Abstract B133: eFT226, a first in class inhibitor of eIF4A1, targets FGFR1/2 and HER2 driven cancers
Authors: Thompson Peggy A , Young Nathan P , Stumpf Craig R , Eam Boreth , Goel Vikas K , Chen Joan , Fish Sarah , Parker Gregory S , Gerson-Gurwitz Adina , Barrera Maria , Sung Eric , Staunton Jocelyn , Chiang Gary G , Wegerski Christopher J , Sperry Samuel , Webster Kevin R , Reich Siegfried H 
Published: March 2020

Abstract
Background: Mutations or amplifications affecting receptor tyrosine kinases (RTKs) activate the RAS/MAPK and PI3K/AKT signaling pathways thereby promoting cancer cell proliferation and survival. Oncoprotein expression is tightly controlled at the level of mRNA translation and is regulated by the eukaryotic translation initiation factor 4F (eIF4F) complex consisting of eIF4A, eIF4E, and eIF4G. eIF4A functions to catalyze the unwinding of secondary structure in the 5’-untranslated region (5’-UTR) of mRNA facilitating ribosome scanning and translation initiation. eFT226 is a first in class inhibitor that converts eIF4A1 into a sequence specific translational repressor. eFT226 increases the affinity between eIF4A1 and polypurine recognition elements in the 5’-UTR leading to selective downregulation of mRNA translation. The polypurine element is highly enriched in the 5’-UTR of eFT226 target genes, many of which are known oncogenic drivers, including FGFR1/2 and HER2, enabling eFT226 to selectively inhibit dysregulated oncogene expression. Methods: 5’-UTR dependency was evaluated using cell-based luciferase reporter assays. Regulation of protein expression was analyzed by western blot analysis. Antitumor activity was assessed in vitro by proliferation and apoptosis assays. For in vivo experiments, athymic nude or NOD/SCID mice were implanted with subcutaneous xenograft models of FGFR1, FGFR2 or HER2 driven tumors and treated with eFT226 administered Q4D IV. Results: eFT226 inhibits the translation of FGFR1, FGFR2 and HER2 through formation of a sequence dependent ternary complex with eIF4A1 and polypurine elements within the 5’-UTR of mRNA [eFT226-eIF4A1-mRNA]. Formation of this ternary complex blocks ribosome scanning along the 5’-UTR leading to dose dependent inhibition of RTK protein expression. Cells transiently transfected with luciferase reporter constructs containing the 5’-UTR of each RTK resulted in 10-45-fold greater sensitivity to inhibition by eFT226 compared to a control 5’-UTR confirming the 5’-UTR dependency. In solid tumor cell lines driven by alterations in FGFR1, FGFR2 or HER2, downregulation of RTK expression by eFT226 resulted in decreased MAPK and AKT signaling, potent inhibition of cell proliferation and an induction of apoptosis suggesting that eFT226 could be effective in treating tumor types dependent on these oncogenic drivers. Solid tumor xenograft models harboring FGFR1/2 or HER2 amplifications treated with eFT226 resulted in significant in vivo tumor growth inhibition and regression at well tolerated doses in breast, non-small cell lung and colorectal cancer models. Treatment with eFT226 also decreased RTK protein levels supporting the potential to use these eFT226 target genes as pharmacodynamic markers of target engagement. Conclusions: eFT226 is efficacious against tumor models with alterations in FGFR1, FGFR2 and HER2 RTKs. The antitumor response observed in preclinical in vivo models driven by RTK amplifications demonstrates the potential for eFT226 in the treatment of solid tumors with FGFR1/2 or HER2 alterations. Furthermore, this data provides a means to select sensitive patient subsets during clinical development. Clinical trials in patients with solid tumor malignancies are planned.
Citation Format: Peggy A Thompson, Nathan P Young, Craig R Stumpf, Boreth Eam, Vikas K Goel, Joan Chen, Sarah Fish, Gregory S Parker, Adina Gerson-Gurwitz, Maria Barrera, Eric Sung, Jocelyn Staunton, Gary G Chiang, Christopher J Wegerski, Samuel Sperry, Kevin R Webster, Siegfried H Reich. eFT226, a first in class inhibitor of eIF4A1, targets FGFR1/2 and HER2 driven cancers [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr B133. doi:10.1158/1535-7163.TARG-19-B133