Idelalisib

1 引言 激酶是一类能够将三磷酸腺苷(adenosine triphosphate, ATP)末端的磷酸基团转移至特定蛋白质或脂质等底物的酶[1]. 激酶介导的磷酸化修饰会导致底物构象变化, 从而影响底物的亚细胞定位、催化活性以及与其他分子的结合能力, 在调控细胞生长、增殖、分化、迁移和凋亡等过程中发挥着关键作用[2]. 激酶包含一个高度保守的ATP结合域, 由一个铰链多肽连接的β-折叠结构域和α-螺旋结构域组成, 是激酶发挥催化活性的中心(图1). 自1956年被Edmond H. Fischer和Edwin G. Krebs发现以来[3,4], 激酶研究迅速发展. 激酶已成为真核生物中第四大基因家族(占比2%), 仅次于C2H2锌指蛋白(3%)、G蛋白偶联受体(G protein-coupled receptors, GPCRs, 2.8%)和主要组织相容性复合体(major histocompatibility complex, MHC)蛋白家族(2.8%)[5]. 人类基因组中约有518种激酶, 包括478种蛋白激酶和40种脂质激酶等, 其功能异常已被证实与癌症、代谢性疾病、神经退行性疾病、免疫性疾病及感染性疾病等多种人类疾病密切相关[6]. 然而, 由于细胞内高浓度ATP的存在、对激酶活性调控机制的认知不足, 以及ATP结合口袋的高度保守性, 靶向ATP结合位点的激酶药物研发最初被视为不可逾越的挑战[7]. 尽管早在1995年, 首个激酶抑制剂法舒地尔(Fasudil)在日本获批上市用于治疗脑血管痉挛, 以及随后在1999年, 西罗莫司(Sirolimus)成为首个在美国获批上市的激酶抑制剂, 但这两种药物的作用靶点(Rho相关激酶(Rho-associated kinase, ROCK)和哺乳动物雷帕霉素靶蛋白(mammalian target of rapamycin, mTOR))均是后期深入的机制研究发现的[8]. 直到2001年, 伊马替尼(Imatinib)获批上市, 成为首个通过靶向特定蛋白激酶(BCR-ABL)开发并获批用于疾病治疗的药物, 其显著的临床疗效成为肿瘤分子靶向治疗领域研究热潮的催化[8]. 到2025年5月31日止, 美国食品药品监督管理局(U.S. Food and Drug Administration, FDA)批准了14种激酶大分子药物和96种激酶小分子药物(图2)[2,8~10]. 其中, 激酶小分子抑制剂最多, 本文采用Roskoski提出的激酶抑制剂分类标准[11], 具体如下. I型抑制剂: 结合于活性激酶的ATP结合口袋; I1/2型与II型抑制剂: 均结合于非活性激酶的ATP结合口袋, 其区别在于非活性构象中DFG基序的取向——I1/2型为“DFG-in”构象, II型为“DFG-out”构象; III型与IV型抑制剂: 指变构抑制剂(非ATP竞争性), 其中III型结合位点毗邻ATP结合位点, IV型则远离该位点; 共价抑制剂: 通过不可逆结合发挥作用, 在此分类体系中单独归类. 本文将归纳总结FDA上市药物的作用靶标、作用模式以及适应证, 并分析探讨了目前激酶药物的研发现状和未来机遇.. 2 FDA批准的激酶药物2.1 FDA批准的小分子激酶药物 1999年, 辉瑞公司的西罗莫司(Sirolimus)获批上市(图3), 用于预防肾移植患者的器官排斥反应. 该药物是一种含有大环内酯结构的天然产物, 是一类变构激酶抑制剂, 通过诱导亲环蛋白FK506结合蛋白12 (FK506-binding protein 12, FKBP12)和mTOR激酶形成复合物, 抑制mTOR的激酶活性及其信号通路从而发挥免疫抑制活性[12,13]. 2001年, 诺华公司的伊马替尼(Imatinib)获批上市, 用于治疗费城染色体阳性的慢性髓性白血病. 该药物是II型ATP竞争性的一代BCR-ABL激酶抑制剂, 通过稳定BCR-ABL的非活性构象抑制其激酶活性发挥从而抑制肿瘤细胞增殖. 该药物也因对KIT激酶的良好抑制活性于2002年获批用于治疗胃肠道间质瘤[12,14,15]. 2003年, 阿斯利康公司的吉非替尼(Gefitinib)获批上市, 用于治疗携带表皮生长因子受体(epidermal growth factor receptor, EGFR) 19号外显子缺失(EGFRDel19)或21号外显子替换突变(EGFRL858R)等激活性突变的非小细胞肺癌. 该药物是I型ATP竞争性的一代EGFR激酶抑制剂, 通过结合活性构象的EGFR抑制其激酶活性发挥从而抑制肿瘤细胞增殖[12,16]. 2004年, 罗氏公司的厄洛替尼(Erlotinib)获批上市, 用于治疗携带EGFRDel19或EGFRL858R等激活性突变的非小细胞肺癌. 该药物属于一代EGFR激酶抑制剂, 既可作为I型ATP竞争性激酶抑制剂结合活性构象的EGFR, 也能以I1/2型结合非活性构象的EGFR来抑制EGFR的激酶活性[12,17,18]. 2005年, 拜耳公司的索拉非尼(Sorafenib)获批上市, 用于治疗肾细胞癌. 该药物是II型ATP竞争性的BRAF激酶抑制剂, 能同时抑制野生型BRAF及其突变体V600E和RAF1等. 该药物还分别于2007年和2013年获批用于治疗肝细胞癌和甲状腺癌[12,19]. 2006年, FDA批准了2款激酶药物, 包括百时美施贵宝公司的达沙替尼(Dasatinib)和辉瑞公司的舒尼替尼(Sunitinib)[12]. 达沙替尼是I型ATP竞争性的二代BCR-ABL激酶抑制剂, 用于治疗对伊马替尼产生耐药的慢性髓性白血病, 对除T315I外的BCR-ABL突变体有良好的抑制效果[20]. 舒尼替尼是I1/2型ATP竞争性的周期蛋白依赖激酶2 (cyclin-dependent kinase 2, CDK2)激酶抑制剂, 同时对KIT、血管内皮细胞生长因子受体2 (vascular endothelial growth factor receptor 2, VEGFR2)和FMS样酪氨酸激酶3 (Fms-like tyrosine kinase, FLT3)等激酶具有良好的抑制活性, 用于治疗对伊马替尼耐药的胃肠道间质瘤和肾细胞癌[14,21]. 2007年, FDA批准了3款激酶药物, 包括葛兰素史克公司的拉帕替尼(Lapatinib)、诺华公司的尼洛替尼(Nilotinib)和辉瑞公司的替西罗莫司(Temsirolimus)[12]. 拉帕替尼是I1/2型ATP竞争性的EGFR和人表皮生长因子受体2 (human epidermal growth factor receptor 2, HER2)等激酶抑制剂, 用于治疗HER2阳性的乳腺癌[14,22]. 尼洛替尼是II型ATP竞争性的二代BCR-ABL激酶抑制剂, 用于治疗对伊马替尼产生耐药的慢性髓性白血病, 对除T315I外的BCR-ABL突变体有良好的抑制效果[23,24]. 替西罗莫司是一种大环内酯类药物, 是西罗莫司的酯类似物, 同样靶向mTOR激酶, 用于静脉注射治疗肾细胞癌[25]. 2009年, FDA批准了2款激酶药物, 包括诺华公司的依维莫司(Everolimus)和葛兰素史克公司的帕唑帕尼(Pazopanib)[12]. 依维莫司是一种大环内酯类药物, 是西罗莫司的类似物, 同样靶向mTOR激酶, 用于预防移植器官排斥反应以及治疗舒尼替尼或索拉非尼耐药的肾细胞癌[26]. 帕唑帕尼是II型ATP竞争性的泛VEGFR激酶抑制剂, 用于治疗肾细胞癌. 该药物于2012年被获批用于治疗软组织肉瘤[27]. 2011年, FDA批准了4款激酶药物, 包括辉瑞公司的克唑替尼(Crizotinib)、Incyte公司的鲁索利替尼(Ruxolitinib)、阿斯利康公司的凡德他尼(Vandetanib)和罗氏公司的维莫非尼(Vemurafenib)[12]. 克唑替尼是I1/2型ATP竞争性的间变性淋巴瘤激酶(anaplastic lymphoma kinase, ALK)、ROS1和间质表皮转化因子(mesenchymal to epithelial transition factor, MET)等激酶抑制剂, 用于治疗ALK阳性或ROS1阳性的非小细胞肺癌[25,28]. 鲁索利替尼是I型ATP竞争性的JAK1和JAK2等激酶抑制剂, 是首个获批用于治疗骨髓纤维化的药物[29,30]. 凡德他尼是I型ATP竞争性的RET、VEGFR和EGFR等激酶抑制剂, 用于治疗甲状腺癌[31,32]. 维莫非尼是I1/2型ATP竞争性的BRAF激酶抑制剂(对BRAFV600E活性更优), 用于治疗携带BRAFV600E突变的黑色素瘤, 是首个针对致癌性BRAF的抑制剂[14,33]. 2012年, FDA批准了6款激酶药物, 包括辉瑞公司的阿昔替尼(Axitinib)、博舒替尼(Bosutinib)、托法替尼(Tofacitinib)、Exelixis公司的卡博替尼(Cabozantinib)、武田公司的普纳替尼(Ponatinib)和拜耳公司的瑞戈非尼(Regorafenib)[12]. 阿昔替尼是II型ATP竞争性的VEGFR激酶抑制剂, 用于治疗肾细胞癌[14,34]. 博舒替尼是I型ATP竞争性的二代BCR-ABL激酶抑制剂, 用于治疗费城染色体阳性的慢性髓性白血病[23,35]. 托法替尼是I型ATP竞争性的泛JAK激酶抑制剂, 用于治疗类风湿关节炎、银屑病关节炎和溃疡性结肠炎[36,37]. 卡博替尼是MET、VEGFR2和RET等激酶抑制剂, 用于治疗甲状腺髓样癌和索拉非尼耐药的肾细胞癌和肝细胞癌[38]. 普纳替尼是II型ATP竞争性的第三代BCR-ABL抑制剂, 用于治疗携带BCR-ABLT315I突变的慢性髓性白血病[39]. 瑞戈非尼是II型ATP竞争性的VEGFR、血小板衍生生长因子受体(platelet-derived growth factor receptor, PDGFR)、成纤维细胞生长因子受体(fibroblast growth factor receptor, FGFR)、BRAF、TIE2、RAF1、KIT和RET等激酶抑制剂, 用于治疗结直肠癌、胃肠道间质瘤和肾细胞癌[40]. 2013年, FDA批准了4款激酶药物, 包括勃林格殷格翰公司的阿法替尼(Afatinib)、葛兰素史克公司的达拉非尼(Dabrafenib)、曲美替尼(Trametinib)和强生公司的伊布替尼(Ibrutinib)[12] (图4). 阿法替尼是二代EGFR激酶抑制剂, 也是首个与ATP结合口袋的Cys797形成共价键的共价EGFR抑制剂, 用于治疗携带EGFRDel19或EGFRL858R等激活性突变的非小细胞肺癌[41]. 达拉非尼是I1/2型ATP竞争性的BRAF激酶抑制剂, 用于治疗携带BRAFV600E的黑色素瘤[42,43]. 曲美替尼是III型MEK1/2变构激酶抑制剂, 用于治疗携带BRAFV600E或BRAFV600K的黑色素瘤[44,45]. 伊布替尼是共价布鲁顿酪氨酸激酶(Bruton’s tyrosine kinase, BTK)激酶抑制剂, 用于治疗套细胞淋巴瘤、慢性淋巴细胞白血病、华氏巨球蛋白血症、慢性移植物抗宿主病和边缘区淋巴瘤[46,47].. 2014年, FDA批准了3款激酶药物, 包括诺华公司的色瑞替尼(Ceritinib)、吉利德公司的艾代拉利司(Idelalisib)和勃林格殷格翰公司的尼达尼布(Nintedanib)[12]. 色瑞替尼是I1/2型ATP竞争性的二代ALK抑制剂, 用于治疗ALK阳性的非小细胞肺癌, 对克唑替尼耐药患者有效[25,48]. 艾代拉利司是I型ATP竞争性的磷脂酰肌醇3-激酶δ (phosphoinositide 3-kinase δ, PI3Kδ)抑制剂, 也是首个上市的PI3K选择性抑制剂, 联合利妥昔单抗治疗慢性淋巴细胞白血病以及治疗B细胞非霍奇金淋巴瘤和小淋巴细胞性淋巴瘤[49,50]. 尼达尼布是II型ATP竞争性的泛VEGFR激酶抑制剂, 用于治疗特发性肺纤维化[14,51]. 2015年, FDA批准了5款激酶药物, 包括罗氏公司的阿来替尼(Alectinib)、考比替尼(Cobimetinib)、卫材公司的仑伐替尼(Lenvatinib)、阿斯利康公司的奥希替尼(Osimertinib)和辉瑞公司的哌柏西利(Palbociclib)[12]. 阿来替尼是I1/2型ATP竞争性的ALK和RET等激酶抑制剂, 也是二代ALK抑制剂, 用于治疗对克唑替尼耐药的ALK阳性的非小细胞肺癌[52]. 考比替尼是III型的MEK1/2变构激酶抑制剂, 该药联合维莫非尼用于治疗携带BRAFV600E或BRAFV600K的黑色素瘤[53]. 仑伐替尼是I1/2型ATP竞争性的VEGFR、RET、PDGFR和KIT等激酶抑制剂, 用于治疗甲状腺癌、肝细胞癌和肾细胞癌[54]. 奥希替尼是三代共价EGFR抑制剂, 用于治疗携带EGFRT790M突变的非小细胞肺癌[55]. 哌柏西利是I型ATP竞争性CDK4和CDK6等激酶抑制剂, 与来曲唑联用治疗激素受体阳性和HER2阴性乳腺癌[56]. 2017年, FDA批准了8款激酶药物, 包括礼来公司的阿贝西利(Abemaciclib)、阿斯利康公司的阿卡替尼(Acalabrutinib)、武田公司的布加替尼(Brigatinib)、拜耳公司的可泮利塞(Copanlisib)、诺华公司的米哚妥林(Midostaurin)、瑞波西利(Ribociclib)、辉瑞公司的来那替尼(Neratinib)和Aerie公司的奈舒地尔(Netarsudil)[12]. 阿贝西利是I型ATP竞争性的 CDK4和CDK6等激酶抑制剂, 联合芳香化酶抑制剂或氟维司群治疗激素受体阳性和HER2阴性的乳腺癌[56]. 阿卡替尼是共价BTK激酶抑制剂, 用于治疗套细胞淋巴瘤、慢性淋巴细胞白血病和小淋巴细胞性淋巴瘤[57]. 布加替尼是I型ATP竞争性的ALK激酶抑制剂, 用于治疗对克唑替尼耐药的ALK阳性的非小细胞肺癌[58]. 可泮利塞是I型ATP竞争性的泛PI3K激酶抑制剂, 用于治疗滤泡性淋巴瘤[59]. 米哚妥林是I型ATP竞争性的蛋白激酶C (protein kinase C, PKC)、FLT3和KIT等激酶抑制剂, 用于治疗FLT3突变的急性髓细胞性白血病、侵袭性系统性肥大细胞增多症、系统性肥大细胞增多症. 伴相关血液系统肿瘤和肥大细胞白血病[60]. 瑞波西利是I1/2型ATP竞争性的CDK4和CDK6等激酶抑制剂, 联合芳香化酶抑制剂治疗激素受体阳性和HER2阴性的乳腺癌[11]. 来那替尼是共价HER2和EGFR等激酶抑制剂, 用于治疗HER2阳性的乳腺癌[16]. 奈舒地尔是ATP竞争性的ROCK激酶抑制剂, 作为滴眼液用于治疗开角型青光眼或高眼压症[61]. 2018年, FDA批准了9款激酶药物, 包括礼来公司的巴瑞替尼(Baricitinib)、辉瑞公司的比美替尼(Binimetinib)、达可替尼(Dacomitinib)、康奈非尼(Encorafenib)、洛拉替尼(Lorlatinib)、Secura公司的度维利塞(Duvelisib)、Rigel公司的福坦替尼(Fostamatinib)、安斯泰来公司的吉瑞替尼(Gilteritinib)和拜耳公司的拉罗替尼(Larotrectinib)[12] (图5). 巴瑞替尼是I型ATP竞争性的Janus激酶1 (Janus kinase 1, JAK1)和JAK2等激酶抑制剂, 用于治疗类风湿性关节炎[30]. 比美替尼是III型的MEK1/2变构激酶抑制剂, 联合康奈非尼治疗携带BRAFV600E或BRAFV600K的黑色素瘤或非小细胞肺癌[25]. 达可替尼是二代共价EGFR激酶抑制剂, 用于治疗携带EGFRDel19或EGFRL858R等激活性突变的非小细胞肺癌[62]. 康奈非尼是BRAFV600E/K激酶抑制剂, 联合比美替尼治疗携带BRAFV600E或BRAFV600K的黑色素瘤或非小细胞肺癌, 以及联合西妥昔单抗治疗携带BRAFV600E的结直肠癌[42]. 