What changed in this filing

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Item 2. Management’s Discussion and Analysis

2026-08-13 compared with 2026-05-14 · 141 added, 95 removed, 181 unchanged (57% of the section changed)

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Approval in this indication was based on the results from the STORM ( S elinexor T reatment of R efractory M yeloma) trial.

Our primary focus is on marketing XPOVIO in its currently approved indications as well as developing and seeking regulatory approval of selinexor as an oral agent targeting multiple high unmet need cancer indications, including our lead clinical programs in myelofibrosis and endometrial cancer and our other late-stage clinical program in multiple myeloma.

Depending on the data in our Phase 3 myelofibrosis and/or endometrial cancer programs and the availability of capital resources, we plan to explore opportunities to develop our leading next-generation XPO1 inhibitor, eltanexor, in additional myeloproliferative neoplasms and TP53 wild-type tumors.

Our primary focus is on marketing XPOVIO in its currently approved indications in multiple myeloma as well as developing and seeking regulatory approval of selinexor in myelofibrosis.

Subject to obtaining additional funding, we plan to explore opportunities to develop our leading next-generation XPO1 inhibitor, eltanexor, in additional myeloproliferative neoplasms.

The commercialization of XPOVIO in the U.S.

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is managed by our partners in their respective territories.

XPOVIO/NEXPOVIO has received regulatory approvals in various indications in more than 50 territories and countries outside the U.S.

XPOVIO/NEXPOVIO has received regulatory

approvals in various indications in more than 50 territories and countries outside the U.S.

and is commercially available in a growing number of countries as our partners continue to secure reimbursement approvals.

RECENT DEVELOPMENTS

Phase 3 SENTRY Trial Topline Data Results

On March 24, 2026, we announced topline data results from our Phase 3 clinical trial to evaluate the efficacy and safety of once-weekly selinexor in combination with ruxolitinib versus placebo plus ruxolitinib in JAK2 inhibitor (“JAKi”)-naive myelofibrosis patients (the “SENTRY Trial”) in which patients were randomized 2:1 to 60 mg of selinexor once weekly plus ruxolitinib or placebo plus ruxolitinib.

Phase 3 XPORT-EC-042 Topline Results

On July 30, 2026, we announced topline results from our Phase 3 randomized, double-blind trial evaluating selinexor as a maintenance-only therapy compared to placebo in adult patients with TP53 wild-type advanced or recurrent endometrial cancer in which patients were randomized 1:1 to receive either a 60 mg, once-weekly, administration of oral selinexor or placebo until disease progression (the “XPORT-EC-042 Trial”).

The trial did not meet its primary endpoint of progression free survival (“PFS”).

The trial included two patient populations, for which the primary endpoint of PFS was designed to be tested sequentially:

(1) a modified intent to treat population (“mITT”) that included patients with either (a) TP53 wild-type tumors with proficient mismatch repair status or (b) TP53 wild-type tumors with deficient mismatch repair status, who are medically ineligible to receive checkpoint inhibitors;

and (2) the trial’s original intent to treat population, which included all patients enrolled in the trial whose tumors are TP53 wild-type, regardless of MMR status.

A trend favoring the selinexor arm was observed in the mITT population (n=236), with a median PFS of 12.75 months in the selinexor arm compared to 7.43 months in the placebo arm (hazard ratio=0.76 [95% CI:

one-sided p-value=0.0791).

The safety and tolerability profile of selinexor was consistent with its established safety profile, with no new safety signals observed.

We intend to complete a full evaluation of the data from the XPORT-EC-042 Trial and plan to present the data at a future medical meeting.

The results of the XPORT-EC-042 Trial do not affect ongoing trials of selinexor in other potential indications.

Myelofibrosis Regulatory Update

On July 30, 2026, we announced that we plan to submit a supplemental New Drug Application (“sNDA”) to the U.S.

Food and Drug Administration (“FDA”) in August 2026 seeking accelerated approval of selinexor in combination with ruxolitinib for the treatment of patients with myelofibrosis.

The planned submission follows productive engagements with the FDA, including written feedback that spleen volume reduction ≥ 35% (“SVR35”) appears to qualify as a reasonably likely surrogate endpoint to predict overall survival and can be used to support an sNDA under the accelerated approval pathway.

We plan to use overall survival data from long-term follow-up of our ongoing randomized, double-blind Phase 3 clinical trial to evaluate the efficacy and safety of once-weekly selinexor in combination with ruxolitinib versus placebo plus ruxolitinib in JAK2 inhibitor (“JAKi”)-naive myelofibrosis patients (the “SENTRY Trial”) to verify clinical benefit.

Overall survival is a pre-specified secondary endpoint of the SENTRY Trial.

The trial does not permit patient crossover;

patients, investigators and the Karyopharm study team remain blinded to treatment assignment during ongoing follow-up.

The results from our SENTRY Trial will be the basis of the planned sNDA, including the statistically significant improvement in SVR35 at week 24, the rapid, deep and sustained nature of the spleen responses, a promising overall survival signal, reductions in variant allele frequency and the overall safety data package.

