www.postersession.com Biomarker and PK/PD analyses of first-in-class FASN inhibitor TVB-2640 in a first-in-human phase 1 study in solid tumor patients Fatty Acid Synthase (FASN) • Central mediator of neoplastic lipogenesis • Generates palmitate, the building block of long chain fatty acids, providing a mechanism to convert glucose and other carbon sources into lipids to support cancer cell signaling • Upregulated in tumor vs normal tissue, and correlates with poor prognosis in certain tumor types Summary • TVB-2640 is a first-in-class FASN inhibitor currently in a Phase 1 oncology clinical study 3V2640-CLIN-002 • Excellent QD oral PK profile • Pharmacodynamic biomarkers identified in patient sera and target engagement observed in ongoing Phase 1 study • Increased malonyl carnitine • Decreased TG16:0 palmitate • Good correlation with TVB-2640 plasma exposure • Similar pharmacodynamic activity in rat model • Pharmacodynamic activity shown in patient tumors • Decreased pAKT S473 in 2/2 patients, also in xenografts • Comprehensive biomarker analysis is underway with analysis in additional patients in ongoing 3V2640 CLIN-002 Phase 1 study • Poised to understand the clinical impact of FASN inhibition Tumor IHC in Phase 1 Thank you to the patients and their families • Multicenter, open label, ongoing phase 1 study • Oral, once daily with 21/28 day continuous cycles • To date, 23 patients enrolled in monotherapy dose escalation at dose levels of 60, 80, 120, 240 mg/m 2 or 200 mg flat dose. 7 patients enrolled in combination with paclitaxel. M. O’Farrell, R. Crowley, T. Heuer, D. Buckley, C. Rubino 1 , W. McCulloch, G. Kemble 1 Institute for Clinical Pharmacodynamics, Latham, NY. 3-V Biosciences, Menlo Park, USA. Biomarker Sampling in FIH Phase I Solid Tumor Study 3V2640-CLIN-002 Malonyl Carnitine Response to FASN Inhibition • Oral, first-in-class, small-molecule reversible inhibitor of FASN. • IC 50 < 0.05 μM. • In vitro and in vivo anti-tumor effects previously shown. TVB-2640, FASN inhibitor CT203. Patel et al. First-In-Human Study of the First-In-Class Fatty Acid Synthase (FASN) Inhibitor, TVB-2640. Monday April 20, 8:00 AM - 12:00 PM #4446. Heuer et al. Discovery of tumor types highly susceptible to FASN inhibition and biomarker candidates for clinical analysis. Tuesday April 21, 1:00 PM - 5:00 PM Global biochemical and lipid extraction • Approx. 1000 readouts analyzed by mass spec Pre, 6 hr Pre, 6 hr FASN inhibitor TVB-2640 QD Day 1 Day 8 •2/2 evaluable biopsy pairs show inhibition of pAKT S473 •pAKT S473 inhibition also observed in preclinical rat xenograft •1 additional pair did not show pAKT inhibition but predose was several weeks prior to first dose, and disparate tumor locations • Pt 004 (monotherapy) • Breast cancer PIK3CA mutant • TVB-2640 at 240 mg/m 2 • Approx. 50% decrease in pAKT S473 • Pt 020 (paclitaxel combination) • Triple negative breast cancer • TVB-2640 at 60 mg/m 2 • Approx. 50% decrease in pAKT S473 Pre-dose Post-dose (end cycle 1) FFPE sections stained with pAKT S473 (Dako, rabbit clone 14-5 )(CST rabbit Ab C20G5) using a validated IHC method. H-score in tumor quantitated by standard pathology review (staining intensity graded 0-3+ and % cells positive). 20x. • Blood – gene expression analysis • Predose, serial timepoints on day 1 and day 8 • Serum – metabolomic, lipidomic and proteomic analysis • Predose, serial timepoints on day 1 and day 8, trough samples in later cycles • Archival tumor – mutational profiling • Fresh tumor biopsies – IHC and gene expression analysis • Predose and end of cycle 1 FFPE sections stained with FASN CST rabbit Ab C20G5) using a validated method. H- score in tumor tissue was quantitated by standard pathology review including staining intensity graded 0-3+ and % cells positive. ELISA for FASN was performed on human sera using a commercially available ELISA kit (Immtech). Banked tumors and cancer patient sera were purchased from commercial sources. CLIN-002 samples are from ongoing Phase 1 study, several ongoing re-assay as exceed ULQ. Line indicates median. N of 5 to 20 per tumor type for IHC, and 14 to 55 for ELISA. FASN expression survey • 9/10 patients tested show decreased TG16:0 palmitate on day 8 • p<0.05 for D8 pre versus D1 pre overall, and for 120 and 240 mg/m 2 dose levels • Other palmitate derivatives also decreased (not shown) • Preliminary analysis shows good correlation with TVB2640 exposure for malonyl carnitine and TG 16:0 palmitate • 9/10 patients showed increased malonyl carnitine on day 8 relative to day 1, up to 7-fold with mean of 3.4-fold • p<0.05 for D8 pre versus D1 pre for 120 and 240 mg/m 2 dose levels • Clear evidence of FASN pathway inhibition in serum • Similar effect in rats treated with FASN inhibitor as below Global biochemical and lipid extraction • Approx. 