KRAS G12V

▎药明康德内容团队编辑 本期看点 1. 口服选择性FGFR3靶向疗法TYRA-300的早期临床结果亮眼，接受剂量≥90 mg/天的FGFR3突变转移性尿路上皮癌（mUC）患者的疾病控制率（DCR）为100%。 2. 泛RAS抑制剂RMC-6236在经治胰腺导管腺癌（PDAC）患者中展现出令人鼓舞的抗肿瘤活性和安全性，携带任意RAS突变的PDAC患者在6个月的总生存率为91%。 3. 治疗转移性透明细胞肾细胞癌（ccRCC）的小分子HIF-2a抑制剂casdatifan在一项1/1b期临床试验中的DCR达81%。 药明康德内容团队整理 TYRA-300：公布1/2期临床试验数据 Tyra Biosciences公司公布了其潜在“first-in-class”的口服疗法TYRA-300治疗转移性尿路上皮癌（mUC）患者的1/2期研究SURF301的数据。TYRA-300是一种FGFR3选择性抑制剂，旨在避免抑制FGFR1、FGFR2和FGFR4时产生的毒性，且无论是否存在与耐药性相关的FGFR3门卫（gatekeeper）突变都能发挥作用。 截至2024年8月15日的数据，接受剂量≥90 mg/天的FGFR3突变mUC患者的DCR为100%，54.5%（6/11）的患者达到部分缓解（PR），其中3例仍在治疗中，接受90 mg/天剂量的患者中有50%（5/10）达到PR。安全性方面，TYRA-300的耐受性总体良好，FGFR2和FGFR1相关毒性不常见。 RMC-6236：公布1/1b期临床试验数据 Revolution Medicines公司宣布，其在研泛RAS抑制剂RMC-6236在经治胰腺导管腺癌患者中展现出令人鼓舞的抗肿瘤活性和安全性。RMC-6236是一款口服、可靶向突变和野生型RAS在GTP结合（具活性，ON）状态下的选择性抑制剂。此次公布的1/1b期多中心、开放标签、剂量递增和剂量扩展研究RMC-6236-001旨在评估RMC-6236作为单药治疗携带RAS突变或野生型RAS晚期实体瘤患者的效果。 结果显示，RMC-6236单药作为二线疗法可改善携带任意RAS突变PDAC患者的中位无进展生存期（PFS）与总生存期（OS）。在二线治疗中，携带KRAS G12X突变（KRAS G12X指的是KRAS蛋白第12位的甘氨酸因为基因突变，转换成其它氨基酸）的PDAC患者的中位PFS为8.5个月，中位OS为14.5个月。携带任意RAS突变的PDAC患者在二线治疗中的中位PFS为7.6个月，中位OS为14.5个月。携带KRAS G12X突变与携带任意RAS突变的PDAC患者在6个月时的总生存率分别为89%与91%。在二线治疗组中，携带KRAS G12X突变患者的客观缓解率（ORR）为29%，在三线及以上治疗组（3L+）中为22%，这些患者的DCR分别为91%和89%。目前该疗法的3期临床试验RASolute 302正在进行中。 Casdatifan：公布1/1b期临床试验数据 Arcus Biosciences公司公布了其在研小分子HIF-2a抑制剂casdatifan治疗转移性透明细胞肾细胞癌的1/1b期临床试验数据。HIF-2a是一种致癌转录因子，参与多个器官和肿瘤中的氧感应。由于VHL通路的基因异常，ccRCC几乎普遍与HIF-2a失调有关。通过选择性抑制HIF-2a，casdatifan可使一系列涉及肿瘤增殖和存活、耐药性和血管生成的通路失效，从而导致癌细胞死亡。 截至2024年8月30日的数据，中位随访时间为11个月。在100 mg每日剂量扩展队列（n=32）中，DCR达81%，ORR为34%（2个待确认的缓解），许多患者仍在接受治疗。安全性方面，casdatifan具有可接受且可管理的安全性。 ▲Casdatifan治疗ccRCC患者的1/1b期试验数据（图片来源：参考资料[7]） NX-5948：公布1a/1b期临床试验数据 Nurix Therapeutics公司公布其在研蛋白降解剂NX-5948在治疗复发/难治性华氏巨球蛋白血症（WM）患者的1a/1b期临床试验中的最新数据。NX-5948是一种口服、可穿越血脑屏障的小分子布鲁顿氏酪氨酸激酶（BTK）蛋白降解剂。Nurix此前报告称，NX-5948对一系列对现有BTK抑制剂耐药的肿瘤细胞系表现出高效的抑制活性，这对于经过大量前期治疗的B细胞恶性肿瘤患者群体尤为重要。 截至2024年10月10日的数据，在9例可评估应答的患者中，7例患者（77.8%）出现客观缓解，两例患者病情稳定（22.2%）。所有7例缓解均在8周的首次评估中观察到，其中5例患者仍在接受治疗，2例患者的治疗时间超过一年。不论患者基线MYD88和CXCR4的突变状态如何，均观察到应答。 Bel-sar（AU-011）：公布1期临床试验数据 Aura Biosciences公司宣布，其在研病毒样偶联药物（VDC）bel-sar（AU-011）在治疗非肌层浸润性膀胱癌（NMIBC）患者的1期临床试验中获得积极早期数据。Bel-sar由靶向肿瘤表面表达的糖蛋白的类病毒颗粒（VLP）与可由光激活的细胞毒性药物偶联生成。它被设计为具有双重作用机制，既能诱导肿瘤细胞坏死，又能激发强大且持久的抗肿瘤免疫反应。 该试验共纳入了13名患者，主要终点是评估bel-sar单独使用（n=5）和bel-sar结合光激活（n=8）局部给药的安全性和可行性。次要终点是评估生物活性及肿瘤微环境（TME）中的免疫介导变化。13名研究参与者中，10名为低级别疾病患者，另外3名为高级别疾病患者。在接受bel-sar结合光激活治疗的患者（n=8）中，5名低级别疾病患者中有4名在组织病理学评估中显示无肿瘤细胞残留，达到了临床完全缓解（CR）。3名高级别疾病患者中有2名在膀胱镜检查中显示肿瘤明显缩小。 ONCT-534：公布1/2期临床试验数据 Oncternal Therapeutics公司公布了其在研雄激素受体（AR）抑制剂ONCT-534治疗复发性或难治性转移性去势抵抗性前列腺癌（mCRPC）患者的1/2期研究的最新数据。ONCT-534在前列腺癌模型中对未发生突变的AR以及多种形式的AR突变和异常都具有活性。ONCT-534具有治疗对AR通路抑制剂耐药（包括AR扩增、AR配体结合域突变或AR配体结合域缺失型剪接变体）的mCRPC患者的潜力。 截至2024年9月30日的数据，每天两次的给药方案耐受性良好，没有出现与治疗相关的3级或更高级别的毒性反应。1名患者在接受每日两次160 mg剂量ONCT-534治疗后，前列腺特异性抗原（PSA）升高，但在随后4周以每日两次300 mg剂量ONCT-534治疗后，PSA下降了50%，同时计算机断层扫描（CT）显示与基线相比，靶病灶减少了16%。循环肿瘤细胞（CTCs）的计数和生物标志物分析显示，在另外6名患者中，ONCT-534对AR调控基因的表达和AR的核转位有令人鼓舞的效果。 Lunresertib+camonsertib：公布1期联合治疗试验数据 Repare Therapeutics公司公布了1期临床试验MYTHIC的最新数据，该试验评估了其PKMYT1抑制剂lunresertib和口服小分子ATR抑制剂camonsertib（lunre+camo）的组合疗法。