CDK6

ItovebiTM (inavolisib)-based regimen demonstrated a statistically significant and clinically meaningful benefit, reducing the risk of disease worsening or death by 57% compared with palbociclib and fulvestrant alone in the INAVO120 study1 The U.S. FDA recently approved the Itovebi-based regimen as a first-line treatment for people with HR-positive, HER2-negative breast cancer with a PIK3CA mutation, one of the most commonly mutated genes in HR-positive disease2 Basel, 31 October 2024 - Roche (SIX: RO, ROG; OTCQX: RHHBY) announced today that a detailed analysis of the positive phase III INAVO120 results, evaluating ItovebiTM (inavolisib) in combination with palbociclib (Ibrance®) and fulvestrant were published in the New England Journal of Medicine.1 The United States Food and Drug Administration (FDA) recently approved Itovebi in combination with palbociclib and fulvestrant, for the treatment of adults with endocrine-resistant, PIK3CA-mutated, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer, as detected by an FDA-approved test, following recurrence on or after completing adjuvant endocrine therapy. Data from INAVO120 are also being used for filing submissions to other global health authorities, including the European Medicines Agency. “With a doubling of progression-free survival and consistent benefits in people whose disease had spread to multiple challenging-to-treat locations, including the liver and lungs, these INAVO120 data are significant for patients,” said Komal Jhaveri, M.D., section head for the endocrine therapy research portfolio and clinical director of the early drug development service at Memorial Sloan Kettering Cancer Center and one of the principal investigators of the INAVO120 study. “I’m confident this Itovebi-based regimen could become a new first-line standard of care for this patient population with one of the most commonly mutated genes in metastatic breast cancer, associated with a poor prognosis.” Results showed the Itovebi-based regimen reduced the risk of disease worsening or death (progression-free survival [PFS]) by 57% compared to palbociclib and fulvestrant alone (15.0 months vs. 7.3 months; hazard ratio [HR]=0.43, 95% CI: 0.32-0.59, p<0.001).1 PFS benefit was consistent across all pre-specified subgroups, including people whose disease had spread to three or more locations, which is characterised as difficult-to-treat disease.1 Overall survival (OS) data were immature at the time of analysis, but a clear positive trend has been observed (stratified HR=0.64, 95% CI: 0.43-0.97, p=0.03 [boundary of 0.0098]).1 Follow-up for OS will continue to the next analysis.1 “Publication of these phase III results in the New England Journal of Medicine further highlights the transformative potential of the Itovebi-based regimen,” said Levi Garraway, M.D., Ph.D., Roche’s Chief Medical Officer and Head of Global Product Development. “This new treatment exemplifies our ambition to target specific disease pathways more effectively and improve outcomes in people with breast cancer, while also emphasising the importance of comprehensive testing for mutations like PIK3CA at the time of diagnosis.” The PIK3CA mutation is found in approximately 40% of HR-positive metastatic breast cancers and is associated with a poor prognosis.2,3 Historically, the use of PI3K targeted therapy in the first-line advanced setting has been limited and therefore testing for PIK3CA mutations is not common at the time of diagnosis.4 Early biomarker testing with an