On May 29, 2020 Caris Life Sciences, a leading innovator in molecular science focused on fulfilling the promise of precision medicine, reported that it will present results from a study today that characterize KRAS mutations in patients with non-small cell lung cancer (NSCLC) (Press release, Caris Life Sciences, MAY 29, 2020, View Source [SID1234558771]). In this study, the molecular profiles of more than 17,000 patients with NSCLC were evaluated using the Caris Molecular Intelligence platform, which were then classified based on specific types of KRAS mutations using a 592-gene DNA sequencing panel. The study found that KRAS mutations are relatively common in NSCLC and that differences between KRAS mutation subtypes warrant further investigation in how they could guide treatment decisions, including the use of targeted and immuno-oncology drugs.

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Across 17,113 NSCLC patients, KRAS mutations were present in 27% of samples (n=4,706), with KRAS G12C being the most common variant and present in 40% of samples that exhibited a mutation. KRAS G12C was associated with the highest rate of PD-L1 expression. The rate of high tumor mutational burden (TMB) (>10 mutations/MB) was significantly different across KRAS mutation subtypes and was most frequently seen in KRAS G13X (68.3%) and least frequently in G12D (43.2%). KRAS mutations were more commonly seen in adenocarcinoma versus squamous subtype (37.2% vs. 4.4%)

The full results will be presented today during a poster session (Abstract 9544/Poster 310) as part of the American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) 2020 (ASCO20) Virtual Scientific Program. The poster is titled, "Characterization of KRAS mutations (mt) in non-small cell lung cancer (NSCLC)."

In a second study, the molecular profiles of a large cohort of KRAS wild-type (WT) pancreatic tumors were evaluated using DNA sequencing and whole transcriptome sequencing (WTS), which were then classified based on specific types of KRAS mutations using a 592-gene DNA sequencing panel. The study looked to assess the prevalence of alterations that could represent targets for personalized treatment. Researchers found that the use of WTS, in combination with DNA sequencing, identified activated molecular pathways in the majority of KRAS WT tumors, and that these tumors are significantly more enriched with targetable alterations (e.g., BRAF, ALK, ROS1, NRG1, MSI-H) compared to KRAS mutant tumors. These findings suggest a potential benefit of using targeted therapies to treat patients with KRAS WT tumors.

"While KRAS mutations in pancreatic cancer are found in the majority of cases, we used comprehensive molecular profiling to generate crucial information on mutations and transcriptional programs found in KRAS wild-type pancreatic cancer that provide additional opportunities for therapeutic intervention in this cancer type that has a low survival rate and few treatment options," said Philip A. Philip, M.D., Ph.D., FRCP., lead investigator of the study and an oncologist with Barbara Ann Karmanos Cancer Institute at Wayne State University, a member of the Caris Precision Oncology Alliance.

The full results will be presented today during a poster session (Abstract 4629/Poster 237). The poster is titled, "Alterations in targetable molecular pathways are enriched in KRAS wild-type (WT) pancreatic cancer (PC)."

"Our data at ASCO (Free ASCO Whitepaper)20 continue to reinforce the power of molecular profiling and precision medicine technologies in changing the face of cancer treatment," said W. Michael Korn, M.D., Chief Medical Officer at Caris Life Sciences. "The combination of Next-Generation DNA Sequencing and whole transcriptome sequencing is giving clinicians new insights and clearer direction in how they approach non-small cell lung cancer and pancreatic cancer, two particularly difficult-to-treat cancers."

Additional Presentations Provide Key Insight Into The Genetic Profile of Cancer
Caris will present additional data from studies highlighting the distinct molecular landscapes of patients across several cancer types, including mesothelioma and gastroesophageal cancers. Better understanding of a tumor’s genomic landscape and distribution of immune biomarkers has the potential to enable the development of new, novel therapies and can help physicians prescribe the optimal treatment to each patient.

