Potential of BCL2 as a target for chronic lymphocytic leukemia treatment

ABSTRACT

Introduction: Chronic lymphocytic leukemia (CLL) is a highly heterogeneous disease. Deregulation of apoptosis is a major pathogenetic feature, and represents a therapeutic target. TP53 disrupted patients are categorized as high risk patients and are treated with novel target therapies. Among these new drugs, venetoclax, an orally bioavailable BCL2 inhibitor, has shown high efficacy also in relapsed/refractory CLL with TP53 disruption. Venetoclax has also been tested in combination with other drugs without compromising venetoclax dose and with a good safety profile.

Areas covered: This article covers the biology of apoptosis in CLL from a translational viewpoint and deals with the mode of action of BCL2 inhibitors, in particular venetoclax. On this biological rationale, the review then focuses on the results obtained in clinical trials with venetoclax in CLL.

Expert commentary: The availability of venetoclax represents a major advance in CLL treatment and offers new opportunities to further improve the results obtained until now by combining venetoclax with other agents. Venetoclax has achieved responses also in patients with TP53 disruption. These results strongly suggest that the mechanism by which venetoclax kills CLL cells might overcome a dysfunctional TP53 that is a major hallmark of chemorefractoriness to conventional antineoplastic agents.

KEYWORDS:

• Chronic lymphocytic leukemia
• apoptosis
• BCL2 inhibitors
• venetoclax
• target therapy

Declaration of interest

G Gaidano has roles on advisory boards or speakers’ bureaus of Roche, Abbvie, Janssen, Gilead, and Morphosys. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. One peer reviewer declares employment by Walter and Eliza Hall Institute but peer reviewers have no other relevant financial relationships to disclose.

Additional information

Funding

The authors acknowledge support by Special Program Molecular Clinical Oncology 5 × 1000 No. 10007, Associazione Italiana per la Ricerca sul Cancro Foundation Milan, Italy; Progetto Ricerca Finalizzata (RF-2011-02349712), Ministero della Salute, Rome, Italy; and MIUR, (PRIN 2015ZMRFEA_004), Rome, Italy.