Pipeline

SynDevRx is developing its lead drug candidate 'evexomostat' (SDX-7320) for cancer patients with metabolic complications, such as overweight/obesity, pre-diabetes and type 2 diabetes.

The first indication for evexomostat is in post-menopausal HR+, Her2- metastatic breast cancer patients with an alteration in the PI3K pathway in combination with standard of care treatment (Truqap(R) or Piqray(R) plus fulvestrant) – the Amelia-1 Study.
We are currently enrolling this Phase 1b/2 combination study in multiple centers throughout the US.

A second clinical trial in 2nd or 3rd line metastatic triple-negative breast cancer (mTNBC) – the Aretha-1 Study – is enrolling in sites in the greater NYC area, greater Miami and in Atlanta.

A pilot study in the aggressive version of metastatic prostate cancer (aka neuroendocrine prostate cancer) will be opening soon in Australia.

Indication

Combination Drug

Pre-clinical

Phase 1

Phase 2

Phase 3

2nd/3rd line, Metastatic Triple-Negative Breast Cancer
Eribulin (Halaven®)

The Aretha-1 study is testing the MetAP2 inhibitor evexomostat in 2nd and 3rd line metastatic triple-negative breast cancer (mTNBC) in patients with baseline metabolic dysfunction (insulin resistance and/or obesity).

Aretha-1 is open to patient accrual in greater Atlanta, NCY, and Miami.

The study is being conducted in partnership with Emory University, Atlanta and with Memorial Sloan Kettering Cancer Center, NY

The Amelia-1 study is testing evexomostat in combination with standard-of-care therapies capivasertib + fulvestrant or alpelisib + fulvestrant in 2nd line hormone receptor positive, Her2 negative (HR+/Her2-) metastatic breast cancer. 

Among other clinical endpoints under exploration, we are closely monitoring the effect of evexomostat on patients’ glycemic response. We hypothesize that evexomostat will help control the hyperglycemia induced by both capivasertib and alpelisib. 

Amelia-1 is open, and is actively accruing patients in the greater LA area, Miami, Nashville, Chicago, Ann Arbor, western Pennsylvania, south-west Texas, and eastern Ohio.

Pilot study of evexomostat for men with metastatic Aggressive Variant prostate cancer (including neuroendocrine) following treatment with an ARPI. 

Enrollment is expected to start in late 2025 at the Princess Alexandra Hospital and Royal Brisbane Women’s Hospital and Herston Imaging Research Facility in Brisbane, Australia.

This study is funded through a grant from the US Dept. of Defense, and includes additional funding for mechanism research on evexomostat/MetAP2 inhibition in prostate cancer. 

The EVEN-1 Study for men who have progressed on an androgen receptor pathway inhibitor (ARPI). Pre-clinical data demonstrates that adding evexomostat to enzalutamide following disease progression on an ARPI may restore sensitivity to enzalutamide and delay chemotherapy treatment.

This study is planned for 2026.

Pre-clinical data in colorectal cancer models suggests evexomostat may potentiate standard-of-care therapies, particularly in patients with baseline metabolic complications (obesity, insulin resistance). 

This study is in the planning stage.

The Amelia-1 study was designed with input from our partners at SurvivngBreastCancer.org and Touch.


About Evexomostat (SDX-7320)

Evexomostat is a first-in-class molecule that targets the clinically-important enzyme Methionine Aminopeptidase type 2 (or ‘MetAP2’).
Our drug conjugation approach optimizes the efficacy and safety of the active drug (SDX-7539) by slowly releasing it from the backbone, thereby minimizing systemic exposure and toxicities.

Evexomostat (SDX-7320) is a fumagillin-class polymer-conjugated methionine aminopeptidase type II (MetAP2) inhibitor that is being developed as an anti-cancer compound with a multi-modal mechanism of action:

  • Anti-tumor (cell cycle arrest),
    Anti-angiogenic (endothelial cell homeostasis), and
    Metabolic hormone regulation.

