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DRUG:

milademetan (RAIN-32)

i
Other names: RAIN-32, DS3032b, DS 3032b, DS3032, DS 3032, DS-3032, RAIN 32, RAIN32
Company:
Daiichi Sankyo, Pathos, Rigel
Drug class:
MDM2 inhibitor
2ms
Effects of Mdm2 Inhibitors on Cellular Viability of Breast Cancer Cell Lines HP100, MCF7. (PubMed, Bratisl Lek Listy)
Our research concluded that Nutlin 3 has a superior effect over Yh239-EE and Miladometan in treating Breast cancer; moreover, the combination group has shown to be more effective than treatment with Doxorubicin or MDM2 inhibitors alone. Interesting information is that Doxorubicin also causes an increase in P53 levels. This result provided us with a promising therapeutic strategy for the treatment of breast cancer. However, more research is required to be conducted on more types of cell lines and in human or animal models (Tab. 4, Fig. 8, Ref. 33). Text in PDF www.elis.sk Keywords: breast cancer, Miladometan, cell viability, proliferation, therapeutic strategy.
Preclinical • Journal
|
MDM2 (E3 ubiquitin protein ligase)
|
TP53 expression
|
doxorubicin hydrochloride • milademetan (RAIN-32) • Nutlin-3
2ms
Combination of MDM2 and Targeted Kinase Inhibitors Results in Prolonged Tumor Control in Lung Adenocarcinomas With Oncogenic Tyrosine Kinase Drivers and MDM2 Amplification. (PubMed, JCO Precis Oncol)
These preclinical in vivo data provide a rationale for further clinical development of this combinatorial targeted therapy approach.
Journal
|
EGFR (Epidermal growth factor receptor) • TP53 (Tumor protein P53) • RET (Ret Proto-Oncogene) • MDM2 (E3 ubiquitin protein ligase)
|
TP53 mutation • EGFR mutation • RET fusion • MDM2 amplification
|
Tagrisso (osimertinib) • Retevmo (selpercatinib) • navtemadlin (KRT-232) • milademetan (RAIN-32)
4ms
Phase 1 dose escalation study of the MDM2 inhibitor milademetan as monotherapy and in combination with azacitidine in patients with myeloid malignancies. (PubMed, Cancer Med)
Milademetan was relatively well tolerated in this population; however, despite signals of activity, clinical efficacy was minimal.
P1 data • Journal • Combination therapy
|
TP53 (Tumor protein P53)
|
azacitidine • milademetan (RAIN-32)
11ms
DEMETER: Milademetan and Fulvestrant in GATA3-mutant, ER+HER- Advanced or Metastatic Breast Cancer (clinicaltrials.gov)
P2, N=1, Terminated, Institut Curie | N=48 --> 1 | Trial completion date: Dec 2026 --> Nov 2023 | Active, not recruiting --> Terminated | Trial primary completion date: Aug 2025 --> Nov 2023; Financial partner providing study drug could no longer support the trial
Enrollment change • Trial completion date • Trial termination • Trial primary completion date • Metastases
|
HER-2 (Human epidermal growth factor receptor 2) • ER (Estrogen receptor) • BRCA (Breast cancer early onset) • GATA3 (GATA binding protein 3)
|
ER positive • HER-2 negative • BRCA mutation • GATA3 mutation
|
fulvestrant • milademetan (RAIN-32)
1year
DEMETER: Milademetan and Fulvestrant in GATA3-mutant, ER+HER- Advanced or Metastatic Breast Cancer (clinicaltrials.gov)
P2, N=48, Active, not recruiting, Institut Curie | Recruiting --> Active, not recruiting
Enrollment closed • Metastases
|
HER-2 (Human epidermal growth factor receptor 2) • ER (Estrogen receptor) • BRCA (Breast cancer early onset) • GATA3 (GATA binding protein 3)
|
ER positive • HER-2 negative • BRCA mutation • GATA3 mutation
|
fulvestrant • milademetan (RAIN-32)
1year
Clinical • P2 data • Metastases
|
HER-2 (Human epidermal growth factor receptor 2) • ER (Estrogen receptor)
|
HER-2 negative
|
fulvestrant • milademetan (RAIN-32)
1year
An Updated Review of the Biomarkers of Response to Immune Checkpoint Inhibitors in Merkel Cell Carcinoma: Merkel Cell Carcinoma and Immunotherapy. (PubMed, Cancers (Basel))
Avelumab therapy has shown promising results in Merkel cell polyomavirus (MCPyV)-negative MCC patients with TMB-H, while pembrolizumab therapy has shown better response in patients with low TMB. A study evaluating neoadjuvant nivolumab therapy found no significant difference in treatment response between the tumor etiologies and TMB levels. In addition to ICI therapy, other treatments that induce apoptosis, such as milademetan, have demonstrated positive responses in MCPyV-positive MCC, with few somatic mutations and wild-type TP53. This review summarizes current knowledge and discusses emerging and potentially predictive biomarkers for MCC therapy with ICI.
