177Lu-EB-PSMA-617(National Institute For Biomedical Imaging And Bioengineering (Nibib))

This article will inventory the anti-tumor targets in the GPCR family and the therapeutic drugs that have been marketed. 01 GnRHRGonadotropin-Releasing Hormone Receptor is a member of the seven-transmembrane GPCR (G protein-coupled receptor) family. It is expressed on the surface of pituitary gonadotropin cells, as well as lymphocytes, mammary glands, ovaries, and prostates. Upon binding with gonadotropin-releasing hormone, the receptor associates with G proteins that activate the phosphatidylinositol-calcium second messenger system. Activation of the receptor ultimately leads to the release of gonadotropins: luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Leuprolide (Leuprorelin) is a synthetic analogue of gonadotropin-releasing hormone (GnRH) developed by Takeda Pharmaceuticals, commonly used for treating certain types of hormone-dependent cancers, such as prostate and breast cancers, as well as non-cancerous conditions like endometriosis, uterine fibroids, and certain types of infertility. Leuprolide mimics the natural GnRH signals in the brain, initially causing a transient increase in hormone levels, followed by suppression of hormone production, thereby reducing symptoms and growth of these hormone-dependent diseases. Leuprolide is an injectable, administered via subcutaneous or intramuscular injection. Due to its control over hormone levels, Leuprolide is also used in treating precocious puberty in children. Additionally, GnRH analogues such as Goserelin developed by AstraZeneca, Buserelin by Sanofi, Nafarelin by Pfizer, and Gonadorelin by Mitsubishi Tanabe are all agnostic drugs of the GnRHR type. In recent years, antagonist drugs targeting GnRHR have also been reported for the treatment of certain hormone-dependent diseases. For instance: Degarelix is a GnRH receptor antagonist developed by Ferring Pharmaceuticals for the treatment of prostate cancer. It is also the first antagonist drug targeting the GnRHR globally, inhibiting the production of sex hormones (such as testosterone) by blocking the GnRH receptor, thereby suppressing the growth of prostate cancer cells. It is typically administered as an injection, rapidly reducing testosterone levels to castration levels. Ferring Pharmaceuticals subsequently licensed the commercial rights for Degarelix to Astellas and Pfizer. Relugolix is another GnRH receptor antagonist used for treating advanced prostate cancer. It also works by blocking the GnRH receptor and lowering sex hormone levels. Relugolix is also under investigation for the treatment of uterine fibroids and endometriosis. Relugolix was originally developed by Takeda Pharmaceuticals and is the first small molecule drug globally targeting the GnRH receptor. Linzagolix is an oral GnRH receptor antagonist for the treatment of various hormone-dependent diseases including endometriosis and uterine fibroids. Linzagolix has been approved in the European Union and the UK for treating moderate to severe symptoms associated with uterine fibroids. 02 SSTRThe Somatostatin Receptor Type (SSTR) belongs to the GPCR (G-protein-coupled receptor) family and comprises five subtypes (SSTR1-SSTR5). SSTRs play a critical role in the endocrine and nervous systems and are potential targets for the treatment of multiple diseases, particularly neuroendocrine tumors (NETs). Somatostatin (SST) is the natural ligand for SSTRs, and cortistatin (CST) is a neuropeptide that also binds with high affinity to all subtypes of SSTRs. Due to the high sequence homology between different SSTR subtypes, developing drugs that can selectively modulate specific subtypes presents a challenge, but this is essential for minimizing off-target effects. In targeted SSTR therapies, peptide radioligand therapies represent a significant research focus. For instance, Novartis's (177Lu)Lutathera, a peptide radioligand therapy targeting SSTR2, has been approved for the treatment of adult patients with SSTR-positive gastroenteropancreatic neuroendocrine tumors. The illustration below shows the differential tissue distribution of various SSTRs. Exploring dual-target drugs is an innovative direction, where the advantage of bi-targeted radiopharmaceuticals lies in the potential synergistic effects between the two targets, thereby enhancing safety and efficacy. Radiopharmaceutical