Abstract 5703: Development of RVL-101, a CDK4/6-selective, small molecule inhibitor with superior CNS penetration and combinability potential for the effective treatment of primary and metastatic brain tumors

Abstract Cyclin-dependent kinases 4 and 6 (CDK4/6) are key regulators of the cell cycle that are frequently dysregulated in cancer, leading to unchecked cell growth. CDK4/6 inhibitors have emerged as a promising class of anticancer agents that selectively target this pathway. The primary mode of action of CDK4/6 inhibitors relies on the disruption of retinoblastoma (Rb) protein phosphorylation, which thereby blocks cell cycle progression from G1 to S phase and reduces proliferation of cancer cells by a cytostatic mechanism. However, despite their efficacy, approved and clinical-stage CDK4/6 inhibitors have modest penetration of unbound drug into the brain, limiting their utility in the treatment of brain metastases and primary brain tumors. Additionally, despite the potential benefits of CDK4/6 inhibitors as combination therapies with cytotoxic agents, adjunctive treatment options remain underexplored due to the poor safety profiles of existing therapies. RVL-101 is a preclinical, investigational drug with a novel pharmacophore that has a low nanomolar activity against CDK4, is CDK2,6,7,9-sparing, and maintains >500-fold selectivity over CDK1. To maximize the potential of RVL-101 as a preferred combination partner, this novel agent has been engineered to have exquisite kinome- and safety-panel selectivity with no measured CYP inhibition or induction liabilities. RVL-101 is differentiated from approved and clinical stage CDK4/6 inhibitors having both high partitioning into the brain (Kp) and high free-brain (Kpu,u = 0.7) levels resulting in equal levels of unbound drug in all relevant compartments at steady state. Like other CDK4/6 agents, RVL-101 is broadly efficacious in vivo in ER+/HER2- xenograft models at well-tolerated doses. However, RVL-101 has also demonstrated robust activity in HR-/HER2+ xenograft models as a single-agent and has uniquely shown improved tumor inhibition effect in combination with approved HER2 cytotoxic therapeutics tucatinib and fam-trastuzumab-deruxtecan. RVL-101 was also tested in a GBM model as a monotherapy and in conjunction with the cytotoxic agent temozolomide (TMZ). Remarkably, QD dosing of the cytostatic agent, RVL-101, after pulsatile pretreatment with TMZ led to dramatic synergistic efficacy compared to either agent alone, leading to 100% survival of all animals on the dual therapy arm for more than 3 weeks post discontinuation of dosing. RVL-101 offers the combination of substantial therapeutic benefit and consistent free-drug levels in plasma and CNS that could lead to safe and effective treatment for a broader patient population. Citation Format: John E. Campbell, Bo-Sheng Pan, Michael Bower, Peter Bertinato, Nisha Perez, Victoria Gras Andreu, Neha Rana, Sophia Tabchouri, Ankit Gupta, Jonah Kallenbach. Development of RVL-101, a CDK4/6-selective, small molecule inhibitor with superior CNS penetration and combinability potential for the effective treatment of primary and metastatic brain tumors [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 5703.