Abstract The BBB can critically limit the delivery of several molecularly-targeted agents into the brain. The discovery of focal BRAF mutations in melanoma has stimulated the development of specific BRAF inhibitors. MEK is downstream of BRAF in the MAPK pathway, and has been targeted for combination therapy with BRAF inhibition. Trametinib is a MEK1/2 inhibitor that has improved survival in combination with dabrafenib in clinical trials for metastatic melanoma. We have recently shown that BRAF inhibitors (vemurafenib and dabrafenib) have limited brain distribution due to active efflux at the blood-brain barrier (BBB). Melanoma metastasizes to the brain and effective treatments require adequate CNS exposure of all drugs used in combination therapy. The study purpose was to investigate mechanisms that influence the CNS distribution of trametinib, particularly focusing on the active efflux transport proteins P-gp and Bcrp in the BBB. Intracellular accumulation and bidirectional flux studies were conducted in polarized MDCKII cells that overexpress human P-gp (MDR1) or murine Bcrp (Bcrp1). The brain and plasma AUCs of trametinib were determined after an intravenous dose of 5 mg/kg in WT, Mdr1a/b (-/-), Bcrp1 (-/-) and Mdr1a/b (-/-) Bcrp1 (-/-) (TKO) mice. The steady-state brain distribution of trametinib was determined using osmotic pumps in WT and Mdr1a/b (-/-) (P-gp KO), Bcrp1 (-/-) (Bcrp KO), and Mdr1a/b (-/-) Bcrp1 (-/-) (TKO) mice. The steady-state brain distribution of a combination of trametinib and dabrafenib were determined in WT and TKO mice. IC50s were determined in patient-derived melanoma cell lines (WT and V600E mutant) using the MTT assay. Intracellular accumulation of trametinib was 45% lower in the MDCKII-MDR1 cells and 81% lower in the MDCKII-Bcrp1 cells as compared to WT. Trametinib permeability was ∼ 2.5 and 3.7-fold greater in the basolateral-to-apical direction as compared to apical-to-basolateral direction in the MDR1 and Bcrp1 cells, respectively. Following a single intravenous dose, the brain-to-plasma AUC ratios were approximately 5-fold greater in P-gp KO and TKO mice as compared to the WT. Interestingly, the brain distribution of trametinib in Bcrp KO mice was no different from WT mice. The steady-state brain to plasma (B/P) ratio of trametinib was 5-fold greater in the TKO mice when compared to the wild-type mice. The B/P ratio of both dabrafenib and trametinib were significantly greater in the TKO mice as compared to WT when dosed simultaneously. The IC50 for trametinib alone was > 10 μM in both the WT (M15) and V600E (M12) mutant cells, while a combination of dabrafenib and trametinib had an IC50 of 2.04 μM in the M12 cells. This study shows that P-gp and BCRP restrict the brain distribution of trametinib with P-gp playing a dominant role in the efflux of trametinib at the blood-brain barrier. These findings are clinically relevant to the efficacy of trametinib in mono or combination therapy for the treatment of melanoma brain metastases. Citation Format: Shruthi Vaidhyanathan, Rajendar K. Mittapalli, Daniel J. Ma, Mark A. Schroeder, Jann N. Sarkaria, William F. Elmquist. Trametinib (Mekinist TM) has limited brain distribution in the mouse model. [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 3714. doi:10.1158/1538-7445.AM2014-3714
Abstract 2737: Modulation of mitotic DNA damage as a paradigm for glioblastoma therapy
Abstract The clinical efficacies of molecularly targeted glioblastomas therapies have been vastly disappointing. The multitudes of resistance mechanisms suggest that glioblastomas possess highly dynamic molecular circuits grounded in functional redundancy. Emerging data suggests that the expression of functionally redundant oncogenes induced similar forms of cellular stress, requiring hyper-activation of common compensatory pathways to ensure cell viability. Targeting these pathways, therefore, afford potential opportunities for tumor ablation while by-passing the redundancy of oncogenic circuitry. To explore this paradigm, we carried out a siRNA screen to identify synthetic lethal partners of the oncogenic Epidermal Growth Factor Receptor variant III (EGFRvIII) in glioblastoma cells and identified Polo-Like Kinase 1 (PLK1). Treatment using a PLK1 inhibitor, BI2536, or siRNAs induced preferential toxicity to the EGFRvIII expressing glioblastoma cells in multiple in vitro (serum and neurosphere lines) and in vivo models (heterotopic and orthotopic xenograft models). Consistent with the