1000 readouts analyzed by mass spec FASN inhibitor QD Day 1 Day 7 Pre 12 hr D1 pre D1 6hr D8 pre D8 6hr 0.7 0.8 0.9 1.0 1.1 1.2 TG 16:0 palmitate n=10 at 60 (3), 120 (3) or 240 (4) mg/m 2 , various tumor types n=12 at 0, 20, 60, 200 mg/kg, 3 per group. 0 100 200 300 400 500 600 700 800 D1 pre D8 pre Malonyl Carni0ne (%D1 pre) Malonyl carnitine Per patient 70 75 80 85 90 95 100 105 110 Day 1 Day 8 TG 16:0 palmitate (% D1 pre) TG 16:0 palmitate Per patient none low mid high FASN inhibitor Malonyl Carnitine TG 16:0 Palmitate none low mid high FASN inhibitor Rat Rat Malonyl-CoA FASN Palmitate in complex lipids Acetyl-CoA Malonyl Carnitine TVB-2640 • >300 tumor samples and cancer patient serum tested for FASN expression (unmatched) • FASN levels markedly higher in both tumor tissue and serum from cancer patients compared to normal donors. NSCLC, CRC and prostate among the highest expression. Of 27 normal tissues tested, only spleen, tonsil and thymus had an IHC signal • FASN expression in tumor and serum is being tested in ongoing Phase 1 study 3V2640-CLIN-002 FASN palmitate Malonyl-CoA Acetyl-CoA Citrate ACLY ACC SCD ELOVLs Lipid signaling eg. diacylglycerol, Energy production Energy storage Protein signaling eg. palmitoylation myristoylation Structural role in membranes and rafts eg. phosphatidylcholine. Fatty Acid Synthesis PK/PD pAKTS473 α-tubulin Veh, pool 1 10 100 1000 10000 0 4 8 12 16 20 24 TVB$2640 (ng/ml) Time (hr) 60 mg/m2 120 mg/m2 240 mg/m2 60 mg/m2 120 mg/m2 240 mg/m2 Day 1; dashed, Day 8; solid Mean +/- SD per cohort Pool, TVB-2640 TVB-2640, 100 mg/kg single animals Veh, pool Decreased pAKT by 30-60% across animals Rat Colo205 xenografts treated with TVB-2640 QD, starting on day 13. 0 200 400 600 800 1000 1200 1400 12 14 16 18 20 22 24 26 28 30 Tumor Size (mm3) Days after Tumor Inoculation Vehicle TVB-2640 30 mg/kg TVB-2640 60 mg/kg TVB-2640 100 mg/kg Western blot analysis of tumors from Colo-205 xenografts collected on last day. H:55 H:30 H:230 H:115 0 100 200 300 400 500 600 700 800 900 0 50,000 100,000 150,000 200,000 250,000 300,000 Malonyl Carni+ne (% C1D1 pre) TVB62640 AUC (0624) hr*ng/ml Mean levels Serum Palmitate Response to FASN Inhibition D1 pre D1 6hr D8 pre D8 6hr 0 1 2 3 4 10 12 14 16 18 Malonyl Carnitine Mean levels Normal male Normal female CRC Bladder Breast Endometrial H/N NSCLC Ovarian Prostate CLIN-002 1 10 100 1000 10000 Serum FASN level (ng/ml) CRC Bladder Breast Endometrial H/N NSCLC Ovarian Prostate 1 10 100 1000 10000 FASN IHC (H score in tumor cells) Tumor IHC Serum ELISA Per patient
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Biomarker and PK/PD analyses of first-in-class FASN inhibitor TVB-2640 in a first-in-human phase 1 study in solid tumor patients
Fatty Acid Synthase (FASN) • Central mediator of neoplastic lipogenesis • Generates palmitate, the building block of long chain fatty acids,
providing a mechanism to convert glucose and other carbon sources into lipids to support cancer cell signaling
• Upregulated in tumor vs normal tissue, and correlates with poor prognosis in certain tumor types
Summary • TVB-2640 is a first-in-class FASN inhibitor currently in a Phase 1
oncology clinical study 3V2640-CLIN-002 • Excellent QD oral PK profile • Pharmacodynamic biomarkers identified in patient sera and
target engagement observed in ongoing Phase 1 study • Increased malonyl carnitine • Decreased TG16:0 palmitate • Good correlation with TVB-2640 plasma exposure • Similar pharmacodynamic activity in rat model
• Pharmacodynamic activity shown in patient tumors • Decreased pAKT S473 in 2/2 patients, also in xenografts
• Comprehensive biomarker analysis is underway with analysis in additional patients in ongoing 3V2640 CLIN-002 Phase 1 study
• Poised to understand the clinical impact of FASN inhibition
Tumor IHC in Phase 1
Thank you to the patients and their families
• Multicenter, open label, ongoing phase 1 study • Oral, once daily with 21/28 day continuous cycles • To date, 23 patients enrolled in monotherapy dose escalation at
dose levels of 60, 80, 120, 240 mg/m2 or 200 mg flat dose. 7 patients enrolled in combination with paclitaxel.
