Effect of RGT-61159 on inhibition of oncogene c-MYB synthesis and tumor growth inhibition in a broad range of ACC PDX models, at well tolerated doses in rodents and non-human primates.

6107 Background: RGT-61159 is a first in-class oral inhibitor of the oncogenic transcription factor c-MYB via selective alteration of its RNA splicing machinery. RGT-61159 selectively induces the inclusion of the cryptic “poison” exon into the c-MYB RNA transcripts, resulting in the robust elimination of c-MYB canonical mRNA transcript and consequently of its protein in cells. Overactivation of the c-MYB oncogene, primarily due to chromosome rearrangements, is a hallmark of adenoid cystic carcinoma. (ACC). ACC is a rare and aggressive type of cancer for which effective treatment does not exist. By inhibiting oncogenic MYB protein production, RGT-61159 has the potential to efficiently and selectively inhibit proliferation or induce cell death of cancer cells overexpressing MYB protein. Methods: RGT-61159 cell killing activity was measured against a broad panel of cancer cell lines in a CellTiter-Glo assay. MYB RNA and MYB protein levels were assessed after drug treatment by RT-qPCR and JESS assay respectively. Anti-tumor activity of RGT-61159 as single agent or in combination was evaluated in a panel of ACC PDX mouse models harboring different molecular alterations in c-MYB, including ACCX6, ACCX11, ACCx5M1 and ST105B2. Results: Here, we showed that RGT-61159 has potent cancer cell killing activity (EC50 – 100nM -200nM) against a large panel of cancer cell lines overexpressing c-MYB, while sparing normal cells. Robust c-MYB RNA and c-MYB protein depletion (>80%) was observed in treated cells confirming RGT-61159 on-target cell killing effect. In addition, RGT-61159 single agent showed a remarkable anti-tumor activity (up to 90% TGI) at tolerated doses in the four ACC PDX models evaluated: ACCX6, ACCx11, ACCx5M1 and STB105B2. Importantly, we confirmed that RGT-61159 anti-tumor activity correlated with c-MYB target modulation. RGT-61159 efficacious doses reduced c-MYB transcript and c-MYB protein levels (by >80%) in all ACC PDx models evaluated. In addition, RNAseq analysis of ACC tumor after treatment showed that RGT-61159 drug treatment reversed the published ACC overexpression gene signature. Notably, the optimal RGT-61159 regimen was well tolerated, as assessed by changes in animal body weight and clinical signs in rodents and non-human primate. Finally, we showed that the combination of RGT-M001, an analog of RGT-61159, with the NOTCH Inhibitor AL-101 resulted in significant tumor regression at well tolerated doses. Conclusions: Altogether, these data demonstrated that RGT-61159 efficiently and safely targets the undruggable oncogenic transcription factor c-MYB. Down-regulation of c-MYB by the RGT-61159 RNA-targeting small molecule is a very promising therapeutic strategy to treat ACC and other cancers driven by c-MYB dysregulation.