Asciminib: an investigational agent for the treatment of chronic myeloid leukemia

ABSTRACT

Introduction: Tyrosine kinase inhibitors (TKIs) have drastically changed the outcome of chronic myeloid leukemia (CML) patients. However, a subset of patients experienced resistance and/or intolerance and need to switch to other agents. Resistance to second-generation TKIs used in first-line treatment is less of an issue when compared to imatinib in first line. New drugs that are able to improve efficacy, without long-term off-target effects are needed. Allosteric inhibitors such as asciminib (ABL001) were created to overcome resistance and off-target toxicity.

Areas covered: In this review, we report the mechanism of action, pharmacokinetic data, and the clinical trial results of asciminib tested in chronic phase CML patients.

Expert Opinion: Asciminib, the first example of allosteric inhibition, could be a promising approach as third-line therapy and in the subset of patients with T315I mutation that, for coexistent comorbidities, cannot receive other drugs. Future results will probably help to move the drug to earlier lines of treatment.

KEYWORDS:

• Chronic myeloid leukemia
• tyrosine kinase inhibitors
• allosteric inhibition
• asciminib

Article Highlights

• Unmet needs in third-line setting remains one of the major criticisms in the treatment of CML.

• Asciminib or STAMP inhibitor binds the myristoyl pocket of ABL1.

• Results of a phase 1a study and of a phase 3, comapring the drug versus second generation TKI, showed efficacy in patients who failed two previous lines of treatment.

• At the dose of 200 mg BID can overcome the resistance due to T315I mutation.

• The selectivity against ABL1 explains the absence of off-target effects in the mentioned studies.

Drug summary

Table

Declaration of interest

M Breccia received honoraria from Novartis, Pfizer, Incyte, BMS/Celgene, AbbVie. 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.

Reviewer disclosures

One reviewer has participated in an advisory board for asciminib but did not receive payment. This reviewer has received payments for other consulting projects with Novartis. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.