Significant Antitumor Activity Research Articles

Advances in CAR-NK cell therapy for lung cancer: is it a better choice in the future?

Lung cancer remains one of the leading causes of cancer-related mortality worldwide necessitating the development of innovative therapeutic strategies. Chimeric antigen receptor (CAR) natural killer (NK) cell therapy represents a promising advancement in the field of oncology offering a novel approach to target and eliminate tumor cells with high specificity and reduced risk of immune-related adverse effects. This paper reviews the mechanism, potential targets, and recent advances in CAR-NK cell therapy for lung cancer, including the design and engineering of CAR-NK cells, preclinical studies, and the outcomes of early-phase clinical trials. We highlight the unique advantages of using NK cells, such as their innate ability to recognize and kill cancer cells and their reduced potential for inducing graft-versus-host disease (GvHD) and cytokine release syndrome (CRS) compared to CAR T-cell therapies. Results from recent studies demonstrate significant antitumor activity in lung cancer models with improved targeting and persistence of CAR-NK cells observed in vitro and in vivo. Finally, we discuss the challenges in optimizing CAR-NK cell therapies, including the potential resistance mechanisms. The paper concludes with an outlook on the future directions of CAR-NK cell research and its implications for lung cancer treatment emphasizing the importance of continued innovation and collaboration in the field.

Unlocking the potential of icaritin derivatives: Synthesis, characterization, and antiproliferative activity against MCF-7 breast cancer cells

Natural products serve as ideal templates for drug development, and screening compounds derived from natural products has been a prominent and viable approach for discovering new drugs, especially in the field of cancer treatment. Icaritin (ICT), a prenylated flavonol glycoside natural product, has demonstrated significant anti-breast cancer activity. In this study, we used ICT as a template to chemically synthesize 16 icariin derivatives and evaluated their effects on the proliferation of the human breast cancer cell line MCF-7 using the CCK-8 assay. Eight of these compounds exhibited significant antitumor activity (IC50 < 20 μM), with the most potent compounds being T14 (IC50 = 2.69 ± 0.28 μM) and T16 (IC50 = 4.72 ± 0.63 μM). Through a structure-activity relationship (SAR) study of ICT, we determined the key features for ICT's in vitro anti-breast cancer activity: the presence of the 8-prenyl group is not essential for activity; the 7-OH group is crucial for activity; replacing the 6-H with a Minnich base enhances activity; acetylation of the 7-OH, 5-OH, and 3-OH groups significantly increases activity; and the nature of the substituent at the 3-OH group plays a critical role in activity, with even minor changes to the substituent having a significant impact on activity.

Enhanced anti-tumor efficacy with multi-transgene armed mesenchymal stem cells for treating peritoneal carcinomatosis

BackgroundMesenchymal stem cells (MSCs) have garnered significant interest for their tumor-tropic property, making them potential therapeutic delivery vehicles for cancer treatment. We have previously shown the significant anti-tumour activity in mice preclinical models and companion animals with naturally occurring cancers using non-virally engineered MSCs with a therapeutic transgene encoding cytosine deaminase and uracil phosphoribosyl transferase (CDUPRT) and green fluorescent protein (GFP). Clinical studies have shown improved response rate with combinatorial treatment of 5-fluorouracil and Interferon-beta (IFNb) in peritoneal carcinomatosis (PC). However, high systemic toxicities have limited the clinical use of such a regime.MethodsIn this study, we evaluated the feasibility of intraperitoneal administration of non-virally engineered MSCs to co-deliver CDUPRT/5-Flucytosine prodrug system and IFNb to potentially enhance the cGAS-STING signalling axis. Here, MSCs were engineered to express CDUPRT or CDUPRT-IFNb. Expression of CDUPRT and IFNb was confirmed by flow cytometry and ELISA, respectively. The anti-cancer efficacy of the engineered MSCs was evaluated in both in vitro and in vivo model. ES2, HT-29 and Colo-205 were cocultured with engineered MSCs at various ratio. The cell viability with or without 5-flucytosine was measured with MTS assay. To further compare the anti-cancer efficacy of the engineered MSCs, peritoneal carcinomatosis mouse model was established by intraperitoneal injection of luciferase expressing ES2 stable cells. The tumour burden was measured through bioluminescence tracking.ResultsFirstly, there was no changes in phenotypes of MSCs despite high expression of the transgene encoding CDUPRT and IFNb (CDUPRT-IFNb). Transwell migration assays and in-vivo tracking suggested the co-expression of multiple transgenes did not impact migratory capability of the MSCs. The superiority of CDUPRT-IFNb over CDUPRT expressing MSCs was demonstrated in ES2, HT-29 and Colo-205 in-vitro. Similar observations were observed in an intraperitoneal ES2 ovarian cancer xenograft model. The growth of tumor mass was inhibited by ~ 90% and 46% in the mice treated with MSCs expressing CDUPRT-IFNb or CDUPRT, respectively.ConclusionsTaken together, these results established the effectiveness of MSCs co-expressing CDUPRT and IFNb in controlling and targeting PC growth. This study lay the foundation for the development of clinical trial using multigene-armed MSCs for PC.

Inhibitory Effects of Soluble Dietary Fiber from Foxtail Millet on Colorectal Cancer by the Restoration of Gut Microbiota.

Colorectal cancer (CRC) is a common malignant tumor that occurs in the colon. Gut microbiota is a complex ecosystem that plays an important role in the pathogenesis of CRC. Our previous studies showed that the soluble dietary fiber of foxtail millet (FMB-SDF) exhibited significant antitumor activity in vitro. The present study evaluated the anticancer potential of FMB-SDF in the azoxymethane (AOM)- and dextran sodium sulfate (DSS)-induced mouse CRC models. The results showed that FMB-SDF could significantly alleviate colon cancer symptoms in mice. Further, we found that FMB-SDF consumption significantly altered gut microbiota diversity and the overall structure and regulated the abundance of some microorganisms in CRC mice. Meanwhile, KEGG pathway enrichment showed that FMB-SDF can also alleviate the occurrence of colon cancer in mice by regulating certain cancer-related signaling pathways. In conclusion, our findings may provide a novel approach for the prevention and biotherapy of CRC.