Review • Journal • Checkpoint inhibition • Tumor mutational burden • PD(L)-1 Biomarker • IO biomarker
|
PD-L1 (Programmed death ligand 1) • TP53 (Tumor protein P53) • TMB (Tumor Mutational Burden) • MSI (Microsatellite instability)
|
PD-L1 expression • TP53 mutation • TMB-H • TP53 wild-type • TMB-L
|
Keytruda (pembrolizumab) • Opdivo (nivolumab) • Bavencio (avelumab) • milademetan (RAIN-32)
1year
MANTRA-2: Milademetan in Advanced/Metastatic Solid Tumors (clinicaltrials.gov)
P2, N=40, Terminated, Rain Oncology Inc | N=65 --> 40 | Trial completion date: Aug 2024 --> Oct 2023 | Active, not recruiting --> Terminated | Trial primary completion date: Aug 2024 --> Oct 2023; Sponsor Decision
Enrollment change • Trial completion date • Trial termination • Trial primary completion date • Pan tumor • Metastases
|
TP53 (Tumor protein P53) • MDM2 (E3 ubiquitin protein ligase)
|
TP53 mutation • TP53 wild-type • MDM2 amplification • TP53 amplification
|
milademetan (RAIN-32)
1year
Enrollment open • Metastases
|
HER-2 (Human epidermal growth factor receptor 2) • ER (Estrogen receptor) • BRCA (Breast cancer early onset) • GATA3 (GATA binding protein 3)
|
ER positive • HER-2 negative • BRCA mutation • GATA3 mutation
|
fulvestrant • milademetan (RAIN-32)
1year
P2 data • Pan tumor • Metastases
|
MDM2 (E3 ubiquitin protein ligase)
|
milademetan (RAIN-32)
over1year
Clinical activity and exploratory resistance mechanism of milademetan, an MDM2 inhibitor, in intimal sarcoma with MDM2 amplification: an open-label phase 1b/2 study. (PubMed, Cancer Discov)
Acquired TP53 mutations were detected in sequential liquid biopsies as a novel exploratory resistance mechanism to milademetan. These results suggest that milademetan could be a potential therapeutic strategy for intimal sarcoma.
