The study consists of a Phase1b lead-in portion to determine the maximum tolerated dose (MTD) of OMP-59R5 in combination with nab-paclitaxel and gemcitabine followed by a Phase 2, multicenter, randomized, placebo-controlled portion to evaluate the efficacy and safety of OMP-59R5 in combination with nab-paclitaxel and gemcitabine in subjects with previously untreated stage IV pancreatic cancer.

开始日期2012-10-01

申办/合作机构-

NCT01859741

/ Terminated临床1/2期

A Phase 1b/2 Study of OMP-59R5 in Combination With Etoposide and Platinum Therapy in Subjects With Untreated Extensive Stage Small Cell Lung Cancer (PINNACLE)

The study consists of a Phase1b lead-in portion to determine the maximum tolerated dose (MTD) of OMP-59R5 (tarextumab) in combination with etoposide (EP) for 6 cycles followed a Phase 2, multi center, randomized, placebo-controlled portion comparing the efficacy and safety of OMP-59R5 in combination with EP for 6 cycles followed by single agent OMP-59R5 relative to EP alone for 6 cycles in subjects receiving first-line therapy for extensive stage small cell lung cancer.

开始日期2012-01-07

申办/合作机构-

NCT01277146

/ Completed临床1期

A Phase 1 Dose Escalation Study of OMP-59R5 in Subjects With Solid Tumors

This is an open-label Phase 1 dose escalation study of OMP-59R5 in subjects with previously treated solid tumors for which there is no remaining standard curative therapy and no therapy with a demonstrated survival benefit. Up to 44 subjects will be enrolled at up to 2 centers. Subjects will be assessed for safety, immunogenicity, pharmacokinetics, biomarkers, and efficacy. No formal interim analyses will be performed.
Prior to enrollment, subjects will undergo screening to determine study eligibility. Upon enrollment, subjects will receive intravenous (IV) infusions of OMP-59R5 at a assigned dosing schedule for 56 days. After 56 days, subjects will be assessed for disease status. If there is no evidence of disease progression or if the tumor is smaller, then subjects may continue to receive IV infusions of OMP-59R5 every week until disease progression.
Dose escalation will be conducted to determine the maximum tolerated dose (MTD). No dose escalation or reduction will be allowed within a dose cohort. The first 2 subjects enrolled in a cohort will not be treated on the same day. The dose may be administered at any time during the day. Three subjects will be treated at each dose level if no dose-limiting toxicities (DLTs) are observed. The first 2 subjects in each cohort will not be started on OMP-59R5 on the same day. If 1 of 3 subjects experiences a DLT, that dose level will be expanded to 6 subjects. If 2 or more subjects experience a DLT, no further subjects will be dosed at that level and 3 additional subjects will be added to the preceding dose cohort unless 6 subjects have already been treated at that dose level. Subjects will be assessed for DLTs from the time of the first dose through 28 days. Dose escalation for newly enrolled subjects, if appropriate, will occur after all subjects in a cohort have completed their Day 28 DLT assessment. Subjects with stable disease or a response at Day 56 will be allowed to continue to receive weekly doses of OMP-59R5 until disease progression. An additional 14 subjects will be enrolled at the highest dose level that result in <2 of the 6 subjects experiencing a DLT.

开始日期2010-12-01

申办/合作机构-

100 项与 Tarextumab 相关的临床结果

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100 项与 Tarextumab 相关的转化医学

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100 项与 Tarextumab 相关的专利（医药）

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项与 Tarextumab 相关的文献（医药）

2019-09-01·Cancer medicine

A randomized phase II trial of nab‐paclitaxel and gemcitabine with tarextumab or placebo in patients with untreated metastatic pancreatic cancer

Article

作者: Yu, Kenneth H. ; Sahai, Vaibhav ; Hatoum, Hassan ; LoConte, Noelle K. ; Firdaus, Irfan ; Wang‐Gillam, Andrea ; Kapoun, Ann M. ; Sohal, Davendra P. S. ; Bullock, Andrea ; Picozzi, Vincent ; Hu, Zishuo Ian ; Zhou, Lei ; Sanchez, James ; Patel, Ravindranath ; Bendell, Johanna C. ; Leach, Joseph W. ; O'Reilly, Eileen M. ; Ritch, Paul ; Strickler, John ; Holmgren, Eric ; Hool, Hugo ; Dupont, Jakob

Abstract:

Purpose:

Notch signaling dysregulation is implicated in the development of pancreatic adenocarcinoma (PDAC). Tarextumab is a fully human IgG2 antibody that inhibits Notch2/3 receptors.

Patients and Methods:

Aphase 2, randomized, placebo‐controlled, multicenter trial evaluated the activity of tarextumab in combination with nab‐paclitaxel and gemcitabine in patients with metastatic PDAC. Patients were stratified based on ECOG performance score and Ca 19‐9 level and randomized 1:1 to nab‐paclitaxel, gemcitabine with either tarextumab or placebo. Based on preclinical and phase Ib results suggesting a positive correlation between Notch3 gene expression and tarextumab anti‐tumor activity, patients were also divided into subgroups of low, intermediate, and high Notch3 gene expression. Primary endpoint was overall survival (OS) in all and in patients with the three Notch3 gene expression subgroups (≥25th, ≥50% and ≥75% percentiles); secondary end points included progression‐free survival (PFS), 12‐month OS, overall response rate (ORR), and safety and biomarker investigation.

