On December 4, 2018 Verastem, Inc. (Nasdaq:VSTM) (Verastem Oncology or the Company), focused on developing and commercializing medicines to improve the survival and quality of life of cancer patients, reported the presentation of seven posters highlighting new and updated clinical and preclinical data from its duvelisib development program at the American Society of Hematology (ASH) (Free ASH Whitepaper) 2018 Annual Meeting, taking place December 1-4, 2018, in San Diego (Press release, Verastem, DEC 4, 2018, View Source;p=RssLanding&cat=news&id=2379420 [SID1234531868]). Duvelisib is an oral inhibitor of phosphoinositide 3-kinase (PI3K), and the first approved dual inhibitor of PI3K-delta and PI3K-gamma.

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"The PI3K pathway is critical for the survival and proliferation of many types of cancer cells," said Robert Forrester, Verastem President and Chief Executive Officer. "At Verastem Oncology we are committed to progressing the scientific research and clinical development with our corporate, clinical and academic research partners worldwide to unlock the potential of PI3K inhibition and usher in new treatment strategies for patients in need."

"Research being presented at ASH (Free ASH Whitepaper) this year by Chen, et al used CLL patient samples to demonstrate critical points about dual PI3K-delta and PI3K-gamma inhibition," said Jonathan Pachter, PhD, Chief Scientific Officer at Verastem Oncology. "This research suggests that while PI3K-delta inhibition targets the malignant B cells directly, PI3K-gamma inhibition blocks the support of CLL growth by macrophages and T cells in the tumor microenvironment. Data presented show that when CLL cells from patients who progressed on ibrutinib were implanted in mice, dual PI3K-delta and PI3K-gamma inhibition effectively reduced the CLL burden thereby suggesting the potential value of the dual inhibition in tumors resistant to BTK inhibition. The importance of dual inhibition of PI3K-delta and PI3K-gamma, in this case in combination with BCL-2 inhibition, was also described by Ye, et al in an aggressive lymphoma model. This study highlights the synergistic activity of the combination in inhibiting ibrutinib resistance compensatory pathways and inducing apoptosis in preclinical models of Mantle Cell Lymphoma."

"We are delighted to have presented a wide range of data from our ongoing duvelisib development programs, including updated long-term follow-up data from the Phase 3 DUO study as well as the DUO crossover extension study," said Hagop Youssoufian, MSc, MD, Head of Medical Strategy at Verastem Oncology. "Other key presentations include the Zinzani and Lehmberg data, which describe compelling new biomarker research being conducted relating to predictive factors for response to duvelisib in certain hematologic malignancies."

Details for the ASH (Free ASH Whitepaper) 2018 poster presentations are as follows:

Poster Presentations

Title: Clinical and Biological Indicators of Duvelisib Efficacy in CLL from the Phase 3 DUO Study
Presenter: Jennifer Brown, Harvard Medical School and Dana-Farber Cancer Institute
Abstract Number/Publication ID: 1856
Session: 642. CLL: Therapy, excluding Transplantation: Poster I

Title: The Efficacy and Safety of Duvelisib Following Disease Progression on Ofatumumab in Patients with Relapsed/Refractory CLL or SLL: Updated Results from the DUO Crossover Extension Study
Presenter: Matthew Davids, Dana-Farber Cancer Institute
Abstract Number/Publication ID: 3140
Session: 642. CLL: Therapy, excluding Transplantation: Poster II

Title: Characterization of the Long-Term Efficacy and Safety of Duvelisib Monotherapy in Patients with Relapsed/Refractory CLL/SLL on Treatment for > 2 Years across 4 Clinical Studies
Presenter: Ian Flinn, Sarah Cannon Research Institute
Abstract Number/Publication ID: 3146
Session: 642. CLL: Therapy, excluding Transplantation: Poster II

Title: Simultaneous inhibition of BCL-2 and PI3K signaling overcomes ibrutinib resistance in mantle cell lymphoma
Presenter: Haige Ye, MD Anderson Cancer Center
Abstract Number/Publication ID: 2950
Session: 625. Lymphoma: Pre-Clinical—Chemotherapy and Biologic Agents: Poster II

