Item 1. Business
ITEM
1. Business
Overview
Unless
otherwise provided in this Annual Report, references to the “Company,” “we,” “us,” and “our”
and similar references refer to Celcuity Inc., a Delaware corporation. We own various unregistered trademarks and service marks, including
our corporate logo. Solely for convenience, the trademarks, trade names and service marks in this Annual Report, including those owned
by third parties, may be referred to without the ® , TM or SM symbols, but such references should
not be construed as any indicator that the owner of such trademarks, trade names and service marks will not assert, to the fullest extent
under applicable law, their rights thereto. We do not intend the use or display of other companies’ trademarks, trade names and
service marks to imply an endorsement or sponsorship of us by any other companies.
We
are a clinical-stage biotechnology company focused on the development of targeted therapies for the treatment of multiple solid
tumor indications. Our lead therapeutic candidate is gedatolisib, a kinase inhibitor of the phosphatidylinositol 3-kinase
(“PI3K”), serine/threonine-protein kinase protein kinase B (“AKT”), mechanistic target of rapamycin
(“mTOR”) pathway that binds to all class I PI3K isoforms and the mTOR complexes, mTORC1 and mTORC2. By targeting all
class I PI3K isoforms and mTORC1/2, gedatolisib induces comprehensive inhibition of the PI3K/AKT/mTOR (“PAM”) pathway.
Its mechanism of action and pharmacokinetic properties are differentiated from other currently approved and investigational
therapies that target PI3Kα, AKT, or mTORC1 alone or together. Our Phase 3 clinical trial, VIKTORIA-1, evaluating gedatolisib
in combination with fulvestrant, with or without palbociclib, in patients with hormone receptor-positive (HR+), human epidermal
growth factor receptor 2-negative (HER2-) (“HR+/HER2-”) advanced breast cancer (“ABC”) has completed
enrollment and reported detailed results for cohort 1, patients with PIK3CA wild-type (“WT”) tumors, and has
completed enrollment of cohort 2, patients with PIK3CA mutant-type (“MT”) tumors. Our Phase 3 clinical trial,
VIKTORIA-2, evaluating gedatolisib in combination with a cyclin-dependent kinase (“CDK”) 4/6 inhibitor and fulvestrant
as first-line treatment for patients with endocrine treatment resistant HR+/HER2- ABC is ongoing. A Phase 1b/2 clinical trial,
CELC-G-201, evaluating gedatolisib in combination with darolutamide in patients with metastatic castration resistant prostate cancer
(“mCRPC”), is ongoing.
In
January 2022, gedatolisib was granted Fast Track designation for the treatment of patients with HR+/HER2- ABC after progression on CDK4/6
therapy. Fast Track designation is granted by the FDA for products that are intended for the treatment of serious or life-threatening
diseases or conditions and which demonstrate the potential to address an unmet medical need.
In
July 2022, gedatolisib was granted Breakthrough Therapy designation for HR+/HER2- ABC after progression on CDK4/6 therapy. Breakthrough
Therapy designation is granted by the FDA to expedite the development and regulatory review of an investigational medicine that is intended
to treat a serious or life-threatening condition. The criteria for Breakthrough Therapy designation requires preliminary clinical evidence
that demonstrates the drug may have substantial improvement on one or more clinically significant endpoints over available therapy.
In
December 2022, we dosed the first patient in our Phase 3, open-label, randomized, two-part clinical trial, VIKTORIA-1. This trial is evaluating
the efficacy and safety of gedatolisib in combination with fulvestrant, with and without palbociclib, in adults with HR+/HER2- ABC who
have received prior treatment with a CDK4/6 inhibitor in combination with an aromatase inhibitor. Two studies based on PIK3CA
mutation status are included in the trial. According to confirmed PIK3CA mutation status, patients were manually assigned either
to a cohort evaluating patients who have PIK3CA WT tumors or to a cohort evaluating patients who have PIK3CA MT tumors.
The two cohorts were randomized separately. The cohort evaluating PIK3CA WT patients reported detailed study results in the third
and fourth quarters of 2025. The cohort evaluating patients with PIK3CA MT tumors has completed enrollment, and topline data is
expected to be available in the second quarter of 2026.
In
February 2024, we dosed our first patient in our Phase 1b/2 clinical trial, CELC-G-201, evaluating gedatolisib in combination with
darolutamide in patients with mCRPC. Initial preliminary data for the Phase 1 portion of the trial were reported in the fourth
quarter of 2025.
7
During
the third quarter of 2024, we commenced site selection and activation activities to support a Phase 3, open-label, randomized
clinical trial, VIKTORIA-2, designed to evaluate the efficacy and safety of gedatolisib plus a CDK4/6 inhibitor and fulvestrant as
first-line treatment for patients with HR+/HER2- endocrine treatment resistant ABC. The first patient was dosed in July 2025. For
the CDK4/6 inhibitor, investigators may choose either ribociclib or palbociclib. This multi-center, international trial enrolled 35
evaluable subjects in the safety run-in portion of the study to evaluate the safety of gedatolisib when combined with ribociclib and
fulvestrant. The safety run-in was completed in the first quarter of 2026. In the Phase 3 portion of the study, approximately 638
subjects are expected to be randomized and assigned to Cohort 1 ( PIK3CA WT) or Cohort 2 ( PIK3CA MT) based on their PIK3CA
status. Subjects in each cohort are expected to be randomized on a 1:1 basis to either Arm A (gedatolisib with fulvestrant and
ribociclib or palbociclib) or Arm B (fulvestrant and ribociclib or palbociclib). We intend to provide an update on our final Phase 3 study design in the second quarter of 2026. It is expected that approximately 200
clinical sites across North America, Europe, and Asia-Pacific will participate, including many sites included in the VIKTORIA-1
clinical trial.
In
August 2025, the FDA granted our request to submit our NDA for gedatolisib under the FDA’s Real-Time Oncology Review (“RTOR”)
program based on data from the PIK3CA WT cohort of the Phase 3 VIKTORIA-1 clinical trial. We made our first NDA pre-submission
in September 2025 and completed our submission of the NDA in November 2025. The FDA accepted our NDA on January 16, 2026, designating
it for Priority Review, with a target user fee goal date of July 17, 2026, pursuant to the Prescription Drug User Fee Act (“PDUFA”)
VII.
The
PI3K/AKT/mTOR (PAM) Pathway
Dysregulation
of the PAM signaling pathway is observed in many types of cancer, including breast and prostate cancer. The important role the PAM pathway
plays in cancer has led to significant investment in the development of many different PI3K and mTOR inhibitors for solid tumors.
Activities
associated with PI3K involve complex essential cell regulatory mechanisms, including feedforward and feedback signaling loops.
Overactivation of the pathway is frequently present in human malignancies and plays a key role in cancer progression. Four catalytic
isoforms of class I PI3K preferentially mediate signal transduction and tumor cell survival based on the type of malignancy and the
genetic or epigenetic alterations an individual patient harbors. Due to the multiple subcellular locations, activities, and
importance of the different PI3K complexes in regulating many types of cancer cell proliferation, control of PI3K activity is an
important target in cancer therapy.
mTOR
is a critical effector in cell-signaling pathways commonly dysregulated in human cancers. The mTOR signaling pathway integrates both
intracellular and extracellular signals and serves as a central regulator of cell metabolism, growth, proliferation, and survival. mTOR
is a serine/threonine protein kinase, a downstream effector of PI3K, and regulated by hormones, growth factors, and nutrients, that are
contained in two functionally distinct protein assemblies – mTORC1 and mTORC2. In cancer, dysfunctional signaling leads to various
constitutive activities of the mTOR complexes, making mTOR a good therapeutic target.
Developing
efficacious and well-tolerated therapies that target this pathway has been challenging. This reflects the inherent adaptability and complexity
of the PAM pathway, where numerous feedforward and feedback loops, crosstalk with other pathways, and compensatory pathways enable resistance
to PAM pathway inhibition. Another major hurdle for the development of PAM pathway inhibitors has been the inability to achieve optimal
drug-target blockade in tumors while avoiding undue toxicities in patients.
8
Gedatolisib
By
inhibiting multiple components of the PAM pathway, gedatolisib can overcome adaptive resistance mechanisms that inhibitors of single
PI3K/AKT/mTOR components do not address. As a result, we believe gedatolisib offers distinct advantages over currently approved and investigational
therapies that target PI3Kα, AKT or mTORC1 alone or together.
●
Overcomes
limitations of therapies that only inhibit a single class I PI3K isoform, AKT, or one mTOR kinase complex.
Gedatolisib
is a pan-class I isoform PI3K inhibitor with low nanomolar potency for the p110α, p110β, p110γ, and p110δ
isoforms and the mTORC1 and mTORC2 complexes. By targeting all class I PI3K isoforms and mTORC1/2, gedatolisib induces comprehensive
inhibition of the PAM pathway. Each PI3K isoform and mTOR complex is known to preferentially affect different signal transduction
events that involve tumor cell survival, depending upon the aberrations associated with the linked pathway. When a therapy only
inhibits a single class I PI3K isoform (e.g., alpelisib, a PI3Kα inhibitor), AKT (e.g., capivasertib, an AKT inhibitor) or
only one mTOR kinase complex (e.g., everolimus, an mTORC1 inhibitor), numerous feedforward and feedback loops between the PI3K
isoforms and mTOR complexes cross-activate the uninhibited sub-units. This, in turn, induces compensatory resistance that reduces
the efficacy of isoform specific PI3Kα, AKT, or mTORC1 kinase inhibitors. Inhibiting all four PI3K isoforms and both the
mTORC1 and mTORC2 complexes, as getatolisib does, thus prevents the confounding effect of isoform interaction that may occur with
isoform-specific PI3K inhibitors and the confounding interaction between PI3K isoforms, AKT, and mTOR.
To
compare the functional effect of inhibiting single versus multiple PAM pathway components, we evaluated gedatolisib, and component-selective
inhibitors for PI3Kα (alpelisib), AKT (capivasertib) and mTORC1 (everolimus) in a panel of breast cancer cell lines using a live
cell proliferation rate dose response analysis. The results of this analysis are presented in the table below.
Breast
Cancer Cell Line Proliferation Rate Dose Response Analysis
Average
values for 14 PIK3CA MT and 14 PIK3CA WT breast cancer cell lines
Note:
Growth rate (“GR”) was assessed using 28 cell lines by measuring live cells reducing potential with Real Time-Glo MT luciferase
assay before and after 72-hour drug treatment. GR50 (concentration required to inhibit growth rate by 50%) is a measure of potency. Max
cell growth inhibition (GR at highest drug concentration tested) is a measure of efficacy.
Source:
Rossetti S. et.al., npj Breast Cancer, 2024
On
average, gedatolisib was at least 300-fold more potent on average than the single component PAM inhibitors analyzed and only gedatolisib
induced a significant cytotoxic effect. In addition, gedatolisib’s potency and efficacy was comparable in cell lines with and without
PIK3CA mutations, in contrast to the single component PAM inhibitors.
●
Better
tolerated by patients than oral PI3K and mTOR drugs.
Gedatolisib
is administered intravenously (“IV”) on a four-week cycle of once a week for three weeks, then one week off, in contrast to the orally
administered pan-PI3K or dual PI3K/mTOR inhibitors that are no longer being clinically developed. Oral pan-PI3K or PI3K/mTOR inhibitors
have repeatably been found to induce significant side effects that were not well tolerated by patients. This typically leads to a high
proportion of patients requiring dose reductions or treatment discontinuation. The challenging toxicity profile of these drug candidates ultimately played a significant role in the decisions to halt their development,
despite showing promising efficacy. By contrast, gedatolisib’s comprehensive inhibition of the PAM pathway at low nanomolar potency,
IV route of administration, and pharmacokinetic properties enables it to achieve optimal anti-proliferative effects on tumor cells without
inducing the levels of hyperglycemia, rash, and diarrhea typically associated with oral single-component inhibitors of the PAM pathway.
