fifty percent by year's end.

Speaker 3

Next, I'm excited to share some of the emerging data and customer feedback that provide important insights into the population of patients being treated with RevuForge and bolster our confidence that the momentum we have seen since launch will continue well into the second half of the year and beyond. First, REVUFORGE is increasingly being used to treat patients earlier in their treatment journey. Early claims data show that seventy percent of REVIFORGE use has been concentrated in the second and third line settings, with approximately 50% of use coming from that second line, which we can also call first relapse patients alone. Second, we estimate that onethree of KMT-2A patients treated with REVUFORGE have proceeded to transplant based on our analysis of medium to large academic institutions using REVUFORGE commercially. In contrast, one out of four KMT-2A patients proceeded to transplant after treatment with REVUFORGE in AUGMENT-one 101, which enrolled a significant percentage of later line and heavily pretreated patients.

Speaker 3

It's important to understand that patients who ultimately proceed to transplant are typically treated with RevuForge for two to four months to ensure complete disease remission before pausing RevuForge for approximately three months to ensure engraftment of the transplant. Notably, physicians tell us they expect to put most, if not all, of their patients back on REVUFORGE post transplant for one to two years. In fact, in our clinical trial experience and compassionate use program, we have already seen transplant patients who have been on RevuForge for one to two years and were still on drug at the time of the data cutoff. Encouragingly, in the commercial setting, we have started to see the first cohort of patients restart RevuForge. Based on a sampling of our accounts, we estimate that at least onethree of transplant patients have already restarted RevuForge, with that percentage expected to grow over time as more patients clear the engraftment period.

Speaker 3

As REVIVORGE continues to move earlier in the treatment paradigm, we expect this will translate to a significant increase in the average duration of therapy over time. Specifically, we expect the average treatment duration to build to four to six months in the first year of launch. According to our assessment of patients who started REBUFORGE shortly after launch, the average time on therapy is already well within the projected four to six month range. And we expect this duration to expand to an average of six to twelve months as treatment patterns mature in the second year of launch. I'd now like to briefly review some other metrics that underscore the strong position we're in for continued growth in KMT-2A and our anticipated launch into relapsedrefractory mutant MPM1 AML.

Speaker 3

First, we have a broad and growing prescriber base. From launch through the June, we've penetrated 65% of our higher priority Tier one and Tier two accounts, up from 44% of accounts at the end of last quarter and continuing to grow into the third quarter. These Tier one and Tier two accounts are the centers of excellence in the medium to large academic institutions, which represent twothree of the patient opportunity. Adoption is also increasing across all of their Tiers too, including in the community setting. Among all accounts that have ordered, the vast majority have ordered multiple times.

Speaker 3

Second, we have established excellent market access. Formulary coverage is now complete with more than ninety seven percent of all lives covered, including commercial, Medicare and Medicaid patients. Nearly all prescriptions are reimbursed with very few patients requiring our patient assistance program. The average time from prescription to first fill is less than four days, significantly faster than typical industry benchmarks. The best in class customer service we are delivering will be a key factor for our long term competitive immunity and brand loyalty.

Speaker 3

Notably, RevuForge performance is outperforming the early launch benchmarks set by other targeted AML therapies on key metrics, including revenue and prescriptions, patients treated activation accounts as well as formulary coverage. Further, all indicators give us confidence that Reviforge is delivering for patients and that we are well positioned to develop this medicine into an industry leading franchise with a market opportunity exceeding $5,000,000,000 across the relapsed refractory and frontline setting as outlined on Slide seven. Now turning to key Nictimbo metrics on Slide eight. Since the beginning of the launch, over 4,000 infusions have been administered to an estimated seven hundred patients, representing approximately ten percent of the third line plus chronic GVHD total market. Of all the patients that have started Nictimbo, approximately eighty percent to ninety percent remain on therapy today.

Speaker 3

More than eighty percent of all bone marrow transplant centers in The U. S. Are using Nictimbo, reflecting solid execution and the strong commercial synergies Nictimvo has with both companies' product portfolios. Importantly, Nictimvo is poised for further growth given the high unmet need in the chronic GVHD space and the positive experience physicians and patients are having with the drug. Physicians are reporting rapid and durable improvements across organ systems, including some of the most difficult to treat organs like the lungs and skin.

Speaker 3

These observations align with the results we demonstrated in our pivotal trial and highlight Nyktymbo's unique ability to address both fibrosis and inflammation, hallmarks of the condition. As shown on Slide nine, Nyktymbo has a multibillion dollar market opportunity. Our current indication allows us to target the six thousand five hundred chronic GVHD patients in The U. S. Who require three or more lines of therapy.

Speaker 3

This represents a $2,000,000,000 total addressable market, assuming an average treatment duration of twelve months, which could be conservative given the chronic nature of the disease and the tolerability of Nictimvo. Notably, in our clinical trial experience, we have seen some patients stay on therapy for more than three years. To summarize, we are very pleased with the progress we've made with both Revuforge and Nictimvo. Early indicators for both launches drive our confidence and continued growth and expansion with both products. With that, I'll hand the call over to Nick.

Speaker 4

It's a pleasure to be on the call today and to have the opportunity to build upon the exceptional work that Syndax has done pioneering two new therapeutic approaches. Starting on Slide 10 with Revuforge or Revumilib, an asset which has the potential to become the menin inhibitor of choice across the breadth of menin driven acute leukemias. In the second quarter, we advanced our leadership position with a strong presence at EHA and ASCO, including two important publications. At EHA, we and our collaborators presented the latest data from AUGMENT-one 101 and the BEAT AML trial. I'd like to highlight two key takeaways from these.

Speaker 4

First, the AUGMENT-one 101 data demonstrate the breadth of revimenop activity across relapsedrefractory mutant MPM1, KM2TA and NUC98R acute leukemias. Notably, in the pivotal NPM1 population, nearly half of the patients achieved an overall response. And in a subgroup analysis, a median overall survival of twenty three months was observed among these responders. These data, along with the rate of CCR CRH and duration of CCR CRH, are encouraging results that really stand out in this population. The compelling results are particularly relevant as efficacy is paramount in patients with acute leukemia given the severity of disease and the need for improved outcomes.

