Innovative Drug and Prodrug Candidates in Cancer Treatment Targeting TP53 Mutations: Challenge and Hope.

In 1994 the first heat shock protein 90 (Hsp90) inhibitor was identified and Hsp90 was reported to be a target for anticancer therapeutics. In the past 18 years there have been 17 distinct Hsp90 inhibitors entered into clinical trial, and the small molecule Hsp90 inhibitors have been highly valuable as probes of the role of Hsp90 and its client proteins in cancer. Although no Hsp90 inhibitor has achieved regulatory approval, recently there has been significant progress in Hsp90 inhibitor clinical development, and in the past year RECIST responses have been documented in HER2-positive breast cancer and EML4-ALK-positive non-small cell lung cancer. All of the clinical Hsp90 inhibitors studied to date are specific in their target, i.e. they bind exclusively to Hsp90 and two related heat shock proteins. However, Hsp90 inhibitors are markedly pleiotropic, causing degradation of over 200 client proteins and impacting critical multiprotein complexes. Furthermore, it has only recently been appreciated that Hsp90 inhibitors can, paradoxically, cause transient activation of the protein kinase clients they are chaperoning, resulting in initiation of signal transduction and significant physiological events in both tumor and tumor microenvironment. An additional area of recent progress in Hsp90 research is in studies of the posttranslational modifications of Hsp90 itself and Hsp90 co-chaperone proteins. Together, a picture is emerging in which the impact of Hsp90 inhibitors is shaped by the tumor intracellular and extracellular milieu, and in which Hsp90 inhibitors impact tumor and host on a microenvironmental and systems level. Here we review the tumor intrinsic and extrinsic factors that impact the efficacy of small molecules engaging the Hsp90 chaperone machine.

Comprehensive Analysis of TP53 and CD58 Mutations and Identification of Patients with Inferior Prognosis and Enhanced Immune Escape in Diffuse Large B Cell Lymphoma

Missense mutations in cancer suppressor gene TP53 are colocalized with exonic splicing enhancers (ESEs)

Introduction and Objective: Prostate cancer (PCa) responds initially to anti-androgen therapies, however, progression to castration resistant disease (CRPC) frequently occurs. Several small molecule inhibitors of HSP90 show promise in CRPC and other cancers. However, most HSP90 inhibitors (17-AAG or PF-04928473 and its prodrug PF-04929113) trigger the elevation of HSPs (HSP90, 70, 27 and clusterin), which lead to tumor cell survival and treatment resistance. We hypothesized that targeting clusterin (CLU) using siRNA or the antisense drug, OGX-011, may enhance HSP90 inhibitors-induced cell death in PCa. Methods: Inducible and constitutive CLU and other HSP mRNA and protein levels were measured by real-time RT-PCR and immunoblot assays. The combination of OGX-011 with PF-04928473 or 17-AAG was evaluated in vitro on LNCaP and PC3 cells growth and apoptosis. The HSP90 inhibitor PF-04929113 was evaluated in combination with OGX-011 in vivo in athymic mice bearing castration resistant LNCaP xenografts, while the combination of OGX-011 with 17-AAG was evaluated in PC3 xenografts. Results: In prostate tumor cell lines, PF-04928473 and 17-AAG induced expression of HSPs in a dose and time dependent manner, and especially CLU at RNA and protein level, by increasing HSF-1 nuclear translocation and transcription activity. In vitro, OGX-011 synergistically enhanced the activity of HSP90 inhibitors on cell growth and apoptosis with increased sub-G1 fraction and PARP cleavage. These biologic events were accompanied by decreased expression of HSPs, Akt, AR and PSA, and HSF-1 transcriptional activity. In vivo, OGX-011, administered 3 times a week (IP, 15mg/kg), potentiated the effect of orally administered HSP90 inhibitors (PF-04929113: 25mg/kg; 17-AAG: 50mg/kg), significantly inhibiting tumor growth by 80% and prolonging survival in PC3 and castrate resistant LNCaP xenograft model compared to the HSP90 inhibitors alone. Conclusions: These results indicate that HSP90 inhibitor-mediated induction of CLU expression can be attenuated by OGX-011, with synergistic effects on delaying progression of CRPC. This work was supported by the Canadian Institutes of Health Research fellowship and Association pour la Recherche sur le Cancer, France. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 623. doi:10.1158/1538-7445.AM2011-623

