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Burton's Tyrosine Kinase Inhibition by Ibrutinib: Current Status

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Burton's Tyrosine Kinase Inhibition by Ibrutinib: Current Status L al of euk rn em u i o a J Journal of Leukemia Mathur, J Leuk 2015, 3:2 ISSN: 2329-6917 DOI: 10.4172/2329-6917.1000e113 Editorial Open Access Burton’s Tyrosine Kinase Inhibition by Ibrutinib: Current Status Rohit Mathur* Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA *Corresponding author: Rohit Mathur, Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, 7455 Fannin St., Houston, TX 77054 , USA, Tel: 713 563-3412; Fax: 713 563-7314; E-mail: [email protected] Rec date: March 30, 2015; Acc date: April 1, 2015; Pub date: April 18, 2015 Copyright: © 2015 Mathur R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Editorial combined with rituximab, bortezomib, bendamustine, lenalidomide, ABT-199, ofatumumab or newly developed anti-CD20 antibodies Burton’s tyrosine kinase (BTK) is a nonreceptor/cytoplasmic Ublituximab (UTX) or Obinutuzumab (GA101) in different clinical tyrosine kinase that modulates the downstream signaling pathway of protocols for MCL and CLL [10-14]. The success of ibrutinib also come B-cell receptor (BCR) [1]. Aberrant BCR signaling including up- from its ability to target tumor microenvironment, chemokines SDF1/ regulation of tyrosine kinases i.e. Lyn, Syk and Btk is a common feature CXCR4 mediated migration. Ibrutinib inhibits concomitant TLR and in lymphoid malignancies such as Chronic Lymphocytic Leukemia BCR- driven proliferation of CLL cells and overrides the supportive (CLL), Mantle Cell Lymphoma (MCL) and other Non-Hodgkin’s survival-promoting effects of microenvironmental signals [15]. Lymphoma (NHL) [2]. Therefore, inhibition of tyrosine kinases is an attractive treatment option in these lymphoid malignancies. Ibrutinib Inspite of a broad clinical activity of ibrutinib, several of patients (formerly PCI-32765) is a first-in-human, orally bioavailable small with B-cell malignancies progressed after treatment with ibrutinib. Few molecule inhibitor of BTK that has shown potent clinical activity in studies undertaken so far, attributes the resistance to ibrutinib with majority of CD20 positive B-cell malignancies. Based on high response mutations in B-cell receptor (BCR) signaling proteins such as BTK rate, tolerability and safety data, Imbruvica/Ibrutinib has recently been C481S, PLCg2 [16,17]. In addition, mutations in MLL2, CREBBP, approved by Food and Drug Administration (FDA) for the treatment PIM1 and ERBB4 kinase were also attributed to resistance mechanisms of MCL (in November 2013) and CLL (in February 2014) with at least to ibrutinib [18]. Interestingly, treatment with ibrutinib, vincristine, or one prior therapy. It is now under evaluation as front line therapy in doxorubicin could induce cell death in MCL cells, but could not reduce other subtypes of NHL and is explored for combination with other the percentage of MCL-initiating cells (MCL-ICs) in a co-culture MCL drugs. model [19]. Therefore, it is important to understand the mechanisms underlying the activity of ibrutinib. However, advanced studies have Ibrutinib showed a response rate of 68% (75 patients) with a shown that treatment with other targeting agents such as inhibitors of complete response rate of 21% and a partial response rate of 47% in a SYK, another downstream mediator of BCR signaling or ABT-199, a phase II study of 111 patients with relapsed or refractory mantle cell Bcl2 inhibitor have potential to sensitize ibrutinib resistant MCL and lymphoma [3]. Previous therapy to these patients had no effect on CLL cells [20]. Pretreatment of DLBCL cells with SYK inhibitors (e.g. overall survival. Updated results presented in American society of R406) re-sensitized resistant B-lymphoma cells with either C481S BTK hematology (Ash) meeting 2014 demonstrated the durability of or R665W PLCG2 mutations to ibrutinib. Ibrutinib in combination response and sustained single agent activity of ibrutinib in an with BCL-2 or SYK inhibitors, inhibiting cell growth, IgM-induced international multicenter phase II study of refractory MCL [4]. In calcium flux, cell adhesion or migration in mutation containing cells another study on previously treated CLL, ibrutinib showed an 71% [21]. Further, other drugs such as Duvelisib (IPI-145), a overall response rate and updated results after 3 years of follow up Phosphoinositide-3-Kinase-δ,γ Inhibitor or RP6530, a Dual PI3Kδ/γ verify the durability of responses, probably on account of lower toxicity Inhibitor and newer generation HSP90 inhibitors (AUY922) have been of ibrutinib in CLL and SLL [5]. Results from other recent studies also shown to have clinical activity in patients progressed after ibrutinib supports ibrutinib as first line or second treatment option in refractory treatment [22-24]. cases [6]. A survival benefit with ibrutinib, together with sustained improvements in hematologic endpoints and PRO suggest