Pipeline Programs and Milestones - Nuvalent is advancing parallel lead programs for ROS1+ and ALK+ NSCLC in global clinical development, with potential for first FDA approval in 2026[4] - The company plans to report pivotal data for TKI pre-treated ROS1+ NSCLC from the ARROS-1 trial in 1H 2025 and complete rolling NDA submission in Q3 2025[14] - Topline pivotal data for TKI pre-treated ALK+ NSCLC from the ALKOVE-1 trial is anticipated by year-end 2025, with ALKAZAR Phase 3 trial for TKI-naïve ALK+ NSCLC planned to initiate in early 2H 2025[14, 205] - NVL-330 for HER2-altered NSCLC is in Phase 1a/1b investigation, with additional discovery research programs ongoing[12, 205] Zidesamtinib (NVL-520) for ROS1+ NSCLC - In TKI pre-treated ROS1+ NSCLC patients, the ORR was 44% (51/117), with 78% (95% CI: 62, 88) DOR ≥ 12 months and 62% (95% CI: 28, 84) DOR ≥ 18 months[73] - In patients with prior crizotinib or entrectinib only ± chemotherapy, the ORR was 51% (28/55), with 93% (95% CI: 74, 98) DOR ≥ 12 months and 93% (95% CI: 74, 98) DOR ≥ 18 months[80] - Zidesamtinib demonstrated CNS activity, with an IC-ORR of 48% (27/56) in any prior ROS1 TKI ± chemotherapy and 85% (11/13) in prior crizotinib only ± chemotherapy[90] - The safety profile of zidesamtinib was generally well-tolerated, with peripheral edema reported in 36% of patients, constipation in 17%, blood CPK increased in 16%, fatigue in 16%, and dyspnea in 15%[96] - In TKI-naïve patients with ROS1+ NSCLC, the ORR was 89% (31/35), with 96% (95% CI: 76, 99) DOR ≥ 6 months and 96% (95% CI: 76, 99) DOR ≥ 12 months[103] Neladalkib (NVL-655) for ALK+ NSCLC - In a heavily pre-treated ALK+ solid tumor population, 51% had any secondary ALK mutation, 26% had a compound ALK mutation, and 56% had a history of CNS metastasis[140, 141] - In all NSCLC response evaluable patients, across all doses, the ORR was 38% (39/103), with a mDOR of 144 months and 78% DOR > 6 months[149] - In patients with any ALK resistance mutation at RP2D, the ORR was 55% (12/22), with a mDOR not reached and 100% DOR > 6 months[158] - The preliminary safety profile of neladalkib was consistent with its ALK-selective design, with ALT increased in 34% of patients, AST increased in 30%, constipation in 16%, dysgeusia in 13%, and nausea in 12%[166] Market Overview - The combined worldwide sales for ALK and ROS1 TKIs in 2024 were approximately $31 billion[27]

Core Insights - Nuvalent, Inc. announced positive pivotal data for zidesamtinib, a novel ROS1-selective inhibitor, in TKI pre-treated patients with advanced ROS1-positive non-small cell lung cancer (NSCLC) from the global ARROS-1 Phase 1/2 clinical trial [1][2] Group 1: Clinical Trial Progress - The company completed a pre-New Drug Application (NDA) meeting with the FDA and plans to initiate a rolling NDA submission in July 2025, targeting completion in the third quarter of 2025 [2][4] - Zidesamtinib demonstrated an overall response rate (ORR) of 44% in 117 TKI pre-treated patients, with a durability of response of 78% at 12 months and 62% at 18 months [4][10] - In a subset of 55 patients treated with one prior ROS1 TKI, the ORR was 51% with a durability of response of 93% at both the 12- and 18-month landmarks [4][12] Group 2: Efficacy and Safety - Zidesamtinib showed intracranial responses and activity against tumors with a ROS1 G2032R resistance mutation, with a well-tolerated safety profile [4][17] - The most frequent treatment-emergent adverse events (TEAEs) included peripheral edema (36%), constipation (17%), and fatigue (16%) [18][20] - Dose reductions due to TEAEs occurred in 10% of patients, and only 2% discontinued treatment due to TEAEs [20] Group 3: Future Development - The company is advancing clinical startup activities for the ALKAZAR Phase 3 trial, which will evaluate neladalkib, a novel ALK-selective inhibitor, against alectinib in TKI-naïve ALK-positive NSCLC patients [5][27] - Zidesamtinib has received breakthrough therapy designation for ROS1-positive metastatic NSCLC and orphan drug designation for ROS1-positive NSCLC [25][28] - The ongoing ARROS-1 trial is designed to evaluate zidesamtinib in both TKI-naïve and TKI pre-treated patients with advanced ROS1-positive NSCLC [26][30]

Topline pivotal data expected for zidesamtinib in TKI pre-treated ROS1-positive NSCLC population in the first half of 2025 in support of anticipated first NDA submission by mid-year 2025 Initiation of ALKAZAR Phase 3 randomized, controlled trial of neladalkib for front-line ALK-positive NSCLC planned for first half of 2025Pivotal data for neladalkib in TKI pre-treated ALK-positive NSCLC population anticipated by year-end 2025Strengthened leadership team with key internal promotionsCAMBRIDGE, Mass., May 8, 2 ...

CAMBRIDGE, Mass., April 23, 2025 /PRNewswire/ -- Nuvalent, Inc. (Nasdaq: NUVL), a clinical-stage biopharmaceutical company focused on creating precisely targeted therapies for clinically proven kinase targets in cancer, today announced two "Trial in Progress" poster presentations for its novel ALK-selective inhibitor, neladalkib, and novel HER2-selective inhibitor, NVL-330, at the 2025 American Society of Clinical Oncology (ASCO) Annual Meeting from May 30 – June 5, 2025, in Chicago. Posters will be archive ...