M. O’Farrell, R. Crowley, T. Heuer, D. Buckley, C. Rubino1, W. McCulloch, G. Kemble
1Institute for Clinical Pharmacodynamics, Latham, NY. 3-V Biosciences, Menlo Park, USA.
Biomarker Sampling in FIH Phase I Solid Tumor Study 3V2640-CLIN-002
Malonyl Carnitine Response to FASN Inhibition • Oral, first-in-class, small-molecule reversible inhibitor of FASN.
• IC50 < 0.05 µM. • In vitro and in vivo anti-tumor effects previously shown.
TVB-2640, FASN inhibitor
CT203. Patel et al. First-In-Human Study of the First-In-Class Fatty Acid Synthase (FASN) Inhibitor, TVB-2640. Monday April 20, 8:00 AM - 12:00 PM #4446. Heuer et al. Discovery of tumor types highly susceptible to FASN inhibition and biomarker candidates for clinical analysis. Tuesday April 21, 1:00 PM - 5:00 PM
Global biochemical and lipid extraction • Approx. 1000
readouts analyzed by mass spec
Pre, 6 hr Pre, 6 hr
FASN inhibitor TVB-2640 QD
Day 1 Day 8
• 2/2 evaluable biopsy pairs show inhibition of pAKTS473 • pAKTS473 inhibition also observed in preclinical rat xenograft • 1 additional pair did not show pAKT inhibition but predose was several weeks prior to first dose, and disparate tumor locations
• Pt 004 (monotherapy) • Breast cancer PIK3CA mutant • TVB-2640 at 240 mg/m2
• Approx. 50% decrease in pAKT S473
• Pt 020 (paclitaxel combination) • Triple negative breast cancer • TVB-2640 at 60 mg/m2
• Approx. 50% decrease in pAKT S473
Pre-dose Post-dose (end cycle 1)
FFPE sections stained with pAKT S473 (Dako, rabbit clone 14-5 )(CST rabbit Ab C20G5) using a validated IHC method. H-score in tumor quantitated by standard pathology review (staining intensity graded 0-3+ and % cells positive). 20x.
• Blood – gene expression analysis
• Predose, serial timepoints on day 1 and day 8
• Serum – metabolomic, lipidomic and proteomic analysis
• Predose, serial timepoints on day 1 and day 8, trough samples in later cycles • Archival tumor – mutational
profiling • Fresh tumor biopsies – IHC
and gene expression analysis • Predose and end of cycle 1
FFPE sections stained with FASN CST rabbit Ab C20G5) using a validated method. H-score in tumor tissue was quantitated by standard pathology review including staining intensity graded 0-3+ and % cells positive. ELISA for FASN was performed on human sera using a commercially available ELISA kit (Immtech). Banked tumors and cancer patient sera were purchased from commercial sources. CLIN-002 samples are from ongoing Phase 1 study, several ongoing re-assay as exceed ULQ. Line indicates median. N of 5 to 20 per tumor type for IHC, and 14 to 55 for ELISA.
