EXTH-67 - LP-184, an MGMT-agnostic small molecule, has potent synergy with Spironolactone to effectively inhibit orthotopic GBM xenograft tumors

Temozolomide (TMZ) is currently the most effective standard-of-care chemotherapy based on its ability to extend survival of patients with newly diagnosed MGMT-methylated glioblastoma (GBM). Blood-brain barrier (BBB) permeable agents effective against TMZ-resistant GBMs (i.e. recurrent GBM, MGMT-unmethylated GBM) are needed. Lantern Pharma is advancing LP-184, an acylfulvene prodrug activated by the enzyme PTGR1. In MGMT-expressing TMZ-resistant GBM cultures, LP-184 was found to be ~5000X more potent than TMZ with LP-184 IC50s ranging from 20-200 nM. DNA damage induced by acylfulvenes is primarily repaired via transcription-coupled nucleotide excision repair (TC-NER) mediated by ERCC complexes. ERCC3 is proteolytically degraded in response to the FDA approved BBB permeable diuretic, spironolactone (SP). We found that SP induces rapid ERCC3 degradation by up to 95% in GBM cells and validated that SP-induced ERCC3 loss led to substantial increases in LP-184 responses (DNA damage, tumor cell death) in vitro and in subcutaneous (s.c.) tumor xenografts. Co-treatment of GBM cells with LP-184 and SP resulted in a 3-6 fold decrease in LP-184 IC50s in PDX-derived (M1123 and Mayo39) and cell line (U87) cultures in vitro. Systemic SP sensitized pre-established s.c. and orthotopic (i.c.) GBM xenografts to LP-184 therapy. Pre-established s.c. U87 tumors recurred after initial regression in 5/5 animals following treatment with LP-184 alone whereas tumors showed durable complete regression without recurrence in 4/5 animals following treatment with LP-184 + SP. Pre-established M1123 i.c. xenografts treated with LP-184 + SP were ~3-fold smaller than those treated with LP-184 alone. LP-184 is a promising agent with potential clinical translation in GBM patients. Our results indicate that LP-184 is MGMT-agnostic and effective in TMZ-resistant preclinical GBM models. The first-in-human LP-184 dose escalation Phase 1A trial enrolling solid tumor patients including GBM is planned to launch Q3 2023.