Our results indicate that BTKi therapy might increase susceptibility of MPN-BP SC to MDM2i therapy, by upregulating p53 activity and dampening NF-κB signaling, and also by disrupting protective TME interactions that sustain MPN-BP SC. This novel combination merits further clinical investigation in advanced phase MPN.
1 year ago
IO biomarker
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KRAS (KRAS proto-oncogene GTPase) • MDM2 (E3 ubiquitin protein ligase) • ETV6 (ETS Variant Transcription Factor 6) • BCL2L1 (BCL2-like 1) • WT1 (WT1 Transcription Factor) • CD34 (CD34 molecule) • PTPRC (Protein Tyrosine Phosphatase Receptor Type C) • EIF4EBP1 (Eukaryotic translation initiation factor 4E binding protein 1) • CDK1 (Cyclin-dependent kinase 1) • CDKN1A (Cyclin-dependent kinase inhibitor 1A) • DDB2 (Damage Specific DNA Binding Protein 2) • ATF3 (Activating Transcription Factor 3) • BTG2 (BTG Anti-Proliferation Factor 2)
TL-895-209 is an ongoing clinical trial evaluating the novel BTK/BMX inhibitor TL-895 added to rux in MF pts who are JAKi-naïve or have suboptimal response to rux. Myelofibrosis, IL-8, Ruxolitinib, Thrombocythemia
Physiological factors underlying higher exposure of TL-895 with fed administration were inferred from a MA-PBPKmodel. Simulations revealed dose linear increases in exposure with fed administration were aided by higher intestinal bile salt concentrations under fed conditions. Absorption was precipitation-limited under fasted conditions.
TL-895-204 is an open-label, 4 period study (N=26): Arm A (Reference) 150 mg TL-895 - low fat meal ( LFM ) (PK/PD); B - high fat meal ( HFM ) (PK); C - LFM and -10h, +2h staggered steady state (SS) famotidine (20 mg BID, PK); D - LFM and SS omeprazole (40 mg QD, PK/PD). TL-895 had appropriate PK for a covalent BTKI, with a short t 1/2 , long PD effect, and dose-proportional PK. Food increased AUC and decreased PK variability, regardless of meal type, TL-895 is given with food. At 300 mg TL-895, BTK occupancy was similar in fed vs fasted states, with saturable maximum BTK occupancy only incrementally higher than 150 mg.
TL-895, a highly selective, novel BTKi demonstrated potent inhibition of cell activation, proinflammatory signaling, migration and cytokine production in lymphoid and myeloid cells. In pts with CLL and MF, the 150mg BID doseachieved complete and sustained BTK occupancy throughout the dosing interval, despite faster BTK resynthesis in myeloid cells. TL-895 holds therapeutic promise by modulating key signaling nodes of cell activation, reducing stromal support, and downregulating proinflammatory cytokines in pts with CLL and MF.