On July 11, 2024 Revolution Medicines, Inc. (Nasdaq: RVMD), a clinical-stage oncology company developing targeted therapies for patients with RAS-addicted cancers, reported the publication of a peer-reviewed research paper in Cancer Discovery (Press release, Revolution Medicines, JUL 11, 2024, View Source [SID1234644794]). The scientific paper demonstrates that the RAS(ON) multi-selective inhibitor RMC-7977 (a preclinical tool compound representative of the investigational drug candidate RMC-6236) exhibited robust and durable anti-tumor activity in multiple preclinical models of KRAS-mutated NSCLC. The data show this activity was further enhanced in the doublet combination with a RAS(ON) G12C-selective inhibitor RMC-4998 (a preclinical tool compound representative of the investigational drug RMC-6291), in preclinical models of KRAS G12C-mutated NSCLC. These findings are the result of original, collaborative research between scientists at Revolution Medicines and The University of Texas MD Anderson Cancer Center.
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Oncogenic RAS proteins drive up to 30 percent of all human cancers, most notably NSCLC, pancreatic ductal adenocarcinoma and colorectal cancer. RAS G12 mutations, such as G12D, G12V and G12C, predominate in these RAS-addicted cancers. Approved RAS-targeted cancer therapies target only one RAS mutation, KRAS G12C, which is present in approximately 13 percent of NSCLC. There remains a large unmet medical need for improved clinical outcomes with KRAS G12C-selective inhibitors and for extending therapy options to patients harboring KRAS non-G12C-driven tumors.
The paper highlights that direct RAS inhibition with a RAS(ON) multi-selective inhibitor monotherapy, alone or in combination with a RAS(ON) G12C-selective inhibitor, elicited rapid, deep and sustained tumor regressions and significantly prolonged time to tumor doubling in preclinical models of refractory KRAS G12C-mutated NSCLC. The combination dramatically improved anti-tumor activity as compared to RAS(ON) multi-selective inhibitor monotherapy and elicited cures (defined as recurrence free survival following treatment withdrawal) in all of the preclinical models bearing alterations in genes associated with the subsets of KRAS G12C-mutated NSCLC (e.g. KEAP1 and SMARCA4). The RAS(ON) multi-selective inhibitor overcame acquired resistance to RAS(OFF) and RAS(ON) G12C-selective inhibitors in these models of advanced KRAS G12C-mutated NSCLC, further underscoring the robust activity of this inhibitor.
The paper also unveils a conserved mucinous regenerative program, apparent upon treatment cessation, that may support long-term tumor cell persistence in the context of sustained RAS pathway inhibition. Characterization of this emergent population of persister cells, a rare slow cycling group of cancer cells that may endure despite ongoing inhibitor treatment, provides insights into potential therapeutic strategies that could prevent them from driving recurrent tumor growth.
"RAS-addicted cancers are widely known for being resistant to current cancer therapies and recent studies have highlighted mechanisms of clinical resistance to RAS(OFF) G12C-inhibitors. We evaluated the anti-tumor activity of a broad spectrum RAS(ON) multi-selective inhibitor alone and in combination with a RAS(ON) G12C mutant-selective inhibitor in models of clinically challenging subsets of KRAS G12C-mutated NSCLC. Given the novel mechanism of action of these inhibitors, directly targeting oncogenic RAS, a key question was whether primary, adaptive or acquired resistance mechanisms would emerge following treatment," said Jan Smith, Ph.D., Chief Scientific Officer of Revolution Medicines. "These encouraging preclinical data provide a strong rationale for our ongoing combination study of RMC-6236 as a doublet with RMC-6291 in patients with advanced KRAS G12C-mutated cancers."
The investigational oral drug RMC-6236 is a RAS(ON) multi-selective inhibitor designed to treat patients with cancers driven by a wide range of common RAS mutations. Revolution Medicines is currently evaluating RMC-6236 as monotherapy in a Phase 1/1b trial in patients with advanced solid tumors harboring G12X, G13X and Q61X mutations (NCT05379985). Following promising preliminary data in this Phase 1/1b study, planning is underway to initiate pivotal studies of RMC-6236 as monotherapy in PDAC and NSCLC. RMC-6236 is also being evaluated in combination with pembrolizumab with or without chemotherapy in patients with advanced RAS-mutated solid tumors (NCT06162221) and in combination with RMC-6291, the company’s investigational RAS(ON) G12C-selective inhibitor, for patients with advanced KRAS G12C-mutated solid tumors (NCT06128551).
The publication, entitled, "Mechanisms of response and tolerance to active RAS inhibition in KRAS-mutant NSCLC," is available online at:
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