On April 27, 2020 Alpine Immune Sciences, Inc. (NASDAQ: ALPN), a leading clinical-stage immunotherapy company focused on developing innovative treatments for cancer and autoimmune/inflammatory diseases, reported the design of NEON-1, the first-in-human study of ALPN-202, a first-in-class, conditional CD28 costimulator and dual checkpoint inhibitor, at the American Association of Cancer Research (AACR) (Free AACR Whitepaper) Virtual Annual Meeting I, in the Phase I Trials in Progress Virtual Poster Session (Press release, Alpine Immune Sciences, APR 27, 2020, View Source [SID1234556622]).

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Many patients treated with checkpoint inhibitors fail to achieve an objective or complete anti-tumor response. This could be due to a lack of sufficient T cell costimluation in the tumor microenvironment, such as inadequate CD28 ligands. To address this, ALPN-202 was designed to inhibit both the PD-L1 and CTLA-4 checkpoints, while also providing a CD28 costimulatory signal. Importantly, ALPN-202’s costimulatory function is designed to depend upon PD-L1, to help ensure clinical safety and tolerability.

NEON-1 includes two parts: dose escalation and expansion cohort(s). It will enroll adults with advanced solid tumors or lymphoma refractory or resistant to standard therapy, including checkpoint inhibitors when indicated. Measurable disease is required for most participants, as are an ECOG status of 0 to 2 and adequate hematological, renal, and hepatic function. Dose escalation begins with single-participant cohorts to minimize the number of participants anticipated to receive subtherapeutic doses, followed by standard 3 + 3 cohorts where two dose regimens, weekly versus every three weeks, will be studied in parallel. Expansion cohorts will explore specific tumor types and/or biomarker-selected tumors, based upon the experience during dose escalation. Safety endpoints include dose-limiting toxicities, adverse events, and circulating cytokines. Objective responses will be assessed by RECIST v1.1 for solid tumors and Lugano criteria for lymphoma. Pharmacokinetics and pharmacodynamics will also be evaluated.

"We are particularly pleased to see ALPN-202 enter the clinic," said Mitchell Gold, MD, Alpine’s Chairman and CEO. "ALPN-202 embodies the unique founding concepts of Alpine’s vIgD platform, incorporating tri-functional agonism and antagonism in a single proprietary functional domain. It is now positioned to determine the clinical relevance of localized CD28 costimulation to the immunotherapy of cancer. We look forward to opportunities to report upon its progress in appropriate future settings."

AACR has made the 2020 virtual Annual Meeting presentations freely available. Alpine’s recorded oral presentation of the NEON-1 trial design can be accessed here.

About ALPN-202

ALPN-202 is a first-in-class, conditional CD28 costimulator and dual checkpoint inhibitor with the potential to improve upon the efficacy of combined checkpoint inhibition while limiting significant toxicities. Preclinical studies of ALPN-202 have successfully demonstrated superior efficacy in tumor models compared to checkpoint inhibition alone. A phase 1 trial of ALPN-202 in advanced malignancies (NEON-1, NCT04186637) is open for enrollment.

On April 27, 2020 Xilio Therapeutics, a company developing potent, tumor-selective immuno-oncology (IO) therapies for patients with cancer, reported that Martin H. Huber, M.D. has joined the company as Chief Medical Officer (Press release, Xilio Therapeutics, APR 27, 2020, View Source [SID1234556638]). In this role, Dr. Huber will oversee all aspects of the Company’s clinical development strategy and operations and lead Xilio’s first two therapeutic candidates, XTX201 (tumor-selective IL-2) and XTX101 (tumor-selective aCTLA4 mAb) into clinical development in 2021, while advancing Xilio’s tumor-selective IL-12 and IL-15 cytokine pipeline programs.

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"Dr. Huber has had a long and distinguished career in immuno-oncology drug development, and he has successfully led multiple cancer immunotherapy programs, from early clinical stage through commercialization," said Rene Russo, Chief Executive Officer of Xilio. "His leadership will accelerate our broad pipeline of potent, tumor-selective IO therapies into clinical development and complement the outstanding team that has been assembled at Xilio."

