ARROS-1 is the pivotal Phase 1/2 trial of zidesamtinib (Jideytro), a brain-penetrant, ROS1-selective, TRK-sparing TKI. In 117 TKI-pretreated ROS1-positive NSCLC patients it delivered an objective response rate of 44% (95% CI 34-53%) with durable intracranial activity. On July 22, 2026 the FDA approved Jideytro (Nuvalent, a GSK company) for ROS1+ NSCLC after a prior ROS1 TKI.
FDA Approved - July 22, 2026ROS1-positive NSCLCPhase 1/2 - NCT05118789Zidesamtinib (Jideytro)Nuvalent / GSK
FDA approved July 22, 2026 - Jideytro (zidesamtinib) for adults with locally advanced or metastatic ROS1-positive NSCLC who received a prior ROS1 TKI. Ahead of the Sept 18, 2026 target action date. FDA approved (2L+ ROS1+ NSCLC)Source: Nuvalent/GSK press release
Design
Global registrational Phase 1/2 trial (NCT05118789); pivotal TKI-pretreated cohort n=117; primary endpoint objective response rate by blinded independent central review (BICR). Data cutoff March 21, 2025 (WCLC 2025).
Efficacy (pretreated, n=117)
ORR 44% (95% CI 34-53%); duration of response 82% at 6 months and 69% at 12 months (FDA label / Nuvalent PR). ORR 51% after a single prior TKI; ORR 47% after prior repotrectinib and 43% after prior taletrectinib (ARROS-1, WCLC 2025, DCO 21-Mar-2025). ORR 44% - 12-mo DoR 69%
CNS activity
Intracranial ORR 48% (27/56, 95% CI 35-62) in patients with measurable CNS lesions; durable intracranial responses including after prior brain-penetrant TKIs; activity against the ROS1 G2032R resistance mutation (ARROS-1, WCLC 2025).
Tolerability
Generally well tolerated: dose reduction ~10%, treatment discontinuation ~2%; TRK-sparing design intended to reduce neurotoxicity (ARROS-1, WCLC 2025).
Investigational Data - Not FDA Approved
The front-line / TKI-naive ARROS-1 data (ORR ~89% (31/35)) are investigational and NOT part of the FDA-approved indication; front-line development is ongoing.
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[Slide 1]
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ARROS-1: Summary
PIVOTAL DATASET
Preliminary
In the pivotal dataset for TKI pre-treated patients with
Any prior
1 prior ROS1 TKI
Advanced
advanced ROS1+ NSCLC, zidesamtinib demonstrated a
ROS1 TKIs
(crizotinib or
ROS1
ROS1+ NSCLC
(range 1-4)
entrectinib)
TKI-naive
clinical profile consistent with its preclinical design goals:
1 chemotherapy
1 chemotherapy
Durable activity, including in heavily pre-treated patients that
ORR (BICR)
44%
51%
89%
have exhausted available options (including prior
% DOR
repotrectinib or taletrectinib) and patients with the ROS1
78%
93%
96%
: 12 months
G2032R resistance mutation
% DOR
62%
93%
: 18 months
Durable intracranial responses, including in patients who
% PFS
48%
68%
previously received the brain-penetrant TKIs entrectinib,
11 12 months
lorlatinib, repotrectinib or taletrectinib
% PFS
40%
68%
E 18 months
Generally well-tolerated with low rates of dose reduction
Any prior
Prior crizotinib
Intracranial
ROS1
(10%) and treatment discontinuation (2%), and a safety profile
ROS1 TKIs
Activity
only t
TKI-naive
t chemotherapy
chemotherapy
consistent with its ROS1-selective, TRK sparing design
IC-ORR (BICR)
48%
85%
83%
Encouraging preliminary data in a TKI-naive population
No CNS
71%
91%
support ongoing investigation in the front-line setting
