CBMT-19. THE ALTERNATIVE LENGTHENING OF TELOMERE (ALT) MECHANISM PROVIDES COLLATERAL SENSITIVITY TO LETHAL TELOMERIC FUSION INDUCED BY TRAPPING PARP INHIBITORS

Abstract

Abstract A subset of human tumors, including all IDH1-mutant astrocytomas, use a homologous recombination-based alternative lengthening of telomere (ALT) pathway to resolve telomeric dysfunction in the absence of TERT. Because ALT is not used by normal cells, targeting of the process may provide new therapeutic options for patients with ALT-dependent tumors. We here report that reliance on the ALT mechanism makes tumors collaterally hypersensitive to clinically-available trapping PARPi (t-PARPi). Specifically we noted that astrocytoma cells dependent on the ALT-mechanism (IDH1-mutant and ATRX-deficient genetically-modified human astrocytes and MGG119 PDX) were significantly more sensitive to trapping PARPi than matched ALT-independent isogenic ATRXWT astrocytes and MGG152 PDX cells, respectively) both in vitro and in vivo. Surprisingly this hypersensitivity was not associated with BRCA-ness, the extent of PARP inhibition, or with t-PARPi-created genomic DNA damage as is the case in most PARPi-sensitive populations. Rather the enhanced activity of t-PARPi in ALT-dependent cells was associated with a novel t-PARPi-induced, lethal telomere fusion. Furthermore, the extent of chromosomal fusion was proportional to the PARP-trapping ability of the five PARP inhibitors tested, and could be prevented by exogenous expression of TERT, which eliminated reliance on ALT but did not alter levels of PARPi-induced genomic DNA damage. The extent of tPARPi-induced telomeric fusion in ALT-dependent cells, which could be directly measured in small amounts of DNA using a q-PCR approach, was also directly proportional to tPARPi-induced cell death in vitro and to prolonged survival of tumor-bearing mice in vivo. These results therefore identify clinically available tPARPi as a new treatment modality for a select and easily genetically definable group of ALT tumors, and also define telomeric fusion as a biomarker of drug action in these tumors.