The Geron Turnaround Could Start Next Quarter

Trying to call a bottom in what has been the most disappointing biotech stock of 2025 to me personally.

Word Count: 3,333 words, Reading Time: 15 minutes. Not financial advice, do your own due diligence, for entertainment purposes only.

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Last week, I spent a little time bragging about my good calls of 2025 and doing a summary of each one of my current “Tier 1” (a.k.a favorite) ideas:

High Quality Commercial-Stage Biotech Is Just Getting Started

One idea in there though I felt needed to be expanded further. That idea is Geron GERN 0.00%↑ …you see, while I still believe in Geron’s potential to be a multi-bagger, I was too early before. In January, I wrote this piece when the stock was priced higher:

An Idea I Have Never Written About Before

Ironically, that is probably my best performing headline ever (people love teases!) but the worst return of the single-idea posts I have done. But since I made clear last week I have not given up on Geron I’m going to take another bite at the apple again this week. Here’s why I think Geron, despite their bad not good year, has a LOT of potential upside heading into 2026. (Like 5x to 10x upside if just a few things go right.)

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“LR-MDS” Opportunity

Geron has one approved product currently approved in only one indication. From the FDA label:

RYTELO is an oligonucleotide telomerase inhibitor indicated for the treatment of adult patients with low- to intermediate-1 risk myelodysplastic syndromes (MDS) with transfusion-dependent anemia requiring 4 or more red blood cell units over 8 weeks who have not responded to or have lost response to or are ineligible for erythropoiesis-stimulating agents (ESA).

I never paid much attention to Geron until their approval in low risk myelodysplastic syndromes. There was confusion on if a telomerase inhibitor could be effective, how exactly it was active in certain disease states, and then if the FDA would approve their product after calling an advisory committee to discuss the risk/benefit profile. If you want to stroll down memory lane you can find materials for that meeting here. An archive of the video broadcast is here. Let me paraphrase the last 15 minutes with the committee members votes and rationale (which are worth watching):

Efficacy: Imetelstat (the product now know as RYTELO) did not appear to modify overall survival or response rates positively or negatively. For the patients who responded (roughly 40%) there was a significant improvement in transfusion dependence and quality of life.

Safety: Imetelstat often caused cytopenias which were manageable by hematologists through dose modification. One clinician noted cytopenias happen with all MDS therapies. The medication did not seem to increase the risk of Gr3/4 infection or bleeding.

Other varied comments from the session: LR-MDS patients have few options, the benefits of transfusion independence from the patient perspective, patients could be trialed and then continued based on physician judgment in only the patients that respond, not a curable disease and hard to show survival benefit in a low-risk population due to longer survival timelines.

The vote essentially came down to was benefit/risk ratio of imetelstat’s transfusion independence and quality of life improvements compared to the adverse events it caused. The committee voted 12-2 for yes for approval. The product was approved June 2024.

Even assuming 40% penetration (roughly the rate of patients who will be “responders” to the drug), the LR-MDS market is still sizable. From the newest company slide deck:

In fact, Geron used to put a graph in this presentation noting how only ~5,000 patients on therapy were needed to be a blockbuster ($1 billion in annual sales).

With an annual cost of $340,000, average duration of therapy of around 8 months (in their IMerge trial it was 7.8 months), and allowing for some gross to net discounting that math sounds roughly right to me. So I’m not sure why they took it out but perhaps they want to set investors near term expectations lower so they can overdeliver.

Here is Geron’s quarterly sales so far starting with their first full quarter on market:

Q3 2024: $28.2 million

Q4 2024: $47.5 million

Q1 2025: $39.4 million

Q2 2025: $49 million

The first two quarters of launch were off to a hot start but the Q4 2024 earnings call (which happened on February 26, 2025) was the start of a terrible year for the stock. On that call, the CEO (now departed for the company) warned that new starts of the medication were flattening out during the at the time in-progress Q1 2025. To have new prescription growth starting to flatten out less than 9 months after launch is, to say the least, NOT IDEAL. Management also pushed back the readouts in the myelofibrosis study (which I will cover later) the only clinical catalyst to be excited about. Soon after this ugly call, the long-time CEO John Scarlett departed, an interim CEO was appointed, and the company basically had to completely regroup.

I have a theory that when launches have hiccups it takes 6 months from the complete company reset to start seeing results. It happened with Avadel AVDL 0.00%↑ six months after they started having trouble growing volume, I believe it’s happening with Evolus EOLS 0.00%↑ right now (I can write an article soon if anyone actually wants it), and Geron started their revamp process in March so by next month maybe those changes will begin to bear fruit.

These are the changes the company has put into place. Notable is that Q2 2025 had a 17% QoQ demand increase vs. Q1 2025. A big emphasis on the slide is just getting out into the community and actually educating physicians that 1) RYTELO exists 2) what it does and how safety can be managed 3) presenting case studies of patients in the community it has already helped. In theory this should not be hard. Especially when you consider how concentrated these patients are with higher volume hematologists:

A group of 1,300 HCPs treating ~7,500 patients. A larger group of 6,300 HCPs (including the previous 1,300 HCPs) treat ~12,000 patients. Again, Geron only needs to treat 5,000 patients per year for this drug to be a blockbuster. While not all patients will respond, all patients should certainly be considered for a trial of the medication since there are no predictive biomarkers for response. Finally with the limited agents available, imetelstat should be getting much more use as a second line treatment based on the NCCN guidelines, which would not only lead to more patient starts but longer duration of therapy:

Geron has finally increased the field force by 20% to increase new starts and increased back office support of clinical educators to improve patient retention. They are improving their prescriber targeting and unified messaging as well as beginning a KOL program and regional case study program. If they could achieve 17% QoQ growth before all this was in place, then 17% QoQ growth should be achievable over the next year. That would mean:

Q3 2025: $57.33 million

Q4 2025: $67.07 million

Q1 2025: $78.47 million

Q2 2025: $91.82 million

Now this is very simplified, does not adjust for seasonality, etc. but if Geron exited their second full year of launch on a $360 million annualized run rate in just the LR-MDS indication I would think perception of this company would change meaningfully.

Here are the analyst consensus projections:

For a company with market cap of $912 million these would be exceptionally strong revenue numbers I think. And again, I also think they can exceed consensus in each one of these next four quarters. But when you’re hated as a biotech - you’re hated.

And Geron is hated.

Management has to execute. There is a new permanent CEO in place now. (More on that later and his qualifications.) There is no time to wait and no time for excuses.

They need to grow the top-line at all costs by the second half of 2026 to raise the stock price. Once they accomplish that, there is another EXTREMELY interesting catalyst that can add lighter fuel to the proverbial fire…