Tumor Growth Kinetics Research Articles

Abstract 1417: IRF8 driven reprogramming of the immune microenvironment enhances anti-tumor adaptive immunity and reduces immunosuppression in murine glioblastoma

Abstract Glioblastoma (GBM) has an extremely immunosuppressive microenvironment, primarily mediated by the recruitment of immature myeloid cells (IMCs) to the tumor. IMCs suppress T cell function and dampen the anti-tumor response. In this study, we sought to “reprogram” IMCs into antigen-presenting cells (APCs) to enhance anti-tumor T cell responses. To induce IMC differentiation into APCs, we utilized a retroviral replicating vector (RRV) expressing IRF8, a master regulator of type 1 conventional dendritic cell (cDC1) development. We evaluated the impact of IRF8 RRV on in vivo tumor growth kinetics, survival, immunosuppression, and immune microenvironment. Because RRV transduction requires the proliferation of target cells, we assessed the proliferative capacity of myeloid cells in murine and human GBM samples. We utilized the SB28 cell line, a poorly immunogenic murine GBM model. We pre-transduced SB28 cells with IRF8 RRV and implanted them intracranially into syngeneic C57BL/6 mice; controls expressed an empty vector. Intratumoral myeloid cells were proliferative in both murine and human samples. In vivo, tumor and myeloid cells are infected proportionately to their respective levels of proliferation. Mice with IRF8 RRV pre-transduced intracranial tumors had significantly longer survival (median 28 days) compared to controls (median 19 days) (p <0.0001). Additionally, tumor growth was delayed in IRF8 RRV mice. IRF8 RRV mice had significant enrichment of dendritic cells (p = 0.0145), cDC1s (p < 0.0001), T cells (p = 0.0025) and CD8+ T cells (p < 0.0001). Both monocytic and granulocytic IMCs had decreased expression of the immunosuppressive markers Arginase 1 and IDO1. Further, ex vivo co-culture of intra-tumoral myeloid cells with naïve T cells showed a functional decrease in immunosuppression in IRF8 RRV tumors compared to controls (p < 0.0001). To study the mechanism of action, we assessed whether IRF8 transduction of tumor cells alone or both tumor and immune cells, was necessary for the observed survival benefit. To inhibit RRV spread from infected cells to other cells, we treated mice with azidothymidine, a reverse transcription inhibitor. A robust survival benefit and tumor growth inhibition were seen only in mice where the RRV could spread freely (p = 0.0005). This finding shows that both tumor and immune cells must be infected to cause the phenotype and suggests that reprogramming immune cells is required for therapeutic efficacy. Our novel approach used RRV to deliver a myeloid transcriptional regulator in intracerebral GBM. This therapy achieved significant survival benefits and increased intratumoral cytotoxic T cells and APCs, while decreasing myeloid immunosuppression. Further studies will expand upon the mechanism of action and test combination therapies. Citation Format: Megan Montoya, Sara A. Collins, Pavlina Chuntova, Noriyuki Kasahara, Hideho Okada. IRF8 driven reprogramming of the immune microenvironment enhances anti-tumor adaptive immunity and reduces immunosuppression in murine glioblastoma [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 1417.

Abstract 5932: Immunomodulatory and anticancer effects of cyclical gemcitabine/nab-paclitaxel with continuous dosing of tinodasertib (AUM001) in preclinical KPC model

