Journal: Clin Cancer Res / Year: 2024 Title: Oral estrogen receptor PROTAC® vepdegestrant (ARV-471) is highly efficacious as monotherapy and in combination with CDK4/6 or PI3K/mTOR pathway inhibitors in preclinical ER+ breast cancer models. Authors: Sheryl M Gough / John J Flanagan / Jessica Teh / Monica Andreoli / Emma Rousseau / Melissa Pannone / Mark Bookbinder / Ryan Willard / Kim Davenport / Elizabeth Bortolon / Gregory Cadelina / ...Authors: Sheryl M Gough / John J Flanagan / Jessica Teh / Monica Andreoli / Emma Rousseau / Melissa Pannone / Mark Bookbinder / Ryan Willard / Kim Davenport / Elizabeth Bortolon / Gregory Cadelina / Deborah Gordon / Jennifer Pizzano / Jennifer Macaluso / Leofal Soto / John Corradi / Katherine Digianantonio / Ieva Drulyte / Alicia Morgan / Connor Quinn / Miklós Békés / Caterina Ferraro / Xin Chen / Gan Wang / Hanqing Dong / Jing Wang / David R Langley / John Houston / Richard Gedrich / Ian C Taylor / Abstract: PURPOSE: Estrogen Receptor (ER) alpha signaling is a known driver of ER-positive (ER+)/human epidermal growth factor receptor 2 negative (HER2-) breast cancer. Combining endocrine therapy (ET) such ...PURPOSE: Estrogen Receptor (ER) alpha signaling is a known driver of ER-positive (ER+)/human epidermal growth factor receptor 2 negative (HER2-) breast cancer. Combining endocrine therapy (ET) such as fulvestrant with CDK4/6, mTOR or PI3K inhibitors is now a central strategy for the treatment of ER+ advanced breast cancer. However, suboptimal ER inhibition and resistance resulting from ESR1 mutation dictates that new therapies are needed. EXPERIMENTAL DESIGN: A medicinal chemistry campaign identified vepdegestrant (ARV-471), a selective, orally bioavailable, potent small molecule PROteolysis-TArgeting Chimera (PROTAC®) degrader of ER. ...EXPERIMENTAL DESIGN: A medicinal chemistry campaign identified vepdegestrant (ARV-471), a selective, orally bioavailable, potent small molecule PROteolysis-TArgeting Chimera (PROTAC®) degrader of ER. We used biochemical and intracellular target engagement assays to demonstrate the mechanism of action of vepdegestrant, and ESR1 wild-type and mutant ER+ preclinical breast cancer models to demonstrate ER degradation-mediated tumor growth inhibition. RESULTS: Vepdegestrant induced ≥90% degradation of wild-type (WT) and mutant ER, inhibited ER-dependent breast cancer cell line proliferation in-vitro and achieved significant tumor growth ...RESULTS: Vepdegestrant induced ≥90% degradation of wild-type (WT) and mutant ER, inhibited ER-dependent breast cancer cell line proliferation in-vitro and achieved significant tumor growth inhibition (TGI) (87-123%) in MCF7 orthotopic xenograft models, better than the ET agent fulvestrant (31-80% TGI). In the hormone-independent ER Y537S patient derived xenograft (PDX) breast cancer model ST941/HI, vepdegestrant achieved tumor regressions and was similarly efficacious in the ST941/HI/PBR palbociclib-resistant model (102% TGI). Vepdegestrant induced robust tumor regressions in combination with each of the CDK4/6 inhibitors palbociclib, abemaciclib, and ribociclib, the mTOR inhibitor everolimus, and the PI3K inhibitors alpelisib and inavolisib. CONCLUSIONS: Vepdegestrant achieved greater ER degradation in-vivo compared to fulvestrant, which correlated with improved tumor growth inhibition, suggesting vepdegestrant could be a more effective ...CONCLUSIONS: Vepdegestrant achieved greater ER degradation in-vivo compared to fulvestrant, which correlated with improved tumor growth inhibition, suggesting vepdegestrant could be a more effective backbone ET for patients with ER+/HER2- breast cancer.
Energy filter - Name: TFS Selectris X / Energy filter - Slit width: 10 eV
Details
The microscope was equipped with an E-CFEG. Fringe-free imaging and aberration-free image shifts were used during data collection. Nominal pixel size for 130,000x - 0.96 A/px, calibrated - 0.933 A/px.
Image recording
Film or detector model: FEI FALCON IV (4k x 4k) / Number grids imaged: 1 / Number real images: 5321 / Average exposure time: 6.32 sec. / Average electron dose: 50.5 e/Å2 Details: Falcon 4i Detector operated in Electron-Event Representation mode was used to record the images.
Electron beam
Acceleration voltage: 300 kV / Electron source: FIELD EMISSION GUN
Type of model: OTHER / Details: ab initio cryoSPARC v3.3.2
Final reconstruction
Resolution.type: BY AUTHOR / Resolution: 3.7 Å / Resolution method: FSC 0.143 CUT-OFF / Number images used: 116673
Initial angle assignment
Type: MAXIMUM LIKELIHOOD / Software - Name: cryoSPARC (ver. 3.3.2)
Final angle assignment
Type: MAXIMUM LIKELIHOOD / Software - Name: cryoSPARC (ver. 3.3.2)
Final 3D classification
Number classes: 3 / Software - Name: cryoSPARC (ver. 3.3.2) Details: 3D Variability Analysis (with a local mask surrounding the CRBN-ER region and the resolution filtered to 10 A) was used to select the best subset of particles.
FSC plot (resolution estimation)
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