A study, "Genomic Landscape and Immune Phenotype of Malignant Pleural Mesothelioma" (Abstract 9056/Poster 249), found that the majority of mesothelioma tumors harbor at least one alteration in key cellular pathways, with homologous recombination (HR) pathway mutations the most common.
"Molecular correlates of PD-L1 expression in patients (pts) with gastroesophageal (GE) cancers" (Abstract 4558/Poster 166) is the largest study to investigate the distinct molecular landscape of patients with different PD-L1 expression levels in GE cancers. These data can be used by oncologists to bring the right treatment to the right patient and by researchers to develop new combination immunotherapy regiments in GE cancers.
"As we continue to learn more about the molecular landscape of cancer, it is important to study all cancers, including those that are more uncommon and those that have an established treatment paradigm," said Chadi Nabhan, M.D., MBA, FACP, Chairman of the Caris Precision Oncology Alliance. "At Caris, our goal is to work with leading institutions to bring precision medicine to all people living with a cancer diagnosis, so that each patient can receive the best possible therapy for their own distinct cancer."

About the Caris Precision Oncology Alliance
A collaborative and growing network of leading cancer centers that demonstrate a commitment to precision medicine. The Alliance currently comprises 38 academic, hospital and community-based cancer institutions, including 12 NCI-designated Comprehensive Cancer Centers and now includes over 2,200 physicians, spanning more than 440 locations, who provide services for over 350,000 people with cancer each year.

On May 29, 2020 BridgeBio Pharma, Inc. (Nasdaq: BBIO) affiliate QED Therapeutics reported that it will present data at the American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) 2020 Virtual Scientific Program showing clinical advancement for infigratinib, QED’s oral FGFR1-3 inhibitor, in both urothelial carcinoma and cholangiocarcinoma (CCA) (Press release, BridgeBio, MAY 29, 2020, View Source [SID1234576229]).

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Title: Infigratinib (BGJ398) in advanced/unresectable or metastatic urothelial carcinoma demonstrates consistent treatment response in both first-line and later-line treatment settings

Abstract: 5038

Presenter: Yung Lyou, City of Hope Comprehensive Cancer Center

An analysis of response rates in patients with advanced/unresectable or metastatic urothelial carcinoma based on the amount of prior lines of treatment showed consistent response to infigratinib. The objective response rate (ORR) for all patients (n=67) was 25% (95% CI 15.5-37.5), while the ORR for patients receiving infigratinib as first-line treatment (n=13) saw a response rate of 31% (95% CI 9.1-61.4) compared to 24% (95% CI 13.5-37.6) for patients receiving infigratinib as a second-line or later treatment (n=54). All eight patients in the study with upper tract urothelial carcinoma (UTUC) received infigratinib as second-line or later therapy. The response rates were higher for patients with UTUC, with an ORR of 50% (95% CI 15.7–84.3) and a disease control rate of 100%. In the study, treatment emergent adverse events occurring in >30% of patients were: hyperphosphatemia (46%), elevated creatinine (42%), fatigue (37%), constipation (37%), anemia (36%), decreased appetite (33%), dry mouth (31%), and alopecia (31%).

"These findings support the design of the ongoing, placebo-controlled PROOF 302 study to evaluate the efficacy of infigratinib in adjuvant urothelial carcinoma," said author and PROOF 302 trial lead Sumanta Pal, MD, professor of medical oncology and therapeutics research at City of Hope Comprehensive Cancer Center. "The results in upper tract urothelial cancer (UTUC) build upon earlier research that the disease has a different genetic profile than urothelial carcinoma of the bladder, particularly with respect to FGFR3 alterations, and warrants further investigation in an even earlier setting."

Title: A retrospective analysis of post second-line chemotherapy treatment outcomes for patients with advanced or metastatic cholangiocarcinoma and FGFR2 fusions

Abstract: 4591

Presenter: Milind M. Javle, MD Anderson Cancer Center

In a retrospective analysis of a subset of a single-arm Phase 2 study of infigratinib (n=37), outcomes from patients with FGFR-fusion-positive bile duct cancer receiving infigratinib as third- and later-line therapy were compared with the tumor response when those same patients received second-line therapy with chemotherapy. Treatment with infigratinib resulted in progression free survival (PFS) improvements. The median PFS was 6.8 months (95% CI 3.9-7.8 months) for third- and later-line infigratinib treatment compared to 4.6 months (95% CI 2.7-7.2 months) for second-line chemotherapy.