heightened PLK1 requirement, EGFRvIII expressing glioblastomas harbored increased levels of the p-Thr210 PLK1 (an activated form of PLK1). Inhibition of PLK1 by BI2536 treatment induced an increase in the proportion of cells that co-stained for p-Histone H3 and γH2AX foci, suggesting accumulation of mitotic DNA damage. This effect was exacerbated by EGFRvIII expression, implicating induction of mitotic DNA damage as a major contributor to the observed synthetic lethality. Consistent with this observation, EGFRvIII expression induced the formation of aberrant mitosis as well as prolonged mitotic progression. Further supporting an essential role for PLK1 in suppressing DNA damage accumulation, BI2536 treatment significantly enhanced the tumoricidal effect of the DNA damaging chemotherapy, temozolomide. Mechanistically, inhibition of PLK1 suppressed the expression of Rad51, the accumulation of pS14 Rad51 (an active form of Rad51), as well as overall homologous recombination efficiency in vitro. We validated the clinical pertinence of these results using three clinically annotated glioblastoma databases (TCGA, REMEBMRANDT, CGGA). In all three datasets, increased expression of a PLK1 signature consistently associated with increased expression of HR genes and lowered gene expression signature associated with DNA damage accumulation. Supporting our proposed paradigm, the tumoricidal effect of BI2536 was universally observed in a panel of eight murine ink4a/arf (-/-) EGFRvIII expressing glioblastoma clones that developed resistance to EGFR inhibitors by distinct and independent mechanisms. In aggregate, our results support the essential role of PLK1 in suppressing mitotic DNA damage and provide a novel framework for glioblastoma therapy. Citation Format: Ying Shen, Masayuki Nitta, Jie Li, Diahnn Futalan, Tyler Steed, Zack Taich, Jeffrey M. Treiber, Deanna Stevens, Mark A. Schroeder, Jann N. Sarkaria, Hong-Zhuan Chen, Tao Jiang, Bob S. Carter, Fumiko Esashi, Jill Wakosky, Frank Furnari, Webster K. Cavenee, Arshad Desai, Clark C. Chen. Modulation of mitotic DNA damage as a paradigm for glioblastoma therapy. [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 2737. doi:10.1158/1538-7445.AM2014-2737
Abstract 2617: Preclinical efficacy of GNE-317, a dual PI3K/mTOR inhibitor, with or without bevacizumab in EGFR and/or PTEN-mutated glioblastoma multiforme
Abstract GNE-317 is a dual PI3K/mTOR inhibitor with excellent blood-brain barrier penetration. In this study, the efficacy of GNE-317 was evaluated in the Mayo panel of primary glioblastoma multiforme (GBM) xenografts. Based on the concept of oncogene addiction, we hypothesized that GNE-317 would be most efficacious in EGFR-hyper-activated and/or PTEN-deficient lines. In a CyQUANT cell proliferation assay, the inhibitory concentration of 50% cell number (IC50) for GBM6, 10, 22, and 84 were 0.59±0.50, 0.72±0.40, 0.26±0.14, and 3.49±1.64 microM, respectively. In these selected lines, there was a poor correlation between EGFR or PTEN status and in vitro response. The efficacy of GNE-317 also was evaluated in 10 lines in an orthotopic xenograft model. Mice with established tumors were randomized to daily dosing with GNE-317 (30 mg/kg) or placebo until moribund. Similar to in vitro data, there was a spectrum of response to GNE-317 (Table 1). The survival benefit ratio (ratio of median survival) did not correlate with EGFR amplification (P=0.78), EGFR mutation (P=0.25), or PTEN (P=0.55) status when analyzed singly. However, GNE-317 did extend survival in 4 of 5 lines in which either EGFR or PTEN were deregulated. To evaluate potentially clinically relevant combinations, the efficacy of GNE-317 combined with bevacizumab (BEV) was tested in the same orthotopic model in GBM8, 10, and 59. In GBM10, GNE-317/BEV provided a significant increase in survival compared to the most effective single agent (P<0.0001). In GBM8, 10, and 59, the ratio of median survival for GNE-317/BEV vs. placebo were 1.47, 1.75, and 1.74, respectively (all P≤0.01). In conclusion, there may be a correlation between deregulation of the EGFR/PTEN signaling network and GNE-317 efficacy, and the efficacy of GNE-317 in some models can be extended when combined with bevacizumab. Table 1:Molecular Characteristics and Efficacy of GNE-317 in Mayo Primary GBM XenograftsEGFR AmplifiedEGFR vIII MutatedPTEN MutatedGNE-317 Responder*Benefit Ratio** of GNE-317GBM6YesYesWTYes1.35GBM8YesNoYes, HDYes1.19GBM10NoNoYes, HDYes1.47GBM22NoNoWTNo0.85GBM59YesYesYes, HDYes1.27GBM84YesNoYes, del Exon 1No1.02GBM115NoNoTBDNo0.86GBM116NoNoTBDNo1.05GBM117NoNoTBDYes1.38GBM122YesNoTBDNo0.99Abbreviations: HD=homozygous deleted; del=deletion in; TBD=to be determined; WT=wild type.