Syros Pharmaceuticals Presents New Data Demonstrating Significant Anti-Tumor Activity of its Selective CDK7 Inhibitor in Preclinical Models of Acute Myeloid Leukemia

On April 20, 2016 Syros Pharmaceuticals reported that SY-1365, a first-in-class potent and selective cyclin-dependent kinase 7 (CDK7) inhibitor, was observed to induce durable tumor regression and prolong survival in in vivo models of acute myeloid leukemia (AML) (Press release, Syros Pharmaceuticals, APR 20, 2016, View Source [SID:1234511184]). These data were presented at the American Association of Cancer Research (AACR) (Free AACR Whitepaper) Annual Meeting in New Orleans. Based on the strong efficacy and safety data, Syros selected SY-1365 as its development candidate and plans to file an Investigational New Drug (IND) application with the U.S. Food and Drug Administration in the second half of 2016 with the goal of initiating a Phase 1/2 clinical study in acute leukemia in the first half of 2017.

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"Up until now, creating medicines to control important disease causing transcription factors has been a major challenge in cancer drug development. SY-1365, our first-in-class CDK7 inhibitor, highlights the potential of our pioneering platform to produce drugs that can selectively modulate these transcription factors," said Nancy Simonian, M.D., Chief Executive of Syros. "Certain hematologic and solid tumor cancers, including AML, are dependent on transcription factors for their growth and survival and have been shown to be particularly dependent on CDK7. Results from preclinical studies demonstrate that SY- 1365 lowers the levels of these disease causing transcription factors and, in so doing, may treat diseases that have eluded other genomics-based approaches and provide a profound and durable benefit for patients with these difficult-to-treat cancers."

In the preclinical studies presented at AACR (Free AACR Whitepaper), SY-1365 was observed to preferentially kill cancer cells over non-cancerous cells and significantly prolong survival in patient-derived xenograft (PDX) models of AML. In the in vitro and in vivo studies, SY-1365 induced:

Tumor regression in 100 percent of treated mice in a cell-line derived xenograft model of AML; tumor regression was maintained through the end of the 38-day study.

Strong survival benefit, with 80 percent of treated mice alive at the end of the 8- week study in a PDX model of treatment-resistant AML; by contrast, none of the untreated mice survived beyond 4-1/2 weeks.

Rapid and dose-dependent apoptosis in AML cell lines treated with SY-1365 while having little to no effect on non-cancerous cells.
Potent and selective inhibition of CDK7, with only six other kinases, none of which are in the CDK family, exhibiting greater than 90 percent binding when profiled across a panel of 468 kinases at a concentration of 1μM.

Minimal effect on blood cell counts in in vivo models, including white blood cells, lymphocytes, neutrophils and reticulocytes, demonstrating a more favorable profile than a non-selective CDK inhibitor.

Reduced expression of cancer-contributing genes associated with specialized regulatory regions of DNA known as super-enhancers, including transcription factors and the oncogenes MYB and MYC, in an AML cell line.

Synergistic activity when combined with other targeted agents in AML, including Flt3, Bcl-2 and pan-Brd inhibitors.

Syros’ selective CDK7 inhibitors, including SY-1365, have been observed to delay tumor progression in additional in vivo models of transcriptionally addicted cancers, including acute lymphoblastic leukemia (ALL), MYCN-amplified neuroblastoma, small cell lung cancer and triple negative breast cancer.

Complementary dynamic BH3 profiles predict co-operativity between the multi-kinase inhibitor TG02 and the BH3 mimetic ABT-199 in acute myeloid leukaemia cells.

Direct co-operation between sensitiser molecules BAD and NOXA in mediating apoptosis suggests that therapeutic agents which sensitise to BAD may complement agents which sensitise to NOXA. Dynamic BH3 profiling is a novel methodology that we have applied to the measurement of complementarity between sensitiser BH3 peptide mimetics and therapeutic agents. Using dynamic BH3 profiling, we show that the agent TG02, which downregulates MCL-1, sensitises to the BCL-2-inhibitory BAD-BH3 peptide, whereas the BCL-2 antagonist ABT-199 sensitises to MCL-1 inhibitory NOXA-BH3 peptide in acute myeloid leukaemia (AML) cells. At the concentrations used, the peptides did not trigger mitochondrial outer membrane permeabilisation in their own right, but primed cells to release Cytochrome C in the presence of an appropriate trigger of a complementary pathway. In KG-1a cells TG02 and ABT-199 synergised to induce apoptosis. In heterogeneous AML patient samples we noted a range of sensitivities to the two agents. Although some individual samples markedly favoured one agent or the other, in the group as a whole the combination of TG02 + ABT-199 was significantly more cytotoxic than either agent individually. We conclude that dynamic NOXA and BAD BH3 profiling is a sensitive methodology for investigating molecular pathways of drug action and complementary mechanisms of chemoresponsiveness.

