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Bezuclastinib

Phase 3

Advanced Gastrointestinal Stromal Tumors | Small molecule | Oncology |Cogent Biosciences, Inc.|Trials Updated: Sep 15, 2026

Development status

Highest phase Phase 3
Registered trials 3 across 1 sponsor since Aug 2021

Target and mechanism

Molecular targetKIT
Target class-Tinib (Kinase)
ModalitySmall molecule

Also known as Bezuclastinib Tablets (Formulation A), CGT9486

Success Probability

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Market & Valuation

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Trial Design

RandomizedACTIVE_CONTROLLEDDMC
Total Trials5
Total Enrollment950

FDA Designations

BREAKTHROUGH_THERAPYPRIORITY_REVIEW

Clinical trial landscape

Bezuclastinib · 5 trials · 16 indications

Phase 3 1Phase 2 3Phase 1 1
NCT05208047(Peak) A Phase 3 Randomized Trial of CGT9486+Sunitinib vs. Sunitinib in Subjects With Gastrointestinal Stromal TumorsAdvanced Gastrointestinal Stromal Tumors
RECRUITING482 Analytics
PHASE3RECRUITING
(Peak) A Phase 3 Randomized Trial of CGT9486+Sunitinib vs. Sunitinib in Subjects With Gastrointestinal Stromal Tumors
Advanced Gastrointestinal Stromal TumorsUnlock trial analytics

Study Endpoints

Primary Endpoints

Part 1a - pharmacokinetics - Cmax
16 days

Maximum plasma concentration (Cmax)

Part 1a - pharmacokinetics - AUC
16 days

Area under the plasma concentration-time curve (AUC)

Part 1b - pharmacokinetics - Cmax
14 days

Maximum plasma concentration (Cmax)

Part 1b - pharmacokinetics - AUC
14 days

Area under the plasma concentration-time curve (AUC)

Part 1b - pharmacokinetics - Tmax
14 days

Time to maximum observed plasma concentration (Tmax)

Part 2 - Progression Free Survival (PFS)
Approximately 48 months

Time from first dose to documented disease progression or death due to any cause, whichever occurs first

DDI Substudy - pharmacokinetics - AUC
16 days

Area under the plasma concentration-time curve (AUC)

DDI Substudy - pharmacokinetics - Cmax
14 days

Maximum plasma concentration (Cmax)

To estimate the median progression free survival (mPFS)
From the time of first dose to the occurrence of disease progression (as accessed by mRECIST v1.1) or death due to any cause prior to documented disease progression, up to 2 years..

mPFS will be summarized with a Kaplan-Meier curve

Part 1: Determine recommended dose of bezuclastinib (CGT9486) in subjects with NonAdvSM
3 months

Selection of the recommended dose to be used in subsequent parts of the study.

Part 2: Efficacy of bezuclastinib at the selected dose versus placebo
24 Weeks

Mean absolute change on the Mastocytosis Symptom Severity Daily Diary (MS2D2)

Part 3: Safety and tolerability of bezuclastinib as assessed by number of adverse events
Up to 5 years

CTCAE v5

Part I: Identify clinically active and tolerable exposures of bezuclastinib in patients with AdvSM
18 months
Part II: - Determine efficacy of bezuclastinib as measured by mIWG Objective Response Rate (ORR) - Confirm the exposure-response relationship of bezuclastinib
18 months
Part 1: Recommended Phase 2 Dose (RP2D) of CGT9486
Cycle 1 of Part 1 (Cycle length = 28 days)

RP2D was determined by incidence of dose limiting toxicity (DLT) using Common Terminology Criteria for Adverse Events (CTCAE) V4.03. DLTs: AEs that occurred during Cycle 1, possibly/probably related to study drug, and met 1 of the following criteria: Hematologic Toxicities: Grade 4 neutropenia for \>7 days, Grade ≥3 neutropenia with fever, Grade 4 thrombocytopenia, Grade ≥3 thrombocytopenia for \>7 days, Grade 4 anemia; Other Toxicities: Any Grade ≥3 (AE or laboratory) toxicity despite adequate supportive care except for following: Grade ≥3 nausea, vomiting, or diarrhea that resolved to Grade ≤2 within 72 hours; Grade 3 fatigue that resolved to Grade ≤2 within 14 days; Grade ≥3 asymptomatic changes in alkaline phosphatase, hypomagnesemia, hyperglycemia, or hypophosphatemia; Grade 3 increases in transaminases for ≤5 days; Any other Grade ≥3 toxicity for which further dose escalation deemed inappropriate.

