This phase I trial tests the safety, side effects studies chemotherapy followed by chemotherapy at the same time as radiation therapy (chemoradiation) before surgery (neoadjuvant) in treating patients with stage gastric (stomach) or gastroesophageal junction cancer . Chemotherapy drugs, such as docetaxel, oxaliplatin , leucovorin, fluorouracil, and capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high energy x-rays to kill tumor cells and shrink tumors. Giving chemotherapy and chemoradiation before surgery may make the tumor smaller and may reduce the amount of normal tissue that needs to be removed.

Start Date31 Dec 2025

Sponsor / Collaborator

Ohio State University Comprehensive Cancer Center

NCT06291064

/ Not yet recruitingPhase 2IIT

TreAtment Response and Omic-Markers in Triple-Negative Breast CAncer Patients Receiving Standard of Care Chemotherapy (TARMAC)

The primary purpose of this study is to determine what proportion of participants will achieve complete pathological response with epirubicin+ cyclophosphamide followed by docetaxel +carboplatin. This will also examine the potential of using signals in the blood (biomarkers) to identify resistance to chemotherapy in Nigerian women with triple negative breast cancer (TNBC).
All enrollment to this trial will occur at sites in Nigeria. University of Chicago is serving as coordinating center and will be involved in data analysis.

Start Date01 Nov 2025

Sponsor / Collaborator

The University of Chicago

NCT06525766

/ Not yet recruitingPhase 2IIT

Single Arm Pilot Trial of Adaptive Therapy (AT) With Capecitabine for the Treatment of Metastatic Estrogen Receptor Positive, Hormone Refractory Breast Cancer

This phase II trial evaluates the effect of capecitabine on tumor response using imaging and tumor markers to adjust dose (adaptive therapy) in patients with estrogen receptor (ER) positive, HER2 negative breast cancer that has spread from where it first started to other areas in the body (metastatic). Capecitabine is in a class of medications called antimetabolites. It is taken up by tumor cells and breaks down into fluorouracil, a substance that kills tumor cells. Adaptive therapy with capecitabine based on tumor burden response may slow or stop the growth of tumor cells in patients with metastatic ER positive, HER2 negative breast cancer.

Start Date15 Oct 2025

Sponsor / Collaborator

Mayo Clinic

100 Clinical Results associated with Capecitabine

100 Translational Medicine associated with Capecitabine

100 Patents (Medical) associated with Capecitabine

12,239

Literatures (Medical) associated with Capecitabine

01 Dec 2025·Journal of Gastrointestinal Cancer

Impact of Retroperitoneal Lymphadenopathy (RPLN) on the Outcomes of Locally Advanced Gall Bladder Cancer (GBC) Following Chemotherapy (CT) or Chemotherapy Followed by Consolidation Chemoradiotherapy (CTRT)

Article

Author: Naik, Nagendra ; Priyanka, Parul ; Agrawal, Sushma

INTRODUCTION:

Retroperitoneal lymphadenopathy is considered a metastatic disease in GBC; however, some surgical series of radical surgery with enlarged RPLN who underwent RPLN dissection have shown results marginally inferior to those without enlarged RPLN. Radiological RPLN comprises a major proportion of advanced non-metastatic GBC. There is dilemma in the intent of treatment to be offered in such cases. We are reporting our series of outcome of GBC with RPLN treated with first-line CT followed by consolidation CTRT.

MATERIALS AND METHODS:

Non-metastatic locally advanced GBC with good performance status (KPS ≥ 80) were initiated on first-line CT (cisplatin-gemcitabine), and thereafter, responders were evaluated by CECT-angiography and PET-CT scan for resectability. If found unresectable, they were offered consolidation CTRT to a dose of 45 Gy by conventional fractionation (3D-CRT technique) along with concurrent capecitabine at 1250 mg/m² to GBC and regional lymphatics including RPLN. Thereafter, boost dose of 9 Gy/5# was given to GBC only. Response assessment was done using CECT abdomen by RECIST criteria v 1.1. Outcomes (overall survival) of the two groups (RPLN vs non-RPLN) were computed with Kaplan-Meier survival curves and chi-square tests using SPSS v 20.

RESULTS:

Among 189 patients of advanced non-metastatic GBC recruited from 2011 to 2022, 80 had RPLN. The demographic features of both groups were comparable. Overall, 68% of the patients were women, 30% underwent upfront stenting for obstructive jaundice, and 90% had T3 and T4 disease. Only 10% had undergone upfront laparoscopic staging and had pathologically proven RPLN. Forty percent of the patients received four cycles of CT only and 50% of the patients received six cycles or more and 33% received CTRT. By RECIST criteria, 10% vs 16% achieved complete response (CR), 39% vs 41% achieved partial response (PR), 16% vs 15% achieved stable disease (SD), 2.7% vs 6% had disease progression (PD), and 14.5% vs 3.7% were non-evaluable in non-RPLN group vs RPLN group, respectively. 12% vs 6% could undergo radical surgery in non-RPLN group vs RPLN group (p = 0.03). The median OS was 9 months (95% CI 7.6-10.3 months) vs 10 months (95% CI 8-9.8 months) (p = NS) in non-RPLN group vs RPLN group, respectively. In those who received CT only, the median OS was 7 months vs 8 months, while in those who received CT followed by CTRT, the median OS was 14 months vs 13 months (p = 0.65) in non-RPLN group vs RPLN group, respectively.

CONCLUSIONS:

Based on this analysis, we conclude that RPLN constitutes a major proportion of advanced non-metastatic GBC and has outcomes similar to those without RPLN if treated with radical intent. RPLN should not be considered a metastatic disease and should be treated with radical intent.

