On January 17, 2018 Curis, Inc. (NASDAQ: CRIS), a biotechnology company focused on the development and commercialization of innovative and effective therapeutics for the treatment of cancer, reported initiation of patient dosing in a Phase 1 trial of CA-4948, an orally available small molecule inhibitor of the IRAK4 kinase, for treatment of patients with lymphoma (Press release, Curis, JAN 17, 2018, View Source [SID1234523297]). CA-4948 was discovered at Aurigene and is the second licensed program from the Curis-Aurigene collaboration to enter the clinic.

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The Phase 1 study is designed to evaluate the safety, tolerability, and pharmacokinetic profile of CA-4948; identify any dose-limiting toxicities; and establish the recommended Phase 2 dose for the treatment of patients with lymphomas. The dose escalation stage of the trial will enroll patients with relapsed/refractory non-Hodgkin’s lymphoma, and the expansion stage will focus on specific populations of patients with lymphomas harboring alterations in the MYD88 gene or Toll-like receptor (TLR) signaling pathway.

"We are pleased to announce the advancement of our clinical pipeline with the initiation of the Phase 1 trial for this selective IRAK kinase inhibitor in patients with lymphomas," commented Ali Fattaey, Ph.D., Curis’s president and CEO. "Given the prevalence of activating mutations in the MYD88 gene and the TLR pathway, IRAK4 represents a significant target for the precision treatment of patients with different hematologic malignancies. In addition to its preclinical anti-tumor activity in MYD88-mutated lymphomas, we have observed encouraging effects of CA-4948 in animal models of acute myeloid leukemia (AML), myelodysplastic syndromes (MDS) as well as non-oncology inflammatory disease models. We look forward to working with our partner Aurigene to develop CA-4948 and explore clinical opportunities for these conditions in the near future."

"We are excited to have enrolled the first patient in this lymphoma clinical trial and look forward to further investigating CA-4948 as a potential new treatment option for patients with hematologic malignancies," said Mathew Lunning, DO, University of Nebraska Medical Center, an investigator for the study.

"We are delighted with our collaboration that has led to the advancement of the second program into the clinic, an IRAK4 targeting molecule that came out of Aurigene’s discovery efforts over many years," said CSN Murthy, Aurigene’s CEO. "Our investment into Curis exhibits our belief and commitment for this program and beyond as we work with Curis to focus our collective resources to advance exciting drug candidates."

About CA-4948, a Small-Molecule Inhibitor of IRAK4 Kinase

Innate immune responses orchestrated through Toll-like receptors are important mediators of the body’s initial defense against infections, while their dysregulation is associated with certain inflammatory conditions. Toll-like receptor signaling through the adaptor protein MYD88 results in the activation of IRAK4, initiating a signaling cascade that induces cytokine and survival factor expression. MYD88 gene mutations occur in approximately 30 percent of activated B-cell subtype of diffuse large B-cell lymphomas (DLBCL)1,2 and in over 90 percent of cases of the B-cell malignancy Waldenstrom’s macroglobulinemia (WM).3 IRAK4 has been validated as a target in DLBCL and WM disease setting, and its inhibition by CA-4948 has been shown to provide potent in vivo anti-tumor activity in animal models.4,5 IRAK4 inhibitors are also in clinical testing for treatment of patients with rheumatoid arthritis.

1Nature. 2011; 470(7332):115–119
2Immunology and Cell Biology. 2011; 89(6):659–660
3N Engl J Med. 2012; 367(9):826–833
4Cancer Res. 2017; 77(13 Suppl): Abstract 1168
5Blood. 2015;126(23):4004–4004

On January 17, 2018 Circle Pharma, Inc. reported that results from its collaborative work with Pfizer Inc. to develop a potent and orally bioavailable macrocycle modulator of the chemokine receptor, CXCR7, have been published in the Journal of Medicinal Chemistry (Press release, Circle Pharma, JAN 17, 2018, View Source [SID1234523306]).

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The goal of the collaboration was to deploy Circle’s rational design platform for macrocycle therapeutics in order to improve the drug-like characteristics of an existing macrocycle compound, and in particular to develop a cell permeable, orally bioavailable compound with enhanced target affinity. As reported in the publication, the collaboration produced a series of permeable and potent derivative macrocycles, including a compound having >500-fold increase in potency (CXCR7 Ki of ~ 9nM versus 2 uM for the starting compound), good cell permeability and 18% oral bioavailability in rats.

Additionally, permeable CXCR7 binding compounds with novel macrocycle backbone scaffolds were discovered through the efforts of the collaboration. This finding was not described in the publication.