Isoform-specific
PI3K or mTORC1 inhibitors administered orally were developed to reduce toxicities in patients. While the range of toxicities
associated with single-component PAM inhibitors is narrower than oral pan-PI3K or PI3K/mTOR inhibitors, administering them orally on
a continuous basis still leads to challenging toxicities. The experience with the FDA approved oral PI3Kα inhibitor,
alpelisib, and mTORC1 inhibitor, everolimus, illustrates the challenge. In their Phase 3 pivotal trials, alpelisib and everolimus
were found to induce hyperglycemia in 79% and 69% of patients evaluated, respectively. In addition, 26% and 24% of patients
discontinued alpelisib and everolimus, respectively, due to treatment related adverse events. By contrast, in the 103-patient dose
expansion portion of the Phase 1b clinical trial with gedatolisib, only 7% of patients experienced Grade 3 or 4 hyperglycemia and
less than 9% discontinued treatment.
9
Clinical
Development
As
of December 31, 2025, 1,127 patients and healthy volunteers have received gedatolisib in 12 completed or ongoing clinical trials.
Of these, 123 patients with solid tumors were treated with gedatolisib as a single agent in two clinical trials, 36 healthy volunteers
were treated in two clinical trials, and the remaining 968 patients received gedatolisib in combination with other anti-cancer agents
in eight clinical trials. Additional patients received gedatolisib in combination with other anti-cancer agents in 10 investigator sponsored
clinical trials.
Breast
Cancer Program
Breast
cancer is the most prevalent cancer in women, accounting for 30% of all female cancers and 7% of cancer-related deaths in the United
States. The National Cancer Institute estimated that approximately 316,950 new cases of breast cancer would be diagnosed in the United
States in 2025, and approximately 42,170 breast cancer patients would die of the disease.
Four
different breast cancer subtypes are currently identified using molecular tests that determine the level of HR and HER2 expression. The
most common subtype of ABC is HR+/HER2-. Approximately 70% of all breast cancer tumors express the estrogen receptor (“ER”),
which, upon activation, regulates the expression of various genes involved in tumor proliferation. Despite progress in treatment strategies,
HR+/HER2- advanced or metastatic breast cancer remains an incurable disease, with a median overall survival (OS) of three years and a
five-year survival rate of 34%.
Three
different classes of targeted therapies are currently used to treat HR+/HER2- tumors: endocrine-based therapies, CDK4/6 inhibitors, and
PAM inhibitors. Each of the CDK4/6 inhibitors and PAM inhibitors are generally used to respond to the related mechanisms of resistance
to endocrine therapy, namely, activation of the CDK4/6 and PAM pathways.
Nearly
80% of breast cancers have direct or indirect activation of the PAM pathway. The upregulation of the PAM pathway promotes hormone-dependent
and independent ER transcriptional activity, which contributes to endocrine resistance, leading to tumor cell growth, survival, motility,
and metabolism. Clinical studies have demonstrated that PAM inhibition can restore sensitivity to endocrine therapy (ET).
Additionally,
the PAM pathway, like other mitogenic pathways, can also promote the activities of cyclin D and CDK4/6 to drive proliferative cell cycling.
The available evidence indicates that resistance to CDK4/6 inhibition in patients with HR+/HER2- ABC is a transient adaptive mechanism,
most likely involving the PAM pathway. This data indicates that CDK4/6 signaling may be restored in CDK4/6 resistant tumors when PAM
inhibitors are applied. Thus, continuing CDK4/6 inhibitor treatment in combination with a PAM inhibitor in patients who progressed on
their prior CDK4/6 inhibitor, would both blockade the potentially reactivated CDK4/6 pathway and prevent adaptive activation of the PAM
pathway. This suggests the limited efficacy induced by current standard-of-care (SOC) therapies in patients who have progressed on a
CDK4/6 therapy reflects the mechanistic inadequacy of relying on partial PAM inhibition (e.g., alpelisib or everolimus) and no CDK4/6
inhibition to address this complex disease mechanism.
We
believe the complex connection between the PAM and CDK4/6 pathways can potentially enable gedatolisib to adaptively reactivate CDK4/6
signaling that reportedly occurs in CDK4/6 resistant tumors when the PAM pathway is comprehensively inhibited. By re-activating CDK4/6
signaling, we believe gedatolisib can restore the therapeutic effect of CDK4/6 inhibition when it is combined with a CDK4/6 inhibitor.
The contributory effect of a CDK4/6 inhibitor when combined with gedatolisib would thus largely reflect the interaction between the two
therapies that gedatolisib initiates.
10
Evidence
of gedatolisib’s anti-tumor activity in breast cancer cells was provided in a study evaluating the MCF7 xenograft model (ER+/HER2-/PIK3CA
mutant), where the combination of gedatolisib with palbociclib and fulvestrant caused 90% tumor regression with no tumor regrowth observed
for more than 60 days after the final dose.
Source:
Layman SABCS 2021
Clinical
Experience with Gedatolisib in Breast Cancer
The
favorability of preliminary results from a Phase 1b clinical trial (B2151009, further described below) which evaluated 138 patients
with HR+/HER2- ABC led us to focus our initial clinical development program on ABC.
On
January 13, 2022, gedatolisib was granted Fast Track designation for the treatment of patients with HR+/HER2- ABC after progression on
CDK4/6 therapy. Fast Track designation is granted by the FDA for products that are intended for the treatment of serious or life-threatening
diseases or conditions and which demonstrate the potential to address an unmet medical need. The designation offers the opportunity for
frequent interactions with the FDA to discuss the drug’s development plan and to ensure collection of appropriate data needed to
support drug approval, as well as eligibility for rolling submission of an NDA.
On
July 18, 2022, gedatolisib was granted Breakthrough Therapy designation for HR+/HER2- ABC after progression on CDK4/6 therapy. Breakthrough
Therapy designation is granted by the FDA to expedite the development and regulatory review of an investigational medicine that is intended
to treat a serious or life-threatening condition. The criteria for Breakthrough Therapy designation require preliminary clinical evidence
that demonstrates the drug may have substantial improvement on one or more clinically significant endpoints over available therapies.
The benefits of Breakthrough Therapy designation include more intensive guidance from the FDA on an efficient development program, access
to a scientific liaison to help accelerate review time, and potential eligibility for Priority Review if relevant criteria are met. Our
breakthrough application was supported by data from a Phase 1b clinical trial that assessed the safety, tolerability and clinical activity
of gedatolisib in combination with palbociclib and fulvestrant in patients with HR+/HER2- ABC whose disease progressed during treatment
with a CDK4/6 therapy and an aromatase inhibitor.
Phase
3 HR+/HER2- ABC Clinical Trial (VIKTORIA-1)
In
2022, we initiated VIKTORIA-1, a Phase 3, open-label, randomized clinical trial to evaluate the efficacy and safety of gedatolisib in
combination with fulvestrant with or without palbociclib in adults with HR+/HER2- ABC whose disease has progressed after prior CDK4/6
therapy in combination with an aromatase inhibitor. This multi-center, international trial has completed enrollment of 754 subjects at
nearly 200 clinical sites across North America, Europe, Latin America, and Asia-Pacific. The first patient was dosed in December 2022.
The
clinical trial is separately evaluating subjects according to their PIK3CA status.
●
Subjects
who meet eligibility criteria and do not have confirmed PIK3CA mutations (i.e., WT) were randomly assigned (1:1:1) to receive
a regimen of either gedatolisib, palbociclib, and fulvestrant (Arm A), gedatolisib and fulvestrant (Arm B), or fulvestrant (Arm C).
During the fourth quarter of 2024, we achieved our enrollment goal of 351 subjects who are PIK3CA WT. We reported topline
data and detailed results for this group in the third and fourth quarters of 2025, as described below.
11
●
Subjects
who meet eligibility criteria and have PIK3CA mutations (i.e., MT) were randomly assigned (3:3:1) to receive a regimen of
either gedatolisib, palbociclib, and fulvestrant (Arm D), alpelisib and fulvestrant (Arm E), or gedatolisib and fulvestrant (Arm
F). Enrollment of up to 350 subjects who are PIK3CA MT is ongoing. We expect topline data for this group to be available in the second
quarter of 2026.
The
clinical trial primary endpoints are progression free survival (“PFS”) , per RECIST 1.1 criteria, as assessed by blinded independent central review (“BICR”).
Two primary endpoints will be evaluated in subjects who are PI3KCA WT, and one primary endpoint will be evaluated in subjects
who are PI3KCA MT. In subjects who are PI3KCA WT, the PFS of gedatolisib in combination with palbociclib and fulvestrant
(Arm A) will be compared to fulvestrant monotherapy (Arm C), and the PFS in gedatolisib in combination with fulvestrant (Arm B) will
be compared to fulvestrant monotherapy (Arm C). In subjects who are PI3KCA MT, the PFS of gedatolisib in combination with palbociclib
and fulvestrant (Arm D) will be compared to alpelisib combined with fulvestrant (Arm E).
All
subjects will receive treatment according to the assigned study arm until objective progressive disease, unacceptable toxicity, death,
or withdrawal of consent, whichever occurs first. Subjects in Arm C will have the option to receive the treatment regimen provided in
Arm A or Arm B upon radiographically confirmed disease progression. Subjects will be followed for adverse events, safety laboratory testing,
tumor assessment by RECIST v1.1, quality of life, and overall survival.
On
July 28, 2025, we announced topline data from the PIK3CA WT cohort of the VIKTORIA-1 clinical trial and on October 18, 2025, at
the European Society of Medical Oncology (“ESMO”) congress, additional efficacy and safety results from this cohort were
presented. The key efficacy and safety data from the PIK3CA WT cohort showed:
●
The
gedatolisib triplet (gedatolisib, fulvestrant and palbociclib) demonstrated a statistically significant and clinically meaningful
improvement in PFS among patients, reducing the risk of disease progression or death by 76% compared to fulvestrant (based on a hazard
ratio [HR] of 0.24, 95% confidence interval [CI] 0.17-0.35; p<0.0001). The median PFS, as assessed by BICR, was 9.3 months with
the gedatolisib triplet versus 2.0 months with fulvestrant, an incremental improvement of 7.3 months.
●
The
gedatolisib doublet (gedatolisib and fulvestrant) also demonstrated a statistically significant and clinically meaningful improvement
in PFS among patients, reducing the risk of disease progression or death by 67% compared to fulvestrant (HR of 0.33, 95% CI 0.24-0.48;
p<0.0001). The median PFS, as assessed by BICR, was 7.4 months with the gedatolisib doublet versus 2.0 months with fulvestrant,
an incremental improvement of 5.4 months.
●
The
objective response rate (“ORR”) of the gedatolisib triplet was 31% compared to 1% with fulvestrant and the median duration
of response (“DOR”) was 17.5 months. The ORR of the gedatolisib doublet was 28.3% and the median DOR was 12.0 months.
The median DOR was not determinable for fulvestrant because there was only one objective response.
●
The
gedatolisib triplet and doublet were generally well tolerated in the trial with mostly low-grade treatment-related adverse events
(“TRAEs”). The most common Grade 3 TRAEs for the gedatolisib triplet, gedatolisib doublet, and fulvestrant groups included
neutropenia (52.3%, 0%, and 0.8% of patients, respectively); stomatitis (19.2%, 12.3%, and 0% of patients, respectively) rash (4.6%,
5.4%, and 0% of patients, respectively); and hyperglycemia (2.3%, 2.3%, and 0% of patients, respectively). The primary Grade 4 TRAEs
for the gedatolisib triplet and gedatolisib doublet groups were neutropenia (10.0% and 0.8%, respectively), leukopenia (0.8% in the
gedatolisib triplet group) and pneumonitis (0.8% in gedatolisib doublet group). TRAEs led to the discontinuation of study treatment
in 2.3% of patients in the gedatolisib triplet group, 3.1% in the gedatolisib doublet group, and 0% in the fulvestrant group.