Dr. Huber has over 20 years of academic, biotechnology, and pharmaceutical drug development experience, most recently serving as Senior Vice President and Chief Medical Officer at Tesaro, Inc. before its acquisition by GSK. While at Tesaro, he drove the expansion of the niraparib program and advanced the company’s immuno-oncology agents into the clinic. Prior to that, he was Vice President, Oncology Clinical Research at Merck Research Laboratories where he was instrumental in the advancement of Merck’s oncology programs, serving as program lead for pembrolizumab in non-small cell lung cancer. Prior to Merck, he served in roles of increasing responsibility at Schering-Plough, Hoffmann-La Roche and Rhone-Poulenc Rorer, where he led teams in the areas of oncology clinical development, drug safety and pharmacovigilance. He previously served as an Assistant Professor of Oncology at the University of Texas MD Anderson Cancer Center. Dr. Huber holds an M.D. from the Baylor College of Medicine.

"I am thrilled to join a deeply experienced oncology drug development team at Xilio and help realize its important mission of transforming cancer treatments by unleashing the full power of highly potent immuno therapies precisely in tumors," said Dr. Huber. "I believe in the potential of Xilio’s tumor-selective technology to revolutionize the efficacy of IO therapies for a broad range of patients living with cancer."

Xilio Therapeutics is developing its proprietary technology to create a new class of ultra-potent IO therapies that are activated selectively within the tumor. These tumor-selective therapies are designed to overcome the significant toxicities associated with clinically validated IO therapies, such as IL-2 and aCTLA4, which have historically limited the number of patients that can be treated and prevented patients from completing full courses of treatment. XTX201 (IL-2) and XTX101 (aCTLA4 mAb) have demonstrated tumor-selective activity in preclinical models, significantly widening the potential therapeutic index for these therapies.

On April 27, 2020 CARsgen Therapeutics Co., Ltd., a clinical-stage biopharmaceutical company, reported the European Medicines Agency (EMA) Committee for Orphan Medicinal Products (COMP) adopted a positive opinion on CARsgen’s application for orphan designation of its investigational CT053 CAR T-cell therapy, fully human anti-BCMA (B cell maturation antigen) autologous chimeric antigen receptor (CAR) T cells for the treatment of multiple myeloma (Press release, Carsgen Therapeutics, APR 27, 2020, View Source [SID1234556661]). CT053 was previously granted orphan drug designation by the US Food and Drug Administration in August 2019.

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"The COMP’s adoption of a positive opinion for CT053 orphan drug designation is another important recognition of CARsgen’s commitment to the development of its potential best-in-class CAR T cell therapy for the treatment of multiple myeloma," said Zonghai Li, M.D., Ph.D., Chief Executive Officer of CARsgen. "We look forward to working closely with the EMA under the recently granted PRIME eligibility and continuing the clinical development of CT053 in Europe."

The positive opinion issued by COMP will be sent to the European Commission, which is expected to grant the orphan designation within 30 days. EMA orphan drug designation helps support the development of new treatments for rare conditions, those affecting not more than five in 10,000 people in the EU, that are life-threatening or chronically debilitating. Medicines that meet the EMA’s orphan designation criteria qualify for incentives to encourage advancement of drug development.

On April 27, 2020 Verastem, Inc. (Nasdaq:VSTM) (also known as Verastem Oncology), a biopharmaceutical company committed to developing and commercializing new medicines for patients battling cancer, reported results from the ongoing investigator-initiated Phase 1 clinical study investigating VS-6766, its RAF/MEK inhibitor, in combination with defactinib, its FAK inhibitor, in patients with KRAS mutant advanced solid tumors (Press release, Verastem, APR 27, 2020, View Source [SID1234556603]). The data will be presented as a virtual poster today at the American Association for Cancer Research (AACR) (Free AACR Whitepaper) 2020 Virtual Annual Meeting I.

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This ongoing study is an open label, dose escalation and expansion study. The expansion cohorts are currently ongoing in patients with advanced solid tumors, including low-grade serous ovarian cancer (LGSOC), KRAS mutant non-small cell lung cancer (NSCLC) and KRAS mutant colorectal cancer (CRC). In the LGSOC cohort, among the patients with KRAS mutant tumors (n=6), 4 patients responded, for an overall response rate (ORR) of 67%. Median time on treatment was 20.5 months. In the KRAS mutant NSCLC cohort (n=10), 1 patient achieved a partial response and 8 patients achieved disease control. In this cohort, 70% of patients continued on treatment at least 12 weeks and 30% of patients continued on treatment at least 24 weeks.

