First published March 13, 2018 - More info
ONC201 is a first-in-class, orally active anti-tumor agent that upregulates cytotoxic TRAIL pathway signaling in cancer cells. ONC201 has demonstrated safety and preliminary efficacy in the first-in-human trial where patients were dosed every 3 weeks. We hypothesized that dose-intensification of ONC201 may impact anti-tumor efficacy. We discovered that ONC201 exerts dose- and schedule-dependent effects on tumor progression and cell-death signaling in vivo. With dose intensification, we note a potent anti-metastasis effect and inhibition of cancer cell migration and invasion. Our preclinical results prompted a change in ONC201 dosing in all open clinical trials. We observe accumulation of activated NK+ and CD3+ cells within ONC201-treated tumors, and NK-cell depletion inhibits ONC201 efficacy in vivo, including against TRAIL/ONC201-resistant Bax–/– tumors. Immunocompetent NCR1-GFP mice with GFP-expressing NK-cells demonstrate GFP(+)-NK cell infiltration of syngeneic MC38 colorectal tumors. Activation of primary human NK cells and increased de-granulation occur in response to ONC201. Co-culture experiments identified a role for TRAIL in human NK-mediated anti-tumor cytotoxicity. Preclinical results indicate potential utility for ONC201 plus anti-PD-1 therapy. We observed an increase in activated TRAIL-secreting NK cells in the peripheral blood of patients after receiving ONC201 treatment. The results offer a unique pathway of immune stimulation for cancer therapy.