01 Dec 2025·CANCER CHEMOTHERAPY AND PHARMACOLOGY

Dihydropyrimidine enzyme activity and its effect on chemotherapy toxicity: importance of genetic testing

Article

Author: Villano, John L ; Pandey, Deepali ; Roberts, Danielle ; Williams, Abby ; Shamaei Zadeh, Alexia

PURPOSE:

Patients with partial or complete DPD deficiency have decreased capacity to degrade fluorouracil and are at risk of developing toxicity, which can be even life-threatening.

CASE:

A 43-year-old man with moderately differentiated rectal adenocarcinoma on capecitabine presented to the emergency department with complaints of nausea, vomiting, diarrhea, weakness, and lower abdominal pain for several days. Laboratory findings include grade 4 neutropenia (ANC 10) and thrombocytopenia (platelets 36,000). Capecitabine is used as a component of first-line adjuvant therapy by approximately 2 million patients worldwide each year. Capecitabine is metabolized to fluorouracil via the enzyme dihydropyrimidine dehydrogenase (DPD). With worsening pancytopenia and diarrhea, genetic testing for DPD deficiency was sent. Prompt treatment with uridine triacetate was initiated for presumed DPD deficiency. Unfortunately, he passed away from an infectious complication and was later confirmed to have a heterozygous DPYD*2A mutation.

DISCUSSION:

Our case demonstrates uneven testing guidelines for DPD prior to initiating 5-FU chemotherapy, appropriateness of treating with uridine triacetate, and analysis of next-generation sequencing (NGS) on tumor samples and co-incidentally obtaining germline DPD deficiency status. Our case also highlights the severe clinical impact of having DPD deficiency even with early uridine triacetate therapy.

CONCLUSION:

It is our recommendation to perform DPD deficiency in curative intent cancer treatment and this information can increasingly be obtained in standard tumor NGS profiling, a growing norm in medical oncology.

01 Dec 2025·CANCER CHEMOTHERAPY AND PHARMACOLOGY

DPYD genotype should be extended to rare variants: report on two cases of phenotype / genotype discrepancy

Article

Author: Goldwirt, Lauriane ; Teixeira, Luis ; Thomas, Fabienne ; Jacqz-Aigrain, Evelyne ; Vilquin, Paul ; Mourah, Samia ; Medard, Yves

The enzyme dihydropyrimidine dehydrogenase (DPD) is the primary catabolic pathway of fluoropyrimidines including 5 fluorouracil (5FU) and capecitabine. Cases of lethal toxicity have been reported in cancer patients with complete DPD deficiency receiving standard dose of 5FU or capecitabine. DPD is encoded by the pharmacogene DPYD in which more than 200 variants have been identified. Different approaches have been developed for screening DPD-deficiency, including DPYD genotyping and phenotyping. Plasma uracil ([U]) and dihydrouracil ([UH₂]) concentrations are routinely used as surrogate markers for systemic DPD activity: [U] ≥ 16 ng/ml and < 150 ng/ml, and [U] ≥ 150 ng/mL indicate partial and complete DPD deficient phenotype, respectively, while values of 5 or 10 for [UH2]/([U] ratio are often cited. Four clinically relevant DPYD defective variants (DPYD*13, DPYD*2A, p.Asp949Val and haplotype B3), are targeted in genetic testing via PCR. In practice, pretreatment [U], alone or combined with these 4 recommended DPYD alleles guides individual dosage selection, though this approach has limitations. This is illustrated by two cases showing discrepancy between DPD deficient phenotype and normal standard genotype. In these two cases, DPYD exome sequencing with Next Generation Sequencing identified rare inactive variants, establishing concordance between phenotype and genotype. In patient 1, [U] levels of 21.1 and 25.5 ng/mL, indicated partial deficiency though the targeted genotype was normal and 5FU dose was adjusted based on the phenotype. In patient 2, [U] levels of 16.2 and 15.2 ng/mL were near the 16 ng/ml threshold. With a normal genotype, he as considered non-deficient as targeted genotype was normal and the standard dose was administered. These two cases underscore the need to pair DPD phenotyping with whole DPYD gene sequencing, due to the frequent discrepancies between these pharmacogenetic tools, the burden of rare variants and ethnic differences in variant frequencies.

341

News (Medical) associated with Capecitabine

12 Mar 2025

·www.drugs.com

ASTRO Issues Clinical Guideline for Use of Radiation Therapy in Anal Cancer

WEDNESDAY, March 12, 2025 -- In a clinical practice guideline issued by the American Society for Radiation Oncology and published online Feb. 27 in Practical Radiation Oncology , evidence-based recommendations are presented to address indications for definitive treatment of primary squamous cell carcinoma of the anal canal and anal margin. Mary Feng, M.D., from the University of California in San Francisco, and colleagues recommend multidisciplinary evaluation and decision-making for all patients. For most patients, definitive treatment with combined modality therapy is recommended using concurrent 5-fluorouracil or capecitabine plus mitomycin, with cisplatin as a conditional alternative to mitomycin with radiation therapy (RT). Local excision alone may be considered for select patients with early-stage disease. The primary tumor/anal canal and rectum and mesorectal, presacral, internal and external iliac, obturator, and inguinal lymph nodes should be included in RT target volumes. The authors also present a recommendation for intensity-modulated RT-based treatment approaches. Depending on disease stage and RT approach and adapted for risk, the primary tumor should receive doses of 4,500 to 5,940 cGy in 25 to 33 fractions, and clinically involved lymph nodes should receive 5,040 to 5,400 cGy in 28 to 30 fractions. To minimize acute and chronic treatment-related toxicity, dose guidance for normal tissues and measures are provided by the guideline. Treatment breaks should be kept to a minimum. "Radiation therapy plays a central role in managing anal cancer , offering patients an effective, organ-preserving definitive treatment," Feng said in a statement. Several authors disclosed ties to the biopharmaceutical industry. Abstract/Full Text Whatever your topic of interest, subscribe to our newsletters to get the best of Drugs.com in your inbox.

