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Abstract BACKGROUND: Primary Mediastinal B-Cell Lymphoma (PMBL) is a rare form of B-cell non-Hodgkin lymphoma (Lones/Cairo et al, JCO 2000). We have previously reported a significant decrease in EFS among pediatric and adolescent patients with PMBL compared with other stage III non-PMBL diffuse large B-cell lymphoma (DLBCL) patients following FAB/LMB 96 therapy, suggesting that new therapeutic targeted agents are needed (Gerrard/Cairo et al, Blood 2013). Activation of the B-cell receptor (BCR) signaling pathway has now emerged as a central oncogenic pathway that promotes growth and survival in both normal and malignant B-cells. The cascade of signaling pathways downstream of the BCR includes BTK, MAPK, NF-κB and AKT. PMBL has a constitutively activated NF-kB pathway (Rosenwald et al, JEM 2003). Ibrutinib is a selective and covalent BTK inhibitor that inhibits chronic active BCR signaling and downstream signaling including the NF-kB pathway (Herman et al, Blood 2014) and is an active agent in ABC-DLBCL, which also has an activated NF-kB pathway (Griner et al, PNAS 2014). Preclinical studies of ibrutinib in CLL and MCL suggested that the inhibitory effects on cell proliferation were seen in the range of 1.0uM to 25.0uM (Herman et al, Blood 2011; Cinar et al, Leuk. Res 2013). Despite these relatively high IC50 values in vitro, ibrutinib has been highly effective in the treatment of patients with refractory CLL and MCL (Byrd et al, NEJM 2013 and Wang et al, NEJM 2013). Ibrutinib was approved by the FDA (IMBRUVICA, USPI) for patients with MCL in November 2013 or CLL in February 2014, who have received at least one prior therapy. However, the antitumor activity against PMBL of ibrutinib alone and in combination with other agents is currently unknown. OBJECTIVES: We hypothesize that ibrutinib in combination with other agents may be a future targeted agent in the treatment of PMBL. Therefore, we investigated the effect of ibrutinib alone and in combination with dexamethasone, rituximab and carfilzomib on cell proliferation and apoptosis in a PMBL cell line. METHODS: The Karpas-1106P PMBL cell line (DSMZ, Germany) was treated with ibrutinib alone (0-10uM, generously provided by Janssen R&D LLC) and in combination with dexamethasone (1uM), rituximab (20ug/ml) and carfilzomib (5nM) for 5 days treatment. The MTS cell proliferation assay (Promega) and western blot analysis were performed. Significant differences were determined by Student's t -test.The IC50 values were determined with CompuSyn software (Chou and Martin, ComboSyn, 2005). RESULTS: We observed a significant down-regulation of phosphorylated BTK after 5 days with ibrutinib treatment in Karpas-1106P cell line with 1uM ibrutinib (0.178 ± 1.63, p<0.0001) and the expression of total BTK protein was also significantly decreased with 1uM ibrutinib following 5 days of treatment (0.803±0.190, p<0.005) compared to control (1.000±0.00). We also observed a significant dose-dependent decrease in cell proliferation (0-10uM, p<0.0001) in ibrutinib-treated Karpas-1106P PMBL cell line. In combination with dexamethasone, the ibrutinib IC50 values for inhibition of cell proliferation were significantly decreased from 0.71uM ± 0.172 (ibrutinib alone) to 0.04uM ± 0.007 (p<0.005) with 1.0uM dexamethasone combination following 5 days of treatment. Second, in combination with rituximab experiment, the ibrutinib IC50 values was significantly decreased from 0.845uM ± 0.289 (ibrutinib alone) to 0.37uM ± 0.056 (p<0.05) with 20ug/ml rituximab following 5 days of treatment. Lastly, the ibrutinib IC50 values were significantly decreased from 0.72uM ± 0.185 (ibrutinib alone) to 0.002uM ± 0.001 (p<0.005) with 5nM carfilzomib combination following 5 days of treatment. CONCLUSIONS: Ibrutinib alone and in combination with dexamethasone, rituximab and carfilzomib significantly inhibited cell proliferation in the Karpas-1106P PMBL cell line. Ibrutinib's potential as an adjuvant agent in combination treatment in patients with PMBL is supported by these experiments. Future studies will focus on the in vivo effects of ibrutinib alone and in combination with dexamethasone and carfilzomib in a NOD/SCID PMBL xenograft mouse model. Disclosures Galardy: Mission Therapeutics: Research Funding.

