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Huppert LA, Gumusay O, Idossa D, Rugo HS. Systemic therapy for hormone receptor-positive/human epidermal growth factor receptor 2-negative early stage and metastatic breast cancer. CA Cancer J Clin 2023; 73:480-515. [PMID: 36939293 DOI: 10.3322/caac.21777] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/09/2023] [Accepted: 02/01/2023] [Indexed: 03/21/2023] Open
Abstract
Hormone receptor (HR)-positive and human epidermal growth factor receptor 2 (HER2)-negative breast cancer is defined by the presence of the estrogen receptor and/or the progesterone receptor and the absence of HER2 gene amplification. HR-positive/HER2-negative breast cancer accounts for 65%-70% of all breast cancers, and incidence increases with increasing age. Treatment varies by stage, and endocrine therapy is the mainstay of treatment in both early stage and late-stage disease. Combinations with cyclin-dependent kinase 4/6 inhibitors have reduced distant recurrence in the early stage setting and improved overall survival in the metastatic setting. Chemotherapy is used based on stage and tumor biology in the early stage setting and after endocrine resistance for advanced disease. New therapies, including novel endocrine agents and antibody-drug conjugates, are now changing the treatment landscape. With the availability of new treatment options, it is important to define the optimal sequence of treatment to maximize clinical benefit while minimizing toxicity. In this review, the authors first discuss the pathologic and molecular features of HR-positive/HER2-negative breast cancer and mechanisms of endocrine resistance. Then, they discuss current and emerging therapies for both early stage and metastatic HR-positive/HER2-negative breast cancer, including treatment algorithms based on current data.
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Affiliation(s)
- Laura A Huppert
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
| | - Ozge Gumusay
- Department of Medical Oncology, Acibadem University, School of Medicine, Istanbul, Turkey
| | - Dame Idossa
- Masonic Comprehensive Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Hope S Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California, USA
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Hanan EJ, Braun MG, Heald RA, MacLeod C, Chan C, Clausen S, Edgar KA, Eigenbrot C, Elliott R, Endres N, Friedman LS, Gogol E, Gu XH, Thibodeau RH, Jackson PS, Kiefer JR, Knight JD, Nannini M, Narukulla R, Pace A, Pang J, Purkey HE, Salphati L, Sampath D, Schmidt S, Sideris S, Song K, Sujatha-Bhaskar S, Ultsch M, Wallweber H, Xin J, Yeap S, Young A, Zhong Y, Staben ST. Discovery of GDC-0077 (Inavolisib), a Highly Selective Inhibitor and Degrader of Mutant PI3Kα. J Med Chem 2022; 65:16589-16621. [PMID: 36455032 DOI: 10.1021/acs.jmedchem.2c01422] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Small molecule inhibitors that target the phosphatidylinositol 3-kinase (PI3K) signaling pathway have received significant interest for the treatment of cancers. The class I isoform PI3Kα is most commonly associated with solid tumors via gene amplification or activating mutations. However, inhibitors demonstrating both PI3K isoform and mutant specificity have remained elusive. Herein, we describe the optimization and characterization of a series of benzoxazepin-oxazolidinone ATP-competitive inhibitors of PI3Kα which also induce the selective degradation of the mutant p110α protein, the catalytic subunit of PI3Kα. Structure-based design informed isoform-specific interactions within the binding site, leading to potent inhibitors with greater than 300-fold selectivity over the other Class I PI3K isoforms. Further optimization of pharmacokinetic properties led to excellent in vivo exposure and efficacy and the identification of clinical candidate GDC-0077 (inavolisib, 32), which is now under evaluation in a Phase III clinical trial as a treatment for patients with PIK3CA-mutant breast cancer.
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Affiliation(s)
- Emily J Hanan
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | | | - Robert A Heald
- Early Discovery Charles River, 7/8 Spire Green Centre, Flex Meadow, Harlow, Essex CM19 5TR, U.K
| | - Calum MacLeod
- Early Discovery Charles River, 7/8 Spire Green Centre, Flex Meadow, Harlow, Essex CM19 5TR, U.K
| | - Connie Chan
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Saundra Clausen
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Kyle A Edgar
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Charles Eigenbrot
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Richard Elliott
- Early Discovery Charles River, 7/8 Spire Green Centre, Flex Meadow, Harlow, Essex CM19 5TR, U.K
| | - Nicholas Endres
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Lori S Friedman
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Emily Gogol
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Xiao-Hui Gu
- Pharmaron Beijing Co., Ltd, No. 6 Taihe Road, BDA, Beijing 100176, P. R. China
| | | | - Philip S Jackson
- Early Discovery Charles River, 7/8 Spire Green Centre, Flex Meadow, Harlow, Essex CM19 5TR, U.K
| | - James R Kiefer
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Jamie D Knight
- Early Discovery Charles River, 7/8 Spire Green Centre, Flex Meadow, Harlow, Essex CM19 5TR, U.K
| | - Michelle Nannini
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Raman Narukulla
- Early Discovery Charles River, 7/8 Spire Green Centre, Flex Meadow, Harlow, Essex CM19 5TR, U.K
| | - Amanda Pace
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Jodie Pang
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Hans E Purkey
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Laurent Salphati
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Deepak Sampath
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Stephen Schmidt
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Steve Sideris