Metformin enhances the anti-tumor effects mediated by attenuated Salmonella typhimurium

In bacterial-based cancer therapy, while attenuated Salmonella treatment effectively inhibits tumor progression, single bacterial therapy struggles to completely suppress tumor growth and metastasis. Metformin, a natural compound derived from Galega officinalis L. and known for its antidiabetic properties, also demonstrates significant anti-tumor activity. However, the combined effect of metformin and attenuated Salmonella on tumor treatment has not been thoroughly investigated. In this study, we observed that metformin enhances attenuated Salmonella-mediated recruitment of tumor-infiltrating immune cells, such as NK cells, neutrophils, M1 macrophages, CD4+, and CD8+T lymphocytes in CT26 tumor-bearing mice. Furthermore, the combined treatment of metformin and attenuated Salmonella increases the protein expression of PEN2, PD1, and PD-L1. This finding is likely associated with the enhanced anti-tumor effects of S.t ΔppGpp by metformin, indicating that the combination of S.t ΔppGpp and metformin holds promise as a synergistic strategy for attenuated Salmonella-based immunotherapy.

Abstract PO1-18-05: Combination treatment with CDK2 inhibitor (BLU-222) and either palbociclib or ribociclib is synergistic in pre-clinical models of CDK4/6 inhibitor-resistant breast cancer

Abstract Background: Cyclin-dependent-kinase-4/6 inhibitors (CDK4/6 inhibitors) plus endocrine therapy (ET) is the standard of care first-line treatment for patients with hormone receptor (HR)-positive, HER2-negative metastatic breast cancer (MBC). However, since most patients progress following long-term treatment, resistance to CDK4/6 inhibitors plus ET remains a clinical problem with limited therapeutic options. Here we show that a potent and selective CDK2 inhibitor, BLU-222, while effective as a single agent, exhibited enhanced, synergistic activity when combined with palbociclib or ribociclib in both in vitro and in vivo (patient-derived xenografts-PDX) models of HR+/HER2- breast cancer resistant to CDK4/6 inhibitors. Methods: MCF7 and T47D palbociclib-resistant (PR) breast cancer cell lines were generated by culturing cells in media supplemented with increasing concentrations of palbociclib, starting at 1.2 µM and reaching a final concentration of 4.8 µM in a stepwise manner over a 6-month period. The single agent activity of BLU-222 and the combination effect of BLU-222 plus palbociclib in vitro were evaluated using the highest single agent model by SynergyFinder. The efficacy of BLU-222 as a single agent or in combination with palbociclib or ribociclib was also assessed in two PDX models (PR 1 and 2) from patients with acquired resistance (i.e. progressed following &amp;gt;6 months of treatment) to palbociclib plus letrozole treatment, and another two PDX models (PR 3 and 4) from patients who were intrinsically resistant (i.e. progressed following &amp;lt; 3 months of treatment) to palbociclib plus fulvestrant or letrozole, respectively. Results: In palbociclib-resistant MCF7 and T47D cells, protein levels of cyclin E and CDK2 were significantly upregulated, but Rb and p21 levels were downregulated compared to the parental cells. While these PR cells were completely refractory to palbociclib, they were significantly more sensitive to BLU-222. Moreover, combining BLU-222 with palbociclib demonstrated a strong synergistic effect in PR cells accompanied by enhanced apoptosis and cell cycle accumulation in G1 or G2/M phases. Consistent with these in vitro findings, combination treatment with BLU-222 (60 mg/kg; b.i.d.) and palbociclib (50 mg/kg; q.d.) or ribociclib (50 mg/kg; q.d.) exhibited significant antitumor activity in all four PDX models, as compared to either treatment alone. The combination of BLU-222 plus the CDK4/6 inhibitor induced durable tumor regression and prolonged survival, which continued unabated following drug removal. Mechanistically, treatment of PR cells and palbociclib-resistant PDX models with BLU-222 as a single agent, resulted in the induction of p21, which can sensitize the cells to palbociclib. Conclusions: These results show robust activity of BLU-222 in combination with CDK4/6 inhibitors in breast cancer cell lines and PDX models resistant to CDK4/6 inhibitors, providing a strong rationale for advancing BLU-222 plus CDK4/6 inhibitor treatment to clinical development in HR-positive/HER2-negative breast cancer patients who have progressed on CDK4/6 inhibitors. Citation Format: Linjie Luo, Juliana Navarro-Yepes, Yan Wang, Tuyen Bui, Nicole Kettner, Debu Tripathy, Kelly Hunt, Kerrie Faia, Khandan Keyomarsi. Combination treatment with CDK2 inhibitor (BLU-222) and either palbociclib or ribociclib is synergistic in pre-clinical models of CDK4/6 inhibitor-resistant breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-18-05.

Abstract PO5-12-12: Implementation of a comprehensive monitoring protocol for the prevention and treatment of interstitial lung disease in patients undergoing treatment with trastuzumab deruxtecan

