Pleasure to introduce Cytokinetics. We are excited to talk to them today. I want to introduce Isaac Ciechanover, who is the Executive Vice President of Corporate Development and Chief Business Officer, and Dan Jacoby, Vice President of Clinical Research. It is a pleasure to have you both here. My name is Jeffrey Walch. I am one of the analysts at Bernstein. I lead the U.S. biotechnology analysis, and I am excited to have a nice conversation with the Cytokinetics team here and introduce them to our investors at the symposium. Thank you both for joining us. Do you have any prepared remarks that you would like to start with, or I can start off with questions? It is up to you.
Just wanted to, first of all, thank you so much for giving us the opportunity to come and introduce you to our company and answer some questions.
Absolutely. Well, thank you both for being here. I will just ask questions and then let the two of you decide who is going to answer and what the flow is. Maybe you could start just with some context setting. Could you give us an overview of the history of Cytokinetics as a company?
For many of you who follow biotechnology, Cytokinetics is a great example of a company with 25 years of development and an overnight success when the reality of it is the company was started in 1997, went into operations in 1998 in South San Francisco. It was started by a number of academics with insight about cellular mechanics, hence the name Cytokinetics and their function in potential in multiple indications. Their original focus for the company was in oncology and antifungal. But some real insights by our early scientists, specifically Fady Malik, about the potential of the sarcomere being a target and playing a role in the cardiovascular space, refocused the company and we're really the pioneers of the CMI space.
Yeah.
Every major therapeutic that's come in that area or being developed comes out of that seminal work that Fady did.
That's amazing. It's great to hear a science story become true for patients and help patients and that's really wonderful. Maybe moving then beyond just an introduction of Cytokinetics and transitioning over to maybe could you highlight the current scientific and clinical stage focus of the company, and then we can maybe dive into some of the specific programs.
Sure. I can grab that. So right now, Cytokinetics is a commercial company, selling and developing drugs in the cardiovascular space, specifically CMIs. MYQORZO was launched this year in the U.S., and now in Europe, for obstructive HCM, so hypertrophic cardiomyopathy. We have a sales force in the U.S. We're launched in Germany, we'll be expanding in Europe. We have partners in China with Sanofi, Japan with Bayer, and our focus really is in the cardiovascular space. That being said, the history of the company is very strong in the muscle biology, so we don't define ourselves as a cardiac company. We continue to develop new agents for conditions in skeletal muscle as well, and so while in the near term, you should expect us to continue to focus on specialty cardiology. Our goal is to expand well beyond that, and we will do that through both internal means as well as external.
That is great. Then as you highlight your projection to grow and your sort of future Vision 2030, is there just for our investors that know more mature companies that maybe are a larger cap, is there any sort of archetype for another company that you see best reflecting the Cytokinetics potential trajectory? You can give a timeline for that.
Sure. We do not model ourselves against any company. As I joked, it really was 27 years. I do not know anybody's business plan.
Yeah.
Suggested that growth.
Yeah.
Our focus is to be the leading specialty cardiology-focused company in the near term. What that means is to build on the strength of MYQORZO in the obstructive space. We will be talking a little bit about the ACACIA data, which, if approved, will allow us to be the only therapeutic. In the non-obstructive area we have a rich pipeline, which we will talk about as well. The growth trajectory for this company is very strong. We have had some really fantastic growth in the early stages, but we are in the early innings of a launch. There have been many plans in regards to how we want to continue to augment.
Yeah.
Both making sure that MYQORZO is in the hands of physicians worldwide. You will hear about expansions into other territories as well as pipeline expansions.
That is great. Well, I have heard about your Vision 2030, and maybe you could give our investors an overview of what Vision 2030 is. Of course, we will eventually spend some time talking about individual programs, but love to hear about that long-term vision, what started it, and what that looks like for you guys.
Sure. Robert Blum, who really personifies Cytokinetics and has been there since the beginning of the company, basically spelled out where he wants this company to be by 2030. We present it in five different categories. I am not going to go into each and every one of them in detail. As you would expect, first of all, it is making sure that we continue to have commercial products moving forward for patients with unmet medical needs. We have articulated that there will be two therapies. Our goal is to have two approved therapies three indications, 10 NMEs, all by 2030 in the space that we've talked about. I mean, that is, for a company to even have one approval.
