Reshma Rangwala
Analyst · Piper Sandler. Please go ahead
Thank you, Richard. As Richard discussed, we believe selinexor has the potential to fundamentally change the treatment of patients with myelofibrosis. I'd like to spend the next few minutes discussing why we believe the scientific evidence supporting that opportunity has continued to strengthen, why it supports our planned sNDA submission, and how we continue to build the clinical foundation for selinexor in myelofibrosis. Turning to slide 10, the biological rationale for combining XPO1 and JAK inhibition is compelling. JAK-STAT activation is a key driver of malignant clone proliferation, splenomegaly, and disease-related symptoms, while XPO1 activity is important for malignant cell survival. By targeting these complementary pathways simultaneously, we believe selinexor has the potential to complement JAK inhibition and improve outcomes beyond symptom control alone. Turning to slide 11, myelofibrosis remains a disease with a high unmet need given clinical activity with the currently approved therapies is modest. As a result, spleen volume reduction of at least 35% is observed in less than 1 third of patients. Overall survival improvements are limited, and meaningful modifications of the underlying disease is not observed. Turning to slide 12, a distinctive profile has been observed from the SENTRY trial, given the compelling SVR35 results that are rapid, deep, and sustained, a promising OS signal, a first-of-a-kind prediction between SVR35 and OS, and a safe and manageable adverse event profile. These data appear to support SVR35 as a reasonably likely surrogate endpoint, enabling an sNDA under the accelerated approval pathway. Turning to slide 13, at week 24, a nearly double spleen response rate was observed with the combination of selinexor plus ruxolitinib versus ruxolitinib alone. What's particularly important is the quality and kinetics of that response. As shown on slide 14, the responses were rapid, emerging as early as week 12, and deep, with greater average spleen volume reductions relative to baseline observed with the combination. Both response rates and depth of response were sustained through week 36. Importantly, as seen on slide 15, the benefit was consistent across pre-specified patient subgroups, reinforcing the robustness of the treatment effect in the vast majority of frontline myelofibrosis patients. Especially important is a subgroup analysis by ruxolitinib dosing as seen on slide 16. Even with average suboptimal doses of ruxolitinib less than 15 milligrams per day, SVR35 rates with the combination were as high as 50% compared to 0 observed with ruxolitinib alone, indicating that with the combination, SVR35 is driven by selinexor and supported by modest doses of ruxolitinib. From a clinical practice standpoint, these data suggest that ruxolitinib dose reductions may not compromise efficacy when combined with selinexor. As shown on slide 17, at the time of the top-line analysis, the overall survival hazard ratio was 0.43, and patients continued to be followed as these data mature. On slide 18, a post hoc landmark analysis demonstrated that irrespective of treatment, SVR35 at week 24 predicted overall survival. This observation is further reinforced by the longer-term follow up from the Phase I trial on slide 19, in which the same relationship between SVR35 and overall survival is observed. On slide 20, the importance of the SVR35-OS relationship becomes even clearer when viewed in the context of the broader myelofibrosis literature. Over the past several years, a substantial body of retrospective evidence from Phase III JAK inhibitor trials has demonstrated that greater SVR35 rate differences observed across the 2 arms correlate with improved overall survival. SENTRY now provides an important opportunity to build on that body of evidence as the first Phase III trial that prospectively demonstrates the same relationship and establishes SVR35 as a potential surrogate endpoint for overall survival. This underscores the importance of treating patients with the combination early in the disease course, increasing the likelihood an SVR35 reduction is observed, thus potentially maximizing overall survival. On slide 21, we also observed higher rates of variant allele frequency reduction with selinexor plus ruxolitinib as early as week 24. These molecular findings are important because VAF reduction was associated with a greater likelihood of achieving SVR35, providing additional biological evidence that is consistent with the clinical findings. Taken together on slide 22, the rapid, deep, and sustained spleen responses, the promising overall survival findings, the relationship between SVR35 and survival, and the molecular data all point in the same direction. We believe this unique and compelling profile strengthens the scientific rationale for SVR35 as a meaningful predictor of long-term survival. It is the combination of this growing body of evidence, the strength of the SENTRY data, and the significant unmet need in myelofibrosis that formed the basis of our scientific discussions with the FDA regarding the role of SVR35 in supporting our planned sNDA submission. We believe the FDA's written feedback indicating that SVR35 appears to qualify as a reasonably likely surrogate endpoint to predict overall survival represents an important scientific and regulatory milestone. Importantly, this builds upon years of scientific evidence supporting the relation between SVR35 and long-term outcomes, together with the prospective randomized evidence generated through SENTRY. Our planned submission will be based on the week 24 SVR35 results. We intend to use additional long-term overall survival data from the ongoing SENTRY trial to verify clinical benefit, a requirement under the accelerated approval pathway to later convert to traditional approval. While our immediate priority is our planned submission, we continue to explore the broader role of selinexor in myelofibrosis. On slide 23, the ongoing SENTRY-2 study provides an opportunity to further characterize the activity of selinexor as a monotherapy and explore the potential flexibility of XPO1 inhibition in combination with additional JAK inhibitors. This study will help us better understand the intrinsic contribution of selinexor and continue to define the broader role of XPO1 inhibition across the treatment of patients with myelofibrosis. As Richard noted, we expect top-line data from the 60-milligram cohort of SENTRY-2 during the second half of this year. Taken together, we believe the strength and consistency of the evidence generated through SENTRY, together with our continued clinical development efforts, provide a strong scientific foundation for our planned sNDA submission, and reinforce our belief that selinexor has the potential to fundamentally change the treatment of patients with myelofibrosis. With that, I'll turn the call over to Sohanya.