Results:

Median OS was 6.4 months in the tarextumab group vs 7.9 months in the placebo group (HR = 1.34 [95% CI = 0.95, 1.89], P = .0985). No difference observed in OS in the Notch3 gene expression subgroups. PFS in the tarextumab‐treated group (3.7 months) was significantly shorter compared with the placebo group (5.5 months) (hazard ratio was 1.43 [95% CI = 1.01, 2.01]; P = .04). Grade 3 diarrhea and thrombocytopenia were more common in the tarextumab group.

Conclusions:

The addition of tarextumab to nab‐paclitaxel and gemcitabine did not improve OS, PFS, or ORR in first‐line metastatic PDAC, and PFS was specifically statistically worse in the tarextumab‐treated patients.

Clinical trial registry no:

NCT01647828.

2019-08-15·Investigational new drugs3区 · 医学

A phase 1 dose escalation and expansion study of Tarextumab (OMP-59R5) in patients with solid tumors

3区 · 医学

Article

作者: Patnaik, Amita ; Dupont, Jakob ; Smith, David C ; Tolcher, Anthony ; Papadopoulos, Kyriakos P ; Chugh, Rashmi ; Wang, Min ; Xu, Lu ; Kapoun, Ann M ; Stagg, Robert J

Summary:

Purpose This Phase I trial evaluated the maximum tolerated dose, safety, pharmacokinetics, pharmacodynamics and preliminary efficacy of tarextumab (OMP-5948), a novel cross-reactive antibody which binds and selectively inhibits signaling via both Notch2 and Notch3, in adult patients with advanced malignancies. Methods Standard 3 + 3 design with tarextumab 0.5, 1, 2.5, or 5 mg/kg weekly, or 5, 7.5, or 10 mg/kg every other week, or 7.5 mg every 3 weeks. Dose-limiting toxicities (DLT) were assessed during the first 28 days. Results Forty-two patients received tarextumab (21 weekly, 15 every other week, 6 every three weeks). 2/6 subjects at the 5 mg/kg weekly dose, 2/3 at 10 mg/kg every other week, and 0/6 at 7.5 mg/kg every three weeks had a DLT. The maximum tolerated dose (MTD) was 2.5 mg/kg weekly, and 7.5 mg/kg on the every other and every three week schedules. Gastrointestinal (GI) toxicity was the most common adverse event with diarrhea (81%), fatigue (48%), nausea (45%), anorexia (38%), and vomiting (38%) and abdominal pain and constipation (24% each). Biomarker analysis showed regulation of stem cell and Notch gene signaling. Conclusion Tarextumab was generally well-tolerated at doses <2.5 mg weekly and 7.5 mg/kg every other and every third week. Diarrhea was dose-limiting above these levels, but relatively easily managed at lower doses. Inhibition of Notch pathway signaling was demonstrated at these doses. ClinicalTrials.gov Identifier: NCT01277146.

2019-05-01·Clinical cancer research : an official journal of the American Association for Cancer Research1区 · 医学

EGFR/Notch Antagonists Enhance the Response to Inhibitors of the PI3K-Akt Pathway by Decreasing Tumor-Initiating Cell Frequency

1区 · 医学

Article

作者: Lei, Changhai ; Li, Tian ; Fu, Wenyan ; Ding, Min ; Hu, Shi ; Yang, Yongji ; Fan, Xiaoyan ; Shen, Yafeng ; Ye, Xuting ; Tang, Ying ; Liu, Shuowu ; Yu, Yue ; Lin, Fangxing

Abstract:

Purpose::

Both EGFR and PI3K-Akt signaling pathways have been used as therapeutically actionable targets, but resistance is frequently reported. In this report, we show that enrichment of the cancer stem cell (CSC) subsets and dysregulation of Notch signaling underlie the challenges to therapy and describe the development of bispecific antibodies targeting both HER and Notch signaling.

Experimental Design::

We utilized cell-based models to study Notch signaling in drug-induced CSC expansion. Both cancer cell line models and patient-derived xenograft tumors were used to evaluate the antitumor effects of bispecific antibodies. Cell assays, flow cytometry, qPCR, and in vivo serial transplantation assays were employed to investigate the mechanisms of action and pharmacodynamic readouts.

Results::

We found that EGFR/Notch targeting bispecific antibodies exhibited a notable antistem cell effect in both in vitro and in vivo assays. Bispecific antibodies delayed the occurrence of acquired resistance to EGFR inhibitors in triple-negative breast cancer cell line–based models and showed efficacy in patient-derived xenografts. Moreover, the EGFR/Notch bispecific antibody PTG12 in combination with GDC-0941 exerted a stronger antitumor effect than the combined therapy of PI3K inhibitor with EGFR inhibitors or tarextumab in a broad spectrum of epithelial tumors. Mechanistically, bispecific antibody treatment inhibits the stem cell–like subpopulation, reduces tumor-initiating cell frequency, and downregulates the mesenchymal gene expression.

Conclusions::

These findings suggest that the coblockade of EGFR and Notch signaling has the potential to increase the response to PI3K inhibition, and PTG12 may gain clinical efficacy when combined with PI3K blockage in cancer treatment.

