Androgen Receptor Splice Variants Research Articles

Abstract A021: Reactive osteogenic-niche regulation of endocrine resistance in prostate cancer bone metastases: Role of tenascin-C induced metabolic shift in regulating therapeutic resistance in prostate cancer

Abstract Background: The main objective of the study is to investigate the regulatory role of reactive osteogenic niche in evolution of therapeutic resistance in prostate cancer bone metastases. Prostate cancer that metastasize to the bone develop into an androgen insensitive/therapeutic resistant state known as metastatic castration resistance prostate cancer (mCRPC). In bone, prostate cancer cells spatially associate with reactive osteogenic niche typified with elevated expression of the repair-associated, extracellular matrix protein- tenascin-C. Our recent finding show that tenascin-C regulates splicing and post-translational stability of therapeutic resistant- androgen receptor splice variant- AR-V7. Expression of AR-V7 and induction of de novo lipogenesis is observed to co-evolve in mCRPC. In this study, we evaluated the role of tenascin-C in regulating de novo lipogenesis in prostate cancer cells and its association with AR-V7 expression. Methods: Immunofluorescence imaging were conducted to assess spatial localization of lipids using BODIPY 493/503 in prostate cancer cells interacting with tenascin-C- expressing osteogenic cells-preosteoblast using a novel heterotypic 3D organoid model. Prostate cancer cells cultured on tenascin-C were subjected to lipidomic analysis using LC-MS for characterization of tenascin-C induced lipid accumulation. RT-qPCR and Western blotting were conducted to evaluate differential regulation of enzymes involved in de novo lipogenesis by tenascin-C. siRNA and small molecular inhibitors were utilized to evaluate molecular association between tenascin-C, enzymes regulating de novo lipogenesis, and AR-V7 in prostate cancer cells. Results: Imaging of heterotypic organoids revealed lipid accumulation in prostate cancer cells interacting with tenascin-C expressing preosteoblasts. Lipidomic analysis confirmed tenascin-C induced enrichment of neutral lipids such as di and triglycerides in prostate cancer cells, a novel finding. Tenascin-C also induced expression of enzymes regulating de novo lipogenesis such as acetyl-CoA carboxylase alpha (ACACA) and fatty acid synthase (FASN) in prostate cancer cells (p˂ 0.01). Assessment of clinical transcriptomic datasets confirm significant upregulation of both tenascin-C and specifically ACACA in prostate cancer bone metastases compared to other visceral metastatic sites (p=1E-10, p=1E-7). Importantly, we observed tenascin-C induced upregulation of ACACA and FASN expression in prostate cancer cells was impeded by AR-V7 knockdown. Conversely, inhibition of ACACA activity (CP-640186 at 0.5 uM) also suppressed AR-V7 protein expression in prostate cancer cells. Conclusions: In summary, this study suggests a complex functional association between a reactive osteogenic niche component -tenascin-C, and AR-V7 expression with de novo lipogenesis in prostate cancer cells. Targeting to uncouple the tenascin-C regulated de novo lipogenesis in prostate cancer cells may be a promising therapeutic strategy to prevent evolution of AR-V7 expression and development of mCRPC. Citation Format: Rintu T. Thomas, David R. Rowley. Reactive osteogenic-niche regulation of endocrine resistance in prostate cancer bone metastases: Role of tenascin-C induced metabolic shift in regulating therapeutic resistance in prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr A021.

Abstract B071: Evaluating the synergy between enzalutamide and SRC kinase inhibitors against castration-resistant prostate cancer

Abstract Prostate Cancer (PCa) remains the most diagnosed non-skin cancer amongst the American male population. Treatment for localized prostate cancer consists of Androgen Deprivation Therapies (ADTs), which inhibit the full-length androgen receptor (AR-FL). Though initially effective, a subset of patients will develop resistance to ADTs and the tumors will transition to Castration-Resistant Prostate Cancer (CRPC). Second-generation hormonal therapies such as abiraterone acetate and enzalutamide (Enza) are typically given to men with CRPC. However, these treatments are not curative and typically prolong survival by a few months, prompting investigators to understand the mechanisms of resistance corresponding to CRPC. Several resistance mechanisms contribute to this lack of efficacy of these therapies such as the emergence of AR mutations, AR amplification, AR splice variants (AR-Vs) and in some cases increased kinase signaling. In this study, we evaluated whether inhibition of a hyperactive tyrosine kinase in CRPC, SRC, synergizes with enzalutamide or chemotherapy in several prostate cancer cell line models expressing variable AR isoforms. Five cell lines were chosen: DU145 (AR-negative), AD-1 (AR-FL positive), R1-D567 (AR-V positive), LNCaP95 and 22Rv1 (AR-FL/AR-V positive), all of which express SRC protein. We then administered enzalutamide, the SRC family kinase inhibitor saracatinib (Sara), or docetaxel (DTX) at varying doses to each cell line to generate dose response curves and IC50 values. Each drug’s IC50 was used for combination therapy studies. To determine synergy, we implemented the Bliss Independence equation and the Combination Index Equation via Chou-Talalay method. To define the mechanism of synergy, we used western blotting and immunofluorescence to measure molecular changes (protein and mRNA) in our cell lines. In our CRPC cell lines, LNCaP95 and 22rv1, we observed robust synergy for Enza plus Sara. Interestingly, we found a lack of synergy for DTX plus Sara, in 22rv1 cells. In this cell line, we also found that Enza and Sara individually induced a greater amount of DNA damage when compared to DTX. We observed higher activation of Caspase 3/7 and cleaved PARP expression when Enza plus Sara was administered. We also observed a significant decrease in AR Y534phosphorylation, a key SRC substrate residue, on both AR-FL and AR-V with a concomitant decrease in AR-V protein expression after saracatinib administration. In addition, we observed a decrease in mRNA expression of AR target genes, TMPRSS2 and KLK3. Overall, our results suggest that SRC inhibition is a potential therapeutic strategy to be used in combination with potent AR targeting agents in the treatment of CRPC, due to its effects on AR/AR-Vs at the protein and mRNA level. By elucidating this synergy, we provide pre-clinical data that suggests combining SRC kinase inhibitors with enzalutamide in certain patients with AR-Vs. Citation Format: Ralph E. White, Victor Tan, Maxwell Bannister, Hai Dang Nguyen, Justin M. Drake. Evaluating the synergy between enzalutamide and SRC kinase inhibitors against castration-resistant prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr B071.

