Pfizer Inc Q1 FY2026 Earnings Call

Good day, everyone, and welcome to Pfizer's First Quarter 2026 Earnings Conference Call. Today's call is being recorded. At this time, I would like to turn the call over to Francesca DeMartino, Chief Investor Relations Officer and Senior Vice President. Please go ahead, ma'am.

Good morning, and welcome to Pfizer's earnings call. I'm Francesca DeMartino, Chief Investor Relations Officer. On behalf of the Pfizer team, thank you for joining us. This call is being made available via audio webcast at pfizer.com. Earlier this morning, we released our results for the first quarter 2026 via press release that is available on our website at pfizer.com. I'm joined today by Dr. Albert Bourla, our Chairman and CEO; and Dave Denton, our CFO. Albert and Dave have some prepared remarks, and we will then open the call for questions. Members of our leadership team will be available for the Q&A session. Before we get started, I want to remind you that we will be making forward-looking statements and discussing certain non-GAAP financial measures. I encourage you to read the disclaimers in our slide presentation, the press release we issued this morning and the disclosures in our SEC filings, which are all available on the IR website on pfizer.com. Forward-looking statements on the call are subject to substantial risks and uncertainties, speak only as of the call's original date, and we undertake no obligation to update or revise any of the statements. With that, I will turn the call over to Albert.