Abstract Abstract 1851 Background: In previous work we performed RNAi sensitizer screening of epigenetic modulation with 5-Azacytidine and the human kinome. Few kinase hits were identified. Therefore we asked if phosphatases might be involved in modulating epigenetic therapies. Thus in order to identify potentiators of the histone deacetylase inhibitor suberoylanilide hydroxamic acid (SAHA) we performed high-throughput RNA-interference (RNAi) lethality screening using the myeloid cell lines HEL, THP-1 and TF-1 in combination with SAHA. Methods: A small-interfering RNA (siRNA) library targeting 206 phosphatases with 4 sequences per target gene was used for this study. siRNA were transfected in a single-siRNA-per-well format in 384-well plates using commercial lipid-based transfection reagents. Non-silencing siRNA were included as negative controls to access non-specific siRNA toxicity and universal lethal siRNA were included as positive controls to indirectly assess functional transfection efficiency. After a 96 hour incubation period, cell viability/proliferation was measured with Cell Titer Glo. For analysis of screen data, log2 values of (SAHA + siRNA treatment/siRNA treatment only) were calculated. Potentiation was defined as two standard deviations from the median log2 ratio of all siRNA (excluding positive controls) on a plate-by-plate basis. Hits were defined as ≥ 2/4 siRNA sequences meeting potentiation criteria. Results: Transfection efficiency was 95, 90 and 70% for HEL, THP-1 and TF-1, respectively. All three cell lines were similarly sensitive to SAHA with IC50 values of 0.3, 0.4 and 0.6 μM for HEL, THP-1 and TF-1, respectively. Resulting SAHA concentrations for screens were between the IC5 to IC30. For THP-1, 5 phosphatases qualified according to the hit selection criteria applied indicating strong potentiation to SAHA. Of these 5 hits, 3 did not exhibit strong reductions in viability with siRNA alone, suggesting a SAHA-dependent relationship. For HEL and TF-1, although no phosphatases met the strict selection cutoff, there were several phosphatases exhibiting potentiation, suggesting biological relevance. The primary screening data and preliminary analysis will be validated with rigorous secondary experimentation and top hits for all cell lines will be investigated and advanced. Conclusions: While there are numerous kinase inhibitors in the clinic and in preclinical development, phosphatases are much less explored as therapeutic targets. Validated potentiating targets from this RNAi screen can facilitate the development of rational SAHA combination therapies. Disclosures: No relevant conflicts of interest to declare.