"Cell permeability and orally bioavailability have been long-standing and well recognized challenges in the development of macrocycle therapeutics: nearly all synthetic macrocycle compounds in clinical development are against extracellular targets and are delivered by injection," noted David J. Earp, JD, PhD, Circle’s CEO. "Circle’s rational design approach coupled with efficient, low-cost synthesis uniquely enables us to design cell permeable, bioavailable macrocycles to address therapeutic targets that have been out of reach, including intracellular protein-protein interactions. This is a large target class with significant unmet clinical need."

"This collaboration successfully achieved its very challenging objective of delivering a potent and orally bioavailable macrocycle targeting CXCR7," said Spiros Liras, PhD, Vice President, Medicinal Chemistry, Pfizer.

The open-access scientific paper, entitled "Discovery of Potent and Orally Bioavailable Macrocyclic Peptide–Peptoid Hybrid CXCR7 Modulators," is available at View Source

About Macrocyclic Peptides

Macrocyclic peptides have the potential to allow drug developers to address the large proportion of known therapeutic targets (estimated at up to 80%) that are considered undruggable with conventional small molecule or biologic modalities. In particular, there is great interest in developing macrocycles to modulate protein-protein interactions, which play a role in almost all disease conditions, including cancer, fibrosis, inflammation and infection. However, the development of macrocyclic therapeutics has been limited by the need for a greater understanding of how to develop macrocycles with appropriate pharmacokinetics, cell permeability and oral bioavailability. Circle is applying its ability to design potent macrocycles with intrinsic cell permeability and drug-like characteristics to unlock access to challenging, high value therapeutic targets that have been out of reach by other approaches.

On January 16, 2018 Athenex, Inc. (Nasdaq:ATNX), a global biopharmaceutical company dedicated to the discovery, development and commercialization of novel therapies for the treatment of cancer and related conditions, reported that the United States Food and Drug Administration ("FDA") has provided positive feedback on the design of the currently ongoing Phase III Clinical Trial for Oraxol, an innovative oral formulation of paclitaxel combined with HM30181A (a novel P-gp inhibitor) (Press release, Athenex, JAN 16, 2018, View Source;p=RssLanding&cat=news&id=2326701 [SID1234523137]). Specifically, the FDA indicated that if the study meets the primary endpoint with an acceptable Benefit/Risk profile, it could be adequate as a single comparative trial to support registration of Oraxol for a metastatic breast cancer indication in the United States.

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The Oraxol Phase III clinical study (KX-ORAX-001) is a randomized controlled international clinical trial investigating the superiority of Oraxol over intravenous ("IV") paclitaxel in the treatment of patients with metastatic breast cancer. The primary endpoint is confirmed tumor response rate assessed by a blinded independent radiologic imaging analysis center using the RECIST Criteria, a generally accepted clinical response criteria for efficacy in tumor reduction. The study has a target sample size of 360 patients. The study has completed the first of two planned interim analyses. The second interim analysis based on 180 evaluable patients is planned for the middle of 2018. The positive US FDA feedback would allow an Oraxol US registration submission upon successful completion of this single Phase III study.

Dr. Rudolf Kwan, Athenex’s Chief Medical Officer, commented, "This positive feedback from the U.S. FDA is an important step in bringing Oraxol closer to the doctors and patients. Our Phase III trial also recently received the unanimous recommendation to continue by an independent Data and Safety Monitoring Board. The recommendation was based on the positive overall response rate of Oraxol and the very low incidence of neuropathy, which is a severe dose-limiting side-effect of IV paclitaxel."

Dr. Johnson Lau, Athenex’s Chief Executive Officer, added, "We are delighted with the positive feedback from the FDA on the Phase III Clinical Study Design for Oraxol, which provides further validation of our regulatory pathway for Oraxol. With the recent allowance of the Oraxol Investigational New Drug application in China and the receipt of the Promising Innovative Medicine designation from the United Kingdom Medicines and Healthcare products Regulatory Agency, we continue to advance towards our goal of improving the lives of cancer patients worldwide."

Athenex previously announced that the Data and Safety Monitoring Board unanimously recommended the continuation of its Phase III clinical trial comparing Oraxol versus IV paclitaxel in the treatment of metastatic breast cancer after the interim analysis of the first 90 patients on October 5, 2017. Additionally, the Company announced the receipt of the Promising Innovative Medicine designation for Oraxol by the United Kingdom Medicines and Healthcare products Regulatory Agency on December 27, 2017, qualifying Athenex to apply for Step II of the Early Access to Medicines Scheme to provide patients early access to Oraxol prior to receiving marketing authorization. Athenex also recently announced that the Chinese FDA has allowed the Investigational New Drug application for Oraxol on January 8, 2018, enabling Athenex to initiate clinical studies in China.

