Androgen Deprivation Therapies Research Articles

Computational Modeling to Identify Drugs Targeting Metastatic Castration-Resistant Prostate Cancer Characterized by Heightened Glycolysis

Metastatic castration-resistant prostate cancer (mCRPC) remains a deadly disease due to a lack of efficacious treatments. The reprogramming of cancer metabolism toward elevated glycolysis is a hallmark of mCRPC. Our goal is to identify therapeutics specifically associated with high glycolysis. Here, we established a computational framework to identify new pharmacological agents for mCRPC with heightened glycolysis activity under a tumor microenvironment, followed by in vitro validation. First, using our established computational tool, OncoPredict, we imputed the likelihood of drug responses to approximately 1900 agents in each mCRPC tumor from two large clinical patient cohorts. We selected drugs with predicted sensitivity highly correlated with glycolysis scores. In total, 77 drugs predicted to be more sensitive in high glycolysis mCRPC tumors were identified. These drugs represent diverse mechanisms of action. Three of the candidates, ivermectin, CNF2024, and P276-00, were selected for subsequent vitro validation based on the highest measured drug responses associated with glycolysis/OXPHOS in pan-cancer cell lines. By decreasing the input glucose level in culture media to mimic the mCRPC tumor microenvironments, we induced a high-glycolysis condition in PC3 cells and validated the projected higher sensitivity of all three drugs under this condition (p < 0.0001 for all drugs). For biomarker discovery, ivermectin and P276-00 were predicted to be more sensitive to mCRPC tumors with low androgen receptor activities and high glycolysis activities (AR(low)Gly(high)). In addition, we integrated a protein–protein interaction network and topological methods to identify biomarkers for these drug candidates. EEF1B2 and CCNA2 were identified as key biomarkers for ivermectin and CNF2024, respectively, through multiple independent biomarker nomination pipelines. In conclusion, this study offers new efficacious therapeutics beyond traditional androgen-deprivation therapies by precisely targeting mCRPC with high glycolysis.

SC912 inhibits AR-V7 activity in castration-resistant prostate cancer by targeting the androgen receptor N-terminal domain.

Androgen deprivation therapies (ADT) are the mainstay treatments for castration-resistant prostate cancer (CRPC). ADT suppresses the androgen receptor (AR) signaling by blocking androgen biosynthesis or inhibiting AR with antiandrogens that target AR's ligand-binding domain (LBD). However, the ADT's effect is short-lived, as the AR signaling inevitably arises again, which is frequently coupled with AR-V7 overexpression. AR-V7 is a truncated form of AR that lacks the LBD, thus being constitutively active in the absence of androgens and irresponsive to AR-LBD-targeting inhibitors. Though compelling evidence has tied AR-V7 to drug resistance in CRPC, pharmacological inhibition of AR-V7 is still an unmet need. Here, we discovered a small molecule, SC912, which binds to full-length AR as well as AR-V7 through AR N-terminal domain (AR-NTD). This pan-AR targeting relies on the amino acids 507-531 in the AR-NTD. SC912 also disrupted AR-V7 transcriptional activity, impaired AR-V7 nuclear localization and DNA binding. In the AR-V7 positive CRPC cells, SC912 suppressed proliferation, induced cell-cycle arrest, and apoptosis. In the AR-V7 expressing CRPC xenografts, SC912 attenuated tumor growth and antagonized intratumoral AR signaling. Together, these results suggested the therapeutic potential of SC912 for CRPC.

Abstract 5593: METTL3-NUP93 axis as a novel therapeutic target in castration-resistant prostate cancer (CRPC)

Abstract Androgens and androgen receptor (AR) are the key factors driving the development and progression of prostate cancer. Extensive studies confirm both androgens and AR are required for normal growth and development of the prostate gland, and also in prostate cancer pathogenesis and androgen-independent cancer progression. Therefore, androgen deprivation therapies or targeting AR function have always been the mainstay of therapeutic strategy against advanced prostate cancers. However, the current therapeutic strategies are temporally effective in suppressing prostate tumors, and eventually develop metastatic disease. Nuclear pore complex (NPC) is a large complex composed of approximately 30 different proteins termed nucleoporins (NUPs), which serve as the structural and functional units for macromolecules shuttling including proteins and messenger RNAs (mRNAs) between nucleus and cytoplasm. Abnormal expression or genetic alterations of NUP genes has been indicated to involve in the progression of prostate cancer, but the underlying molecular mechanisms are poorly understood. We recently found that the m6A methyltransferase METTL3 directly interacts with nucleoporin 93 (NUP93), one of the NPC components in multiple prostate cancer cells, which seems to be more robust in the castration-resistant prostate cancer (CRPC) cell lines. Disruption of METTL3-NUP93 axis abrogated proliferation and oncogenic phenotypes of CRPC cells, suggesting that the METTL3-NUP93 axis may play an important role in prostate cancer progression to castration resistance. Most importantly, a subgroup of mRNAs regulated through METTL3-NUP93 axis encode cholesterol biosynthesis enzymes that trigger the activation of persistent AR signaling in CRPC. Therefore, Our current findings suggest that inhibition of METTL3-NUP93 axis may represent a promising therapeutic strategy for CRPC, the lethal form of the disease. Citation Format: Jihoon Lee, Zhao Zhang, Juyeong Hong, Kexin Xu. METTL3-NUP93 axis as a novel therapeutic target in castration-resistant prostate cancer (CRPC) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5593.