development is exploring new indications such as pancreatic cancer, renal cancer, stomach cancer, thyroid cancer, lung cancer, and Parkinson's disease to broaden the therapeutic spectrum. Somatostatin is a polypeptide hormone composed of 14 amino acid residues, including a single disulfide bond. This hormone inhibits the secretion of growth hormone, insulin, glucagon, gastrin, pancreatic enzymes, and thyrotropin. However, due to its very short half-life in the body (less than 3 minutes), its therapeutic value is limited. Research on the β-turn pharmacophore of somatostatin has led to the development of more biologically stable and potent analogs. Octreotide was developed based on this lead sequence and approved for treating acromegaly, adenomas, and pancreatic, breast, and prostate tumors. DOI: 10.3390/molecules25174012 Subsequent research has pushed the development of selective receptor antagonists such as lanreotide, vapreotide, and pasireotide, and has introduced peptide imaging and peptide receptor radionuclide therapy. In these radiological therapies, radioactive elements like 111In, 90Y, 68Ga, or 99mTc are linked to selective somatostatin analogs through chelating groups, which led to the approval of radiopharmaceutical preparations such as 111In-labeled pentetreotide, 99mTc-labeled depreotide, 68Ga-labeled DOTA-TATE and DOTA-TOC, and 64Cu-labeled DOTA-TATE. These drugs are used for tumor detection. Several synthetic peptides and radiopharmaceuticals targeting SSTRs have been approved for market, with representative drugs including: Octreotide, developed by Novartis as a synthetic octapeptide somatostatin analog, is an SSTR agonist. Clinically, it is primarily used to treat conditions such as acromegaly, thyrotoxicosis, gastrointestinal fistulas, and symptoms and signs associated with gastroenteropancreatic neuroendocrine tumors. Octreotide inhibits the secretion of growth hormone, thyroid-stimulating hormone, insulin, and glucagon by binding to SSTRs, especially subtypes SSTR2 and SSTR5. Pentetreotide is another synthetic octapeptide that, unlike Octreotide, forms the radioactive drug 111In-pentetreotide by binding to the radiolabeled isotope Indium-111 via the chelator DTPA. This compound enables the use of Pentetreotide in single photon emission computed tomography (SPECT) imaging to detect tumors expressing SSTRs. It has a relatively fast renal clearance rate, offering a significant advantage over the first-generation [123I-Tyr3]-octreotide, a radioactive iodine-labeled octapeptide somatostatin analog. However, it has shortcomings, such as the need for a high tumor/noise intensity ratio, lower imaging resolution, medium affinity for receptors, and high γ-energy, which results in a higher radiation dose to patients. 111In-pentetreotide Lanreotide is a synthetic somatostatin analog, belonging to octapeptide derivatives. It has structural and functional similarities to Octreotide, but with different pharmacokinetic properties that make it a long-acting somatostatin analog. Gallium Dotatate Ga-68, developed by Advanced Accelerator Applications, is a radioactive diagnostic agent that uses DOTA to chelate Gallium-68 for positron emission tomography (PET) imaging, mainly targeting neuroendocrine tumors (NETs) expressing somatostatin receptors. The three radioactive drugs differ slightly in pharmacokinetic properties, primarily due to variations in affinity for specific receptor subtypes. [68Ga]-DOTATATE specifically binds to SSTR2, indicating its primary interaction with this receptor subtype; [68Ga]-DOTATOC has high affinity for SSTR2 and moderate affinity for SSTR5; while [68Ga]-DOTANOC shows high affinity for SSTR2, SSTR3, and SSTR5, making it a broad-target drug for multiple receptor subtypes. Lutetium Lu-177 dotatate, another therapeutic radiopharmaceutical developed by Advanced Accelerator Applications, targets tumor cells by binding to SSTR, particularly SSTR2 subtype. This binding allows the radioactive isotope Lutetium-177 to emit β-particles, thereby killing tumor cells. Yttrium-90 (a pure high-energy β-emitter with a half-life T1/2 = 64 hours) and Lutetium-177 (a moderate energy β-emitter with a half-life T1/2 = 6.7 days) are the most commonly used elements in peptide receptor radionuclide therapy. Each has specific advantages for targeted therapy. 