Abstract B135: The mechanism of action of BT1718, a novel small-molecule drug conjugate for the treatment of solid tumors expressing MT1-MMP

BT1718 is a small-molecule drug conjugate, also called Bicycle drug conjugate (BDC), comprising a constrained bicyclic peptide (Bicycle) that binds with high affinity and specificity to membrane type 1-matrix metalloprotease (MT1-MMP; MMP14; MT1) covalently linked through a hindered disulfide linker to the potent antitubulin agent DM1. MT1 is naturally involved in tissue remodeling; however, its overexpression is linked to increased tumor aggressiveness and metastasis. Overexpression of MT1 is associated with poor survival in NSCLC, TNBC, and other solid tumors. MT1 expression can also be observed in tumor-associated stromal cells. The Bicycle binder for BT1718 was identified using a proprietary phage display peptide technology consisting of highly diverse phage libraries of linear amino acid sequences constrained into two loops by a central chemical scaffold. While binding with similar affinity and specificity to that observed with monoclonal antibodies, the small size of a Bicycle (1.5-3 kDa) aids in its rapid extravasation and tumor penetration, making it an ideal format for the targeted delivery of cytotoxic payloads. BT1718 shows profound antitumor activities as a single agent when given at doses as low as 3mg/kg biw, producing complete regression of tumors in cell-line and patient-derived xenograft models. BT1718 is also able to produce rapid complete regression of very large tumors (~1000 mm3). We have evaluated the target dependence of antitumor activities of BT1718 by evaluating tumor response in a range of xenograft models with varying expression of MT1, as measured by mRNA, FACS, and IHC. We evaluated a panel of cell-line derived xenograft (CDX) and patient-derived xenograft (PDX) tumors across various indications including lung, breast, colorectal, stomach, head and neck cancer, and multiple myeloma. In both CDX and PDX models, the efficacy of BT1718 was dependent on the MT1 expression levels. Moderate and high MT1-expressing cell lines showed partial or complete regression when treated with BT1718, while low MT1-expressing lines showed limited or no effect. BT1718 is a first-in-class, cytotoxic small-molecule drug conjugate with great potential for treatment of MT1-expressing solid tumors and is about to begin clinical testing.

Citation Format: Gavin Bennett, Mike Rigby, Bob Lutz, Peter Park, Nicholas Keen. The mechanism of action of BT1718, a novel small-molecule drug conjugate for the treatment of solid tumors expressing MT1-MMP [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr B135.

Abstract 1167: Development of BT1718, a novel Bicycle Drug Conjugate for the treatment of lung cancer

BT1718 is a Bicycle Drug Conjugate (BDC®) comprising a constrained bicyclic peptide (Bicycle®) that binds with high affinity and specificity to membrane type 1-matrix metalloprotease (MT1-MMP; MMP14) covalently linked through a hindered disulfide linker to the potent anti-tubulin agent DM1. MT1-MMP is involved in normal tissue remodeling and is also expressed in tumor associated stromal cells. However, overexpression is linked to increased tumor aggression and metastasis. Specifically, over-expression of MT1-MMP is also associated with poor clinical prognosis and shorter survival times in patients with NSCLC and a range of other solid tumors. The Bicycle MT1-MMP binding element within BT1718 was identified using a proprietary phage display peptide technology consisting of highly diverse phage libraries of linear amino acid sequences constrained into two loops by a central tri-functional chemical scaffold. These MT1-MMP binding Bicycles exhibit a profound affinity and specificity, more often associated with monoclonal antibodies, whilst their low molecular weight (1.5-3 kDa), akin to that of a small molecule, aids in rapid extravasation and tumor penetration. Together these attributes make Bicycles an ideal format for the targeted delivery of cytotoxic payloads. We evaluated the ability of BT1718 to bind to and kill tumor cells in vitro and in vivo in a panel of tumor cells. BT1718 demonstrated MT1-MMP target-specific binding and MT1-MMP-dependent cell killing of lung tumor cells in vitro as well as efficacy across a panel of lung tumor xenograft mouse models. For example, in the Met-amplified squamous NSCLC lung EBC-1 model, complete regressions were observed in all mice at doses as low as 5 mg/kg (iv) twice weekly and across a range of other dosing schedules, from daily to weekly. MT1-MMP-dependent activity was demonstrated by blocking target specific interactions through co-administration of an excess of unconjugated Bicycle binder, which inhibited tumour regression, or a non-binding Bicycle, which had no effect. Further evaluation in patient-derived lung xenograft (PDX) models indicates a similar activity to that seen in cell-line derived xenografts, with efficacy seen from 3mg/kg twice weekly and rapid full regression of tumors at higher doses. The molecular attributes of these Bicycles: rapid tumor penetration and specific binding, makes them ideal therapeutics for targeted delivery of toxins as Bicycle drug conjugates (BDCs). The small size of the BDC may offer a significant advantage to other targeted cytotoxic approaches such as antibody-drug conjugates due to rapid extravasation and improved tumor penetration. BT1718, a Bicycle Drug Conjugate, shows potent anti-tumor activity in human lung tumor xenograft models and IND-enabling studies are underway.