P1/2 data • Journal
|
TP53 (Tumor protein P53) • CDKN2A (Cyclin Dependent Kinase Inhibitor 2A) • MDM2 (E3 ubiquitin protein ligase) • TWIST1 (Twist Family BHLH Transcription Factor 1)
|
TP53 mutation • TP53 wild-type • MDM2 amplification • CDKN2A negative • TP53 amplification
|
milademetan (RAIN-32)
over1year
MANTRA-2: Milademetan in Advanced/Metastatic Solid Tumors (clinicaltrials.gov)
P2, N=65, Active, not recruiting, Rain Oncology Inc | Recruiting --> Active, not recruiting
Enrollment closed • Pan tumor • Metastases
|
TP53 (Tumor protein P53) • MDM2 (E3 ubiquitin protein ligase)
|
TP53 mutation • TP53 wild-type • MDM2 amplification • TP53 amplification
|
milademetan (RAIN-32)
over1year
Efficacy and safety findings from MANTRA: A global, randomized, multicenter, phase III study of the MDM2 inhibitor milademetan vs trabectedin in patients with dedifferentiated liposarcomas (ESMO 2023)
Further evaluation of milademetan is warranted in populations that may benefit from MDM2 inhibition. Table: LBA89 Study findings Efficacy population Milademetan (n=86) Trabectedin (n=89) Median PFS by BICR, m 3.6 2.2 HR=0.89 (95% CI 0.61–1.29; p=0.53) Median PFS by investigator, m 3.7 2.1 HR=0.80 (95% CI 0.55–1.15; p=0.22) Median OSa, m 9.5 10.2 HR=1.27 (95% CI 0.80–2.04; p=0.31) ORR, n (%) 4 (4.7) 3 (3.4) p=0.67 DCR, n (%) 29 (33.7) 24 (27.0) p=0.33 Safety population n=86 n=79 Most common milademetan TEAEs, %NauseaThrombocytopeniaAnemiaVomiting 70.961.644.244.2 58.225.336.719.0 Most common grade 3/4 milademetan TEAEs, %ThrombocytopeniaNeutropeniaAnemia 39.525.618.6 13.926.619.0 TEAEs – fatal/grade 5, % 0 6.3 TEAEs leading to dose reductions, % 44.2 29.1 TEAEs leading to discontinuations, % 11.6 19.0
Clinical • P3 data • Late-breaking abstract
|
MDM2 (E3 ubiquitin protein ligase)
|
TP53 wild-type
|
Yondelis (trabectedin) • milademetan (RAIN-32)
over1year
New P2 trial • Metastases
|
HER-2 (Human epidermal growth factor receptor 2) • ER (Estrogen receptor) • BRCA (Breast cancer early onset) • GATA3 (GATA binding protein 3)
|
ER positive • HER-2 negative • BRCA mutation • GATA3 mutation
|
fulvestrant • milademetan (RAIN-32)
over1year
A Phase I study of Milademetan (DS3032b) in combination with low dose cytarabine with or without venetoclax in acute myeloid leukemia: Clinical safety, efficacy, and correlative analysis. (PubMed, Blood Cancer J)
The combination of milademetan, LDAC±venetoclax led to only modest responses with recognizable gastrointestinal toxicity. Treatment-induced reduction of MCL1 and YTHDF2 in an immune-rich milieu correlate with treatment response.
P1 data • Journal • Combination therapy
|
MCL1 (Myeloid cell leukemia 1) • MDM2 (E3 ubiquitin protein ligase) • YTHDF2 (YTH N6-Methyladenosine RNA Binding Protein 2)
|
TP53 wild-type
|
Venclexta (venetoclax) • cytarabine • milademetan (RAIN-32)
over1year
Milademetan Tosylate and Low-Dose Cytarabine With or Without Venetoclax in Treating Participants With Recurrent or Refractory Acute Myeloid Leukemia (clinicaltrials.gov)
P1/2, N=16, Terminated, M.D. Anderson Cancer Center | Completed --> Terminated; This study was terminated early due to lack of adequate response, and did not move to the Phase II portion of the study
Trial termination • Combination therapy
|
TP53 (Tumor protein P53)
|
TP53 mutation • TP53 wild-type
|
Venclexta (venetoclax) • cytarabine • milademetan (RAIN-32) • Starasid (cytarabine ocfosfate)
over1year
New targeted treatments for advanced sarcomas. (PubMed, Curr Opin Oncol)
Molecular-guided precision medicine holds a bright future in bringing more active treatments for advanced sarcoma patients.
Journal • IO biomarker • Metastases
|
MDM2 (E3 ubiquitin protein ligase) • XPO1 (Exportin 1) • SS18 (SS18 Subunit Of BAF Chromatin Remodeling Complex)
|
CDK4 amplification • MDM2 overexpression • MDM2 amplification + CDK4 amplification • SS18-SSX fusion
|
imatinib • Xpovio (selinexor) • Tazverik (tazemetostat) • milademetan (RAIN-32) • Fyarro (nanoparticle albumin-bound rapamycin) • brigimadlin (BI 907828)
over1year
Combination therapy with MDM2 and MEK inhibitors is effective in patient-derived models of lung adenocarcinoma with concurrent oncogenic drivers and MDM2 amplification. (PubMed, J Thorac Oncol)
Combined MDM2/MEK inhibition demonstrates efficacy across multiple patient-derived LUAD models harboring MDM2amp and concurrent oncogenic drivers. This combination, potentially applicable to LUADs with a wide variety of oncogenic driver mutations and kinase fusions activating the MAPK pathway, has evident clinical implications and will be investigated as part of a planned phase 1/2 clinical trial.
