zotatifin (eFT226) / eFFECTOR Therap - LARVOL DELTA

Novel EIF4A1 inhibitors with anti‐tumor activity (ASH 2025) - "Zotatifin, a novel eIF4A inhibitor currentlyin Phase I/II trials, has aimed to overcome these limitations...The discovery of RBF197 and RBF208 represents a significant advance inthe field, providing new RocA-independent inhibitors with a unique mechanism of action and potent anti-tumor activity in both in vitro and in vivo models. These novel inhibitors pave the way for future bench tobedside research, offering a promising strategy to target dysregulated translation in cancer, with thepotential to expand therapeutic options for patients with DLBCL and other malignancies characterized byaberrant eIF4A1 activity/expression."

IO biomarker • B Cell Lymphoma • Diffuse Large B Cell Lymphoma • Hematological Malignancies • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology • BCL2 • CCND1 • EIF4A1 • EIF4A2 • MYC

Targeting eIF4A unleashes type I IFN immunity in triple-negative breast cancer (SABCS 2025) - "Targeting eIF4A with the first-in-class inhibitor zotatifin remodels tumor translatome, suppresses TNBC growth, and synergizes with carboplatin in syngeneic mouse models. These data define the mechanistic basis of eIF4A-targeted therapy, linking translational inhibition to innate immune activation, and provide a biomarker framework to guide future clinical trials combining zotatifin with chemotherapy in TNBC."

Breast Cancer • Oncology • Solid Tumor • Triple Negative Breast Cancer • EIF4A1 • EIF4A2 • IFIH1 • IFNAR1 • IFNB1

Enhanced Ferroptosis Induction Susceptibility in Diffuse Large B-Cell Lymphoma through Rocaglate-Mediated Translation Inhibition (ASH 2023) - "Additionally, we quantified reduced glutathione (GSH) levels, reactive oxygen species (ROS) levels, and synergy with ferroptosis inducers (e.g., erastin, RSL3) to elucidate the mechanism of rocaglates in enhancing susceptibility to the ferroptosis pathway...Correspondingly, there was strong synergy between the clinical rocaglate zotatifin and different ferroptosis inducers (Bliss δ synergy score > 10) and antagonism with ferroptosis inhibitors (Bliss δ synergy score < -10)... In conclusion, rocaglate-induced stress upregulates multiple ferroptosis suppressors, suggesting that cap-dependent translation disruption triggers a protective response against ferroptosis. Strikingly, these factors did not protect DLBCL tumors from ferroptosis inducers, which synergized remarkably with rocaglates, yielding promising new combination drug strategies. The proteomic basis for ferroptosis sensitization by rocaglate therapy remains under active investigation."

B Cell Lymphoma • Brain Cancer • CNS Tumor • Diffuse Large B Cell Lymphoma • Glioblastoma • Hematological Malignancies • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology • Solid Tumor • Targeted Protein Degradation • ATF2 • GPX4 • MYSM1 • NRF1 • SDHB • SLC3A2 • TNFA

Translational Disruption of NRF2 By Zotatifin Enhances Sensitivity to Ferroptosis and CAR-T Cells in Diffuse Large B-Cell Lymphoma (ASH 2024) - "We observed strong synergy, however, between zotatifin and various ferroptosis inducers, including erastin, RSL3, dimethyl formamide (DMF), sulfasalazine (SASP), ML385, and the pharmacokinetically optimized compound imidazole ketone erastin (IKE), while the anti-ferroptotic antioxidant N-acetyl cysteine (NAC) was antagonistic. These results advocate for clinical strategies to enhance investigational ferroptosis inducers and approved CAR-T cells. Further optimization of these regimens holds potential to enhance therapeutic efficacy and overcome resistance mechanisms in DLBCL treatment."

