EX-99.2 3 d809273dex992.htm EX-99.2 EX-99.2

Slide 1

Margaret von Mehren, Steven Attia, Sebastian Bauer, Ping Chi, Gina D’Amato, Suzanne George, Hans Gelderblom, Michael C. Heinrich, Robin L. Jones, Peter Reichardt, Patrick Schoffski, Cesar Serrano, John Zalcberg, Julie Meade, Kelvin Shi, Rodrigo Ruiz-Soto, Jean-Yves Blay INVICTUS: A Phase 3, INterVentional, Double-Blind, Placebo-Controlled Study to Assess the Safety and Efficacy of Ripretinib as ≥4th Line Therapy In Patients with AdvanCed Gastrointestinal Stromal TUmorS (GIST) Who Have Received Treatment with Prior Anticancer Therapies (NCT03353753) Exhibit 99.2


Slide 2

Acknowledgements We would like to thank the patients and their families and caregivers, the investigators, and the investigational site staff of the INVICTUS study. Each flag corresponds to the participating country and the number of participating centers within that country.


Slide 3

Disclosures Margaret von Mehren: advisory/consultancy role with Deciphera Pharmaceuticals, LLC, Blueprint MedicinesTM Corporation, and Exelixis, Inc.; travel accommodations from Deciphera Pharmaceuticals, LLC and the National Comprehensive Cancer Network®; institutional supportive research funding from ASCO, Deciphera Pharmaceuticals, LLC, Blueprint MedicinesTM Corporation, AROG Pharmaceuticals, Inc., Novartis, Gradalis®, Inc., and Genmab. The INVICTUS study was sponsored by Deciphera Pharmaceuticals, LLC, Waltham, MA, USA.


Slide 4

KIT Mutations Drive ~80% of GIST GIST is a rare sarcoma accounting for 1% to 2% of GI malignancies1 Primary mutations in KIT or PDGFRA occur in >85% of patients with GIST2 Mutations lead to activation of the kinase3 1. Parab TM, et al. J Gastrointest Oncol. 2019;10:144-154. 2. Hsueh YS, et al. PLOS One.2013;e65762. 3. Smith BD, et al. Cancer Cell. 2019;35:738-751 4. Bai Y, et al. Leukemia.2013;27:278-285. 5. Oppelt PJ, et al. J Gastrointest Oncol. 2017;8:466-473. *Exon 11 mutations of the JM domain result in loss of function of the KIT inhibitory switch4 **Mutations in the TK1 region of KIT reflect mutations in the ATP-binding pocket (“switch pocket region”)4,5 ***Mutations in the activation loop of KIT reflect mutations in the KIT activating switch region4 From Hemming M, et al. Ann Oncol. 2018;29:2037-2045 by permission of Oxford University Press on behalf of the European Society for Medical Oncology.


Slide 5

GIST Current Treatment Landscape Line of Therapy 1st line 2nd line 3rd line 4th line Current approved therapy Imatinib Sunitinib Regorafenib No approved therapy Median PFS Imatinib 400 mg: 20.4 mo1a Imatinib 800 mg: 24.0 mo1a P=0.18 Sunitinib: 5.6 mo2b Placebo: 1.4 mo2b P<0.0001 Regorafenib: 4.8 mo3 Placebo: 0.9 mo3 P<0.0001 Overall response rate (CR + PR) Imatinib 400 mg: 51.0%1 Imatinib 800 mg: 56.7%1 P=0.08 Sunitinib: 6.8%2 Placebo: 0% P=0.006 Regorafenib: 4.5%4 Placebo: 1.5% P=NR Median OS Imatinib 400 mg: 46.8 mo1a Imatinib 800 mg: 46.8 mo1a P=0.31 Sunitinib: 17.0 mo5b Placebo: 14.9 mo5b P=0.161 Regorafenib: 17.4 mo3 Placebo: 17.4 mo3 P=0.5716 a PFS / OS converted from years to months. b PFS converted from weeks to months. NR, not reported. No approved 4th line therapies are available 1. Casali PG, et al. J Clin Oncol. 2017;35:1713-1720. 2. Sutent [package insert]. New York, NY: Pfizer Labs; 2017. 3. Stivarga [package insert]. Whippany, NJ: Bayer HealthCare Pharmaceuticals Inc; 2017. 4. Demetri GD, et al. Lancet. 2013;381:295-302. 5. Garrett CR, et al. Poster presented at: Connective Tissue Oncology Society: November 13-15, 2008; London, UK. Abstract 35049.


