Abstract In the tumor microenvironment, high concentrations of extracellular adenosine promote tumor proliferation through various immunosuppressive mechanisms. High expression of CD73—an ecto-nucleotidase that produces adenosine from adenosine monophosphate—has been associated with poorer prognosis in several tumor types. Herein, we describe the drug discovery efforts that resulted in the discovery of quemliclustat, a highly potent and selective inhibitor of CD73. As a small molecule with excellent drug-like properties, quemliclustat offers several advantages over CD73 antibodies in development, such as greater inhibition of CD73 enzymatic activity (both soluble and membrane-bound), deeper tumor penetration, and the potential for both IV and oral formulations. Quemliclustat was the first small molecule CD73 inhibitor to enter clinical development and is currently being evaluated in various Phase 1/2 studies in advanced solid tumors, including lung and pancreatic cancers. Recent data in metastatic pancreatic cancer are supportive of further study in this disease setting. Citation Format: Jenna Jeffrey Structure-guided design and optimization of small molecule CD73 inhibitors with excellent drug-like properties: discovery of quemliclustat. [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 PR003
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