Unraveling the Global Proteome and Phosphoproteome of Prostate Cancer Patient-Derived Xenografts.

Resistance to androgen deprivation therapies leads to metastatic castration-resistant prostate cancer (mCRPC) of adenocarcinoma (AdCa) origin that can transform to emergent aggressive variant prostate cancer (AVPC) which has neuroendocrine (NE)-like features. In this work, we used LuCaP patient-derived xenograft (PDX) tumors, clinically relevant models that reflects and retains key features of the tumor from advanced prostate cancer patients. Here we performed proteome and phosphoproteome characterization of 48 LuCaP PDX tumors and identified over 94,000 peptides and 9,700 phosphopeptides corresponding to 7,738 proteins. We compared 15 NE versus 33 AdCa samples, that included six different PDX tumors for each group in biological replicates and identified 309 unique proteins and 476 unique phosphopeptides that were significantly altered and corresponded to proteins that are known to distinguish these two phenotypes. Assessment of concordance from PDX tumor matched protein and mRNA revealed increased dissonance in transcriptionally regulated proteins in NE and metabolite interconversion enzymes in AdCa. Implications: Overall, our study highlights the importance of protein-based identification when compared to RNA and provides a rich resource of new and feasible targets for clinical assay development and in understanding the underlying biology of these tumors.

(290) Impact of Neoadjuvant Relugolix on Patient-Reported Sexual Function and Bother

Abstract Introduction Relugolix is an oral GnRH receptor antagonist used in combination with radiation therapy in the treatment of unfavorable prostate cancer. It has been shown to achieve rapid and profound testosterone suppression (total testosterone <20 ng/dL) without the need for bothersome injections. Such low testosterone levels may impact sexual functioning and perceptions. Objective Given the potential benefits of Relugolix over other androgen deprivation therapies (ADTs), this prospective study sought to assess neoadjuvant Relugolix-induced sexual dysfunction prior to the initiation of stereotactic body radiation therapy (SBRT). Methods Prospective, patient-reported data was collected from a male cohort diagnosed with localized prostate cancer and subsequently treated with neoadjuvant Relugolix and SBRT. Relugolix was initiated at least 2 months prior to SBRT. Sexual function and bother were assessed via the sexual domain of the validated Expanded Prostate Index Composite (EPIC-26) survey which includes five function questions (erections and orgasm) and one overall bother question. Individual scores ranged from 0-100 with higher scores reflecting improved function/less bother. EPIC-26 was collected for each patient at pre-Relugolix baseline and one hour prior to SBRT initiation. Individual items were evaluated for statistical significance (paired t-test, p < 0.05) and clinical significance by minimally important difference (MID, +/- 0.5 SD from baseline score). Results Between July 2021 and January 2023, 49 patients with localized prostate cancer were treated with neoadjuvant Relugolix (4-6 months) and SBRT (36.25-40 Gy in 5 fractions) at Georgetown University Hospital per institutional protocol IRB 12-1775. The median age was 73 years. 27% of patients were black and 26.1% were obese (BMI ≥30 kg/m2). Patients initiated Relugolix at a median of 3.6 months prior to SBRT. 82% of patients had intermediate risk disease. All individual EPIC sexual function scores declined in a similar manner following neoadjuvant Relugolix therapy. These declines were both statistically and clinically significant. There was no statistically or clinically significant change in the EPIC sexual overall bother score. Conclusions In concordance with known side effects of ADT, neoadjuvant Relugolix was associated with a significant decline in self-reported sexual function. However, patients indicated only a minimal and non-significant increase in bother. Relugolix was well-tolerated as patients on Relugolix did not subjectively find their sexual dysfunction troublesome. Future investigations should compare outcomes while on Relugolix directly to GnRH agonist-induced sexual dysfunction. Disclosure No.

