zilurgisertib (INCB00928) / Incyte - LARVOL DELTA

The activin receptor-like kinase-2 inhibitor zilurgisertib (INCB000928) as monotherapy or with ruxolitinib in patients with anemia due to myelofibrosis: Phase 1/2 study final results (ASH 2025) - P1/2 | "Zilurgisertib monotherapy or in combination with ruxolitinib had a favorable tolerabilityprofile, with few DLTs and no apparent correlation between dose and TEAE frequency. However, despiteevidence of on-target hepcidin suppression, zilurgisertib provided minimal improvements for anemia.These findings highlight the multifactorial nature of anemia in MF and suggest that selective inhibition ofALK2/ACVR1 may not be sufficient to effectively ameliorate MF-related anemia."

Clinical • Monotherapy • P1/2 data • Anemia • Infectious Disease • Myelofibrosis • Septic Shock • ACVR1

Details on Incyte data presentations at ASH include: Poster Presentations (Incyte Press Release)

Clinical data • Acute Graft versus Host Disease • Anemia • Chronic Graft versus Host Disease • Essential Thrombocythemia • Follicular Lymphoma • Myelofibrosis • Myeloproliferative Neoplasm • Polycythemia Vera

MODULE 4: Future Directions in the Management of MF (ASH 2024) - "This program is supported by educational grants from CTI BioPharma, a Sobi Company, Geron Corporation, GSK, Incyte Corporation and Karyopharm Therapeutics.Mechanism of antitumor activity of navitoclax and biological rationale for its evaluation for MF Available efficacy and safety findings from the Phase III TRANSFORM-1 study of navitoclax in combination with ruxolitinib versus ruxolitinib alone for patients with previously untreated MF Potential role of navitoclax in the up-front setting and ongoing evaluation for relapsed/refractory (R/R) disease in the Phase III TRANSFORM-2 study Rationale for the evaluation of BET inhibitors for MF; updated findings from the Phase III MANIFEST-2 study combining pelabresib to ruxolitinib for JAK inhibitor-naïve disease Scientific justification for the evaluation of selinexor for MF; early efficacy and safety findings with selinexor as monotherapy and in combination with ruxolitinib Ongoing evaluation of the combination of..."

Myelofibrosis • Oncology

Discovery and Characterization of Zilurgisertib, a Potent and Selective Inhibitor of Activin Receptor-like Kinase‑2 (ALK2) for the Treatment of Fibrodysplasia Ossificans Progressiva. (PubMed, ACS Med Chem Lett) - "Zilurgisertib fully suppresses HO in a pediatric mouse model of injury-induced FOP and therefore holds great potential as a novel targeted disease-modifying therapy for FOP. The candidate is being evaluated in clinical trials."

Journal • Pediatrics • ACVR1

ALK2 and JAK2 Inhibition for Improved Treatment of Anemia in Myelofibrosis Patients: Preclinical Profile of an ALK2 Inhibitor Zilurgisertib in Combination with Ruxolitinib (ASH 2023) - P1/2 | "Taken together, the potent and selective on-target activity of zilurgisertib suggests that ALK2 inhibition could reduce hepcidin and improve anemia, and that the combination of zilurgisertib with ruxolitinib is a rational and attractive approach to mitigate anemia in patients with MF. The combination of ruxolitinib and zilurgisertib is currently being evaluated in a phase 1 clinical trial in patients with anemia due to myeloproliferative disorders (NCT04455841)."

Combination therapy • Preclinical • Anemia • Hematological Disorders • Hematological Malignancies • Lymphoma • Multiple Myeloma • Myelofibrosis • Myeloproliferative Neoplasm • Oncology • ACVR1 • ALK1

Phase 1/2 Study of the Activin Receptor-like Kinase-2 Inhibitor Zilurgisertib (INCB000928, LIMBER-104) As Monotherapy or with Ruxolitinib in Patients with Anemia Due to Myelofibrosis (ASH 2023) - P1/2 | "Treatment with zilurgisertib monotherapy or in combination with RUX in this pt population was generally well tolerated, with predominantly grade 1/2 TEAEs. Reduced hepcidin levels were observed at all dose levels with both monotherapy and in combination with RUX, with greater control of hepcidin over time observed at higher zilurgisertib doses. Preliminary improvements in anemia were observed in non–transfusion-dependent pts during dose escalation, suggesting potential for therapeutic activity."

