Citations

4155 Background: The tumor microenvironment (TME) that surrounds pancreatic ductal adenocarcinoma (PDAC) is a multi-faceted and dynamic ecosystem in which stromal fibroblasts communicate with cancer cells to mediate tumor growth, metastasis, and chemotherapy resistance. It is well recognized that both cancer-associated fibroblasts (CAFs) and its non-cellular, fibrotic components within the TME can foster a protumorigenic environment for PDAC. However, we still lack a comprehensive understanding of the precise mechanisms in which this dense, fibrotic matrix can help drive malignant behaviors. Here, we reveal a novel mechanism in which the zinc-finger transcription factor GLI2 regulates type 1 collagen expression within CAFs and how the soluble variant of this collagen promotes irinotecan chemoresistance. Methods: We leveraged transcriptomic data from The Cancer Genome Atlas, International Cancer Genome Consortium, and Clinical Proteomic Tumor Analysis Consortium to evaluate GLI2 expression and stromal content of human PDAC tumors through bulk RNA-sequencing deconvolution. Using single-nucleus RNA sequencing of human PDAC tumors, we validated the association of GLI2 expression and stromal matrix constituents in CAFs. Chromatin immunoprecipitation assays in human CAFs confirmed GLI2 binding at the COL1A1 promoter. Through RNAi-based inactivation of GLI2, we determined how loss of GLI2 impacts regulation of type 1 collagen. Additionally, we conducted MTT assays to assess tumor viability in response to irinotecan treatment. Results: Transcriptomic analysis revealed that GLI2 is highly enriched in CAFs and strongly correlated with stromal fibrosis compared to other non-tumor cell constituents within the TME. We have shown that GLI2 directly binds to the promoter of COL1A1, a key component of type 1 collagen, in CAFs and regulates its transcription in a manner dependent on TGFβ1 signaling. Interestingly, PDAC tumors exposed to type 1 collagen show increased expression of pro-tumorigenic pathways involved in inflammation, EGR signaling, cytokine-receptor interactions, and irinotecan resistance. We further validate that human PDAC cells pre-treated with collagen can confer chemoresistance to irinotecan with viability assays. Conclusions: Taken together, our study demonstrates a novel mechanism in which GLI2 regulates the secretion of collagen within CAFs, which in turn can enable PDAC to acquire resistance to standard-of-care treatments. These findings highlight not only the oncogenic functions for CAFs and their fibrotic secretome, but also open new avenues in which therapeutic targeting of the TME may provide clinical benefit for PDAC patients.

175 Background: It is well-known that patients with liver metastases from metastatic castration resistant prostate cancer (mCRPC) have poorer or transient responses to many forms of systemic therapy. Data on outcomes following treatment with Lutetium-177–PSMA-617 is scarce. The VISION trial reports hazard ratios for overall survival in the subgroup of patients with liver metastases without disclosing the absolute duration of survival. Using real-world clinical data, we examine this important subgroup of patients, describing their PSA response rates and survival. Methods: A single institution database was assembled to include all patients receiving 177-Lu-PSMA-617 at Mayo Clinic Rochester, MN, and starting treatment in the interval of March 2022 to March 2023. Baseline clinicopathologic and imaging characteristics were abstracted. Patients were categorized based on the presence or absence of measurable liver metastases on their baseline PSMA PET scan. Best PSA response while on treatment was annotated and reported as percent decline from baseline. Survival was calculated from date of first cycle of 177-Lu-PSMA-617. PSA50 response and overall survival (OS) outcomes for the two groups (liver metastases versus no liver metastases) were compared using Chi square test and Kaplan-Meier method, respectively. Those with available pre-treatment circulating tumor DNA (ctDNA) genomic profiling, performed by Guardant (83 gene panel), were assessed for the presence of pathogenic and likely pathogenic alterations. Findings are summarized using descriptive statistics. Results: The overall cohort consisted of 212 patients, including 29 (14%) with liver metastases on pre-treatment PSMA PET/CT. The median number of cycles received was 4 (range, 1-6) for patients with liver metastases and 6 (range, 1-6) for those without hepatic involvement. The observed PSA50 response trended lower for those with liver metastases (34.5% [10/29] versus 51% [94/183], p= 0.091). At median (IQR) follow-up of 10 (8-12) months, there was a numerical but not statistically significant difference in median OS (11.28 months versus NR, p=0.066). In the exploratory analysis of baseline ctDNA, BRCA2 copy number loss was relatively enriched among patients with liver metastases (4 of 19, 21%) versus patients without liver disease (5.7%, 9/158). Conclusions: Our data suggest that the presence of liver metastases predict poorer outcomes in patients receiving Lutetium-177–PSMA-617 treatment, which is similar to data reported with other forms of systemic therapy for mCRPC. To maximize the anti-tumor activity of radioligand therapy in the liver, combination approaches should be explored.