"Through this retrospective analysis, we can see that infigratinib may have potential for patients whose tumors progress after second-line chemotherapy," said Susan Moran, MD, MSCE, chief medical officer for QED. "These data support continued investigation of infigratinib in patients with FGFR-driven cholangiocarcinoma."

On May 29, 2020 Chugai Pharmaceutical Co., Ltd. (TOKYO: 4519) reported that it obtained an approval from the Ministry of Health, Labour and Welfare (MHLW) for expanded use of the genomic mutation analysis program, FoundationOne CDx Cancer Genomic Profile as a companion diagnostic of the Novartis’ investigational MET inhibitor, capmatinib (INC280) for the treatment of unresectable advanced and/or metastatic non-small cell lung cancer (NSCLC) with that leads to MET exon 14 skipping (METex14) (Press release, Chugai, MAY 29, 2020, View Source [SID1234558655]).

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"We are pleased that FoundationOne CDx Cancer Genomic Profile was approved as a companion diagnostic of an investigational MET inhibitor, capmatinib. Since the standard treatment of NSCLC is decided based on whether the cancer has a driver mutation, we believe NSCLC is one of the cancer types that comprehensive genomic profiling can particularly contribute to its treatment decision," said, Dr. Osamu Okuda, Chugai’s President and COO. "By continuing to collaborate with many biopharma partners, we will expand the companion diagnostic functions and are committed to working toward the realization of precision medicine."

The approval aims to expand the program for use as a companion diagnostic to aid in identifying patients who could benefit from capmatinib for the treatment of unresectable advanced and/or metastatic NSCLC with METex14 by detecting mutations that lead to METex14. It is estimated that 3-4% of all patients with NSCLC have an identified METex141) and is said to be a poor prognosis factor2). Capmatinib is a selective MET inhibitor and is confirmed to strongly inhibit the kinase activity of the METex143). Efficacy and safety of capmatinib are investigated in patients with advanced and/or metastatic NSCLC in the phase II GEOMETRY mono-1 study conducted by Novartis. Novartis Japan K.K. has submitted the regulatory application of capmatinib to the MHLW.

Developed by Foundation Medicine Inc., FoundationOne CDx Cancer Genomic Profile is a next-generation sequencing based in vitro diagnostic device for the detection of substitutions, insertion and deletion alterations, and copy number alterations in 324 genes and select gene rearrangements, as well as genomic signatures including microsatellite instability (MSI) and tumor mutational burden (TMB) using DNA isolated from formalin-fixed, paraffin-embedded (FFPE) tumor tissue specimens. The program is available as a companion diagnostic for multiple molecular-targeted drugs approved in Japan.

As a leading company in the field of oncology, Chugai is committed to realize advanced personalized oncology care and contribute to patients and healthcare professionals through improving access to comprehensive genomic profiling.

Approval information The underlined part has been newly added.
Intended uses or indications

The Product is used for comprehensive genomic profiling of tumor tissues in patients with solid cancers.
The Product is used for detecting gene mutations and other alterations to support the assessment of drug indications listed in the table below.
Alterations Cancer type Relevant drugs
EGFR exon 19 deletions and EGFR exon 21 L858R alterations Non-small cell lung cancer (NSCLC) afatinib dimaleate, erlotinib hydrochloride, gefitinib, osimertinib mesylate
EGFR exon 20 T790M alterations osimertinib mesylate
ALK fusion genes alectinib hydrochloride, crizotinib, ceritinib
ROS1 fusion genes entrectinib
MET exon 14 skipping alterations capmatinib hydrochloride hydrate
BRAF V600E and V600K alterations Malignant melanoma dabrafenib mesylate, trametinib dimethyl sulfoxide, vemurafenib
ERBB2 copy number alterations (HER2 gene amplification positive) Breast cancer trastuzumab (genetical recombination)
KRAS/NRAS wild-type Colorectal cancer cetuximab (genetical recombination), panitumumab (genetical recombination)
NTRK1/2/3 fusion gene Solid tumors entrectinib
BRCA1/2 alterations Ovarian cancer olaparib
Trademarks used or mentioned in this release are protected by laws.

