Richard C. Bates

Spheroids and cell survival

In contrast to most traditional cell culture systems, spheroids represent a unique opportunity to recapitulate aspects of cell homeostasis and as such better reflect in vivo tumor biology. This review highlights recent spheroid-based studies which have defined a role for intercellular adhesion in dictating cellular fate. Critical roles for adhesion molecules, such as the integrin and cadherin families, have been established. In addition, it appears that components of the signaling pathways that control cellular proliferation may also influence the cellular decision to live or die. Further complexity arises from the action of soluble factors, like epidermal growth factor, and three-dimensional culture systems are providing insights into how integration of these multiple signals is achieved. Given that cellular adhesion may serve as a regulator of apoptosis, and in particular that correct receptor engagement can activate signaling pathways promoting cell survival, additional implications for our understanding of tumor biology are discussed.

Involvement of integrins in cell survival

SummaryApoptosis is a regulated process of cell death by which cells actively participate in their own destruction. In multicellular organisms, the balance between cell proliferation and apoptosis provides homeostatic control, and a regulatory failure of either event can contribute to oncogenesis. The extracellular matrix (ECM) is known to play a regulatory role in cellular growth and differentiation, but only more recently has it been recognized as a regulator of apoptosis. In these processes the major transmitters of ECM-derived signals to the cell are members of the integrin family, although the mechanical process of cell spreading also plays a role. Bothin vivo andin vitro the loss of adhesion to specific components of the ECM can lead to cell death, and such apoptosis can be induced experimentally by blocking integrin binding. Heterotypic and homotypic cell-cell adhesion can also protect from adhesion-dependent apoptosis and there is evidence to suggest that this too is integrin mediated. In addition, some integrin mediated signaling appears to promote apoptosis. The downstream mechanisms of integrin signaling causing cell death have not been greatly explored, but there is evidence from two different systems that the induction of ICE transcription and nuclear translocation of p53 are candidate processes. Alterations in integrin expression or signaling therefore are likely to contribute to tumor development by enabling escape from apoptosis. Also, the recognition of the importance of cell-cell adhesion in tumor cell survival offers the potential of developing improved drug regimes for the treatment of malignancy.

Ganetespib and HSP90: Translating Preclinical Hypotheses into Clinical Promise

As with many physiologic processes that become subverted during tumorigenesis, the chaperoning activity of heat shock protein 90 (HSP90) is often exploited by cancer cells to confer aberrant proliferative, survival, and/or metastatic potential. Functional inhibition of HSP90 results in the degradation of its client proteins, in turn providing a means to concomitantly disrupt multiple oncogenic signaling cascades through one molecular target. Pharmacologic blockade of HSP90 has, therefore, emerged as an innovative and multifaceted approach for the development of new antineoplastic agents. However, no HSP90 inhibitors are currently approved for cancer therapy and the full promise of this class of agents is yet to be realized. This review focuses on the preclinical activity profile of ganetespib, a potent small-molecule inhibitor of HSP90, the characterization of which has provided important frameworks for the optimal design and application of HSP90 inhibitor-based strategies in a variety of cancer types. Beyond client protein-driven tumors, ganetespib can also potentiate the effects of other molecularly targeted and standard-of-care therapeutics while simultaneously overcoming drug resistance in multiple tumor types, thereby positioning this compound as the leading HSP90 inhibitor currently under clinical development.