Abstract Abstract 180 Background: Proliferative signals in myeloid malignancies/leukemias are often driven by kinase activating events. Phosphatases often counteract these effects, though some phosphatases are oncogenes as well. To characterize these opposing signaling networks and build a loss of function intervention map, we performed the first phosphatome RNAi screen in conjunction with a kinome RNAi screen in myeloid leukemia cells. Methods: Four myeloid cell lines, TF-1, THP-1, HEL and MDS-L were incubated with siRNA against 206 phosphatases and 711 kinases with 4 different siRNA sequences (4x) per gene. After 96 hours, viability/proliferation was assessed by luminescence with Cell Titer Glo. Tranfection efficacy was determined by the ratio of the median of an universal lethal control vs. all siRNA. Normalization was done calculating the percent of sample median according to % proliferation = [siRNA signal × 100] / [median all siRNA signals]. Hits were defined using the median absolute deviation (MAD) of > 2 standard deviation above or below the individual siRNA signal (Birmingham et al, Nature Methods 2009) for at least 2 of 4 siRNA per gene. Results: Transfection efficacy was around 70, 95, 95 and 80 percent for TF-1, THP-1, HEL and MDS-L cells respectively. In TF-1, five kinases met hit selection criteria reducing proliferation whereas surprisingly no phosphatase was a hit. In THP-1, five kinases each reduced or increased proliferation respectively and only one phosphatase was a hit altogether increasing proliferation upon siRNA silencing. A different trend was seen in HEL cells: siRNA silencing of 16 kinases decreased and silencing of one kinase increased proliferation. Interestingly, inhibition of six phosphatases reduced proliferation in HEL whereas none increased proliferation. In MDS-L cells, siRNA inhibition of 9 kinases reduced and of 1 kinases increased viability respectively; inhibition of two phosphatases increased and of one decreased viability. The most common universal hit was PLK1 across 3 of 4 cell lines. No phosphatase was found to be a common hit across several lines. Conclusion: RNAi kinome-phosphatome profiling of 917 phosphatases and kinases reveals distinct signaling patterns among representative myeloid leukemia cell lines. Some cell lines, like HEL, which harbors a Jak2 mutation, are possibly more driven by kinase activating events but also show putative phosphatases as therapeutic targets. Candidate kinases whose siRNA silencing reduces viability/proliferation may uncover synthetic lethal interactions between known mutational and genomic abnormalities. The identified siRNA hits are potential novel targets for drug development. This combined functional genomics approach also highlights the complexity of signaling and that inhibition of some kinases can accelerate growth at least in vitro, e.g. inhibition of PIM3 in THP-1 cells. Phosphatases are an emerging network of cellular regulators with occasional oncogenic potential. A “loss-of-phosphatome/ase” RNAi approach is a fast way to gain new insights into the complex and little researched field. Disclosures: No relevant conflicts of interest to declare.

Background: Anaplastic thyroid cancer (ATC) has poor prognosis with median overall survival (OS) of ∼6 months. We previously reported high PD-1/PDL-1 staining in ATC, raising the possibility of the productive application of the immunotherapeutic pembrolizumab. However, having found pembrolizumab to anecdotally have limited single-agent activity in ATC, we sought to alternatively define whether pembrolizumab might synergistically combine with chemoradiotherapy as initial ATC therapy. Methods: An investigator-initiated therapeutic phase 2 trial of pembrolizumab, 200 mg intravenously (IV) every 3 weeks, combined with chemoradiotherapy (docetaxel/doxorubicin, 20 mg/m 2 each IV weekly plus volumetric modulated arc therapy) was initiated as frontline therapy (with or without surgery) in ATC to assess efficacy and toxicities. Six-month OS was selected as the primary endpoint using a Simon's optimal design with interim analysis (targeting accrual of 25 patients; Cohort A: prior resection, Cohort B: no resection). Based on a prior patient cohort-treated similarly, but without pembrolizumab, the design was such that, if 6-month true survival is 75%, the probability of declaring the approach worthy of further pursuit would be 91%. Results: Three patients were enrolled, two with rapidly enlarging unresectable neck masses. Early tumor responses were favorable in all three, and all three satisfactorily completed: intended radiotherapy, preceding and radiotherapy-concurrent pembrolizumab, and concurrent chemoradiotherapy. However, all three patients died <6 months following therapy initiation—one from pulmonary metastases and two from otherwise unexpected fatal pulmonary complications occurring subsequent to chemoradiotherapy completion—prompting study closure. Conclusions: Although initially tolerated and effective in terms of locoregional disease control, disappointing survival outcomes compared with historical controls raise uncertainty that the piloted approach merits further pursuit in ATC.