PARP Inhibitors in Prostate Cancer – Understanding the Current Landscape

Poly (ADP [adenosine diphosphate]-ribose) polymerase inhibitors (PARPi) are a current standard of care treatment option for patients with metastatic castration resistant prostate cancer (mCRPC), defined as prostate cancers that continue to progress despite treatment with the usual first-line androgen-deprivation therapies. PARPi’s function by targeting faulty homologous recombination repair pathways that result in cytotoxic double strand DNA break (DSB) accumulation in prostate cancer cells. While the efficacy of PARPi’s as a monotherapy option in mCRCP has been demonstrated clinically, the added utility of PARPi’s in combination with other anti-cancer agents is still being explored. This article will review the scientific rationale behind PARP-inhibitors, discuss the germline and somatic mutation testing critical to identifying predictive biomarkers for PARPi efficacy, and present the currently approved PARPi combination therapies and their indications. This review will also examine the incidence and management of PARPi toxicity, summarize ongoing trials, and propose areas of future study.

Microfluidic-based human prostate-cancer-on-chip.

Lack of adequate models significantly hinders advances in prostate cancer treatment, where resistance to androgen-deprivation therapies and bone metastasis remain as major challenges. Current in vitro models fail to faithfully mimic the complex prostate physiology. In vivo animal models can shed light on the oncogenes involved in prostate cancer development and progression; however, the animal prostate gland is fundamentally different from that of human, and the underlying genetic mechanisms are different. To address this problem, we developed the first in vitro microfluidic human Prostate-Cancer-on-Chip (PCoC) model, where human prostate cancer and stromal fibroblast cells were co-cultivated in two channels separated by a porous membrane under culture medium flow. The established microenvironment enables soluble signaling factors secreted by each culture to locally diffuse through the membrane pores affecting the neighboring culture. We particularly explored the conversion of the stromal fibroblasts into cancer-associated fibroblasts (CAFs) due to the interaction between the 2cell types. Immunofluorescence microscopy revealed that tumor cells induced CAF biomarkers, αSMA and COL1A1, in stromal fibroblasts. The stromal CAF conversion level was observed to increase along the flow direction in response to diffusion agents, consistent with simulations of solute concentration gradients. The tumor cells also downregulated androgen receptor (AR) expression in stromal fibroblasts, while an adequate level of stromal AR expression is maintained in normal prostate homeostasis. We further investigated tumor invasion into the stroma, an early step in the metastatic cascade, in devices featuring a serpentine channel with orthogonal channel segments overlaying a straight channel and separated by an 8µm-pore membrane. Both tumor cells and stromal CAFs were observed to cross over into their neighboring channel, and the stroma's role seemed to be proactive in promoting cell invasion. As control, normal epithelial cells neither induced CAF conversion nor promoted cell invasion. In summary, the developed PCoC model allows spatiotemporal analysis of the tumor-stroma dynamic interactions, due to bi-directional signaling and physical contact, recapitulating tissue-level multicellular responses associated with prostate cancer in vivo. Hence, it can serve as an in vitro model to dissect mechanisms in human prostate cancer development and seek advanced therapeutic strategies.

Drug Resistance and Cardiovascular Safety of Second-Generation Anti-Androgens in Patients with Advanced Prostate Cancer

Prostate cancer is recognized as one of the most common cancers affecting the male population. The prostate is revealed to be a hormone-dependent tissue as testosterone and dihydrotestosterone could bind to the androgen receptor, activate it, and initiate the nuclear translocation of this receptor which is followed by subsequent signaling cascades. Regarding this androgen dependency of the prostate, it is believed that androgen deprivation therapies are able to confront aggressive prostate cancer as first-line treatment. However, prostate cancer could overcome hormone deprivation strategies through a number of cellular mechanisms, such as intratumoral androgen production and the production of ligand-independent androgen receptor splice variants, which are known clinically as castration-resistant prostate cancer. Due to the limited efficacy of first-generation antiandrogens in complete blockage of androgen receptor activity, recently, four second-generation anti-androgens, including abiraterone acetate, enzalutamide, apalutamide, and darolutamide approved by the Food and Drug Administration, and considered standard of care for patients with advanced prostate cancer. Nevertheless, prostate cancer cells may acquire drug-resistance mechanisms to overcome these novel chemotherapeutics. Furthermore, potential adverse effects on nontargeted organs such as the cardiovascular system, are possible. Hence, the current study aimed to review the efficacy and cardio-safety of these novel therapeutical strategies.

