On August 3, 2020 Aileron Therapeutics (NASDAQ:ALRN) reported that it has completed enrollment in the dose optimization expansion cohort of its ongoing open-label Phase 1b clinical study of ALRN-6924 (Press release, Aileron Therapeutics, AUG 3, 2020, View Source [SID1234565067]). Aileron is focused on transforming the experience of chemotherapy for cancer patients by developing and delivering a novel chemoprotective medicine to protect against multiple chemotherapy-induced side effects. The proof-of-concept Phase 1b study is evaluating ALRN-6924 as a therapeutic agent administered ahead of chemotherapy to prevent chemotherapy-induced bone marrow toxicities, such as severe anemia, thrombocytopenia and neutropenia, in patients with p53-mutated small cell lung cancer (SCLC) who are being treated with topotecan. The protocol for this study consists of a phase 1b and a randomized, controlled phase 2; the Phase 1b has two parts: dose optimization and schedule optimization.
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"We’re very encouraged by the data we reported from the dose optimization part of the Phase 1b in June demonstrating ALRN-6924’s potential to shield multiple healthy cell types from chemotherapy-induced damage without limiting the effect of chemotherapy on cancer cells," said Manuel Aivado, M.D., Ph.D., President and Chief Executive Officer at Aileron. "Per the interim findings, the 0.3 mg/kg dose of ALRN-6924 achieved the most robust and consistent chemoprotective effects of the three dose levels evaluated. The chemoprotection results were further supported by pharmacodynamic biomarker results also observed in the interim analysis."
Dr. Aivado continued, "We look forward to reporting the final results of the dose optimization part of the Phase 1b, including findings from the 0.3 mg/kg expansion cohort, as well as preliminary results from the recently initiated schedule optimization part of the Phase 1b, in Q4 of this year. We believe that the results from the Phase 1b, along with results from a healthy volunteer study that we plan to initiate in Q3 of this year, will further support and de-risk our plans to develop ALRN-6924 as a chemoprotective agent for patients with multiple cancer types who are treated with various chemotherapies."
In June 2020, Aileron announced positive interim data from the dose optimization part of the Phase 1b study demonstrating that treatment with ALRN-6924 resulted in protective effects against severe chemotherapy-induced anemia and thrombocytopenia in patients across three dose levels (0.3, 0.6, and 1.2 mg/kg) relative to historical controls. In addition, patients treated with 0.3 mg/kg ALRN-6924 also met the protocol-defined criterion for reduction of NCI CTC Grade 3/4 neutropenia to ≤50% in the first treatment cycle, triggering a cohort expansion at this dose level, from six to 14 patients.
As previously guided, in the fourth quarter of 2020, Aileron plans to report final Phase 1b dose optimization data, including data from the dose optimization expansion cohort as well as pharmacodynamic biomarker and tumor efficacy data, in addition to preliminary Phase 1b schedule optimization data. Additionally, in the third quarter or 2020, Aileron plans to initiate enrollment in a healthy volunteer study to determine dosing schedules for ALRN-6924 that will support and further de-risk the company’s long-term vision to provide a chemoprotective medicine for patients with a p53-mutation regardless of cancer type or chemotherapeutic drug. Aileron will continue to carefully monitor the effect of the coronavirus pandemic on its clinical trial sites and the healthcare system, which may impact its planned data announcements.
About the Dose Optimization Expansion Cohort Design
In the dose optimization expansion cohort, which has completed planned enrollment of eight patients, ALRN-6924 is being administered at a 0.3 mg/kg dose level 24 hours before each dose of topotecan. Topotecan is being administered days 1 through 5 every 21 days.
How ALRN-6924 Works to Protect Healthy Cells from Chemotherapy-Induced Damage
ALRN-6924 is being developed by Aileron as a novel chemoprotective medicine to treat and protect healthy cells in patients with cancer that harbors p53-mutations to reduce or eliminate chemotherapy-induced side effects.
Chemotherapy targets cells that are cycling, or undergoing the process of cell division. In cancer cells, the cell cycle is unchecked, which leads to uncontrolled cell proliferation, a hallmark of cancer. Certain types of healthy cells also naturally need to cycle, such as bone marrow cells (which give rise to red blood cells, white blood cells, and platelets), hair follicle cells, skin cells, and cells lining the oral cavity and the gastrointestinal tract. As a result, chemotherapy targets and kills both cycling healthy cells and cycling cancer cells. This, in turn, leads to a spectrum of chemotherapy-induced side effects, from unpleasant to life-threatening.
ALRN-6924, an investigational first-in-class MDM2/MDMX dual inhibitor, is administered to cancer patients shortly before chemotherapy. ALRN-6924 is designed to selectively activate normal p53 protein in patients’ healthy cells, temporarily and reversibly pausing cell cycling to shield healthy cells from chemotherapy. The protection is limited to healthy cells, as ALRN-6924 cannot work in p53-mutated cancer cells given that p53 has lost function in those cells. Therefore, cancer cells continue to cycle uninterrupted, remaining fully susceptible to destruction by chemotherapy.