* If in vivo survival difference reached P<0.05 by Log-rank Kaplan-Meier method between the GNE-317 treated and placebo groups, the GBM line was classified as a responder to GNE-317.** The benefit ratio equals to median survival of the GNE-317 treated group, divided by that of the placebo group. Note: This abstract was not presented at the meeting. Citation Format: Terence T. Sio, Jenny L. Pokorny, Ann C. Mladek, Brett L. Carlson, Mark A. Schroeder, Dennis O. Iyekegbe, Katrina Bakken, Laurent Salphati, Heidi Phillips, Jann N. Sarkaria. Preclinical efficacy of GNE-317, a dual PI3K/mTOR inhibitor, with or without bevacizumab in EGFR and/or PTEN-mutated glioblastoma multiforme. [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 2617. doi:10.1158/1538-7445.AM2014-2617
The Efficacy of the Wee1 Inhibitor MK-1775 Combined with Temozolomide Is Limited by Heterogeneous Distribution across the Blood–Brain Barrier in Glioblastoma
Discordant
In Vitro
and
In Vivo
Chemopotentiating Effects of the PARP Inhibitor Veliparib in Temozolomide-Sensitive versus -Resistant Glioblastoma Multiforme Xeno
Abstract Purpose/Background: The first-line chemotherapeutic temozolomide (TMZ) does not offer any therapeutic benefit in some cases of glioblastoma (GBM) and emergence of resistance leads to tumor progression in almost all patients. While the expression of O-6-methylguanine-DNA-methyltransferase (MGMT) correlates well with TMZ resistance, its expression varies among GBM tumors. The goal of this study is to identify additional genes with potential roles in TMZ resistance. Materials and Methods: Five primary GBM xenografts were generated from patient samples, and subsequent secondary models for resistance were developed by subjecting tumor-bearing mice to escalating doses of TMZ. Triplicate samples from parental and TMZ-resistant xenografts were analyzed for gene expression using the Illumina BeadChip microarray platform. The top 100 differentially expressed genes for each line were considered candidates. Genes were selected for qRT-PCR validation after ontological and pathway analysis. A lentivirus-mediated shRNA knockdown was performed to validate the role of several candidate genes in TMZ resistance in U87 and primary GBM12 cell lines. Knockdown was confirmed with qRT-PCR and western blots. TMZ responsiveness was assessed using CyQUANT and Neurosphere assays. Results: Upregulated MGMT expression was found in 3 of the 5 xenografts (GBM12TMZ, GBM14TMZ and GBM28TMZ) and was mechanistically linked with TMZ resistance in these lines using O6-benzylguanine to reverse the resistance phenotype. Differential expression of other DNA damage response genes included CCND2, CDKN1A, GADD45B, UBB as well as apoptosis regulators NFKB2 and BIRC3. In lines with unchanged MGMT expression (GBM22TMZ and GBM39TMZ), changes in anti-apoptosis genes NFKB2 and MAP3K1, transcription factor SRF and signal transduction gene PRKCDBP were validated by qRT-PCR. In GBM12TMZ, in addition to MGMT upregulation, expression of Ubiquitin B (UBB) was found to be the most significantly down-regulated gene both on microarray (Log2FC = −4.55, Fold change = 0.043) and qRT-PCR (Log2RQ =-4.04, RQ = 0.061). To test a possible role of UBB in TMZ resistance, knockdown was achieved in U87 (knockdown efficiency=91.2%) and in primary xenograft line GBM12 (knockdown efficiency=84.4%). The CyQUANT assay for U87UBB-KD and U87NT treated with escalating doses of TMZ revealed no significant difference in cell survival (10 M TMZ relative survival= 89.7% for U87UBB-KD and 79.2% for U87NT; p-value=0.53). Similarly, a neurosphere assay for GBM12UBB-KD and GBM12NT also yielded no significant difference in cell survival (10 M TMZ relative survival= 25.13% for GBM12UBB-KD and 23.35% for GBM12NT; p-value=0.83). Conclusions: We have used a TMZ resistance xenograft model to identify candidate TMZ resistance genes. The current data provides evidence on the role of MGMT in the development of acquired TMZ resistance while ruling out UBB as potential TMZ resistance gene in GBM. Additional studies are underway to assess the functional significance of other candidate genes, particularly those with differential expression in the setting of constant MGMT expression. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr B68.