Radiation TherapyClinical Study

27 Feb 2025

·investor.pumabiotechnology.com

Puma Biotechnology Reports Fourth Quarter and Full Year 2024 Financial Results

LOS ANGELES--(BUSINESS WIRE)-- Puma Biotechnology, Inc. (NASDAQ: PBYI), a biopharmaceutical company, announced financial results for the fourth quarter and year ended December 31, 2024. Unless otherwise stated, all comparisons are for the fourth quarter and full year 2024 compared to the fourth quarter and full year 2023. Product revenue, net consists entirely of revenue from sales of NERLYNX®, Puma’s first commercial product. Product revenue, net for the fourth quarter of 2024 was $54.4 million, compared to $53.2 million in the fourth quarter of 2023. Product revenue, net for the full year 2024 was $195.2 million, compared to $203.1 million in 2023. Based on accounting principles generally accepted in the United States (GAAP), Puma reported net income of $19.3 million, or $0.39 per basic and diluted share, for the fourth quarter of 2024, compared to net income of $12.3 million, or $0.26 per basic and diluted share, for the fourth quarter of 2023. Net income for full year 2024 was $30.3 million, or $0.62 per basic and diluted share, compared to net income of $21.6 million, or $0.46 per basic share and $0.45 per diluted share, for full year 2023. The fourth quarter 2024 net income of $19.3 million, or $0.39 per basic and diluted share includes a partial release of our valuation allowance that favorably impacted net income by $7.1 million and favorably impacted earnings per share by $0.15 per basic and diluted share. This compares to net income in the third quarter 2024 of $20.3 million, or $0.41 per basic and diluted share. Non-GAAP adjusted net income was $21.1 million, or $0.43 per basic and diluted share, for the fourth quarter of 2024, compared to non-GAAP adjusted net income of $14.8 million, or $0.31 per basic and diluted share, for the fourth quarter of 2023. Non-GAAP adjusted net income for full year 2024 was $38.5 million, or $0.79 per basic and $0.78 per diluted share, compared to non-GAAP adjusted net income of $31.8 million, or $0.68 per basic share and $0.67 per diluted share, for full year 2023. Non-GAAP adjusted net income excludes stock-based compensation expense. For a reconciliation of GAAP net income to non-GAAP adjusted net income and GAAP net income per share to non-GAAP adjusted net income per share, please see the financial tables at the end of this news release. Net cash provided by operating activities for the fourth quarter of 2024 was $15.6 million, compared to net cash provided by operating activities of $10.5 million for the fourth quarter of 2023. Net cash provided by operating activities for full year 2024 was $38.9 million, compared to net cash provided by operating activities of $27.0 million for full year 2023. At December 31, 2024, Puma had cash, cash equivalents, and marketable securities of approximately $101 million, compared to cash, cash equivalents, and marketable securities of $96 million at December 31, 2023. “We are very pleased with our financial results for the fourth quarter of 2024, as well as for the full year 2024, and we are very pleased to be able to report positive net income for the third consecutive year, reflecting our strong execution and disciplined financial management,” said Alan H. Auerbach, Chairman, Chief Executive Officer and President of Puma. “This execution was driven by both our continued commercial performance in the United States and abroad, as well as effective implementation of our planned initiatives to raise patient awareness and expand access channels. In addition, we are pleased to be able to initiate the ALI-1201/ALISCA™-Breast1 Phase II trial of alisertib in combination with endocrine treatment in patients with chemotherapy-naïve HER2-negative, hormone receptor-positive metastatic breast cancer in November, which is a significant step in our clinical development plan for alisertib.” Mr. Auerbach added, “We anticipate the following key milestones over the next 12 months: (i) presentation of interim data from the Phase I trial of neratinib given in combination with trastuzumab deruxtecan in solid tumors with HER2 alterations (H1 2025); (ii) presentation of interim data from ALISCA™-Breast1, a Phase II trial of alisertib in combination with endocrine treatment in patients with chemotherapy-naïve HER2-negative, hormone receptor-positive metastatic breast cancer (2025); and (iii) presentation of additional interim data from the ALI-4201/ALISCA™-Lung1, a Phase II clinical trial of alisertib monotherapy for the treatment of patients with extensive stage small cell lung cancer (2025). Revenue Total revenue consists of product revenue, net from sales of NERLYNX, license revenue and royalty revenue. For the fourth quarter of 2024, total revenue was $59.1 million, of which $54.4 million was product revenue, net and $4.7 million was royalty revenue. This compares to total revenue of $72.2 million for the fourth quarter of 2023, of which $53.2 million was product revenue, net and $19.0 million was royalty revenue. For the year ended December 31, 2024, total revenue was $230.5 million, of which $195.2 million was product revenue, net and $35.3 million was royalty revenue. This compares to total revenue in 2023 of $235.6 million, of which $203.1 million was product revenue, net and $32.5 million was royalty revenue. Puma reported no license revenue for the years ended December 31, 2024 and 2023. Operating Costs and Expenses Total operating costs and expenses were $45.7 million for the fourth quarter of 2024, compared to $57.4 million for the fourth quarter of 2023. Total operating costs and expenses were $199.5 million for full year 2024, compared to $203.0 million for full year 2023. Cost of Sales Cost of sales was $13.9 million for the fourth quarter of 2024, compared to $24.3 million for the fourth quarter of 2023. Cost of sales was $64.4 million for full year 2024, compared to cost of sales of $62.7 million for full year 2023. The $1.7 million increase in full year 2024 was primarily due to the increase of product unit sales to our sub-licensees and the related cost of sales (primarily sales in China), partially offset by lower domestic sales. Selling, General and Administrative Expenses Selling, general and administrative (SG&A) expenses were $16.6 million for the fourth quarter of 2024, compared to $20.2 million for the fourth quarter of 2023. SG&A expenses for full year 2024 were $80.2 million, compared to $89.9 million for full year 2023. The $9.7 million decrease in SG&A expenses for full year 2024 compared to 2023 resulted primarily from a decrease in professional fees and