On September 14, 2024 Nuvation Bio Inc. (NYSE: NUVB), a late clinical-stage, global biopharmaceutical company tackling some of the greatest unmet needs in oncology, reported positive pooled data from the pivotal Phase 2 TRUST-I and TRUST-II studies evaluating taletrectinib, an investigational next-generation ROS1 TKI (Press release, Nuvation Bio, SEP 14, 2024, View Source [SID1234646589]). The findings will be highlighted in a poster presentation on September 14, 2024, at the European Society of Medical Oncology (ESMO) (Free ESMO Whitepaper) Congress 2024 in Barcelona, Spain.

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Maurice Perol, M.D., TRUST-II study investigator and Head of Thoracic Oncology at Léon Bérard Cancer Center, commented on the results: "The unmet need for more effective and tolerable treatments for patients with advanced ROS1-positive NSCLC remains critical. The pooled analysis from the TRUST-I and TRUST-II studies reinforces taletrectinib’s potential to offer clinically meaningful advancements in efficacy combined with a favorable safety profile, including reported median duration of response of 44 months and progression-free survival of 46 months in patients who were TKI-naïve."

"We are excited to present compelling pooled data from the TRUST-I and TRUST-II studies at ESMO (Free ESMO Whitepaper), which highlight taletrectinib’s durable response, prolonged disease control, and favorable safety profile. We believe these results position taletrectinib as a potential best-in-class treatment option for people living with advanced ROS1-positive NSCLC," said David Hung, M.D., Founder, President, and Chief Executive Officer of Nuvation Bio. "These pivotal data will support our planned NDA submission in the fourth quarter of 2024 and, assuming regulatory approval, will enable us to launch taletrectinib in the U.S. in 2025. We are committed to making a positive impact on the lung cancer community and look forward to sharing updates as we continue toward becoming a commercial stage organization."

Summary of Pivotal Pooled Data

The pooled efficacy and safety data from the TRUST-I and TRUST-II studies presented at ESMO (Free ESMO Whitepaper) are as of June 7, 2024; both studies remain ongoing. The ESMO (Free ESMO Whitepaper) data set includes 337 patients with advanced ROS1+ NSCLC who received 600mg of taletrectinib orally once daily in 21-day cycles.

The primary endpoint of these registrational studies is confirmed objective response rate (cORR) as assessed by an independent review committee (IRC). Key secondary endpoints include intracranial cORR, DOR, PFS, and safety.

Significant Tumor Shrinkage and Durability

The pooled efficacy analyses included 160 patients with advanced ROS1+ NSCLC who had not previously been treated with a ROS1 TKI (TKI-naïve) and 113 patients who had previously been treated with crizotinib or entrectinib (TKI-pretreated).

Among these two populations, 94% of patients had stage IV NSCLC. In addition, 20% of TKI-naïve and 37% of TKI-pretreated patients received prior chemotherapy, while 23% of TKI-naïve and 49% of TKI-pretreated patients had brain metastases at baseline.

The efficacy results, independently assessed by an IRC, showed:

In TKI-naïve patients (n=160):

Tumors shrank in 89% of taletrectinib-treated patients (cORR).
Measurable brain metastases shrank in 77% (13/17) of taletrectinib-treated patients (intracranial cORR).
After median follow-up of 21 months, the median DOR and the median PFS were 44 months and 46 months, respectively.
In TKI-pretreated patients (n=113):

Tumors shrank in 56% of taletrectinib-treated patients (cORR).
Measurable brain metastases shrank in 66% (21/32) of taletrectinib-treated patients (intracranial cORR).
Tumors shrank in 62% (8/13) of taletrectinib-treated patients with G2032R mutations (cORR).
After median follow-up of 21 months, the median DOR and the median PFS were 17 months and 10 months, respectively.
Favorable and Consistent Safety Profile Across Studies

The pooled safety analysis included 337 patients with advanced ROS1+ NSCLC. The results demonstrated a favorable safety and tolerability profile, with a low incidence and a limited spectrum of neurologic TEAEs and a low rate of treatment discontinuation.

The most frequent TEAEs were increased aspartate aminotransferase (72%; 8% ≥ Grade 3), alanine aminotransferase (68%; 10% ≥ Grade 3), diarrhea (63%; 2% ≥ Grade 3), and nausea (47%; 2% ≥ Grade 3).

The incidence of neurologic TEAEs was low; the most common were dizziness (21%) and dysgeusia (15%), most of which were Grade 1. The rate of treatment discontinuation due to TEAEs was 7% and the rate of dose reduction due to TEAEs was 29%.

Data Presentation and Availability

The data in the ESMO (Free ESMO Whitepaper) poster from the Response Evaluable Population, which includes all patients with measurable disease who received at least one dose of taletrectinib as of June 7, 2024, form the primary efficacy analysis that will support Nuvation Bio’s planned NDA submission in the United States.

The data in the ESMO (Free ESMO Whitepaper) abstract represent clinical results from patients enrolled at least 14 months before the data cutoff of March 29, 2024.

The poster presentation (abstract #1289P) will take place on Saturday, September 14, 2024, at 12:00-1:00 p.m. CEST / 6:00-7:00 a.m. EDT, and is available on Nuvation Bio’s website at www.nuvationbio.com/publications.

About Taletrectinib

Taletrectinib is an oral, potent, central nervous system-active, selective, next-generation ROS1 inhibitor specifically designed for the treatment of patients with advanced ROS1+ NSCLC. Taletrectinib is being evaluated for the treatment of patients with advanced ROS1+ NSCLC in two Phase 2 single-arm pivotal studies: TRUST-I (NCT04395677) in China, and TRUST-II (NCT04919811), a global study.

Taletrectinib has been granted Orphan Drug Designation by the U.S. FDA for the treatment of patients with ROS1+ NSCLC and other NSCLC indications, and Breakthrough Therapy Designations by both the U.S. FDA and China’s National Medical Products Administration (NMPA) for the treatment of patients with advanced or metastatic ROS1+ NSCLC. Based on results of the TRUST-I clinical study, China’s NMPA has accepted and granted Priority Review Designations to New Drug Applications for taletrectinib for the treatment of adult patients with locally advanced or metastatic ROS1+ NSCLC who either have or have not previously been treated with ROS1 TKIs.

In 2021, AnHeart Therapeutics Ltd., a Nuvation Bio company, entered into an exclusive license agreement with Innovent Biologics, Inc. for the co-development and commercialization of taletrectinib in Greater China, including mainland China, Hong Kong, Macau, and Taiwan.

About ROS1+ NSCLC

Each year, more than one million people globally are diagnosed with NSCLC, the most common form of lung cancer. It is estimated that approximately 2% of people with NSCLC have ROS1+ disease. Up to 35% of people newly diagnosed with metastatic ROS1+ NSCLC have tumors that spread to their brain, increasing up to 55% for those whose cancer has progressed following initial treatment. Despite recent progress for people with ROS1+ NSCLC, there remains a need for more effective and tolerable treatment options.