Title: Prognostic and Immune-Related Factors for Response to Duvelisib in the Phase 2 DYNAMO Clinical Trial in iNHL
Presenter: Pier Luigi Zinzani, University of Bologna Institute of Hematology
Abstract Number/Publication ID: 4167
Session: 623. Mantle Cell, Follicular, and Other Indolent B-Cell Lymphoma—Clinical Studies: Poster III

Title: Dual Inhibition of PI3K-δ and PI3K-γ by Duvelisib Impairs CLL B Cells and CLL-Supporting Cells and Overcomes Ibrutinib Resistance in a Patient-Derived Xenograft Model
Presenter: Shih-Shih Chen, The Feinstein Institute for Medical Research, Northwell Health
Abstract Number/Publication ID: 4420
Session: 642. CLL: Therapy, excluding Transplantation: Poster III

Title: Dynamic BH3 Profiling Predicts Patient Response and MRD Status in Chronic Lymphocytic Leukemia (CLL) Patients Undergoing Frontline Treatment with Kinase Inhibitor Augmented (KIA) FCR
Presenter: Timothy Z. Lehmberg, Dana-Farber Cancer Institute
Abstract Number/Publication ID: 4395
Session: 641. CLL: Biology and Pathophysiology, excluding Therapy: Poster III

PDF copies of these poster presentations will be available here following the conclusion of the meeting.

On December 4, 2018 Clovis Oncology, Inc. (NASDAQ:CLVS) reported after opposition proceedings at The Hague, Netherlands, that the European Patent Office upheld claims of European Patent 2534153 in amended form covering certain crystalline forms of rucaparib camsylate, including rucaparib S-camsylate Form A, the crystalline form in Rubraca (Press release, Clovis Oncology, DEC 4, 2018, View Source [SID1234531884]).

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In its oral decision announced at the hearing, the Opposition Division upheld claims, narrowed from the originally granted patent, to certain crystalline forms of rucaparib camsylate. These forms include, but are not limited to, the commercial product. The European Opposition Division found patentability of the claimed forms based on the inventiveness of these crystalline forms and a constellation of unexpected properties. The European patent was opposed by two opponents. Clovis and/or either opponent have an opportunity to appeal the decision of the European Opposition Division within two months of the written decision, which is expected in the next few months. If appealed, all claims in the originally granted patent will remain in force until the Technical Board of Appeal issues its decision.

In addition to the rucaparib camsylate patent protection through at least 2031 confirmed today, the commercial form of Rubraca is also entitled to European regulatory exclusivity until at least 2028 (and 2029 if an indication in a second tumor type is approved). Also, Clovis has filed for supplementary protection certificate (SPC) extension on this rucaparib camsylate patent in various European countries, which if approved, would provide extension of protection until 2033 under this patent.

"We are very pleased with the outcome of the opposition proceedings today, but more importantly, we are gratified that the European Patent Office acknowledged the innovation behind this invention and upheld robust patent protection for Rubraca in Europe," said Patrick J. Mahaffy, President and CEO of Clovis Oncology. "This patent represents an important component of the intellectual property for Rubraca and we are happy that the Opposition Division upheld the relevant claims of the patent that cover the commercial form of Rubraca as well as other forms of rucaparib camsylate. We look forward to commercializing Rubraca in Europe and with this outcome, we are well-positioned to do so for a very long time."

About Rubraca (rucaparib)

Rubraca is an oral, small molecule inhibitor of PARP1, PARP2 and PARP3 being developed in multiple tumor types, including ovarian, metastatic castration-resistant prostate, and bladder cancers, as monotherapy, and in combination with other anti-cancer agents. Exploratory studies in other tumor types are also underway. Clovis holds worldwide rights for Rubraca. Rubraca is an unlicensed medical product outside of the U.S. and Europe.

On December 4, 2018 City of Hope physicians and researchers reported at the American Society of Hematology (ASH) (Free ASH Whitepaper) meeting in San Diego presented clinical trials for new leukemia and lymphoma treatments, laying the groundwork for innovative therapeutic approaches aimed at improving treatment options and quality of life for patients (Press release, City of Hope, DEC 4, 2018, View Source [SID1234531885]).

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The ASH (Free ASH Whitepaper) meeting hosted more than 25,000 hematology professionals who focus on research and treatment for blood cancers and other diseases.

