Final results of a first-in-human phase I dose escalation trial of daily oral zelenirstat, a n-myristoyltransferase inhibitor, in patients with advanced solid tumors and relapsed/refractory B-cell lymphomas.
Bibliographic record
Abstract
3082 Background: Myristoylation, the N-terminal modification of proteins with the fatty acid myristate, regulates multiple membrane-bound signal transduction pathways important in cancer cell biology, including Src and Src family of protein tyrosine kinases. This modification is catalyzed by two N-myristoyltransferases (NMT), NMT1 and NMT2. Zelenirstat is a first-in-class oral small molecule NMT inhibitor with strong affinity for both NMT1 and NMT2 proteins. Transcriptomic analysis of zelenirstat treated cell lines identified a myristoylation inhibition sensitivity signature in cancer cells most likely to respond to NMT inhibitor therapy; high sensitivity scores were seen in a range of solid cancers and diffuse large B-cell lymphoma. Based on tumor regression and safety in preclinical models, we hypothesized zelenirstat would be safe to administer and show anticancer activity. Methods: Patients (pts) with advanced solid tumors and relapsed/refractory (R/R) B-cell lymphomas were enrolled in a multicenter, open label, phase I dose escalation trial of oral daily zelenirstat, administered in 28-day cycles until disease progression or unacceptable toxicity (NCT04836195). The primary endpoints were to evaluate dose-limiting toxicities (DLT) to establish a maximum tolerated dose (MTD). Secondary endpoints were to characterize the pharmacokinetic parameters of zelenirstat and assess anticancer activity. Results: Twenty-nine pts (17 females; 12 males; median age 65 years; median prior systemic treatments 4; 25 advanced solid tumor; 4 R/R B-cell lymphoma) were enrolled and 24 pts were DLT-evaluable. Dose cohorts ranged from 20 mg once daily (OD) to 280 mg OD without DLT until the 280 mg cohort where three DLTs were observed: Gr 3 diarrhea, Gr 3 diverticulitis, and Gr 3 dehydration. MTD and recommended phase 2 dose was established at 210 mg OD. Common adverse events were Gr ≤ 2 nausea, vomiting, diarrhea, and fatigue. Plasma concentrations peaked between 1 and 4 hours across the cohorts with terminal half-lives ranging from 6.7 to 12 hours. Steady state was achieved by Day 8 to 15, and in the higher dose cohorts, trough concentrations exceeded the levels predicted to be therapeutic. Stable disease as best response was seen in 8 (28%) heavily pre-treated pts (3 colorectal, 2 ovarian, 1 pancreatic, 1 appendiceal, and 1 bladder). Progression-free survival, overall survival, and weighted health status were significantly better in pts receiving 210 mg OD compared to those receiving lower doses. Conclusions: Zelenirstat is well-tolerated, reaches plasma concentrations highly active in preclinical models, and shows preliminary signs of encouraging anticancer activity. NMT inhibition represents a new target for ongoing research efforts and further clinical development of zelenirstat is warranted. Clinical trial information: NCT04836195 .
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".