Binding of steroid hormones to their cognate receptors regulates the growth of most prostate and breast cancers. We hypothesized that CYP11A inhibition might halt the synthesis of all steroid hormones, since CYP11A is the only enzyme that catalyses the first step of steroid hormone biosynthesis. We speculated that a CYP11A inhibitor could be administered safely provided that the steroids essential for life are replaced. Virtual screening and systematic structure-activity relationship optimization were used to develop ODM-208, the first-in-class, selective, non-steroidal, oral CYP11A1 inhibitor. Safety of ODM-208 was assessed in rats and Beagle dogs, and efficacy in a VCaP castration-resistant prostate cancer (CRPC) xenograft mouse model, in mice and dogs, and in six patients with metastatic CRPC. Blood steroid hormone concentrations were measured using liquid chromatography-mass spectrometry. ODM-208 binds to CYP11A1 and inhibited its enzymatic activity. ODM-208 administration led to rapid, complete, durable, and reversible inhibition of the steroid hormone biosynthesis in an adrenocortical carcinoma cell model in vitro, in adult non-castrated male mice and dogs, and in patients with CRPC. All measured serum steroid hormone concentrations reached undetectable levels within a few weeks from the start of ODM-208 administration. ODM-208 was well-tolerated with steroid hormone replacement. The toxicity findings were considered related to CYP11A1 inhibition and were reversed after stopping of the compound administration. Steroid hormone biosynthesis can be effectively inhibited with a small-molecule inhibitor of CYP11A1. The findings suggest that administration of ODM-208 is feasible with concomitant corticosteroid replacement therapy.

Nimodipine is a widely used medication for treating delayed cerebral ischemia (DCI) after subarachnoid hemorrhage. When administrated orally or intravenously, systemic hypotension is an undesirable side effect. Intracranial subarachnoid delivery of nimodipine during aneurysm clipping may be more efficient way of preventing vasospasm and DCI due to higher concentration of nimodipine in cerebrospinal fluid (CSF). The risk of systemic hypotension may also be decreased with intracranial delivery. We used animal models to evaluate the feasibility of surgically implanting a silica-based nimodipine releasing implant into the subarachnoid space through a frontotemporal craniotomy. Concentrations of released nimodipine were measured from plasma samples and CSF samples. Implant degradation was followed using CT imaging. After completing the recovery period, full histological examination was performed on the brain and meninges. The in vitro characteristics of the implant were determined. Our results show that the biodegradable silica-based implant can be used for an intracranial drug delivery system and no major histopathological foreign body reactions were observed. CT imaging is a feasible method for determining the degradation of silica implants in vivo. The sustained release profiles of nimodipine in CSF were achieved. Compared to a traditional treatment, higher nimodipine CSF/plasma ratios can be obtained with the implant.

340 Background: Castration-resistant prostate cancer (CRPC) is a major cause of cancer mortality worldwide. The mechanisms behind the development of resistance are complex and not fully understood; altered androgen synthesis, androgen receptor (AR) overexpression or gene amplification, and mutations have been indentified. However, tumor growth may still be responsive to therapies that can further suppress de novo intratumoral steroid synthesis upstream of CYP17A1. ODM-208 is an oral, non-steroidal and selective inhibitor of CYP11A1 enzyme that suppresses the synthesis of all steroid hormones and their precursors. Methods: The inhibition of CYP11A1 was measured in vitro by the formation of radiolabelled isocapronic acid in a human adrenal cortex cell line (H295R), and further analysing pregnenolone (Preg) and testosterone (T) formation by ELISA. The tumor growth inhibition of ODM-208 alone or in combination with prednisone (Pred) was studied in VCaP CRPC xenograft where also concentrations of main steroid hormones progesterone (P), corticosterone (CORT) and T in tumors and adrenals were analysed. In addition, plasma ACTH and LH levels were measured at the end of the xenograft study. In dogs an ACTH stimulation test was done. Toxicity studies were conducted in rats and dogs. Results: ODM-208 potently inhibits CYP11A1 and synthesis of Preg and T with nM concentrations in vitro. In the VCaP CRPC xenograft ODM-208 alone and in combination with Pred significantly inhibited tumor growth. Concentrations of T, P and CORT were significantly decreased in the adrenals, indicating strong CYP11A1 inhibition. Also, significantly decreased steroid levels in tumors was observedhe Pred combination increased plasma ACTH levels less than ODM-208 alone, whereas no difference was seen in the LH. In dogs ACTH-stimulated cortisol production was significantly inhibited after single oral dose of ODM-208. In toxicological studies ODM-208 showed expected reversible findings in target tissues, mainly related to the pharmacology. Conclusions: ODM-208 shows promising antitumor activity in preclinical CRPC models with favorable toxicological profile. Thus, ODM-208 might have potential for treating the patients with CRPC.