Based on an observation of higher response rates seen in patients with KRASG12V mutations in the investigator-initiated Phase 1 combination study, we conducted a combined analysis with data from the combination study and the prior single-agent study that utilized a twice-weekly dosing schedule of VS-67661 to get a more complete picture of activity in KRASG12V mutations. The subsequent, combined analysis (VS-6766 monotherapy and defactinib combination) showed a 57% ORR (4/7 patients); as a single agent (2/5 patients) and in combination with defactinib (2/2 patients) in KRASG12V mutant NSCLC. Similarly, the combined analysis showed a 60% ORR (3/5 patients); as a single agent (1/2 patients) and in combination with defactinib (2/3 patients) in KRASG12V mutant gynecologic cancers. These additional analyses were conducted by Verastem Oncology to understand the impact that various KRAS variants may have had on response to identify potential signals to pursue in future prospective studies. This additional analysis was not part of the AACR (Free AACR Whitepaper) 2020 poster presentation.

"Earlier research has demonstrated MEK inhibitors can cause upregulation of FAK in KRAS mutant tumors, which are notoriously difficult to treat and quite common across solid tumors. The combination of a RAF/MEK and FAK inhibitor can potentially overcome this challenge and opens up an exciting new pathway for treatment," stated Professor Udai Banerji, Professor of Molecular Cancer Pharmacology at The Institute of Cancer Research, London, and Honorary Consultant in Medical Oncology, MBBS, MD, DNB, PhD, FRCP at The Royal Marsden NHS Foundation Trust, London, and lead investigator of the clinical study. "We found that the combination of VS-6766 and defactinib in low-grade serous ovarian cancer (LGSOC) was well tolerated by the patients in the trial and shows promising clinical activity, including durable response that is associated with clinically meaningful benefit. The study continues to enroll additional patients into the ovarian, lung and colorectal expansion cohorts with additional responses seen in all cohorts."

"We are encouraged by these early response rates in KRAS mutant LGSOC and in KRASG12V mutant tumors as they underscore the significant potential of this novel approach in areas of high unmet medical need," said Brian Stuglik, Chief Executive Officer of Verastem Oncology. "The potential of the combination of VS-6766 and defactinib is rapidly evolving as we continue to gain more insights and analyze the data. We plan to initiate discussions with regulatory authorities as soon as possible to define a path forward, with the goal of commencing a registration-directed clinical trial during 2020."

Initial Results from the Phase 1 Study Investigating the Combination of VS-6766 and Defactinib in Patients with KRAS Mutant Cancers and Subsequent Analyses

The poster presentation describes safety and dose response data from the dose-escalation portion and expansion cohorts from an open-label, investigator-initiated Phase 1 study conducted in the United Kingdom assessing the combination of RAF/MEK and FAK inhibitor therapy in patients with LGSOC and KRAS mutant NSCLC. The study evaluated the combination of VS-6766 and defactinib. VS-6766 was administered using a twice-weekly dose escalation schedule and was administered 3 out of every 4 weeks. Defactinib was administered using a twice-daily dose escalation schedule, also 3 out of every 4 weeks. Dose levels were assessed in 3 cohorts: cohort 1 (VS-6766 3.2mg, defactinib 200mg); cohort 2a (VS-6766 4mg, defactinib 200mg); and cohort 2b (VS-6766 3.2mg, defactinib 400mg).

In the patients with LGSOC (n=8), the ORR was 50% (n=4). Among the patients with KRAS mutant LGSOC (n=6), the ORR was 67% (n=4). Of the 4 patients who have responded, 3 had a prior MEK inhibitor and as of November 2019 had been on study for a median of 20.5 months (range 7-23 months). In the patients with NSCLC (n=10), all of which had KRAS mutations, 1 patient achieved a partial response and 1 patient with a 22% tumor reduction still on treatment as of November 2019. Median time on treatment for this cohort was approximately 18 weeks.

Based on an observation of higher response rates seen in patients with KRASG12V mutations in the investigator-initiated Phase 1 combination study, we conducted a combined analysis with data from the combination study and the prior single-agent study that utilized a twice-weekly dosing schedule of VS-67661 to get a more complete picture of activity in KRASG12V mutations. The subsequent, combined analysis (VS-6766 monotherapy and defactinib combination) showed a 57% ORR (4/7 patients); as a single agent (2/5 patients) and in combination with defactinib (2/2 patients) in KRASG12V mutant NSCLC. Similarly, the combined analysis showed a 60% ORR (3/5 patients); as a single agent (1/2 patients) and in combination with defactinib (2/3 patients) in KRASG12V mutant gynecologic cancers. These additional analyses were conducted by Verastem Oncology to understand the impact that various KRAS variants may have had on response to identify potential signals to pursue in future prospective studies. This additional analysis was not part of the AACR (Free AACR Whitepaper) 2020 poster presentation.