Abstract B068: Treatment combinations targeting MCL-1 and BCL-xL exert synergistic anti-tumor effects in AR-V7 expressing CRPC cell lines

Abstract Therapeutic agents that overcome acquired resistance to current androgen receptor (AR) pathway targeted therapies in patients with castration-resistant prostate cancer (CRPC) remain an unmet clinical need. A multitude of pathways are implicated in acquired treatment resistance, including the PI3K/mTOR/AKT, WNT/β-catenin, and DNA damage repair pathways. Notably, the androgen receptor splice variant 7 (AR-V7) activates the AR pathway in the absence of androgens, playing a crucial role in CRPC progression. An unbiased high throughput drug screen evaluating an array of inhibitors targeting diverse signaling pathways revealed highly synergistic activity of BH3 mimetics in AR-V7 expressing CRPC cell lines (e.g. LNCaP95, 22Rv1, VCaP-CR). Combinations targeting MCL-1 and BCL-xL (S63845 with A-1331852 or Navitoclax) displayed increased antitumor activity compared to those targeting MCL-1 and BCL-2 (S63845 with Venetoclax). Synergy among BCL-xL and MCL-1 targeted combinations was demonstrated using 2D and 3D CellTiter-Glo viability assays. Combination treatments in 3D spheroid cultures of 22RV1 and LNCaP95 cells confirmed the synergy observed in 2D assays. Furthermore, combined BCL-xL and MCL-1 inhibition altered AR-V7 expression and activated c-PARP cleavage. Drug combinations synergistically targeting BCL-xL and MCL-1 should be further explored for the treatment of therapy-resistant CRPC. Citation Format: Giulia C. Napoli, Andres F. Leon, Erica L. Beatson, Keith T. Schmidt, Emily N. Risdon, Cindy H. Chau, Douglas K. Price, William D. Figg. Treatment combinations targeting MCL-1 and BCL-xL exert synergistic anti-tumor effects in AR-V7 expressing CRPC cell lines [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr B068.

Abstract A009: Distinct activity of androgen receptor splice variants in promoting prostate cancer metastasis

Abstract Introduction: Constitutively active androgen receptor splice variant 7 (AR-V7) correlates with the adaptation to androgen receptor signaling inhibition treatment in prostate cancer (PCa) patients. Despite intensive studies of AR-V7, it is still unclear how the distinct genomic and epigenomic characteristics of AR-V7-dependent cistrome and transcriptome are distinct from full-length AR (AR-FL) and whether AR-V7 may play a role in promoting the metastatic progression of castration-resistant PCa (CRPC). Experiments: To accurately compare the activity of AR-V7 with AR-FL, we generated lentiviral stable cell lines with inducible overexpression of AR-V7 or AR-FL using AR-V7 negative LNCaP and C4-2 cell lines. We assessed the in vivo impact of AR-V7 or AR-FL expression on PCa metastasis by injecting cells in zebrafish embryos and the tibias of castrated male mice. ChIP-seq analyses of AR-V7, AR-FL, FOXA1, and H3K27ac, ATAC-seq analysis, and RNA-seq analysis were conducted in to characterize the global cistrome and transcriptome activity of AR-V7 in comparison with AR-FL. In addition, we also examined how a posttranslational modification, Ser81 phosphorylation, affects AR-V7 activity by generating an S81A mutant of AR-V7 and using S81-phosphorylation inhibitors. Results: Our in vivo study revealed that overexpressed-AR-V7, but not AR-FL, strongly promotes tumor cell invasion into blood vessels and induces osteoblastic bone lesions. Through integrated ChIP-, ATAC- and RNA-seq analysis, we determined that AR-V7 has a “pioneer factor-like” ability to bind to androgen-responsive elements (AREs) located at compact chromatin regions and activates the enhancers by increasing the chromatin accessibility. This mechanism leads to a unique AR-V7-regulated transcriptional program that is completely independent of AR-FL activity and is highly enriched for genes mediating epithelial-mesenchymal transition and metastatic functions. We then identified a subset of AR-V7-specific targets with significant overexpression in CRPC tumor samples and associated with poor clinical outcomes. In particular, we found that SOX9, a critical metastasis driver gene, was a direct target and downstream effector of AR-V7, and its protein expression was dramatically upregulated at AR-V7-induced bone lesions. Furthermore, we found that the pro-metastasis function of AR-V7 can be enhanced by Ser81 phosphorylation through chromatin-binding-independent mechanisms, and that targeting this phosphorylation by CDK9 inhibitors can block AR-V7-induced SOX9 expression and impair AR-V7-mediated metastasis function. Conclusion: Our study provides novel molecular insights into the role of AR splice variants in driving the metastatic progression of CRPC. In specific, these data have demonstrated the distinctive transcriptional program of AR-V7 from AR-FL, identified critical AR-V7 targets, and determined the function of Ser81 phosphorylation on AR-V7. Our data also suggest a new therapeutic strategy to target AR-V7-induced metastasis cascade in CRPC by using CDK9 inhibitor treatment. Citation Format: Maryam Labaf, Dong Han, Yawei Zhao, Jude Owiredu, Songqi Zhang, Kavita Venkataramani, Jocelyn S. Steinfeld, Wanting Han, Muqing Li, Mingyu Liu, Zifeng Wang, Anna Besschetnova, Susan C. Patalano-Salsman, Jill A. Macoska, Xin Yuan, Steven P. Balk, Stephen R. Plymate, Shuai Gao, Kellee R. Siegfried-Harris, Ruihua Liu, Gabrielle Foxa, Mary M. Stangis, Piotr J. Czernik, Bart Williams, Kourosh Zarringhalam, Xiaohong Li, Changmeng Cai. Distinct activity of androgen receptor splice variants in promoting prostate cancer metastasis [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr A009.