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TH-302 in Combination with Radiotherapy Enhances the Therapeutic Outcome and Is Associated with Pretreatment [18F]HX4 Hypoxia PET Imaging.

Conventional anticancer treatments are often impaired by the presence of hypoxia. TH-302 selectively targets hypoxic tumor regions, where it is converted into a cytotoxic agent. This study assessed the efficacy of the combination treatment of TH-302 and radiotherapy in two preclinical tumor models. The effect of oxygen modification on the combination treatment was evaluated and the effect of TH-302 on the hypoxic fraction (HF) was monitored using [(18)F]HX4-PET imaging and pimonidazole IHC stainings.
Rhabdomyosarcoma R1 and H460 NSCLC tumor-bearing animals were treated with TH-302 and radiotherapy (8 Gy, single dose). The tumor oxygenation status was altered by exposing animals to carbogen (95% oxygen) and nicotinamide, 21% or 7% oxygen breathing during the course of the treatment. Tumor growth and treatment toxicity were monitored until the tumor reached four times its start volume (T4×SV).
Both tumor models showed a growth delay after TH-302 treatment, which further increased when combined with radiotherapy (enhancement ratio rhabdomyosarcoma 1.23; H460 1.49). TH-302 decreases the HF in both models, consistent with its hypoxia-targeting mechanism of action. Treatment efficacy was dependent on tumor oxygenation; increasing the tumor oxygen status abolished the effect of TH-302, whereas enhancing the HF enlarged TH-302’s therapeutic effect. An association was observed in rhabdomyosarcoma tumors between the pretreatment HF as measured by [(18)F]HX4-PET imaging and the T4×SV.
The combination of TH-302 and radiotherapy is promising and warrants clinical testing, preferably guided by the companion biomarker [(18)F]HX4 hypoxia PET imaging for patient selection.
©2015 American Association for Cancer Research (AACR) (Free AACR Whitepaper).

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Development of engineered T cells expressing a chimeric CD16-CD3ζ receptor to improve the clinical efficacy of mogamulizumab therapy against adult T cell leukemia.

Mogamulizumab (Mog), a humanized anti-CC chemokine receptor 4 (CCR4) monoclonal antibody (mAb) that mediates antibody-dependent cellular cytotoxicity (ADCC) using FcγR IIIa (CD16)-expressing effector cells, has recently been approved for treatment of CCR4-positive adult T-cell leukemia (ATL) in Japan. However, Mog failure has sometimes been observed in patients who have accompanying chemotherapy-associated lymphocytopenia. In this study, we examined whether adoptive transfer of artificial ADCC effector cells combined with Mog would overcome this drawback.
We lentivirally gene-modified peripheral blood T cells from healthy volunteers and ATL patients expressing the affinity-increased chimeric CD16-CD3ζ receptor (cCD16ζ-T cells). Subsequently we examined the ADCC effect mediated by those cCD16ζ-T cells in the presence of Mog against ATL tumor cells both in vitro and in vivo.
cCD16ζ-T cells derived from healthy donors killed in vitro Mog-opsonized ATL cell line cells (n=7) and primary ATL cells (n=4) depending on both the number of effector cells and the dose of the antibody. cCD16ζ-T cells generated from ATL patients (n=3) also exerted cytocidal activity in vitro against Mog-opsonized autologous ATL cells. Using both intravenously disseminated model (n=5) and subcutaneously inoculated model (n=4), co-administration of Mog and human cCD16ζ-T cells successfully suppressed tumor growth in xenografted immunodeficient mice, and significantly prolonged their survival (p<0.01 and p=0.02, respectively).
These data strongly suggest clinical feasibility of the novel combined adoptive immunotherapy using cCD16ζ-T cells and Mog for treatment of aggressive ATL, particularly in patients who are ineligible for allo-HSCT.
Copyright ©2016, American Association for Cancer Research (AACR) (Free AACR Whitepaper).

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Juno’s Investigational CAR T Cell Product Candidates JCAR018 and JTCR016 Demonstrate Encouraging Clinical Responses in Patients with B-Cell and Mesothelioma Cancers

On April 20, 2016 Juno Therapeutics, Inc. (NASDAQ: JUNO), a biopharmaceutical company focused on re-engaging the body’s immune system to revolutionize the treatment of cancer, reported, in partnership with its collaborators, early clinical data from two oral presentations for two product candidates at the American Association for Cancer Research (AACR) (Free AACR Whitepaper) Annual Meeting 2016 in New Orleans, Louisiana (Press release, Juno, APR 20, 2016, View Source;p=RssLanding&cat=news&id=2158810 [SID:1234511172]).

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JCAR018 is a chimeric antigen receptor (CAR) T cell product candidate targeting CD22, and had data from a Phase I trial in pediatric and young adult patients with relapsed or refractory B-cell acute lymphoblastic leukemia (r/r ALL). JTCR016, a T cell receptor (TCR) cell product candidate targeting Wilms tumor-1 (WT-1), had data from a Phase I trial in patients with acute myelogenous leukemia (AML) at high risk of relapse following an allogeneic hematopoietic stem cell transplant and patients with either mesothelioma or non-small cell lung cancer.