Reference

Salgia R. MET in Lung Cancer: Biomarker Selection Based on Scientific Rationale. Mol Cancer Ther. 2017; 16(4):555-565.
Tong JH, Yeung SF, Chan AWH, et al. MET Amplification and Exon 14 Splice Site Mutation Define Unique Molecular Subgroups of Non–Small Cell Lung Carcinoma with Poor Prognosis. Clin Cancer Res. 2016; 22(12):3048-3056.
Fujino T, Kobayashi Y, Suda K, et al. Sensitivity and Resistance of MET Exon 14 Mutations in Lung Cancer to Eight MET Tyrosine Kinase Inhibitors In Vitro. J Thorac Oncol: 2019 Oct;14(10):1753-1765

On May 29, 2020 Alligator Bioscience (Nasdaq Stockholm: ATORX), reported that the company today presents additional novel data from the ongoing Phase I clinical trial with the bispecific drug candidate ATOR-1015 developed as tumor-directed therapy for metastatic cancer, which further validates the potential of the drug (Press release, Alligator Bioscience, MAY 29, 2020, View Source [SID1234558672]). The presentation will be held at the ASCO (Free ASCO Whitepaper) (American Society of Clinical Oncology) Annual Meeting, which this year is being held virtually.

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The results from the evaluation of doses up and including 600 mg (about 10 mg/kg) show that ATOR-1015 is well tolerated, and dose-escalation has continued to 750 mg (12.5 mg/kg). In this presentation, 21 patients with varying cancer types (colon cancer, eye melanoma, pancreatic cancer, ovarian cancer, gallbladder cancer, gastric cancer, and melanoma) are included and evaluated in terms of safety. The drug related adverse events in the study have generally been mild and transient. No dose-limiting toxicity or severe immune-related adverse events have been reported.

"The results presented at ASCO (Free ASCO Whitepaper) truly support the fact that ATOR-1015 could be a safer and more efficacious drug than current treatment options for spread cancer disease. We are consequently very much looking forward to moving ATOR-1015 into efficacy studies," said Per Norlén, CEO of Alligator Bioscience.

Due to the positive tolerability profile of ATOR-1015, dose escalation will continue at even higher doses than expected but still allows for a preliminary efficacy readout in melanoma patients already towards the end of 2021.

The ASCO (Free ASCO Whitepaper) poster presentation with the title "A first-in-human phase I study in patients with advanced and/or refractory solid malignancies to evaluate the safety of ATOR-1015, a CTLA-4 x OX40 bispecific antibody" is available on the company website View Source

For further information, please contact:
Cecilia Hofvander, Director Investor Relations & Communications
Phone +46 46 540 82 06
E-mail: [email protected]

This information is such information as Alligator Bioscience AB (publ) is obliged to make public pursuant to the EU Market Abuse Regulation. The information was submitted for publication, through the agency of the contact person set out above, at 2:00 p.m. CEST on May 29, 2020.

About the ATOR-1015 Phase I study
The Phase I study with ATOR-1015 is a dose escalation study in patients with metastatic cancer (NCT03782467). The primary endpoint of the study is to investigate the safety and tolerability of ATOR-1015 and to determine the recommended dose for subsequent Phase II studies. The first patient was dosed in March 2019 and following the establishment of the maximum tolerable dose or recommended dose for Phase II, further clinical development of ATOR-1015 is planned, primarily for the treatment of malignant melanoma.