Abstract C056: Characterization of prostate cancer secretomes for therapeutic intervention

Abstract Introduction: Prostate cancer (PC) is a common malignancy among men, often driven by dysregulated androgen receptor (AR) signaling. Earlier stages of PC can be favorably treated with androgen deprivation therapies or AR signaling inhibitors. Unfortunately, metastatic PC (mPC) is currently incurable. Neuroendocrine prostate cancer (NEPC) is a subgroup of mPC that may be derived as result of transdifferentiation of adenocarcinomas, after AR-directed treatment. Previous studies using preclinical models have suggested a potentially beneficial relationship between NEPC and AR-active prostate cancer (ARPC) cells. We hypothesize that secreted factors derived from NEPC cells influence local, and distant ARPC cell types to promote treatment resistance. Methods: Five NEPC in vitro cell models: NCI-H660, MSKCC-EF1, LTL331R, LuCaP-49 and LuCaP-173.1 were maintained in serum free media for 24 hours. The conditioned media (CM) was then collected and admixed with growth medium for ARPC cells. The ARPC growth medium was either supplemented with Fetal Bovine Serum (FBS) or Charcoal Stripped fetal bovine Serum (CSS). GFP-labelled ARPC cells: LnCaP and C42B were seeded in the respective media admixed with the CM. The viability of cells was measured using a Cytation5 microplate reader. We implemented a transcriptomic (RNAseq) and mass-spectrometry based proteomic analysis to identify differentially expressing secretory proteins that could have an impact on the treatment resistance of ARPC cell types. Results: All 5 NEPC-CM showed qualitative growth promoting effects towards ARPC C42B cells grown in CSS supplemented media. Only CM from EF1 and H660 promoted the growth of ARPC C42B in FBS supplemented media. NEPC-CM did not affect growth of LnCaP ARPC cells. Mass-spectrometry for secreted proteins was performed on 3 NEPC cell models. Analysis of the proteins against the PANTHER gene ontology database shows: (i) cell communication, and (ii) cellular response to stimulus,  as two important biological processes active in NEPC. Genes involved in the two pathways were further compared against a comprehensive transcriptomic dataset spanning distinct mPC phenotypes and genotypes. Neurotrophic growth factors: Brain-derived growth factor (BDNF), Nerve-growth factor (NGF), VGF and neurotrophin-3 (NT-3) emerged as important targets that were differentially expressed in NEPC versus ARPC cells. Conclusions: NEPC cells have the potential to influence ARPC phenotypes that include enhanced proliferation, AR targeting, and potentially other drug resistance programs. As mPC exhibits substantial intra-individual and intra-tumor heterogeneity, understanding a targeting heterotypic cell interactions could lead to new druggable targets and address treatment resistance resulting from complex inter-cellular interactions. (Funding: PC220408) Citation Format: Tarana Arman, Lisa A. Jones, Ilsa M. Coleman, Philip R. Gafken, Peter S. Nelson. Characterization of prostate cancer secretomes for therapeutic intervention [abstract]. In: Proceedings of the AACR-NCI-EORTC Virtual International Conference on Molecular Targets and Cancer Therapeutics; 2023 Oct 11-15; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2023;22(12 Suppl):Abstract nr C056.

Fascin-1 expression is associated with neuroendocrine prostate cancer and directly suppressed by androgen receptor

BackgroundNeuroendocrine prostate cancer (NEPC) is an aggressive form of prostate cancer, arising from resistance to androgen-deprivation therapies. However, the molecular mechanisms associated with NEPC development and invasiveness are still poorly understood. Here we investigated the expression and functional significance of Fascin-1 (FSCN1), a pro-metastasis actin-bundling protein associated with poor prognosis of several cancers, in neuroendocrine differentiation of prostate cancer.MethodsDifferential expression analyses using Genome Expression Omnibus (GEO) database, clinical samples and cell lines were performed. Androgen or antagonist’s cellular treatments and knockdown experiments were used to detect changes in cell morphology, molecular markers, migration properties and in vivo tumour growth. Chromatin immunoprecipitation-sequencing (ChIP-Seq) data and ChIP assays were analysed to decipher androgen receptor (AR) binding.ResultsWe demonstrated that FSCN1 is upregulated during neuroendocrine differentiation of prostate cancer in vitro, leading to phenotypic changes and NEPC marker expression. In human prostate cancer samples, FSCN1 expression is restricted to NEPC tumours. We showed that the androgen-activated AR downregulates FSCN1 expression and works as a transcriptional repressor to directly suppress FSCN1 expression. AR antagonists alleviate this repression. In addition, FSCN1 silencing further impairs in vivo tumour growth.ConclusionCollectively, our findings identify FSCN1 as an AR-repressed gene. Particularly, it is involved in NEPC aggressiveness. Our results provide the rationale for the future clinical development of FSCN1 inhibitors in NEPC patients.

Making the Case for Autophagy Inhibition as a Therapeutic Strategy in Combination with Androgen-Targeted Therapies in Prostate Cancer.