在这项分析中，Repare公司对接受2期段推荐剂量（RP2D）的患者进行了约9个月的随访。结果显示，lunre+camo在保持临床疗效的同时，成功地减轻了与抗肿瘤药物机制相关的贫血。此外，在这些患者中未观察到任何级别的血小板减少或严重的中性粒细胞减少。 ATX-559：IND申请获得FDA许可 Accent Therapeutics公司宣布美国FDA已批准其潜在“first-in-class”的DHX9抑制剂ATX-559的IND申请，可在实体瘤患者中开展1期研究，重点关注BRCA1/2缺陷的乳腺癌和微卫星不稳定性高（MSI-H）和/或错配修复缺陷（dMMR）的实体瘤，预计首例患者将在2024年第四季度接受给药。 DHX9是一种DNA/RNA螺旋酶，据报道在复制、转录、翻译、RNA剪接、RNA处理以及维持基因稳定性等方面发挥着重要作用，该酶是一个有吸引力的新肿瘤学靶点。ATX-559通过抑制DHX9可利用关键的肿瘤弱点，导致癌症特异性细胞死亡。 ▲欲了解更多前沿技术在生物医药产业中的应用，请长按扫描上方二维码，即可访问“药明直播间”，观看相关话题的直播讨论与精彩回放 参考资料（可上下滑动查看） [1] Revolution Medicines Presents Updated Data from RMC-6236 Monotherapy Study in Patients with Advanced Pancreatic Ductal Adenocarcinoma. Retrieved October 23, 2024 from https://www.globenewswire.com/en/news-release/2024/10/23/2967583/0/en/Revolution-Medicines-Presents-Updated-Data-from-RMC-6236-Monotherapy-Study-in-Patients-with-Advanced-Pancreatic-Ductal-Adenocarcinoma.html [2] Multiple Clinical Complete Responses Demonstrated Following Single Low Dose Administration of Bel-sar in Patients with Non-Muscle-Invasive Bladder Cancer (NMIBC) in Ongoing Phase 1 Trial. Retrieved October 18, 2024, from https://ir.aurabiosciences.com/news-releases/news-release-details/multiple-clinical-complete-responses-demonstrated-following [3] Oncternal Therapeutics Announces Updated Safety and Efficacy Data for Phase 1/2 Study of ONCT-534 for the Treatment of R/R Metastatic Castration-Resistant Prostate Cancer. Retrieved October 25, 2024, from https://www.globenewswire.com/news-release/2024/10/22/2967000/0/en/Oncternal-Therapeutics-Announces-Updated-Safety-and-Efficacy-Data-for-Phase-1-2-Study-of-ONCT-534-for-the-Treatment-of-R-R-Metastatic-Castration-Resistant-Prostate-Cancer.html [4] Nurix Therapeutics Presents Positive Results from the Ongoing Clinical Trial of Its BTK Degrader NX-5948 in Patients with Relapsed/Refractory Waldenstrom’s Macroglobulinemia. Retrieved October 21, 2024, from https://www.globenewswire.com/en/news-release/2024/10/19/2965795/0/en/Nurix-Therapeutics-Presents-Positive-Results-from-the-Ongoing-Clinical-Trial-of-Its-BTK-Degrader-NX-5948-in-Patients-with-Relapsed-Refractory-Waldenstrom-s-Macroglobulinemia.html [5] Repare Therapeutics Announces Updated Positive Safety and Tolerability Results from the Phase 1 MYTHIC Clinical Trial. Retrieved October 25, 2024, from https://ir.reparerx.com/news-releases/news-release-details/repare-therapeutics-announces-updated-positive-safety-and [6] Tyra Biosciences Reports Interim Clinical Proof-of-Concept Data for TYRA-300, an Investigational Oral FGFR3-Selective Inhibitor, in Phase 1/2 SURF301 Study in Patients with Metastatic Urothelial Cancer (mUC). Retrieved October 25, 2024, from https://www.callunapharma.com/wp-content/uploads/2024/01/Calluna_Pharma_Launch_PR.pdf [7] First Clinical Data for Arcus Biosciences’ HIF-2a Inhibitor, Casdatifan, Showed Promising Clinical Activity and Tumor Shrinkage in Patients with Metastatic Kidney Cancer. Retrieved October 25, 2024, from