Item 1A. Risk Factors 30
Item 1B. Unresolved Staff Comments 51
Item 1C. Cybersecurity 51
Item 2. Properties 53
Item 3. Legal Proceedings 53
Item 4. Mine Safety Disclosures 53
PART II
Item 6. Reserved 54
Item 7A. Quantitative and Qualitative Disclosures About Market Risk 64
Item 8. Financial Statements and Supplementary Data 65
Item 9A. Controls and Procedures 91
Item 9B. Other Information 91
Item 9C. Disclosure Regarding Foreign Jurisdictions that Prevent Inspections 91
PART III
Item 10. Directors, Executive Officers and Corporate Governance 92
Item 11. Executive Compensation 92
Item 14. Principal Accountant Fees and Services 92
PART IV
Item 15. Exhibits and Financial Statement Schedules 92
Signatures 93
SPECIAL
NOTE REGARDING FORWARD-LOOKING STATEMENTS
The
Private Securities Litigation Reform Act of 1995 provides a “safe harbor” for forward-looking statements. This
Annual Report on Form 10-K (this “Annual Report”) contains forward-looking statements regarding us, our business prospects
and our results of operations that are subject to certain risks and uncertainties that could cause our actual business, prospects and
results of operations to differ materially from those that may be anticipated by such forward-looking statements. Factors that could
cause or contribute to such differences include, but are not limited to, those described in Part I, Item 1A, “Risk Factors”
and elsewhere in this Annual Report. Readers are cautioned not to place undue reliance on these forward-looking statements, which speak
only as of the date of this Annual Report. We expressly disclaim any intent or obligation to update or revise any forward-looking statements,
whether as a result of new information, future events or otherwise. Readers are urged to carefully review and consider the various disclosures
made by us in this Annual Report and in our other reports filed with the Securities and Exchange Commission (the “SEC”) that
advise interested parties of the risks and uncertainties that may affect our business.
All
statements, other than statements of historical facts, contained in this Annual Report, including statements regarding our plans, objectives
and expectations for our business, operations and financial performance and condition, are forward-looking statements. In some cases,
you can identify forward-looking statements by the following words: “anticipate,” “believe,” “continue,”
“could,” “estimate,” “expect,” “intend,” “may,” “might,” “ongoing,”
“plan,” “potential,” “predict,” “should,” “target,” “will,” “would,”
or the negative of these terms or other comparable terminology, although not all forward-looking statements contain these words. Forward-looking
statements involve known and unknown risks, uncertainties and other factors that may cause our results, performance or achievements to
be materially different from the information expressed or implied by the forward-looking statements in this Annual Report. Additionally,
our forward-looking statements do not reflect the potential impact of any future acquisitions, mergers, dispositions, joint ventures
or investments that we may make. Forward-looking statements may include, among other things, statements relating to:
● our revenue expectations;
● our expectations as to the use of proceeds from our financing activities;
● our plans with respect to potentially raising capital; and
These
statements involve known and unknown risks, uncertainties and other factors that may cause our results or our industry’s actual
results, levels of activity, performance or achievements to be materially different from the information expressed or implied by these
forward-looking statements. Certain risks, uncertainties and other factors include, but are not limited to, our limited operating history;
our potential inability to develop, validate, obtain regulatory approval for and commercialize gedatolisib on a timely basis or at all;
the uncertainties and costs associated with clinical studies and with developing and commercializing pharmaceuticals; the complexity
and difficulty of demonstrating the safety and sufficient magnitude of benefit to support regulatory approval of gedatolisib and other
products we may develop; challenges we may face in developing and maintaining relationships with pharmaceutical company partners, including
our current and any future suppliers of our product candidate; the uncertainty and costs associated with clinical trials; the uncertainty
regarding market acceptance by physicians, patients, third-party payors and others in the medical community, and with the size of market
opportunities available to us; difficulties we may face in managing growth, such as hiring and
retaining a qualified sales force and attracting and retaining key personnel; changes in government regulations; tightening credit markets
and limitations on access to capital; stock market volatility or other factors that may affect our ability to access capital on favorable
terms or at all; and obtaining and maintaining intellectual property protection for gedatolisib and time and expense associated with
enforcing our intellectual property rights against third parties, and defending third-party claims of intellectual property infringement,
investigations or litigation threatened or initiated against us. See “Risk Factors” in Part I, Item 1A of this Annual
Report for additional risks, uncertainties and other factors applicable to us.
SUMMARY
OF RISK FACTORS
Below
is a summary of the material factors that make an investment in our common stock speculative or risky. This summary does not address
all of the risks that we face. Additional discussion of the risks summarized in this risk factor summary, and other risks that we face,
can be found in the “Risk Factors” section of Part I, Item 1A of this Annual Report and should be carefully considered, together
with other information in this Annual Report and our other filings with the SEC before making investment decisions regarding our common
stock.
● We are dependent on our ability to attract and retain key personnel;
● The successful development of our products is highly uncertain;
● We face significant competition from other pharmaceutical companies;
PART
I
ITEM
1. Business
Overview
Unless
otherwise provided in this Annual Report, references to the “Company,” “we,” “us,” and “our”
and similar references refer to Celcuity Inc., a Delaware corporation. We own various unregistered trademarks and service marks, including
our corporate logo. Solely for convenience, the trademarks, trade names and service marks in this Annual Report, including those owned
by third parties, may be referred to without the ®,TM or SM symbols, but such references should
not be construed as any indicator that the owner of such trademarks, trade names and service marks will not assert, to the fullest extent
under applicable law, their rights thereto. We do not intend the use or display of other companies’ trademarks, trade names and
service marks to imply an endorsement or sponsorship of us by any other companies.
We
are a clinical-stage biotechnology company focused on the development of targeted therapies for the treatment of multiple solid
tumor indications. Our lead therapeutic candidate is gedatolisib, a kinase inhibitor of the phosphatidylinositol 3-kinase
(“PI3K”), serine/threonine-protein kinase protein kinase B (“AKT”), mechanistic target of rapamycin
(“mTOR”) pathway that binds to all class I PI3K isoforms and the mTOR complexes, mTORC1 and mTORC2. By targeting all
class I PI3K isoforms and mTORC1/2, gedatolisib induces comprehensive inhibition of the PI3K/AKT/mTOR (“PAM”) pathway.
