Cancer cells are addicted to inhibitors of apoptosis Jean-Pierre Abastado Institut de Recherches Internationales Servier 1 Disclaimer I am full-time employee of ‘Servier Research Group’, a French Research—based group dedicated to healthcare with research & clinical-stage programs in oncology. 2 Outlines Rationale for targeting inhibitors of apoptosis Clinical development of inducers of apoptosis 3 Outlines Rationale for targeting inhibitors of apoptosis Clinical development of inducers of apoptosis 4 Resistance to apoptosis: hallmark of cancer 5 Resistance to apoptosis Hallmark of cancer Sensitization to: – Mitosis inhibiting agents – Oncogene inhibition (EGFR, RAF, MEK..) – Chemotherapy Common mechanism of drug resistance – Cancer stem cells and resistance to chemotherapy 6 Mitochondrial apoptosis is controlled by the Bcl-2 protein family Death cues DNA Damage Death receptors Oncogenic stress Cytoskeleton damage NOXA PUMA tBID BIM BAD PRO-APOPTOTIC ANTI-APOPTOTIC EXECUTOR MOMP Permeabilization 7 Resistance to apoptosis: a hallmark of cancer Bcl-2: at the t(14;18) translocation breakpoint in FL - Overexpression (translocation, amplification, loss of miRNA, transcriptional activation …) in CLL, NHL, SCLC, luminal BC, ProCa Mcl-1: induced by TPA in ML-1 cells – overexpression in AML, MCL, DLBCL, NHL, MM 8 Bcl2l1 is frequently amplified in cancer Copy-number profiles among 50 tumors of various lineages (shown across the top) with focal amplification of BCL-XL (Bcl2L1) are displayed for the region around BCL2L1 Beroukhim et al.; Nature, 2010 9 Oncogene activation induces apoptosis or transformation Oncogene Bcl-2 family members Apoptosis Oncogene Bcl-2 family members Transformation Apoptosis Transformation 10 Oncogene addiction 11 Resistance to oncogene inhibition MEKi=selumitinib Corcoran et al. Cancer Cell 2013 12 Combined Bcl-XL and MEK inhibition: synthetic lethality Corcoran et al. Cancer Cell 2013 HCT116 CRC KRASmt Colland et al. Unpublished LTI8: Bcl-XL-specific inhibitor Pimasertib MEK1/2 inhibitor 13 Synthetic lethality of BRAF and Bcl-XL inhibition 300nM 100nM 30nM 10nM LTI8 300nM 100nM 30nM LTI8 10nM DMSO Cleaved caspase-3 COLO205 treated in association with PLX-4032 6h + cpd 16h PLX-4032 1µM PLX-4032 1µM + P-ERK Bim PARP Actin LTI8 LTI8 + PLX-4032 PLX-4032 = vemurafenib COLO205: CRC BRAFV600E Colland et al. Unpublished 14 Synergy with Mitosis Inhibiting Agents Mcl-1 degradation Cell vulnerability to apoptosis 15 Synergy with mitosis inhibiting agents Taxol Mitotic arrest Mcl-1 ubiquitination Mcl-1 degradation Bcl-XL dependancy Wertz et al Nature 2011 16 Role of Bcl-xL in resistance to taxol in ovarian cancer Paclitaxel (nM) Clinical response to Taxanes Bcl-xL expression (IHC) ABT-263 Synergy between Taxol and ABT-263 Poor responders Responders Wong et al Mol. Cancer Ther 2012 17 Synergy between Taxol and Bcl-xL inhition Caspase 3 activation PARP BclXL Mcl-1 Bax +Taxol HCT116 Actin Colland et