On January 6, 2018 Context Therapeutics, a biopharma company dedicated to developing new medicines for patients with hormone responsive cancers, reported that it has acquired worldwide rights to Apristor (Onapristone XR) (Press release, Context Therapeutics, JAN 16, 2018, View Source [SID1234523265]). Onapristone has been extensively studied and has established efficacy in two Phase 2 metastatic breast cancer clinical trials. In these trials, meaningful clinical benefit and response rates were seen in 120 metastatic breast cancer patients, 101 of whom were actively progressing on Tamoxifen before Onapristone treatment initiation. Onapristone has been studied in over 200 patients, and it was well tolerated with no drug-related serious adverse events.

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Martin Lehr, CEO of Context stated: "We are excited to advance the development of Apristor and to potentially provide a mechanistically novel option for patients diagnosed with metastatic breast cancer. Unfortunately, the median life expectancy of a woman diagnosed with metastatic breast cancer is approximately three years. In the United States alone 40,000 women die each year as a result. These women deserve better, and we are committed to improving their treatment and removing the fear that comes along with this diagnosis."

Apristor blocks the binding of progesterone, a carcinogen, to the progesterone receptor (PR). Up to 70% of metastatic breast cancers express PR and are said to be PR+. If approved, Apristor would provide physicians with a novel product that could be used in combination with standard of care agents targeting the estrogen receptor or as a monotherapy.

Context made a one-time payment to Arno Therapeutics in exchange for the worldwide rights to Apristor. Apristor is a new chemical entity and is protected by a robust patent estate that should provide exclusivity through at least 2034.

Scott Applebaum, President of Context stated: "Context has taken a big leap forward and is now a clinical-stage company. This transformation is consistent with our mission of discovering, developing, and commercializing treatments for hormone-responsive cancers. We are building a world-class global clinical trial organization to bring Apristor to market as fast as possible. In addition, we have an Apristor fast-follower program for progesterone receptor-mediated diseases and continue to advance our preclinical Sigma1 program."

On January 16, 2018 Constellation Pharmaceuticals, Inc., a clinical-stage biopharmaceutical company developing tumor-targeted and immuno-oncology therapies based on its pioneering research and development in cancer epigenetics, reported it has initiated a Phase 1b/2 clinical trial to evaluate CPI-1205, a small-molecule inhibitor of Enhancer of Zeste Homolog 2 (EZH2), combined with checkpoint inhibitor ipilimumab (marketed as YERVOY by Bristol-Myers Squibb) and potentially other cancer immunotherapies (Press release, Constellation Pharmaceuticals, JAN 16, 2018, View Source [SID1234523138]). The study, named ORIOn-E, is based on translational insights which identified combination approaches using epigenetics-mediated mechanisms aimed at Overcoming Resistance to Immune Oncology therapies by inhibiting EZH2.

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"This is the second combination study we’ve initiated evaluating the potential for CPI-1205 to overcome resistance mechanisms to existing cancer therapies," said Jigar Raythatha, president and chief executive officer of Constellation Pharmaceuticals. "Our preclinical results with CPI-1205 demonstrate that epigenetic targets can be utilized by cancers to suppress the immune system and render immunotherapy treatment options less effective. We aim to build on this insight with CPI-1205 in clinical trials and with other epigenetic therapies that we discover and develop in this important area of research."

CPI-1205 is a potent, highly selective, first-generation small-molecule inhibitor of an enzyme called EZH2. In pre-clinical studies, CPI-1205 has shown potential to re-wire T regulatory and T effector cells within tumors to enhance tumor rejection alone and synergistically in combination with immune checkpoint inhibition.

"Since they were first made available in the U.S., checkpoint inhibitor therapies like ipilimumab have provided considerable benefit for patients with many different cancers. However, many patients do not respond to therapy or relapse after initial response," said Adrian Senderowicz, M.D., senior vice president and chief medical officer of Constellation Pharmaceuticals. "CPI-1205 plays a critical role in inhibiting the suppressive function of regulatory T cells and consequently may address resistance mechanisms that limit the benefit of immune checkpoint inhibitors in patients."

The Phase 1b portion is a dose escalation study designed to evaluate the safety, pharmacokinetics, pharmacodynamics and the assessment of potential predictive biomarkers in patients across solid tumors when treated with CPI-1205 in combination with ipilimumab. The Phase 2 portion will be conducted in melanoma patients, among other cancers.

About CPI-1205
CPI-1205 is a therapeutic candidate from Constellation Pharmaceuticals’ EZH2 portfolio and is an inhibitor of Enhancer of Zeste Homolog 2 (EZH2). The function of EZH2 is to selectively suppress gene expression of several pro-cancer pathways that contribute to drug resistance.