Syndax Pharmaceuticals, Inc. (SNDX) Q3 2026 Earnings Call Transcript

Operator: Good day, everyone, and welcome to the Syndax Third Quarter 2026 Earnings Conference Call. Today's call is being recorded. [Operator Instructions] At this time, I would like to turn the call over to Sharon Klahre, Head of Investor Relations at Syndax Pharmaceuticals.

Sharon Klahre: Thank you, operator. Welcome, and thank you all for joining us today for a review of Syndax's third quarter 2026 financial and operating results. I'm Sharon Klahre, and with me this afternoon to provide an update on the company's progress and discuss financial results are Michael Metzger, Chief Executive Officer; Steven Closter, Chief Commercial Officer; Dr. Nick Botwood, Head of R&D and Chief Medical Officer; and Keith Goldan, Chief Financial Officer. This call is accompanied by a slide deck that has been posted on the Investor page of the company's website. You can now turn to our forward-looking statements on Slide 2. Before we begin, I'd like to remind you that any statements made during this call that are not historical are considered to be forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Actual results may differ materially from those indicated by these statements as a result of various important factors, including those discussed in the Risk Factors section in the company's most recent quarterly report on Form 10-Q, as well as other reports filed with the SEC. Any forward-looking statements made represent our views as of today, November 2n, 2026, only. A replay of this call will be available on the company's website, www.syndax.com, following its completion. With that, I am pleased to turn the call over to Michael Metzger, Chief Executive Officer of Syndax.

Michael Metzger: Thank you, Sharon, and good afternoon, everyone. Let's start on Slide 3. Syndax delivered another strong quarter of commercial growth and pipeline momentum. Total revenue reached $83 million this quarter, up 82% year-over-year. Demand for both medicines is robust, and we are moving decisively towards profitability. Revuforj net revenue grew to $61 million in the third quarter, underscoring our market leadership in both relapsed/refractory NPM1 and KMT2A acute leukemia. Similar to prior quarters, we expect Revuforj to account for the vast majority, more than 80%, of the revenue for the class this quarter, a leading position we intend to carry forward. We achieved our seventh consecutive quarter of double-digit quarter-over-quarter Revuforj net revenue growth, driven by a 20% increase in new patients and an increasing number of patients resuming Revuforj after stem cell transplant. Notably, a growing number of both KMT2A and NPM1 patients are proceeding to transplant after receiving Revuforj. As patients pause treatment to receive a transplant, this creates a short-term headwind that will become a long-term tailwind as more patients resume therapy post-transplant, extending the average duration of therapy and driving durable growth for the franchise. Every indicator of Revuforj demand is positive. The latest data are clear. We continue to lead new menin inhibitor starts across every age group, including age groups where NPM1 is predominant. With an unmatched body of clinical trial and real-world evidence and 2 years of deep clinician experience in the commercial setting, we are confident Revuforj will remain the menin inhibitor of choice for all menin-dependent acute leukemias. The clinical impact of our medicine was showcased last week when Revuforj received the prestigious Best Product for Rare Orphan Diseases Award from the Galien Foundation, on the heels of being recognized by TIME as one of the best inventions of 2026. These awards are a testament to our leadership in menin inhibition and the profound difference we have made for patients with some of the most aggressive forms of acute leukemia. Looking ahead, multiple value-driving Revuforj milestones are on deck. As in prior years, Revuforj will have a leading presence at the American Society of Hematology, or ASH, annual meeting in December. New data will be presented from multiple clinical trials and real-world studies spanning the entire acute leukemia treatment continuum, including new front-line combination data that highlight the potential for our ongoing pivotal front-line trials to deliver transformative results. We remain well positioned to be the first to front-line with a menin inhibitor in an area of high unmet need and substantial commercial opportunity. With anticipated front-line indications, we expect Revuforj could exceed $2 billion in peak annual net revenue in the U.S. alone. Nearer term, we expect to publish Revuforj data in relapsed/refractory NUP98-rearranged acute leukemia in the fourth quarter. This landmark publication will inform clinical practice and could support guideline inclusion in a patient population with high unmet need. NUP98 rearrangements, estimated to be found in approximately 2% to 5% of AML cases, are associated with a poor prognosis and resistance to conventional therapies. No targeted treatments have been approved for these patients. As the first and only company to report clinical activity with a menin inhibitor in this subtype, we have a unique opportunity to pursue a guideline listing that could meaningfully expand the patient population treated with Revuforj. Turning to Niktimvo in chronic graft-versus-host disease, or cGVHD, Niktimvo net revenue grew to $67 million in the third quarter, up 47% year-over-year and 12% quarter-over-quarter. Our 50% share of Niktimvo net profit delivered $23 million in collaboration revenue, a meaningful contribution to our bottom line. Collaboration revenue to Syndax is now annualizing at over $90 million, and we expect it to keep growing as we further penetrate fourth- and third-line chronic GVHD. Positive results from the ongoing combination trials of Niktimvo in front-line chronic GVHD could set a new treatment paradigm and unlock another multibillion-dollar opportunity in the near-term. Beyond moving Revuforj and Niktimvo into earlier lines of treatment, we are advancing our mutant-selective, allosteric EGFR inhibitor for non-small cell lung cancer and our next-generation inhibitor for menin for myelofibrosis. Backed by compelling preclinical data and mechanistic insights, both molecules are on track to enter the clinic next year. Each brings a novel mechanism of action to diseases with high unmet need where we can efficiently generate clinical data that inform and derisk further development. We took our first 2 medicines from IND to FDA approval in about 5 years, and we will leverage that experience to bring innovation to new areas. With a pipeline of promising programs, world-class R&D capabilities and a solid financial position, Syndax is poised to deliver breakthroughs that improve outcomes for patients and build long-term value. Before I turn the call over to Steve, I want to sincerely thank Keith Goldan for his many contributions, including leading Syndax's financial and capital strategy during an important time in the company's history and spearheading numerous long-term growth initiatives. After more than 4 years at the company and over 30 years in the industry, Keith Goldan has decided to retire as Chief Financial Officer. I am pleased to welcome Aaron Ondrey as our new CFO effective Monday, November 9. Aaron brings extensive financial and operational leadership experience in biopharmaceutical companies, spanning financial management, corporate strategy and commercialization. I will now turn the call over to Steve to discuss our commercial results in more detail.