The
detailed results from cohort 1, PIK3CA WT cohort, established several new milestones in the history of drug development for HR+/HER2-
ABC:
●
The
hazard ratios for the gedatolisib triplet and doublet are more favorable than have ever been reported by any Phase 3 trial for patients
with HR+/HER2- ABC.
12
●
The
7.3- and 5.4-months incremental improvements in median PFS for the gedatolisib triplet and gedatolisib doublet over fulvestrant,
respectively, are higher than have ever been reported by any Phase 3 trial for patients with HR+/HER2- ABC receiving at least their
second line of therapy.
●
Gedatolisib
is the first inhibitor targeting the PAM pathway to demonstrate positive Phase 3 results in patients with HR+/HER2-/ PIK3CA
WT ABC whose disease progressed on or after treatment with a CDK4/6 inhibitor.
●
The
median DOR and incremental ORR improvement relative to control for the gedatolisib triplet and doublet are the highest reported for
an endocrine therapy-based regimen in 2L HR+/HER2- ABC.
In
December 2025, updated efficacy and safety results from the Phase 3 VIKTORIA-1 PIK3CA WT cohort were presented at the 2025 San Antonio
Breast Cancer Symposium including patient sub-group analyses, safety analyses and patient reported outcomes for well-being measures.
●
For patients enrolled in the U.S., Canada, Western Europe,
and Asia Pacific, median PFS was 16.6 months with the gedatolisib triplet and 7.1 months with the gedatolisib doublet versus 1.9 months
for fulvestrant (HR=0.14; 95% CI: 0.08-0.28; p<0.0001).
●
Both gedatolisib regimens delayed time to definitive deterioration
versus fulvestrant according to patient reported outcomes for well-being measures that included mobility, self-care, usual activities,
pain/discomfort, and anxiety/depression (the EQ-5D-5L score). The median time to definitive deterioration was 23.7 months (HR=0.39; 95%
CI: 0.25-0.67; p = 0.0003) for patients treated with the gedatolisib triplet and not reached for the gedatolisib doublet (HR=0.37; 95%
CI: 0.24-0.66; p = 0.0003) versus 4.0 months for fulvestrant. Additionally, for the first eight cycles of treatment, the patients’ assessment of their well-being remained
stable relative to their assessment prior to starting treatment with gedatolisib.
The
median PFS benefit of the gedatolisib triplet and doublet compared to fulvestrant was consistent across subgroups with the gedatolisib
triplet showing higher clinical benefit in nearly all subgroups compared to the gedatolisib doublet, particularly for patients who were
pre/perimenopausal, endocrine therapy resistant, or had visceral metastases. For patients enrolled in the United States and Canada, median
PFS was 19.3 months (HR=0.13; 90% CI: 0.07-0.29) for the gedatolisib triplet and 14.9 months (HR=0.35; 90% CI: 0.17-0.76) for the gedatolisib
doublet.
With
these results, the gedatolisib regimens represent a potential new standard of care for patients with HR+/HER2-, PIK3CA WT ABC
whose disease progressed on or after treatment with a CDK4/6 inhibitor.
Results
from cohort 2 of the VIKTORIA-1 Phase 3 clinical trial, the PIK3CA MT cohort, are expected to be available in the second quarter
of 2026.
B2151009 Phase
1b HR+/HER2- ABC Clinical Trial
A
Phase 1b dose-finding trial with an expansion portion for safety and efficacy evaluated gedatolisib when added to either the standard
doses of palbociclib plus letrozole or palbociclib plus fulvestrant in patients with HR+/HER2- ABC. PI3K mutation status was not used
as an eligibility criterion. Patient enrollment for the trial is complete.
A
total of 138 patients with HR+/HER2- ABC were dosed in the clinical trial. Four patients from this study continue
to receive study treatment, as of December 31, 2025, each of whom has received study treatment for more than six years.
●
35
patients were enrolled in two dose escalation arms to evaluate the safety and tolerability and determine the maximum tolerable dose
(“MTD”) of gedatolisib when used in combination with the standard doses of palbociclib and endocrine therapies. The MTD
was determined to be 180 mg administered intravenously once weekly.
●
103
patients were enrolled in one of four expansion arms (A, B, C, D) to determine if the triplet combination of gedatolisib plus palbociclib
and letrozole or gedatolisib plus palbociclib and fulvestrant produced a superior objective response (OR), compared to historical
control data of the doublet combination (palbociclib plus endocrine therapy). All patients received gedatolisib in combination with
standard doses of palbociclib and endocrine therapy (either letrozole or fulvestrant). In Arms A, B, and C, patients received an
intravenous dose of 180 mg of gedatolisib once weekly. In Arm D, patients received an intravenous dose of 180 mg of gedatolisib on
a four-week cycle of three-weeks-on, one-week-off. Objective response was determined using Response Evaluation Criteria in Solid
Tumors v1.0, or RECIST v1.0.
○
Arm
A : ABC with progression and no prior endocrine-based systemic therapy or a CDK4/6 inhibitor in the metastatic setting. First-line
endocrine-based therapy for advanced disease (CDK4/6 treatment naive).
○
Arm
B : ABC with progression during one or two prior endocrine-based systemic therapies in the advanced setting, with no prior therapy
with any CDK inhibitor. Second- or third-line endocrine-based therapy for metastatic disease.
○
Arm
C : ABC with progression during one or two prior endocrine-based systemic therapies in the advanced setting and following prior
therapy with a CDK inhibitor. Second- or third-line endocrine-based therapy for advanced disease.
13
○
Arm
D : ABC with progression during one or two prior endocrine-based systemic therapies in the advanced setting and following prior
therapy with a CDK inhibitor. Second- or third-line endocrine-based therapy for advanced disease.
●
For
the 103 patients enrolled in the expansion portion of the Phase 1b clinical trial, the ORR in aggregate among patients with evaluable
tumors was 63%.
●
Best
responses, as measured by RECIST v1.0, are shown in the following chart for Arm A (1 st line patients) and Arm D
(2 nd /3 rd line patients who received the VIKTORIA-1 Phase 3 trial dosing regimen). The dotted line represents
the cutoff for partial response (PR), defined as a 30% reduction from the baseline tumor assessment.
Source:
Layman SABCS 2021
●
Safety
analysis:
○
For
all arms in aggregate, all patients experienced at least one Grade 1 or Grade 2 treatment-emergent adverse event. The Grade 3 and
4 treatment-emergent adverse events occurring in at least 20% of patients were neutropenia (63%), stomatitis (27%) and rash (20%).
Neutropenia is a known class effect of CDK4/6 inhibitors. Stomatitis was reversible in most patients with a steroidal mouth rinse.
All grades of treatment-related adverse events related to hyperglycemia were reported in 22% of patients; Grade 3 or 4 hyperglycemia
was reported in 7% of patients. Gedatolisib was discontinued in less than 9% of patients.
○
For
the patients in Arm D, who received the Phase 3 dosing schedule, Grade 3 and 4 treatment-emergent adverse events occurring in at
least 20% of patients were neutropenia (67%), leukopenia (22%), and stomatitis (22%). All grades of treatment-related adverse events
related to hyperglycemia were reported in 26% of patients; Grade 3 or 4 hyperglycemia were reported in 7% of patients. Gedatolisib
was discontinued in 4% of patients.
●
Best
overall response data for each arm is presented in the table below:
Total Expansion Arms (N=103)
Arm A
Arm B
Arm C
Arm D
Prior Therapy
1L
CDKi-naive
2L+
CDKi-naive
2L/3L
CDKi-pretreated
2L/3L
CDKi-pretreated
n (Full, response evaluable)
31, 27
13,13
32, 28
27, 27
Study Treatment
P + L + G
P + F + G
P + F + G
P + F + G
Gedatolisib schedule
weekly
weekly
weekly
3 wks on/1 wk off
ORR (1) (evaluable)
85%
77%
36%
63%
mPFS (2) , mos (range)
48.4
(16.9, NR)
12.9
(7.6, 38.3)
5.1
(3.3, 7.5)
12.9
(7.4, 16.7)
PFS % at 12 mos (2)
72.1%
54.5%
23.6%
53.2%
WT
MT
WT
MT
WT
MT
WT
MT
PIK3CA status
81%
16%
69%
31%
75%
25%
56%
41%
ORR (evaluable)
81%
100%
78%
75%
25%
63%
60%
73%
PFS at 12 months
74%
60%
50%
67%
22%
29%
49%
60%
(1)
ORR represents PR, except in Arm A, which had 1 CR = Complete response. Responses per RECIST 1.1; (2) Includes 2 unconfirmed PR
Abbreviations:
1L = first line, 2L = second line; mos = months; NR = not reached; ORR = objective response rate; PFS = progression free
survival
Source:
Layman R. et. al, Lancet Oncol., 2024
14
Additional
results from the Phase 1b portion of the clinical trial were presented at the ESMO congress in October 2025. The analyses reported efficacy
data from patients who were treated with the same drug regimen being evaluated in the VIKTORIA-1 study, gedatolisib combined with fulvestrant
and palbociclib. This included patients from Escalation Arm B and Expansion Arms B, C and D of the Phase 1b study.
As
described above, patients in Escalation Arm B and Expansion Arms B and C received a 180 mg dose of gedatolisib once weekly (“weekly
dose”). Patients in Expansion Arm D received a 180 mg dose of gedatolisib on days 1, 8, and 15 of a four-week cycle (“intermittent
dose”), which is the same dose regimen patients in the VIKTORIA-1 study receive. The proportion of patients who received the intermittent
dose of gedatolisib was 37% for those with PIK3CA MT tumors and 25% for those with PIK3CA WT tumors. The proportion of
patients who received prior treatment with a CDK4/6 inhibitor was 73% for those with PIK3CA WT tumors, and 71% for those with
PIK3CA MT tumors.
Median
PFS and the ORR were assessed in sub-groups of patients according to their PIK3CA status (Table 1). For all analyzed patients
with PIK3CA MT tumors (n=30), median PFS was 14.6 months and the ORR in response evaluable patients was 48%. Median PFS was 19.7
months and the ORR was 64% in patients with PIK3CA MT tumors who received the intermittent dose of gedatolisib used in the VIKTORIA-1
study. For patients with PIK3CA WT tumors (n=60), median PFS was 9.0 months and the ORR in response evaluable patients was 41%.
Median PFS was 9.1 months and the ORR was 53% in patients with PIK3CA WT tumors who received the intermittent dose of gedatolisib
used in the VIKTORIA-1 study.
Table
1: Efficacy Analysis of Phase 1b Patients Treated with Gedatolisib Plus Palbociclib Plus Fulvestrant
PIK3CA MT
PIK3CA WT
All
Intermittent Dose
All
Intermittent dose
N
30
11
60
15
Median PFS (months)
14.6
19.7
9.0
9.1
ORR
48 %
64 %
41 %
53 %
Phase
3 HR+/HER2- ABC Clinical Trial (VIKTORIA-2)
In
July 2025, we dosed the first patient in VIKTORIA-2, a Phase 3, multi-center, open-label, randomized, clinical trial designed to
evaluate the efficacy and safety of gedatolisib plus a CDK4/6 inhibitor and fulvestrant as first-line treatment for patients with
HR+/HER2- endocrine treatment resistant ABC. For the CDK4/6 inhibitor, investigators may choose either ribociclib or palbociclib.
