Abstract Although treatment of patients (pts) with metastatic RCC with VEGFR2 inhibitors induces disease regression, these responses tend to be short-lived. Mouse models of VEGFR TKI treatment of RCC were used to study the mechanisms of resistance and identify novel targets. Drug-induced growth arrest was associated with enhanced expression of sphingosine kinase (sphk) whose only product is the bioactive signaling lipid, S1P. To explore the role of this pathway in mice bearing 786-O RCC were treated with a neutralizing antibody against S1P. Vehicle treated tumors increased by 2mm after 5.8 ± 4.1 days (n=6) and treatment with 10mg/kg or 50mg/kg anti-S1P led to growth after 15.3 ± 3.5 days (n=7) and 20.5 ± 3.9 days (n=6) respectively (P<0.01 for PBS vs. 10mg/kg or 50mg/kg), demonstrating that anti-S1P exhibits single agent activity in treatment naïve tumors. To assess the activity of S1P ab in the setting of sunitinib resistance, mice whose tumors developed resistance to sunitinib, were switched to either an anti-isotype negative control antibody, or anti-S1P. Treatment with anti-S1P produced relative tumor stabilization: 23.0 ± 16.5 days (n=10) vs. isotype control 6.9 ± 2.1 days for switch to isotype (n=7, P=0.01). In an A498 RCC tumor xenograft model, vehicle and isotype treated tumors increased by 2mm after 5.0 ± 1.17 days (n=7) compared to15.3 ± 5.8 days (n=6) for mice treated with 50mg/kg anti-S1P (P<0.01) and time to reach sacrifice size of 20mm was 30.7 ± 3.8 days (n=7) in vehicle and isotype treated tumors and 45.0 ± 8.6 days (n=6) with 50mg/kg anti-S1P (P=0.01). S1P levels in pts with RCC were found to be significantly higher than control pts (2.7 ± 0.032uM (n=23) vs 0.588 ± 0.057 M (n=20, P<0.0001). Thus, the S1P pathway is a novel target for the treatment of both treatment naïve and VEFGR TKI refractory RCC and anti-S1P therapy is an attractive new option for clinical investigation in RCC patients. The humanized anti-S1P mAb, ASONEPTM, has recently completed Phase I clinical trials in cancer and planning for Phase II efficacy trials is underway. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr LB-369.
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