We remain on track for a planned August 2026 sNDA submission and have continued to productively engage with the FDA on the final details of the data that will be used to confirm the anticipated clinical benefit, a requirement under the accelerated approval pathway.

These confirmatory data will be used to convert potential accelerated approval to traditional approval.

We continue to address the FDA’s requests and provide the FDA with additional data and information in advance of the sNDA submission in August 2026.

We intend to request Priority Review at the time of submission of the sNDA, which, if granted, would result in a Prescription Drug User Fee Act target action date of approximately six months following the FDA’s receipt of the application.

Phase 3 SENTRY Trial Topline Results

On March 24, 2026, we announced topline results from the SENTRY Trial in which patients were randomized 2:1 to 60 mg of selinexor once weekly plus ruxolitinib or placebo plus ruxolitinib.

The ruxolitinib dose was determined based on the patients’ baseline platelet count per the drug’s prescribing information.

The SENTRY Trial met the first co-primary endpoint, demonstrating statistically significant improvement in spleen volume reduction of 35% or more for patients treated with the combination of selinexor plus ruxolitinib, with rapid, deep and sustained spleen volume reduction rates seen in the combination arm, but did not meet its second co-primary endpoint in absolute total symptom score.

The SENTRY Trial met the first co-primary endpoint, demonstrating statistically significant improvement in SVR35 for patients treated with the combination of selinexor plus ruxolitinib, with rapid, deep and sustained spleen volume reduction rates seen in the combination arm, but did not meet its second co-primary endpoint in absolute total symptom score.

The mean change in absolute total symptom score at week 24 relative to baseline was comparable across the two arms with similar symptom improvement relative to baseline;

the difference across the two arms was not statistically significant.

In addition, a promising overall survival signal was observed in the topline data, which further reinforces the relevance of XPO1 inhibition in combination with ruxolitinib in frontline myelofibrosis.

addition, a promising overall survival signal was observed in the topline data, which further reinforces the relevance of XPO1 inhibition in combination with ruxolitinib in frontline myelofibrosis.

Further, a greater proportion of patients on the combination arm compared to ruxolitinib alone experienced reductions in variant allele frequency, which may be indicative of an underlying effect on disease biology, raising the potential for disease modification.

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No new safety signals were observed.

Our key near term objectives in advancing our SENTRY program include:

engagement with the U.S.

Food and Drug Administration (“FDA”) to discuss the data from the SENTRY Trial and our supplemental new drug application filing plan;

disclosure of additional data from the Phase 3 SENTRY Trial at an upcoming medical meeting;

and potential inclusion of the combination in relevant compendia, which could occur in the second half of 2026.

Other Clinical Trial Updates

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We expect to report topline data from all patients in the 60 mg cohort with at least 24 weeks of follow-up in the second half of 2026.

We have completed enrollment of our global, Phase 3, randomized, double-blind trial evaluating selinexor as a maintenance-only therapy following systemic therapy in patients with TP53 wild-type advanced or recurrent endometrial cancer (the “XPORT-EC-042 Trial”).

Approximately 220 patients enrolled in the modified intent-to-treat (“mITT”) population and 257 enrolled in the intent-to-treat population.

Enrollment in the mITT population was focused on patients with either proficient mismatch repair status tumors or patients with deficient mismatch repair status tumors who are medically ineligible for checkpoint inhibitors.

We expect to report topline data from this event-driven trial in mid-2026.

Patients enrolled in a randomized global Phase 3 trial sponsored by the European Myeloma Network evaluating an all-oral combination of selinexor 40 mg in combination with pomalidomide and dexamethasone versus elotuzumab, pomalidomide, and dexamethasone in patients with previously treated multiple myeloma who received an anti-CD38 in their immediate prior line of therapy (the “EMN29 Trial”).

The patients enrolled in this event-driven trial continued to be followed for progression-free survival events contributing towards the primary endpoint.

We expect to report topline data from the EMN29 Trial in the second half of 2026.

We expect to report topline data from this event-driven trial in the second half of 2026.

In March 2026, we met with the FDA regarding the Accelerated Approval of the Diffuse Large B-Cell Lymphoma (“DLBCL”) indication of XPOVIO, which was granted on June 22, 2020 for the treatment of adult patients with relapsed or refractory DLBCL, not otherwise specified, including DLBCL arising from follicular lymphoma, after at least two lines of systemic therapy.

The FDA requested and we agreed to voluntarily withdraw the accelerated approval of the DLBCL indication in light of the infeasibility of completing the confirmatory trial, especially considering the evolving treatment landscape, including the availability of new therapeutic options.

As a result, we expect to terminate our ongoing company-sponsored trials in this indication.

As a result, we are in the process of terminating our ongoing company-sponsored trials in this indication.

This withdrawal is not due to safety concerns with the DLBCL indication and does not affect the regulatory approval of any other indications for XPOVIO.

Business and Financial Updates

We expect our existing liquidity, including cash, cash equivalents and investments, as well as cash flow from net product revenue and license and other revenue, will enable us to fund our current operating plans into September 2026.