https://investors.arcusbio.com/investors-and-media/press-releases/press-release-details/2024/First-Clinical-Data-for-Arcus-Biosciences-HIF-2a-Inhibitor-Casdatifan-Showed-Promising-Clinical-Activity-and-Tumor-Shrinkage-in-Patients-with-Metastatic-Kidney-Cancer/default.aspx [8] Interius BioTherapeutics Doses First Patient with in vivo Chimeric Antigen Receptor (CAR) Gene Therapy for B-cell Malignancies. Retrieved October 25, 2024, from https://interiusbio.com/2024/10/interius-biotherapeutics-doses-first-patient-with-in-vivo-chimeric-antigen-receptor-car-gene-therapy-for-b-cell-malignancies/ [9] Spur Therapeutics Showcases Positive New Data from Phase 1/2 GALILEO-1 Trial of FLT201, Its Novel Gene Therapy Candidate for Gaucher Disease, in Oral Presentation at ESGCT 31st Annual Congress. Retrieved October 25, 2024, from https://www.globenewswire.com/news-release/2024/10/23/2967469/0/en/Spur-Therapeutics-Showcases-Positive-New-Data-from-Phase-1-2-GALILEO-1-Trial-of-FLT201-Its-Novel-Gene-Therapy-Candidate-for-Gaucher-Disease-in-Oral-Presentation-at-ESGCT-31st-Annua.html [10] Find Therapeutics Announces First Subject Dosed in Phase 1 Clinical Study of FTX-101. Retrieved October 25, 2024, from https://www.prnewswire.com/news-releases/find-therapeutics-announces-first-subject-dosed-in-phase-1-clinical-study-of-ftx-101-302278520.html [11] Zymeworks Announces First Patient Dosed in Phase 1 Clinical Trial Evaluating ZW171 in Advanced Mesothelin-Expressing Cancers. Retrieved October 25, 2024, from https://www.globenewswire.com/news-release/2024/10/21/2966023/0/en/Zymeworks-Announces-First-Patient-Dosed-in-Phase-1-Clinical-Trial-Evaluating-ZW171-in-Advanced-Mesothelin-Expressing-Cancers.html [12] Aligos Therapeutics Announces U.S. FDA Clearance of IND Application for ALG-000184. Retrieved October 25, 2024, from https://www.globenewswire.com/news-release/2024/10/22/2966892/0/en/Aligos-Therapeutics-Announces-U-S-FDA-Clearance-of-IND-Application-for-ALG-000184.html [13] Pierre Fabre宣布在PFL-002/VERT-002的I/II期首次给药，这是一种MET改变的NSCLC靶向治疗. Retrieved October 25, 2024, from https://www.prnasia.com/story/465694-1.shtml [14] Inozyme Pharma Announces Positive Interim Data from Phase 1 SEAPORT 1 Trial of INZ-701. Retrieved October 25, 2024, from https://www.globenewswire.com/news-release/2024/10/24/2968997/0/en/Inozyme-Pharma-Announces-Positive-Interim-Data-from-Phase-1-SEAPORT-1-Trial-of-INZ-701.html [15] Apogee Therapeutics Announces Results Up to 9 Months from Phase 1 Trial of APG777, its Novel Half-Life Extended Anti-IL-13 Antibody for the Treatment for Atopic Dermatitis and Other Inflammatory Diseases. Retrieved October 25, 2024, from https://www.globenewswire.com/news-release/2024/10/24/2968646/0/en/Apogee-Therapeutics-Announces-Results-Up-to-9-Months-from-Phase-1-Trial-of-APG777-its-Novel-Half-Life-Extended-Anti-IL-13-Antibody-for-the-Treatment-for-Atopic-Dermatitis-and-Other.html [16] BridgeBio Shares Positive Data from High Dose Cohort of Phase 1/2 CANaspire Study of Gene Therapy BBP-812 for Canavan Disease at ESGCT 2024. Retrieved October 25, 2024, from