Repotrectinib exhibits potent antitumor activity in treatment-naïve and solvent-front-mutant ROS1-rearranged non-small cell lung cancer

Mi Ran Yun, Dong Hwi Kim, Seok Young Kim, Hyeong Seok Joo, You Won Lee, Hun Mi Choi, Chae Won Park, Seong Gu Heo, Han Na Kang, Sung Sook Lee, Adam J. Schoenfeld, Alexander Drilon, Seok Gu Kang, Hyo Sup Shim, Min Hee Hong, J. Jean Cui, Hye Ryun Kim, Byoung Chul Cho

Research output: Contribution to journalArticlepeer-review

42 Citations (Scopus)


Purpose: Although first-line crizotinib treatment leads to clinical benefit in ROS1þ lung cancer, high prevalence of crizotinib-resistant ROS1-G2032R (ROS1G2032R) mutation and progression in the central nervous system (CNS) represents a therapeutic challenge. Here, we investigated the antitumor activity of repotrectinib, a novel next-generation ROS1/TRK/ALKtyrosine kinase inhibitor (TKI) in ROS1þ patient-derived preclinical models. Experimental Design: Antitumor activity of repotrectinib was evaluated in ROS1þ patient-derived preclinical models including treatment-naïve and ROS1G2032R models and was further demonstrated in patients enrolled in an on-going phase I/II clinical trial (NCT03093116). Intracranial antitumor activity of repotrectinib was evaluated in a brain-metastasis mouse model. Results: Repotrectinib potently inhibited in vitro and in vivo tumor growth and ROS1 downstream signal in treatment-naïve YU1078 compared with clinically available crizotinib, ceritinib, and entrectinib. Despite comparable tumor regression between repotrectinib and lorlatinib in YU1078-derived xenograft model, repotrectinib markedly delayed the onset of tumor recurrence following drug withdrawal. Moreover, repotrectinib induced profound antitumor activity in the CNS with efficient blood-brain barrier penetrating properties. Notably, repotrectinib showed selective and potent in vitro and in vivo activity against ROS1G2032R. These findings were supported by systemic and intracranial activity of repotrectinib observed in patients enrolled in the on-going clinical trial. Conclusions: Repotrectinib is a novel next-generation ROS1-TKI with improved potency and selectivity against treatment-naïve and ROS1G2032R with efficient CNS penetration. Our findings suggest that repotrectinib can be effective both as first-line and after progression to prior ROS1-TKI.

Original languageEnglish
Pages (from-to)3287-3295
Number of pages9
JournalClinical Cancer Research
Issue number13
Publication statusPublished - 2020 Jul

Bibliographical note

Funding Information:
We thank all the patients who participated in this study. This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (2016R1A2B3016282, to B.C. Cho) and NRF grant funded by the Korean government (NRF-2018R1D1A1B07050233, to M.R. Yun).

Publisher Copyright:
© 2020 American Association for Cancer Research.

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research


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