Abstract Background: PDAC has a poor 5-year survival outcome, and its aggressiveness limits the treatment efficacy. This is often driven by dysregulated mRNA translation of pro-tumorigenic genes that contribute to the proliferative and metastatic nature of PDAC. Synergizing chemotherapy with inhibition of oncogenic mRNA translation via MNK-coupled phosphorylation of eIF4E could potentially be viable. To support this hypothesis, we combined AUM001, a MNK inhibitor, with gemcitabine (GEM)-nab-paclitaxel (nPTX) with the aim of modulating tumor growth kinetics and maintaining it in a stable state. Methods: PDAC KPC cells were subcutaneously inoculated into BL6 mice and randomized to five treatment groups. Chemotherapy involved administering GEM-nPTX intraperitoneally on days 1, 4, and 8. AUM001 was given orally daily for 8 days for both mono- and combination therapies and was further administered for an additional 3 weeks in continuous dosing group. IHC staining for Ki67, MVD, and stromal markers was conducted on FFPE sections as well as Western blot analysis of tumor tissues. Apoptosis was assessed using Annexin V. Immune profiling were evaluated by flow cytometric assay and GeoMx spatial transcriptomics analysis. Results: The administration of GEM-nPTX and AUM001 (GPA) or GEM-nPTX alone (GP) led to an average 38% reduction in net tumor growth with no observed toxicity. Notably, continuous dosing of AUM001 (GPAc) following the cessation of chemotherapy exhibited a 45% decrease in net tumor growth (P=0.056) when compared to GPA. EIF4E phosphorylation and Myc expression were markedly inhibited in GPAc with lower recovery rate for MVD as compared to the GPA group at EOO (P < 0.05). A higher fraction of apoptotic cells was detected in the GPAc group at EOO than GPA group in reference to GP group (P=NS). GPA also resulted in a lower frequency of NK cells which was partially lifted in GPAc during observation phase. Macrophages which are known to have a pro-tumor role initially increased in frequency upon addition of AUM during chemotherapy, but subsequently decreased during observation. These modulations in infiltrating immune cells correlated with the differential expression of several immune related genes in the tumor associated CD45+ immune cells, revealed by the GeoMx analysis. Conclusions: This study showed that sustained administration of AUM001 alongside cyclical GEM-nPTX is well-tolerated with good anti-tumor outcomes. Additionally, the maintenance of AUM001 may enhance the decrease in pro-oncogenic protein expression and remodel the tumor immune microenvironment. In conclusion, continuous dosing of AUM001 following the cessation of chemotherapy could stabilize the tumor state, potentiating its application in clinical settings as maintenance therapy for PDAC. Citation Format: Wai Fook Leong, Sze Sing Lee, Jyue Yuan Lim, Siwen Sylvialin Chen, Fara Faye Desacola Regis, Romana Vidergar, Subhra K. Biswas, Balram Chowbay. Immunomodulatory and anticancer effects of cyclical gemcitabine/nab-paclitaxel with continuous dosing of tinodasertib (AUM001) in preclinical KPC model [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 5932.

Abstract 7151: Targeting metabolic pathway in triple negative breast cancer with a small molecule inhibitor

Abstract Background: Triple Negative Breast Cancer (TNBC) is the most aggressive type of breast cancer, making up 15-20% of diagnosed cases, and has high rates of metastasis and recurrence. Most women with this disease experience a recurrence after curative-intent therapy for early breast cancer, while a smaller proportions are diagnosed with distant metastases initially. Cancer cells are characterized by their reprogramming of glucose metabolism. Cancer cells show increased proliferation along with higher energy and substrate demands. Through our efforts to find effective therapies for TNBC, we have identified CET019, a new small molecule that effectively suppresses the growth of breast cancer cells. Methods: Cell viability and clonogenic assays were performed on a range of TNBC cells, including MDA-MB-231, MDA-MB-468, SUM159, HCC1395, HCC1806, EMT6, and 4T1. Cell cycle distribution was assessed through flow cytometry. LC-MS/MS analysis was performed on TMT-labeled samples for global proteome profiling. The efficacy of CET019 (30 mg/kg) was tested using tumor and patient derived xenograft studies. Results: Our studies show that CET019 suppresses the clonogenic potential and growth of various triple-negative breast cancer cells. The CET019 treatment causes cell cycle arrest in TNBC cells at the G2/M phase. Proteomics analysis suggests that CET019 specifically affects metabolic and proteosomal pathways. In vivo studies with CET019 found an inhibition of tumor growth kinetics in the mouse xenograft study with different TNBC models, as compared to the control group. We also observed that CET019 inhibited metastatic lung nodules. The results were further substantiated in three Patient Derived Xenograft (PDX) models. Conclusion: In summary, our study has identified a novel small molecule candidate CET019 as a promising lead candidate for TNBC treatment, paving the way for further development.“The complete chemical structures of the compounds used will be disclosed at the time of presentation at the meeting.” Citation Format: Arpit Dheeraj, Fernando Jose Marques, Dhanir Tailor, Abel Bermudez, Benedikt Grau, Sharon Pitteri, Sanjay V. Malhotra. Targeting metabolic pathway in triple negative breast cancer with a small molecule inhibitor [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 7151.