Speaker 4

Data from the pivotal NPM1 population were recently published in blood, an important milestone that makes these landmark results available to the clinical community. Turning now to NUC98R. Phase I data from the AUGMENT-one 101 trial show an overall response rate of sixty percent among five patients with relapsed or refractory NUC98R AML, which is an aggressive, difficult to treat form of acute leukemia. While the sample size is small, physicians are encouraged by these data and further trials are underway that will evaluate revimenop in NUC98R as well as other acute leukemias associated with HOX upregulation. The compelling and consistent results observed with revimenop across these genetic subtypes highlights the potential for rebuminib to transform the standard of care for potentially fifty percent or more of all patients with AML.

Speaker 4

Moving now to the second key takeaway. The BEAT AML data presented at EHA and simultaneously published in the Journal of Clinical Oncology are encouraging. As a reminder, this is a Phase Ib trial evaluating Rebuminav in combination with venetoclax and azacitidine in newly diagnosed older patients with mutant MPM1 or KMT2A rearranged AML. The data support the combinability of rebuminib with Venaza in the frontline setting and the potential for the triplet to provide high rates of complete remission and MRD negativity, two treatment goals associated with improved clinical outcomes. The overall response rate was eighty eight percent and the complete remission rate was sixty seven percent in the forty three patient intent to treat population.

Speaker 4

Importantly, MRD negativity was one hundred percent by centralized flow cytometry testing. Both the CR and MR negativity compare very favorably to the historical rates reported in the VIALI A trial of ANASA. Looking ahead, we have recommended publications and presentations planned at major upcoming medical congresses, including the anticipated presentation of the first real world evidence before the end of the year. Given the strong clinical interest in real world evidence, we are thrilled to be working with leading cancer centers and physicians to present outcomes for this new therapeutic class. Turning now to Slide 11 and our further work developing Revuforge and Naktivvo into industry leading franchises, I want to highlight three key points.

Speaker 4

First, we are laser focused on extending our leadership position in menin inhibition into the frontline setting. Enrollment is well underway in the pivotal EVOLVE-two trial of revimenop in combination with Venaza in newly diagnosed patients with mutant MPM1 or KMT2A rearranged AML who are ineligible or unfit to receive intensive chemotherapy. EVOLVE-two is a Phase III randomized, double blind, placebo controlled trial. This trial will have dual primary endpoints of complete remission and overall survival to support potential accelerated approval and full approval, respectively. While the trial is open to both MPM1 and KMT2A patients for enrollment, primary efficacy analysis will be based on the MPM1 population.

Speaker 4

This is the population that is more commonly ineligible for intensive chemotherapy due to advanced age or other comorbidities, unlike the KMT2A population, which tends to be younger and fit enough for intensive chemotherapy. We are conducting this trial in partnership with the Hovon Group, a leading clinical trial cooperative known for executing clinical trials that deliver practice changing data in hematology. Second, in the newly diagnosed FIT population, study start up activities are well underway for two randomized placebo controlled trials with studies of revimenov in combination with intensive chemotherapy followed by maintenance. We have named these the REVEAL trials. One trial is designed for patients with an NPM1 mutation and one for patients with KM2T2A rearrangements.

Speaker 4

We expect to initiate in the 2025. In the NPM1 population, the study will have dual primary endpoints of MRD negative CR and event free survival. These are important clinical endpoints in this population and could have the potential to support accelerated approval and full approval, respectively. We expect that high awareness of RevuForge and positive experience in the clinic will drive rapid enrollment across our frontline programs. In support of our trials in the FIT population, we are also looking forward to reporting Phase I data in newly diagnosed patients treated with revimenop and intensive chemotherapy in the fourth quarter of the year.

Speaker 4

Lastly, I want to highlight the work underway to develop niktimbo or axatilamab for additional patient populations. In partnership with Incyte, several important trials are well underway, including a Phase II trial studying axatilamab in combination with ruxolitinib and a Phase III placebo controlled registration directed trial investigating axatilamab in combination with steroids. Beyond chronic graft versus host disease, we have an ongoing Phase II placebo controlled trial called MAXPYRE, which is studying axatilamab in idiopathic pulmonary fibrosis or IPF. Enrollment is proceeding very well, and we are on track to complete enrollment in the fourth quarter of this year with top line data anticipated in the 2026. We are optimistic about the potential for axatilamab in IPF and beyond, given the strong mechanistic rationale and preclinical evidence along with the remarkable lung responsive observed in the AGARVE-two zero one trial.

Speaker 4

With that, I will hand the call over to Keith to discuss our financials.

Speaker 5

Thank you, Nick. Earlier this afternoon, we reported detailed second quarter twenty twenty five financial results, and I'll touch on a few of these key points on Slide 12. For the second quarter twenty twenty five, we reported RevuForge net revenue of $28,600,000 Quarter over quarter sales growth was driven by demand as inventory levels remained stable to the first quarter at two to three weeks. We expect quarterly growth to meaningfully accelerate over the next year with the potential approval in NPM1 as well as the benefit of a longer duration of treatment in KMT-2AR acute leukemia. Also in the second quarter, Incyte reported Nictimbo net revenue of $36,200,000 with inventory accounting for less than 5% of sales.

Speaker 5

Syndax reported $9,400,000 in Nictimbo collaboration revenue after deducting the cost of sales and commercial expenses. Importantly, Nictimbo is already a positive cash flow contributor to Syndax in just its first full quarter of sales. We expect the Nictimbo margin contribution, defined as collaboration revenue recorded by Syndax as a percentage of Nictimbo net sales, to be in the 20% to 30% range in the near term, and we anticipate this will improve longer term as sales grow and the partnership leverages a largely fixed expense base. We expect continued sales growth given GVHD remains a chronic disease where there is a high response rate to Nyktymbo, and the average patient will likely remain on therapy for years. R and D expense was $62,200,000 in 2Q with the increase versus the comparable prior year, driven by costs related to ongoing trials and increased activities to support commercialization.

Speaker 5

SG and A expense was $43,800,000 with the increase versus the comparable prior year driven by costs related to The U. S. Commercial launch of RevuForge. With regard to expenses, you can find our guidance for the 2025 and full year in the press release we issued today. Notably, we announced today that we expect our operating expenses to remain stable over the next few years.

Speaker 5

Turning to the balance sheet. We continue to maintain a strong financial position with $518,000,000 in cash, equivalents and short and long term investments as of June 30. As I've said in the past, and I reiterate today, we expect Syndax will reach profitability with current funds on hand. In fact, my confidence is higher today given both drugs are outperforming our original forecasts. We are confident we can execute commercially and also deliver on our integrated clinical development plans for both drugs while keeping operating expenses at today's levels.