This multi-center, international trial enrolled 35 evaluable subjects in the safety run-in portion of the study to evaluate the
safety of gedatolisib when combined with ribociclib and fulvestrant. The safety run-in was completed in the first quarter of 2026.
In the Phase 3 portion of the study, approximately 638 subjects are expected to be randomized and assigned to Cohort 1
( PIK3CA WT) or Cohort 2 ( PIK3CA MT) based on their PIK3CA status. Subjects in each cohort are expected to be
randomized on a 1:1 basis to either Arm A (gedatolisib with fulvestrant and ribociclib or palbociclib) or Arm B (fulvestrant and
ribociclib or palbociclib). We intend to provide an update on our final Phase 3 study design in the second quarter of 2026. It is expected that approximately 200 clinical sites across North America, Europe, and
Asia-Pacific will participate, including many sites included in the VIKTORIA-1 clinical trial.
Prostate
Cancer Program
In
the United States, prostate cancer is the second leading cause of cancer death in men. Current estimates predict that one in eight men
will be diagnosed with prostate cancer in his lifetime. The National Cancer Institute estimated that in 2025 there would be over 313,780
new cases of prostate cancer in the United States and approximately 35,770 deaths from the disease. Although approximately 69% of patients
are diagnosed with localized prostate cancer, about 8% of patients present with metastatic disease with a 5-year survival rate of 38%.
Androgen deprivation therapy (“ADT”) via medical or surgical castration has been the mainstay treatment for metastatic prostate
cancer. However, prostate cancer cells develop resistance to ADT and progress to castration resistance, leading to poor prognosis and
a median overall survival of about three to five years.
Men
with mCRPC have a poor prognosis and a predicted survival rate of fewer than two years from the initial time of progression. Treatment
options for prostate cancer depend on many different factors, including the stage of the cancer. Castration-resistant prostate cancer
is defined by disease progression despite ADT and is often indicated by rising levels of PSA. Current standard of care for men with castration-resistant
prostate cancer provides that patients should initially receive a combination of ADT and either abiraterone, which works by decreasing
androgen levels, or enzalutamide, which works by blocking androgen binding to androgen receptors (“AR”). If the disease progresses
despite these second-generation hormonal therapies, chemotherapy is considered the next treatment option. Treatment with chemotherapy
is generally postponed for as long as possible due to the potential for severe side effects including neuropathies, nausea, diarrhea,
decreased mental capacity and increased risk of infections.
Preclinical
studies have demonstrated a potential association between the PAM pathway and AR signaling in prostate cancer cells developing resistance
to ADT. In these studies, the AR and PAM pathways were shown to cross-regulate each other. This is similar to the relationship demonstrated
in breast cancer with the estrogen receptor pathway and the PAM pathway. Additionally, 70% - 100% of mCRPC tumors have PAM related pathway
alterations.
Several
clinical studies have shown promising results by inhibiting the PAM pathway in combination with an AR inhibitor. In separate Phase 2
and Phase 3 trials, the AKT inhibitor, ipatasertib, showed improvement in radiographic PFS (“rPFS”) in patients with mCRPC
and tumors with phosphatase and tensin homolog (“PTEN”) loss when ipatasertib was combined with the AR inhibitor, abiraterone,
versus abiraterone alone. In a Phase 2 trial, the pan-PI3K inhibitor, samotolisib, reported median rPFS of 10.2 when combined with enzalutamide
versus 5.5 months for enzalutamide alone.
15
Evidence
of gedatolisib’s in vivo activity in prostate cancer was provided in a study evaluating the 22RV-1, PC3, and enzalutamide sensitive
model (“C4-2”) prostate cancer xenograft models. As seen in the figures below, gedatolisib induced greater than 80% tumor
growth inhibition, regardless of the xenograft model’s sensitivity to the AR inhibitor, enzalutamide and the cell lines’
PTEN or AR status. In addition, gedatolisib combined with enzalutamide induced significantly greater tumor growth inhibition than enzalutamide
alone in the C4-2.
S ource:
Sen, ASCO-GU, 2023
Phase
1b/2 mCRPC Clinical Trial (CELC-G-201)
We
received approval from the FDA in mid-2023 to proceed with the clinical development of gedatolisib in combination with Nubeqa ®
(darolutamide), an approved androgen receptor inhibitor, for the treatment of patients with mCRPC. We have since initiated a Phase 1b/2
clinical trial (CELC-G-201) that will enroll up to 54 participants with mCRPC who progressed after treatment with an AR inhibitor. We
dosed our first patient in this trial in February 2024.
The primary objectives of the Phase 1b portion of the trial include assessment of the safety and tolerability of gedatolisib in combination
with darolutamide and determination of the recommended Phase 2 dose (“RP2D”) of gedatolisib. The primary objective of the
Phase 2 portion of the trial is to assess the radiographic PFS at six months of patients who received the RP2D.
In
the Phase 1b portion of the clinical trial, we enrolled 38 participants randomly assigned to receive 600 mg of darolutamide twice
daily combined with either 120 mg of gedatolisib in Arm 1 or 180 mg of gedatolisib in Arm 2. In both arms, gedatolisib was
administered once weekly for three weeks, then one week off. Additionally, all patients received prophylactic treatment for
stomatitis.
On June 30, 2025, we announced preliminary data for the CELC-G-201 Phase 1b trial, utilizing a May 30, 2025 data cut-off. Based on these
data, we amended the clinical trial protocol to enable exploration of additional doses in the Phase 1b portion of this clinical trial
to determine the RP2D. Once RP2D is determined, an additional 12 participants will then be enrolled in the Phase 2 portion of the study
at the RP2D level to enable evaluation of 30 participants treated with the RP2D of gedatolisib.
On October 18,
2025, at the ESMO congress, we presented updated clinical results for the CELC-G-201 Phase 1b trial based on an August 15, 2025 data
cut-off. Among the 38 patients enrolled, 61% had received
one line of prior systemic therapy and 39% had received at least two or more lines of prior therapy.
Updated
clinical results from the Phase 1 portion of the clinical trial were presented at the ESMO congress in October 2025. The Phase 1 data
set utilized an August 15, 2025 data cut-off. Median duration of follow-up was 9.0 months.
The
six-month rPFS rate and median rPFS for patients from both arms combined was 67% and 9.1 months, respectively. For patients treated with
120 mg gedatolisib, the six-month rPFS rate was 74% and median rPFS was 9.5 months. For patients treated with 180 mg gedatolisib, the
six-month rPFS rate was 61% and the median rPFS was 7.4 months.
The
combination of gedatolisib and darolutamide was generally well tolerated in the trial with mostly low-grade TRAEs. No dose limiting toxicities
were observed in either arm. The only Grade 3 TRAEs for patients from both arms combined included rash (5.3%), stomatitis (2.6%), and
pruritus (2.6%); no Grade 3 hyperglycemia was reported. Additionally, no Grade 4 or 5 TRAEs were observed, and no patients discontinued
study treatment due to a TRAE.
In
the amended Phase 1/1b portion of the clinical trial, up to six patients are planned to be enrolled in each of three arms and treated
with different doses. Upon completion of Phase 1, up to an additional 40 patients will be randomly assigned to up to four Phase 1b cohorts
to determine the RP2D. Dose levels will be selected based on the results from the Phase 1 clinical
trial. In the Phase 2 dose expansion study, which will include subjects from the Phase 1/1b clinical trial, up to 18 additional subjects
will be enrolled to achieve a total of approximately 30 subjects treated with the RP2D. All patients will also receive standard doses
of darolutamide.
16
Investigator-Sponsored
Trials
In
an investigator-sponsored Phase 2 clinical trial, 44 patients with HER2+/ PIK3CA mutated metastatic breast cancer were treated
with gedatolisib plus standard doses of trastuzumab-pkrb. No prophylaxis for stomatitis was administered. The median number of prior
anti-HER2 therapies enrolled patients received in the metastatic setting was four or more; 86% of patients had received at least three
prior anti-HER2 therapies. The data cut-off was February 10, 2025.
Key
efficacy and safety results, as presented at the American Society of Clinical Oncology meeting in June 2025, showed:
●
The
ORR among all patients enrolled was 43%.
●
Median
PFS was 6.0 months (95% CI, 5.0-7.7).
●
Median
overall survival was 24.7 months (95% CI; 17.3-NA).
●
No
patients discontinued gedatolisib due to a treatment-related AE.
●
One
(2.3%) patient experienced Grade 3 hyperglycemia.
An
investigator sponsored trial has been initiated in collaboration with the Dana-Farber Cancer Institute and Massachusetts General Hospital
to evaluate gedatolisib in combination with abemaciclib and letrozole in patients with endometrial cancer.
Pfizer
Gedatolisib License Agreement
In
April 2021, we entered into a license agreement (the “Gedatolisib License Agreement”) with Pfizer pursuant to which we acquired
exclusive (including as to Pfizer) worldwide sublicensable rights to research, develop, manufacture, and commercialize gedatolisib for
the treatment, diagnosis and prevention of all diseases. Pursuant to the Gedatolisib License Agreement, we are obligated to use commercially
reasonable efforts to develop and seek regulatory approval for at least one product in the U.S. and if regulatory approval is obtained,
to commercialize such product in the U.S. and at least one international major market.
We
paid Pfizer a $5.0 million upfront fee upon execution of the Gedatolisib License Agreement and issued 349,406 shares of our common
stock to Pfizer pursuant to an Equity Grant Agreement. We are also required to make milestone payments to Pfizer upon achievement of
certain development and commercial milestone events, including a $5.0 million milestone payment we made in January 2026 following
FDA acceptance of our NDA submission, up to an aggregate of $335.0 million. We will pay Pfizer tiered royalties on sales of
gedatolisib at percentages ranging from the low to mid-teens, that may be subject to deductions for expiration of valid claims,
amounts due under third-party licenses and generic competition. Unless earlier terminated, the Gedatolisib License Agreement will
expire upon the expiration of all royalty obligations. The royalty period will expire on a country-by-country basis upon the later
of (a) 12 years following the date of First Commercial Sale of such Product in such country, (b) the expiration of all regulatory or
data exclusivity in such country for such Product, or (c) the date upon which the manufacture, use, sale, offer for sale or
importation of such Product in such country would no longer infringe, but for the license granted herein, a Valid Claim of a
Licensed Patent Right. Capitalized terms in this paragraph have the meanings set forth in the Gedatolisib License
Agreement.
We
have the right to terminate the Gedatolisib License Agreement for convenience upon 90 days’ prior written notice. Pfizer may not
terminate the agreement for convenience. Either we or Pfizer may terminate the Gedatolisib License Agreement if the other party is in
material breach and such breach is not cured within the specified cure period. In addition, either we or Pfizer may terminate the Gedatolisib
License Agreement in the event of specified insolvency events involving the other party.
Formulation,
Manufacturing and Distribution
We
rely on third parties to formulate, manufacture and distribute gedatolisib. We have entered into agreements with contract manufacturing
organizations (“CMOs”) to produce the drug substance gedatolisib and formulate, produce and package finished drug product
for clinical use and, if approved, commercial supply. We have entered into agreements with distributors and a third-party logistics provider
(“3PL”) to distribute finished product for clinical use and, if approved, commercial supply. We require all of our CMOs,
distributors, and our 3PL to conduct manufacturing and distribution activities in compliance with applicable laws, including current
good manufacturing practice (“cGMP”) and current good distribution practice, requirements. We anticipate that these CMOs,
distributors, and 3PL will have the capacity to support both clinical- and commercial-scale production and distribution. We may also
elect to enter into agreements with other CMOs to formulate and manufacture supplies of drug substance and finished drug product.
