Dysregulation of the PI3K/AKT/mTOR pathway has the potential to trigger the activation of class I phosphoinositide 3-kinases (PI3Ks) and eventually lead to cancer. Class I PI3Ks are heterodimers composed of the regulatory subunit p85 and the catalytic subunit p110. There are four isoforms of p110, alpha and beta, important in solid tumors, and delta and gamma, preferentially expressed in leukocytes, and drivers in hematological malignancies. While activation of PI3K p110alpha is the most frequent oncogenic event in solid tumors, p110beta plays an important role in PTEN deficient cancers and in mediating resistance to p110alpha selective PI3K inhibitors.MEN1611 is a PI3K inhibitor active on p110alpha (both mutants and wt), beta and gamma (8.6- and 2.2- fold less potent compared to the alpha, respectively), while sparing the delta isoform (36-fold less potent compared to the alpha). Thus, MEN1611 differs from other selective PI3K inhibitors such as alpelisib (p110alpha selective) and taselisib (p110beta sparing). MEN1611 is currently in clinical development for patients with HER2 positive advanced or metastatic breast cancer in combination with trastuzumab with/without fulvestrant (B-PRECISE-01).

Patient-derived xenograft (PDX) models and breast cancer cell lines with different genetic background were used to assess the antitumor activity of MEN1611 in p110 alpha- and beta- dependent tumors. Healthy-donors derived CD69+ B-cells, which are primarily dependent on p110 delta for proliferation and survival were used to test the activity of the compound against the p110delta.

According to the biochemical selectivity, MEN1611 demonstrated a lower cytotoxic potential in a p110delta-driven cellular model (CD19+ B-cells), when compared to taselisib (>150-fold) and an improved cytotoxic activity in the p110beta-driven cellular model (PTEN-null breast cancer cells) when compared to alpelisib. Moreover, MEN1611 selectively decreases the p110alpha protein levels in PIK3CA mutated breast cancer cells in a concentration-dependent manner, with a corresponding reduction in pAKT. In vivo, MEN1611 monotherapy showed significant and long-lasting anti-tumor activity, reflected in tumor-stasis or tumor regression in several trastuzumab-resistant PIK3CA-mutant HER2 positive PDXs with different concomitant genomic aberrations. The combination of trastuzumab and MEN1611 significantly improved the efficacy compared to single agent treatment. Interestingly, MEN1611 monotherapy showed a significant tumor volume inhibition in a PTEN-null breast cancer PDX model.

Overall, our data provide evidence that MEN1611 is active against HER2 positive and PTEN-null breast tumors. Moreover, its delta-sparing profile may have potential implications on MEN1611 tolerability and ability to overcome resistance to p110alpha selective inhibitors.

Citation Format: Alessio Fiascarelli, Corrado Carrisi, Giuseppe Merlino, Stefania Capano, Diego Bisignano, Simone Talucci, Alessandro Bressan, Daniele Bellarosa, Mario Bigioni, Maurizio Scaltriti, Joaquin Arribas, Andrea Pellacani, Massimiliano Salerno, Monica Binaschi. Men1611 is a pi3k α/β selective and δ sparing inhibitor with long-lasting antitumor activity in different genetic backgrounds of pik3ca mutant breast cancer models [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS18-13.