I'm one of the biotech analysts at Cantor. Very happy to introduce our new guest, the CEO and President of Rigel Pharmaceuticals, Raul Rodriguez. Thank you so much for being here.
Thank you, Kristen. Thank you, Kristen, and thank you, our Cantor colleagues, for inviting us this year to present at your conference. So, I have quite a bit to share with you, and, I know it's an exciting morning as well, so I'll be mindful of that. First, though, some important forward-looking statements. These are also available on our website, so feel free to review those pertinent to this presentation. Really excited in terms of having added a new product. Can I ask you to close the door? A new product, Gavreto, to our portfolio this past quarter. Gavreto is a once-a-day oral, in fact, the only once-a-day oral RET inhibitor approved for patients with non-small cell lung cancer and thyroid cancer for, with RET fusion, RET gene fusions. It's an exciting addition.
We're delighted to keep this product on the market for patients who are benefiting from this product, and it's a product that has tremendous synergy with our current commercial infrastructure. I'll tell you more throughout this presentation about why we're excited about having it part of our portfolio. I'd like to tell you about Rigel. Rigel is a hematology oncology company, and we like where we are as a business right now, but what we want to do is be substantially bigger, and here's four ways we're going to do that. One, commercial execution. We now have three products in our commercial portfolio: Tavalisse for chronic adult ITP, Rezlidhia for mutant IDH1 relapsed and refractory AML, and our latest addition, Gavreto, for RET fusion-positive non-small cell lung cancer and thyroid cancer.
So those are core assets to the business, and they will continue to grow, and I'll show you the performance of these products over the last couple of years, which has been outstanding. On the right side of this slide, the development and expansion. In development programs, there are tremendous opportunities for Rezlidhia in a broad range of IDH1 mutant cancers, including frontline AML, MDS, and probably most exciting, glioma. Several pockets within glioma that are exciting to look forward, and I'll share with you some of the efforts as we begin to explore this next, and what we're hoping to do in the future. In addition to that, we have R289, our IRAK1/4 inhibitor, in development in a Phase 1b trial, a dose-escalating trial in lower-risk MDS.
This is an incredibly exciting opportunity since low-risk MDS is still very poorly treated, and I'll share with you where we are with that trial. We hope to have data, we plan to have data at the ASH meeting later this year, really only a few months away. We've been very successful in building the portfolio via in-licensing and product acquisitions, with both Gavreto and Rezlidhia added in the last two years. We're continuing that effort. We're looking for late-stage assets that leverage our current commercial capabilities, and you'll, you know, in the future, hopefully hear about additional products to the portfolio. Couple all that with financial discipline. Where we are as a company is at a very important place. Last quarter, Q2, we were just above financial break even.
What we're looking for in the future, with growth of the products and moderate expenses, to be able to generate cash, to allow us to develop Rezlidhia and R289 in a number of very important indications, which we will share with you in next year, so all of these components work together to create, I think, a company that is at a place where we're able to take the next leap forward as a company. Let's start with commercial execution. The net product sales has been, like I said, outstanding. Last quarter, Q2, was our best quarter ever. Over $33 million in sales last quarter. Tavalisse, our main product, you see here in orange, its best quarter ever.
Contributions from Rezlidhia, still in launch phase, $5 million, and then a little bit of Gavreto even, even though it was only one week in the market, and that's mostly stocking. It wasn't patient-driven as yet, but as you see here, a really great quarter. When you look at how this year is performing relative to prior years, we're at $59.5 million in sales at half a year. Really, well ahead of last year's numbers, and you see there, really great performances in Q1 and Q2 of this year relative to their companion quarters prior year, so really pleased where we are with the sales growth overall and the individual products. I'll tell you about Tavalisse a little bit. Tavalisse is indicated for the treatment of adult patients with chronic immune thrombocytopenia, who have insufficient response to a previous treatment.
The original, the first treatment is almost always a steroid. After that doesn't work, that's where fostamatinib, Tavalisse, is able to be used. And it's a market about of about 81,000 patients in the US. And here you see on the left side of the chart, 37,000 are just watchful waiting, but those are patients in some form of remission or a milder case that eventually progresses to needing treatment. 20,000 is first line, that's, like I said, mostly a steroid. And then on the boxes, on the light green, what you see is where Tavalisse is indicated, about 24,000 patients. And you see there, second and third line are the largest categories there.