Slide 6

Ripretinib Mechanism of Action Ripretinib is a novel tyrosine kinase switch control inhibitor engineered to broadly inhibit KIT and PDGFRA mutated kinases by using a unique dual mechanism of action that regulates the kinase switch pocket and activation loop Smith BD, et al. Cancer Cell. 2019;35:738-751.


Slide 7

Objective response rate (ORR) assessed by BICR (Key endpoint) Overall survival (OS) INVICTUS: Randomized Phase 3 Study Design Evaluated ripretinib as ≥4th line therapy in patients with advanced GIST Primary endpoint PFS (per modified RECIST based on Blinded Independent Central Review [BICR]) Select Secondary endpoints May 31, 2019 Ripretinib 150 mg QD (28-day cycles) Dose escalate to 150 mg BID Continue on same dose Discontinue study treatment Cross over to ripretinib 150 mg QD Discontinue study treatment Disease progression Dose escalate to 150 mg BID Discontinue study treatment Continue on same dose or or or or or Placebo (28-day cycles) Randomization 2:1 (n=120) Stratification Prior treatments: 3 vs ≥4 ECOG PS: 0 vs 1 or 2 Ripretinib 150 mg QD n=80 (28-day cycles) Placebo n=40 (28-day cycles) Disease progression by blinded independent central review/ unblinding Data cutoff


Slide 8

Patient Disposition Receiving ripretinib at cutoff (n=36) Receiving ripretinib at cutoff (n=11) Receiving placebo at cutoff (n=1) Eligibility assessed (n=154) Screen failures (n=25) Randomized (ITT population) (n=129) Ripretinib (double-blind period) (n=85) Placebo (double-blind period) (n=44) Discontinued blinded ripretinib (n=17) Discontinued blinded placebo (n=13) Did not receive placebo (n=1) Ripretinib received (n=85) Placebo received (n=43) Discontinued open-label ripretinib (n=32) Discontinued open-label ripretinib (n=18) Entered open-label ripretinib (n=42) Continued blinded ripretinib (n=26) Crossed over to open-label ripretinib (n=29) Continued blinded placebo (n=1)


Slide 9

Baseline Characteristics Ripretinib (n=85) Placebo (n=44) Total (n=129) Age (years) Median (min, max) 59 (29, 82) 65 (33, 83) 60 (29, 83) 18–64 years 57 (67%) 22 (50%) 79 (61%) 65–74 years 20 (24%) 12 (27%) 32 (25%) ≥ 75 years 8 (9%) 10 (23%) 18 (14%) Gender Male (%) 47 (55%) 26 (59%) 73 (57%) Race White (%) 64 (75%) 33 (75%) 97 (75%) Region US (%) 40 (47%) 20 (46%) 60 (47%) ECOG PS (%) ECOG PS 0 37 (44%) 17 (39%) 54 (42%) ECOG PS 1/2 48 (56%) 27 (61%) 75 (58%) Number of prior therapies (%) 3 54 (64%) 27 (61%) 81 (63%) ≥4 (range, 4-7) 31 (36%) 17 (39%) 48 (37%) Primary mutation (central testing of tumor tissue) n (%) KIT exon 9 14 (17%) 6 (14%) 20 (16%) KIT exon 11 47 (55%) 28 (64%) 75 (58%) Other KIT 2 (2%) 2 (5%) 4 (3%) PDGFRA 3 (4%) 0 3 (2%) KIT/PDGFRA wild type 7 (8%) 3 (7%) 10 (8%) Not available / not done* 12 (14%) 5 (11%) 17 (13%) *Not available=tumor tissue analyzed for baseline mutations but analysis failed; Not done=biopsy completed per protocol but sample not received for analysis.


