Department of Medical Oncology, Dana-Farber Cancer Institute, Jerome Lipper Center for Multiple Myeloma Research, Harvard Medical School, Boston, MA, USA.
Division of Hematology, Brigham and Women's Hospital, Boston, MA, USA.
Expert Rev Hematol. 2024 Aug;17(8):445-465. doi: 10.1080/17474086.2024.2382897. Epub 2024 Jul 27.
INTRODUCTION: The treatment of multiple myeloma (MM) is evolving rapidly. Quadruplet regimens incorporating proteasome inhibitors, immunomodulatory drugs (IMiDs), and CD38 monoclonal antibodies have emerged as standard-of-care options for newly diagnosed MM, and numerous novel therapies have been approved for relapsed/refractory MM. However, there remains a need for novel options in multiple settings, including refractoriness to frontline standards of care. AREAS COVERED: Targeting degradation of IKZF1 and IKZF3 - Ikaros and Aiolos - through modulation of cereblon, an E3 ligase substrate recruiter/receptor, is a key mechanism of action of the IMiDs and the CELMoD agents. Two CELMoD agents, iberdomide and mezigdomide, have demonstrated substantial preclinical and clinical activity in MM and have entered phase 3 investigation. Using a literature search methodology comprising searches of PubMed (unlimited time-frame) and international hematology/oncology conference abstracts (2019-2023), this paper reviews the importance of Ikaros and Aiolos in MM, the mechanism of action of the IMiDs and CELMoD agents and their relative potency for targeting Ikaros and Aiolos, and preclinical and clinical data on iberdomide and mezigdomide. EXPERT OPINION: Emerging data suggest that iberdomide and mezigdomide have promising activity, including in IMiD-resistant settings and, pending phase 3 findings, may provide additional treatment options for patients with MM.
简介:多发性骨髓瘤(MM)的治疗正在迅速发展。包含蛋白酶体抑制剂、免疫调节药物(IMiDs)和 CD38 单克隆抗体的四联方案已成为新诊断 MM 的标准治疗选择,并且许多新疗法已被批准用于复发性/难治性 MM。然而,在多种情况下仍需要新的选择,包括对一线标准治疗的耐药性。
涵盖领域:通过调节 E3 连接酶底物招募/受体 cereblon,靶向降解 IKZF1 和 IKZF3(Ikaros 和 Aiolos)是 IMiDs 和 CELMoD 药物的关键作用机制。两种 CELMoD 药物,iberdomide 和 mezigdomide,在 MM 中表现出显著的临床前和临床活性,并已进入 3 期研究。本文使用包括在 PubMed(无时间限制)和国际血液学/肿瘤学会议摘要(2019-2023 年)中进行的文献搜索方法,综述了 Ikaros 和 Aiolos 在 MM 中的重要性、IMiDs 和 CELMoD 药物的作用机制及其针对 Ikaros 和 Aiolos 的相对效力,以及 iberdomide 和 mezigdomide 的临床前和临床数据。
专家意见:新出现的数据表明,iberdomide 和 mezigdomide 具有有前途的活性,包括在 IMiD 耐药环境中,并且在 3 期研究结果公布之前,可能为 MM 患者提供额外的治疗选择。
J Med Chem. 2017-4-20
Hematol Oncol Clin North Am. 2024-4