Androgen receptor targeting remains the primary therapeutic strategy in prostate cancer, encompassing androgen biosynthesis inhibitors and androgen receptor antagonists. While both androgen-receptor-positive and "castration-resistant" prostate cancer are responsive to these approaches, the development of resistance is an almost inevitable outcome leading to the castration-resistant form of the disease. Given that "cytoprotective" autophagy is considered to be a predominant mechanism of resistance to various chemotherapeutic agents as well as to radiation in the cancer literature, the purpose of this review is to evaluate whether autophagy plays a central role in limiting the utility of androgen deprivation therapies in prostate cancer. Unlike most of our previous reports, where multiple functional forms of autophagy were identified, making it difficult if not impossible to propose autophagy inhibition as a therapeutic strategy, the cytoprotective form of autophagy appears to predominate in the case of androgen deprivation therapies. This opens a potential pathway for improving the outcomes for prostate cancer patients once effective and reliable pharmacological autophagy inhibitors have been developed.

A role for GnRH in olfaction and cognition: Implications for veterinary medicine.

Pulsatile secretion of gonadotropin-releasing hormone (GnRH) is essential for the activation and maintenance of the function of the hypothalamic-pituitary-gonadal (HPG) axis, which controls the onset of puberty and fertility. Two provocative recent studies suggest that, in addition to control reproduction, the neurons in the brain that produce GnRH are also involved in the control postnatal brain maturation, odour discrimination and adult cognition. Long-acting GnRH antagonists and agonists are commonly used to control fertility and behaviour in veterinary medicine, primarily in males. This review puts into perspective the potential risks of these androgen deprivation therapies and immunization on olfactory and cognitive performances and well-aging in domestic animals, including pets. We will also discuss the results reporting beneficial effects of pharmacological interventions restoring physiological GnRH levels on olfactory and cognitive alterations in preclinical models of Alzheimer's disease, which shares many pathophysiological and behavioural hallmarks with canine cognitive dysfunction. These novel findings raise the intriguing possibility that pulsatile GnRH therapy holds therapeutic potential for the management of this behavioural syndrome affecting older dogs.

Use of expectant management based on prostate cancer risk and health status: How far are we from a risk-adapted approach?

While active surveillance, a form of expectant management (EM), is preferred for patients with low-risk prostate cancer (PCa), some favor a more risk-adapted approach that recognizes patient preferences and condition-specific factors. However, previous research has shown non-patient-related factors often drive PCa treatment. In this context, we characterized trends in AS with respect to disease risk and health status. Using SEER-Medicare data, we identified men 66 years and older diagnosed with localized low- and intermediate-risk PCa from 2008 to 2017 and examined receipt of EM, defined as the absence of treatment (i.e., surgery, cryotherapy, radiation, chemotherapy, and androgen deprivation therapies) within 1 year of diagnosis. We performed bivariable analysis to compare trends in use for EM vs. treatment, stratified by disease risk (i.e., Gleason 3+3, 3+4, 4+3; PSA<10, 10-20) and health status (i.e., NCI Comorbidity Index (NCI), frailty, life expectancy). We then ran a multivariable logistic regression model to examine determinants of EM. Within this cohort, 26,364 (38%) were categorized as low-risk (i.e., Gleason 3+3 and PSA<10) and 43,520 (62%) as intermediate-risk (i.e., all others). Over the study period, use of EM significantly increased across all risk groups, except for Gleason 4+3 (P = 0.662), as well across all health status groups. However, linear trends did not differ significantly between frail vs. nonfrail patients for both those categorized as low-risk (P = 0.446) and intermediate-risk (P = 0.208). Trends also did not differ between NCI 0 vs. 1 vs. >1 for low-risk PCa (P = 0.395). In the multivariable models, EM was associated with increasing age and being frail for men with both low- and intermediate risk disease. Conversely, EM selection was negatively associated with higher comorbidity score. EM increased significantly over time for patients with low- and favorable intermediate-risk disease, with the most notable differences based on age and Gleason score. In contrast, trends in uptake of EM did not differ substantively by health status, suggesting that physicians may not be effectively incorporating patient health into PCa treatment decisions. Additional work is needed to develop interventions that recognize health status as an essential component of a risk-adapted approach.

Saracatinib synergizes with enzalutamide to downregulate AR activity in CRPC.

