FDA Grants Fast Track Designation to Remix Therapeutics' REM-422 for Adenoid Cystic Carcinoma Treatment
Key Insights
The FDA has granted Fast Track designation to REM-422, a first-in-class oral small molecule MYB (search) mRNA degrader developed by Remix Therapeutics (search) for treating recurrent, metastatic or unresectable adenoid cystic carcinoma (search).
Preliminary Phase 1 results demonstrate strong anti-tumor activity and favorable safety profile in patients whose tumors express MYB (search) transcripts containing a poison exon.
The designation addresses a critical unmet medical need, as there are currently no approved treatment options for patients with MYB (search)-driven adenoid cystic carcinoma (search).
Remix Therapeutics (search) announced that the U.S. Food and Drug Administration has granted Fast Track designation to REM-422, a first-in-class small molecule MYB (search) mRNA degrader, for treating patients with recurrent, metastatic or unresectable adenoid cystic carcinoma (search) whose tumors express MYB transcripts containing a poison exon. The designation was based on positive preliminary results from a Phase 1 clinical trial demonstrating proof-of-mechanism and proof-of-concept along with a favorable safety profile.
Novel Mechanism of Action
REM-422 represents a breakthrough approach in targeting MYB (search), a key oncogenic driver in adenoid cystic carcinoma (search) that has historically been difficult to drug. The oral small molecule works by inducing incorporation of a poison exon in the MYB transcript, leading to degradation of the mRNA and suppression of MYB protein expression. This mechanism leverages nonsense-mediated decay of the transcript to reduce MYB expression.
"REM-422 represents a novel approach designed to target MYB (search), a key oncogenic driver in ACC that has historically been difficult to drug," said Peter Smith, PhD, Co-Founder and Chief Executive Officer of Remix Therapeutics (search). "This designation supports our ongoing efforts to expeditiously advance REM-422 through clinical development to bring this potential therapy to patients as quickly as possible."
Clinical Development Program
REM-422 is currently being investigated in the ongoing Phase 1/2 ARIA study, evaluating safety, pharmacokinetics and preliminary anti-tumor activity in patients with recurrent or metastatic, and unresectable adenoid cystic carcinoma (search). The Phase 1/2, open-label, non-randomized, multicenter study includes both a Dose Escalation Phase and a Dose Expansion Phase.
The Dose Escalation Phase aims to determine the maximum tolerated dose and recommended Phase 2 dose of REM-422 in patients with recurrent, metastatic, or unresectable adenoid cystic carcinoma (search). The Dose Expansion phase will further evaluate the safety and anti-tumor activity of the recommended Phase 2 dose in biomarker positive patients.
Addressing Critical Unmet Medical Need
Adenoid cystic carcinoma (search) is a solid tumor that most commonly arises in the salivary glands, characterized by frequent recurrence, perineural invasion and dysregulation of the MYB (search) oncogene. Depending on tumor location, symptoms may include facial numbness, difficulties swallowing, vision changes, or breathing difficulties.
"Receiving Fast Track designation for REM-422 underscores the urgent need for new treatment options for patients with ACC," Smith noted. Currently, there are no approved treatment options for patients with this MYB (search)-driven solid tumor. Many therapeutic approaches, including chemotherapy, kinase inhibitors, and immunotherapy, have been studied in adenoid cystic carcinoma (search) with modest or disappointing results.
Broader Development Pipeline
Beyond adenoid cystic carcinoma (search), REM-422 is also being evaluated in Phase 1/2 clinical studies for acute myeloid leukemia (search) and high-risk myelodysplastic syndrome (search), as MYB (search) dysregulation is a hallmark driver in several hematologic malignancies. The FDA has previously granted REM-422 Orphan Drug Designation for both adenoid cystic carcinoma and acute myeloid leukemia.
The drug candidate emerged from Remix Therapeutics (search)' REMaster technology platform, which leverages data science, biomolecular sciences and chemistry approaches to identify orally administered compounds that modulate gene expression by reprogramming RNA processing.