FDA-approved test, such as Foundation Medicine’s FoundationOne®Liquid CDx, before first-line treatment is crucial to help identify people who may benefit from targeted therapy, such as Itovebi.4,5 Itovebi is currently being investigated in three company-sponsored phase III clinical studies (INAVO120, INAVO121, INAVO122) in PIK3CA-mutated locally advanced or metastatic breast cancer in various combinations.6-8 We are exploring additional studies in breast cancer and other tumour types with the hope of bringing the benefit of this targeted therapy to more people with PIK3CA mutations and addressing patient unmet needs. About the INAVO120 studyThe INAVO120 study [NCT04191499] is a phase III, randomised, double-blind, placebo-controlled study evaluating the efficacy and safety of Itovebi (inavolisib) in combination with palbociclib and fulvestrant versus placebo plus palbociclib and fulvestrant in people with PIK3CA-mutated, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer whose disease progressed during treatment or within 12 months of completing adjuvant endocrine therapy and who have not received prior systemic therapy for metastatic disease.6 The study included 325 patients, who were randomly assigned to either the investigational or control treatment arm.6 The primary endpoint is progression-free survival, as assessed by investigators, defined as the time from randomisation in the clinical trial to the time when the disease progresses, or a patient dies from any cause.6 Secondary endpoints include overall survival, objective response rate, and clinical benefit rate.6 Beyond INAVO120, Itovebi is currently being investigated in two additional company-sponsored phase III clinical studies in PIK3CA-mutated locally advanced or metastatic breast cancer in various combinations:7,8 in combination with fulvestrant versus alpelisib plus fulvestrant in HR-positive/HER2-negative breast cancer post cyclin-dependent kinase 4/6 inhibitor and endocrine combination therapy (INAVO121; NCT05646862), andin combination with pertuzumab plus trastuzumab for subcutaneous injection (SC) versus pertuzumab plus trastuzumab for SC and optional physician's choice of endocrine therapy as a maintenance treatment in HER2-positive disease (INAVO122; NCT05894239). About hormone receptor (HR)-positive breast cancerHR-positive breast cancer is the most prevalent type of all breast cancers, accounting for approximately 70% of cases.9,10 A defining feature of HR-positive breast cancer is that its tumour cells have receptors that attach to one or both hormones – oestrogen or progesterone – which can contribute to tumour growth. People diagnosed with HR-positive metastatic breast cancer often face the risk of disease progression and treatment side effects, creating a need for additional treatment options.10-12 The PI3K signalling pathway is commonly dysregulated in HR-positive breast cancer, often due to activating PIK3CA mutations, which have been identified as a potential mechanism of intrinsic resistance to standard of care endocrine therapy in combination with cyclin-dependent kinase 4/6 inhibitors.3 About Roche in breast cancerRoche has been advancing breast cancer research for more than 30 years with the goal ofhelping as many people with the disease as possible. Our medicines, along with companiondiagnostic tests, have contributed to bringing breakthrough outcomes in human epidermal growth factor 2-positive and triple-negative breast cancers. As our understanding of breast cancer biology rapidly