Abstract Background: In the DESTINY-BREAST studies, Trastuzumab deruxtecan (T-DXd) demonstrated significant antitumor activity in heavily pretreated patients (pts) with HER2-positive and HER2-low advanced breast cancer (ABC). T-DXd is associated with an increased risk of interstitial lung disease (ILD), which occurs in 10-15% of patients with a 2.2% rate of fatal events. Increased monitoring for ILD within DESTINY-BREAST03 showed a reduction in grade 3-5 events. Patients with a history of clinically significant lung disease were excluded from this study, however this may not be reflective of the standard community patient population treated with T-DXd. There are currently no standardized monitoring protocols for ILD/pneumonitis for pts treated with T-DXd. We conducted a retrospective chart review to assess the benefit of implementing an ILD monitoring protocol in a cohort of patients receiving treatment with T-DXd at the Duke Cancer Institute. Methods: Patients with HER2-positive or HER2-low ABC who received ≥ five cycles of T-DXd between Jan 1, 2020- April 30, 2022 were included. Imaging with CT chest ILD protocol and pulmonary function testing with diffusing capacity for carbon monoxide (DLCO) were performed at baseline prior to initiation of T-DXd, prior to cycle 3 and cycle 5 in conjunction with ILD chest CT and then every 6 weeks to monitor for ILD. DLCO was corrected for hemoglobin. Clinical symptoms including cough, shortness of breath, dyspnea, and new or worsening respiratory symptoms were recorded. For pts that experienced more than a 10% decrease in corrected DLCO (DLCOc), a pulmonology consult was recommended. DLCOc was reviewed in combination with chest imaging and clinical history to evaluate for ILD and guidance was provided for continuation or cessation of T-DXd. Results: A total of 33 patients with HER2-positive (N=27) and HER2-low (N=6) ABC were monitored as per the predefined ILD monitoring protocol. There were 5 confirmed cases of ILD/pneumonitis within the pt cohort. 16 patients (48%) experienced DLCOc decreases &amp;gt;10% warranting a pulmonology consult or further review. Upon further assessment, ILD/pneumonitis was ruled out based on chest imaging and/or asymptomatic presentation in 11 patients and therapy continued without treatment delay or discontinuation. There were 5 confirmed cases of ILD/pneumonitis within the patient cohort. 3 of the 5 patients diagnosed with ILD experienced DLCOc decreases ≥10%, while 2 of the 5 diagnosed patients had DLCOc changes of &amp;lt; 10% but had concern for ILD on ILD/chest CT and were diagnosed after pulmonology consult. Additional results to be presented at meeting. Conclusion: For patients receiving T-DXd, implementation of a comprehensive protocol to monitor and assess for ILD secondary to treatment may allow patients with suspected ILD to begin treatment sooner or prevent permanent discontinuation by excluding ILD diagnosis. While PFT monitoring can be helpful for some patients to monitor for ILD, continuous PFT monitoring is not recommended for all patients given inconsistency. However, baseline PFTs prior to initiation and with suspected ILD in combination with imaging warrants further investigation. The use of a multidisciplinary team including pulmonologists experienced with T-DXd-induced ILD may assist in diagnosing or excluding ILD and allow for continuation of T-DXd therapy. Citation Format: Heather Moore, Kelly Westbrook, Thomas Bagwell, Scott Shofer, Carey Anders, Amy Guisinger, Olivia White, Susan Dent. Implementation of a comprehensive monitoring protocol for the prevention and treatment of interstitial lung disease in patients undergoing treatment with trastuzumab deruxtecan [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-12-12.

Abstract PO1-24-08: Targeting of HER3 potentiates the antitumor activity of paclitaxel against triple negative breast cancer

Abstract Background: Triple negative breast cancer (TNBC) is characterized by the absence of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) overexpression. This aggressive form of breast cancer carries a higher risk of recurrence compared to other subtypes, presenting a significant clinical challenge. Although chemotherapy is commonly used as the primary treatment for a substantial number of TNBC patients, it is often accompanied by drug resistance and frequent tumor recurrence. Urgent efforts are needed to identify novel molecular targets specific to TNBC and develop effective therapies to combat this aggressive disease. The ultimate objective is to discover treatments capable of overcoming drug resistance and improving the overall survival of patients with TNBC. Methods: Immunohistochemistry was performed to examine the expression of HER3 in TNBC samples. Western blots were used to assess protein expression and activation. Cell proliferation and viability were determined by cell growth (MTS) assays. TCGA databases were analyzed to correlate HER3 mRNA expression with the clinical outcomes of TNBC patients. Specific shRNA was used to knockdown HER3 expression. LIVE/DEAD Cell Imaging was to detect live and dead cells. Orthotopic tumor models were established in nude mice to determine the capability of TNBC cells forming tumors and to test if our newly developed anti-HER3 monoclonal antibody (mAb) 4A7 could potentiate the antitumor activity of paclitaxel in vivo. Results: The chemo-resistant subline HCC1806-TR was obtained by subjecting TNBC HCC1806 cells to prolonged treatment with paclitaxel. In comparison to the parental cell line HCC1806-P, HCC1806-TR exhibited enhanced HER3 expression and activation. It is noteworthy that approximately half of the tested TNBC specimens and cell lines displayed elevated expression of HER3. Analyzing TCGA databases revealed that TNBC patients with high levels of HER3 mRNA expression in their tumors had significantly poorer overall survival (OS) and relapse-free survival (RFS) compared to those with low HER3 expression. Specifically knockdown of HER3 markedly inhibited TNBC cell proliferation and mammosphere formation in vitro and tumor growth in vivo. Blockade of HER3 signaling with our mAb (4A7) in combination with paclitaxel exerted significant antitumor activity against TNBC in vitro and in vivo. Conclusions: Our data demonstrate that increased HER3 is an effective therapeutic target for TNBC and our anti-HER3 mAb (4A7) may enhance the efficacy of paclitaxel in TNBC. Keywords: HER3, Anbibody, Chemotherapy, Triple Negative Breast Cancer Citation Format: Hui Lyu, Sanbao Ruan, Congcong Tan, Ann Thor, Bolin Liu. Targeting of HER3 potentiates the antitumor activity of paclitaxel against triple negative breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-24-08.

Abstract PO1-14-07: Programme of mast cell subsets to potentiate breast cancer immunotherapy: from bed to bench to bed (the phase 2 platform RENAISSANCE trial)

