Abstract B47: Identification of a novel ALK inhibitor active against Crizotinib-allele resistant mutants

Anaplastic lymphoma kinase (ALK) is a receptor tyrosine kinase belonging to the insulin receptor superfamily. Activating mutations in ALK are oncogenic and cause 10% to 15% of neuroblastoma cases. Similarly, activating ALK fusions have been detected in several cancers, including ALCL (NPM-ALK in 70% of patients) and NSCLC (EML4-ALK in 3% to 7% of patients). Several ALK inhibitors are currently undergoing clinical development, among which crizotinib has recently received marketing approval from the U.S. FDA under the name Xalkori. This nonselective ALK inhibitor has provided clinical benefit to lung cancer patients, but its sustained efficacy seems to be impaired by acquired drug resistance and several publications have already described ALK secondary mutations identified in patients who progressed while on crizotinib therapy. In this study, we have: Identified EML4-ALK mutations able to confer resistance to crizotinib. A screen using the Ba/F3 system found 24 residues in the ALK kinase domain where mutations can cause crizotinib resistance. Some of these mutations (L1152R, C1156Y, F1174L, G1202R, S1206F) have been identified in lung cancer patients progressing under crizotinib treatment Evaluated the activity of novel in-house and reference ALK kinase inhibitors against Ba/F3 cell lines stably expressing wild-type EML4-ALK and selected crizotinib-allele resistant mutantsPerformed in vivo head to head studies with a representative in-house ALK inhibitor and crizotinib to compare their pharmacodynamic properties This work resulted in the identification of an ALK kinase inhibitor with similar potency against wild-type EML4-ALK and crizotinib-allele resistant mutants and displaying significant target coverage in in vivo settings.