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Updated Data for Nuvalent's ALK-Selective Inhibitor, NVL-655, and ROS1-Selective Inhibitor, Zidesamtinib, Continue to Support Potential Best-in-Class Profiles

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Nuvalent (NUVL) announced updated Phase 1 data for its ALK-selective inhibitor NVL-655 and ROS1-selective inhibitor zidesamtinib at ESMO Congress 2024. Key highlights:

- NVL-655 showed 38% overall response rate (ORR) in heavily pre-treated ALK+ NSCLC patients, with 9.2 month median duration of response (DOR)

- Zidesamtinib demonstrated 38% ORR in ROS1+ NSCLC patients previously treated with ROS1 TKIs, with median DOR not reached

- Both drugs showed promising intracranial activity and favorable safety profiles

- Phase 2 trials with registrational intent are ongoing for both drugs in TKI-naïve and pre-treated patients

The company believes these results support the potential for NVL-655 and zidesamtinib to become best-in-class therapies for ALK+ and ROS1+ NSCLC, respectively.

Nuvalent (NUVL) ha annunciato dati aggiornati della Fase 1 per il suo inibitore selettivo ALK NVL-655 e l'inibitore selettivo ROS1 zidesamtinib al Congresso ESMO 2024. I punti salienti:

- NVL-655 ha mostrato un tasso di risposta globale (ORR) del 38% nei pazienti ALK+ NSCLC fortemente pre-trattati, con una durata mediana della risposta (DOR) di 9,2 mesi.

- Zidesamtinib ha dimostrato un ORR del 38% nei pazienti ROS1+ NSCLC precedentemente trattati con TKI ROS1, senza una DOR mediana raggiunta.

- Entrambi i farmaci hanno mostrato un'attività intracranica promettente e profili di sicurezza favorevoli.

- Sono in corso studi di Fase 2 con intento registrativo per entrambi i farmaci in pazienti naïve ai TKI e pre-trattati.

La società ritiene che questi risultati supportino il potenziale di NVL-655 e zidesamtinib per diventare terapie d'eccellenza per NSCLC ALK+ e ROS1+, rispettivamente.

Nuvalent (NUVL) anunció datos actualizados de la Fase 1 para su inhibidor selectivo de ALK NVL-655 y el inhibidor selectivo de ROS1 zidesamtinib en el Congreso ESMO 2024. Aspectos destacados:

- NVL-655 mostró una tasa de respuesta global (ORR) del 38% en pacientes ALK+ NSCLC que habían recibido múltiples tratamientos previos, con una duración mediana de respuesta (DOR) de 9,2 meses.

- Zidesamtinib demostró un ORR del 38% en pacientes ROS1+ NSCLC que habían sido tratados previamente con TKI de ROS1, sin DOR mediana alcanzada.

- Ambos medicamentos mostraron una actividad intracraneal prometedora y perfiles de seguridad favorables.

- Se están llevando a cabo ensayos de Fase 2 con intención de registro para ambos medicamentos en pacientes naïve a TKI y pre-tratados.

La compañía cree que estos resultados apoyan el potencial de NVL-655 y zidesamtinib para convertirse en terapias de primera clase para NSCLC ALK+ y ROS1+, respectivamente.

Nuvalent (NUVL)는 ESMO 2024 학회에서 ALK 선택적 억제제 NVL-655와 ROS1 선택적 억제제 zidesamtinib의 업데이트된 1상 데이터를 발표했습니다. 주요 하이라이트:

- NVL-655는 치료를 많이 받은 ALK+ NSCLC 환자에서 38%의 전반적인 반응률(ORR)을 보였으며, 반응 지속 기간(DOR)의 중앙값은 9.2개월이었습니다.

- Zidesamtinib은 ROS1 TKIs를 이전에 치료받은 ROS1+ NSCLC 환자에서 38%의 ORR을 나타내었으며, 중앙값 DOR은 도달하지 않았습니다.

- 두 약물 모두 유망한 두개내 활성을 보였으며, 안전성 프로파일이 우호적이었습니다.