Its mechanism of action and pharmacokinetic properties are differentiated from other currently approved and investigational
therapies that target PI3Kα, AKT, or mTORC1 alone or together. Our Phase 3 clinical trial, VIKTORIA-1, evaluating gedatolisib
in combination with fulvestrant, with or without palbociclib, in patients with hormone receptor-positive (HR+), human epidermal
growth factor receptor 2-negative (HER2-) (“HR+/HER2-”) advanced breast cancer (“ABC”) has completed
enrollment and reported detailed results for cohort 1, patients with PIK3CA wild-type (“WT”) tumors, and has
completed enrollment of cohort 2, patients with PIK3CA mutant-type (“MT”) tumors. Our Phase 3 clinical trial,
VIKTORIA-2, evaluating gedatolisib in combination with a cyclin-dependent kinase (“CDK”) 4/6 inhibitor and fulvestrant
as first-line treatment for patients with endocrine treatment resistant HR+/HER2- ABC is ongoing. A Phase 1b/2 clinical trial,
CELC-G-201, evaluating gedatolisib in combination with darolutamide in patients with metastatic castration resistant prostate cancer
(“mCRPC”), is ongoing.
In
January 2022, gedatolisib was granted Fast Track designation for the treatment of patients with HR+/HER2- ABC after progression on CDK4/6
therapy. Fast Track designation is granted by the FDA for products that are intended for the treatment of serious or life-threatening
diseases or conditions and which demonstrate the potential to address an unmet medical need.
In
July 2022, gedatolisib was granted Breakthrough Therapy designation for HR+/HER2- ABC after progression on CDK4/6 therapy. Breakthrough
Therapy designation is granted by the FDA to expedite the development and regulatory review of an investigational medicine that is intended
to treat a serious or life-threatening condition. The criteria for Breakthrough Therapy designation requires preliminary clinical evidence
that demonstrates the drug may have substantial improvement on one or more clinically significant endpoints over available therapy.
In
December 2022, we dosed the first patient in our Phase 3, open-label, randomized, two-part clinical trial, VIKTORIA-1. This trial is evaluating
the efficacy and safety of gedatolisib in combination with fulvestrant, with and without palbociclib, in adults with HR+/HER2- ABC who
have received prior treatment with a CDK4/6 inhibitor in combination with an aromatase inhibitor. Two studies based on PIK3CA
mutation status are included in the trial. According to confirmed PIK3CA mutation status, patients were manually assigned either
to a cohort evaluating patients who have PIK3CA WT tumors or to a cohort evaluating patients who have PIK3CA MT tumors.
The two cohorts were randomized separately. The cohort evaluating PIK3CA WT patients reported detailed study results in the third
and fourth quarters of 2025. The cohort evaluating patients with PIK3CA MT tumors has completed enrollment, and topline data is
expected to be available in the second quarter of 2026.
In
February 2024, we dosed our first patient in our Phase 1b/2 clinical trial, CELC-G-201, evaluating gedatolisib in combination with
darolutamide in patients with mCRPC. Initial preliminary data for the Phase 1 portion of the trial were reported in the fourth
quarter of 2025.
During
the third quarter of 2024, we commenced site selection and activation activities to support a Phase 3, open-label, randomized
clinical trial, VIKTORIA-2, designed to evaluate the efficacy and safety of gedatolisib plus a CDK4/6 inhibitor and fulvestrant as
first-line treatment for patients with HR+/HER2- endocrine treatment resistant ABC. The first patient was dosed in July 2025. For
the CDK4/6 inhibitor, investigators may choose either ribociclib or palbociclib. This multi-center, international trial enrolled 35
evaluable subjects in the safety run-in portion of the study to evaluate the safety of gedatolisib when combined with ribociclib and
fulvestrant. The safety run-in was completed in the first quarter of 2026. In the Phase 3 portion of the study, approximately 638
subjects are expected to be randomized and assigned to Cohort 1 (PIK3CA WT) or Cohort 2 (PIK3CA MT) based on their PIK3CA
status. Subjects in each cohort are expected to be randomized on a 1:1 basis to either Arm A (gedatolisib with fulvestrant and
ribociclib or palbociclib) or Arm B (fulvestrant and ribociclib or palbociclib). We intend to provide an update on our final Phase 3 study design in the second quarter of 2026. It is expected that approximately 200
clinical sites across North America, Europe, and Asia-Pacific will participate, including many sites included in the VIKTORIA-1
clinical trial.
In
August 2025, the FDA granted our request to submit our NDA for gedatolisib under the FDA’s Real-Time Oncology Review (“RTOR”)
program based on data from the PIK3CA WT cohort of the Phase 3 VIKTORIA-1 clinical trial. We made our first NDA pre-submission
in September 2025 and completed our submission of the NDA in November 2025. The FDA accepted our NDA on January 16, 2026, designating
it for Priority Review, with a target user fee goal date of July 17, 2026, pursuant to the Prescription Drug User Fee Act (“PDUFA”)
VII.
The
PI3K/AKT/mTOR (PAM) Pathway
Dysregulation
of the PAM signaling pathway is observed in many types of cancer, including breast and prostate cancer. The important role the PAM pathway
plays in cancer has led to significant investment in the development of many different PI3K and mTOR inhibitors for solid tumors.
Activities
associated with PI3K involve complex essential cell regulatory mechanisms, including feedforward and feedback signaling loops.