With the assistance of our advisors, including our financial advisor Centerview Partners and other advisors, we are actively evaluating a range of financing opportunities and strategic alternatives with the objective of extending our cash runway, preserving strategic flexibility and maximizing long-term shareholder value as we advance our myelofibrosis program.

On September 10, 2026, a $15.8 million principal payment is due under our senior secured term loan facility;

if this payment is made without additional financing or a waiver from our lenders, we expect that (i) our cash, cash equivalents and investments will fall below our $10.0 million minimum liquidity covenant, which would trigger a default on our term loan and (ii) we will not have sufficient resources to fund our operations following such payment.

In addition to the $15.8 million principal payment due on September 10, 2026, we have approximately $10.1 million of aggregate interest payments due on September 30, 2026 under our senior secured term loan, 2028 Notes and 2029 Notes, all as defined below.

Our ability to successfully consummate a financing transaction or execute on a strategic alternative is dependent on a number of factors.

There is no assurance that these efforts will result in additional funding, executing a strategic alternative transaction, will increase value for stakeholders, or will sufficiently address our ability to continue as a going concern.

On February 27, 2026, we entered into the Second Amendment to Credit and Guaranty Agreement (the “Amendment”) with the lenders party thereto and Wilmington Savings Fund Society, FSB, as administrative agent and collateral agent, which amended our Credit and Guaranty Agreement, dated May 8, 2024 (as previously amended, the “Credit Agreement”).

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The Capital Raise Trigger was satisfied and the Forbearance Agreement became effective in March 2026 upon receipt of the proceeds from the Private Placement (as defined below).

Under the Amendment and the Forbearance Agreement, we can defer certain principal and interest payments until September 2026 and the Consenting Parties agreed not to exercise certain rights and remedies with respect to specified matters, including:

(i) payment-related defaults through September 30, 2026 that would result from our non-payment of the interest due on June 30, 2026 for the New 2029 Notes and 2028 Notes and (ii) any defaults that result from a requirement under the indentures of the New 2029 Notes and 2028 Notes for us to have a Minimum Liquidity Covenant Amount greater than the lesser of (i) $10.0 million plus 50% of the net cash proceeds received from certain debt and equity issuances and (ii) $25.0 million through October 10, 2026.

Under the Amendment and the Forbearance Agreement, certain principal and interest payments were deferred until September 2026 and the Consenting Parties agreed not to exercise certain rights and remedies with respect to specified matters, including:

(i) payment-related defaults through September 30, 2026 that would result from our non-payment of the interest due on June 30, 2026 for the New 2029 Notes and

2028 Notes and (ii) any defaults that result from a requirement under the indentures of the New 2029 Notes and 2028 Notes for us to have a Minimum Liquidity Covenant Amount greater than the lesser of (i) $10.0 million plus 50% of the net cash proceeds received from certain debt and equity issuances and (ii) $25.0 million through October 10, 2026.

After October 10, 2026, the minimum liquidity covenant will require minimum consolidated liquidity of $25.0 million.

See “ Liquidity, Capital Resources and Going Concern ” below for a further discussion of our liquidity and our need to raise additional capital.

On March 24, 2026, we entered into a Securities Purchase Agreement with RA Capital Healthcare Fund, L.P.

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(i) 1,030,354 shares of common stock, (ii) pre-funded warrants to purchase up to 3,391,164 shares of common stock, and (iii) accompanying warrants to purchase 4,421,518 shares of common stock with an exercise price of $10.00 per share (the “2026 Warrants”) for aggregate net proceeds of $26.9 million.

The 2026 Warrants are exercisable until 30 days following our public announcement of topline data results from our Phase 3 XPORT-EC-042 clinical trial of selinexor in patients with endometrial cancer and the pre-funded warrants do not expire.

As of March 31, 2026, none of these warrants have been exercised.

The 2026 Warrants are exercisable until August 29, 2026 and the pre-funded warrants do not expire.

As of June 30, 2026, none of these warrants have been exercised.

In addition, in March 2026, we issued and sold an aggregate of 2,994,441 shares of Common Stock under our Open Market Sale Agreement SM , by and between us and Jefferies LLC, dated February 17, 2023 for total proceeds, net of sales commissions, of approximately $19.8 million.

As of March 31, 2026, we had an accumulated deficit of $1.8 billion.

We had operating losses of $26.8 million and $33.3 million for the three months ended March 31, 2026 and 2025, respectively.

We recognized total revenue of $35.1 million and $30.0 million for the three months ended March 31, 2026 and 2025, respectively, including $29.2 million and $21.1 million of XPOVIO net product revenue, respectively, and $5.9 million and $9.0 million of license revenue, respectively.

As of March 31, 2026, we had $90.9 million in cash and cash equivalents.

Based on our current business plan and current capital resources, combined with the uncertainty regarding the availability of additional funding or other strategic alternatives and considering our debt service obligations and financial covenant to maintain minimum liquidity, we have concluded that there is substantial doubt regarding our ability to continue as a going concern within one year after the date the accompanying consolidated financial statements are issued.

As of June 30, 2026, we had an accumulated deficit of $1.8 billion.

We had operating losses of $49.3 million and $57.6 million for the six months ended June 30, 2026 and 2025, respectively.

