Live from ASCO 2013: Targeted B cell therapies
Typing fast. May have made errors but wanted to get this out
After my bad karma of a weird 35 miles and 16 minute diversion from Orange County to Ontario and then another three hour delay due to weather, I arrive in Chicago four hours late.
Today my karma was good: the hotel and shuttle were perfect. At the meeting 10 minutes early.
ABC diffuse B cell lymphoma DLBCL
Stuck in the on position
Message from BCR- turns out that BTK is turned on upstream
Ibrutinib binds to site only found in 10 kinases covalent binds to cysteine 481, lasts all day
Inhibits BCR signaling and works other ways when BCR not turned on
Failed in primary refractory disease, worked better in relapsed/refractory
Works great in ABC type as expected Small #s
CD79B mutation 70% response rate, without still 31% response rate-
MYD88 +CD79B 4 of 5 response
MYD88 resistant Poor response??
CARD 11 downstream no response as expected
Ibrutinib synergizes w PI3K (inhibitor maybe alpha) mTOR, lenalidomide, steroids, chemo
IRAK4 inhibitors???- selective. Works with ibrutinib
- SYK non receptor fostamanib
BTK inhibitor (ibrutinib)
Little cumulative toxicity- marrow and elsewhere counts stay good
PFS 96%? in RX naive (Byrd from ASH 2012) abound 60% in R/R 17 p at 2 yrs
high response rates 70%
like other biologicals improves the longer patient stays on drug
CC292 (used to be AVL-292)
Didn't mention but ONO has a BTK inhibitor in early trials that pre-clinical is strong
CLL significant nodal reduction including those with 17p
Also MCL and others
Little marrow toxicities, some liver enzymes up, pneumonia
IPI-145 Phase 1 study Good responses including response in Hodgkin's and T cells!
Dumping of cells from nodes and marrow into the blood (evidence from the marrow is thin- I asked)
Don't get the high WBC when mixed with chemo
EPIGENETICS (Dana Farber)
IN THE NUCLEUS that the actions happens
Sequencing cancer genomes
600,000 events altered, at least 486 important??? ( not sure of #)
Only 15 drugs that targets somatic mutation
Also progression- Need to get to master regulator in nucleus
Histone is critical
HDAC removes markers (placeholders)
Binds zinc -removes reminder cap
Early w cardiac toxicity
Topical T cells treatment that breaks down when absorbed into blood so less toxicity
Bromodomain inhibitor JQ1
? turns off master growth MYC genes in MM
XANX bromodomain inhibitors
Dana Farber open-source model of drug discovery.
Questions about how to control cost
That's it for now. I am sure there are mistakes in this. Please forgive. I just wanted to get this out fast in this unedited form to give you a sense of the barrage of information, but later I will of course return to my more editorial style. And videos too soon.
So much happening. So much info. This is all good.