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Kyung Song
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | | | - Mark Ultsch
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Heidi Wallweber
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Jianfeng Xin
- Pharmaron Beijing Co., Ltd, No. 6 Taihe Road, BDA, Beijing 100176, P. R. China
| | - SiewKuen Yeap
- Early Discovery Charles River, 7/8 Spire Green Centre, Flex Meadow, Harlow, Essex CM19 5TR, U.K
| | - Amy Young
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Yu Zhong
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
| | - Steven T Staben
- Genentech, Inc., 1 DNA Way, South San Francisco, California 94080, United States
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Song KW, Edgar KA, Hanan EJ, Hafner M, Oeh J, Merchant M, Sampath D, Nannini MA, Hong R, Phu L, Forrest WF, Stawiski E, Schmidt S, Endres N, Guan J, Wallin JJ, Cheong J, Plise EG, Lewis Phillips GD, Salphati L, Heffron TP, Olivero AG, Malek S, Staben ST, Kirkpatrick DS, Dey A, Friedman LS. RTK-Dependent Inducible Degradation of Mutant PI3Kα Drives GDC-0077 (Inavolisib) Efficacy. Cancer Discov 2022; 12:204-219. [PMID: 34544753 PMCID: PMC9762331 DOI: 10.1158/2159-8290.cd-21-0072] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/03/2021] [Accepted: 09/15/2021] [Indexed: 01/07/2023]
Abstract
PIK3CA is one of the most frequently mutated oncogenes; the p110a protein it encodes plays a central role in tumor cell proliferation. Small-molecule inhibitors targeting the PI3K p110a catalytic subunit have entered clinical trials, with early-phase GDC-0077 studies showing antitumor activity and a manageable safety profile in patients with PIK3CA-mutant breast cancer. However, preclinical studies have shown that PI3K pathway inhibition releases negative feedback and activates receptor tyrosine kinase signaling, reengaging the pathway and attenuating drug activity. Here we discover that GDC-0077 and taselisib more potently inhibit mutant PI3K pathway signaling and cell viability through unique HER2-dependent mutant p110a degradation. Both are more effective than other PI3K inhibitors at maintaining prolonged pathway suppression. This study establishes a new strategy for identifying inhibitors that specifically target mutant tumors by selective degradation of the mutant oncoprotein and provide a strong rationale for pursuing PI3Kα degraders in patients with HER2-positive breast cancer. SIGNIFICANCE: The PI3K inhibitors GDC-0077 and taselisib have a unique mechanism of action; both inhibitors lead to degradation of mutant p110a protein. The inhibitors that have the ability to trigger specific degradation of mutant p110a without significant change in wild-type p110a protein may result in improved therapeutic index in PIK3CA-mutant tumors.See related commentary by Vanhaesebroeck et al., p. 20.This article is highlighted in the In This Issue feature, p. 1.
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Affiliation(s)
- Kyung W Song
- Department of Discovery Oncology, Genentech, Inc., South San Francisco, California
| | - Kyle A Edgar
- Department of Discovery Oncology, Genentech, Inc., South San Francisco, California
| | - Emily J Hanan
- Department of Discovery Chemistry, Genentech, Inc., South San Francisco, California
| | - Marc Hafner
- Department of Oncology Bioinformatics, Genentech, Inc., South San Francisco, California
| | - Jason Oeh
- Department of Translational Oncology, Genentech, Inc., South San Francisco, California
| | - Mark Merchant
- Department of Translational Oncology, Genentech, Inc., South San Francisco, California
| | - Deepak Sampath
- Department of Translational Oncology, Genentech, Inc., South San Francisco, California
| | - Michelle A Nannini
- Department of Translational Oncology, Genentech, Inc., South San Francisco, California
| | - Rebecca Hong
- Department of Translational Oncology, Genentech, Inc., South San Francisco, California
| | - Lilian Phu
- Department of Microchemistry, Proteomics & Lipidomics, Genentech, Inc., South San Francisco, California
| | - William F Forrest
- Department of Oncology Bioinformatics, Genentech, Inc., South San Francisco, California
| | - Eric Stawiski
- Department of Oncology Bioinformatics, Genentech, Inc., South San Francisco, California
| | - Stephen Schmidt
- Department of Biochemical and Cell Pharmacology, Genentech, Inc., South San Francisco, California
| | - Nicholas Endres
- Department of Biochemical and Cell Pharmacology, Genentech, Inc., South San Francisco, California
| | - Jane Guan
- Department of Discovery Oncology, Genentech, Inc., South San Francisco, California
| | - Jeffrey J Wallin
- Department of Translational Oncology, Genentech, Inc., South San Francisco, California
| | - Jonathan Cheong
- Department of Translational Oncology, Genentech, Inc., South San Francisco, California
| | - Emile G Plise
- Department of Drug Metabolism and Pharmacokinetics, Genentech, Inc., South San Francisco, California
| | | | - Laurent Salphati
- Department of Drug Metabolism and Pharmacokinetics, Genentech, Inc., South San Francisco, California
| | - Timothy P Heffron
- Department of Discovery Chemistry, Genentech, Inc., South San Francisco, California
| | - Alan G Olivero
- Department of Discovery Chemistry, Genentech, Inc., South San Francisco, California
| | - Shiva Malek
- Department of Discovery Oncology, Genentech, Inc., South San Francisco, California
| | - Steven T Staben
- Department of Discovery Chemistry, Genentech, Inc., South San Francisco, California
| | - Donald S Kirkpatrick
- Department of Microchemistry, Proteomics & Lipidomics, Genentech, Inc., South San Francisco, California
| | - Anwesha Dey
- Department of Discovery Oncology, Genentech, Inc., South San Francisco, California.
| | - Lori S Friedman
- Department of Translational Oncology, Genentech, Inc., South San Francisco, California.
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