项与 Tarextumab 相关的新闻（医药）

2023-09-23

·生物探索

胰腺癌化疗耐药的潜在新机制

胰腺癌细胞中广泛激活的Notch信号通路在癌变、化疗耐药和复发中起重要作用。靶向这一途径是一种很有前景的胰腺癌治疗策略。然而，很少有成功的方法被报道，目前使用的这一途径的分子抑制剂表现出有限的临床益处。2023年9月15日，上海交通大学沈柏用、邓侠兴、符达及施昱晟共同通讯在Cell Discovery（IF=34）在线发表题为“A microprotein N1DARP encoded by LINC00261 promotes Notch1 intracellular domain (N1ICD) degradation via disrupting USP10-N1ICD interaction to inhibit chemoresistance in Notch1- hyperactivated pancreatic cancer”的研究论文，该研究鉴定了一个以前未被鉴定的微蛋白，Notch1降解相关调控多肽(N1DARP)，由LINC00261编码。N1DARP敲除加速了胰腺癌类器官和LSL-Kras、LSL-Trp53和Pdx1-Cre (KPC)小鼠的肿瘤进展，增强了干细胞特性。在机制上，N1DARP通过竞争性地破坏N1ICD与泛素特异性肽酶10 (USP10)之间的相互作用来抑制规范和非规范Notch1途径，从而促进K11和k48相关的N1ICD多泛素化。为了评估N1DARP的治疗潜力，该研究设计了一种穿透细胞的钉接肽，SAH-mAH2-5，具有与N1DARP相似的螺旋结构，具有显著的物理化学稳定性。SAH-mAH2-5与蛋白酶体介导的N1ICD降解相互作用并促进其降解。在Notch1激活的胰腺癌模型中，SAH-mAH2-5注射剂具有显著的治疗效果，但脱靶和全身不良反应有限。胰腺癌是最恶性的消化道肿瘤之一，与其他主要恶性肿瘤相比预后最差，5年生存率< 10%。只有20%的胰腺癌患者有资格接受手术治疗，而其他患者则必须接受化疗。胰腺导管腺癌（PDAC）以其对标准化疗的难治性耐药性而闻名，这可以归因于其固有的瘤内异质性和高度桥粒增生的肿瘤微环境。最近的证据支持使用在胰腺癌中持续激活的高度保守的信号通路，如Notch，Hedgehog和Wnt信号通路，以确定新的生物标志物和治疗靶点。Notch通路在多种人类癌症中都很活跃，包括乳腺癌、结肠直肠癌、肺癌、前列腺癌、胶质母细胞瘤和胰腺癌。在细胞系和基因突变小鼠模型中，Notch信号与胰腺肿瘤的发生、进展和耐药性呈正相关。在临床前模型中，通过旨在影响HES1转录功能的小分子(JI051和JI130)和靶向Notch通路的天然药物，如姜黄素、染料木素、槲皮素和萝卜硫素，药物抑制Notch信号传导，减缓肿瘤的增殖和侵袭，诱导肿瘤内凋亡，并增强化疗作用。值得注意的是，阻断Notch切割的γ-分泌酶抑制剂，包括PF-03084014、MK-0752和RO4929097，已在临床研究中用于治疗转移性胰腺癌。遗憾的是，没有观察到明显的缓解，可能是由于Notch1和其他家族成员的双重或泛notch抑制，导致其他信号通路的代偿激活。这表明，特异性靶向单个Notch家族成员或其他配体，如抗体或阻断蛋白质相互作用的蛋白质亚基，是一种很有希望的破坏Notch信号传导的方法。最近，一项针对转移性胰腺癌的II期研究显示，tarextumab(一种抑制Notch2/3受体的全人源IgG2抗体)联合吉西他滨(GEM)和紫杉醇治疗，在患者中显示出显著的缓解和耐受性，这表明针对特定Notch家族成员的治疗具有良好的前景。机理模式图（图源自Cell Discovery ）Notch是一个短寿命蛋白家族，主要通过泛素-蛋白酶体系统进行快速降解，其各种成分可积极或消极地调节Notch1的稳定性。这表明促进泛素介导的Notch家族成员降解可能是靶向Notch激活癌症的一种有希望的策略。USP10是一种序列高度保守的去泛素化酶，是参与肿瘤发生的p53负调控因子。USP10通过去泛素化多种蛋白使癌细胞产生化学耐药。N1ICD在USP10介导的生物过程中起着至关重要的作用，如细胞发育、血管生成和心功能障碍。因此，靶向USP10-N1ICD相互作用可能是Notch1过度激活癌症的潜在抗肿瘤策略。长链非编码RNA(lncRNAs)可作为信号、诱饵、向导和支架。最近的证据表明，在多种生物过程中发挥关键作用的功能肽是由lncRNAs中的短开放阅读框(ORFs)编码的。然而，在胰腺癌中很少有lncRNAs编码肽及其在肿瘤发生和肿瘤进展中的作用的报道。该研究通过RNA测序和核糖体分析鉴定了一种以前未被鉴定的多肽，N1DARP，由LINC00261编码，作为一种新的肿瘤抑制和化疗增敏剂，用于胰腺癌治疗，它通过干扰USP10-N1ICD相互作用而起作用。该研究还评估了利用N1DARP衍生的修饰钉状肽SAH-mAH2-5靶向N1DARP的治疗潜力，该修饰钉状肽干扰了USP10-N1ICD相互作用并抑制Notch1激活的胰腺癌的肿瘤生长，从而为如何靶向N1DARP - n1icd相互作用以开发精确和个性化的胰腺癌治疗提供了见解。综上所述，这些发现证实了N1DARP通过调节USP10-Notch1致癌信号作为肿瘤抑制因子和化学增敏剂，并提出了一种针对N1DARP-N1ICD相互作用的治疗Notch1激活胰腺癌的有希望的治疗策略。文章来源“iNature”责编|文竞择校对|文竞择End往期精选围观历史性突破！不需卵子和精子就可以合成人类胚胎热文富豪用儿子血浆“回春”科学吗？Science：血液牛磺酸缺乏驱动衰老热文世界首例！35岁的她，通过机器人操刀移植的子宫，成功诞下宝宝热文为了避免心脏骤停，53岁的他成为“第一个”植入开创性除颤器的心脏病患者热文首次披露！175家生物制药公司的薪资数据：薪资中位数达20万美元点击“阅读原文”，了解更多~

