MedPath

Adagrasib

Generic Name
Adagrasib
Brand Names
Krazati
Drug Type
Small Molecule
Chemical Formula
C32H35ClFN7O2
CAS Number
2326521-71-3
Unique Ingredient Identifier
8EOO6HQF8Y
Background

Adagrasib (MRTX849) is an oral, small-molecule KRAS inhibitor developed by Mirati Therapeutics. KRAS mutations are highly common in cancer and account for approximately 85% of all RAS family mutations. However, the development of KRAS inhibitors has been challenging due to their high affinity for guanosine triphosphate (GTP) and guanosine diphosphate (GDP), as well as the lack of a clear binding pocket. Adagrasib targets KRAS, one of the most common KRAS mutations, at the cysteine 12 residue and inhibits KRAS-dependent signalling. In a phase I/IB clinical study that included patients with KRAS-mutated advanced solid tumors (NCT03785249), adagrasib exhibited anti-tumor activity. The phase II of the same study showed that in patients with KRAS-mutated non-small-cell lung cancer (NSCLC), adagrasib was efficient without new safety signals.

In February 2022, the FDA accepted a new drug application (NDA) for adagrasib for the treatment of patients with previously treated KRAS–positive NSCLC. In December 2022, the FDA granted accelerated approval to adagrasib for the treatment of KRAS-mutated locally advanced or metastatic NSCLC who have received at least one prior systemic therapy. Adagrasib joins sotorasib as another KRAS inhibitor approved by the FDA.

Indication

Adagrasib is indicated for the treatment of adult patients with KRAS G12C-mutated locally advanced or metastatic non-small cell lung cancer (NSCLC), as determined by an FDA-approved test, who have received at least one prior systemic therapy.

This indication is approved under accelerated approval based on objective response rate (ORR) and duration of response (DOR). Continued approval for this indication may be contingent upon verification and description of a clinical benefit in a confirmatory trial(s).

Associated Conditions
Locally Advanced Non-Small Cell Lung Cancer, Metastatic Non-Small Cell Lung Cancer

KRAS Inhibitors Market Set to Exceed $2 Billion by 2030 with Next-Generation Therapies Advancing

• The global KRAS inhibitors market has experienced over 400% growth since the first approval in 2021, with four drugs now authorized for treating cancers with KRAS mutations. • Next-generation KRAS inhibitors like BridgeBio's BBO-8520 are showing enhanced potency by targeting both active and inactive KRAS states, potentially overcoming resistance limitations of current therapies. • More than 80 KRAS inhibitor candidates are currently in clinical trials, with expanding applications beyond lung cancer to colorectal, pancreatic, and other solid tumors.

SUNLIGHT Trial Highlights Importance of Sequential Therapies in Refractory Colorectal Cancer

• The SUNLIGHT trial demonstrated significant survival benefits when adding bevacizumab to trifluridine/tipiracil in refractory metastatic colorectal cancer, showing a 39% improvement in overall survival. • Despite having three FDA-approved regimens for refractory colorectal cancer (trifluridine/tipiracil plus bevacizumab, fruquintinib, and regorafenib), many patients don't receive all available treatment options. • Dr. John Marshall of Georgetown Lombardi Comprehensive Cancer Center emphasizes the need for personalized sequencing strategies and warns against non-medical factors influencing treatment decisions.

Promising Pipeline for Soft Tissue Sarcoma Treatment Expands with 130+ Therapies in Development

• Global soft tissue sarcoma pipeline constitutes 125+ companies developing 130+ treatment therapies, with significant progress in clinical trials across various stages of development. • FDA grants Orphan Drug Designation to Actuate Therapeutics' elraglusib for soft tissue sarcoma treatment, highlighting its potential to address unmet needs in this rare cancer. • Novel approaches include tumor-targeting antibody-cytokine fusion proteins, intratumoral administration techniques, and GSK-3β inhibition, offering hope for improved outcomes in this challenging disease.

Fulzerasib-Cetuximab Combination Shows Promise as First-Line Treatment for KRAS G12C-Mutated NSCLC

• The combination of fulzerasib and cetuximab demonstrated an 80% objective response rate with 100% disease control rate in previously untreated patients with KRAS G12C-mutated non-small cell lung cancer, according to updated KROCUS trial data. • The doublet therapy showed efficacy across all PD-L1 expression levels and in patients with brain metastases, with 71.4% of patients with brain metastases achieving systemic response. • With a median follow-up of 12.8 months, the treatment exhibited a manageable safety profile with mostly grade 1-2 adverse events, positioning it as a potential chemotherapy-free first-line option for this patient population.

