Casey G. Langdon

Genotype-Selective Combination Therapies for Melanoma Identified by High-Throughput Drug Screening

UNLABELLED Resistance and partial responses to targeted monotherapy are major obstacles in cancer treatment. Systematic approaches to identify efficacious drug combinations for cancer are not well established, especially in the context of genotype. To address this, we have tested pairwise combinations of an array of small-molecule inhibitors on early-passage melanoma cultures using combinatorial drug screening. Results reveal several inhibitor combinations effective for melanomas with activating RAS or BRAF mutations, including mutant BRAF melanomas with intrinsic or acquired resistance to vemurafenib. Inhibition of both EGF receptor and AKT sensitized treatment-resistant BRAF mutant melanoma cultures to vemurafenib. Melanomas with RAS mutations were more resistant to combination therapies relative to BRAF mutants, but were sensitive to combinations of statins and cyclin-dependent kinase inhibitors in vitro and in vivo. These results show the use of combinatorial drug screening for discovering unique treatment regimens that overcome resistance phenotypes of mutant BRAF- and RAS-driven melanomas. SIGNIFICANCE We have used drug combinatorial screening to identify effective combinations for mutant BRAF melanomas, including those resistant to vemurafenib, and mutant RAS melanomas that are resistant to many therapies. Mechanisms governing the interactions of the drug combinations are proposed, and in vivo xenografts show the enhanced benefit and tolerability of a mutant RAS -selective combination, which is currently lacking in the clinic.

PDK1 and SGK3 contribute to the growth of BRAF mutant melanomas and are potential therapeutic targets

Melanoma development involves members of the AGC kinase family, including AKT, PKC, and, most recently, PDK1, as elucidated recently in studies of Braf::Pten mutant melanomas. Here, we report that PDK1 contributes functionally to skin pigmentation and to the development of melanomas harboring a wild-type PTEN genotype, which occurs in about 70% of human melanomas. The PDK1 substrate SGK3 was determined to be an important mediator of PDK1 activities in melanoma cells. Genetic or pharmacologic inhibition of PDK1 and SGK3 attenuated melanoma growth by inducing G1 phase cell-cycle arrest. In a synthetic lethal screen, pan-PI3K inhibition synergized with PDK1 inhibition to suppress melanoma growth, suggesting that focused blockade of PDK1/PI3K signaling might offer a new therapeutic modality for wild-type PTEN tumors. We also noted that responsiveness to PDK1 inhibition associated with decreased expression of pigmentation genes and increased expression of cytokines and inflammatory genes, suggesting a method to stratify patients with melanoma for PDK1-based therapies. Overall, our work highlights the potential significance of PDK1 as a therapeutic target to improve melanoma treatment.

The broad-spectrum receptor tyrosine kinase inhibitor dovitinib suppresses growth of BRAF-mutant melanoma cells in combination with other signaling pathway inhibitors

BRAF inhibitors have revolutionized treatment of mutant BRAF metastatic melanomas. However, resistance develops rapidly following BRAF inhibitor treatment. We have found that BRAF‐mutant melanoma cell lines are more sensitive than wild‐type BRAF cells to the small molecule tyrosine kinase inhibitor dovitinib. Sensitivity is associated with inhibition of a series of known dovitinib targets. Dovitinib in combination with several agents inhibits growth more effectively than either agent alone. These combinations inhibit BRAF‐mutant melanoma and colorectal carcinoma cell lines, including cell lines with intrinsic or selected BRAF inhibitor resistance. Hence, combinations of dovitinib with second agents are potentially effective therapies for BRAF‐mutant melanomas, regardless of their sensitivity to BRAF inhibitors.