Speaker 5

Our combined cash with increasing RevuForge and Niktymbo cash flow contributions alongside fixed expense base will drive our path to profitability. I'll turn the call back over to Michael.

Speaker 2

Thank you, Keith. Before we move to Q and A, I want to take a moment on Slide 13 to reiterate how well positioned Syndax is as a company. RevuForge and Niktimbo are outperforming expectations as strong physician enthusiasm drives robust adoption. We have a very sizable cash balance that will allow us to control our destiny and achieve sustained profitability with what we know are two dominant products in multibillion dollar markets. A few key points to recap on RevuForge.

Speaker 2

REVIVORGE is the only FDA approved therapy for KMT-2A patients, and we have already identified and treated over 500 patients since launch, with ninety percent of those being on label. Physicians are treating earlier relapsedrefractory patients, which portends more favorable outcomes. REVIVORGE is getting patients to transplant at an even higher rate than what was observed in our clinical trials. Physicians are eager to put their patients back on REVIVORGE post transplant, and we have begun to see evidence this is happening. Further, all key indicators of demand remain strong in July, which gives us confidence in the continued momentum of this launch.

Speaker 2

Ultimately, in the future, KMT-two 80 patients on REVIVORGE and with the aid of transplant will likely remain on drug for a year or more with the best hope of improved survival. In the near term, we are poised to expand into relapsedrefractory mutant NPM1 AML pending the FDA's anticipated approval of our sNDA. Additionally, we are extending our leadership position to the frontline with enrollment already under well underway in our first pivotal frontline trial. It is important to keep in mind that acute leukemia is an efficacy driven market, and it is clear that REVIFORGE is a highly effective therapy with a favorable safety and tolerability profile. Finally, I will also note that we've retained worldwide rights to REVIFORGE and patent protection continues through at least the late 2030s.

Speaker 2

Turning to a few key points on Nyktymvo. In collaboration with our partners at Incyte, the leaders in GVHD, the Nyktymvo launch is off to an exceptional start. It is well positioned for growth in a $2,000,000,000 market GVHD treatments with patent protection extending to the late 2030s. Nictimbo provides a novel option in a market that needs new mechanisms of action. Patients initiating therapy may continue drug for years.

Speaker 2

We and Incyte continue to advance development programs designed to bring this drug into earlier lines of chronic GVHD therapy and other diseases, starting with IPF. Nictimbo's financial contribution to Syndax is already profitable in its first full quarter. This will grow materially as sales ramp and operating margins continue to expand. Syndax has never been in a stronger position than we are today, and I look forward to sharing additional progress with you in the months ahead. As always, I want to close by thanking everyone who has supported us on this journey, including most importantly, the patients and families who have placed their trust in us as well as our dedicated Syndax employees and long term investors.

Speaker 2

With that, I would like to open the call for questions. Operator?

Operator

Our first question will come from Anupam Rama with JPMorgan. Your line is open.

Speaker 6

Hey, guys. Thanks so much for taking the question. Just wanted to ask a question about this path to profitability. Keith, I know you mentioned operating expenses staying stable over the next couple of years. But what are you assuming in terms of the top line in terms of treatment settings for REVIVORGE and NYCTIMBO?

Speaker 6

Can you get to profitability on sort of the refractory settings alone? Is there some sort of assumptions on frontline expansion baked into getting to profitability? How should we be thinking about that?

Speaker 5

Anupam, thanks for the question. We have been pretty consistent since November that we expect to get profitability with the existing resources that we have today. And I would say the only thing that's changed since then is that we have two launches that are both outperforming our expectations. So the new disclosure that we provided today, stable operating expenses for the foreseeable future, say, the next two to three years, we're doing that because we want to give the buy side and sell side. We want to give the Street the appropriate data for them to model our business better.

Speaker 5

So you guys can get to the same answer that we're getting to. We're not giving revenue guidance per se, Anupam, but I will say that given the time lines to get to approval in the frontline setting, you can definitely assume that we are getting the profitability on the relapsedrefractory indications alone. And I think I just want to add the guidance that we are giving, stable operating expenses, is not to be taken as we are taking our foot off the gas pedal because we're not. The modeling that we've done allow us to fully invest in the continuing successful launches of two products, executing commercially, but additionally, our integrated clinical development plan, as Nick talked about, both for ReviForge and Niktymbo. So I think we're in a pretty unique position to control our own destiny.

Speaker 5

We have two launches that are both outperforming and a stable expense base. And the team has worked extremely hard to put ourselves in this position to specifically reward our shareholders for their investment. So thanks for the question.

Operator

Our next question will come from Corinne Johnson with Goldman Sachs. This

Speaker 7

is Kevin Strang on for Corinne. I had a quick question on the patients with on to transplant. After how many cycles is that typically occurring? And for patients that are going back on drug, you said that it was about onethree of patients so far. What are your expectations for the ultimate proportion of patients that will move on to maintenance therapy?

Speaker 7

And is this something you'll report quarterly? Thanks.

Speaker 2

Kevin, thanks for your questions. So we look, I think we're very encouraged by what we're seeing with patients going to transplant. As we had noted early on when we first started developing this drug, patients do respond very quickly to revimenop and that's usually within the first few cycles. That generally is preceded by transplant thereafter. And that transplant can happen very quickly.

Speaker 2

It can happen within a couple of weeks. That's usually for KMT-2A patients, goal to get them to transplant as quickly as possible. So a few cycles, certainly two to three, getting into remission, moving to transplant. That's how it generally works. We do see in our trial about onethree in our commercial experience, rather, about onethree of patients getting to transplant.

Speaker 2

We expect that number to accelerate. And the reason for that is we are treating patients earlier and earlier in the treatment paradigm. Physicians had told us they would put patients on REVUFORGE in sort of second line or first relapse. We see a vast majority of our patients being treated now in second and third line, which is a great outcome for them, generally means patients do stay on drug longer, do better and have a better chance of going to transplant. So we do think that, that onethree number could go up from here, and we expect it to.

Speaker 2

And ultimately, we will continue to track this over time. It's early days in the launch, and we do expect to report on that metric at some point going forward. And then in terms of maintenance, I think your last question, patients are coming back on maintenance. We know that. We've reported that based on the earliest patients that earliest cohort of patients that we've seen, about onethree of patients have already come back.