"As we advance our CD19-directed portfolio, we are encouraged by the early signs of clinical activity from product candidates against different targets," said Mark J. Gilbert, M.D., Juno’s Chief Medical Officer. "The data from JCAR018 suggest two paths to improve outcomes – use in patients with CD19 negative disease and a combination of CD19 and CD22 to decrease the risk of resistant cells and increase the percentage of patients that demonstrate a long-term durable remission in B cell malignancies. Additionally, JTCR016 continues to show an encouraging safety profile and signals of clinical activity, including evidence of tumor reduction as well as significant T cell expansion and persistence in a patient with mesothelioma."

In an oral presentation on Monday, April 18, 2016, Terry J. Fry, M.D., Investigator, Pediatric Oncology Branch and Head of Hematologic Malignancies Section, National Cancer Institute, National Institutes of Health, presented "CD22 CAR Update and Novel Mechanisms of Leukemic Resistance." Dr. Fry reported on CD22-directed CAR T cell therapy (JCAR018) in pediatric and young adult patients with r/r B-cell ALL. Key takeaways include:

Data from nine enrolled and treated patients were reported in this Phase I dose-escalation trial. (JCAR018; Clinical Trials Identifier: NCT02315612).

As previously reported at the American Society of Hematology (ASH) (Free ASH Whitepaper) meeting in December 2015, six patients were treated at the lowest dose, with one patient achieving a complete remission (CR) and complete molecular remission as measured by flow cytometry (CmR). This patient relapsed after three months.

Three patients have enrolled at dose level 2 (1 x 106 cells/kg), which is in the dose range of CD19-directed CAR T programs. All three patients achieved a CR and CmR. These patients remain in complete remission with follow-up ranging from 3 to 6 months.
The complete remissions have been seen in both patients naïve to CAR T therapies as well as those with CD19 negative relapse after prior CD19-directed CAR T therapy.

Limited cytokine release syndrome (CRS) was seen at dose level 2, with two patients at Grade 1 and one patient at Grade 2. No severe neurotoxicity was observed in these treatment cohorts. Dose limiting toxicity was observed at higher doses, so dosing continues at dose level 2 (1 x 106 cells/kg).

In an oral presentation on Wednesday, April 20, 2016, Phil Greenberg, M.D., Head of Program in Immunology at the Fred Hutchinson Cancer Research Center and Professor, Medicine/Oncology and Immunology, University of Washington, presented "Targeting Cancer with Engineered T Cells." Dr. Greenberg reported on WT-1 TCR cell therapy (JTCR016) in refractory mesothelioma and AML. Key takeaways include:

In a Phase I/II study designed to evaluate genetically modified T cells targeting WT-1 in WT-1-expressing non-small cell lung cancer (NSCLC) and mesothelioma using a WT-1-specific T-cell receptor, WT-1 TCR (JTCR016; Clinical Trials Identifier: NCT02408016), there have been five patients enrolled.

Three patients have been treated to date. Preliminary data show one mesothelioma patient with an ongoing partial response to the WT-1 TCR and one with stable disease. The responses appear to correlate with the pharmacokinetics of the engineered T cells, as the patient with the partial response had the best T cell expansion and persistence. The patient had progressed after multiple therapies, including chemotherapy and radiation, prior to receiving JTCR016.

JTCR016 was generally well-tolerated in these three patients, with no evidence of severe CRS or severe neurotoxicity.
In a Phase I dose-escalation trial in patients with AML following allogeneic hematopoietic stem cell transplantation, 11 patients with no measurable disease but at high risk of relapse have been treated to date. JTCR016 continues to be relatively well-tolerated with prolonged persistence of the engineered T cells and no relapses to date.

This AACR (Free AACR Whitepaper) 2016 Major Symposium presentation also highlighted encouraging pre-clinical data from a mesothelin-directed TCR for the treatment of pancreatic cancer, demonstrating the potential of these therapies in treating solid tumors, and next-generation strategies to make these T cells more potent.

About Juno’s Chimeric Antigen Receptor (CAR) and T Cell Receptor (TCR) Technologies
Juno’s CAR and TCR technologies genetically engineer T cells to recognize and kill cancer cells. Juno’s CAR T cell technology inserts a gene for a particular CAR into the T cell, enabling it to recognize cancer cells based on the expression of a specific protein located on the cell surface. Juno’s TCR technology provides the T cells with a specific T cell receptor to recognize protein fragments derived from either the surface or inside the cell. When either type of engineered T cell engages the target protein on the cancer cell, it initiates a cell-killing response against the cancer cell. JCAR018 and JTCR016 are investigational product candidates and their safety and efficacy have not been established.