Overactivation of the pathway is frequently present in human malignancies and plays a key role in cancer progression. Four catalytic
isoforms of class I PI3K preferentially mediate signal transduction and tumor cell survival based on the type of malignancy and the
genetic or epigenetic alterations an individual patient harbors. Due to the multiple subcellular locations, activities, and
importance of the different PI3K complexes in regulating many types of cancer cell proliferation, control of PI3K activity is an
important target in cancer therapy.
mTOR
is a critical effector in cell-signaling pathways commonly dysregulated in human cancers. The mTOR signaling pathway integrates both
intracellular and extracellular signals and serves as a central regulator of cell metabolism, growth, proliferation, and survival. mTOR
is a serine/threonine protein kinase, a downstream effector of PI3K, and regulated by hormones, growth factors, and nutrients, that are
contained in two functionally distinct protein assemblies – mTORC1 and mTORC2. In cancer, dysfunctional signaling leads to various
constitutive activities of the mTOR complexes, making mTOR a good therapeutic target.
Developing
efficacious and well-tolerated therapies that target this pathway has been challenging. This reflects the inherent adaptability and complexity
of the PAM pathway, where numerous feedforward and feedback loops, crosstalk with other pathways, and compensatory pathways enable resistance
to PAM pathway inhibition. Another major hurdle for the development of PAM pathway inhibitors has been the inability to achieve optimal
drug-target blockade in tumors while avoiding undue toxicities in patients.
Gedatolisib
By
inhibiting multiple components of the PAM pathway, gedatolisib can overcome adaptive resistance mechanisms that inhibitors of single
PI3K/AKT/mTOR components do not address. As a result, we believe gedatolisib offers distinct advantages over currently approved and investigational
therapies that target PI3Kα, AKT or mTORC1 alone or together.
Gedatolisib
is a pan-class I isoform PI3K inhibitor with low nanomolar potency for the p110α, p110β, p110γ, and p110δ
isoforms and the mTORC1 and mTORC2 complexes. By targeting all class I PI3K isoforms and mTORC1/2, gedatolisib induces comprehensive
inhibition of the PAM pathway. Each PI3K isoform and mTOR complex is known to preferentially affect different signal transduction
events that involve tumor cell survival, depending upon the aberrations associated with the linked pathway. When a therapy only
inhibits a single class I PI3K isoform (e.g., alpelisib, a PI3Kα inhibitor), AKT (e.g., capivasertib, an AKT inhibitor) or
only one mTOR kinase complex (e.g., everolimus, an mTORC1 inhibitor), numerous feedforward and feedback loops between the PI3K
isoforms and mTOR complexes cross-activate the uninhibited sub-units. This, in turn, induces compensatory resistance that reduces
the efficacy of isoform specific PI3Kα, AKT, or mTORC1 kinase inhibitors. Inhibiting all four PI3K isoforms and both the
mTORC1 and mTORC2 complexes, as getatolisib does, thus prevents the confounding effect of isoform interaction that may occur with
isoform-specific PI3K inhibitors and the confounding interaction between PI3K isoforms, AKT, and mTOR.
To
compare the functional effect of inhibiting single versus multiple PAM pathway components, we evaluated gedatolisib, and component-selective
inhibitors for PI3Kα (alpelisib), AKT (capivasertib) and mTORC1 (everolimus) in a panel of breast cancer cell lines using a live
cell proliferation rate dose response analysis. The results of this analysis are presented in the table below.
Breast
Cancer Cell Line Proliferation Rate Dose Response Analysis
Average
values for 14 PIK3CA MT and 14 PIK3CA WT breast cancer cell lines
Note:
Growth rate (“GR”) was assessed using 28 cell lines by measuring live cells reducing potential with Real Time-Glo MT luciferase
assay before and after 72-hour drug treatment. GR50 (concentration required to inhibit growth rate by 50%) is a measure of potency. Max
cell growth inhibition (GR at highest drug concentration tested) is a measure of efficacy.
Source:
Rossetti S. et.al., npj Breast Cancer, 2024
On
average, gedatolisib was at least 300-fold more potent on average than the single component PAM inhibitors analyzed and only gedatolisib
induced a significant cytotoxic effect. In addition, gedatolisib’s potency and efficacy was comparable in cell lines with and without
PIK3CA mutations, in contrast to the single component PAM inhibitors.
● Better tolerated by patients than oral PI3K and mTOR drugs.
Gedatolisib
is administered intravenously (“IV”) on a four-week cycle of once a week for three weeks, then one week off, in contrast to the orally
administered pan-PI3K or dual PI3K/mTOR inhibitors that are no longer being clinically developed. Oral pan-PI3K or PI3K/mTOR inhibitors
have repeatably been found to induce significant side effects that were not well tolerated by patients. This typically leads to a high
proportion of patients requiring dose reductions or treatment discontinuation. The challenging toxicity profile of these drug candidates ultimately played a significant role in the decisions to halt their development,
despite showing promising efficacy. By contrast, gedatolisib’s comprehensive inhibition of the PAM pathway at low nanomolar potency,
IV route of administration, and pharmacokinetic properties enables it to achieve optimal anti-proliferative effects on tumor cells without
inducing the levels of hyperglycemia, rash, and diarrhea typically associated with oral single-component inhibitors of the PAM pathway.
Isoform-specific
PI3K or mTORC1 inhibitors administered orally were developed to reduce toxicities in patients. While the range of toxicities
associated with single-component PAM inhibitors is narrower than oral pan-PI3K or PI3K/mTOR inhibitors, administering them orally on
a continuous basis still leads to challenging toxicities. The experience with the FDA approved oral PI3Kα inhibitor,
alpelisib, and mTORC1 inhibitor, everolimus, illustrates the challenge. In their Phase 3 pivotal trials, alpelisib and everolimus
were found to induce hyperglycemia in 79% and 69% of patients evaluated, respectively. In addition, 26% and 24% of patients
discontinued alpelisib and everolimus, respectively, due to treatment related adverse events. By contrast, in the 103-patient dose
expansion portion of the Phase 1b clinical trial with gedatolisib, only 7% of patients experienced Grade 3 or 4 hyperglycemia and
less than 9% discontinued treatment.
Clinical
Development
As
of December 31, 2025, 1,127 patients and healthy volunteers have received gedatolisib in 12 completed or ongoing clinical trials.
