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Inavolisib

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Inavolisib, sold under the brand name Itovebi, is an anti-cancer medication used for the treatment of breast cancer.[1][2] It is a inhibitor and degrader of mutant phosphatidylinositol 3-kinase (PI3K) alpha.[3] The PI3K-mediated signalling pathway has shown to play an important role in the development of tumours as dysregulation is commonly associated with tumour growth and resistance to antineoplastic agents and radiotherapy.[4]

Inavolisib
Clinical data
Trade namesItovebi
Other namesGDC-0077, RG6114, Ro7113755
License data
Routes of
administration		By mouth
Drug classPI3K inhibitor
ATC code
  • None
Legal status
Legal status
Identifiers
  • (2S)-2-[[2-[(4S)-4-(difluoromethyl)-2-oxo-1,3-oxazolidin-3-yl]-5,6-dihydroimidazo[1,2-d][1,4]benzoxazepin-9-yl]amino]propanamide
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEMBL
PDB ligand
Chemical and physical data
FormulaC18H19F2N5O4
Molar mass407.378 g·mol−1
3D model (JSmol)
  • C[C@@H](C(=O)N)NC1=CC2=C(C=C1)C3=NC(=CN3CCO2)N4[C@@H](COC4=O)C(F)F
  • InChI=1S/C18H19F2N5O4/c1-9(16(21)26)22-10-2-3-11-13(6-10)28-5-4-24-7-14(23-17(11)24)25-12(15(19)20)8-29-18(25)27/h2-3,6-7,9,12,15,22H,4-5,8H2,1H3,(H2,21,26)/t9-,12-/m0/s1
  • Key:SGEUNORSOZVTOL-CABZTGNLSA-N

The most common adverse reactions include decreased neutrophils, decreased hemoglobin, increased fasting glucose, decreased platelets, decreased lymphocytes, stomatitis, diarrhea, decreased calcium, fatigue, decreased potassium, increased creatinine, increased ALT, nausea, decreased sodium, decreased magnesium, rash, decreased appetite, COVID-19 infection, and headache.[2]

Inavolisib was approved by the US Food and Drug Administration (FDA) for treatment of PIK3CA-mutant breast cancer in October 2024.[2][5][6]

Medical uses

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Inavolisib is indicated in combination with palbociclib and fulvestrant for the treatment of adults with endocrine-resistant, PIK3CA-mutated, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer, as detected by an FDA-approved test, following recurrence on or after completing adjuvant endocrine therapy.[2]

Side effects

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The most common adverse reactions include decreased neutrophils, decreased hemoglobin, increased fasting glucose, decreased platelets, decreased lymphocytes, stomatitis, diarrhea, decreased calcium, fatigue, decreased potassium, increased creatinine, increased ALT, nausea, decreased sodium, decreased magnesium, rash, decreased appetite, COVID-19 infection, and headache.[2]

History

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Efficacy was evaluated in INAVO120 (NCT04191499), a randomized, double-blind, placebo-controlled, multicenter trial in 325 participants with endocrine-resistant, PIK3CA-mutated HR-positive, HER2-negative locally advanced or metastatic breast cancer whose disease progressed during or within twelve months of completing adjuvant endocrine therapy and who had not received prior systemic therapy for locally advanced or metastatic disease.[2] Primary endocrine resistance was defined as relapse while on the first two years of adjuvant endocrine therapy (ET) and secondary endocrine resistance was defined as relapse while on adjuvant ET after at least two years or relapse within twelve months of completing adjuvant ET.[2]

Structure, reactivity, and synthesis

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Inavolisib is a synthetic, organic, small compound (the full structure can be seen here).[7] When binding to phosphatidylinositol-4,5-bisphosphate 3-kinase, catalytic subunit alpha (p110α), inavolisib’s carbonyl group can accept a hydrogen bond from the Tyr836 (conserved) in p110α. The difluoromethyl group can interact with the hydroxyl group presented on Ser774 (conserved) in p110α, which is 3.2Å nearer than of which on the equivalent residue Ser754 in p110δ. Additionally, the amide group can interact with Gln859 (non-conserved). This results in a very high selectivity regarding PI3Kα isoforms.[3][8]

Compared to similar PI3K inhibiting compounds, inavolisib has a higher thermodynamic aqueous solubility that proved advantageous in the formulation process and aiding greater consistency in predictions of absorption.[3]

Inavolisibcan be developed as a derivative of 1,3-oxazole[9] or by means of stereo-controlled N-arylation of alpha-amino acids.[10]

Metabolism and biotransformation

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Inavolisib is orally administered, though there is little knowledge about its metabolism.[11][unreliable medical source?] However, absorption, metabolism, and excretion data of taselisib, a molecule with a related chemical scaffold, suggest moderately slow absorption into the systemic circulation, metabolism to play a minor role in drug clearance, and biliary excretion to be the main route of excretion.[12]

Molecular mechanisms of action

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Inavolisib is a selective PI3K-p110α (PIK3CA) inhibitor, which may offer antineoplastic functionality.[7] Therefore, it may serve as a new addition to combination therapy with conventional cancer treatment, such as chemotherapy. Combining inavolisib with palbociclib and fulvestrant might improve treatment of breast cancer.[13]

Next to its inhibitory enzymatic ability, it is suggested that inavolisib binds to - and activates degradation of - mutated forms of p110α. Members of the PI3K family regulate cellular processes such as cell growth and proliferation, survival, remodelling, and intracellular transport of organelles.[14] PI3K also plays an essential role for the immune system.

