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  Title	(Community Post)
  ID	31467180
  External ID	f4103997-4336-4b95-8602-831823dd1dcf
  Author	hodl69
  Published Date	June 8, 2026, 3:21 p.m.
  Summary	Harout Semerjian CEO, President & Director Yes\. I mean, hopefully, the idea is to grow it quarter\-over\-quarter\. And that's really the case\. I mean, this is a large market, Corinne, that even with a good asset like Luspa, they're not getting every first\-line patient\. And still, it's like a $2\.5 billion business, right? So these are thousands of patients who can be helped\. And our aspiration is to grow that in the second\-line patient population quarter\-over\-quarter\. And really, over time, folks can see the steadiness of those curves\. Corinne Jenkins Goldman Sachs Group, Inc\., Research Division Okay\. What about the average dose you're seeing for patients in RYTELO? And I think in IMerge, there was something like 50% of those patients saw some sort of dose reduction\. Could you talk about the dose intensity you're seeing over the duration of therapy? Harout Semerjian CEO, President & Director Do you want to tackle that? Joseph Eid Executive VP of Research & Development and Chief Medical Officer Yes\. So there are \-\- obviously, there's a spectrum of management of patients\. When patients are managed according to the label, they tend to stay on the drug\. And you have a different approach\. You have a dose reduction and resumption at the higher dose that was started, which is the 7\.1 milligram per kilogram every 4 weeks or they go down and they stay down or they go down and they have a second reduction of dose\. So there's hold, there's reduction and there's resumption\. Patients tend to respond even when their dose is reduced after and sustained responses\. So the key education that we've been entertaining is to make sure that patients are maintained on drug as opposed to what we have seen in the first few months after launch\. Cytopenia was observed and patients were dropped after 1, 2 or 3 cycles, which is not doing patients any favor\. So that's the approach that we have been educating\. And again, the ASH data validates that point that cytopenia is \-\- has to be seen in a positive way, not as a negative\. It's not a safety\. It's an on\-target observation\. Corinne Jenkins Goldman Sachs Group, Inc\., Research Division So maybe could you speak a little bit more about this, like what the dose intensity is today versus kind of what it could be if you are able to get through these educational efforts and get more physician understanding around keeping patients on drug? Joseph Eid Executive VP of Research & Development and Chief Medical Officer I mean it's \-\- again, tailored to the individual\. Every patient is different\. So you can't say everybody has to treat the patient equally\. Some patients actually, in my view, need to have a higher dose escalation, which is not something that we have studied in the past, but something that we would look forward in the future\. Harout Semerjian CEO, President & Director And this happens in oncology quite a bit\. I mean, I remember back when we launched everolimus, I mean, it was the same thing where withholding dose, reducing dose, these are things that oncologists and hematologists are used to\. So we're not discovering a new path over here\. What we're doing is making sure that there is a proactive education in terms of what they're going to see once they put a patient on RYTELO, what that data is and how do you go through it? And how do you go through it? It's quite simple between withholding dose, reduction of dose\. And you get that durability of response that we've seen in IMerge, including dose tactics\. It's not like those were perfect patients, no one reduced the dose\. It's part of life\. That's kind of what we're saying is you can mimic IMerge and actively manage the patient\. Corinne Jenkins Goldman Sachs Group, Inc\., Research Division What's the \-\- if you can share kind of impact on revenue at different dose levels? Does it scale like linearly? Or is it\.\.\. Harout Semerjian CEO, President & Director I mean it can\. Obviously, the more folks use the RYTELO appropriately, that's kind of what we want them to do\. But our guidance and our aspirations do take into consideration that some people will have to dose escalate \-\- de\-escalate or withhold doses mimicking IMerge\. We don't have a reason to believe that somehow every patient is going to get on therapy\. I mean, if that was the case with 8,000 patients, I mean that would be a very, very different number\. So our guidance and all that takes into consideration how IMerge was\. And what I'm also excited about our efforts for this year is in addition to the ISTs that have been launched is starting to have some of those real\-world evidences start to report back where we're seeing a mimicking of IMerge in the real world\. That's a good thing because sometimes in oncology or