Abstract Background: Immune checkpoint inhibitors (ICIs) have heralded a new era in breast cancer treatment; however, response rates remain limited, making precision immune-oncology a major unmet need. In addition to T cells, effective immune responses to ICIs rely on coordinated interactions between innate and adaptive immune cells. Mast cells are evolutionarily conserved, tissue-resident cells of importance to human health. Specific subsets of mast cells might be endowed with opposite roles in cancer treatment, yet the extent of mast cell heterogeneity and its clinical merit in immunotherapy remain undefined. Objective: We sought to comprehensively characterize mast cells in breast cancer, investigate their association with immunotherapy response with in-depth mechanistic insights, and identify actionable strategies to modulate mast cell functional states, thereby optimizing immunotherapy efficacy. Methods: We employed single-cell profiling on longitudinal breast cancer samples from three independent clinical trials (NCT04613674, NCT03197389 and GSE169246) to delineate mast cell heterogeneity in anti-PD-(L)1 therapy. By integrating multi-omic analyses, tissue characterization, preclinical experiments, transgenic mice, and high-throughput drug screening, we outlined the molecular features, underlying mechanisms, and clinical relevance of distinct mast cells to elicit ICI-responsive microenvironments. Subsequently, we launched RENAISSANCE (NCT05076682), a proof-of-concept, Bayesian adaptive, phase 2 platform trial, to evaluate the efficacy and safety of combining mast cell therapeutics with anti-PD-1 backbone therapy in metastatic triple-negative breast cancer (TNBC) patients who progressed after immunotherapy. The primary endpoint was the objective response rate (ORR) assessed using RECIST v1.1 criteria. Results: We identified a distinct population of mast cells termed antigen-presenting mast cells (APMCs), constituting approximately 30% of intratumoral mast cells and correlating with improved clinical benefit of anti-PD-(L)1 therapy in TNBC. APMCs displayed MHC-II and costimulatory molecules, and indicated the presence of tumor-reactive T cells and tertiary lymphoid structures. Using three immunocompetent mouse models, we confirmed the immunomodulatory capacity of APMCs in immunotherapy. Mechanistically, by employing Cpa3CreERT2Cd74fl/fl mice, we demonstrated that APMCs potentiate anti-PD-1 efficacy and antitumor T cell immunity through their antigen-presentation machinery. Interestingly, we identified cromolyn, an FDA-approved drug for allergy, as a potential therapeutic agent that elicited APMC-dependent CD8+ T cell cytotoxicity to synergize with anti-PD-1 therapy. Between February 2022 and March 2023, 10 patients with immunotherapy-refractory metastatic TNBC were enrolled to receive cromolyn plus camrelizumab backbone treatment. Given Bayesian predictive probability, this arm was “graduated” due to meeting the pre-specified efficacy boundary, with an ORR of 40.0% (4/10). The treatment was well tolerated with similar safety profiles of relevant drugs. Conclusions: Our findings provide crucial insights into the impact of mast cell heterogeneity on the clinical response to ICIs at a single-cell level, and pave the way for APMC-directed therapeutic interventions in cancer treatment. To our knowledge, this is the first prospective study in breast cancer of cromolyn plus anti-PD-1 backbone regimen after anti-PD-(L)1 immunotherapy failure, demonstrating significant antitumor activity and commendable tolerability. Consequently, we suggest a phase 3 randomized study to consolidate this finding, which might be an effective treatment in patients for whom there are few effective treatment options. Citation Format: Song-Yang Wu, Xi Jin, Yin Liu, Wen-Jia Zuo, Li Chen, Xiyu Liu, Lei Fan, Zhong-Hua Wang, Yan-Fei Liu, Yi-Zhou Jiang, Zhi-Ming Shao. Programme of mast cell subsets to potentiate breast cancer immunotherapy: from bed to bench to bed (the phase 2 platform RENAISSANCE trial) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-14-07.

Abstract PO4-27-05: A phase I open-label dose escalation trial of FWD1802 as monotherapy and in combination with palbociclib in patients with ER+/HER2- unresectable locally advanced or metastatic breast cancer with or without ESR1 mutations

Abstract Background: Estrogen receptor (ER) signaling sits at center of the tumor biology in ER+/HER2- breast cancers. Current standard of care involves hormone therapy with agents including selective estrogen receptor modulators (SERMs), selective estrogen receptor degraders (SERDs), and aromatase inhibitors (AIs). Unfortunately, most patients eventually develop resistance to these therapies. Mutations in estrogen receptor 1 (ESR1) are partially responsible for the acquired resistance. Mutated estrogen receptors are still sensitive to fulvestrant but with a much less sensitivity. In January 2023, elacestrant received its first approval for the treatment of postmenopausal women or adult men with breast cancer harboring ESR1 mutations in US. However, there is still great unmet medical need for this population. FWD1802 is a third-generation oral SERD for ER-positive breast cancer patients. It binds competitively to ER, with a much higher affinity than that of fulvestrant. Preclinically, FWD1802 alone and in combination with palbociclib exhibits significant anti-tumor activity in the ER+/HER2- models and in ESR1-mutated models in vitro and in vivo. This ongoing phase I study is to assess the safety, tolerability, pharmacokinetics (PK) and clinical activity of FWD1802 as monotherapy and in combination with palbociclib in ER+/HER2- unresectable locally advanced or metastatic breast cancer with or without ESR1 mutations. Methods: This clinical study (CTR20232130) consists of three parts: monotherapy dose escalation (Part A), dose escalation in combination with palbociclib (Part B) and monotherapy dose expansion in ESR1-mutated patients (Part C). A conventional “3+3” design is used for this study. Approximately a total of 129 patients will be enrolled. FWD1802 is administered orally daily. In monotherapy dose escalation study (Part A), at each dose level, a single ascending dose (SAD) is followed by a 28-day continuous multiple ascending dose (MAD) period (defined as 1 cycle). In Part B dose, palbociclib (125 mg daily) is administered on a 28-day treatment cycle with 21-day on treatment and 7-day off treatment, along with the 28-day treatment cycle of FWD1802. The primary objectives include dose limiting toxicity (DLT), maximum tolerated dose (MTD), safety, tolerability, and the recommended phase 2 dose (RP2D) of FWD1802. Secondary objectives include pharmacokinetics characteristics of FWD1802 and its major metabolite as monotherapy and in combination with palbociclib. Preliminary anti-tumor activity including objective response rate (ORR), duration of response (DoR), disease control rate (DCR) and progression-free survival (PFS) will also be evaluated. DLT evaluation will be conducted after the first cycle of multi-dose period, and tumor assessment will be conducted every 8 weeks by investigators according to RECIST version 1.1. Patients with ER+/HER2- unresectable locally advanced or metastatic breast cancer with or without ESR1 mutation are eligible for the enrollment. Enrolled patients should have progressed disease, or failed from previous therapy, or intolerable or inaccessible to standard therapy. In addition, patients with ECOG score ≤1 and with adequate renal, cardiac, hepatic, and hematologic function are eligible for enrollment. The monotherapy dose escalation (Part A) is currently ongoing. The dose selection for Part B and Part C will be based on the data from the ongoing Part A. Clinical trial information: CTR20232130. Research Sponsor: Shenzhen Forward Pharmaceuticals Co., Ltd. (FORWARD PHARMA). Citation Format: Ling Zeng, Jin Liu, Dan Wu, Huiwen Ge, Zirui Bian, Chenggang Zhu. A phase I open-label dose escalation trial of FWD1802 as monotherapy and in combination with palbociclib in patients with ER+/HER2- unresectable locally advanced or metastatic breast cancer with or without ESR1 mutations [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-27-05.