Yeah.
Is really daunting. But at this point, with the obstructive indication already approved with positive ACACIA, and with omecamtiv, we feel pretty strongly that we'll be able to achieve that. In addition, we want it to be in over 15 countries.
Wow.
By 2030. It's pretty rare for a company to have the vision of not just early research and discovery, but commercializing your own products. We have the opportunity to potentially partner in some of these territories, but that would go against our Vision 2030. At this point, we are approved in the U.S., we are approved in Germany, we are approved in China. You will hear about the U.K. an d other territories along the way. Again, we feel very strongly that we will be able to achieve that goal. The other is to continue to be leaders in the muscle space. As we have talked earlier, not just cardiac, but focused also in skeletal muscle. It is an area that is really growing. Some of our success has now carried over into the field, and we are really excited to make sure that those innovations come through to patients. Patients, again, at the end of the day, all of us are working one way or the other to make sure that we can give good solutions to patients. We talk about making sure that Cytokinetics drugs between clinical trials and commercialization will touch at least 100,000 patients.
Yeah.
That is again, that is a pretty ambitious goal for a company that was private for many years. But we are well on our way to be able to do that. Lastly, and probably as important than anything else we do, make sure that we have a strong culture both internally and externally about being able to develop novel therapies and support the communities, and make sure that there is access to drugs. Those are the five pillars that we are focusing on, and we feel pretty strongly about being able to achieve those and potentially even revising them and growing them.
That is great. Just a quick follow-on, on something you said. You highlighted you had the opportunity to partner with some companies as you expand, and that was against your vision, not something that you want to do. Could you maybe take us through what you would have thought were some of the pros of partnerships, the cons of partnerships, and why ultimately it did not fit your vision?
Sure. We do partner.
Sure.
As I mentioned, we are a great relationship with Sanofi in China, Bayer in Japan. There are obvious territories where.
Yeah.
We're not going to be able to go into every single territory, and our investors aren't going to want us to set up shop in every place. But the U.S. and Europe are particularly important, and was so for Robert and the board. I would imagine many of you wouldn't push back on this notion that no one is going to focus on a company and on a product better than yourself.
Yeah.
That's not to say that there aren't fantastic partners who have great franchises, but it's a franchise, and it's a pipeline.
Yeah.
Focus changes. When it is yours.
Yeah.
You will make sure that there is consistency in messaging, consistency in efforts, and that is the ideal goal. The flip side to it costs money.
Yeah.
It requires, long gone are the days of the water cooler.
Yeah.
Where we could all meet and share information. We have multiple offices, the sun never sets for Cytokinetics. There is always somebody to communicate at any point in time. That balance is one that I think was a very strong decision by the board and Robert, and we are making it happen.
That's great. Well, thank you for that. Your team has talked about the three legs of the cardiovascular stool. I was wondering if you could spend some time just giving us an overview of what that is, and then, of course, we'll dive deep into each one at a time. But I'm curious if you could give an overview.
Sure. The three legs I would simply focus on timing. They're the most advanced programs.
Yeah.
But we love all our children.
Yeah.
We'll start off with MYQORZO.
Yeah.
Which is our commercial product for obstructive HCM. We have omecamtiv mecarbil, which is in a phase III study in HFrEF, and ulacamten, which is our novel HFpEF agent.
Great. Well, maybe then let's start off with MYQORZO as you highlight your cardiac myosin inhibitor that's approved for obstructive hypertrophic cardiomyopathy. Would you be able to give us an update on the launch?
Sure. So, it's been an amazing launch, as says the Chief Business Officer.
Yeah.
Our commercial team.
Yeah.
Have really hit the ground running. Just to give you some context, we are the second to market, four years after the first launch.
Yeah.
If you put that into context, the statistics that we've already talked about really bode well for how the launch is going. You have new patients start, but before we launched, we're about 2,000 patients a quarter.