Speaker 2

Again, early days of launch, that's a very good indicator. And physicians have told us repeatedly that they expect to put the vast majority of their patients back on maintenance. And that could range anywhere seventy percent, eighty ninety percent of the patients, assuming that they're eligible for maintenance. And so that's, I think, a goal for us, and we'll see that play out over time.

Operator

Our next question will come from Kelly Hsu with Jefferies. Your line is open.

Speaker 8

Thank you for taking my questions. So after the second full quarter of launch, could you comment on the latest observation of treatment duration for RAV4J in real world practice? And also how do you expect the treatment duration to evolve over time, now when you have more earlier second lines of a patient on the treatment? Thank you.

Speaker 2

Kelly, thank you for the question. So first question, duration in the real world, what are we seeing? I'm going to hand that to Steve to answer that.

Speaker 3

Yes. Thanks, Kelly, for the question. And we'd always predicted this first year would be roughly in the four to six month range for average duration. And based on data that we've been able to see, we're very confident that's the case. We take a look at the earliest cohort of patients, and they're certainly within that range.

Speaker 3

That will improve over time. I appreciate the mention of the earlier line patients, which were also in our prepared remarks. And that's a real phenomenon. And this happened very, very quickly. The first patients at launch were not these patients.

Speaker 3

They were likely more third, fourth line patients, but it moved earlier very, very quickly. And that portends well in terms of treatment duration. So better chance of success of getting to a transplant and more likely, as Michael just described on the previous question, the concept of returning to drug. So that will build over the course of this year. We would expect in 2026 that, that average treatment duration will be six to twelve months and could skew towards the latter end of that as the launch matures and we're able to move patients earlier and physicians gain more experience.

Speaker 8

Thanks very much. Just one more question, if I may. So on the cost side, how could we expect the change quarter over quarter for the rest of the year? Thanks.

Speaker 2

Thanks, Kelly. I'm going to ask you

Speaker 5

to The cost side?

Speaker 2

The cost just change over quarter to quarter.

Speaker 5

Yes. Kelly, thanks for the question. So we gave guidance today that we expect we changed the way we gave guidance actually. We used to give guidance with respect to OpEx inclusive of non cash stock comp, but we heard from investors that they're more focused on our cash consumption. So today, we changed the way we gave guidance to focus on our operating expenses less non cash stock comp.

Speaker 5

We said that for the third quarter, we expected that to be 95,000,000 to $100,000,000 and reiterated our full year guidance that we expect that to be now $370,000,000 to $3.90 We implicitly gave fourth quarter guidance because we have three quarters of two quarters of expenses, gave third quarter guidance. So the fourth quarter guidance that is implicit through the math is almost exactly even with our third quarter guidance for research and development plus selling, general and administrative expenses, lessnoncash.com.

Speaker 8

Thanks very much. Congrats on a quarter great quarter.

Speaker 2

Thank you, Kelly. Thanks, Kelly.

Operator

Our next question comes from Phil Nadeau with TD Cowen. Your line is open.

Speaker 9

Good afternoon. Congrats on the two successful launches. A couple of questions from us. First, on the KMT-2A launch for Revu Forge. You suggested, I think, that twenty five percent of patients with KMT-2A for a year have initiated therapy in the second quarter, which suggests in the incident population that the penetration is probably quite high.

Speaker 9

Can you give us a sense of where you think the penetration is in the instant KMT2A population here today in 2025 and kind of where could that go at peak? I guess we're trying to understand how much growth could be left over the next couple of quarters before the label expansion. And then second on the NPM1 label expansion, any update on inclusion of NPM1 in the NCCN guidelines? Thanks.

Speaker 2

Yes, Phil, thanks for the questions. The first question related to KMT2A and penetration in '25. I think we're going clarify that. I'm going to ask Steve to clarify that a little bit.

Speaker 3

Yes. Phil, thanks for the question. And yes, I mean, so we've treated over five hundred patients since launch. We often measure ourselves versus that overall available market of two thousand KMT2A relapsedrefractory AML and ALL patients. So since launch, we estimated we've covered about twenty five percent of that population.

Speaker 3

I think one thing to think about two thousand patients over the course of the year, not at any one point in time. There's going to be some variability as those patients are identified and diagnosed. We feel great about finding patients. REV is very early. It's become the standard of care.

Speaker 3

Physicians are diagnostic testing is prevalent, so they're finding patients. And over the course of the quarter, the number of new patients coming in has been strong and robust. So we expect that to continue. For the rest of this year, we'd expect to finish the year roughly at fifty percent of the identified population. We think that would be a great launch, doing a lot of good for patients, but also really filling the funnel for Reviforge in our initial indication.

Speaker 2

And then in terms of your second question, Phil, about label expansion in MPM1, you had asked about the guidelines. Comment is, we've submitted to the guidelines. We published in blood, the data is available, very helpful to our medical team to help educate in advance of launch. Guidelines, we don't have perfect information about when the guidelines will be updated, could be any day. We do expect it before we get approval in NPM1 and that will help aid our launch even more by having guidelines.

Speaker 2

I think that's important for payers as well as physicians. So looking forward to that, but everything is all set up and ready for launch. We're just we're eager to continue to make progress.

Speaker 9

Great. Can I just follow-up on the first one? So if there's 2,000 patients in a year, it's reasonable to assume 1,000 patients in six months it's been six months since launch, five hundred patients have started therapy, so that's fifty percent. You're suggesting fifty percent in the identified population by the end of the year. Obviously, more and more patients will go on over time, but this is a very sick population, so some are going to fall off.

Speaker 9

So are you kind of at peak penetration now and therefore revenue growth over in the KMT-two eighty population specifically, revenue growth over the next six to twelve months will be basically dependent on patients living longer and the duration of therapy increasing?

Speaker 3

No, Phil, there's a lot of upside. So what we're seeing is over the first year, there's 2,000 eligible patients, we're going to get to 1,000 of them over the year, right, through the 2025. We can go higher than that. So there is definitely some upside. I'd say we're not at peak penetration right now.

Speaker 3

There are more patients that will ultimately be diagnosed. We have a great deal of momentum executing at a very high level. But there's a lot of upside still on KNT2AR. And then the next driver of growth on top of that is going to be NPM1, right, which PDUFA date in late October, and that will be the next leg of the stool. And that's obviously a much larger patient population.

Speaker 3

But that's how we think about growth on the new patient side.