洛拉替尼是I型大环类ALK和ROS1等激酶抑制剂, 用于治疗ALK阳性的非小细胞肺癌[63]. 度维利塞是I型ATP竞争性的PI3Kδ和PI3Kγ等激酶抑制剂, 用于治疗慢性淋巴细胞白血病、小淋巴细胞性淋巴瘤和滤泡性淋巴瘤[64]. 福坦替尼是I型ATP竞争性的脾酪氨酸激酶(spleen tyrosine kinase, Syk)抑制剂的口服前药, 用于治疗慢性免疫性血小板减少症[65]. 吉瑞替尼是II型ATP竞争性的FLT3和AXL等激酶抑制剂, 用于治疗携带FLT3致癌突变的急性髓系白血病[66]. 拉罗替尼是原肌球蛋白受体激酶A/B/C (tropomyosin receptor kinase A/B/C, TRKA/B/C)等激酶抑制剂, 是首个获得美国FDA“组织不确定”突破性疗法认定的小分子药物, 用于治疗神经营养性酪氨酸受体激酶(neurotrophic tyrosine receptor kinase, NTRK)基因融合的实体瘤[25]. 2019年, FDA批准了7款激酶药物, 包括诺华公司的阿培利司(Alpelisib)、罗氏公司的恩曲替尼(Entrectinib)、强生公司的厄达替尼(Erdafitinib)、赛诺菲公司的菲卓替尼(Fedratinib)、第一三共公司的培西达替尼(Pexidartinib)、艾伯维公司的乌帕替尼(Upadacitinib)和百济神州公司的泽布替尼(Zanubrutinib)[12]. 阿培利司是I型ATP竞争性的PI3Kα激酶抑制剂, 联合氟维司群治疗激素受体阳性、HER2阴性和携带PIK3CA突变的乳腺癌[67]. 恩曲替尼是I1/2型ATP竞争性的TRKA/B/C、ROS1和ALK等激酶抑制剂, 用于治疗携带NTRK基因融合的实体瘤和ROS1阳性的非小细胞肺癌[68]. 厄达替尼是I1/2型ATP竞争性的泛FGFR激酶抑制剂, 用于治疗携带FGFR基因改变的尿路上皮癌[69]. 菲卓替尼是I型ATP竞争性的JAK2激酶抑制剂, 用于治疗骨髓纤维化[30]. 培西达替尼是II型ATP竞争性的集落刺激因子1受体(colony stimulating factor 1 receptor, CSF1R)激酶抑制剂, 用于治疗腱鞘巨细胞瘤[70]. 乌帕替尼是I型ATP竞争性的JAK1抑制剂, 用于治疗类风湿关节炎、银屑病和特应性皮炎[71]. 泽布替尼是共价BTK激酶抑制剂, 选择性优于伊布替尼, 用于治疗套细胞淋巴瘤[72]. 2020年, FDA批准了8款激酶药物, 包括Blueprint Medicines公司的阿伐替尼(Avapritinib)、普拉替尼(Pralsetinib)、诺华公司的卡马替尼(Capmatinib)、Incyte公司的佩米替尼(Pemigatinib)、Deciphera公司的瑞派替尼(Ripretinib)、礼来公司的塞普替尼(Selpercatinib)、阿斯利康公司的司美替尼(Selumetinib)和辉瑞公司的妥卡替尼(Tucatinib)[12]. 阿伐替尼是I型ATP竞争性的KIT和PDGFRA等激酶抑制剂, 用于治疗携带PDGFRA外显子18突变的胃肠道间质瘤[73]. 普拉替尼是I型ATP竞争性的RET激酶抑制剂, 治疗RET融合的非小细胞肺癌、RET突变的甲状腺髓样癌或RET融合的甲状腺癌[74]. 卡马替尼是ATP竞争性的MET激酶抑制剂, 用于治疗携带MET基因14号外显子跳跃突变的非小细胞肺癌[75]. 佩米替尼是ATP竞争性的泛FGFR激酶抑制剂, 用于治疗FGFR2融合或其他重排的胆管癌[76]. 瑞派替尼是II型ATP竞争性的KIT和PDGFR等激酶抑制剂, 用于治疗胃肠道间质瘤[77]. 塞普替尼是I型ATP竞争性的RET激酶抑制剂, 用于治疗RET融合的非小细胞肺癌、RET突变的甲状腺髓样癌或RET融合的甲状腺癌[74]. 司美替尼是III型的MEK1变构激酶抑制剂, 用于治疗神经纤维瘤[78]. 妥卡替尼是ATP竞争性的HER2激酶抑制剂, 联合曲妥珠单抗和卡培他滨治疗HER2阳性乳腺癌[79]. 2021年, FDA批准了8款激酶药物, 包括默克公司的特泊替尼(Tepotinib)、TG Therapeutics公司的厄布利塞(Umbralisib)、G1 Therapeutics公司的曲拉西利(Trilaciclib)、诺华公司的英菲格拉替尼(Infigratinib)、赛诺菲公司的贝舒地尔(Belumosudil)武田公司的莫博替尼(Mobocertinib)、Aveo公司的替沃扎尼(Tivozanib)和诺华公司的阿西米尼(Asciminib)[12] (图6). 特泊替尼是I型ATP竞争性的MET激酶抑制剂, 用于治疗携带MET外显子14跳跃突变的非小细胞肺癌[80]. 厄布利塞是PI3Kδ和酪蛋白激酶1ε (casein kinase 1ε, CK1ε)双靶抑制剂, 用于治疗边缘区淋巴瘤或滤泡性淋巴瘤[81]. 曲拉西利是静脉给药的CDK4/6激酶抑制剂, 是首款骨髓保护疗法, 用于减少广泛期小细胞肺癌患者接受大剂量化疗所导致骨髓抑制频率[82]. 英菲格拉替尼是ATP竞争性的泛FGFR激酶抑制剂, 用于治疗携带FGFR2融合或其他重排的胆管癌[83]. 贝舒地尔是ROCK2激酶抑制剂, 用于治疗慢性移植物抗宿主病[84]. 莫博替尼是EGFR外显子20激活突变体抑制剂, 是首个用于治疗携带EGFR外显子20激活突变的非小细胞肺癌[85]. 替沃扎尼是II型ATP竞争性的泛VEGFR激酶抑制剂, 用于治疗肾细胞癌[34]. 阿西米尼是IV型的BCR-ABL变构激酶抑制剂, 通过结合BCR-ABL融合蛋白特有的肉豆蔻酰口袋来发挥作用, 用于携带BCR-ABLT315I的慢性髓性白血病[86]. 2022年, FDA批准了5款激酶药物, 包括辉瑞公司的阿布昔替尼(Abrocitinib)、百时美施贵宝公司的氘可来昔替尼(Deucravacitinib)、Tiaho公司的福巴替尼(Futibatinib)、Sobi公司的帕克替尼(Pacritinib)和Agios公司的米他匹伐(Mitapivat)[12]. 阿布昔替尼是I型ATP竞争性的JAK1激酶抑制剂, 是首个用于治疗特应性皮炎的激酶抑制剂[87]. 氘可来昔替尼是IV型的TYK2变构激酶抑制剂, 通过结合TYK2的假激酶口袋发挥作用, 用于治疗银屑病, 是首个结构中包含氘原子的激酶抑制剂[88]. 福巴替尼是共价泛FGFR激酶抑制剂, 用于治疗FGFR2融合的肝内胆管癌[89]. 帕克替尼是I型ATP竞争性的选择性JAK2激酶抑制剂, 用于治疗骨髓纤维化[90]. 米他匹伐是丙酮酸激酶(pyruvate kinase, PK)变构激活剂, 用于治疗溶血性贫血[91]. 2023年, FDA批准了8款激酶药物, 包括阿斯利康公司的卡匹色替(Capivasertib)、和记黄埔的呋喹替尼(Fruquintinib)、葛兰素史克公司的莫洛替尼(Momelotinib)、礼来公司的吡托布鲁替尼(Pirtobrutinib)、第一三共公司的奎扎替尼(Quizartinib)、百时美施贵宝公司的瑞普替尼(Repotrectinib)、辉瑞公司的利特昔替尼(Ritlecitinib)和Pharming公司的莱尼奥利西布(Leniolisib)[12]. 卡匹色替是I型ATP竞争性的AKT激酶抑制剂, 用于治疗激素受体阳性和HER2阴性的乳腺癌[92]. 呋喹替尼是ATP竞争性的VFGFR2激酶抑制剂, 用于治疗结直肠癌[93]. 莫洛替尼是I型ATP竞争性的JAK1/2激酶抑制剂, 用于治疗骨髓纤维化[90]. 吡托布鲁替尼是I1/2型ATP竞争性的BTK激酶抑制剂, 用于治疗套细胞淋巴瘤、慢性淋巴细胞白血病和小淋巴细胞淋巴瘤[94]. 奎扎替尼是II型ATP竞争性的FLT3激酶抑制剂, 用于治疗FLT3内部串联重复的急性髓性白血病[95]. 瑞普替尼是I型ATP竞争性的ROS1和TRK双靶激酶抑制剂, 用于治疗ROS1阳性的非小细胞肺癌[96]. 利特昔替尼是I型ATP竞争性的JAK3激酶抑制剂, 用于治疗斑秃[97]. 莱尼奥利西布是ATP竞争性的选择性PI3Kδ激酶抑制剂, 用于治疗PI3Kδ过度活化综合征[98]. 2024年, FDA批准了5款激酶药物, 包括Sun公司的氘代芦可替尼(Deuruxolitinib)、贝达药业的恩沙替尼(Ensartinib)、强生公司的拉泽替尼(Lazertinib)、Day One公司的托沃拉非尼(Tovorafenib)、基因泰克公司的伊那利塞(Inavolisib)[12]. 氘代芦可替尼是ATP竞争性的JAK1/2激酶抑制剂, 用于治疗斑秃[99]. 恩沙替尼是ATP竞争性的ALK激酶抑制剂, 用于治疗ALK阳性的非小细胞肺癌[100]. 拉泽替尼是I1/2型ATP竞争性的三代EGFR激酶抑制剂, 用于治疗携带EGFRDel19或EGFRL858R等激活性突变的非小细胞肺癌患者[101]. 托沃拉非尼是II型ATP竞争性的B-Raf激酶抑制剂, 用于治疗儿童低恶性胶质瘤[102]. 伊那利塞是ATP竞争性的PI3Kα激酶抑制剂, 用于治疗具有PI3Kα基因突变、激素受体阳性(HR+)、HER2阴性、局部晚期或转移性乳腺癌的成年患者[103]. 2025年(截至5月31日), FDA批准了4款激酶药物, 包括SpringWorks公司的米尔德替尼(Mirdametinib)、小野制药的维姆塞替尼(Vimseltinib)和Verastem公司的艾沃美替尼(Avutometinib)、地法替尼(Defactinib)[12]. 米尔德替尼是III型的MEK变构激酶抑制剂, 用于治疗I型神经纤维瘤[45]. 维姆塞替尼是II型ATP竞争性的CSF1R激酶抑制剂, 用于治疗腱鞘巨细胞瘤[104]. 艾沃美替尼通过诱导MEK与RAF形成非活性复合物, 抑制MEK/RAF活性, 用于治疗KRAS突变的低级别浆液性卵巢癌[105]. 地法替尼是I型ATP竞争性的FAK激酶抑制剂, 用于治疗KRAS突变的低级别浆液性卵巢癌[106].2.2 大分子激酶药物(抗体) 1998年, 罗氏公司的曲妥珠单抗(Trastuzumab)获批上市, 用于治疗HER2阳性乳腺癌, 是首个应用于实体肿瘤的人源化单抗. 该药物是抗HER2的单克隆抗体, 通过结合到HER2的胞外结构域IV, 阻止其与其他HER2形成同源二聚体, 从而抑制下游的信号传导路径, 阻止肿瘤细胞的增殖, 以及引发抗体依赖的细胞毒作用[12,107]. 2004年, 默克公司的西妥昔单抗(Cetuximab)获批上市, 用于治疗结肠直肠癌和头颈癌. 该药物是抗EGFR的单克隆抗体, 与EGFR胞外域结合, 阻断其二聚活化, 抑制细胞增殖, 以及引发抗体依赖的细胞毒作用[12,108]. 2006年, 安进公司的帕尼单抗(Panitumumab)获批上市, 用于治疗结直肠癌. 该药物也是抗EGFR的单克隆抗体[12,109]. 2012年, 罗氏公司的帕妥珠单抗(Pertuzumab)获批上市, 用于治疗HER2阳性乳腺癌. 该药物也是抗HER2单克隆抗体, 结合到HER2的胞外结构域II, 阻止HER2与其他EGFR家族受体(HER1、HER3、HER4)形成二聚体, 抑制肿瘤细胞增殖[12,110]. 2013年, 罗氏公司的恩美曲妥珠单抗(Trastuzumab-emtansine)获批上市, 用于治疗HER2阳性乳腺癌. 该药物是由抗HER2靶向药物曲妥珠单抗与抑制微管聚集的化疗药物美坦新通过硫醚连接子连接而成的抗体偶联物(antibody-drug conjugate, ADC)[12,111]. 2014年, 礼来公司的雷莫芦单抗(Ramucirumab)和尼妥珠单抗(Nimotuzumab)获批上市[12]. 雷莫芦单抗是抗VEGFR2单克隆抗体, 结合VEGFR2胞外域的末端, 诱导受体构象的改变, 阻止配体与VEGFR2结合, 从而抑制下游信号传导, 用于治疗胃癌或胃食管交界处癌[112]. 尼妥珠单抗也是一种EGFR单克隆抗体, 用于与放疗联合治疗EGFR阳性的鼻咽癌[113]. 2016年, 礼来公司的奥拉单抗(Olaratumab)获批上市, 用于治疗软组织肉瘤. 该药物是PDGFRα单克隆抗体, 结合人PDGFRα并阻断其与配体PDGFs结合, 抑制下游信号通路[12,114]. 2019年, 第一三共公司的德曲妥珠单抗(Trastuzumab-Deruxtecan)获批上市, 用于治疗HER2阳性的乳腺癌和胃癌. 该药物是一种ADC, 由抗HER2单克隆抗体与DNA拓扑异构酶I抑制剂依沙替康衍生物组成[12,115]. 2020年, MacroGenics公司的马吉妥昔单抗(Margetuximab)获批上市, 用于治疗HER2阳性乳腺癌. 该药物是一种抗HER2的单克隆抗体[12,116]. 2021年, 强生公司的埃万妥单抗(Amivantamab)获批上市, 用于治疗EGFR外显子20插入突变的非小细胞肺癌. 该药物是一种直接针对EGFR和MET的双特异性抗体, 可以与EGFR和MET的胞外域结合, 同时抑制EGFR和MET信号通路[12,117]. 2024年, 百济神州公司的泽尼达妥单抗(Zanidatamab)和Merus公司的泽妥珠单抗(Zenocutuzumab)获批上市[12]. 泽尼达妥单抗是HER2双特异性抗体, 用于治疗HER2阳性胆道癌. 该抗体可同时与HER2上两个不同表位结合, 既可以阻断HER2信号, 也可以促进内化, 导致肿瘤细胞表面受体减少从而抑制肿瘤细胞增长[118]. 泽妥珠单抗是靶向HER2/HER3的双特异性抗体, 用于治疗非小细胞肺癌和胰腺癌. 该药物通过阻止NRG1与HER3结合, 抑制HER2/HER3二聚化并诱导NRG1基因融合肿瘤细胞死亡[119]. 2025年, 艾伯维的特立妥珠单抗(Telisotuzumab)获批上市, 用于治疗c-Met高表达的非鳞状非小细胞肺癌. 该抗体由c-Met靶向抗体、可裂解连接子和单甲基奥瑞他汀E (MMAE)载荷组成的ADC. 针对肿瘤细胞表面的c-Met突变进行追踪, 并释放抗有丝分裂药物MMAE抑制肿瘤细胞增长[12,120]. 3 总结与展望 从1995年第一个激酶抑制剂法舒地尔获批30年以来, FDA共批准了110个激酶药物, 包括96个小分子药物和14个大分子药物. 分析这96个激酶小分子药物, 我们得到如下结论. (1) 在这96种药物中, 除了有95种不同类型的激酶抑制剂, 还包含1个丙酮酸激酶变构激活剂米他匹伐. 尽管目前仅有一款激酶激活剂获批用于疾病治疗, 但这有力证实了激活相关激酶是治疗疾病的可行策略, 拓展了激酶药物研发的空间. (2) 53种药物靶向受体酪氨酸激酶, 22种药物抑制非受体酪氨酸激酶, 14种药物拮抗丝氨酸/苏氨酸激酶, 6种药物靶向双特异性蛋白激酶(MEK1/2), 以及1种药物激动糖酵解过程相关的丙酮酸激酶. 由此可知, 尽管在蛋白激酶中, 大部分为丝氨酸/苏氨酸激酶, 但酪氨酸激酶仍然是大部分激酶药物的作用对象. 这可能是因为酪氨酸激酶的病理作用更明确、致癌驱动突变集中, 如EGFR、ALK、BCR-ABL等酪氨酸激酶的突变或融合是多种癌症的直接驱动因素, 而丝氨酸/苏氨酸激酶更多作为下游信号节点(如mTOR、AKT). 另外, 丝氨酸/苏氨酸激酶(如CDKs、PKC)常参与细胞周期、代谢等基础生命活动, 抑制后易导致广泛毒性. 但随着变构调节、蛋白降解及相关生物学技术的发展, 丝氨酸/苏氨酸激酶抑制剂研究将会得到极大助力. (3) 在被批准上市药物的结合模式中, 以吉非替尼为代表的I型ATP竞争性抑制剂达30种, 其结合特点为嘌呤类核心骨架模拟ATP与铰链区形成氢键作用, α-C螺旋处于活性位置(α-C螺旋上的保守谷氨酸与β3折叠上的保守赖氨酸形成离子键), DFG基序为“in”活性构象. 以伊马替尼为代表的II型ATP竞争性抑制剂有15种, 与I型抑制剂不同的是, 其DFG基序为“out”非活性构象. 该构象往往会产生一个新的疏水口袋, 为高选择性化合物的产生带来新的机会. 除去经典的I型或II型结合模式外, 以舒尼替尼为代表的14种药物呈现I1/2型结合模式, 其结构特征为α-C螺旋处于非活性位置, DFG基序为“in”活性构象. 