improves, we are working to identify new biomarkers and approaches to treatment for other subtypes of the disease, including oestrogen receptor-positive breast cancer, which is a form of hormone receptor-positive breast cancer, the most prevalent type of all breast cancers.9,10 About RocheFounded in 1896 in Basel, Switzerland, as one of the first industrial manufacturers of branded medicines, Roche has grown into the world’s largest biotechnology company and the global leader in in-vitro diagnostics. The company pursues scientific excellence to discover and develop medicines and diagnostics for improving and saving the lives of people around the world. We are a pioneer in personalised healthcare and want to further transform how healthcare is delivered to have an even greater impact. To provide the best care for each person we partner with many stakeholders and combine our strengths in Diagnostics and Pharma with data insights from the clinical practice. For over 125 years, sustainability has been an integral part of Roche’s business. As a science-driven company, our greatest contribution to society is developing innovative medicines and diagnostics that help people live healthier lives. Roche is committed to the Science Based Targets initiative and the Sustainable Markets Initiative to achieve net zero by 2045. Genentech, in the United States, is a wholly owned member of the Roche Group. Roche is the majority shareholder in Chugai Pharmaceutical, Japan. For more information, please visit www.roche.com. All trademarks used or mentioned in this release are protected by law.References[1] Turner NC, et al. Inavolisib-Based Therapy in PIK3CA-Mutated Advanced Breast Cancer. NEJM. 2024;391(17).[2] Fillbrunn M, et al. PIK3CA mutation status, progression and survival in advanced HR+/HER2- breast cancer: a meta-analysis of published clinical trials. BMC Cancer. 2022;22:1002.[3] Anderson E, et al. A Systematic Review of the Prevalence and Diagnostic Workup of PIK3CA Mutations in HR+/HER2– Metastatic Breast Cancer. Int J Breast Cancer. 2020;2020:3759179.[4] Princic N, et al. Abstract P1-18-18: PIK3CA mutation testing prevalence among post-menopausal (PM) women with hormone receptor positive and human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer (mBC) using real world data. Cancer Res. 2020;80(4):P1-18-18.[5] Wales Cancer Network. PIK3CA-mutated breast cancer clinical guidance document [Internet; cited 2024 October]. Available from: https://executive.nhs.wales/functions/networks-and-planning/cancer/wcn-documents/mutated-breast-cancer-clinical-guidance-document//.[6] ClinicalTrials.gov. A Study Evaluating the Efficacy and Safety of Inavolisib + Palbociclib + Fulvestrant vs Placebo + Palbociclib + Fulvestrant in Patients With PIK3CA-Mutant, Hormone Receptor-Positive, Her2-Negative, Locally Advanced or Metastatic Breast Cancer (INAVO120) [Internet; cited 2024 October]. Available from: https://classic.clinicaltrials.gov/ct2/show/NCT04191499.[7] ClinicalTrials.gov. A Study Evaluating the Efficacy and Safety of Inavolisib Plus Fulvestrant Compared With Alpelisib Plus Fulvestrant in Participants With HR-Positive, HER2-Negative, PIK3CA Mutated, Locally Advanced or Metastatic Breast Cancer Post CDK4/6i and Endocrine Combination Therapy (INAVO121) [Internet; cited 2024 October]. Available from: https://classic.clinicaltrials.gov/ct2/show/NCT05646862.