临床结果临床研究

2023-04-15

·生物制药小编

Nature Reviews：抗血管生成药物的新靶点和新未来（上）

近期《Nature Reviews Drug Discovery》发表了一篇关于抗血管生成药物的综述，抗血管生成药物对于人们来说可能相对较为熟悉了，特别是以2004年2月26日，人源化抗VEGF单克隆抗体贝伐单抗(Avastin)问世为分界点，抗血管生成药物逐步在肿瘤，眼科中展现出了广泛的应用。尤其是眼科，抗VEGF单一疗法能够显著改善新生血管性AMD和糖尿病性黄斑水肿(DME)患者的视力和生活质量，阿柏西普更是代表着这类眼科疾病治疗的黄金标准。而在肿瘤中靶向VEGF的疗法也成为了多种联用手段的优选方案，其中抗血管生成＋肿瘤免疫检查点抑制剂的组合的治疗效果尤其令人瞩目。而在VEGF在眼科和肿瘤的应用之外，还有其他靶点和其他应用方式可能为血管生成药物的开发提供更广泛的适应途径，该综述对其进行了简单介绍。本文将在该综述的新靶点基础上进一步拓展。非VEGF抗血管生成靶点临床前研究表明，阻断VEGF-VEGFR信号通常会通过缺氧的可能机制引发其他促血管生成因子的过度产生，如FGFs、ANGs、肝细胞生长因子(HGF)、整联蛋白和PDGFs。这些额外的促血管生成因子不是基于抗VEGF的抗血管生成药物的靶点，因此可能提供耐药机制。此外，一些炎性细胞的浸润，也可以产生对VEGF靶点的耐药性。因此应对VEGF的耐药性，理论上来看非VEGF靶点可能提供一种补偿机制，通过使血管生成转向非VEGF依赖性来规避抗VEGF抗体的作用。但不幸的是，没有确凿的证据表明将非VEGF与VEGF一起靶向治疗能提供任何额外的益处。这也是为什么目前的研究还在临床探索阶段。ANG/Tie2血管生成素（ANG）家族与Tie2通路也参与血管形成的重要阶段，如血管重塑和成熟。Ang/Tie2轴使用酪氨酸激酶进行信号转导，在病理过程中ANG2释放更多，因此目前对Ang靶点的开发主要集中在ANG2。Ang2的表达在血管重塑和炎症过程中由内皮细胞增加和释放。Ang2作为血管生成的自分泌早期启动因子，首先破坏静止血管的稳定性，从而使VEGF驱动血管生成新生血管的增殖和趋化迁移。此外，Ang2还激活表达Tie2的单核细胞/巨噬细胞(TEMs ),它们具有自身的促血管生成、促肿瘤发生、促转移和免疫抑制功能，也有关于肿瘤细胞表达Ang2的报道。图：ANG/Tie2通路相关管线统计来源：doi:10.15252/emmm.36866.88868688666迄今为止，抗Ang2疗法的临床测试仅限于晚期癌症疾病的评估，这些研究显示出令人失望的结果。然而，有临床前证据表明，在围手术期新辅助或辅助治疗中，调节Ang2功能或Tie1/Tie2受体的药物可能更有希望治疗或抑制早期微转移疾病。这种方法的潜在危险警告包括Ang2阻断或Tie2激活增强癌细胞肝转移的可能性。未来将Ang/Tie调节剂与其他疗法(如VEGF/VEGFR2途径抑制剂、常规(或节律)化疗或免疫疗法)相结合的研究可能值得进一步的临床前验证和未来的临床试验评估，以治疗早期疾病。虽然在癌症方面受挫，Ang-2和VEGF-A在驱动血管不稳定方面具有协同作用，来自临床前研究的数据表明，Ang-2阻断与抗VEGF治疗的组合可以有效地减少渗漏、病理性新生血管形成和炎症，从而潜在地改善视网膜和脉络膜疾病的结果。而这一临床转化已经得到很好的落实。其中特别是罗氏的VEGF/Ang2双抗Faricimab已经成功上市，并在AMD、DME等疾病中达到了终点，提升了给药间隔。国内信达的IBI324，奥赛康/蔼睦医疗的ASKG712（ AM712）也是同靶点的有利竞争者。HIF抑制剂HIF（缺氧诱导因子）是一种异二聚体转录因子，由HIF1α和HIF1β亚单位组成。HIF1α由缺氧诱导，HIF1β的组成型表达不依赖于氧水平。由于缺氧是实体瘤的特征之一，这会使得HIF途径经常被激活。除了缺氧，基因突变导致的VHL功能失活（一种肿瘤抑制基因）——例如在RCCs亚群（肾透明细胞癌亚群）和VHL综合征(希佩尔-林道综合征——一种以各种器官的异常血管增生和肿瘤为特征的遗传疾病)——也能够通过稳定作用显著增加HIF表达。重要的是，HIF在促进肿瘤发生和耐药性方面也有多重作用。有趣的是该靶点还是2019年诺贝尔生理学奖的明星靶点，由19年生理学奖得主格雷格·塞门扎（Gregg L. Semenza）发现，并因为他在这方面（理解了细胞在分子水平上感受氧气的基本原理）的贡献而获奖。实际上，HIF-1抑制剂的治疗效果已经在临床前和临床研究中反复得到证实。值得注意的是，阻断哺乳动物雷帕霉素靶蛋白(mTOR)可以抑制HIF 1α-VEGF介导的血管生成途径，表明联合应用mTOR抑制剂和抗VEGF治疗可增强临床疗效。事实上，mTOR抑制剂依维莫司确实改善了接受一线VEGFR靶向TKI lenvatinib治疗的转移性肾细胞癌患者的无进展生存期。最令人瞩目的要属默沙东的Belzutifan (MK-6482，以前称为PT2977)，该药物的疗效令人印象深刻，该药物在)治疗二三线VHL突变型肾细胞癌患者的临床中观察到36.1%的患者对Belzutifan有部分反应，62.3%的患者病情稳定。这一临床数据使得该药物在2021年8月获得FDA批准。