Nobuyuki Ishikura

Prolonged treatment with bicalutamide induces androgen receptor overexpression and androgen hypersensitivity

Various hormone refractory prostate cancer cell models have been established with androgen depletion and have helped to clarify the mechanism for the transition into androgen‐depletion independent status. However, the mechanism of bicalutamide resistance remains unclear because few cell models have been generated.

Establishment and characterization of an androgen receptor‐dependent, androgen‐independent human prostate cancer cell line, LNCaP‐CS10

Hormone refractoriness is a lethal event for advanced prostate cancer patients, but the mechanisms of the disease are not well elucidated, especially for the so‐called “outlaw” pathways of androgen receptor (AR)‐dependent, androgen‐independent hormone‐refractory prostate cancer.

Design and synthesis of an androgen receptor pure antagonist (CH5137291 ) for the treatment of castration-resistant prostate cancer

A series of 5,5-dimethylthiohydantoin derivatives were synthesized and evaluated for androgen receptor pure antagonistic activities for the treatment of castration-resistant prostate cancer. Since CH4933468, which we reported previously, had a problem with agonist metabolites, novel thiohydantoin derivatives were identified by applying two strategies. One was the replacement of the alkylsulfonamide moiety by a phenylsulfonamide to avoid the production of agonist metabolites. The other was the replacement of the phenyl ring with a pyridine ring to improve in vivo potency and reduce hERG affinity. Pharmacological assays indicated that CH5137291 (17b) was a potent AR pure antagonist which did not produce the agonist metabolite. Moreover, CH5137291 completely inhibited in vivo tumor growth of LNCaP-BC2, a castration-resistant prostate cancer model.

Structure–activity relationships of bioisosteric replacement of the carboxylic acid in novel androgen receptor pure antagonists

A series of 5,5-dimethylthiohydantoin derivatives were synthesized and evaluated for androgen receptor pure antagonistic activities for the treatment of hormone refractory prostate cancer. CH4933468 (32d) with a sulfonamide side chain not only exhibited antagonistic activity with no agonistic activity in the reporter gene assay but also inhibited the growth of bicalutamide-resistant cell lines. This compound also inhibited tumor growth of the LNCaP xenograft in mice dose-dependently.

Biological properties of androgen receptor pure antagonist for treatment of castration-resistant prostate cancer: Optimization from lead compound to CH5137291†

Castration‐resistant prostate cancer (CRPC) is still dependent on androgen receptor (AR) signaling. We previously reported that a novel nonsteroidal AR pure antagonist, CH4933468, which is a thiohydantoin derivative with a sulfonamide side chain, provided in vitro proof of concept but did not in vivo.

Bevacizumab counteracts VEGF-dependent resistance to erlotinib in an EGFR-mutated NSCLC xenograft model

Erlotinib, an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), shows superior efficacy in patients with non-small cell lung cancer (NSCLC) harboring activating EGFR mutations (EGFR Mut+). However, almost all tumors eventually develop resistance to erlotinib. Recently, the Phase II JO25567 study reported significant prolongation of progression-free survival (PFS) by erlotinib plus bevacizumab combination compared with erlotinib in EGFR Mut+ NSCLC. Herein, we established a preclinical model which became refractory to erlotinib after long-term administration and elucidated the mode of action of this combination. In this model, tumor regrowth occurred after remarkable shrinkage by erlotinib; regrowth was successfully inhibited by erlotinib plus bevacizumab. Tumor vascular endothelial growth factor (VEGF) was greatly reduced by erlotinib in the erlotinib-sensitive phase but significantly increased in the erlotinib-refractory phase despite continued treatment with erlotinib. Although EGFR phosphorylation remained suppressed in the erlotinib-refractory phase, phosphorylated extracellular signal-regulated kinase (pERK), phosphorylated AKT, and phosphorylated signal transducer and activator of transcription 3 (pSTAT3) were markedly higher than in the erlotinib-sensitive phase; among these, pERK was suppressed by erlotinib plus bevacizumab. MVD was decreased significantly more with erlotinib plus bevacizumab than with each drug alone. In conclusion, the erlotinib plus bevacizumab combination demonstrated promising efficacy in the B901L xenograft model of EGFR Mut+ NSCLC. Re-induction of VEGF and subsequent direct or indirect VEGF-dependent tumor growth was suggested as a major mechanism of erlotinib resistance, and erlotinib plus bevacizumab achieved remarkably prolonged antitumor activity in this model.