Speaker 2

Yes. And I would just add, Phil, other part of this is duration as you brought up. The duration of therapy is going to be a key driver for KMT-2A. As you treat patients earlier, more patients are going to transplant. We're seeing that evidence in our commercial experience, and you're going to be able to put more patients back on therapy.

Speaker 2

We're seeing that early evidence as well. So we expect those to be major drivers year over year as you've added you're adding new patients, so new patient starts plus the compounding effect of duration of therapy for these patients who come back and stay on maintenance. So I think there's quite a bit of growth left to do.

Speaker 9

That's very helpful. Thank you.

Speaker 2

Thank you, Phil.

Operator

Our next question comes from Peter Lawson with Barclays. Your line is now open.

Speaker 10

Thank you so much. Congratulations on the quarter. Just when you think about the looming FDA approval, kind of what can you tell us around any remaining open items or feedback you've got from the FDA and kind of just anything that kind of helps add around the confidence around the FDA approval? And then kind of second question would just be around the maintenance setting and what percentage of patients do you think you can eventually get on the maintenance setting? Thank you.

Speaker 2

Yes, Phil, thanks sorry, Peter, thank you for the questions. First on FDA approval, I'm going to turn it over to Nick. Are we learning anything new?

Speaker 4

Yes. Thank you. The submission is progressing very well. We have our PDUFA date. We've been working very closely with the FDA.

Speaker 4

It's a team we know well now and things are progressing very well according to plan. So we're looking forward to the PDUFA as guided on October 25.

Speaker 2

Yes. And with regard to your second question, maintenance, what percentage do we think we can put back on? Look, I think we had heard from physicians, we continue to hear from physicians, the vast majority, if not all of their patients, they'd like to put back on maintenance. We know that not every patient will be eligible for maintenance. But with physicians treating patients earlier and the majority of the treatment being concentrated in second line, even at this early stage of launch, that's a very good sign that physicians will drive hard to take more patients to transplant, which give us more opportunity to put them back on once they clear their transplant and engraft.

Speaker 2

So can't give you exact percentage, but it should be a very high percentage of KNT2A patients.

Speaker 10

Thank you. Maybe I could circle back on the first question, just around the FDA. Know there's always a level of uncertainty, and it seems to be a heightened level of uncertainty. Have you seen any changes in that dialogue, any moving targets?

Speaker 2

Yes. Peter, no. I mean, I think that's clearly, that's not what's there's nothing to indicate that it's anything other than really very good progress. We have priority review. We're under our tour.

Speaker 2

We're having consistent quality dialogue with the agency. The feedback has been very good. We have a PDUFA date that's coming close and we're prepared for launch. So I think everything was on the regulatory front is really hitting on all cylinders, no indication that is any it's anything other than that.

Speaker 10

Perfect. Thank you so much.

Speaker 2

Thanks, Peter.

Operator

Our next question will come from Michael Schmidt with Guggenheim. Your line is now open.

Speaker 6

Hey, guys. This is Paul on for Michael. Thanks for taking our questions. I have two on the frontline combo opportunities. So first on the recent EHA updates from the AML, It seems pretty clear that remimandib is enhancing the CR and MRD compared to benazolone.

Speaker 6

But I would love to get your thoughts on the degree of OS improvement you're seeing and whether or not you plan to provide another survival update in the study with additional follow-up. And then secondly, just looking ahead to the intensive chemo combo, can you sort of talk about how we should think about key CR and MRD benchmarks for that combo and sort of what to expect for the update later this year? You.

Speaker 2

Paul, thank you so much for the questions. I'm going to turn it over to Nick to touch on the beat AML piece of this first.

Speaker 4

Yes. Thank you for that. And firstly, very encouraged by the beat AML study. I mean this was an important study. We were to confirm a dose to take into Phase III and show that the dose was tolerable.

Speaker 4

And also, as you say, report out some early efficacy measures. And I think the efficacy measures that are probably most important in this setting are the complete response rate and MRD negativity because remember, this is a relatively small 43 patient Phase Ib study. So interpretation in that context is quite difficult. And the CR8 and MRD negativity were very high. They were 67100% MRD negativity, which, as I said in the earlier comments, are really a step change above what you expect from historical controls.

Speaker 4

Now when you look at the overall survival, you have to remember that the median follow-up is quite short currently. The median follow-up was only around seven months, and it's over twenty months in VREA. So certainly, we expect as those data mature, you'll see some changes in the median OS. There's a lot of steps in the Kaplan Meier currently, which suggests the median is quite unstable and is, therefore, very difficult to estimate. Having said that, it's already very comparable or somewhat similar to VREA, which you must also recall is a very heterogeneous group of subtypes of AML with a variety of different genetic mutations.

Speaker 4

And when you actually benchmark against MPM1, you probably find the median overall survival is a little less than was reported and closer to ten months. In summary, we remain extremely confident in the profile of the combination of Venaza. And I think it gives us a very high level of confidence that the EVOLVE-two study that we're doing in collaboration with Hovong will read out well in due course. With regard the intensive chemotherapy and the MRD negative CR, we think both CR for unfit and MRD negative CR, both plasma and bone marrow are important endpoints in this setting. They've been shown to predict for improved outcomes around event free survival and OS and believe that they could serve as surrogates to support accelerated approval.

Speaker 4

Those are obviously discussions we have had with the agency and have refined those. They are built into the protocols as dual primary endpoints, which means that they are independently powered. So you could have either the surrogate CR endpoint or the time to event endpoint, whether that be OS or EF to give a positive study. And we remain quite confident that both of those should read out favorably. As previously indicated, we will be updating data for our combination with intensive chemotherapy for FIT patients, specifically the seven plus three regimen from our own sponsor study, the seven zero eight study.

Speaker 4

And also, we'll likely hear from the study we're doing in collaboration with the NCI, which is also a combination of intensive chemotherapy in the latter part of this year. And those data should both confirm the dose, tolerability and also early signs of efficacy to support our Phase III with intensive chemotherapy. So overall, we feel very confident about the programs, and we really have very good momentum going into the latter part of this year.

Operator

Our next question comes from Yigal Nochomovitz with Citi. Your line is open.

Speaker 11

Hey, Michael and team. Thank you. On the onethree of the patients that have restarted after the transplant and then the twothree that don't, could you just clarify? So of those twothree, are they not expected to restart? Or is it simply that they're not ready to restart and the expectation is that most of them, in fact, will restart?