Combination therapy • Journal
|
EGFR (Epidermal growth factor receptor) • KRAS (KRAS proto-oncogene GTPase) • ALK (Anaplastic lymphoma kinase) • MDM2 (E3 ubiquitin protein ligase) • TRIM33 (Tripartite Motif Containing 33)
|
EGFR exon 19 deletion • TP53 wild-type • KRAS wild-type • MDM2 amplification
|
MSK-IMPACT
|
Mekinist (trametinib) • Retevmo (selpercatinib) • Tabrecta (capmatinib) • milademetan (RAIN-32)
over1year
Exploratory novel biomarker and resistance mechanism of milademetan, an MDM2 inhibitor, in amplified MDM2 intimal sarcoma from an open-label phase 1b/2 trial (NCCH1806/MK004). (ASCO 2023)
CDKN2A loss and amplified TWIST1 could be associated with the anti-tumor activity of milademetan in patients with amplified MDM2 intimal sarcoma. Acquired TP53 mutations were detected in sequential liquid biopsies as loss-of-function mutations, and these TP53 mutations might compromise the anti-tumor activity. Clinical trial information: JMA-IIA00402.
Clinical • P1/2 data
|
EGFR (Epidermal growth factor receptor) • TP53 (Tumor protein P53) • ATM (ATM serine/threonine kinase) • CDKN2A (Cyclin Dependent Kinase Inhibitor 2A) • ERBB3 (V-erb-b2 avian erythroblastic leukemia viral oncogene homolog 3) • PDGFRA (Platelet Derived Growth Factor Receptor Alpha) • AKT1 (V-akt murine thymoma viral oncogene homolog 1) • MDM2 (E3 ubiquitin protein ligase) • CDK4 (Cyclin-dependent kinase 4) • CDKN2B (Cyclin Dependent Kinase Inhibitor 2B) • CHEK2 (Checkpoint kinase 2) • MDM4 (The mouse double minute 4) • PPM1D (Protein Phosphatase Mg2+/Mn2+ Dependent 1D) • PMAIP1 (Phorbol-12-Myristate-13-Acetate-Induced Protein 1) • TWIST1 (Twist Family BHLH Transcription Factor 1) • CDKN1A (Cyclin-dependent kinase inhibitor 1A) • BBC3 (BCL2 Binding Component 3) • CDKN1C (Cyclin Dependent Kinase Inhibitor 1C)
|
TP53 mutation • TP53 wild-type • CDKN2A negative
|
milademetan (RAIN-32)
over1year
MDM2 inhibition in combination with MEK inhibition in pre-clinical models of lung adenocarcinomas with MDM2 amplification (AACR 2023)
The small molecule MDM2 inhibitor milademetan (mila) caused growth inhibition as a single-agent in MDM2amp patient-derived cell lines with concurrent kinase alterations including ECLC5-GLx (MDM2amp/TRIM33::RET/TP53 wildtype (WT)) and LUAD12c (MDM2amp/METex14/KRASG12S/TP53 WT)...At 48 hours, ERK phosphorylation was suppressed by concurrent mila and MEK inhibition using trametinib (tram). In contrast, ERK phosphorylation was not suppressed by concurrent mila and KIF5B::RET inhibition using selpercatinib (in ECLC5-GLx) or MET inhibition using capmatinib (in LUAD12c)...These results suggest that combined MDM2/MEK inhibition is effective in patient-derived LUAD models harboring MDM2amp. This combination, potentially applicable to LUADs with a wide variety of oncogenic driver mutations and kinase fusions will be investigated as part of a phase 1/2 clinical trial.