Abstract 5337: Profiling of human CD34+ donors in a myeloid-supportive HIS model provides increased predictability and facilitates study design for evaluation of immuno-oncology therapeutics

Abstract Background: Humanized immune system (HIS) mice are critical immuno-oncology tools for in vivo evaluation of therapeutic target engagement and efficacy. HIS mice require a human donor source of CD34+ hematopoietic stem cells to provide the human immune cell system. However, variance across donors complicates study design and hypothesis testing. To determine if parameters critical to drug discovery are consistent across batches of HIS mice from the same donor, we evaluated two independent cohorts of human tumor xenograft-bearing mice made using a common set of five different CD34+ cell donors. Our study included evaluation of tumor growth kinetics, human immune reconstitution and phenotype, and the pharmacokinetics and anti-tumor efficacy of a therapeutic monoclonal antibody directed against a human target expressed on tumor-associated macrophages (TAMs). Method: HIS NOG-EXL (huNOG-EXL) mice were created using CD34+ cells from five donors in two independent cohorts (~12 weeks apart). Baseline immune reconstitution in blood was assessed at 10 weeks post engraftment. MDA-MB-231 cells were inoculated bilaterally and mice were randomized into groups for immune profiling, pharmacokinetics, and efficacy studies. Body weight, clinical observations, endogenous hIgG levels, and tumor growth were measured. For efficacy, tumors grew to ~100 mm3 and mice were dosed intraperitoneally every five days (6 doses total). Separate cohorts of mice were used for immune phenotyping and the single-dose PK study. Results: Donor consistency was seen for some of the parameters assessed but not all. The overall health outcomes for a given donor appeared to have an impact on the consistency of important parameters (e.g. efficacy). Donors that had poor health outcomes (body condition scores [BCS] <3) showed less consistency than those that experienced good (BCS=3) outcomes. The health trajectory, peripheral human immune cell engraftment, and PK profiles were similar across experiments for a given donor. Total human immune cell infiltration in tumors was similar across experiments, but there were notable shifts in immune cell composition. Whereas mice in the first cohort showed a dominant TAM phenotype within the tumor (~>50% of all hCD45+ cells), mice across donors in the second cohort had reduced TAMs and corresponding increases in several T cell subsets. Efficacy was consistent in donors with good health outcomes (Donors 1 and 4) and was inconsistent in those with poor outcomes (Donors 3 and 5). Conclusion: Our study demonstrates that a return-to-donor approach can provide information that is reproducible across cohorts to help build a donor profile. An understanding of this profile should afford greater predictability and facilitate study design for drug discovery applications. Citation Format: Janell R. Richardson, Megan M. MacBride, Esther Andino, Emily Sack, Nicholas Smith, Po Y. Ho, Fang Xiao, Katelynn A. McEachin, David T. Omstead, Rachel Grgich, Michael N. Alonso, Justin A. Kenkel, Shelley E. Ackerman. Profiling of human CD34+ donors in a myeloid-supportive HIS model provides increased predictability and facilitates study design for evaluation of immuno-oncology therapeutics [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 5337.

Abstract 5338: Evaluation of checkpoint inhibitor efficacy in a humanized immune system mouse model lacking murine Fc gamma receptors

Abstract Humanized immune system (HIS) mice are critical immuno-oncology tools for evaluating antibody-based therapeutic target engagement and efficacy in a human-like context. Most antibody-based therapeutics have an IgG backbone and thus engage Fc gamma receptors. Traditional HIS mice retain murine immune cells such as neutrophils and macrophages which can interact with human IgG-based therapeutics and confound preclinical results. To determine whether knockout of murine Fc gamma receptors (FcγRs) in a super-immunodeficient mouse model would alter anti-PD1 efficacy compared to the parent strain, we studied tumor growth kinetics, human reconstitution, and tumor infiltrating leukocytes (TILs) in each strain engrafted with HCC827 lung adenocarcinoma tumor cells treated with pembrolizumab or vehicle. Methods: HIS NOG (huNOG) or HIS FcγR knockout NOG mice (FcResolv™ huNOG) were created using identical protocols with CD34+ cells from three human donors shared across both strains. Baseline reconstitution was evaluated in naïve animals via flow cytometry. HCC827 cells were inoculated in remaining animals. Animals were randomized on day 7 post-tumor implantation into 12 groups. Body weight, clinical observations, and tumor growth were measured. Mice received treatment from D7, dosed twice weekly for four weeks, and were then euthanized for FACS analysis, collecting blood, spleen, and tumor samples. Results: For a given donor, no significant differences were seen between strains in human immune reconstitution and kinetics. Pembrolizumab treatment showed significant tumor growth inhibition in one donor in FcResolv huNOG, but not in donor-matched huNOG mice. Evaluation of human TILs in pembrolizumab-treated animals showed significant differences between the strains across all donors, with FcResolv huNOG mice showing increased CD8+ T cells and decreased tumor-associated macrophages compared to vehicle-treated mice, and no significant differences in huNOG. Evaluation of murine TILs revealed differences in murine macrophage populations, regardless of treatment, with Ly6Clo dominant in FcResolv huNOG and Ly6Chi dominant in huNOG. In the presence of pembrolizumab, the murine myeloid and granulocyte population within the spleen is significantly decreased in FcResolv huNOG mice whereas no change was seen in huNOG. Conclusions: Our study demonstrates when treated with anti-PD1, FcResolv huNOG mice show expected pharmacodynamic changes and donor-dependent efficacy whereas, despite identical donors and creation protocols, pembrolizumab-treated huNOG mice showed neither. These differences are due to the presence or absence of murine FcγRs and their impact on antibody IgG-based therapeutics. Citation Format: Nicholas Smith, Monika Buczek, Megan MacBride, Esther Andino, Emily Sack, Debra Freer, Michelle Vedder, Kathleen Bott, Louise Baskin, Damien France, Francis Bichat, Caroline Mignard, Janell Richardson. Evaluation of checkpoint inhibitor efficacy in a humanized immune system mouse model lacking murine Fc gamma receptors [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 5338.