BackgroundMagnetic resonance elastography (MRE) can determine the presence and stage of liver fibrosis. Data on normative MRE values, while reported in adults, are limited in children.PurposeTo determine the distribution of MRE‐measured liver stiffness in children without liver disease.Study TypeProspective, observational.PopulationEighty‐one healthy children (mean 12.6 ± 2.6 years, range 8–17 years).Field Strength/Sequence3.0T Signa HDxt, General Electric MR Scanner; 2D GRE MRE sequence.AssessmentHistory, examination, laboratory evaluation, and (MR) exams (proton density fat fraction, PDFF, and MRE) were performed. MR elastograms were analyzed manually at two reading centers and compared with each other for agreement and with published values in healthy adults and thresholds for fibrosis in adult and pediatric patients.Statistical TestsDescriptive statistics, Bland–Altman analysis, t‐test to compare hepatic stiffness values with reference standards.ResultsStiffness values obtained at both reading centers were similar, without significant bias (P = 0.362) and with excellent correlation (intraclass correlation coefficient [ICC] = 0.782). Mean hepatic stiffness value for the study population was 2.45 ± 0.35 kPa (95th percentile 3.19 kPa), which was significantly higher than reported values for healthy adult subjects (2.10 ± 0.23 kPa, P < 0.001). In all, 74–85% of subjects had stiffness measurements suggestive of no fibrosis.Data ConclusionMean liver stiffness measured with MRE in this cohort was significantly higher than that reported in healthy adults. Despite rigorous screening, some healthy children had stiffness measurements suggestive of liver fibrosis using current published thresholds. Although MRE has the potential to provide noninvasive assessment in patients with suspected hepatic disease, further refinement of this technology will help advance its use as a diagnostic tool for evidence of fibrosis in pediatric populations.Level of Evidence: 1Technical Efficacy: 5J. Magn. Reson. Imaging 2020;51:919–927.

Abstract The goal of this study is to evaluate the potential use of gene expression profile of peripheral blood mononuclear cells (PBMCs) as a non-invasive biomarker for predicting the response of anti-PD-1 therapy in non-small cell lung cancer (NSCLC) subjects. Peripheral blood of NSCLC stage 4 subjects treated with an anti-PD-1 monoclonal antibody was collected prior to treatment (week 0) and subsequent infusions. Total RNA was extracted, and libraries were prepared using TruSeq Stranded mRNA LT Sample Prep Kit and sequenced by Illumina NextSeq. The paired-end reads were mapped to human reference hg38 using STAR and gene expressions were calculated using RSEM. Preliminary analysis of differential gene expression (DE) was performed among the responders at respectively (T1) weeks 3-4, (T2) weeks 6-9 and (T3) weeks 12-16 after treatment, compared with the baseline at T0. Further DE analysis was performed between the baseline samples of responders and non-responders. Genes with FDR-adjusted p values less than 0.05 were selected for pathway enrichment analysis with DAVID. Altogether 30 RNA-Seq samples of seven subjects were collected at multiple time points before and after treatment. According to standard RECIST 1.1 criteria, five subjects had a partial response to the therapy, whereas two subjects had stable disease or no response. In addition, liquid biopsy results were available for selected samples. Among the responders, there are 203 DE genes for T1 with log2 fold change (LFC) of gene expression from -2.4 to 3.5, 859 DE genes for T2 with LFC from -3.4 to 3.3, and 395 DE genes for T3 with LFC from -3 to 6.8. Among the DE genes for the three time points, 155 genes are common to T1/T2, 250 common to T2/T3, and 104 common to T1/T2/T3. Pathway enrichment test using Gene Ontology Biological Process terms shows that the strongest DE pathways for initial response after treatment at T1 are regulation of immune response (FDR adjusted p = 2.5E-5), oxygen transport (p = 5.5E-3) and T cell costimulation (p = 3.9E-3). Based on the 104 common DE genes, oxygen transport (p = 0.029) is the only pathway consistently perturbed due to an increase in hemoglobin. When comparing the baseline of responders and non-responders, we identified a candidate gene signature, with some of the genes also reported in other studies. However, more samples are required to establish its statistical significance. Systemic immune response after first dose of anti-PD1 treatment is reflected by DE genes in blood samples collected in weeks 3-4. Tumor regression might be indicated by the consistent increase in hemoglobin level. The results of these analyses show promise of developing a predictive signature for the response of anti-PD-1 immunotherapy in NSCLC subjects based on the gene expression profile of PBMCs. While these are preliminary results, we continue to recruit subjects, and will present the up-to-date results at the conference. Citation Format: Yee Him Cheung, Jie Wu, Weihua Huang, Changhong Yin, Katherine Linder, Kaushal Parikh, Ke Tang, Christopher Kasbek, Jun Huang, Zeil Rosenberg, Michael Fanucchi, John Fallon, Nevenka Dimitrova. Differential gene expression analysis reveals pathways involved in anti-pd-1 therapy response prediction [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4994.