https://www.globenewswire.com/news-release/2024/10/24/2968601/0/en/BridgeBio-Shares-Positive-Data-from-High-Dose-Cohort-of-Phase-1-2-CANaspire-Study-of-Gene-Therapy-BBP-812-for-Canavan-Disease-at-ESGCT-2024.html [17] Precision BioSciences Receives First Approval of Clinical Trial Application to Initiate PBGENE-HBV First-In-Human Study for the Treatment of Chronic Hepatitis B. Retrieved October 25, 2024, from https://investor.precisionbiosciences.com/news-releases/news-release-details/precision-biosciences-receives-first-approval-clinical-trial [18] First Patients Dosed in Phase 1 Clinical Study of ImmunityBio’s CAR-NK Cell Therapy for the Treatment of Relapsed B-Cell Non-Hodgkin Lymphoma. Retrieved October 25, 2024, from https://ir.immunitybio.com/news-releases/news-release-details/first-patients-dosed-phase-1-clinical-study-immunitybios-car-nk?field_nir_news_date_value[min]= [19] Aprea Therapeutics Presents Preliminary Findings on Oral WEE1 Inhibitor APR-1051 at EORTC-NCI-AACR International Conference on Molecular Targets and Therapeutics. Retrieved October 25, 2024, from https://ir.aprea.com/news-releases/news-release-details/aprea-therapeutics-presents-preliminary-findings-oral-wee1 [20] Autolus Therapeutics Presents Clinical Data Update at the 2024 Lymphoma, Leukemia & Myeloma Congress. Retrieved October 25, 2024, from　https://www.globenewswire.com/news-release/2024/10/16/2964125/0/en/Autolus-Therapeutics-Presents-Clinical-Data-Update-at-the-2024-Lymphoma-Leukemia-Myeloma-Congress.html [21] Accent Therapeutics Announces FDA Clearance of IND Application for ATX-559, a First-In-Class Oral DHX9 Inhibitor. Retrieved October 25, 2024, from　https://www.prnewswire.com/news-releases/accent-therapeutics-announces-fda-clearance-of-ind-application-for-atx-559-a-first-in-class-oral-dhx9-inhibitor-302285845.html [22] Calluna Pharma launches and announces EUR 75 million Series A financing to develop novel therapies for inflammatory and fibrotic diseases. Retrieved October 25, 2024, from　 https://www.businesswire.com/news/home/20241023939388/en/Calluna-Pharma-Successfully-Completes-Phase-1-Clinical-Study-of-CAL101-a-First-in-Class-Therapeutic-for-Fibrotic-and-Fibro-Inflammatory-Indications/#:~:text=Calluna%20Pharma%20Successfully%20Completes%20Phase%201%20Clinical%20Study,CAL101%20is%20now%20entering%20Phase%202%20clinical%20development 免责声明：药明康德内容团队专注介绍全球生物医药健康研究进展。本文仅作信息交流之目的，文中观点不代表药明康德立场，亦不代表药明康德支持或反对文中观点。本文也不是治疗方案推荐。如需获得治疗方案指导，请前往正规医院就诊。 版权说明：本文来自药明康德内容团队，欢迎个人转发至朋友圈，谢绝媒体或机构未经授权以任何形式转载至其他平台。转载授权请在「药明康德」微信公众号回复“转载”，获取转载须知。 分享，点赞，在看，聚焦全球生物医药健康创新

3D Illustration of a pancreas with tumors iStock, libre de droit Jefferies analyst Kelly Shi in a Sunday note to investors said that both data drops for Revolution Medicines’ experimental RAS inhibitors are positive for the two promising assets in pancreatic ductal adenocarcinoma, which could be “synergistic” in the first-line setting based on preclinical combination data. Revolution Medicines on Friday posted a pair of readouts for its investigational RAS inhibitors, demonstrating strong survival outcomes and response rates in patients with advanced