Abstract A019: Enzalutamide resistance is driven by adaptations that enhance AR splice variant and FOXA1 activities

Abstract Prostate cancer (PCa) that progresses on therapy with an androgen receptor (AR) inhibitor such as enzalutamide (Enz) generally continues to express high levels of transcriptionally active AR, but mechanisms driving this persistent AR activity remain to be established. These tumors also generally express increased levels of AR splice variants that lack the ligand binding domain and hence have androgen-independent activity (with ARv7 being the most common), but the extent to which these variants contribute to AR activity, and their dependence on the full length AR (ARfl), also remain unclear. We found Enz treatment initially suppressed AR activity in VCaP cells, despite an increase in ARv7 splice variant, while Enz-resistant VCaP cells (VCaPEnzR) generated by prolonged culture in Enz had restoration of AR transcriptional activity. Notably, this restored AR activity was not associated with further increases in ARv7 expression. However, by ChIP-seq we found it was associated with increased ARv7 chromatin binding, with ARv7 binding at a subset of the sites occupied by ARfl, but not at any unique sites. Moreover, approaches using RNAi and an AR degrader targeting ARfl showed that ARv7 was the major driver of AR transcriptional activity in the VCaPEnzR cells, despite much higher levels of ARfl expression, and was not dependent on ARfl. ATAC-seq showed there was a global increase in chromatin accessibility in the VCaPEnzR cells, with the greatest increase being at ARv7 sites. This suggested these sites had decreased nucleosome occupancy, which was confirmed by MNase-seq. As FOXA1 can act as a pioneer factor to open chromatin, we next carried out FOXA1 ChIP-seq. This showed increased FOXA1 binding across all FOXA1 sites in the VCaPEnzR cells versus parental VCaP, with the greatest increases being at ARv7 binding sites and at sites that showed the greatest increases in accessibility by ATAC-seq. Notably, frameshift mutations in the C-terminus of FOXA1 are found at increased frequency in castration-resistant prostate cancer (CRPC) and may enhance FOXA1 activity, but FOXA1 was not mutated in the VCaPEnzR versus parental VCaP cells. Mass spectrometry then identified posttranslational modifications (PTMs) in FOXA1 that have been previously reported in PCa, including K270 methylation that can impair FOXA1 chromatin binding, but this was not consistently decreased in VCaPEnzR cells. In contrast, we found consistent increases in phosphorylation at C-terminal sites including T334 and Y429. Notably, the Y429 phosphorylation was reported previously to enhance FOXA1 chromatin binding and estrogen receptor activity. Together these findings indicate that progression to Enz-resistance is dependent on adaptations that enhance ARv7 activity. These adaptations include increasing chromatin accessibility at ARv7 binding sites, which may be driven by PTMs in FOXA1. Citation Format: Betul Ersoy-Fazlioglu, Larysa Poluben, Mannan Nouri, Henry W. Long, Joshua W. Russo, Steven P. Balk. Enzalutamide resistance is driven by adaptations that enhance AR splice variant and FOXA1 activities [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr A019.

Abstract B016: Liquid biopsy biomarker analysis of a phase II trial of sacituzumab govitecan in castrate resistant metastatic prostate cancer

Abstract Background: Sacituzumab Govitecan (SG) is an antibody-drug conjugate targeting Trop-2 and has been approved for use in breast and bladder cancers. Trop-2 has been shown to be overexpressed in multiple solid tumors including prostate cancer. Here we report an interim analysis of longitudinal liquid biopsies collected in a phase II clinical trial of SG to identify biomarkers of response and resistance. Methods: We collected longitudinal blood samples from 20 patients for circulating tumor cell (CTC) and cell-free DNA (cfDNA) analysis as part of an open label Phase II trial of SG in patients with mCRPC (ClinicalTrials.gov Identifier: NCT03725761). Eligibility criteria for the trial included rising PSA and radiographic progression on abiraterone acetate or enzalutamide in the mCRPC setting. Liquid biopsies were collected at baseline, C1D8, and then every 3 cycles until disease progression. cfDNA was sequenced using a custom 822 gene targeted capture panel (IDT). CTCs were isolated with antibodies to either EpCAM or Trop-2 followed by parallel enumeration, EpCAM and Trop-2 protein phenotyping and RNA extraction for AR/NEPC marker transcriptional profiling. Results: Although no PSA50 responses were observed, the 6-month rPFS rate was 45% (64% in chemotherapy naïve patients). For this analysis, these patients will be termed responding patients. The number of Trop-2-postive CTCs at baseline was significantly higher in responding (24.3 ±13.4 per 7.5 mL blood) than non-responding (10.0±3.8) patients. During treatment the number of Trop-2 positive CTCs in responders significantly decreased by C3D1 to 10.0 ±3.8. Interestingly, while the number of Trop-2 positive CTCs continued to decline to 2.8±1.99 cells/7.5 mL, EpCAM-positive CTCs increased from 12.5±10.52 cells/7.5 mL to 23.2±19.49 at end of trial. Gene expression analysis demonstrated high expression of genes specific to adenocarcinoma including AR-splice variants, TMPRSS2, KLK2 and KLK3 in the majority of patients, with conversion to AR-variant negative CTCs identified in responders. Preliminary cfDNA analysis identified one patient with a mutation acquired in the gene encoding topoisomerase 1 (TOP1) upon progression on SG, with additional analysis ongoing. Conclusions: Patients who responded to SG had a more Trop-2 positive CTCs with adenocarcinoma characteristics with expression of AR pathway genes. Longitudinal analysis of liquid biopsy biomarkers identified multiple mechanisms of acquired SG resistance. Decline in Trop2-CTC population with parallel expansion of EpCAM-CTC population in multiple patients suggests loss of Trop2 surface protein expression as resistance mechanism, while identification of a cfDNA TOP1 mutation in one patient at time of progression is consistent with acquired resistance to the topoisomerase inhibitor payload as has been reported in metastatic triple negative breast cancer. Citation Format: Jamie M. Sperger, Amy K. Taylor, Yue Shi, Charlotte N. Stahlfeld, Kyle Helzer, Matthew Bootsma, Katherine R. Kaufmann, Marina N. Sharifi, Christos E. Kyriakopoulos, Susan Slovin, Scott Tagawa, Scott Dehm, Shuang G. Zhao, Joshua M. Lang. Liquid biopsy biomarker analysis of a phase II trial of sacituzumab govitecan in castrate resistant metastatic prostate cancer [abstract]. In: Proceedings of the AACR Special Conference: Advances in Prostate Cancer Research; 2023 Mar 15-18; Denver, Colorado. Philadelphia (PA): AACR; Cancer Res 2023;83(11 Suppl):Abstract nr B016.