The class I isoform PI3K alpha (PI3Kα) is often times expressed in solid tumours through gene amplification or activated mutations.[3] Mutations in PI3Kα can often be found in cancer cells, especially HR+ breast cancer, which causes a disruption of the PI3K pathway. This leads to increased tumour growth and metastasis. One of the most common mutations can be found in PIK3CA, which plays a significant role in tumour cell proliferation.

In preclinical studies, inavolisib has shown to specifically initiate the degradation of this p110α oncogene with the help of proteasomes.[15] After binding to the mutant PI3Kα, inavolisib blocks phosphorylation of PIP2 to PIP3, thereby stopping downstream signalling.[16]

Consequently, biomarkers in the PI3K pathway are reduced, cell proliferation inhibited, and the rate of PIK3CA-mutant breast cancer apoptosis increased (in comparison to the wild type). The exact mechanism of action of inhibitors like inavolisib on mutated PI3Kα and the inhibitors' influence on mutant structures are still unknown.[17]

Toxicity

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Inavolisib is able to induce a cytotoxic response but this is directed towards tumour cells that contain the PI3K mutation, thereby inhibiting further tumour growth and leading to cell loss.[18]

Society and culture

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In October 2024, the US Food and Drug Administration FDA approved inavolisib for the treatment of PIK3CA-mutant breast cancer based on the results from the INAVO120 trial.[2][19][20] The drug application was granted priority review and breakthrough therapy designations by the FDA.[2][5][21]

Names

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Inavolisib is the international nonproprietary name.[22][23]

Inavolisib is sold under the brand name Itovebi.[2]

Research

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Due to inavolisib’s ability to inhibit the PI3K pathway through HER2-dependent degradation, it is undergoing clinical trials to potentially make use of it as an antineoplastic (anti-cancer) drug to treat breast cancer.[3][24][16]