然而，在一些研究中，HIF-1抑制剂偶尔不能表现出良好的治疗效果，这也是目前需要解决的问题。一般认为，HIF-1抑制剂的开发方向是①优化HIF-1抑制剂的药代动力学和药效学性质，②寻找多种HIF-1抑制剂的良好组合，③开发一种并行的伴随诊断方法，④通过与其他抗癌策略相结合而协同获得治疗效果。图：处于研发阶段的HIF-1抑制剂来源：doi:10.3390/cancers13112813Notch抑制剂NOTCH受体是跨膜细胞表面蛋白，控制细胞间通讯、胚胎发生和组织定向。Notch信号控制不同生理过程的稳态，其改变可引起不同的病理状态或疾病，包括遗传性综合征或获得性恶性肿瘤。而目前人类癌症中NOTCH受体的大多数致癌性改变发生在NOTCH1基因。NOTCH1受体及其配体DLL4是血管生成的重要调节因子。DLL4在肿瘤中的高表达发生在血管内皮细胞中，并与存活率降低相关。DLL 4–Notch 1和VEGF–VEGFR 2信号通路在肿瘤微血管网络的形成中相互调节。但是DLL 4–Notch 1的临床转化却并不顺利，尽管具有有效的抗肿瘤活性，但DLL4抑制剂在肝脏、心脏、肺和皮肤中表现出广泛的毒性。OncoMed公司在I期癌症研究中，测试了人源化抗-DLL4抗体demcizumab，但胰腺癌和肺癌的II期研究因毒性和缺乏疗效而中止。又例如MedImmune（后被阿斯利康收购）的DLL4单抗MEDI0639也因为种种原因而被从管线中砍去。还有，RO4929097，MRK003，tarextumab等Notch-DLL4通路抑制剂均未给出较为积极的临床数据。此外，也有研究想要通过Notch1的更上游通路来解决毒性问题，例如SERCA抑制可以有效地控制NOTCH1的运输，并且这种阻断可以在临床前白血病模型中实现，而不会引起明显的心脏毒性，不过SERCA抑制尚且等待临床转化。最有希望的一种开发方向似乎在于DLL 4/VEGF双抗，Mereo BioPharma在收购了OncoMed公司后开始开发DLL 4/VEGF双抗 OMP-305B83（Navicixizumab），2020年Mereo与鼎航医药展开了合作，由鼎航医药获得全球开发和商业化Navi的独家授权。TRIGR Therapeutics（后被Compass Therapeutics收购）也开发了一款VEGF和DLL4双抗药物ES104（TR009），后来将大中华区权益授权给了科望医药。目前正在国内开展针对不可手术切除的局部晚期或转移性结直肠癌（CRC）的1/2期临床试验(NCT05167448)。ES104是目前我国唯一进入临床试验的靶向VEGF和DLL4的双特异性抗体候选药物。图：DLL 4/VEGF双抗作用机理来源：科望医药官网PlGF胎盘生长因子（PlGF）是个有些争议的靶点，不少研究呈现出完全矛盾的结果，目前对于它在促进肿瘤生长、血管生成和转移中的作用仍不清楚。一些临床前研究表明，PlGF与VEGF具有相同的冗余功能，用抗PlGF抗体抑制PlGF可抑制原发性肿瘤的生长和转移。其他的一些研究却得出了相互矛盾的发现，例如，显示在多种癌症模型中发现PlGF阻断反而会缺少抗血管生成作用。此外，著名的眼科用药阿柏西普可以同时靶向VEGF（A）、PlGF和VEGFB，但阿柏西普在肿瘤用药的疗效还不如贝伐单抗。尽管阿柏西普在多种肿瘤中进行了临床研究，但它只获得了FDA对二线CRC治疗的批准。Oncurious NV开发了一款PlGF单抗TB-403（ RO5323441 ）不过临床开发并不太顺利，与贝伐单抗联合治疗实体瘤的临床研究被终止。此外，TB-403与ranibizumab (Lucentis)联合用于眼科疾病，如新生血管性AMD和DME，但是这些研究似乎也停止了。对于TB-403近期的好消息只有在原位髓母细胞瘤（MB）展现出了较为安全的初步结果，结果据称令人鼓舞：11名复发MB受试者中的7名疾病稳定，这在7名受试者中的4名中稳定持续超过100天。有趣的是，已有研究表明，至少在某些情况下，由于PlGF-VEGF异二聚体的形成，PlGF表达减少而不是促进肿瘤生长，而异二聚体在刺激血管生成方面不如VEGF有效。FGFR成纤维细胞生长因子受体(FGFR)是由四个不同基因(FGFR 1-4)编码的酪氨酸激酶受体(RTKs)家族。这些受体共享相同的典型蛋白质结构，它们的信号轴参与细胞增殖、分化、组织建模和血管生成。第一代非选择性FGFR tki与受体催化位点的ATP结合域结合，但不是激酶选择性的，也靶向其他RTK，如VEGFRs和PDGFRs。这些抑制剂具有同时靶向肿瘤血管生成和增殖的优点，但是它们显示出对FGFR信号通路的适度作用，同时具有多种副作用，这限制了它们在临床实践中的应用。尽管如此，这些治疗药物中的一些已被批准用于治疗几种肿瘤类型，通常与化疗联合使用或在一线治疗失败后使用。为了克服由于非选择性抑制剂的脱靶效应引起的并发症，已经开发了第二代选择性FGFR tki，由于该受体家族不同成员的结构同源性，大多数TKI能够靶向一种以上的FGFR。但目前只有少数进入临床试验。与非选择性TKIs相比，这些选择性治疗剂的副作用减少了，最显著的副作用表现为FGF23途径的调节，随之发生钙和磷代谢的改变，如高磷血症和组织钙化。