expenses of approximately $4.1 million, primarily due to a decrease in consultant and contractor expenses (primarily marketing related) of approximately $2.7 million, a decrease in legal fees of approximately $1.0 million, and a decrease in insurance and other expense of approximately $0.4 million; a decrease in payroll and related costs of approximately $1.9 million, primarily due to lower headcount, partially offset by annual salary increases; a decrease in provision for credit loss (recovery) of approximately $1.4 million, due to an overdue receivable as of December 31, 2023 that was collected in 2024; a decrease in stock-based compensation expense of approximately $1.3 million, primarily due to lower fair value on equity grants as a result of a lower market price for our common stock; and a decrease in loss on impairment of asset expense of $0.6 million in connection with our decision to sublease a portion of our leased office space in 2023, which was recorded as an operating asset in accordance with ASC 842. Research and Development Expenses Research and development (R&D) expenses were $15.2 million for the fourth quarter of 2024, compared to $12.9 million for the fourth quarter of 2023. R&D expenses for full year 2024 were $54.9 million, compared to $50.4 million for full year 2023. The $4.5 million increase in R&D expenses during full year 2024 compared to full year 2023 resulted from an increase in clinical trial expense of approximately $3.5 million, primarily due to the procurement of our alisertib drug product, as well as increased alisertib study activity, partially offset by the achievement of fewer clinical milestones; an increase in internal R&D of approximately $1.5 million, primarily due to higher compensation related to achieving company goals and one-time payroll and severance-related expenses; partially offset by a decrease in stock-based compensation of approximately $0.7 million, primarily due to lower fair value on equity grants as a result of a lower market price for our common stock. Total Other Income (Expenses) Total other expenses were $1.1 million for the fourth quarter of 2024, compared to total other expenses of $2.0 million for the fourth quarter of 2023. Total other expenses were $6.9 million for full year 2024, compared to $9.9 million for full year 2023. The $3.0 million decrease in other expenses in full year 2024 resulted primarily from a $2.1 million increase in interest income, which reflected higher balances in cash equivalents and marketable securities, and a $0.9 million decrease in interest expense, which was due to the pay down of debt in 2024, as well as ending imputed interest on $8.0 million related to the final installment payment of the Eshelman litigation settlement paid in October 2024. Deferred Income Tax Benefit In the fourth quarter of 2024, Puma released a portion of its valuation allowance resulting in a non-cash, deferred tax income benefit of $7.1 million. The valuation allowance was established to offset Puma’s deferred tax assets, which are primarily related to its historical losses. This significantly increased Puma’s net income for the fourth quarter and full year 2024. First Quarter 2025 and Full Year 2025 Financial Outlook First Quarter 2025 Full Year 2025 Net Product Revenue $41–$43 million $192–$198 million Royalty Revenue $1.5–$2.5 million $20–$24 million License Revenue $0 million $0 million Net Income/(Loss)* $(2)–$0 million $23–$28 million Gross to Net Adjustment 22.5%–23.5% 20.5%–21.5% *There are no tax valuation allowance adjustments included in the outlook above. Conference Call Puma Biotechnology will host a conference call to report its fourth quarter and full year 2024 financial results and provide an update on Puma’s business and outlook at 1:30 p.m. PT/4:30 p.m. ET on Thursday, February 27, 2025. The call may be accessed by dialing 1-877-709-8150 (domestic) or 1-201-689-8354 (international). Please dial in at least 10 minutes in advance and inform the operator that you would like to join the “Puma Biotechnology Conference Call.” A live webcast of the conference call and presentation slides may be accessed on the Investors section of the Puma Biotechnology website at https://www.pumabiotechnology.com. A replay of the call will be available approximately one hour after completion of the call and will be archived on Puma’s website for 90 days. About Puma Biotechnology Puma Biotechnology, Inc. is a biopharmaceutical company with a focus on the development and commercialization of innovative products to enhance cancer care. Puma in-licensed the global development and commercialization rights to PB272 (neratinib, oral) in 2011. Neratinib, oral was approved by the U.S. Food and Drug Administration in 2017 for the extended adjuvant treatment of adult patients with early stage HER2-overexpressed/amplified breast cancer, following adjuvant trastuzumab-based therapy, and is marketed in the United States as NERLYNX® (neratinib) tablets. In February 2020, NERLYNX was also approved by the FDA in combination with capecitabine for the treatment of adult patients with advanced or metastatic HER2-positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting. NERLYNX was granted marketing authorization by the European Commission in 2018 for the extended adjuvant treatment of adult patients with early stage hormone receptor-positive HER2-overexpressed/amplified breast cancer and who are less than one year from completion of prior adjuvant trastuzumab-based therapy. NERLYNX® is a registered trademark of Puma Biotechnology, Inc. In September 2022, Puma entered into an exclusive license agreement for the development and commercialization of the anti-cancer drug alisertib, a selective, small molecule, orally administered inhibitor of aurora kinase A. Initially, Puma intends to focus the development of alisertib on the treatment of small cell lung cancer and breast cancer. In February 2024, Puma initiated ALISCA™-Lung1, a Phase II clinical trial of alisertib monotherapy for the treatment of patients with extensive-stage small cell lung cancer. In November 2024, Puma initiated ALISCA™-Breast1, a Phase II clinical trial of alisertib in combination with endocrine therapy for the treatment of patients with HER2-negative, HR-positive metastatic breast cancer. To help ensure patients have access to NERLYNX, Puma has implemented the Puma Patient Lynx support program to assist patients and healthcare providers with reimbursement support and referrals to resources that can help with financial assistance. More information on the Puma Patient Lynx program can be found at https://www.NERLYNX.com or by calling 1-855-816-5421. Further information about Puma Biotechnology