17
Sales
and Marketing
If
any of our product candidates are approved, we intend to market and commercialize them in the U.S. and select international markets,
either alone or in partnership with others. Cancer patients are primarily treated by medical, surgical, or radiation oncologists, and
we believe these physicians, and the multi-disciplinary teams surrounding them, including nurses, advanced practitioners, and pharmacists,
can be reached with a targeted sales force.
Competition
for Gedatolisib
The
pharmaceutical industry is characterized by rapid evolution of technologies and intense competition. We face competition from major pharmaceutical
and biotechnology companies, academic institutions, governmental agencies and public and private research institutions, among others.
Any product candidates that we successfully develop and commercialize will compete with approved treatment options, including off-label
therapies, and new therapies that may become available in the future. Key considerations that would impact our ability to effectively
compete with other therapies include the efficacy, safety, method of administration, cost, level of promotional activity, and intellectual
property protection of our products. Many of the companies against which we may compete have significantly greater financial resources
and expertise than we do in research and development, manufacturing, preclinical testing, conducting clinical trials, obtaining regulatory
approvals and marketing approved products.
There
are several PI3K, AKT, and mTOR inhibitors approved by the FDA, including PIQRAY and AFINITOR from Novartis AG, TRUQAP from AstraZeneca
plc, ITOVEBI from F. Hoffmann-La Roche Ltd, COPIKTRA from Verastem, Inc., and ZYDELIG from Gilead Sciences, Inc. We are aware that other
companies are, or may be, developing products for this indication, including BridgeBio Pharma Inc., Eli Lilly and Company, Kazia Therapeutics
Limited, Relay Therapeutics, Inc., Revolution Medicines Inc., and Takeda Pharmaceutical Company Limited. There may be additional companies
with programs suitable for addressing these patient populations that could be competitive with our efforts but that have not yet disclosed
specific clinical development plans. Smaller or early-stage companies, including oncology-focused therapeutics companies, may also prove
to be significant competitors, particularly through collaborative arrangements with large and established companies. These companies
may also compete with us in recruiting and retaining qualified scientific and management personnel, establishing clinical trial sites,
enrolling patients in clinical trials and acquiring technologies complementary to, or necessary for, our programs. The availability of
reimbursement from government and private payors will also significantly impact the pricing and competitiveness of our products. Our
competitors may obtain FDA or other regulatory approvals for their products more rapidly than we may obtain approvals for our product
candidates, which could result in our competitors establishing a strong market position before we are able to commercialize our product
candidates.
Market Opportunity
Based on our analysis of published epidemiological data, we estimate that approximately 37,000 patients in the U.S.
have HR+/HER2- ABC who have progressed after a CDK4/6 inhibitor. If gedatolisib ultimately receives FDA approval for the treatment
of both PIK3CA WT and PIK3CA MT populations,
using internal duration of treatment estimates and pricing assumptions consistent with currently available novel therapeutics for breast
cancer, we estimate the total addressable market for gedatolisib in the second-line setting is more than $5.0 billion. Given the
significant penetration our research is suggesting we can achieve, we believe it is reasonable to estimate that a second-line indication
for gedatolisib could potentially generate peak revenue of up to $2.5 billion annually.
Intellectual
Property
Our
success depends in part on our ability to obtain and maintain proprietary protection for our product candidates, to operate without
infringing the proprietary rights of others, and to prevent others from infringing our proprietary rights. We plan to protect our
proprietary positions using a variety of methods, which include obtaining U.S. and foreign patents related to our inventions and
improvements, and prosecuting additional U.S. and foreign patents that we determine are important to the development and
implementation of our business. For example, we, directly and via our licensors, currently have, or are
pursuing, patents covering the composition of matter, formulation, and methods of using our drug product candidates and we plan to
pursue additional patent protection as appropriate. We also rely on trade secrets, trademarks, know-how, continuing technological
innovation and potential in-licensing opportunities to develop and maintain our proprietary position.
18
Gedatolisib
Patents
We
entered into the Gedatolisib License Agreement with Pfizer in April 2021, pursuant to which we acquired exclusive worldwide rights under
Pfizer patents and know-how to develop, manufacture and commercialize gedatolisib. We have an exclusive license under the Gedatolisib
License Agreement to patent rights in the U.S. and numerous foreign jurisdictions relating to gedatolisib, in addition to our own patents.
The patent rights we own or which we have in-licensed under the Gedatolisib License Agreement include 13 granted patents in the U.S.
and more than 297 patents granted in numerous foreign jurisdictions. A U.S. patent covering gedatolisib as a composition of matter has
a statutory expiration date in December 2029 (including 209 days of Patent Term Adjustment), a U.S. patent that covers the cyclodextrin
formulation of gedatolisib that is currently used in our clinical trials expires in January 2041 (including 578 days of Patent Term Adjustment),
and a U.S. patent that covers the method of using gedatolisib in breast cancer expires in August 2042 (including 37 days of Patent Term
Adjustment), not including any Patent Term Extension that may be awarded by the U.S. Patent and Trademark Office (“USPTO”),
and relevant foreign counterparts. Issued patents will, as appropriate, be listed in the FDA’s Approved Drug Products with Therapeutic
Equivalence Evaluations (“Orange Book”).
Product
Trademark
We
have applied for trademark protection for our preferred commercial product tradename, and the USPTO has allowed the tradename for
registration. The FDA has conditionally approved the use of this tradename subject to the FDA’s approval of our NDA.
Trade
Secrets
In
addition to patents, we rely on trade secrets and know-how to develop and maintain our competitive position. We typically rely on trade
secrets to protect aspects of our business that are not amenable to, or that we do not consider appropriate for, patent protection. We
protect trade secrets and know-how by establishing confidentiality agreements and invention assignment agreements with our employees,
consultants, scientific advisors, contractors and partners. These agreements generally provide that all confidential information developed
or made known during the course of an individual or entity’s relationship with us must be kept confidential during and after the
relationship. These agreements also generally provide that all inventions resulting from work performed for us or relating to our business
and conceived or completed during the period of employment or assignment, as applicable, shall be our exclusive property. In addition,
we take other appropriate precautions, such as physical and technological security measures, to guard against misappropriation of our
proprietary information by third parties.
Government
Regulation
Approval
of Gedatolisib and Other Drug Products
Government
authorities in the U.S. at the federal, state and local level and in other countries and jurisdictions, including the EU, extensively
regulate, among other things, the research, development, testing, manufacture, quality control, approval, labeling, packaging, storage,
record-keeping, promotion, advertising, marketing, distribution, post-approval monitoring and reporting, and export and import of drug
products, such as gedatolisib and other drugs that may be used in combination with, or compete with, gedatolisib. Generally, before a
new drug can be marketed, considerable data demonstrating its quality, safety and efficacy must be obtained, organized into a format
specific for each regulatory authority and submitted for review and approved by the regulatory authority. The regulatory approval process
is time-consuming and requires significant capital expenditures.
U.S.
Approval Process
Overview
of FDA Approval Process
In
the U.S., pharmaceutical products are subject to extensive regulation by the FDA. The Federal Food, Drug, and Cosmetic Act, and other
federal and state statutes and regulations, govern, among other things, the research, development, testing, manufacture, storage, recordkeeping,
approval, labeling, promotion and marketing, distribution, post-approval monitoring and reporting, sampling, and import and export of
pharmaceutical products. Failure to comply with applicable U.S. requirements may subject a company to a variety of administrative or
judicial sanctions, such as FDA refusal to approve pending NDAs, warning or untitled letters, product recalls, product seizures, total
or partial suspension of production or distribution, injunctions, fines, civil penalties and criminal prosecution. The process required
by the FDA before a drug may be marketed in the U.S. generally involves the following:
●
completion
of nonclinical laboratory tests, animal studies and formulation studies according to good laboratory practices (“GLPs”),
or other applicable regulations;
19
●
submission
to the FDA of an application for an investigational new drug application (“IND”), which must become effective before
human clinical trials may begin;
●
performance
of adequate and well-controlled human clinical trials according to the FDA’s regulations commonly referred to as current good
clinical practices (“cGCPs”), to establish the safety and efficacy of the proposed drug for its intended use;
●
submission
to the FDA of an NDA for a new drug;
●
satisfactory
completion of an FDA pre-approval inspection (“PAI”) of the manufacturing facility or facilities where the drug is produced
to assess compliance with the FDA cGMPs, to assure that the facilities, methods and controls are adequate to preserve the drug’s
identity, strength, quality and purity;
●
FDA Bioresearch Monitoring (“BIMO”) inspections
of the nonclinical and clinical trial sites that generated the data in support of the NDA; and
●
FDA
acceptance, review and approval of the NDA.
The
lengthy process of seeking required approvals and the continuing need for compliance with applicable statutes and regulations require
the expenditure of substantial resources and approvals are inherently uncertain.
Preclinical
and Clinical Stages
Preclinical
tests include laboratory evaluation of product chemistry, formulation and toxicity, as well as animal trials to assess the characteristics
and potential safety and efficacy of the product. The conduct of the preclinical tests must comply with federal regulations and requirements,
including GLPs. The results of preclinical testing are submitted to the FDA as part of an IND along with other information, including
information about product chemistry, manufacturing and controls and a proposed clinical trial protocol. Long term preclinical tests,
such as animal tests of reproductive toxicity and carcinogenicity, may continue after the IND is submitted. A 30-day waiting period after
the submission of an IND is required prior to the commencement of clinical testing in humans. If the FDA has neither commented on nor
questioned the IND within this 30-day period, the clinical trial proposed in the IND may begin.
The
clinical stage of development involves the administration of the investigational product to healthy volunteers or disease-affected patients
under the supervision of qualified investigators, generally physicians not employed by, or under control of, the trial sponsor, in accordance
with cGCPs. Clinical trials are conducted under protocols detailing, among other things, the objectives of the clinical trial, dosing
procedures, subject selection and exclusion criteria and the parameters to be used to monitor subject safety and assess efficacy. Each
protocol, and any subsequent amendments to the protocol, must be submitted to the FDA as part of an IND. Furthermore, each clinical trial
must be reviewed and approved by an Institutional Review Board (“IRB”), for each institution at which the clinical trial
will be conducted to ensure that the risks to individuals participating in the clinical trials are minimized and are reasonable in relation
to anticipated benefits. The IRB also monitors the clinical trial until completed. Human clinical trials are typically conducted in three
sequential phases, which may overlap or be combined:
●
Phase
1 clinical trials generally involve a small number of healthy volunteers or disease-affected patients who are initially exposed to
a single dose and then multiple doses of the product candidate. The primary purpose of these clinical trials is to assess the metabolism,
pharmacologic action, side effect tolerability and safety of the drug.
●
Phase
2 clinical trials involve studies in disease-affected patients to determine the dose required to produce the desired benefits. At
the same time, safety and further pharmacokinetic and pharmacodynamic information is collected, possible adverse effects and safety
risks are identified, and a preliminary evaluation of efficacy is conducted.
●
Phase
3 clinical trials generally involve a larger number of patients at multiple sites and are designed to provide the data necessary
to demonstrate the effectiveness of the product for its intended use, its safety in use and to establish the overall benefit/risk
relationship of the product and provide an adequate basis for product approval. These trials may include comparisons with placebo
and/or other comparator treatments. The duration of treatment is often extended to mimic the actual use of a product during marketing.
20
A
registrational trial is a clinical trial that adequately meets regulatory agency requirements for the evaluation of a drug candidate’s
efficacy and safety such that it can be used to justify the approval of the drug. Generally, registrational trials are Phase 3 trials
but may be Phase 2 trials if the trial design provides a reliable assessment of clinical benefit, particularly in situations where there
is an unmet medical need.