Steven Closter: Thank you, Michael, and starting with Revuforj on Slide 4. We delivered strong third quarter Revuforj results with double-digit quarter-over-quarter growth across all key demand metrics and growing commercial momentum. Net revenue totaled $61 million, up 90% year-over-year and 11% quarter-over-quarter. We expect Revuforj to account for the vast majority of all menin inhibitor sales this quarter, highlighting our position as the clear market leader in menin now and well into the future. Total prescriptions were approximately 1,700, up 13% quarter-over-quarter, primarily driven by growth in new patients and an expanding number of patients on therapy in the post-transplant setting. Compared to Q3 of last year, prescription volume has doubled, highlighting the robust business we are building with multiple drivers. As we expected, new starts returned to growth with about 300 new patients this quarter, up approximately 20% quarter-over-quarter. This increase reflects growth in both new NPM1 and KMT2A patients and creates strong momentum heading into the end of this year. As highlighted on Slide 5, we estimate that about 50% of new Revuforj patients this quarter were NPM1 patients. Between the new patients and those who started in prior quarters, we estimate our NPM1 business accounted for more than 35% of the $61 million in net revenue this quarter. That's up more than 30% of our net revenue last quarter. Importantly, claims and prescription data indicate we continue to have dominant share of all patients starting a menin inhibitor. Notably, Medicare data showed Revuforj accounted for the majority of new patients in the third quarter, as well as all prior quarters. This dataset provides a view of the split of new patients in an age group that is predominantly NPM1. Claims data also show we continue to have the dominant share of new patients in all age groups, not just the 65 and older group. Turning to the right side of the slide and the latest treatment patterns, as we add more NPM1 patients to our mix, we continue to see Revuforj used early in the relapsed/refractory treatment paradigm, and often in combination with other therapies. Claims data show 75% of use in the second and third line, and approximately 40% of use is in combination. Notably, we're observing robust transplant rates amongst both relapsed/refractory NPM1 and KMT2A patients treated with Revuforj. While 11% of NPM1 patients in our pivotal trial underwent a transplant following treatment with Revuforj, recent claims data indicate that about 40% of our NPM1 patients are proceeding to transplant, of which about 50% have resumed therapy afterward. The transplant rate observed with Revuforj is very encouraging and highlights the clinical value of having a medicine with a high overall response rate, or ORR. A high ORR is meaningful because it provides increased chance of being able to proceed to a stem cell transplant, the only potentially curative treatment for relapsed/refractory NPM1 and KMT2A patients. Notably, approximately 1 out of 2 NPM1 patients achieved an overall response in the pivotal trial of Revuforj, a result others have not matched. Importantly, the ORR observed with Revuforj was also clinically meaningful for patients who are not candidates to receive a transplant. Turning to KMT2A, claims data indicate that approximately 50% of KMT2A patients are proceeding to transplant, of which about 60% have resumed therapy afterward, up from about 50% last quarter. We expect the percentage resuming therapy will continue to increase as our colleagues in medical report additional evidence from the post-transplant setting in collaboration with leading treatment centers, building on the encouraging data presented at ASCO and EHA earlier this year. Over time, we expect that up to 70% to 80% of KMT2A patients will ultimately return to therapy for 1 to 2 years, based on feedback from thought leaders and our clinical trial and real-world experience. We expect the treatment patterns in relapsed/refractory NPM1 will be relatively similar to the patterns that we see in KMT2A. As the number of KMT2A and NPM1 patients on Revuforj in the post-transplant setting continues to stack, this will have a meaningful impact on the average duration of therapy and drive durable growth. The group of patients on Revuforj in the post-transplant setting is already averaging at least 9 months of therapy, with this duration expected to increase as we continue to follow patients over time. Importantly, we are also seeing encouraging trends among patients who do not receive a transplant after starting Revuforj. Over half of those patients stay on therapy for a significant period, with an average treatment duration of more than 7 months. Moving to Slide 6. We have an excellent commercial foundation to support continued growth in both our indications. Nearly 2 years after launch, our broad prescriber base continues to expand, including our activation of Tier 1 and Tier 2 accounts. More than 90% of these accounts have now ordered, up from 70% prior to the approval of Revuforj in NPM1. Overall, more than 620 accounts have ordered. That is up about 8% from the prior quarter, reflecting growing adoption at centers of all sizes, including community practices. Notably, claims data indicate Revuforj has a substantially larger prescriber base than the other approved menin inhibitor, and we continue to add more new prescribers and accounts each month than our competition, despite being on the market for twice as long. Patients have reliable access to Revuforj, with formulary coverage in place for nearly 100% of all covered lives for both indications. As we look ahead, we remain confident we will continue to lead this market and deliver for patients. Our conviction is underpinned by the strength of our product profile, the rapidly growing body of clinical trial and real-world evidence that differentiates Revuforj and the extensive experience and comfort physicians have built over the past 2 years with nearly 2,000 patients treated with commercial drug and hundreds more treated in clinical trials. Switching gears to Niktimvo on Slide 7. Niktimvo net revenue totaled $67 million in the third quarter, up 47% year-over-year and 12% quarter-over-quarter. This performance reflects strong and consistent new patient starts and solid persistency. More than 300 new patients were added, and about 6,350 infusions were administered in the third quarter. As experience with Niktimvo grows, physicians continue to report impressive activity in multiple organs, with particularly notable responses in the lung. We have captured about 1/3 of the third-line-plus chronic GVHD market with strong adoption in the fourth line and steadily increasing uptake in the third line, driven by a broad and productive prescriber base. Niktimvo is now annualizing at over $260 million and continues to track with the launch of Rezurock, which reached $500 million in annual U.S. net sales within the first 4 years of launch in the same indication. Niktimvo is well positioned for further growth with steadily increasing uptake in the third line and a profile that allows patients to stay on therapy for extended periods. With that, I will hand the call over to Nick to talk about our development programs.