In our Q1, we said we were at 2,500. Now we're seeing 3,000 in Q2, and we'll be presenting more information at our next quarter call. The market is growing significantly. In addition, at the end of the day, we talk about prescriptions. We more than tripled the prescriptions being dispensed to patients from less than 400 in Q1 to close to 1,500 in Q2. Again, for a second in class against a very successful and well-respected incumbent, that's pretty good metric.
Absolutely.
From any stage. That being said, it's early days.
Yeah.
This is the early days of a launch. We should hope that we are in a growth. We've already said that when a physician decides between therapies to prescribe, we were a little over 40% of all new prescriptions. Our goal, aspirational, by the end of the year is 50%. Again, in a first year, that's a pretty aggressive undertaking, but we feel really strongly. While we have an incredible sales force and a fantastic organization supporting it's really about the strength of MYQORZO and the clinical data that Dan and his team have been able to create. We have a REMS program that physicians feel comfortable around. No need for DDI testing, a flexible titration. Patients feel better on the drug. Physicians feel comfortable prescribing it.
Yeah.
That's ultimately led to the growth within the sector. The only other aspect that I'd really focus on is we talk about the prescriber base. We've said that at this point we've hit over 700 physicians who potentially can prescribe CMIs. What's particularly interesting is, as you would expect, there's some proportion of those that are high volume prescribers. We've actually hit those really well, but we've now over half of that number are physicians who either didn't write prescriptions on a regular basis or never wrote a prescription.
Yeah.
For CMI. We don't see this as a competition base.
Yeah.
We see this as the expansion of the indication. We're seeing that with these metrics that that's in fact what's happening. This is just in the obstructive indication. When we get into non-obstructive, if we're fortunate enough to get approved based on ACACIA data, which we feel really strongly about, then that whole indication will grow as well.
Absolutely. You touched on it a little bit, but maybe we could spend just another question on it. The competitive profile for MYQORZO versus CAMZYOS. Any other details you want to share, just how you think of, obviously not the head-to-head, but how you think your competitive profile compares versus CAMZYOS and what is helping to grow that prescriber base that you highlight?
Yeah. First of all, we all work for patients.
Yeah.
I think physicians who feel comfortable with the drug, whichever drug, as long as they dispense it to patients and patients feel better, that's the win. But as I told you a little bit about the history, Fady Malik and the organization really pioneered the CMI space. In fact, some of our competitive come out of our own labs. From the start, MYQORZO and aficamten in its clinical trials were designed to be easier to use and have the potential to be dispensed with every type of patient, and that's where the ACACIA data really comes through. We presented our ACACIA data. We're in the process of filing an sNDA, but assuming that we're fortunate enough to be approved, we'll be the only CMI approved for both indications, the non-obstructive and the obstructive. That's probably the best differentiator at the end of the day because no drug has been able to show a successful clinical trial in that patient population. We were able to hit on both endpoints, which there's this very high bar to be able to achieve. Again, we feel pretty confident about the growth and the expansion, not just in the obstructive indication, but the non-obstructive as well.
You sort of highlighted it here, but any other next steps that you want to highlight in terms of the development and the commercialization strategy for MYQORZO?
The focus has really been on the U.S. You'll be hearing more and more about Europe over time. As I said, Germany has already launched, the U.K., and we'll be rolling into other territories. But I think the key is really the ACACIA data. While we will continue to focus on expanding the obstructive, the non-obstructive indication is one that's really a huge opportunity as well because we believe that it could nearly double the patient population that could be addressed with this therapeutic and be the only drug to be approved in both indications should we be fortunate enough to do so. That creates an immense opportunity for patients, for physicians, and for the growth of the company. If you think about it, there are very few companies that will launch in one territory, let alone three with China, U.S., and Europe in its first year, but then to also expand into an indication that's nearly as large as the current one creates nothing but opportunity for us. We've built a sales force to be able to deal.
Yeah.
With that population. Obviously, as we get feedback from agencies, we get more information from the market, we'll be able to make certain changes. We right-sized accordingly, and thankfully, we now have really strong clinical data to be able to try and pursue it.
Excellent. You started to touch on this, but what does your team project as the long-term outlook for MYQORZO in terms of life cycle management, maybe sales, utilization?