Post-approval
trials, sometimes referred to as Phase 4 clinical trials, may be conducted after initial marketing approval. These trials are used to
gain additional experience from the treatment of patients in the intended therapeutic indication, particularly for long-term safety follow
up.
Progress
reports detailing the results of the clinical trials must be submitted at least annually to the FDA and more frequently if serious adverse
events occur. The FDA or the sponsor may suspend or terminate a clinical trial at any time, or the FDA may impose other sanctions on
various grounds, including a finding that the research patients are being exposed to an unacceptable health risk. Similarly, an IRB can
suspend or terminate approval of a clinical trial at its institution if the clinical trial is not being conducted in accordance with
the requirements of the IRB or if the drug has been associated with unexpected serious harm to patients.
There
also are requirements governing the reporting of ongoing clinical trials and completed clinical trial results to public registries. Information
about most clinical trials must be submitted within specific timeframes for publication on the www.clinicaltrials.gov website. Information
related to the product, patient population, phase of investigation, trial sites and investigators and other aspects of the clinical trial
is made public as part of the registration of the clinical trial. Sponsors are also obligated to discuss the results of their clinical
trials after completion. Disclosure of the results of these trials can be delayed in some cases for up to two years after the date of
completion of the trial. Competitors may use this publicly available information to gain knowledge regarding the progress of development
programs.
FDA
Review and Approval Process
After
completion of the required clinical testing, an NDA is prepared and submitted to the FDA. Prior to granting approval of the NDA, which
is required before marketing of the product may begin in the U.S., the FDA must determine whether to accept the submission and, thereafter,
conduct an in-depth review. This process may take a year or more. The NDA must include the results of all preclinical, clinical and other
testing and a compilation of data relating to the product’s pharmacology, chemistry, manufacture and controls. The cost of preparing
and submitting an NDA is substantial. The submission of an NDA to the FDA, absent an applicable application user fee waiver, is subject
to a substantial application user fee, currently $4,682,003 for Fiscal Year 2026, and the manufacturer and/or sponsor under an approved
NDA are also subject to annual program fees for eligible products, which are currently $442,213 for Fiscal Year 2026. As a company with
fewer than 500 employees submitting its first NDA, we have qualified for the application fee waiver.
The
FDA may also refer applications for novel drug products, or drug products that present difficult questions of safety or efficacy, to
an advisory committee—typically a panel that includes clinicians and other experts—for review, evaluation and a recommendation
as to whether the application should be approved. The FDA is not bound by the recommendation of an advisory committee, but it generally
follows such recommendations. Before approving an NDA, the FDA will typically conduct a BIMO inspection, including inspecting one or
more clinical sites to assure compliance with cGCPs. Additionally, the FDA will conduct a PAI of the facility or the facilities at which
the finished drug is manufactured to assure compliance with cGMP. The FDA will not approve the product unless compliance with cGMP is
satisfactory and the NDA contains data that provide substantial evidence that the drug is safe and effective in the indication studied.
After
the FDA evaluates the NDA and the manufacturing facilities, it issues either an approval letter or a complete response letter (“CRL”).
A CRL generally outlines the deficiencies in the submission and may require substantial additional testing, or information, in order
for the FDA to reconsider the application. If, or when, those deficiencies have been addressed to the FDA’s satisfaction in a resubmission
of the NDA, the FDA will issue an approval letter. The FDA has committed to reviewing such resubmissions in two to six months depending
on the type of information included.
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An
approval letter authorizes commercial marketing of the drug with specific prescribing information for specific indications. As a condition
of NDA approval, the FDA may require a risk evaluation and mitigation strategy (“REMS”), to help ensure that the benefits
of the drug outweigh the potential risks. REMS can include medication guides, communication plans for healthcare professionals, and elements
to assure safe use (“ETASU”). ETASU can include, but are not limited to, special training or certification for prescribing
or dispensing, dispensing only under certain circumstances, special monitoring and the use of patient registries. The requirement for
a REMS can materially affect the potential market and profitability of the drug. Moreover, product approval may require substantial post-approval
testing and surveillance to monitor the drug’s safety or efficacy. Once granted, product approvals may be withdrawn if compliance
with regulatory standards is not maintained or problems are identified following initial marketing.
Changes
to some of the conditions established in an approved application, including changes in indications, labeling or manufacturing processes
or facilities, require submission and FDA approval of a new NDA or NDA supplement before the change can be implemented. An NDA supplement
for a new indication typically requires clinical data similar to that in the original application, and the FDA uses the same procedures
and actions in reviewing NDA supplements as it does in reviewing NDAs.
U.S.
Marketing Exclusivity
Upon
NDA approval of a new chemical entity (“NCE”), which is a drug (i.e., gedatolisib) that contains no active moiety that has
been approved by the FDA in any other NDA, that drug receives five years of marketing exclusivity during which the FDA cannot accept
any Abbreviated New Drug Application (“ANDA”), seeking approval of a generic version of that drug. Certain changes to a drug,
such as the addition of a new indication to the package insert, are associated with a three-year period of exclusivity during which the
FDA cannot approve an ANDA for a generic drug that includes the change. An ANDA may be submitted one year before NCE exclusivity expires
if a Paragraph IV certification is filed with the ANDA. If there is no listed patent in the Orange Book, no ANDA may be filed before
the expiration of the exclusivity period. If approved, we expect to receive five-year NCE exclusivity for gedatolisib.
Patent
Term Extension
After
NDA approval, owners of relevant drug patents may apply to the USPTO for up to a five-year patent term extension (“PTE”)
for one patent. The allowable PTE is calculated as half of the drug’s testing phase—the time between IND and NDA submission—and
all of the review phase—the time between NDA submission and approval, up to a maximum of five years. The time can be shortened
if the USPTO, in coordination with the FDA, determines that the applicant did not pursue approval with due diligence. The total patent
term after the extension may not exceed 14 years from NDA approval. We intend to seek five-year PTE should the FDA approve our NDA for
gedatolisib.
For
patents that might expire during the application phase, the patent owner may request an interim patent extension. An interim patent extension
increases the patent term by one year and may be renewed up to four times. For each interim patent extension granted, the post-approval
patent extension is reduced by one year. The director of the USPTO must determine that approval of the drug covered by the patent for
which a patent extension is being sought is likely. Interim patent extensions are not available for a drug for which an NDA has not been
submitted.
Fast
Track Designation
The
FDA is required to facilitate the development, and expedite the review, of drugs that are intended for the treatment of a serious or
life-threatening disease or condition for which there is no effective treatment, and which demonstrate the potential to address unmet
medical needs for the condition. Under the Fast Track program, the sponsor of a new drug candidate may request that the FDA designate
the drug candidate for a specific indication as a Fast Track drug concurrent with, or after, the filing of the IND for the drug candidate.
The FDA must determine if the drug candidate qualifies for Fast Track designation within 60 days of receipt of the sponsor’s request.
Gedatolisib has received Fast Track designation from the FDA.
Under
the Fast Track program and the FDA’s accelerated approval regulations, the FDA may approve a drug for a serious or life-threatening
illness that provides meaningful therapeutic benefit to patients over existing treatments based upon a surrogate endpoint that is reasonably
likely to predict clinical benefit, or on a clinical endpoint that can be measured earlier than irreversible morbidity or mortality,
that is reasonably likely to predict an effect on irreversible morbidity or mortality or other clinical benefit, taking into account
the severity, rarity or prevalence of the condition and the availability or lack of alternative treatments.
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In
clinical trials, a surrogate endpoint is a measurement of laboratory or clinical signs of a disease or condition that substitutes for
a direct measurement of how a patient feels, functions or survives. Surrogate endpoints can often be measured more easily or more rapidly
than clinical endpoints. A drug candidate approved on this basis is subject to rigorous post-marketing compliance requirements, including
the completion of Phase 4 or post-approval clinical trials to confirm the effect on the clinical endpoint. Failure to conduct required
post-approval studies, or confirm a clinical benefit during post-marketing studies, will allow the FDA to withdraw the drug from the
market on an expedited basis. All promotional materials for product candidates approved under accelerated regulations are subject to
prior review by the FDA.
In
addition to other benefits such as the ability to use surrogate endpoints and engage in more frequent interactions with the FDA, the
FDA may initiate review of sections of a Fast Track drug’s NDA before the application is complete. This rolling review is available
if the applicant provides, and the FDA approves, a schedule for the submission of the remaining information and the applicant pays applicable
user fees if not waived. However, the FDA’s time period goal for reviewing an application does not begin until the last section
of the NDA is submitted. Additionally, the Fast Track designation may be withdrawn by the FDA if the FDA believes that the designation
is no longer supported by data emerging in the clinical trial process.
Breakthrough
Therapy Designation
Breakthrough
Therapy designation by the FDA provides more extensive development consultation opportunities with FDA senior staff, allows for the rolling
review of the drug’s application for approval and indicates that the product could be eligible for Priority Review if supported
by clinical data at the time of application submission for drugs that are intended to treat a serious or life-threatening disease or
condition where preliminary clinical evidence indicates that the drug may demonstrate substantial improvement over existing therapies
on one or more clinically significant endpoints. Under the Breakthrough Therapy program, the sponsor of a new drug candidate may request
that the FDA designate the drug candidate for a specific indication as a Breakthrough Therapy concurrent with, or after, the filing of
the IND for the drug candidate. The FDA must determine if the drug candidate qualifies for Breakthrough Therapy designation within 60
days of receipt of the sponsor’s request. Gedatolisib received Breakthrough Therapy
designation.
Real-Time
Oncology Review (“RTOR”)
RTOR
is an FDA review program within the Oncology Center of Excellence that allows sponsors to submit key sections of an oncology NDA on a
rolling basis. The intent of RTOR is to start FDA review earlier, improve efficiency, and potentially shorten overall NDA review times.
On August 27, 2025, the FDA granted our request to submit our NDA on a rolling basis via the RTOR program.
Priority
Review
FDA
Priority Review is a designation by the FDA that shortens the review timeline for certain marketing applications, including NDAs. Priority
Review reduces the FDA’s PDUFA goal review time from the standard 10 months to six months. The FDA grants Priority Review if the
NDA is for a drug that treats a serious condition and, if approved, would provide a significant improvement in safety or effectiveness
over available therapies. On January 16, 2026, the FDA accepted our NDA and awarded Priority Review, with a PDUFA goal date
of July 17, 2026.
Disclosure
of Clinical Trial Information
Sponsors
of clinical trials of FDA regulated products, including drugs, are required to register and disclose certain clinical trial information.
Information related to the product, patient population, phase of investigation, trial sites and investigators and other aspects of the
clinical trial is then made public as part of the registration at www.clinicaltrials.gov. Sponsors are also obligated to discuss the results
of their clinical trials after completion. Disclosure of the results of these trials can be delayed in certain circumstances for up to
two years after the date of completion of the trial. Competitors may use this publicly available information to gain knowledge regarding
the progress of development programs.
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European
Union Approval Process
Overview
In
the EU, our product candidates may also be subject to extensive regulatory requirements. As in the U.S., medicinal products can be marketed
only if a marketing authorization from the competent regulatory agencies has been obtained. Similar to the U.S., the various phases of
preclinical and clinical research in the EU are subject to significant regulatory controls.
The
Clinical Trials Regulation (EU) No 536/2014 came into effect in 2022. The Clinical Trials Regulation is directly applicable in all the
EU Member States, and repealed the Clinical Trials Directive 2001/20/EC. The Clinical Trials Regulation aims to simplify and streamline
the approval of clinical trials in the EU. The main characteristics of the regulation include: a streamlined application procedure via
a single-entry point, the Clinical Trial Information System; a single set of documents to be prepared and submitted for the application
as well as simplified reporting procedures for clinical trial sponsors; and a harmonized procedure for the assessment of applications
for clinical trials, which is divided in two parts. Part I is assessed by the competent authorities of all EU Member States in which
an application for authorization of a clinical trial has been submitted (Member States concerned). Part II is assessed separately by
each Member State concerned. Strict deadlines have been established for the assessment of clinical trial applications. The role of the
relevant ethics committees in the assessment procedure will continue to be governed by the national law of the concerned EU Member State.
