- Maciag, Anna;
- Stice, James;
- Wang, Bin;
- Sharma, Alok;
- Chan, Albert;
- Lin, Ken;
- Singh, Devansh;
- Dyba, Marcin;
- Yang, Yue;
- Setoodeh, Saman;
- Smith, Brian;
- Ju, Jin;
- Jeknic, Stevan;
- Rabara, Dana;
- Zhang, Zuhui;
- Larsen, Erik;
- Esposito, Dominic;
- Denson, John-Paul;
- Ranieri, Michela;
- Meynardie, Mary;
- Mehdizadeh, Sadaf;
- Alexander, Patrick;
- Abreu Blanco, Maria;
- Turner, David;
- Xu, Rui;
- Lightstone, Felice;
- Wong, Kwok-Kin;
- Stephen, Andrew;
- Wang, Keshi;
- Simanshu, Dhirendra;
- Sinkevicius, Kerstin;
- Nissley, Dwight;
- Wallace, Eli;
- Mccormick, Frank;
- Beltran, Pedro
Approved inhibitors of KRASG12C prevent oncogenic activation by sequestering the inactive, GDP-bound (OFF) form rather than directly binding and inhibiting the active, GTP-bound (ON) form. This approach provides no direct target coverage of the active protein. Expectedly, adaptive resistance to KRASG12C (OFF)-only inhibitors is observed in association with increased expression and activity of KRASG12C(ON). To provide optimal KRASG12C target coverage, we have developed BBO-8520, a first-in-class, direct dual inhibitor of KRASG12C(ON) and (OFF) forms. BBO-8520 binds in the Switch-II/Helix3 pocket, covalently modifies the target cysteine, and disables effector binding to KRASG12C(ON). BBO-8520 exhibits potent signaling inhibition in growth factor-activated states, in which current (OFF)-only inhibitors demonstrate little measurable activity. In vivo, BBO-8520 demonstrates rapid target engagement and inhibition of signaling, resulting in durable tumor regression in multiple models, including those resistant to KRASG12C(OFF)-only inhibitors. BBO-8520 is in phase 1 clinical trials in patients with KRASG12C non-small cell lung cancer. Significance: BBO-8520 is a first-in-class direct, small molecule covalent dual inhibitor that engages KRASG12C in the active (ON) and inactive (OFF) conformations. BBO-8520 represents a novel mechanism of action that allows for optimal target coverage and delays the emergence of adaptive resistance seen with (OFF)-only inhibitors in the clinic. See related commentary by Zhou and Westover, p. 455.