Clinical • Monotherapy • P1/2 data • Anemia • Hematological Disorders • Myelofibrosis • Oncology • Thrombocytopenia • ACVR1

Evaluation of clinical cardiac safety of zilurgisertib, an activin receptor-like kinase-2 (ALK2) inhibitor, in healthy participants. (PubMed, Clin Pharmacol Drug Dev) - "No clinically meaningful effects on cardiac conduction (PR and QRS intervals) or any categorical PR or QRS outliers were observed. These data support further clinical development of zilurgisertib."

Journal • ACVR1

INCB 00928-105: To Assess the Safety and Tolerability of INCB000928 in Participants With Myelodysplastic Syndromes or Multiple Myeloma (clinicaltrials.gov) - P1/2 | N=22 | Terminated | Sponsor: Incyte Corporation | Completed ➔ Terminated; Strategic Business Decision

Monotherapy • Trial termination • Anemia • Hematological Disorders • Hematological Malignancies • Multiple Myeloma • Myelodysplastic Syndrome • Oncology

To Assess the Efficacy, Safety, and Tolerability of INCB000928 in Participants With Fibrodysplasia Ossificans Progressiva (clinicaltrials.gov) - P2 | N=98 | Recruiting | Sponsor: Incyte Corporation | Trial primary completion date: Jul 2025 ➔ Feb 2025

Trial primary completion date

INCB 00928-104: INCB000928 Administered as a Monotherapy or in Combination With Ruxolitinib in Participants With Anemia Due to Myeloproliferative Disorders (clinicaltrials.gov) - P1/2 | N=84 | Active, not recruiting | Sponsor: Incyte Corporation | Trial completion date: Oct 2025 ➔ Nov 2027

Monotherapy • Trial completion date • Anemia • Hematological Disorders • Myelofibrosis • Myeloproliferative Neoplasm • Thrombocytosis

Effect of Itraconazole or Rifampin on Zilurgisertib Pharmacokinetics When Administered Orally in Healthy Participants. (PubMed, Clin Pharmacol Drug Dev) - "No dose-limiting toxicities occurred in either cohort, and all treatment-emergent adverse events were Grade 1 in severity. Zilurgisertib dose adjustment may be necessary with concomitant administration of strong CYP3A4 inhibitors, and coadministration of zilurgisertib with strong CYP3A4 inducers is not recommended."

Journal • PK/PD data • ACVR1

LIMBER: INCB000928 Administered as a Monotherapy or in Combination With Ruxolitinib in Participants With Anemia Due to Myeloproliferative Disorders (clinicaltrials.gov) - P1/2 | N=84 | Active, not recruiting | Sponsor: Incyte Corporation | Trial completion date: Jun 2026 ➔ Oct 2025 | Trial primary completion date: Nov 2025 ➔ Apr 2025

Monotherapy • Trial completion date • Trial primary completion date • Anemia • Hematological Disorders • Myelofibrosis • Myeloproliferative Neoplasm • Thrombocytosis

To Assess the Efficacy, Safety, and Tolerability of INCB000928 in Participants With Fibrodysplasia Ossificans Progressiva (clinicaltrials.gov) - P2 | N=98 | Recruiting | Sponsor: Incyte Corporation | N=60 ➔ 98 | Trial completion date: Apr 2028 ➔ Dec 2032

