在GBM和黑色素瘤转移PDX模型中对ATM抑制剂WSD0628的药代动力学和疗效建模

Radiation is a cornerstone of glioblastoma (GBM) treatment, however, the majority of tumors progress within the radiation field due to inherent radiotherapy (RT) resistance. The integration of highly potent radiosensitizers, such as the ATM inhibitors AZD1390 or WSD0628, could reverse resistance and significantly improve local control of these tumors. However, the achievable brain tumor exposure of these inhibitors may be limited by drug exposure in skin and mucosa, leading to enhanced radiation toxicity. To support the clinical development of WSD0628, we developed pharmacokinetic (PK)-efficacy models to help interpret ongoing PK analyses. A model based on in vitro cell studies was based on the in vitro observations that 30 nM WSD0628 provided maximum ATM inhibition and the extent of radiosensitization was directly related to the duration of drug incubation after irradiation, up to a maximum of 24 hours. The unbound WSD0628 concentration, measured by rapid equilibrium dialysis, was 66% of the total concentration in cell culture media, and was used to define an optimal radiosensitizing target of 20 nM free WSD0628 for 4 to 24 hours. Previous PK analyses showed that the free, unbound fraction (fu) of WSD0628 in plasma and brain tumor tissue are 0.02 and 0.054, respectively, and the brain tumor-to-plasma ratio is 0.32 in GBM43 patient-derived xenografts (PDXs). From these data, a total drug level of 1160 nM in plasma is predicted to achieve unbound drug levels above the 20 nM WSD0628 target unbound concentration. To validate this prediction, parallel in vivo dose-ranging studies were performed in orthotopic PDXs. Mice with orthotopic GBM43 were randomized to treatment with RT (8 Gy x1) alone or in combination with a range of WSD0628 doses. RT combined with 0.25 mg/kg and 1 mg/kg WSD0628 had no impact on survival, compared to RT alone, while median survival increased by 1.3-fold for RT combined with 2.5 mg/kg, 1.7-fold with 5 mg/kg, and 3.2-fold with 10 mg/kg WSD0628. A similar dose-response was observed in an M12 melanoma brain metastasis PDX. Based on PK modeling of these drug doses, 2.5 mg/kg dosing will maintain total WSD0628 plasma levels above 1160 nM for 11.9 hours, 5 mg/kg for 23.6 hours, and 10 mg/kg for 40 hours. Taken together, we have developed a model to predict efficacious dosing of a brain tumor based on the free drug hypothesis, which allows integration of multiple aspects of in vitro modeling with measured drug levels in animal models to predict total plasma levels associated with robust sensitizing effects. Assuming similar tissue to plasma partitioning in human GBM, this model could be directly applied to interpret the ongoing Phase 1 PK analysis of WSD0628 in recurrent GBM.