Sure. Maybe let's talk about where we are right now.
Sure.
There are 110,000, 120,000 patients in the U.S. who are diagnosed in the obstructive setting. About 20,000- 25,000 of those patients have received therapy. You are talking about 20% of the market. There is a huge opportunity to be able to expand, and as I have shared with you some of the metrics, we are already seeing that happening on both sides, and having two strong drugs in the market creates a great environment to be able to do that. Non-obstructive, we believe, as I said, is about as large, so 50/50. And those patients historically have nothing available to them. When you see a situation where a new therapy comes in, that is available, physicians can already identify those patients. Historically, they tend not to try to push very hard because the reality of it is you do not want to diagnose someone and then ultimately have nothing to give them.
Yeah.
While these patients are being seen by the same physician base, our sales force will be detailing the same area, we see a great opportunity for growth there as well. And then, as I said, we would be expanding into other territories, and then we can talk about the other legs of the stool. The growth of the company will go even beyond the HCM market with our other novel agents.
Definitely. Before we move on to the other leg of the stool, which we do next, anything else you want to highlight about MYQORZO that you feel like we haven't touched on yet?
I would just say that the other thing that is the hallmark of Cytokinetics is being able to support our vision through a wall of data. If you look at every major scientific meeting in this space, we've had multiple publications, peer-reviewed publications, but also symposium. Just came out of the ESC meeting, where we were in the largest hall, standing room only.
Yeah.
It's very gratifying, but also helpful to be in a situation where you're just not presenting an opportunity. You're being able to, in very succinct ways, show the strength of the molecule and the thoughtfulness of the study and the patient population. So that ultimately is a piece that I would try to emphasize to people who aren't familiar with Cytokinetics. That is a pretty rare situation.
Yeah.
Usually you just make a claim. Ours is based on significant amount of randomized, well-controlled studies where the consistency of the results really bode well for the therapy and for patients as well.
That's great. Well then, as you say, switching gears to the next leg of the stool, omecamtiv, your cardiac myosin activator. Would you be able to give us an overview of the current ongoing phase III, strategy, rough timeline, et cetera?
Sure. Dan, do you want to?
Yeah, sure. Is this, yeah, seems to be working. So it was nice to hear Isaac touting the scientific work that we stay up nights and weekends to do.
Yeah.
That was a great ending to that part of the meeting. Yes, I am Dan Jacoby. I am actually a heart failure doctor.
Oh, yeah.
Spent years running the heart failure and heart transplant program at Yale School of Medicine and doing cardiovascular genetics and cardiomyopathy work over there, and was involved in the academic side running clinical trials, even as part of our competitor clinical trials as well.
Oh.
Which was really gratifying. Patients really appreciate these opportunities, as Isaac outlined. For omecamtiv mecarbil, I was aware of that drug even when I was doing the heart failure work. There is just a tremendous amount of enthusiasm around that drug and the mechanism and the unmet need in that population that I think frequently is underappreciated. The study itself is designed based on a really robust subgroup from the GALACTIC study. It is large, almost half the patients in that study fell into this sort of progressive heart failure category of patients with lower LVEF, around 20%-30%, and recent hospitalization, and more elevated NT-proBNP. Those patients are already on the best that guideline-directed medical therapy can do, and they are not doing well.
Yeah.
You know how popular this field is because people are still doing digoxin studies.
Oh, okay.
You know that there is a lot of unmet need out there, and all you have to do is take care of one patient who ultimately succumbs to needing a left ventricular assist device to know how important it is to help this population. The study is designed to enroll this specific population, and it has a run-in period. That is important because we make sure that patients are actually taking the medication and are not going to have any early sort of unmodifiable events during that run-in period. That kind of helps with the powering and making sure that you do not have noise there in the study. Then we are cooking along. I guess the strategy here is to present information that will be helpful guidance to clinicians who seek to treat patients with progressive heart failure in a meaningful way on top of existing guideline-directed medical therapy when the study ultimately reads out in 2028 or so.