Enrollment change • Trial completion date

Emerging Pathogenetic Mechanisms and New Drugs for Anemia in Myelofibrosis and Myelodysplastic Syndromes. (PubMed, Am J Hematol) - "These include TGF-β ligand traps (luspatercept, elritercept), activin A receptor type 1 (ACVR1)/activin receptor-like kinase 2 (ALK2) inhibitors (momelotinib, zilurgisertib), and anti-hemojuvelin antibody-based therapies (DISC-0974). Luspatercept and momelotinib are approved for anemia related to lower-risk MDS and MF, respectively, and represent an important addition to the treatment armamentarium, along with imetelstat, a telomerase inhibitor, recently ratified for anemia in lower-risk MDS. A promising strategy to overcome the limitations of existing anemia-directed therapies includes the use of drug combinations with complementary mechanisms (luspatercept + erythropoiesis stimulating agents, luspatercept + momelotinib, DISC-0974 + momelotinib), and harnessing the erythropoietic potential of sodium-glucose co-transporter-2 inhibitors (SGLT-2I). Future research should address the complex pathophysiology of anemia, standardize definitions for anemia with gender-specified..."

Journal • Review • Anemia • Hematological Disorders • Hematological Malignancies • Myelodysplastic Syndrome • Myelofibrosis • Oncology • ACVR1 • SMAD2 • SMAD4 • TGFB1

LIMBER: INCB000928 Administered as a Monotherapy or in Combination With Ruxolitinib in Participants With Anemia Due to Myeloproliferative Disorders (clinicaltrials.gov) - P1/2 | N=84 | Active, not recruiting | Sponsor: Incyte Corporation | Recruiting ➔ Active, not recruiting | N=206 ➔ 84

Enrollment change • Enrollment closed • Monotherapy • Anemia • Hematological Disorders • Myelofibrosis • Myeloproliferative Neoplasm • Thrombocytosis

Pharmacokinetics of Zilurgisertib With and Without Food from Single and Multiple Ascending Dose Phase 1 Studies in Healthy Adults. (PubMed, Eur J Drug Metab Pharmacokinet) - "Zilurgisertib exhibited a favorable pharmacokinetic profile amenable to once-daily dosing that can be administered without regard to food. Study results support further clinical development of zilurgisertib in patients."

Journal • P1 data • PK/PD data • Hematological Disorders • ACVR1

INCB 00928-105: To Assess the Safety and Tolerability of INCB000928 in Participants With Myelodysplastic Syndromes or Multiple Myeloma (clinicaltrials.gov) - P1/2 | N=22 | Completed | Sponsor: Incyte Corporation | Active, not recruiting ➔ Completed

Trial completion • Anemia • Hematological Disorders • Hematological Malignancies • Multiple Myeloma • Myelodysplastic Syndrome • Oncology

ALK2 AND JAK2 INHIBITION FOR IMPROVED TREATMENT OF ANEMIA IN MYELOFIBROSIS PATIENTS: PRECLINICAL PROFILE OF AN ALK2 INHIBITOR ZILURGISERTIB IN COMBINATION WITH RUXOLITINIB (EHA 2024) - P1/2 | "Zilurgisertib is a potent and selective ALK2 inhibitor that can reduce hepcidin levels and improve anemia. Zilurgisertib directly inhibits ALK2 activity, reducing phosphorylation of the direct target SMAD1, and levels ofthe SMAD target gene hepcidin. These data suggest JAK2 inhibition does not inhibit erythropoiesis restoredfollowing ALK2 inhibition."

Combination therapy • Preclinical • Anemia • Hematological Disorders • Hematological Malignancies • Lymphoma • Multiple Myeloma • Myelofibrosis • Myeloproliferative Neoplasm • Oncology • ACVR1 • ALK1

THE ACTIVIN RECEPTOR-LIKE KINASE-2 INHIBITOR ZILURGISERTIB (INCB000928) AS MONOTHERAPY OR WITH RUXOLITINIB IN PATIENTS WITH ANEMIA DUE TO MYELOFIBROSIS: PHASE 1/2 STUDY RESULTS (EHA 2024) - P1/2 | "Zilurgisertib as monotherapy or in combination with RUX had a favorable tolerance profile, with predominantlygrade 1/2 TEAEs and only 1 DLT. Greater hepcidin control over time was observed at higher zilurgisertib dosesin both treatment groups. Preliminary improvements in anemia were observed in non–transfusion-dependentpts during dose escalation, suggesting potential for therapeutic activity."