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 typically inhibit androgen production and the androgen receptor (AR). 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 are typically given to men with CRPC. However, these treatments are not curative and typically prolong survival only by a few months. Several resistance mechanisms contribute to this lack of efficacy such as the emergence of AR mutations, AR amplification, lineage plasticity, AR splice variants (AR-Vs) and increased kinase signaling. Having identified SRC kinase as a key tyrosine kinase enriched in CRPC patient tumors from our previous work, we evaluated whether inhibition of SRC kinase synergizes with enzalutamide or chemotherapy in several prostate cancer cell lines expressing variable AR isoforms. We observed robust synergy between the SRC kinase inhibitor, saracatinib, and enzalutamide, in the AR-FL+/AR-V+ CRPC cell lines, LNCaP95 and 22Rv1. We also observed that saracatinib significantly decreases AR Y534 phosphorylation, a key SRC kinase substrate residue, on AR-FL and AR-Vs, along with the AR regulome, supporting key mechanisms of synergy with enzalutamide. Lastly, we also found that the saracatinib-enzalutamide combination reduced DNA replication compared to the saracatinib-docetaxel combination, resulting in marked increased apoptosis. By elucidating this combination strategy, we provide pre-clinical data that suggests combining SRC kinase inhibitors with enzalutamide in select patients that express both AR-FL and AR-Vs.

Resource use in the last year of life of prostate cancer patients-A register-based analysis.

Given the paucity of data on the end of life (EOL) of prostate-cancer (PC) patients, we investigated medication prescription patterns and hospitalizations during their final year of life. The data base of the Österreichische Gesundheitskasse Vienna (ÖGK-W) was used to identify all men who died with the diagnosis PC between 1.1.2015 and 31.12.2021 and who were under androgen deprivation and/or new hormonal therapies. Patient age, prescription patterns and hospitalizations during the last year of life were recorded, odds ratios for age groups were analyzed. A total of 1.109 patients were included. ADT was given in 86.7% (n = 962) and NHT in 62.8% (n = 696). Overall, prescription of analgesics increased from 41% (n = 455) during the first to 65.1% (n = 722) in the last quarter of the final year of life. Prescription of NSAIDs was almost consistent (18-20%) whereas the number of patients receiving other non-opioids (paracetamol, metamizole) more than doubled (18 to 39%). Older men had lower prescription rates for NSAID (OR: 0.47, 95% CI: 0.35-0.64), non-opioids (OR: 0.43, 95% CI: 0.32-0.57), opioids (OR: 0.45, 95% CI: 0.34-0.6) and adjuvant analgesics (OR: 0.42, 95% CI: 0.28-0.65). Approximately 2/3 of patients (n = 733) died in the hospital with a median of four hospitalizations in the final year of life. The overall cumulative length of admission was less than 50d in 61.9%, 51-100d in 30.6% and >100d in 7.6%. Younger patients (<70 yrs) were more likely to die in the hospital (OR: 1.66, 95% CI: 1.15-2.39), had a higher median rate of hospitalizations (n = 6) and longer cumulative duration of admissions. Resource use increased during the last year life of PC patients with highest rates in younger men. Hospitalization rates were high and 2/3 died in the hospital, both showed clear age dependency with higher rates, duration and death in the hospital for younger men.

Abstract B008: Tumor-stromal 3D co-cultures to study the role of cancer-associated fibroblasts in the acquisition of androgen-deprivation therapy resistance in prostate cancer

Abstract Introduction and Objective Several studies have shown that cancer-associated fibroblasts (CAFs), the most abundant component in prostate cancer (PCa) microenvironment, promote resistance to androgen deprivation therapies, and metastatic development. The aim of this study is to elucidate the mechanisms of CAF-induced therapy resistance through the establishment of in vitro 3D co-cultures. Methods In this study, the androgen-dependent PNPCa patient-derived xenograft (PDX) model (derived from soft tissue metastasis), and the androgen-independent LAPC9 PDX model (bone metastasis) are used. Epithelial and stromal cells (human and mouse origin, respectively) are separated through magnetic-associated cell sorting to generate PDX-derived organoids and fibroblasts. Fibroblast RNA and protein expression is assessed through RT-qPCR, Western Blot, and Immunofluorescence. Direct 3D co-cultures are obtained by combining fluorescently labelled organoids and fibroblasts in ultra-low attachment plates in defined media. In indirect co-cultures, organoids are cultured in Spherical Plates (Kugelmeiers) with fibroblasts on transwell inserts. Organoid viability is measured after 9 days by CellTiter-Glo 3D Assay. Results PDX-derived fibroblasts express typical CAF genes (e.g. α-smooth muscle actin and Tenascin C), and androgen receptor (AR), both at RNA and protein level. AR protein expression (as well as RNA expression of the AR target gene Fkbp5) is increased in CAFs upon treatment with dyhydrotestosterone (DHT) 10nM, while co-treatment with the AR inhibitor Enzalutamide 10mM abrogates this effect, suggestive of functional AR signaling. These CAFs can organize into tumor/CAF organoid 3D structures upon combination with PDX-derived tumor epithelial cells, providing an in vitro functional model to study tumor-stromal interactions. In indirect (transwell) co-cultures, CAFs increase the viability of the androgen dependent PNPCa organoids, but not that of androgen independent LAPC9. This growth-promoting effect is observed even upon culturing of PNPCa organoids in non-optimal growth conditions, at low DHT concentrations (DHT 0.5nM and 0.25nM versus the standard DHT 1nM). The factors mediating this process will be identified by gene expression profiling of CAFs and organoids in transwell co-cultures and/or monoculture. Conclusions Our data indicate that PCa metastatic cells modify the properties of neighbor stromal cells to support tumorigenesis, since PDX-derived fibroblasts, originally part of the mouse dermal stroma, display CAF features and active AR signaling. 3D co-cultures represent a useful tool to study the tumor-stromal interactions. Our transwell co-culture experiments suggest that CAFs play an important role in supporting the viability and growth of early metastatic androgen dependent PCa cells (PNPCa) by secreting pro-tumorigenic factors. The possibility that CAFs exert different effects depending on the tumor stage setting (early vs advanced) will be subsequently investigated. Citation Format: Francesco Bonollo, Natalie Sampson, George Thalmann, Sofia Karkampouna, Marianna Kruithof-de Julio. Tumor-stromal 3D co-cultures to study the role of cancer-associated fibroblasts in the acquisition of androgen-deprivation therapy 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 B008.