- 두 약물 모두 TKI에 나이브한 환자와 이전에 치료받은 환자를 대상으로 등록 의도를 가진 2상 시험이 진행 중입니다.

회사는 이러한 결과가 NVL-655와 zidesamtinib이 각각 ALK+ 및 ROS1+ NSCLC 치료를 위한 최고의 치료제로 발전할 가능성을 뒷받침한다고 믿고 있습니다.

Nuvalent (NUVL) a annoncé des données mises à jour de la Phase 1 pour son inhibiteur sélectif de l’ALK NVL-655 et l’inhibiteur sélectif de ROS1 zidesamtinib lors du Congrès ESMO 2024. Principaux points forts :

- NVL-655 a montré un taux de réponse global (ORR) de 38 % chez les patients ALK+ NSCLC fortement prétraités, avec une durée médiane de réponse (DOR) de 9,2 mois.

- Zidesamtinib a démontré un ORR de 38 % chez les patients ROS1+ NSCLC ayant déjà reçu des TKI ROS1, sans DOR médian atteint.

- Les deux médicaments ont montré une activité intracrânienne prometteuse et des profils de sécurité favorables.

- Des essais de Phase 2 avec intention d’enregistrement sont en cours pour les deux médicaments, chez des patients naïfs de TKI et prétraités.

L’entreprise estime que ces résultats soutiennent le potentiel de NVL-655 et de zidesamtinib pour devenir des traitements de référence pour NSCLC ALK+ et ROS1+, respectivement.

Nuvalent (NUVL) hat auf dem ESMO-Kongress 2024 aktualisierte Phase-1-Daten zu seinem ALK-selektiven Inhibitor NVL-655 und dem ROS1-selektiven Inhibitor zidesamtinib vorgestellt. Wichtige Highlights:

- NVL-655 zeigte eine Gesamtansprechrate (ORR) von 38 % bei stark vorbehandelten ALK+ NSCLC-Patienten, mit einer medianen Ansprechdauer (DOR) von 9,2 Monaten.

- Zidesamtinib demonstrierte eine ORR von 38 % bei ROS1+ NSCLC-Patienten, die zuvor mit ROS1 TKIs behandelt wurden, wobei die mediane DOR nicht erreicht wurde.

- Beide Medikamente zeigten vielversprechende intrakranielle Aktivitäten und günstige Sicherheitsprofile.

- Phase-2-Studien mit registrierungsrelevantem Interesse sind für beide Medikamente bei TKI-naiven und vorbehandelten Patienten im Gange.

Das Unternehmen ist der Ansicht, dass diese Ergebnisse das Potenzial von NVL-655 und zidesamtinib unterstützen, jeweils erstklassige Therapien für ALK+ und ROS1+ NSCLC zu werden.

Positive
  • NVL-655 showed 38% ORR and 9.2 month median DOR in heavily pre-treated ALK+ NSCLC patients
  • Zidesamtinib demonstrated 38% ORR with median DOR not reached in ROS1+ NSCLC patients previously treated with ROS1 TKIs
  • Both drugs showed promising intracranial activity against brain metastases
  • Favorable safety profiles observed for both NVL-655 and zidesamtinib
  • Phase 2 trials with registrational intent are ongoing for both drugs
Negative
  • None.

The updated Phase 1 data for NVL-655 and zidesamtinib show promising results in heavily pre-treated ALK+ and ROS1+ NSCLC patients, respectively. For NVL-655, the 38% overall response rate and 9.2 month median duration of response across all doses are encouraging, especially given the challenging patient population. The 76% response rate in G1202R mutation patients is particularly notable. For zidesamtinib, the 38% response rate and not reached median duration of response in prior ROS1 TKI-treated patients are impressive. The 57% intracranial response rate in patients with measurable brain metastases who received ≥2 prior ROS1 TKIs highlights its potential CNS activity. These data support further investigation in earlier treatment lines and could position both drugs as potential best-in-class options if confirmed in larger studies.