Speaker 2

Yigal, thanks for the questions. It's the latter, right? So clearly, we said early days, one third have restarted already, which is very encouraging to us, which does leave two thirds of those patients who could restart. And we expect a very high proportion of patients to restart out of that cohort as well. So it's an ongoing evolving landscape of patients coming back from transplant and going on to maintenance.

Speaker 2

So we haven't excluded that twothree. We actually we're waiting for those to come back.

Speaker 11

Okay. And then just can you clarify on the mechanics? Do they need to get a reimbursement approval again when they come back after the transplant? Or is it seamless and they just start RevuForge again without a second need to request the reimbursement?

Speaker 2

Yes. Steve, do want to address that? Yes. Our expectation, you

Speaker 3

can all add, it's pretty seamless. I mean there's typically in this industry, I mean, it's six month renewals, which are pretty standard. That may be the case here. But typically, if you're within that window, they'll restart without any challenges from payers. And even when there is a restart or a reinitiation of a prescription, we have not heard of any challenges with doing that.

Speaker 3

Payers' coverage, the formulary coverage is over 97. Claims are being reimbursed on a regular basis. So we're not expecting any challenges with restarting at all.

Speaker 11

Okay. And lastly, I'm just curious if you could speak in a little more detail about this first wave of the real world evidence that you're going to have at the end of the year. Can you just expand on that a little, please?

Speaker 2

Sure. Maybe Nick can take that.

Speaker 4

Yes, I'd be happy to. So we're obviously working with leading centers across The U. S. And leading thought leaders. And we're at the point now with the drug being used in clinic from commercial supply that we're getting some interesting series of data from physicians' experience in the real world.

Speaker 4

So we're collaborating closely with them to collect those data and look forward to presenting those real world experiences from those centers in the latter part of this year. And I think we're uniquely well placed to be able to do that with these new therapeutic classes. We're now available commercially in the clinic and can actually report real world experience versus just clinical trial experience. So I think those data and how the drug is getting used in the real world will very insightful, and we're looking forward to those reporting out later in the year.

Speaker 11

Thanks.

Speaker 2

Thank you, Yigal.

Operator

Our next question will come from Justin Zelen with BTIG. Your line is open.

Speaker 7

Congrats on the strong quarter. So looking ahead to the October 25 PDUFA date for MPM1 label expansion, can you walk us through how you're preparing the commercial organization for launch readiness? And do you anticipate a meaningful incremental uptake in the population right out of the gate? Or would it be more gradual?

Speaker 2

Yes. Thanks, Justin, for the questions. I'm going to turn it over to Steve to touch on the launch readiness, launch maintenance.

Speaker 3

Yes. So we're in market, Justin, appreciate, obviously, with another indication, which would be different from someone who's entering the market. So here's how I would think about this launch. I mean part of the success or the preparation is doing a great job right now, right? So physicians, we're leveraging that market experience in KMT-2AR.

Speaker 3

Patients understand how to dose the drug. They appreciate the dosing options that they have, How do they initiate treatments? How to manage any AEs that might occur in treatment initiation getting through them? What do they expect from efficacy and how to bring the drug in, right? How do they, as a treatment center, prefer to bring the drug in?

Speaker 3

So that's one piece. I think the other piece is we're in the same audience, right, right now. So when we think about treatment centers that treat TNT2AR, they're the same ones that treat MPM1, so we're already there. We've got a best in class customer facing team. They have excellent relationships.

Speaker 3

They understand the space. They understand how these treatment centers treat. So they've already got a leg up at once the indication is granted on the sNDA. And the last piece is just a great drug, right? We believe we've got a best in class profile with NPM1 data.

Speaker 3

Any physician would tell you most important across any of these types of agents is does the drug work and does it work better than anything else that's out there. We believe we've got a winner in REVUFORGE. The efficacy data really screams physicians tell us that. Think as Michael may point out in his comments, the fact that we've got multiple indications for one man inhibitor, that is a big deal. That is not something that's minor.

Speaker 3

And that holds for treaters, it also holds for payers, right? Payers, when looking at a second indication like they are with RevuForge, it's an easy add and that will get us ahead. So those are the things I think about. In terms of uptake, absolutely, we're expecting a bump, right? We know that right now, the usage outside of KMT-two AR is small.

Speaker 3

We maintain it's about 10%. We'll call it spontaneous or off label use. The biggest bang for MPL1 is going be at the indication granting, right? When promotionally, commercially, We can stand behind the drug. We think it will make a big splash.

Speaker 3

Physicians are ready for it. So we'll expect a decent driver at that time later this year. Yes.

Speaker 2

I'll just add that adding NPM1, you take your patient population of about 2,000 patients to 6,000 patients, that's a big difference. And so we expect it to be a really important driver, not only starting at the end of the year, but going into next year and beyond. It's important to be first. It's important to have the best profile. We have both.

Speaker 2

So we're in good shape.

Speaker 7

Okay. Thanks for taking the questions.

Speaker 2

Thanks, Justin.

Operator

Our next question will come from Salim Syed with Mizuho. Your line is open.

Speaker 12

Great. Hey, guys. Congrats on the quarter. Mike, Keith, maybe just a couple from us. One on Niktinva.

Speaker 12

So I apologize, this is going to be another math question. But when I look at 2026, consensus currently, I think, is around $240,000,000 or so on the end user sales number. And just kind of like looking at some of the numbers that have been released between yourselves and Insight, there were $45,000,000 of sales, I think, or so ex inventory. That's our number, I think. 4,500 infusions, I think they mentioned that on their call.

Speaker 12

I know you guys are saying over 4,000, but they said 4,500. So it looks like about $10,000 net price per infusion, assuming the trial duration of ten point three months, you start to get to this price of $225,000 before the 22 infusions that would take place. So assuming you're they talked about having 1,000 patients at the end of this year perhaps. So you start to get to these numbers of 225,000. And again, that's using the 10.3, not the twelve month duration, no additional inventory impact, no additional penetration, no growth.

Speaker 12

Is it just me? Or is that number just incredibly light, the 26 Nick Timbo end user sales number, just based on that math? Is there something I'm missing?

Speaker 2

Thanks for the question, Salim. So we're tracking with your we're trying to track with your math here, but Keith, don't you comment?

Speaker 5

Yes, trying to track with your math. I mean, I think going back to some of the comments that Mohamed and Bill made on the call that Insight had last week, I think they were asked a question about peak sales and there was a response that included an estimate of looking at the Resurac launch and comparing the Victimba launch to that launch. We like we and Insight both think that, that could be a low watermark for us. And if you just look forward, Michael made comments in his prepared remarks that third full year of launch, Niktivos annualized in over $500,000,000 U. S.