We’ve completed a safety, dose-escalation study in end-stage cancer patients in which evexomostat demonstrated anti-tumor activity (stable disease) in 75% of solid tumor patients, plus potent anti-angiogenic effects and systemic, global metabolic improvements in this hard-to-treat population.

 

Evexomostat uniquely compliments major treatment modalities, including;

targeted therapies,
immune-oncology, and
traditional chemotherapy.

Potent anti-angiogenic and anti-tumor activity coupled with metabolic hormone regulating activity is expected to potentiate these complementary treatment modalities, and  improve the lives of millions of cancer patients worldwide.

About MetAP2

MetAP2 is a cytosolic protein with two distinct biological activities necessary for regulating protein synthesis.

(1) The enzymatic function of MetAP2 catalyzes the removal of the N-terminal initiator methionine from a specific set of nascent proteins. This amino peptidase activity is key for allowing post-translational modifications (e.g., myristoylation) that direct sub-cellular trafficking of proteins, protein turnover and specific functional activities.

Over 70% of proteins undergo this processing in a co-translational manner, which is also an important regulator of the N-degron protein degradation pathway, highlighting the important role of MetAP2 activity in protein homeostasis.

Although MetAP2 shares some overlap in sequence and activity with the related MetAP1, there are subtle differences in their substrate specificity and incomplete functional redundancy. Uniquely, MetAP2 substrate specificity and enzymatic activity is also post-translationally regulated by the cellular redox state, suggesting it is regulated by cell metabolism.

(2) MetAP2 protects eIF-2α from inhibitory phosphorylation from the enzyme eIF-2α kinase, inhibits RNA-dependent protein kinase (PKR)-catalyzed eIF-2 R-subunit phosphorylation, and also reverses PKR-mediated inhibition of protein synthesis in intact cells.

A large volume of literature on the back of extensive drug development efforts targeting MetAP2 has since demonstrated important roles for this protein in cancer, however, the direct and indirect molecular mechanisms of MetAP2 in these contexts are not completely understood.

Latest Clinical Trials Updates

Amelia-1 Study - A Phase 1b/2 Study Assessing the Safety and Efficacy of Evexomostat (SDX-7320) in Combination with the PI3Kα Inhibitor Alpelisib (PIQRAY®) plus Fulvestrant in Postmenopausal Women at Risk for Hyperglycemia with Advanced Breast Cancer and a PIK3CA Mutation Who Have Progressed on or Following Endocrine Therapy plus a CDK4/6 Inhibitor

The Amelia-1 Study is a multicenter Phase 1b/2 study to assess the safety, tolerability and efficacy of subcutaneously administered evexomostat (SDX-7320) in combination with alpelisib (PIQRAY(R)) plus fulvestrant (triplet therapy) in postmenopausal women  with advanced or metastatic HR+/HER2- breast cancer with an alteration in the PIK3CA gene who have progressed after treatment with endocrine therapy plus a CDK 4/6 inhibitor.

Status : Enrollment Open

A Phase II Study of Evexomostat plus Eribulin for People with Triple-Negative Breast Cancer

The purpose of this study is to assess the safety and effectiveness of adding the drug evexomostat (SDX-7320) to standard eribulin chemotherapy in people with triple-negative breast cancer (TNBC) that has come back or spread despite treatment. In addition, the participants in this study have metabolic disorders such as high blood sugar and/or obesity.
TNBC includes breast cancers do not contain receptors for estrogen or progesterone and do not have the HER2 protein, so they cannot be treated with medications that target those proteins.
Metabolic disorders, such as high blood sugar and/or obesity, can accelerate the growth of breast cancers and possibly cause resistance to standard cancer treatments. Evexomostat has been shown to slow tumor growth, improve metabolic disorders, and was safe when given by itself in earlier phase 1 trials. This study will determine whether there is a benefit to adding evexomostat to standard chemotherapy.

