LGG-02. ELUCIDATING THE ROLE OF FGFR1 ALTERATIONS IN PEDIATRIC GLIOMAS

Abstract

Abstract BACKGROUND Pediatric brain cancers are the leading cause of cancer-related deaths in children. We (and others) have recently found that close to 10% of all pediatric gliomas, encompassing low-grade gliomas (LGGs) and high-grade gliomas (HGGs), harbor recurrent driver alterations in FGFR proteins, most frequently FGFR1, the gene encoding Fibroblast Growth Factor Receptor 1. In pediatric gliomas, FGFR1 alterations present as either structural variants (SVs), including kinase duplications and fusion proteins, or kinase-activating single nucleotide variants (SNVs). Recurrent FGFR1 alterations represent a promising therapeutic target for precision medicine approaches, however a challenge has been the lack of clinical trials for FGFR inhibitors. A major goal of this project is to identify preclinical FGFR inhibitor candidates for FGFR1-altered pediatric gliomas. METHODS We have generated isogenic mouse and human neural stem cell (NSC) models driven by FGFR1 and BRAF alterations commonly seen in pediatric gliomas to test the oncogenic properties and therapeutic capacities of these alterations. RESULTS We found that NSC lines grow independent of growth factors and form tumors in mice. RNA-sequencing of these lines revealed the FGFR1-altered lines are enriched in neuronal gene programs. The FGFR1-altered models are exquisitely sensitive to the four FDA-approved panFGFR inhibitors Infigratinib, Erdafitinib, Pemigatinib, and Futibatinib. However, the FGFR1 SNV + PTPN11 co-occurring SNV line is the least sensitive to FGFR inhibition, which suggests combination therapies may be needed. Combination drug studies with FGFR inhibition in our FGFR1-altered lines reveal the best synergy with mTOR inhibition. Finally, we present examples of case studies of patients with FGFR1-altered tumors treated with targeted inhibitors. CONCLUSIONS Taken together, our studies have established models that have generated key insights into the biology of FGFR1-altered gliomas and how to best target them therapeutically.