此外, 上市药物还包括以曲美替尼为代表的5种III型变构抑制剂, 以阿西米尼为代表的2种IV型变构抑制剂和以阿法替尼为代表的11种共价抑制剂. 因此, 我们看到激酶抑制剂的作用模式呈现出丰富的多样性. 特别值得注意的是, 近些年上市的药物中, 以艾沃美替尼为代表, 通过诱导形成新蛋白-蛋白相互作用, 从而抑制激酶活性的小分子药物或将成为激酶药物开发的全新方向. (4) 从化学结构多样性角度分析, 上市激酶药物主要可以分为三类: 以首个激酶抑制剂法舒地尔为代表的六元稠环骨架, 包括喹啉、异喹啉及喹唑啉类, 共计20个; 六元芳环氨基嘧啶、氨基吡啶、氨基哒嗪已成为最常用的ATP模拟物骨架, 以伊马替尼为代表的上市药物共计26个; 第三类骨架为五元并六元稠环骨架, 包括吡咯并嘧啶、嘌呤、氧杂吲哚、吡咯或咪唑三嗪等, 共计23个. 其余抑制剂骨架还包括五元并六元稠环的氨基类似物, 非芳香的羧酰胺结构. 由此可见, 目前激酶抑制剂使用的骨架仍然比较局限. 但随着近些年化学合成特别是手性合成的巨大进步, 具有更加立体特性的新型激酶抑制剂骨架有望得到拓展. (5) 1999~2012年间, 有22个激酶小分子药物获批, 在随后的五年(2013~2018)间, 有29个激酶小分子药物上市, 从2019年之后, 药物获批速度进一步加快, 总计45个激酶小分子药物获批上市, 凸显了激酶药物研发的加速趋势. (6) 在适应证上, 81种激酶抑制剂获批用于治疗实体瘤或者非实体瘤. 其中依维莫司和伊布替尼也被用于预防移植物抗宿主病. 17种药物被用于治疗非肿瘤类疾病. 例如, 托法替尼、尼达尼布、阿布希替尼、氘可来昔替尼等用于治疗类风湿性关节炎、肺纤维化、特应性皮炎、银屑病等免疫性疾病. 这些非肿瘤激酶药物的获批, 证实激酶药物的广泛应用价值, 也为激酶药物的应用空间拓展提供了充分的依据. 相信未来我们将看到激酶药物用于更多其他非肿瘤疾病的治疗. (7) 给药方式上, 93种小分子抑制剂采用口服给药的方式, 只有替西罗莫司与曲拉西利采用静脉注射给药方式, 奈舒地尔由于适应证为眼部疾病, 采用滴眼液给药方式. 因此, 口服因其便捷性仍然是激酶药物优选服药方式. 值得一提的是, 截至2025年5月31, 中国国家药品监督管理局(National Medical Products Administration, NMPA)批准上市的国产原研激酶药物也达40个(表1), 包括我们团队研发的奥雷巴替尼和利厄替尼. 在临床肿瘤治疗中, 激酶靶点的选择大致遵循两种策略: 首先, 重点关注已获批激酶抑制剂靶点突变耐药的患者, 开发对突变型激酶具有良好活性的下一代药物. 其次, 针对全新致病激酶靶点, 开发全新的激酶抑制剂. 我国在对现有靶点的下一代药物开发中取得了重要进展, 以奥雷巴替尼为例, 该药物对携带BCR-ABLT315I突变的慢性髓性白血病患者显示出了良好效果, 接连获得美国FDA和欧洲药品管理局孤儿药认可. 但对于针对全新靶点的激酶药物, 我国临床转化领域仍存在较大空白, 亟需针对尚未探索的激酶开发首创小分子调节剂. 另外, 近年来, 更多的FDA批准的激酶药物被应用于非肿瘤类疾病治疗, 包括类风湿性关节炎、肺纤维化、特应性皮炎、银屑病等免疫性疾病, 而我国批准的激酶药物仍集中于癌症, 亟需往更多非癌疾病拓展. Table 1  NMPA-approved domestically developed original kinase-targeted drugs 上市时间 药品名(商品名) 靶标 批准适应证 原研公司 2011 埃克替尼(凯美纳) EGFR 非小细胞肺癌 贝达药业 2014 阿帕替尼(艾坦) VEGFR-2 胃癌; 肝细胞癌 江苏恒瑞 2018 安罗替尼(福可维) VEGFR/PDGFR/FGFR/C-KIT 非小细胞肺癌 正大天晴 2018 吡咯替尼(艾瑞妮) HER2 乳腺癌 江苏恒瑞 2018 呋喹替尼(爱优特) VEGFR 结直肠癌 和记黄埔 2019 泽布替尼(百悦泽) BTK 套细胞淋巴瘤; 慢性淋巴细胞白血病/小淋巴细胞淋巴瘤 百济神州 2019 氟马替尼(豪森昕福) BCR-ABL 费城染色体阳性的慢性髓性白血病 翰森制药 2020 阿美替尼(阿美乐) EGFR-T790M 非小细胞肺癌 豪森药业 2020 恩沙替尼(贝美纳) ALK 非小细胞肺癌 贝达药业 2020 奥布替尼(宜诺凯) BTK 套细胞淋巴瘤; 慢性淋巴细胞白血病/小淋巴细胞淋巴瘤 北京诺诚健华 2021 索凡替尼(苏泰达) CSF-1R/FGFR1/VEGFR 神经内分泌瘤 和记黄埔 2021 伏美替尼(艾弗沙) EGFR-T790M 非小细胞肺癌 艾力斯医药 2021 多纳非尼(泽普生) 多激酶 肝细胞癌; 甲状腺癌 苏州泽璟 2021 赛沃替尼(沃瑞沙) MET 非小细胞肺癌 和记黄埔 2021 奥雷巴替尼(耐立克) BCR-ABL-T315I 耐药慢性髓细胞白血病 亚盛医药 2022 林普利塞(因他瑞) PI3Kδ 滤泡性淋巴瘤 上海璎黎 2023 谷美替尼(海益坦) c-MET 非小细胞肺癌 上海海和 2023 伏罗尼布(伏美纳) 多激酶 肾细胞癌; 多癌症 贝达药业 2023 舒沃替尼(舒沃哲) EGFR 非小细胞肺癌 迪哲医药 2023 贝福替尼(赛美纳) EGFR-T790M 非小细胞肺癌 贝达药业 2023 伯瑞替尼(万比锐) c-MET 非小细胞肺癌; 脑胶质瘤 北京浦润奥 2023 伊鲁阿克(启欣可) ALK, ROS1 非小细胞肺癌 齐鲁制药 2024 妥拉美替尼(科露平) MEK1/2 黑色素瘤 科州制药 2024 安奈克替尼(安柏尼) ROS1, ALK, c-Met 非小细胞肺癌 正大天晴 2024 瑞齐替尼(瑞必达) EGFR-T790M 非小细胞肺癌 上海倍而达 2024 氟泽雷塞(达伯特) KRAS-G12C 非小细胞肺癌 信达生物 2024 依奉阿克(安洛晴) ALK 非小细胞肺癌 正大天晴 2024 瑞厄替尼(圣瑞沙) EGFR-T790M 非小细胞肺癌 圣和药业 2024 戈利昔替尼(高瑞哲) JAK1 外周T细胞淋巴瘤 迪哲医药 2024 佐利替尼(泽瑞尼) EGFR-19del/L858R 非小细胞肺癌 江苏晨泰医药 2024 他雷替尼(达伯乐) ROS1 非小细胞肺癌 葆元生物 2025 利厄替尼(奥壹新) EGFR-T790M 非小细胞肺癌 奥赛康 2025 艾玛昔替尼(艾速达) JAK1 强直性脊柱炎 江苏恒瑞 2025 吡洛西利(轩悦宁) CDK4/6 乳腺癌 轩竹生物 2025 来罗西利(汝佳宁) CDK4/6 乳腺癌 嘉和生物 2025 伏维西利(复妥宁) CDK4/6 乳腺癌 复星医药/奥鸿药业 2025 法米替尼(艾比特) 多靶点(RTKs) 宫颈癌 江苏恒瑞 2025 芦沃美替尼(复迈宁) MEK1/2 朗格汉斯细胞组织细胞增生症; 组织细胞肿瘤; 神经纤维瘤(儿童/青少年) 复星医药 2025 吉卡昔替尼(泽普平) JAK, ACVR1 骨髓纤维化 苏州泽璟 2025 戈来雷塞(艾瑞凯) KRAS-G12C 非小细胞肺癌 加科思/艾力斯医药 总的来说, 30年来的激酶药物研发取得了丰硕成果. 但激酶领域仍然有许多问题值得进一步研究, 如提高激酶抑制剂选择性、克服激酶抑制剂耐药性以及靶向激酶的非酶功能等. 综合采用共价结合、蛋白降解、变构调节等多种策略, 以及结合组学和人工智能技术进行激酶小分子调节剂研究是解决这些需求的重要路径. 基于此, 我们认为, 激酶仍然是未来药物研发的重要方向. 声明：发表/转载本文仅仅是出于传播信息的需要，并不意味着代表本公众号观点或证实其内容的真实性。据此内容作出的任何判断，后果自负。若有侵权，告知必删！ 长按关注本公众号  粉丝群/投稿/授权/广告等 请联系公众号助手 觉得本文好看，请点这里↓

Product Sales Excluding Veklury Increased 4% Year-Over-Year to $6.9 billion Biktarvy Sales Increased 9% Year-Over-Year to $3.5 billion FOSTER CITY, Calif.--(BUSINESS WIRE)-- Gilead Sciences, Inc. (Nasdaq: GILD) announced today its second quarter 2025 results of operations. “This was a very successful second quarter for Gilead, including the FDA approval for Yeztugo as the world’s first twice-yearly HIV prevention option,” said Daniel O’Day, Gilead’s Chairman and Chief Executive Officer. “Our strong growth this quarter was driven by Biktarvy, Descovy, Trodelvy and Livdelzi, reflecting the diversity of our portfolio. As we enter the third quarter, we are increasing revenue and earnings guidance for the year, and look forward to delivering continued innovation and growth across our core therapeutic areas.” Second Quarter 2025 Financial Results Total second quarter 2025 revenue increased 2% to $7.1 billion compared to the same period in 2024, driven by higher HIV, Livdelzi® (seladelpar) and Trodelvy® (sacituzumab govitecan-hziy) sales, partially offset by lower chronic hepatitis C virus (“HCV”) and Veklury® (remdesivir) sales. Diluted earnings per share (“EPS”) was $1.56 in the second quarter 2025 compared to $1.29 in the same period in 2024. The increase was primarily driven by net unrealized gains on securities compared to net unrealized losses in 2024 and higher product sales, partially offset by a pre-tax in-process research and development (“IPR&D”) impairment charge of $190 million related to assets acquired as part of the MYR GmbH (“MYR”) acquisition and higher research and development (“R&D”) expenses. Non-GAAP diluted EPS of $2.01 in the second quarter 2025 remained flat compared to the same period in 2024, with higher product sales offset by higher R&D expenses. As of June 30, 2025, Gilead had $7.1 billion of cash, cash equivalents and marketable debt securities compared to $10.0 billion as of December 31, 2024. During the second quarter 2025, Gilead generated $827 million in operating cash flow, net of a final $1.3 billion transition tax payment associated with the Tax Cuts and Jobs Act of 2017. During the second quarter 2025, Gilead paid dividends of $994 million and repurchased $527 million of common stock. Second Quarter 2025 Product Sales Total second quarter 2025 product sales increased 2% to $7.1 billion compared to the same period in 2024. Total second quarter 2025 product sales excluding Veklury increased 4% to $6.9 billion compared to the same period in 2024, primarily due to higher HIV, Livdelzi and Trodelvy sales, partially offset by lower HCV sales. HIV product sales increased 7% to $5.1 billion in the second quarter 2025 compared to the same period in 2024, primarily driven by increased demand and higher average realized price. Biktarvy®(bictegravir 50mg/emtricitabine (“FTC”) 200mg/tenofovir alafenamide (“TAF”) 25mg) sales increased 9% to $3.5 billion in the second quarter 2025 compared to the same period in 2024, primarily driven by higher demand. Descovy®(FTC 200mg/TAF 25mg) sales increased 35% to $653 million in the second quarter 2025 compared to the same period in 2024, primarily driven by higher average realized price and demand. The Liver Disease portfolio sales decreased 4% to $795 million in the second quarter 2025 compared to the same period in 2024. This was primarily driven by lower HCV sales, partially offset by increased demand for Livdelzi, Hepcludex® (bulevirtide) and chronic hepatitis B virus (“HBV”) products. Veklury