"City of Hope clinical and laboratory investigators enjoyed sharing our leading-edge research findings and demonstrating our continued commitment to advancing the most promising cures against cancers, including finding new targets in CAR T cell therapy," said Stephen J. Forman, M.D., leader of City of Hope’s Hematologic Malignancies and Stem Cell Transplantation Institute and the Francis & Kathleen McNamara Distinguished Chair in Hematology and Hematopoietic Cell Transplantation.

City of Hope physician-scientists presented clinical trials that provide the foundation for new treatments for patients with T cell lymphoma, non-Hodgkin’s lymphoma and acute lymphoblastic leukemia. They also discussed mouse studies that experimented with a different and possibly more effective way of delivering chimeric antigen receptor (CAR) T cells for leukemia and lymphoma in the central nervous system (CNS). The research is discussed in more detail below.

Delivering CD19-CAR T cells directly into cerebrospinal fluid to treat a lymphoma

This study is touted as the first to demonstrate that local brain delivery of CAR T cells are capable of treating both systemic lymphoma and the CNS. Xiuli Wang, Ph.D., research professor in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope, said immunotherapy that uses T cells genetically modified with the CD19-CAR lentivirus have been effective in treating acute lymphoblastic leukemia and diffuse large B cell lymphoma. Notably, CNS lymphoma, a disease limited to brain, cannot be treated through surgery because the tumors are widespread, and chemo-drugs cannot pass through the protective blood-brain barrier. CAR T cell therapies are usually delivered intravenously and have not been used in treatment for CNS lymphoma due to concerns of effectiveness and potential side effects such as cytokine release syndrome.

People with CNS lymphoma have limited options; City of Hope wants to expand their options. Using a mouse model, Wang and her colleagues delivered T cells modified to express a CD19-CAR directly into cerebro-spinal fluid via cerebral ventricles, a process called intracerebroventricular infusion. A single local infusion was enough to completely eradicate CNS lymphoma and systemic lymphoma throughout the mouse body after 14 days. The mice remained tumor-free for 300 days, the length of the experiment. Comparatively, the mice who received the immunotherapy treatment intravenously had delayed anti-tumor activity: Complete remission was observed about 40 days post CAR T treatment. Eventually the tumors relapsed, and all of the control mice died before day 180.

The experiment demonstrated that delivering CAR T locally into the cerebro-spinal fluid appears to be more efficacious than intravenous delivery. When researchers imaged the mice, they found that CAR T cells migrated to the tumor sites outside the brain. So, local brain delivery of this immunotherapy was able to spread throughout their body. Lastly, the CAR T cells persisted in the mice with the experimental treatment much longer than when they are delivered intravenously – helping to maintain an anti-tumor environment to ward off relapse.

Wang hypothesizes that intracerebroventricular infusion of CAR T therapy may be safer and more effective than intravenous infusion. Her team will test this hypothesis in a phase 1 clinical trial next year.

A chemotherapy-free immunotherapy that uses a special two-armed antibody

In a multisite, international phase 1/1b clinical trial, Lihua Elizabeth Budde, M.D., Ph.D., assistant professor in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope, et al. are testing a promising two-armed antibody that could strong-arm relapsed/refractory B cell non-Hodgkin’s lymphoma into remission. (Normal antibodies have only one arm.) If proven effective, the treatment heralds a new age where chemotherapy and its painful side effects will be obsolete in the treatment of this disease.

The ongoing first-in-human study testing for safety has recruited more than 98 patients to receive varying doses of mosunetuzumab, an experimental antibody with two arms. One arm grabs specific immune cells in the body while the other grabs lymphoma cells. Now in close proximity, the immune cells are trained or forced to recognize and attack lymphoma cells.

Unlike CAR T therapy, this treatment option does not involve removing a patient’s immune cells, modifying them to attack disease and expanding the T cells outside the body. Mosunetuzumab is delivered intravenously and redirects T cells to recognize the cancer; everything happens inside the human body.

The trial’s response rate is around 70 percent, which is promising because the maximum tolerated dose has not yet been reached. So far, most patients who experienced adverse effects had minor, manageable and reversible side effects, Budde said. Most of the patients are in complete remission and have stayed in remission – the longest patient has been cancer-free for more than two years –without needing any other treatment, she added.

