KAT6 inhibitors under investigation for solid tumors: the preclinical and early phase progress

Introduction KAT6A and its paralog KAT6B (KAT6) are part of the MYST family of histone acetyltransferases. KAT6 is involved in regulating multiple cellular processes by acetylating different lysine residues on histone H3. While KAT6A is overexpressed in various solid tumors, KAT6 is best characterized for its role in ESR1 transcription in estrogen receptor-positive (ER+) breast cancer.Areas covered Prifetrastat (PF-07248144), a first-in-class KAT6A/B inhibitor, has been tested in a phase I trial, mainly for patients with ER+ breast cancer, and demonstrated promising efficacy with a favorable safety profile, albeit frequent dysgeusia. Prifetrastat in combination with fulvestrant is now being evaluated in a phase III trial for pretreated ER+ advanced breast cancer. In parallel, numerous KAT6 catalytic inhibitors and degraders have entered preclinical and clinical development.Expert opinion A phase III study of prifetrastat will provide initial data on the clinical significance of KAT6 inhibitors. The application of Prifetrastat and other KAT6 inhibitors to wider breast cancer subpopulations and other solid tumors is anticipated. Additionally, mitigation strategies for dysgeusia and clinically available response-predictive biomarkers should be developed. KAT6 inhibitors with different target spectra, including KAT6A-selective and KAT6/7 inhibitors, may exhibit differential efficacy and safety profiles, offering deeper insights into KAT6-targeted therapy.