that it Pre-clinical reports suggests that ibrutinib antagonizes rituximab- enhances quality of life, while prolonging survival in CLL including dependent NK-cell mediated cytotoxicity (ADCC) due to its secondary with p17 deletion [7]. irreversible binding to interleukin-2 inducible tyrosine kinase (ITK), which is required for FcR-stimulated NK cell function including Further, treatment of ibrutinib is under evaluation for other tumors calcium mobilization, granule release, and overall ADCC [25]. such as Follicular lymphoma (FL), diffuse large B-cell lymphoma Therefore, new BTK inhibitors, BTK-InhA (ACP-196), BTK-InhB (DLBCL), and Multiple myeloma (MM). Early results of various (BGB-3111), and CGI-1746 (GDC-0834) [26,27] have been studies showed promise of using it as a single agent treatment in synthesized with lower ITK binding, which may preserve NK cell relapsed/refractory lymphomas and myeloma. Although, ibrutinib function and therefore synergize rather than antagonize rituximab. appears less active in FL than in MCL and CLL but it may be a good Preclinical studies showed that the efficacy of therapeutics which do option for refractory FL [8]. Recent study with multiple myeloma in not inhibit NK cell function, including three novel BTK inhibitors, is heavily pre-treated patient population also showed evidence of anti- superior to ibrutinib [26,28]. Further, clinical investigation with newer tumor activity with treatment of ibrutinib, as a single agent and in inhibitors is needed to determine the impact of this finding on patients combination with dexamethasone, as the treatment was well tolerated with lymphoma receiving rituximab. with manageable toxicities [9]. In addition, several drug combinations of ibrutinib with other drugs are under evaluation. Initial results from In conclusion, ibrutinib has a broad clinical activity in all B-cell recent studies have also shown that ibrutinib can be successfully malignancies and provided a good treatment option for J Leuk Volume 3 • Issue 2 • 1000e113 ISSN:2329-6917 JLU, an open access journal Citation: Mathur (2015) Burton’s Tyrosine Kinase Inhibition by Ibrutinib: Current Status. J Leuk 3: e113. doi:10.4172/2329-6917.1000e113 Page 2 of 2 chemorefractory MCL, and CLL. More mechanistic insights into its Monoclonal Antibody, in Combination with Ibrutinib Is Highly Active in function, resistance mechanisms will clearly help understand its Patients with Relapsed and/or Refractory CLL and MCL; Results of a Phase clinical activity and its possible use in other leukemia, indolent and II Trial. Blood 21 : 4679-4685 other types of lymphomas. 14. Herter S, Sagiv-Barfi I, Chester C, Sadaram M, Hebb J, et al. (2014) Obinutuzumab (GA101) Is Less Prone to Antagonism of Immune Effector Function By Ibrutinib Than Rituximab in Vitro and in Vivo. Blood 21: References 1765-1772 1. Mohamed AJ, Nore BF, Christensson B, Smith CI (1999) Signalling of 15. Temburni S, Barrientos JC, Kolitz JE, Allen SL, Rai KR, et al. (2014) Bruton's tyrosine kinase, Btk. Scand J Immunol 49: 113-118. Ibrutinib Inhibits Concomitant TLR and BCR- Driven Proliferation of Chronic Lymphocytic Leukemia Cells and Overrides the Supportive Shaffer AL, Rosenwald A, Staudt LM (2002) Lymphoid malignancies: the 2. Survival-Promoting Effects of Microenvironmental Signals. Blood 21: dark side of B-cell differentiation. Nat Rev Immunol 2: 920-932. 3310-3312 Wang ML, Rule S, Martin P, Goy A, Auer R, et al. (2013) Targeting BTK 3. Furman RR, Cheng S, Lu P, Setty M, Perez AR, et al. (2014) Ibrutinib with ibrutinib in relapsed or refractory mantle-cell lymphoma. N Engl J 16. resistance in chronic lymphocytic leukemia. N Engl J Med 370: 2352-2354. Med 369: 507-516. Woyach JA, Furman RR, Liu TM, Ozer HG, Zapatka M, et al. (2014) Wang M, Goy A, Martin P, Ramchandren R, Alexeeva J, et al. (2014) 17. 4. Resistance mechanisms for the Bruton's tyrosine kinase inhibitor ibrutinib. Efficacy and Safety of Single-Agent Ibrutinib in Patients with Mantle Cell N Engl J Med 370: 2286-2294. Lymphoma Who Progressed after Bortezomib Therapy. Blood 21: 4471-4475 18. Balasubramanian S, Schaffer M, Deraedt W, Davis C, Stepanchick E, et al. (2014) Mutational Analysis of Patients with Primary Resistance to Single- Byrd JC, Furman RR, Coutre SE, Burger JA, Blum KA, et al. (2015) Three- 5. Agent Ibrutinib in Relapsed or Refractory Mantle Cell Lymphoma (MCL). year follow-up of treatment-naïve and previously treated patients with CLL Blood 21: 78-79. and SLL receiving single-agent ibrutinib. Blood (Epub ahead of print). Samaniego F, Sehgal L, Braun FK, Berkova Z, Romaguera JE, et al. (2014) Farooqui MZ, Valdez J, Martyr S, Aue G, Saba N, et al. (2015) Ibrutinib for 19. 6. Molecular Signatures of Tumor-Initiating Cells Unveil Wnt Pathway As a previously untreated and relapsed or refractory chronic lymphocytic Therapeutic Target in Mantle Cell Lymphoma. Blood 21: 2148-2150. leukaemia with TP53 aberrations: a phase 2, single-arm trial. Lancet Oncol 16: 169-176.
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