Well, maybe this is a quick follow-up for you, Dan, but the three drugs in the cardiac stool, they all target the sarcomere directly, but among them, omecamtiv is unique in that it's an activator instead of an inhibitor. Maybe be able to highlight how that mechanistic difference leads to distinct physiological differences and what that means.
Sure. Yeah, it's really interesting. The fundamental underlying disease mechanism of hypertrophic cardiomyopathy is hypercontractility at the level of the cardiac sarcomere with too much engagement between myosin and actin and too much force being generated, which leads to all the downstream phenotypic consequences of the disease. On the reverse side, converse of that is that in heart failure with reduced ejection fraction, what you end up with is too little force generation, frequently at the level of the cardiac sarcomere. So generating more force over there has been a goal of heart failure doctors for 50 years. The problem has always historically been that in order to do that, you end up perturbing calcium cycling, you end up increasing energy utilization, and you end up stimulating arrhythmias, myocardial cell death, and other downstream problems that progress the disease. So some of those therapies, such as milrinone or amrinone, oral PDE3 inhibitor, led to actually adverse events. What you have with omecamtiv mecarbil is a medication that uniquely does not perturb calcium cycling, does not increase oxygen demand, it doesn't cause cellular injury, and yet increases the contractility of the heart, allowing it to push more blood to supply the body with more blood, which is the underlying problem of the condition. None of the other guideline-directed medical therapies in heart failure address this problem. The only other thing that does it is heart transplant or LVAD. This, you know.
A long time.
Yeah.
Well, thank you. Thank you for that. Well, actually, maybe one more clinical follow-on for you. Omecamtiv is going to enter a patient population that has some treatments currently. Just curious what you sort of think through when you think you'll see your phase III data, and then what's going to be distinct about that data set?
Yeah.
That's going to push prescribing patterns in your direction?
Yeah. Well, I think what has happened is we've had the opportunity, and frequently you do when you walk along the road of life of stepping in potholes and learning from the experience. We saw that GALACTIC was a positive study, but it required a follow-on to get that level of understanding of the statistical and clinical significance squared away. What we were able to do was really identify that subset of patients that are likely to benefit a lot.
Yeah.
These patients are looking at a very, very bad quality of life, near-term hospitalization, near-term death. When COMET reads out and shows a reduction, ideally, hopefully in those endpoints, what you are going to see is physicians are going to look and patients are going to look to that because it is a little bit hard to appreciate if you are not in the clinic, but when you are in the clinic, what you see is it is actually very, very challenging to get patients on maximal dose GDMT the current therapy. They make you feel bad. They lower your blood pressure. There is interaction between the pills in terms of your electrolyte balance and so on. To have another rail to that functions in a completely different way, that addresses directly the underlying mechanism that reduces the morbidity and mortality associated with this, that is going to lead, and that is logically aligned with how we think about the underlying problem of the condition. That is a very, very exciting opportunity for physicians and patients to explore, and I think what you are going to see is very rapid exploration and uptake of this on top of guideline-directed medical therapy, which is very effective as well.
Yeah.
There is still, if you look at those Kaplan-Meier curves. Hey, a 50% reduction in mortality.
Yeah.
Still leaves a lot of mortality on the table.
Absolutely.
Yeah.
It absolutely does.
Yeah.
Well, thank you for that, and this is a question for either of you. Back to sort of the higher-level vision. Give us an overview of what you think of the long-term vision for omecamtiv and how it fits into what the long-term life cycle management potential indications, how you think it fits into this door and what it looks like down the road.
Well, I think Isaac kind of covered that a little bit in the sense that the doctors, and I was thinking about this as you were talking, the doctors and physician assistants and nurses in clinics, really it's a multidisciplinary clinics, pharmacists and so on, who take care of patients with HFrEF are also the same clinics, generally speaking, that take care of the patients with HCM. There's a broad overlap there. In fact, you see that in our clinical trials. Many of the clinical trial leads who were working on HCM with us are working on COMET with us. There's just tremendous overlap between these fields. The long-term strategy here is to be able to provide for medicines that encompass the full scope of what happens in patients' heart failure. I know you have a question coming on ulacamten and AMBER heart failure, but that is another component of this. You have patients who have heart failure, who don't have reduced ejection fraction, they don't have hypertrophic cardiomyopathy, but what they have is a certain kind of heart failure related largely to diastolic dysfunction. What you need is a medication that can modulate and reduce the contractility in just the right way to address that, and that's what.