Abstract 2688: Age-associated changes in macrophage function and phenotype affects cancer development, and the efficacy of macrophage targeted anticancer therapies in murine melanoma model

Abstract Introduction: Aging of the immune system is a critical risk factor for chronic diseases, including cancer. Globally, cancer incidence is higher between 45 to 75 years of age and declines thereafter. However, the implications of aging in cancer are understudied, and aged populations are underrepresented, both in preclinical and clinical studies. The role of macrophages in cancer progression has gained attention as a tool and target for anticancer therapies. Tumor-associated macrophages (TAMs) mainly exhibit an anti-inflammatory M2 phenotype, promote an immunosuppressive tumor microenvironment (TME), and contribute to developing resistance against immunotherapies. Therefore, several strategies targeting the phenotype and function of TAMs are being explored, including inhibitors of histone deacetylases (HDACis), adoptive macrophage cell therapy, and CAR macrophages. Studies from our group have shown that ultra-specific HDAC6is can switch macrophages from anti-inflammatory, M2, to pro-inflammatory and antitumoral M1 phenotype with minimal cytotoxicity to cancer cells. However, it is unknown if age-related changes in macrophages affect such therapeutic strategies and the TME. Objective: To characterize the changes in macrophage function and phenotype with aging and study its implications on the TME and the efficacy of macrophage-based anticancer therapies. Methods: Wildtype mice of ages 6-8 WKS, 3-6 MO, 10-12 MO, and 20-24 MO were injected with SM1 melanoma cells to study tumor growth kinetics. Bone marrow-derived macrophages (BMDMs) isolated from tumor-bearing and healthy mice were polarized to M1 and M2 phenotype treated with HDAC6i to study age-associated changes in phagocytic activity, antigen presentation, and gene expression. Pathways associated with macrophage polarization were examined by flow cytometry, qRT-PCR, western blot, and single-cell proteomics. Immune cells in TME were characterized in flow cytometry and single-cell RNA and secretome analyses. Results: Tumor growth in SM1 murine melanoma model was significantly slower in older mice when compared to younger mice. Aged macrophages demonstrated significant defect in polarization to M1 and M2 phenotypes that was more pronounced in BMDMs from tumor-bearing mice. Tumor-associated macrophages showed inefficient monocyte-to-macrophage transition, as also reflected in the single-cell secretome analysis. The ability of HDAC6i to enhance macrophage function was reduced among older mice. Conclusions: The functional and phenotypic characteristics of macrophages change with age and can significantly affect tumor growth and the effectiveness of macrophage-targeted anticancer therapies. Our study highlights the importance of studying aging in macrophages and better representation of aged populations in preclinical and clinical studies. Citation Format: Manasa Suresh, Xintang Li, Satish Noonepalle, Nithya Gajendran, Marie Durr, David Quiceno-Torres, Karen Tan, Alejandro Villagra. Age-associated changes in macrophage function and phenotype affects cancer development, and the efficacy of macrophage targeted anticancer therapies in murine melanoma model [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 2688.

Abstract 4307: Quantifying the cell-intrinsic and cell-extrinsic growth effects of cancer-causing mutations in vivo

