objectives 2009-2012 · · 2014-12-23the elusive quest for effective cancer treatments 134 new...
TRANSCRIPT
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BIO 302:
APRIL 22, 2014
LECTURE 1:
DEVELOPING THERAPIES FOR CANCER: DRUG
DISCOVERY, DEVELOPMENT AND REGULATION
Dr. George Poste Chief Scientist, Complex Adaptive Systems Initiative
and Del E. Webb Chair in Health Innovation Arizona State University
(e-mail: [email protected]; Tel. 480-727-8662) www.casi.asu.edu
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Confronting Cancer:
Changing Outcomes to Reduce the Massive
Clinical, Economic and Personal Impact of a
Devastating Disease
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The Elusive Quest for Effective Cancer Treatments
134 new cancer drugs approved by FDA in last 28
years
gains in disease-free interval/QOL but only limited
gains in overall survival (OS)
greater Rx progress in hematologic malignancies
(HM) versus solid tumor (SM)
– reduced cellular heterogeneity in HM?
changing therapeutic paradigms
– cytotoxic agents (1940s to present)
– targeted therapies (1990s to present)
unlikely prospect of major gains in OS without
radical changes in therapeutic strategies
– understanding the complex evolutionary ecology
of tumors and their escape from homeostatic
histiotypic control systems
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Dynamic Clonal Heterogeneity in Tumor Progression:
The Most Clinically Dangerous Phenotypes
Evasion of Detection/Destruction
by Host Immune System
Use of Host Systems to
Promote Progression
Invasion and Metastasis Emergence of
Drug-Resistant Clones
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The Current Status of Too Many Therapeutic Decisions in Cancer
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Non-responders to Oncology Therapeutics
Are Highly Prevalent and Very Costly
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One Size Does Not Fit All:
The Huge Economic Waste in Therapeutics
Antidepressants Asthma Diabetes
Arthritis Cancer
Percent of population for whom class of drugs do not work
Cost of Ineffective Rx
90% of drugs work in only 30-50% individuals
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The Biological Complexity of Cancer:
Understanding the Limited Effectiveness of
Current Therapy and the Urgent Need to
Design New Treatment Strategies
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The Biological Complexity of Cancer
and the Design of Future Treatment Strategies
successful surgical removal of primary tumor
assumed (except brain tumors)
targeting metastatic disease and circumventing
Rx resistance
– subclinical (adjuvant Rx)
– clinically evident advanced metastasis
– minimal residual disease and tumor dormancy
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The Biological Complexity of Cancer
and the Design of Future Treatment Strategies
hit all clones
hit all clones in multiple metastases in
multiple body locations
hit all new emergent Rx-resistant clones
Formidable Performance Requirements
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Future Innovation from the 2014 Class of Bio302?
The Discovery of Comptonomycin (panOncoRx)
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The Journey of Comptonomycin:
From Discovery to Regulatory Approval
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(Bio) Pharmaceutical R&D: How Much Does It Cost to Successfully Develop a New Pharmaceutical Drug or Biological Agent?
$100 million?
$250 million?
$500 million?
$1 billion?
$1.5 billion?
$2.5 billion?
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The Complexity and Protracted Process of New Drug Development
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The Challenge of Successful Drug Delivery
Stage Preclinical Phase I Phase II Phase III Regulatory
Review
Percent
Success 70% X 50% X 35% X 50% =
5% overall
success
Cost
$MM 10 X 15 X
100-
150 X
300-1
billion =
450 to
1 billion plus
Time
Years 2 X 1.5 X 2 X 4-8 = 9.5 to 13.5
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Drug Classes
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(Bio) Pharmaceutical R&D
small molecules (Mr typically <500 Daltons)
biologicals (nucleic acids, genes, proteins,
monoclonal antibodies, vaccines)
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(Bio) Pharmaceutical R&D
small molecules (Mr typically <500 Daltons)
– proprietary drugs (on patent) and generic
versions (off-patent)
biologicals (nucleic acids, genes, proteins,
monoclonal antibodies, vaccines)
– proprietary biologicals (on-patent) and
biosimilars (off patent)
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Regulatory Criteria for Drug Approval
safety
efficacy
safety
efficacy
cost-effectiveness
separate review for
regulatory approval
(EU wide) and pricing
(national)
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Center for Drug Evaluation and Research (CDER)
– small molecules
Center for Biologics Evaluation and Research
(CBER)
– biologicals
Center for Devices and Radiological Health
(CDRH)
– diagnostic tests
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FDA Review and Approval of New Drugs