Abstract B100: Preclinical evaluation of a novel HSP90 inhibitor HSP990 in glioblastoma multiforme.
Abstract Heat shock protein (HSP) 90 is a molecular chaperone that modulates stability of several client proteins, many of which are key regulators of signaling pathways in glioblastoma multiforme (GBM). The potential for targeting multiple effectors makes HSP90 an appealing therapeutic target for GBM. The biological activity of HSP990, a novel HSP90 inhibitor (Novartis Pharmaceuticals) as single agent was evaluated in a panel of short-term explant cultures derived from primary GBM xenografts (n=10). HSP990 treatment resulted in a dose-dependent growth inhibition in the all xenograft lines, with an IC50 ranging from 5 to 30 nM. A 72 h exposure to HSP990 (10–30 nM) resulted in a dose-dependent decrease in the HSP90 client proteins Akt, Cdc2 and Cdc25C, a decrease in associated post-translational modifications p-Akt (S473), p-CDC2 (Y15), p-CDC25 (S216), and increased expression of HSP70. Additionally, a dose-dependent increase in HSP990-induced apoptosis (Annexin-V positivity), was observed within 24–72 hours of drug treatment. GBM tumors harbor a subpopulation of glioma stem cells that grow as neurospheres in neurobasal media and are considered important for tumor maintenance and progression. The effects of HSP990 were tested in neurospheres derived from 4 of the xenografts tested above (GBM12, GBM39, GB59, GBM12TMZ). These cultures demonstrated potential for tri-lineage differentiation upon serum challenge and had robust secondary neurosphere formation, demonstrating two hallmark features of cancer stem cells. In a bulk-culture neurosphere formation assay, co-incubation with 5 to 10 nM HSP990 was highly effective at suppressing neurosphere formation in all 4 xenograft lines. Notably, in GBM12 neurosphere cultures maintained in either serum-free media or challenged with serum, 30 nM HSP990 was equally effective at promoting up-regulation of HSP70, but exhibited less effect on Akt or Cdc2 in serum-free cultures as compared to cultures supplemented with serum. Incubation of serum-free neurosphere cultures with 5 nM HSP990 (5 days) resulted in increased glioneuronal differentiation exhibiting elevated GFAP, Oct-4 and beta-tubulin expression compared to untreated controls. To test ‘self renewal’ GBM12 neurospheres were treated with HSP990 (10, 30 nM) for 7 days followed by dissociation and plating equal numbers of viable cells at low density in fresh drug-free neurobasal media. Interestingly, HSP990 treatment did not affect the number of secondary neurospheres (surviving fraction: control = 1.00, 10 nM = 1.30, 30 nM = 1.05). Treatment of GBM12TMZ flank tumor xenografts with weekly HSP990 (13 mg/kg P.O.) resulted in a modest 9 day delay in tumor re-growth (40.3 and 49.3 respectively) compared to placebo treatment. In conclusion, HSP990 (a) had anti-proliferative, pro-apoptotic effect on differentiated serum-supplemented xenograft cultures (b) a pro-differentiation effect on serum-free GBM stem cell cultures (c) markedly suppressed neurosphere formation with prolonged drug exposure but not with more limited drug exposure (d) inhibited GBM growth in vivo. Thus, HSP990 may inhibit GBM growth both through direct growth inhibition and through pro-differentiation effects on GBM stem-like cells. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr B100.
Abstract A77: Efficacy of PARP inhibitor AG014699 in orthotopic GBM xenografts is limited by ineffective drug penetration into the central nervous system.