Yeah.
We're exploring with our phase II study, AMBER. We're in the dose-ranging part of that study at this time. We're anticipating completion of enrollment this year, and we'll learn a lot from that in terms of how to dose it, what to look for in the endpoints, and how to structure a phase III study for this complex population.
Oh, that's great. Well, before moving on to ulacamten entirely, any final comments about omecamtiv or any additional perspectives or thoughts that you didn't have a chance to share?
I'd say just from your audience perspective, we're getting more and more questions about omecamtiv. This is an agent that has history, we think that now that it's in our hands, and in a more discrete patient population, that we feel it's an undervalued and underappreciated opportunity, and one that I think people should spend significant amount of time. The company isn't predicated on its success, but we feel pretty strongly given the history and our knowledge base about.
Yeah.
The patient population, and if you just think about it in the context of a company that's launching an agent that has significant growth, and then right behind it comes another therapeutic in the same space. I challenge you to find another company that has that opportunity.
Absolutely. Well then now switching gears to the last leg of the stool, ulacamten, as you mentioned earlier, another cardiac myosin inhibitor. Maybe going back to that phase II trial, just give us an overview of where things stand, the strategy, timeline, et cetera. Any details you'd like to add?
Yeah. Very exciting. Super-duper exciting space over here because HFpEF, heart failure preserved ejection fraction, we've made a few sort of inroads in that space, but generally speaking there's not a lot you can do there.
Yeah.
It's kind of trail of tears, HFpEF, in many ways, in terms of drug development, has been. We have this opportunity because of what Isaac explained in terms of our science team, in terms of our pre-clinical team, that is really amazing to have this molecule that has kind of unique features. We were able to design a study that would identify patients with HFpEF who have this characteristic of really having a cardiac phenotype with the right kind of features that would be expected to respond. So predominantly diastolic dysfunction-driven HFpEF. Remember, HFpEF can also be driven by lots of things. If you're very overweight, have sleep apnea, have hypertension, have renal disease, diabetes can also drive HFpEF. You wouldn't necessarily think a person like that would automatically benefit tremendously.
Yeah.
From a specific cardiac myosin inhibitor. It's a subpopulation of HFpEF, but that's who we're enrolling into AMBER, and that's where we're going to discover what's going on, what's happening with the biomarkers, what the right dose is, what the PK/PD is. We need all that information in order to determine how to design our phase III study, which will look more broadly at this population and help clinicians. Ultimately, the goal here is to design a study that will allow people to make a decision about whether this medicine is right for their patient.
Do you have, on that, you mentioned potential future phase III study, any sense of a rough timeline as to what you'd see for that?
We're moving as quickly as we can. Obviously, one of the things that's been interesting about transitioning from being an academic faculty to working at Cytokinetics is that deadlines are real.
Yeah.
As it turns out. You can't just say, "I didn't get to it." We're moving quickly with this. We're looking to get the results of at least the results of our initial cohort of the phase II in 2027, and we'll be determining if we need another cohort or if we're ready to move on to phase III at that time. Wish I could give you more concrete, but with these things, the data is the answer, and we don't have the data yet.
Yeah. No. Totally understand. Come from your background in clinical development, so I know what you mean.
Yeah.
Maybe just at a high level about ulacamten, what do you guys consider the long-term vision for the drug and how it fits into the stool in terms of any other potential indications, any other life cycle management, or too early to tell at this point because we're in phase II?
Well, I don't know how to speak necessarily specifically to life cycle management. I'm sure you have the same thing. I have a million ideas. Ideas are cheap. I think right now we stay focused. Your best way to define yourself initially really is by saying no to the myriad of things that are distractions and staying focused on the goal. Our goal right now is to develop a medicine that treats HFpEF. We have a medicine that treats HCM. We believe we have a medicine that effectively treats HFrEF. If we can get all these things in place, going back to Isaac's initial point, what we're going to do is feel really good about what we've been able to do for patients suffering with heart failure around the world. That's the goal. I like to see that be the end of my career.