and Vaccines
Investigational New Drug (IND) application
New Drug Application (NDA)
– small molecular weight drugs
Biological Licensing Application (BLA)
– biologicals
– vaccines
approval and labeling
post-approval obligations
– REMS (risk evaluation measurement system)
– SENTINEL (adverse event monitoring)
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Drug Discovery
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Mapping Dysregulation of Biological Networks in Disease
Disease Profiling to Identify Subtypes (+ or - Rx Target)
ID Molecular Targets for Rx Action and Blockade of Compensatory
“By pass” Pathways
*
*
*
*
*
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“Druggability”
Different Molecular Targets Pose Different
Challenges for Drug Discovery
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The Challenge of “Druggability”
druggable targets
non-druggable targets
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The Challenge of “Druggability”
surface receptors versus intracellular targets
(access)
target altered in disease versus normal cells
(lower risk of toxicities)
over-expression of the target in disease versus
reduced expression/deletion in disease
knocking out the target (antagonism) versus
restoration of function (agonism)
targets that are individual molecular nodes in a
network versus ‘hubs’ connected to multiple
nodes
successful control of by-pass pathways as driver of
Rx-resistance
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Rx Blockade of Target Molecule Function (Antagonism)
Is Easier to Achieve Than Restoration of
Target Molecule Function (Agonist)
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Cancer Driver Genes as Rx Targets
gain-of-function
mutations
antagonist Rx
(targeted therapies
to block activity)
loss-of-function
mutations
agonist Rx
(restore function)
Oncogenes Tumor Suppressor Genes
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Cancer Driver Genes as Rx Targets
gain-of-function
mutations
antagonist Rx
(targeted therapies
to block activity)
range of Rx design
options
loss-of-function
mutations
agonist Rx
(restore function)
far more difficult Rx
design (very few
examples in any
therapeutic area)
Oncogenes Tumor Suppressor Genes
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Distribution of mutations in two oncogenes (PIK3CA and IDH1)
and two tumor suppressor genes (RB1 and VHL)
From: B. Volgelstein et al. (2013) Science 339, 1546
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Targeting the Elusive Mutated K-RAS Gene in Cancer
30% of human tumors
90% of pancreatic cancers
40% of colon cancers
20% of non-small cell lung cancers
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Matching Drug Candidates to Molecular Targets
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Drug Discovery: Two Approaches
rational drug design based on knowledge of
detailed structure of the desired target
screening of libraries of structurally diverse
molecules against desired target(s) to identify
‘hits’ for subsequent refinement as potential
candidate Rx
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Design of Candidate Rx via Detailed Structural
Knowledge of ‘Active Site’ in the Target Molecule
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Drug Discovery
Rational Drug Design of Small Molecule Candidates
low molecular weight heterocyclic molecules
prediction of likely desired activity of a candidate
molecule based on its chemical structure/reactivity
and knowledge of the tertiary (3D) structure of the
target
databases of accumulated knowledge of drug-like
properties and structure activity relationships
(SAR) of particular classes of chemical structure
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The Value of Experience and Creativity
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DRUGDEX
Drug-Disease
Knowledge Base
(DrDKB)
Understanding How Different Chemical Structures
Interact with Different Target Molecules
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Big Data in Drug Discovery
Chem2Bio2RDF Mapping Large Scale
Chemoinformatics Space
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Lipinski’s Rule of Five for Drug-Like
Properties for Small Molecules
Drug-Like
Properties
not more than 5
hydrogen bond
donors
not more than
10 hydrogen
bond acceptors
molecular
weight less
than 500
ClogP not
greater than 5
(lipophilicity)
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Automated High Throughput Screening of Structurally Diverse Chemical Libraries to Identify ‘Hits’ as Leads for Drug Discovery
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Drug Discovery Automated High Throughput Screening (HTS) of
Small Molecule Candidate Rx
screen large ‘libraries’ of compounds for
interaction with proposed target
– 100,000 or more chemical candidates
screen ‘focused’ libraries of 5-10,000
compounds based on prior knowledge of likely
potential to interact with the target
identification of ‘leads’ (5-10) for more detailed
exploration of action of the target
– target specificity or promiscuity for multiple
targets?