CH5137291, an androgen receptor nuclear translocation-inhibiting compound, inhibits the growth of castration-resistant prostate cancer cells

Resistance of prostate cancer to castration is currently an unavoidable problem. The major mechanisms underlying such resistance are androgen receptor (AR) overexpression, androgen-independent activation of AR, and AR mutation. To address this problem, we developed an AR pure antagonist, CH5137291, with AR nuclear translocation-inhibiting activity, and compared its activity and characteristics with that of bicalutamide. Cell lines corresponding to the mechanisms of castration resistance were used: LNCaP-BC2 having AR overexpression and LNCaP-CS10 having androgen-independent AR activation. VCaP and LNCaP were used as hormone-sensitive prostate cancer cells. In vitro functional assay clearly showed that CH5137291 inhibited the nuclear translocation of wild-type ARs as well as W741C- and T877A-mutant ARs. In addition, it acted as a pure antagonist on the transcriptional activity of these types of ARs. In contrast, bicalutamide did not inhibit the nuclear translocation of these ARs, and showed a partial/full agonistic effect on the transcriptional activity. CH5137291 inhibited cell growth more strongly than bicalutamide in VCaP and LNCaP cells as well as in LNCaP-BC2 and LNCaP-CS10 cells in vitro. In xenograft models, CH5137291 strongly inhibited the tumor growth of LNCaP, LNCaP-BC2, and LNCaP-CS10, whereas bicalutamide showed a weaker effect in LNCaP and almost no effect in LNCaP-BC2 and LNCaP-CS10 xenografts. Levels of prostate-specific antigen (PSA) in plasma correlated well with the antitumor effect of both agents. CH5137291 inhibited the growth of LNCaP tumors that had become resistant to bicalutamide treatment. A docking model suggested that CH5137291 intensively collided with the M895 residue of helix 12, and therefore strongly inhibited the folding of helix 12, a cause of AR agonist activity, in wild-type and W741C-mutant ARs. In cynomolgus monkeys, the serum concentration of CH5137291 increased dose-dependently and PSA level decreased 80% at 100 mg/kg. CH5137291 is expected to offer a novel therapeutic approach against major types of castration-resistant prostate cancers.

Abstract A220: Design and synthesis of an androgen receptor pure antagonist (CH5137291) for treatment of castration‐resistant prostate cancer

Background: We hypothesized that the androgen receptor (AR) pure antagonists, which exhibit no agonist activities, would inhibit AR signaling completely and would be efficacious against castration‐resistant prostate cancer (CRPC). Based on our understanding of estrogen receptor pure antagonists, we designed dihydrotestosterone (DHT) derivatives and nonsteroidal RU56187 derivatives that inhibit the folding of helix 12 of AR and screened AR pure antagonists. Although a non‐steroidal derivative (CH4933468) showed improved metabolic stability compared with DHT derivatives, it metabolized into an extremely small amount of a dealkylated metabolite with strong agonist effect. Therefore, CH4933468 did not show antitumor activity against the CRPC xenograft model. Methods: For metabolic stability, we designed and synthesized sulfonamide‐substituted aryl compounds without dealkylated agonist metabolites. The production of agonist metabolites was examined in rat, mouse, monkey and dog. The efficacy of our compounds was measured using an in vitro reporter assay, a cell growth assay and in vivo prostate cancer xenograft models. Results: As a result of our optimization, CH5137291 was discovered and found to be an orally‐active androgen receptor pure antagonist without agonistic activities derived from dealkylated agonist metabolites in vivo in rat, mouse, monkey and dog. CH5137291 exhibited AR antagonistic activities of IC50 of 300 nM and no agonist activity even at 30,000 nM in the reporter gene assay. In LNCaP‐BC2 cells (AR overexpression CRPC model), CH5137291 was more efficient than bicalutamide. CH5137291 completely inhibited cell growth, in contrast to the partial inhibition of bicalutamide. Furthermore, CH5137291 inhibited the tumor growth and PSA production in the LNCaP‐BC2 xenograft model. CH5137291 also inhibited AR nuclear translocation in the presence of R1881. According to the binding models of CH5137291 and bicalutamide to wild type AR, the sulfonamide of CH5137291 directly collided with M895 and thus prevented the folding of helix 12 completely. On the other hand, bicalutamide did not collide with M895 from helix 12 and inhibited helix 12 folding indirectly through W741. Hence, CH5137291 might act as an AR pure antagonist, but bicalutamide apparently does not. Conclusions: CH5137291, a novel AR pure antagonist without agonistic activities derived from dealkylated agonist metabolites, has shown antitumor activities in both in vitro and in vivo CRPC models. Our experimental results for clinical candidate CH5137291 corroborate our hypothesis that pure antagonists inhibit the folding of helix 12 completely, leading to the complete inhibition of the transcription activity of AR. Based on the strong efficacy against CRPC xenograft model and the inhibition of AR nuclear translocation, CH5137291 may offer more benefit than bicalutamide. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):A220.