sales decreased 44% to $121 millionin the second quarter 2025 compared to the same period in 2024, primarily driven by lower rates of COVID-19-related hospitalizations. Cell Therapy product sales decreased 7% to $485 million in the second quarter 2025 compared to the same period in 2024, reflecting ongoing competitive headwinds. Yescarta® (axicabtagene ciloleucel) sales decreased 5% to $393 million in the second quarter 2025 compared to the same period in 2024, primarily driven by lower demand, partially offset by higher average realized price. Tecartus® (brexucabtagene autoleucel) sales decreased 14% to $92 million in the second quarter 2025 compared to the same period in 2024, primarily reflecting lower demand, partially offset by higher average realized price. Trodelvy sales increased 14% to $364 million in the second quarter 2025 compared to the same period in 2024, primarily driven by higher demand and inventory dynamics. Second Quarter 2025 Product Gross Margin, Operating Expenses and Effective Tax Rate Product gross margin was 78.7% in the second quarter 2025 compared to 77.7% in the same period in 2024. Non-GAAP product gross margin was 86.9% in the second quarter 2025 compared to 86.0% in the same period in 2024. The increases were primarily driven by product mix. R&D expenses were $1.5 billion in the second quarter 2025 compared to $1.4 billion in the same period in 2024, primarily due to increased clinical manufacturing and study expenses, as well as valuation adjustments to the MYR-related contingent consideration. Non-GAAP R&D expenses were $1.5 billion in the second quarter 2025 compared to $1.3 billion in the same period in 2024, primarily due to increased clinical manufacturing and study activities. Acquired IPR&D expenses were $61 million in the second quarter 2025, primarily reflecting expenses related to the strategic partnership with Kymera Therapeutics, Inc. (“Kymera”) announced in June 2025. Selling, general and administrative (“SG&A”) expenses and non-GAAP SG&A expenses of $1.4 billion in the second quarter 2025 remained flat compared to the same period in 2024, with higher promotional expenses offset by lower corporate expenses. The effective tax rate (“ETR”) was 19.3% in the second quarter 2025 compared to 21.4% in the same period in 2024, primarily driven by lower non-taxable unrealized losses on securities, partially offset by a beneficial prior year settlement with a tax authority that did not repeat. The non-GAAP ETR was 18.8% in the second quarter 2025 compared to 17.8% in the same period in 2024, primarily reflecting the same non-recurring tax settlement in the prior year. Guidance and Outlook For the full-year, Gilead expects: August 7, 2025 Guidance Low End High End Comparison to Prior Guidance Product sales $ 28,300 $ 28,700 Previously $28,200 to $28,600 Product sales excluding Veklury $ 27,300 $ 27,700 Previously $26,800 to $27,200 Veklury $ 1,000 $ 1,000 Previously $1,400 Diluted EPS $ 5.85 $ 6.15 Previously $5.65 to $6.05 Non-GAAP diluted EPS $ 7.95 $ 8.25 Previously $7.70 to $8.10 Additional information and a reconciliation between GAAP and non-GAAP financial information for the 2025 guidance is provided in the accompanying tables. The financial guidance is subject to a number of risks and uncertainties. See the Forward-Looking Statements section below. Key Updates Since Our Last Quarterly Release Virology Received U.S. Food and Drug Administration (“FDA”) approval for Yeztugo® (lenacapavir) for pre-exposure prophylaxis (“PrEP”) to reduce the risk of sexually acquired HIV-1 in adults and adolescents weighing at least 35kg. Yeztugo is the first and only twice-yearly HIV PrEP option available in the United States. Received a positive opinion under accelerated review from the European Medicines Agency’s Committee for Medicinal Products for Human Use recommending lenacapavir for use as PrEP to reduce the risk of sexually acquired HIV-1 in adults and adolescents with increased HIV-1 acquisition risk. The recommendation will now be reviewed by the European Commission. Lenacapavir for HIV PrEP is not approved for use outside of the United States. Announced a strategic partnership agreement with the Global Fund to Fight AIDS, Tuberculosis and Malaria (“Global Fund”) to accelerate access, subject to regulatory approvals, to twice-yearly lenacapavir for HIV PrEP for up to two million people in primarily low- and lower-middle-income countries over three years, at no profit to Gilead. Presented new data at the International AIDS Society conference, including from the PURPOSE 1 and 2 trials evaluating twice-yearly lenacapavir for HIV PrEP in a broad range of populations, including pregnant and lactating women, adolescents, and young people. Announced that the World Health Organization released new guidelines recommending the use of twice-yearly lenacapavir for HIV PrEP, as well as new guidelines on HIV testing protocols for long-acting prevention medications. Announced that FDA had placed a clinical hold on the HIV treatment trials of GS-1720 and/or GS-4182, including the WONDERS-1 and WONDERS-2 trials. These drug candidates are investigational and not approved anywhere globally. Presented final data from the Phase 3 MYR301 study evaluating bulevirtide as a treatment for adults with chronic hepatitis delta virus (“HDV”) at the European Association for the Study of the Liver (“EASL”) Congress. Bulevirtide remains the only approved treatment for HDV in the EU and is not approved in the U.S. Additionally, presented clinical and real-world data on HBV and HCV programs. Oncology Announced positive topline results from the Phase 3 ASCENT-03 trial evaluating Trodelvy in patients with 1L metastatic triple-negative breast cancer (“mTNBC”) who are not candidates for PD-1/PD-L1 checkpoint inhibitors. Additionally, presented results from the Phase 3 ASCENT-04 trial evaluating Trodelvy plus Keytruda® (pembrolizumab) in 1L PD-L1+ mTNBC at the American Society of Clinical Oncology (“ASCO”) meeting. Trodelvy is not approved in either of these settings. Presented new real-world data at ASCO supporting the use of Yescarta in outpatient care settings for patients with relapsed or refractory (“R/R”) large B-cell lymphoma (“LBCL”), as well as other early-stage investigational CAR T data in glioblastoma and LBCL. Presented data in partnership with Arcellx, Inc. (“Arcellx”) at the European Hematology Association congress from the iMMagine-1 trial evaluating investigational anitocabtagene-autoleucel (“anito-cel”) in R/R multiple myeloma. Entered into an exclusive option and license agreement with Kymera to develop novel oral molecular glue CDK2 degraders with broad oncology treatment potential. Inflammation Presented new data from multiple analyses at EASL evaluating Livdelzi for the treatment of primary biliary cholangitis, including interim analysis from the