Nuvalent's data demonstrates the potential of their precision oncology approach. The durability of responses, especially in heavily pre-treated populations, is a key differentiator. For NVL-655, the 79% of responses lasting over 6 months is impressive. Similarly, for zidesamtinib, 85% of responses lasted over 6 months, with 69% extending beyond 12 months. These figures suggest potential for improved outcomes in earlier treatment lines. The favorable safety profiles, likely due to their selective designs, could provide a competitive edge. The preclinical data showing zidesamtinib's superior intracranial activity compared to competitors further supports its potential. With Phase 2 trials ongoing and designed with registrational intent, Nuvalent is well-positioned to advance these candidates towards potential regulatory submissions in the near future.

The clinical data for NVL-655 and zidesamtinib are encouraging for patients with ALK+ and ROS1+ NSCLC, respectively. Both drugs show activity in heavily pre-treated populations, including those with prior next-generation TKI exposure and brain metastases. NVL-655's efficacy against the challenging G1202R mutation (76% response rate) is particularly noteworthy. Zidesamtinib's activity in G2032R mutation patients (65% response rate in repotrectinib-naïve) addresses an important unmet need. The CNS activity of both drugs is promising, given the high incidence of brain metastases in these patient populations. The favorable safety profiles, with low rates of treatment discontinuation, are important for potential long-term use. If these results are confirmed in larger studies, both drugs could become valuable options in the treatment algorithm for ALK+ and ROS1+ NSCLC, potentially improving outcomes for patients with therapeutic options.

Updated Phase 1 data from ALKOVE-1 and ARROS-1 clinical trials to be presented at the ESMO Congress 2024

Durable activity of NVL-655 and zidesamtinib in heavily pre-treated patient populations supports ongoing Phase 2 investigation in earlier lines of treatment

Company plans to host a conference call on September 14, 2024 at 8:30 a.m. ET/2:30 p.m. CEST following oral presentations at ESMO

CAMBRIDGE, Mass., Sept. 9, 2024 /PRNewswire/ -- Nuvalent, Inc. (Nasdaq: NUVL), a clinical-stage biopharmaceutical company focused on creating precisely targeted therapies for clinically proven kinase targets in cancer, today announced data from abstracts to be presented at the European Society for Medical Oncology (ESMO) Congress 2024 in Barcelona, Spain, including updates from the Phase 1 portions of the ongoing ALKOVE-1 Phase 1/2 clinical trial of ALK-selective inhibitor NVL-655 and ARROS-1 Phase 1/2 clinical trial of ROS1-selective inhibitor zidesamtinib, and new preclinical data further characterizing the intracranial activity of zidesamtinib accepted for a poster session.

The Phase 1 data described in the abstracts will be updated in two oral presentations at ESMO and discussed during a live webcast and conference call with management on Saturday, September 14, 2024, at 8:30 a.m. ET/2:30 p.m. CEST, along with updates on the status of the global Phase 2 portions of both studies which are designed with registrational intent.

"Our development strategy has been anchored around our guiding hypothesis: that we could drive deep and durable responses for patients by creating precisely targeted therapies that address the limitations of currently available options. We believe the data from the fully enrolled Phase 1 portions of our ALKOVE-1 and ARROS-1 clinical trials continue to support the potential for our parallel lead programs to achieve this goal through addressing the combined challenges of treatment-emergent resistance, brain metastases, and off-target central nervous system (CNS) adverse events," said Christopher Turner, M.D., Chief Medical Officer of Nuvalent. "We are particularly encouraged by the durability of responses seen with both NVL-655 and zidesamtinib in these heavily pre-treated patient populations, which we believe has the potential to be differentiated and to translate into meaningful improvements in earlier lines of treatment."

"Complementary to our clinical updates at ESMO, we are pleased to also share new preclinical data that characterize the intracranial activity of our ROS1-selective inhibitor zidesamtinib in comparison to FDA-approved or investigational dual TRK/ROS1 inhibitors, which we believe supports the potential for zidesamtinib to deliver more durable intracranial responses while avoiding TRK inhibition," said Henry Pelish, Ph.D., Chief Scientific Officer at Nuvalent. "These data further add to the body of evidence that we believe supports the differentiated profile of zidesamtinib for patients with ROS1-positive NSCLC."

