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Resistance to rezatapopt: New TP53 mutations identified in cancer patients

Mutations in the tumor suppressor TP53 are a common cause of cancer, making the altered protein an attractive target for therapeutics. Among them, the Y220C mutation is the ninth most frequent and it creates a small crevice in the mutant protein that is not pr

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Mutations in the tumor suppressor TP53 are a common cause of cancer, making the altered protein an attractive target for therapeutics. Among them, the Y220C mutation is the ninth most frequent and it creates a small crevice in the mutant protein that is not present in the wild type conformation. This druggable cavity has led to the development of small molecules such as rezatapopt that are designed to restore p53 and reactivate its normal tumor suppressor function. Rezatapopt has shown promising efficacy in early studies, but as with most targeted therapies, patients can eventually develop resistance to treatment.

A new study by Mass General Brigham investigators identifies mutations that drive clinical resistance to rezatapopt treatment. Researchers analyzed samples from patients who developed resistance to this drug and validated the underlying mechanisms using preclinical experiments, suggesting a path forward toward overcoming resistance. Results are published in Cancer Discovery.

Our findings establish a molecular basis for why patients treated with rezatapopt may experience therapeutic failure and provide the first clinical evidence that on-target secondary TP53 mutations can lead to acquired resistance. This work galvanizes us to further investigate whether next-generation agents or combination therapies may overcome or delay the emergence of resistance." Ferran Fece de la Cruz, PhD, first author, instructor with the Krantz Family Center for Cancer Research, Mass General Brigham Cancer Institute

Seeking insight, the investigators examined blood and tumor samples from two patients enrolled in the ongoing PYNNACLE clinical trial, which is evaluating rezatapopt in participants with metastatic solid tumors with a Y220C mutation. The patients, each of whom had different types of solid tumors, both responded to treatment initially but eventually became resistant to the drug. Genetic analyses of tumor DNA revealed several new TP53 mutations that emerged during treatment - including nearly 100 new mutations in one of the patient's samples.

To characterize how these new mutations led to drug insensitivity, the research team expressed them along with Y220C in cultured cancer cells. The researchers found that the acquired mutations fell into two main categories: those that altered p53 transcriptional activity and thus impaired its function, and others that potentially altered the Y220C pocket and disrupted rezatapopt binding.

The authors note that the former class of mutation is more likely to cause universal drug resistance to all agents within this therapeutic class, while the latter may be more drug-specific and circumvented with improved strategies, such as next-generation Y220C reactivators with a distinct mode of action. Further studies involving larger cohorts are needed to evaluate different types of acquired drug resistance.

Fece de la Cruz, F., et al. (2026). Acquired on-target alterations drive clinical resistance to p53-Y220C reactivators. Cancer Discovery. doi: 10.1158/2159-8290.cd-25-1761. https://aacrjournals.org/cancerdiscovery/article/doi/10.1158/2159-8290.CD-25-1761/771480/Acquired-on-target-alterations-drive-clinical

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Related questions

01How does COTI-2 compare to other p53 restoration drug candidates in development?

COTI-2 has an effect on mutated p53 protein that is similar to that documented for a few other members of the same class of compounds. COTI-2 is a third generation thiosemicarbazone specifically engineered for low toxicity. Other drugs in development target the mdm2 protein leading to increased functional p53 by decreasing the destruction of normal p53 protein. COTI-2 also has a unique effect on the PI3K/AKT pathway via a direct gene level up regulation of a specific protein (PIK3IP) that is known to inhibit PI3K. This means that COTI-2 is potentially effective in cancers with p53 mutations as well as in mutations of the PI3K/AKT pathway. This effect has been confirmed in an animal model of human ovarian cancer.

Source: www.news-medical.net ↗
02With emerging fields like AI and machine learning, how are these technologies being integrated into your research and drug discovery to accelerate the identification of potential drug candidates?

While we've initiated dialogues on integrating AI, it hasn't transformed our work yet. However, I see it as a significant tool, especially for handling and processing big data. AI can help bridge the expertise gap in understanding both bioinformatics and biological terms, aiding in the efficient mining of information.

Source: www.news-medical.net ↗
03What are 'dancing molecules'?

Stupp and his team posited that "dancing molecules" might encourage the stubborn tissue to regenerate. Previously invented in Stupp's laboratory, dancing molecules are assemblies that form synthetic nanofibers comprising tens to hundreds of thousands of molecules with potent signals for cells. By tuning their collective motions through their chemical structure, Stupp discovered the moving molecules could rapidly find and properly engage with cellular receptors, which also are in constant motion and extremely crowded on cell membranes. Once inside the body, the nanofibers mimic the extracellular matrix of the surrounding tissue. By matching the matrix's structure, mimicking the motion of biological molecules and incorporating bioactive signals for the receptors, the synthetic materials are able to communicate with cells. "Cellular receptors constantly move around," Stupp said. "By making our molecules move, 'dance' or even leap temporarily out of these structures, known as supramolecular polymers, they are able to connect more effectively with receptors."

Source: www.news-medical.net ↗
04How will this discovery change cancer science?

This is a win for the field. Until now, we have been focused on immune therapies that might make tumors more vulnerable to the body's immune system, and on finding new chemotherapy combinations that kill cancer cells. This new treatment has given us a new focus, and I think it will spur a lot of scientific discovery over the next few years. There have only been a handful of KRAS researchers and their relevance to therapy was always questioned. That is about to change. The most important next step for the field is to better understand the biology of cancer. We know that many pancreatic tumors will eventually become resistant to daraxonrasib, and we need to understand how this happens. We also need to identify additional genetic pathways and treatments that can target them. That's how we will turn pancreas cancer from a deadly, deadly cancer into something we can manage-and one day, even cure.

Source: www.news-medical.net ↗
05How much protein should you eat daily?

For the average adult, the Recommended Dietary Allowance (RDA) for protein or the amount you need to meet your basic nutritional requirements and not get sick, is 0.8 grams of protein per kilogram of body weight, or 0.36 grams per pound. For a person who weighs 75 kg (165 pounds), that comes to 60 grams of protein per day. To determine your target daily protein intake, you can multiply your weight in pounds by 0.36, or use this online calculator. It's important to keep in mind that your daily protein need is not a fixed number. For example, your protein needs will fluctuate depending on your level of physical activity, and whether you are pregnant or breastfeeding.

Source: www.health.harvard.edu ↗
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Peptide Therapy Guide Editorial Team

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