The HSP90 inhibitor ganetespib has chemosensitizer and radiosensitizer activity in colorectal cancer

SummaryThe integration of targeted agents to standard cytotoxic regimens has improved outcomes for patients with colorectal cancer (CRC) over recent years; however this malignancy remains the second leading cause of cancer mortality in industrialized countries. Small molecule inhibitors of heat shock protein 90 (HSP90) are one of the most actively pursued classes of compounds for the development of new cancer therapies. Here we evaluated the activity of ganetespib, a second-generation HSP90 inhibitor, in models of CRC. Ganetespib reduced cell viability in a panel of CRC cell lines in vitro with low nanomolar potency. Mechanistically, drug treatment exerted concomitant effects on multiple oncogenic signaling pathways, cell cycle regulation, and DNA damage repair capacity to promote apoptosis. Combinations of ganetespib and low-dose ionizing radiation enhanced the radiosensitivity of HCT 116 cells and resulted in superior cytotoxic activity over either treatment alone. In vivo, the single-agent activity of ganetespib was relatively modest, suppressing HCT 116 xenograft tumor growth by approximately half. However, ganetespib significantly potentiated the antitumor efficacy of the 5-Fluorouracil (5-FU) prodrug capecitabine in HCT 116 xenografts, causing tumor regressions in a model that is intrinsically resistant to fluoropyrimidine therapy. This demonstration of combinatorial benefit afforded by an HSP90 inhibitor to a standard CRC adjuvant regimen provides an attractive new framework for the potential application of ganetespib as an investigational agent in this disease.

mTOR Inhibition Potentiates HSP90 Inhibitor Activity via Cessation of HSP Synthesis

Because of their pleiotropic effects on critical oncoproteins, inhibitors of HSP90 represent a promising new class of therapeutic agents for the treatment of human cancer. However, pharmacologic inactivation of HSP90 subsequently triggers a heat shock response that may mitigate the full therapeutic benefit of these compounds. To overcome this limitation, a clinically feasible method was sought to block HSP synthesis induced by the potent HSP90 inhibitor ganetespib. An immunoassay screen of 322 late-stage or clinically approved drugs was performed to uncover compounds that could block upregulation of the stress-inducible HSP70 that results as a consequence of HSP90 blockade. Interestingly, inhibitors of the phosphoinositide 3-kinase (PI3K)/mTOR class counteracted ganetespib-induced HSP70 upregulation at both the gene and protein level by suppressing nuclear translocation of heat shock factor 1 (HSF1), the dominant transcription factor controlling cellular stress responses. This effect was conserved across multiple tumor types and was found to be regulated, in part, by mTOR-dependent translational activity. Pretreatment with cycloheximide, PI3K/mTOR inhibitor, or an inhibitor of eIF4E (a translation initiation factor and downstream effector of mTOR) all reduced ganetespib-mediated nuclear HSF1 accumulation, indicating that mTOR blockade confers a negative regulatory effect on HSF1 activity. Moreover, combined therapy regimens with mTOR or dual PI3K/mTOR inhibitors potentiated the antitumor efficacy of ganetespib in multiple in vivo models. Implications: Collectively these data identify a novel strategy to optimize the therapeutic potential of HSP90 inhibitors. Mol Cancer Res; 12(5); 703–13. ©2014 AACR.

Engagement of Variant CD44 Confers Resistance to Anti-Integrin Antibody-Mediated Apoptosis in a Colon Carcinoma Cell Line

The LIM 1863 colon carcinoma cell line grows as structured organoids around a central lumen, and we have previously demonstrated that the three-dimensional arrangement protects the individual cells from apoptosis induced by an anti-alpha v integrin antibody, 23C6 (Bates et al., 1994). Here we show that the intercellular forces which drive spheroid formation can be overcome by exposure of the cells to a collagen substrate, or more specifically through ligation of the CD44 receptor by a monoclonal antibody. Binding to immobilized anti-CD44 antibody induced a monolayer morphology which is accompanied by fibronectin production and secretion, and expression of the integrin alpha v beta 6. Significantly, the cells of the monolayer acquired resistance to 23C6 antibody-mediated apoptosis over time and this property was sustained even after removal from the monolayer. We provide data to show that this resistance is not dependent on monolayer morphology, constant engagement of the CD44 receptor, loss of the 23C6 antigen, or elevation of Bcl-2 or Bcl-XL protein. The CD44 expressed by LIM 1863 is shown to be the metastatic variant of the molecule therefore these results provide a possible explanation for the selective advantages conferred by expression of this variant for metastasizing colon cancer cells. Overall, the findings of this study support a model for the development of malignancy through the production of specific survival and growth signals as a direct consequence of a signaling event induced by stimulation of an epithelial variant of CD44.