Abstract Adaptive driver phenotypes in cancer must confer either a cell-intrinsic (birth minus death) or cell-extrinsic (field) effect on growth. These effects can be summarized by an r/K logistic growth curve, whereby cell-intrinsic effects manifest as a change in the early, exponential growth constant (r) of a tumor population while cell-extrinsic effects alter the long-term ‘carrying capacity’ (K). Previously, we developed a novel genetically-engineered mouse model that tracks tumor growth dynamics with unprecedented precision via Tumor Barcoding, termed TuBa-seq1. Here, we quantify the growth trajectories of thousands of Kras-driven lung tumors over eight months. Median tumor size is best-described by a Gomp-Ex growth law (i.e. Nν/K where ν → +0), which also characterizes advanced-stage human tumors2. Carrying capacities of individual isogenic tumors varied by over four orders of magnitude, suggesting that microenvironmental heterogeneity profoundly impacts growth dynamics. Our approach further allowed us to track the growth effects of eleven canonical tumor suppressor gene knockouts introduced via multiplexed CRISPR/Cas genome-engineering. All but one of these secondary mutations augmented either the exponential growth rate or the carrying capacity of the tumor. However, only three tumor suppressor losses increased both growth parameters (Rb1, Setd2, and Stk11). Hence, the growth benefits of most cancer-causing mutations are missed when growth is measured only at a single time point. Clinically, we find that r-promoting and K-promoting mutations interact synergistically to create the most aggressive tumors in human patients (HR = 1.71, P-value < 10-10). Collectively, these results support a universal r/K framework for tumor growth and progression.

Abstract 7537: “Cross-over Effect” in survival curves with immune-checkpoint inhibition: Identifying ideal candidates for immunotherapy-only approaches in specific tumor histologies

Abstract Immune checkpoint inhibition (ICI), a cornerstone of modern immunotherapy (IO), has revolutionized cancer treatment, offering significant survival benefits across various malignancies. Initial trials with ICI in refractory cancers demonstrated remarkable efficacy compared to standard-of-care (SOC) treatments. With the integration of ICI into combination therapies, including chemotherapy and multi-tyrosine kinase inhibitors (TKI), its role in frontline, early-stage, and locally advanced cancers has grown. However, the potential of an immunotherapy-only strategy, especially in advanced malignancies, warrants better biomarker selected approaches given the inconsistencies with existing biomarkers. This study investigates the "cross-over” effect observed in Kaplan-Meier survival curves from randomized trials comparing ICI with non-ICI agents where the survival curves, assumed to be proportionally constant distinctly cross over each other during the on-treatment monitoring period. We initiated a meta-analysis investigating randomized trials comparing ICIs with non-ICI historical SOC agents and finally analyzed data from 38 large clinical trials. Trials were selected based on their comparative nature with overall survival (OS) and progression-free survival (PFS) data as outcomes. A positive “cross-over” in Kaplan-Meier curves was identified when divergence occurred for at least three consecutive months. Cross-over in PFS and OS curves were observed in 53% (20/38) and 43% (16/37) of trials, respectively. All cross-overs were one-sided with the ICI arm crossing over the non-ICI arm with a superior tail. Notably, 100% of trials with OS curve cross-over involved ICIs against chemotherapy. A significant association (Fischer’s exact test, p=0.01) was found between OS curve cross-over and adenocarcinoma histologies, in contrast to trials with no cross-over effect, predominantly featuring squamous cell carcinomas. This pattern persisted within various organ sites such as the lung, esophagus, and cervix where both adenocarcinomas and squamous histological patterns are seen. Cross-over of Kaplan-Meier curves blatantly violates the cox-proportional hazard assumption, potentially underestimating the impact of the ICI-only approach compared to alternative therapies. These observations highlight substantial biological heterogeneity in tumor responses to ICI versus chemotherapy. The cross-over effect, particularly pronounced in gland-forming tumors (adenocarcinomas), underscores the urgent need to investigate mechanisms of ICI resistance in these tumor types and incorporate tumor histology and longitudinal tumor growth dynamics into existing predictive models for biomarkers for IO response and help identify patients who would benefit the most from immunotherapy-only approaches. Citation Format: Shubhank Goyal, Anish Thomas, Parth Anil Desai. “Cross-over Effect” in survival curves with immune-checkpoint inhibition: Identifying ideal candidates for immunotherapy-only approaches in specific tumor histologies [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 7537.

Prognostic value of tumor volume doubling time in lung-metastatic adenoid cystic carcinoma