Clinical • Monotherapy • P1/2 data • Anemia • Hematological Disorders • Myelofibrosis • Oncology • ACVR1

Incyte to Highlight Data From its Oncology Portfolio at the 2024 ASCO Annual Meeting and EHA2024 Congress (Businesswire) - "Incyte...announced that several abstracts featuring data from its oncology portfolio will be presented at the upcoming 2024 American Society of Clinical Oncology (ASCO) Annual Meeting held May 31 - June 4 in Chicago, and at the European Hematology Association 2024 (EHA2024) Congress held on June 13-16 in Madrid, Spain, and virtually."

Clinical data • Diffuse Large B Cell Lymphoma • Myelofibrosis • Polycythemia Vera

Incyte Reports 2024 First Quarter Financial Results and Provides Updates on Key Clinical Programs (Businesswire) - "Jakafi (ruxolitinib) net product revenues of $572 million in Q1'24, total paid patients increased +5% Y/Y; reiterating full year 2024 guidance of $2,690 - $2,750 million....Phase 3 study for BETi is anticipated to initiate in the second half of 2024 and clinical proof-of-concept for zilurgisertib is anticipated by mid-2024."

New P3 trial • Sales • Hematological Malignancies • Myelodysplastic Syndrome • Myelofibrosis • Myeloproliferative Neoplasm • Oncology • Polycythemia Vera

LIMBER: INCB000928 Administered as a Monotherapy or in Combination With Ruxolitinib in Participants With Anemia Due to Myeloproliferative Disorders (clinicaltrials.gov) - P1/2 | N=206 | Recruiting | Sponsor: Incyte Corporation | N=100 ➔ 206 | Trial completion date: Apr 2024 ➔ Jun 2026 | Trial primary completion date: Apr 2024 ➔ Nov 2025

Combination therapy • Enrollment change • Monotherapy • Trial completion date • Trial primary completion date • Anemia • Hematological Disorders • Myelofibrosis • Myeloproliferative Neoplasm • Thrombocytosis

To Assess the Efficacy, Safety, and Tolerability of INCB000928 in Participants With Fibrodysplasia Ossificans Progressiva (clinicaltrials.gov) - P2 | N=60 | Recruiting | Sponsor: Incyte Corporation | Trial completion date: Dec 2024 ➔ Apr 2028 | Trial primary completion date: Dec 2023 ➔ Apr 2025

Trial completion date • Trial primary completion date

ACVR1: A Novel Therapeutic Target to Treat Anemia in Myelofibrosis. (PubMed, Cancers (Basel)) - "Among the approved JAK inhibitors (ruxolitinib, fedratinib, momelotinib, and pacritinib) for MF, momelotinib and pacritinib are preferably used in cytopenic patients; both agents are potent ACVR1 inhibitors that suppress hepcidin expression via the BMP6/ACVR1/SMAD pathway and restore iron homeostasis/erythropoiesis...Zilurgisertib (ACVR1 inhibitor) and DISC-0974 (anti-hemojuvelin monoclonal antibody) are evaluated in early phase clinical trials in patients with MF and anemia. Luspatercept (ACVR2B ligand trap) is assessed in transfusion-dependent MF patients in a registrational phase 3 trial. Approved ACVR1 inhibitors and novel agents in development are poised to improve the outcomes of anemic MF patients."

Journal • Review • Anemia • Hematological Disorders • Hematological Malignancies • Myelofibrosis • Myeloproliferative Neoplasm • Oncology • ACVR1 • ACVR2B • BMP6

INCB 00928-105: To Assess the Safety and Tolerability of INCB000928 in Participants With Myelodysplastic Syndromes or Multiple Myeloma (clinicaltrials.gov) - P1/2 | N=22 | Active, not recruiting | Sponsor: Incyte Corporation | Recruiting ➔ Active, not recruiting | N=80 ➔ 22

Enrollment change • Enrollment closed • Monotherapy • Anemia • Hematological Disorders • Hematological Malignancies • Multiple Myeloma • Myelodysplastic Syndrome • Oncology