Combination therapy • Preclinical
|
EGFR (Epidermal growth factor receptor) • KRAS (KRAS proto-oncogene GTPase) • ALK (Anaplastic lymphoma kinase) • KIF5B (Kinesin Family Member 5B) • MDM2 (E3 ubiquitin protein ligase) • TRIM33 (Tripartite Motif Containing 33) • ANXA5 (Annexin A5)
|
TP53 mutation • KRAS G12C • EGFR exon 19 deletion • TP53 wild-type • MDM2 amplification • RET mutation
|
MSK-IMPACT
|
Mekinist (trametinib) • Retevmo (selpercatinib) • Tabrecta (capmatinib) • milademetan (RAIN-32)
over1year
MDM2 inhibition in combination with imipridone ONC201 treatment as a synergistic combination in solid tumors (AACR 2023)
Preliminary investigation into this effect suggests synergism in combination with milademetan treatment, with the MDM2-p53 inhibition driven increase in MDM2 levels being abolished upon cotreatment of ONC201 and milademetan. Further exploration of this combination is underway, and may serve as a novel translatable therapeutic approach, particularly in combination with checkpoint blockade.
Combination therapy
|
MDM2 (E3 ubiquitin protein ligase)
|
TP53 wild-type • MDM2 amplification
|
milademetan (RAIN-32) • dordaviprone (ONC201)
almost2years
MDM2 inhibition in combination with MEK inhibition in pre-clinical models of lung adenocarcinomas with MDM2 amplification (IASLC-TTLC 2023)
In contrast, ERK phosphorylation was not suppressed by concurrent milademetan and KIF5B::RET inhibition using selpercatinib (in ECLC5-GLx), MET inhibition using capmatinib (in LUAD12c), or KRASG12C inhibition using sotorasib (in SW1573)...In vivo, milademetan+trametinib was more effective than milademetan or trametinib alone in ECLC5-GLx (p<0.0001 and p<0.0001, respectively), LX-285 (EGFRex19del/MDM2amp) (p<0.0001 and p<0.0001, respectively), L-13BS1 (model resistant to capmatinib) (METex14/MDM2amp) (p<0.05 and p<0.0001, respectively)...CONCLUSION Combined MDM2/MEK inhibition is effective in patient-derived LUAD models harboring MDM2amp. This combination, potentially applicable to LUADs with a wide variety of oncogenic driver mutations and kinase fusions will be investigated as part of a phase 1/2 clinical trial.
Combination therapy • Preclinical
|
EGFR (Epidermal growth factor receptor) • KRAS (KRAS proto-oncogene GTPase) • ALK (Anaplastic lymphoma kinase) • KIF5B (Kinesin Family Member 5B) • MDM2 (E3 ubiquitin protein ligase) • TRIM33 (Tripartite Motif Containing 33) • ANXA5 (Annexin A5)
|
TP53 mutation • EGFR exon 19 deletion • TP53 wild-type • MDM2 amplification • RET mutation • KRAS G12S
|
MSK-IMPACT
|
Mekinist (trametinib) • Lumakras (sotorasib) • Retevmo (selpercatinib) • Tabrecta (capmatinib) • milademetan (RAIN-32)
2years
Characterize Biomarkers and Mechanisms of Resistance for MDM2 Inhibitors in AML (ASH 2022)
Similar results were obtained for the other two MDM2 inhibitors, AMG232 and DS-3032b, and a BCL2 inhibitor, venetoclax...Furthermore, overexpressing GATA2 conferred Idasanutlin resistance at high concentrations. Finally, we observed that combining a FLT3/IRAK dual inhibitor, pacritinib, or an IRAK1 /IL-1 receptor antagonist, anakinra, partially rescued IL-1α and IL-1β mediated drug resistance of MDM2 inhibitors. As such, we uncovered the role of leukemia-associated monocyte in driving intrinsic and extrinsic MDM2 inhibitor resistance and the potential underlying mechanisms.