Development and Evaluation of a Novel Hyaluronic Acid and Chitosan-modified Phytosome for Co-delivery of Oxymatrine and Glycyrrhizin for Combination Therapy.

Multidrug resistance (MDR) of cancer cells is a major obstacle to efficient cancer chemotherapy. Combination therapy is expected to enhance the anticancer effect and reverse MDR. Numerous patents involve different kinds of nanoparticles for the co-delivery of multiple chemotherapeutics, but the FDA has approved none. In this study, oxymatrine (OMT) and glycyrrhizin (GL) were co-loaded into phytosomes as the core of nanocarriers, and the shell was cross-linked with chitosan (CS) and hyaluronic acid (HA) with the capability for the controlled, sequential release and the targeted drug uptake. Phospholipid complexes of OMT and GL (OGPs) were prepared by a solvent evaporation technique and could self-assemble in an aqueous solution to form phytosomes. CS and HA were sequentially coated on the surface of OGPs via electrostatic interactions to obtain CS coated OGPs (CS-OGPs) and HA modified CS-OGPs (HA-CS-OGPs), respectively. The particle size and zeta potential were measured to optimize the formulations. In vitro cytotoxicity and cellular uptake experiments on HepG2 cells were performed to evaluate the anticancer activity. OGPs were obtained with nano-size around 100 nm, and CS and HA coating on phytosomes could change the particle size and surface potential. The drug loading of OMT and GL showed that the nanocarriers could maintain a fixed ratio of 1:1. The in vitro release experiments indicated the release of OMT and GL was pH-dependent and sequential: the release of OMT from CS-OGPs and HA-CS-OGPs was significantly increased at pH 5.0 compared to the release at pH 7.4, while GL exhibited sustained released from CS-OGPs and HA-CS-OGPs at pH 5.0. Furthermore, in vitro cytotoxicity and cellular uptake experiments on HepG2 cells demonstrated that the co-delivery system based on phytosomes had significant synergistic anti-tumor activities, and the effects were enhanced by CS and HA modification. The delivery of OMT and GL via HA-CS-OGPs might be a promising treatment to reverse MDR in cancer therapy.

Small-Molecule Inhibitors of TIPE3 Protein Identified through Deep Learning Suppress Cancer Cell Growth In Vitro.

Tumor necrosis factor-α-induced protein 8-like 3 (TNFAIP8L3 or TIPE3) functions as a transfer protein for lipid second messengers. TIPE3 is highly upregulated in several human cancers and has been established to significantly promote tumor cell proliferation, migration, and invasion and inhibit the apoptosis of cancer cells. Thus, inhibiting the function of TIPE3 is expected to be an effective strategy against cancer. The advancement of artificial intelligence (AI)-driven drug development has recently invigorated research in anti-cancer drug development. In this work, we incorporated DFCNN, Autodock Vina docking, DeepBindBC, MD, and metadynamics to efficiently identify inhibitors of TIPE3 from a ZINC compound dataset. Six potential candidates were selected for further experimental study to validate their anti-tumor activity. Among these, three small-molecule compounds (K784-8160, E745-0011, and 7238-1516) showed significant anti-tumor activity in vitro, leading to reduced tumor cell viability, proliferation, and migration and enhanced apoptotic tumor cell death. Notably, E745-0011 and 7238-1516 exhibited selective cytotoxicity toward tumor cells with high TIPE3 expression while having little or no effect on normal human cells or tumor cells with low TIPE3 expression. A molecular docking analysis further supported their interactions with TIPE3, highlighting hydrophobic interactions and their shared interaction residues and offering insights for designing more effective inhibitors. Taken together, this work demonstrates the feasibility of incorporating deep learning and MD simulations in virtual drug screening and provides inhibitors with significant potential for anti-cancer drug development against TIPE3-.

Macrophage hitchhiking for systematic suppression in postablative multifocal hepatocellular carcinoma.

Hepatocellular carcinoma (HCC), particularly the multifocal HCC, features aggressive invasion and dismal prognosis. Locoregional treatments were often refractory to eliminate tumor tissue, resulting in residual tumor cells persisting and subsequent progression. Owing to problematic delivery to the tumor tissue, systemic therapies, such as lenvatinib (LEN) therapy, show limited clinical benefit in preventing residual tumor progression. Therefore, more advanced strategies for postablative multifocal HCC are urgently needed. Motivated by the chemotaxis in tumor penetration of macrophages, we report a strategy named microinvasive ablation-guided macrophage hitchhiking (MAMH) for the targeted therapy toward HCC. In this study, the strategy leverages the natural inflammatory gradient induced by ablation to guide LEN-loaded macrophages toward tumor targeting, which increased by ~10-fold the delivery efficiency of LEN in postablative HCC in vivo. MAMH has demonstrated significant antitumor activity in various HCC models, including the hydrodynamic tail vein injection multifocal HCC mouse model and the orthotopic xenograft HCC rabbit model, systematically inhibiting residual tumor progression after ablation and prolonging the median survival of tumor-bearing mice. The potential antitumor mechanism was explored using techniques such as flow cytometry, enzyme-linked immunosorbent assay, and immunohistochemistry. We found that the strategy significantly suppressed tumor cell proliferation and neovascularization, and such enhanced delivery of LEN stimulated systemic immune responses and induced durable immune memory. The macrophage hitchhiking strategy demonstrates exceptional therapeutic efficacy and biosafety across various species, offering promising prospects for clinical translation in controlling residual tumor progression and improving outcomes following HCC ablation.