Robust Pipeline of 200+ Therapies Targets Colorectal Cancer Treatment Landscape

• DelveInsight's latest report reveals a robust pipeline with over 195 companies developing 200+ therapies for colorectal cancer, highlighting significant innovation in targeted treatments and immunotherapies. • Key drug candidates include XL092 (Exelixis), Adagrasib (Mirati Therapeutics), Olaparib (Merck/AstraZeneca), and novel approaches like LYL845, an autologous tumor-infiltrating lymphocyte therapy from Lyell Immunopharma. • The metastatic colorectal cancer segment shows particular promise with 150+ companies advancing 180+ pipeline therapies, including innovative treatments targeting specific mutations and immune pathways.

FDA Approves Lumakras and Vectibix Combination for KRAS G12C-Mutated Metastatic Colorectal Cancer

• The FDA has approved Lumakras (sotorasib) combined with Vectibix (panitumumab) for treating KRAS G12C-mutated metastatic colorectal cancer in adults after prior chemotherapy. • CodeBreaK 300 trial data showed the combination significantly improved progression-free survival compared to standard of care in chemorefractory patients. • Patients on Lumakras and Vectibix had a median progression-free survival of 5.6 months, compared to 2 months on standard of care, with a 26% overall response rate. • This approval provides a new targeted treatment option for a subset of colorectal cancer patients with limited alternatives, emphasizing the importance of biomarker testing.

FDA Grants Accelerated Approval to Krazati for KRAS G12C-Mutated Colorectal Cancer

• The FDA has granted accelerated approval to Krazati (adagrasib) in combination with Erbitux (cetuximab) for KRAS G12C-mutated colorectal cancer after prior chemotherapy. • This approval is based on Phase 1/2 KRYSTAL-1 study data, demonstrating a 34% overall response rate and a median duration of response of 5.8 months. • Krazati, developed by Bristol-Myers Squibb, now has a second indication, potentially boosting sales in the competitive KRAS inhibitor market. • The accelerated approval is contingent upon confirmatory trial results, with the KRAS-targeting oncology market projected to reach $4 billion by 2029.

Amgen Explores First-Line Use of KRAS Inhibitor Lumakras in NSCLC Treatment

Amgen is investigating the potential of its KRAS inhibitor, Lumakras, as a first-line treatment for non-small cell lung cancer (NSCLC) with KRAS mutations. Recent phase 1b trial results showed a 65% objective response rate when combined with chemotherapy, indicating promising efficacy. This move could significantly impact the treatment landscape for KRAS-mutated NSCLC.

Combination Therapies Show Promise in Treating MSS Metastatic Colorectal Cancer

• Combination therapies are being explored to improve immunotherapy efficacy in pMMR/MSS metastatic colorectal cancer (mCRC) patients, who do not typically respond well to single-agent immune checkpoint inhibitors. • Multi-target tyrosine kinase inhibitors combined with ICIs have shown some success in converting 'cold tumors' to 'hot tumors,' enhancing immune response, but results vary across studies. • Dual ICI regimens and combinations with chemotherapy or radiotherapy are under investigation to overcome resistance and improve outcomes in MSS mCRC, with encouraging results in some trials. • Emerging biomarkers like TMB and POLE/POLD1 mutations may help identify MSS mCRC patients who are more likely to benefit from immunotherapy, guiding personalized treatment strategies.

BioNTech's Bispecific Antibody BNT-327 Shows Promise in Triple-Negative Breast Cancer

• BioNTech's BNT-327, a bispecific antibody targeting PD-L1 and VEGF, has demonstrated positive early results in patients with triple-negative breast cancer. • The bispecific antibody builds on the success of checkpoint inhibitors like Keytruda, potentially representing the next generation of immunotherapy drugs. • Early trial data, presented at the San Antonio Breast Cancer Symposium, suggest BNT-327 could become a critical component in treating triple-negative breast cancer. • The development of BNT-327 aligns with a broader interest in PD1/PD-L1 and anti-VEGF bispecifics, following promising results from Summit Therapeutics in lung cancer.