Novel regimen for patients with certain lymphomas undergoing a stem cell transplant

In a phase 1 clinical trial designed to test the safety and tolerability of a novel conditioning regimen for patients with peripheral T cell lymphomas undergoing autologous stem cell transplants (which use the patient’s own stem cells), Jasmine Zain, M.D., director of City of Hope’s T cell Lymphoma Program, and her colleagues found that City of Hope-manufactured 90Yttrium-radiolabeled (90Y) basiliximab appears to be safe when used in combination with BEAM. There was no increased toxicity compared to using BEAM chemotherapy alone, and side effects were minimal, the study found.

Peripheral T cell lymphomas have a poor prognosis with current treatment regimens. In spite of autologous stem cell transplants, patients often relapse within a few years. The protein CD25 is differentially expressed in T cell lymphomas. Basliximab is an antibody that targets CD25. 90Y basiliximab provides targeted radiation to tumor cells and has been shown to successfully inhibit the growth of T cell lymphomas in mouse models.

In this phase 1 study, three different dose levels of targeted radiation were explored in combination with chemotherapy with BEAM. Fourteen patients underwent the experimental treatment over a nearly three-year period with no additional toxicity. Eight patients remain in remission. A safe dose level has been established. The study was not designed to assess efficacy of the regimen, but a dose expansion phase is in progress to answer that question.

Memory-enriched CAR T cells: High response rates and low toxicity

CAR T cell therapy reportedly achieves complete remission in patients with acute lymphoblastic leukemia about 80 percent of the time; however, a large proportion of these patients have side effects such as cytokine release syndrome and neurotoxicity. Samer Khaled, M.D., associate clinical professor in the Department of Hematology & Hematopoietic Cell Transplantation at City of Hope, said he may have found a CAR T product that is more potent and less toxic – a potential game-changer if the early results of his ongoing phase 1 clinical trial holds through future testing.

So far, the clinical trial has enrolled 16 patients with relapsed or refractory B cell acute lymphoblastic leukemia, a disease that has poor survival rates. The physician-scientists treated 13 eligible patients with T cells engineered to express CD19:28z-CAR. Investigators used a unique manufacturing platform developed at City of Hope that generates therapeutic cells from enriched memory and "naïve T cells" – immune soldiers known for their capacity for long-term persistence.

Eleven out of 11 patients evaluable for response received the treatment and are in complete remission, showing a 100 percent response rate with no significant increase in toxicity. Two patients were not eligible for response evaluation but were included in the toxicity assessment. Though the sample size was small, it is noteworthy. "Traditionally, high CAR T activity is associated with high toxicity, but our CD19 CAR T product appears to be a very powerful therapy with lower-than-normal side effects," Khaled said.

City of Hope research on a new CAR T therapy, BAFF-R

Hong Qin, Ph.D., associate research professor in City of Hope’s Department of Hematology & Hematopoietic Cell Transplantation, and Larry Kwak, M.D., Ph.D., Dr. Michael Friedman Professor in Translational Medicine and director of the Toni Stephenson Lymphoma Center, have conducted new research demonstrating that a CAR T cell therapy targeting the B-cell activating factor receptor (BAFF-R), a protein which is primarily expressed on B-cells and various subtypes of B-cell non-Hodgkin’s lymphoma (NHL) and acute lymphoblastic leukemia (ALL), can be used to help patients who are experiencing relapse after receiving other CAR T therapies.

CAR T therapies targeting CD19, another target on B-cell tumors, is becoming more common, but so are cases of CD19 antigen-loss relapse. The increase of relapse highlights an urgent need for new therapies and tumor targets.

City of Hope research has led to the development of a highly effective BAFF-R targeting CAR T cells that works against a variety of human B-cell leukemia and lymphoma models. Encouragingly, BAFF-R CAR T cells remain effective against tumor samples from ALL patients who experienced CD19 antigen-loss relapse. The new data suggest that targeting BAFF-R may add to existing alternative strategies to overcome relapse from CD19 antigen loss.

"City of Hope is planning a clinical trial in the coming year that will be the first BAFF-R CAR T trial for patients, providing new hope for patients who have no other therapeutic options," Qin said.