al. Unpublished 18 Bcl-2-mediated chemoresistance of HCC Cancer Stem Cells Ma et al. Oncogene 2008 19 Bcl-xL- mediated chemoresistance of colon CSC Growth of spheroid cultures Caspase activation in spheroid cultures Oxaliplatin ABT-199 (Bcl-2i) + Oxaliplatin ABT-737 (Bcl-2i/Bcl-xLi) + Oxaliplatin WEHI-539 (Bcl-xLi) + Oxaliplatin Colak et al. CDD 2014 20 Rationale for targeting inhibitors of apoptosis Clinical development of inducers of apoptosis 21 The Bcl-2 proteins are essential for the development and homeostasis of the hematopoietic system Brinkmann et al CDD 2014 22 Multi-specific inhibitors AT-101 (Gossypol pro-drug)*-> pan-Bcl-2. Heme tox Obatoclax*: pan-Bcl-2-> Limited activity in Hodgkin’s lymphoma ABT-737: Bcl-xL, Bcl-2 and Bcl-w -> poor ADME ABT-263 (Navitoclax): Bcl-xL, Bcl-2 and Bcl-w -> activity in CLL but thrombocytopenia * Induce apoptosis in BAX/BAK deficient cells (Vogler et al CDD 2009) 24 Bcl-2-specific inhibitors Company Drug Target Comments Phase Indication Genta Genasense (Oblimersen) Antisense oligo targeting Bcl-2 Various combinations Failure and bankruptcy Ph 3 AML, CLL, MM, Mel, NSCLC AbbVie Genentech ABT-199 (Venetoclax) Bcl-2 +RTX vs Benda + RTX Ph 3 CLL Servier Novartis S 55746 Bcl-2 monotherapy + RTX + Obituzumab +RTX and Bendamustine + R-CHOP ou Obi-CHOP CLL, NHL Ph 1 Ph 1b Ph 1b Ph 1b monotherapy + Decitabine or Aza + Cytarabine Ph 2 Ph 1 Ph 1/2 AML monotherapy + Bortezomid and Dexamethasone Ph 1 Ph 1b MM monotherapy Ph 1 CLL, NHL AML, MDS 25 BCL-2-selective S55746 induces apoptosis with no platelet toxicity Apoptosis induction in RS4;11 leukemia xenograft model Platelet count (16 hours post Per Os treatment) (16 hours post Per Os treatment DEVDase/Caspase-3 activities in tumour lysates,) 1400 1200 Platelets (x103/µl) 10000 8000 6000 4000 1000 800 600 400 2000 200 ABT-263 100 mg/kg S 55746 100 mg/kg Vehicle 0 Untreated ABT-263 100 mg/kg S 55746 100 mg/kg S 55746 25 mg/kg 1 Vehicle 0 Untreated DEVDase activity (RFUs) 12000 Geneste et al. Unpublished 26 Activity of S 55746 in ALL model Leukemia xenograft model (RS4;11) per os administration: RS 4;11 MTT IC50 = 61 nM 2500 2250 Tumour weight (mg) Median +/- IQR 2000 1750 1500 1250 Dosing 1000 750 Control (untreated) 500 12.5 mg/kg 25 mg/kg 250 50 mg/kg 0 100 mg/kg 0 5 10 15 20 25 30 35 40 45 50 55 Time after treatment initiation (days) Geneste et al. Unpublished 27 Ongoing clinical studies w S55746 Phase I dose-escalation study of oral administration of the selective Bcl-2 inhibitor S 55746 in patients with refractory or relapsed Chronic Lymphocytic Leukemia and B-Cell Non-Hodgkin Lymphoma Phase I dose-escalation study of the orally administrated selective Bcl-2 inhibitor S 55746 as monotherapy for the treatment of patients with Acute Myeloid Leukemia (AML) or high or very high risk Myelodysplastic Syndrome (MDS) 28 Mcl-1 is frequently amplified in human cancers Most frequently amplified Targeted therapies Beroukhim et