IC-DOR
progression
: 12 months
: 12 months
among confirmed
CNS responders
Tab out off March 21,2025
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[Slide 1]
ASC
2023 Conference
#WCLC25
Cancer
ARROS-1: G2032R Resistance Mutation and CNS Subgroups
ROS1 G2032R Resistance Mutation
Measurable CNS lesions by BICR at baseline
Advanced ROS1+
1 prior ROS1 TKI
Advanced ROS1+
NSCLC
Any prior ROS1 TKI
(crizotinib or entrectinib)
NSCLC
Any prior ROS1 TKI
Prior crizotinib only
1 chemotherapy
1 chemotherapy
1 chemotherapy
1 chemotherapy
Analysis by BICR
Analysis by BICR
ORR, % (n/N)
54% (14/26)
83% (5/6)
IC-ORR, % (n/N)
48% (27/56)
85% (11/13)
(95% ci]
[33,73]
36, 100]
195% ci]
(35, 62]
(55, 98]
IC-CR % (n/N)
20% (11/56)
54% (7/13)
% DOR t 6 months
79%
80%
(95% CI]
[47,93]
[20, 97]
% IC-DOR : 6 months
79%
91%
95% ci]
[56, 91]
[51,99]
% DOR t 12 months
60%
80%
% IC-DOR : 12 months
71%
91%
95% ci]
[28,81]
[20,97]
(95% ci]
[46, 87]
[51,99]
Responses were also observed in patients with
CNS responses also observed in patients who had received 21 prior brain-
ROS1 G2032R mutation following >2 prior ROS1 TKIs : chemotherapy,
penetrant TKI. including prior entrectinib, forfatinib, repotrectinib. or
including forlatinib or repotrectinib
taletrectinib IC-ORR: 37% (16/43 95% CI 23, 53]), including 4 IC-CRs
Other ROS1 resistance mutations, including G1957A L1982V, S1986F,
No CNS progression was observed among patients who entered the study
F2004C/V, G2032K, and D2033N
without brain metastases at baseline per BICR
Patients received zidesamtinib as their first TKI designed with activity against
ROS1 02032R
includes 2 unconfirmed intracranial partial responses (PR).
Analyses of DOR based on Kaplan-Meier estimates.
Analyses of DOR based on Kaplan-Meier estimates.
One progression event among responders
One CNS progression event among CNS responders (n=11).
(ats off March 21, 2025 C.
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[Slide 2]
EASLC
2025 World Conference
#WCLC25
Lung Cancer
......
ARROS-1: Safety in Advanced ROS1+ NSCLC
All Treatment-Emergent Adverse Events (TEAEs) in >15%
of Patients Treated with Zidesamtinib 100 mg QD (N = 432) a
Dose reduction due to TEAEs: 10% (43/432)
Preferred or grouped term
Any Grade
Grade 2 3
Most common (>2 patients): peripheral edema
Peripheral edema
36%
0.7%
(n=8), blood CPK increased (n=4), peripheral
Constipation
17%
0%
sensory neuropathy (n=4), arthralgia (n=3),
paresthesia (n=3)
Blood CPK increased
16%
3.5%
Fatigue 6
16%
0.7%
Discontinuation due to TEAE: 2% (10/432)
Dyspnea
15%
3.0%
Most common (>2 patients): pneumonia (n=3)
Patients received at least 1 dose of zidesamtinib at 100 mg QD with median duration
of exposure of 5 months (range: 0. 32).
The only treatment-related adverse event in >15%
b
Includes terms peripheral edema, peripheral swelling. edema, generalized edema.
of patients was peripheral edema b (29%)
includes terms fatigue, asthenia, malaise
if Includes terms dyspnea, dyspnea exertional, orthopnea
I ata pooled for patients a the Phase I or Phase 2 portion of ARROS I - a data cut-off of March 21,2025 CPK, creatine phosphokinase
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[Slide 1]
ASLC
2025 World Conference
#WCLC25
on Long Cancer
SEPTEMBER
......
