Project Details
Description
Project Summary/Abstract
Endometrial cancer (EC) is the most common gynecologic malignancy with poor outcomes for those with
serous histology. Chemotherapy resistance is common in recurrent disease and very few targeted therapies
are available. However, there is growing evidence that some serous or molecularly serous-like ECs have
evidence for homologous recombination (HR) deficiency (HRD). Here we show that EC patient derived
xenograft (PDX) models also revealed a higher frequency of HRD in serous EC, as determined by a genomic
score of HRD (based on telomeric allelic imbalance, large state transitions, and loss of heterozygosity). Serous
EC were also more sensitive to rucaparib, a poly (ADP ribose) polymerase (PARP) inhibitor (PARPi), in an ex
vivo 3D culture system. To confirm the dependence of an HRD-high EC on HR DNA repair, SN38 was used to
provoke single- and double-strand DNA breaks concurrently with rucaparib and indeed, the observed synergy
was consistent with a deficiency of HR repair. Further validation of HRD was demonstrated in an in vivo PDX
study showing the combination of rucaparib plus a novel formulation of SN38 (PLX038A) resulted in a marked
and unparalleled regression of tumors. Remarkably, four of eight mice had undetectable tumors. However,
several questions require investigation to facilitate the clinical use of PARPis and/or the combination with
PLX038A. It is unknown whether the HRD score of other ECs (e.g serous-like, regardless of histology) will
predict response to a PARPi and if the genetic HRD score can be improved by including another omics data to
more accurately predict response to a PARPi. To test the hypothesis that an HRD score in ECs can predict
response to a PARPi and the synergy with SN38 is dependent on HR deficiency, the following aims are
planned. We propose to i) predict PARPi sensitivity using the genomic HRD score and a novel mRNA
signature of PARPi response, ii) determine the efficacy of rucaparib alone and in combination with SN38 in a
larger cohort of EC PDXs ex vivo and in vivo, and iii) evaluate a dual-omics score in relation to PARPi
response in fresh surgical specimens of primary patient tumors ex vivo. The data generated from this
application will be used to justify clinical use of PARPis in a molecularly defined subset of ECs. In addition,
since rucaparib + PLX038 is currently in phase 1 trials (NCT04209595) with plans to open a phase 2 trial in
ovarian cancer, these data will support an expansion cohort in EC.
Status | Active |
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Effective start/end date | 12/1/21 → 11/30/23 |
Funding
- National Cancer Institute: $222,998.00
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