The most common side effects seen in the Phase 1 study were rash, creatine kinase elevation, nausea, hyperbilirubinemia and diarrhea, most being NCI CTC Grade 1/2 and all were reversible. The recommended Phase 2 dose was determined to be cohort 1 (VS-6766 3.2mg, defactinib 200mg).

The preliminary data reported in the study suggest that a novel intermittent dosing schedule of RAF/MEK and FAK inhibitor combination therapy has promising clinical activity in patients with KRASmutant LGSOC and KRASG12V mutant NSCLC, including patients previously treated with a MEK inhibitor. Expansion cohorts remain ongoing.

Details for the AACR (Free AACR Whitepaper) 2020 Virtual Meeting I presentation are as follows:

Title: Phase 1 study of the combination of a RAF-MEK inhibitor CH5126766 (VS-6766) and FAK inhibitor defactinib in an intermittent dosing schedule with expansions in KRAS mutant cancers
Lead author: Udai Banerji, The Institute of Cancer Research and The Royal Marsden
Poster #: CT143
Session: VPO.CT01 – Phase I Clinical Trials
Date and Time: Monday, April 27, 2020; 9:00 a.m. to 6:00 p.m. ET
URL: View Source!/9045/presentation/10642

Conference Call and Webcast Information

The Verastem Oncology management team will host a conference call and webcast on Monday, April 27, 2020, at 8:00 AM ET to discuss the Phase 1 RAF/MEK/FAK combination data. The call can be accessed by dialing (877) 341-5660 (U.S. and Canada) or (315) 625-3226 (international), five minutes prior to the start of the call and providing the passcode 8390795.

The live, listen-only webcast of the conference call can be accessed by visiting the investors section of the Company’s website at www.verastem.com. A replay of the webcast will be archived on the Company’s website for 90 days following the call.

About VS-6766

VS-6766 (formerly known as CH5126766, CKI27 and RO5126766) is a unique inhibitor of the RAF/MEK signaling pathway. In contrast to other MEK inhibitors in development, VS-6766 blocks both MEK kinase activity and the ability of RAF to phosphorylate MEK. This unique mechanism allows VS-6766 to block MEK signaling without the compensatory activation of MEK that appears to limit the efficacy of other inhibitors. The combination of VS-6766 and the focal adhesion kinase (FAK) inhibitor defactinib is currently being investigated in an investigator-initiated Phase 1 dose escalation and expansion study. The expansion cohorts are currently ongoing in patients with KRAS mutant advanced solid tumors, including low grade serous ovarian cancer (LGSOC), non-small cell lung cancer (NSCLC) and colorectal cancer (CRC).2 The ongoing clinical study of the VS-6766/defactinib combination is supported by single-agent Phase 2 studies which investigated defactinib in KRAS mutant NSCLC3 and VS-6766 in KRAS mutant NSCLC and LGSOC.1

About Defactinib

Defactinib is an oral small molecule inhibitor of FAK and PYK2 that is currently being evaluated as a potential combination therapy for various solid tumors. The Company has received Orphan Drug designation for defactinib in ovarian cancer and mesothelioma in the US, EU and Australia. Preclinical research by Verastem Oncology scientists and collaborators at world-renowned research institutions has described the effect of FAK inhibition to enhance immune response by decreasing immuno-suppressive cells, increasing cytotoxic T cells, and reducing stromal density, which allows tumor-killing immune cells to enter the tumor.4,5 Additionally, in both preclinical and clinical studies, FAK activation has been shown to occur as a potential resistance mechanism in response to MEK inhibitor treatment, and synergy of a FAK inhibitor with a RAF/MEK inhibitor has been shown in several preclinical models. The combination of defactinib and VS-6766 is currently being investigated in an investigator-initiated Phase 1 dose escalation and expansion study. The expansion cohorts are currently ongoing in patients with KRAS mutant advanced solid tumors, including low grade serous ovarian cancer (LGSOC), non-small cell lung cancer (NSCLC) and colorectal cancer (CRC).2 The ongoing clinical study of the VS-6766/defactinib combination is supported by single-agent Phase 2 studies which investigated defactinib in KRAS mutant NSCLC3 and VS-6766 in KRAS mutant NSCLC and LGSOC.4 Defactinib is also in clinical testing in combination with pembrolizumab for treatment of patients with pancreatic cancer, NSCLC and mesothelioma.6

On April 27, 2020 Aptose Biosciences Inc. (Nasdaq: APTO; TSX: APS), a clinical-stage company developing highly differentiated therapeutics that target the underlying mechanisms of cancer, reported the early clinical data on CG-806, the company’s oral, first-in-class FLT3/BTK cluster selective kinase inhibitor, at the AACR (Free AACR Whitepaper) Virtual Annual Meeting I (April 27-28), in lieu of the live oral presentation originally planned (Press release, Aptose Biosciences, APR 27, 2020, View Source [SID1234556623]).