A novel biguanide derivative, IM176, induces prostate cancer cell death by modulating the AMPK-mTOR and androgen receptor signaling pathways

Metformin and phenformin, biguanide derivatives that are widely used to treat type 2 diabetes mellitus, have recently been shown to exert potential anticancer effects in prostate cancer. This study compared the anti-prostate cancer effects of the novel biguanide derivative IM176 with those of metformin and phenformin. Prostate cancer cell lines and patient-derived castration-resistant prostate cancer (CRPC) cells were treated with IMI76, metformin, and phenformin. The effects of these agents on cell viability, annexin V-FITC apoptosis, mTOR inhibition, protein expression and phosphorylation, and gene expression were evaluated. IM176 dose-dependently reduced the viability of all prostate cancer cell lines tested, with IC 50 s (LNCaP: 18.5 μM; 22Rv1: 36.8 μM) lower than those of metformin and phenformin. IM176 activated AMP-activated protein kinase (AMPK), inhibiting mTOR and reducing the phosphorylation of p70S6K1 and S6. IM176 inhibited the expression of androgen receptor (AR), the AR splice variant 7 (AR-V7) and prostate-specific antigen in LNCaP and 22Rv1 cells. IM176 increased caspase-3 cleavage and annexin V-positive/PI-positive cells, which indicated apoptosis. Moreover, IM176 reduced viability, with low IC 50 , in cultured cells derived from two patients with CRPC. The antitumor effects of IM176 were comparable with those of other biguanides. IM176 may therefore be a novel candidate for the treatment of patients with prostate cancer, including those with CRPC.

Identification of clinically actionable biomarkers in an Indian cancer cohort using comprehensive genomic profiling (CGP): An institutional experience.

e15166 Background: CGP through Next-Generation Sequencing (NGS) has substituted single-gene testing to identify more druggable gene aberrations. The simultaneous detection of broad spectrum predictive biomarkers and molecular signatures including tumor mutational burden (TMB), microsatellite instability (MSI) burden, somatic BRCA, homologous recombination repair genes (HRR) and RNA variants by CGP provides a more cost efficient and tissue-preserving approach than serial single-biomarker analyses. Methods: 750 biopsy proven patients of various cancer spectrum at HCG cancer center were consented and profiled using Illumina TruSight Oncology 500 (TSO500) assay that interrogates 523 cancer-related genes on NextSeq in an IRB-approved prospective study. The findings were discussed in molecular tumor board (MTB) and recommendations from treating physicians were documented in patient records for change in clinical management and follow up. Results: A total of 1291 genomic alterations were detected in 750 cases (mean 1.7 mutations/sample). CGP identified genetic alterations with therapeutic and prognostic implications in 77% patients (Tier I- 34%, Tier II-64%, Tier III-14%). CGP revealed higher number of druggable genes (47%) than small panels (14%).Tumor agnostic markers for immunotherapy (IO) were observed in 20% of the current cohort, based on which IO was initiated and are on follow up. In 20% of the cohort, HRR pathway alterations including s BRCA (7%) were detected providing an option to treat with platinum or PARP inhibitors. Other significant alterations like EGFR, RAS/RAF, ERBB2, PIK3CA, cKIT, PDGFRA, ARID1A, ARID2, POLE, and FGFR were found. RNA sequencing yielded 54 RNA alterations (38 translocations and 16 splice variants). Androgen receptor splice variants were observed in 50% prostate carcinoma patients for whom taxane therapy was initiated. Other frequent fusions detected were: TMPRSS-ERG, RPS6KB1-VMP1, EML4-ALK, NTRK, PDGFRA and EWSR. Conclusions: CGP reports actionable and prognostic genetic alterations in 77% of patients who could potentially benefit by tumor-matched targeted and immunotherapy. Post MDT patients were assigned to approved therapies (5-80%) or change in clinical management (5-25%) based on the cancer type (Table). 25% patients were enrolled for investigator initiated clinical trials and are on follow up for clinical outcome and analysis of independent prognostic and therapeutic value of novel biomarkers in a larger cohort of Indian patient. [Table: see text]

A randomized phase II study of apalutamide with or without carotuximab (ant-CD105) in metastatic, castration-resistant prostate cancer.

TPS5107 Background: CD105 (endoglin) is a co-receptor for the transforming growth factor-beta (TGF-β) receptor family. TGF-β signaling is activated in response to castration and is a determinant of PCa epithelial cell death in response to castration. In prostate cancer, silencing of TGF-ß receptor type 2 (Tgfbr2) in cancer-associated fibroblasts (CAF) potentiates tumor progression and castrate resistance primarily by paracrine signaling mechanisms mediated by the bone morphogenic protein (BMP)-SMAD axis. Upregulation of CD105 is observed in the face of progression through AR suppression and can drive pro-survival, pro-metastatic pathways BMP-SMAD signaling. This is accompanied with an increase in neural differentiation and the generation of AR-splice variants. In model systems, suppression of CD105-mediated signaling reversed these behaviors and resorted sensitivity to AR suppression. Carotuximab is a humanized monoclonal antibody that potently inhibits CD105-mediated signaling. It was originally developed for clinical use as an anti-angiogenic agent and was found to have an acceptable toxicity profile. Given our previous work, we hypothesized that use of CD105 will restore sensitivity to AR inhibition in men who have developed early resistance to an AR signaling inhibitor (ARSI) that would result in a synthetic lethality from combination treatment that will manifest as an extension of progression free survival when compared to ARSI therapy alone. Methods: This study (NCT05534646) is open to men with metastatic, castration-resistant prostate cancer who have progressed on previous ARSI therapy. Patients with recent thrombotic and/or cardiovascular events are excluded. Patients are allowed to have had prior docetaxel only in the setting of castration sensitive disease. The study includes a safety lead-in of 10 patients on combination therapy based on our previous work with carotuximab with other ARSI in NCT03418324. This will ensure that the probability of starting the phase 2 dose with a safe dose is sufficiently high. The study then proceeds to a (1:1) randomized study of apalutamide with or without carotuximab (n = 90). Patients randomized to apalutamide alone are permitted to cross over to combination therapy at the time of radiographic progression. The primary endpoint of the study is radiographic progression free survival (rPFS) and is designed to detect a 45% difference in rPFS in the two arms with 81% power and two-sided alpha of 0.10. This study also includes extensive correlative studies focusing on circuating tumor cells and extracellular vesicles which will be enriched and studies using novel nanotechnology enabled methodologies from our group as well as cell free DNA studies which will be used identify those patients with the greatest benefits from this form of therapy to expedite the development of this therapeutic approach. Clinical trial information: NCT05534646 .