open-label, long-term ASSURE study. Corporate The Board declared a quarterly dividend of $0.79 per share of common stock for the third quarter of 2025. The dividend is payable on September 29, 2025, to stockholders of record at the close of business on September 15, 2025. Future dividends will be subject to Board approval. The Board authorized a new $6.0 billion stock repurchase program, with no fixed expiration, which will commence upon the completion of the previously approved program. Reached a final settlement agreement with the U.S. Department of Justice resolving a legacy compliance matter. This settlement was accrued in 2024 and reported under SG&A expenses. Named by TIME as a 2025 Most Influential Company. Certain amounts and percentages in this press release may not sum or recalculate due to rounding. Conference Call At 1:30 p.m. Pacific Time today, Gilead will host a conference call to discuss Gilead’s results. A live webcast will be available on http://investors.gilead.com and will be archived on www.gilead.com for one year. Non-GAAP Financial Information The information presented in this document has been prepared in accordance with U.S. generally accepted accounting principles (“GAAP”), unless otherwise noted as non-GAAP. Management believes non-GAAP information is useful for investors, when considered in conjunction with Gilead’s GAAP financial information, because management uses such information internally for its operating, budgeting and financial planning purposes. Non-GAAP information is not prepared under a comprehensive set of accounting rules and should only be used to supplement an understanding of Gilead’s operating results as reported under GAAP. Non-GAAP financial information generally excludes acquisition-related expenses including amortization of acquired intangible assets and other items that are considered unusual or not representative of underlying trends of Gilead’s business, fair value adjustments of equity securities and discrete and related tax charges or benefits associated with such exclusions as well as changes in tax-related laws and guidelines, transfers of intangible assets between certain legal entities, and legal entity restructurings. Although Gilead consistently excludes the amortization of acquired intangible assets from the non-GAAP financial information, management believes that it is important for investors to understand that such intangible assets were recorded as part of acquisitions and contribute to ongoing revenue generation.Non-GAAP measures may be defined and calculated differently by other companies in the same industry. Reconciliations of the non-GAAP financial measures to the most directly comparable GAAP financial measures are provided in the accompanying tables. About Gilead Sciences Gilead Sciences, Inc. is a biopharmaceutical company that has pursued and achieved breakthroughs in medicine for more than three decades, with the goal of creating a healthier world for all people. The company is committed to advancing innovative medicines to prevent and treat life-threatening diseases, including HIV, viral hepatitis, COVID-19, cancer and inflammation. Gilead operates in more than 35 countries worldwide, with headquarters in Foster City, California. Forward-Looking Statements Statements included in this press release that are not historical in nature are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Gilead cautions readers that forward-looking statements are subject to certain risks and uncertainties that could cause actual results to differ materially. These risks and uncertainties include those relating to: Gilead’s ability to achieve its full year 2025 financial guidance, including as a result of the uncertainty of the amount and timing of Veklury revenues, the impact of the Inflation Reduction Act, changes in U.S. regulatory or legislative policies, and changes in U.S. trade policies, including tariffs; Gilead’s ability to make progress on any of its long-term ambitions or priorities laid out in its corporate strategy; Gilead’s ability to accelerate or sustain revenues for its virology, oncology and other programs; Gilead’s ability to realize the potential benefits of acquisitions, collaborations or licensing arrangements, including the acquisitions of MYR, and the arrangements with Arcellx, Kymera and the Global Fund; patent protection and estimated loss of exclusivity for our products and product candidates; Gilead’s ability to initiate, progress or complete clinical trials within currently anticipated timeframes or at all, the possibility of unfavorable results from ongoing and additional clinical trials, including those involving Livdelzi, Trodelvy, Yescarta, Yeztugo (lenacapavir), anito-cel, bulevirtide, GS-1720, and GS-4182 (such as the ASCENT-03, ASCENT-04, ASSURE, iMMagine-1, MYR301, PURPOSE 1 PURPOSE 2, WONDERS-1, and WONDERS-2 studies), and the risk that safety and efficacy data from clinical trials may not warrant further development of Gilead’s product candidates or the product candidates of Gilead’s strategic partners; Gilead’s ability to resolve the issues cited by the FDA in the clinical hold on the GS-1720 and GS-4182 trials to the satisfaction of the FDA and the risk that FDA may not remove the clinical hold, in whole or in part, in a timely manner or at all; Gilead’s ability to submit new drug applications for new product candidates or expanded indications in the currently anticipated timelines; Gilead’s ability to receive or maintain regulatory approvals in a timely manner or at all, including for additional approvals for lenacapavir for HIV PrEP, and the risk that any such approvals, if granted, may be subject to significant limitations on use and may be subject to withdrawal or other adverse actions by the applicable regulatory authority; Gilead’s ability to successfully commercialize its products; the risk of potential disruptions to the manufacturing and supply chain of Gilead’s products; pricing and reimbursement pressures from government agencies and other third parties, including required rebates and other discounts; a larger than anticipated shift in payer mix to more highly discounted payer segments; market share and price erosion caused by the introduction of generic versions of Gilead products; the risk that physicians and patients may not see advantages of Gilead’s products over other therapies and may therefore be reluctant to prescribe the products, including Yeztugo; Gilead’s ability to effectively manage the access strategy relating to lenacapavir for HIV PrEP, subject to necessary regulatory approvals; and other risks identified from time to time in Gilead’s reports filed with the SEC, including annual reports on Form 10-K, quarterly reports on Form 10-Q and current reports on Form 8-K. In addition, Gilead makes estimates and judgments that affect the reported amounts of