与TKIs相比，中和性抗FGFR单克隆抗体的特征在于更高的特异性，由于没有脱靶效应，这可能降低药物毒性。总结——目前尚且离不开VEGF最后，该综述对目前的新靶点进行了总结。尽管进行了广泛的临床前和临床努力，但没有令人信服的证据表明靶向血管生成途径而非VEGF在癌症或眼科疾病中提供治疗益处。虽然HIF和mTOR抑制剂已被批准用于治疗肾细胞癌，但它们的作用至少部分是由VEGF抑制介导的。该综述期望，综述内提到的靶点能够改善目前的情况。扩展阅读:VEGF靶向药物革新参考来源：Shirai Y, Chow CCT, Kambe G, Suwa T, Kobayashi M, Takahashi I, Harada H, Nam JM. An Overview of the Recent Development of Anticancer Agents Targeting the HIF-1 Transcription Factor. Cancers (Basel). 2021 Jun 4;13(11):2813. doi: 10.3390/cancers13112813. PMID: 34200019; PMCID: PMC8200185.Khan KA, Wu FT, Cruz-Munoz W, Kerbel RS. Ang2 inhibitors and Tie2 activators: potential therapeutics in perioperative treatment of early stage cancer. EMBO Mol Med. 2021 Jul 7;13(7):e08253. doi: 10.15252/emmm.201708253. Epub 2021 Jun 14. PMID: 34125494; PMCID: PMC8261516.Choueiri TK, Bauer TM, Papadopoulos KP, Plimack ER, Merchan JR, McDermott DF, Michaelson MD, Appleman LJ, Thamake S, Perini RF, Zojwalla NJ, Jonasch E. Inhibition of hypoxia-inducible factor-2α in renal cell carcinoma with belzutifan: a phase 1 trial and biomarker analysis. Nat Med. 2021 May;27(5):802-805. doi: 10.1038/s41591-021-01324-7. Epub 2021 Apr 22. Erratum in: Nat Med. 2021 Oct;27(10):1849. PMID: 33888901; PMCID: PMC9128828.Pagliaro L, Marchesini M, Roti G. Targeting oncogenic Notch signaling with SERCA inhibitors. J Hematol Oncol. 2021 Jan 6;14(1):8. doi: 10.1186/s13045-020-01015-9. PMID: 33407740; PMCID: PMC7789735.Saulnier-Sholler G, Duda DG, Bergendahl G, Ebb D, Snuderl M, Laetsch TW, Michlitsch J, Hanson D, Isakoff MS, Bielamowicz K, Kraveka JM, Ferguson W, Carmeliet P, De Deene A, Gijsen L, Jain RK. A Phase I Trial of TB-403 in Relapsed Medulloblastoma, Neuroblastoma, Ewing Sarcoma, and Alveolar Rhabdomyosarcoma. Clin Cancer Res. 2022 Sep 15;28(18):3950-3957. doi: 10.1158/1078-0432.CCR-22-1169. PMID: 35833850; PMCID: PMC9481695.Ghedini GC, Ronca R, Presta M, Giacomini A. Future applications of FGF/FGFR inhibitors in cancer. Expert Rev Anticancer Ther. 2018 Sep;18(9):861-872. doi: 10.1080/14737140.2018.1491795. Epub 2018 Jul 2. PMID: 29936878.Cao, Y., Langer, R. & Ferrara, N. Targeting angiogenesis in oncology, ophthalmology and beyond. Nat Rev Drug Discov (2023). https://doi-org.libproxy1.nus.edu.sg/10.1038/s41573-023-00671-z