1279 CLU INHIBITION USING OGX-011 IS A NEW ADJUVANT THERAPEUTIC STRATEGY FOR HSP90 INHIBITION IN PROSTATE CANCER

Background: Deleterious TP53 mutations are found in 99% of patients with high-grade serous ovarian cancer (HGSOC). TP53 missense mutations, found in two-thirds of HGSOC tumors, endow the mutant protein with new gain-of-function (GOF) activities leading to altered expression of genes involved in maintaining controlled cellular metabolism and the development of drug resistance. Identification of specific altered pathways could be exploited therapeutically. We investigated whether all missense mutations alter the same metabolic pathways. Methods: We used publicly available data from The Cancer Genome Atlas (TCGA) and the Australia Ovarian Cancer Study (AOCS). TCGA and AOCS gene expression datasets were downloaded from the Curated Ovarian Data, a resource of uniformly prepared microarray data from 23 studies with curated and documented clinical metadata. We merged gene expression data from TCGA (Affymetrix HT_HG-U133A) and AOCS (Affymetrix HG-U133Plus2), subset to 12,211 features common to both datasets and included non-missing values of invasive HGSOC. TP53 mutations were downloaded from TCGA and obtained for AOCS and merged with the curated datasets. The final datasets consisted of 295 patients in TCGA (N=184 with missense mutations with putative GOF activity, and N=111 nonsense mutations with putative loss of function (LOF) activity and 21 wild-type) and 142 patients in AOCS (N=83 missense mutations with putative GOF activity, N=59 nonsense mutations with putative LOF activity and N=13 wild-type). Gene expression values were normalized in each dataset separately by subtracting the mean value of each gene and dividing by the standard deviation. Mutations were categorized according to missense vs nonsense mutation class and also according to specific mutations. We evaluated all gene sets in KEGG but focused a priori on the association of Oxidative Phosphorylation (OXPHOS), Fatty Acid Metabolism (FA), Glycolysis and Gluconeogenesis (GLY), and the P53 pathway with overall (OS) and progression-free survival (PFS) using Cox regression models stratified by mutation class and adjusted for age and stage. Results: There were no significant differences between TP53 missense vs nonsense mutation class for gene set expressions for a priori pathways of interest in TCGA, and a nominal difference for the P53 gene set expression (P=0.07) in AOCS. Comparing TCGA, AOCS, and the combined datasets, differential gene set expressions by TP53 mutation class were observed in all three datasets at P<0.10 for the sulfur relay system, melanogenesis, peroxisome, and purine metabolism pathways. In AOCS among patients with missense, but not nonsense, mutations, FA gene set expression (P=0.06) was associated with PFS, and FA (P=0.03) and P53 (P=0.09) gene set expressions were associated with OS. No significant associations were observed in TCGA or after combining datasets. When categorized according to specific TP53 mutations, we observed significant differences in gene set expressions. Compared to nonsense mutations, TP53 mutations p.I195N or p.I195T were associated with differentially expressed genes in the GLY pathway (P=0.04) and TP53 mutations p.Y220C or p.Y220H (P=0.01) as well as p.R248G, p.R248Q or p.R248W (P=0.04) were associated with differentially expressed genes in the P53 pathway. Compared with survival among patients with nonsense mutations (median 43.4 months, range 0.3-116 months), patients with p.I195 mutations had OS of 47.7 months (range 3-64 months), patients with Y220 mutations had OS of 37.5 months (range 5-69 months) and patients with p.R248 mutations had OS of 33.6 months (range 0.8-59). Patients with the longest median OS of 84.1 months (range 1-180 months) had mutations p.R273C, p.R273C/R248Q combined, p.R273H, p.R273H/R248Q combined, p.R273L, or p.R273P. Conclusions: Specific TP53 missense mutations are associated with different metabolic pathways and may lead to differences in survival. Citation Format: Linda E. Kelemen, James D. Brenton, David D. Bowtell, Brooke L. Fridley. TP53 missense mutations associate with different metabolic pathways. [abstract]. In: Proceedings of the AACR Conference: Addressing Critical Questions in Ovarian Cancer Research and Treatment; Oct 1-4, 2017; Pittsburgh, PA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(15_Suppl):Abstract nr A14.

