Abstract 5949: The clinical dual KRASG12C inhibitor FMC-376 has demonstrated potential as both a monotherapy and in combination for the treatment of patients with KRASG12C mutation positive NSCLC
Authors: Wang Yan , Roberts Allison , Calses Philamer , Neve Richard M. , Staunton Jocelyn , Webster Kevin R. 
Published: March 2024

Abstract
KRAS, a membrane-associated guanosine triphosphatase (GTPase), is the most frequently mutated oncogene in cancer with activating mutations occurring in approximately 25% of NSCLC. Of these, KRASG12C occurs in approximately 14% of adenocarcinomas and in 0.5 to 4% of squamous NSCLCs. This mutation impairs GTPase activity and GTP-hydrolysis leading to an increase in the active, GTP-bound (ON), state. KRAS was long considered undruggable until the recent discovery of inhibitors that bind the GDP-bound, inactive (OFF) state of KRASG12C. The most clinically advanced of these first-generation molecules have demonstrated clinical response rates of 37-43% and 6 to 7-month progression-free survival in patients with KRASG12C positive NSCLC. While significant, a majority of cancers do not respond, and acquired resistance is common. FMC-376 is a next-generation dual inhibitor of both the ON and OFF states of KRASG12Cwith the potential to deliver improved outcomes as both a monotherapy and in combination, for patients with KRASG12C positive NSCLC. FMC-376 was discovered through the FrontierTM platform, which integrates chemoproteomics, machine-learning, and covalent fragment-based drug discovery. The potential for FMC-376 in the treatment of patients with KRASG12C mutant NSCLC has been assessed in a broad panel of NSCLC PDX models representing settings of sotorasib/adagrasib resistance, in a model of NSCLC CNS-metastasis and in combination with an immune checkpoint inhibitor. The dual ON + OFF state mechanism of action of FMC-376 is highly active across a panel of NSCLC CDX and PDX models, including those that carry co-mutations that are associated with both primary and acquired resistance to the OFF-state inhibitors adagrasib and sotorasib in NSCLC. These drivers of resistance include activating mutations of receptor tyrosine kinases (e.g. EGFR, MET, etc.), co-mutations including KEAP1 and adaptive resistance due to release of negative feedback control. Evaluation of FMC-376 in models where EGFR signaling is induced by EGF demonstrated rapid and durable target engagement in contrast to both sotorasib and adagrasib which show decreased effectiveness after EGF stimulation. As a result, FMC-376 is highly effective in NSCLC PDX models that have EGFR and MET upregulation. In addition, 27-42% of patients with KRASG12C positive NSCLC present with CNS metastasis. FMC-376 is highly active in an intracranial NSCLC model of CNS-metastasis, resulting in tumor regression. Furthermore, FMC-376 has demonstrated activity in combination with an anti-PD-1 mAb in a KRASG12C mutant mouse syngeneic tumor model. Together, these data demonstrate the potential of FMC-376, a next-generation clinical stage dual inhibitor of ON and OFF state KRASG12C, for the treatment of patients with KRASG12C mutant NSCLC as well as other KRASG12C positive tumors.
Citation Format: Yan Wang, Allison Roberts, Philamer Calses, Richard M. Neve, Jocelyn Staunton, Kevin R. Webster. The clinical dual KRASG12C inhibitor FMC-376 has demonstrated potential as both a monotherapy and in combination for the treatment of patients with KRASG12C mutation positive NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5949.