CAR T-Cell Therapy • IO biomarker • B Cell Lymphoma • B Cell Non-Hodgkin Lymphoma • Diffuse Large B Cell Lymphoma • Hematological Malignancies • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology • EIF4A1 • EIF4A2 • IFNG • NFE2L2 • SLC3A2

Blocking NRF2 Translation by Inhibition of Cap-Dependent Initiation Sensitizes Lymphoma Cells to Ferroptosis and CAR T-cell Immunotherapy. (PubMed, Cancer Res) - "In vivo, combining zotatifin with the optimized ferroptosis inducer imidazole ketone erastin significantly reduced tumor burden in DLBCL patient-derived xenografts. Treatment with zotatifin in combination with chimeric antigen receptor (CAR) T cells, a vital treatment modality for DLBCL patients, revealed that zotatifin pre-exposure sensitized DLBCL tumors to CD19-directed CAR T cells in vitro and extended survival of CAR T-cell treated immunocompetent mice bearing syngeneic DLBCL tumors in vivo. Overall, eIF4A1 inhibition-induced translational disruption provides opportunities to leverage the therapeutic impacts of ferroptosis inducers, including cytotoxic immunotherapies."

Journal • B Cell Lymphoma • Diffuse Large B Cell Lymphoma • Hematological Malignancies • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology • Rheumatology • EIF4A1

eIF4A controls translation of estrogen receptor alpha and is a therapeutic target in advanced breast cancer. (PubMed, Proc Natl Acad Sci U S A) - P1/2 | "In an early clinical trial (NCT04092673), the eIF4A inhibitor zotatifin was combined with either fulvestrant or fulvestrant plus CDK4 inhibitor, abemaciclib, in patients with acquired resistance to these agents. Multiple clinical responses including a handful of durable regressions were observed, with little toxicity. Thus, eIF4A inhibition could be useful for treating ER+ breast cancer resistant to other modalities."

Journal • Breast Cancer • Hormone Receptor Breast Cancer • Hormone Receptor Positive Breast Cancer • Oncology • Solid Tumor • CCND1 • EIF4A1 • EIF4A2 • EIF4E • ER

Umbrella Trial of Subtype-Targeted Therapies in ER+/HER2- Breast Cancer (clinicaltrials.gov) - P2 | N=19 | Suspended | Sponsor: Stanford University | Active, not recruiting ➔ Suspended

Trial suspension • Breast Cancer • Estrogen Receptor Positive Breast Cancer • HER2 Breast Cancer • HER2 Negative Breast Cancer • Hormone Receptor Positive Breast Cancer • Oncology • Solid Tumor • ER • HER-2 • PGR

RESOLVE: Abemaciclib + Letrozole +/- Metformin, Zotatifin, or Gedatolisib in Endometrial or Low-Grade Serous Ovarian Cancer (clinicaltrials.gov) - P2 | N=180 | Recruiting | Sponsor: Dana-Farber Cancer Institute | Active, not recruiting ➔ Recruiting | N=130 ➔ 180 | Trial completion date: Aug 2030 ➔ Aug 2031 | Trial primary completion date: Aug 2027 ➔ Aug 2028

Enrollment change • Enrollment open • P53WT • Trial completion date • Trial primary completion date • Endometrial Cancer • Oncology • Ovarian Cancer • Ovarian Serous Adenocarcinoma • Solid Tumor • ER

Targeting EIF4A1 is effective against human intrahepatic cholangiocarcinoma. (PubMed, JHEP Rep) - "Moreover, the Bcl-xl inhibitors A-1155463 and DT2216 profoundly augmented apoptotic cell death when administered in association with zotatifin. From a clinical standpoint, these results suggest that zotatifin improves patient outcomes by inhibiting iCCA growth and reducing tumor aggressiveness. Furthermore, combining zotatifin with other drugs could represent a promising therapeutic strategy for targeting iCCA."