Citation Format: Gavin Bennett, Robert Lutz, Peter Park, Helen Harrison, Kevin Lee. Development of BT1718, a novel Bicycle Drug Conjugate for the treatment of lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1167. doi:10.1158/1538-7445.AM2017-1167

Abstract 5144: BT1718, a novel bicyclic peptide-maytansinoid conjugate targeting MT1-MMP for the treatment of solid tumors: Design of bicyclic peptide and linker selection

Bicycles® are novel binding agents comprising small bicyclic peptides (1.5-3 KDa) constrained via a chemical scaffold, selected for high affinity and selectivity to targets of interest. MT1 (MMP14/MT1-MMP) is a membrane-associated metalloprotease overexpressed in many solid tumours and is implicated in tumor invasion and metastasis. MT1 expression positively correlates with poor prognosis.

Phage libraries containing 1015 unique peptide sequences were post-translationally cyclized with thiol-reactive scaffold and used in an optimized, high-throughput selection process to identify Bicycles® to the hemopexin domain of MT1. Additional iterative rounds of directed phage based screening were used to optimize affinity and off-phage non-natural amino acids were introduced at select positions to improve plasma stability to generate the lead Bicycle binder. The lead anti-MT1 Bicycle was further modified with a sarcosyl spacer to form N241. N241 binds specifically to the hemopexin domain of MT1 with a Kd of approximately 2 nM with no binding observed to the catalytic domain of the protease nor to any of the related MMP family members tested. Importantly and in contrast to most antibodies, N241 binds with similar affinity to MT1 from multiple species including rodent, dog and non-human primate.

Since the expected rapid tumor penetration and specific binding of these small peptidyl-binders makes them ideal for use in targeted delivery approaches, a series of Bicycle drug conjugates (BDCs) were prepared; N241 was conjugated to potent maytansinoid cytotoxics via linkers which varied in their cleavability. Though all the BDCs maintained high affinity for MT1, efficacy toward MT1-positive human tumor mouse xenografts varied with linker stability. BDCs with the most stable linkers were the least active suggesting that optimal tumor activation was obtained with linkers that could be cleaved more rapidly. Due to the rapid clearance and limited systemic exposure of these small-targeting BDCs, only the most labile linker showed toxicity in the mouse studies. Of the BDCs tested, BT1718, composed of N241 and DM1 conjugated via the SPP linker, demonstrated an optimal therapeutic index. Potent anti-tumor efficacy with BT1718 was observed across a panel of MT1-positive xenografts with complete tumor regressions observed in most models at doses that were well tolerated. In one example, HT-1080 fibrosarcoma subcutaneous xenografts were intraveneously treated with BT1718 when the tumor size had reached approximately 180 mm3. BT1718 given at 3 mg/kg once a week resulted in tumor stasis while BT1718 given at 10 mg/kg once a week or 3 mg/kg twice a week induced complete regression.

In summary, BT1718, a highly active, targeted drug conjugate with unique pharmacological properties is a promising therapeutic candidate for the treatment of MT1-MMP-positive solid tumors.

Citation Format: Helen Harrison, Gavin Bennett, Diane Blakeley, Amy Brown, Spencer Campbell, Liuhong Chen, Robert J. Lutz, Silvia Pavan, Katerine van Rietschoten, Daniel Teufel, Peter U. Park, Kevin Lee. BT1718, a novel bicyclic peptide-maytansinoid conjugate targeting MT1-MMP for the treatment of solid tumors: Design of bicyclic peptide and linker selection [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5144. doi:10.1158/1538-7445.AM2017-5144

Pitfalls and tips in the diagnosis of ectopic pregnancy

Women of reproductive age with pelvic pain, vaginal bleeding, and a positive pregnancy test often require evaluation with pelvic ultrasound. In these situations, the primary role of pelvic ultrasound is to differentiate an ectopic pregnancy from either a normal or abnormal intrauterine pregnancy. While an accurately performed and interpreted pelvic ultrasound results in rapid diagnosis and management, numerous diagnostic pitfalls can lead to negative outcomes. Therefore, familiarity with the appropriate laboratory tests, sonographic technique, and imaging features of ectopic pregnancy is essential for all radiologists. We present a review of ectopic pregnancy cases from our institution with attention to common pitfalls and troubleshooting tips for physicians who perform and interpret pelvic ultrasounds. We also present recently published literature to aid in the management of first trimester pregnancy.