On December 4, 2018 Triumvira Immunologics Inc. (Triumvira), reported the presentation of key preclinical data at the American Society of Hematology (ASH) (Free ASH Whitepaper) 60th Annual Meeting and Exposition, held December 1-4, 2018, in San Diego, CA (Press release, Triumvira Immunologics, DEC 4, 2018, View Source [SID1234531886]). The data show that TAC-engineered T cells provide long-lasting tumor rejection in mouse models of BCMA-positive and CD19-positive hematological malignancies and suggest the presence of persisting TAC-T cells that protect against tumor regrowth upon tumor rechallenge.

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The results build on data recently published in Nature Communications (Helsen et al., 2018) describing the proprietary T cell Antigen Coupler (TAC) technology, a chimeric receptor that co-opts the endogenous T cell receptor (TCR) for T cell activation and tumor cell killing. The new data, presented during a podium presentation and a poster presentation, now describe additional preclinical pharmacology of the company’s therapeutic programs in multiple myeloma (BCMA) and B-cell lymphoma (CD19). A CD19-directed TAC-T cell product is expected to enter clinical testing in H1 2019.

The podium presentation, presented by Ksenia Bezverbnaya, BSc., McMaster University, (Publication 3267: T cell engineered with a novel chimeric receptor demonstrate durable in vivo efficacy against disseminated multiple myeloma) focused on two TAC constructs each of which was fused to a different BCMA binder. A single dose of TAC-T cells (106) engineered with either construct cured mice with disseminated KMS-11 multiple myeloma cells and protected mice, in remission for 3 months after treatment, against tumor regrowth upon a fresh inoculation of tumor cells.

The poster presentation, presented by Christopher Helsen, Ph.D., Director of Research & Development, and Head of Platform Development at Triumvira (Publication 962: T cells engineered with T cell antigen coupler (TAC) receptors for haematological malignancies) described the preclinical pharmacology of TAC-T cells directed against the CD19 and BCMA antigens in multiple models of CD19-positive leukemia and lymphoma and the BCMA-positive KMS-11 multiple myeloma model. TAC-T cells specific for either antigen produced long-lasting tumor rejection and effectively protected mice in tumor rechallenge experiments indicating the presence of persisting TAC-T cells.

"These data provide further evidence that TAC furnishes T cells with properties that are highly desirable attributes for future T cell therapies," states Dr. Paul Lammers, President & CEO of Triumvira, "TAC-T cells demonstrate superiority over 2nd generation CAR-T cells, and effectively rids animals from cancer in the absence of notable toxicities and protects these animals for a prolonged period of time. These new data further strengthens the argument for bringing the TAC technology to patients."

On December 4, 2018 Moleculin Biotech, Inc., (Nasdaq: MBRX) ("Moleculin" or the "Company"), a clinical stage pharmaceutical company focused on the development of oncology drug candidates, all of which are based on license agreements with The University of Texas System on behalf of the M.D. Anderson Cancer Center, reported that its own sponsored research has now confirmed a recent published study demonstrating the ability of its clinical-stage immuno-stimulating STAT3 inhibitor, WP1066, to inhibit a key immune checkpoint target known as PD-L1 (Press release, Moleculin, DEC 4, 2018, View Source [SID1234531871]).

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"We have known for some time that WP1066 had the potential to stimulate a natural immune response," commented Dr. Donald Picker, Moleculin’s Chief Science Officer. "But, this data suggests that our drug may be capable of having a major impact on the field of checkpoint blockades. With this information combined with findings from other recently published studies demonstrating the impotant role of STAT3 in cancer immunology, we plan to run additional in vitro and in vivo studies, some of which are already underway, with WP1066 in combination with well-known checkpoint inhibitors to gather more data on this response."

Walter Klemp, Moleculin’s Chairman and CEO added, "This potential was initially reported in a 2017 Japanese study (Journal of clinical and experimental hematopathology, Vol. 57 No.1, 21-25, 2017), but we have now been able to confirm this activity with our own sponsored research at MD Anderson. Also, very recent independent research (Front Pharmacol. 2018 May 22;9:536. doi: 10.3389/fphar.2018.00536. eCollection 2018.) has linked STAT3, HIF1-a and c-Myc (all targets of WP1066) to the mechanism (a ligand known as PD-L1) believed to be largely responsible for resistance to current checkpoint blockade therapies. We believe this could put WP1066 center-stage in the field of immunotherapy. It’s potentially a tremendous breakthrough for our company."