Journal • Biliary Cancer • Cholangiocarcinoma • Liver Cancer • Oncology • Solid Tumor • BCL2L1 • CAFs • EIF4A1 • EIF4E • EIF4G1

Targeting eIF4F-mediated translation to reduce T cell exhaustion and enhance PD-1 blockade efficacy in melanoma (AACR 2025) - "These experiments were performed with and without inhibition of the eIF4F-dependent translation using three different inhibitors of the eIF4A helicase (eIF4A-i: silvestrol, EFT226 and RBX0901)... Our findings unveil a previously unrecognized role of eIF4F in orchestrating the translational regulation of key proteins driving T cell exhaustion. This study is the first to demonstrate that targeting eIF4F with eIF4A inhibitors not only downregulates exhaustion markers but also synergistically enhances the efficacy of anti-PD-1 therapy across multiple models, including human TILs and murine cancer systems. This novel insight underscores the immense therapeutic potential of combining eIF4A inhibitors with ICIs to overcome resistance mechanisms and reinvigorate anti-tumor immunity."

Clinical • IO biomarker • Colon Cancer • Colorectal Cancer • Melanoma • Oncology • Solid Tumor • CD8 • EIF4A1 • EIF4A2 • EIF4E • EIF4G1 • HAVCR2 • LAG3 • STAT1

Anticancer effects of zotatifin are mediated by RNA structure remodelling. (PubMed, Nat Rev Mol Cell Biol) - No abstract available

Journal • Oncology

Small-molecule RNA therapeutics to target prostate cancer. (PubMed, Cancer Cell) - "Remarkably, tumors treated with zotatifin become more sensitive to anti-androgen therapy and radiotherapy. Therefore, "translatome therapy" provides additional strategies to treat the deadliest cancers."

Journal • Castration-Resistant Prostate Cancer • Genito-urinary Cancer • Oncology • Prostate Cancer • Solid Tumor • EIF4A1 • EIF4A2 • HIF1A

Discovery of RNA-Protein Molecular Clamps Using Proteome-Wide Stability Assays. (PubMed, J Proteome Res) - "We report novel DDX targets of high-profile rocaglates-including the clinical candidate Zotatifin-and validate our findings using limited proteolysis-mass spectrometry and fluorescence polarization (FP) experiments. We also provide structural insight into divergent DDX3X affinities between synthetic rocaglates. Taken together, our study provides a model for screening uncompetitive inhibitors using a chemical proteomics approach and uncovers actionable DDX clamping targets, clearing a path toward characterization of novel molecular clamps and associated RNA helicases."

Journal • Targeted Protein Degradation • DDX3X • EIF4A1 • EIF4A2

Large Oncosomes Loaded with circPEX13 Enhance Osteoclast Differentiation and Facilitate Breast Cancer Bone Metastasis (SABCS 2024) - "Concurrently, circPEX13 acted as a sponge for HDAC1, thereby relieving HDAC1-mediated transcriptional repression of NFATc1.Based on these findings, we discovered that treatment with Zotatifin reduced circPEX13 expression and effectively suppressed BC bone metastasis in BC patient-derived xenograft models. In conclusion, these findings unveil a plausible mechanism whereby LOs secreted by bone metastatic BC cells mediate bone tropism by establishing PMNs in bone, and suggest a potential strategy for treating BC patients with bone metastasis."

Breast Cancer • Oncology • Solid Tumor • EIF4A3 • HDAC1 • NFATC1

RESOLVE: Abemaciclib + Letrozole +/- Metformin or Zotatifin in Endometrial or Low-Grade Serous Ovarian Cancer (clinicaltrials.gov) - P2 | N=130 | Active, not recruiting | Sponsor: Dana-Farber Cancer Institute | Recruiting ➔ Active, not recruiting | Trial completion date: Aug 2029 ➔ Aug 2030 | Trial primary completion date: Aug 2026 ➔ Aug 2027

Combination therapy • Enrollment closed • Trial completion date • Trial primary completion date • Endometrial Cancer • Oncology • Ovarian Cancer • Ovarian Serous Adenocarcinoma • Solid Tumor • ER

NRF2 disruption by rocaglate translation inhibitors sensitizes tumors to induction of ferroptosis and killing by CAR-T cells (EORTC-NCI-AACR 2024) - "We assessed the combination of zotatifin and the optimized ferroptosis-inducing compound imidazole ketone erastin (IKE) in vivo against lymphoma xenografts. Zotatifin synergizes strongly with IKE and multiple other ferroptosis inducers in vitro. We reveal NRF2 can be indirectly targeted through disruption of its translation by eIF4A inhibition with rocaglates, including the clinical compound zotatifin. NRF2 loss causes profound sensitization to ferroptosis-inducing drugs and killing by cytotoxic T cells. These results inform clinical strategies to enhance activities of investigational ferroptosis inducers and approved CAR-T cells."