Bone scan index (BSI) scoring by using bone scintigraphy and circulating tumor cells (CTCs): predictive factors for enzalutamide effectiveness in patients with castration-resistant prostate cancer and bone metastases

Reports of Bone Scan Index (BSI) calculations as imaging biomarkers to predict survival in patients with metastatic castration-resistant prostate cancer (mCRPC) have been mainly from retrospective studies. To evaluate the effectiveness of enzalutamide (ENZ) in Japanese patients with mCRPC and bone metastases using BSI (bone scintigraphy) and circulating tumor cell (CTC) analysis. Prospective, single-arm study at Juntendo University affiliated hospitals, Japan. Patients were administered 160 mg ENZ daily, with 3 monthly assessments: BSI, prostate specific antigen (PSA), CTC and androgen receptor splicing variant-7 (AR-V7) status. Primary endpoint: BSI-decreasing rate after ENZ treatment. Secondary endpoints: PSA-decreasing rate and progression free survival (PFS). Statistical analyses included the Wilcoxon t-test, Cox proportional hazard regression analysis, and log-rank test. Median observation period: 17.9 months, and median PFS: 13.8 (2.0–43.9) months (n = 90 patients). A decrease in BSI compared to baseline as best BSI change on ENZ treatment was evident in 69% patients at the end of the observation period (29% patients showed a complete response, BSI 0.00). At 3 months 67% patients showed a ≥ 50% PSA reduction, and 70% after ENZ treatment. PSA decline (3 months) significantly associated with a prolonged median PFS: 18.0 (estimated) versus 6.4 months (HR 2.977 [95% CI 1.53–5.78], p = 0.001). Best BSI decline response significantly associated with a prolonged PFS: 18.1(estimated) versus 7.8 months (HR 2.045 [95% CI: 1.07–3.90], p = 0.029). CTC negative status (n = 20) significantly associated with a prolonged PFS: 13.4 [estimated] vs 8.6 months (HR 2.366, 95% CI 0.97–5.71, p = 0.041). CTC positive/AR-V7 positive status significantly associated with a shorter PFS: 5.9 months (HR 8.56, 95% CI 2.40–30.43, p = 0.0087). -reduction (3 months) and BSI-reduction (on ENZ treatment) were significant response biomarkers, and a negative CTC status was a predictive factor for ENZ efficacy in patients with mCRPC.

Discovery of a Small-Molecule Inhibitor Targeting the Androgen Receptor N-Terminal Domain for Castration-Resistant Prostate Cancer.

The current mainstay therapeutic strategy for advanced prostate cancer is to suppress androgen receptor (AR) signaling. However, castration-resistant prostate cancer (CRPC) invariably arises with restored AR signaling activity. To date, the AR ligand-binding domain (LBD) is the only targeted region for all clinically available AR signaling antagonists, such as enzalutamide (ENZ). Major resistance mechanisms have been uncovered to sustain the AR signaling in CRPC despite these treatments, including AR amplification, AR LBD mutants, and the emergence of AR splice variants (AR-Vs) such as AR-V7. AR-V7 is a constitutively active truncated form of AR that lacks the LBD; thus, it can not be inhibited by AR LBD-targeting drugs. Therefore, an approach to inhibit AR through the regions outside of LBD is urgently needed. In this study, we have discovered a novel small molecule SC428, which directly binds to the AR N-terminal domain (NTD) and exhibits pan-AR inhibitory effect. SC428 potently decreased the transactivation of AR-V7, ARv567es, as well as full-length AR (AR-FL) and its LBD mutants. SC428 substantially suppressed androgen-stimulated AR-FL nuclear translocation, chromatin binding, and AR-regulated gene transcription. Moreover, SC428 also significantly attenuated AR-V7-mediated AR signaling that does not rely on androgen, hampered AR-V7 nuclear localization, and disrupted AR-V7 homodimerization. SC428 inhibited in vitro proliferation and in vivo tumor growth of cells that expressed a high level of AR-V7 and were unresponsive to ENZ treatment. Together, these results indicated the potential therapeutic benefits of AR-NTD targeting for overcoming drug resistance in CRPC.

The CDK7 inhibitor CT7001 (Samuraciclib) targets proliferation pathways to inhibit advanced prostate cancer

BackgroundCurrent strategies to inhibit androgen receptor (AR) are circumvented in castration-resistant prostate cancer (CRPC). Cyclin-dependent kinase 7 (CDK7) promotes AR signalling, in addition to established roles in cell cycle and global transcription, providing a rationale for its therapeutic targeting in CRPC.MethodsThe antitumour activity of CT7001, an orally bioavailable CDK7 inhibitor, was investigated across CRPC models in vitro and in xenograft models in vivo. Cell-based assays and transcriptomic analyses of treated xenografts were employed to investigate the mechanisms driving CT7001 activity, alone and in combination with the antiandrogen enzalutamide.ResultsCT7001 selectively engages with CDK7 in prostate cancer cells, causing inhibition of proliferation and cell cycle arrest. Activation of p53, induction of apoptosis, and suppression of transcription mediated by full-length and constitutively active AR splice variants contribute to antitumour efficacy in vitro. Oral administration of CT7001 represses growth of CRPC xenografts and significantly augments growth inhibition achieved by enzalutamide. Transcriptome analyses of treated xenografts indicate cell cycle and AR inhibition as the mode of action of CT7001 in vivo.ConclusionsThis study supports CDK7 inhibition as a strategy to target deregulated cell proliferation and demonstrates CT7001 is a promising CRPC therapeutic, alone or in combination with AR-targeting compounds.