We recognized total revenue of $68.5 million and $67.9 million for the six months ended June 30, 2026 and 2025, respectively, including $59.9 million and $50.7 million of XPOVIO net product revenue, respectively, and $8.6 million and $17.2 million of license revenue, respectively.

As of June 30, 2026, we had $65.1 million in cash, cash equivalents, and investments.

See “ Liquidity, Capital Resources, and Going Concern ” below for a further discussion of our liquidity and the conditions that raise substantial doubt regarding our ability to continue as a going concern.

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The following table summarizes our results of operations (in thousands, except for percentages):

For the Three Months Ended March 31,

For the Three Months Ended June 30,

For the Six Months Ended June 30,

Product revenue, net

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Loss from operations

Other income, net

Other expense, net

Loss before income taxes

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Product Revenue, net (in thousands, except for percentages)

For the Three Months Ended March 31,

For the Three Months Ended June 30,

For the Six Months Ended June 30,

Product revenue, net

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sales of XPOVIO.

Net product revenue for the three months ended March 31, 2026 increased by $8.1 million compared to the same period in 2025.

This increase was primarily attributable to an unusually high product return reserve recorded in the prior-year period, which reduced net revenue in that period, as well as lower gross-to-net discounts, specifically a decrease in chargebacks and Medicare rebate reserve in the first quarter of 2026 compared to the first quarter of 2025.

Net product revenue for the three months ended June 30, 2026 remained relatively consistent as compared to the three months ended June 30, 2025, reflecting relatively consistent demand for XPOVIO in an increasingly competitive multiple myeloma marketplace.

Net product revenue for the six months ended June 30, 2026 increased by $9.2 million compared to the six months ended June 30, 2025.

This increase was primarily attributable to an unusually high product returns reserve recorded during the six months ended June 30, 2025, which reduced net revenue in the prior-year period.

The increase was also driven by lower gross-to-net deductions, primarily due to lower chargebacks and a reduction in the Medicare rebate reserve during the six months ended June 30, 2026 compared to the prior-year period.

License and Other Revenue (in thousands, except for percentages)

For the Three Months Ended March 31,

For the Three Months Ended June 30,

For the Six Months Ended June 30,

Menarini Group (“Menarini”)

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Total license and other revenue

License and other revenue for the three months ended March 31, 2026 decreased by $3.1 million as compared to the three months ended March 31, 2025, primarily due to a decrease of $7.0 million of reimbursement revenue from Menarini for development-related expenses as their obligation to reimburse us expired on December 31, 2025.

This decrease was partially offset by an increase in milestone-related revenue from our other partners in the three months ended March 31, 2026, primarily due to a $3.5 million milestone payment under a licensing agreement with a privately-held biotech company related to the research, development and commercialization of verdinexor for the treatment of cancer in certain animals.

We expect license and other revenue to decrease in the second quarter of 2026 as compared to the first quarter of 2026, as we do not anticipate recognizing any milestone-related revenue.

License and other revenue for the three months ended June 30, 2026 decreased by $5.6 million compared to the three months ended June 30, 2025, primarily due to a $6.5 million decrease in reimbursement revenue from Menarini for development-related expenses following the expiration of its reimbursement obligation on December 31, 2025.

This decrease was partially offset by a $0.9 million increase in royalty revenue from our partners.

License and other revenue for the six months ended June 30, 2026 decreased by $8.7 million as compared to the six months

ended June 30, 2025, primarily due to a decrease of $13.5 million of reimbursement revenue from Menarini for development-related expenses following the expiration of its reimbursement obligation on December 31, 2025.

This decrease was partially offset by higher milestone and royalty revenue, including a $3.5 million milestone payment under a licensing agreement with a privately held biotechnology company related to the research, development and commercialization of verdinexor for the treatment of cancer in certain animals, as well as a $1.2 million increase in royalty revenue from our partners.

Operating Expenses (in thousands, except for percentages)

For the Three Months Ended March 31,

For the Three Months Ended June 30,

For the Six Months Ended June 30,

Cost of sales

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Cost of Sales

Cost of sales for the three months ended March 31, 2026 and 2025 were relatively consistent.

Cost of sales for the three and six months ended June 30, 2026 and 2025 were relatively consistent.

Research and Development Expenses (in thousands, except for percentages)

For the Three Months Ended March 31,

For the Three Months Ended June 30,

For the Six Months Ended June 30,

Clinical trial and related costs:

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We track our external clinical trial and related costs on a program-by-program basis.

Our major programs include our lead clinical programs in myelofibrosis and endometrial cancer and our other late-stage clinical program in multiple myeloma.

Our major programs reported in the table above include our clinical programs in myelofibrosis, endometrial cancer and multiple myeloma.

To the extent that external clinical trial and related costs are not attributable to a major program, they are included in “ Other programs ” and to the extent external clinical trial and related costs cannot be allocated to a specific program, they are included in “ Non-program specific clinical trial and related costs .” We also have unallocated research and development costs, which we do not track on a program-by-program basis.

These costs represent expenses incurred across multiple programs or to support our general research and development operations.

Research and development expenses for the three months ended March 31, 2026 were relatively consistent as compared to the three months ended March 31, 2025.