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Rafael Bejar M.D., Ph.D., Aptose’s Chief Medical Officer, presented a video summary of Abstract # 9967 – Early clinical findings from a phase 1a/b dose escalation trial to evaluate the safety and tolerability of CG-806 in patients with relapsed or refractory CLL/SLL or non-Hodgkin’s lymphomas [link].

The first-in-human tests of CG-806 are being carried out in a Phase 1a/b clinical study. The target population in the study includes patients with significant unmet needs including patients with relapsed or refractory chronic lymphocytic leukemia (CLL), small lymphocytic leukemia (SLL) or non-Hodgkin lymphoma (NHL) who have failed or been intolerant to two lines of established therapy. CG-806 is administered as oral capsules dosed twice daily in 28-day cycles. The study design includes an accelerated titration followed by a 3+3 dose escalation to establish the recommended Phase 2 dose for planned expansion cohorts and future studies.

The first patient, treated with 150 mg BID of CG-806, was heavily pretreated, carried a TP53 mutation, and had severe thrombocytopenia prior to study entry. This patient currently is in the eleventh cycle of therapy without having experienced a dose-limiting toxicity (DLT) and has been dose escalated to the 450 mg BID dose level.

The second patient, treated at the 300 mg BID dose level, had significant marrow involvement with neutropenia and thrombocytopenia at study entry, and developed a brisk lymphocytosis, but did not experience a DLT through four cycles of therapy including no worsening of their thrombocytopenia or neutropenia.

The study has now completed three dose levels without observing any drug-related severe adverse events (SAE) and has not reached a dose-limiting toxicity. Three patients completed the safety evaluation period at the third dose level, 450 mg BID, and as a result, the fourth dose level was opened. The first patient, previously dosed at 150 mg BID was dose escalated to dose level 3 at 450 mg BID. Enrollment is open and dosing is ongoing at the 600 mg BID dose level with no drug-related SAEs or DLTs encountered to date.

Key findings to date:

No drug-related SAEs or DLTs have been observed in patients to date
CG-806 demonstrates favorable steady state pharmacokinetics evidenced by stable trough plasma concentrations reached by Day 8 in the first two patients treated at dose levels 1 and 2
CG-806 has shown on-target pharmacologic activity demonstrated by plasma inhibitory assays with reporter cells exposed to patient plasma for 6 hours
Phospho-BTK is markedly reduced after exposure to plasma from the patient treated at dose level 1 and completely abrogated with plasma form the patient treated at dose level 2
Similar results are seen for the phosphorylation of PDGFR-alpha, a target of CG-806, for SYK, which lies in the same signaling pathway as BTK and for ERK
Lymphocytosis was noted at dose level 2 – pharmacologic BTK inhibition in CLL promotes exfiltration
Dr. Bejar summarized the team’s findings: "CG-806 is a novel and unique cluster selective kinase inhibitor with activity against clinically validated targets in both lymphoid and myeloid malignancies through its potent inhibition of BTK and FLT3. The ongoing Phase 1 study in relapsed/refractory B-cell malignancies has demonstrated the safety of CG-806 to date, pharmacologic activity, and predictable pharmacokinetic behavior. We look forward to presenting new data from higher dose cohorts at a future medical meeting."

The slide deck of this presentation is available on the Aptose website View Source

About CG-806

CG-806 is an oral, first-in-class FLT3/BTK cluster selective kinase inhibitor and is in Phase 1 clinical studies for the treatment of hematologic malignancies. This small molecule, demonstrates potent inhibition of wild type and all mutant forms of FLT3 (including internal tandem duplication, or ITD, and mutations of the receptor tyrosine kinase domain and gatekeeper region), cures animals of AML in the absence of toxicity in murine xenograft models, and represents a potential best-in-class therapeutic for patients with AML and other myeloid malignancies. Likewise, CG-806 demonstrates potent, non-covalent inhibition of the wild type and Cys481Ser (C481S) mutant forms of the BTK enzyme, as well as other oncogenic kinase pathways operative in B cell malignancies, suggesting CG-806 may be developed for various B cell malignancy patients (including CLL/SLL, FL, MCL, DLBCL and others) that are resistant/refractory/intolerant to covalent or other non-covalent BTK inhibitors. Because CG-806 targets key kinases/pathways operative in malignancies derived from the bone marrow, it is in development for B-cell cancers and AML.