may be found at https://www.pumabiotechnology.com. INDICATIONS NERLYNX® (neratinib) tablets, for oral use, is a kinase inhibitor indicated: As a single agent, for the extended adjuvant treatment of adult patients with early stage HER2-positive breast cancer, to follow adjuvant trastuzumab-based therapy. In combination with capecitabine, for the treatment of adult patients with advanced or metastatic HER2-positive breast cancer, who have received two or more prior anti-HER2 based regimens in the metastatic setting. Important Safety Information Regarding NERLYNX® (neratinib) U.S. Indication CONTRAINDICATIONS: None WARNINGS AND PRECAUTIONS: Diarrhea: Manage diarrhea through either NERLYNX dose escalation or loperamide prophylaxis. If diarrhea occurs despite recommended prophylaxis, treat with additional antidiarrheals, fluids, and electrolytes as clinically indicated. Withhold NERLYNX in patients experiencing severe and/or persistent diarrhea. Permanently discontinue NERLYNX in patients experiencing Grade 4 diarrhea or Grade ≥ 2 diarrhea that occurs after maximal dose reduction. Hepatotoxicity: Monitor liver function tests monthly for the first 3 months of treatment, then every 3 months while on treatment and as clinically indicated. Withhold NERLYNX in patients experiencing Grade 3 liver abnormalities and permanently discontinue NERLYNX in patients experiencing Grade 4 liver abnormalities. Embryo-Fetal Toxicity: NERLYNX can cause fetal harm. Advise patients of potential risk to a fetus and to use effective contraception. ADVERSE REACTIONS : The most common adverse reactions (reported in ≥ 5% of patients) were as follows: NERLYNX as a single agent: Diarrhea, nausea, abdominal pain, fatigue, vomiting, rash, stomatitis, decreased appetite, muscle spasms, dyspepsia, AST or ALT increased, nail disorder, dry skin, abdominal distention, epistaxis, weight decreased, and urinary tract infection. NERLYNX in combination with capecitabine: Diarrhea, nausea, vomiting, decreased appetite, constipation, fatigue/asthenia, weight decreased, dizziness, back pain, arthralgia, urinary tract infection, upper respiratory tract infection, abdominal distention, renal impairment, and muscle spasms. To report SUSPECTED ADVERSE REACTIONS, contact Puma Biotechnology, Inc. at 1-844-NERLYNX (1-844-637-5969) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . DRUG INTERACTIONS: Gastric acid reducing agents: Avoid concomitant use with proton pump inhibitors. Separate NERLYNX by at least 2 hours before or 10 hours after H2-receptor antagonists. Or separate NERLYNX by at least 3 hours with antacids. Strong CYP3A4 inhibitors: Avoid concomitant use. P-gp and moderate CYP3A4 dual inhibitors: Avoid concomitant use. Strong or moderate CYP3A4 inducers: Avoid concomitant use. Certain P-gp substrates: Monitor for adverse reactions of P-gp substrates for which minimal concentration change may lead to serious adverse reactions when used concomitantly with NERLYNX. USE IN SPECIFIC POPULATIONS : Lactation: Advise women not to breastfeed. Please see Full Prescribing Information for additional safety information. Forward-Looking Statements This press release contains forward-looking statements, including statements regarding Puma’s anticipated milestones and estimates of future financial results for the first quarter and full year 2025. All forward-looking statements involve risks and uncertainties that could cause Puma’s actual results to differ materially from the anticipated results and expectations expressed in these forward-looking statements. These statements are based on current expectations, forecasts and assumptions, and actual outcomes and results could differ materially from these statements due to a number of factors, which include, but are not limited to, any adverse impact on Puma’s business or the global economy and financial markets, any changes in Puma’s product candidates’ regulatory approvals, results from Puma’s clinical trials, any litigation involving Puma, any changes to Puma’s in-licensed intellectual property and the risk factors disclosed in the periodic and current reports filed by Puma with the Securities and Exchange Commission from time to time, including Puma’s Annual Report on Form 10-K for the year ended December 31, 2024 and subsequent filings. Readers are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. Puma assumes no obligation to update these forward-looking statements, except as required by law. 2024 2023 2024 2023 $ 54.4 $ 53.2 195.2 203.1 4.7 19.0 35.3 32.5 59.1 72.2 230.5 235.6 13.9 24.3 64.4 62.7 16.6 20.2 80.2 89.9 15.2 12.9 54.9 50.4 45.7 57.4 199.5 203.0 13.4 14.8 31.0 32.6 1.2 0.7 4.7 2.6 (2.6 ) (3.3 ) (12.5 ) (13.3 ) 0.2 0.6 0.9 0.8 (1.2 ) (2.0 ) (6.9 ) (9.9 ) 12.2 12.8 24.1 22.7 — (0.5 ) (0.9 ) (1.1 ) 7.1 — 7.1 — $ 19.3 $ 12.3 $ 30.3 $ 21.6 $ 0.39 $ 0.26 $ 0.62 $ 0.46 $ 0.39 $ 0.26 $ 0.62 $ 0.45 49,095,583 47,600,505 48,648,701 47,134,331 49,408,877 48,040,118 49,100,433 47,550,852 2024 2023 $ 69.2 $ 84.6 $ 31.7 $ 11.4 $ 51.5 $ 56.8 $ 45.3 $ 34.0 $ 21.7 $ 65.7 $ 92.1 $ 53.4 2024 2023 $ 38.9 $ 27.0 (20.4 ) (19.1 ) (33.9 ) — $ (15.4 ) $ 7.9 Use of Non-GAAP Measures In addition to operating results as calculated in accordance with GAAP, Puma uses certain non-GAAP financial measures when planning, monitoring, and evaluating operational performance. The following table presents Puma’s net income and net income per share calculated in accordance with GAAP and as adjusted to remove the impact of stock-based compensation expense. For the three months and twelve months ended December 31, 2024, stock-based compensation represented approximately 5.5% and 6.1% of total selling, general and administrative expense and research and development expense, respectively, and 7.4% and 7.3% for the same periods in 2023. Puma’s management believes that these non-GAAP financial measures are useful to enhance understanding of Puma’s financial performance, are more indicative of its operational performance, and facilitate a better comparison among fiscal periods. These non-GAAP financial measures are not, and should not be viewed as, substitutes for GAAP reporting measures 2024 2023 $ 19.3 $ 12.3 1.3 1.5 0.5 1.0 $ 21.1 $ 14.8 $ 0.39 $ 0.26 0.04 0.05 $ 0.43 (3) $ 0.31 (3) $ 0.39 $ 0.26 0.04 0.05 $ 0.43 (4) $ 0.31 (4) 2024 2023 $ 30.3 $ 21.6 5.5 6.9 2.7 3.3 $ 38.5 $ 31.8 $ 0.62 $ 0.46 0.17 0.22 $ 0.79 (5) $ 0.68 (5) $ 0.62 $ 0.45 0.16 0.22 $ 0.78 (6) $ 0.67 (6) Alan H. Auerbach or Mariann Ohanesian, Puma Biotechnology, Inc., +1 424 248 6500 info@pumabiotechnology.com ir@pumabiotechnology.com David Schull or Olipriya Das, Russo Partners, +1 212 845 4200 david.schull@russopartnersllc.com olipriya.das@russopartnersllc.com