Nicholas Botwood: Thank you, Steve, and I would like to start with revumenib, which is on Slide 8. We have made excellent progress advancing our lifecycle management program designed to unlock the full potential of revumenib. In partnership with leading researchers around the world, we continue to advance the pivotal front-line trials of revumenib and remain well positioned to be the first to deliver a menin inhibitor for newly diagnosed AML. Global site activation and patient enrollment is well established in these pivotal trials, informed by an extensive body of clinical evidence, allowing for optimization of our endpoint assumptions and other aspects of the study designs. We are also advancing an industry-leading portfolio of studies in partnership with clinicians at the forefront of menin research. These studies will provide important practice-informing and potentially guideline-enabling evidence across the acute leukemia treatment continuum and multiple patient populations with high unmet need. We will share the latest results from a number of these studies in the fourth quarter. The upcoming presentations will highlight the unique breadth and depth of clinical evidence supporting revumenib and the vast experience clinicians have established with our medicine. We expect new data in the fourth quarter across 3 key themes. First is the potential for revumenib to benefit patients earlier in the treatment paradigm. Second, the ability of revumenib to bring patients to transplant and its potential in the post-transplant setting. And third, real-world evidence supporting the effectiveness and safety of revumenib, particularly in combination therapy. So I would like to walk through each of these areas separately. So firstly, we expect new front-line combination data that will provide strong support for our ongoing pivotal front-line trials of revumenib. Updates from the BEAT AML and SAVE trials will provide additional evidence supporting the potential for revumenib in combination with venetoclax and a hypomethylating agent in NPM1 and KMT2A patients who are unfit to receive intensive chemotherapy. Notably, compared to the landmark BEAT AML data published in June, the upcoming analysis will have significantly longer follow-up and report outcomes in a larger cohort of patients. These updated data will build on the previously reported BEAT AML and SAVE data showing overall response rates approaching 90% and 100% MRD negativity among responders by flow cytometry, along with encouraging early survival data. Additionally, we will provide an update from our Phase I front-line trial of revumenib in combination with intensive chemotherapy in NPM1 and KMT2A patients. These data will build on the previously reported results showing high rates of remission and MRD negativity with the triplet, along with encouraging durability and tolerability. We also look forward to updated results from INTERCEPT. This is the first trial studying the use of a menin inhibitor as a so-called MRD eraser. A research area of high clinical interest, INTERCEPT explores using revumenib to intervene early at MRD or early relapse, rather than waiting for morphological relapse, which can trail rising MRD by 3 to 4 months in NPM1 patients. Results presented at ASH 2024 from the first 11 NPM1 patients were encouraging, 54% of patients achieved a reduction in MRD, including 36% who actually achieved MRD negativity. We anticipate the presentation of more mature data from a larger cohort in the fourth quarter. Positive results could support the use of revumenib to intervene earlier in the acute leukemia treatment journey. Now turning to the pre- and post-transplant setting, we will present results that highlight the relationship between the robust overall response rate observed with revumenib and its ability to enable a meaningful number of relapsed/refractory KMT2A and NPM1 patients to proceed to stem cell transplant. We also expect the first data from a Phase I multicenter trial evaluating revumenib as a post-transplant maintenance. This dataset will build on the encouraging data from MD Anderson presented at ASCO and EHA earlier this year. They reported a 2-year overall survival rate of 90% among heavily pretreated KMT2A, NPM1 and NUP98 patients who resumed revumenib post-transplant, nearly double the historical rate observed prior to the introduction of revumenib. And then additionally, we will expand the body of real-world evidence supporting clinical decision-making with new data from multiple centers. To date, Syndax is the first and only company to report real-world data supporting the effectiveness and safety of our menin inhibitor as a monotherapy or in combination with other therapies in NPM1, KMT2A and NUP98 patients with relapsed/refractory or MRD-positive disease. Previously reported results were encouraging. Those data showed high rates of response, MRD negativity and transplant, along with evidence of durable, ongoing remissions. Prior datasets also underscored revumenib's predictable and manageable safety profile, including in combination therapy. Turning to Slide 9 now and the other programs in our pipeline, in partnership with Incyte, we are advancing a robust lifecycle management program for axatilimab. Two trials of axatilimab in newly diagnosed chronic GVHD are underway. We now expect the top line results from the Phase II trial of axatilimab in combination with ruxolitinib to be reported at a medical meeting in the first quarter of 2027. The updated timing reflects the goal of presenting a mature and comprehensive dataset that includes not only the primary endpoint of overall response rate, but also key secondary measures such as event-free survival, which will be important for understanding the profile of the regimens. We expect top line results from the Phase 3 trial of axatilimab in combination with corticosteroids in early 2028. Both of these trials have the potential to impact the treatment paradigm for front-line chronic GVHD. We also recently published data from AGAVE-201 supporting the safety and feasibility of reduced frequency dosing of axatilimab in patients with recurrent or refractory chronic GVHD in Blood Advances. These data show that transition from axatilimab 0.3 mg/kg every 2 weeks to 0.6 mg/kg every 4 weeks was feasible and well tolerated. Patients had a long duration of therapy after the switch, with a median of 21 months, and 84% remained on treatment at data cutoff, suggesting ongoing clinical benefit. This is an important publication that provides physicians with evidence that can inform their treatment decisions. Turning now to our pipeline assets, SNDX-4321 and 62122. 4321 is a novel, mutant-selective, allosteric inhibitor in development for EGFR-mutated non-small cell lung cancer. 62122 is a next-generation menin inhibitor in development for myelofibrosis, or MF. Like revumenib and axatilimab, these assets have first- and best-in-class potential in areas of high unmet need. We expect both molecules to be in the clinic next year and remain on track to submit the IND for 4321 by the end of 2026 and the IND for 62122 next year. Both of these clinical development programs are designed to efficiently generate clinical data that could validate the target and the potential for these 2 approaches. Our development of 62122 will be supported by a Phase I/II proof-of-principle trial of revumenib in MF that we expect will initiate in the fourth quarter of 2026, with initial data anticipated in the second half of next year. This trial, conducted in partnership with a group of leading MF researchers, will be the first to explore the potential for menin inhibition in MF. With 4321, we expect to get the first assessment of monotherapy in lung cancer in early 2028. We look forward to sharing more details on both programs as we get closer to advancing into the clinic next year. So in summary, we are executing on a bold R&D vision that aims to deliver novel therapies that transform cancer care. With world-class R&D capabilities, strong partnerships with leading scientists and clinicians and the resources to drive innovation, I have great confidence we will deliver on this vision. With that, I will hand it over to Keith to discuss our financials.