About ATOR-1015
ATOR-1015, wholly owned by Alligator, is a bispecific CTLA-4 antibody developed as tumor targeted immunotherapy with increased capacity for killing regulatory T cells. ATOR-1015 binds to two different immune receptors – the checkpoint receptor CTLA-4 and the co-stimulatory receptor OX40. The immune activation is increased in areas where both target molecules are expressed at high levels, notably in the tumor microenvironment, which can lead to reduced side effects.

On May 29, 2020 MD Anderson reported that Patients with advanced non-small cell lung cancer (NSCLC) and the MET exon 14 (METex14) skipping mutation had a 46.5% objective response rate to the targeted therapy drug tepotinib, as shown in a study published today in the New England Journal of Medicine and presented at the American Society of Clinical Oncology (ASCO) (Free ASCO Whitepaper) Annual Meeting (Abstract 9556 – Poster 322) by researchers from The University of Texas MD Anderson Cancer Center (Press release, MD Anderson, MAY 29, 2020, View Source [SID1234558688]).

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"The success of this trial, alongside other studies on the same class of drugs, establishes MET exon 14 as an actionable target for non-small cell lung cancer," said senior author Xiuning Le, M.D., Ph.D., assistant professor of Thoracic-Head & Neck Medical Oncology. "We’re pleased to show that another group of lung cancer patients may benefit from precision medicine."

METex14 skipping is a mutation that drives cancer growth and occurs in 3-4% of all NSCLC patients. Patients with METex14 skipping tend to be older, with a median age of 74, and typically don’t have other actionable mutations with existing targeted therapy options.

The study results represent cohort A of the single-arm, international Phase II VISION trial, which is ongoing with additional cohorts. More than 6,700 NSCLC patients were prescreened for MET alterations through liquid and/or tissue biopsy. A total of 152 patients with advanced NSCLC and METex14 skipping were treated with tepotinib. Patients with prior treatment and/or stable brain metastasis were allowed to participate in the trial. Participants were treated with 500mg daily oral tepotinib.

Meaningful benefit for an elderly population

The primary endpoint was objective response rate, defined as complete or partial response, according to the RECIST v1.1 criteria and confirmed by independent review. After nine months follow-up, the primary efficacy population of 99 patients had a 46.5% objective response rate and durable response of 11.1 months.

"The median duration of response of almost one year is very meaningful for this patient population," Le said. "It’s important for these elderly patients to have another treatment option, other than traditional chemotherapy, in oral form that can improve their quality of life for a long duration."

Toxicities were manageable, with grade ≥ 3 treatment-related adverse events reported in 27.6% of patients. The most common side effect was peripheral edema. Eleven percent of patients discontinued treatment due to adverse events.

The study also collected patient-reported outcomes, which indicated an improvement in coughing and overall maintenance of quality of life.

Liquid biopsy for biomarker detection

The VISION study represents the largest METex14 skipping cohort to be identified prospectively through liquid biopsy, verifying that liquid biopsy is a reliable method to detect the mutation. The study also showed that liquid biopsy was a useful tool to identify response to the drug.

Matched liquid biopsy samples for baseline and on-treatment were available for 51 patients. Next-generation sequencing found 34 of those patients had a molecular response with a complete or deep reduction of the mutation, and radiographic response was confirmed in 68% of patients who had a molecular response.

"This study marked a major advance in that we now have a highly effective, oral therapy for a group of non-small lung cancer patients that previously did not have any targeted therapy options," said co-author John Heymach, M.D., Ph.D., chair of Thoracic-Head & Neck Medical Oncology. "We are proud to lead the field forward as we work to provide novel treatments to patients."

Tepotinib was granted breakthrough therapy designation by the U.S. Food and Drug Administration (FDA) in September 2019, based on early data from the VISION study. It was approved for use as the first oral targeted therapy for MET-positive NSCLC in Japan in March 2020.

A full list of co-authors and their disclosures are included in the paper. The research was supported by Merck KGaA, Darmstadt, Germany.