Article
作者: Zenonos, Zenon ; Brier, Tim ; Cosulich, Sabina ; Rosfjord, Edward ; Meekin, John H. ; De Almeida, Ana ; Shandilya, Harini ; Beaumont, Kevin ; Anderton, Judith ; Dino, Iris ; Chesebrough, Jon ; Godfrey, Lisa ; Falck, Tillmann ; Pugh, Kathryn ; Myers, Claire ; Bisha, Ina ; Gasper, Diana ; Patel, Neki V. ; Lan, Lingyun ; Dodd, Roger B. ; Sapra, Puja ; Hood, John ; Cronin, Shane ; Zoeller, Jason J. ; Mitchell, Pat ; Saleh, Ali ; Thomas, Tima ; Naseer, Humaira ; Ward, Christopher ; Tilmont, Isabella ; Sargeant, Rebecca ; Gymnopoulos, Marco ; Christ, Simon ; Lehmann, Michael ; Cox, Megan ; Guza, Xhenifer ; Andoni, Alma ; Turner, Simon ; Hurt, Elaine ; Neal, Frances ; Recolin, Benedicte ; Lee, Nancy ; Tammali, Ravinder ; Wang, Jixin ; Chooi, K. Phin ; Fraenkel, Paula G.
Abstract:Purpose: Folate receptor alpha (FRα) is expressed in most ovarian cancers. However, only patients with high expression levels are eligible for Elahere, an FRα-targeted microtubule inhibitor antibody-drug conjugate (ADC). Efficacy limitations and safety concerns underscore the need to develop next-generation FRα-targeted ADCs to treat tumors expressing variable levels of FRα and incorporate different payloads to reduce safety risks. Herein, we present the characterization of AZD5335, a novel FRα-targeted topoisomerase-1 inhibitor ADC. Experimental Design: The efficacy of AZD5335 was assessed and correlated with FRα-expression using cell- and patient-derived models. Focusing on models with low FRα, AZD5335 was directly compared to an Elahere-analog. Additionally, AZD5335 was evaluated in a model of acquired Elahere-resistance. Combined treatments including AZD5335 plus either standard-of-care drugs or a PARP1-inhibitor were also explored. Results: A single dose of AZD5335 (2.5mg/kg) achieved an overall response rate of 82% in ovarian cancer patient-derived xenografts (n=17). Anti-tumor responses were observed in models expressing both high and low levels of FRα. Specifically within FRα low models, AZD5335 demonstrated superiority over an Elahere-analog. In the context of acquired Elahere-resistance, AZD5335 treatments resulted in complete tumor regressions. Additionally, combining AZD5335 with standard-of-care drugs or a PARP1-inhibitor resulted in enhanced efficacy and sustained durability. Two clinical case studies that demonstrated significant AZD5335 responses in tumors exhibiting high and low FRα expression are also provided. Conclusions: AZD5335 is a promising next-generation ADC capable of targeting ovarian cancers with both high and low FRα expression. AZD5335 demonstrates efficacy in overcoming Elahere-resistance and supports combined treatment strategies.