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 B070: Global proteomics and phosphoproteomics profiling of prostate cancer patient derived xenografts tumors from the LuCaP series

Abstract Castration Resistant Prostate Cancer (CRPC) is a form of prostate cancer (PCa) that is resistant to androgen deprivation therapies. Resistance to these therapies leads to metastatic CRPC of adenocarcinoma (AD) origin and can transform to emergent aggressive variant prostate cancer (AVPC) which has genetic aberration features similar to neuroendocrine (NE) phenotypes. Understanding and identifying the underlying mechanisms of resistance and genetic transformations leading to protein alterations will enable us to develop novel therapeutic methods to counteract this resistance and improve outcomes for men with lethal metastatic prostate cancer. To this end, we used patient-derived xenografts (PDXs), an in-vivo clinically relevant model from advanced prostate cancer (PC) patients, to investigate the biology, identify novel protein targets and evaluate new treatment modalities. We aimed to identify known and novel protein kinase targets that might be phospho-regulated unique between CRPC, in AD and AVPC in NE. To pursue this, we applied a mass spectrometry base phosphoproteomics analysis. We processed 48 PDX samples, which included 15 non-castrated (NCR), 18 castration resistant (CR), which are the AD samples and 15 AVPC, the NE tumors. To enrich for global phosphorylated residues, we used sequential metal oxide affinity chromatography. We sequenced peptides from each sample using liquid chromatography in tandem with Orbitrap Eclipse Tribid MS and FAIMS technology for 2 hour gradients. To normalize and calibrate the LC method and to compare across all 48 runs, we spiked-in 400 femtomol of internal standards (iRT) to each sample. For peptide sequence and search analysis, we used Maxquant search algorithm. Using a &amp;gt; 0.75 probability phospho-residue cut-off and 5% FDR, we identified more than 9,700 phospho-residues. We identified RET, ASCL1, CHGA and SYP in NEPC and Androgen Receptor (AR), FOXA1, HOXB13, NKX3.1 and TACSTD2 in the adenocarcinoma PDX LuCap tumor samples, which confirms that our approach detected specific proteins already previously established. We subsequently performed a kinase substrate enrichment analysis and identified GSK-3, ERK1, ERK2, CDK5 kinases to be significantly enriched in the NE tumors while ATM kinase and PKC alpha and beta were enriched in the AD PDX tumor samples. Hierarchical clustering analysis across NE versus AD tumor samples indicated that samples within each group clustered uniquely where we observed intra and inter sample variability. We generated pathway enrichment and GSEA analysis, identified novel targets for therapeutic treatments and novel surface proteins. In conclusion, we have performed a global mass spectrometry based proteomic analysis and created an important first global phosphoproteomics and proteomics database that provides insights into the differentially regulated protein and phosphoproteins between AD and NE PDX tumors and provide a protein database source to develop new hypothesis. Citation Format: Zoi E. Sychev, Gabbrianne E. Larson, Hannah E. Bergom, Abderrahman E. Day, Megan E. Ludwig, Atef E. Ali, Eva Corey, Stephen R. Plymate, Justin E. Hwang, Justin M. Drake. Global proteomics and phosphoproteomics profiling of prostate cancer patient derived xenografts tumors from the LuCaP series [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 B070.