2017-04-17

·BioSpace

When It Rains, It Pours: Bay Area’s OncoMed Tanks Again as Lung Cancer Med Fails Phase II, Discontinues Phase I Study

April 17, 2017 By Alex Keown , BioSpace.com Breaking News Staff REDWOOD CITY, Calif. – Shares of OncoMed Pharmaceuticals are down more than 18 percent this morning after the company announced its mid-stage combination lung cancer treatment failed to meet endpoints. OncoMed said tarextumab (anti-Notch2/3, OMP-59R5) in combination with etoposide and a chemotherapy drug to treat patients with extensive-stage small cell lung cancer showed results that were “undifferentiated from those of chemotherapy plus placebo.” As a result, the company said the trial did not meet primary endpoints of progression-free survival, nor secondary endpoints of overall survival. The median progression-free survival for tarextumab plus chemotherapy was 5.6 months versus 5.5 months for chemotherapy plus placebo. Overall response rates were 68.5 percent and 70.8 percent in the tarextumab and placebo arms respectively, the company said. Tarextumab (anti-Notch2/3, OMP-59R5) is a fully human monoclonal antibody that targets the Notch2 and Notch3 receptors. The drug is part of OncoMed’s collaboration with GlaxoSmithKline . Small cell lung cancer is expected to make up between 10 and 15 percent of the 224,390 newly diagnosed lung cancer cases and the 158,080 deaths estimated to occur in the U.S. Current standard of care in treating small cell lung cancer is the chemotherapeutic etoposide in combination with either cisplatin or carboplatin. “Small cell lung cancer is a very difficult-to-treat disease and unfortunately, tarextumab did not show benefit over placebo in this Phase 2 trial,” Paul Hastings , OncoMed’s chairman and chief executive officer said in a statement. Additionally, OncoMed said it will discontinue enrollment in the Phase 1b clinical trial of brontictuzumab (anti-Notch1, OMP-52M51) in combination with trifluridine/tipiracil (Lonsur) in third-line colorectal cancer patients. The combination of brontictuzumab plus chemotherapy was not tolerable in this patient population. April has not been kind to OncoMed. On April 10, the company announced its partnership with Bayer to develop two drugs, vantictumab and ipafricept , both Wnt pathway inhibitors, had ended due to “strategic reasons.” With Bayer’s withdrawal, OncoMed retains worldwide rights to both drugs. Also on April 10, the company announced it was terminating a Phase II trial testing demcizumab in combination with Abraxane as a first-line treatment in metastic pancreatic cancer after the drug failed to meet endpoints. Due to the events announced today and last week, Hastings said the company will undergo an immediate comprehensive portfolio prioritization review. “The immediate task ahead is to thoroughly examine the available data, our resources and the opportunities to re-focus our efforts. We ended the first quarter of 2017 with $156.9 million in cash and short-term investments,” Hastings said.

临床2期临床结果临床1期临床3期临床失败

100 项与 Tarextumab 相关的药物交易

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KEGG	Wiki	ATC	Drug Bank
D11775	Tarextumab	-	DB12104

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适应症	最高研发状态	国家/地区	公司	日期
胰腺导管腺癌	临床2期	美国	-	2012-10-01
广泛期小细胞肺癌	临床2期	美国	-	2012-01-07
小细胞肺癌	临床2期	美国	Mereo BioPharma 5, Inc.	2012-01-07
胰腺癌	临床2期	-	GSK Plc	-

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研究	分期	人群特征	评价人数	分组	结果	评价	发布日期