Abstract Fibroproliferative diseases are a leading cause of morbidity and mortality featuring localized and systematic tissue/organ fibrosis, which account for nearly 45% of all deaths in the developed world, with an unknown etiology and no effective treatment. Transforming growth factor beta (TGF-β) is a ubiquitous cytokine that contributes to fibroblast activation, myofibroblast differentiation, collagen overproduction and pathological tissue fibrosis. In that mounting evidence indicate that altered glutamine metabolism has critical roles in regulating signaling pathways, maintaining redox balance and macromolecular biosynthesis, we wished to test the general hypothesis that intervention of these metabolic processes could provide novel approaches to developing anti-fibrotic therapies. To that end, in the current work we provide a framework integrating glutamine dysregulation with profibrotic TGF-β signaling. We found that Glutaminase 1 (GLS1), which converts glutamine to glutamate, is induced by TGF-β and is also elevated in (i) fibroblasts isolated from Idiopathic Pulmonary Fibrosis (IPF) patients; and (ii) the murine bleomycin (i.e., TGF-β driven) model of lung fibrosis. While phosphorylation of Smad2 and Smad3 occurs independently of GLS1, TGF-β stimulated expression of profibrotic targets (i.e., Collagen I, PAI-1, CTGF, α-SMA and fibronectin) as well as biological actions (i.e., cell migration and anchorage independent growth) require GLS1 activity. Moreover, knockdown of Smad2 or Smad3 as well as inhibition of MAPK, PI3K, Akt or mTOR abrogates the induction of GLS1 by TGF-β; documenting that TGF-β regulates GLS1 expression via both Smad and non-Smad signaling. As GLS1 represents a critical component mediating the fibroproliferative actions of TGF-β, in order to identify the operative molecular mechanism(s) we focused on (i) a group of histone deacetylases called sirtuins (SIRT) which are known to elicit antifibrotic effects; and (ii) the Forkhead box protein O4 (FOXO4) transcription factor which has been shown to bind the GLS1 promoter. We found that there is not only a decrease in SIRT7 and FOXO4 coincident with the induction of GLS1 by TGF-β, but TGF-β inhibits SIRT7 deacetylation activity which in turn prevents FOXO4 deacetylation and inhibition of GLS1 expression. Last, consistent with SIRT7 and FOXO4 being negative regulators of profibrotic TGF-β signaling, their levels were also decreased in IPF fibroblasts and bleomycin-induced lung fibrosis. These studies point to an exciting, novel and unexplored connection between sirtuins, FOXOs and glutamine metabolism by elucidating the mechanism(s) by which epigenetic and transcriptional processes cooperate to regulate glutamine metabolism and fibrotic development in a TGF-β dependent manner. Citation Format: Malay Choudhury, Xueqian Yin, Jeong-Han Kang, Mahefatiana Andrianifahanana, Edward B. Leof. Cooperativity between glutaminase 1 and histone deacetylase SIRT7 regulates TGF-β mediated lung fibrosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1847.