CZ415, a Highly Selective mTOR Inhibitor Showing in Vivo Efficacy in a Collagen Induced Arthritis Model

CZ415, a potent ATP-competitive mTOR inhibitor with unprecedented selectivity over any other kinase is described. In addition to a comprehensive characterization of its activities in vitro, in vitro ADME, and in vivo pharmacokinetic data are reported. The suitability of this inhibitor for studying in vivo mTOR biology is demonstrated in a mechanistic mouse model monitoring mTOR proximal downstream phosphorylation signaling. Furthermore, the compound reported here is the first ATP-competitive mTOR inhibitor described to show efficacy in a semitherapeutic collagen induced arthritis (CIA) mouse model.

The effects of colony structure and resource abundance on food dispersal in Tapinoma sessile (Hymenoptera: Formicidae)

The odorous house ant, Tapinoma sessile (Say) (Hymenoptera: Formicidae), exhibits a high degree of variation in colony spatial structure, which may have direct and indirect effects on foraging. Protein marking and mark-release-recapture techniques were utilized to examine the effect of colony spatial structure on food dispersal. Sucrose water spiked with rabbit IgG protein was presented to colonies with varying spatial configurations in laboratory and field experiments. In monodomous laboratory colonies, the rate and extent of food dispersal was rapid due to a decrease in foraging area. In polydomous colonies, food dispersal was slower because conspecifics were forced to forage and share food over longer distances. However, over time, food was present in all extremities of the colony. Experiments conducted in the field produced similar results, with nests in close proximity to food yielding higher percentages of workers scoring positive for the marker. However, the percentage of workers possessing the marker decreased over time. Results from this study provide experimental data on mechanisms of food dispersal in monodomous and polydomous colonies of ants and may be important for increasing the efficacy of management strategies against T. sessile and other pest ant species.

The effects of colony structure and resource abundance on food dispersal in Tapinoma sessile (Hymenoptera: Formicidae)

The odorous house ant, Tapinoma sessile (Say) (Hymenoptera: Formicidae), exhibits a high degree of variation in colony spatial structure which may have direct and indirect effects on foraging. Protein marking and mark-release-recapture techniques were utilized to examine the effect of colony spatial structure on food dispersal. Sucrose water spiked with rabbit IgG protein was presented to colonies with varying spatial configurations in laboratory and field experiments. In monodomous lab colonies, the rate and extent of food dispersal was rapid due to a decrease in foraging area. In polydomous colonies, food dispersal was slower because conspecifics were forced to forage and share food over longer distances. However, over time, food was present in all extremities of the colony. Experiments conducted in the field produced similar results, with nests in close proximity to food yielding higher percentages of workers scoring positive for the marker. However, the percentage of workers possessing the marker decreased over time. Results from this study provide experimental data on mechanisms of food dispersal in monodomous and polydomous colonies of ants, and may be important for increasing the efficacy of management strategies against T. sessile and other pest ant species.

The cost and management of different types of clinical mastitis in dairy cows estimated by dynamic programming

The objective of this study was to estimate the cost of 3 different types of clinical mastitis (CM) (caused by gram-positive bacteria, gram-negative bacteria, and other organisms) at the individual cow level and thereby identify the economically optimal management decision for each type of mastitis. We made modifications to an existing dynamic optimization and simulation model, studying the effects of various factors (incidence of CM, milk loss, pregnancy rate, and treatment cost) on the cost of different types of CM. The average costs per case (US$) of gram-positive, gram-negative, and other CM were $133.73, $211.03, and $95.31, respectively. This model provided a more informed decision-making process in CM management for optimal economic profitability and determined that 93.1% of gram-positive CM cases, 93.1% of gram-negative CM cases, and 94.6% of other CM cases should be treated. The main contributor to the total cost per case was treatment cost for gram-positive CM (51.5% of the total cost per case), milk loss for gram-negative CM (72.4%), and treatment cost for other CM (49.2%). The model affords versatility as it allows for parameters such as production costs, economic values, and disease frequencies to be altered. Therefore, cost estimates are the direct outcome of the farm-specific parameters entered into the model. Thus, this model can provide farmers economically optimal guidelines specific to their individual cows suffering from different types of CM.