Rivipansel (GMI-1070) is a glycomimetic compound that acts as a pan-selectin inhibitor (binding to E-, P- and L-selectin). It has a 100-fold greater inhibitory acitivity for E-selectin than for P-selectin. In a phase II clinical trial, rivipansel has shown potential to reduce time of resolution for vaso-occlusive crises (although statistically insignificant) and to reduce opioid analgesic use in sickle cell disease patients. Two phase III studies evaluating the efficacy and safety of rivipansel in sickle cell disease patients were still ongoing in 2019. Besides studies in sickle cell disease or related disorders, clinical trials have also evaluated the use of rivipansel in moderate hepatic and renal impairment.

Buthionine sulfoximine (BSO) is a selective inhibitor of γ-glutamylcysteine synthetase (γ-GCS), the rate-limiting enzyme in glutathione (GSH) synthesis. In cancer cells, glutathione depletion significantly increased cytotoxicity via oxidative stress. In addition, in neuroblastoma cells susceptible to Buthionine sulfoximine treatment, DNA damage and cell apoptosis occurred via ROS production. Buthionine sulfoximine plus melphalan was effective in treatment for patients with recurrent/refractory neuroblastoma. Buthionine sulfoximine may also be used to increase the sensitivity of parasites to oxidative antiparasitic drugs. Buthionine sulfoximine has been shown to increase the efficacy of nifurtimox against T. cruzi and has also been shown to be an effective modulator of GSH-mediated chemoresistance by increasing the in vitro cytotoxicity of alkylating agents and radiation. Buthionine sulfoximine has been tested in animal studies and in human phase I trials for adults with solid tumors, with documented clinical responses in patients with melanoma, ovarian carcinoma and small cell carcinoma of the lung treated with the combination of Buthionine sulfoximine and melphalan.

Veledimex is an oral activator ligand for a proprietary gene therapy promoter system, and a moderate inhibitor of and substrate for CYP3A4/5. Veledimex controls the expression of the target gene. The amount of gene product produced by the system and the duration of the effect is dependent on veledimex dose level and duration of dosing. Nonclinical studies demonstrated that intratumoral administration of Ad-RTS-IL12 along with oral administration of veledimex elicited dose-dependent anti-tumor effects in murine melanoma, breast cancer and glioma models which correlated with increased plasma exposure of veledimex. The FDA granted Fast Track designation for Ad-RTS-hIL-12 plus veledimex for the treatment of recurrent or progressive glioblastoma multiforme in adults. Ad-RTS-hIL-12 is an inducible adenoviral vector encoding human pro-inflammatory cytokine interleukin-12 (IL-12), which is under the transcriptional control of the RheoSwitch Therapeutic System. Veledixmex is an oral activator ligand. Data previously presented suggest that Ad-RTS-hIL-12 with 20 mg veledimex improves the median overall survival from 6 to 9 months seen with available therapies to 12.7 months, with further improvement in median overall survival to 17.8 months in a subset of subjects with reduced cumulative steroid exposure during the active dosing period of veledimex. Veledimex has been used in trials studying the treatment of glioblastoma multiforme, metastatic breast cancer, and anaplastic oligoastrocytoma.

Tyroserleutide (YSL) is a tripeptide treatment being developed by Shenzhen Kangzhe Pharmaceutical Co Ltd, a subsidary of China Medical System Holdings (CMS), for the treatment of liver cancer. It is initially separated and purified from the hydrolyzates of pig’s spleen, but now can be obtained by chemical synthesis, its chemical name is L-tyrosine-L-serine-L-leucine. Tyroserleutide is an active, low-molecular-weight polypeptide, comprised of three amino acids, that has shown antitumor effects on human hepatocarcinoma BEL-7402 in vitro and in vivo. Tyroserleutide has various advantages over the other bioactive peptides such as its low molecular weight, simple construction, nonimmunogenicity, specificity, few side effects, and ease of synthesis. Tyroserleutide is in Phase-III clinical trials for the treatment of liver cancer.

Peldesine (also known as BCX-34) was developed as a purine nucleoside phosphorylase (PNP) inhibitor. It is known PNP inhibitors may be useful for treating a variety of T-cell related autoimmune diseases including psoriasis, rheumatoid arthritis, and Crohn s disease and T-cell cancers. Peldesine has undergone phase I trials for the treatment of human Immunodeficiency virus (HIV) infections. In addition, this drug participated in phase III clinical trial as a topical therapy for cutaneous T-cell lymphoma. This drug was also studied as a potential therapy for psoriasis, multiple sclerosis; rheumatoid arthritis; transplant rejection. However, all these indications were discontinued because of the lack of significant effects over placebo.

BMS-906024 is a lead candidate of a series of inhibitors of gamma secretase-mediated Notch signalling. BMS-906024 is an orally bioavailable, small-molecule gamma secretase (GS) and pan-Notch inhibitor, with potential antineoplastic activity. Upon administration, GS/pan-Notch inhibitor BMS-906024 binds to GS and blocks activation of Notch receptors, which may inhibit the proliferation of tumor cells with an overly-active Notch pathway. The integral membrane protein GS is a multi-subunit protease complex that cleaves single-pass transmembrane proteins, such as Notch receptors, at residues within their transmembrane domains that lead to their activation. Overexpression of the Notch signaling pathway has been correlated with increased tumor cell growth. BMS-906024 is currently in Phase 1 clinical trials for patients with T-cell acute lymphoblastic leukemia and metastatic solid tumors, including lung cancer.

METHYLENETETRAHYDROFOLIC ACID, L-(+), an endogenous biomodulator that was developed under the brand name modufolin or arfolitixorin by the Isofol Medical. Arfolitixorin is developed to increase the efficacy of standard of care chemotherapy for advanced colorectal cancer. This drug is currently being studied in a global phase 3 clinical trial. Besides, the drug successfully completed phase II as rescue therapy for osteosarcoma. 21 May 2019 Isofol Medical has received clinical patent protection for the arfolitixorinin USA. It relates to a method of increasing blood concentration of deoxyuridine, a blood biomarker for inhibition of tumor growth in human cancer treatment.