Part 1: Number of Participants With Treatment Emergent Adverse Events (TEAEs)
From the date of first dose of study drug up to 30 days after last dose of study drug (maximum exposure: 670 days)

An adverse event (AE) was any untoward medical occurrence in a participant administered study drug, which did not necessarily have a causal relationship with the treatment. An AE could be any unfavorable and unintended sign (for example, including an abnormal laboratory finding), symptom, or disease temporally associated with the use of the study drug, whether or not it was considered to be study drug related. This included any newly occurring event or previous condition that had increased in severity or frequency since the administration of study drug. A treatment-emergent AE (TEAE) was an AE that started or worsened in severity on or after the date of the initial dose of study drug. A summary of serious and all other non-serious adverse events regardless of causality is located in the Reported Adverse Events module.

Part 1: Area Under The Concentration Time Curve From Time Zero to 24 Hours After Dosing (AUC0-24) of CGT9486
Predose, 1, 3, 5, 7, 9, and 24 hours postdose at Cycle 1 Day 1 and Cycle 1 Day 15

AUC0-24 was determined by the linear trapezoidal rule for the ascending portion and by the log trapezoidal rule for the descending portion of the plasma profile. For BID dosing, Cycle 1 Day 15 AUC0-24 was calculated as 2 x area under the concentration time curve from time zero to 12 hours after dosing (AUC0-12). Missing concentration data were excluded from Pharmacokinetic (PK) analysis.

Part 1: Maximum Observed Plasma Concentration (Cmax) of CGT9486
Predose, 1, 3, 5, 7, 9, and 24 hours postdose at Cycle 1 Day 1 and Cycle 1 Day 15

Cmax was taken directly from bioanalytical data.

Part 1: Time to Reach Cmax (Tmax) of CGT9486
Predose, 1, 3, 5, 7, 9, and 24 hours postdose at Cycle 1 Day 1 (Day -10 for 350 mg QD cohort) and Cycle 1 Day 15

Tmax was taken directly from merged clinical and bioanalytical data, with time presented as nominal time relative to dose.

Part 1: Half Life (T1/2) of PLX9486
Predose, 0.5, 1, 2, 4, 9, 24, 49, 72, 96, 120, 144, 168, 192, 216 hours postdose on Day -10

Participants in a selected Part 1 cohort (350 mg QD) participated in a PK substudy to obtain more complete information on the PK profile of PLX9486. Participants received a single dose of 350 mg of PLX9486 10 days prior to the start of repeated QD dosing and plasma concentrations were followed 0.5, 1, 2, 4, 6, and 9 hours postdose, and then once daily for 9 additional days prior to Cycle 1 Day 1.

Part 2e: RP2D of CGT9486 in Combination With Sunitinib
Cycle 1 of Part 2e (Cycle length = 28 days)

RP2D was determined by incidence of DLT using CTCAE version 4.03 for severity grade. DLTs were defined as AEs that occurred during Cycle 1, classified as possibly/probably related to study drug, and met 1 of the following criteria: Hematologic Toxicities: Grade 4 neutropenia for \>7 days, Grade ≥3 neutropenia with fever, Grade 4 thrombocytopenia, Grade ≥3 thrombocytopenia for \>7 days or with bleeding, Grade 4 anemia; Other Toxicities: Any Grade ≥3 (AE or laboratory) toxicity despite adequate supportive care except for the following: Grade ≥3 nausea, vomiting, or diarrhea that resolved to Grade ≤2 within 72 hours; Grade 3 fatigue that resolved to Grade ≤2 within 14 days; Grade ≥3 asymptomatic changes in alkaline phosphatase, hypomagnesemia, hyperglycemia, or hypophosphatemia; Grade 3 increases in transaminases for ≤5 days; Any other Grade ≥3 toxicity for which further dose escalation deemed inappropriate.