"At the outset of these programs, we set out to design best-in-class molecules that could deliver clinically meaningful outcomes for patients with ALK- or ROS1-positive NSCLC and eventually become the front-line standard of care. Our Phase 1 updates at ESMO are a critical milestone towards achieving our goal, with longer follow-up demonstrating that NVL-655 and zidesamtinib can drive deep and durable responses even in heavily pre-treated patients that have exhausted all other treatment options," said James Porter, Ph.D., Chief Executive Officer at Nuvalent. "These data support the ongoing Phase 2 investigation of NVL-655 and zidesamtinib in both TKI pre-treated and TKI naïve patients, and we look forward to providing further program updates during our conference call later this week."

Updated ALKOVE-1 Phase 1 Data

Title: Phase 1/2 ALKOVE-1 study of NVL-655 in ALK-positive solid tumors
Presentation Number: 1253O
Session Category: Proffered paper session
Session Title: NSCLC metastatic
Updated Presentation Date and Time: Saturday September 14, 2024, 9:30 – 9:40 a.m. CEST
Location: Barcelona Auditorium – Hall 2
Presenter: Alexander Drilon, M.D. (Memorial Sloan Kettering Cancer Center, New York, USA)

Background: NVL-655 is a potent, brain-penetrant, ALK-selective tyrosine kinase inhibitor (TKI) designed to address key limitations of prior generation ALK TKIs (first generation (1G), second generation (2G) and third generation (3G)); it demonstrates preclinical activity against diverse ALK fusions and resistance mutations, including lorlatinib-refractory compound mutations, while avoiding tropomyosin receptor kinase (TRK) inhibition, which is associated with neurologic toxicities.

Methods: The global ALKOVE-1 Phase 1 (NCT05384626) enrolled patients with pretreated advanced ALK-positive solid tumors. Key objectives were selection of a recommended Phase 2 dose (RP2D), safety, and efficacy (RECIST 1.1, investigator assessment).

Results: As of the data cut-off date of March 23, 2024, 133 patients (131 NSCLC, 2 other) received NVL-655 (15-200 mg orally once daily (QD)) in Phase 1. Patients were heavily pre-treated with a median of 3 (range: 1-8) prior anticancer therapies and included:

  • patients treated with a 2G ALK TKI (alectinib, brigatinib, ceritinib) or the 3G ALK TKI lorlatinib (100%);
  • patients who had received ≥1 2G ALK TKI and the 3G ALK TKI lorlatinib (79%);
  • patients who had received ≥3 prior ALK TKIs (46%);
  • patients who had also received prior chemotherapy (56%); and,
  • patients with a history of treated/untreated CNS metastases (56%).

A maximum tolerated dose was not reached. 150 mg QD was selected as the RP2D, providing favorable safety, activity and exposure exceeding targeted efficacy thresholds for ALK resistance mutations. The most common treatment-related adverse events (TRAEs) were ALT increase (33%), AST increase (29%), constipation (15%), nausea (12%) and dysgeusia (11%); 2% discontinued due to TRAEs.

ALK+ NSCLC response-
evaluable (± chemo)

ORR at all
doses, % (n/n)

Median DOR,
months (m),

(95% CI)

% DOR > 6 m

(95% CI)

ORR at

150 mg, % (n/n)

All

38% (39/103)

9.2 (6.9, NE)

79 %(56, 91)

39% (15/38) *

≥3 prior ALK TKI inc. 2G and lorlatinib

37% (16/43)

7.7 (5.6, NE)

79 %(37, 95)

38% (6/16)

lorlatinib-naïve (≥1 2G ± 1G)

53% (9/17)

NR (3.5, NE)

83 %(27, 97)

57% (4/7)

ALK mutation

55% (30/55)

14.4 (6.9, NE)

86 %(63, 95)

57% (12/21)

G1202R

76% (22/29)

14.4 (6.9, NE)

88 %(60, 97)

83% (10/12)

prior lorlatinib

49% (23/47)

14.4 (6.9, NE)

83 %(56, 94)

50% (8/16)

    compound (≥2) mut.