The HSP90 inhibitor ganetespib potentiates the antitumor activity of EGFR tyrosine kinase inhibition in mutant and wild-type non-small cell lung cancer

Small molecule inhibitors of epidermal growth factor receptor (EGFR) tyrosine kinase activity, such as erlotinib and gefitinib, revolutionized therapy for non-small cell lung cancer (NSCLC) patients whose tumors harbor activating EGFR mutations. However, mechanisms to overcome the invariable development of acquired resistance to such agents, as well as realizing their full clinical potential within the context of wild-type EGFR (WT-EGFR) disease, remain to be established. Here, the antitumor efficacy of targeted EGFR tyrosine kinase inhibitors (TKIs) and the HSP90 inhibitor ganetespib, alone and in combination, were evaluated in NSCLC. Ganetespib potentiated the efficacy of erlotinib in TKI-sensitive, mutant EGFR-driven NCI-HCC827 xenograft tumors, with combination treatment causing significant tumor regressions. In erlotinib-resistant NCI-H1975 xenografts, concurrent administration of ganetespib overcame erlotinib resistance to significantly improve tumor growth inhibition. Ganetespib co-treatment also significantly enhanced antitumor responses to afatinib in the same model. In WT-EGFR cell lines, ganetespib potently reduced cell viability. In NCI-H1666 cells, ganetespib-induced loss of client protein expression, perturbation of oncogenic signaling pathways, and induction of apoptosis translated to robust single-agent activity in vivo. Dual ganetespib/erlotinib therapy induced regressions in NCI-H322 xenograft tumors, indicating that the sensitizing properties of ganetespib for erlotinib were conserved within the WT-EGFR setting. Mechanistically, combined ganetespib/erlotinib exposure stabilized EGFR protein levels in an inactive state and completely abrogated extracellular-signal-regulated kinase (ERK) and AKT signaling activity. Thus, selective HSP90 blockade by ganetespib represents a potentially important complementary strategy to targeted TKI inhibition alone for inducing substantial antitumor responses and overcoming resistance, in both the mutant and WT-EGFR settings.

HSP90 Inhibitor–SN-38 Conjugate Strategy for Targeted Delivery of Topoisomerase I Inhibitor to Tumors

The clinical benefits of chemotherapy are commonly offset by insufficient drug exposures, narrow safety margins, and/or systemic toxicities. Over recent decades, a number of conjugate-based targeting approaches designed to overcome these limitations have been explored. Here, we report on an innovative strategy that utilizes HSP90 inhibitor–drug conjugates (HDC) for directed tumor targeting of chemotherapeutic agents. STA-12-8666 is an HDC that comprises an HSP90 inhibitor fused to SN-38, the active metabolite of irinotecan. Mechanistic analyses in vitro established that high-affinity HSP90 binding conferred by the inhibitor backbone could be exploited for conjugate accumulation within tumor cells. In vivo modeling showed that the HSP90 inhibitor moiety was required for selective retention of STA-12-8666, and this enrichment promoted extended release of active SN-38 within the tumor compartment. Indeed, controlled intratumoral payload release by STA-12-8666 contributed to a broad therapeutic window, sustained biomarker activity, and remarkable degree of efficacy and durability of response in multiple cell line and patient-derived xenograft models. Overall, STA-12-8666 has been developed as a unique HDC agent that employs a distinct mechanism of targeted drug delivery to achieve potent and sustained antitumor effects. These findings identify STA-12-8666 as a promising new candidate for evaluation as novel anticancer therapeutic. Mol Cancer Ther; 14(11); 2422–32. ©2015 AACR.