Abstract Poly (ADP-ribose) polymerase (PARP) inhibition can enhance the efficacy of temozolomide (TMZ) and has been shown to significantly prolong survival in orthotopic GBM xenografts. Here the effects of PARP inhibitor AG014699 (AG699) on the efficacy of TMZ was evaluated and corresponding pharmacokinetic and pharmacodynamic studies were performed in the MGMT methylated GBM12 primary GBM xenograft line. AG699 effectively sensitized GBM12 cells to TMZ in vitro in a neurosphere formation assay: IC50 of 1.56 M for TMZ when combined with 1 μM AG699 compared to 8.16 M TMZ when used alone). Using these same cells, orthotopic xenografts were established and mice were randomized to 3–28 day cycles of placebo or TMZ (50 mg/kg days 1–5) with or without AG699 (1 mg/kg IP days 1–5). Although this model is responsive to other TMZ/PARP inhibitor combinations, the addition of AG699 was ineffective (median survival: placebo 16 days, TMZ 68 days and TMZ/AG699 81 days, p=0.883). In contrast, AG699 significantly potentiated TMZ-induced tumor regrowth delay in a flank tumor model with GBM12 (median time for tumors to reach endpoint: placebo 32 days, TMZ 86 days and TMZ/AG699 121 days, p<0.01). To more clearly understand the discrepancy between intracranial and flank studies, drug accumulation and target inhibition were assessed. Plasma and tissue distribution studies in mice bearing GBM12 orthotopic xenografts showed that 0.5 h after AG699 treatment its level in brain and tumor xenograft was much lower compared with that in liver (see table). In an assessment of catalytic activity, PARP activity in liver was inhibited more than 95% of control at least 2 h after AG699 treatment, while it was inhibited less than 50% and 30% in orthotopic xenograft tissue and normal brain, respectively (Table). Collectively, these data support the hypothesis that the efficacy of AG699 combined with TMZ is limited in the orthotopic model due to limited drug accumulation within the brain, and the mechanisms of which are under investigation. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2011 Nov 12-16; San Francisco, CA. Philadelphia (PA): AACR; Mol Cancer Ther 2011;10(11 Suppl):Abstract nr A77.
Abstract C191: The effect of the cyclin-dependent kinase inhibitor PD 0332991 on glioblastoma cells and relationship with p15INK4B/p16INK4A expression
Abstract Glioblastoma multiforme (GBM) is the most common and highly malignant primary brain tumor in adults with a median survival just over 1 year, and novel therapies are urgently needed. Deregulation of the p16 (INK4A)-CDK4/6-pRb pathway are commonly found in human GBM patients and selective inhibitors of CDK4/6 may be specifically useful to suppress proliferation associated with these alterations. PD0332991 is an orally active small molecule that specifically inhibits CDK4 and CDK6. Therefore, the efficacy of PD0332991 was evaluated in the Mayo panel of primary GBM xenograft lines using short-term explant cultures. We hypothesized that expression of p15 and/or p16, endogenous inhibitors of CDK4/6 activity, would suppress the response of GBM tumors to PD0332991 treatment. To test this hypothesis, 2 GBM xenograft cell lines with wild-type p16/p15 levels (GBM5 and 28) and 2 lines without detectable p16/p15 levels (GBM22 and 43) were selected for further analysis. Tumor cells were treated with graded concentrations (10 nanoM to1 microM) of PD0332991 for 5 days and subjected to CyQUANT cell proliferation assays. Consistent with our hypothesis, treatment with 1 microM PD0332991 effectively inhibited cell proliferation to 56.6±3.5% (P<0.001) and 44.3±3.4% (P<0.001) of control in GBM22 and GBM43 cells respectively, but did not affect cell proliferation in GBM5 and GBM28 cells (98.7±15.6% and 101.8±12.0% of control, respectively). In addition, 1 microM PD0332991 induced G1-phase cell cycle arrest in GBM22 (treated 79.7±0.8% vs. control 63.4±0.5% of cells in G1 phase, P<0.001) and GBM43 (treated 70.6±1.1% vs. control 48.9±4.6% of cells in G1 phase, P<0.001) but not in GBM5 and GBM28 (treated 52.3±2.7% vs. control 54.0±5.1%, treated 52.4±4.7% vs. control 54.6±2.6%, respectively). The status of p15 and p16 was confirmed by RT-PCR, which demonstrated readily detectable expression of p15 and p16 in GBM5 and GBM28, but not in GBM22 and GBM43 cells. Additional comparative genomic hybridization (CGH) data showed that CDKN2A and 2B (genes encode for p16 and p15 respectively) are homozygously deleted in GBM22 and 43, hemizygously deleted in GBM5 and normal in GBM28. We also examined the status of CDK4, CDK6, pRb and other molecules in the p16-CDK4/6-pRb pathway by Western, RT-PCR and CGH in these GBM lines and the data will be presented. We are now testing whether shRNA knockdown and/or re-expression of p15/p16 in the relevant cell lines alters their responsiveness to PD0332991. In conclusion, CDK4/6 inhibitor PD0332991 inhibits cell proliferation and induces G1 cell cycle arrest in p15/p16- null GBM tumors, but is less effective in p15/p16 expressing tumors. Citation Information: Mol Cancer Ther 2009;8(12 Suppl):C191.