Alpha fetoprotein (AFP) is a human protein produced during fetal development. It protects the embryo from the mother’s immune system and carries nutrients to rapidly growing embryonic cells via AFP receptors (AFPRs). After birth, AFP production and AFPR expression recede — and AFPRs reappear on most cancer cells and on myeloid-derived suppressor cells (MDSCs).
ACT-101 is ACT’s recombinant human AFP, differing from natural human AFP by a single amino acid substitution at position 233 (glutamine for asparagine). It is non-glycosylated, has 16 disulphide bridges, and is now produced from an E. coli cell line developed by Absci. ACT-101 has been studied in over 300 patients in non-cancer clinical studies with an excellent safety record and no neutralizing antibodies.
ACT-903 is ACT’s lead oncology program: a protein drug conjugate (PDC) that links ACT-101 to a proprietary maytansine payload with a glutathione-sensitive linker. It targets AFPRs on cancer cells and MDSCs. ACT-903 is preclinical — it has not been tested in humans. In an ovarian cancer xenograft study it eliminated tumors completely with no regrowth to day 62; that study used immunodeficient mice, so the immune effect of removing MDSCs remains to be demonstrated in clinical studies.
Preclinical. IND-enabling work is ongoing, and a Phase Ia/b multiple-ascending-dose basket study is planned, enriched to an orphan indication such as platinum-resistant ovarian cancer or testicular germ cell cancer. No IND has been filed yet.
- Because AFPRs are present on most cancers and on MDSCs but absent on normal adult cells in studies to date, attaching a potent payload to ACT-101 is designed to concentrate treatment in tumors while sparing normal tissue — and, by removing the MDSC shield, to let the immune system attack the tumor as well. The receptor has not yet been clinically validated; that is what the planned clinical studies are for.
ACT-101 is Phase II-ready in Myasthenia Gravis (FDA Orphan Drug Designation granted) and in Inflammatory Bowel Disease, and is being positioned for partnering and outlicensing. Note: the earlier 78-patient IBD study used wild-type AFP from human fetal tissue, not ACT-101.
Maytansine is roughly 1,000-fold more potent than first-generation toxins such as doxorubicin, and the maytansinoid class is clinically validated in approved conjugates such as Kadcyla (DM1) and Elahere (DM4). ACT-903 uses a proprietary maytansine with a glutathione-sensitive linker created for ACT.
In clinical studies in over 300 patients, no neutralizing antibodies were found. In animal toxicology studies, neutralizing antibodies to AFP were detected in rodents, and low titers in about 50% of marmosets dosed every 72 hours for 26 weeks.