Supplementary Data from First-in-Class Small Molecule to Inhibit CYP11A1 and Steroid Hormone Biosynthesis

Several new treatments have been developed to target the androgen signaling axis in CRPC over the last decade. Despite the new treatment options, the challenge for managing CRPC is the limited duration of clinical benefit from treatments due to primary and acquired resistance. Altered steroid biosynthesis and adaptive signaling by endogenous steroids especially in AR mutated tumors have been suggested to be one of the resistance mechanisms. Inhibition of CYP11A1 enzyme (cytochrome P450scc) that catalyzes the first step in the steroidogenic pathway and leads to suppression of the synthesis of all steroid hormones and their precursors is expected to be a target with therapeutic potential in CRPC patients. Here we show, using multiple in vitro and in vivo models, selectivity and anti-tumor activity of a potent, orally bioavailable, inhibitor of CYP11A1 enzyme, ODM-208. The potency and specificity of ODM-208 was tested by using targeted screening assay and human recombinant CYP11A1 enzyme. The inhibition potential of ODM-208 in vitro was studied in H295R cells. The selectivity of ODM-208 to wide panel of different target classes including GPCRs, nuclear receptors, ion channels and enzymes was evaluated. Inhibition of steroidogenesis in vivo was studied in intact male dogs after repeated 4-week dosing of ODM-208, with and without corticosteroid replacement therapy. Steroid hormone concentrations in plasma and cell culture media were analyzed by LC-MS/MS. In vivo antitumor effects of ODM-208 were assessed in murine subcutaneous CRPC VCaP xenograft model. Strong reduction of androgen and other steroid hormones in H295R cells was shown with ODM-208, whereas with abiraterone clear increases in concentrations of pregnenolone, progesterone and corticosterone were observed. ODM-208 showed high selectivity to CYP11A1 and no significant off-target binding was detected in the broad panel. ODM-208 exposure-dependent decreases in plasma testosterone and cortisol concentrations were detected. ODM-208 inhibited substantially tumor growth in murine CRPC VCaP xenograft model. A phase 1/2 study of ODM-208 administered concomitantly with corticosteroid replacement and androgen deprivation therapy in metastatic CRPC subjects is ongoing (NCT03436485). In subjects with ODM-208 treatment all studied serum steroid hormones were decreased to under lower limit of quantification in the LC-MS/MS assays. These preclinical and clinical data suggest that ODM-208 has potential to provide clinical benefit to patients with treatment-resistant CRPC bearing altered steroid synthesis and/or mutated AR. Citation Format: Mari Karimaa, Henna Kettunen, Meri Ramela, Suvi Mansikka-Savolainen, Marcin Chrusciel, Outi Simola, Päivi Taavitsainen, Gerd Wohlfahrt, Petteri Rummakko, Annamari Vuorela, Karim Fizazi, Riikka Oksala. ODM-208, a novel, small-molecule CYP11A1 inhibitor, demonstrates strong inhibition of steroid biosynthesis and antitumor activity in castration-resistant prostate cancer (CRPC) model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 1250.