Abstract A219: Universal efficacy of novel androgen receptor pure antagonist, CH5137291, against broad spectrum prostate cancer including castration‐resistant prostate cancers

Background: Prostate cancer resistant to total androgen depletion therapies is termed castration‐resistant prostate cancer and novel therapeutic approaches are in demand. The mechanisms of castration resistance in prostate cancer are reported to be: 1) hypersensitivity to androgen derived from overexpression of androgen receptor (AR), 2) androgen‐independent activation of AR, termed “outlaw”, and 3) loss of ligand specificity derived from mutation of AR. To address this demand, we screened and developed an AR antagonist without agonist activity, a so‐called AR pure antagonist, CH5137291. Methods: We compared the inhibitory effects of CH5137291 with bicalutamide on the growth of hormone‐sensitive and castration‐resistant prostate cancer cells. To confirm the in vivo efficacy of CH5137291, we used xenograft models. The antagonist/agonist effect of CH5137291 on AR transcriptional activity was analyzed using reporter gene assays. To elucidate the mechanisms of CH5137291, we examined the effect of CH5137291 on the protein level of nuclear AR in LNCaP‐CS10 and the effect of CH5137291 on the subcellular localization of AR in LNCaP cells. Finally, the exposure of CH5137291 and its effect on serum prostate‐specific antigen (PSA) level were investigated in cynomolgus monkey. Results: CH5137291 showed in vitro inhibitory effects superior to bicalutamide in all models tested including hormone‐sensitive VCaP, LNCaP and castration‐resistant, LNCaP‐BC2 (overexpression model) and LNCaP‐CS10 (outlaw model). CH5137291 treatment (10, 100 mg/kg) inhibited the tumor growth to initial levels and PSA production to lower than initial levels in castration‐resistant LuCaP35V, LNCaP‐BC2 and LNCaP‐CS10 xenograft models. In contrast, bicalutamide (10, 100 mg/kg) did not inhibit tumor growth or PSA production in any of the xenograft models. In addition, CH5137291 exhibited prolongation of the time to progression compared with bicalutamide in the LNCaP xenograft model. In vitro functional assays clarified that CH5137291 showed pure antagonist activity against wild type, bicalutamide‐resistant type (W741C), and flutamide‐resistant type (T877A) AR in transcription and inhibited the nuclear translocation of all types of AR tested. CH5137291 also exhibited a dose‐dependent increase in serum concentration and inhibited PSA production in cynomolgus monkey. Conclusion: Our novel AR pure antagonist CH5137291 inhibited AR nuclear translocation and showed not only superior efficacy in prostate cancers with castration‐resistance acquired from AR overexpression, mutation and outlaw mechanisms but also prolonged time to progression in hormone‐sensitive prostate cancer compared with bicalutamide. CH5137291 is expected to contribute to novel therapeutic approaches against a broad spectrum of prostate cancers. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):A219.