pancreatic ductal adenocarcinoma. According to a company presentation on Friday, these data will help advance its mission “to revolutionize patients with RAS-addicted cancers,” leading to better treatment outcomes in pancreatic ductal adenocarcinoma (PDAC), a highly aggressive and lethal type of pancreatic cancer. According to Revolution, more than 90% of PDAC tumors carry oncogenic RAS mutations. In a Friday late-breaking oral session at the 2024 Symposium on Molecular Targets and Cancer Therapeutics of the EORTC-NCI-AACR, Revolution revealed Phase I/Ib data for RMC-9805, an orally available RAS(ON) G12D-selective inhibitor. The biotech touted strong preliminary efficacy for RMC-9805, which elicited a 30% objective response rate and an 80% disease control rate. Revolution combined both confirmed and pending treatment responses in its outcome assessment. RMC-9805 also had an “encouraging safety profile,” the company said in its announcement. In the 99 patients who were treated with 1,200 mg of RMC-9805 daily, the most common treatment-related toxicities were gastrointestinal in nature, including nausea and diarrhea. There were no grade 4 or 5 adverse events, though four patients needed to have their doses lowered due to side effects. Revolution CEO Mark Goldsmith in a statement said that the company is “pleased” with these early data for RMC-9805, “which demonstrate encouraging initial safety, tolerability and antitumor activity.” These findings suggest that the candidate “has the potential to play a role in an emerging treatment paradigm” for PDAC patients, and further provide compelling evidence of Revolution’s approach to target RAS(ON) in RAS-addicted cancers. Also last week, the biotech revealed more data to back its RAS(ON) pipeline, announcing that its Phase I/Ib RMC-6236 showed “ durable antitumor activity ” in advanced PDAC patients, resulting in “encouraging” progression-free and overall survival outcomes. Unlike RMC-9805, RMC-6236 is a RAS(ON) multi-selective inhibitor. The study results— which were also presented at the EORTC-NCI-AACR meeting—primarily enrolled patients with KRAS G12X mutations, in whom RMC-6236 had landmark overall survival of 89% at six months. Objective response rate was 29%. RMC-6236 was generally well-tolerated at the tested dose levels of 160 mg to 300 mg, once-daily. The most common adverse events grade 3 and above were rashes, stomatitis and diarrhea. Toxicities necessitating dose adjustment were reported in 35% of patients. In a Sunday investor note, Jefferies analyst Kelly Shi said that both readouts “are straightforwardly positive” for Revolution and called both RMC-9806 and RMCM-6236 “promising assets” that could be “synergistic” in the first-line setting for PDAC. Both molecules have “complementary” mechanisms of action, Shi said, and Revolution is “committed” to studying the combo in first-line PDAC, though it has yet to reveal specific details for this program.