Thank you, Francesca. Good morning, everyone. Thank you for joining our call. It's a wonderful day here in New York. We've had a strong start to the year. Our business continues to perform well, and we are making strategic progress. One of our great strengths is the ability to execute. And we are delivering on our financial commitments while we also invest to strengthen Pfizer for future growth and impact. In the first quarter, we exceeded expectations for both total revenues and adjusted diluted earnings per share. We have made progress so far this year in delivering our 2026 critical R&D milestones, including three positive Phase III readouts and encouraging mid-stage readouts for both approved and investigational medicines. We are keeping pace with our robust agenda of approximately 20 planned pivotal study starts this year. We also had two significant legal developments that improved our growth profile post-2028 and, of course, our cash flow outlook. Our recent settlement agreements resolving infringement of patents related to Vyndamax have the potential to change the growth profile of the company significantly post-2028. This gives us greater confidence that starting in 2029, we will enter a five-year period of high single-digit revenue CAGR. Additionally, we view the recent Belgian court ruling regarding Comirnaty contracts with EU member countries as a positive for future EPS and cash flow. The improved visibility into our cash flow provides is a positive for our longer-term capital allocation priorities, including, of course, our ability to preserve and support the dividend. As we look to the rest of the year, we are clearly focused on our most impactful opportunities to create value for patients and our shareholders. We previously shared our strategic priorities for 2026, and I will walk you through the progress we are making on all four. Our launched and acquired products had a tremendous start to the year with 22% growth. Three of our business development transactions represent about 8% of the invested capital in recent years, and they are all progressing very well. Oncology represents our most advanced and concentrated area of research and commercial focus and our Seagen acquisition is a central reason why. Since bringing the company into Pfizer, we have transformed our oncology organization, unifying our team, expanding our commercial portfolio and advancing a leading ADC platform. The 20% year-over-year operational revenue growth in the quarter of our Seagen products shows that we have made good progress in deepening our presence within the oncology community. We continue to strengthen physician engagement and drive greater recognition of the clinical value of our medicines. We are also executing with focus to maximize the value of our Metsera acquisition. This underpins the strategy intended to position Pfizer as a leader in the next generation of obesity therapies. We intend to advance 10 Phase III studies this year, and we are targeting a first approval in 2028 from a portfolio that includes ultra-long-acting peptides with the potential, if successful, to be developed and approved for competitive efficacy and tolerability with a differentiated monthly maintenance dosing schedule. The success we have achieved with Nurtec since our Biohaven acquisition shows the power of our leading field force and commercial capabilities at work. Nurtec contributed in the first quarter with 41% operational growth driven by robust demand for both acute and preventive migraine treatments. We continue to see a meaningful growth opportunity in the oral CGRP class of medicines for patients with migraine. Of course, 2026 is a pivotal year for R&D, and I'm pleased with our early progress this quarter. While we have a large active pipeline, we rely on a rigorous and disciplined approach to focus resources where we see the greatest potential. We are targeting approximately 20 pivotal study starts, eight key data readouts and four regulatory decisions this year. Our critical R&D milestones reinforce how we are concentrating investment in key areas such as oncology, metabolic disease and vaccines, where we have existing commercial infrastructure, scientific expertise and significant opportunity for competitive differentiation. Roughly half of our anticipated key data readouts and regulatory decisions in 2026 are expected to come from oncology where we are advancing multiple programs across areas such as breast, genitourinary, thoracic, gastrointestinal and blood cancer. During the quarter, we presented notable EV-304 study findings for Padcev at ASCO GU. The results show that Padcev and pembrolizumab reduces the risk of recurrence or death by nearly 50% in patients with cisplatin-eligible muscle-invasive bladder cancer. Combined with the recent compelling data from the EV-303 trial, this highlights the potential for this regimen to become the new standard of care for patients with muscle-invasive bladder cancer, regardless of cisplatin eligibility. Bladder cancer is diagnosed in more than 614,000 patients each year globally, including an estimated 85,000 in the U.S. MIBC represents approximately 30% of all these bladder cancer cases. The positive topline results we shared last week from the Phase III MagnetisMM-5 study of Elrexfio represent a meaningful step toward our goal of reaching more patients earlier in the course of their disease. In this study, Elrexfio significantly improved progression-free survival for double-class exposed patients with relapsed or refractory multiple myeloma who received at least one prior line of treatment. This is a significant opportunity to address patient need. Multiple myeloma, an aggressive and currently incurable blood cancer, is the second most common type of blood cancer worldwide with over 36,000 new cases each year in the United States and over 187,000 new cases globally. During the quarter, we also shared randomized Phase II data for atirmociclib, our potential first-in-class CDK4 inhibitor, in patients with HR+/HER2-negative breast cancer who received prior CDK4/6 inhibitor-based treatment. These data suggest that atirmociclib has the potential to differentiate from the CDK4/6 inhibitor class with improved efficacy and tolerability, reinforcing our confidence in the molecule. Looking ahead, we remain focused on accelerating this investigational medicine's development in first-line and early breast cancer, where it may provide even greater impact for patients. We view this as an important opportunity to deliver a next-generation backbone therapy, building on Pfizer's long commitment to patients with breast cancer. In vaccines, we have been working with regulators on the pathway for expanding coverage through our next-generation pneumococcal conjugate vaccine to extend our leadership in this competitive space. Yesterday, we initiated our Phase III program for our 25-valent pediatric vaccine candidate with increased valency and next-generation serotype 3 technology. I'm also pleased to provide an update on our strategy in the adult market. We have decided to advance directly to our fifth-generation adult vaccine candidate. And, today, I am proud to share for the first time that it includes coverage for 35 serotypes. We believe this gives us the strongest opportunity to maintain our current market leadership in the adult market over the long term, and we expect to enter clinical development this year. In I&I, we announced a positive readout in March from a Phase II trial of tilrekimig, our investigational trispecific antibody, in atopic dermatitis. We intend to advance a broad clinical development program for this investigational medicine, which was discovered in-house at Pfizer and is currently being evaluated in atopic dermatitis and also in asthma and COPD. We remain on track with our commitment and our continued focus on what matters most: maximizing the long-term value of our pipeline for patients and shareholders. We are investing with strategic discipline and focus to build a foundation supporting our aim of high single-digit five-year revenue CAGR. It's vital that our R&D organization has the resources to advance our robust pipeline, including both internally discovered programs and opportunities we have added through strategic moves such as our acquisition of Metsera and our in-licensing agreements with 3SBio and YaoPharma. Our commercial teams are the leaders in translating scientific progress into real-world impact. We are furthering investments to provide them with capabilities, technology and support helping our medicines reach the right patients at the right time so we can deliver sustained value. We also remain deeply committed to our shareholders. We intend to maintain and, over time, grow our dividend as we continue to delever and build long-term value. Embedding the use of artificial intelligence across our company is a key strategic priority, and we are driving continued progress in R&D, commercial, manufacturing and core enterprise functions. We are empowering our colleagues to accelerate innovation by pairing frontier AI tools, tailored to function and role, with comprehensive and continuously updated training. One of the areas where we see the most substantial promise is the discovery, development and delivery of new medicines and vaccines. Leveraging the power of AI to compress timelines and improve decision-making is central to our innovation strategy. We are embedding AI into each functional line of R&D. Pfizer has a vast repository of small and large molecule, translational and clinical data and AI is creating the opportunity to unlock insights that could drive a significant impact on how we discover and develop medicines and vaccines. So with that now, I will turn it over to Dave to speak about the financial performance of the company.