However, overall related timelines will be defined by the Clinical Trials Regulation.
To
obtain a marketing authorization of a drug in the EU, we may submit Marketing Authorisation Applications (“MAA”), either
under the so-called centralized or national authorization procedures.
Centralized
Procedure
The
centralized procedure provides for the grant of a single marketing authorization following a favorable opinion by the European Medicines
Agency (the “EMA”), that is valid in all EU Member States, as well as Iceland, Liechtenstein and Norway. The centralized
procedure is compulsory for medicines produced by specified biotechnological processes, products designated as orphan medicinal products,
advanced therapy medicines (such as gene-therapy, somatic cell-therapy or tissue-engineered medicines) and products with a new active
substance indicated for the treatment of specified diseases, such as HIV/AIDS, cancer, diabetes, neurodegenerative disorders or autoimmune
diseases and other immune dysfunctions and viral diseases. The centralized procedure is optional for products that represent a significant
therapeutic, scientific or technical innovation, or whose authorization would be in the interest of public health. Under the centralized
procedure, the maximum timeframe for the evaluation of an MAA by the EMA is 210 days, excluding clock stops, when additional written
or oral information is to be provided by the applicant in response to questions asked by the Committee for Medicinal Products for Human
Use (the “CHMP”). Accelerated assessment might be granted by the CHMP in exceptional cases when a medicinal product is expected
to be of a major public health interest, particularly from the point of view of therapeutic innovation. The timeframe for the evaluation
of an MAA under the accelerated assessment procedure is 150 days, excluding clock stops.
National
Authorization Procedures
There
are also two other possible routes to authorize medicinal products in several EU countries, which are available for investigational medicinal
products that fall outside the scope of the centralized procedure:
●
Decentralized
procedure. Using the decentralized procedure, an applicant may apply for simultaneous authorization in more than one EU country of
medicinal products that have not yet been authorized in any EU country and that do not fall within the mandatory scope of the centralized
procedure.
●
Mutual
recognition procedure. In the mutual recognition procedure, a medicine is first authorized in one EU Member State, in accordance
with the national procedures of that country. Following this, further marketing authorizations can be sought from other EU countries
in a procedure whereby the countries concerned agree to recognize the validity of the original, national marketing authorization.
Under
the above-described procedures, before granting an MAA, the EMA or the competent authorities of the Member States of the European Economic
Area (the “EEA”), assess the risk-benefit balance of the product on the basis of scientific criteria concerning its quality,
safety and efficacy.
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EU
Regulatory Exclusivity
In
the EU, new products authorized for marketing (i.e., reference products) qualify for eight years of data exclusivity and an additional
two years of market exclusivity upon marketing authorization. The data exclusivity period prevents generic applicants from relying on
the preclinical and clinical trial data contained in the dossier of the reference product when applying for a generic marketing authorization
in the EU during a period of eight years from the date on which the reference product was first authorized in the EU. The market exclusivity
period prevents a successful generic applicant from commercializing its product in the EU until ten years have elapsed from the initial
authorization of the reference product in the EU. The ten-year market exclusivity period can be extended to a maximum of eleven years
if, during the first eight years of those ten years, the marketing authorization holder obtains an authorization for one or more new
therapeutic indications which, during the scientific evaluation prior to their authorization, are held to bring a significant clinical
benefit in comparison with existing therapies.
Drug
Approval-Related Regulations – Rest of the World
For
other countries outside of the EU and the U.S., such as countries in Eastern Europe, Latin America or Asia, the requirements governing
the conduct of clinical trials, product licensing, pricing and reimbursement vary from jurisdiction to jurisdiction. Additionally, the
clinical trials must be conducted in accordance with cGCP requirements and the applicable regulatory requirements and the ethical principles
that have their origin in the Declaration of Helsinki. If we fail to comply with applicable foreign regulatory requirements, we may be
subject to, among other things, fines, suspension or withdrawal of regulatory approvals, product recalls, seizure of products, operating
restrictions and criminal prosecution.
Pricing
and Reimbursement of our Product Candidates
Significant
uncertainty exists as to the coverage and reimbursement status of any products we sell or may sell. Sales of our drug products will depend,
in part, on the extent to which the costs of the products will be covered by third-party payors, including government health programs
such as VA, Tricare, Medicare and Medicaid, commercial health insurers, and other managed care organizations.
In
order to obtain coverage and reimbursement for our drug product, we will conduct extensive pharmacoeconomic studies in order to demonstrate
the medical necessity and cost-effectiveness of our product. Whether or not we conduct such studies, our products may not be considered
medically necessary or cost-effective. A third-party payor’s decision to provide coverage for a product does not imply that an
adequate reimbursement rate will be approved. Further, one payor’s determination to provide coverage for a product does not assure
that other payors will also provide coverage, and adequate reimbursement, for the product. Third-party reimbursement may not be sufficient
to enable us to maintain price levels high enough to realize an appropriate return on our investment in product development.
The
containment of healthcare costs has become a priority of federal, state and foreign governments, and the prices of drugs have been a
focus in this effort. Third-party payors are increasingly challenging the prices charged for medical products, examining the medical
necessity and reviewing the cost-effectiveness of drug products and questioning product safety and efficacy. If these third-party payors
do not consider our product to be cost-effective compared to other available products, they may not cover our product or, if they do,
the level of reimbursement may not be sufficient to allow us to realize a profit on the use of our product. The U.S. government, state
legislatures and foreign governments have shown significant interest in implementing cost-containment programs to limit the growth of
government-paid healthcare costs, including price controls and restrictions on reimbursement. Adoption of such controls and measures,
and tightening of restrictive policies in jurisdictions with existing controls and measures, could limit payments for our product and
could adversely affect our net revenue and results.
In
August 2022, the Inflation Reduction Act (the “IRA”) was signed into law, which, among other things, requires manufacturers
of certain drugs to engage in price negotiations with Medicare (beginning in 2026), imposes rebates under Medicare Part B and Medicare
Part D to penalize price increases that outpace inflation, and replaces the Part D coverage gap discount program with a new discounting
program. Gedatolisib, if approved, will be subject to these provisions of the IRA, and we have taken these provisions into account when developing our business strategy, operations, and our projected financial condition and results. In addition, changes to the Medicaid
program or the federal 340B drug pricing program, which imposes ceilings on prices that drug manufacturers can charge for medications
sold to certain health care facilities, could have a material impact on our business following commercialization. We expect to see continued
focus by Congress and the Trump Administration on regulating drug pricing, which could result in legislative and regulatory changes designed
to control costs.
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Pricing
and reimbursement schemes vary widely from country to country. Some countries may require the completion of additional studies that compare
the cost-effectiveness of a particular drug product to currently available drugs. The downward pressure on healthcare costs in general,
particularly prescription drugs, has become intense. As a result, increasingly high barriers are being erected to the entry of new drug
products. In addition, in some countries, cross-border imports from low-priced markets exert competitive pressure that may reduce pricing
within a country. Any country that has price controls or reimbursement limitations for drug products may not allow favorable reimbursement
and pricing arrangements for our product.
Coverage
policies, third-party reimbursement rates and pricing regulation may change at any time.
Other
Healthcare Laws
Manufacturing,
sales, promotion and other activities following product approval are also subject to regulation by numerous regulatory authorities in
the U.S. in addition to the FDA, including CMS, the HHS Office of Inspector General and HHS Office for Civil Rights, other divisions
of the HHS, the Department of Justice, and state regulatory bodies including Boards of Pharmacy and Price Transparency Boards.
Healthcare
systems, physicians, pharmacists, and third-party payors will play a primary role in the recommendation and prescription of any products
for which we obtain marketing approval. Our current and future arrangements with third-party payors, healthcare systems, physicians and
pharmacists may expose us to broadly applicable fraud and abuse and other healthcare laws and regulations that may constrain the business
or financial arrangements and relationships through which we market, sell and distribute our drug product. In the U.S., these laws include,
without limitation, state and federal anti-kickback, false claims, physician payment transparency, and patient data privacy and security
laws and regulations, including but not limited to those described below.
The
U.S. federal Anti-Kickback Statute (the “AKS”) prohibits, among other things, any person or entity from knowingly and willfully
offering, paying, soliciting, receiving or providing any remuneration, directly or indirectly, overtly or covertly, to induce or in return
for purchasing, leasing, ordering or arranging for or recommending the purchase, lease or order of any good, facility, item or service
reimbursable, in whole or in part, under Medicare, Medicaid or other federal healthcare programs. The term “remuneration”
has been broadly interpreted to include anything of value. The AKS has been interpreted to apply to arrangements between pharmaceutical
and medical device manufacturers on the one hand and prescribers, purchasers, formulary managers and beneficiaries on the other hand.
A person does not need to have actual knowledge of the statute or specific intent to violate it in order to have committed a violation
of the AKS.
Moreover,
a claim including items or services resulting from a violation of the AKS constitutes a false or fraudulent claim for purposes of the
federal civil False Claims Act, which imposes civil penalties, including through civil whistleblower or qui tam actions, against individuals
or entities (including manufacturers) for, among other things, knowingly presenting, or causing to be presented to federal programs (including
Medicare and Medicaid) claims for items or services that are false or fraudulent, claims for items or services not provided as claimed,
or claims for medically unnecessary items or services. This could apply even if we are not submitting claims directly to payors as would
be the case with sales of drug products.
In
addition, under a federal law directed at “self-referral,” commonly known as the “Stark Law,” there are prohibitions,
with certain exceptions, on referrals for certain designated health services, including laboratory services, that are covered by the
Medicare and Medicaid programs by physicians who personally, or through a family member, have an investment or ownership interest in,
or a compensation arrangement with, an entity performing the tests. The prohibition also extends to payment for any testing referred
in violation of the Stark Law. Bills submitted in violation of the Stark Law may not be paid by Medicare or Medicaid, and there may be
significant penalties for violations. Many states have comparable laws that are not limited to Medicare and Medicaid referrals.
These
regulations present compliance and litigation risks for our business and others in our industry. We incur compliance-related expenses
and expect to incur additional expenses if and when our products are commercialized. We may be subject to penalties or limitations on
government program participation if we are found to have violated these regulations.
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The
federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) created additional federal criminal statutes
that prohibit, among other actions, knowingly and willfully executing, or attempting to execute, a scheme to defraud or to obtain, by
means of false or fraudulent pretenses, representations or promises, any money or property owned by, or under the control or custody
of, any healthcare benefit program, including private third-party payors, knowingly and willfully embezzling or stealing from a healthcare
benefit program, willfully obstructing a criminal investigation of a healthcare offense and knowingly and willfully falsifying, concealing
or covering up a material fact or making any materially false, fictitious or fraudulent statement in connection with the delivery of
or payment for healthcare benefits, items or services. Similar to the AKS, a person or entity does not need to have actual knowledge
of the statute or specific intent to violate it in order to have committed a violation.
In
addition, there has been a recent trend of increased federal and state regulation of payments made to physicians and certain other healthcare
providers, and their ownership and investment interests. The Affordable Care Act, imposed, among other things, annual reporting requirements
through the Physician Payments Sunshine Act for covered manufacturers for certain payments and “transfers of value” to these
providers. Failure to submit timely, accurately and completely the required information for all payments, transfers of value and ownership
or investment interests may result in civil monetary penalties.
