Identification

Summary

Tagraxofusp is a CD123-directed cytotoxin used to treat plasmacytoid dendritic cell neoplasm.

Brand Names
Elzonris
Generic Name
Tagraxofusp
DrugBank Accession Number
DB14731
Background

Tagraxofusp is an IL-3 conjugated truncated diphtheria toxin.4 It is composed by the catalytic and translocation domains of diphtheria toxin fused via Met-His linker to a full-length human IL-3.6,7 Tagraxofusp was developed by Stemline Therapeutics Inc and FDA approved on December 21, 2018, as the first therapy for blastic plasmacytoid dendritic cell neoplasm.3 This drug achieved approval after being designated with the title of breakthrough therapy, priority review, and orphan drug status.2 Tagraxofusp has been designated as an orphan drug in the EU since November 2015.7

Type
Biotech
Groups
Approved, Investigational
Biologic Classification
Protein Based Therapies
Fusion proteins
Protein Structure
Protein Chemical Formula
C2553 H4026 N692 O798 S16
Protein Average Weight
Not Available
Sequences
>>tagraxofusp<<<
MGADDVVDSSKSFVMENFSSYHGTKPGYVDSIQKGIQKPKSGTQGNYDDDWKGFYSTDNK
YDAAGYSVDNENPLSGKAGGVVKVTYPGLTKVLALKVDNAETIKKELGLSLTEPLMEQVG
TEEFIKRFGDGASRVVLSLPFAEGSSSVEYINNWEQAKALSVELEINFETRGKRGQDAMY
EYMAQACAGNRVRRSVGSSLSCINLDWDVIRDKTKTKIESLKEHGPIKNKMSESPNKTVS
EEKAKQYLEEFHQTALEHPELSELKTVTGTNPVFAGANYAAWAVNVAQVIDSETADNLEK
TTAALSILPGIGSVMGIADGAVHHNTEEIVAQSIALSSLMVAQAIPLVGELVDIGFAAYN
FVESIINLFQVVHNSYNRPAYSPGHKTRPHMAPMTQTTSLKTSWVNCSNMIDEIITHLKQ
PPLPLLDFNNLNGEDQDILMENNLRRPNLEAFNRAVKSLQNASAIESILKNLLPCLPLAT
AAPTRHPIHIKDGDWNEFRRKLTFYLKTLENAQAQQTTLSLAIF
References:
  1. WHO reports [Link]
Download FASTA Format
Synonyms
  • Diphtheria toxin-il-3 fusion protein targeting IL-3 receptor
  • Tagraxofusp
  • tagraxofusp-erzs
External IDs
  • DT-3881L3
  • DT388IL3
  • Molecule 129
  • Molecule-129
  • SL-401

Pharmacology

Indication

Tagraxofusp is indicated for the treatment of blastic plasmacytoid dendritic cell neoplasm (BPDCN) in adults and pediatric patients over 2 years old. This treatment allows an alternative for the previous intense treatment which consisted of intensive chemotherapy followed by bone marrow transplantation.2

BPDCN is a rare hematologic malignancy derived from plasmacytoid dendritic cells. It is characterized by the significantly increased expression of cells expressing CD4/CD56/CD123 and other markers restricted to plasmacytoid dendritic cells and a lack of expression of lymphoid, natural killer or myeloid lineage-associated antigens.1 A key feature of the malignant cells is the overexpression of CD123, also known as interleukin-3 receptor, and the constant requirement of IL-3 for survival.6

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Associated Conditions
Contraindications & Blackbox Warnings
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Pharmacodynamics

In vitro studies showed that BPDCN blasts are ultrasensitive to tagraxofusp by presenting IC50 values in the femtomolar scale.6 One of the main physiological changes of BPDCN is the presence of elevated interferon alpha and to produce an inflammatory response. In trials with tagraxofusp and following cell depletion, there was observed a significant reduction in the levels of interferon alpha and interleukin 6.5

In clinical trials, tagraxofusp reported complete remission and complete remission with a skin abnormality not indicative of active disease in 54% of the treated patients.2