License out/inDrug ApprovalPhase 2Phase 1Financial Statement

25 Feb 2025

·www.prnewswire.com

CStone Announces Publication of GEMSTONE-303 Study Results for Sugemalimab (Cejemly®) in JAMA

Sugemalimab is the world's first anti-PD-L1 monoclonal antibody approved for the treatment of gastric or gastroesophageal junction (G/GEJ) adenocarcinoma. The GEMSTONE-303 study results support sugemalimab in combination with chemotherapy as a new standard first-line treatment for patients with PD-L1 combined positive score (CPS) ≥5. Sugemalimab is the first anti-PD-L1 monoclonal antibody demonstrating superior overall survival (OS) and progression free survival (PFS) with a manageable safety profile in combination with chemotherapy compared to placebo plus chemotherapy in patients with locally advanced or metastatic G/GEJ adenocarcinoma who have not received prior systemic treatment for advanced disease and have PD-L1 CPS ≥5. Sugemalimab has received approvals for five indications in China, and for first-line treatment of Stage IV non-small cell lung cancer (NSCLC) in China, Europe and the UK. CStone will continue to engage with health authorities in Europe and other regions for regulatory expansion. SUZHOU, China, Feb. 24, 2025 /PRNewswire/ -- CStone Pharmaceuticals ("CStone", HKEX: 2616), an innovation-driven biopharmaceutical company focused on the research and development of anti-cancer therapies, today announced the publication of the GEMSTONE-303 study results for sugemalimab (brand name: Cejemly®) in the prestigious Journal of the American Medical Association (JAMA) . GEMSTONE-303 is a Phase 3, randomized, double-blind, placebo-controlled study designed to evaluate the efficacy of sugemalimab in combination with capecitabine and oxaliplatin (CAPOX) compared to placebo plus CAPOX as first-line treatment for patients with unresectable locally advanced or metastatic G/GEJ adenocarcinoma with PD-L1 CPS ≥5. The dual primary endpoints were OS and investigator-assessed PFS. Key secondary endpoints included PFS assessed by the Blinded Independent Central Review Committee (BICR), objective response rate (ORR), and duration of response (DoR). The GEMSTONE-303 article published in JAMA highlights the following key efficacy and safety findings: In patients with PD-L1 CPS ≥5, the sugemalimab group showed statistically significant and clinically meaningful improvements in both OS and PFS compared with the control group. Median OS was 15.6 months in the sugemalimab group compared with 12.6 months in the control group, with a hazard ratio (HR) of 0.75 (95% CI, 0.61-0.92), P=0.006, indicating that sugemalimab plus CAPOX could reduce the risk of death by 25%. Median PFS was 7.6 months in the sugemalimab group versus 6.1 months in the control group, with a HR of 0.66 (95% CI, 0.54-0.81), P<0.001. Grade ≥3 treatment-related adverse events (TRAE) occurred in 53.9% of patients in the sugemalimab group and 50.6% in the control group, indicating that the safety of this combination regimen was manageable. Subgroup analyses demonstrated consistent clinical benefits across all pre-defined subgroups, including patients with varying PD-L1 expression levels: Sugemalimab plus CAPOX significantly prolonged OS in patients with PD-L1 CPS ≥10; median OS was 17.8 months in the sugemalimab group compared with 12.5 months in the control group, with a HR of 0.64 (95% CI, 0.48-0.85), P=0.002. In patients with PD-L1 CPS ≥10, median PFS was 7.8 months in the sugemalimab group compared with 5.5 months in the control group, with a HR of 0.58 (95% CI, 0.43-0.77), P<0.001. In patients with PD-L1 CPS ≥10, ORR was 71.4% in the sugemalimab group compared with 48.6% in the control group. Dr. Jason Yang, CEO, President of R&D, and Executive Director at CStone, stated: "We are honored to see the GEMSTONE-303 study results published in JAMA. This study establishes sugemalimab in combination with chemotherapy as the new standard first-line treatment for patients with PD-L1 CPS ≥5 G/GEJ adenocarcinoma. To date, sugemalimab has been approved for five indications in China. Internationally, we have expanded its regulatory pathways and forged commercialization partnerships in various global markets. The compelling clinical data from GEMSTONE-303 reinforce our confidence in advancing the global registration and commercialization of sugemalimab. We are committed to unlocking its full clinical potential and providing greater survival benefits to patients worldwide." Professor Lin Shen, Peking University Cancer Hospital, the leading principal investigator of the GEMSTONE-303 study, said: "Before the availability of PD-1 monoclonal antibodies, chemotherapy was the standard first-line treatment for unresectable, locally advanced or metastatic G/GEJ adenocarcinoma, with median OS rarely exceeding one year. The combination of anti-PD-1 antibodies and chemotherapy has significantly extended survival for these patients. The GEMSTONE-303 study builds on this progress. As the first anti-PD-L1 antibody approved for this patient population, sugemalimab specifically targeted the PD-L1-expressing population in its pivotal study, achieving significant efficacy with a manageable safety profile. The acceptance and publication of these results in JAMA affirm the innovation of GEMSTONE-303 and the valuable contributions of all researchers and participants involved." *Link to JAMA Network: About Sugemalimab The anti-PD-L1 monoclonal antibody sugemalimab was developed by CStone using OmniRat® transgenic animal platform, which allows creation of fully human antibodies in one step. Sugemalimab is a fully human, full-length anti-PD-L1 immunoglobulin G4 (IgG4) monoclonal antibody, which may reduce the risk of immunogenicity and toxicity for patients, a unique advantage over similar drugs. The National Medical Products Administration (NMPA) of China has approved sugemalimab for five indications: In combination with chemotherapy as first-line treatment of patients with metastatic squamous and non-squamous NSCLC; For the treatment of patients with unresectable Stage III NSCLC whose disease has not progressed following concurrent or sequential platinum-based chemoradiotherapy; For the treatment of patients with relapsed or refractory extranodal NK/T-cell lymphoma; In combination with fluorouracil and platinum-based chemotherapy as first-line treatment of patients with unresectable locally advanced, recurrent or metastatic ESCC; and In combination with fluoropyrimidine- and platinum-containing chemotherapy as first-line treatment for unresectable locally advanced or metastatic gastric or gastroesophageal junction (G/GEJ) adenocarcinoma with a PD-L1 expression CPS ≥5. The European Commission (EC) has approved sugemalimab (brand name: Cejemly®) in combination with platinum-based chemotherapy for the first-line treatment of patients with metastatic NSCLC with no sensitizing EGFR mutations, or ALK, ROS1 or RET genomic tumor aberrations. The Medicines and Healthcare products Regulatory Agency (MHRA) in the United Kingdom has approved the marketing authorization application for sugemalimab in combination with platinum-based chemotherapy for first-line treatment of metastatic NSCLC with no sensitizing EGFR mutations, or ALK, ROS1 or RET genomic tumor aberrations. About CStone CStone (HKEX: 2616), established in late 2015, is an innovation-driven biopharmaceutical company focused on the research and development of anti-cancer therapies. Dedicated to addressing patients' unmet medical needs in China and globally, the Company has made significant strides since its inception. To date, the Company has successfully launched 4 innovative drugs and secured approvals for 16 new drug applications (NDAs) covering 9 indications. The company's pipeline is balanced by 16 promising candidates, featuring potentially first-in-class or best-in-class antibody-drug conjugates (ADCs), multispecific antibodies, immunotherapies and precision medicines. CStone also prides itself on a management team with comprehensive experiences and capabilities that span the entire drug development spectrum, from preclinical and translational research to clinical development, drug manufacturing, business development, and commercialization. For more information about CStone, please visit . Forward-looking statements The forward-looking statements made in this article only relate to events or information as of the date when the statements are made in this article. Except as required by law, we undertake no obligation to update or publicly revise any forward-looking statements, whether as a result of new information, future events or otherwise, after the date on which the statements are made or to reflect the occurrence of unanticipated events. You should read this article completely and with the understanding that our actual future results or performance may be materially different from what we expect. All statements in this article are made on the date of publication of this article and may change due to future developments. Disclaimer: only for communication and scientific use by medical and health professionals, it is not intended for promotional purposes. SOURCE CStone Pharmaceuticals WANT YOUR COMPANY'S NEWS FEATURED ON PRNEWSWIRE.COM? 440k+ Newsrooms & Influencers 9k+ Digital Media Outlets 270k+ Journalists Opted In GET STARTED