CAR T-Cell Therapy • IO biomarker • B Cell Lymphoma • Diffuse Large B Cell Lymphoma • Hematological Malignancies • Lung Cancer • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology • Solid Tumor • EIF4A1 • EIF4A2 • IFNG • NFE2L2

NRF2 translation block by inhibition of cap-dependent initiation sensitizes lymphoma cells to ferroptosis and CAR-T immunotherapy. (PubMed, bioRxiv) - "Moreover, we found zotatifin pre-exposure sensitized DLBCL to CD19-directed chimeric antigen receptor (CAR-19) T cells. Translational disruption therefore provides new opportunities to leverage therapeutic impacts of ferroptosis inducers including cytotoxic immunotherapies."

IO biomarker • Journal • Diffuse Large B Cell Lymphoma • Hematological Malignancies • Lymphoma • Non-Hodgkin’s Lymphoma • Oncology • EIF4A1

Phase I/II dose escalation study evaluating first-in-class eIF4A inhibitor zotatifin in ER+ metastatic breast cancer (ESMO 2024) - P1/2 | "In dose escalation cohorts of heavily pre-treated ER+ MBC pts, eIF4A inhibitor zotatifin achieved the RP2D of 0.2 mg/kg Q2W and showed evidence of anti-tumor activity in combination with ful. The combination of Q2W zotatifin is currently being evaluated in part 2 of the study in combination with abemaciclib and fulvestrant in late line ER+ MBC."

Metastases • P1/2 data • Breast Cancer • Estrogen Receptor Positive Breast Cancer • HER2 Breast Cancer • Oncology • Solid Tumor • CCND1 • EIF4A1 • EIF4A2 • FGFR1 • HER-2 • KRAS

Pharmacologic inhibition of eIF4A blocks NRF2 synthesis to prevent osteosarcoma metastasis. (PubMed, Clin Cancer Res) - "Collectively, our data reveal that pharmacologic targeting of eIF4A1 is highly effective in blocking OS metastasis by blunting the NRF2 antioxidant response."

Journal • Oncology • Osteosarcoma • Sarcoma • Solid Tumor • EIF4A1 • EIF4A2

Umbrella Trial Testing Integrative Subtype Targeted Therapeutics in Estrogen Receptor Positive, HER2-Negative Breast Cancer (clinicaltrials.gov) - P2 | N=19 | Active, not recruiting | Sponsor: Stanford University | Recruiting ➔ Active, not recruiting | N=150 ➔ 19

Enrollment change • Enrollment closed • Breast Cancer • Estrogen Receptor Positive Breast Cancer • HER2 Breast Cancer • HER2 Negative Breast Cancer • Hormone Receptor Breast Cancer • Hormone Receptor Positive Breast Cancer • Oncology • Solid Tumor • ER • HER-2 • PGR

RESOLVE: Abemaciclib + Letrozole +/- Metformin or Zotatifin in Endometrial or Low-Grade Serous Ovarian Cancer (clinicaltrials.gov) - P2 | N=130 | Recruiting | Sponsor: Dana-Farber Cancer Institute | N=60 ➔ 130 | Trial completion date: May 2026 ➔ Aug 2029 | Trial primary completion date: May 2024 ➔ Aug 2026