ARROS-1: G2032R Resistance Mutation and CNS Subgroups
ROS1 G2032R Resistance Mutation
Measurable CNS lesions by BICR at baseline
Advanced ROS1+
1 prior ROS1 TKI
Advanced ROS1+
NSCLC
Any prior ROS1 TKI
(crizotinib or entrectinib)
NSCLC
Any prior ROS1 TKI
Prior crizotinib only
t chemotherapy
* chemotherapy
1 chemotherapy
t chemotherapy
Analysis by BICR
Analysis by BICR
ORR, % (n/N)
54% (14/26)
83% (5/6)
IC-ORR, % (n/N)
48% (27/56)
85% (11/13)
95% CI]
[33, 73]
[36, 100]
[95% ci]
[35,62]
[55,98]
IC-CR. % (n/N)
20% (11/56)
54% (7/13)
% DOR : 6 months
79%
80%
95% ci]
[47,93]
[20, 97]
% IC-DOR : 6 months
79%
91%
95% CI] b
[56, 91]
[51,99]
% DOR : 12 months
60%
80%
% IC-DOR : 12 months
71%
91%
95% ci] b
[28, 81]
[20, 97]
95% CI]
[46,87]
[51,99]
Responses were also observed in patients with:
CNS responses also observed in patients who had received 21 prior brain-
ROS1 G2032R mutation following >2 prior ROS1 TKIs * chemotherapy,
penetrant TKI, including prior entrectinib, lorlatinib, repotrectinib, or
including lorlatinib or repotrectinib
taletrectinib: IC-ORR: 37% (16/43 : 95% CI 23, 53]), including 4 IC-CRs
Other ROS1 resistance mutations, including G1957A, L1982V, S1986F,
No CNS progression was observed among patients who entered the study
F2004C/V, G2032K, and D2033N
without brain metastases at baseline per BICR
Patients received zidesamtinib as their first TKI designed with activity against
ROS1 G2032R.
Includes 2 unconfirmed intracranial partial responses (PR).
a
Analyses of DOR based on Kaplan-Meier estimates
Analyses of DOR based on Kaplan-Meier estimates.
One progression event among responders.
One CNS progression event among CNS responders (n=11).
I ata cut off March 2025 IC intracrapial
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[Slide 2]
ASIC
2025 World Conference
#WCLC25
Lung Cancer
SEPTEMBER
......
ARROS-1: Duration of Response and Progression-Free Survival
Duration of Response
Progression-Free Survival
Advanced ROS1+ NSCLC
Any prior ROS1 TKIs
1 prior ROS1 TKI
Any prior ROS1 TKIs
1 prior ROS1 TKI
(range 1-4)
(crizotinib or entrectinib)
(range 1-4)
(crizotinib or entrectinib)
Kaplan-Meier Estimate
* chemotherapy
: chemotherapy
: chemotherapy
1 chemotherapy
%2 6 months 95% ci]
84% [71, 92]
93% 74. 98]
57% [47, 66]
70% [56, 81]
% : 12 months [95% ci]
78% 62, 88]
93% 74, 98]
48% [38, 57]
68% [53, 79]
% 2 18 months [95% CI]
62% [28, 84]
93% 74, 98]
40% [24, 55]
68% [53, 79]
Tata out off March 21, 2025
100
93%
93%
93%
100
"Any prior ROST TKL Emerging
median DOR of 22 months (95%
CE 17.NET continues to manure
75
84%
75
70%
68%
68%
Median PFS was 9.7 5.5. NE]
months with median follow up of
Paters Response 2 $
78%
50
62%
Progression-Free Surval
50
11.1 months trange 02-25-6)
57%
48%
1 prior ROS1 110 (crizotinib)(C) or
40%
25
25
entrectinib] Emerging median
DOR of 22 months 95% DI 22.
NE] and median PFS of 23.8
0
0
months 295% Ct 23.8 NE)
0
0
12
18
24 Months
0
0
12
18
24 Months
continue to mature median
ALRISK
ALROA
folow up was 11.8 months
Any proor ROST Tide
11
40
10
3
-
ROST DOB
117
04
27
$
trange 1.2-25.6)
Prior Cer only
29
26
0
3
0
Prior or only
55
37
14
4
0
In patients that received prior crizotinib only, there were no progression events among responders (DOR range: 7.3+ to 23.2+ months).