Real world study of sacituzumab govitecan in metastatic triple-negative breast cancer in the United Kingdom.

Treatment options for pre-treated patients with metastatic triple-negative breast cancer (mTNBC) remain limited. This is the first study to assess the real-world safety and efficacy of sacituzumab govitecan (SG) in the UK. Data was retrospectively collected from 16 tertiary UK cancer centres. Pts had a diagnosis of mTNBC, received at least two prior lines of treatment (with at least one being in the metastatic setting) and received at least one dose of SG. 132 pts were included. Median age was 56 years (28-91). All patients were ECOG performance status (PS) 0-3 (PS0; 39, PS1; 76, PS2; 16, PS3;1). 75% (99/132) of pts had visceral metastases including 18% (24/132) of pts with CNS disease. Median PFS (mPFS) was 5.2 months (95% CI 4.5-6.6) with a median OS (mOS) of 8.7 months (95% CI 6.8-NA). The most common adverse events (AEs) were fatigue (all grade; 82%, G3/4; 14%), neutropenia (all grade; 55%, G3/4; 29%), diarrhoea (all grade; 58%, G3/4, 15%), and nausea (all grade; 38%, G3/4; 3%). SG dose reduction was required in 54% of pts. This study supports significant anti-tumour activity in heavily pre-treated pts with mTNBC. Toxicity data aligns with clinical trial experience.

Britanin - a beacon of hope against gastrointestinal tumors?

Britanin is a bioactive sesquiterpene lactone known for its potent anti-inflammatory and anti-oxidant properties. It also exhibits significant anti-tumor activity, suppressing tumor growth in vitro and in vivo. The current body of research on Britanin includes thirty papers predominantly related to neoplasms, the majority of which are gastrointestinal tumors that have not been summarized before. To drive academic debate, the present paper reviews the available research on Britanin in gastrointestinal tumors. It also outlines novel research directions using data not directly concerned with the digestive system, but which could be adopted in future gastrointestinal research. Britanin was found to counteract liver, colorectal, pancreatic, and gastric tumors, by regulating proliferation, apoptosis, autophagy, immune response, migration, and angiogenesis. As confirmed in pancreatic, gastric, and liver cancer, its most commonly noted molecular effects include nuclear factor kappa B and B-cell lymphoma 2 downregulation, as well as Bcl-2-associated X protein upregulation. Moreover, it has been found to induce the Akt kinase and Forkhead box O1 axis, activate the AMP-activated protein kinase pathway, elevate interleukin-2 and peroxisome proliferator-activated receptor-γ levels, reduce interleukin-10, as well as downregulate matrix metalloproteinase-9, Twist family bHLH transcription factor 1, and cyclooxygenase-2. It also inhibits Myc-HIF1α interaction and programmed death ligand 1 transcription by interrupting the Ras/ RAF/MEK/ERK pathway and mTOR/P70S6K/4EBP1 signaling. Future research should aim to unravel the link between Britanin and acetylcholinesterase, mast cells, osteolysis, and ischemia, as compelling data have been provided by studies outside the gastrointestinal context. Since the cytotoxicity of Britanin on noncancerous cells is significantly lower than that on tumor cells, while still being effective against the latter, further in-depth studies with the use of animal models are merited. The compound exhibits pleiotropic biological activity and offers considerable promise as an anti-cancer agent, which may address the current paucity of treatment options and high mortality rate among patients with gastrointestinal tumors.

Biochemical and Histoarchitectural evaluation of 4-Vinylcyclohexane induced ovarian cancer against Alpinia purpurata (Vieill). K. Schum

ObjectiveAlpinia purpurata is being studied for its potential to treat various conditions, including diabetes, arthritis, and tuberculosis. This research explores the impact of Alpinia purpurata (Vieill). K. Schum on ovarian cancer induced by 4-vinyl cyclohexane in Wistar albino rats. Materials and methodsFive sets of 100–120 g Wistar albino rats were assembled. Group 1 was the control group. Group 2 received intraperitoneal injection of 4-vinyl cyclohexane (80 mg/kg) for one month. Group 3 Treated similarly to Group 2 subsequently for the next two months treated with oral administration of A. purpurata ethyl acetate leaf extract (200 mg/kg body weight) Group 4 Treated similarly to Group subsequently for the next two months treated with Standard Drug Cisplatin (5 mg/kg body weight) weekly twice intraperitoneally. Group 5 acquired daily oral A. purpurata leaf extract (200 mg/kg) for two months. The rats were euthanized after the experiment under light chloroform anesthesia. Ovary and liver samples were obtained for lipid peroxidation, anti-oxidants, membrane-bound enzymes, tumor indicators, and histological investigation. ResultsOver a 60-day period, rats were given an ethyl acetate extract of A. purpurata at a dose of 200 mg/kg, which lead to in a substantial (p < 0.05) increase in body protein content, as well as enzyme levels. Furthermore, the use of the ethyl acetate extract significantly (p < 0.05) recovered the altered lipid peroxidation activities in the ovarian tissues of both control and experimental rats to near-normal levels. These data imply that the extract has the capacity to quench free radicals, indicating possible anticancer effects. ConclusionThe results suggested that, the ethyl acetate extract of A. purpurata exhibited significant antitumor activity against 4-vinyl cyclohexane induced ovarian cancer bearing rats.