Systematic drug screening identifies tractable targeted combination therapies in triple-negative breast cancer

Triple-negative breast cancer (TNBC) remains an aggressive disease without effective targeted therapies. In this study, we addressed this challenge by testing 128 FDA-approved or investigational drugs as either single agents or in 768 pairwise drug combinations in TNBC cell lines to identify synergistic combinations tractable to clinical translation. Medium-throughput results were scrutinized and extensively analyzed for sensitivity patterns, synergy, anticancer activity, and were validated in low-throughput experiments. Principal component analysis revealed that a fraction of all upregulated or downregulated genes of a particular targeted pathway could partly explain cell sensitivity toward agents targeting that pathway. Combination therapies deemed immediately tractable to translation included ABT-263/crizotinib, ABT-263/paclitaxel, paclitaxel/JQ1, ABT-263/XL-184, and paclitaxel/nutlin-3, all of which exhibited synergistic antiproliferative and apoptotic activity in multiple TNBC backgrounds. Mechanistic investigations of the ABT-263/crizotinib combination offering a potentially rapid path to clinic demonstrated RTK blockade, inhibition of mitogenic signaling, and proapoptotic signal induction in basal and mesenchymal stem-like TNBC. Our findings provide preclinical proof of concept for several combination treatments of TNBC, which offer near-term prospects for clinical translation. Cancer Res; 77(2); 566-78. ©2016 AACR.

SMAC mimetic Debio 1143 synergizes with taxanes, topoisomerase inhibitors and bromodomain inhibitors to impede growth of lung adenocarcinoma cells

Targeting anti-apoptotic proteins can sensitize tumor cells to conventional chemotherapies or other targeted agents. Antagonizing the Inhibitor of Apoptosis Proteins (IAPs) with mimetics of the pro-apoptotic protein SMAC is one such approach. We used sensitization compound screening to uncover possible agents with the potential to further sensitize lung adenocarcinoma cells to the SMAC mimetic Debio 1143. Several compounds in combination with Debio 1143, including taxanes, topoisomerase inhibitors, and bromodomain inhibitors, super-additively inhibited growth and clonogenicity of lung adenocarcinoma cells. Co-treatment with Debio 1143 and the bromodomain inhibitor JQ1 suppresses the expression of c-IAP1, c-IAP2, and XIAP. Non-canonical NF-κB signaling is also activated following Debio 1143 treatment, and Debio 1143 induces the formation of the ripoptosome in Debio 1143-sensitive cell lines. Sensitivity to Debio 1143 and JQ1 co-treatment was associated with baseline caspase-8 expression. In vivo treatment of lung adenocarcinoma xenografts with Debio 1143 in combination with JQ1 or docetaxel reduced tumor volume more than either single agent alone. As Debio 1143-containing combinations effectively inhibited both in vitro and in vivo growth of lung adenocarcinoma cells, these data provide a rationale for Debio 1143 combinations currently being evaluated in ongoing clinical trials and suggest potential utility of other combinations identified here.

p90RSK Blockade Inhibits Dual BRAF and MEK Inhibitor-Resistant Melanoma by Targeting Protein Synthesis

Despite improvements in survival in metastatic melanoma with combined BRAF and mitogen-activated protein kinase/extracellular signal-regulated kinase inhibitor treatment, the overwhelming majority of patients eventually acquire resistance to both agents. Consequently, new targets for therapy in resistant tumors are currently being evaluated. Previous studies have identified p90 subfamily of ribosomal S6 kinase (p90RSK) family kinases as key factors for growth and proliferation, as well as protein synthesis via assembly of the 7-methyl-guanosine triphosphate cap-dependent translation complex. We sought to evaluate inhibitors of p90RSK family members: BI-D1870 and BRD7389, for their ability to inhibit both proliferation and protein synthesis in patient-derived melanoma cell lines with acquired resistance to combined treatment with the BRAF inhibitor vemurafenib and the mitogen-activated protein kinase/extracellular signal-regulated kinase inhibitor selumetinib. We found that the RSK inhibitors blocked cell proliferation and protein synthesis in multiple dual-resistant melanoma lines. In addition, single agent RSK inhibitor treatment was effective in drug-naïve lines, two of which are innately vemurafenib resistant. We also used Reverse Phase Protein Array screening to identify differential protein expression that correlates with BI-D1870 sensitivity, and identified prognostic biomarkers for survival in human melanoma patients. These findings establish p90RSK inhibition as a therapeutic strategy in treatment-resistant melanoma and provide insight into the mechanism of action.

