Abstract 4939: Combinatorial approach using covalent menin inhibitor, BMF-219, and/or covalent FLT3 inhibitor, BMF-500, with MEK or BCL2 blockade potentiates therapeutic use in AML

Abstract

Abstract Introduction: Acute myeloid leukemia (AML) is a clinically and genetically heterogeneous disease characterized by a highly diverse genomic landscape. Despite recent advances in therapies, treatment outcome remains variable and largely defined by genomic abnormalities such as gene fusions, copy number alterations and point mutations. Mutations in epigenic modifiers, nucleophosmin (NPM1c), signaling and kinase pathway such as KMT2A-re-arrangements (KMT2A-r), internal tandem duplication (ITD) insertions in FLT3, and NRAS mutations are amongst the highest alterations in AML patients with a propensity towards poor response to treatment and overall disease outcome. Such limitations impact the ability to achieve long-lasting response to treatment and result in therapy-induced resistance eventually leading to relapse. Combinatorial strategies are required to combat resistance and maximize duration of antitumor activity. BCL2 and MEK blockade in combination with menin and/or FLT3 inhibitors potentiates an improved therapeutic strategy to achieve increased antitumor activity and overcome AML resistance. Here we explored the use of our clinical-stage covalent menin inhibitor, BMF-219, and BMF-500, a covalent FLT3 inhibitor, in combination with each other and in combination with BCL2 and MEK inhibitors in MV-4-11 and MOLM-13 cell lines for 4-days, then viability was measured using CellTiter Glo. Results: BMF-219 and BMF-500 as single agents induce effective antitumor activity on MOLM-13 and MV-4-11 cells lines. When dosed in combination, BMF-219 and BMF-500 show beneficial effects affording higher cell killing at lower concentrations. Repeated experiments revealed patterns of increased cell killing is achieved when trametinib, MEK inhibitor, and venetoclax, BCL2 inhibitor, are combined with BMF-219 treatment. Conclusions: Collectively, our studies demonstrate the utility of combination strategies to achieve higher antileukemic cell killing with reduced concentrations of menin and FLT3 covalent inhibitors. Additionally, we show benefit of combinatorial approaches of menin and FLT3 covalent inhibitors with MEK and BCL2 blockade. These data provide initial pre-clinical evidence for combining pathway specific inhibitors as a promising therapeutic strategy for further investigation in acute leukemia. Citation Format: Brian Law. Combinatorial approach using covalent menin inhibitor, BMF-219, and/or covalent FLT3 inhibitor, BMF-500, with MEK or BCL2 blockade potentiates therapeutic use in AML. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4939.