Great. Thank you, Albert, and good morning. Let me begin by highlighting that our strong first-quarter performance reflects the continued disciplined execution across our strategic priorities, and importantly, continued progress in repositioning the company for sustainable growth. We are making targeted investments today to drive revenue growth later in the decade and beyond. Looking ahead, Pfizer is entering a new phase. Our launched and acquired products, combined with the strengthening pipeline, are positioning the company with the ability to deliver growth towards the end of the decade. While we remain focused on managing near-term loss of exclusivity headwinds, we are actively building the foundation for durable long-term value creation. And with that as context, I'll review our first quarter results, discuss our capital allocation priorities, and conclude with an update on our '26 guidance, which we are reaffirming today. In the first quarter of '26, revenues were $14.5 billion, exceeding our expectations and representing an operational increase of 2%. Excluding our COVID products, the underlying business delivered approximately 7% operational revenue growth, reflecting solid demand across key brands and continued strong commercial execution. On the bottom line, first quarter reported diluted earnings per share was $0.47, and adjusted diluted earnings per share was $0.75, also exceeding our expectations. In addition to our strong revenue, this outperformance also reflects our ongoing commitment to managing our cost base and to drive productivity across the organization. Our results this quarter demonstrate the effectiveness of our refined commercial strategy. We saw solid contributions across our product portfolio, primarily driven by Padcev, Eliquis, Nurtec, Lorbrena and the Vyndaqel family, each reflecting focused execution in our key therapeutic areas. Our launch and acquired products delivered $3.1 billion in the first quarter revenues and grew by approximately 22% operationally. These results demonstrate the early impact of our portfolio transition and our investment strategies. We continue to invest behind these product groups to support their growth, which we expect will enable the company to partially offset upcoming LOE headwinds over the next several years. Adjusted gross margin for the first quarter was approximately 76%, primarily the result of product mix during the quarter and ongoing cost control measures. I do want to note, accrued royalty expense was higher this quarter and dampened gross margin compared to the first quarter of last year. With that said, strong cost management across our manufacturing footprint remains a top priority. As a reminder, over the past several years, our adjusted gross margins have generally remained in the mid-to-upper 70s when excluding Comirnaty, which is a 50-50 profit split with our partner BioNTech. We continue to expect approximately $700 million in savings from Phase I of our manufacturing optimization program this year with approximately $175 million realized in this quarter. Total adjusted operating expenses were $5.5 billion for the first quarter of '26, an increase of 4% operationally versus the first quarter of last year. And now looking at the components. Adjusted SI&A expenses decreased 5% operationally, primarily reflecting lower marketing and promotional spending on various products from more targeted investments and ongoing productivity improvements, as well as lower spending in corporate enabling functions. Adjusted R&D expenses increased 11% operationally, primarily driven by an increase in spending in certain oncology and obesity product candidates. First quarter 2026 adjusted operating margin was strong at 38% and above pre-pandemic levels, demonstrating effective cost management as well as revenue performance. We have already made meaningful progress on our productivity initiatives and remain on track to deliver the majority of the anticipated $7.2 billion in total net cost savings by the end of '26. And looking ahead, we will continue to identify opportunities to further enhance efficiencies while prioritizing investments that support future growth. Turning to the bottom line. Q1 reported diluted earnings per share again was $0.47, and our adjusted diluted earnings per share was $0.75, which benefited from our strong non-COVID revenue and efficient operating structure. Now with that, let me turn to our capital allocation strategy. Our strategy is designed to enhance long-term shareholder value while preserving flexibility. It includes reinvesting in the business at appropriate returns, maintaining and over time growing our dividend and preserving optionality for future value-enhancing actions, including share repurchases. In Q1, we invested $2.5 billion in internal R&D, returned $2.4 billion to shareholders via the quarterly dividend and our completed business development activity was minimal. We closed on the sale of our stake in ViiV in the second quarter, providing us with approximately $1.65 billion in net proceeds, after taxes and customary closing costs. Our BD capacity, when including the ViiV proceeds, is approximately $7 billion. First quarter '26 operating cash flow was $2.6 billion and leverage ended the quarter at approximately 2.8x. And as just a reminder, given the LOE headwinds over the next few years, we expect leverage to remain around the current levels or even slightly higher through the transition period. I will also mention that we made our final TCJA repatriation tax payment of approximately $2.6 billion in April. Based on our performance to date and continued execution, we are reaffirming our full year '26 guidance today. We continue to expect total company revenues in the range of $59.5 billion to $62.5 billion and adjusted diluted earnings per share in the range of $2.80 to $3 a share. This outlook reflects our expectation of strong contributions across our product portfolio, adjusted gross margins in the mid-70s range, disciplined cost management and continued investments to support growth by the end of this decade. As a reminder, sustained low disease levels of COVID will likely continue to weigh on Paxlovid utilization over the next several months. And additionally, our plan assumes that the majority of Comirnaty sales will occur towards the end of the year and consistent with the vaccination season. And as always, we continue to monitor currency fluctuation as the year progresses. In closing, over the next several years, our focus remains on investing in key assets while managing upcoming LOE events, primarily from this year through 2028. As we look towards the end of the decade, growth is expected to be driven by our advancing R&D pipeline and the continued progress of our launched and acquired products. Following the Vyndamax settlement, we now have a clear line of sight to a high single-digit five-year revenue CAGR post-2028. Furthermore, this event, combined with our legal win in the Belgium court regarding the EU Comirnaty contract will enhance our cash flow post-2028. We continue to position Pfizer for durable long-term growth and shareholder value. And with that, I'll now turn the call back over to Albert to begin the Q&A session.

