Core Points - The Regulation Agency for Medical and Pharmaceutical Activities (RAMPA) in Georgia has approved the Clinical Trial Application (CTA) for the pivotal Phase 2B/3 MIRACLE trial of Annamycin in combination with cytarabine for treating adult patients with relapsed or refractory acute myeloid leukemia (AML) [2][3] - The European Medicines Agency (EMA) has also granted approval for the trial, enhancing its profile and recruitment efforts [3][5] - Enrollment in Part A of the MIRACLE trial has reached seven subjects treated, with one additional subject in screening, and the company plans to expand to over 30 clinical sites by the end of the year [3][4] Company Overview - Moleculin Biotech, Inc. is a late-stage pharmaceutical company focused on developing drug candidates for hard-to-treat cancers and viral infections, with Annamycin as its lead program [11][12] - Annamycin has received Fast Track Status and Orphan Drug Designation from the FDA for treating relapsed or refractory AML, as well as similar designations from the EMA [8][11] - The MIRACLE trial is designed to combine data from the Phase 2B and Phase 3 portions to measure the primary efficacy endpoint, utilizing an adaptive design [3][12] Trial Details - The MIRACLE trial will randomize the first 75 to 90 subjects to receive high-dose cytarabine combined with either placebo or two different doses of Annamycin [3][6] - The first unblinding of preliminary efficacy data is expected in the second half of 2025, with a second unblinding anticipated in the first half of 2026 [4][6] - Approximately 220 additional subjects will be randomized in Part B of the trial to receive either high-dose cytarabine plus placebo or the optimum dose of Annamycin [6] Recruitment and Collaboration - The company expects to add 16 additional clinical sites in Europe and the US by the end of August, building to over 30 sites for Part A of the trial [3][4] - The recruitment success is attributed to the capabilities of clinical sites, particularly the ARENSIA Exploratory Medicine's research clinic in Kyiv, Ukraine [3][9]

Investment Rating - The report maintains a "Positive" investment rating for the healthcare sector [11] Core Insights - Menin is identified as a crucial epigenetic regulatory factor that drives the abnormal activation of the HOX/MEIS1 axis in acute leukemia subtypes, making it an important target for precision therapy in AML [2][7] - As of June 2025, there are 9 Menin inhibitors in clinical development or already approved globally, with Revumenib showing a complete response rate (CRc) of 81% when combined with Azacitidine and Venetoclax, and a median overall survival (mOS) of 15.5 months [2][8] - Ziftomenib has demonstrated a CRc rate of 94% in newly diagnosed NPM1m patients when used in combination with the "7+3" regimen [9] Summary by Sections Menin Inhibitors Overview - Menin, encoded by the MEN1 gene, plays a key role in gene transcription regulation and maintaining genomic stability, particularly in AML where it drives leukemia stemness and disease persistence [7][20] - Menin inhibitors are particularly effective for AML subtypes that depend on KMT2A rearrangements and NPM1 mutations, which are associated with poor prognosis [27][29] Clinical Development of Menin Inhibitors - Revumenib, developed by Syndax Pharmaceuticals, is the first Menin inhibitor approved by the FDA, showing promising efficacy in clinical trials with a CRc rate of 43.9% and an overall response rate (ORR) of 63.2% [8][33] - Ziftomenib, developed by Kura Oncology, has received FDA fast track designation and has shown high efficacy in initial clinical trials, with CR rates of 88% for NPM1m patients [9][42] - BN104, developed by BioNova, has shown a CR/CRh rate of 60.9% in KMT2A-r patients and is positioned as a potential best-in-class Menin inhibitor [45] Market and Competitive Landscape - The report highlights the competitive landscape with multiple companies, including domestic firms, actively developing Menin inhibitors, indicating a robust pipeline and potential for market growth [31][45] - The acquisition of BN104 by Sihuan Pharmaceutical reflects strategic moves to strengthen global positioning in the Menin inhibitor market [45]

Financial Data and Key Metrics Changes - Curis reported a net loss of $10.6 million or $1.25 per share for Q1 2025, compared to a net loss of $11.9 million or $2.05 per share for the same period in 2024, indicating an improvement in loss per share [12] - Research and development expenses decreased to $8.5 million in Q1 2025 from $9.6 million in Q1 2024, primarily due to lower employee-related costs [12] - General and administrative expenses also decreased to $4 million in Q1 2025 from $4.9 million in Q1 2024, attributed to lower employee-related costs and professional fees [12] - Cash and cash equivalents totaled $20.3 million as of March 31, 2025, with expectations to fund operations into Q4 2025 [13] Business Line Data and Key Metrics Changes - The Take Aim Lymphoma study is evaluating emavucertib in combination with ibrutinib in patients with relapsed/refractory primary CNS lymphoma (PCNSL), with 27 patients treated as of the latest data cutoff [8] - Among 20 BTKi experienced patients, 9 showed a reduction in tumor burden, including 6 objective responses, while 5 out of 7 BTKi naive patients also demonstrated a reduction [8] - In the AML segment, a 38% composite complete response (CR) rate was reported in a study involving patients with FLT3 mutations, showcasing the potential of emavucertib [10] Market Data and Key Metrics Changes - The company is focusing on expanding the use of emavucertib beyond primary CNS lymphoma into additional indications such as NHL, AML, and solid tumors [5] - The enrollment for the lymphoma study is ongoing, with 37 sites currently open across major centers in the U.S., Europe, and Israel [20] Company Strategy and Development Direction - Curis is prioritizing the PCNSL study while simultaneously advancing its AML studies, with a focus on safety and tolerability in frontline AML [18] - The company aims to enroll 30 to 40 additional patients for NDA submission in the lymphoma study, targeting 6 to 8 responses in that dataset [9] - The addition of Dr. Ahmed Hamdy to the executive team is expected to enhance the company's strategic direction in both lymphoma and AML [4][22] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the collaboration with the FDA, indicating no concerns about changes affecting their agreement despite industry turmoil [28] - The company is optimistic about the potential of emavucertib, particularly in combination therapies, and is focused on maximizing its utility across various indications [37] Other Important Information - Curis completed a registered direct financing and private placement in March 2025, raising approximately $8.8 million [13] - The company plans to provide additional updates on the Take Aim Lymphoma study at the upcoming ASH conference later this year [9] Q&A Session Summary Question: Positioning of lymphoma versus AML - Management confirmed that resources are primarily dedicated to the PCNSL study while also advancing AML studies, with a focus on safety and initial patient enrollment [18][22] Question: Enrollment and FDA discussions - Management stated that they are on track with enrollment and have no concerns regarding their agreement with the FDA, appreciating the timing of their collaboration [28] Question: Mutations affecting responses and EMA development steps - Management indicated it is too early to discuss specific mutations impacting responses, emphasizing the mechanism of action instead [34] - Future plans for AML development will be discussed after completing the ongoing triplet study [36]