Part 2b: RP2D of PLX9486 in Combination With Pexidartinib
Cycle 1 of Part 2 b (Cycle length = 28 days)

RP2D was determined by incidence of DLT using CTCAE version 4.03 for severity grade. DLTs were defined as AEs that occurred during Cycle 1, classified as possibly/probably related to study drug, and met 1 of the following criteria: Hematologic Toxicities: Grade 4 neutropenia for \>7 days, Grade ≥3 neutropenia with fever, Grade 4 thrombocytopenia, Grade ≥3 thrombocytopenia for \>7 days or with bleeding, Grade 4 anemia; Other Toxicities: Any Grade ≥3 (AE or laboratory) toxicity despite adequate supportive care except for the following: Grade ≥3 nausea, vomiting, or diarrhea that resolved to Grade ≤2 within 72 hours; Grade 3 fatigue that resolved to Grade ≤2 within 14 days; Grade ≥3 asymptomatic changes in alkaline phosphatase, hypomagnesemia, hyperglycemia, or hypophosphatemia; Grade 3 increases in transaminases for ≤5 days; Any other Grade ≥3 toxicity for which further dose escalation deemed inappropriate.

Part 2b: Number of Participants With Any TEAEs and Treatment-Related TEAEs
From the date of first dose of study drug up to 30 days after last dose of study drug (maximum exposure: 868 days)

An AE was any untoward medical occurrence in a participant administered study drug, which did not necessarily have a causal relationship with the treatment. An AE could be any unfavorable and unintended sign (for example, including an abnormal laboratory finding), symptom, or disease temporally associated with the use of the study drug, whether or not it was considered to be study drug related. This included any newly occurring event or previous condition that had increased in severity or frequency since the administration of study drug. A TEAE was an AE that started or worsened in severity on or after the date of the initial dose of study drug. Treatment-related TEAEs included all events reported as "possibly related" or "probably related" to any of study treatment. A summary of serious and all other non-serious adverse events regardless of causality is located in the Reported Adverse Events module.

Part 2e: Number of Participants With Any TEAEs and Treatment-Related TEAEs
From the date of first dose of study drug up to 30 days after last dose of study drug (maximum exposure: 825 days)

An AE was any untoward medical occurrence in a participant administered study drug, which did not necessarily have a causal relationship with the treatment. An AE could be any unfavorable and unintended sign (for example, including an abnormal laboratory finding), symptom, or disease temporally associated with the use of the study drug, whether or not it was considered to be study drug related. This included any newly occurring event or previous condition that had increased in severity or frequency since the administration of study drug. A TEAE was an AE that started or worsened in severity on or after the date of the initial dose of study drug. Treatment-related TEAEs included all events reported as "possibly related" or "probably related" to any of study treatment. A summary of serious and all other non-serious adverse events regardless of causality is located in the Reported Adverse Events module.

Secondary Endpoints

All Study Parts - observing the safety of each treatment regimen.
Approximately 48 months
Part 1a, Part 1b, Part 2 - Overall Survival (OS)
Approximately 48 months
Part 1a, Part 1b, Part 2 - Objective Response Rate (ORR)
Approximately 48 months
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Study Design & Arms