Abstract B066: Genome-wide CRISPR screens identify PTGES3 as a druggable AR modulator

Abstract BACKGROUND The androgen receptor (AR) is the central therapeutic target in advanced prostate cancer (PCa). While treatments that directly target AR are effective in prolonging patient survival, aggressive prostate cancers invariably find a way to evade these therapies. Frequently, evasion mechanisms reestablish AR expression and therefore AR-driven oncogenic pathways are restored. Comprehensively understanding the protein regulation machinery of AR and identifying alternative therapeutic targets are crucial for effective treatment of this disease. METHODS To study regulators of AR, we utilized CRISPR-Cas9 technology to knock-in a split neon green fluorescent protein onto AR in prostate cancer cells. We evaluated the AR expression and activity in these AR reporter cell lines by multiple approaches including ARE-luciferase assay, ChIP, and RNA-seq. We further built a unique loss-of-function CRISPRi screening system in this AR reporter cell line where we performed a genome-wide fluorescence-activated cell sorting based screen and functionally interrogated hits that modulate AR protein levels. RESULTS We established the first prostate cancer cell line models harboring an endogenous AR reporter. Extensive genotypic and phenotypic characterization of this system demonstrated that the reporter is effective and does not alter AR activity. These models have enabled us to precisely measure the dynamic endogenous AR protein levels by its fluorescence signal. By utilizing a genome-wide CRISPRi screening method in this system, we identified classic AR regulators such as HOXB13, GATA2 and GRHL2, as well as many novel genes that have not been characterized in the context of prostate cancer. Among these novel hits, Prostaglandin E synthase 3 (PTGES3) is the highest ranked druggable target. We validated this finding by establishing PTGES3 knockdown cell lines and demonstrated that loss of PTGES3 downregulated AR and its downstream genes. Follow-up studies show that beyond the canonical chaperone function, PTGES3 physically interacts with AR in the nucleus, where it promotes AR activity. PTGES3 is required for cell proliferation in vitro and in vivo in multiple AR-driven PCa models but not in AR-independent PCa models, such as PC3 cells. From our preliminary data, this unique interaction further suggests that high tumor PTGES3 expression is associated with resistance to first-line androgen deprivation therapies in a retrospective clinical cohort. These results collectively confirm that PTGES3 regulates AR activity and is a potential therapeutic target. Lastly, using a disulfide tethering fragment screen, we developed a PTGES3 inhibitor that blocks the PTGES3/AR interaction and represses AR signaling in PCa cells. We aim to further optimize this PTGES3-specific inhibitor as a therapeutic alternative for patients with aggressive prostate cancer. CONCLUSIONS Together, these genetic, biochemical and chemical biology experiments point to a new class of AR-directed PTGES3 inhibitor therapies that may overcome known mechanisms of ARSI resistance in mCRPC. Citation Format: Haolong Li, James E. Melnyk, Becky Xu Hua Fu, Siyu Feng, Martin Sjöström, Raunak Shrestha, Meng Zhang, Lisa N. Chesner, Hyun Jin Shin, Marsha Calvert, Jonathan Chou, Rajdeep Das, Emily A. Egusa, Aidan Winters, Jun Zhu, Ashutosh Maheshwari, Junjie T. Hua, Mohammed Alshalalfa, William S. Chen, Bradley A. Stohr, Javed Siddiqui, Bo Huang, Eric J. Small, David A. Quigley, Kevan M. Shokat, Luke A. Gilbert, Felix Y. Feng. Genome-wide CRISPR screens identify PTGES3 as a druggable AR modulator [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 B066.

Cancer-biomarkers associated with sex hormone receptors and recent therapeutic advancements: a comprehensive review

Hormones and its regulation plays vital role in causing breast, prostate, ovarian and endometrial cancers collectively known as hormone-sensitive cancers. This review discusses the various functions of the sex hormones and the biological pathways involved in causing hormone-associated cancer under differential regulation. We have also attempted to explore the biomarkers associated with the cancers and the current therapeutic availability to treat such cancers. Among various sex hormones such as estrogen, progesterone and androgen, estrogen the female sex hormone and its receptor had a major contribution in causing cancer and hence are considered a predominant target in treating the associated cancers. Other hormones and receptors such a androgen, progesterone, and their respective receptors were also reported to have a significant correlation in causing cancers. Apart from these receptors certain enzymes that act as precursors or as promoters are also targeted for treatment strategies. The drugs commonly used belong to the selective drug classes such as selective estrogen receptor modulators and selective progesterone receptor modulators. In the case of androgen regulation androgen deprivation therapies are practiced. It is also suggested that the use of natural substances to treat cancer could prevent resistance and reduce side effects. Identification of significant targets and the discovery of many efficient drugs shall be possible in the future with better understanding of hormone regulation and its influence on cancer causative mechanisms.