Of these, 123 patients with solid tumors were treated with gedatolisib as a single agent in two clinical trials, 36 healthy volunteers
were treated in two clinical trials, and the remaining 968 patients received gedatolisib in combination with other anti-cancer agents
in eight clinical trials. Additional patients received gedatolisib in combination with other anti-cancer agents in 10 investigator sponsored
clinical trials.
Breast
Cancer Program
Breast
cancer is the most prevalent cancer in women, accounting for 30% of all female cancers and 7% of cancer-related deaths in the United
States. The National Cancer Institute estimated that approximately 316,950 new cases of breast cancer would be diagnosed in the United
States in 2025, and approximately 42,170 breast cancer patients would die of the disease.
Four
different breast cancer subtypes are currently identified using molecular tests that determine the level of HR and HER2 expression. The
most common subtype of ABC is HR+/HER2-. Approximately 70% of all breast cancer tumors express the estrogen receptor (“ER”),
which, upon activation, regulates the expression of various genes involved in tumor proliferation. Despite progress in treatment strategies,
HR+/HER2- advanced or metastatic breast cancer remains an incurable disease, with a median overall survival (OS) of three years and a
five-year survival rate of 34%.
Three
different classes of targeted therapies are currently used to treat HR+/HER2- tumors: endocrine-based therapies, CDK4/6 inhibitors, and
PAM inhibitors. Each of the CDK4/6 inhibitors and PAM inhibitors are generally used to respond to the related mechanisms of resistance
to endocrine therapy, namely, activation of the CDK4/6 and PAM pathways.
Nearly
80% of breast cancers have direct or indirect activation of the PAM pathway. The upregulation of the PAM pathway promotes hormone-dependent
and independent ER transcriptional activity, which contributes to endocrine resistance, leading to tumor cell growth, survival, motility,
and metabolism. Clinical studies have demonstrated that PAM inhibition can restore sensitivity to endocrine therapy (ET).
Additionally,
the PAM pathway, like other mitogenic pathways, can also promote the activities of cyclin D and CDK4/6 to drive proliferative cell cycling.
The available evidence indicates that resistance to CDK4/6 inhibition in patients with HR+/HER2- ABC is a transient adaptive mechanism,
most likely involving the PAM pathway. This data indicates that CDK4/6 signaling may be restored in CDK4/6 resistant tumors when PAM
inhibitors are applied. Thus, continuing CDK4/6 inhibitor treatment in combination with a PAM inhibitor in patients who progressed on
their prior CDK4/6 inhibitor, would both blockade the potentially reactivated CDK4/6 pathway and prevent adaptive activation of the PAM
pathway. This suggests the limited efficacy induced by current standard-of-care (SOC) therapies in patients who have progressed on a
CDK4/6 therapy reflects the mechanistic inadequacy of relying on partial PAM inhibition (e.g., alpelisib or everolimus) and no CDK4/6
inhibition to address this complex disease mechanism.
We
believe the complex connection between the PAM and CDK4/6 pathways can potentially enable gedatolisib to adaptively reactivate CDK4/6
signaling that reportedly occurs in CDK4/6 resistant tumors when the PAM pathway is comprehensively inhibited. By re-activating CDK4/6
signaling, we believe gedatolisib can restore the therapeutic effect of CDK4/6 inhibition when it is combined with a CDK4/6 inhibitor.
The contributory effect of a CDK4/6 inhibitor when combined with gedatolisib would thus largely reflect the interaction between the two
therapies that gedatolisib initiates.
Evidence
of gedatolisib’s anti-tumor activity in breast cancer cells was provided in a study evaluating the MCF7 xenograft model (ER+/HER2-/PIK3CA
mutant), where the combination of gedatolisib with palbociclib and fulvestrant caused 90% tumor regression with no tumor regrowth observed
for more than 60 days after the final dose.
Source:
Layman SABCS 2021
Clinical
Experience with Gedatolisib in Breast Cancer
The
favorability of preliminary results from a Phase 1b clinical trial (B2151009, further described below) which evaluated 138 patients
with HR+/HER2- ABC led us to focus our initial clinical development program on ABC.
On
January 13, 2022, gedatolisib was granted Fast Track designation for the treatment of patients with HR+/HER2- ABC after progression on
CDK4/6 therapy. Fast Track designation is granted by the FDA for products that are intended for the treatment of serious or life-threatening
diseases or conditions and which demonstrate the potential to address an unmet medical need. The designation offers the opportunity for
frequent interactions with the FDA to discuss the drug’s development plan and to ensure collection of appropriate data needed to
support drug approval, as well as eligibility for rolling submission of an NDA.
On
July 18, 2022, gedatolisib was granted Breakthrough Therapy designation for HR+/HER2- ABC after progression on CDK4/6 therapy. Breakthrough
Therapy designation is granted by the FDA to expedite the development and regulatory review of an investigational medicine that is intended
to treat a serious or life-threatening condition. The criteria for Breakthrough Therapy designation require preliminary clinical evidence
that demonstrates the drug may have substantial improvement on one or more clinically significant endpoints over available therapies.
The benefits of Breakthrough Therapy designation include more intensive guidance from the FDA on an efficient development program, access
to a scientific liaison to help accelerate review time, and potential eligibility for Priority Review if relevant criteria are met. Our
breakthrough application was supported by data from a Phase 1b clinical trial that assessed the safety, tolerability and clinical activity
of gedatolisib in combination with palbociclib and fulvestrant in patients with HR+/HER2- ABC whose disease progressed during treatment
with a CDK4/6 therapy and an aromatase inhibitor.
Phase
3 HR+/HER2- ABC Clinical Trial (VIKTORIA-1)
In
2022, we initiated VIKTORIA-1, a Phase 3, open-label, randomized clinical trial to evaluate the efficacy and safety of gedatolisib in
combination with fulvestrant with or without palbociclib in adults with HR+/HER2- ABC whose disease has progressed after prior CDK4/6
therapy in combination with an aromatase inhibitor. This multi-center, international trial has completed enrollment of 754 subjects at
nearly 200 clinical sites across North America, Europe, Latin America, and Asia-Pacific. The first patient was dosed in December 2022.