Abstract CT191: First-in-human, dose escalation and expansion study of MT-6402, a novel engineered toxin body (ETB) targeting PD-L1, in patients with PD-L1 expressing relapsed/refractory advanced solid tumors: Interim data

Abstract MT-6402 is a PD-L1-targeted ETB capable of directly killing PD-L1 expressing cells by internalization of a de-immunized Shiga-like toxin A subunit (SLTA), resulting in ribosomal destruction. Targeting PD-L1 expressing tumor cells may directly drive tumor regression, whereas targeting PD-L1 expressing immune cells may release immunosuppression and drive tumor immune recognition. MT-6402 also delivers an HLA-A*02 restricted cytomegalovirus (CMV) class I antigen into PD-L1 expressing cells (antigen seeding) that can be recognized by existing CMV-specific cytotoxic T cells. A first-in-human dose escalation (Part A) and expansion (Part B) study with a weekly intravenous administration of MT-6402 in 4-week cycles was initiated in 2021. Safety and tolerability are primary objectives. Efficacy, pharmacokinetics, and pharmacodynamic data are also collected. As of 10Dec2023, 53 total patients (pts) with PD-L1-expressing advanced solid tumors received ≥ 1 dose of MT-6402: 48 pts in Part A ranging in dose 16 to 100 µg/kg and 5 pts in Part B at 63 µg/kg, just below the maximum tolerated dose (MTD) of 83 µg/kg. MT-6402 was well tolerated in Part A, completed Sept2023. 5 dose limiting toxicities have been reported: a Grade (G)3 maculopapular rash at 24 µg/kg, a G3 infusion related reaction at 63 µg/kg, a G1 cardiac troponin T increase leading to dosing hold for ≥2 weeks at 83 µg/kg, a G3 maculopapular rash at 100 µg/kg, and a G1 cardiac troponin T increase at 100 µg/kg. There were no G4 or G5 drug-related adverse events. In Part B, pts with PD-L1 scores of TPS ≥ 50% will be treated at MTD or lower and 5 pts have been treated at 63 µg/kg. Signs of antitumor activity have been reported including a long-lasting PR with 70% tumor reduction have been observed in a pt with CPI-refractory nasopharyngeal carcinoma on treatment 14+ cycles at 63 µg/kg. This pt has a PD-L1 TPS score of 2% indicating immune cell clearance may have driven the response. The most common cancer in Part A is Squamous Cell Carcinoma of the Head and Neck (10 pts). Pharmacodynamic effects include a significant reduction in peripheral PD-L1+ immune cells, indicating a PD-L1 target-specific effect. Substantial alterations in serum cytokines associated with the tumor microenvironment were noted after each dose in most pts in a dose dependent manner. Most pts display increased CD8/CD4 ratios with IL-2 and TNFα cytokine release, indicative of immune activation due to elimination of immune cells. CMV-specific CD8 T-cells exhibited a pattern of extravasation from the periphery in HLA-A*02+/CMV+ pts suggesting antigen seeding. These results describe a novel approach to checkpoint modulation by MT-6402 with targeted cell killing and altered tumor immunophenotype, particularly in HLA-A*02/CMV+ pts. These results provide rationale for continued development of MT-6402. Citation Format: Brian A. Van Tine, Eugene Ahn, Rebecca A. Redman, Minal A. Barve, William J. Edenfield, Julio Peguero, Victoria M. Villaflor, Drew W. Rasco, Steven F. Powell, Admasu T. Mamuye, Chris B. Moore, Joshua M. Pelham, Soratree Charoenthongtrakul, David R. Spigel. First-in-human, dose escalation and expansion study of MT-6402, a novel engineered toxin body (ETB) targeting PD-L1, in patients with PD-L1 expressing relapsed/refractory advanced solid tumors: Interim data [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT191.

Abstract LB022: Preclinical anti-tumorigenic evaluation of AXL targeting antibody-drug-conjugate in an adenoid cystic carcinoma cell line xenograft model

Abstract Adenoid cystic carcinoma (ACC) is a rare type of salivary gland cancer. Despite the many advances made in helping understand the disease behavior and characteristics, the prevailing challenge in managing patients with ACC is the lack of clinically approved systemic therapy drugs to successfully treat those with advanced recurrent or metastatic disease. There are multiple promising candidate agents being evaluated preclinically and in early phase clinical trials, yet an effective drug with consistent overall response remains to be identified. AXL is a member of the TAM family of tyrosine kinase receptors, and its overexpression and activation is generally associated with poor prognosis and chemoresistance in many cancer types. Previous reports show AXL is significantly upregulated in a subset of ACC tumors. Here, we evaluate the tumor growth inhibition effects of a newly developed antibody-drug-conjugate targeting AXL (ADCT-601) in a xenograft ACC cell line model. MDA-ACC-01 cells express high levels of cell surface AXL as confirmed by biochemical analysis. The tumor growth inhibition of MDA-ACC-01 cell xenograft was tested in a single-dose drug administration study. Immunodeficient mice bearing ACC tumors were either injected with vehicle (n=7) or with ADCT-601 at 0.5 (n=9) or 1.0 mg/kg (n=7). ADCT-601 treatment with either 0.5 mg/kg or 1.0 mg/kg resulted in complete response (CR) for all tumor implants. To reaffirm the drug’s efficacy, we challenged the vehicle-treated tumor, prior to exceeding the tumor volume endpoint, with a single-dose of ADCT-601 at 1.0 mg/kg. Strikingly, by day 6 post-treatment, tumor volume began to shrink and eventually resulted in CR except in all but one case. These results demonstrate ADCT-601 is an effective drug with significant anti-tumor activity in our preclinical models and is worthy of additional investigation to determine its translational potential. Citation Format: Joseph O. Humtsoe, Anita Pothukuchi, Hyunseok Kang, Patrick Ha. Preclinical anti-tumorigenic evaluation of AXL targeting antibody-drug-conjugate in an adenoid cystic carcinoma cell line xenograft model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB022.