hematology, you don't necessarily have this\. And for me, that was a very important validation for us that if we are able to get our educational pieces going in the way we are, we're going to get more and more patients in the second\-line setting, which will give a lot of those physicians the ability to say, "Oh, I can actually see those results but have read about in IMerge, and that would really have that positive reinforcement\. Corinne Jenkins Goldman Sachs Group, Inc\., Research Division Sure\. You mentioned earlier that you kind of took a fresh look at tiering of the physician market and how you would go to market with that population\. I guess what can you share at this point about how you are tiering the prescribers? And what percentage of patients are seen by the doctors that you're now able to kind of both directly and then indirectly reach? Harout Semerjian CEO, President & Director Yes\. So one of the things of having the benefit of fresh eyes, especially with our Chief Commercial Officer and I would say also our medical affairs head is really taking \-\- stepping back and leveraging their experiences in having dealt with these patient populations and these physicians and really understanding where is the source of business going to come from, not where it is today, but ultimately, where is it's going to come from\. And this is a 80% community\-driven disease\. It really is\. So in the beginning, it does happen where our proportion of our sales will be more from the academic medical centers\. It's just \-\- they're the first ones to start off with\. But we also want to make sure that ultimately, if we're doing our job right, 80% of that is going to come from the community\. So community physicians with high volume loads are really our priority \#1\. I mean, those happen to be also the toughest accounts to get into, because everybody is doing that\. But that's where even some of the revamping we've done in our field force in terms of making sure that we really have the connections\. I mean, in a biotech setting, it's very different than a big pharma setting\. In a big pharma setting, you're kind of developing people over time\. In biotech, at least in a company like us, we don't have that time\. That luxury doesn't exist\. Everybody coming in has to hit the ground running very rapidly\. We almost have a joking way of saying, after 2 paychecks, you're no longer new\. And we pay every 2 weeks\. So\.\.\. Corinne Jenkins Goldman Sachs Group, Inc\., Research Division 1 month\. Harout Semerjian CEO, President & Director It really is\. So it's a very different shift in terms of how a commercial company works\. Very different than a development company where it's all about precision\. Let it take however many years it will take\. We really need to get the precise\. And that's important because you're dealing with FDA, you're dealing with very important things\. But that changes\. The company needs to kind of change with it\. So that's where our targeting now is very much on \-\- our efforts are on the high\-volume ones, but also we have now a lot of capital deployed into digital and non\-personal, where we can reach the tail end of those folks, but not necessarily having the rep chase down every single person, but really making sure that they're getting their information from online from where they actually do get in or from the regional meetings\. And that's another area where we spent quite heavily versus our previous approaches is there are a lot of regional meetings\. Some of them are announced, some of them are more lucky, where it's 50 hematologists, 60 hematologists, they get together over a weekend, really discussing certain topics\. So what we have said in the marketplace is whenever that's happening and there is an MDS topic, RYTELO should be on the agenda, being debated, and we should be part of that partnership conversation\. So that's another area where there's been a redeployment of cash really taking away from some of the areas that helped us get here, but not necessarily \-\- especially in R&D, not necessarily in need for us to carry that forward because a lot of that search has already been done\. Corinne Jenkins Goldman Sachs Group, Inc\., Research Division What are the metrics that you as the management team are tracking to ensure this strategy is working? And can you share anything around kind of how those metrics are tracking right now? Harout Semerjian CEO, President & Director Yes\. So internally, we have almost reset our entire way of how we track performance, how we track early indicators, not just lagging indicators like sales because those happen \-\- if everything else goes well, then in a few months, you'll get the sales, but really tracking some of the early indicators in terms of effort, precision of where we target, making sure where our bulk of investments are going rapidly\. So we've been really revamping our eyes and ears from that side\. What we have shared publicly