Phase 2 test of QBS72S for breast cancer leptomeningeal disease
Seema Nagpal, Brandon Carlson-Clarke, Sahara S Rout, Thy T H Trinh, Meaghan Roy-O’Reilly, Sarah N Tedjakusuma, Rukayat Taiwo, Paul M Harary, Monica Granucci, Sophia B Chernikova, Sophie Bertrand, Kate E Therkelsen, Summer S Han, Bo Gu, Krishna L Bharani, John M Newman, Giuseppe Barisano, Maxine C Umeh-Garcia, Daniel Herrick, Hannes Vogel, Mili Arora, Cynthia H Samos, Scott G Soltys, Erqi L Pollom, Elham Rahimy, Michael Iv, Michelle E Melisko, Melanie Hayden GephartAbstract
Background
Leptomeningeal disease (LMD) is a devastating complication of metastatic breast cancer that leads to severe neurologic symptoms and a poor prognosis. Current treatment options, including radiation and intrathecal chemotherapy, offer limited efficacy and are associated with significant toxicity. Generally, systemic therapy in LMD poorly penetrates the blood-brain barrier (BBB). Leveraging the L-type amino acid transporter 1 (LAT1) represents a unique therapeutic strategy, as LAT1 facilitates transport of medications across the BBB, and is also highly expressed in metastatic cancer cells. QBS72S is a first-in-class BBB-penetrant bifunctional molecule targeting overexpression of LAT1 to selectively eliminate cancer cells. It has shown preclinical efficacy in a mouse model of breast cancer LMD.
Methods
This Phase 2a, single-arm, open-label clinical trial (NCT05305365) investigated the safety, cerebrospinal fluid (CSF) concentration, pharmacokinetics, and preliminary efficacy of QBS72S in participants with breast cancer brain metastases. Secondary endpoints included progression-free survival, overall survival, and duration of response. Correlative analyses included LAT1 immunohistochemistry and CSF cell-free RNA sequencing.
Results
In this analysis, we report results from breast cancer patients with LMD (n = 10) treated with QBS72S. QBS72S was reliably detected in CSF, adequately tolerated, and two participants exhibited long-term radiographic stability or improvement lasting 6-7 months.
Conclusions
These early findings support further investigation of QBS72S as a targeted therapy for LMD, addressing an urgent unmet need in metastatic breast cancer.