HSP90 Inhibitor-Based Strategies for Cancer Therapy: Advancing Toward Clinical Impact

The discovery of selective inhibitors of HSP90 two decades ago has enabled both a better understanding of the biology of HSP90 as well as its validation as a pharmacologic target for cancer. A number of HSP90 inhibitors have entered human clinical trials; to date, however, none have been approved for cancer therapy and thus the full potential of this class of agents remains to be realized. In this chapter we review the current status of HSP90 inhibitor development for cancer treatment, with particular emphasis on the second-generation, synthetic classes of compounds. In addition, we highlight various strategies currently being pursued that are designed to exploit specific cancer cell vulnerabilities and provide frameworks for optimization of HSP90 inhibitor-based strategies across a broad spectrum of cancer types.

Abstract 4409: STA-12-8666: a first-in-class HSP90 inhibitor drug conjugate (HDC) designed to selectively deliver chemotherapy to tumors

Chemotherapeutic drugs have been a mainstay of cancer therapy for decades; however, their effectiveness is often hampered by inefficient drug exposures and undesirable toxicity to normal tissues. Here we report on a novel drug delivery system, termed heat shock protein 90 (HSP90) inhibitor-drug conjugates (HDC), based on the property that small molecule inhibitors of HSP90 are preferentially retained in tumors cells in contrast to their rapid clearance from the circulation and normal tissues. By attaching chemotherapeutic drugs to HSP90 inhibitor backbones, HDC technology exploits this inherent retention property to efficiently deliver cytotoxic payloads directly into tumor tissues and provide extended drug exposure. STA-12-8666 is an HDC that comprises an HSP90 inhibitor fused to the topoisomerase inhibitor SN-38 (active metabolite of irinotecan). In vivo modeling showed that the HSP90 inhibitor moiety was required for tumor-selective retention of STA-12-8666. Prolonged exposure of STA-12-8666 provided extended release of active SN-38 within the tumor compartment, generating up to two weeks of biomarker engagement (γ-H2AX) in contrast to 3-4 days with irinotecan. The broad therapeutic window exhibited by STA-12-8666 conferred superior efficacy and durability over irinotecan treatment alone - resulting in complete or near complete responses (CR) across a broad spectrum of solid tumor models, including an irinotecan-insensitive bladder cancer model and an aggressive lung cancer model where biweekly treatment of STA-12-8666 was initiated at a starting tumor volume 5-times greater that of typical studies. CRs were also observed in a human pancreatic PDX model following 3 doses of STA-12-8666, which were maintained for more than a month. Of note, recurrent PDX tumors remained sensitive to subsequent therapeutic challenge with STA-12-8666 suggesting HDC delivery may circumvent common mechanisms of resistance to irinotecan. Preliminary findings from an ongoing Phase 1 dose escalation study in dogs with spontaneous tumors suggest a well-managed safety profile and encouraging tumor responses. Overall, STA-12-8666 is a promising investigational agent prototypical of a platform technology that can be applied to other cytotoxic payloads to improve therapeutic indices as well as generating new pharmaceutical entities for evaluation as novel anticancer drugs. Citation Format: David A. Proia, Donald L. Smith, Junyi Zhang, Dan Zhou, John-Paul Jimenez, Jim Sang, Sarah Rippy, Cheryl London, Luisa S. Ogawa, Jun Jiang, Teresa Przewloka, Manuel Sequeira, Jaime Acquaviva, Suqin He, John Chu, Chaohua Zhang, Yuan Liu, Josephine Ye, Vladimir Khazak, Igor Astsaturov, Takayo Inoue, Noriaki Tatsuta, Richard C. Bates, Andrew Sonderfan, Dinesh Chimmanamada, Weiwen Ying. STA-12-8666: a first-in-class HSP90 inhibitor drug conjugate (HDC) designed to selectively deliver chemotherapy to tumors. [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 4409. doi:10.1158/1538-7445.AM2015-4409