[8] ClinicalTrials.gov. A Study to Evaluate the Efficacy and Safety of Inavolisib in Combination With Phesgo Versus Placebo in Combination With Phesgo in Participants With PIK3CA-Mutated HER2-Positive Locally Advanced or Metastatic Breast Cancer [Internet; cited 2024 October]. Available from: https://classic.clinicaltrials.gov/ct2/show/NCT05894239.[9] National Cancer Institute: Surveillance, Epidemiology and Ends Result Program. Cancer Stat Facts: Female Breast Cancer Subtypes [Internet; cited 2024 October]. Available from: https://seer.cancer.gov/statfacts/html/breast-subtypes.html.[10] Lim E, et al. The natural history of hormone receptor-positive breast cancer. Oncology (Williston Park). 2012;26(8):688-94,696.[11] Tomas R and Barrios CH. Optimal management of hormone receptor positive metastatic breast cancer in 2016. Ther Adv Med Oncol. 2015;7(6):304-20.[12] Galipeau N, et al. Understanding key symptoms, side effects, and impacts of HR+/HER- advanced breast cancer: qualitative study findings. J Patient-Rep Outcomes. 2019;3(1):10. Dr. Jhaveri has financial interests related to Roche and Genentech. Roche Global Media RelationsPhone: +41 61 688 8888 / e-mail: media.relations@roche.com Hans Trees, PhDPhone: +41 79 407 72 58 Sileia UrechPhone: +41 79 935 81 48 Nathalie AltermattPhone: +41 79 771 05 25 Lorena CorfasPhone: +41 79 568 24 95 Simon GoldsboroughPhone: +44 797 32 72 915 Karsten KleinePhone: +41 79 461 86 83 Nina MählitzPhone: +41 79 327 54 74 Kirti PandeyPhone: +49 172 6367262 Yvette PetillonPhone: +41 79 961 92 50 Dr Rebekka SchnellPhone: +41 79 205 27 03 Attachment 31102024_Itovebi NEJM_en

来源：药渡 撰文：balabala     编辑：维他命 近期，南京大学张晶晶教授研究团队针对上述新型PROTAC策略的局限性，以miRNA触发的DNA编码的pre-PROTAC的形态调节为依据，成功开发出一种全新的miRNA启动的组装pre-PROTAC平台——miRiaTAC。 PART. 01 传统PROTAC技术所面临的挑战 靶向蛋白水解嵌合体（PROTACs）作为一种极具前景的治疗策略，通过利用细胞天然蛋白质降解机制靶向消除疾病相关蛋白，展现出与传统占位驱动抑制剂不同的独特优势，如在低剂量下发挥催化作用以及降解顽固蛋白等（图1）。 图1. 基于靶蛋白降解的各种嵌合体策略 然而，在临床应用中，PROTACs面临着诸多挑战。 首先，肿瘤选择性差是一个突出问题。由于无法精准区分肿瘤细胞和正常细胞，PROTACs在发挥作用时可能会对正常组织造成不良影响，降低了治疗的特异性。这种缺乏肿瘤选择性的特性可能导致治疗效果受限，同时增加了患者出现副作用的风险。 其次，蛋白质不受控制的降解带来了非癌组织全身毒性风险。PROTACs引发的蛋白质降解若失去控制，可能会对正常组织和器官的蛋白质平衡产生破坏，干扰人体正常的生理功能。这种全身毒性风险不仅影响患者的生活质量，还可能对治疗的安全性和可持续性构成威胁。 此外，过度激活也是PROTACs面临的挑战之一。过度激活可能引发一系列未知的生理反应或副作用，进一步加重患者的病情或导致新的健康问题。这种不确定性增加了治疗的复杂性和风险。 因此，研发一种按需开关策略，以实现选择性激活和终止PROTACs介导的蛋白质降解，成为当前迫切需要解决的问题。这将有助于提高PROTACs的治疗特异性和安全性，为其在临床治疗中的广泛应用奠定基础。 PART. 02 新型PROTAC技术 对副作用的优化策略 1 Nano-PROTACs策略 2023年7月，国家纳米科学中心的王浩研究员开发了一种用于肿瘤治疗的Nano-PROTACs技术，该技术旨在解决传统PROTACs的问题。其设计的Nano-PROTAC 系统由含特定结构域的两个肽基前体组成，在肿瘤细胞高GSH水平下经点击反应自组装成有序纳米结构。 图2. 原位自组装Nano-protacs的示意图 体外研究表明，它能形成多元纳米复合物，有效降解EGFR和AR等蛋白，且具有剂量依赖性和抗钩效应。体内研究显示，Nano-PROTACs可在肿瘤部位富集和保留，在荷瘤小鼠模型中呈现剂量依赖性的肿瘤抑制效果，通过降解靶蛋白诱导凋亡发挥抗肿瘤作用，同时该系统具有良好生物相容性和细胞选择性。 Nano-PROTAC技术虽然在蛋白降解领域显示出巨大潜力，但仍面临靶点单一、不能即时终止降解过程和制造成本昂贵等多方面的挑战。 2 Ligation to Scavenging策略 在探索靶蛋白可控降解以及按需终止相关问题的进程中，中国药科大学姜正羽教授研究团队于2023年3月开创性地提出了一种能够即时终止蛋白降解过程的连接-清除（Ligation to Scavenging）策略（图3）。 图3. 受控的PROTACs和连接-清除系统示意图 该策略由经反式环辛烯（TCO）修饰的树枝状大分子（PAMAM-G5-TCO）以及四嗪标记的PROTACs（Tz-PROTACs）这两个关键部分构成。其中，PAMAM-G5-TCO能够借助逆电子需求的Diels-Alder反应（IEDDA），快速且有效地清除细胞内处于游离状态的PROTACs，进而达成对靶向蛋白降解过程的终止调控。通过这一调控机制，那些已经出现下调情况的靶蛋白能够逐步恢复到正常水平。 在研究过程中，研究人员针对BET蛋白、PARP蛋白等多个底物蛋白展开了降解终止的相关实验，充分论证了该策略具备可靠性以及广泛的适用性，为PROTAC降解技术装上了可靠的“刹车”。 然而，该策略在选择性和特异性方面可能会受到特定靶蛋白以及降解条件的限制，这一局限给这一颇具潜力的策略未来发展蒙上了一层阴影。 3 DbTAC策略 2023年7月，中国药科大学马祎教授研究团队受到DNA框架所具备的可寻址性、可编程性以及刚性特质的启发，成功开发出基于共价DNA框架的PROTACs（DbTACs）。这种DbTACs能够借助简单的生物正交化学以及自组装方式，实现高通量合成（图4）。 图4. 选择性靶向蛋白降解的DbTACs平台设计示意图 在其构建过程中，采用DNA四面体作为模板，此模板能够精准地定义每个原子的空间位置。基于这一特性，通过在模板上对POI和E3连接酶的配体进行精确的定位操作，就能够对配体间距进行有效控制，其范围可从8 Å到57 Å。研究人员经研究发现，具有配体之间最佳连接长度的dbtac，展现出了更高的降解率以及更强的结合亲和力。 此外，具有三价配体组装的双特异性DbTACs（双-DbTACs）表现出独特优势，它能够在确保对蛋白质亚型进行高度选择性降解的同时，实现对多个靶点的消耗。