Research Papers:

The acylfulvene alkylating agent, LP-184, retains nanomolar potency in non-small cell lung cancer carrying otherwise therapy-refractory mutations

Aditya Kulkarni _, Joseph Ryan McDermott, Umesh Kathad, Rama Modali, Jean-Philippe Richard, Panna Sharma and Kishor Bhatia

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Oncotarget. 2021; 12:791-806. https://doi.org/10.18632/oncotarget.27943

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Aditya Kulkarni1, Joseph Ryan McDermott1, Umesh Kathad1, Rama Modali2, Jean-Philippe Richard2, Panna Sharma1 and Kishor Bhatia1

1 Lantern Pharma, Inc., Dallas, TX 75201, USA

2 REPROCELL USA Inc., Beltsville, MD 20705, USA

Correspondence to:

Aditya Kulkarni,email: [email protected]

Keywords: non-small cell lung cancer; acylfulvene; alkylating agent; PTGR1; LP-184

Received: January 11, 2021     Accepted: March 29, 2021     Published: April 13, 2021

Copyright: © 2021 Kulkarni et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY 3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


More than 40% of non-small cell lung cancer (NSCLC) patients lack actionable targets and require non-targeted chemotherapeutics. Many become refractory to drugs due to underlying resistance-associated mutations. KEAP1 mutant NSCLCs further activate NRF2 and upregulate its client PTGR1. LP-184, a novel alkylating agent belonging to the acylfulvene class is a prodrug dependent upon PTGR1. We hypothesized that NSCLC with KEAP1 mutations would continue to remain sensitive to LP-184. LP-184 demonstrated highly potent anticancer activity both in primary NSCLC cell lines and in those originating from brain metastases of primary lung cancers. LP-184 activity correlated with PTGR1 transcript levels but was independent of mutations in key oncogenes (KRAS and KEAP1) and tumor suppressors (TP53 and STK11). LP-184 was orders of magnitude more potent in vitro than cisplatin and pemetrexed. Correlative analyses of sensitivity with cell line gene expression patterns indicated that alterations in NRF2, MET, EGFR and BRAF consistently modulated LP-184 sensitivity. These correlations were then extended to TCGA analysis of 517 lung adenocarcinoma patients, out of which 35% showed elevated PTGR1, and 40% of those further displayed statistically significant co-occurrence of KEAP1 mutations. The gene correlates of LP-184 sensitivity allow additional personalization of therapeutic options for future treatment of NSCLC.

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