FDA Wraps Up 2024 with Key Approvals for Drugs Targeting Various Conditions

• The FDA approved Vertex's Alyftrek for cystic fibrosis, offering improved dosing and potential market exclusivity. • Novo Nordisk's Alhemo was approved for hemophilia A and B, providing a new option for patients with inhibitors. • Bristol Myers Squibb's Opdivo Qvantig gained approval as a subcutaneous formulation, offering faster administration for various solid tumors. • Eli Lilly's Zepbound secured approval for obstructive sleep apnea in obese adults, marking the first prescription medicine for this condition.

KRAS Inhibitors Market Set for Growth with Novel Therapies Targeting Key Mutations in Cancer

• The KRAS inhibitors market is projected to grow significantly, driven by increasing cancer incidence and advancements in targeted therapies. • KRAZATI (adagrasib) is expected to lead in revenue among approved KRAS inhibitors, surpassing LUMAKRAS (sotorasib) during the forecast period. • Pan-KRAS drugs, targeting multiple KRAS mutations, hold substantial market potential due to their broader applicability across cancer types. • Emerging therapies like JDQ443 and avutometinib are poised to transform the treatment landscape, offering new options for patients with KRAS-mutated cancers.

Advancements in HER2-Mutant NSCLC Therapies: A Pipeline Overview

• Several companies are actively developing novel therapies for HER2-mutant non-small cell lung cancer (NSCLC), indicating a robust pipeline. • Key players like AstraZeneca and Dizal Pharmaceuticals are advancing treatments such as Trastuzumab deruxtecan and DZD-9008 through clinical trials. • Clinical trials are evaluating the efficacy and safety of various therapeutic approaches, including tyrosine kinase inhibitors and antibody-drug conjugates. • These emerging therapies aim to address unmet needs in HER2-mutant NSCLC, offering potential improvements in treatment outcomes.

Verastem Oncology Announces Positive Interim Results and FDA Submission for Cancer Therapies

• Verastem Oncology reported an 83% overall response rate in a Phase 1/2 trial of avutometinib plus defactinib with chemotherapy for metastatic pancreatic cancer. • The company initiated a rolling NDA submission to the FDA for avutometinib and defactinib in recurrent KRAS mutant low-grade serous ovarian cancer (LGSOC). • A Phase 3 trial is underway comparing the combination therapy to standard chemotherapy or hormonal therapy for recurrent LGSOC.

ASCO 2024 Highlights: Key Updates in Cancer Therapies

• Bristol Myers Squibb's Opdivo/Yervoy combo demonstrated superior overall survival in first-line unresectable hepatocellular carcinoma compared to Lenvima or Nexavar. • Sanofi's Sarclisa combination reduced the risk of death or disease progression by 40% in transplant-ineligible multiple myeloma patients. • AstraZeneca and Daiichi Sankyo's Enhertu showed significant progression-free survival improvement versus chemotherapy in HER2-low breast cancer.

EMA Validates Bristol Myers Squibb's Repotrectinib Application for ROS1-Positive and NTRK-Positive Tumors

• The European Medicines Agency (EMA) has validated Bristol Myers Squibb's marketing authorization application (MAA) for repotrectinib. • The MAA seeks approval for treating ROS1 TKI-naïve and pretreated NSCLC patients, as well as NTRK-positive solid tumor patients. • The application is based on positive results from the TRIDENT-1 and CARE studies, demonstrating robust responses and durability. • Repotrectinib, already FDA-approved as Augtyro for NSCLC, expands Bristol Myers' precision medicine portfolio in oncology.

AstraZeneca Secures KRAS G12D Inhibitor in $419M Deal with Usynova

• AstraZeneca has licensed UA022, a novel KRAS G12D inhibitor, from Chinese biotech Usynova for $24 million upfront, with potential milestone payments reaching $395 million. • The preclinical compound targets KRAS G12D mutations, which account for 26% of all KRAS mutations and are commonly found in pancreatic and colorectal cancers, addressing a significant unmet medical need. • This strategic move positions AstraZeneca among select companies developing KRAS G12D inhibitors, including Mirati, Revolution Medicines, and Roche/Chugai, expanding the frontier of precision oncology.
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