Combinatorial screening of pancreatic adenocarcinoma reveals sensitivity to drug combinations including bromodomain inhibitor plus neddylation inhibitor

Pancreatic adenocarcinoma (PDAC) is the fourth most common cause of cancer-related death in the United States. PDAC is difficult to manage effectively, with a five-year survival rate of only 5%. PDAC is largely driven by activating KRAS mutations, and as such, cannot be directly targeted with therapeutic agents that affect the activated protein. Instead, inhibition of downstream signaling and other targets will be necessary to effectively manage PDAC. Here, we describe a tiered single-agent and combination compound screen to identify targeted agents that impair growth of a panel of PDAC cell lines. Several of the combinations identified from the screen were further validated for efficacy and mechanism. Combination of the bromodomain inhibitor JQ1 and the neddylation inhibitor MLN4294 altered the production of reactive oxygen species in PDAC cells, ultimately leading to defects in the DNA damage response. Dual bromodomain/neddylation blockade inhibited in vivo growth of PDAC cell line xenografts. Overall, this work revealed novel combinatorial regimens, including JQ1 plus MLN4294, which show promise for the treatment of RAS-driven PDAC. Mol Cancer Ther; 16(6); 1041–53. ©2017 AACR.

Abstract 2529: Debio 1143 synergizes with taxanes, topoisomerase and bromodomain inhibitors to inhibit growth of lung adenocarcinoma

Efficient induction of cell death is essential for efficacy of cancer therapies, and may be enhanced in combination therapies that promote apoptosis. Small molecule mimetics of the pro-apoptotic protein SMAC antagonize Inhibitor of Apoptosis Proteins (IAPs). Debio 1143 is a potent oral SMAC mimetic currently assessed in clinical trials in combination with chemo- and radiotherapy in different cancer indications. We have conducted a “one vs. many” drug combination screen in which Debio 1143 is combined pairwise with a panel of 128 candidate partner agents in order to identify drug combinations that inhibit growth of lung adenocarcinoma cells. Several synergistic Debio 1143 combinations were selected for further analysis. We confirmed that Debio 1143 synergistically inhibited growth in combination with taxanes paclitaxel and docetaxel, topoisomerase inhibitor SN-38, and the bromodomain inhibitor JQ1. The combination of Debio 1143 with any of these agents further inhibited clonogenic colony formation and induced apoptosis more than either agent alone. In two Debio 1143-sensitive cell lines Debio 1143 also induced formation of the cell-death inducing complex - the ripoptosome. Interestingly, while Debio 1143 broadly reduced protein levels of cIAP1 across cell lines, specifically the combination with JQ1 also reduced cIAP2 and XIAP levels and inhibited the canonical NF-κB pathway while inducing the non-canonical NF-κB pathway. Overall, these data support utility of several combinations of Debio 1143 with other agents, especially bromodomain inhibitors, in lung adenocarcinoma and other cancers. Specifically, these findings indicate that the synergy between JQ1 and Debio 1143 may derive from JQ1 contributing on different levels to key mechanisms relevant for SMAC mimetic antitumor activity. Citation Format: Casey G. Langdon, Norbert Wiedemann, Matthew A. Held, James T. Platt, Ramanaiah Mamillapalli, Pinar Iyidogan, Nicholas Theodosakis, Frederic Levy, Denis Robichon, Claudio Zanna, Gregoire Vuagniaux, Mel Sorensen, Shaomeng Wang, Marcus W. Bosenberg, David F. Stern. Debio 1143 synergizes with taxanes, topoisomerase and bromodomain inhibitors to inhibit growth of lung adenocarcinoma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 2529. doi:10.1158/1538-7445.AM2015-2529

