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Targeting BET bromodomain proteins in cancer: The example of lymphomas
Filippo Spriano1, Anastasios Stathis2, Francesco Bertoni3
1Institute of Oncology Research, Faculty of Biomedical Sciences, USI, Bellinzona, Switzerland.
Abstract:
The Bromo- and Extra-Terminal domain (BET) family proteins act as "readers" of acetylated histones and they are important transcription regulators. BRD2, BRD3, BRD4 and BRDT, part of the BET family, are important in different tumors, where upregulation or translocation often occurs. The potential of targeting BET proteins as anti-cancer treatment originated with data obtained with a first series of compounds, and there are now several data supporting BET inhibition in both solid tumors and hematological malignancies. Despite very positive preclinical data in different tumor types, the clinical results have been so far moderate. Using lymphoma as an example to review the data produced in the laboratory and in the context of the early clinical trials, we discuss the modalities to make BET targeting more efficient both generating novel generation of compounds and by exploring the combination with small molecules affecting various signaling pathways, BCL2, or DNA damage response signaling, but also with additional epigenetic agents and with immunotherapy. We also discuss the mechanisms of resistance and the toxicity profiles so far reported.
Insights
Targeting Bromo- and Extra-Terminal domain (BET) proteins shows promise in cancer treatment. Enhancing BET inhibitors through novel compounds and combination therapies may improve clinical efficacy against various malignancies.
Area of Science:
- Epigenetics and Cancer Biology
- Molecular Oncology
- Pharmacology
Background:
- Bromo- and Extra-Terminal domain (BET) proteins are key epigenetic regulators involved in transcription.
- Dysregulation of BET proteins (BRD2, BRD3, BRD4, BRDT) is implicated in various cancers.
- BET inhibition is a promising anti-cancer strategy with significant preclinical data.
Purpose of the Study:
- To review laboratory and early clinical trial data on BET protein inhibition, using lymphoma as a model.
- To discuss strategies for enhancing the efficacy of BET-targeting therapies.
- To explore potential combination treatments and address resistance mechanisms and toxicity.
Main Methods:
- Review of preclinical data on BET inhibitors in various tumor types.
- Analysis of early-phase clinical trial outcomes for BET-targeted agents.
- Exploration of combination strategies with other therapeutic modalities.
Main Results:
- While preclinical data for BET inhibition are highly encouraging, clinical results have been moderate.
- Lymphoma serves as a case study for evaluating BET targeting efficacy.
- Potential for improved outcomes exists through novel compound development and combination therapies.
Conclusions:
- BET inhibitors represent a valuable therapeutic avenue in oncology, particularly for hematological malignancies.
- Overcoming current limitations requires developing next-generation BET inhibitors and exploring rational combination strategies.
- Combinations with signaling pathway inhibitors, BCL2 inhibitors, DNA damage response agents, epigenetic drugs, or immunotherapy warrant further investigation to improve clinical responses and manage resistance and toxicity.
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