assets, liabilities, revenues and expenses and related disclosures. Gilead bases its estimates on historical experience and on various other market specific and other relevant assumptions that it believes to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. There may be other factors of which Gilead is not currently aware that may affect matters discussed in the forward-looking statements and may also cause actual results to differ significantly from these estimates. Further, results for the quarter ended June 30, 2025 are not necessarily indicative of operating results for any future periods. Gilead directs readers to its press releases, annual reports on Form 10-K, quarterly reports on Form 10-Q and other subsequent disclosure documents filed with the SEC. Gilead claims the protection of the Safe Harbor contained in the Private Securities Litigation Reform Act of 1995 for forward-looking statements. The reader is cautioned that forward-looking statements are not guarantees of future performance and is cautioned not to place undue reliance on these forward-looking statements. All forward-looking statements are based on information currently available to Gilead and Gilead assumes no obligation to update or supplement any such forward-looking statements other than as required by law. Any forward-looking statements speak only as of the date hereof or as of the dates indicated in the statements. Additional information is available on our Investor Relations website, https://investors.gilead.com. Among other things, an estimate of Acquired IPR&D expenses is expected to be made available on the Quarterly Results page within the first ten (10) days after the end of each quarter. Gilead owns or has rights to various trademarks, copyrights and trade names used in its business, including the following: GILEAD®, GILEAD SCIENCES®, KITE™, AMBISOME®, ATRIPLA®, BIKTARVY®, CAYSTON®, COMPLERA®, DESCOVY®, DESCOVY FOR PREP®, EMTRIVA®, EPCLUSA®, EVIPLERA®, GENVOYA®, HARVONI®, HEPCLUDEX®, HEPSERA®, JYSELECA®, LIVDELZI®/LYVDELZI®, LETAIRIS®, ODEFSEY®, SOVALDI®, STRIBILD®, SUNLENCA® , TECARTUS®, TRODELVY®, TRUVADA®, TRUVADA FOR PREP®, TYBOST®, VEKLURY®, VEMLIDY®, VIREAD®, VOSEVI®, YESCARTA®, YEZTUGO® and ZYDELIG®. KEYTRUDA® is a registered trademark of Merck Sharp & Dohme LLC., a subsidiary of Merck & Co., Inc., Rahway, NJ, USA. Other trademarks and trade names are the property of their respective owners. For more information on Gilead Sciences, Inc., please visit www.gilead.com or call the Gilead Public Affairs Department at 1-800-GILEAD-5 (1-800-445-3235). GILEAD SCIENCES, INC. CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions, except per share amounts) 2025 2024 2025 2024 Revenues: Product sales $ 7,054 $ 6,912 $ 13,668 $ 13,559 Royalty, contract and other revenues 27 41 81 81 Total revenues 7,082 6,954 13,749 13,640 Costs and expenses: Cost of goods sold 1,501 1,544 3,041 3,096 Research and development expenses 1,491 1,351 2,870 2,871 Acquired in-process research and development expenses 61 38 315 4,169 In-process research and development impairments 190 — 190 2,430 Selling, general and administrative expenses 1,365 1,377 2,623 2,752 Total costs and expenses 4,608 4,309 9,038 15,317 Operating income (loss) 2,474 2,644 4,711 (1,678 ) Interest expense 254 237 513 491 Other (income) expense, net (208 ) 355 120 265 Income (loss) before income taxes 2,429 2,053 4,077 (2,433 ) Income tax expense 468 438 802 123 Net income (loss) 1,960 1,614 3,275 (2,556 ) Net income attributable to noncontrolling interest — — — — Net income (loss) attributable to Gilead $ 1,960 $ 1,614 $ 3,275 $ (2,556 ) Basic earnings (loss) per share attributable to Gilead $ 1.57 $ 1.29 $ 2.63 $ (2.05 ) Diluted earnings (loss) per share attributable to Gilead $ 1.56 $ 1.29 $ 2.61 $ (2.05 ) Shares used in basic earnings (loss) per share attributable to Gilead calculation 1,245 1,247 1,246 1,247 Shares used in diluted earnings (loss) per share attributable to Gilead calculation 1,255 1,251 1,257 1,247 Supplemental Information: Cash dividends declared per share $ 0.79 $ 0.77 $ 1.58 $ 1.54 Product gross margin 78.7 % 77.7 % 77.7 % 77.2 % Research and development expenses as a % of revenues 21.1 % 19.4 % 20.9 % 21.0 % Selling, general and administrative expenses as a % of revenues 19.3 % 19.8 % 19.1 % 20.2 % Operating margin 34.9 % 38.0 % 34.3 % (12.3 )% Effective tax rate 19.3 % 21.4 % 19.7 % (5.1 )% GILEAD SCIENCES, INC. TOTAL REVENUE SUMMARY (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions, except percentages) 2025 2024 Change 2025 2024 Change Product sales: HIV $ 5,088 $ 4,745 7 % $ 9,675 $ 9,088 6 % Liver Disease 795 832 (4 )% 1,553 1,569 (1 )% Oncology 849 841 1 % 1,606 1,629 (1 )% Other 202 280 (28 )% 410 504 (19 )% Total product sales excluding Veklury 6,934 6,698 4 % 13,245 12,790 4 % Veklury 121 214 (44 )% 423 769 (45 )% Total product sales 7,054 6,912 2 % 13,668 13,559 1 % Royalty, contract and other revenues 27 41 (34 )% 81 81 1 % Total revenues $ 7,082 $ 6,954 2 % $ 13,749 $ 13,640 1 % GILEAD SCIENCES, INC. NON-GAAP FINANCIAL INFORMATION(1) (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions, except percentages) 2025 2024 Change 2025 2024 Change Non-GAAP: Cost of goods sold $ 922 $ 965 (4 )% $ 1,883 $ 1,939 (3 )% Research and development expenses $ 1,450 $ 1,335 9 % $ 2,789 $ 2,738 2 % Acquired IPR&D expenses(2) $ 61 $ 38 61 % $ 315 $ 4,169 (92 )% Selling, general and administrative expenses $ 1,358 $ 1,351 — % $ 2,580 $ 2,646 (3 )% Other (income) expense, net $ (66 ) $ (37 ) 82 % $ (164 ) $ (141 ) 17 % Diluted earnings per share attributable to Gilead $ 2.01 $ 2.01 — % $ 3.82 $ 0.70 NM Shares used in non-GAAP diluted earnings per share attributable to Gilead calculation 1,255 1,251 — % 1,257 1,254 — % Product gross margin 86.9 % 86.0 % 89 bps 86.2 % 85.7 % 52 bps Research and development expenses as a % of revenues 20.5 % 19.2 % 128 bps 20.3 % 20.1 % 21 bps Selling, general and administrative expenses as a % of revenues 19.2 % 19.4 % -26 bps 18.8 % 19.4 % -64 bps Operating margin 46.5 % 47.0 % -49 bps 45.0 % 15.7 % NM Effective tax rate 18.8 % 17.8 % 96 bps 17.6 % 51.4 % NM ________________________________ NM - Not Meaningful (1) Refer to Non-GAAP Financial Information section above for further disclosures on non-GAAP financial measures. A reconciliation between GAAP and non-GAAP financial information is provided in the tables below. (2) Equal to GAAP financial information. GILEAD SCIENCES, INC. RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions, except percentages and per share amounts) 2025 2024 2025 2024 Cost of goods sold reconciliation: GAAP cost of goods sold $ 1,501 $ 1,544 $ 3,041 $ 3,096 Acquisition-related – amortization(1) (579 ) (579 ) (1,158 ) (1,158 ) Restructuring — — — 1 Non-GAAP cost of goods sold $ 922 $ 965 $ 1,883 $ 1,939 Product gross margin reconciliation: GAAP