As I have mentioned before, late May and early June is typically a busy time for Follicular Lymphoma research, with presentations at ASCO. (Though this year was kind of a less busy year for FL). But soon after that, in mid-June, the European Hematalogical Association's conference on Lymphoma takes place in Lugano, Switzerland. I don't usually hear as much about that conference, so I don't write about it as much. But there have been some interesting results coming from it this year.
One presentation that I have seen several stories about was called "BMS-986458, A FIRST-IN-CLASS, BIFUNCTIONAL CEREBLON-DEPENDENT LIGAND-DIRECTED DEGRADER (LDD) OF B-CELL LYMPHOMA 6 (BCL6) IN PATIENTS WITH RELAPSED/REFRACTORY NON-HODGKIN LYMPHOMA: INITIAL PH 1 RESULTS."
The presentation describes the very early results of a phase 1 clinical trial, so there's certainly no guarantee that this research will ultimately be successful. (Remember that less than 10% of cancer treatments that enter clinical trials are eventually approved.) But it's a very different kind of treatment, and worth writing about and keeping an eye on.
The treatment is currently known as BMS-986458, though it will eventually have a name that's easier to remember if it keeps moving forward. BMS-986458 is "oral, highly selective bifunctional cereblon-dependent LDD of BCL6."
There's lots of unpack there.
First, let's look at the target for this treatment, BCL6. As the leader of this research says in an interview about the presentation, BCL6, short for B Cell Lymphoma 6, has been a target for Lymphoma researchers for a long time. It is a protein that is connected to the BCL6 gene. The main function of BCL6 is to make sure B Cells (the cells that are cancerous in FL) can change so they can recognize invaders like bacteria or viruses. The B Cells can recognize an invader, fight it off, and then die. But if something happens to BCL6, then the B Cells can grow without apoptosis -- the natural process that results in the cells dying. No dying means they continue to grow uncontrolled, and uncontrolled cells means cancer, in the case FL or Diffuse Large B Cell Lymphoma or some other kind of B Cell Lymphoma.
So BMS-986458 is meant to find cancerous B Cells by focusing on the BCL6 protein. It "degrades" or breaks down that protein, and since that protein is necessary for cell growth, the result is apoptosis -- the cell dies the way it is supposed to.
In the small phase 1 study that is described in the EHA presentation, BMS-986458 was given to 22 patients, including 13 with DLBCL, 3 with high-grade B-cell lymphoma with MYC and BCL2 rearrangements, and 5 with Follicular Lymphoma. A total of 13 patients were evaluated after a median of 2.4 months. 7 of them had a Partial Response and 3 had a Complete Response to the treatment.
The primary goal of a phase 1 treatment, however, is to evaluate safety -- to figure out the best dose of a treatment while causing the fewest side effects. Safety was good -- there were no grade 3 or greater Adverse Events, which is very encouraging. However, one patient had to leave the trial because it seemed to affect a different health issue and another had to have the dose reduced because of side effects. In all 4 of the patients who were not evaluated had to leave the study because of adverse events/side effects.
The early results are very interesting. Definitely worth keeping track of. The lead researcher said in that interview that combining BMS-986458 with bispecifics or monoclonal antibodies seems like a logical next step, since the combination would work against the cancer cells in different, hopefully complimentary ways.
But they are very early results. Lots can happen as the trials move forward. But it's good to be hopeful.