References

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  1. ^ a b https://www.accessdata.fda.gov/drugsatfda_docs/label/2024/219249s000lbl.pdf
  2. ^ a b c d e f g h i j k "FDA approves inavolisib with palbociclib and fulvestrant for endocrine-resistant, PIK3CA-mutated, HR-positive, HER2-negative, advanced breast cancer". U.S. Food and Drug Administration (FDA). 10 October 2024. Retrieved 11 October 2024.   This article incorporates text from this source, which is in the public domain.
  3. ^ a b c d e Hanan EJ, Braun MG, Heald RA, MacLeod C, Chan C, Clausen S, et al. (December 2022). "Discovery of GDC-0077 (Inavolisib), a Highly Selective Inhibitor and Degrader of Mutant PI3Kα". Journal of Medicinal Chemistry. 65 (24). American Chemical Society (ACS): 16589–16621. doi:10.1021/acs.jmedchem.2c01422. PMID 36455032. S2CID 254149451.
  4. ^ "CID 124173720, Inavolisib". PubChem. National Center for Biotechnology Information, U.S. National Library of Medicine. Retrieved 21 September 2023.
  5. ^ a b "FDA Approves Inavolisib Plus Standard Therapy in PIK3CA-Mutant Breast Cancer". Targeted Oncology. 10 October 2024. Retrieved 11 October 2024.
  6. ^ Research Cf (28 October 2024). "Novel Drug Approvals for 2024". FDA.
  7. ^ a b "inavolisib — Ligand page". IUPHAR/BPS Guide to Pharmacology. Retrieved 21 September 2023.
  8. ^ Vanhaesebroeck B, Perry MW, Brown JR, André F, Okkenhaug K (October 2021). "PI3K inhibitors are finally coming of age". Nature Reviews. Drug Discovery. 20 (10). Springer Science and Business Media LLC: 741–769. doi:10.1038/s41573-021-00209-1. PMC 9297732. PMID 34127844.
  9. ^ Chen J, Lv S, Liu J, Yu Y, Wang H, Zhang H (December 2021). "An Overview of Bioactive 1,3-Oxazole-Containing Alkaloids from Marine Organisms". Pharmaceuticals. 14 (12). MDPI AG: 1274. doi:10.3390/ph14121274. PMC 8706051. PMID 34959674.
  10. ^ Han C, Kelly SM, Cravillion T, Savage SJ, Nguyen T, Gosselin F (2019). "Synthesis of PI3K inhibitor GDC-0077 via a stereocontrolled N-arylation of α-amino acids". Tetrahedron. 75 (32). Elsevier BV: 4351–4357. doi:10.1016/j.tet.2019.04.057. ISSN 0040-4020. S2CID 150262658.
  11. ^ "Inavolisib: Uses, Interactions, Mechanism of Action". DrugBank. 20 May 2019. DB15275. Retrieved 21 September 2023.
  12. ^ Ma S, Cho S, Sahasranaman S, Zhao W, Pang J, Ding X, et al. (April 2023). "Absorption, Metabolism, and Excretion of Taselisib (GDC-0032), a Potent β-Sparing PI3K Inhibitor in Rats, Dogs, and Humans". Drug Metabolism and Disposition. 51 (4): 436–450. doi:10.1124/dmd.122.001096. PMID 36623882.
  13. ^ "A trial looking at a new drug called inavolisib for breast cancer that has spread (WO41554)". Cancer Research UK. 22 June 2021. Retrieved 21 September 2023.
  14. ^ Koyasu S (April 2003). "The role of PI3K in immune cells". Nature Immunology. 4 (4). Springer Science and Business Media LLC: 313–319. doi:10.1038/ni0403-313. PMID 12660731. S2CID 9951653.
  15. ^ Hong R, Edgar K, Song K, Steven S, Young A, Hamilton P, et al. (15 February 2018). "Abstract PD4-14: GDC-0077 is a selective PI3Kalpha inhibitor that demonstrates robust efficacy in PIK3CA mutant breast cancer models as a single agent and in combination with standard of care therapies". Cancer Research. 78 (4_Supplement). American Association for Cancer Research (AACR): PD4–14–PD4–14. doi:10.1158/1538-7445.sabcs17-pd4-14. ISSN 0008-5472.
  16. ^ a b "Inavolisib (PI3K alpha inhibitor)". Genentech. Retrieved 21 September 2023.
  17. ^ Menteş M, Karakuzulu BB, Uçar GB, Yandım C (August 2022). "Comparative molecular dynamics analyses on PIK3CA hotspot mutations with PI3Kα specific inhibitors and ATP". Computational Biology and Chemistry. 99. Elsevier BV: 107726. doi:10.1016/j.compbiolchem.2022.107726. PMID 35842959. S2CID 250404770.
  18. ^ Song KW, Edgar KA, Hanan EJ, Hafner M, Oeh J, Merchant M, et al. (January 2022). "RTK-Dependent Inducible Degradation of Mutant PI3Kα Drives GDC-0077 (Inavolisib) Efficacy". Cancer Discovery. 12 (1). American Association for Cancer Research (AACR): 204–219. doi:10.1158/2159-8290.cd-21-0072. PMC 9762331. PMID 34544753.
  19. ^ "FDA Approves Genentech's Itovebi, a Targeted Treatment for Advanced Hormone Receptor-Positive, HER2-Negative Breast Cancer With a PIK3CA Mutation" (Press release). Genentech. 10 October 2024. Retrieved 11 October 2024 – via Business Wire.
  20. ^ "U.S. Food and Drug Administration Approves FoundationOne Liquid CDx as a Companion Diagnostic for Itovebi (inavolisib) to Identify Patients with Hormone Receptor-Positive, HER2-Negative Breast Cancer with a PIK3CA Mutation" (Press release). Foundation Medicine. 11 October 2024. Retrieved 11 October 2024 – via Business Wire.
  21. ^ "FDA Approves Inavolisib Plus Palbociclib/Fulvestrant for Endocrine-Resistant, PIK3CA-Mutated, HR+, HER2– Advanced Breast Cancer". OncLive. 10 October 2024. Retrieved 11 October 2024.
  22. ^ World Health Organization (2020). "International nonproprietary names for pharmaceutical substances (INN): recommended INN: list 84". WHO Drug Information. 34 (3). hdl:10665/340680.
  23. ^ World Health Organization (2023). "International nonproprietary names for pharmaceutical substances (INN): recommended INN: list 90". WHO Drug Information. 37 (3). hdl:10665/373341.
  24. ^ Vanhaesebroeck B, Burke JE, Madsen RR (January 2022). "Precision Targeting of Mutant PI3Kα in Cancer by Selective Degradation". Cancer Discovery. 12 (1). American Association for Cancer Research (AACR): 20–22. doi:10.1158/2159-8290.cd-21-1411. PMC 7612218. PMID 35022207.
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  • Clinical trial number NCT04191499 for "A Study Evaluating the Efficacy and Safety of Inavolisib + Palbociclib + Fulvestrant vs Placebo + Palbociclib + Fulvestrant in Patients With PIK3CA-Mutant, Hormone Receptor-Positive, Her2-Negative, Locally Advanced or Metastatic Breast Cancer (INAVO120)" at ClinicalTrials.gov
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