58% (15/26)

14.4 (5.1, NE)

80 %(50, 93)

78% (7/9)

lorlatinib-naïve (≥1 2G ± 1G)

88% (7/8)

NR (NE, NE)

100 %(100, 100)

80% (4/5)

NE, not estimable; NR, not reached

*13/15 responses ongoing (DOR range 1.1 – 9.0 m)

CNS activity, including complete resolution of CNS metastases in lorlatinib-experienced patients, was observed.

Conclusions: NVL-655 demonstrated encouraging efficacy and durability in heavily pretreated ALK-positive NSCLC patients, including patients who exhausted available therapies (including lorlatinib), with ALK single and compound resistance mutations, and with CNS metastases. Safety was favorable, consistent with the ALK-selective, TRK-sparing design. Phase 2 enrollment is ongoing with registrational intent for previously treated patients. 

Updated ARROS-1 Phase 1 Data

Title: Phase 1/2 ARROS-1 study of zidesamtinib (NVL-520) in ROS1 fusion-positive solid tumors
Presentation Number: 1256MO
Session Category: Mini oral session
Session Title: NSCLC metastatic
Updated Presentation Date and Time: Saturday September 14, 2024, 10:25 – 10:30 a.m. CEST
Location: Santander Auditorium – Hall 5
Presenter: Benjamin Besse, M.D., Ph.D. (Institut Gustav Roussy, Villejuif, France)

Background: Zidesamtinib is a brain-penetrant, TRK-sparing, highly selective ROS1 TKI with activity against diverse ROS1 fusions and resistance mutations including G2032R.

Methods: The global ARROS-1 Phase 1 (NCT05118789) enrolled patients with heavily pretreated advanced/metastatic ROS1-positive solid tumors. Key objectives were selection of the RP2D and evaluation of safety and efficacy (RECIST 1.1, investigator assessment).

Results: As of the data cut-off date of March 12, 2024, 104 patients (99 NSCLC, 5 other) received zidesamtinib (25-150 mg orally QD) in Phase 1. Patients were heavily pre-treated with a median of 3 (range: 1-11) prior anticancer therapies including any ROS1 TKI (99%), and included:

  • the most heavily pre-treated of patients, receiving two or more prior ROS1 TKIs (69%) and one or more prior lines of chemotherapy (66%);
  • patients previously treated with lorlatinib (55%), repotrectinib (repo; 21%), or either (67%); and,
  • patients with a history of treated/untreated CNS metastases (53%).

100 mg QD was selected as the RP2D with no observed dose relationships for safety or efficacy. No dose-limiting toxicity or discontinuation due to TRAE occurred. TRAE led to dose reduction in 5.8%. Most common TRAEs were peripheral edema (18%) and transaminase increase (12%); TRAEs were grade ≥3 in 7.7%.

73 patients with ROS1-positive NSCLC were response-evaluable:

# Prior ROS1 TKIs ±
Chemo

ORR

Median DOR,
months (m)

(95% CI)

% DOR

> 6m

(95% CI)

% DOR

> 12m

(95% CI)

Any prior ROS1 TKI (range: 1-4)

38% (28/73*)

NR (10.2, NE)

85 %(64, 94)

69 %(45, 84)

Repo-naïve

45% (25/55*)

NR (10.2, NE)

91 %(69, 98)

74 %(48, 89)

≥2

36% (19/53*)

15.8 (6, NE)

79 %(53, 92)

62 %(35, 80)

Repo-naïve

42% (16/38*)

NR (6.4, NE)

88 %(59, 97)

68 %(38, 85)

1 (crizotinib)

64% (7/11)

NR (NE, NE)

All ongoing (range, 1.8+ - 22.8+m)

NE, not estimable; NR, not reached.

*2 complete responses (CRs), ongoing with DOR 16.6+ and 23.5+m

Median follow-up for response evaluable patients 9.4m (range, 0.8 – 25.8m)

In patients with known ROS1 G2032R, ORR was 65% (11/17) with a median duration of response (mDOR) of 15.8m (6, NE) among repo-naïve patients and ORR was 38% (3/8) among repo-pretreated patients. In patients with measurable intracranial (IC) metastases and ≥2 prior ROS1 TKIs (all with prior lorlatinib and/or repo), IC-ORR was 57% (4/7), and IC-DOR range was 1.9+ - 17.3+m with no IC progression.

