Lisaftoclax (APG-2575; BCL-2-selective inhibitor)
A Highly selective and potent BCL-2 Inhibitor for the Treatment of
Multiple Solid and Hematologic Malignancies
Lisaftoclax (APG-2575) is a novel, oral Bcl-2 inhibitor developed to treat a variety of hematologic malignancies and solid tumors by selectively blocking Bcl-2 to restore the normal apoptosis process in cancer cells.
We plan to submit an NDA for lisaftoclax for the treatment of r/r CLL/SLL to the Center of Drug Evaluation, or CDE, of China’s National Medical Products Administration, or NMPA, in 2024 and expect it will be the second Bcl-2 inhibitor for which an NDA application is filed in the world and the first in China for the CLL/SLL indication.
Currently, lisaftoclax has received clearances and approvals for 21 Phase Ib/II clinical studies in China, the United States, Australia, and Europe, with indications including chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), non-Hodgkin’s lymphoma (NHL), AML, MDS, multiple myeloma (MM), Waldenström’s macroglobulinemia (WM), with potential for treatment of additional types of solid tumors and hematologic malignancies. Among those trials, we received clearances and approvals for registrational clinical trials for CLL/SLL, AML and MDS in multiple countries.
As a prime example of rational drug design, Ascentage has engineered a state-of-the-art, highly selective, oral BCL-2 inhibitor with a unique pharmacokinetic (PK) profile. This PK profile, which features a short elimination half-life and a high maximum concentration (Cmax), is based on the principles of the “hit and run” hypothesis critical for BCL-2 inhibition. The “hit” signifies potent target inhibition at Cmax, while the “run” relates to limited plasma residence because of the short half-life, which may circumvent potentially later-emerging systemic toxicities. Our preclinical and preliminary clinical data suggest significant efficacy for lisaftoclax while potentially limiting toxicities such as neutropenia, thrombocytopenia, and tumor lysis syndrome. Another potentially beneficial property of lisaftoclax is a short ramp-up period (1 week), which quickly allows patients to receive the full therapeutic dose of drug while potentially reducing burden on the healthcare system.
Ascentage retains global rights to lisaftoclax and is conducting global studies in multiple cancer types, as both a single agent and in combination with other standard-of-care drugs.
Pelcitoclax (APG-1252; dual BCL-2/BCL-xL inhibitor)
A Potent, Dual BCL-2/BCL-xL Inhibitor for Treatment of Lung Cancer and Myeloproliferative Neoplasms
Pelcitoclax is a novel, highly potent, small-molecule candidate designed to restore apoptosis through selective inhibition of BCL-2 and BCL-xL proteins. This agent has demonstrated an overall favorable safety and tolerability profile, including limited platelet toxicity. Its safety profile as a single agent suggests broad potential as one component of a combination approach. Pelcitoclax combination treatments are being evaluated for the treatment of small-cell and non-small-cell lung cancer and has potential in the treatment of specific lymphomas, gastrointestinal tumors, and myelofibrosis.
APG-1252 has been granted Orphan Drug Designations by the US Food and Drug Administration (FDA) for the treatment of small cell lung cancer.
Ascentage retains global rights to APG-1252 and is conducting global studies.
Alrizomadlin (APG-115; MDM2 inhibitor)
An MDM2-p53 Inhibitor for Solid Tumors and Hematologic Malignancies
Alrizomadlin (APG-115) is a novel, orally bioavailable, highly selective, small molecule inhibitor of mouse double minute 2 homolog, MDM2. Alrizomadlin is a MDM2 inhibitor that has a stable chemical structure, high cell permeability, high binding affinity and favorable PK profile. The MDM2 protein is an antagonist of the p53 transcription factor, a well-known tumor suppressor. Overexpression and amplification of MDM2 has been associated with various cancers, such as liposarcomas, soft tissue tumors, osteosarcomas, and esophageal carcinomas, and implicated in disease progression, treatment resistance and poor patient outcomes for other immunotherapies, such as PD-1/PD-L1 checkpoint inhibitors. Various approaches to inhibit MDM2 have been attempted for more than three decades, with hundreds of small molecule inhibitors evaluated in preclinical studies and clinical trials, but no MDM2 inhibitors havebeen approved to date. Using a structure-based approach, we designed a new class of potent, selective, cell permeable, non-peptidic, small molecule inhibitors of the MDM2, and selected alrizomadlin as our lead MDM2 inhibitor.
Alrizomadlin is undergoing multiple clinical trials as a monotherapy or in combination with immunotherapy or chemotherapy in treating solid tumors and hematologic malignancies in sites around the world, including United States, China and Australia. We believe alrizomadlin has potential to treat a number of serious rare and orphan diseases and address unmet medical need in both adult and pediatric indications. Compared with adult tumors, pediatric solid tumors are characterized by low TP53 mutation frequency and high MDM2 amplification frequency. To date, the FDA has granted us six ODDs, including for soft-tissue sarcoma, gastric cancer and neuroblastoma, and two RPDD, including for neuroblastoma and retinoblastoma. In addition, we plan to pursue FTD, ODD and RPDD for our late-stage programs for alrizomadlin in malignant peripheral nerve sheath tumors, or MPNST, and adenoid cystic carcinoma, or ACC, for which we recently reported preliminary Phase 2 results in 2022 and 2023, respectively. The preliminary clinical data from an ongoing Phase II study has also shown that alrizomadlin in combination with pembrolizumab is efficacious in patients with IO relapsed/refractory metastatic melanoma, including uveal, mucosal and cutaneous melanoma. We are also developing alrizomadlin for the treatment of other solid tumors and hematological malignancies, including AML, MDS, and T-PLL.