al. Nature (2009) 29 BH3 mimetics activity in AML cell lines Activity on AML cell lines: Cell line IC50 (M) HL-60 5.25E-08 KG-1 7.65E-08 MOLM-13 2.00E-09 NOMO-1 5.00E-09 OCI-AML2 5.95E-08 PL-21 4.40E-08 THP-1 9.00E-09 MV4;11 1.37E-09 Activity in primary AML: S-Mcl1-i2 S-Mcl1-i1 Control Wei et al. Unpublished 30 Mcl-1 inhibition in primary AML S-Mcl1-i1 Wei et al. Unpublished 31 In vivo activity in xenograft models MM model: AMO-1 AML model: MV4;11 3000 2800 2600 2400 3 T u m o u r v o lu m e s (m m ) 2200 00 00 00 00 00 00 00 00 00 2000 M e d ia n + /- IQ R 00 1800 1600 1400 1200 1000 800 T r e a tm e n t Q 1 D x 5 600 S 6 4 3 1 5 - 1 3 . 1 2 5 m g /k g IV Q D 5 400 S 6 4 3 1 5 - 1 6 .2 5 m g / k g IV Q D 5 200 S 6 4 3 1 5 - 1 1 2 .5 m g / k g IV Q D 5 0 C o n tr o l ( u n tr e a te d ) 0 4 8 12 16 20 24 28 32 36 40 44 48 52 56 60 64 D a y s a fte r tr e a tm e n t in itia tio n ( D a y s ) 00 T r e a tm e n t Q 1 D x 5 00 T r e a tm e n t Q 1 D x 5 00 S 6 4 3 1 5 - 1 3 . 1 2 5 m g /k g IV Q D 5 S 6 4 3 1 5 - 1 3 . 1 2 5 m g /k g IV Q D 5 00 S 6 4 3 1 5 - 1 6 .2 5 m g / k g IV Q D 5 S 6 4 3 1 5 - 1 6 .2 5 m g / k g IV Q D 5 S 6 4 3 1 5 - 1 1 2 .5 m g / k g IV Q D 5 S 6 4 3 1 5 - 1 1 2 .5 m g / k g IV Q D 5 S-Mcl1-i1 00 Control 0 C o n tr o l ( u n tr e a te d ) C o n tr o l ( u n tr e a te d ) 2 0 0 2 4 4 2 8 8 3 21 2 3 61 6 4 02 0 4 42 4 4 82 8 5 23 2 5 63 6 6 04 0 6 44 4 48 D a y s a fte r tr e a tm e n t in itia D tioany s( Da afte y sr )tr e a tm e n t in itia tio n ( D a y s ) 52 56 60 Geneste et al. Unpublished 64 32 Synergy between Mcl-1 and MEK inhibition Untreated S-Mcl1-i1 MEK1/2i Combination Geneste et al. Unpublished 33 Synergy between BCL-xL/Mcl1 inhibition S-Mcl1-i LT18 + S-Mcl1-i NSCLC Colland et al. Unpublished 34 Conclusions The balance between pro- and anti-apoptotic Bcl-2 family proteins is altered in many cancers Strong rationale to inhibit anti-apoptotic proteins Need for highly specific drugs with good ADME properties Combinations with chemo- or targeted therapies 35 Acknowledgments Servier Director Project Leaders Chemistry John Hickman Olivier Geneste Frédéric Colland Andras Kotschy Zoltan Szlavik Jerôme Starck Arnaud Le Tiran Ana Leticia Maragno Gaëtane Le Toumelin Ghislaine Guasconi In vitro Pharmacology Marion Zarka Aurélie Studeny Vincent Lemesre In vivo Pharmacology Alain Bruno Maïa Chanrion Gaelle Lysiak Emilie Schneider Anne Marie Girard Vernalis Biophysics and Structural Sciences James Murray Structure Guided Med. Chem. James Davidson Modelling Ijen Chen The Alfred Hospital Monash Univ Project leader Andrew Wei Donia Moujalled Tse-Chieh Teh 36 Triple inhibition of MEK, PI3K and Bcl-XL in NSCLC cells MEK + Bcl-XL MEK + Bcl-XL + PI3K Tan et al. MCT 2013 37 Oncogene activation induces apoptosis or transformation Oncogene Bcl-2 family members Apoptosis Oncogene Bcl-2 family members Transformation Apoptosis Transformation 38
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