Division of Hematology and Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Expert Opin Pharmacother. 2022 Feb;23(3):295-301. doi: 10.1080/14656566.2021.2014815. Epub 2021 Dec 14.
Follicular lymphoma (FL) is the second most common form of B cell lymphoma and generally presents as an indolent and relatively slow-growing tumor. However, most FLs are incurable with a shortening of subsequent responses. Therefore, novel and more effective treatments are desperately needed. Tazemetostat is a first-in-class, selective, oral inhibitor of EZH2, a lysine methyltransferase that is mutated in about 25% of FL. Tazemetostat has been recently approved for relapsed/refractory FL after two or more lines of therapy in the presence of an EZH2 mutation or independent of an EZH2 mutation in the absence of other options.
Here, the authors provide a review focusing on the molecular mechanisms of EZH2, clinical development of tazemetostat and other EZH2 inhibitors (EZH2i), as single-agent therapy and in combinatorial regimens. Finally, they provide a futuristic look at therapeutic approaches for this disease.
Tazemetostat monotherapy showed clinically meaningful and durable responses with a favorable toxicity profile, especially in EZH2 mutant lymphoma. Future studies should explore mechanism-based combinatorial regimens to maximize and prolong the anti-lymphoma effect.
滤泡性淋巴瘤(FL)是第二常见的 B 细胞淋巴瘤,通常表现为惰性和相对缓慢生长的肿瘤。然而,大多数 FL 是不可治愈的,随后的反应时间缩短。因此,迫切需要新的、更有效的治疗方法。他泽莫司他是一种首创的、选择性的 EZH2 口服抑制剂,EZH2 是一种赖氨酸甲基转移酶,约 25%的 FL 中存在突变。在存在 EZH2 突变或在没有其他选择的情况下独立于 EZH2 突变的情况下,他泽莫司他已在二线或二线以上治疗后复发/难治性 FL 中获得批准。
作者在这里提供了一篇综述,重点介绍了 EZH2 的分子机制、他泽莫司他和其他 EZH2 抑制剂(EZH2i)的临床开发情况,包括单药治疗和联合治疗方案。最后,他们对这种疾病的治疗方法进行了前瞻性展望。
他泽莫司他单药治疗具有临床意义的持久反应,且毒性特征良好,特别是在 EZH2 突变淋巴瘤中。未来的研究应探索基于机制的联合治疗方案,以最大程度地提高和延长抗淋巴瘤作用。