is other than our sales numbers, obviously, is the demand growth, that is a very important metric\. We also have shared our number of new accounts that have ordered RYTELO for the first time because that's also another metric in terms of activation of new accounts, and that has been steadily going up 150 to 100 accounts every quarter\. And also our source of business in terms of patient type\. So first line, second line versus the later line\. So ideally, we would want to see demand growth\. We would want to see the right patients in terms of first, second\-line patients versus later line patients and getting more and more sites to actually use it for the first time\. Even I would say our rewarding system internally has shifted \-\- in the first year, it's typical that you're rewarding any kind of performance\. But now we're not in that stage\. Now it's about what are we actually rewarding is second\-line performance\. And that's going to be very important in terms of what you kind of shift is what you usually get\. Corinne Jenkins Goldman Sachs Group, Inc\., Research Division Right\. You do anticipate clinical \-\- a clinical update later this year from myelofibrosis\. I guess what are the range of potential outcomes out of that interim update? And how do you plan to share it or communicate it with investors? Harout Semerjian CEO, President & Director Yes\. So other than low\-risk MDS, I mean, we're very excited to have completed a Phase III in terms of enrollment in another high unmet medical area of not just myelofibrosis overall, but relapsed and refractory to a JAK inhibitor, in this case, ruxolitinib\. And that's a patient population that needs additional options\. So we were very interested to see the Phase II data\. And that's where we started the Phase III\. Now it's fully enrolled\. Data is maturing as of last fall\. We have said that interim analysis based on the projection of events because it is a primary endpoint is overall survival, is before end of this year\. That's on the IA\. And then if we keep on going, the full maturity of the data would be in the second half of 2028\. What we have all seen in our previous career is that most of the time, those trials typically take the full maturity time line to \-\- for the data to mature\. But of course, we're going to be ready to do an interim analysis with the high\-quality data\. And usually, because we want to stay blinded to that, the DMC will take a look at it\. The DMC has been meeting on a regular basis for the last several years anyway\. So the range of outcomes can be stopped for futility where that's not helping anybody or even with the minimal alpha that we're spending in the interim analysis, stopping for overwhelming efficacy, which would be the best case outcome\. Most of the time, it will be where they tell the company, keep on going\. And our intent is that we communicate whatever they tell us accordingly with the marketplace\. So this is a big deal\. So we're very excited about it, but we, as a company, can continue our lower\-risk journey as we let that data mature\. And then once we get there, we look forward to helping more patients as well in the myelofibrosis period\. Corinne Jenkins Goldman Sachs Group, Inc\., Research Division Maybe a quick question on funding, which is how are you thinking about funding to profitability at this point? And are there any adjustments that you anticipate making to your commercial infrastructure now that you're reviewing it, et cetera, and have had it in place for about a year? Harout Semerjian CEO, President & Director Yes\. We did that review very rapidly, Corinne, because that was one of the things which was very important\. It was primarily driven by simplifying our organization\. We had at one point like 6 layers of people reporting to each other for a tiny biotech with one drug, one indication\. And that's not how companies can really thrive and go\. So we really made sure that we declutter the organization and we did that very rapidly and really actually helped us move forward\. So from that side, it gave us the option \-\- not just the ability to move forward in terms of impact, but also extend our cash runway, which gives us optionality\. So now that's one of the things which is very special, in my opinion, about Geron is, we have an asset that's growing\. We have another Phase III that's maturing, and we have the cash runway to keep on going and to, at one point, rise up to our real aspiration of building a hematology company with the $400 million plus cash that we have and another $200 million plus coming in every year in a very simplified manner\. So that's really something that we're very excited about\. Corinne Jenkins Goldman Sachs Group, Inc\., Research Division Sounds like much to come\. And with that, I think we're basically at time\. So thank you guys both for joining us\. Thanks, everyone, who joined us here as well\.
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