90Y has higher particle energy and penetration, useful for treating larger tumors, while 177Lu, emitting lower-energy radiation, is better suited for smaller tumors. Additionally, its γ-radiation energy allows for scintigraphy scanning and dose determination during therapy. The image above shows [68Ga]-DOTATOC (commercial name Somakit®) and [177Lu]-DOTATATE (commercial name Lutatherav®), which are used to treat patients with progressive metastatic midgut neuroendocrine tumors. In October 2017, Novartis acquired French innovator Advanced Accelerator Applications for $3.9 billion to build and expand its radioligand therapy platform. In 2018, Novartis further invested $2.1 billion to acquire the biopharmaceutical company Endocyte, gaining more radiopharmaceutical candidates. Through these acquisitions, Novartis has established and expanded its radioligand therapy platform, holding several marketed products like Lutathera (177Lu-DOTATATE) and 68Ga-Edotreotide, along with many in development, including 177Lu-PSMA-617, 177Lu-PSMA-R2, 177Lu-NeoB, 177Lu-FF58, and 255Ac-PSMA-617. According to the Synapse database, multiple drugs targeting SSTRs or selectively targeting different SSTR subtypes are approved for the market or are in clinical research, with radiopharmaceuticals and diagnostics focusing on this target being particularly noteworthy. How to obtain the latest research advancements in the field of biopharmaceuticals? In the Synapse database, you can keep abreast of the latest research and development advances in drugs, targets, indications, organizations, etc., anywhere and anytime, on a daily or weekly basis. Click on the image below to embark on a brand new journey of drug discovery!

On May 2nd, Novartis announced the official signing of an agreement to acquire Mariana Oncology located in Watertown, Massachusetts, USA. According to the terms of the agreement, Novartis will initially pay $1 billion and, upon achieving predefined milestone objectives, will pay an additional $750 million. Mariana is a preclinical-stage biotechnology company focused on developing novel radioligand therapies for cancers with high unmet medical needs. This acquisition will not only enrich Novartis's research and development pipeline in Radioligand Therapy (RLT) but will also enhance the company’s research foundation and clinical supply capabilities in oncology and RLT platform innovations, showcasing its strategic focus in the field of cancer treatment. Radioligand therapy is a form of precision medicine that involves coupling tumor-targeting molecules (ligands) with therapeutic radioactive isotopes to precisely target specific tumor surface receptors. Once bound to the target cells, the radioactive isotopes release radiation that causes DNA damage, inhibits cell proliferation, and may induce cell death, thereby delivering radiation directly to the tumor while minimizing damage to surrounding healthy tissue. It is reported that Mariana Oncology has joined Novartis with a series of Radioligand Therapy (RLT) projects that span multiple solid tumor indications, such as breast cancer, prostate cancer, lung cancer, etc., including the candidate drug MC-339 for small cell lung cancer research. MC-339 is a radio-ligand therapy based on the actinide elements. Mariana Oncology, with its strategy centered on driving the biology of tumor targets, precisely matches ligand modalities with target characteristics. For targets with clear extracellular domains, drug discovery based on macrocyclic peptides is key to Mariana's strategy. For high-value targets with poorly defined structures or prone to shedding, the company employs unique peptide and non-peptide methods for research. Beyond ligand discovery, Mariana’s in-house radiochemistry and radiobiology team utilizes alpha and beta radioactive nuclides as effective payloads to build radiopharmaceuticals from scratch that balance optimal properties. The standards for ligand design include maximum efficacy, high selectivity, stability, physicochemical multiparameter optimization, and the avoidance of drug efflux/uptake transporters. This is complemented by linker and chelation chemistry techniques to carry radioactive active components. With a solid R&D background and flexible operations in peptide and non-peptide small molecule drug discovery, Mariana Oncology tactfully balances these elements. Radiopharmaceuticals enable personalized treatment strategies