Allosteric kinase inhibitors

Background. Inhibition of the kinase activity of the BCR-ABL1 oncoprotein by an allosteric mechanism of action facilitates alternative treatment options for chronic myeloid leukemia (CML) patients who cannot be adequately treated with conventional catalytic site-directed tyrosine kinase inhibitor (TKI). Objectives. Pathophysiologic role of the BCR-ABL1 oncogene, mechanisms of action of catalytic site-directed TKI, clinical need for new therapies in BCR-ABL1 positive leukemias, mechanism of allosteric inhibition, development of the first clinically applicable allosteric ABL inhibitor ABL001 (asciminib), preclinical data, clinical development. Methods. Mechanistic and preclinical studies published to date and clinical results of the initial phase 1 dose escalation trial are summarized. Result. ABL001 is a potent, highly selective inhibitor of BCR-ABL, with a resistance profile distinct from that of ATP-competitive TKI. In murine models, combination studies demonstrate pronounced antileukemic efficacy with complete and sustained leukemia regression and confirmation of the non-overlapping mechanisms of resistance. In the first phase 1 study in humans, ABL001 exhibits rapid antileukemic activity and appears well tolerated to date in a heavily pretreated subgroup of patients with CML. Conclusions. Proof of principle of the effectiveness of allosteric inhibition of BCR-ABL kinase activity with ABL001 as the first-in-class compound holds promise as a novel therapeutic option for treatment of CML patients who respond insufficiently to or are intolerant of conventional TKI, and may contribute to further improving treatment of CML.