The
clinical trial is separately evaluating subjects according to their PIK3CA status.
The
clinical trial primary endpoints are progression free survival (“PFS”), per RECIST 1.1 criteria, as assessed by blinded independent central review (“BICR”).
Two primary endpoints will be evaluated in subjects who are PI3KCA WT, and one primary endpoint will be evaluated in subjects
who are PI3KCA MT. In subjects who are PI3KCA WT, the PFS of gedatolisib in combination with palbociclib and fulvestrant
(Arm A) will be compared to fulvestrant monotherapy (Arm C), and the PFS in gedatolisib in combination with fulvestrant (Arm B) will
be compared to fulvestrant monotherapy (Arm C). In subjects who are PI3KCA MT, the PFS of gedatolisib in combination with palbociclib
and fulvestrant (Arm D) will be compared to alpelisib combined with fulvestrant (Arm E).
All
subjects will receive treatment according to the assigned study arm until objective progressive disease, unacceptable toxicity, death,
or withdrawal of consent, whichever occurs first. Subjects in Arm C will have the option to receive the treatment regimen provided in
Arm A or Arm B upon radiographically confirmed disease progression. Subjects will be followed for adverse events, safety laboratory testing,
tumor assessment by RECIST v1.1, quality of life, and overall survival.
On
July 28, 2025, we announced topline data from the PIK3CA WT cohort of the VIKTORIA-1 clinical trial and on October 18, 2025, at
the European Society of Medical Oncology (“ESMO”) congress, additional efficacy and safety results from this cohort were
presented. The key efficacy and safety data from the PIK3CA WT cohort showed:
The
detailed results from cohort 1, PIK3CA WT cohort, established several new milestones in the history of drug development for HR+/HER2-
ABC:
In
December 2025, updated efficacy and safety results from the Phase 3 VIKTORIA-1 PIK3CA WT cohort were presented at the 2025 San Antonio
Breast Cancer Symposium including patient sub-group analyses, safety analyses and patient reported outcomes for well-being measures.
The
median PFS benefit of the gedatolisib triplet and doublet compared to fulvestrant was consistent across subgroups with the gedatolisib
triplet showing higher clinical benefit in nearly all subgroups compared to the gedatolisib doublet, particularly for patients who were
pre/perimenopausal, endocrine therapy resistant, or had visceral metastases. For patients enrolled in the United States and Canada, median
PFS was 19.3 months (HR=0.13; 90% CI: 0.07-0.29) for the gedatolisib triplet and 14.9 months (HR=0.35; 90% CI: 0.17-0.76) for the gedatolisib
doublet.
With
these results, the gedatolisib regimens represent a potential new standard of care for patients with HR+/HER2-, PIK3CA WT ABC
whose disease progressed on or after treatment with a CDK4/6 inhibitor.
Results
from cohort 2 of the VIKTORIA-1 Phase 3 clinical trial, the PIK3CA MT cohort, are expected to be available in the second quarter
of 2026.
B2151009 Phase
1b HR+/HER2- ABC Clinical Trial
A
Phase 1b dose-finding trial with an expansion portion for safety and efficacy evaluated gedatolisib when added to either the standard
doses of palbociclib plus letrozole or palbociclib plus fulvestrant in patients with HR+/HER2- ABC. PI3K mutation status was not used
as an eligibility criterion. Patient enrollment for the trial is complete.
A
total of 138 patients with HR+/HER2- ABC were dosed in the clinical trial. Four patients from this study continue
to receive study treatment, as of December 31, 2025, each of whom has received study treatment for more than six years.
Source:
Layman SABCS 2021
● Safety analysis:
● Best overall response data for each arm is presented in the table below:
Total Expansion Arms (N=103)
Arm A Arm B Arm C Arm D
Study Treatment P + L + G P + F + G P + F + G P + F + G
Gedatolisib schedule weekly weekly weekly 3 wks on/1 wk off
WT MT WT MT WT MT WT MT
(1)
ORR represents PR, except in Arm A, which had 1 CR = Complete response. Responses per RECIST 1.1; (2) Includes 2 unconfirmed PR
Abbreviations:
1L = first line, 2L = second line; mos = months; NR = not reached; ORR = objective response rate; PFS = progression free
survival
Source:
Layman R. et. al, Lancet Oncol., 2024
Additional
results from the Phase 1b portion of the clinical trial were presented at the ESMO congress in October 2025. The analyses reported efficacy
data from patients who were treated with the same drug regimen being evaluated in the VIKTORIA-1 study, gedatolisib combined with fulvestrant
and palbociclib. This included patients from Escalation Arm B and Expansion Arms B, C and D of the Phase 1b study.
As
described above, patients in Escalation Arm B and Expansion Arms B and C received a 180 mg dose of gedatolisib once weekly (“weekly
dose”). Patients in Expansion Arm D received a 180 mg dose of gedatolisib on days 1, 8, and 15 of a four-week cycle (“intermittent
dose”), which is the same dose regimen patients in the VIKTORIA-1 study receive. The proportion of patients who received the intermittent
dose of gedatolisib was 37% for those with PIK3CA MT tumors and 25% for those with PIK3CA WT tumors. The proportion of
patients who received prior treatment with a CDK4/6 inhibitor was 73% for those with PIK3CA WT tumors, and 71% for those with
PIK3CA MT tumors.
Median
PFS and the ORR were assessed in sub-groups of patients according to their PIK3CA status (Table 1). For all analyzed patients
with PIK3CA MT tumors (n=30), median PFS was 14.6 months and the ORR in response evaluable patients was 48%. Median PFS was 19.7
months and the ORR was 64% in patients with PIK3CA MT tumors who received the intermittent dose of gedatolisib used in the VIKTORIA-1
study. For patients with PIK3CA WT tumors (n=60), median PFS was 9.0 months and the ORR in response evaluable patients was 41%.
Median PFS was 9.1 months and the ORR was 53% in patients with PIK3CA WT tumors who received the intermittent dose of gedatolisib
used in the VIKTORIA-1 study.