product gross margin 78.7 % 77.7 % 77.7 % 77.2 % Acquisition-related – amortization(1) 8.2 % 8.4 % 8.5 % 8.5 % Restructuring — % — % — % — % Non-GAAP product gross margin 86.9 % 86.0 % 86.2 % 85.7 % Research and development expenses reconciliation: GAAP research and development expenses $ 1,491 $ 1,351 $ 2,870 $ 2,871 Acquisition-related – other costs(2) (35 ) (3 ) (37 ) (70 ) Restructuring (6 ) (13 ) (44 ) (63 ) Non-GAAP research and development expenses $ 1,450 $ 1,335 $ 2,789 $ 2,738 IPR&D impairment reconciliation: GAAP IPR&D impairment $ 190 $ — $ 190 $ 2,430 IPR&D impairment (190 ) — (190 ) (2,430 ) Non-GAAP IPR&D impairment $ — $ — $ — $ — Selling, general and administrative expenses reconciliation: GAAP selling, general and administrative expenses $ 1,365 $ 1,377 $ 2,623 $ 2,752 Acquisition-related – other costs(2) — (17 ) — (84 ) Restructuring (7 ) (8 ) (43 ) (22 ) Non-GAAP selling, general and administrative expenses $ 1,358 $ 1,351 $ 2,580 $ 2,646 Operating income (loss) reconciliation: GAAP operating income (loss) $ 2,474 $ 2,644 $ 4,711 $ (1,678 ) Acquisition-related – amortization(1) 579 579 1,158 1,158 Acquisition-related – other costs(2) 35 21 37 153 Restructuring 13 21 88 84 IPR&D impairment 190 — 190 2,430 Non-GAAP operating income $ 3,290 $ 3,265 $ 6,183 $ 2,148 Operating margin reconciliation: GAAP operating margin 34.9 % 38.0 % 34.3 % (12.3 )% Acquisition-related – amortization(1) 8.2 % 8.3 % 8.4 % 8.5 % Acquisition-related – other costs(2) 0.5 % 0.3 % 0.3 % 1.1 % Restructuring 0.2 % 0.3 % 0.6 % 0.6 % IPR&D impairment 2.7 % — % 1.4 % 17.8 % Non-GAAP operating margin 46.5 % 47.0 % 45.0 % 15.7 % Other (income) expense, net reconciliation: GAAP other (income) expense, net $ (208 ) $ 355 $ 120 $ 265 Gain (loss) from equity securities, net 142 (392 ) (284 ) (405 ) Non-GAAP other (income) expense, net $ (66 ) $ (37 ) $ (164 ) $ (141 ) Income (loss) before income taxes reconciliation: GAAP income (loss) before income taxes $ 2,429 $ 2,053 $ 4,077 $ (2,433 ) Acquisition-related – amortization(1) 579 579 1,158 1,158 Acquisition-related – other costs(2) 35 21 37 153 Restructuring 13 21 88 84 IPR&D impairment 190 — 190 2,430 (Gain) loss from equity securities, net (142 ) 392 284 405 Non-GAAP income before income taxes $ 3,103 $ 3,065 $ 5,834 $ 1,798 GILEAD SCIENCES, INC. RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION - (Continued) (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions, except percentages and per share amounts) 2025 2024 2025 2024 Income tax expense reconciliation: GAAP income tax expense $ 468 $ 438 $ 802 $ 123 Income tax effect of non-GAAP adjustments: Acquisition-related – amortization(1) 120 121 241 242 Acquisition-related – other costs(2) — 7 — 37 Restructuring 2 7 15 16 IPR&D impairment 51 — 51 611 (Gain) loss from equity securities, net (11 ) 33 10 (6 ) Discrete and related tax charges(3) (48 ) (60 ) (90 ) (100 ) Non-GAAP income tax expense $ 583 $ 546 $ 1,029 $ 923 Effective tax rate reconciliation: GAAP effective tax rate 19.3 % 21.4 % 19.7 % (5.1 )% Income tax effect of above non-GAAP adjustments and discrete and related tax adjustments(3) (0.5 )% (3.5 )% (2.0 )% 56.4 % Non-GAAP effective tax rate 18.8 % 17.8 % 17.6 % 51.4 % Net income (loss) attributable to Gilead reconciliation: GAAP net income (loss) attributable to Gilead $ 1,960 $ 1,614 $ 3,275 $ (2,556 ) Acquisition-related – amortization(1) 459 458 917 916 Acquisition-related – other costs(2) 35 14 37 117 Restructuring 11 14 72 68 IPR&D impairment 139 — 139 1,819 (Gain) loss from equity securities, net (131 ) 359 275 412 Discrete and related tax charges(3) 48 60 90 100 Non-GAAP net income attributable to Gilead $ 2,521 $ 2,519 $ 4,806 $ 874 Diluted earnings (loss) per share reconciliation: GAAP diluted earnings (loss) per share $ 1.56 $ 1.29 $ 2.61 $ (2.05 ) Acquisition-related – amortization(1) 0.37 0.37 0.73 0.73 Acquisition-related – other costs(2) 0.03 0.01 0.03 0.09 Restructuring 0.01 0.01 0.06 0.05 IPR&D impairment 0.11 — 0.11 1.46 (Gain) loss from equity securities, net (0.10 ) 0.29 0.22 0.33 Discrete and related tax charges(3) 0.04 0.05 0.07 0.08 Non-GAAP diluted earnings per share $ 2.01 $ 2.01 $ 3.82 $ 0.70 Non-GAAP adjustment summary: Cost of goods sold adjustments $ 579 $ 579 $ 1,158 $ 1,157 Research and development expenses adjustments 41 16 81 133 IPR&D impairment adjustments 190 — 190 2,430 Selling, general and administrative expenses adjustments 7 26 43 106 Total non-GAAP adjustments to costs and expenses 817 620 1,472 3,826 Other (income) expense, net, adjustments (142 ) 392 284 405 Total non-GAAP adjustments before income taxes 675 1,012 1,757 4,231 Income tax effect of non-GAAP adjustments above (162 ) (168 ) (316 ) (900 ) Discrete and related tax charges(3) 48 60 90 100 Total non-GAAP adjustments to net income attributable to Gilead $ 560 $ 905 $ 1,530 $ 3,431 ________________________________ (1) Relates to amortization of acquired intangibles. (2) Adjustments include integration expenses and contingent consideration fair value adjustments associated with Gilead’s recent acquisitions. (3) Represents discrete and related deferred tax charges or benefits primarily associated with acquired intangible assets and transfers of intangible assets from a foreign subsidiary to Ireland and the United States. GILEAD SCIENCES, INC. RECONCILIATION OF GAAP TO NON-GAAP 2025 FULL-YEAR GUIDANCE(1) (unaudited) (in millions, except percentages and per share amounts) Provided February 11, 2025 Updated April 24, 2025 Updated August 7, 2025 Projected product gross margin GAAP to non-GAAP reconciliation: GAAP projected product gross margin 77.0% - 78.0% 77.0% - 78.0% ~ 78.0% Acquisition-related expenses ~ 8.0% ~ 8.0% ~ 8.0% Non-GAAP projected product gross margin 85.0% - 86.0% 85.0% - 86.0% ~ 86.0% Projected operating income GAAP to non-GAAP reconciliation: GAAP projected operating income $10,200 - $10,700 $10,200 - $10,700 $10,300 - $10,700 Acquisition-related, IPR&D impairment and restructuring expenses ~ 2,500 ~ 2,500 ~ 2,700 Non-GAAP projected operating income $12,700 - $13,200 $12,700 - $13,200 $13,000 - $13,400 Projected effective tax rate GAAP to non-GAAP reconciliation: GAAP projected effective tax rate ~ 20% ~ 21% ~ 21% Income tax effect of above non-GAAP adjustments and fair value adjustments of equity securities, and discrete and related tax adjustments (~ 1%) (~ 2%) (~ 2%) Non-GAAP projected effective tax rate ~ 19% ~ 19% ~ 19% Projected diluted EPS GAAP to non-GAAP reconciliation: GAAP projected diluted EPS $5.95 - $6.35 $5.65 - $6.05 $5.85 - $6.15 Acquisition-related, IPR&D impairment and restructuring expenses, fair value adjustments of equity securities and discrete and related tax adjustments ~ 1.75 ~ 2.05 ~ 2.10 Non-GAAP projected diluted EPS $7.70 - $8.10 $7.70 - $8.10 $7.95 - $8.25 ________________________________ (1) Our full-year guidance excludes