to be integrated into clinical development and subsequent commercialization processes. The same ligand can be loaded with therapeutic radioactive nuclides (therapeutic type) or diagnostic/imaging radioactive nuclides (diagnostic type). By adopting a 'theranostic' strategy, we confirm target binding in the clinical development phase, select appropriate patient groups, and optimize dosing, thus maximizing therapeutic effects. This strategy, combining diagnostic and therapeutic dual functions, not only helps in precise disease diagnosis but also customizes treatment plans based on individual differences, representing an important aspect of precision medicine. Novartis Expands Its Nuclear Medicine Collaboration with PeptiDreamOn April 30, the Japanese biopharmaceutical company PeptiDream announced that it has further expanded its collaboration with Novartis in the field of peptide discovery. Under this multi-project collaboration agreement, PeptiDream will use its Peptide Discovery Platform System (PDPS) technology to identify and optimize macrocyclic peptides targeting specific molecules selected by Novartis. The peptides developed will be conjugated with radioactive isotopes to form Radioligand Therapies (RLTs) or other applications for therapeutic and diagnostic purposes. PeptiDream will receive an upfront payment of approximately $180 million from Novartis, along with the opportunity to earn milestone payments of up to $2.7 billion upon achieving various research, regulatory, and commercial goals. Furthermore, Novartis will also pay royalties to PeptiDream based on the tiered net sales of the products. This collaboration deepens the partnership between the two companies in the development of peptide-based drugs, aimed at fostering the creation of more innovative therapies, particularly in the field of radioligand therapies, to meet unmet medical needs. PeptiDream is a biotechnology company headquartered in Japan, leading the transition to a new class of innovative drugs in the macrocyclic peptide sector, aiming to address unmet medical needs and improve the quality of life for patients worldwide. Since its inception in 2006, PeptiDream has utilized its proprietary Peptide Discovery Platform System (PDPS) technology, an advanced and highly flexible discovery platform capable of efficiently generating highly diverse (trillions of) non-standard peptide libraries for identifying highly potent and highly selective macrocyclic peptide candidate molecules. These candidate molecules can subsequently be developed into therapeutic and diagnostic products based on peptides, small molecules, peptide-drug conjugates (PDCs), and multifunctional peptide conjugates (MPCs). PeptiDream has established an extensive global R&D partnership network, facilitating the development and commercialization of a diverse and varied pipeline of investigational therapeutic drugs. Furthermore, through its wholly owned subsidiary PDRadiopharma, PeptiDream markets and sells several radiopharmaceuticals and radiodiagnostic products in the Japanese market. Novartis's Blueprint for Nuclear MedicineNovartis is attempting to consolidate its leadership in the field of radioligand therapies (RLTs). Currently, this highly sought-after track has become a battleground for MNCs, with various companies making major deals. For example, Bristol-Myers Squibb (BMS) spent $4.1 billion to acquire RayzeBio, Eli Lilly invested $1.4 billion to purchase POINT Biopharma, and AstraZeneca acquired Fusion Pharmaceuticals for $2 billion. As a global leader in nuclear medicine, Novartis has several drugs targeting SSTR receptors that have been approved and are on the market, including 5 approved projects and 2 Phase II clinical projects. In October 2017, Novartis acquired the French innovative drug company Advanced Accelerator Applications for $3.9 billion to establish and expand its radioligand therapy platform. In 2018, Novartis made another acquisition worth $2.1 billion of the biopharmaceutical company Endocyte, gaining several more radiopharmaceutical candidates. Through these acquisitions, Novartis established and expanded its radioligand therapy platform, and now has several market products such as Lutathera (177Lu-DOTATATE) and 68Ga-Edotreotide, as well as numerous products in development, including 177Lu-PSMA-617, 177Lu-PSMA-R2, 177Lu-NeoB, 177Lu-FF58, and 255Ac-PSMA-617.