Table
1: Efficacy Analysis of Phase 1b Patients Treated with Gedatolisib Plus Palbociclib Plus Fulvestrant
PIK3CA MT PIK3CA WT
All Intermittent Dose All Intermittent dose
Phase
3 HR+/HER2- ABC Clinical Trial (VIKTORIA-2)
In
July 2025, we dosed the first patient in VIKTORIA-2, a Phase 3, multi-center, open-label, randomized, clinical trial designed to
evaluate the efficacy and safety of gedatolisib plus a CDK4/6 inhibitor and fulvestrant as first-line treatment for patients with
HR+/HER2- endocrine treatment resistant ABC. For the CDK4/6 inhibitor, investigators may choose either ribociclib or palbociclib.
This multi-center, international trial enrolled 35 evaluable subjects in the safety run-in portion of the study to evaluate the
safety of gedatolisib when combined with ribociclib and fulvestrant. The safety run-in was completed in the first quarter of 2026.
In the Phase 3 portion of the study, approximately 638 subjects are expected to be randomized and assigned to Cohort 1
(PIK3CA WT) or Cohort 2 (PIK3CA MT) based on their PIK3CA status. Subjects in each cohort are expected to be
randomized on a 1:1 basis to either Arm A (gedatolisib with fulvestrant and ribociclib or palbociclib) or Arm B (fulvestrant and
ribociclib or palbociclib). We intend to provide an update on our final Phase 3 study design in the second quarter of 2026. It is expected that approximately 200 clinical sites across North America, Europe, and
Asia-Pacific will participate, including many sites included in the VIKTORIA-1 clinical trial.
Prostate
Cancer Program
In
the United States, prostate cancer is the second leading cause of cancer death in men. Current estimates predict that one in eight men
will be diagnosed with prostate cancer in his lifetime. The National Cancer Institute estimated that in 2025 there would be over 313,780
new cases of prostate cancer in the United States and approximately 35,770 deaths from the disease. Although approximately 69% of patients
are diagnosed with localized prostate cancer, about 8% of patients present with metastatic disease with a 5-year survival rate of 38%.
Androgen deprivation therapy (“ADT”) via medical or surgical castration has been the mainstay treatment for metastatic prostate
cancer. However, prostate cancer cells develop resistance to ADT and progress to castration resistance, leading to poor prognosis and
a median overall survival of about three to five years.
Men
with mCRPC have a poor prognosis and a predicted survival rate of fewer than two years from the initial time of progression. Treatment
options for prostate cancer depend on many different factors, including the stage of the cancer. Castration-resistant prostate cancer
is defined by disease progression despite ADT and is often indicated by rising levels of PSA. Current standard of care for men with castration-resistant
prostate cancer provides that patients should initially receive a combination of ADT and either abiraterone, which works by decreasing
androgen levels, or enzalutamide, which works by blocking androgen binding to androgen receptors (“AR”). If the disease progresses
despite these second-generation hormonal therapies, chemotherapy is considered the next treatment option. Treatment with chemotherapy
is generally postponed for as long as possible due to the potential for severe side effects including neuropathies, nausea, diarrhea,
decreased mental capacity and increased risk of infections.
Preclinical
studies have demonstrated a potential association between the PAM pathway and AR signaling in prostate cancer cells developing resistance
to ADT. In these studies, the AR and PAM pathways were shown to cross-regulate each other. This is similar to the relationship demonstrated
in breast cancer with the estrogen receptor pathway and the PAM pathway. Additionally, 70% - 100% of mCRPC tumors have PAM related pathway
alterations.
Several
clinical studies have shown promising results by inhibiting the PAM pathway in combination with an AR inhibitor. In separate Phase 2
and Phase 3 trials, the AKT inhibitor, ipatasertib, showed improvement in radiographic PFS (“rPFS”) in patients with mCRPC
and tumors with phosphatase and tensin homolog (“PTEN”) loss when ipatasertib was combined with the AR inhibitor, abiraterone,
versus abiraterone alone. In a Phase 2 trial, the pan-PI3K inhibitor, samotolisib, reported median rPFS of 10.2 when combined with enzalutamide
versus 5.5 months for enzalutamide alone.
Evidence
of gedatolisib’s in vivo activity in prostate cancer was provided in a study evaluating the 22RV-1, PC3, and enzalutamide sensitive
model (“C4-2”) prostate cancer xenograft models. As seen in the figures below, gedatolisib induced greater than 80% tumor
growth inhibition, regardless of the xenograft model’s sensitivity to the AR inhibitor, enzalutamide and the cell lines’
PTEN or AR status. In addition, gedatolisib combined with enzalutamide induced significantly greater tumor growth inhibition than enzalutamide
alone in the C4-2.
Source:
Sen, ASCO-GU, 2023
Phase
1b/2 mCRPC Clinical Trial (CELC-G-201)
We
received approval from the FDA in mid-2023 to proceed with the clinical development of gedatolisib in combination with Nubeqa®
(darolutamide), an approved androgen receptor inhibitor, for the treatment of patients with mCRPC. We have since initiated a Phase 1b/2
clinical trial (CELC-G-201) that will enroll up to 54 participants with mCRPC who progressed after treatment with an AR inhibitor. We
dosed our first patient in this trial in February 2024.
The primary objectives of the Phase 1b portion of the trial include assessment of the safety and tolerability of gedatolisib in combination
with darolutamide and determination of the recommended Phase 2 dose (“RP2D”) of gedatolisib. The primary objective of the
Phase 2 portion of the trial is to assess the radiographic PFS at six months of patients who received the RP2D.
In
the Phase 1b portion of the clinical trial, we enrolled 38 participants randomly assigned to receive 600 mg of darolutamide twice
daily combined with either 120 mg of gedatolisib in Arm 1 or 180 mg of gedatolisib in Arm 2. In both arms, gedatolisib was
administered once weekly for three weeks, then one week off. Additionally, all patients received prophylactic treatment for
stomatitis.