Status : Enrollment Open (Greater NYC, Miami)

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A Dose Escalation Study of SDX-7320 in Patients With Advanced Refractory or Late-Stage Solid Tumors

SDX-7320 is a cytostatic drug with anti-angiogenic activity and anti-metabolic activity. There was stable disease in >50% of the patients for at least the first CT scan (2 months) with the median treatment period was 6 cycles (1 cycle = 28 days). We noted significant reductions in key angiogenic markers, VEGF-C and bFGF, plus significant changes in the key metabolic markers leptin and adiponectin, and significant improvements in insulin sensitivity. These changes occurred over a broad range of doses.
Target engagement was measured in a surrogate compartment (whole blood) and was dose dependent.
Safety: SDX-7320 was generally well tolerated with thrombocytopenia being the DLT, which was reversible upon drug cessation without intervention. There was minimal site-of-injection reactions. Otherwise, toxicities were generally mild in nature (G1-G2).
We believe the safety profile makes SDX-7320 a good drug for future combination studies.

AACR 2020: SynDevRx Selected to Present the Results from its Phase 1 Study of SDX-7320 in Late-Stage Cancer Patients

Presented by Monica Mita, MD, Professor of Medicine, Co-Director, Experimental Therapeutics Program at Cedars-Sinai Medical Center Los Angeles, CA

Status : Completed

SynDevRx is a clinical-stage biotechnology company focused on developing treatments that address a serious and unmet medical need: cancers that are sensitive to dysregulated metabolic hormones. It is well established that obesity and diabetes increase the risks for developing cancer, but new research shows that these same risk factors also promote cancer and increase its lethality. Our approach combines standard of care therapies with our lead drug evexomostat (SDX-7320) to improve the tumor micro-environment by correcting the systemic metabolic hormones and key angiogenic factors that promote cancer progression and metastasis. We are the first company to target this significant yet underfunded area of research in drug development – an area called ‘metabo-oncology’.

SynDevRx has completed a Phase 1 study and is conducting 2 Phase 2 clinical studies – the first in post-menopausal HR+, Her2- metastatic breast cancer patients with the PIK3CA mutation in combination with standard of care treatment (Piqray(R) and fulvestrant). The second clinical study is in patients with triple-negative breast cancer (TNBC) and an HbA1c >5.5 or a BMI >30.
Information regarding our clinical trials can be accessed at www.clinicaltrials.gov.

In addition to our clinical trials, SynDevRx has an Expanded Access Policy for evexomostat (SDX-7320) for eligible patients in the U.S. Expanded Access refers to the use of an investigational drug by an individual patient outside of a clinical trial to prevent or treat a serious condition when the patient is unable to obtain the investigational drug under an IND (e.g., when a patient is not eligible for a clinical study or a clinical study is not recruiting or has been completed). To qualify for the SynDevRx Expanded Access Program, the patient’s physician must determine that probable risk to the patient from the investigational drug is not greater than the probable risk from the disease or condition. Expanded access is different from a clinical trial where the primary purpose is to collect extensive safety and efficacy data to support submission of an application to the U.S. Food and Drug Administration (FDA) to market a drug.

Physicians seeking additional information regarding Expanded Access for evexomostat (SDX-7320) should submit a request via expandedaccess@syndevrx.com (telephone number 1-617-401-3110). SynDevRx considers providing access to our investigational drug evexomostat (SDX-7320) on a case-by-case basis, dependent on available drug supplies, the physician’s determination as to whether the potential benefit to the patient justifies the potential risks, and company resources. A requesting oncologist/physician should expect to receive a response acknowledging receipt of a request within 5 business days after a completed request has been received.
The request for access to a SynDevRx investigational medicine can only be considered if the patient’s treating physician is committed to, and supportive of, the requested treatment.

In accordance with the 21st Century Cures Act, this policy may be revised at any time. Should you have additional questions, please reach out to your oncologist/physician.

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