而且，当运用不同类型的弹头，如小分子、抗体以及DNA基元时，DbTACs在针对多种靶标进行降解方面彰显出强大的功效，这些靶标涵盖了位于不同细胞区室的蛋白激酶和转录因子等。 DbTACs这一策略突破了传统PROTAC分子仅能降解单一靶点的局限，然而，它也面临着一些挑战，例如无法即时终止降解过程且不具有细胞选择性等。 4 Dual-PROTAC策略 2021年5月，华中科技大学同济药学院李华教授研究团队，鉴于单一靶点治疗存在诸多局限，创新性地提出了双靶向PROTAC分子（Dual-PROTAC）这一概念。 受到双靶向药物的启发，研究人员设计并合成了一种能够同时对表皮生长因子受体（EGFR）和聚（ADP-核糖）聚合酶（PARP）进行降解的双靶点PROTAC分子。在合成过程中，研究团队巧妙地运用天然氨基酸作为连接体，并选取吉非替尼、奥拉帕利以及CRBN或VHL的E3配体作为底物来合成相关分子（图5）。 图5. Dual-PROTAC策略示意图 细胞实验结果显示，所合成的双靶点PROTAC在SW1990和H1299细胞系中，能够同时实现对EGFR和PARP的降解，并且其降解效果呈现出浓度和时间的依赖性。此研究首次成功实现一个小分子同时降解两种不同靶蛋白，拓展了PROTAC技术应用并开辟药物发现新领域，然而该策略可能会由于分子量的增加，从而引发药物性质和药代动力学方面的一系列问题。 PART. 03 miRNA-触发DNA编码的 前PROTAC平台 DNA具备可编程性，这一特性使其能够构建多种多样的纳米结构，进而为动态DNA纳米技术的开发奠定了基础。近期，南京大学张晶晶教授研究团队针对上述新型PROTAC策略的局限性，以miRNA触发的DNA编码的pre-PROTAC的形态调节为依据，成功开发出一种全新的miRNA启动的组装pre-PROTAC平台，即miRiaTAC。 miRiaTAC的模块化工具包含一对可修饰的DNA发夹H1和H2。在癌细胞中，靶miR -21呈现过表达的状态，H1和H2能够对其做出响应，并通过HCR形成交替共聚物。具体而言，弹头JQ-1（L1）标记的H1可以招募靶蛋白BRD4，而H2与配体pomalidomide（L2）结合以招募CRBN E3泛素连接酶。精确确定L1和L2的修饰位点，以确保在miR-21启动时L1/L2对的邻近性，使miRiaTAC诱导BRD4多泛素化，引起其蛋白酶体介导的降解，并形成（BRD4）m:miRiaTAC:(E3)n复合物（图6）。 图6. 原位miRNA启动组装预protac（miRiaTAC）系统的示意图 为了进一步降低过度降解所带来的副作用，研究人员设计了一种用于时空控制终止蛋白质降解的概念策略。他们通过在合适的位置插入可光性基团，实现了对长dsDNA纳米结构拆卸过程的光学调节，从而构建出一个具有理想可控性的系统。针对多重蛋白降解这一挑战，研究人员将另一种配体（L3）添加到H1上，以此来募集CDK6。借助可编程的配体比例，成功实现了正交多靶点降解（图7）。此外，体内实验也进一步证实了miRiaTAC在小鼠肿瘤模型中展现出强大的抗癌活性以及显著的肿瘤抑制效果。 图7. miRiaTAC的多重蛋白降解模式 miRiaTAC策略通过插入光不稳定基团实现了对蛋白质降解的时空控制终止，避免了过度蛋白降解。同时，研究人员设计了一种新的DNA编码预PROTAC（H1-Pal），可实现单靶点和双靶点蛋白降解，拓宽了miRiaTAC在多靶点治疗中的应用。 总之，miRiaTAC平台解决了传统PROTACs和miRNA疗法的关键挑战，为开发下一代靶向癌症治疗提供了有前景的途径。 参考文献(可上下滑动）： [1]Zhang, Ni-Yuan et al. “Nano Proteolysis Targeting Chimeras (PROTACs) with Anti-Hook Effect for Tumor Therapy.” Angewandte Chemie (International ed. in English) vol. 62,37 (2023): e202308049. doi:10.1002/anie.202308049 [2]Jin, Yuhui et al. “Ligation to Scavenging Strategy Enables On-Demand Termination of Targeted Protein Degradation.” Journal of the American Chemical Society vol. 145,13 (2023): 7218-7229. doi:10.1021/jacs.2c12809 [3]Zhou, Li et al. “DNA framework-engineered chimeras platform enables selectively targeted protein degradation.” Nature communications vol. 14,1 4510. 27 Jul. 2023, doi:10.1038/s41467-023-40244-7 [4]Zheng, Mengzhu et al. “Rational Design and Synthesis of Novel Dual PROTACs for Simultaneous Degradation of EGFR and PARP.” Journal of medicinal chemistry vol. 64,11 (2021): 7839-7852. doi:10.1021/acs.jmedchem.1c00649 [5]Hollingsworth, S., Johnson, S., Khakbaz, P. et al. The rise of targeting chimeras (TACs): next-generation medicines that preempt cellular events. Med Chem Res 32, 1294–1314 (2023). https://doi-org.libproxy1.nus.edu.sg/10.1007/s00044-023-03104-z [6]Zhan, Jiayin et al. “MicroRNA-Triggered Programmable DNA-Encoded Pre-PROTACs for Cell-Selective and Controlled Protein Degradation.” Angewandte Chemie (International ed. in English), e202415323. 9 Oct. 2024, doi:10.1002/anie.202415323 *声明：本文仅是介绍医药疾病领域研究进展或简述研究概况或分享医药相关讯息，并非也不会进行治疗或诊断方案推荐，也不对相关投资构成任何建议。内容如有疏漏，欢迎沟通指出！ 「医药一哥」赴港二次上市传闻起，拟募资20亿美元，透露哪些信号？ 辉瑞DMD基因疗法折戟，试验结果“打脸”FDA 这5家核药公司，值得关注！