Thanks, Dave. Nice quarter. Now operator, please assemble the queue.

Operator instructions. And our first question today comes from Vamil Divan with Guggenheim.

I'll keep it to one. I think a lot of focus on the upcoming ADA meeting. Just curious if you can clarify exactly what we should expect to see. I know we obviously see VESPER-3, but any other data that we should expect from a Pfizer perspective? And I think hosting an investor event in conjunction with ADA. So curious if there's any other details you can share around that?

So Chris, the question is for you. How much of the data are we going to disclose at the ADA?

Thank you very much for the question. It's obviously a very important program. We're excited with the progress. And since the close of Metsera, as you know, we had exceptional execution, not only in the clinical development, but also on the commercial development side as well as CMC and in pharmaceutical sciences and devices. Detailed data from VESPER-3 will be shared; the topline data we presented last time at the 4Q '25 earnings. Data from VESPER-1, the open-label extension, will be shared as well as data from VESPER-2, which is weekly danuglipron, our new name for the GLP-1, with or without titration in participants with type 2 diabetes will be shared. We will not share at ADA yet data on amylin monotherapy. We expect 24-week monotherapy and 28-week combination data with the amylin and GLP-1 to be shared in the second half of this year.

Our next question comes from Dave Risinger with Leerink Partners.

So my questions are on your oncology readouts this year that could move the needle for the company. Could you comment on your expectations for SV and mevrometostat pivotal readouts this year? And then separately, if you could please provide an update on your restructuring of corporate strategy and business development operations at the company?

Thank you very much, Dave. Let me take the second one and then Chris will address the SV and mevrometostat. We did some changes in our organizational structure that are aligned with our constant effort to simplify. We have reduced the members of my executive team by four over the last two years. So the business development moved under Chris Boshoff because most of the business development today is related to R&D pipeline and choices. We see significant improvement in any friction that could exist and how smoothly things can work by doing that. We also moved the commercial development, which is all the commercial strategies, into the global marketing organization. And that creates also a significant amount of synergies by having global market strategy for new products and for our established products. Alexandre took over the responsibility to manage the portfolio management team. He's focusing on prioritizing the pipeline. And then the strategy group moved to my Chief of Staff, in the office of the CEO, where I can have better supervision. So these are the changes that happened in our organization. And we feel that they are consistent with everything we were planning, which is simplification of our business.