Keith Goldan: Thanks, Nick. Earlier this afternoon, we reported detailed third quarter 2026 financial results, and I'll take -- I'll highlight a few key points on Slide 10. Total revenue for the third quarter of 2026 was $83.3 million, up 82% over the same period last year. Revuforj net revenue grew to $60.7 million, and Niktimvo collaboration revenue to $22.6 million. Looking ahead, we expect revenue from both medicines to continue growing and advancing the company towards profitability. The Niktimvo margin contribution, defined as collaboration revenue recorded by Syndax as a percentage of Niktimvo net sales, was approximately 34% this quarter. The margin this quarter was slightly benefited by the impact of a one-time, nonrecurring adjustment. But going forward, we do expect the margin contribution to be in the low-to-mid-30% range, an increase from the 25% to 30% range we guided to earlier in the launch. Our guidance for total R&D plus SG&A expenses for 2026 remains approximately $400 million, excluding the impact of $50 million in estimated noncash stock compensation expense. We ended the third quarter in a strong cash position with $551 million in cash, equivalents and investments and growing revenue from 2 medicines. We are fully funded to execute our commercial and R&D priorities, including the front-line trials of revumenib and axatilimab, as well as the development of our earlier pipeline assets just highlighted by Nick. With relatively modest investments in proof-of-principle trials of SNDX-4321 and 62122, we believe we can quickly generate meaningful clinical data that creates significant value for the company. And with that, I will hand the call back to Michael for closing remarks.

Michael Metzger: Thank you, Keith. Moving to Slide 11. Syndax is positioned to deliver breakthroughs in cancer care that create long-term value for patients and shareholders. Our first 2 medicines are improving patient outcomes and generating meaningful revenue to fuel our R&D engine and advance us towards profitability. Revuforj is the market leader in relapsed/refractory NPM1 and KMT2A acute leukemia. A growing number of patients we treat are reaching transplant and resuming therapy afterwards, creating a foundation for durable franchise growth. Our next ambition is clear: be first to front-line AML and establish Revuforj as the menin inhibitor of choice across the acute leukemia treatment continuum. At ASH in December, we will showcase an unmatched and rapidly expanding body of clinical evidence supporting that ambition. Niktimvo is poised to drive continued growth and contribute meaningfully to our bottom line. Beyond that, 2 ongoing trials in newly diagnosed chronic GVHD could redefine the treatment paradigm and unlock a new multibillion-dollar opportunity. We are working to realize that potential. We are just getting started. Our proven R&D engine, strong financial position and 2 innovative pipeline assets entering the clinic next year position Syndax for long-term value creation as we deliver on the milestones shown on Slide 12. Our focus is also clear: deliver first- and best-in-class medicines, address major unmet needs and build shareholder value. To the patients, clinicians, Syndax team members and everyone who has supported our work, thank you. You have helped bring 2 much-needed medicines to thousands of patients. That progress is our foundation, not our finish line, and we are ready to build on that momentum. I'll now open up for questions.

Operator: [Operator Instructions] Our first question comes from Anupam Rama with JPMorgan.

Unknown Analyst: This is [ Dilp Dales ] for Anupam Rama at JPMorgan. We have 2 quick questions. Number one, you mentioned a 50% to 60% rate of patients with KMT2 (sic) [ KMT2A ] and NPM1 AML who are resuming treatment after transplant. We are curious about what you are seeing in this patient population. And question number two, what are your expectations for the upcoming first-line combo data readout from the BEAT AML and SAVE trials?

Michael Metzger: Thanks for the questions. So first question, we are in fact seeing very nice resumption of therapy post-transplant, which is something that we have talked about repeatedly. 50% of the patients who have KMT2A and gone to transplant, 60% of them are now getting maintenance. And so that's an increase from last quarter. And where we expect it to go, 70% to 80% at maturity, that seems to be very much within our reach. So that's a very positive driver of growth for us. And actually in this quarter, we have seen NPM1 grow from a transplant rate which was much lower, we believe, to now 40% with 50% of patients resuming with maintenance. And that, of course, is a new phenomenon, something that we have seen and are very encouraged by, especially because NPM1 patients are generally older, and this would lead to longer duration of therapy, perhaps. And that is a very encouraging second driver of growth for the business long-term. So very encouraging overall. And let me turn it over to Nick. Maybe we will talk about the front-line, combo and what to necessarily expect.

Nicholas Botwood: Yes, thank you for the question. We are anticipating presenting a number of front-line data in the fourth quarter. I think you were particularly interested in the BEAT and the SAVE data, so these are combinations with venetoclax and hypomethylating agents. I think we presented these data previously, but I think what's going to be significant from this update is considerably longer follow-up and also an expanded cohort of patients, which is going to give much more meaningful data. When we presented the data previously, we only had 7 months of median follow-up, and therefore the survival data we presented were quite immature. So we are really looking forward to updating the data. And what I would advise you to watch out for are probably 3 things. I mean, one is, again, always we should look towards tolerability and confirm tolerability with an expanded cohort and longer follow-up. That's always important that you can combine safely. Number two is the CR rate. This is one of the dual primary endpoints in our EVOLVE-2 pivotal study we are undertaking with HOVON. So look at the CR rate and how it compares with historical controls from VIALE-A in the mid-to-low 30s. And then I would really encourage you to look at the survival data with an expanded cohort and longer follow-up. I think this is going to be a much more accurate representation of survival. So those are things we are looking forward to updating. And then I would suggest a similar approach to the SAVE front-line data. In this case, it's with an oral hypomethylating agent, but again similar, you want to focus on tolerability, the CR rates, MRD eradication and again the survival.

Operator: The next question is from Faisal Khurshid with Jefferies.

Faisal Khurshid: I want to ask about the competitive landscape. I think we are expecting that it might be possible that we see potential registration-enabling Phase II datasets from J&J and Sumitomo potentially at ASH. Just curious how you think about those programs and how you think revumenib compares to those.