If the topline data of our trials is positive or we are able to submit a supplemental New Drug Application (“sNDA”), we expect our research and development expenses will increase, primarily due to costs associated with regulatory filings.

Research and development expenses for the three and six months ended June 30, 2026 decreased by $3.8 million and $4.7 million, respectively, as compared to the three and six months ended June 30, 2025.

The decreases were driven by our continued

prioritization, focus, and efficient spending while advancing our late-stage programs, with our Phase 3 trials having completed enrollment.

Research and development expenses for our multiple myeloma program decreased by $1.8 million and $2.0 million for the three and six month periods, respectively, mainly driven by timing of comparator drug expenses related to the EMN29 trial.

The decrease in our myelofibrosis program expenses was primarily driven by the SENTRY Trial transitioning from enrollment to the maintenance phase, resulting in lower trial site and patient-related costs of $1.1 million and $1.5 million for the three and six month periods, respectively.

We expect research and development expenses to remain relatively consistent as we continue to balance the near-term requirements of our ongoing programs with actions intended to materially reduce our cost base and advance our most important near-term value drivers in myelofibrosis.

Selling, General and Administrative Expenses (in thousands, except for percentages)

For the Three Months Ended March 31,

For the Three Months Ended June 30,

For the Six Months Ended June 30,

Personnel costs

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Total selling, general and administrative expenses

Selling, general and administrative expenses for the three months ended March 31, 2026 were relatively consistent as compared to the three months ended March 31, 2025.

If the anticipated topline data of our trials in 2026 is positive or we are able to submit a sNDA, we expect that our selling, general administrative expenses will increase, primarily due to launch preparation costs.

Selling, general and administrative expenses for the three and six months ended June 30, 2026 decreased by $2.6 million and $3.2 million, respectively, as compared to the three and six months ended June 30, 2025.

The decreases were primarily driven by proactive cost containment while maintaining disciplined alignment of pre-launch investments with clinical and regulatory milestones.

In the near term, we expect selling, general and administrative expenses to increase due to incremental professional advisory fees related to our ongoing liquidity and strategic initiatives, as well as targeted retention costs intended to support organizational continuity and execution during this pivotal period.

Other Income (Expense), net (in thousands, except for percentages)

For the Three Months Ended March 31,

For the Three Months Ended June 30,

For the Six Months Ended June 30,

Interest expense

Interest income

Other income, net

Total other income, net

Total other income, net for the three months ended March 31, 2026 decreased as compared to the three months ended March 31, 2025 by $5.5 million.

The decrease was primarily due to the fair value remeasurement of embedded derivatives and liability-classified common stock warrants, both of which are non-cash items.

Other (expense) income, net

Total other expense, net

Total other expense, net for the three and six months ended June 30, 2026 increased by $31.7 million and $37.1 million, respectively, as compared to the three and six months ended June 30, 2025 .

The increases were primarily due to the fair value remeasurement of embedded derivatives and liability-classified common stock warrants, both of which are non-cash items.

There was also an increase in interest expense due to an increase to the interest rate in October 2025 on our senior secured term loan facility and convertible debt.

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and (vii) business development activities.

As of March 31, 2026, our principal source of liquidity was $90.9 million of cash and cash equivalents.

We have had recurring losses since inception and incurred an operating loss of $26.8 million for the three months ended March 31, 2026.

As of June 30, 2026, our principal source of liquidity

was $65.1 million of cash, cash equivalents, and investments.

We have had recurring losses since inception and incurred an operating loss of $49.3 million for the six months ended June 30, 2026.

We anticipate that we will continue to incur significant operating losses in the foreseeable future.

Based on our current business plan and current capital resources, combined with the uncertainty regarding the availability of additional funding or other strategic transactions and considering our debt service obligations and financial covenant to maintain minimum liquidity, we have concluded that there is substantial doubt regarding our ability to continue as a going concern within one year after the date the accompanying condensed consolidated financial statements are issued.

We expect that our existing liquidity, including cash and cash equivalents as of March 31, 2026 as well as cash flow from net product revenue and license and other revenue, will enable us to fund our current operating plans to late in the third quarter of 2026.

We expect that our existing liquidity, including cash, cash equivalents, and investments as well as cash flow from net product revenue and license and other revenue, will enable us to fund our current operating plans into September 2026.

On September 10, 2026, a $15.8 million principal payment is due under our senior secured term loan facility;

See “ Liquidity and Capital Resources – Funding Requirements ” below and Note 1 “ Nature of Business, Basis of Presentation and Segment Information ” to the condensed consolidated financial statements included under Part I, Item 1 of this Quarterly Report on Form 10-Q for a further discussion of our liquidity and the conditions that raise substantial doubt regarding our ability to continue as a going concern.

The following table provides information regarding our cash flows (in thousands):

For the Three Months Ended March 31,

For the Six Months Ended June 30,

Net cash used in operating activities

Net cash provided by investing activities

Net cash (used in) provided by investing activities

Net cash provided by financing activities

Effect of exchange rates on cash, cash equivalents and restricted cash

Net increase (decrease) in cash, cash equivalents and restricted cash

Net decrease in cash, cash equivalents and restricted cash

Operating activities.