Clinical ResultDrug ApprovalPhase 3Immunotherapy

100 Deals associated with Capecitabine

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KEGG	Wiki	ATC	Drug Bank
D01223	Capecitabine	L01BC06	DB01101

R&D Status

Approved

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Indication	Country/Location	Organization	Date
Gastrooesophageal junction cancer	United States	CHEPLAPHARM Arzneimittel GmbH	14 Dec 2022
Pancreatic Cancer	United States	CHEPLAPHARM Arzneimittel GmbH	14 Dec 2022
Rectal Cancer	Japan	Chugai Pharmaceutical Co., Ltd.	19 Sep 2016
Esophageal Carcinoma	Australia	Dr. Reddy's Laboratories (Australia) Pty Ltd.	24 Jun 2013
Locally advanced breast cancer	European Union	Accord Healthcare SLU	20 Apr 2012
Locally advanced breast cancer	European Union	Teva Pharmaceuticals Europe BV	20 Apr 2012
Locally advanced breast cancer	European Union	KRKA dd	20 Apr 2012
Locally advanced breast cancer	Iceland	Accord Healthcare SLU	20 Apr 2012
Locally advanced breast cancer	Iceland	Teva Pharmaceuticals Europe BV	20 Apr 2012
Locally advanced breast cancer	Iceland	KRKA dd	20 Apr 2012
Locally advanced breast cancer	Liechtenstein	KRKA dd	20 Apr 2012
Locally advanced breast cancer	Liechtenstein	Accord Healthcare SLU	20 Apr 2012
Locally advanced breast cancer	Liechtenstein	Teva Pharmaceuticals Europe BV	20 Apr 2012
Locally advanced breast cancer	Norway	KRKA dd	20 Apr 2012
Locally advanced breast cancer	Norway	Accord Healthcare SLU	20 Apr 2012
Locally advanced breast cancer	Norway	Teva Pharmaceuticals Europe BV	20 Apr 2012
Stomach Cancer	China	Chugai Pharmaceutical Co., Ltd.	17 Oct 2008
Breast cancer recurrent	Japan	CHEPLAPHARM Arzneimittel GmbH	12 Dec 2007
Colonic Cancer	Japan	Chugai Pharmaceutical Co., Ltd.	30 Apr 2003
Advanced gastric carcinoma	European Union	CHEPLAPHARM Arzneimittel GmbH	02 Feb 2001