Michael Metzger: Yes, Faisal, thanks for the question. And I will let my colleagues jump in. Look, I think we have not seen data obviously yet, so we'll reserve judgment until we do. I'll just point out a couple things. Revuforj has been on the market for a few years and will be probably on the market for 3 years by the time the next competitor beyond the one that's on the market today reaches the market. So that's maybe just one fact. Look, I think they're -- whether they have data in KMT2A and NPM1 or just one of the subsets will be interesting to us. But our view on competition is that it's unlikely to be differentiated. We have a very broad profile, believed to be best-in-class. We have long experience. Physicians are very keen to put their patients on Revuforj with a very strong efficacy profile which wins in this category. So we are very well positioned to continue our leadership. And we will see data. We will have lots of data ourselves at the upcoming medical meeting, which we are excited to talk about. And so this will be just one point to discuss when the data does in fact come out. Nick, anything to add?

Nicholas Botwood: I would just add, if your question was in relation to front-line, again, we are looking forward to updating the totality of our front-line data, including with intensive chemotherapy. We are feeling extremely confident in the profile that we are seeing across the important parameters that inform our Phase III. Those data have really helped us design, I would suggest, a very innovative and efficient approach to our Phase III pivotal studies. We were the first to get a Phase III study up and running in the front-line setting back in May 2025. We are feeling very good about the execution of those studies now. We have good momentum, sites have opened up worldwide and tracking quite nicely. So obviously we'll be interested to see of course what data are presented at ASH. Competition is good for us, but we are feeling extremely confident about where we are and how we are executing on our programs.

Michael Metzger: Yes. Lastly, I just said, I think that the bar is quite high for competitors to come behind us. We are feeling quite confident about what we have built and will be able to leverage that going forward. But thanks for the question.

Faisal Khurshid: Got it. And on that point on front-line, when do you expect to be able to give the Street a little more clarity on when to expect front-line data? Because I believe you're not the only company that says that they are first to front-line.

Michael Metzger: Sure. No, look, I think we feel quite confident in our ability to get to front-line first. As Nick mentioned, we have probably the broadest set of data presented to date, quite compelling data, and we are going to update those datasets at the upcoming medical conference. Our execution is on point, opening up hundreds of sites worldwide, enrolling patients, so the momentum is there. We feel really good about how this is going. In terms of updating our guidance or informing the Street on exactly when we'll complete enrollment and get to potentially an approval, that will come in time. I think there is -- for us, obviously it is a competitive space, and it doesn't seem to be the right time to necessarily update on that, but we will of course do that at the right time.

Operator: The next question is from Ellen Horste with TD Cowen.

Ellen Horste: Congrats on the quarter. I am just wondering, with a year or so of commercial use now in the NPM1 population, what can you tell us about the duration of Revuforj therapy in this population among the patients that do and do not proceed to transplant and eventual maintenance therapy? How should we think about the incremental benefit from use in the post-transplant setting?

Michael Metzger: Yes, Ellen, thanks for the question on NPM1 use. Maybe I'll take a shot at it, and maybe Steve, if you want to chime in here. So look, duration is very encouraging overall. I think we're -- we have mentioned and guided to that we would expect to be in the 6 to 12 month range for patients who receive a response, and I think we are nicely in that range. For NPM1 patients, what was encouraging this quarter is many of the patients are actually going to transplant, 40%, and that half of those patients are resuming maintenance, which as a headwind in terms of a little bit of revenue today will be a tailwind tomorrow, and especially so because they have longer duration when they get maintenance. So that's very encouraging. When we see -- we look at the patient population of patients who have not gotten a transplant, but have gotten to response, we are talking about 7-plus months of duration. That is for patients who predominantly are NPM1 patients. So they are doing well, and we expect that to continue and build as we go quarter-to-quarter and more patients come get transplant and then get maintenance. So I don't know, Steve, anything to add?

Steven Closter: I think the only thing to add is that the drug is outperforming in the real world than it did in the clinical trials. You know, we have been talking for several quarters on the evolution of the KMT2A patient moving to transplant. We have seen that transplant move up to 50%, possibly could go higher over time. And as Michael mentioned, the increase to 60% of patients returning post-transplant is encouraging. It could certainly go higher than that. But the NPM1 patient, if we looked at the clinical trials, about 11% of patients went to transplant. So we are seeing earlier stage patients, about 75% are first and second line, combination treatment is in 40% of patients, and I think physicians were unlocking. And this may not be just a menin effect; this could be a Revuforj effect in that NPM1 patient. So 40%, first time we have revealed that in a quarter, so that is new information, of patients moving to transplant that are NPM1 patients, and 50% returning post. So as Michael mentioned, short headwind now, but the tailwind is going to be significant. Either you're seeing patients stay on much longer, the longest duration of treatment is going to be that transplant, post-transplant start. That group will grow, and as mentioned, if they are not fit to go to transplant, that duration is also increasing over time. So we feel like we are in a very, very, very good spot heading into the end of the year and into next year.

Operator: The next question is from Stephen Willey with Stifel.

Stephen Willey: Yes, congrats on the quarter. And also, just want to say, great working with Keith and wishing him all the best in his work. Quick question on the NPM1 transplant rate that you are seeing. I know that you kind of alluded to it. This 40% is higher than what was thought for this patient population. I know it's probably more than 2x what most of the KOLs have told us. Do you think that this is a durable trend? Do you think this has something to do with just the onboarding of new patients just having a certain phenotype? We would just be kind of curious how you think about the durability of this 40% getting transplanted, and then just have a follow-up.

Michael Metzger: Yes, Steve, thanks for the question. No, actually, what I think is happening, what we hear from physicians, is that we are treating patients earlier, we are treating them in combination, and they are getting to response. And so I think that's essentially true for KMT2A, but it is also true for NPM1. We are having great success in getting them to a response. Remember, in our trial, we treated later-line patients and we had a 50% overall response rate. We believe that's by treating them earlier and treating them in combination, you can drive a higher percentage of patients into response. And I think that's what's getting patients to a transplant, the ability to bridge that and get them there quickly. And then ultimately, the fact that they have received less therapy over time, meaning like if you treat them earlier, they do not get as worn down from subsequent therapy, you can get them on to maintenance. And so I think that is that coupled with the fact that physicians have told us that transplant techniques have improved, and that allows for more flexibility in how you treat these patients. So the openness to transplant and maintenance seems to be quite real to us and encouraging. I don't know, Nick, if you have anything to add on that front?