Net cash used in operating activities decreased by $16.3 million for the three months ended March 31, 2026 compared to the three months ended March 31, 2025, primarily due to a $7.3 million decrease in interest and royalty payments as a result of certain debt modifications which occurred in October 2025.

Net cash used in operating activities decreased by $10.0 million for the six months ended June 30, 2026 compared to the six months ended June 30, 2025, primarily due to a decrease in interest and royalty payments in 2026 as a result of certain debt modifications which occurred in October 2025.

Investing activities.

Net cash provided by investing activities decreased by $12.1 million for the three months ended March 31, 2026 compared to the three months ended March 31, 2025, primarily due to lower proceeds from maturities of investments as a result of a lower investment balance in the three months ended March 31, 2026.

Net cash provided by investing activities decreased by $40.4 million for the six months ended June 30, 2026 compared to the six months ended June 30, 2025, primarily due to lower proceeds from maturities of investments as a result of a lower investment balance between periods as well as increased purchases of investments during the six months ended June 30, 2026 due to the cash inflows from the financing activities described below.

Financing activities .

Net cash provided by financing activities increased by $49.8 million for the three months ended March 31, 2026 compared to the three months ended March 31, 2025, primarily due to the proceeds from the issuance of common stock during the three months ended March 31, 2026 under our Private Placement and Open Market Sale Agreement, as described in further detail under the heading “ Sources of Liquidity ”.

Net cash provided by financing activities increased by $48.5 million for the six months ended June 30, 2026 compared to the six months ended June 30, 2025, primarily due to the proceeds from the issuance of common stock during the six months ended June 30, 2026 under our Private Placement and Open Market Sale Agreement, as described in further detail under the heading “ Sources of Liquidity ”.

Sources of Liquidity

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(i) 1,030,354 shares of common stock, (ii) pre-funded warrants to purchase up to 3,391,164 shares of common stock, and (iii) accompanying 2026 Warrants to purchase 4,421,518 shares of common stock with an exercise price of $10.00 per share for aggregate net proceeds of $26.9 million.

As of March 31, 2026, none of these warrants have been exercised.

The 2026 Warrants are exercisable until August 29, 2026 and the pre-funded warrants do not expire.

As of June 30, 2026, none of these warrants have been exercised.

In October 2025, we entered into a securities purchase agreement with certain institutional investors to which we issued and sold, in a private placement, (i) 1,487,917 shares of common stock and (ii) accompanying warrants to purchase 1,317,771 shares of common stock at an exercise price of $6.64 per share.

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The 2028 Notes will mature on October 15, 2028, unless earlier converted, redeemed or repurchased in accordance with their terms.

In September 2019, we and certain of our subsidiaries entered into the Revenue Interest Financing Agreement with certain entities managed by HCRx, which was subsequently amended on June 23, 2021, August 1, 2023, May 8, 2024, August 14, 2025, August 27, 2025 and October 7, 2025 and which was assigned in July 2025 by HCRx to KKR in connection with its acquisition of a majority ownership stake in HCRx (the “Revenue Interest Agreement” and, as amended, the “Amended Revenue Interest Agreement”), pursuant to which, HCRx paid us a total of $135.0 million, less certain transaction expenses.

in connection with its acquisition of a majority ownership stake in HCRx (the “Revenue Interest Agreement” and, as amended, the “Amended Revenue Interest Agreement”), pursuant to which, HCRx paid us a total of $135.0 million, less certain transaction expenses.

On October 7, 2025, we entered into the Sixth Amendment to the Revenue Interest Financing Agreement pursuant to which (i) HCRx waived our obligation to pay royalties on revenue recognized between April 1, 2025 and March 31, 2026 and (ii) we agreed to increase the Applicable Tiered Percentage (as defined in the Amended Revenue Interest Agreement ) to 8.00% beginning on April 1, 2026.

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For additional information, see Note 10, “ Long-Term Obligations ”, to the condensed consolidated financial statements included under Part I, Item 1 of this Quarterly Report on Form 10-Q.

In May 2024, we entered into a credit and guaranty agreement (the “Credit Agreement”) with certain existing lenders and HCRx, which was subsequently assigned by HCRx to KKR in connection with its acquisition of a majority ownership stake in HCRx in July 2025, which provides for a senior secured term loan facility of $100.0 million (the “Term Loan”).

In May 2024, we entered into a credit and guaranty agreement (the “Credit Agreement”) with certain existing lenders and HCRx, which provides for a senior secured term loan facility of $100.0 million (the “Term Loan”).

On October 7, 2025, we entered into the First Amendment and Waiver to Credit and Guaranty Agreement, pursuant to which, among other things, the lenders provided $12.5 million principal amount of additional loans (the “Amended Term Loan”).

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The amendments to the Credit Agreement include, among other things (i) reducing the financial covenant requiring us to maintain liquidity of at least the lesser of (i) $10.0 million plus 50% of the net cash proceeds received from certain debt and equity issuances and (ii) $25.0 million, through October 10, 2026, after which we will be required to maintain liquidity of at least $25.0 million and (ii) increasing the interest rate on borrowings under the Amended Term Loan to the secured overnight financing rate plus 10.25% for interest payments occurring after June 30, 2025.