In an interview Friday, Revolution Medicines CEO Mark Goldsmith, who says he prefers to understate rather than exaggerate, floated a lofty goal: cure pancreatic cancer — or get close. “That’s our aim, and we don’t think that’s right around the corner, but we’re off to a very good start,” he told Endpoints News. It’s an ambitious vision, given that the five-year survival rate for pancreatic cancer is 13%, according to the American Cancer Society. Revolution is developing a suite of RAS inhibitors, and the company’s shares have more than doubled in the past 12 months because of excitement over their potential to treat solid tumors, particularly pancreatic cancer. The Redwood City, CA-based company reported results this week from early-stage trials of two of its experimental treatments in pancreatic cancer, where more than 90% of cases harbor RAS mutations. In a late-breaking presentation Friday, Revolution Medicines said that 12 of 40 previously treated pancreatic cancer patients who received a 1,200 mg daily dose of its KRAS G12D inhibitor, called RMC-9805, saw their tumors shrink at least 30%. (The company included confirmed responses as well as unconfirmed responses still on treatment.) That’s good for a 30% response rate, and the company said it would use a 1,200 mg dose in a Phase 2 trial for pancreatic cancer. The data, presented at what’s known as the Triple Meeting, were the first clinical results from RMC-9805. They’re from a broader Phase 1/1b study looking at the drug in patients with solid tumors harboring KRAS G12D mutations who had received a median of two previous treatments. The company, which informally goes by RevMed, said that 179 patients have been dosed with the drug. At the 1,200 mg daily dose, with which 99 patients have been treated, the most common side effects were nausea, diarrhea and vomiting and rash. It described those adverse events as low-grade and limited, though there was one grade 3 case of elevated liver enzymes. The company also has a multi-RAS inhibitor that can tackle a range of mutations in a Phase 3 trial. Known as RMC-6236, RevMed announced it dosed a first pancreatic cancer patient in that trial on Monday. The study will include a core population of pancreatic cancer patients with RAS G12X mutations, as well as other mutations. RevMed shared updated results from 127 patients in an earlier Phase 1/1b study of RMC-6236. In that study, overall survival rates were 14.5 months in both previously treated pancreatic cancer patients with any RAS mutation, as well as with those with a mutation at codon 12 (which is referred to as KRAS G12X). While the study didn’t have a control arm, Jefferies analyst Kelly Shi said the benchmark for survival in those patients with chemotherapy is about six to seven months. Grade 3 or greater side effects related to the drug were rash (which impacted 8% of patients), stomatitis and diarrhea, and 35% of patients required dose modifications because of side effects, but none dropped out because of that. Goldsmith said the two experimental compounds have “overlapping but also distinct profiles, and two overlapping but also distinct ranges of target.”