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ONO-4578 is an orally bioavailable small molecule antagonist of the prostaglandin E2 receptor subtype 4 (EP4, also known as PTGER4). It is being developed primarily for oncology indications. By selectively binding to and inhibiting EP4, ONO-4578 blocks the immunosuppressive signaling mediated by prostaglandin E2 (PGE2), which can promote tumor cell proliferation and invasion. Inhibition of EP4 also reduces activity of tumor-associated myeloid cells in the tumor microenvironment by suppressing interleukin-23 production and Th17 cell expansion. Clinical studies have shown that ONO-4578 has a manageable safety profile and signs of antitumor activity when used alone or in combination with nivolumab (a PD-1 inhibitor) in patients with advanced solid tumors, including colorectal cancer[2][3][5][6].
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