Abstract LB262: HSK38008: An oral AR-V7 degrader for metastatic castration-resistant prostate cancer

Abstract The androgen deprivation therapy (ADT) alone and its combination with hormone therapy that block AR signaling (e.g., enzalutamide or abiraterone) are effective treatments for advanced prostate cancer. Unfortunately, patients with truncated AR splice variants which lacking the ligand-binding domain still developed resistance to these AR-targeting compounds. The truncated AR splice variant 7 (AR-V7), which is the most clinically relevant variants, remains constitutively active as a transcription factor in 75% of the patients with mCRPC, associated with shorter PFS and OS with abiraterone or enzalutamide treatment. Therefore, AR-V7 has become a promising target for mCRPC.As a novel oral AR-V7 degrader with favorable bioavailability, HSK38008 could degrade the AR-V7 protein with DC50 of 136 nM and achieve the maximum degradation at 24h at 10 μM. In the meanwhile, HSK38008 also degrade AR with weaker IC50 of 110 nM and the maximum degradation at 48hrs at 10 μM. By validation of protease inhibitor MG341, HSK38008 could not degrade ARV7 and AR at high concentration. Compared with enzalutamide and ARV-110, HSK38008 could block the AR-V7 pathway and AR pathway in luciferase report assay with IC50 of 400 nM and 1913 nM respectively. Importantly, HSK38008 also showed significant inhibition of AR mutants (AR-T878A/S889G, T878S, H875Y, T878A) in luciferase assay but not ARV110 and enzalutamide. HSK38008 significantly inhibit the cell proliferation in AR-V7 positive cell line, e.g., 22RV1, but weak antiproliferation in AR and ARV7 positive cell line such as VCAP However, when combination with enzalutamide there is synergistic effect for the anti-proliferation in VCAP. It means the potential to use the compounds in a broader population of mCRPC.In the xenograft model, the mice which were orally given HSK38008 showed 22RV1 tumor growth inhibition in a dose-dependent manner, with the TGI = 89.8% at 10 mpk and the intratumoral AR-V7 protein degradation rate was 73%. 30 mpk of HSK38008 showed completely tumor regression. At the same time, abiraterone and ARV-110 did not show significantly tumor growth inhibition at 30 mpk. There is no influence on mice body weight at all HSK38008 dose groups, while 3 mice in the 30 mpk of ARV-110 group died during the experiment. These results indicated that HSK38008 achieved better therapeutic effects than enzalutamide and ARV-110 did in AR-V7 positive 22RV1 xenograft model.Rats were dosed with 10, 30 and 60 mg/kg HSK38008 once daily for up to 28 days via oral gavage and main study animals were necropsied on Day 29 or Day 57. No animal was found dead or moribund and no test article-related changes in clinical signs, body weights, food consumption, ophthalmologic examinations, clinical pathology parameters, sperm analysis, urinalysis, organ weights, histopathology. In conclusion, HSK38008 is a promising oral AR-V7 degrader with better efficacy than enzalutamide and ARV-110 in AR and AR-V7 positive, and potential AR mutants mCRPC. Citation Format: Ju Wang, Meilin Qian, Pangke Yan, Linli Li, Chen Zhang, Yan Yu, Lihua Tao, Pingming Tang, Yuting Liao, Xiaogang Chen, Xinfan Cheng, Jinxiong Xu, Xuemei Wan, Luchan Deng, Hongjiao Dong, Haixian Zhang, Maotao He. HSK38008: An oral AR-V7 degrader for metastatic castration-resistant prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr LB262.

Co-expression and clinical utility of AR-FL and AR splice variants AR-V3, AR-V7 and AR-V9 in prostate cancer

BackgroundAndrogen receptor (AR) splice variants (AR-Vs) have been discussed as a biomarker in prostate cancer (PC). However, some reports question the predictive property of AR-Vs. From a mechanistic perspective, the connection between AR full length (AR-FL) and AR-Vs is not fully understood. Here, we aimed to investigate the dependence of AR-FL and AR-V expression levels on AR gene activity. Additionally, we intended to comprehensively analyze presence of AR-FL and three clinically relevant AR-Vs (AR-V3, AR-V7 and AR-V9) in different stages of disease, especially with respect to clinical utility in PC patients undergoing AR targeted agent (ARTA) treatment.MethodsAR-FL and AR-V levels were analyzed in PC and non-PC cell lines upon artificial increase of AR pre-mRNA using either drug treatment or AR gene activation. Furthermore, expression of AR-FL and AR-Vs was determined in PC specimen at distinct stages of disease (primary (n = 10) and metastatic tissues (n = 20), liquid biopsy samples (n = 422), mCRPC liquid biopsy samples of n = 96 patients starting novel treatment). Finally, baseline AR-FL and AR-V status was correlated with clinical outcome in a defined cohort of n = 65 mCRPC patients undergoing ARTA treatment.ResultsWe revealed rising levels of AR-FL accompanied with appearance and increase of AR-Vs in dependence of elevated AR pre-mRNA levels. We also noticed increase in AR-FL and AR-V levels throughout disease progression. AR-V expression was always associated with high AR-FL levels without any sample being solely AR-V positive. In patients undergoing ARTA treatment, AR-FL did show prognostic, yet not predictive validity. Additionally, we observed a substantial clinical response to ARTA treatment even in AR-V positive patients. Accordingly, multivariate analysis did not demonstrate independent significance of AR-Vs in neither predictive nor prognostic clinical utility.ConclusionWe demonstrate a correlation between AR-FL and AR-V expression during PC progression; with AR-V expression being a side-effect of elevated AR pre-mRNA levels. Clinically, AR-V positivity relies on high levels of AR-FL, making cells still vulnerable to ARTA treatment, as demonstrated by AR-FL and AR-V positive patients responding to ARTA treatment. Thus, AR-FL and AR-V might be considered as a prognostic, yet not predictive biomarker in mCRPC patients.

Abstract 6542: Detection of androgen receptor splice variants from clinical sequencing