On June 30, 2025, we announced preliminary data for the CELC-G-201 Phase 1b trial, utilizing a May 30, 2025 data cut-off. Based on these
data, we amended the clinical trial protocol to enable exploration of additional doses in the Phase 1b portion of this clinical trial
to determine the RP2D. Once RP2D is determined, an additional 12 participants will then be enrolled in the Phase 2 portion of the study
at the RP2D level to enable evaluation of 30 participants treated with the RP2D of gedatolisib.
On October 18,
2025, at the ESMO congress, we presented updated clinical results for the CELC-G-201 Phase 1b trial based on an August 15, 2025 data
cut-off. Among the 38 patients enrolled, 61% had received
one line of prior systemic therapy and 39% had received at least two or more lines of prior therapy.
Updated
clinical results from the Phase 1 portion of the clinical trial were presented at the ESMO congress in October 2025. The Phase 1 data
set utilized an August 15, 2025 data cut-off. Median duration of follow-up was 9.0 months.
The
six-month rPFS rate and median rPFS for patients from both arms combined was 67% and 9.1 months, respectively. For patients treated with
120 mg gedatolisib, the six-month rPFS rate was 74% and median rPFS was 9.5 months. For patients treated with 180 mg gedatolisib, the
six-month rPFS rate was 61% and the median rPFS was 7.4 months.
The
combination of gedatolisib and darolutamide was generally well tolerated in the trial with mostly low-grade TRAEs. No dose limiting toxicities
were observed in either arm. The only Grade 3 TRAEs for patients from both arms combined included rash (5.3%), stomatitis (2.6%), and
pruritus (2.6%); no Grade 3 hyperglycemia was reported. Additionally, no Grade 4 or 5 TRAEs were observed, and no patients discontinued
study treatment due to a TRAE.
In
the amended Phase 1/1b portion of the clinical trial, up to six patients are planned to be enrolled in each of three arms and treated
with different doses. Upon completion of Phase 1, up to an additional 40 patients will be randomly assigned to up to four Phase 1b cohorts
to determine the RP2D. Dose levels will be selected based on the results from the Phase 1 clinical
trial. In the Phase 2 dose expansion study, which will include subjects from the Phase 1/1b clinical trial, up to 18 additional subjects
will be enrolled to achieve a total of approximately 30 subjects treated with the RP2D. All patients will also receive standard doses
of darolutamide.
Investigator-Sponsored
Trials
In
an investigator-sponsored Phase 2 clinical trial, 44 patients with HER2+/PIK3CA mutated metastatic breast cancer were treated
with gedatolisib plus standard doses of trastuzumab-pkrb. No prophylaxis for stomatitis was administered. The median number of prior
anti-HER2 therapies enrolled patients received in the metastatic setting was four or more; 86% of patients had received at least three
prior anti-HER2 therapies. The data cut-off was February 10, 2025.
Key
efficacy and safety results, as presented at the American Society of Clinical Oncology meeting in June 2025, showed:
● The ORR among all patients enrolled was 43%.
● Median PFS was 6.0 months (95% CI, 5.0-7.7).
● Median overall survival was 24.7 months (95% CI; 17.3-NA).
● No patients discontinued gedatolisib due to a treatment-related AE.
● One (2.3%) patient experienced Grade 3 hyperglycemia.
An
investigator sponsored trial has been initiated in collaboration with the Dana-Farber Cancer Institute and Massachusetts General Hospital
to evaluate gedatolisib in combination with abemaciclib and letrozole in patients with endometrial cancer.
Pfizer
Gedatolisib License Agreement
In
April 2021, we entered into a license agreement (the “Gedatolisib License Agreement”) with Pfizer pursuant to which we acquired
exclusive (including as to Pfizer) worldwide sublicensable rights to research, develop, manufacture, and commercialize gedatolisib for
the treatment, diagnosis and prevention of all diseases. Pursuant to the Gedatolisib License Agreement, we are obligated to use commercially
reasonable efforts to develop and seek regulatory approval for at least one product in the U.S. and if regulatory approval is obtained,
to commercialize such product in the U.S. and at least one international major market.
We
paid Pfizer a $5.0 million upfront fee upon execution of the Gedatolisib License Agreement and issued 349,406 shares of our common
stock to Pfizer pursuant to an Equity Grant Agreement. We are also required to make milestone payments to Pfizer upon achievement of
certain development and commercial milestone events, including a $5.0 million milestone payment we made in January 2026 following
FDA acceptance of our NDA submission, up to an aggregate of $335.0 million. We will pay Pfizer tiered royalties on sales of
gedatolisib at percentages ranging from the low to mid-teens, that may be subject to deductions for expiration of valid claims,
amounts due under third-party licenses and generic competition. Unless earlier terminated, the Gedatolisib License Agreement will
expire upon the expiration of all royalty obligations. The royalty period will expire on a country-by-country basis upon the later
of (a) 12 years following the date of First Commercial Sale of such Product in such country, (b) the expiration of all regulatory or
data exclusivity in such country for such Product, or (c) the date upon which the manufacture, use, sale, offer for sale or
importation of such Product in such country would no longer infringe, but for the license granted herein, a Valid Claim of a
Licensed Patent Right. Capitalized terms in this paragraph have the meanings set forth in the Gedatolisib License
Agreement.
We
have the right to terminate the Gedatolisib License Agreement for convenience upon 90 days’ prior written notice. Pfizer may not
terminate the agreement for convenience. Either we or Pfizer may terminate the Gedatolisib License Agreement if the other party is in
material breach and such breach is not cured within the specified cure period. In addition, either we or Pfizer may terminate the Gedatolisib
License Agreement in the event of specified insolvency events involving the other party.