Loss of TP53 function through gene mutation is a critical event in the development and progression of colorectal cancer (CRC). Here we examined 51 primary CRC tumors from Tunisia for mutations in TP53 exons 4-9 using PCR-direct sequencing. TP53 status and mutation site/type were than correlated with nuclear protein accumulation, familial and clinicopathologic variables and data on KRAS mutations and microsatellite instability (MSI-H). The TP53 mutation analysis was possible in the tumor of 47 patients and a deleterious somatic mutation has been detected in 59.6% of the patients (28/47) including 20 (71.4%) missense mutations, 7 nonsense mutations (25%) and 1 (3.6%) frameshift mutation. 89.3% (25/28) of the detected mutations were in exons 5-8, whereas 10.7% (3/28) were in exon 4. Among the 27 non frameshift mutations, 89% (24/27) were transitions and 11% (3/27) were transversions. 64.3% (18/27) of the altered amino acids corresponded to arginine. 74% (20/27) were G>C to A>T transitions, and more than half (14/27) occur at hotspots codons with CpG sites. TP53 mutations correlated closely with TP53 accumulation (p = 0.0090) and inversely with MSI phenotype (p = 0.0658). A KRAS somatic mutation was identified in 25% (7/28) of the TP53 mutated tumors. All these mutations were G>A transitions in codon 12 and all the tumors with combined alterations but one were distally located and MSS. In conclusion, frequency and types of TP53 mutations and correlations with TP53 protein accumulation, and MSI were as reported for non-Tunisian patients. However, no significant associations have been detected between TP53 mutations and clinicopathological data in Tunisian patients as previously reported.

TP53 Mutations Negatively Impact Survival of Acute Myeloid Leukemia Patients Treated with Standard Doses of Azacitidine

Introduction/BackgroundThe 100,000 Genomes Project aims to improve cancer services through providing whole genome sequencing (WGS) of normal and tumour tissue in order to determine the genomic mutation responsible. This has...

Landscape of TP53 Mutations in MPN

PurposeTP53 mutation is the most common genetic variation type in Hepatocellular carcinoma (HCC). We aim to illustrate the landscape of genomic alterations and TP53 mutation related and directly regulated lncRNA prognosis markers.Materials and MethodsUtilizing the clinical and transcriptome data from The Cancer Genome Atlas (TCGA) website, we present the landscape of genomic alterations and RNA differential expression profiles. By analyzing the ENCODE TP53 ChIP-seq data, we get the TP53 chromatin binding profiles. By Kaplan–Meier (KM) survival analysis and ROC analysis, we identify lncRNA prognosis markers.ResultsTP53 ranks the highest mutation frequency gene and the maximum mutation type of TP53 is Missense Mutation (> 2.5×104). TP53 mutation showed poor clinical outcome among the pathological Stage II and Stage III HCC patients. By differential expression analysis of the TP53 wild type and mutation HCC, we find thousands of misregulated genes, including 699 differential expression lncRNAs (p <0.05, |log2FC| ≥1). Functional enrichment analysis of the misregulated genes shows that TP53 mutation events mainly alter DNA replication, cell cycle and immune response signaling pathways. By estimation of tumor-infiltrating immune cells through CIBERSORT, we find that the TP53 mutation events are significantly correlated with the different proportions of nine immune cells. We then integratively analyze the differential expression lncRNAs in TP53 wild type and mutation groups and the TP53 ChIP-seq binding lncRNAs, and get 112 overlap lncRNAs. By Kaplan–Meier survival analysis and ROC analysis, we identify two lncRNAs (RP4-736L20.3 and SNRK-AS1) that show significant prognosis value. Using the collected HCC samples, we validate the misregulated expression of RP4-736L20.3 and SNRK-AS1.ConclusionThe work presents the landscape of genomic variations and two TP53 mutation related and directly regulated lncRNA prognosis markers of HCC.