AllocationRANDOMIZED
MaskingNONE
ModelPARALLEL
PurposeTREATMENT

Treatment Arms

ArmTypeDescription
Part 1aEXPERIMENTALCGT9486 plus sunitinib 37.5 mg QD
Part 2 - Experimental GroupEXPERIMENTALCGT9486 plus sunitinib 37.5 mg QD
Part 2 - Control GroupACTIVE_COMPARATORsunitinib 37.5 mg QD
Part 1b - DDI Cohort 1EXPERIMENTALCGT9486 plus sunitinib 37.5 mg QD
Part 1b - DDI Cohort 2EXPERIMENTALsunitinib 37.5 mg QD plus CGT9486
DDI Substudy (Midazolam)EXPERIMENTALMidazolam, CGT9486, sunitinib
GIST 1L SubstudyEXPERIMENTALCGT9486, sunitinib
bezuclastinib in combination with sunitinibEXPERIMENTALBezuclastinib 600 mg (tablet) administered orally daily Sunitinib 37.5 mg administered orally daily Patients will begin bezuclastinib and add sunitinib 2 weeks later. Each cycle is 28 days.
(Part 1a) Bezuclastinib Dose 1 + BSCEXPERIMENTAL -
(Part 1a) Bezuclastinib Dose 2 + BSCEXPERIMENTAL -
(Part 1a) Placebo + BSCPLACEBO_COMPARATOR -
(Part 1b) Bezuclastinib Dose 1 + BSCEXPERIMENTAL -
(Part 1b) Bezuclastinib Dose 2 + BSCEXPERIMENTAL -
(Part 1b) Placebo + BSCPLACEBO_COMPARATOR -
(Part 2) Bezuclastinib Selected Dose + BSCEXPERIMENTAL -
(Part 2) Placebo + BSCPLACEBO_COMPARATOR -
(Part 3) Bezuclastinib + BSCEXPERIMENTAL -
(Prior Therapy Sub-study) BezuclastinibEXPERIMENTAL -
bezuclastinibEXPERIMENTAL -
Part 1: CGT9486 250 mg QDEXPERIMENTALParticipants will receive CGT9486 250 milligrams (mg) orally once daily (QD) in 28-day dosing cycles. Treatment will continue until participant discontinuation, withdrawal, or study termination.
Part 1: CGT9486 350 mg QDEXPERIMENTALParticipants will receive CGT9486 350 mg orally QD in 28-day dosing cycles. Treatment will continue until participant discontinuation, withdrawal, or study termination.
Part 1: CGT9486 500 mg QDEXPERIMENTALParticipants will receive CGT9486 500 mg orally QD in 28-day dosing cycles. Treatment will continue until participant discontinuation, withdrawal, or study termination.
Part 1: CGT9486 1000 mg QDEXPERIMENTALParticipants will receive CGT9486 1000 mg orally QD in 28-day dosing cycles. Treatment will continue until participant discontinuation, withdrawal, or study termination.
Part 1: CGT9486 500 mg BIDEXPERIMENTALParticipants will receive CGT9486 500 mg orally twice daily (BID) in 28-day dosing cycles. Treatment will continue until participant discontinuation, withdrawal, or study termination.
Part 2b: CGT9486 500 mg QD + Pexidartinib 600 mg (Fasting)EXPERIMENTALParticipants in fasting condition will receive CGT9486 500 mg orally QD in combination with pexidartinib 600 mg (administered as 1 capsule of 200 mg in the morning and 2 capsules of 200 mg in the evening) orally in 28-day dosing cycles. Treatment will continue until participant discontinuation, withdrawal, or study termination.
Part 2b: CGT9486 500 mg QD + Pexidartinib 600 mg (Non-Fasting)EXPERIMENTALParticipants in non-fasting condition will receive CGT9486 500 mg orally QD in combination with pexidartinib 600 mg (administered as 1 capsule of 200 mg in the morning and 2 capsules of 200 mg in the evening) orally in 28-day dosing cycles. Treatment will continue until participant discontinuation, withdrawal, or study termination.
Part 2e: CGT9486 500 mg QD + Sunitinib 25 mgEXPERIMENTALParticipants will receive CGT9486 500 mg orally QD in combination with sunitinib 25 mg orally in 28-day dosing cycles. Treatment will continue until participant discontinuation, withdrawal, or study termination.
Part 2e: CGT9486 1000 mg QD + Sunitinib 25 mgEXPERIMENTALParticipants will receive CGT9486 1000 mg orally QD in combination with sunitinib 25 mg orally in 28-day dosing cycles. Treatment will continue until participant discontinuation, withdrawal, or study termination.
Part 2e: CGT9486 1000 mg QD + Sunitinib 37.5 mgEXPERIMENTALParticipants will receive CGT9486 1000 mg orally QD in combination with sunitinib 37.5 mg orally in 28-day dosing cycles. Treatment will continue until participant discontinuation, withdrawal, or study termination.