Mechanism of action

Tagraxofusp binds to cells expressing the IL-3 receptor and delivers in them the diphtheria toxin after binding. This is very useful as the malignant cells in BPDCN present a particularly high expression of IL-3 receptor (CD123+ pDC).5 To be more specific, tagraxofusp gets internalized to the IL-3 receptor-expressing cell allowing for diphtheria toxin translocation to the cytosol and followed by the binding to ADP-ribosylation elongation factor 2 which is a key factor for protein translation. Once the protein synthesis is inhibited, the cell goes under a process of apoptosis.4,6

As the apoptosis induction requires an active state of protein synthesis, tagraxofusp is not able to perform its apoptotic function in dormant cells.6

TargetActionsOrganism
AInterleukin-3 receptor subunit alpha
binder
Humans
AADP-ribosylation factor-like protein 2
binder
Humans
Absorption

The reported Cmax in clinical trials was of around 23 ng/ml.6 After a 15 min infusion of a dose of 12 mcg/kg the registered AUC and Cmax was 231 mcg.h/L and 162 mcg/L respectively.Label

Volume of distribution

In BPDCN patients, the reported volume of distribution is of 5.1 L.Label

Protein binding

Tagraxofusp is not a substrate of p-glycoprotein and other efflux pump proteins associated with multidrug resistance.6

Metabolism

For the metabolism, as tagraxofusp is a fusion protein, it is expected to get processed until small peptides and amino acids by the actions of proteases.

Route of elimination

Tagraxofusp is eliminated as small peptides and amino acids. More studies need to be performed to confirm the main elimination route.

Half-life

The reported half-life of tagraxofusp is of around 51 minutes.6

Clearance

The clearance of tagraxofusp was reported to fit a mono-exponential model.6 The reported clearance rate is reported to be of 7.1 L/h.Label

Adverse Effects
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Toxicity

There haven't been analysis observing the carcinogenic, mutagenic potential nor the effect on fertility. However, in studies performed in cynomolgus monkeys at an overdose rate of 1.6 times the recommended dose, it was observed severe kidney tubular degeneration. Similar studies at the recommended dose reported the presence of degeneration and necrosis of choroid plexus in the brain were. This effect seems to be progressive even 3 weeks after therapy withdrawal.Label

Pathways
Not Available
Pharmacogenomic Effects/ADRs
Not Available

Interactions

Drug Interactions
This information should not be interpreted without the help of a healthcare provider. If you believe you are experiencing an interaction, contact a healthcare provider immediately. The absence of an interaction does not necessarily mean no interactions exist.
DrugInteraction
Darbepoetin alfaThe risk or severity of Thrombosis can be increased when Darbepoetin alfa is combined with Tagraxofusp.
ErythropoietinThe risk or severity of Thrombosis can be increased when Erythropoietin is combined with Tagraxofusp.
Methoxy polyethylene glycol-epoetin betaThe risk or severity of Thrombosis can be increased when Methoxy polyethylene glycol-epoetin beta is combined with Tagraxofusp.
PeginesatideThe risk or severity of Thrombosis can be increased when Peginesatide is combined with Tagraxofusp.
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Food Interactions
No interactions found.

Products

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Brand Name Prescription Products
NameDosageStrengthRouteLabellerMarketing StartMarketing EndRegionImage
ElzonrisInjection, solution, concentrate1 mg/mlIntravenousStemline Therapeutics B.V.2021-01-28Not applicableEU flag
ElzonrisInjection, solution1000 ug/1mLIntravenousStemline Therapeutics, Inc.2019-01-18Not applicableUS flag

Categories

ATC Codes
L01XX67 — Tagraxofusp
Drug Categories
Chemical TaxonomyProvided by Classyfire
Description
Not Available
Kingdom
Organic Compounds
Super Class
Organic Acids
Class
Carboxylic Acids and Derivatives
Sub Class
Amino Acids, Peptides, and Analogues
Direct Parent
Peptides
Alternative Parents
Not Available
Substituents
Not Available
Molecular Framework
Not Available
External Descriptors
Not Available
Affected organisms
  • Humans and other mammals

