Sponsor: PMV Pharmaceuticals, Inc (industry)
Phase: 1/2
Start date: Oct. 29, 2020
Planned enrollment: 230
Rezatapopt (PC14586) is an investigational oral drug for advanced solid tumors carrying the TP53 Y220C mutation. It is being studied as a single agent in the phase 1/2 PYNNACLE trial; the recommended phase 2 dose is 2,000 mg once daily with food. The available efficacy results come from single-arm studies, so they do not establish how rezatapopt compares with other treatments. (nejm.org)
Rezatapopt selectively binds the Y220C-mutant p53 protein, stabilizing a form intended to restore p53’s tumor-suppressor activity. It targets this specific mutation rather than TP53 mutations generally. (nejm.org)
In a peer-reviewed phase 1 study of 77 heavily pretreated patients, the overall response rate was 20% across all doses. It was 30% among patients with KRAS wild-type tumors who received at least 1,150 mg once daily; all patients who responded had KRAS wild-type tumors. (nejm.org)
In the phase 2 ovarian-cancer cohort, a 2026 conference abstract reported an investigator-assessed response rate of 44.4% among 72 evaluable patients, with a median response duration of 8.2 months. A later company-reported interim update, not a peer-reviewed publication, reported 46% (35/76) as of a May 14, 2026 data cutoff; this included two unconfirmed partial responses. Its reported median duration of confirmed responses was 10.0 months. (ascopubs.org)
In phase 1, treatment-related adverse events occurred in 87% of patients, and 3% stopped treatment because of one. The most common adverse events, regardless of attribution, were nausea (58%), vomiting (44%), increased blood creatinine (39%), fatigue (39%), and anemia (36%); anemia was the most common grade 3 or higher event (16%). In the later phase 2 company update, discontinuation due to treatment-related adverse events was reported at approximately 5%. (nejm.org)
Last updated: Sep 2026
Goal: Evaluate the safety, dosing, pharmacokinetics, and antitumor activity of rezatapopt, alone or with pembrolizumab, in TP53 Y220C–mutant advanced solid tumors. The enrolling phase 2 portion focuses on monotherapy efficacy.
Patients: Patients with locally advanced or metastatic solid tumors harboring TP53 Y220C, ECOG performance status 0–1, progression after at least one prior anticancer regimen, and adequate organ function. Phase 2 requires RECIST-measurable disease and excludes tumors with a KRAS single-nucleotide variant. Enrollment generally begins at age 18, with ages 12–17 permitted after safety review approval.
Design: Open-label, multicenter, nonrandomized dose-escalation and expansion study without a control arm. Phase 1 monotherapy and phase 1b combination enrollment are complete; phase 2 monotherapy enrollment remains open in ovarian, lung, breast, endometrial, and other solid-tumor cohorts.
Treatments: Phase 2 participants receive rezatapopt 2,000 mg orally once daily with food. Earlier cohorts evaluated escalating daily doses alone or with pembrolizumab 200 mg IV every three weeks, followed by combination expansion in PD-(L)1–naive and relapsed/refractory patients. Rezatapopt is an investigational small molecule that selectively binds and stabilizes Y220C-mutant p53 to restore tumor-suppressor activity. In a published phase 1 study, the response rate was 20% across doses; a phase 2 ovarian-cancer conference abstract reported a 44.4% investigator-assessed response rate among 72 evaluable patients. These single-arm findings do not establish comparative benefit.
Outcomes: The phase 2 primary measure is independently reviewed RECIST v1.1 overall response rate, including evaluation in the ovarian cohort and across cohorts. Phase 1/1b primary measures include dose-limiting toxicities, adverse events, maximum tolerated dose, and recommended dose. Additional measures include response duration, disease control, progression-free and overall survival, pharmacokinetics, safety, and phase 2 quality of life.
Burden on patient: Moderate to high. Daily oral treatment and repeated response scans require ongoing visits; pharmacokinetic blood sampling adds procedures, particularly during dose escalation. Combination participants also need pembrolizumab infusions every three weeks. The provided details do not specify mandatory biopsies or an exact visit schedule.
Last updated: Sep 2026
Caution: ClinicalTrials.gov appears to have newer eligibility criteria than the version saved here. Review the current criteria in ClinicalTrials.gov.
Inclusion Criteria:
* At least 18 years of age or 12 to 17 years of age after Safety Review Committee approval.
* Locally advanced or metastatic solid malignancy with a TP53 Y220C mutation
* Eastern Cooperative Oncology Group (ECOG) status of 0 or 1
* Previously treated with one or more lines of anticancer therapy and progressive disease
* Adequate organ function
* Measurable disease per RECIST v1.1 (Phase 2)
Additional Criteria for Inclusion in Phase 1b (rezatapopt) + pembrolizumab combination)
* Anti-PD-1/PD-L1 naive or must have progressed on treatment
* Measurable disease
Exclusion Criteria:
* Anti-cancer therapy within 21 days (or 5 half-lives) of receiving the study drug
* Radiotherapy within 28 days of receiving the study drug
* Primary CNS tumor
* History of leptomeningeal disease or spinal cord compression
* Brain metastases, unless neurologically stable and do not require steroids to treat associated neurological symptoms
* Stroke or transient ischemic attack within 6 months prior to screening
* Heart conditions such as unstable angina, uncontrolled hypertension, a heart attack within 6 months prior to screening, congestive heart failure, prolongation of QT interval, or other rhythm abnormalities
* Strong CYP3A4 inducers
* History of gastrointestinal (GI) disease that may interfere with absorption of study drug or patients unable to take oral medication
* History of prior organ transplant
* Known, active malignancy, except for treated cervical intraepithelial neoplasia, or non-melanoma skin cancer
* Known, active uncontrolled Hepatitis B, Hepatitis C, or human immunodeficiency virus infection
Additional Criteria for Exclusion from Phase 2 (rezatapopt monotherapy)
* Known KRAS mutation, defined as a single nucleotide variant (SNV) (Phase 2)
Additional Criteria for Exclusion from Phase 1b (rezatapopt) + pembrolizumab combination)
* Received prior therapy with an anti-PD-1, anti-PD-L1, or anti-PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor and discontinued from that treatment due to a Grade 3 or higher immune-related AE (irAE)
* Received a live or live-attenuated vaccine within 30 days prior to the first dose of study intervention
* Diagnosis of immunodeficiency or receiving chronic systemic steroid therapy within 7 days prior to the first dose of study drug
* Hypersensitivity (≥ Grade 3) to pembrolizumab and/or any of its excipients
* Active autoimmune disease that has required systemic treatment in past 2 years
* History of radiation pneumonitis
* History of (non-infectious) or active pneumonitis / interstitial lung disease that required steroids
* Active infection requiring systemic therapy
* Known history of HIV infection
* Has previously received rezatapopt
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Cleveland, Ohio, 44195, United States
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Oklahoma City, Oklahoma, 73104, United States
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Fairfax, Virginia, 22031, United States
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Seattle, Washington, 98109, United States
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Madison, Wisconsin, 53705, United States
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Dallas, Texas, 75235, United States
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Frankfurt am Main, Hesse, Germany
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Charleston, South Carolina, 29425, United States
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