When Tavalisse launched, and we launched this into a market where TPO agents existed, Rituxan is commonly used, we were used in more refractory lines. You see they're far smaller. As doctors have gotten experience with the product and had positive results with their patients, and that confidence has given them the ability to use it in earlier and earlier lines, and that's been the objective of ours since we launched that product: to go into earlier lines because that's where more patients exist. And perhaps unsurprisingly to you, that's where the best results with the product exist. The earlier you use this product, the better your results will be. So in second line or third line, your results are better than in fourth or fifth line, after they failed many other things.
And that's been the objective, and it's been a good objective because we've been able to succeed in this. As you see from this chart, the product continues to grow quite nicely. Things were kinda slow during the COVID years, 2020 and 2021. Coming out of that, 2022, 2023, and 2024, very robust growth on a quarterly basis, as you see from these charts. That continues to be. Last quarter, 24% growth from Q1, and 25% growth from Q2 of 2023. Really good numbers for a product in this position. It shows you that doctors are confident in the product and are repeatedly using it, and repeatedly in the same line or in earlier lines, exactly the direction we'd like to go.
We outgrew the sector overall, the ITP market, in the form of TPO agents last quarter, very nicely. Let me move on to Rezlidhia in mutant IDH1 relapsed or refractory AML. AML is really a very aggressive, complicated, and really a disease where you wish it on no one. It's just, just horrible how quickly it progresses, how quickly it mutates. There are about 20,000 cases in the U.S., about 11,000 patients succumb to it on a yearly basis. IDH1 mutation, 6%-9% of total AML, that's about 1,200-1,800, maybe 2,000 patients overall. And in the box there on the right, you see where we're indicated. It's the orange boxes, the relapsed or refractory cases in both fit or unfit patients. Patients typically come in, they receive...
The most common therapy they receive is venetoclax and azacitidine, and then, having failed that, then they move on to something else. Now, somewhere in there, they're genotyped, and the genotyping occurs, certainly before they get to relapse refractory, and that's where, if they're IDH1 mutant, that's where a product like Rezlidhia can be used, and that's where we're positioning the product. It's an attractive market because the frontline therapy really don't work for a very long period of time, and we have excellent data that in the post-venetoclax setting, Rezlidhia works quite well. The sales of the product reflect that. On the left here is bottles shipped to patients and clinics, and that's really what we control. That's what we go out. Sometimes there's uptake or downtake in inventory, and that's in the total bottles there.
But you see some quarters a little more muted because there was a drawdown in inventory, such as last quarter. But you see the slide on the left there, very robust growth, and that's what you expect to see in a product that's at launch phase. Making really good progress in introducing the product to patients that are in the institutional side, as well as patients that are now in the community side. Initially, we had a lot of uptake in the institutional doctors, and now we're seeing more balance, where more uptake in the community as well as institutional. So we're really pleased with that as well, to have broad-based beginning of broad-based uptake for Rezlidhia.
You may have seen just recently, we signed our first ex-US collaboration with Rezlidhia, with our existing partner, Kissei, in Asia, Japan, Korea, and Taiwan. We have a previous relationship with Kissei and know them quite well because they are the partners for Tavalisse in these markets already, where they've done an excellent job. They did a Phase 3 trial in Japan, showing very nice results, filed for approval, got approval, launched the product, and have been quite successful in introducing Tavalisse in Japan. And now we're hoping to replicate that very experience with Rezlidhia. They're excited about the addition of Rezlidhia for the same reason as we were. It's in mutant IDH1, AML, and it's an area where there's tremendous need in Japan as well. So we were delighted to sign a second deal with Kissei.
We're comfortable that they would do just as good with this product and would fit perfectly in their portfolio as it does with ours. The terms you see there, $10 million upfront, a potential $152 million in milestone payments, obviously, and there's a royalty embedded in a transfer price, which is between 20%, mid-twenties to lower 30% range tiered. Some of this goes into our former partner. When we in-licensed it, they agreed, we agreed to with them that we would share some of the revenue from licensing with Forma, which originated this product. So we're excited about this new collaboration. We're excited about expanding our working relationship with Kissei and hope to wish them tremendous success as they move forward for a clinical trial in Japan and then filing an approval.