Chemical Identifiers

UNII
8ZHS5657EH
CAS number
2055491-00-2

References

General References
  1. Kharfan-Dabaja MA, Lazarus HM, Nishihori T, Mahfouz RA, Hamadani M: Diagnostic and therapeutic advances in blastic plasmacytoid dendritic cell neoplasm: a focus on hematopoietic cell transplantation. Biol Blood Marrow Transplant. 2013 Jul;19(7):1006-12. doi: 10.1016/j.bbmt.2013.01.027. Epub 2013 Feb 5. [Article]
  2. FDA news [Link]
  3. FDA Approved Drug Products: Apadaz (benzhydrocodone and acetaminophen) tablets [Link]
  4. Oncology nursing news [Link]
  5. Stemline therapeutics news [Link]
  6. Blood journal [Link]
  7. NHS reports [Link]
RxNav
2109054
Wikipedia
Tagraxofusp
FDA label
Download (455 KB)

Clinical Trials

Clinical Trials
PhaseStatusPurposeConditionsCount
2Active Not RecruitingTreatmentBlastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN)1
2Not Yet RecruitingTreatmentAcute Myeloid Leukemia (AML)1
2RecruitingTreatmentAcute Myeloid Leukemia (AML)1
2RecruitingTreatmentBlastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN)1
2RecruitingTreatmentChronic Myelomonocytic Leukemia (CMML) / Myelofibrosis1
1Not Yet RecruitingTreatmentAcute Lymphoblastic Leukemia (ALL) / Acute Myeloid Leukemia (AML) / Acute Undifferentiated Leukemia (AUL) / B Cell Lymphoma (BCL) / BPDCN / Lymphoma, Hodgkins / Lymphoma, Lymphoblastic / Malignancies, Hematologic / MDS / Mixed Phenotype Acute Leukemia (MPAL) / T-cell type lymphoma1
1RecruitingTreatmentAcute Myeloid Leukemia (AML) / Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) / Myelodysplastic Syndromes (MDS)1
1RecruitingTreatmentAcute Myeloid Leukemia (AML) / Chronic Myelomonocytic Leukemia (CMML) / Myelofibrosis1
1, 2CompletedTreatmentAcute Myeloid Leukemia (AML) / Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN)1
1, 2CompletedTreatmentBlastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN) / Leukemias / Myelodysplastic Syndromes (MDS)1

Pharmacoeconomics

Manufacturers
Not Available
Packagers
Not Available
Dosage Forms
FormRouteStrength
Injection, solutionIntravenous1000 ug/1mL
Injection, solution, concentrateIntravenous1 mg/ml
Prices
Not Available
Patents
Not Available

Properties

State
Solid
Experimental Properties
Not Available

Targets

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Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Binder
General Function
Interleukin-3 receptor activity
Specific Function
This is a receptor for interleukin-3.
Gene Name
IL3RA
Uniprot ID
P26951
Uniprot Name
Interleukin-3 receptor subunit alpha
Molecular Weight
43329.585 Da
References
  1. Stemline therapeutics news [Link]
Kind
Protein
Organism
Humans
Pharmacological action
Yes
Actions
Binder
General Function
Small GTP-binding protein which cycles between an inactive GDP-bound and an active GTP-bound form, and the rate of cycling is regulated by guanine nucleotide exchange factors (GEF) and GTPase-activating proteins (GAP). GTP-binding protein that does not act as an allosteric activator of the cholera toxin catalytic subunit. Regulates formation of new microtubules and centrosome integrity. Prevents the TBCD-induced microtubule destruction. Participates in association with TBCD, in the disassembly of the apical junction complexes. Antagonizes the effect of TBCD on epithelial cell detachment and tight and adherens junctions disassembly. Together with ARL2, plays a role in the nuclear translocation, retention and transcriptional activity of STAT3. Component of a regulated secretory pathway involved in Ca(2+)-dependent release of acetylcholine. Required for normal progress through the cell cycle.
Specific Function
Gtp binding
Gene Name
ARL2
Uniprot ID
P36404
Uniprot Name
ADP-ribosylation factor-like protein 2
Molecular Weight
20877.765 Da
References
  1. Oncology nursing news [Link]
  2. Blood journal [Link]

Drug created at December 21, 2018 18:08 / Updated at August 17, 2021 04:17