Speaker 5

Only. Again, we think looking forward to 2028, when we'll still only have a relapse refracting, we don't expect to have necessarily frontline indications by then. But we definitely think this can be several $100,000,000 product in the next few years.

Speaker 12

Okay. Yes, I mean, did talk about the 1,000 sort of at the end of the year from the current 700 or so. That's sort of the basis for the math. But I understand your point. And just quickly, I guess, your slides, it looks like you updated your EPI data for the NTM-one from 3,000 to 4,500 just to 4,500.

Speaker 12

Is there something you guys did on the EPI to make you more confident around the upper end of that range? The one that's $5,000,000,000 TAM?

Speaker 2

So Leon, thanks for the question. And look, the only thing that lot of things give us confidence. I think when we think about the epi, I mean, we're treating patients now really much more in the second line. So you're going to capture the upper end of that number if you continue to treat in that capacity. So that's how physicians tell us they want to treat, they want to treat earlier.

Speaker 2

And so that gives us confidence to kind of capture the upper end of that range. Just making a comment, want to go back to for a second to your Niximbo question. You mentioned duration at ten months. I would just point you to the fact that this is a drug that physicians intend to keep patients on potentially for years. I mean, this is a very efficacious drug.

Speaker 2

And so we believe that there's potentially a lot of upside in duration of therapy. And so I would be thinking about your assumptions there and we'll track with that obviously over time. But I think that's a one thing that stood out to me in your math that you might want to take a look at.

Speaker 12

And so Yes. Was meant to be conservative, yes.

Speaker 2

Yes. No, I'm just again, I think it's as a conservative estimate, understand where you're coming from, but I think we are encouraged by duration here and what this category and what specifically this drug and mechanism can bear. So I would just pay attention. Yes, but

Speaker 5

five months into launch, Insati made comments that eighty percent to ninety percent of patients that started on therapy are still on therapy. Very good point.

Speaker 12

Yes, fair enough. Thanks so much, guys. Appreciate it.

Speaker 2

Thanks, Alain. Thanks, Alain.

Operator

Our next question will come from David Dye with UBS. Your line is open.

Speaker 6

Great. Thanks for taking my questions and congrats on the quarter. A couple from me. One is just on the $20,000,000 of Road Forge revenue. Could you talk about the percentage of revenue is inventory?

Speaker 6

And also how much of that is coming from new patient start versus refill?

Speaker 5

Thanks, David. Yes. So David made comments that I made, said that only well, I'm sorry, let me back up. The demand in the quarter was driven by patient growth, patient demand. Inventory stayed level, two to three weeks.

Speaker 5

And we expect that to be the case going forward. It's pretty typical of a drug that's used distributed using specialty pharmacies, specialty distributors, two to three weeks of inventory. So we don't expect that to grow.

Speaker 6

Got it. Okay. And then just another question on the patients on the stem cell transplant. And right now, have about thirty three percent, a quarter of it, or one third. I'm just curious, do you expect this to increase given that you have fifty percent of patients currently treated in the second line?

Speaker 6

So how should we think about this going forward in terms of the increase in stem cell transplantation?

Speaker 2

David, thanks for the question. We try to get at this a little earlier. Look, I think the transplant rate at a third remember, in AUGMENT-one hundred one, we're at about a quarter of patients going to transplant. Now we're at about a third. We're treating patients a lot earlier instead of third and fourth line, second and third line.

Speaker 2

Seventy percent of our prescriptions are in that second and third line. Transplant rate could go 50% higher. We don't know. But we are expecting it to materially change over time and get better. And what gives us confidence is that we know if we treat patients earlier, they tend to get to a higher level of response, higher rate of response and are more eligible or will be eligible for a transplant.

Speaker 2

So I think that's what's giving us confidence. We don't have the upper bound of that, but we do expect it to grow over time.

Speaker 11

Well, thank you for taking my questions.

Speaker 2

Thank you, David.

Operator

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

Speaker 7

on the quarter, and thank you so much for taking our questions. A couple from us, if we may, based on your earlier comments. But first being, of the two thousand or so relapsedrefractory KMT2A patients, can you give us any color on your assumptions regarding the overall peak penetration here? And then similarly, given the comments regarding the overall opportunity in relapsedrefractory, at least as far as your cash runway goes, any color on your insights or assumptions as far as the competitive split in the NPM1 population look like? Thanks.

Speaker 2

Thanks, Jason. Thanks for the question. So first question related to peak penetration, our estimates on peak penetration for the 2,000 kmT2A patients. Steve, do you want take a shot at Yes.

Speaker 3

Think we can as we've said, we've already covered twenty five percent of the population, we'll get to fifty percent of that. There's some upside to that. We haven't guided to a number on peak. But I think we'll be at levels at 1,000 that are close to the upper end of models that some of you may have, but we think there's some beyond that. Treating earlier, I think as Michael said, brings more people in.

Speaker 3

Just remember, Jason and everyone, that in KNCT2AR, there's no one in the near term coming to market. So it is really white space and rev is already the standard of care after just seven months on market and physicians are using it that way.

Speaker 2

Yes. Jason, I would just I would say there's penetration into a market never happens within one year. It always takes in oncology more than that. And I think we expect, as Steve said, within 1,000 patients this year. So we have more work to do next year and the year beyond.

Speaker 2

So that's I think just in terms of new patient starts. In terms of really building this market, I'll say it again, duration of therapy is going to be key, right? Physicians treating earlier, we know that, that's going to give us the best outcomes. Patients are going back on therapy post transplant. That will ultimately compound the revenue as it goes forward, patients staying on drug for long periods of time.

Speaker 2

So I think those are the real drivers, those two things. It's actually pretty simple. But that's it's not just about how many patients you could penetrate on KMT2A, it's how long they stay on drug as well. And then overall opportunity, you had mentioned the second question being, what do you what's your estimate for competitive split in MPM1? Look, I think we're first to market.

Speaker 2

We know we have best profile. I think the data speaks for itself. We're feeling very confident about that. We would expect to have a significant percentage of that market in dominating MPM1 as well as KMT2A. We feel very positive about the fact that we're entering the market first.

Speaker 2

And that's essentially how we see it. So we're not we can't guide exactly to what the split would be, but we would expect to have a big share.

