Activating the stimulator
of interferon genes (STING)
pathway with
STING agonists is an attractive immune oncology concept to treat patients
with tumors that are refractory to single-agent anti-PD-1 therapy.
For best clinical translatability and broad application to cancer
patients, STING agonists with potent cellular activation of all STING
variants are desired. Novel cyclic dinucleotide (CDN)-based selective
STING agonists were designed and synthesized comprising noncanonical
nucleobase, ribose, and phosphorothioate moieties. This strategy led
to the discovery of 2′,3′-CDN 13 (BI 7446),
which features unprecedented potency and activates all five STING
variants in cellular assays. ADME profiling revealed that CDN 13 has attractive drug-like properties for development as
an intratumoral agent. Injection of low doses of CDN 13 into tumors in mice induced long-lasting, tumor-specific immune-mediated
tumor rejection. Based on its compelling preclinical profile, BI 7446
has been advanced to clinical trials (monotherapy and in combination
with anti-PD-1 antibody).