ObjectivesLung metastases in adenoid cystic carcinoma (ACC) usually have indolent growth and the optimal timing to start systemic therapy is not established. We assessed ACC lung metastasis tumor growth dynamics and compared the prognostic value of time to progression (TTP) and tumor volume doubling time (TVDT). MethodsThe study included ACC patients with ≥1 pulmonary metastasis (≥5 mm) and at least 2 chest computed tomography scans. Radiology assessment was performed from the first scan showing metastasis until treatment initiation or death. Up to 5 lung nodules per patient were segmented for TVDT calculation. To assess tumor growth rate (TGR), the correlation coefficient (r) and coefficient of determination (R2) were calculated for measured lung nodules. TTP was assessed per RECIST 1.1; TVDT was calculated using the Schwartz formula. Overall survival was analyzed using the Kaplan-Meier method. ResultsThe study included 75 patients. Sixty-seven patients (89%) had lung-only metastasis on first CT scan. The TGR was overall constant (median R2 = 0.974). Median TTP and TVDT were 11.2 months and 7.5 months. Shorter TVDT (<6 months) was associated with poor overall survival (HR = 0.48; p = 0.037), but TTP was not associated with survival (HR = 1.02; p = 0.96). Cox regression showed that TVDT but not TTP significantly correlated with OS. TVDT calculated using estimated tumor volume correlated with TVDT obtained by segmentation. ConclusionMost ACC lung metastases have a constant TGR. TVDT may be a better prognostic indicator than TTP in lung-metastatic ACC. TVDT can be estimated by single longitudinal measurement in clinical practice.

Examining avascular tumour growth dynamics: A variable-order non-local modelling perspective

This study investigates the growth of an avascular tumour described through the interchange of mass among its constituents and the production of inelastic distortions induced by growth itself. A key contribution of this research examines the role of non-local diffusion arising from the complex and heterogeneous tumour micro-environment. In our context, the non-local diffusion is enhanced by a variable-order fractional operator that incorporates crucial information about regions of limited nutrient availability within the tissue. Our research also focuses on the identification of an evolution law for the growth-induced inelastic distortions recast through the identification of non-conventional forces dual to suitable kinematic descriptors associated with the growth tensor. The establishment of such evolution law stems from examining the dissipation inequality and subsequently determining a posteriori connections between the inelastic distortions and the source/sink terms in the mass balance laws. To gain insights into the dynamics of tumour growth and its response to the proposed modelling framework, we first study how the variables governing the tissue evolution are affected by the introduction of the new growth law. Second, we investigate how regions of limited diffusion within the tumour, encoded into a fractional operator of variable-order, influence its growth.

Quantitative systems pharmacology modeling of HER2-positive metastatic breast cancer for translational efficacy evaluation and combination assessment across therapeutic modalities

HER2-positive (HER2+) metastatic breast cancer (mBC) is highly aggressive and a major threat to human health. Despite the significant improvement in patients’ prognosis given the drug development efforts during the past several decades, many clinical questions still remain to be addressed such as efficacy when combining different therapeutic modalities, best treatment sequences, interindividual variability as well as resistance and potential coping strategies. To better answer these questions, we developed a mechanistic quantitative systems pharmacology model of the pathophysiology of HER2+ mBC that was extensively calibrated and validated against multiscale data to quantitatively predict and characterize the signal transduction and preclinical tumor growth kinetics under different therapeutic interventions. Focusing on the second-line treatment for HER2+ mBC, e.g., antibody-drug conjugates (ADC), small molecule inhibitors/TKI and chemotherapy, the model accurately predicted the efficacy of various drug combinations and dosing regimens at the in vitro and in vivo levels. Sensitivity analyses and subsequent heterogeneous phenotype simulations revealed important insights into the design of new drug combinations to effectively overcome various resistance scenarios in HER2+ mBC treatments. In addition, the model predicted a better efficacy of the new TKI plus ADC combination which can potentially reduce drug dosage and toxicity, while it also shed light on the optimal treatment ordering of ADC versus TKI plus capecitabine regimens, and these findings were validated by new in vivo experiments. Our model is the first that mechanistically integrates multiple key drug modalities in HER2+ mBC research and it can serve as a high-throughput computational platform to guide future model-informed drug development and clinical translation.

Abstract B027: Molecular characterization and therapeutic approaches for VISTA+ triple-negative breast cancers