Inhibition of isoprenylation synergizes with MAPK blockade to prevent growth in treatment-resistant melanoma, colorectal, and lung cancer

This study evaluates the use of HMG‐CoA reductase inhibitors, or statins, as an adjunctive to BRAF and MEK inhibition as a treatment in melanomas and other tumors with driver mutations in the MAPK pathway. Experiments used simvastatin in conjunction with vemurafenib and selumetinib in vitro and simvastatin with vemurafenib in vivo to demonstrate additional growth abrogation beyond MAPK blockade alone. Additional studies demonstrated that statin anti‐tumor effects appeared to depend on inhibition of isoprenoid synthesis given rescue with add‐back of downstream metabolites. Ultimately, we concluded that statins represent a possible useful adjunctive therapy in MAPK‐driven tumors when given with current approved targeted therapy.

Abstract 1792: Identification of synergistic drug combinations with the oral HSP90 inhibitor Debio 0932 in non-small cell lung cancer and renal cell cancer

Proceedings: AACR Annual Meeting 2014; April 5-9, 2014; San Diego, CA Background: Drug resistance is a major problem in cancer therapy, which can be addressed by simultaneously targeting multiple critical nodes of the signalling networks controlling growth and survival of cancer cells. One such approach is to target heat shock protein 90 (HSP90), a chaperone for many potent oncogenic proteins involved in proliferation, survival, invasion, metastasis and angiogenesis. Pharmacologic inhibition of HSP90 results in the proteasomal degradation of client oncoproteins thereby eliminating their oncogenic activity. The oral HSP90 inhibitor Debio 0932 displays favorable pharmacologic features. The goal of this study was to identify novel synergistic drug combinations for Debio 0932 in non-small cell lung cancer (NSCLC) and renal cell cancer (RCC) which would support the clinical development of Debio 0932 in those two indications. Material and Methods: For NSCLC, an in vitro high-throughput combination screen was performed using 6 human NSCLC cell lines bearing various genetic alterations, where Debio 0932 was combined pairwise with 128 commercially available oncology compounds in a cell viability assay. Some additional compounds not included in the panel were also tested independently. For RCC, combination of Debio 0932 with several selected standard-of-care drugs was analyzed on a panel of 8 human RCC cell lines. Synergy was assessed by using an AUC-based curve shift analysis method or according to the Chou-Talalay equation. A selection of synergistic drug combinations was further studied using tumor xenograft mouse models of human NSCLC and RCC. Results: In NSCLC, anti-proliferative synergism with Debio 0932 was observed in vitro in combination with the standard-of-care drugs docetaxel, paclitaxel or gemcitabine, as well as with mTOR inhibitors. In RCC cell lines, combinations of Debio 0932 with RCC standard-of-care drugs also displayed anti-proliferative synergy. The synergy observed in vitro was further confirmed in mouse xenografts of human NSCLC and RCC cell lines, where the drug combinations caused marked anti-tumor activity that was superior to either monotherapy. Conclusion: Several synergistic drug combinations were identified for the HSP90 inhibitor Debio 0932 in NSCLC and RCC. These findings underline the feasibility of using in vitro high-throughput screening for the discovery of novel drug combinations with increased in vivo anti-tumor efficacy . Furthermore, they provide a rationale for the combination of Debio 0932 with standard-of-care drugs in NSCLC and RCC and are the basis for ongoing clinical trials in several cancer types. Citation Format: Casey G. Langdon, Norbert Wiedemann, Helene Maby-El Hajjami, Mathew A. Held, James T. Platt, Gregoire Vuagniaux, Marcus W. Bosenberg, David F. Stern, Frederic Levy. Identification of synergistic drug combinations with the oral HSP90 inhibitor Debio 0932 in non-small cell lung cancer and renal cell cancer. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1792. doi:10.1158/1538-7445.AM2014-1792