The newest drugs to target chronic lymphocytic leukaemia (CLL) include the inhibitors of the intracellular B-cell receptor signalling (BCR inhibitor) 1 and the BCL2 inhibitor venetoclax. 2,3 B-cell receptor signalling inhibitors incorporate the direct BTK inhibitor ibrutinib and the inhibitor of PI3K-delta, 4 a BTK downstream effector, idelalisib. Both ibrutinib and idelalisib have entered the clinical field with impressive results in chemotherapy-refractory CLL patients. However, both drugs are less effective with p53 mutated/deleted CLL cells. This type of CLL remains highly challenging form which should better benefit from the treatment with the BCL2 inhibitor, venetoclax, which acts as a pro-apoptotic trigger. 5 With such a remarkable option of drugs and the possibility to target p53 mutated/deleted clones, CLL should be considered as an easily treatable cancer and the intent to eradicate the disease no longer a fleeting mirage. Unfortunately, cases of resistance to each of these novel drugs have already been reported and mechanisms of resistance deeply investigated. 2,6-8 Interestingly, however, no recurrent abnormalities or mutations have been associated with a specific pattern of resistance, posing some concerns on how resistant patients can be further treated.
AbstractThe development of drugs able to target BTK, PI3k-delta and BCL2 has dramatically improved chronic lymphocytic leukaemia (CLL) therapies. However, drug resistance to these therapies has already been reported due to non-recurrent changes in oncogenic pathways and genes expression signatures. In this study, we investigated the cooperative role of the BCL2 inhibitor venetoclax and the BRD4 inhibitor JQ1. In particular, we found that JQ1 shows additional activity with venetoclax, in CLL cell lines and in ex vivo isolated primary CD19 + lymphocytes, arguing in favour of combination strategies. Lastly, JQ1 is also effective in venetoclax-resistant CLL cell lines. Together, our findings indicated that the BET inhibitor JQ1 could be a promising therapy in CLL, both as first-line therapy in combination with venetoclax and as second-line therapy, after the emergence of venetoclax-resistant clones.