the potential impact of any (i) acquisitions or business development transactions that have not been executed, (ii) future fair value adjustments of equity securities and (iii) discrete tax charges or benefits associated with changes in tax related laws and guidelines that have not been enacted, as Gilead is unable to project such amounts. The non-GAAP full-year guidance includes non-GAAP adjustments to actual current period results as well as adjustments for the known future impact associated with events that have already occurred, such as future amortization of our intangible assets and the future impact of discrete and related deferred tax charges or benefits primarily associated with acquired intangible assets and in-process research and development, transfers of intangible assets from a foreign subsidiary to Ireland and the United States, and legal entity restructurings. GILEAD SCIENCES, INC. CONDENSED CONSOLIDATED BALANCE SHEETS (unaudited) June 30, December 31, (in millions) 2025 2024 Assets Cash, cash equivalents and marketable debt securities $ 7,126 $ 9,991 Accounts receivable, net 4,781 4,420 Inventories(1) 3,913 3,589 Property, plant and equipment, net 5,459 5,414 Intangible assets, net 18,566 19,948 Goodwill 8,314 8,314 Other assets 7,563 7,319 Total assets $ 55,721 $ 58,995 Liabilities and Stockholders’ Equity Current liabilities $ 11,189 $ 12,004 Long-term liabilities 24,942 27,744 Stockholders’ equity(2) 19,590 19,246 Total liabilities and stockholders’ equity $ 55,721 $ 58,995 ________________________________ (1) Includes current and long-term inventories, which are disclosed separately in the notes to our financial statements in Form 10-K and Form 10-Q. (2) As of June 30, 2025 and December 31, 2024, there were 1,242 and 1,246 shares of common stock issued and outstanding, respectively. GILEAD SCIENCES, INC. SELECTED CASH FLOW INFORMATION (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions) 2025 2024 2025 2024 Net cash provided by operating activities $ 827 $ 1,325 $ 2,584 $ 3,544 Net cash used in investing activities (2,116 ) (307 ) (2,531 ) (2,514 ) Net cash used in financing activities (1,566 ) (2,953 ) (4,993 ) (4,314 ) Effect of exchange rate changes on cash and cash equivalents 73 (11 ) 92 (29 ) Net change in cash and cash equivalents (2,782 ) (1,947 ) (4,848 ) (3,313 ) Cash and cash equivalents at beginning of period 7,926 4,718 9,991 6,085 Cash and cash equivalents at end of period $ 5,144 $ 2,772 $ 5,144 $ 2,772 Three Months Ended Six Months Ended June 30, June 30, (in millions) 2025 2024 2025 2024 Net cash provided by operating activities $ 827 $ 1,325 $ 2,584 $ 3,544 Purchases of property, plant and equipment (107 ) (130 ) (211 ) (235 ) Free cash flow(1) $ 720 $ 1,195 $ 2,373 $ 3,309 ________________________________ (1) Free cash flow is a non-GAAP liquidity measure. Please refer to our disclosures in the Non-GAAP Financial Information section above. GILEAD SCIENCES, INC. PRODUCT SALES SUMMARY (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions) 2025 2024 2025 2024 HIV Biktarvy – U.S. $ 2,799 $ 2,585 $ 5,272 $ 4,900 Biktarvy – Europe 429 370 804 735 Biktarvy – Rest of World 302 277 603 542 3,530 3,232 6,679 6,177 Descovy – U.S. 601 434 1,139 805 Descovy – Europe 24 25 45 51 Descovy – Rest of World 28 26 55 55 653 485 1,239 911 Genvoya – U.S. 322 372 627 704 Genvoya – Europe 40 45 79 95 Genvoya – Rest of World 16 23 35 44 377 440 741 843 Odefsey – U.S. 221 233 436 457 Odefsey – Europe 66 72 123 148 Odefsey – Rest of World 11 10 20 21 298 315 579 626 Symtuza - Revenue share(1) – U.S. 88 131 170 236 Symtuza - Revenue share(1) – Europe 33 34 62 67 Symtuza - Revenue share(1) – Rest of World 3 3 6 6 124 168 238 309 Other HIV(2) – U.S. 65 65 115 125 Other HIV(2) – Europe 33 25 63 70 Other HIV(2) – Rest of World 9 15 19 27 107 105 198 222 Total HIV – U.S. 4,096 3,821 7,760 7,226 Total HIV – Europe 624 571 1,177 1,167 Total HIV – Rest of World 368 353 738 695 5,088 4,745 9,675 9,088 Liver Disease Sofosbuvir / Velpatasvir(3) – U.S. 184 267 351 515 Sofosbuvir / Velpatasvir(3) – Europe 81 84 161 163 Sofosbuvir / Velpatasvir(3) – Rest of World 76 126 175 203 342 476 687 881 Vemlidy – U.S. 122 117 222 212 Vemlidy – Europe 13 11 24 22 Vemlidy – Rest of World 117 115 257 233 252 243 504 467 Other Liver Disease(4) – U.S. 106 47 175 89 Other Liver Disease(4) – Europe 76 47 152 94 Other Liver Disease(4) – Rest of World 19 19 35 38 201 113 362 221 Total Liver Disease – U.S. 413 431 748 816 Total Liver Disease – Europe 170 142 338 279 Total Liver Disease – Rest of World 211 259 467 474 795 832 1,553 1,569 Veklury Veklury – U.S. 51 76 250 391 Veklury – Europe 19 53 41 123 Veklury – Rest of World 50 85 132 255 121 214 423 769 GILEAD SCIENCES, INC. PRODUCT SALES SUMMARY - (Continued) (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions) 2025 2024 2025 2024 Oncology Cell Therapy Tecartus – U.S. 41 63 82 118 Tecartus – Europe 41 37 72 73 Tecartus – Rest of World 9 7 17 16 92 107 171 207 Yescarta – U.S. 162 186 321 357 Yescarta – Europe 154 169 304 327 Yescarta – Rest of World 77 58 154 110 393 414 779 794 Total Cell Therapy – U.S. 203 250 403 475 Total Cell Therapy – Europe 196 206 376 400 Total Cell Therapy – Rest of World 86 66 171 126 485 521 949 1,001 Trodelvy Trodelvy – U.S. 224 224 405 429 Trodelvy – Europe 96 69 171 137 Trodelvy – Rest of World 44 26 81 62 364 320 657 628 Total Oncology – U.S. 427 474 808 904 Total Oncology – Europe 291 275 547 537 Total Oncology – Rest of World 131 92 252 188 849 841 1,606 1,629 Other AmBisome – U.S. 7 17 13 31 AmBisome – Europe 65 69 132 139 AmBisome – Rest of World 56 65 123 124 129 151 268 294 Other(5) – U.S. 44 98 91 156 Other(5) – Europe 8 8 16 18 Other(5) – Rest of World 21 24 35 36 73 130 143 209 Total Other – U.S. 52 115 104 188 Total Other – Europe 73 77 149 156 Total Other – Rest of World 77 88 158 160 202 280 410 504 Total product sales – U.S. 5,038 4,916 9,669 9,525 Total product sales – Europe 1,178 1,118 2,251 2,262 Total product sales – Rest of World 838 878 1,747 1,772 $ 7,054 $ 6,912 $ 13,668 $ 13,559 ________________________________ (1) Represents Gilead’s revenue from cobicistat (“C”), FTC and TAF in Symtuza (darunavir/C/FTC/TAF), a fixed dose combination product commercialized by Janssen Sciences Ireland Unlimited Company. (2) Includes Atripla, Complera/Eviplera, Emtriva, Sunlenca, Stribild, Truvada, Tybost and Yeztugo. (3) Includes Epclusa and the authorized generic version of Epclusa sold by Gilead’s separate subsidiary, Asegua Therapeutics LLC (“Asegua”). (4) Includes ledipasvir/sofosbuvir (Harvoni and the authorized generic version of Harvoni sold by Asegua), Hepcludex, Hepsera, Livdelzi/Lyvdelzi, Sovaldi, Viread and Vosevi. (5) Includes Cayston, Jyseleca, Letairis and Zydelig. Investors: Jacquie Ross, CFA investor_relations@gilead.com Media: Ashleigh Koss public_affairs@gilead.com