Nicholas Botwood: Summed it up.

Stephen Willey: Okay. And then just a quick follow-up. I know the extension of the front-line Niktimvo rocks for steroid data was pushed into the first quarter. I know it sounds like that was a byproduct of wanting to be able to present durability data. Can you just remind us what the kind of benchmark durability data is in terms of response duration with steroids in the front-line, and I guess just kind of any ballpark estimate of what you think would be clinically meaningful in terms of exceeding that?

Michael Metzger: Yes, thanks for the second question, Steve. So I'm going to turn it to Nick.

Nicholas Botwood: Yes, thank you, Steve. So yes, we're going to -- as you heard, we have moved it into Q1 and hope to present it in Q1 in order to present the totality of the data. We've talked previously about the primary endpoint, which is the response rate at 6months, where we're anticipating a benchmark historical for steroids of around 40%, the alternative hypothesis being around 60%, so we'll be able to present that. But then I think it's important to present both the duration of response and the EFS. Now it's not built into the statistics, but if you look at roughly what you'd expect for the EFS for steroids alone, it's probably of the order of 6 to 7 months. And I would anticipate that an increment of that of the order of 3 to 4 months would be quite clinically meaningful to physicians and patients to avoid them having to have a steroid regimen and all of the morbidity associated with having to take dexamethasone. So that's the sort of order of magnitude we would be hoping to see a difference in. But obviously, we'll look forward to reporting those data in totality in Q1.

Operator: The next question is from Etzer Darout with Barclays.

Gustave Diep: This is Gustave on for Etzer. Two quick ones for us. The first one is on the AGAVE-201 data that showed the transition from 0.3 to 0.6 Q2 to Q4 weeks. What's the significance of this data moving forward? And then number two is around the combination use, it's to about 40% still. At this point, are you able to tell whether the combination use is associated with higher transplant rate, or longer duration of treatment, or deeper responses in the commercial setting?

Michael Metzger: Maybe I'll turn it over -- thanks for the question, Gustave. Let me turn it over to Nick about the AGAVE-201.

Nicholas Botwood: Thank you for the question. I think this is a very patient-centric approach. I mean, I think the simple clinical benefit is that you are able to transition a patient from a 2-weekly IV to a monthly IV with comparable tolerability and prolonged duration of therapy. That's what we have shown in the manuscript and in the publication. And I think that's a benefit to patients. That's something that could ultimately inform guidelines and potentially even inform labeling in due course, which is a consideration. But again, I think it's a patient-centric approach just requiring less health care burden and importantly less burden for the patient to have a 4-weekly infusion as opposed to 2-weekly.

Michael Metzger: And the second question, I guess, was about combo use and the 40% that we are seeing, and really what's the breakdown in that percentage, and I guess, what's driving them there. I don't know, Steve, do you want to make any comments?

Steven Closter: I would probably pass to Nick. I think the claims data does not really give that subset, but we haven't shared data previously, but I think...

Nicholas Botwood: We've seen, I mean, I think there's a drive. Because we've presented such compelling data of revumenib in combination, I think particularly with Ven/Aza combinations, there is a desire for physicians to use revumenib in a combination with a variety of different chemotherapies. We will be updating later this quarter some 2 to -- a few real-world series from multiple centers that I think really emphasizes the desire of centers to use revumenib in combination when they can, because you get much higher response rates. And the much higher response rates, including responses like MLFS, give the patients the opportunity to go to transplant. And again, we're hoping to present data demonstrating revumenib bridging patients from responses into transplant and then potentially onto maintenance. And that's really the best opportunity to give patients a durable remission and outcome. So that's really the drive that you are seeing to combination.

Operator: The next question is from Yigal Nochomovitz with Citi.

Joohwan Kim: This is Joohwan Kim on for Yigal. On the 20% sequential increase in new Revuforj patients, was that growth broad-based across newer accounts or primarily concentrated within the established high-volume centers? And just wondering, are you seeing meaningful repeat prescribing among the newer accounts?

Michael Metzger: Thanks for the questions. First, the 20% quarter-over-quarter growth, where accounts is that kind of falling into, Steve?

Steven Closter: Yes, I think the exact question was 20% increase in new patients: where are we seeing that from?

Michael Metzger: Right. Where is it rising from?

Steven Closter: It's coming from all over. I mean, 2/3 of our business comes from what we will call Tier 1, Tier 2, and then the rest of the business comes from, we'll say, smaller accounts of which there are hundreds. We have had over 620 accounts prescribed to date. That is most of the Tier 1s and Tier 2s, about 90%, the rest are smaller community practices. That continues to grow. I think we had 8% growth in new accounts. So the business is being spread, and that's how you want it. You want a large foundation of users, treating a wide range of patients. That's how you build a big brand, and that's exactly what is happening today, and that will continue over time.

Michael Metzger: And how would you characterize the repeat business?

Steven Closter: High repeat business. We'll say this, the patients like this are, in general, challenging to treat. Even from early on in the launch, we've got a multifunction-type team, including nursing support care, to make sure clinicians and their entire staff know how to treat patients successfully with Revuforj. So from the launch, and that continues today, from a customer and account that prescribes for the first time, they are going to get the care. So the repeat rate is incredibly high, assuming they are seeing patients. Even smaller accounts will continue to use the drug on multiple occasions. And as we know, Revuforj has been the standard of care in KMT2A and established itself in NPM1 patients to treat more patients on a continual basis.

Joohwan Kim: Got it. And if I could just ask one more quick one. On EVOLVE-2 and REVEAL, should we be thinking that the 2 studies complete enrollment on broadly similar time lines, or are you seeing that one is perhaps tracking ahead of the other?

Michael Metzger: Thanks for the final question. We haven't updated our guidance on either one of them, so I don't want to get into that at this point. But both are moving along well and on our schedule, so we feel encouraged.