Slide 10

85% Risk Reduction of Disease Progression or Death With Ripretinib Compared With Placebo *Double-blind period. Ripretinib (n=85) Placebo (n=44) Events, n (%) 51 (60.0%) 37 (84.1%) Censored, n (%) 34 (40.0%) 7 (15.9%) PFS 6 months, % (95% CI) 51.0% (39.4–61.4) 3.2% (0.2–13.8) 100 80 60 40 20 0 0 2 4 6 8 10 12 14 Months Survival probability (%) 85 44 64 7 52 4 37 1 18 1 8 0 1 0 Ripretinib 150 mg QD Placebo Number of patients at risk: Ripretinib 150 mg QD Placebo Censored Median PFS 6.3 months vs 1.0 month* HR=0.15 (95% CI, 0.09–0.25) P<0.0001


Slide 11

Ripretinib Showed PFS Benefit in All Assessed Patient Subgroups In favor of ripretinib In favor of placebo


Slide 12

Median duration of response has not been reached yet *7 of 8 ripretinib responders are still responding as of data cutoff All responders had partial responses Durable Response With Ripretinib ORR 9.4% Confirmed ORR (n=8) ORR 0% (n=0) Ripretinib (n=85) Placebo (n=44) P=0.0504 Patients Who Responded (n=8) 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Months Time to Response Duration of Response PFS Censor PFS Event * * * * * * *


Slide 13

OS Benefit: 64% Risk Reduction of Death Compared With Placebo *Due to hierarchal testing procedures of the end points, the OS end point could not be formally tested because the ORR was not statistically significant. Ripretinib (n=85) Placebo (n=44) Events, n (%) 26 (30.6%) 26 (59.1%) Censored, n (%) 59 (69.4%) 18 (40.9%) OS 6 months, % (95% CI) 84.3% (74.5–90.6) 55.9% (39.9–69.2) OS 12 months, % (95% CI) 65.4% (51.6–76.1) 25.9% (7.2–49.9) Median OS 15.1 vs 6.6 months HR=0.36 (95% CI, 0.20–0.62) Nominal P=0.0004* 100 80 60 40 20 0 0 2 4 6 8 10 12 16 Months Survival probability (%) 85 44 Ripretinib 150 mg QD Placebo Number of patients at risk: Ripretinib 150 mg QD Placebo 14 81 34 76 29 67 24 42 14 24 8 10 1 0 0 2 1 Censored


Slide 14

Crossover Provided OS Benefit Median OS (months) 95% CI Ripretinib 15.1 (12.3–15.1) Placebo patients with crossover 11.6 (6.3–NE) Placebo patients without crossover 1.8 (0.9–4.9) 100 80 60 40 20 0 0 4 6 8 10 16 Months Survival probability (%) 85 29 15 Ripretinib Placebo patients with crossover Placebo patients without crossover Number of patients at risk: 12 14 81 28 6 76 24 5 67 22 2 42 13 1 24 8 0 10 1 0 0 2 1 Censored 2 NE, not estimable.


Slide 15

TEAEs in >10% of Patients Preferred Term Ripretinib any grade (n=85) Placebo any grade (n=43)* Any TEAE or grade 3/4 TEAE** 84 (98.8%) 42 (97.7%) Alopecia 44 (51.8%) 2 (4.7%) Fatigue 36 (42.4%) 10 (23.3%) Nausea 33 (38.8%) 5 (11.6%) Abdominal pain 31 (36.5%) 13 (30.2%) Constipation 29 (34.1%) 8 (18.6%) Myalgia 27 (31.8%) 5 (11.6%) Diarrhea 24 (28.2%) 6 (14%) Decreased appetite 23 (27.1%) 9 (20.9%) Palmar-plantar erythrodysesthesia syndrome 18 (21.2%) 0 Vomiting 18 (21.2%) 3 (7%) Headache 16 (18.8%) 2 (4.7%) Weight decreased 16 (18.8%) 5 (11.6%) Preferred Term Ripretinib any grade (n=85) Placebo any grade (n=43)* Arthralgia 15 (17.6%) 2 (4.7%) Blood bilirubin increased 14 (16.5%) 0 (0%) Edema peripheral 14 (16.5%) 3 (7%) Muscle spasms 13 (15.3%) 2 (4.7%) Anemia 12 (14.1%) 8 (18.6%) Hypertension 12 (14.1%) 2 (4.7%) Asthenia 11 (12.9%) 6 (14%) Dry skin 11 (12.9%) 3 (7%) Dyspnea 11 (12.9%) 0 Hypophosphatemia 9 (10.6%) 0 Lipase increased 9 (10.6%) 0 Pruritus 9 (10.6%) 2 (4.7%) Stomatitis 9 (10.6%) 0 *44 patients were randomized to placebo, but 1 did not receive treatment. **Regardless of causality