Conclusions: Zidesamtinib demonstrated encouraging efficacy and durability in patients with pretreated ROS1-positive NSCLC, including those who had exhausted available therapies, with ROS1 resistance mutations including G2032R, and/or with CNS metastases. Safety was favorable and consistent with the highly ROS1-selective and TRK-sparing design. Phase 2 enrollment is ongoing with registrational intent in patients with TKI-naïve and pre-treated ROS1-positive NSCLC. 

Preclinical Intracranial Activity of Zidesamtinib

Title: Profiling of Zidesamtinib and Other ROS1 Inhibitors in an Intracranial CD74-ROS1 G2032R Preclinical Model

Presentation Number: 8P
Abstract Number: 4811

Onsite Poster Display Date: Sunday September 15, 2024
Presenter: Anupong Tangpeerachaikul (Nuvalent, Inc., Cambridge, Massachusetts, United States)

Introduction. TKIs crizotinib, entrectinib, and repotrectinib (US only) are approved for the treatment of ROS1-positive non-small cell lung cancer. Depth and durability of responses can be limited by the ROS1 G2032R resistance mutation and brain metastases, identified in ~40% and ~50% of patients, respectively, after disease progression on crizotinib. ROS1-selective TKI zidesamtinib and dual-TRK/ROS1 TKIs repotrectinib and taletrectinib have reported clinical activity against ROS1 G2032R and intracranial activity, with different adverse event profiles. In this study, we compared these three TKIs in a preclinical ROS1 G2032R brain tumor model.

Methods. Ba/F3 CD74-ROS1 G2032R luciferase cells were implanted in the brain of Balb/c nude mice. Mice were orally treated with TKIs for 25 days QD or twice daily (BID). Brain tumors were monitored 1 – 2 times per week by bioluminescence imaging (BLI). At the endpoint, plasma and brain samples were collected for pharmacokinetics analyses.

Results. Zidesamtinib (3 mg/kg BID) suppressed CD74-ROS1 G2032R brain tumors to <5% of initial BLI signal through day 25. Brain tumors were suppressed by repotrectinib (15 or 75 mg/kg BID) and taletrectinib (100 mg/kg QD) up to day 8 but regrew and eventually exceeded the initial BLI signal by 300 – 3,000%. Switching from repotrectinib (15 mg/kg BID) to zidesamtinib (3 mg/kg BID) on day 8 kept brain tumors to <15% of initial BLI signal. In this study, all TKIs achieved plasma exposures near or above their reported clinical plasma exposures. Zidesamtinib brain exposure exceeded its in vitro ROS1 G2032R IC50 but not TRKB IC50; by contrast, repotrectinib brain exposure exceeded its TRKB IC50 but not ROS1 G2032R IC50.

Conclusion. In this preclinical model, zidesamtinib demonstrated more durable intracranial activity than repotrectinib and taletrectinib at clinically relevant plasma concentrations. Switching treatment from repotrectinib to zidesamtinib resulted in improved preclinical intracranial activity. Preclinical activity against ROS1 G2032R, including in the brain, together with a TRK-sparing design supports zidesamtinib as a potential best-in-class ROS1-selective therapy.

Conference Call Information

Following oral presentations at the ESMO Congress 2024 in Barcelona, Spain, management will host a live webcast and conference call on Saturday, September 14, 2024 at 8:30 a.m. ET/2:30 p.m. CEST.

To access the call, register online here for the live webcast or dial +1 (800) 836-8184 (domestic) or +1 (646) 357-8785 (international) at least 10 minutes prior to the start time and ask to be joined to the Nuvalent call. Accompanying slides and a live video webcast will be available in the Investors section of the Nuvalent website at https://investors.nuvalent.com/events. A replay and accompanying slides will be archived on the Nuvalent website for 30 days.