Developing

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Indication	Highest Phase	Country/Location	Organization	Date
ER-positive/HER2-negative Breast Cancer	Phase 3	France	UNICANCER	11 Jun 2020
GRPR Positive/ER Positive/HER2 Negative Breast Cancer	Phase 3	France	UNICANCER	11 Jun 2020
Metastatic gastric adenocarcinoma	Phase 3	United States	Eli Lilly & Co.	20 Jan 2015
Metastatic gastric adenocarcinoma	Phase 3	Japan	Eli Lilly & Co.	20 Jan 2015
Metastatic gastric adenocarcinoma	Phase 3	Argentina	Eli Lilly & Co.	20 Jan 2015
Metastatic gastric adenocarcinoma	Phase 3	Belgium	Eli Lilly & Co.	20 Jan 2015
Metastatic gastric adenocarcinoma	Phase 3	Canada	Eli Lilly & Co.	20 Jan 2015
Metastatic gastric adenocarcinoma	Phase 3	Czechia	Eli Lilly & Co.	20 Jan 2015
Metastatic gastric adenocarcinoma	Phase 3	Denmark	Eli Lilly & Co.	20 Jan 2015
Metastatic gastric adenocarcinoma	Phase 3	Finland	Eli Lilly & Co.	20 Jan 2015

Clinical Result

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT04380337 (SHORT-FOX, CTgov)	Phase 2	Rectal Cancer \| Rectal Adenocarcinoma	38	IMRT+LEUCOVORIN CALCIUM+irinotecan+oxaliplatin+capecitabine+Fluorouracil	phhhdiocpo(ktqmsgwkfa) = onnkzsarbk jvvvznynvu (syrdnxluzn, kkrzdhlsbu - exqadbbrif) View more	-	25 Feb 2025
NCT01972919 (CTgov)	Phase 2	Pancreatic carcinoma non-resectable	23	Radiation Therapy+Gemcitabine+Capecitabine	rqrfmkdpyw(vtuzuxdrgs) = eproeiesto pkliclbrmh (dgavevxgel, jclhnvlxka - nppchpibqx) View more	-	10 Feb 2025
NCT02451553 (Phase I/Ib study of afatinib with capecitabine, ASCO_GI2025)	Phase 1	Solid tumor \| Neoplasms EGFR amplified \| EGFR/HER2/HER3 pathway alterations	41	Afatinib 20 mg	jawltpwngv(ytzbcgtrrs) = lcesoskyhl nqtfatayci (gmpdpwpuwn ) View more	Negative	23 Jan 2025
				Afatinib 30 mg	jawltpwngv(ytzbcgtrrs) = bbsdzoilsz nqtfatayci (gmpdpwpuwn ) View more
PRODIGE83-ACABi-PRONOBIL (ASCO_GI2025)	Not Applicable	Biliary Tract Neoplasms Adjuvant	324	Capecitabine	rrsxblhmsv(qtbucshptw) = 27% of grade 3-4 jopsiyvxds (pnrtjkzwrb ) View more	Positive	23 Jan 2025
				capecitabine (No adjuvant treatment)
NCT02767661 (MECCA, Pubmed \| Literature) Manual	Phase 3	Hormone receptor positive HER2 negative breast cancer Hormone Receptor Positive \| HER2 Negative	254	metronomic capecitabine + an aromatase inhibitor	kmvjkwmnru(evtemlwrik) = tzdffpmbak vnttmshjob (nongijbkze ) View more	Positive	02 Jan 2025
				An aromatase inhibitor	kmvjkwmnru(evtemlwrik) = cdxyfvaixy vnttmshjob (nongijbkze ) View more
NCT04324476 (Pubmed) Manual	Phase 2	Metastatic Colorectal Carcinoma	52	CAPOX/CAPIRI plus bevacizumab	tyuevtujkf(frjyvazmui) = lxfsothdmz ndvfgquoyo (hwomubqlgh, 9.0 - 12.4) View more	Positive	11 Dec 2024
ESMO_ASIA2024	Not Applicable	Head and Neck Neoplasms	101	Capecitabine 2000 mg + Cyclophosphamide 100 mg	gsmyveyuzb(fltkrsltax) = most patients experiencing manageable Grade 1 mucositis lballxqask (wnoszncfsu )	Positive	07 Dec 2024
ESMO_ASIA2024	Not Applicable	Colorectal Cancer	214	capecitabine (Age ≥60 years)	knwxifdxeb(ioikyieagb) = rfccqzdqyl jfqpkblwzz (nlvfdajixf )	-	07 Dec 2024
				Capecitabine monotherapy	knwxifdxeb(ioikyieagb) = mzkjwavxuq jfqpkblwzz (nlvfdajixf )
NCT03487666 (CTgov)	Phase 2	Triple Negative Breast Cancer	45	Nivolumab (Arm A- Nivolumab)	omajmondam(blunxrbzcq) = mvbnqimjnw eocbpojdnb (gwnhylmnap, ikzvnxzvru - qdpckdurre) View more	-	03 Dec 2024
				Capecitabine (Arm B- Capecitabine)	omajmondam(blunxrbzcq) = xozpexosor eocbpojdnb (gwnhylmnap, xfzufmkdri - bvffdtivcm) View more

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