IO biomarker
|
FLT3 (Fms-related tyrosine kinase 3) • MDM2 (E3 ubiquitin protein ligase) • IL6 (Interleukin 6) • TNFA (Tumor Necrosis Factor-Alpha) • CXCL8 (Chemokine (C-X-C motif) ligand 8) • CD34 (CD34 molecule) • CSF2 (Colony stimulating factor 2) • GATA2 (GATA Binding Protein 2) • IL1A (Interleukin 1, alpha) • IL1B (Interleukin 1, beta) • IRAK1 (Interleukin 1 Receptor Associated Kinase 1)
|
TP53 mutation • TP53 wild-type • RAS mutation • TP53 expression
|
Venclexta (venetoclax) • navtemadlin (KRT-232) • milademetan (RAIN-32) • idasanutlin (RG7388) • Vonjo (pacritinib) • Kineret (anakinra)
2years
MDM2 antagonist improves therapeutic activity of azacitidine in myelodysplastic syndromes and chronic myelomonocytic leukemia. (PubMed, Leuk Lymphoma)
We investigated the combination of the HMA azacitidine (AZA) with DS-3032b and DS-5272, novel antagonists of the TP53 negative regulator MDM2, in cellular and animal models of MDS and CMML. RNA-Seq analysis in mouse bone marrow hematopoietic stem and progenitors indicated that DS-5272 and AZA combination caused down-regulation of leukemia stem cell marker genes and activation of pathways of TP53 function and stability. These findings demonstrate that combining an MDM2 antagonist with AZA has potential to improve AZA treatment in TP53 wildtype MDS and CMML.
Journal
|
TP53 (Tumor protein P53) • TET2 (Tet Methylcytosine Dioxygenase 2)
|
TP53 wild-type
|
azacitidine • milademetan (RAIN-32) • DS-5272
2years
Combination of MDM2 inhibition with milademetan and MEK inhibition leads to improved anti-tumor activity in cancer models harboring WT TP53 (AACR-NCI-EORTC 2022)
The combination of milademetan and trametinib demonstrated synergy in vitro and combinatorial superiority in vivo. These data support the exploration of combination of milademetan and MAPK inhibition in patients whose tumors harbor selected genetic alterations, including MDM2 amplification, CDKN2A loss or WT TP53.
Preclinical
|
KRAS (KRAS proto-oncogene GTPase) • TP53 (Tumor protein P53) • NRAS (Neuroblastoma RAS viral oncogene homolog) • CDKN2A (Cyclin Dependent Kinase Inhibitor 2A) • MDM2 (E3 ubiquitin protein ligase) • CDKN1A (Cyclin-dependent kinase inhibitor 1A)
|
TP53 mutation • KRAS mutation • TP53 wild-type • MDM2 amplification • KRAS G12 • NRAS Q61 • KRAS G12S • NRAS Q61R • NRAS G12S • TP53 amplification
|
Mekinist (trametinib) • milademetan (RAIN-32)
over2years
Molecular docking of DS-3032B, a mouse double minute 2 enzyme antagonist with potential for oncology treatment development. (PubMed, World J Clin Oncol)
Molecular docking indicated that DS-3032B antagonist binds to the same region of the p53 binding site in the MDM2 with high affinity and stability, and this suggests therapeutic efficiency.
Preclinical • Journal
|
MDM2 (E3 ubiquitin protein ligase)
|
milademetan (RAIN-32)
over2years
Milademetan is a highly potent MDM2 inhibitor in Merkel cell carcinoma. (PubMed, JCI Insight)
Milademetan showed a dose-dependent inhibition of tumor growth in MKL-1 xenograft and patient-derived xenograft models. Here, along with preclinical data for the efficacy of milademetan in WT p53 MCC tumors, we report several in vitro and in vivo models useful for future MCC studies.
Journal • Tumor Mutational Burden
|
TMB (Tumor Mutational Burden) • MDM2 (E3 ubiquitin protein ligase)
|
TP53 mutation • TMB-H • TP53 wild-type • TP53 expression
|
milademetan (RAIN-32)
over2years
A PHASE I/II STUDY OF MILADEMETAN (DS3032B) IN COMBINATION WITH LOW DOSE CYTARABINE WITH OR WITHOUT VENETOCLAX IN ACUTE MYELOID LEUKEMIA (EHA 2022)
Conclusion The combination of milademetan with LDAC ± venetoclax was reasonably well tolerated but showed only minimal clinical responses at all 3 dose levels in a heavily pre-treated AML population. Further studies are needed to decipher the most appropriate combination regimen and pt population to benefit from milademetan.