NCT01647828 (ALPINE, CTgov)	临床1/2期	胰腺导管腺癌 \| 胰腺癌	217	OMP-59R5+Gem (P1B: OMP-59R5 2.5 mg/kg + Gem)	餘選鑰繭鬱鬱憲衊築範 = 遞淵鹽積鏇淵選夢壓醖艱膚夢繭製繭繭願鑰製 (襯顧廠餘醖積壓餘獵齋, 蓋鹽鏇鑰顧鏇網齋網糧 ~ 衊夢鹽醖廠艱鏇蓋繭顧) 更多	-	2023-02-15
				OMP-59R5+Gem (P1B: OMP-59R5 5 mg/kg + Gem)	餘選鑰繭鬱鬱憲衊築範 = 繭醖齋鏇鏇獵鏇網獵繭艱膚夢繭製繭繭願鑰製 (襯顧廠餘醖積壓餘獵齋, 願衊醖積觸鏇製壓廠窪 ~ 構鹹壓製築襯齋蓋鑰壓) 更多
NCT01647828 (Pubmed) 人工标引	临床2期	转移性胰腺癌一线	-	nab-paclitaxel+gemcitabine+tarextumab	糧淵鑰醖廠積膚憲蓋範(製憲鑰憲窪鏇膚製蓋淵) = 窪鬱願艱遞窪築窪窪遞繭夢艱範窪衊鑰築製餘 (觸衊構觸襯鑰遞範製糧 ) 更多	不佳	2019-09-01
				nab-paclitaxel+gemcitabine+Placebo	糧淵鑰醖廠積膚憲蓋範(製憲鑰憲窪鏇膚製蓋淵) = 構淵築簾憲網窪齋繭簾繭夢艱範窪衊鑰築製餘 (觸衊構觸襯鑰遞範製糧 ) 更多
NCT01277146 (Pubmed \| Invest New Drugs)	临床1期	实体瘤	42	Tarextumab 0.5 mg/kg	鑰繭觸築製網鑰窪構積(憲淵廠淵淵構遞網蓋醖) = 齋衊淵積範製獵廠鹹廠獵襯窪願艱鑰淵鏇衊餘 (憲觸構醖壓窪鑰鹹壓淵 ) 更多	-	2019-08-01
				Tarextumab 1 mg/kg	鑰繭觸築製網鑰窪構積(憲淵廠淵淵構遞網蓋醖) = 築壓遞簾構製糧鏇襯製獵襯窪願艱鑰淵鏇衊餘 (憲觸構醖壓窪鑰鹹壓淵 ) 更多
NCT01859741 (PINNACLE, CTgov)	临床1/2期	广泛期小细胞肺癌	172	ETO+OMP-59R5 (P1B: OMP-59R5 5mg/kg + ETO + CIS)	積餘積蓋願廠積鑰壓夢 = 網積壓鏇獵憲製膚鹹餘夢鏇夢廠餘鹽範鏇願艱 (製範製鏇簾築遞鑰襯鹽, 襯醖夢窪衊壓餘鹽醖願 ~ 窪憲蓋齋選鬱膚願衊廠) 更多	-	2019-05-01
				ETO+OMP-59R5 (P1B: OMP-59R5 7.5 mg/kg + ETO + CIS)	積餘積蓋願廠積鑰壓夢 = 範廠衊製窪衊顧製遞構夢鏇夢廠餘鹽範鏇願艱 (製範製鏇簾築遞鑰襯鹽, 範遞積選糧範鬱鹽鹽衊 ~ 齋糧膚鑰鑰願衊齋構觸) 更多
NCT01859741 (PINNACLE, GlobeNewswire) 人工标引	临床2期	小细胞肺癌一线	145	Chemotherapy+Tarextumab	鹹選鹽齋鹽構糧觸壓鑰(衊獵構艱繭窪膚範積鑰) = 構獵簾淵鏇鬱觸鏇糧遞繭觸觸鏇廠糧築鹹簾廠 (廠築鏇壓觸齋鹽鏇鹽蓋 ) 更多	不佳	2017-04-17
				Chemotherapy+Placebo	鹹選鹽齋鹽構糧觸壓鑰(衊獵構艱繭窪膚範積鑰) = 餘顧糧蓋餘範遞淵觸憲繭觸觸鏇廠糧築鹹簾廠 (廠築鏇壓觸齋鹽鏇鹽蓋 ) 更多
NCT01859741 (ASCO2016)	临床1期	广泛期小细胞肺癌	27	Tarextumab + Etoposide + Cisplatin	鏇觸積夢鏇鏇糧製醖範(鹽築齋構築鬱選構夢齋) = 22.2% 鹹鹽糧壓範醖夢製餘艱 (製醖餘壓觸鬱繭製築願 ) 更多	积极	2016-05-20
				Tarextumab + Etoposide + Carboplatin
NCT01859741 (ASCO2015)	临床1/2期	广泛期小细胞肺癌	27	Tarextumab (TRXT) with EP	鹹範範構顧簾鏇繭遞窪(選製醖夢艱觸觸淵壓憲) = 膚獵餘積選繭鹽構鏇繭鑰鏇鹹築範蓋蓋範廠積 (鏇獵鏇繭蓋製築壓憲鹹 ) 更多	-	2015-05-20
NCT01647828 (ASCO_GI2015)	临床1/2期	转移性胰腺癌	40	Tarextumab 15 mg/kg	夢壓觸鏇鬱積簾壓憲淵(鏇範範鬱簾築夢鑰夢顧) = 鬱選壓簾鏇餘淵壓衊鏇鹹襯獵選衊範蓋鹽積積 (膚簾廠鹹鑰衊襯膚齋壓 ) 更多	-	2015-01-20
NCT01647828 (ASCO_GI2014)	临床1/2期	转移性胰腺癌	24	OMP-59R5	鏇製願廠鏇選窪憲壓鹽(願齋鹽鏇齋糧糧簾願積) = 鏇繭醖艱願鏇廠膚簾繭築築遞積餘齋鹽襯蓋衊 (淵築鬱觸廠製壓積製鹽 ) 更多	-	2014-01-20
				Nab-P+Gem	鏇製願廠鏇選窪憲壓鹽(選鹽憲憲餘選製積獵蓋) = 鹽夢鏇糧繭顧蓋醖糧鏇夢壓壓廠膚繭齋艱顧艱 (網選遞膚壓淵襯餘選築 )