Abstract CT289: A phase II study of Tucatinib and Ado-trastuzumab Emtansine (T-DM1) in patients with HER2-positive metastatic solid tumors and metastases to brain (TUCATEMEB)

Abstract Background: HER2 overexpression or amplification is a validated prognostic and predictive biomarker for treatments in several tumor types. The development of brain metastases is an unfortunate and common complication in patients with metastatic cancer and the incidence of brain metastases continues to grow as advances in cancer treatment extend the survival. Unfortunately many of the clinical trials still exclude patients with brain metastases. Tucatinib is a selective small molecule HER2 inibitor that has shown intracranial activity and it is approved with trastuzumab and capecitabine for treatment of patients with breast cancer including with active brain metastases. Tucatinib showed significant preclinical and clinical antitumor activity in combination with other HER2-targeted therapies, including T-DM1 in breast and other cancers. We hypothesize that the combination of tucatinib and T-DM1 will be a safe and effective treatment in HER2-positive (+) metastatic solid tumors that have metastasized to the brain. To test this hypothesis, we are conducting a Phase II Study of Tucatinib and T-DM1 in Patients with HER2+ Metastatic Solid Tumors and Metastases to Brain (TUCATEMEB). Methods: Eligible adult patients with HER2-positive solid tumors and active brain metastases (with at least one untreated brain lesion ≥0.5 cm and &amp;lt;3.0 cm) will be enrolled in the study. HER2 positivity is defined as HER2 overexpression by immunohistochemistry 3+ or 2+ and fluorescence in situ hybridization positive and/or HER2 amplification by in situ hybridization or next-generation sequencing and/or activating ERBB2 mutation. Patients will receive the study treatment in 21-day cycles: Tucatinib 300 mg orally twice daily; T-DM1 3.6 mg/kg intravenously on Day 1. The primary objective is to determine the intracranial antitumor activity of the tucatinib and T-DM1 combination per the modified RECIST in patients with HER2+ metastatic solid tumors and brain metastases. The secondary objectives are to determine the intracranial antitumor activity per the RANO-BM criteria; to evaluate the safety and tolerability, the duration of intracranial response, the overall survival, the progression free survival, the systemic antitumor activity and clinical benefit rate in patients with HER2+ metastatic solid tumors and brain metastases. Exploratory objectives are to assess predictive and pharmacodynamic markers of response and to corelate them with clinical and molecular characteristics. The efficacy endpoint will be monitored using the Bayesian optimal phase 2 BOP2 design and safety and tolerability will be monitored based on Bayesian posterior probability. Restaging brain MRI and systemic scans will be performed every 6 weeks for the first 12 weeks, and every 9 weeks thereafter. The trial opened in May 2023 and is enrolling patients (NCT05673928). Citation Format: Ecaterina E. Dumbrava, Amber M. Kennon, Rashmi K. Murthy, Emma J. Montazari, Hussein Tawbi, Jing Li, Frederick F. Lang, Gisela Sanchez, Jianbo Wang, Isabella C. Glitza, Barbara J. O'Brien, Thomas Beckham, Todd Swanson, Martin C. Tom, Uyen M. Vu, Tanisha T. Darko, Tiantian Cai, Komal Shah, Funda Meric-Bernstam, Jordi Rodon. A phase II study of Tucatinib and Ado-trastuzumab Emtansine (T-DM1) in patients with HER2-positive metastatic solid tumors and metastases to brain (TUCATEMEB) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr CT289.

Abstract LB402: In vivo efficacy of anti-B7-H3 antibody-drug conjugate (ADC) ifinatamab deruxtecan (I-DXd; DS-7300): An update from the Pediatric Preclinical In Vivo Testing (PIVOT) Program

Abstract Introduction: I-DXd (DS-7300) is a B7-H3-directed ADC with a topoisomerase 1 inhibitor payload (an exatecan derivative, DXd). I-DXd has demonstrated clinical efficacy in adults with heavily pretreated solid tumors (Patel et al., ESMO 2023). We previously reported that I-DXd induced objective responses in PDX models for multiple B7-H3 (CD276) expressing pediatric histologies, including rhabdomyosarcoma, osteosarcoma, neuroblastoma, and Wilms tumor. We extend these results with dose-response testing and include an isotype control ADC (IC-ADC) to evaluate whether B7-H3 expression is required for optimal response. Methods: PDX models were dosed with vehicle, I-DXd, or IC-ADC, the latter two at 1, 3, and 10 mg/kg intravenously on days 1 and 15. Testing was performed using 5 animals per treatment group. Activity was assessed by the PIVOT objective response measure (ORM) (Ped Blood Cancer 2007;49:928-940) that defines objective response as partial, complete, or maintained complete response (PR, CR, and MCR) compared to stable disease (SD) or progressive disease, with or without growth delay (PD2 and PD1, respectively). Results: I-DXd showed dose-dependent activity with MCR for all 5 models at 10 mg/kg. PR or MCR responses were observed in 4 of 5 models to I-DXd at 3 mg/kg, with no objective responses to I-DXd at 1 mg/kg. Only the RMS model showed objective response to IC-ADC. For all models I-DXd was significantly more active than IC-ADC. Conclusions: We confirm significant anti-tumor activity for I-DXd for multiple pediatric solid tumors with B7-H3 expression and provide evidence of a dose response effect for I-DXd and for enhanced efficacy for I-DXd versus IC-ADC. Testing in additional preclinical models (neuroblastoma and glioblastoma) is underway. Due to the uniform high expression of B7-H3 in multiple pediatric histologies, I-DXd warrants evaluation for clinical activity in pediatric solid tumor patients. TABLE 1. NAND Activity for DS-7300a and Isotype Control using the PIVOT Objective Response Measure (ORM) Line IHC B7-H3 H-Score Diagnosis DS-7300a Isotype Control 1 mg/kg 3 mg/kg 10 mg/kg 1 mg/kg 3 mg/kg 10 mg/kg OS-9 230 Osteosarcoma PD2 PR MCR PD1 PD1 PD1 OS-33 240 Osteosarcoma PD2 MCR MCR PD1 PD2 SD Rh30 140 Rhabdomyosarcoma PD2 MCR MCR PD1 PR MCR WT11 150 Wilms tumor PD1 PD2 MCR PD1 PD1 PD1 Felix 210 Neuroblastoma PD2 MCR MCR PD1 PD1 PD2 Citation Format: Richard Gorlick, Jonathan Gill, Wendong Zhang, Yael Mosse, John Maris, David Groff, Malcolm Smith, Beverly Teicher, Steve Neuhauser, Tim Stearns, Vivek Philip, Emily Jocoy, Jeff Chuang, Carol J. Bult, Jun Hasegawa, Xiaozhong Qian, Peter Houghton, Raushan Kurmasheva. In vivo efficacy of anti-B7-H3 antibody-drug conjugate (ADC) ifinatamab deruxtecan (I-DXd; DS-7300): An update from the Pediatric Preclinical In Vivo Testing (PIVOT) Program [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB402.