Turalio (pexidartinib)

P3, N=40, Active, not recruiting, Daiichi Sankyo Co., Ltd. | Trial completion date: Feb 2026 --> Mar 2027

P2, N=9, Completed, Daiichi Sankyo Co., Ltd. | Active, not recruiting --> Completed

When macrophage-targeting immunotherapies (CSF1R inhibition with PLX3397 or CCR2 inhibition with PF-4136309) were combined with systemic hyperglycemia, tumors exhibited a pronounced increase in iNOS⁺ M1-like macrophages, a reduction in arginase⁺ M2-like macrophages, enhanced CD8⁺ T cell infiltration, and decreased abundance of tumor-associated fibroblasts. Analyses of patient samples confirmed the presence of a favorable anti-tumor immune infiltrate with elevated glucose levels. Together, these findings identify glucose availability as a key regulator of macrophage polarization and immunotherapy efficacy in PDAC.

This study demonstrates that FNDC1 is upregulated in breast cancer tissues and promotes breast cancer cell migration and invasion by inducing M2 macrophage polarization and exosome secretion. FNDC1 may serve as a novel therapeutic target for modulating the tumor microenvironment and improving outcomes for breast cancer patients.

More importantly, LL-08 caused less damage to the liver than pexidartinib, which was in accordance with its enzymatic and cellular selectivity. In summary, LL-08 is a highly active and selective CSF1R inhibitor, showing potential for TNBC treatment by TAMs reprogramming.

Pexidartinib inhibited macrophage activity, suppressed STAT3 phosphorylation, reduced ARG1 expression, and increased lymphocyte viability, thereby enhancing the antitumor efficacy of palbociclib in HR + /HER2- breast cancer. These findings reveal a previously unrecognized immunosuppressive mechanism induced by CDK4/6 inhibition and support CSF1R blockade as a promising combination strategy.

These clinical and preclinical findings provide rationale for therapies to increase therapeutic index of aPD-1 therapy by diminishing presence of T cell-suppressive myelomonocytic cells to improve outcomes for patients with refractory disease.

Preclinical studies demonstrate CSF-1R inhibitors (e.g., pexidartinib) disrupt LSC-TAM crosstalk, while CAR-M therapy synergizes with phagocytosis-promoting agents. Despite challenges, macrophage-targeted therapies offer transformative potential by remodeling the TME, overcoming resistance, and augmenting immunotherapy. This review outlines mechanistic insights and translational strategies to harness macrophage plasticity for leukemia treatment.

Furthermore, there is an absence of severe toxicities that have arisen with other agents in the TGCT treatment space, specifically liver failure. Vimseltinib is a favorable option for patients with TGCTs and further efforts to determine its place in the sequence of overall management are needed.

The results of in vitro-in vivo extrapolation (IVIVE) indicated that coadministration of pexidartinib at a clinically approved dose (400 mg twice daily) with the drugs primarily cleared by UGT1A1, UGT1A6, UGT1A7, UGT1A9, and UGT2B15 would result in a higher risk of DDI. In summary, our results provide useful information for the mechanism underlying pexidartinib-induced hepatotoxicity and clinical safe medication of pexidartinib.

This study underscores the dual role of CSF1 in regulating both tumor survival and M2 macrophage activation in HNSCC. Targeting the DKK1/CSF1 axis may represent a promising strategy to overcome chemoresistance by disrupting tumor-macrophage crosstalk and reprogramming the immunosuppressive microenvironment.

Nf1 OPG mice were treated with standard of care (SOC; carboplatin), clinically evaluated (everolimus, mirdametinib), and investigational (pexidartinib, HBS-101, lamotrigine) drugs during the period of most rapid tumor growth (6-12 weeks of age). This referential preclinical study design affords direct head-to-head comparisons of investigational therapies relative to SOC treatment using clinically meaningful outcomes (OPG growth and RNFL thickness). Using this strategy, lamotrigine emerged as the most promising therapy for limiting tumor progression and vision loss in Nf1-OPG mice, relevant to clinical translation for children with NF1-OPG.