About NVL-655 and the ALKOVE-1 Phase 1/2 Clinical Trial

NVL-655 is a novel brain-penetrant ALK-selective inhibitor created with the aim to overcome limitations observed with currently available ALK inhibitors. NVL-655 is designed to remain active in tumors that have developed resistance to first-, second-, and third-generation ALK inhibitors, including tumors with single or compound treatment-emergent ALK mutations such as G1202R. In addition, NVL-655 is designed for central nervous system (CNS) penetrance to improve treatment options for patients with brain metastases, and to avoid inhibition of the structurally related tropomyosin receptor kinase (TRK) family. Together, these characteristics have the potential to avoid TRK-related CNS adverse events seen with dual TRK/ALK inhibitors and to drive deep, durable responses for patients across all lines of therapy. NVL-655 has received breakthrough therapy designation for the treatment of patients with locally advanced or metastatic ALK-positive non-small cell lung cancer (NSCLC) who have been previously treated with 2 or more ALK tyrosine kinase inhibitors and orphan drug designation for ALK-positive NSCLC. 

NVL-655 is currently being evaluated in the Phase 2 portion of the ALKOVE-1 Phase 1/2 clinical trial, a first-in-human study of NVL-655 in patients with advanced ALK-positive NSCLC and other solid tumors (NCT05384626). The completed Phase 1 portion enrolled ALK-positive NSCLC patients who previously received at least one ALK TKI and patients with other ALK-positive solid tumors who had been previously treated with at least one prior systemic anticancer therapy. The primary objectives were to determine the recommended Phase 2 dose (RP2D) and if applicable, the maximum tolerated dose (MTD) of NVL-655 in patients with ALK-positive solid tumors. Additional objectives included characterization of the overall safety, tolerability, and pharmacokinetic profile, and evaluation of the preliminary antitumor activity of NVL-655. The ongoing global, single arm, open label Phase 2 portion is designed with registrational intent for TKI pre-treated patients with ALK-positive NSCLC and to enable preliminary investigation for patients with ALK-positive NSCLC who are TKI naïve.

About Zidesamtinib and the ARROS-1 Phase 1/2 Clinical Trial

Zidesamtinib is a novel brain-penetrant ROS1-selective inhibitor created with the aim to overcome limitations observed with currently available ROS1 inhibitors. Zidesamtinib is designed to remain active in tumors that have developed resistance to currently available ROS1 inhibitors, including tumors with treatment-emergent ROS1 mutations such as G2032R. In addition, zidesamtinib is designed for central nervous system (CNS) penetrance to improve treatment options for patients with brain metastases, and to avoid inhibition of the structurally related tropomyosin receptor kinase (TRK) family. Together, these characteristics have the potential to avoid TRK-related CNS adverse events seen with dual TRK/ROS1 inhibitors and to drive deep, durable responses for patients across all lines of therapy. Zidesamtinib has received breakthrough therapy designation for the treatment of patients with ROS1-positive metastatic non-small cell lung cancer (NSCLC) who have been previously treated with 2 or more ROS1 tyrosine kinase inhibitors and orphan drug designation for ROS1-positive NSCLC.

Zidesamtinib is currently being investigated in the ARROS-1 trial (NCT05118789), a first-in-human Phase 1/2 clinical trial for patients with advanced ROS1-positive NSCLC and other solid tumors. The completed Phase 1 portion enrolled ROS1-positive NSCLC patients who previously received at least one ROS1 TKI, or patients with other ROS1-positive solid tumors who had been previously treated. The Phase 1 portion of the trial was designed to evaluate the overall safety and tolerability of NVL-520, with additional objectives including determination of the recommended Phase 2 dose (RP2D), characterization of the pharmacokinetic profile, and evaluation of preliminary anti-tumor activity. The ongoing global, single arm, open label Phase 2 portion is designed with registrational intent for TKI naïve and TKI pre-treated patients with ROS1-positive NSCLC.