IntroductionHeat shock protein 90 (HSP90) is a key component of a multichaperone complex involved in the post-translational folding of a large number of client proteins, many of which play essential roles in tumorigenesis. HSP90 has emerged in recent years as a promising new target for anticancer therapies.MethodsThe concentrations of the HSP90 inhibitor NVP-AUY922 required to reduce cell numbers by 50% (GI50 values) were established in a panel of breast cancer cell lines and patient-derived human breast tumors. To investigate the properties of the compound in vivo, the pharmacokinetic profile, antitumor effect, and dose regimen were established in a BT-474 breast cancer xenograft model. The effect on HSP90-p23 complexes, client protein degradation, and heat shock response was investigated in cell culture and breast cancer xenografts by immunohistochemistry, Western blot analysis, and immunoprecipitation.ResultsWe show that the novel small molecule HSP90 inhibitor NVP-AUY922 potently inhibits the proliferation of human breast cancer cell lines with GI50 values in the range of 3 to 126 nM. NVP-AUY922 induced proliferative inhibition concurrent with HSP70 upregulation and client protein depletion – hallmarks of HSP90 inhibition. Intravenous acute administration of NVP-AUY922 to athymic mice (30 mg/kg) bearing subcutaneous BT-474 breast tumors resulted in drug levels in excess of 1,000 times the cellular GI50 value for about 2 days. Significant growth inhibition and good tolerability were observed when the compound was administered once per week. Therapeutic effects were concordant with changes in pharmacodynamic markers, including HSP90-p23 dissociation, decreases in ERBB2 and P-AKT, and increased HSP70 protein levels.ConclusionNVP-AUY922 is a potent small molecule HSP90 inhibitor showing significant activity against breast cancer cells in cellular and in vivo settings. On the basis of its mechanism of action, preclinical activity profile, tolerability, and pharmaceutical properties, the compound recently has entered clinical phase I breast cancer trials.

TP53 and FGFR3 mutations are the most common mutations in bladder cancers. FGFR3 mutations are most frequent in low-grade low-stage tumours, whereas TP53 mutations are most frequent in high-grade high-stage tumours. Several studies have reported FGFR3 and TP53 mutations to be mutually exclusive events, whereas others have reported them to be independent. We carried out a meta-analysis of published findings for FGFR3 and TP53 mutations in bladder cancer (535 tumours, 6 publications) and additional unpublished data for 382 tumours. TP53 and FGFR3 mutations were not independent events for all tumours considered together (OR = 0.25 [0.18–0.37], p = 0.0001) or for pT1 tumours alone (OR = 0.47 [0.28–0.79], p = 0.0009). However, if the analysis was restricted to pTa tumours or to muscle-invasive tumours alone, FGFR3 and TP53 mutations were independent events (OR = 0.56 [0.23–1.36] (p = 0.12) and OR = 0.99 [0.37–2.7] (p = 0.35), respectively). After stratification of the tumours by stage and grade, no dependence was detected in the five tumour groups considered (pTaG1 and pTaG2 together, pTaG3, pT1G2, pT1G3, pT2-4). These differences in findings can be attributed to the putative existence of two different pathways of tumour progression in bladder cancer: the CIS pathway, in which FGFR3 mutations are rare, and the Ta pathway, in which FGFR3 mutations are frequent. TP53 mutations occur at the earliest stage of the CIS pathway, whereas they occur would much later in the Ta pathway, at the T1G3 or muscle-invasive stage.