Positive feedback received from US FDA regarding the planned TACTI-004 Phase III in first-line non-small cell lung cancer successfully concluding regulatory preparations for the trial designEfti in combination with MSD’s KEYTRUDA® reports positive efficacy and favourable safety in first-line head and neck cancer in TACTI-003 Phase IIb trialFirst participant successfully dosed in the first-in-human Phase I trial of IMP761, a novel LAG-3 agonist antibody designed to treat autoimmune diseasesImmutep added to the S&P ASX300 Index, recognising its considerable growth and enhancing market visibilityImmutep has a strong aggregate cash, cash equivalent and term deposit position of A$172.3 million as at 30 September 2024 with an expected cash reach to the end of CY2026. SYDNEY, AUSTRALIA, Oct. 29, 2024 (GLOBE NEWSWIRE) -- Immutep Limited (ASX: IMM; NASDAQ: IMMP) ("Immutep” or “the Company”), a clinical-stage biotechnology company developing novel LAG-3 immunotherapies for cancer and autoimmune disease, provides an update on its activities for the quarter ended 30 September 2024 (Q1 FY25). EFTI DEVELOPMENT PROGRAM FOR CANCER TACTI-004 (KEYNOTE-PNC91) – 1L NSCLC Phase III Clinical Collaboration with MSD In July, Immutep received positive feedback from the US Food and Drug Administration (FDA) regarding its planned TACTI-004 Phase III trial of eftilagimod alfa (efti) in combination with KEYTRUDA® (pembrolizumab), MSD’s (Merck & Co., Inc., Rahway, NJ, USA) anti-PD-1 therapy, and histology-based platinum doublet chemotherapy for the treatment of first-line metastatic non-small cell lung cancer (1L NSCLC), regardless of PD-L1 expression. The FDA feedback builds on previously received guidance from the Paul-Ehrlich-Institut and the Spanish Agency for Medicines and Health Products, successfully concluding the preparatory regulatory interactions for the design of this registrational trial. The study will enrol ~750 patients regardless of PD-L1 expression in order to address the entire 1L NSCLC market eligible for anti-PD-1 therapy. TACTI-003 (KEYNOTE-C34) – Phase IIb clinical trial in 1L HNSCCTACTI-003 is evaluating efti in combination with MSD’s anti-PD-1 therapy KEYTRUDA® (pembrolizumab) as first-line treatment of recurrent or metastatic head and neck squamous cell carcinoma patients (1L HNSCC). The randomized Cohort A portion of the study is evaluating efti in combination with KEYTRUDA as compared to KEYTRUDA monotherapy in patients with PD-L1 positive (Combined Positive Score [CPS] ≥1) tumours, whereas Cohort B is evaluating efti in combination with KEYTRUDA in patients with PD-L1 negative tumours (CPS <1). In July, Immutep reported updated positive efficacy and safety results from Cohort B of the TACTI-003 Phase IIb trial at an ESMO Virtual Plenary session. In patients with negative PD-L1 expression (CPS <1) in Cohort B, efti in combination with KEYTRUDA® achieved a 35.5% objective response rate (ORR). This is among the highest recorded for a treatment approach not containing chemotherapy in patients with CPS <1. The immuno-oncology combination with efti also attained a high complete response rate of 9.7%, which compares favourably to a historical control of 0% from anti-PD-1 monotherapy in 1L HNSCC patients with a CPS <1. Additionally, durability of responses was tracking well. In September, further data was reported from Cohort A of the TACTI-003 trial in a late-breaking abstract and prestigious Proffered Paper oral presentation at ESMO Congress 2024. At ESMO, late-breaking abstracts are generally reserved for high-quality, new research findings from randomised phase II or phase III trials with implications for clinical practice or understanding of disease processes. Proffered Papers are oral presentations of original data of superior quality, followed by expert discussion and perspectives. In patients with PD-L1 positive tumours (CPS ≥1), efti in combination with KEYTRUDA outperformance was largest in CPS ≥20 with 31.0% ORR (34.5% ORR including a