About Nuvalent

Nuvalent, Inc. (Nasdaq: NUVL) is a clinical-stage biopharmaceutical company focused on creating precisely targeted therapies for patients with cancer, designed to overcome the limitations of existing therapies for clinically proven kinase targets. Leveraging deep expertise in chemistry and structure-based drug design, we develop innovative small molecules that have the potential to overcome resistance, minimize adverse events, address brain metastases, and drive more durable responses. Nuvalent is advancing a robust pipeline with investigational candidates for ROS1-positive, ALK-positive, and HER2-altered non-small cell lung cancer, and multiple discovery-stage research programs.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, as amended, including, without limitation, implied and express statements regarding Nuvalent's strategy, business plans, and focus; the clinical development programs for zidesamtinib and NVL-655; the potential clinical effects of zidesamtinib and NVL-655; the potential of Nuvalent's pipeline programs, including zidesamtinib and NVL-655; the implications of data readouts and presentations; Nuvalent's research and development programs for the treatment of cancer; and risks and uncertainties associated with drug development. The words "may," "might," "will," "could," "would," "should," "expect," "plan," "anticipate," "aim," "goal," "intend," "believe," "expect," "estimate," "seek," "predict," "future," "project," "potential," "continue," "target" or the negative of these terms and similar words or expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. Drug development and commercialization involve a high degree of risk, and only a small number of research and development programs result in commercialization of a product. You should not place undue reliance on these statements or the scientific data presented.

Any forward-looking statements in this press release are based on management's current expectations and beliefs and are subject to a number of risks, uncertainties, and important factors that may cause actual events or results to differ materially from those expressed or implied by any forward-looking statements contained in this press release, including, without limitation: risks that Nuvalent may not fully enroll the ARROS-1 or ALKOVE-1 trials or that enrollment will take longer than expected; unexpected concerns that may arise from additional data, analysis, or results obtained during preclinical studies or clinical trials; the risk that results of earlier clinical trials may not be predictive of the results of later-stage clinical trials; the risk that data from our clinical trials may not be sufficient to support registration and that Nuvalent may be required to conduct one or more additional studies or trials prior to seeking registration of our product candidates; risks that Nuvalent may not achieve the goals and milestones set forth in its OnTarget 2026 operating plan; the occurrence of adverse safety events; risks that the U.S. Food and Drug Administration, European Medicines Agency or other foreign regulators may not approve our potential products on the timelines we expect, or at all; risks of unexpected costs, delays, or other unexpected hurdles; risks that Nuvalent may not be able to nominate drug candidates from its discovery programs; the direct or indirect impact of public health emergencies or global geopolitical circumstances on the timing and anticipated timing and results of Nuvalent's clinical trials, strategy, and future operations, including the ARROS-1 and ALKOVE-1 trials; the timing and outcome of Nuvalent's planned interactions with regulatory authorities; and risks related to obtaining, maintaining, and protecting Nuvalent's intellectual property. These and other risks and uncertainties are described in greater detail in the section entitled "Risk Factors" in Nuvalent's Quarterly Report on Form 10-Q for the quarterly period ended June 30, 2024, as well as any prior and subsequent filings with the Securities and Exchange Commission. In addition, any forward-looking statements represent Nuvalent's views only as of today and should not be relied upon as representing its views as of any subsequent date. Nuvalent explicitly disclaims any obligation to update any forward-looking statements.

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SOURCE Nuvalent, Inc.

FAQ

What was the overall response rate for NVL-655 in ALK-positive NSCLC patients?

NVL-655 showed a 38% overall response rate (ORR) in heavily pre-treated ALK-positive NSCLC patients in the Phase 1 ALKOVE-1 trial.

What was the median duration of response for zidesamtinib in ROS1-positive NSCLC patients?

The median duration of response (DOR) for zidesamtinib was not reached in ROS1-positive NSCLC patients previously treated with ROS1 TKIs in the Phase 1 ARROS-1 trial.

Did NVL-655 and zidesamtinib show activity against brain metastases?

Yes, both NVL-655 and zidesamtinib demonstrated promising intracranial activity against brain metastases in their respective trials.

What is the current stage of clinical development for NVL-655 and zidesamtinib?

Phase 2 trials with registrational intent are ongoing for both NVL-655 and zidesamtinib in TKI-naïve and pre-treated patients with ALK-positive and ROS1-positive NSCLC, respectively.

Nuvalent, Inc.

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