Combination therapy • Enrollment change • Trial completion date • Trial primary completion date • Endometrial Cancer • Oncology • Ovarian Cancer • Ovarian Serous Adenocarcinoma • Solid Tumor • ER

eFFECTOR Therapeutics to Collaborate with the Dana-Farber Cancer Institute on an Investigator-Sponsored Phase 2 Clinical Trial Evaluating Zotatifin as Combination Treatment in ER+ Endometrial Cancer and in Low Grade Serous Ovarian Cancer (GlobeNewswire) - "eFFECTOR Therapeutics, Inc...today announced a collaboration to conduct an investigator-sponsored trial (IST) evaluating zotatifin in combination with abemaciclib and letrozole in patients with estrogen receptor-positive (ER+) endometrial cancer and low grade serous ovarian cancer at the Dana-Farber Cancer Institute (DFCI) under the direction of Panagiotis Konstantinopoulos, M.D., Ph.D., Director of Translational Research and attending oncologist in the Division of Gynecologic Oncology at DFCI, and an Associate Professor of Medicine at Harvard Medical School....In parallel, we continue to advance development of zotatifin in ER+ metastatic breast cancer and anticipate determination of the Phase 2 dose (RP2D) of zotatifin in combination with fulvestrant and abemaciclib, in the second half of 2024."

Licensing / partnership • Trial status • Breast Cancer • Endometrial Cancer • Estrogen Receptor Positive Breast Cancer • Oncology • Ovarian Cancer

eFFECTOR Therapeutics Reports Fourth Quarter and Full Year 2023 Financial Results and Provides Corporate Update (GlobeNewswire) - "In the first quarter of 2024, dose escalation of the ZF doublet concluded with the determination of 0.2 mg/kg zotatifin Q2W as the new RP2D for the doublet, which is projected to provide approximately twice the overall zotatifin exposure compared to the initial RP2D. Determination of the RP2D for the ZFA triplet is ongoing. The company looks forward to finalizing the dose and schedule for zotatifin in the ZFA triplet and interacting with the FDA prior to initiating a randomized, potentially registrational, trial in ER+ breast cancer."

Trial status • Estrogen Receptor Positive Breast Cancer • HER2 Negative Breast Cancer • Hormone Receptor Positive Breast Cancer

eFFECTOR Therapeutics to Host Virtual Investor R&D Day on January 24, 2024 (GlobeNewswire) - "eFFECTOR Therapeutics, Inc...today announced that it will host a virtual investor R&D Day on Wednesday, January 24, 2024, at 4:30 pm ET...Topics for the webinar will include a summary of development progress for tomivosertib and zotatifin, a review of recently announced Phase 2 data of zotatifin in estrogen receptor-positive (ER+) metastatic breast cancer patients, potential market opportunities and competitive positioning of tomivosertib and zotatifin and a preview of expected 2024 catalysts...'We look forward to reporting topline results from our Phase 2b KICKSTART clinical trial of tomivosertib combined with pembrolizumab for the treatment of frontline NSCLC in the first quarter of 2024. We recently announced positive interim data for zotatifin, highlighted by the 7.4 month mPFS in the ZFA cohort of heavily pretreated ER+ metastatic breast cancer patients and look forward to reporting additional data in the first half of 2024.'"

P2 data • P2b data • Breast Cancer • Estrogen Receptor Positive Breast Cancer • Lung Cancer • Non Small Cell Lung Cancer • Oncology • Solid Tumor

Phase 1/2 Dose Expansion Study Evaluating First-In-Class eIF4A Inhibitor Zotatifin in Patients with ER+ Metastatic Breast Cancer (SABCS 2023) - "Methods Part 1 is a 3+3 dose escalation portion of the protocol followed by Part 2 as a Simon's two-stage design in patients with ER+ MBC enrolled at the recommended phase 2 dose (RP2D) of zotatifin (0.07 mg/kg IV two weeks on/one week off) in combination with fulvestrant (ful) and abemaciclib (abema) (Z+F+A). Efficacy was seen independent of ESR1 or PIK3CA mutations, suggesting the potential to treat a broad, unrestricted patient population. Initial results with Z+F Q2W dosing are encouraging and support continued dose escalation of this regimen."

Clinical • Metastases • P1/2 data • Breast Cancer • HER2 Breast Cancer • Oncology • Solid Tumor • CCND1 • EIF4A1 • EIF4A2 • ER • HER-2 • KRAS • PIK3CA