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Ref Type Journal Article
PMID (38437498)
Authors Fiskus W, Piel J, Collins MP, Hentemann M, Cuglievan B, Mill CP, Birdwell C, Das K, Davis JA, Hou H, Jain A, Malovannaya A, Kadia TM, Daver NG, Sasaki K, Takahashi K, Hammond D, Reville PK, Wang J, Loghavi S, Sen R, Ruan X, Su X, Flores L, DiNardo CD, Bhalla KN
Title BRG1/BRM inhibitor targets AML stem cells and exerts superior preclinical efficacy combined with BET or Menin inhibitor.
URL
Abstract Text BRG1 (SMARCA4) and BRM (SMARCA2) are the mutually exclusive core ATPases of the chromatin remodeling BAF (BRG1/BRM-associated factor) complexes. They enable transcription factors/co-factors to access enhancers/promoter and modulate gene-expressions responsible for cell growth and differentiation of AML stem/progenitor cells. In AML with MLL1r (MLL1 rearrangement) or mutant (mt) NPM1, although Menin inhibitor (MI) treatment induces clinical remissions, most patients either fail to respond or relapse, some harboring Menin mutations. FHD-286 is an orally bioavailable, selective inhibitor of BRG1/BRM under clinical development in AML. Present studies show that FHD-286 induces differentiation and lethality in AML cells with MLL1r or mtNPM1, concomitantly causing perturbed chromatin accessibility and repression of c-Myc, PU.1 and CDK4/6. Co-treatment with FHD-286 and decitabine, BET inhibitor (BETi) or MI, or venetoclax synergistically induced in vitro lethality in AML cells with MLL1r or mtNPM1. In patient-derived xenograft (PDX) models of AML with MLL1r or mtNPM1, FHD-286 treatment reduced AML burden, improved survival, and attenuated AML-initiating potential of stem-progenitor cells. Compared to each drug, co-treatment with FHD-286 and BETi, MI, decitabine or venetoclax significantly reduced AML burden and improved survival, without inducing significant toxicity. These findings highlight the FHD-286-based combinations as promising therapy of AML with MLL1r or mtNPM1.

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Molecular Profile Treatment Approach
Gene Name Source Synonyms Protein Domains Gene Description Gene Role
Therapy Name Drugs Efficacy Evidence Clinical Trials
FHD-286 FHD-286 1 2
Drug Name Trade Name Synonyms Drug Classes Drug Description
FHD-286 FHD286|FHD 286 FHD-286 inhibits SMARCA4 (BRG1) and SMARCA2 (BRM), which may lead to altered chromatin accessibility and decreased tumor growth (Cancer Res 2022;82(12_Suppl):Abstract nr ND14, PMID: 38437498).
Gene Variant Impact Protein Effect Variant Description Associated with drug Resistance
Molecular Profile Indication/Tumor Type Response Type Therapy Name Approval Status Evidence Type Efficacy Evidence References
KMT2A rearrange acute myeloid leukemia sensitive Decitabine + FHD-286 Preclinical - Cell culture Actionable In a preclinical study, the combination of FHD-286 and Dacogen (decitabine) synergistically inhibited viability of acute myeloid leukemia cell lines harboring a KMT2A rearrangement in culture (PMID: 38437498). 38437498
KMT2A rearrange acute myeloid leukemia sensitive FHD-286 + Venetoclax Preclinical - Patient cell culture Actionable In a preclinical study, the combination of FHD-286 and Venclexta (venetoclax) synergistically inhibited viability of acute myeloid leukemia cell lines and a patient-derived cell line harboring a KMT2A rearrangement in culture (PMID: 38437498). 38437498
KMT2A rearrange acute myeloid leukemia sensitive FHD-286 Preclinical - Patient cell culture Actionable In a preclinical study, FHD-286 induced differentiation and decreased viability in acute myeloid leukemia cell lines and patient-derived cells harboring a KMT2A rearrangement in culture (PMID: 38437498). 38437498
KMT2A rearrange acute myeloid leukemia sensitive Birabresib + FHD-286 Preclinical - Patient cell culture Actionable In a preclinical study, the combination of FHD-286 and Birabresib (OTX015) synergistically inhibited viability of acute myeloid leukemia cell lines and a patient-derived cell line harboring a KMT2A rearrangement in culture (PMID: 38437498). 38437498
KMT2A rearrange acute myeloid leukemia sensitive FHD-286 + Revumenib Preclinical - Patient cell culture Actionable In a preclinical study, the combination of FHD-286 and Revuforj (revumenib) synergistically inhibited viability of acute myeloid leukemia cell lines and a patient-derived cell line harboring a KMT2A rearrangement in culture (PMID: 38437498). 38437498