Interventions

NameTypeDescription
CGT9486DRUGParticipants will receive CGT9486 orally until study stopping rules are met.
SunitinibDRUGParticipants will receive sunitinib until steady state then both sunitinib and CGT9486 orally until study stopping rules are met.
MidazolamDRUGParticipants will receive a single-dose of midazolam on Day 1 and Day 16
Bezuclastinib in combination with sunitinibDRUGBezuclastinib in combination with sunitinib (sutent)
Bezuclastinib Tablets (Formulation A)DRUGBezuclastinib will be administered orally, once daily continuously for 28-day cycles
Bezuclastinib Tablets (Formulation B)DRUGBezuclastinib will be administered orally, once daily continuously for 28-day cycles
Placebo TabletsDRUGPlacebo will be administered orally, once daily continuously for 28-day cycles
bezuclastinibDRUGBezuclastinib is administered as tablets to be taken orally, continuously in 28-day cycles.
PexidartinibDRUGPexidartinib capsules will be administered per dose and schedule specified in the arm.
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Eligibility Criteria

Age Range18 Years to N/A
SexALL
Healthy VolunteersNo
Study Sites126

Key Inclusion Criteria: 1. Histologically confirmed locally advanced, metastatic, and/or unresectable GIST. Molecular pathology report must be available for Part 2; if molecular pathology report is unavailable or inadequate, an archival or fresh tumor tissue sample will be required to evaluate muta...

Countries:United StatesArgentinaAustraliaBrazilCanadaChileCzechiaDenmarkFranceGermanyHong KongHungaryItalyMexicoNetherlandsNorwayPolandSouth KoreaSpainSwedenTaiwanUnited KingdomBelgiumIrelandSwitzerlandAustria
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Recent Changes (Last 90 Days)

LOWSep 16, 2026NCT04996875lastUpdatePostDate: changed
LOWSep 16, 2026NCT04996875lastUpdatePostDate: changed
LOWSep 16, 2026NCT04996875lastUpdatePostDate: changed
LOWSep 16, 2026NCT04996875lastUpdatePostDate: changed
LOWJul 31, 2026NCT04996875lastUpdatePostDate: changed
LOWJul 31, 2026NCT04996875lastUpdatePostDate: changed

Frequently asked questions about Bezuclastinib

What is bezuclastinib?

Bezuclastinib is an investigational small molecule kinase inhibitor being developed by Cogent Biosciences, Inc. for gastrointestinal stromal tumors and systemic mastocytosis. It is in Phase 3 clinical development and has received FDA Breakthrough Therapy and Priority Review designations. It is also known as CGT9486.

What is bezuclastinib used for?

Bezuclastinib is being studied for advanced gastrointestinal stromal tumors (GIST) and for systemic mastocytosis, including advanced systemic mastocytosis (AdvSM), smoldering systemic mastocytosis (SSM), and indolent systemic mastocytosis. It is investigational and has not been approved for any indication.

What does bezuclastinib target?

Bezuclastinib targets KIT, a receptor tyrosine kinase. It belongs to the -tinib class of kinase inhibitors. By inhibiting KIT, bezuclastinib is designed to address the driver mutations that fuel gastrointestinal stromal tumors and the mast cell proliferation seen in systemic mastocytosis.

Who makes bezuclastinib?

Bezuclastinib is developed by Cogent Biosciences, Inc., which trades on the Nasdaq under the ticker COGT. The company is running the clinical program across gastrointestinal stromal tumors and systemic mastocytosis, including combination studies with sunitinib.

What phase is bezuclastinib in?

Bezuclastinib is in Phase 3 clinical development. The pivotal Peak trial, NCT05208047, is a Phase 3 randomized study of bezuclastinib plus sunitinib versus sunitinib in advanced gastrointestinal stromal tumors. The drug is investigational and has not been approved by the FDA.

What clinical trials is bezuclastinib in?

Bezuclastinib is being evaluated in several trials. NCT05208047 (Peak) is a Phase 3 study in advanced GIST. NCT06208748 (SARC044) is a Phase 2 trial in GIST. NCT05186753 (Summit) is a Phase 2 study in indolent or smoldering systemic mastocytosis, and NCT04996875 (Apex) is a Phase 2 study in advanced systemic mastocytosis.

Is bezuclastinib the same as CGT9486?

Yes, bezuclastinib is also known as CGT9486. The name bezuclastinib tablets (Formulation A) refers to an oral formulation, and bezuclastinib in combination with sunitinib refers to the regimen under study in gastrointestinal stromal tumors. All refer to the same investigational drug.