Interest on borrowings under the Amended Term Loan incurred from July 1, 2025 to March 31, 2026 were paid in kind.

Interest on borrowings incurred from April 1, 2026 to June 30, 2026 will be paid in kind on June 30, 2026 and cash interest payments will begin on September 30, 2026.

Interest on borrowings under the Amended Term Loan incurred from July 1, 2025 to June 30, 2026 were paid in kind and we are obligated to make cash interest payments beginning on September 30, 2026.

For additional information, see Note 10, “ Long-Term Obligations ”, to the condensed consolidated financial statements included under Part I, Item 1 of this Quarterly Report on Form 10-Q.

In February 2023, we entered into an Open Market Sale Agreement (the “Open Market Sale Agreement”) with Jefferies LLC, as agent (“Jefferies”).

Under the Open Market Sale Agreement, we may issue and sell shares of our common stock having an aggregate

offering price of up to $100.0 million (the “Shares”) from time to time through Jefferies.

During the three months ended March 31, 2026, we sold an aggregate of 2,994,441 Shares under the Open Market Sale Agreement, resulting in net proceeds of $19.8 million.

We did not sell any Shares under the Open Market Sale Agreement during the three months ended March 31, 2025.

As of March 31, 2026, $79.8 million of Shares was available for issuance and sale under the Open Market Sale Agreement.

During the three months ended March 31, 2026, we received $3.5 million in milestone payments under our license and distribution agreements pursuant to which we are entitled to receive additional milestone payments, if certain development goals and sales milestones are achieved as well as royalties on future net sales of the licensed and sold products in the territories under such arrangements.

Under the Open Market Sale Agreement, we may issue and sell shares of our common stock having an aggregate offering price of up to $100.0 million (the “Shares”) from time to time through Jefferies.

During the six months ended June 30, 2026, we sold an aggregate of 2,994,441 Shares under the Open Market Sale Agreement, resulting in net proceeds of $19.8 million.

We did not sell any Shares under the Open Market Sale Agreement during the six months ended June 30, 2025.

Pursuant to a prospectus we thereafter filed with the SEC as part of a registration statement on Form S-3 on May 4, 2026, as of June 30, 2026, $100.0 million of Shares were available for issuance and sale under the Open Market Sale Agreement.

During the six months ended June 30, 2026, we received $3.5 million in milestone payments under our license and distribution agreements pursuant to which we are entitled to receive additional milestone payments, if certain development goals and sales milestones are achieved as well as royalties on future net sales of the licensed and sold products in the territories under such arrangements.

Commitments, Contingencies and Contractual Obligations

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Funding Requirements

We expect to continue to incur costs related to our clinical development programs as we continue to advance our lead clinical programs in myelofibrosis and endometrial cancer and our other late-stage clinical program in multiple myeloma, as well as commercialization expenses related to sales, marketing, manufacturing and distribution of our approved products, to the extent that these functions are not the responsibility of our collaborators.

Identifying potential product candidates and conducting preclinical studies and clinical trials is a time-consuming, expensive and uncertain process that takes years to complete.

In addition, our product candidates for which we receive marketing approval may not achieve commercial success.

We expect to continue to incur costs related to our clinical development programs as we continue to advance our clinical programs in myelofibrosis and multiple myeloma, as well as costs associated with continued patient follow-up and other wind-down activities related to our endometrial cancer clinical trial.

We also expect to incur commercialization expenses related to sales, marketing, manufacturing and distribution of our approved products, to the extent that these functions are not the responsibility of our collaborators.

Our ability to become and remain profitable depends on our ability to generate revenue.

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Adequate additional financing may not be available to us on acceptable terms, or at all.

We may seek additional capital due to favorable market conditions or strategic considerations, even if we believe we have sufficient funds for our current or future operating plans.

If we are unable to raise capital when needed or on attractive terms, we would be forced to delay, reduce or eliminate our research and development programs or commercialization efforts.

See Note 1 “ Nature of Business, Basis of Presentation and Segment Information ” to the condensed consolidated financial statements included under Part I, Item 1 of this Quarterly Report on Form 10-Q for a further discussion of the conditions that raise substantial doubt regarding our ability to continue as a going concern.

We currently expect that our existing liquidity, including cash and cash equivalents as well as cash flow from net product revenue and license and other revenue, will enable us to fund our current operating plans to late in the third quarter of 2026.

We will require additional capital to fund the ongoing clinical development of selinexor and other product candidates and to pursue potential regulatory approvals.

We plan to address the conditions that raise substantial doubt regarding our ability to continue as a going concern by, among other things, obtaining additional funding through equity offerings, debt financings and refinancings, collaborations, strategic alliances and/or licensing arrangements.

We expect to evaluate opportunities to raise additional funds from time to time, including through the issuance and sale of shares of our common stock under our Open Market Sale Agreement and in

connection with the reporting of data from our ongoing Phase 3 XPORT-EC-042 trial.

