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Zenith's BET Inhibitor ZEN-3694 is Currently Being Evaluated in Multiple Oncology Clinical Trials

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Message: ZEN-3694 Single Agent Trial Status

My first post in this thread was from July 14th, 2017 and I posted an updated version last month. This version is now updated with the info from the BIO Investor Forum presentation last week.

ZEN-3694/enzalutamide combo trial:

  • Still in dose escalation stage as of 10/17/2017
  • Dose escalation is listed as 3+3 design, and dosing strategy should be informed by the previous single agent trial. My guess is that it shouldn't take more than 4 escalating doses to arrive at the combo therapy maximally tolerated dose (MTD). Back in 12/2016 Zenith new released that the combo trial had been initiated and in the 2/14/2017 presentation they stated that the combo trial dose escalation was still being planned and was open for enrollment. So hard to say when dosing began but in the 6/20/2017 slide presentation, they stated that 2 cohorts had already been completed. 
  • Slide 17 of 10/17/2017 presentation indicates 12 or 13 patients so far in combo trial.
  • Cohort 1 (four patients) started at the lowest dose and 3 of the 4 are no longer ongoing due to withdrawl of consent, radiographic progression or clinical progression. The one remaining cohort 1 patient (patient #2) has been ongoing w/o disease progression for over 39 weeks. The graph was dated 9/20/2017 so if all is still good this patient is now at 44 weeks as of today. This not only smashes the median progression free survival of 18 weeks for standard of care therapy, but also exceeds the target goal of 36 weeks. 
  • Cohort 2 (five patients) is the most informative group as of the slides shown 10/17/2017 (data as of 9/20/2017). Three of the five in this cohort have been ongoing for 26-29 weeks as of 9/20/2017 and if all is still good these patients are now at 31-34 weeks as of today. All three of these have exceeded the median standard of care progression free survival (18 weeks) and are approaching the target goal of 36 weeks. These three patients also shown robust suppression of the PSA response and have maintained this low PSA level for beyond the 18 week standard of care mark. The other two Cohort 2 patients were added after Cohort 3 started.
  • One of the Cohort 2 patients (patient 6) is shown on slide 17 of the 10/17/2017 slides to have had 5 dose modifications (blue squares), which occured at weeks 4, 5, 7, 8 and 25. This stands out as odd since only 2 patients show any blue squares and the only other one (rock star patient 2) only had one dose modification.
  • Cohort 3 (3 patients) are at 9 to 13 weeks as of the 9/20/2017 date listed on the October 2017 slides. If all is still good, these patients are now at 14 to 18 weeks as of today and are starting to exceed the 18 week mark for the standard of care progression free survival.
  • Data shown in the slides from 10/17/2017 was based on data dated 9/20/2017. Will the slides from BIO Europe on November 7th contain more recent data? Will they have arrived at the MTD? Will they have started expansion cohorts at the recommended Phase 2 dose? Will they choose an intermittent dosing for the ZEN-3694 part of the combo therapy? Stay tuned!

Single agent ZEN-3694 trial:

  • Dose escalation for the single agent trial began 6/15/2016 (news release). Maximally tolerated dose (MTD) with every day dosing was confirmed in the AGM presentation 12/15/2016.
  • On slide 14 of the 10/17/2017 presentation, it is stated that ~12 patients participated in the dose escalation portion. Since this was a 3+3 dose escalation design, I am interpreting this to mean that 4 escalating doses were required to arrive at the MTD.
  • Longest patient on drug was on drug 8/24/2016 – 7/16/2017, 45 weeks per 10/17/2017 presentation
  • Intermittent dosing cohort was initiated sometime on or before 2/14/2017 (announced in 2/14/2017 BIO CEO slides), which was after arriving at the MTD. Presumably, this intermittent dosing was chosen as the recommended Phase 2 dose since this 2/14/2017 presentation also contained the statement "Cohort with intermitten dosing has been initiated for recommended Phase 2 dose"
  • Dose expansion cohort at recommended Phase 2 dose (presumed to be intermittent dosing) initiated as of 6/20/2017 Bio International presentation.
  • This study is fully enrolled and no longer recruiting patients; study closeout ongoing (per slide 14 of 10/17/2017 presentation).
  • Will Zenith even do a Phase 2 single agent trial for mCRPC?
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