Abstract Androgen receptor (AR) splice variants (AR-Vs) have been widely studied on its important role in prostate cancer (PC) progression. In particular, AR-Vs lacking ligand binding domains, such as AR splice variant 7 (AR-v7) that links exon 3 and cryptic exon 3 or AR variant that losses exons 5 to 7 (ARv567es), have been demonstrated as one of the resistant mechanisms to androgen deprivation therapy in PC. Despite its clinical importance, the current algorithms to detect fusions such as TopHat-Fusion have limitation to detect intra-chromosomal rearrangements including AR-Vs. In this respect, we propose a novel approach to identify AR-Vs from targeted RNA sequencing (RNA-seq) dataset. In short, our two-step approach first gathers soft-clipped or divided reads that are adjacent to the splicing sites of AR-Vs and then yields the number of splitting reads that support the existence of AR-Vs. Next, the algorithm selects the paired-end reads whose one side and the other side are mapped to the preceding and following exons, respectively. The final number of spanning reads are calculated following to the removal of low-quality reads. We validated the proposed approach using two large-scale, independent RNA-seq datasets of PC samples: 34 samples from Seoul National University Hospital (SNUH) and 558 samples from The Cancer Genome Atlas (TCGA) dataset. Overall, our approach successfully identified samples with putative AR-Vs, including AR-v7 and ARv567es. In addition, our approach successfully detected AR-v7 with reliable number of supporting reads, from the RNA-seq dataset of AR-v7-expressing cell line. Finally, statistical analyses of 34 SNUH PC patients suggested potential detection threshold in clinical sequencing settings (at least 10 split reads and 1% proportion). In the SNUH dataset, The AR-v7 positive group, which included 6 patients (17.1%) with values above the threshold, had higher AR-v7 expression levels than the negative group (p=4.8E-04). The similar pattern was also found in the analysis of TCGA dataset. Owing to its flexibility, we also confirmed that the developed approach can be used to detection of other AR-Vs, including AR-v3 and ARv567es. We expect that the further in-depth analyses including larger samples and clinical outcomes can discover clinical applicability of AR-Vs. Citation Format: Suhyun Hwangbo, Sungyoung Lee, Sheehyun Kim, Hongseok Yun. Detection of androgen receptor splice variants from clinical sequencing [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6542.

Abstract 4802: Identification of critical hypoxia induced factors in castrate resistant prostate cancer

Abstract Background: Prostate cancer (PCa) is the second most diagnosed cancer in men and the second cause of cancer-related death amongst men worldwide. PCa is a heterogeneous disease, and the outcome is worse for patients when the disease progresses from localized PCa to a castrate-resistant disease. Androgen receptor (AR) signaling is crucial for PCa development and has been a major therapeutic target for decades. Despite the success made with hormone therapy to block AR signaling, castration resistant disease can arise through mutations and amplifications of the androgen receptor (AR) and AR splice variants (AR-Vs). Amongst them, AR-V7 and AR-V12 can promote AR signaling independent of androgen. Furthermore, prostate tumors are highly hypoxic due to abnormal tumor vasculature. Hypoxia influences the efficacy of local and systemic treatment strategies, such as radiotherapy, hormone therapy, and chemotherapy, resulting in poorer clinical outcomes for PCa patients. Therefore, a complete understanding of AR and AR variant function, as well as how they are modulated by hypoxia and therapy is warranted for developing new strategies to treat PCa. Methods: To identify the transcriptional apparatus associated with the AR and its variants under normal and hypoxic conditions, we carried out Bio-ID proximity labeling mass spectrometry (BioID-MS). We generated stable androgen-independent human prostate cancer cell lines, PC-3 and DU145, expressing AR and the AR-V7 and AR-V12 variants fused to a MiniTurboID (MTID) enzyme. To delineate the AR proximal interaction network, we treated cells with androgen or vehicle for 3 hours and affinity-purified biotinylated proteins after the addition of biotin for the final 2 hours. Cells were grown in normoxia (20% O2) or treated with hypoxia (95% N2,5% CO2 and 0.5% O2) for 24 h. Nonspecific interactions were filtered using controls and statistical methods to identify high-confidence interactomes. Results: BioID proximity labeling in PC3 cells identified several AR-associated proteins, including many knowninteractors, validating the approach. Hypoxic conditions led to a striking alteration in proximal interactions and many metabolic proteins were highly enriched with AR upon exposure of cells to hypoxia for 24h. Among these, phosphoglycerate kinase 1 (PGK1) was a top hit. PGK1 has been reported to interact with AR to mediate the expression of genes that regulates cell proliferation and apoptosis. Additionally, PGK1 has an essential role in metabolic reprogramming induced by c-MYC and HIF-1α, leading to enhanced tumorigenesis. Conclusion: Bio-ID mass spectrometry was used to map the proximal interactome of AR and its variants, identifying novel interactions partners for further analysis. We found that hypoxia strongly alters interactors with the AR, and we identified PGK1 as a hypoxia induced AR interaction in PCA. Current work to functionally validate this interaction will be presented. Citation Format: Oloruntoba I. Osagie, Jordann Smakk, Deborah E. Citrin, Travis H. Stracker. Identification of critical hypoxia induced factors in castrate resistant prostate cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4802.

Molecular basis and therapeutic targets in prostate cancer: A comprehensive review.

Prostate cancer is one of the most significant causes of morbidity and mortality in male patients. The incidence increases with age, and it is higher among African Americans. The occurrence of prostate cancer is associated with many risk factors, including genetic and hereditary predisposition. The most common genetic syndromes associated with prostate cancer risk are BRCA-associated hereditary breast and ovarian cancer (HBOC) and Lynch syndrome. Local-regional therapy, i.e., surgery is beneficial in early-stage prostate cancer management. Advanced and metastatic prostate cancers require systemic therapies, including hormonal inhibition, chemotherapy, and targeted agents. Most prostate cancers can be treated by targeting the androgen-receptor pathway and decreasing androgen production or binding to androgen receptors (AR). Castration-resistant prostate cancer (CRPC) usually involves the PI3K/AKT/mTOR pathway and requires targeted therapy. Specific molecular therapy can target mutated cell lines in which DNA defect repair is altered, caused by mutations ofBRCA2, partner and localizer of BRCA2 (PALB2), and phosphatase and tensin homolog (PTEN) or the transmembrane protease serine 2-ERG (TMPRSS2-ERG)fusion. Most benefits were demonstrated incyclin dependent-kinase 12 (CDK12)mutated cell lines when treated with anti-programmed cell death protein 1 (PD1) therapy. Therapies targetingp53and AKT are the subject of ongoing clinical trials. Many genetic defects are listed as diagnostic, prognostic, and clinically actionable markers in prostate cancer. Androgen receptor splice variant 7 (AR-V7) is an important oncogenic driver and an early diagnostic and prognostic marker, as well as a therapeutic target in hormone-resistant CRPC. This review summarizes the pathophysiological mechanisms and available targeted therapies for prostate cancer.