Abstract Introduction: VISTA (V-domain Ig suppressor of T cell activation) is a single-pass transmembrane immune checkpoint receptor that is an emerging clinical target for cancer immunotherapy. Although VISTA confers quiescence to naïve T cells, molecular mechanisms responsible for this effect remain unclear. Also, the effects of VISTA expression on tumor cells remains poorly defined. Methods: Multi-omic profiling was performed in human breast cancer cells lines to determine immune regulatory genes. Human triple-negative breast cancers (N=248) were examined by immunohistochemistry for expression of VISTA, PDL1, PD1 and FoxP3. VISTA expression was engineered into human and mouse triple-negative breast cancer cell lines and growth was characterized in vitro and in mouse models. Membrane receptor trafficking and localization of EGFR and clathrin adapters was performed in cells expressing VISTA, VISTA mutants and VISTA knockouts. Proximity biotinylation identified protein partners that interacted with VISTA’s intracellular domain. Deletion mutagenesis was performed to identify functional VISTA cytoplasmic motifs. Cytokine response and tumor growth kinetics were measured in TNBC mouse models expressing VISTA or VISTA mutants. Results: A class of human triple-negative breast cancers were identified with high VISTA expression, low tumor infiltrating lymphocytes and low proliferative index (8-20% of all TNBCs). Tumor models demonstrated that enforced expression of VISTA in tumor cells caused growth suppression, even in the absence of an immune system. This effect was mapped to the cytoplasmic domain of VISTA, which lacks defined signaling domains. Through biochemical approaches, the clathrin-adaptor molecules NUMB and GULP1 were found in complex with a VISTA intracellular NPGF motif. This motif sequestered NUMB at early endosomes, resulting in diminished NUMB recycling for EGFR endocytosis, thereby causing growth suppression. VISTA impaired NUMB recycling by blocking Rab11 effector complex formation. VISTA NPGF mutations did not disrupt cytokine secretion in mixed lymphocyte assays. VISTA-targeted antibodies did not disrupt NUMB sequestration. VISTA+ tumors were selectively sensitive to VISTA-blocking antibodies. Conclusions: VISTA+ TNBC have distinct features including slower proliferative index and increased sensitivity to VISTA-blocking antibodies. This work identifies mechanisms by which VISTA enforces a quiescent cellular state by sequestering clathrin adapter proteins away from sites of endocytosis in cancer cells. This is the first description of intracellular molecular mechanisms controlled by VISTA’s intracellular tail. It may inform features of the VISTA-dependent immune checkpoint that could be exploited to improve anti-tumor immunity. Integration of these findings with ongoing VISTA clinical trials will be discussed. Citation Format: Joshua Gruber, Yan Zhao, Fatima Charles, Priyanka Reddy, Kristina Paul, Virginia Ezenwa, Marisa Juntilla, Idit Sagiv-Barfi, Yan Peng, Song Zhang, Allison Kurian, Michael Snyder. Molecular characterization and therapeutic approaches for VISTA+ triple-negative breast cancers [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Breast Cancer Research; 2023 Oct 19-22; San Diego, California. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_1):Abstract nr B027.

Incidence of immunotherapy-related hyperprogressive disease (HPD) across HPD definitions and cancer types in observational studies: A systematic review and meta-analysis.

While evidence of hyperprogressive disease (HPD) continues to grow, the lack of a consensual definition obscures a proper characterization of HPD incidence. We examined how HPD incidence varies by the tumor type or the type of definition used. We searched PubMed, Embase, the Cochrane Library of Systematic Reviews, and Web of Science from database inception to June 21, 2022. Observational studies reporting HPD incidence, in patients diagnosed with solid malignant tumors and treated with immune checkpoint inhibitors (ICI), were included. Random-effects meta-analyses were performed, and all statistical tests were 2-sided. HPD incidence was 12.4% (95% CI 10.2%-15.0%) with evidence of heterogeneity (Q = 119.32, p < 0.001). Meta-regression showed that the risk of developing HPD was higher in patients with advanced gastric cancer (adjusted odds ratio [OR], 10.83; 95% CI, 2.14-54.65; p < 0.001), hepatocellular carcinoma (adjusted OR, 7.99; 95% CI, 1.68-38.13; p = 0.006), non-small cell lung cancer (adjusted OR, 7.14; 95% CI, 1.58-32.29; p = 0.005), and mixed or other types (adjusted OR, 5.09; 95% CI, 1.12-23.14, p = 0.018) than in patients with renal cell carcinoma. Across definitions, HPD defined as a tumor growth kinetics ratio ≥ 2 (adjusted OR, 1.82; 95% CI, 1.08-3.07; p = 0.025) based on the Response Evaluation Criteria in Solid Tumors (RECIST) reported higher incidence than when HPD was defined as RECIST-defined progressive disease and a change in the tumor growth rate (TGR) exceeding 50% (∆TGR > 50). The incidence of immunotherapy-related HPD may vary across tumor types and definitions used, supporting the argument for a uniform and improved method of HPD evaluation for informed clinical decision-making.