Two of the most common events in human tumors are mutation of the tumor suppressor gene TP53 and development of aneuploidy. In addition to losing their wild-type (WT) tumor-suppressive function, mutant p53 proteins are proposed to acquire gain-of-function (GOF) activity, leading to novel oncogenic phenotypes. Mechanistic understanding of mutant p53 GOF activities is complicated by the diversity and context-specific nature of reported GOF phenotypes. The study of mutant p53 GOF activities is especially challenging because mutations in p53 are positively correlated with the development of aneuploidy, which can increase heterogeneity through diverse chromosomal alterations and itself contributes to tumorigenesis. To study mutant p53 GOF mechanisms and phenotypes, we used CRISPR/Cas9-mediated genome editing and developed two isogenic epithelial cell line models (one non-transformed and one tumor-derived) that express the most frequently occurring p53 missense mutations (R175H and R273H), are deficient for functional p53 protein (null), or retain the wild-type (WT) protein. In these engineered models, endogenous p53 expression is regulated by the native p53 promoter, thus providing a controlled system for rigorous functional experimentation across different p53 states. Additionally, the use of clonally-derived cell lines originating from the same near diploid parental genetic background allows for assessment of the genomic alterations and resulting molecular heterogeneity following mutation of TP53. Through genomic, transcriptomic, and cellular based assays we have validated our cell line models and found that missense mutant and p53 null cells display loss of p53 function. Through functional genomics analyses comparing isogenic epithelial cells, which initially differed only by the TP53 genotype, we have evaluated the relationship between mutant p53 and aneuploidy and assessed whether our clonal cell lines display several previously reported mutant p53 GOF phenotypes such as altered gene expression, proliferation, metabolism, drug sensitivity, and migration. Further, using lentiviral mediated knockdown of p53 protein we evaluated the dependency of these phenotypes on expression of mutant p53 protein. Finally, data from The Cancer Genome Atlas (TCGA) was used for the analysis of manifestations of clinical mutant p53 GOF phenotypes. The dissection of mutant p53 GOF phenotypes will improve the current understanding of the role of mutant p53 in tumorigenesis. The results generated from these studies have the potential for clinical translation in major types of human cancer that have high-frequency p53 mutation. Citation Format: Lindsay N. Redman-Rivera, Timothy M. Shaver, Hailing Jin, Johanna M. Schafer, Quanhu Sheng, Rachel A. Hongo, Kathryn E. Beckermann, Brian D. Lehmann, Ferrin C. Wheeler, Jennifer A. Pietenpol. A functional genomics approach to determine mutant p53 gain-of-function mechanisms and phenotypes in tumorigenesis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2489.

Breast cancer is a heterogeneous disease and has subtypes with distinct phenotypic and molecular characteristics. Genetically, 30% of all breast tumors and 80% of the basal-like breast cancer (BLBC) subtype harbor mutations in TP53 and numerous sporadic somatic mutations in other genes. This molecular heterogeneity has posed a challenge in developing safe and effective therapeutic regimens to treat a broad spectrum of breast cancer patients, and discovery of intra-subtype along with inter-subtype heterogeneity has added another layer of complexity for targeted therapies. Based on the analysis of somatic mutation profiles in the BLBC subtype, we identified a wide variety of TP53 missense mutations and thousands of co-existing mutations, which led us to hypothesize that intra-subtype heterogeneity is derived from combinatorial effects of neo-morphic (gain-of-function) activities of different types of missense mutant p53 proteins and complex interplay between specific driver mutations in TP53 and a distinct subset of functionally important co-mutations (or “co-drivers”). We ectopically overexpressed the ten most prevalent missense mutations in TP53 found in breast cancer tumors in non-transformed mammary epithelial cells and examined their cellular functions associated with the hallmarks of cancer. The results showed widely different spectrums of phenotypic changes in cell proliferation, resistance to apoptosis, cell invasion, anoikis resistance and cell polarity. As a proof of concept for the 'co-drivers', we knocked-out PTEN in a non-invasive TP53 mutant cell using the CRISPR and shRNA systems. Inactivation of PTEN in non-invasive TP53-mutant cell increased its invasiveness. TP53 mutations and PTEN deletions are frequent in BLBC patients, who have significantly higher rates of metastasis, recurrence and a lower survival rate than the other subtypes. The absence of three signaling hormone receptors, which can be targeted by specific inhibitors, significantly limits available therapies for the majority of BLBC patients to surgery and cytotoxic chemo/radiotherapies. Combination therapies targeting the driver and co-driver gene associated pathways could be quite promising solutions to treat aggressive breast cancer cases. To address this, we have developed a genome-wide CRISPR based gene knock-out screening approach to test the effect of loss-of-function of individual human genes in clinically important TP53 mutant backgrounds that can promote cancer-like behaviors and identify the combinations of 'TP53 mutation and co-driver pathways' that can be targeted by specific inhibitors. Citation Format: Pal A, Park J, Gonzalez-Malerva L, Eaton S, LaBaer J. Discovering drug targets for aggressive breast cancer with TP53 missense mutations by a genome-wide screen [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-08-05.