Slide 16

*44 patients were randomized to placebo, but 1 did not receive treatment. **Regardless of causality TEAEs in >10% of Patients Preferred Term Ripretinib any grade (n=85) Placebo any grade (n=43)* Any TEAE or grade 3/4 TEAE** 84 (98.8%) 42 (97.7%) Alopecia 44 (51.8%) 2 (4.7%) Fatigue 36 (42.4%) 10 (23.3%) Nausea 33 (38.8%) 5 (11.6%) Abdominal pain 31 (36.5%) 13 (30.2%) Constipation 29 (34.1%) 8 (18.6%) Myalgia 27 (31.8%) 5 (11.6%) Diarrhea 24 (28.2%) 6 (14%) Decreased appetite 23 (27.1%) 9 (20.9%) Palmar-plantar erythrodysesthesia syndrome 18 (21.2%) 0 Vomiting 18 (21.2%) 3 (7%) Headache 16 (18.8%) 2 (4.7%) Weight decreased 16 (18.8%) 5 (11.6%) Preferred Term Ripretinib any grade (n=85) Placebo any grade (n=43)* Arthralgia 15 (17.6%) 2 (4.7%) Blood bilirubin increased 14 (16.5%) 0 (0%) Edema peripheral 14 (16.5%) 3 (7%) Muscle spasms 13 (15.3%) 2 (4.7%) Anemia 12 (14.1%) 8 (18.6%) Hypertension 12 (14.1%) 2 (4.7%) Asthenia 11 (12.9%) 6 (14%) Dry skin 11 (12.9%) 3 (7%) Dyspnea 11 (12.9%) 0 Hypophosphatemia 9 (10.6%) 0 Lipase increased 9 (10.6%) 0 Pruritus 9 (10.6%) 2 (4.7%) Stomatitis 9 (10.6%) 0 Grade 3/4 TEAEs Ripretinib grade 3/4 (n=85)† Placebo grade 3/4 (n=43)*† 0 0 1 (1.2%) 0 1 (1.2%) 0 0 0 8 (9.4%) 6 (14%) 6 (7.1%) 0 1 (1.2%) 2 (4.7%) 0 0 0 0 4 (4.7%) 0 4 (4.7%) 0 0 0 0 0 †Corresponding grade 3/4 TEAEs to TEAEs in >10% of patients receiving ripretinib. Ripretinib grade 3/4 (n=85)† Placebo grade 3/4 (n=43)*† 42 (49.4%) 19 (44.2%) 0 0 3 (3.5%) 1 (2.3%) 3 (3.5%) 0 6 (7.1%) 2 (4.7%) 1 (1.2%) 0 1 (1.2%) 0 1 (1.2%) 1 (2.3%) 1 (1.2%) 1 (2.3%) 0 0 3 (3.5%) 0 0 0 0 0


Slide 17

TEAE Leading to Dose Modification *44 patients were randomized to placebo, but one did not receive treatment. **One patient in each arm considered possibly related to blinded study drug Categories n (%) Ripretinib (n=85) Placebo (n=43)* Any TEAE leading to dose reduction 6 (7.1%) 1 (2.3%) Any TEAE leading to dose interruption 20 (23.5%) 9 (20.9%) Any TEAE leading to treatment discontinuation 7 (8.2%) 5 (11.6%) Any TEAE leading to death** 5 (5.9%) 10 (23.3%)


Slide 18

INVICTUS: Conclusions Median PFS was significantly improved with ripretinib compared with placebo (6.3 vs 1.0 months; HR=0.15 [95% CI, 0.09–0.25]) Risk of progression or death reduced by 85% compared with placebo Median OS with ripretinib was 15.1 months vs 6.6 months in the placebo arm (HR=0.36 [95% CI, 0.20–0.63]) Risk of death reduced by 64% compared with placebo Ripretinib was associated with a favorable tolerability profile Ripretinib represents a potential new standard of care with broad activity in ≥4th line GIST, a patient population with advanced refractory disease and no other approved options Enrollment is ongoing in intrigue, a Phase 3, interventional, randomized, multicenter, open-label study of ripretinib vs sunitinib in patients with advanced GIST after treatment with imatinib (NCT03673501)