Yeah.
Be able to do that.
Well, that's great. Well, before we switch you out of the stool, any last comments or thoughts on ulacamten before moving on?
Nothing from me. Isaac?
No. HFpEF is a very large indication. I think you should think about it as several different based on their patient population. Again, you're seeing Cytokinetics in the pioneering position of being able to drive novel therapeutic modalities into this patient population. As we've done with HCM, we will be the pioneer.
Absolutely. Isaac, I think this question is definitively for you, but could you give us an overview on business development and any partnerships you'd like to highlight?
Sure. No, I love it. I never get this question. Business development is always an important arm of any organization. I spent my career focused on business development across a number of private and public companies. I think you have to put it into the context of where the company is. I've never been in a situation like Cytokinetics where we have such a rich pipeline and such clear priorities in regards to the launch. That being said, you can't rest on your laurels. You can't time the market. We will be opportunistic, but you shouldn't expect us to acquire or bring in a phase III or phase II asset.
Yeah.
We have pretty incredible opportunities, and we don't want to distract ourselves. That being said, we talked about Vision 2030 and being able to have 10 programs in our arsenal. We are a small molecule company today. We know very well that there are other modalities, be it RNAi, biologics, others, that we need to think about as it relates to augmenting our pipeline, both from a research perspective as well as in clinical development. In the near term, our focus is really on the earlier stage, pioneering novel targets, novel modalities.
Yeah.
Don't expect us to go into cell therapy or gene therapy. It's probably a bridge too far, but you never know. We will be opportunistic if the data presents itself. But we are in a very fortunate situation in growth and having more potential opportunity to do transactions that historically the company hasn't been able to do. I mean, if you think about it, like any other biotech company, we were net out-licensors. We are now an in-licensor.
Yeah.
Of technologies. If I think about it from a category perspective, as it relates to late stage, you should be thinking about rest of the world and us out-licensing opportunities.
Okay.
Because that would probably be the last of those type of business dealings. We are not going to go While we cover the majority of the financial developed market, the vast majority of patients don't sit there. As we said, our vision is to make sure that all patients receive their therapeutics. So we will be doing a rest of the world type of collaboration. As it relates to clinical development, I think as MYQORZO grows, as we are in a stronger and stronger financial situation, we'll look at phase I, phase II programs, but we'll do it from an opportunistic perspective and from a balance sheet-friendly way. Right now, we've already augmented and will continue to augment our research pipeline, expanding into other modalities. Those tend to look like collaborations where we identify multiple targets. We work with a partner of choice as it relates to modalities, and we share in the development costs, and ultimately, we take over the development and commercialization of the agents. That's something that we can do today, we've done it in the past, but again, doing it in a very prudent, balance sheet-friendly way.
Mm-hmm. That sounds great, and that's a really nice, detailed answer to that question. Maybe taking a step back just to get to know a little bit about the people and the culture. Anything you'd like to share about how Cytokinetics works and the people behind the drug development and the sales team, et cetera?
Yeah. I'll just quickly comment and then turn over to Dan. First of all, I've been in multiple companies, and I've been very lucky in my career, but I've never been in a situation like this where I have such utmost respect and really enjoy working with each and every one of my colleagues, and that has everything to do with Robert. He sets a culture and a tone within the organization that focuses on the team because he knows that if you cannot have a strong working environment, you will not be at your best innovating and then ultimately helping patients, which is our goal. We are now across multiple territories. We have our international headquarters in Zug, our commercial group in Radnor. We have a supply chain group. We are literally.
Yeah.
All around. It becomes harder and harder to be able to continue to build those relationships, as I talked about the water cooler. But the culture of Cytokinetics is very unique and allows for it, and I think we are really well-positioned to continue to augment and invest in that unique culture.
Dan, any thoughts in the last bit of time?
No, we're over time, and Isaac really covered it.
Excellent. Well, thank you both for telling us about Cytokinetics today, and appreciate you joining us.
Well, thank you for having me.
Thanks. Take care.