Operator: The next question is from David Dai with UBS.

Xiaochuan Dai: Great. So very encouraging new patient starts where there is about 20% quarter-over-quarter growth versus decline in 2Q that you characterized as temporary. I mean, help us understand a little more around whether the improvement reflects a normalization of patient flow, better patient identification, broader account penetration or share gains from other menin inhibitors? And more importantly, what gives you confidence that this growth rate can remain positive next several quarters?

Michael Metzger: Thanks, David. Steve, you want to tackle the new patient start question?

Steven Closter: Yes, we can, David. Appreciate the question, and question, right, reasonable question to ask where the growth come from and why. I think, as we described last quarter, which Q2 was a somewhat down quarter for the entire market, things happen. I mean, there is just variability quarter-to-quarter. There's not any one thing that drives this. I think what we are seeing in Q3 for us, encouraged by the 20% increase in new patient starts, there was growth in both KMT2A and NPM1. We continue to see the number of our accounts expand. Formulary coverage is still holding. We -- obviously, we talk to clinicians and market research and gain insight. So we're encouraged overall by what we see in the business. And just to reiterate, even the dynamic we see in the NPM1 patient moving from transplant, patients coming back, these are all good things that are based in the trust in the clinical profile. We talk about use, there is over 2,000 patients that have used the drug commercially, hundreds more in clinical trials. ASH is going to be great. There's so much new data coming. So in the forward, we're optimistic. We are not going to really comment on this quarter, but we gained a lot of steam in Q3 and that will continue for the rest of this year.

Michael Metzger: Right. And I would just add that, look, remember, we have 80-plus percent of this business, right? Relapsed/refractory is really ours, and we are continuing to build on that momentum. KMT2A, NPM1, we kind of have the dominant share across all age groups. So I think that is a very good place to be as we enter the last part of the year here.

Operator: The next question is from Salim Syed with Mizuho.

Salim Syed: Congrats on the progress. I guess one from us on the CFO transition. And thanks to Keith for all his help, and welcome to Aaron. Keith, so the press release was worded today as retiring. Just curious here why you felt like -- first of all, is this the loose definition of retirement that we should be thinking about here, and you plan on doing something else? And why did you feel like right now was the right time to -- I guess it looks like it was your decision, why was it the right time to make that transition out of Syndax and maybe to something else?

Keith Goldan: Yes. Salim, thanks for the kind words and the question. So yes, this was purely a personal decision that I made along with my family. Maybe the time was probably right a little earlier in the year. I care tremendously about this company, the patients that we treat, the teams that we have built, and wanted to ensure that the transition was as smooth as it could be, so there was -- to minimize any adverse impact on the business, on the team, on patients. So worked with the leadership team, the board to find a great replacement. And yes, this is not a retirement in the loose setting, so I'm looking forward to spending more time with my family, with my friends, pursuing some of my hobbies, doing some philanthropic work. So it has been a good run. I have been a CFO for 26 years, and just looking ahead to the future.

Salim Syed: Okay. All right. Well, we wish you well, and congratulations. And thanks for the additional color, Keith.

Operator: The next question is from Andres Maldonado with H.C. Wainwright.

Andres Maldonado: Keith, I wish you the best as well. Maybe circling back to some of the commentary on the transplantation eligibility. In the context of what you guys gave us today, the 40% in NPM1 versus the 50% in KMT2A, was curious on how much of that gap reflects age and fitness versus essentially cohort maturity? And I guess how realistically can that signal go? And my second question is on combination use. Given the roughly you stated today that 40% of the use is in combinations. I guess, can you provide a little bit more color about which regimens are driving that outside of the usual suspects? And are they essentially -- how should we think about the breakdown of whether they are extending treatment duration or just primarily getting those patients to transplant?

Michael Metzger: Great, Andres. Thanks for the questions. So in terms of what we are seeing with transplant, and where is -- essentially took your question as where is it really going here? The 40% for NPM1 with 50% of the patients returning for maintenance, 40% is a lot higher than we had expected. And so could it get to 40%, 50%? I expect it could, just given the momentum we are seeing. And at 50% of those patients resuming, we expect maybe 60%, 70% of those patients to resume maintenance. So that is sort of how we see that. And again, it's more of a projection than a hard and fast rule; it is based on physician conversations and some research that we have done and what we are seeing in the real world. Then if you look at KMT2A, that has been creeping up over time, also much higher than we have seen in clinical trials, now at 50% transplant rate, 60% resuming maintenance, up from about 55% or 50% last quarter. So it's really moving up on the patients returning for maintenance, which is quite encouraging. We have said that the transplant rate for KMT2A could probably go up to maybe 60%, probably not a lot higher, and we expect 70% to 80% of those patients with KMT2A to come back on for maintenance. Again, thinking about how long they can stay on maintenance therapy and reflecting from what physicians have told us and what we've seen in some of our real-world work that we'll report on even at this upcoming meeting, you see that the desire is to treat them for 1 to 2 years in maintenance. And that would be a very good outcome for patients, keep them in remission for a long time and hopefully move them forward. And that is, I think, the paradigm that we are pursuing, again with some estimates for what the rates could be. But Nick, maybe I'll pass to you for the combination question.

Nicholas Botwood: Yes, just a few additional comments on that, including in combination. I mean, one is, I think the drive to transplant, remember in relapsed/refractory is really the best chance a patient can have of a durable remission. So it's a little different from a consideration front-line. Once you have relapsed, you really want to get a patient to transplant if you can. We are hoping to update some data in the fourth quarter which looks at our patients that have gone on to get a transplant and looks at the role of revumenib as a sort of bridge to transplant. How do you get them there? What kind of response do you need to see, including all of the contributors to overall response rate, which we know we have the highest overall response rate in the class. So that would include MLFS, and this makes these patients eligible for transplant, which I think is quite promising for patients. Combination use varies. I think what we see most commonly is Ven/Aza or single-agent Ven, occasionally other sorts of chemotherapy. Only rarely do we see combinations with targeted agents. It's not a high priority for our program. They tend to be sequenced more, but occasionally it might be a combination. And then maintenance of course is really important. And again, I think we have the most mature and significant data really trying to elucidate how to optimally treat a patient with maintenance revumenib. We will be updating some data from a Phase I we are doing with Dr. Ball, which I am excited about, which looks at optimization of dose and managing patients, and then a variety of real-world data again optimizing patients with revumenib in the maintenance therapy. And as Michael said, physicians tend to want to keep them on if they can for one to two years. Again, we are hoping to update data on the MRD -- erasing MRD, which is really exciting, and I think that will be the first data to be presented showing that. And then perhaps the last thing I would say, as the data continues to mature, we are hearing from physicians now, if the patient has done really well and tolerating the drug well at 2 years, sometimes they don't even want to come off at 2 years. And so we are having discussions now with physicians who want to keep a patient on because they are just happy to be relapse-free at 2 years after their transplant and doing well. So that's also a trend we are beginning to see as the data matures.