FASN expression survey
• 9/10 patients tested show decreased TG16:0 palmitate on day 8
• p<0.05 for D8 pre versus D1 pre overall, and for 120 and 240 mg/m2 dose levels
• Other palmitate derivatives also decreased (not shown) • Preliminary analysis shows good correlation with
TVB2640 exposure for malonyl carnitine and TG 16:0 palmitate
• 9/10 patients showed increased malonyl carnitine on day 8 relative to day 1, up to 7-fold with mean of 3.4-fold
• p<0.05 for D8 pre versus D1 pre for 120 and 240 mg/m2 dose levels
• Clear evidence of FASN pathway inhibition in serum • Similar effect in rats treated with FASN inhibitor as below
Global biochemical and lipid extraction • Approx. 1000
readouts analyzed by mass spec
FASN inhibitor QD
Day 1 Day 7 Pre 12 hr
D1 pre D1 6hr D8 pre D8 6hr0.7
0.8
0.9
1.0
1.1
1.2
TG 1
6:0
palm
itate
n=10 at 60 (3), 120 (3) or 240 (4) mg/m2 , various tumor types
n=12 at 0, 20, 60, 200 mg/kg, 3 per group.
0"
100"
200"
300"
400"
500"
600"
700"
800"
D1#pre# D8#pre#
Malon
yl#Carni0n
e#(%
D1#pre)#
Malonyl carnitine
Per patient 70#
75#
80#
85#
90#
95#
100#
105#
110#
Day$1$$ Day$8$
TG$16:0$pa
lmita
te$(%
$D1$pre)$
TG 16:0 palmitate
Per patient
none low mid high FASN inhibitor
Mal
onyl
Car
nitin
e
TG 1
6:0
Pal
mita
te
none low mid high FASN inhibitor
Rat Rat
Malonyl-CoA
FASN Palmitate in complex lipids
Acetyl-CoA
Malonyl Carnitine
TVB-2640
• >300 tumor samples and cancer patient serum tested for FASN expression (unmatched)
• FASN levels markedly higher in both tumor tissue and serum from cancer patients compared to normal donors. NSCLC, CRC and prostate among the highest expression. Of 27 normal tissues tested, only spleen, tonsil and thymus had an IHC signal
• FASN expression in tumor and serum is being tested in ongoing Phase 1 study 3V2640-CLIN-002
FASN palmitate
Malonyl-CoA
Acetyl-CoA
Citrate ACLY
ACC
SCD ELOVLs
Lipid signaling eg. diacylglycerol,
Energy production
Energy storage
Protein signaling eg. palmitoylation myristoylation
Structural role in membranes and rafts eg. phosphatidylcholine.
Fatty Acid Synthesis
PK/PD
pAKTS473
α-tubulin
Veh,
poo
l
1"
10"
100"
1000"
10000"
0" 4" 8" 12" 16" 20" 24"
TVB$26
40)(n
g/ml))
Time)(hr))
60"mg/m2"120"mg/m2"240"mg/m2"60"mg/m2"120"mg/m2"240"mg/m2"
Day 1; dashed, Day 8; solid Mean +/- SD per cohort
Poo
l, TV
B-2
640
TVB-2640, 100 mg/kg single animals Ve
h, p
ool
Decreased pAKT by 30-60% across animals
Rat Colo205 xenografts treated with TVB-2640 QD, starting on day 13.
0
200
400
600
800
1000
1200
1400
12 14 16 18 20 22 24 26 28 30
Tum
or S
ize
(mm
3)
Days after Tumor Inoculation
Vehicle
TVB-2640 30 mg/kg
TVB-2640 60 mg/kg
TVB-2640 100 mg/kg
Western blot analysis of tumors from Colo-205 xenografts collected on last day.
H:55 H:30
H:230 H:115
0"
100"
200"
300"
400"
500"
600"
700"
800"
900"
0" 50,000" 100,000" 150,000" 200,000" 250,000" 300,000"
!Malon
yl!Carni+n
e!!(%
!C1D
1!pre)!!
TVB62640!AUC!(0624)!hr*ng/ml!
Mean levels
Serum Palmitate Response to FASN Inhibition
D1 pre D1 6hr D8 pre D8 6hr0
1
2
3
41012141618
Mal
onyl
Car
nitin
e
Mean levels
Nor
mal
mal
e
Nor
mal
fem
ale
CR
C
Bla
dder
Bre
ast
Endo
met
rial
H/N
NSC
LC
Ova
rian
Pros
tate
CLI
N-0
02
1
10
100
1000
10000
Seru
m F
ASN
leve
l (ng
/ml)
CR
C
Bla
dder
Bre
ast
Endo
met
rial
H/N
NSC
LC
Ova
rian
Pros
tate
1
10
100
1000
10000
FASN
IHC
(H s
core
in tu
mor
cel
ls)
Tumor IHC Serum ELISA
Per patient
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