The U.S. Food and Drug Administration approved Kura Oncology's once-daily pill Komzifti (ziftomenib) on Thursday for treating relapsed or refractory acute myeloid leukemia (AML) with NPM1 mutations, positioning the drug with a notable safety advantage over its primary competitor.
The approval targets AML patients with NPM1 mutations, a genetic change found in approximately 30% of cases of this aggressive blood and bone marrow cancer. Komzifti will be available within the next few business days at $48,500 for a one-month supply, according to Kura Oncology.
Safety Profile Provides Competitive Edge
Komzifti's approval comes with a differentiated safety profile compared to Syndax Pharmaceuticals' Revuforj, which received FDA approval for the same indication last month. While both drugs carry warnings for QTc interval prolongation—a delay in the heart's electrical recovery after a beat—Komzifti avoided the boxed warning that accompanies Revuforj for cardiac side effects including QTc prolongation and Torsades de Pointes.
"The risk of QTc prolongation with Komzifti is low," said Kura's Chief Medical Officer Mollie Leoni, adding it is "extraordinarily unlikely" to lead to a boxed warning. The company is in dialogue with the FDA about potential post-approval steps that could help refine the labeling.
Komzifti does carry a boxed warning for differentiation syndrome, which is considered a class effect of menin inhibitors, and an additional warning for potential harm to unborn babies. A boxed warning represents the FDA's strongest alert for serious or life-threatening risks.
Market Competition and Commercial Strategy
The approval creates direct competition between Komzifti and Revuforj, with both drugs demonstrating similar efficacy in their registrational trials—Komet-001 and Augment-101, respectively. Kura also highlighted that Komzifti offers once-daily dosing compared to Revuforj's twice-daily regimen.
Wedbush analysts noted that avoiding the cardiac boxed warning gives Kura "a significant competitive advantage" over Syndax's product. Revuforj, which was first approved last year for KMT2Ar leukemia, generated $32 million in sales during the third quarter.
Under Kura's collaboration with Japanese partner Kyowa Kirin, Kura will handle manufacturing and lead U.S. commercialization, while Kyowa manages commercial strategy and development outside the United States.
Market Projections and Future Development
Analysts project Komzifti will achieve annual sales of $1.32 billion by 2031, according to LSEG data. The competitive landscape is expected to expand further as companies advance into first-line AML treatment, where combination studies are underway and Johnson & Johnson's bleximenib is also in development.
The approval represents a significant milestone for Kura Oncology, which has long maintained that its menin inhibitor could offer superior safety compared to competing drugs in the class. With both approved menin inhibitors now available for NPM1-mutated AML, the safety differentiation may prove crucial in determining market share in this rare but aggressive cancer indication.