Thank you very much. So to start with SV, it's an important program for us. Integrin αvβ6 is a highly differentiated target overexpressed in a high percentage of lung cancers and minimally expressed in normal lung tissue. We were encouraged by the Phase I data we shared, albeit a single-arm experience with a median overall survival of approximately 16.3 months. The second-line study, just a reminder, is focused on non-squamous based on the signals we've seen and is a Phase III study against docetaxel. The study is statistically powered; should it be positive for overall survival, it will also be clinically meaningful. Just a reminder, we also have an ongoing Phase III trial in the TPS-high population, TPS greater than 50, and data will be shared at ASCO from the Phase I experience. This is pembrolizumab versus pembrolizumab plus SV. A reminder that last year, we shared data for that combination in PD-L1-high in a small cohort of patients; all of those responded in that population. For mevrometostat, again, an important differentiated, highly specific EZH2 inhibitor. The first study that will read out is MEVPRO-1, which is in patients post-abiraterone in a setting of significant unmet need, and it compares enzalutamide plus EZH2 inhibitor versus physician's choice of enzalutamide or docetaxel. That should read out in the middle or second half of this year.

Our next question comes from Chris Schott with JPMorgan.

Maybe two for me. First, maybe for Dave or the broader team. I know you typically don't raise guidance with 1Q, but this seems like a very solid start to the year from a revenue perspective. Can you just talk generally about the business trends versus your expectations and just how you're thinking about the year progressing from here? And then second question for me was on BD capacity. You mentioned $7 billion. Given the Vyndamax clarity, could the company look at larger transactions if the right deal were to present itself? Or is the focus still much more on the internal pipeline and maybe small tuck-ins from here?

Yes. Chris, Dave here. Thank you. Yes, I think to your first question, the company is off to a really solid start in Q1. If you look up and down and across the board from a product perspective, we exceeded expectations on top line and bottom line with very strong cost control and disciplined execution. So yes, we're setting ourselves up well for delivery for the balance of the year. As you well know, Chris, I have a philosophy of not adjusting guidance in Q1. If you look at our COVID franchise, it will always be back-half weighted because of the seasonality. So we have, if anything, de-risked delivery on that without raising guidance. So absent COVID seasonality, we might be raising guidance. On your BD question, as I said, we do have about $7 billion in BD capacity. This legal development actually gives us more confidence in our cash flow delivery over the next several years. We constantly evaluate business development and understand what is appropriate strategically to support the needs of the company and deliver long-term value.

Our next question comes from Kerry Holford with Berenberg.

Just on Comirnaty, can you talk a little bit more about the vaccination rates you're expecting this year within the U.S. and international regions? And then coming back to the international region, can you talk a bit more about the existing European contracts, remind us of those existing phase payments, and in the context of that recent Belgian court decision, how should we think about the evolution of ex-U.S. sales for that vaccine?

Okay. Let's start with international, and then Alexandre and Aamir will speak about vaccination rates in the U.S.

Yes, good question. To put it in context, the decline that you see in Q1 on Comirnaty has nothing to do with vaccination rates. It's really the effect of last year. We shipped the last contract elements of our contract with the U.K., so we don't have that contract anymore in 2026, and that's why you have a reduction. But that reduction doesn't reflect current vaccination rates. Vaccination numbers in Europe in 2025 were mostly stable versus 2024. Of course, there are differences by country: for instance, in France, the vaccination rate is around 25% in adults; in Spain, it's around 35%. Those rates are stable, and we see governments' willingness to continue to invest and increase awareness for their older and at-risk populations to get vaccinated. In 2026, we will work with those governments across the European Union to continue to execute our contracts the same way we did in previous years. Now with regard to the legal case and the court judgment on April 1, 2026, the court judgment is very clear, and we've started to work with the governments in Poland and Romania to execute the judgment and we're discussing the best path forward to implement that judgment.

Thank you, Alexandre. Aamir, what about the U.S.?

Vaccination rates in the U.S. obviously differ by segment. For COVID with Comirnaty, there was a narrowing of the label, so we did see a shrinking of that market a bit. In the case of RSV, we are now past our third season and it's tougher to activate the adult population, but we're growing in the maternal space and there are population dynamics with infants and adults. So we see ups and downs in vaccination rates as a result of those dynamics. But I feel very good and very confident about the way we're executing in that market. If you look at our positions, Prevnar is more than 60% share, Comirnaty more than 60%, Abrysvo now at 84% and Prevnar adult, even after many months of competition from Merck, is holding steady at 70%. So I feel very good about the way that we're executing in a slightly turbulent market.

Our next question comes from Umer Raffat with Evercore ISI.