Speaker 9

Fair enough. Appreciate the color. Thanks, guys.

Operator

Our next question will come from George Farmer with Scotiabank. Your line is open.

Speaker 13

Hi. This is Chloe on for George. Thank you for squeezing us in. A couple from us. Can you talk a little bit about the monitoring that's happening in the real world right now for potential cardiac AEs, how they're being managed?

Speaker 13

And to the extent that you're privy to this information, what percent of these cardiac AEs, like the QT prolongation, is due to revimenop as opposed to any concomitant medications, and how many of those have resulted in in discontinuations in the real world? Then number two, if you could give some color on how to model the royalty pharma interest expense in the P and L moving forward, that'd be super helpful. And the last one on Nictimbo. In IPF, could you please speak to the unmet need, how big that opportunity is and how you're thinking about positioning in a market that's dominated currently by generics?

Speaker 2

Chloe, thanks for your questions. So I counted three. So let's start with the first one. Nick will take that. How is monitoring being done very well?

Speaker 4

Yes. Thank you for the question. So firstly, we've shown in our extensive clinical trial experience now that management of QT has done very simply. If there's clear guidelines in the label now for QTs in the first month. We know that almost all patients that have any sign of prolongation happens early and is monitored and managed appropriately.

Speaker 4

That's very consistent with our real world experience. As I said, we'll be reporting on some of that later in this year. We, of course, have very extensive safety surveillance systems in place, but we're really not hearing any evidence of concerns with standard guidelines and management of those patients. So things are progressing very well. The physicians are very happy with the profile and not flagging any concerns.

Speaker 4

Great. And Keith, do want talk about the royalty, please? Yes. Chloe, so

Speaker 5

with respect to your question about how to model the Niktimbo. So we've already achieved profitability. First full quarter sales, we mentioned that, 36,000,000 in net revenue. We reported $9,000,000 in collaboration revenue. So we're already in a range of 25% to 30% from a gross contribution perspective.

Speaker 5

And like I said in my prepared remarks, we only expect that to grow. With respect to the royalty, it's really easy. It's simply 13.8% of the net revenue that is reported by Incyte. So in second quarter, that represents $5,000,000 in royalties paid on $9,400,000 in collaboration revenue. We're using the effective interest rate method, so the cash paid to Royalty Pharma won't exactly match what we report on the P and L.

Speaker 2

And then lastly, I think you asked about IPF. So IPF, important indication for us. We have a Phase II trial ongoing, expect to fully enroll that trial this year, data next year. That's a big market opportunity. As you pointed out, there are some entrenched competitors, different mechanism of action brought by this drug, we think a very impactful one, about one hundred and fifty thousand patients into the market in The U.

Speaker 2

S, two hundred and eighty thousand worldwide. So it's a big market. Patients are still in absolute need of new therapy. And we think we bring that with Nyktymvo potentially with this mechanism. So we'll have those trial results, and we think we'll meaningfully differentiate over time if those are obviously positive.

Speaker 2

So more to come on that, but it's a we think a very big opportunity for us to exploit as a second indication.

Speaker 13

Great. Thank you very much.

Speaker 2

Thank you. Thanks, Bose.

Operator

Our last question comes from Mayank Matamy with B. Riley Securities. Your line is open.

Speaker 14

Yes. Good afternoon, team. Thanks for taking our questions and congrats on the progress. Could you just clarify, I'm sorry if I missed that, if there's any real world evidence you're planning to generate as you strengthen the case for Rebufor's use as maintenance therapy post transplant? And what's your expectation for duration of therapy there, say, relative to the four to six months you're seeing in pre transplant?

Speaker 14

And I have a quick follow-up.

Speaker 2

Yes. Thank you. Thanks so much for your question. I'm going let Nick address the real world part.

Speaker 4

Yes. We'll be presenting some relatively preliminary data from the series we'll be monitoring towards the latter part of this year, second half of this year, we look forward presenting. That will obviously include patients' demography, how they do on therapy and importantly, also the proportion of patients that go on to transplant in the real world from these series and also those patients that then start on Reviforge after transplant. I think those will be important data. Obviously, as time goes by and our commercial experience increases, we'll be able to add to those data.

Speaker 4

But I think it will be interesting preliminary data, and we'll look forward to reporting those out. And I think they'll shed some light on some important questions.

Speaker 2

And I'll just make a comment, I think, you asked about what our assumptions are on post transplant maintenance, what percentage of patients are likely to go on to transplant and then, of course, on what time frame. And I think we commented earlier about high percentage of patients going to transplant. I think that's obviously very clear to us now and exciting. And then in terms of staying on therapy, physicians have repeatedly told us a year to two years, as I said in my prepared remarks, a year to two years is pretty consistent. Could be longer.

Speaker 2

Some physicians say that they will keep them on indefinitely without a real compelling reason to take them off. And obviously, these patients are at high risk of relapse. You want to keep them in remission as long as possible. That's the key goal. So think an assumption you can make on average for maintenance that physicians are thinking about a year to two year timeframe.

Speaker 14

Very helpful. Thank you. And then on nictimbo, can you just remind us what development milestones to look out for as you think about the therapy moving into earlier line GVHD? I believe the label is third line, fourth line, but the uptake is in earlier lines. But I was curious if any additional clinical data milestones we should be on the lookout for.

Speaker 14

Thanks for taking my questions.

Speaker 2

Thank you. Nick, do you want take the question?

Speaker 4

Yes. And just to recap, and we haven't guided specifically on the time lines. We have two important studies in the frontline setting, one in combination with dexamethasone, that's a Phase III with registrational TEND. Again, we haven't guidelines specifically on when that study will read out. And an important Phase II study as well in combination with Jakafi.

Speaker 4

And then obviously, our IPF randomized Phase II study, which is around one hundred and thirty five patients we're anticipating will complete enrollment towards the latter part of this year and data in the second half of next year. So a number of important milestones reading out both in earlier lines of GVHD and in IPF.

Speaker 10

Thank you.

Operator

This concludes our question and answer session. I will now turn the floor over to Mr. Michael Metzger for any additional comments or closing remarks.

Speaker 2

Thank you all. We appreciate you all tuning in today to discuss our recent progress and the exciting milestones ahead. We look forward to seeing many of you at several investor conferences and events in the third quarter. With that, have a great evening.

Operator

The call has now concluded. Thank you for joining. You may now disconnect.

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