Abstract In the last decade, genetic activation of PPARG in muscle invasive urothelial cancer (MIUC) has emerged as a potential therapeutic intervention point. More than two decades ago, the first PPARG covalent inverse agonist was described. While cellularly potent, subsequent drug discovery efforts to understand and improve the pharmacology of this initial inverse agonist were largely unsuccessful until quite recently. We have recently disclosed FX-909, a covalent inverse agonist of PPARG that shows durable tumor regressions in PPARG-activated xenograft models. Detailed structural, biochemical and medicinal chemistry studies were critical to both rational and rapid evolution from previously described covalent PPARG inverse agonists to FX-909, which exhibits both superior pharmacological and in vivo properties. Mechanistic understanding of the altered conformational landscape of PPARG in MIUC integrated with detailed insights into the covalent reaction coordinate of PPARG inverse agonists enabled the design of FX-909, specifically tailored to exhibit robust “conformational biasing” that counters the PPARG conformational “activation bias” observed in MIUC. Citation Format: Jacob I. Stuckey, Jennifer Mertz, Jonathan Wilson, Yong Li, Gregg Chenail, Miljan Kuljanin, James Audia, Robert Sims. Mechanistic insights for the advancement of PPARG inverse agonists in muscle invasive urothelial cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Optimizing Therapeutic Efficacy and Tolerability through Cancer Chemistry; 2024 Dec 9-11; Toronto, Ontario, Canada. Philadelphia (PA): AACR; Mol Cancer Ther 2024;23(12_Suppl):Abstract nr IA014.
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