Let me move to Gavreto for RET fusion-positive non-small cell lung cancer and thyroid cancer. This is the official indication statement. So we acquired rights to Gavreto, and this is why we're excited about Gavreto. It's a once-daily oral, in fact, the only once-daily oral small molecule inhibitor of wild-type RET and oncogenic RET fusions. It's highly synergistic with our current portfolio. Now, you may say, "You sell products to hemonc doctors." Actually, we sell products in the community. Those same doctors treat solid tumors as well. On the academic side, it's more specialized, and there we have a person on the academic side that goes into a particular center. They may see two doctors there, a AML doctor and a solid tumor doctor in the form that treats lung cancer, for example. So it is highly synergistic. We also have...
When we surveyed our sales force, more than half our sales force had solid tumor experience. And quite a number of them had lung tumor experience as well. In fact, on average, about three years. So it's an area that our sales force knows quite well, where they have existing relationships with doctors who treat non-small cell lung cancer. So we're excited about that synergy, 'cause we don't have to add substantial numbers to sell this product successfully. Last year, Genentech Roche, who was selling this product, sold about $28 million in the U.S. We hope to capture as much of that as possible in this transition. I'll tell you a little bit about that in a few minutes.
We paid Blueprint, which is the originator of this product, $15 million in upfront payments, $10 million payable on the first commercial sale that happened last July, and $5 million on the first anniversary of the signing agreement. That'll happen in the first quarter. We'll pay $15 million for a $28 million product. The economics are outstanding, to say the least. We're delighted with this. We think we'll do quite well with this, and obviously, Blueprint and Genentech are both delighted that we're able to keep the product on the market, helping the patients that it serves currently. Here's why we're excited about it.
It's a well-identified subset of a very large solid tumor market, our first, and these patients are very difficult to treat, and this product does quite well in treating them, and the subset of these patients. On the bar chart, what you see here in deeper blue and lighter blue, here's where RET inhibitors are used. Gavreto is in the 15%, the Lilly product is the 60%. What's interesting is that 25% of the patients in this category are still being treated with multi-kinase inhibitors and chemotherapy and immune checkpoint. The results with those mechanisms are not very good, and in fact, they really should be using one of the RET inhibitors, preferably ours. So our objective is to grow that twenty
Our share, the 15%, by eating into the gray and black bars there, because there's tremendous opportunity to improve the outcomes in those patients. We're gonna do this by sharing the information that we have, which is very solid, very good data on the efficacy and safety side, and using our market access team to help this, make this product readily available. Here's what. When we looked at this product, we thought, "This is, these are features that really differentiate the product." It's the only oral, once daily, RET inhibitor for these indications. The results are durable, high and durable response rates. This has excellent response rates relative to other non RET mechanisms, and comparable to the Lilly product. Promising intracranial efficacy in patients with brain mets.
As you may know, people with lung cancer frequently have metastasis, including to the brain. This product works in diminishing that. The safety and tolerability is quite good. In fact, there's some pockets where this should be the preferred agent, and RET inhibition as treatments for lung cancer and advanced thyroid cancer is part of the recommended guidelines already, so we're in a good starting point in terms of physicians understanding the value of RET inhibitor in patients with these mutations, and commonly using them. Our data is comparable, maybe in some ways, a little better than the competition, and what we have to do now is educate those doctors about this data and this product, and educate them why they should use it, particularly in those patients that are now getting multi-kinase inhibitors and immunochemotherapy.
The transition is currently underway in this quarter, and so far it's going very well. Across all the different areas, supply chain, regulatory distribution system, patient services, which are critical here, and commercial and medical affairs, our teams have worked very hard to make sure this transition and all the patients that are currently on therapy, remain on therapy now in our hands. And that, so far, has gone quite well, so we hope to transition as many of those as we possibly can. Here's a picture of the product. It comes in two different types of bottles. We typically will report sixty-count equivalent bottles, 'cause that's the most commonly used one. And last quarter, Q2, we had 1.928 million bottles that were sold. Now, that is all pipeline stocking, distribution network stocking. It actually didn't.
