Abstract
Only few drugs have shown activity in patients with advanced soft-tissue and the median overall survival is only 18 months. Alterations of genes involved in the DNA damage repair pathway have been associated with sarcoma risk and prognosis. ATR plays a crucial role in maintaining genomic integrity by responding to a large spectrum of DNA damage, including double strand breaks (DSBs) that interfere with replication. The objective of this study is to evaluate the pre-clinical activity of ATR inhibition in soft tissue sarcomas (STS). We explored the ability of the ATR inhibitor, VE-822, to prevent chemotherapy-induced intra-S-phase checkpoint activation and evaluated the antitumor potential of this combination in vitro and in vivo in STS cell lines and in a patient-derived xenograft model. The combination of VE-822 and gemcitabine in vitro was synergistic, inhibited cell proliferation, induced apoptosis, and accumulated in the S phase of the cell cycle with higher efficacy than either single agent alone. The combination also resulted in enhanced γH2AX intranuclear accumulation as a result of DNA damage induction. These effects were unrelated to the alternative lengthening of telomeres pathway. In vivo, the combination of VE-822 and gemcitabine significantly enhanced tumor growth inhibition and progression-free survival in an aggressive model of undifferentiated pleomorphic sarcoma. The combination of ATR inhibitor and chemotherapy is beneficial in pre-clinical models of soft-tissue sarcoma and deserves further exploration in the clinical setting.
Highlights
A recent international study has shown that germline variants in several genes encoding proteins involved in DNA repair such as BRCA2, ATM, ATR, and ERCC2, contributed significantly to sarcoma risk[5]
We studied the sensitivity of 8 soft tissue sarcomas (STS) cell lines to VE-822 and gemcitabine
Cancer cells are characterized by defects in DDR which results in increased mutational load, replication stress and genome instability
Summary
A recent international study has shown that germline variants in several genes encoding proteins involved in DNA repair such as BRCA2, ATM, ATR, and ERCC2, contributed significantly to sarcoma risk[5]. ATR plays a crucial role in maintaining genomic integrity by responding to a large spectrum of DNA damage, including double strand breaks (DSBs) that interfere with replication. There are no specific data related to the impact of ATR inhibition in a panel of STS pre-clinical models. We used the ATR inhibitor, VE-822, to investigate the effect of ATR inhibition in STS cell lines and patient derived- xenograft. ALT * status positive positive negative positive negative positive negative negative ability of VE-822 to sensitize STS cells to chemotherapy, and characterized the features of the synergy to provide a rational for clinical studies
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