partial response recorded after data cut-off date) versus 18.5% ORR for KEYTRUDA monotherapy. Efti in combination with KEYTRUDA led to a high durability of response of 17.5 months in patients with CPS ≥1 and the combination continues to have favourable safety profile. Additionally, a statistically significant increase in absolute lymphocyte count, measured as an exploratory biomarker, was seen in the efti with KEYTRUDA arm indicating an effective efti-induced immune response in this randomised setting. Immutep will continue to follow the maturing data from TACTI-003, with the most relevant endpoint of Overall Survival expected in 2025 and engage with regulatory authorities regarding potential paths forward. TACTI-002 (KEYNOTE-PN798) – Phase II clinical trial in 1L NSCLCImmutep continues to follow patients with first-line non-small cell lung cancer (1L NSCLC), in Part A of the TACTI-002 trial, where excellent median Overall Survival (mOS) rates were seen across all levels of PD-L1 expression. Immutep has previously reported final data from the other parts of the TACTI-002 trial. AIPAC-003 – Integrated Phase II/III trial in MBCSubsequent to quarter end, Immutep completed patient enrolment in the randomised Phase II portion of the AIPAC-003 trial in October. The Phase II portion enrolled 65 metastatic hormone receptor positive (HR+), HER2-negative/low or triple-negative breast cancer patients who had exhausted endocrine therapy including cyclin-dependent kinase 4/6 (CDK4/6) inhibitors. The patients have been enrolled across 22 clinical sites in Europe and the United States and have been randomised 1:1 to receive either 30mg or 90mg dosing of efti in combination with paclitaxel to determine the optimal biological dose of efti consistent with the FDA’s Project Optimus initiative. Further updates will be provided after data collection, data cleaning and analysis. INSIGHT-003 – Phase I in non-squamous 1L NSCLCThe investigator-initiated INSIGHT-003 trial continued to enrol patients throughout the quarter and they have been safely dosed across six sites in Germany. Further updates from the trial are anticipated in Q 4 CY2024. INSIGHT-005 – Phase I trial in Urothelial CarcinomaThe INSIGHT-005 trial is evaluating efti and the anti-PD-L1 therapy BAVENCIO® (avelumab) in up to 30 patients with metastatic urothelial cancer. The study is jointly funded with Merck KGaA, Darmstadt, Germany. EFTISARC-NEO – Phase II Trial in Soft Tissue SarcomaNew data from the EFTISARC-NEO Phase II investigator-initiated trial of efti in combination with radiotherapy plus KEYTRUDA® (pembrolizumab) for patients with soft tissue sarcoma (STS) will be presented on 14 November at the Connective Tissue Oncology Society (CTOS) 2024 Annual Meeting taking place in San Diego, California. IMP761 DEVELOPMENT PROGRAM FOR AUTOIMMUNE DISEASEIn August, Immutep successfully dosed the first participant in the first-in human Phase I trial of IMP761 after receiving regulatory clearance from the ethics and competent authority in the Netherlands to initiate the study. Safety data from this first-in-human study is anticipated by the end of the calendar year 2024, with pharmacokinetics and pharmacodynamics data in first half CY2025. IMP761 is a first-in-class agonist LAG-3 antibody designed to restore balance to the immune system by enhancing the “brake” function of LAG-3 to silence dysregulated self-antigen-specific memory T cells that cause many autoimmune diseases. INTELLECTUAL PROPERTY During the quarter, Immutep was granted