P1/2 data • Combination therapy • IO biomarker
|
BCL2 (B-cell CLL/lymphoma 2) • MDM2 (E3 ubiquitin protein ligase) • CD34 (CD34 molecule)
|
TP53 mutation • TP53 wild-type • BCL2 expression
|
Venclexta (venetoclax) • cytarabine • milademetan (RAIN-32)
over2years
A phase 2 study of the MDM2 inhibitor milademetan in patients with TP53-wild type and MDM2-amplified advanced or metastatic solid tumors (MANTRA-2). (ASCO 2022)
Enrollment of 65 patients is planned to ensure that 57 patients have centrally confirmed TP53 WT and MDM2 copy number ≥ 12. The trial opened in November 2021 and is actively enrolling patients.
Clinical • P2 data
|
MDM2 (E3 ubiquitin protein ligase)
|
TP53 mutation • TP53 wild-type • MDM2 amplification • TP53 amplification
|
milademetan (RAIN-32)
over2years
Milademetan Tosylate and Low-Dose Cytarabine With or Without Venetoclax in Treating Participants With Recurrent or Refractory Acute Myeloid Leukemia (clinicaltrials.gov)
P1/2, N=21, Completed, M.D. Anderson Cancer Center | Active, not recruiting --> Completed | Trial completion date: Dec 2023 --> Apr 2022 | Trial primary completion date: Dec 2022 --> Apr 2022
Trial completion • Trial completion date • Trial primary completion date • Combination therapy
|
TP53 (Tumor protein P53)
|
TP53 mutation • TP53 wild-type
|
Venclexta (venetoclax) • cytarabine • milademetan (RAIN-32)
over2years
Milademetan Tosylate and Low-Dose Cytarabine With or Without Venetoclax in Treating Participants With Recurrent or Refractory Acute Myeloid Leukemia (clinicaltrials.gov)
P1/2, N=21, Active, not recruiting, M.D. Anderson Cancer Center | Recruiting --> Active, not recruiting | N=58 --> 21
Enrollment closed • Enrollment change • Combination therapy
|
TP53 (Tumor protein P53)
|
TP53 mutation • TP53 wild-type
|
Venclexta (venetoclax) • cytarabine • milademetan (RAIN-32)
over2years
GATA3 and MDM2 are synthetic lethal in estrogen receptor-positive breast cancers (AACR 2022)
Pharmacological inhibition of MDM2 using three different compounds (RG7388-idasanutlin, RAIN-32 and MI-733) significantly impaired tumor growth in GATA3-deficient models in vitro, in vivo and in patient-derived organoid/ xenograft (PDO/ PDX) harboring GATA3 somatic mutation. Our results present MDM2 as a novel therapeutic target in the substantial cohort of ER-positive, GATA3-mutant breast cancer patients. With MDM2 inhibitors widely available, our findings can be rapidly translated into clinical trials to evaluate in-patient efficacy.
Synthetic lethality
|
ER (Estrogen receptor) • MDM2 (E3 ubiquitin protein ligase) • GATA3 (GATA binding protein 3)
|
TP53 mutation • ER positive • ER expression
|
milademetan (RAIN-32) • idasanutlin (RG7388)
over2years
A phase 2 study of the MDM2 inhibitor milademetan in patients with TP53-wild type and MDM2-amplified advanced or metastatic solid tumors (MANTRA-2) (AACR 2022)
Enrollment of 65 patients is planned to ensure that 57 patients have centrally confirmed TP53 WT and MDM2 copy number ≥12. The trial opened in November 2021 and is actively enrolling patients.