PFS rate was 89% (95% Cl: 70, 96) at 6, 12, and 18 months with median not reached.
In patients that received >2 prior ROS1 TKIs 1 chemotherapy, DOR rate was 71% (95% Cl: 46, 86) at 6 months and 56% (95% CI: 29, 76) at 12 months.
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[Slide 3]
ASC
World Conference
#WCLC25
Lung Cancer
ARROS-1 Preliminary Data:
TKI-Naive Patients with Advanced ROS1+ NSCLC
TKI-naive advanced
Response-evaluable
TKI-naive advanced
Measurable intracranial lesions
ROS1+ NSCLC
ROS1+ NSCLC
n 35
n= 6
Analysis by BICR
Analysis by BICR
ORR, % (n/N)
89% (31/35)
IC-ORR, % (n/N)
83% (5/6)
CR, % (n/N)
9% (3/35)
% DOR : 6 months [95% CI]
96% [76, 99]
IC-CR, % (n/N)
67% (4/6)
% DOR 2 12 months [95% CI]
96% [76, 99]
IC-DOR
No CNS progression events among
DOR range
1.9+ to 13.9+ months
intracranial responders
1 Includes 1 unconfirmed CR following confirmed partial response (PR).
IC-DOR range
4.6+ to 11.1+ months
. Analyses of DOR based on Kaplan-Meier estimates
40
ROS1 TKI-naive
Best %change in target lesions
20
0
No prior
2
chemotherapy
$
1 prior line of
00
chemotherapy
8
100
so PD so PR PR PM PR PM PR PR PM PR PR PR PR PR PM CR PR PR PM PM PR PR PM PR PR UCR PR PR PR PR PM CR
Date for patients treated with ridesar with 100Γ or by August 31, 2024 in the Phose 2) portion of ARROS I with a data cut off of March 21, 2025 Patients may have received up to 1 prior line of chemoltherapy
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The U.S. FDA approved Jideytro (zidesamtinib) for the treatment of adult patients with locally advanced or metastatic ROS1-positive non-small cell lung cancer (NSCLC) who received a prior ROS1 kinase inhibitor. The approval - granted to Nuvalent, Inc. (now part of GSK following completion of the acquisition) about two months ahead of the September 18, 2026 target action date - is based on the pivotal ARROS-1 Phase 1/2 trial (ORR 44%, 95% CI 34-53%; duration of response 82% at 6 months and 69% at 12 months). No companion diagnostic was co-approved.
Approved indication is limited to prior-TKI (2L+) patients; front-line / TKI-naive use remains investigational.
ARROS-1 (NCT05118789) is the global registrational Phase 1/2 study of zidesamtinib (Jideytro), a next-generation ROS1-selective kinase inhibitor engineered by Nuvalent to be brain-penetrant, to remain active against ROS1 resistance mutations (including G2032R), and to spare TRK - the mechanism behind the neurologic toxicity seen with earlier ROS1/TRK inhibitors. The pivotal cohort enrolled 117 patients with advanced or metastatic ROS1-positive NSCLC who had received one or more prior ROS1 TKIs (crizotinib, entrectinib, repotrectinib, or taletrectinib). Results were presented by Dr. Alexander Drilon at the 2025 World Conference on Lung Cancer (WCLC 2025) and formed the basis of the July 22, 2026 FDA approval. The trial also includes an encouraging TKI-naive (front-line) cohort that remains under investigation.
None co-approved; ROS1 fusion status determined by standard molecular testing.
Lead Investigator
Alexander Drilon, MD (presenter, WCLC 2025); Benjamin Besse, MD and colleagues.