We
may also be subject to data privacy and security regulation by both the federal government and the states in which we conduct our
business. HIPAA, as amended by the Health Information Technology for Economic and Clinical Health Act (“HITECH”), and
their respective implementing regulations, impose specified requirements relating to the privacy, security and transmission of
individually identifiable health information held by covered entities and their business associates. Among other things, HITECH made
HIPAA’s security standards directly applicable to “business associates,” defined as independent contractors or
agents of covered entities that create, receive, maintain or transmit protected health information in connection with providing a
service for or on behalf of a covered entity. Although we are not a “covered entity” and we would not be considered a
“business associate” in the normal course of our business and therefore not regulated by HIPAA, our business frequently interacts with covered entities and business associates
who are subject to HIPAA. In addition, state laws govern the privacy and security of
health information in certain circumstances, many of which differ from each other in significant ways and may not have the same
requirements, thus complicating compliance efforts. See “International Data Collection” below for a discussion of data
privacy and security enactments of the EU.
At
the state level, the California Consumer Privacy Act, as amended and expanded by the California Privacy Rights Act (collectively,
the “CCPA”), imposes data protection obligations on certain businesses. Although we are not currently regulated by any comprehensive state privacy law, we expect we will be regulated by
such laws in the future as our business develops. While there are certain limited exceptions under
the CCPA for clinical trial data and other health data that would apply to us, these regulations exemplify the vulnerability of our
business to the evolving regulatory environment related to personal data and protected health information, which causes us to incur
compliance costs. Privacy legislation similar to the CCPA has been adopted in many other U.S. states, and regulation of the collection, use, and disclosure of personal information remains a common focus of state legislation.
States
and foreign jurisdictions also have fraud and abuse laws and regulations, such as state anti-kickback and false claims laws, which may
apply to sales or marketing arrangements and claims involving healthcare items or services. Some state laws also require pharmaceutical
companies to comply with the brand pharmaceutical industry’s voluntary compliance guidelines (i.e., the PhRMA Code) and the
relevant federal government compliance guidances, and require drug manufacturers to report information related to payments and other
transfers of value to physicians and other healthcare providers, marketing expenditures, or drug pricing.
In
order to sell products, we will need to comply with state laws, including those that require the registration of manufacturers and wholesale
distributors of drug and biological products. Several states have enacted legislation requiring pharmaceutical and biotechnology companies
to establish marketing compliance programs, file periodic reports with the state, make periodic public disclosures on sales, marketing,
pricing, clinical trials and other activities, and/or register their sales representatives, as well as to prohibit pharmacies and other
healthcare entities from providing certain physician prescribing data to pharmaceutical and biotechnology companies for use in sales
and marketing, and to prohibit certain other sales and marketing practices. If and when we commercialize our products, all of our activities
are potentially subject to federal and state consumer protection and unfair competition laws.
27
The
scope and enforcement of each of these laws is uncertain and subject to rapid change in the current environment, especially in light
of the lack of applicable precedent and regulations. If our operations are found to be in violation of any of these laws or any other
governmental regulations that may apply to us, we may be subject to significant civil, criminal and administrative penalties, damages,
fines, disgorgement, contractual damages, reputational harm, diminished profits and future earnings, imprisonment, exclusion of drugs
from government funded healthcare programs, such as Medicare and Medicaid, and the curtailment or restructuring of our business strategy
operations, as well as additional reporting obligations and oversight if we become subject to a corporate integrity agreement or other
agreement to resolve allegations of non-compliance with these laws, any of which could adversely affect our ability to operate our business
and our financial results. If any of the physicians or other healthcare providers or entities with whom we expect to do business is found
to be not in compliance with applicable laws, they may be subject to significant criminal, civil or administrative sanctions, including
exclusions from government funded healthcare programs. Ensuring business arrangements comply with applicable healthcare laws, as well
as responding to possible investigations by government authorities, can be time- and resource consuming and can divert a company’s
attention from the business.
International
Data Collection
Our
contract research organizations (“CROs”) and clinical investigators involved in our clinical trials may collect,
receive, store, process, use, generate, transfer, disclose, make accessible, protect, secure, dispose of, transmit and share
(collectively, “process”) personal data as defined in data protection laws, from individuals residing outside the U.S.
Accordingly, we are subject to numerous foreign privacy and security laws regulating the collection, use, safeguarding, transfer and
other processing of personal data.
Globally,
virtually every jurisdiction in which we operate has established its own data security and privacy frameworks with which we must
comply. For example, in the EU/EEA, we are subject to the EU General Data Protection Regulation (the “EU GDPR”), and
associated Data Protection Legislation, which govern the collection and use of personal data as it pertains to individuals residing
in the EU/EEA. This legislation imposes several requirements, including, but not limited to: providing information to individuals
regarding data processing activities, implementing safeguards to protect the security and confidentiality of personal data,
processing personal data only under one of the six lawful bases for processing, managing
contractual relationships with vendors and other third parties, and notifying the appointment of a data protection officer to
the relevant EU/EEA competent national data protection authorities. The EU GDPR also imposes strict rules on the transfer of
personal data outside of the EU/EEA. Personal data transferred to a jurisdiction outside the EU/EEA that does not provide adequate
protection for personal data (an “adequate jurisdiction”) must be protected by standard contractual clauses (a standard
form of contract approved by the European Commission). Currently, the U.S. is only an adequate jurisdiction for companies that
certify to the EU-U.S. Data Privacy Framework. As we are not certified to the EU-U.S. Data Privacy Framework, we must rely on
standard contractual clauses and other Article 45 protections when transferring personal data from the EU/EEA to the U.S. Companies
that must comply with the EU GDPR face increased compliance obligations and risk, including more robust regulatory enforcement of
data protection requirements and potential fines for noncompliance of up to €20 million or 4% of the annual global revenue of
the noncompliant company, whichever is greater. The EU GDPR also confers a private right of action in some circumstances on data
subjects and consumer associations to lodge complaints with supervisory authorities, seek judicial remedies, and obtain compensation
for damages resulting from violations of the EU GDPR. We have incurred, and expect to continue to incur, compliance expenses in
connection with the EU GDPR. If we are found to be in violation of the EU GDPR, our product development timeline may be affected,
which would potentially affect our ability to generate revenue and might impact our competitive position.
Further,
following the withdrawal of the United Kingdom from the EU, we have to comply with the GDPR as implemented in the United Kingdom (the
“UK GDPR”). The UK GDPR penalty structure mirrors the EU GDPR and has the ability to fine up to the greater of €20 million/£17
million or 4% of global turnover. The European Commission has adopted an adequacy decision in favor of the United Kingdom, enabling data
transfers from European Union member states to the United Kingdom without additional safeguards. However, the framework for transfer
of personal data from the UK to jurisdictions outside the UK, EU, or EEA is different from the EU GDPR. The UK has implemented its own
standard contractual clauses to protect UK personal data transferred to countries that are not adequate jurisdictions.
Current
and Future Legislation
In
the U.S. and other jurisdictions, continued healthcare reform measures may result in more rigorous coverage criteria and additional downward
pressure on the price that we, or any collaborators, may receive. Individual states in the U.S. have also been increasingly passing legislation
and implementing regulations designed to control pharmaceutical and biological product pricing, including price or patient reimbursement
constraints, discounts, restrictions on certain product access and marketing cost disclosure and transparency measures, and, in some
cases, designed to encourage importation from other countries and bulk purchasing. Regulations may also prevent or delay marketing approval
of our product candidates, restrict or regulate post-approval activities and affect our ability to profitably sell any product candidates.
Other
Regulatory Requirements
Our
operations use small amounts of hazardous materials in research and development and generate regulated medical waste in the normal course
of performing our laboratory tests. This subjects us to a variety of federal, state and local environmental and safety laws and regulations.
Some of the regulations under the current regulatory structure provide for strict liability, holding a party potentially liable without
regard to fault or negligence. We could be held liable for damages and fines as a result of our, or others’, business operations
should contamination of the environment or individual exposure to hazardous substances occur. We cannot predict how changes in laws or
development of new regulations will affect our business operations or the cost of compliance.
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Corporate
History
We
were organized as a Minnesota limited liability company in 2011 and commenced operations in 2012. On September 15, 2017, we converted
from a Minnesota limited liability company into a Delaware corporation and changed our name from Celcuity LLC to Celcuity Inc.
Employees
and Labor Relations
As
of December 31, 2025, we had 155 full-time employees, most of which were engaged in research and development activities, though hiring
employees in preparation for anticipated commercial launch has begun. None of our employees are currently represented by a labor union
or covered by a collective bargaining agreement and we believe that our relations with our employees are good. During 2025, our voluntary
turnover rate was approximately 4%.
Information
About Our Executive Officers
The
following table sets forth information concerning our executive officers.
Name
Age
Position
Brian
F. Sullivan
64
Chief
Executive Officer and Chairman of the Board
Lance
G. Laing, Ph.D.
64
Chief
Science Officer, Vice President, Secretary and Director
Vicky
Hahne
59
Chief
Financial Officer
Brian
F. Sullivan is our co-founder and has served as Chairman of the Board and Chief Executive Officer since we commenced operations in
2012. Mr. Sullivan has over 30 years of experience founding and building successful, high-growth technology companies. He was Chairman
and CEO of SterilMed, a medical device reprocessing company, from 2003, when he led an investment group to acquire a majority interest,
until its sale to Ethicon Endo-Surgery Inc., a Johnson & Johnson company, for $330 million in 2011. Previously, he was co-founder
and Chief Executive Officer of Recovery Engineering, a filtration company, which he took public and subsequently sold to Procter &
Gamble for $265 million in 1999. Mr. Sullivan previously served on the board of directors of two publicly-held companies, Entegris, Inc.
and Virtual Radiologic Inc. Mr. Sullivan has received nine U.S. patents and has several patents pending. He graduated magna cum laude
with distinction from Harvard College with an A.B. in economics.
Lance
G. Laing, Ph.D. is our co-Founder and has served as Chief Science Officer, Vice President, Secretary and a director since we
commenced operations in 2012. Dr. Laing’s career spans more than 20 years in drug discovery research and technology
development. He received his doctorate in biophysics and biochemistry from The Johns Hopkins University and completed a National
Institutes of Health post-doctoral fellowship at Washington University Medical School in biophysics. He has received 27 U.S. patents
and has several U.S. patents pending. His drug discovery research career began at Scriptgen/Anadys Pharmaceuticals (purchased
by Novartis), where he worked under Professor Peter Kim. He also was Director of Chemistry and Bioapplications and Director of
Detection Product Development for two companies that each developed instruments similar to those used by Celcuity. His work at these
two instrument companies gave him unique expertise and experience in developing a variety of patented applications for these
instruments. Most recently, he served as an executive director for an international drug discovery and development
company.
Vicky
Hahne joined as our Chief Financial Officer in July 2017. She has more than 25 years of financial leadership experience, including
the most recent 20 years in the healthcare industry. Prior to joining Celcuity, Ms. Hahne served as Controller of Respiratory Technologies
Inc., a medical device manufacturer, from 2015 to 2017. While at Respiratory Technologies, she played a key role in the due diligence
process to sell the company to Koninklijke Philips. In 2014, she served as Controller for Ability Network Inc., a healthcare information
technology company. From 2007 to 2012, Ms. Hahne served as Controller of SterilMed Inc., a medical device reprocessing company, where
she was significantly involved in the sale of the company to Johnson & Johnson. Prior to these roles, Ms. Hahne held several senior
financial positions at SimonDelivers Inc., including Chief Financial Officer. Ms. Hahne has extensive experience in early stage, high
growth companies with responsibilities including financial controls and stewardship, financial analysis, mergers and acquisitions, building
infrastructure and systems. She received a B.S. degree in Finance and Accounting from Northern State University and received her CPA
certificate in 1990.
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