I appreciate some of the comments you made around maintaining the dividend. I wanted to approach it from two angles. First, what's the likelihood that Pfizer entertains a transformative M&A in the near or medium term, which could end up impacting the dividend as we've seen in the past? And secondly, Albert, how are you personally and how is the Board thinking about your tenure at Pfizer and how it ties to dividend integrity beyond?

We never say never, and we always look at any potential business combination for M&A. If you are asking whether right now we plan to pursue something very large, a mega merger, the answer is no. We think that in the next few years it's the time to execute on AI transformation across our organization, and that does not require a disruptive mega merger. So we are open to everything and we look at anything that can create shareholder value, but it is not currently high on our list to pursue something very large. On my tenure, I see it continuing. I have said multiple times that I was very proud of what we were able to achieve with COVID. But being satisfied with past achievements makes you want to do it again. I'm planning to continue to lead and to pursue additional impact in areas like cancer, obesity and vaccines.

Our next question comes from Asad Haider with Goldman Sachs.

Albert, just going back to last December's guidance call, you highlighted $17 billion of annual revenue impacted by LOEs by 2030. Now with the Vyndamax patent settlement extending exclusivity to mid-2031, and your comments aiming for high single-digit five-year revenue growth starting in 2029, could you double-click on that a bit more? Looking at the pipeline and the current BD aperture you described, level set us on updated thoughts on the levers to drive this growth against the stacked LOEs. And related, embedded in this high single-digit CAGR, what are the assumptions around your base business such as COVID and the current oncology products?

It is easier to forecast the base business because it's more constant, and it follows the normal trend we expect on a product-by-product basis. The LOEs are also easier to predict because they are events with certainty. With this roughly 2.5-year delay of the LOE for a product at more than $6 billion, it provides significant opportunity for cash flow, EPS and changes the growth profile. That's why we're speaking about our expectation to start a five-year high single-digit CAGR in 2029. That projection is built with the current portfolio, the declines from LOEs and the additions from the pipeline that are heavily risk-adjusted. We're not assuming binary outcomes; the pipeline includes many assets, and risk adjustment accounts for failures and successes. I'm confident about the growth trajectory starting in 2029 because when you have a larger number of risk-adjusted assets, statistics favor predictable uplift: some fail and some succeed, and the risk adjustments account for that. We are also already navigating LOEs well, as you can see this year. Our strategy for LOEs has been to rely on launched and acquired products to offset them. Those new and acquired products are growing 22% this year and generated $3.1 billion in the quarter. If you annualize that run rate, you can see significant contribution. With the updated timing of LOEs, the $17 billion estimate is now more like $14 to $15 billion rather than $17 billion, which I think is manageable.

Our next question comes from Evan Seigerman with BMO Capital Markets.

I want to touch on capital deployment, specifically share repurchases. Dave, I know that's been a method you'd like to employ. Now with clarity on Vyndamax and the CAGR post-2028, what else do you need to see to potentially start buying back shares, especially at these levels?

Yes, Evan, great question. We always look at our capital allocation strategy as a balance between reinvesting in the business, paying the dividend, and share repurchases. At the moment, our focus is on investing in our R&D platform and on business development to drive long-term value. The development in these court cases gives us a bit more confidence in our cash flow over time, so share repurchases will come back into greater consideration going forward. We'll continue to evaluate what's best for the company and shareholders over the long term.

Our next question comes from Courtney Breen with Bernstein.

I wanted to probe a bit more on sigtolimod vedotin and positioning in that frontline setting, all-comers, relative to the Symbiotic-Lung-01 study that you've already started with the PD-1 plus VEGF combination. I also note you have a Phase I/II running combining these two assets. Can you help contextualize that new Phase III all-comers trial you intend to start this year for SV in first-line and how that may be positioned relative to Symbiotic-Lung-01?

Chris?

Thank you. Lung cancer is a significant unmet need and having multiple differentiated approaches gives us confidence we can play an important role beyond targeted therapies. For SV, we are encouraged by the data for the combination of pembrolizumab plus SV in the PD-L1-high population, where the small cohort we tested had high response rates. The ongoing Phase III study of pembrolizumab versus pembrolizumab plus SV in the first-line setting is recruiting well and we are confident in the potential for a positive readout. The second-line study versus docetaxel is expected to read out midyear and is powered for overall survival. If positive, it would be clinically meaningful. We are also planning broader population studies in combination with chemotherapy plus pembrolizumab and will share early combination data later this year. Regarding the VEGF-targeted program, at ASCO we will share Phase II data of the VEGF agent monotherapy in first-line PD-L1-expressing non-small cell lung cancer. We recently presented data at AACR supporting the preclinical and early data generated previously, and we believe this is a differentiated VEGF-targeting molecule with high affinity for VEGF compared with existing agents. We will share more data later this year and plan a broad program including combinations with chemotherapy. Also at ASCO we will share data for the VEGF agent plus chemo in first-line advanced recurrent endometrial cancer, another program for which we plan a Phase III.