seven new patents for efti, IMP761 and LAG525 (ieramilimab) in various territories. Two patents were granted for efti in combination with a PD-1 pathway inhibitor in South Korea and Brazil and one patent was granted in Mexico for a binding assay for determining MHC Class II binding activity. The assay is used in the characterisation of efti in GMP-grade manufacturing. New patents were also granted for IMP761 in India and Israel. For LAG525, which is exclusively licensed to Novartis by Immutep, two new patents were granted in Australia and Taiwan. CORPORATE & FINANCIAL SUMMARY Immutep enters the ASX300Following the September quarterly review of the S&P Dow Jones Indices, Immutep was added to the S&P/ASX 300 index. Joining the ASX300 recognises the Company's considerable growth over the years, enhances its market visibility and supports investor confidence. Cash Flow SummaryDuring the quarter, Immutep continued to advance its clinical trial programs for efti and preclinical program for IMP761 to create value for shareholders. The Company is well funded with a strong cash and cash equivalent balance as at 30 September 2024 of approximately A$120.3 million. In addition to this cash balance, Immutep has an A$52.0 million bank term deposit, which has been recognised as a short-term investment due to the maturity date of 5-12 months. This aggregate position of A$172.3 million as at 30 September 2024 gives Immutep an expected cash reach to the end of CY2026. Cash receipts from customers in Q1 FY25 were $20k. During the quarter, Immutep received a €2,194,918 (~A$3,602,362) research and development (R&D) tax incentive payment in cash from the French Government under its Crédit d’Impôt Recherche scheme and $549k from the Australian government R&D tax rebate. The net cash used in G&A activities in the quarter was $961k, compared to $1.9 million in Q4 FY24. Payments to Related Parties comprises Non-Executive Directors’ fees and Executive Directors’ remuneration of $576 k. The net cash used in R&D activities during the quarter was $9.5 million, compared to $3.8 million to Q4 FY24. The increase is mainly due to the increased level of clinical trial activities. Payment for staff costs was $2.8 million in the quarter compared to $2.0 million in Q4 FY24. Total net cash outflows used in operating activities in the quarter were $8.6 million compared to $7.4 million in Q4 FY24. For the cash flow used in investing activities, the company invested $32.4 million in bank term deposits with maturity between 5 and 6 months which has been recognised as a short-term investment. Net cash outflow from financing activities for the quarter was approximately $373 k including $254k for the payment of capital raising cost. About ImmutepImmutep is a clinical-stage biotechnology company developing novel LAG-3 immunotherapy for cancer and autoimmune disease. We are pioneers in the understanding and advancement of therapeutics related to Lymphocyte Activation Gene-3 (LAG-3), and our diversified product portfolio harnesses its unique ability to stimulate or suppress the immune response. Immutep is dedicated to leveraging its expertise to bring innovative treatment options to patients in need and to maximise value for shareholders. For more information, please visit www.immutep.com. Australian Investors/Media:Catherine Strong, Sodali & Co+61 (0)406 759 268; catherine.strong@sodali.com U.S. Investors/Media:Chris Basta, VP, Investor Relations and Corporate Communications+1 (631) 318 4000; chris.basta@immutep.com