There is no assurance that such additional financing or strategic alternatives will be available on terms acceptable to us, or at all.

Our ability to successfully raise additional funds or execute on a strategic alternative is dependent on a number of factors.

If we are not able to successfully consummate a financing transaction or strategic alternative, our Board may explore a sale of assets or the initiation of bankruptcy proceedings under Chapter 11 of the U.S.

Bankruptcy Code.

On September 10, 2026, a $15.8 million principal payment is due under our senior secured term loan facility;

In addition, prior to October 10, 2026, the minimum liquidity covenant will increase by 50% of the net cash proceeds of any issuance of debt or sale of capital stock up to a maximum amount of $25.0 million and will increase to $25.0 million on October 10, 2026.

We will require additional capital to fund our operations and clinical development of selinexor and to pursue regulatory approval of selinexor in myelofibrosis.

Our ability to successfully consummate a financing transaction or execute on a strategic alternative is dependent on a number of factors.

Absent additional funding or our ability to successfully complete one or more strategic transactions to extend our cash runway beyond September 10, 2026, we will be unable to continue as a going concern and we may have to consider seeking protection under the bankruptcy laws, liquidating our assets or ceasing our operations.

If we decide to seek protection under the bankruptcy laws, we expect that we would file for bankruptcy protection at a time that is earlier than when we would otherwise exhaust our cash resources.

In any of these circumstances, it is likely that investors will lose all or part of their investment.

If there remains substantial doubt about our ability to continue as a going concern, investors or other financing sources may be unwilling to provide funding to us on commercially reasonable terms, if at all.

Further, our indebtedness, as discussed under the risk factor titled “ Our indebtedness could limit cash flow available for our operations, expose us to risks that could adversely affect our business, financial condition and results of operations and impair our ability to satisfy our obligations under the Amended Term Loan, the Convertible Notes, or the Amended Revenue Interest Agreement ,” may be unattractive to potential sources of funding and strategic partners and may decrease our ability to consummate a financing transaction or enter into a strategic alternative.

Additionally, the negotiation and consummation of a financing transaction or strategic alternative may be costly and time-consuming.

Our future long-term capital requirements will depend on many factors, as described more fully in the risk factor entitled “ We will need additional funding or to enter into strategic alternatives to achieve our business objectives.

If we are unable to raise sufficient capital or to enter into strategic alternatives on acceptable terms to meet our needs, we may be forced to delay, reduce or eliminate our research and development programs and/or commercialization efforts ,” under the heading “Risk Factors ” in this Quarterly Report on Form 10-Q.

In addition to the expenses required to fund our operations described above, our funding requirements as of March 31, 2026 also include the following:

Our future long-term capital requirements will depend on many factors, as described more fully in the risk factor entitled “ We need additional funding or to enter into strategic alternatives to achieve our business objectives.

If we are unable to raise sufficient capital or to enter into strategic alternatives on acceptable terms to meet our needs, we may be forced to undertake additional cost reduction measures such as further reducing operating expenses, including through additional workforce reductions, delay, reduce or eliminate our research and development programs and/or commercialization efforts or at any time we may elect to or may be required to cease operations entirely, liquidate all or a portion of our assets, and/or seek protection under the U.S.

Bankruptcy Code, and you may lose all or part of your investment,” un der the heading “Risk Factors ” in this Quarterly Report on Form 10-Q.

In addition to the expenses required to fund our operations described above, our funding requirements as of June 30, 2026 also include the following:

• Lease costs for our headquarters in Newton, Massachusetts of $8.5 million through September 30, 2030;

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• Future obligations related to the New 2029 Notes of $138.3 million through May 13, 2029;

• Future royalty obligations to KKR under the Amended Revenue Interest Agreement of $116.2 million by October 1, 2035.

• Future royalty obligations to HCRx under the Amended Revenue Interest Agreement of $116.2 million by October 1, 2035.

Quantitative and Qualitati ve Disclosures About Market Risk.

We are exposed to market risk related to changes in interest rates.

We had cash and cash equivalents of $90.9 million as of March 31, 2026.

We had cash, cash equivalents, and investments of $65.1 million as of June 30, 2026.

Our primary exposure to market risk is interest rate sensitivity, which is affected by changes in the general level of U.S.

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Due to the short-term duration of our investment portfolio and the low risk profile of our investments, an immediate 100 basis point shift in interest rates would not have a material effect on the fair market value of our cash equivalents.

We do not believe our cash and cash equivalents have significant risk of default or illiquidity.

While we believe our cash and cash equivalents do not contain excessive risk, we cannot provide absolute assurance that in the future our investments will not be subject to adverse changes in securities at one or more financial institutions that are in excess of federally insured limits.

We do not believe our cash, cash equivalents, and investments have significant risk of default or illiquidity.

While we believe our cash, cash equivalents, and investments do not contain excessive risk, we cannot provide absolute assurance that in the future our investments will not be subject to adverse changes in securities at one or more financial institutions that are in excess of federally insured limits.

Given the potential instability of financial institutions, we cannot provide assurance that we will not experience losses on these deposits and investments.

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What changed 10-Q

Item 2. Management’s Discussion and Analysis