Our final question comes from Louise Chen with Scotiabank.

Which key products do you think will drive the reacceleration of your growth in 2029 and beyond? And regarding the international obesity opportunity, what have you learned from the launch of your GLP-1 in China?

Alexandre, let's start with international and the China launch, and then Aamir can speak to U.S. drivers for growth in '29.

Good question on the ecnoglutide launch in China. It's very early; we launched just last week, so it's too early to comment on penetration. But what's interesting is the incidence of chronic overweight and obesity in China is quite high—about 15% of the population. Given China's population size, that makes it one of the larger markets for chronic weight management. That's why we pursued a collaboration with Hangzhou Sciwind Biosciences for commercialization of ecnoglutide in China. Since then, we obtained approval and launched the asset. Ecnoglutide has a compelling profile; in a placebo-controlled study it demonstrated 15.1% weight loss at 48 weeks, which is on par with leading GLP-1s. With its mechanism and tolerability profile, we believe we are bringing to market a very effective asset. We'll leverage our strong primary care capabilities in China, which position Pfizer China well in primary care. The combination of an attractive clinical profile and our capabilities gives us confidence to be a leader in this category. We're not coming extremely late; Lilly introduced their asset at the beginning of last year, so timing is reasonable. On the broader question of what will drive international growth, if you look at the quarter, our non-COVID primary care grew double-digit and delivered about $2 billion in the quarter. Specialty care, about $1.5 billion, also delivered double-digit growth. There are assets in these areas that will continue to power growth. Vaccines are growing strongly, driven by Prevnar and RSV, and two-thirds of our vaccine business comes from pediatrics. We have a large pediatric population to continue to grow. A substantial part of growth at the end of the decade will come from Metsera access in chronic weight management because this category is underserved and the prevalence of obesity is high globally. Our primary care presence in many markets will allow us to tap into that. Also, obesity treatments can be introduced more rapidly as cash-pay or with faster reimbursement in many markets compared to other categories that face longer reimbursement negotiations. So you see a mix of in-line assets that will continue to power growth and new launches like Metsera that can go straight to market; oncology will contribute but may take longer for reimbursement negotiations.

Thanks, Louise. There are many things giving us confidence about driving growth in the U.S. in '29. First, we have products on the market today with significant upside. For example, Padcev growth has been primarily driven by LAM UC where penetration is high but there is lots of upside in MIBC with EV-303 and EV-304 data and broader label expansion. Nurtec also has tailwind; only about 60% of people who write a triptan have written an oral CGRP, so there's headroom for growth and we're executing well. For large franchises like Vyndaqel/Vyndamax, the additional exclusivity gives us the opportunity to invest and grow diagnosis and new patient starts, and we are defending and expanding our patient base. Complementing that, obesity is a major new growth area. We have unique capabilities to win there, including ways to activate consumers and patients and established relationships with physicians—almost 60% of physicians who will write these products we touch today. These combinations—existing product upside, strong franchises, and new launches like obesity—are examples of what gives us confidence for growth in '29 and beyond.

Thank you, everyone, for your attention. Our strong performance in the quarter reflects the impact of our continued focus and disciplined execution. We are engaging with precision to maximize the value of our commercial portfolio, and we are seeing the results in our financial performance. In R&D, we are making meaningful progress with a robust slate of critical milestones ahead in 2026 that we believe will further demonstrate the strength and breadth of our pipeline. I want to thank my Pfizer team. I believe we have the best team Pfizer has ever had. They are dedicated to our purpose, continue to deliver and embrace our commitment to creating long-term value for patients and for our shareholders. Thank you for joining the call today, and thank you for your interest in Pfizer. We look forward to sharing further updates as we execute our priorities throughout the year.

Thank you. This brings us to the end of today's meeting. We appreciate your time and participation. You may now disconnect.