None of them went to patients. It really all occurred in the last few days of June, so this quarter, when we report on our quarterly numbers, we'll see for the first time what the patient side demand is of this. We're delighted to present that to you in an upcoming meet call. Let me move on to the second part of that chart that I began with, clinical development program updates, so this is an important chart, 'cause this is how we're gonna grow the company substantially and in the future. On the right, in in-licensing and product acquisition, we're looking for assets that are in the heme and onc, and related areas, that are late stage, and by that, I mean, having registrational data, having filed an NDA already, having an NDA approved, or already being on the market in these areas.
Those are the gamut of things that we're looking for, things that can be deployed very rapidly and very quickly in the next few years. We think they need to be synergistic with our in-house capabilities, and we have broad oncology capabilities in both community settings and academic institutional settings, and to leverage those things. For the two prior acquisitions, we really grew the organization very little to be able to commercialize them. So you can imagine the profitability of a product like that. So we hope to continue that and make additional in-licenses and product acquisitions in the near future. Now, you may ask, "Well, how are you going to grow the company beyond that?" It's on the left-hand side of this slide.
olutasidenib, as I mentioned, has opportunities in frontline AML, MDS, and importantly, glioma, where IDH inhibition has showed to be quite beneficial. I'll tell you a little bit about that as we discussed our first step into that. R289, our IRAK1/4 inhibitor, is in development for lower-risk MDS, which we're very excited about that. Let me dive into our first couple efforts here. For olutasidenib, what we've done, because we want to generate data and generate data quickly in many different indications, we've signed two strategic collaborations. One of them is with MD Anderson. As you may know, MD Anderson is a premier cancer center in the world and key to really the future of treatment of cancers.
We signed a broad collaboration with them, $15 million, five years, where we will look at four or more different clinical trials. AML, frontline and relapse/refractory, higher-risk MDS, lower-risk MDS and CCUS, and post-transplant maintenance. Those are the four trials currently contemplated by our collaboration to launch soon. AML just launched, where we're looking at relapse/refractory and frontline, as a triple therapy. We're really excited about that, and they'll begin generating data once they have that, and we'll be reporting it. It's a great organization to work with 'cause their volumes of patients are quite large, and they are really in the forefront on developing the future paradigms for treating some of these very difficult cancers. So we're delighted by this. The other trials that you see here, we hope to start in the next handful of months as well.
So we will have a multitude of trials launched with MD Anderson and generating data across these over the next years. In addition, we will examine for ourselves what we want to do with these areas and come back to you in terms of here's our development plan in AML in particular, but also some of these other areas where there might be tremendous opportunities for olutasidenib. In addition to that, our second collaboration is with the CONNECT organization. CONNECT is an organization that has a targeted trial. This is a molecularly guided, phase two umbrella trial in glioma, high-grade glioma, and now we're going to add olutasidenib onto that trial so that they will be studying mutant IDH1 patients and providing olutasidenib.
They're going to be newly diagnosed, post-radiation, that are going to receive olutasidenib plus temozolomide, a commonly used agent here, and then after a year, just as monotherapy, and they're going to be studying adolescents and adults up to 39 years old with IDH-positive high-grade glioma, so we're excited about the launch of this trial. The need in glioma is tremendous. This is an incredibly underserved, poorly served disease, where a large number of patients progress, where there's just nothing useful so far, so the excitement we have for this is tremendous because olutasidenib may offer a new treatment approach to treating some of these patients, and in the future, we will discuss this further with you in terms of what our plans are ourselves beyond this trial in glioma.
Let me move on to R289, our IRAK1/4 inhibitor. R289 is a discovery of Rigel, and we've moved it forward. We own this fully, globally. And one of the important things about lower-risk MDS is that it is really characterized by a pro-inflammatory environment in the bone marrow that leads to various cytopenias. And IRAK1/4 is a very potent down regulator of that pro-inflammatory cytokines, and that might be very useful in the treatment of lower-risk MDS, broadly speaking. That is, it's a product that could address a broad range of lower-risk MDS patients 'cause this is such a central pathway. It inhibits two key pathways, the toll-like receptor pathway and the IL-1 receptor pathway, and those are central to that pro-inflammatory environment that I just discussed.