Abstract 683: Vaccination against androgen receptor splice variant induces anti-tumor adaptive immune responses

Abstract Background: Androgen receptor (AR) signaling has been the central target for standard-of-care prostate cancer therapies, although de novo resistance to these therapies occurs in many metastatic prostate cancer patients within 2-3 years. Resistance to AR targeting agents most often develops through overexpression of AR and expression of truncated, constitutively active RNA splice variants of AR. While clinical use of PD-1/PD-L1 immune checkpoint blockade has failed to demonstrate clinical success in treating resistance prostate cancers, the slower progression of prostate cancer provides an opportunity for immune targeted interventions. Cancer specific vaccines have the potential to enable and enhance tumor specific immune responses by stimulating and directing T cell immunity to important oncologic targets. We hypothesized that a cancer vaccine designed to induce a T cell response against cells expressing high levels of AR would result in an anti-tumor effect and potentially prevent or delay the development of therapeutic resistance. Methods: To evaluate AR and AR variants as potential immunological targets, we produced adenoviral vaccines against AR (Ad-AR) or AR splice variant 7 (Ad-AR-V7). We vaccinated naïve mice and examined AR and AR variant specific immunity in peptide restimulation. We further tested our vaccines in prophylactic and therapeutic regimens using multiple subcutaneous syngeneic tumor models (including prostate tumor lines, such as TrampC2) which were engineered to express AR or AR-V7. Results: Adenoviral vaccines targeting AR or AR-V7 produced robust T-cell responses against the N-terminal domain of AR. Notably, vaccination with both Ad-AR or Ad-AR-V7 induced significant anti-tumor immune responses, inducing complete tumor clearance against tumors expressing AR-V7 and allowing for long-term survival in the majority of vaccinated mice. Conclusions: These data demonstrate the potential of AR and AR splice variants as immunologic targets of prostate cancer vaccines, which elicit AR specific T cell immunity and produce anti-tumor responses in prostate cancers. Citation Format: Robert D. Marek, Junping Wei, Tao Wang, Xiao-Yi Yang, Gangjun Lei, Zachary C. Hartman. Vaccination against androgen receptor splice variant induces anti-tumor adaptive immune responses [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 683.

Abstract 1620: Identification of a molecular degrader targeting the AR-V7 splice variant

Abstract Prostate cancer is the most common cancer in males and the fifth leading cause of cancer mortality worldwide. A variety of therapeutic approaches exist including steroid synthesis inhibitors and next-generation ligand binding domain (LBD) antagonists [e.g., enzalutamide (Enza)]. However, these approaches are only effective against tumors bearing the full-length androgen receptor (AR-FL). In the course of their disease, many patients acquire androgen receptor splice variant 7 (AR-V7), a mutant form of the receptor which lacks the LBD and is constitutively activated. To date, no effective therapy has been demonstrated for patients with metastatic prostate cancer bearing the AR-V7 signature. We have recently developed a high throughput platform that allows for the identification of ligands that can bind to wide variety of protein targets. Using this approach, we screened a diverse chemical library of 100,000 small molecules to identify compounds that bound to AR-V7. One such molecule, CL-AR-100, directly bound to AR-V7 and moreover, induced proteasomal-mediated targeted protein degradation of both AR-V7 and AR-FL. This compound did not affect the expression of other structurally related ligand-activated nuclear receptors. In prostate cancer cell lines expressing AR-FL, CL-AR-100 induced a gene expression profile similar to cells treated with Enza including a marked reduction in KLK3 (PSA) expression. Moreover, CL-AR-200 inhibited the growth of 22RV1 cells (IC50=0.3uM), a cell line that predominantly expresses AR-V7. In contrast, the compound did not affect the growth of a wide variety of non-tumorigenic cells, non-prostate tumor cell lines or PC3 cells, a prostate cell line that exhibits AR-independent cell growth. These results thereby identify a small molecule molecular degrader that can specifically induce the targeted protein degradation of the AR-V7 splice variant. Given the strong association of this isoform with treatment resistance, this approach would appear to provide an attractive strategy for patients with metastatic castration resistant prostate cancer. Citation Format: Yuan Liu, Bo Lin, Mads B. Larsen, Irene Alfaras, Jason R. Kennerdell, Daniel P. Camarco, Ferhan Tuncer, Toren Finkel, Bill B. Chen. Identification of a molecular degrader targeting the AR-V7 splice variant [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1620.

Abstract 3441: A multivalent peptoid conjugate that inhibits therapy-resistant prostate cancer cell proliferation by modulating androgen receptor transcriptional activity

Abstract Prostate cancers adapt to androgen receptor (AR) pathway inhibitors and progress to castration resistance despite the continued expression and function of the AR. We developed a new approach to antagonize the proliferative activity of AR and inhibit castration-resistant prostate cancer (CRPC) growth using multivalent peptoid conjugates (MPCs). Our strategy is to display multiple copies of the AR antagonist, ethisterone, on a peptoid scaffold. Such a multivalent display increases the ligand’s effective local concentration, thus targeting AR with high affinity and affecting AR interactions with coregulators. Here, we report a new potent MPC called MPC309, which displays three ethisterone groups and binds to AR with nanomolar affinity. MPC309 reduces the proliferation of enzalutamide-resistant prostate cancer cells, including those harboring AR splice variants, AR ligand binding mutations, and non-canonical AR gene expression programs. We provide evidence that MPC309 enters cells via macropinocytosis, which facilitates the fluid-phase uptake of extracellular macromolecules. Macropinocytotic uptake of MPC309 enhances cancer cell-specific delivery, thus limiting systemic toxicities. MPC309 displays favorable pharmacological properties and produced significantly greater tumor suppression in xenograft studies than enzalutamide, the standard of care anti-androgen in clinical use. Mechanistically, MPC309 inhibits prostate cancer growth by eliciting a unique gene expression program through alterations in AR chromatin occupancy compared to dihydrotestosterone (DHT) or enzalutamide. Thus, MPC309 represents a novel AR antagonist that activates an AR anti-proliferative program to repress the growth of CRPC and supports further investigation of the MPC compound class for treating CRPC. Citation Format: Justine Habault, Jeffrey A. Schneider, Susan Ha, Rachel Ruoff, Joseph Puccini, Dafna Bar-Sagi, Kwok-Kin Wong, Amina Zoubeidi, Frank Claessens, David R. Wise, Susan K. Logan, Kent Kirshenbaum, Michael J. Garabedian. A multivalent peptoid conjugate that inhibits therapy-resistant prostate cancer cell proliferation by modulating androgen receptor transcriptional activity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3441.