Objective Response (pretreated)
ORR 44% (51/117; 95% CI 34-53%), CR 1% (1/117). ORR 51% (28/55) after a single prior TKI (crizotinib or entrectinib); 68% after prior crizotinib only. Responses after prior repotrectinib (ORR 47%, 8/17) and taletrectinib (ORR 43%, 3/7); ORR 38% (22/58) after >=2 prior ROS1 TKIs. ORR 44% (95% CI 34-53%)Source: ARROS-1, WCLC 2025 (DCO 21-Mar-2025)
Duration of Response
In the FDA-label pivotal population, DoR was 82% at 6 months and 69% at 12 months (Nuvalent/GSK press release / FDA label). The WCLC 2025 dataset (DCO 21-Mar-2025) reported a 12-month DoR of 78% in the any-prior-TKI cohort - a different analysis cut; the two are not mixed here. 12-month DoR 69% (FDA label)Source: Nuvalent/GSK press release
Intracranial Activity
Among patients with measurable CNS lesions, intracranial ORR was 48% (27/56; 95% CI 35-62) with IC-CR 20% (11/56). Durable CNS responses were observed, including in patients previously treated with the brain-penetrant TKIs entrectinib, lorlatinib, repotrectinib or taletrectinib (IC-ORR 37%, 16/43). No CNS progression occurred among patients without baseline brain metastases. Intracranial ORR 48%Source: ARROS-1, WCLC 2025 (DCO 21-Mar-2025)
Safety & Tolerability
Zidesamtinib was generally well tolerated, with a treatment discontinuation rate of ~2% and dose reduction ~10%. Its ROS1-selective, TRK-sparing design is intended to avoid the neurologic toxicity associated with TRK inhibition. Discontinuation ~2%Source: ARROS-1, WCLC 2025 (DCO 21-Mar-2025)
Yes. On July 22, 2026, the U.S. FDA approved Jideytro (zidesamtinib), a ROS1-selective TKI from Nuvalent (now part of GSK), for adults with locally advanced or metastatic ROS1-positive non-small cell lung cancer (NSCLC) who received a prior ROS1 kinase inhibitor. The approval is based on the pivotal ARROS-1 Phase 1/2 trial.
What were the ARROS-1 efficacy results for zidesamtinib?
In the TKI-pretreated pivotal population (n=117), zidesamtinib showed an objective response rate (ORR) of 44% (95% CI 34-53%), with duration of response of 82% at 6 months and 69% at 12 months (FDA label / Nuvalent press release). At WCLC 2025 (data cutoff March 21, 2025), intracranial ORR was 48% (27/56, 95% CI 35-62) and ORR was 51% after a single prior TKI.
Does zidesamtinib work against ROS1 resistance mutations and brain metastases?
Yes. ARROS-1 (WCLC 2025) reported activity against the ROS1 G2032R resistance mutation and responses after prior repotrectinib (ORR 47%, 8/17) and taletrectinib (ORR 43%, 3/7). Intracranial ORR was 48% (27/56), and durable CNS responses were seen in patients previously treated with brain-penetrant TKIs. Zidesamtinib is designed to spare TRK, reducing neurotoxicity.
Is zidesamtinib approved for first-line (TKI-naive) ROS1-positive NSCLC?
No. The FDA approval is limited to patients who received a prior ROS1 TKI. The TKI-naive front-line data reported in ARROS-1 (ORR ~89% (31/35)) are investigational and not part of the approved indication; front-line investigation is ongoing.
Who presented the ARROS-1 trial and where?
The pivotal ARROS-1 dataset was presented by Dr. Alexander Drilon at the 2025 World Conference on Lung Cancer (WCLC 2025) and discussed widely by lung-cancer KOLs including Stephen V. Liu, Patrick Forde, Julien Mazieres, Sarah Waliany and Chul Kim.
Compiled and reviewed by the KOL Pulse research team, led by Brian Shields, Founder, KOL Pulse. Last updated 2026-07-22. All clinical figures are traceable to the ARROS-1 WCLC 2025 presentation, the FDA label, or the Nuvalent/GSK press release; front-line (TKI-naive) data are labeled investigational.
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