Operator: The next question is from Jason Zemansky with Bank of America.

Unknown Analyst: This is [ Jackie ] on for Jason. Congrats on the progress. So you've talked about transplant creating a near-term headwind, but ultimately becoming a meaningful tailwind as the post-transplant population stacks. So with the KMT2A restart rate now at 60% and NPM1 already at 50%, how should we think about the timing of that inflection? Is that something you expect to become a more meaningful driver of Revuforj growth over the course of 2027?

Michael Metzger: Jackie, thanks for the question. I think you hit it on the head. Honestly, I think this is a really important phenomenon that takes some time to play out. Basically, it's because you have patients who are going to transplant within, call it, 3 months of being put on Revuforj, and then they pause treatment for a number of months, call it, 2 to 4, to 5 months in some cases, maybe even more, and they pause treatment and then they resume. And so what that means is you are going to have the tailwind that kicks in quite a bit later. And you need time for the number of patients who drop for transplant to be kind of overcome by patients coming back, meaning in terms of revenue stacks. So again, that takes time, and it takes time for both now NPM1 and KMT2A. We are not -- we haven't been kind of thinking about how NPM1 was part of this equation until recently when we saw the data that it's really very much the same and very similar paradigm to what we are seeing with KMT2A. That was a bit of news to us, but we think it will be ultimately a very good thing for patients as they come back on and can stay on treatment for a long time, as Nick had mentioned earlier. So yes, I think 2027 is where you'll see the greatest impact. We have started to see some of that, but we'll start to see more as it stacks in '27.

Operator: Our final question today is from Mayank Mamtani with B. Riley.

Mayank Mamtani: Yes, congrats on a strong execution quarter. And best wishes to Keith for his next chapter. Just a clarification question, and maybe if you could update us how maybe 4Q to date is progressing on the TRX versus NRX. Obviously, NRX did very well quarter-over-quarter. TRX is lagging a little bit, 20% versus 13%. Is there, again, anything you can comment on 4Q, how that is kind of progressing would be helpful, but more sort of long-term, just thinking about how, in a sustainable manner, we can see TRX accelerating? That would be just part one, commercial question. And then second, on the -- Nick, your comments on the newly diagnosed Phase III program, very helpful. Was just wondering if you could contextualize some of the paradigm Ven/Aza, EFS and MRD data we recently saw? And how do you think about MRD-negative CR as a surrogate endpoint? And then just your expectation in fit versus unfit control arm for EVOLVE-2 also, and how do you see essentially maintenance being handled given you are getting so much deep remission in the front-line setting across fit and unfit? Sorry, that was long-winded, but would be great to hear your thoughts.

Michael Metzger: Anyway, thanks for the questions. Yes, so the good news is I get the short question, which is the first one. What are we seeing in the fourth quarter? We are not going to comment on the fourth quarter. I'll say, look, we feel good momentum coming out of third quarter, so we are very hopeful that the business will continue to really ramp from here. But that's my answer. I am going to turn to the second set of questions for Nick.

Nicholas Botwood: Yes, great questions, and we can maybe talk a little bit more about the trials when we have presented our data at ASH, or at least the abstracts are open, on the relevance of those data to inform the Phase IIIs. But what I would say is they give us a lot of confidence in the assumptions around the endpoints. And just to remind everybody very briefly, for EVOLVE-2, we have 2 dual primary endpoints. One is CR, the other is overall survival. So those are relatively simple, and we will be updating data from both BEAT and SAVE that I think is very informative to those endpoints. And we feel very confident in the way we have designed those studies, I think is quite strategically smart. And then for REVEAL, which is in fit patients, patients eligible to receive intensive chemotherapy, again, we have dual primary endpoints. One of them is quite stringent, which is looking at MRD-negative CR, but assessed in the bone marrow. Again, look for updates for our study 708, which is revumenib in combination with intensive chemotherapy that informed that study, and the relevance of those data for that study. And then the other dual primary endpoint in REVEAL is event-free survival, which again takes a little time to mature, but is it going to be the definitive endpoint? I would say, for potential approvals. So more on that to come, but the data are very helpful in ensuring we have got the studies designed and executed in the most efficient way we can, with the highest probability of success.

Mayank Mamtani: And how are you handling maintenance crossover in these front-line studies, Nick?

Michael Metzger: Sorry, Mayank, can you repeat that?

Mayank Mamtani: Just the final part of that question was how are you handling crossover and some of the maintenance settings given you are getting deep remissions and some of them might be even going in transplant? Was just curious how the follow-ups are handled in the 2 studies?

Nicholas Botwood: Yes, the studies do not allow for formal crossover for that reason, and recall in REVEAL, the dual primary endpoint is event-free survival, which we are not anticipating to be unduly impacted by any subsequent therapies.

Operator: This concludes our question-and-answer session. I will now turn the floor over to Michael Metzger for any additional comments or closing remarks.

Michael Metzger: Thank you all. We appreciate everyone tuning in today to discuss our recent progress and the exciting milestones ahead. We look forward to seeing many of you at the upcoming investor conferences in Q4 and at ASH. And before I say good evening, I want to thank Keith Goldan for all he has done for us. We wish you all the best in your retirement.

Keith Goldan: Thank you.

Michael Metzger: Have a good evening, everyone.

Operator: This concludes today's call. Thank you, and you may now disconnect.