Formulation,
Manufacturing and Distribution
We
rely on third parties to formulate, manufacture and distribute gedatolisib. We have entered into agreements with contract manufacturing
organizations (“CMOs”) to produce the drug substance gedatolisib and formulate, produce and package finished drug product
for clinical use and, if approved, commercial supply. We have entered into agreements with distributors and a third-party logistics provider
(“3PL”) to distribute finished product for clinical use and, if approved, commercial supply. We require all of our CMOs,
distributors, and our 3PL to conduct manufacturing and distribution activities in compliance with applicable laws, including current
good manufacturing practice (“cGMP”) and current good distribution practice, requirements. We anticipate that these CMOs,
distributors, and 3PL will have the capacity to support both clinical- and commercial-scale production and distribution. We may also
elect to enter into agreements with other CMOs to formulate and manufacture supplies of drug substance and finished drug product.
Sales
and Marketing
If
any of our product candidates are approved, we intend to market and commercialize them in the U.S. and select international markets,
either alone or in partnership with others. Cancer patients are primarily treated by medical, surgical, or radiation oncologists, and
we believe these physicians, and the multi-disciplinary teams surrounding them, including nurses, advanced practitioners, and pharmacists,
can be reached with a targeted sales force.
Competition
for Gedatolisib
The
pharmaceutical industry is characterized by rapid evolution of technologies and intense competition. We face competition from major pharmaceutical
and biotechnology companies, academic institutions, governmental agencies and public and private research institutions, among others.
Any product candidates that we successfully develop and commercialize will compete with approved treatment options, including off-label
therapies, and new therapies that may become available in the future. Key considerations that would impact our ability to effectively
compete with other therapies include the efficacy, safety, method of administration, cost, level of promotional activity, and intellectual
property protection of our products. Many of the companies against which we may compete have significantly greater financial resources
and expertise than we do in research and development, manufacturing, preclinical testing, conducting clinical trials, obtaining regulatory
approvals and marketing approved products.
There
are several PI3K, AKT, and mTOR inhibitors approved by the FDA, including PIQRAY and AFINITOR from Novartis AG, TRUQAP from AstraZeneca
plc, ITOVEBI from F. Hoffmann-La Roche Ltd, COPIKTRA from Verastem, Inc., and ZYDELIG from Gilead Sciences, Inc. We are aware that other
companies are, or may be, developing products for this indication, including BridgeBio Pharma Inc., Eli Lilly and Company, Kazia Therapeutics
Limited, Relay Therapeutics, Inc., Revolution Medicines Inc., and Takeda Pharmaceutical Company Limited. There may be additional companies
with programs suitable for addressing these patient populations that could be competitive with our efforts but that have not yet disclosed
specific clinical development plans. Smaller or early-stage companies, including oncology-focused therapeutics companies, may also prove
to be significant competitors, particularly through collaborative arrangements with large and established companies. These companies
may also compete with us in recruiting and retaining qualified scientific and management personnel, establishing clinical trial sites,
enrolling patients in clinical trials and acquiring technologies complementary to, or necessary for, our programs. The availability of
reimbursement from government and private payors will also significantly impact the pricing and competitiveness of our products. Our
competitors may obtain FDA or other regulatory approvals for their products more rapidly than we may obtain approvals for our product
candidates, which could result in our competitors establishing a strong market position before we are able to commercialize our product
candidates.
Market Opportunity
Based on our analysis of published epidemiological data, we estimate that approximately 37,000 patients in the U.S.
have HR+/HER2- ABC who have progressed after a CDK4/6 inhibitor. If gedatolisib ultimately receives FDA approval for the treatment
of both PIK3CA WT and PIK3CA MT populations,
using internal duration of treatment estimates and pricing assumptions consistent with currently available novel therapeutics for breast
cancer, we estimate the total addressable market for gedatolisib in the second-line setting is more than $5.0 billion. Given the
significant penetration our research is suggesting we can achieve, we believe it is reasonable to estimate that a second-line indication
for gedatolisib could potentially generate peak revenue of up to $2.5 billion annually.
Intellectual
Property
Our
success depends in part on our ability to obtain and maintain proprietary protection for our product candidates, to operate without
infringing the proprietary rights of others, and to prevent others from infringing our proprietary rights. We plan to protect our
proprietary positions using a variety of methods, which include obtaining U.S. and foreign patents related to our inventions and
improvements, and prosecuting additional U.S. and foreign patents that we determine are important to the development and
implementation of our business. For example, we, directly and via our licensors, currently have, or are
pursuing, patents covering the composition of matter, formulation, and methods of using our drug product candidates and we plan to
pursue additional patent protection as appropriate. We also rely on trade secrets, trademarks, know-how, continuing technological
innovation and potential in-licensing opportunities to develop and maintain our proprietary position.
Gedatolisib
Patents
We
entered into the Gedatolisib License Agreement with Pfizer in April 2021, pursuant to which we acquired exclusive worldwide rights under
Pfizer patents and know-how to develop, manufacture and commercialize gedatolisib. We have an exclusive license under the Gedatolisib
License Agreement to patent rights in the U.S. and numerous foreign jurisdictions relating to gedatolisib, in addition to our own patents.
The patent rights we own or which we have in-licensed under the Gedatolisib License Agreement include 13 granted patents in the U.S.
and more than 297 patents granted in numerous foreign jurisdictions. A U.S. patent covering gedatolisib as a composition of matter has
a statutory expiration date in December 2029 (including 209 days of Patent Term Adjustment), a U.S. patent that covers the cyclodextrin
formulation of gedatolisib that is currently used in our clinical trials expires in January 2041 (including 578 days of Patent Term Adjustment),
and a U.S. patent that covers the method of using gedatolisib in breast cancer expires in August 2042 (including 37 days of Patent Term
Adjustment), not including any Patent Term Extension that may be awarded by the U.S. Patent and Trademark Office (“USPTO”),
and relevant foreign counterparts. Issued patents will, as appropriate, be listed in the FDA’s Approved Drug Products with Therapeutic
Equivalence Evaluations (“Orange Book”).
Product
Trademark
We
have applied for trademark protection for our preferred commercial product tradename, and the USPTO has allowed the tradename for
registration. The FDA has conditionally approved the use of this tradename subject to the FDA’s approval of our NDA.
Trade
Secrets
In
addition to patents, we rely on trade secrets and know-how to develop and maintain our competitive position. We typically rely on trade