Clinical • P2 data
|
MDM2 (E3 ubiquitin protein ligase)
|
TP53 mutation • TP53 wild-type • MDM2 amplification • TP53 amplification
|
milademetan (RAIN-32)
3years
Milademetan in Advanced/Metastatic Solid Tumors (clinicaltrials.gov)
P2, N=65, Recruiting, Rain Therapeutics Inc. | Not yet recruiting --> Recruiting
Enrollment open • Pan tumor
|
TP53 (Tumor protein P53) • MDM2 (E3 ubiquitin protein ligase)
|
TP53 wild-type
|
milademetan (RAIN-32)
3years
Single-Cell Proteomics Identifies Leukemia Landscape Associated with Clinical Outcomes in R/R AML Treated with MDM2i (Milademetan) and FLT3i (Quizartinib): Putative Role of CD68 and Diversity Index (ASH 2021)
Further validation is needed in a larger cohort of patients. Such approaches could be utilized in clinical-trial settings to predict therapy response with targeted agents and inform clinical decision-making.
Clinical • Clinical data
|
FLT3 (Fms-related tyrosine kinase 3) • KIT (KIT proto-oncogene, receptor tyrosine kinase) • NPM1 (Nucleophosmin 1) • MDM2 (E3 ubiquitin protein ligase) • CD34 (CD34 molecule) • CD68 (CD68 Molecule)
|
NPM1 mutation • KIT expression
|
Vanflyta (quizartinib) • milademetan (RAIN-32)
3years
Enhanced p53 Activation By Dual Inhibition of MDM2 and XPO1 Disrupts MYC Transcriptional Program and Restores Sensitivity to BCL-2 Inhibition in Ven/HMA Resistant AML (ASH 2021)
Clinical grade MDM2 and XPO1 inhibitors milademetan (mil) and selinexor (sel) significantly reduced leukemia burden and prolonged survival in the xenograft model injected with MV4;11 VR cells...In a clinical trial of Idasanutlin + Venetoclax we observed over 45% response rates in relapsed/refractory AML patients (Daver, ASH 2020)...Next, we treated NSG mice injected with PDX AML cells with FLT3-ITD, GATA2 and NRAS mutations obtained from a patient who relapsed after ven/decitabine treatment...In conclusion, the concomitant inhibition of MDM2, XPO1 and BCL-2 was feasible and exerted dramatic and sustained anti-leukemia activity in ven/HMA resistant AML cell in vitro and in vivo. Milademetan (RAIN-32) is currently being developed by Rain Therapeutics.
PARP Biomarker • IO biomarker
|
FLT3 (Fms-related tyrosine kinase 3) • NRAS (Neuroblastoma RAS viral oncogene homolog) • MYC (V-myc avian myelocytomatosis viral oncogene homolog) • MDM2 (E3 ubiquitin protein ligase) • PTPRC (Protein Tyrosine Phosphatase Receptor Type C) • XPO1 (Exportin 1) • CASP3 (Caspase 3) • GATA2 (GATA Binding Protein 2) • ATF4 (Activating Transcription Factor 4) • CDKN1A (Cyclin-dependent kinase inhibitor 1A)
|
NRAS mutation • FLT3-ITD mutation • MYC expression
|
Venclexta (venetoclax) • Xpovio (selinexor) • decitabine • milademetan (RAIN-32) • idasanutlin (RG7388)
3years
Milademetan Tosylate and Low-Dose Cytarabine With or Without Venetoclax in Treating Participants With Recurrent or Refractory Acute Myeloid Leukemia (clinicaltrials.gov)
P1/2, N=58, Recruiting, M.D. Anderson Cancer Center | Trial completion date: May 2022 --> Dec 2023 | Trial primary completion date: May 2021 --> Dec 2022
Clinical • Trial completion date • Trial primary completion date • Combination therapy
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TP53 (Tumor protein P53)
|
TP53 mutation • TP53 wild-type
|
Venclexta (venetoclax) • cytarabine • milademetan (RAIN-32)
3years
Synthetic lethality
|
ER (Estrogen receptor) • MDM2 (E3 ubiquitin protein ligase) • GATA3 (GATA binding protein 3)
|
ER positive
|
milademetan (RAIN-32)
over3years
Milademetan in Advanced/Metastatic Solid Tumors (clinicaltrials.gov)
P2, N=65, Not yet recruiting, Rain Therapeutics Inc.
New P2 trial • Pan tumor
|
TP53 (Tumor protein P53) • MDM2 (E3 ubiquitin protein ligase)
|
milademetan (RAIN-32)