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BMS-986158 is a selective oral bromodomain and extra-terminal motif inhibitor currently under evaluation in combination with the Janus kinase inhibitors (JAKi) ruxolitinib or fedratinib in patients with treatment-naïve (TN) and relapsed/refractory (R/R) myelofibrosis (MF), as part of the phase 1b/2 CA011-023 (NCT04817007) study.
JAKi are the current standard of care for MF. The use of bromodomain and extra-terminal motif inhibitor in combination has been shown to reduce proinflammatory signals and disease burden preclinically – a key differentiator from the standard of care in MF.
During the 65th American Society of Hematology (ASH) Annual Meeting, Lee-Hoflich, et al. presented an analysis of the early disease-modifying properties of BMS-986158 in combination with JAKi. Here, we summarize the key points.
Check out our top abstracts presented at the 65th ASH Annual Meeting and Exposition here.
A summary of the trial design and key eligibility criteria are provided in Figure 1.
Figure 1. CA011-023 study design and eligibility criteria*
BID, twice a day; DIPSS, Dynamic International Prognostic Scoring System; ECOG PS, Eastern Cooperative Oncology Group performance status; FED, fedratinib; Int, intermediate; MF, myelofibrosis; QD, daily; RP2D, recommended phase II dose; RUX, ruxolitinib.
*Adapted from Lee-Hoflich, et al.1
In this analysis, exploratory measures of disease modification included:
A summary of Grade ≥1 BMF reductions for TN and R/R patients are outlined in Tables 1 and 2, respectively.
Table 1. Bone marrow fibrosis reduction in patients with treatment-naïve myelofibrosis*
BMS-986158 QD + RUX 15 mg BID, % (unless otherwise specified) |
Grade ≥1 reduction |
Stabilized (maintained at MF 1 or MF 2) |
Progressed (increased MF score or at highest grade MF 3) |
---|---|---|---|
2.0 mg |
0 |
100 |
0 |
3.0 mg |
50 |
25 |
25 |
3.75 mg |
100 |
0 |
0 |
BID, twice daily; MF, myelofibrosis; QD, daily; RUX, ruxolitinib. |
Table 2. Bone marrow fibrosis reduction in patients with relapsed/refractory myelofibrosis*
BMS-986158 QD + FED 400 mg, % (unless otherwise specified) |
Grade ≥1 reduction |
Stabilized (maintained at MF 1 or MF 2) |
Progressed (increased MF score or at highest grade MF 3) |
---|---|---|---|
0.5 mg |
0 |
0 |
100 |
0.75 mg |
0 |
25 |
75 |
1.0 mg |
50 |
50 |
0 |
BID, twice daily; FED, fedratinib; MF, myelofibrosis; QD, daily. |
Data from this biomarker analysis highlights potential disease-modifying properties of combination BMS-986158 + JAKi in both TN and R/R MF. In this small cohort, most patients reached ≥20% JAK2v617F VAF reduction, as the dose levels increased. This suggests that this combination could be a feasible treatment option for further clinical trials.
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