– binding affinities
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Assessment of Rx Activity
interaction of Rx with molecular target(s)
agonist or antagonist?
binding affinity and kinetics: reversible or
irreversible?
direct action at active site on the target or allosteric
effects?
pharmacodynamics
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Pharmacodynamics
desired
target
molecule
off-target binding to non-target molecules
with structurally-related binding sites
(benign effects or toxicity)
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Pharmacodynamics
reversible
binding to
active site on
the target
irreversible
binding to
active site on
the target
allosteric binding to
target at non-active
sites induces structural
change in active site
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Thinking About ‘Downstream’
Development Challenges
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Thinking About ‘Downstream’ Development Challenges
pharmacokinetics
toxicology
pharmaceutical formulation
cost and complexity of scale up of chemical
synthesis for clinical trials and eventual marketing
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Structural Complexity as Barrier to Cost Effective
Large Scale Chemical Synthesis
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Multi-step Synthesis as an Economic Barrier to
Cost-Effective Large Scale Synthesis
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Drug Discovery:
A Complex Multi-Disciplinary Exercise
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Drug Discovery
A Complex Multi-Disciplinary Exercise
multiple specialized “ologies”
– oncology, gastroenterology, neurology,
cardiology, nephrology….
– physiology, pathology, toxicology
analysis and curation of large scale datasets
– V4: volume, variety, velocity, validity
– computational science, informatics
– novel algorithms for big data
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Drug Discovery
A Complex Multi-Disciplinary Exercise
chemistry
– synthetic, analytical
– scale up technologies
– formulation technologies
– materials science
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Drug Discovery
A Complex Multi-Disciplinary Exercise
specialized support services
– animal facilities
– biobanks
– large scale instrumentation resources (mass
spec., electron microscopy, ‘panOmics’…..)
regulatory compliance
– Good Laboratory Practice (GLP)
– verifiable records for FDA inspection
– relentless QC/QA audit
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Progress:
The Transition to Preclinical Development
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Preclinical Development
complex series of tasks to fulfill regulatory
requirements for first human tests
large scale chemical synthesis
pharmacokinetics
toxicology
pharmaceutical formulation and purity
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Pharmacokinetics
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Assessment of Rx Activity
timing and pattern of accumulation of Rx and
its metabolites in tissue and body fluids
pharmacokinetics
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Preclinical Development: Pharmacokinetics
ADME
Absorption, Distribution, Metabolism and Excretion
typically studied in three species
– rodents or rabbits, dogs, primates
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Plotting Rx Pharmacokinetics: Concentration and Clearance
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Preclinical Development: Pharmacokinetics
ADME: Absorption, Distribution, Metabolism and
Excretion
kinetics and sites of tissue uptake (A and D)
time to maximum concentration in blood/tissue and
kinetics of clearance (A, D and M)
ADME variation with different dosage levels
ADME variation with extended dosing
– acute vs chronic administration
– drug tolerance (tachyphylaxis)
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Preclinical Development:
Pharmacokinetics Metabolism (M)
characterization of metabolic sites and molecular
pathways for metabolic degradation
liver > GI > kidney as typical metabolic sites
identification of different class I/II drug
metabolism enzyme isoform pathways
impact of genetic variation in drug metabolism
enzymes on clearance (pharmacogenetics)
– slow, intermediate and fast metabolizers
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Preclinical Toxicology Testing
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Drug Safety Testing in Laboratory Animals
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Drug Safety Testing in Laboratory Animals
contentious issue but formal regulatory
requirements
the 3R’s
– refine, reduce, replace
the ‘fourth R’ (relevance)
– relevance to human disease processes
– cultured cell lines largely inadequate
variable validity for extrapolation of laboratory
animal data to human trials
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Preclinical Development: Toxicology
acute, subacute and long term toxicology
assessment
– 30 days, 6 months, 2 years
assessment of multiples of anticipated human
dose
– input from preclinical pharmacokinetic studies
of peak plasma/tissue concentrations to
establish dose multiples
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Preclinical Development: Toxicology
30 day (acute) profiling typically sufficient to initiate
human Phase I trials
– rodents, rabbits and larger mammals (dogs, pigs)
6 month and 2 year trials
– rodents
selective use of non-human primates/primates
– depends on Rx mode-of-action and whether it is
active in lower species
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Scale-Up of Drug Synthesis
Purity, Stability and Cost
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Preclinical Development
rigorous QA/QC compliance and FDA inspection
scale up synthesis method ‘locked in’ to ensure
that initial clinical trials conducted with identical
materials to those used in preclinical testing
all instrumentation calibrated an documented at
defined intervals
all processes, procedures and documentation
must fulfill FDA Good Laboratory Practice (GLP)
requirements
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Preclinical Development: Pharmaceutical Formulation
stability of Rx substance
– 2 year shelf-life requirement
storage requirements
– room temp. or refrigerated (most biologicals)
– thermotolerance in more extreme climates
interaction with components in Rx containers or
delivery systems
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The Great Day Arrives!
Comptonomycin is Ready to Begin Human Clinical Trials