Multiple kinase target inhibition with EMND-2076 in multiple myeloma

描述（由申请人提供）：目前多发性骨髓瘤（MM）的治疗仍然不令人满意，尽管最近治疗有所改善，但该疾病仍然无法治愈，这表明需要继续研究新的药物。我们研究了一种新的药物ENMD-2076，用于MM。ENMD-2076是一种口服生物可利用的多靶点激酶抑制剂，具有复杂的作用机制，包括抗增殖和促凋亡活性，以及抑制血管生成。在临床前研究中，我们已经证明ENMD-2076在体外和体内对MM细胞系和原代MM细胞具有显著的活性，并靶向对骨髓瘤细胞生长和存活至关重要的多种途径。除了对MM细胞具有细胞毒性外，我们已经证明ENMD-2076切割Mcl-1并下调抗凋亡蛋白survivin和X-linked inhibitor of apoptosis (XIAP)；抑制磷脂酰肌醇3-激酶(PI3K)/Akt通路、成纤维细胞生长因子受体-3 （FGFR3）受体酪氨酸激酶活性以及极光激酶A和B，诱导G2/M期细胞周期阻滞；抑制血管生成。对MM细胞的显著活性，以及该药物在MM发病机制中靶向途径的重要性，为临床开发ENMD-2076治疗MM提供了强有力的理论依据。目前还没有关于ENMD-2076的临床经验报道。因此，基于我们的实验室研究，我们建议开展ENMD-2076在MM患者中的临床研究。具体而言，我们建议1)开展一项I期试验，研究复发或难治性MM患者口服ENMD-2076的剂量限制毒性和最大耐受剂量，2)描述口服ENMD-2076的药代动力学特征。3)评估ENMD-2076在临床前研究中确定的重要靶点通路上的体内生物活性，并探索在未来临床试验中利用其中一些潜在的生物标志物来评估疗效的可行性。本研究结果对于了解ENMD-2076的临床作用机制及在未来MM临床研究中优化使用具有重要意义，对这种目前无法治愈的疾病的预后具有重要意义。

DESCRIPTION (provided by applicant): Current therapy for multiple Myeloma (MM) remains unsatisfactory, and despite recent improvements in treatment, the disease remains incurable indicating the need for continued investigation of novel agents. We have investigated a novel agent, ENMD-2076, in MM. ENMD-2076 is an orally bioavailable, multi-target kinase inhibitor with a complex mechanism of action, including antiproliferative and pro-apoptotic activity, and inhibition of angiogenesis. In preclinical studies, we have shown that ENMD-2076 has significant in vitro and in vivo activity against MM cell lines and primary MM cells, and targets multiple pathways critical to the growth and survival of myeloma cells. In addition to being cytotoxic to MM cells, we have shown that ENMD-2076 cleaves Mcl-1 and down regulates the anti-apoptotic proteins survivin and X-linked inhibitor of apoptosis (XIAP); inhibits the phosphatidylinositol 3-kinase (PI3K)/Akt pathway, fibroblast growth factor receptor-3 (FGFR3) receptor tyrosine kinase activity, and the aurora kinases A and B, inducing cycle arrest in the G2/M phase cell; and inhibits of angiogenesis. The significant activity against MM cells, and the importance of the pathways targeted by this agent in the pathogenesis of MM, provides strong rationale for clinical development of ENMD- 2076 in MM. No clinical experience has been reported with ENMD-2076. Therefore, based on our laboratory studies we propose to initiate clinical investigation of ENMD-2076 in patients with MM. Specifically, we propose 1) to conduct a phase I trial to investigate the dose limiting toxicity and maximal tolerated dose of oral ENMD-2076 in patients with relapsed or refractory MM, 2) Describe the pharmacokinetic profile of ENMD-2076 following oral administration, and 3) Assess the in vivo biological activity of ENMD-2076 on important target pathways identified in our preclinical studies, and explore the feasibility of utilizing some of these as potential biomarkers for testing in future clinical trials that will assess efficacy. The results of this research will be important to the understanding of clinical mechanism of action of ENMD-2076 and its optimal use in future clinical investigation in MM, which has important significance for the outcome of this currently incurable disease.