PURPOSE Older women with breast cancer remain under-represented in clinical trials. The Cancer and Leukemia Group B 49907 trial focused on women age 65 years and older. We previously reported the primary analysis after a median follow-up of 2.4 years. Standard adjuvant chemotherapy showed significant improvements in recurrence-free survival (RFS) and overall survival compared with capecitabine. We now update results at a median follow-up of 11.4 years. PATIENTS AND METHODS Patients age 65 years or older with early breast cancer were randomly assigned to either standard adjuvant chemotherapy (physician’s choice of either cyclophosphamide, methotrexate, and fluorouracil or cyclophosphamide and doxorubicin) or capecitabine. An adaptive Bayesian design was used to determine sample size and test noninferiority of capecitabine. The primary end point was RFS. RESULTS The design stopped accrual with 633 patients at its first sample size assessment. RFS remains significantly longer for patients treated with standard chemotherapy. At 10 years, in patients treated with standard chemotherapy versus capecitabine, the RFS rates were 56% and 50%, respectively (hazard ratio [HR], 0.80; P = .03); breast cancer–specific survival rates were 88% and 82%, respectively (HR, 0.62; P = .03); and overall survival rates were 62% and 56%, respectively (HR, 0.84; P = .16). With longer follow-up, standard chemotherapy remains superior to capecitabine among hormone receptor–negative patients (HR, 0.66; P = .02), but not among hormone receptor–positive patients (HR, 0.89; P = .43). Overall, 43.9% of patients have died (13.1% from breast cancer, 16.4% from causes other than breast cancer, and 14.1% from unknown causes). Second nonbreast cancers occurred in 14.1% of patients. CONCLUSION With longer follow-up, RFS remains superior for standard adjuvant chemotherapy versus capecitabine, especially in patients with hormone receptor–negative disease. Competing risks in this older population dilute overall survival benefits.

Circulating extracellular vesicles (EVs) are a novel and emerging biomarker for nonalcoholic steatohepatitis (NASH). It has been demonstrated that total circulating EVs and hepatocyte‐derived EVs are elevated in male mice with diet‐induced NASH. How hepatocyte‐derived EVs change over time and other cellular sources of EVs in NASH have not been determined. Our objective was to define the quantitative evolution of hepatocyte‐derived, macrophage‐derived, neutrophil‐derived, and platelet‐derived EVs in male and female mice with dietary NASH. Fluorescently labeled antibodies and a nanoscale flow cytometer were used to detect plasma levels of EVs. Asialoglycoprotein receptor 1 (ASGR1) and cytochrome P450 family 2 subfamily E member 1 (CYP2E1) are markers of hepatocyte‐derived EVs; galectin 3 is a marker of macrophage‐derived EVs; common epitope on lymphocyte antigen 6 complex, locus G/C1 (Ly‐6G and Ly‐6C) is a marker of neutrophil‐derived EVs; and clusters of differentiation 61 (CD61) is a marker of platelet‐derived EVs. Nonalcoholic fatty liver disease activity score (NAS) was calculated using hematoxylin and eosin‐stained liver sections, and magnetic resonance imaging (MRI) was used for measurement of the fat fraction and elastography. Hepatocyte‐derived EVs increased in both male and female mice at 12 and 10 weeks of feeding, respectively, and remained elevated at 24 weeks in both male and female mice and at 48 weeks in male mice and 36 weeks in female mice. Macrophage‐ and neutrophil‐derived EVs were significantly elevated at 24 weeks of dietary feeding concomitant with the histologic presence of inflammatory foci in the liver. In fat‐, fructose‐, and cholesterol‐ (FFC) fed male mice, platelet‐derived EVs were elevated at 12, 24, and 48 weeks, whereas in female mice, platelet derived EVs were significantly elevated at 24 weeks. Hepatocyte‐, macrophage‐ and neutrophil‐derived EVs correlated well with the histologic NAS. Conclusion: Circulating cell‐type‐specific EVs may be a novel biomarker for NASH diagnosis and longitudinal follow up.