The inhibition of IRAK1 and 4, we've shown to be more broadly immunosuppressive of those in cytokines than just IRAK4, and that's important because we think that this is a better tool to achieve this. Other companies have IRAK4 inhibitors in development for various immune indications, rheumatoid arthritis, for example. But IRAK1 and 4 is much more profoundly inhibitory of this, and we think a better tool for this particular setting, maybe other settings as well. And R835 is a selective inhibitor of IRAK1 and 4. In the body, that is what circulates. R289 is a prodrug of R835, and it converts to R835 in the gut.
What we've been able to show also is that R835 also reduces cytokine release in healthy, normal volunteers that are given an LPS challenge, which causes a cytokine storm, and then we're able to address that using R 835 successfully. So we're delighted by these experiments 'cause they lead to a product that we're really excited about studying in this setting. So what we've done is launch this trial. It's a phase one B trial that is in the dose escalation phase currently. We've completed enrollment in dose group one, two, three, four, and now we're enrolling dose group five. And we will have this data at the end of this year at the ASH meeting, and we're excited about that. It's open label. I can't tell you the results, obviously, until then, but we look forward to sharing them with you then.
The primary endpoint here is a safety readout. We have to find a dose that's safe, but importantly, a dose that also shows signs of efficacy in the form of transfusion independence response rates and hematologic improvement overall. Obviously, PK and PD markers as well. So with that, we will then choose a dose expansion cohort at a particular dose and move forward into additional patients. Later on next year, we will tell you what our plan forward is in terms of getting to a registrational program in lower risk MDS with this molecule, if appropriate. So look forward to this. We're excited about having the first meaningful data with this product to share with you in really just a few months. In addition to those programs, I don't talk about this very much, we have a partnership with Eli Lilly on our RIP1 inhibitor program.
RIP1 is an interesting molecule that's an immune regulator. We have two different programs with them. One is on the immune disease side, where the lead molecule, R552, a potent selective RIP inhibitor, completed phase 1 successfully and is currently in a Phase 2a clinical trial in patients, adult patients with rheumatoid, moderate to severe rheumatoid arthritis. They should have some interim data sometime next year, and they do at ACR have a poster that I encourage you to look at in addition. On the CNS side, our job was to give them a basket of RIP inhibitors that then they would select and move forward. So we've done that, and now they're looking at that basket to see which of those they move forward into preclinical development.
The diseases of indication here are wide-ranging, but they could include things like, like Alzheimer's disease, and other areas that are-- have areas of tremendous needs. So we're looking forward to their progress, particularly with R552, and being able to share data with you from the RA trial in the, in the future. Let me go on financials. Our product sales have done quite well, as you see here from, from this bar graph. Now, particularly in the last quarter, Q1, we had a Q1 stocking, inventory, downturn. That's what caused that one. But generally, very strong growth, and we'll look forward to reporting Q3 numbers as well. All three products have had really fantastic performance. Tavalisse, our mainstay product, has continued to do well. Rezlidhia uptake, has gone quite well in its launch phase, and we're just getting Gavreto.
This will be the first full quarter of Gavreto, so we look forward to reporting those sales. Last quarter, like I said, we were at financial break-even. Our cash usage last quarter, 49.1, was our cash flow, which is pretty comparable to what we started the quarter with, so really not very much cash usage overall at this point, as you would expect. Let me conclude by telling you, here's what we're going to do in terms of growing the company. One, we're going to continue to grow the three commercial products, Tavalisse, Rezlidhia, and Gavreto. And there's great opportunity for continued growth in Tavalisse, the launch of Rezlidhia, and the first numbers for Gavreto in our hands. And we'll identify other products to bring in beyond that. I'll go to the bottom.
Couple that with good financial discipline, that is, our expenses won't grow all that much. What it leads to is going from a break-even situation, which is roughly where we are now, to a cash generation situation. What we hope to do with that cash is to advance development programs for olutasidenib in glioma and AML, and for R289 in lower risk MDS. Areas of tremendous medical need, where we have products that offer real advantages and help to patients. And in addition, we'll continue to grow the portfolio by identifying additional acquisition and in-license opportunities. So we're in a great place as a company. We're at a place where we're very happy to have arrived here. We're pleased with the commercial performance.
We're pleased with the portfolio of products that support that, 'cause the opportunities there are far larger, addressing much bigger medical need areas, and we're delighted to be able to fund those ourselves. So with that, thank you, and I appreciate your support.