Abstract IA004: Insights into lung cancer evolution and metastases in TRACERx and PEACE

Abstract TRACERx is a prospective longitudinal cancer evolution programme which investigates the relationship between intratumour heterogeneity and clinical outcomes in non-small cell lung cancer (NSCLC). In an interim cohort of 421 patients with extended follow up, matched primary and metastatic tumour analysis has demonstrated the impact of cancer evolution on patient outcomes. Large dominant subclones in primary tumours were associated with positive subclonal selection, and mutations in specific genes were found to be under significant subclonal, and not clonal, selection. Subclonal genome doubling was identified in 20% of tumours and multiple genome doubling events were identified in 10% of tumours. Patients with tumours containing large recent subclonal expansions had significantly shorter disease-free survival (DFS), and as previously demonstrated, chromosomal instability was associated with poor outcomes, in particular, extrathoracic disease relapse. Metastatic relapse was found to occur late in tumour evolution in 75% of tumours, and early divergence (25% of tumours) was found to occur at predicted tumour volumes below the threshold for further investigation using radiological imaging, suggesting potential implications for clinical intervention. Metastasis-seeding subclones in primary tumours were subject to subclonal expansion, likely reflective of the acquisition of subclonal driver mutations and somatic copy number alterations. ctDNA analyses in this larger cohort demonstrated the value of ctDNA to predict the likelihood of future relapse, but also its use in tracking tumour growth dynamics and emergence of relapse. Patients who develop relapsed disease in TRACERx after surgery are co-recruited into PEACE, a national research autopsy programme. Early findings from PEACE have demonstrated the genomic complexity of cancer relapse and metastatic heterogeneity and the different patterns of cellular migration that aid metastatic dissemination with both primary-to-metastasis and metastasis-to-metastasis seeding. Citation Format: Mariam Jamal-Hanjani. Insights into lung cancer evolution and metastases in TRACERx and PEACE [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Cancer Evolution and Data Science: The Next Frontier; 2023 Dec 3-6; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_2):Abstract nr IA004.

Abstract IA016: Bayesian phylodynamics to quantify cancer growth across space and time

Abstract Phylogenetics has traditionally inferred shared genetic histories of species over macroevolutionary time. With the expansion of cancer multi-region and single-cell sequencing, phylogenetic approaches have found new uses mapping the evolutionary histories of tumors as well. Recently developed “phylodynamic” methods that integrate phylogenetic and population dynamic modeling offer further promise - uncovering cancer growth dynamics from the topologies and branch lengths of tumor trees. Here, I discuss two recent efforts in this area: 1) Heterogeneous growth rates across a tumor become encoded in the branching patterns of phylogenetic trees built from multi-region sequencing. We introduce a cancer-specific extension to a class of multi-state birth-death models to infer these growth rate differences across space. We apply our model (SDevo) to a sample of hepatocellular carcinomas and infer that these tumor peripheries grow 2-6 times faster than their interiors. 2) Tumors experience differential growth rates over time as they acquire new driver mutations and invade their surrounding tissues, and these growth dynamics similarly leave characteristic signatures in their phylogenies. We employ Bayesian skyline models to dissect tumor growth dynamics from a dataset of diverse cancers and reveal variation in cancer growth rates over time. As cancer sequencing continues to proliferate, phylodynamic approaches are poised to reveal new quantitative insights into cancer growth dynamics across time and space. Citation Format: Maya Lewinsohn, Trevor Bedford, Nicola F. Müller, Alison Feder. Bayesian phylodynamics to quantify cancer growth across space and time [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Cancer Evolution and Data Science: The Next Frontier; 2023 Dec 3-6; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_2):Abstract nr IA016.

Abstract A021: Evolutionary immunotherapy in NSCLC: An integrated approach

Abstract Purpose: Our study examines tumor growth dynamics and immunosuppression under the presence of immune attack to identify optimal immune pulsing treatment strategies. Motivation: Checkpoint inhibitors disrupting the PD-1/PD-L1 axis are used in multiple cancer subtypes. However, not all patients respond, and predictive biomarkers are needed to better stratify patients. Therapy for PD-L1, the most studied biomarker, has given mixed results in non-small cell lung cancer (NSCLC). The complexity of the immune response and plastic nature of PD-L1/PD-1 expression on tumor and immune cells contributes to the heterogeneity of success. IFN-γ, a cytokine released by activated immune cells, induces PD-L1 expression in some tumor cells. Chronic IFN-γ results in long-term PD-L1 expression. However, relaxation dynamics following removal of IFN-γ remains unexplored. In this study, we investigate these complex PD-L1 dynamics through a unique combination of in vitro studies and mathematical modeling. METHODS: In vitro experimental data: We have collected in vitro and temporal confocal microscopy images of PD-L1 expression on NSCLC cells, which were either untreated or treated for 48 hours with high dose IFN-γ followed by chronic low dose IFN-γ for 21 days.Agent-based model: To reinforce our in vitro experiments and findings, we developed a hybrid agent-based model (ABM) to study PD-L1 dynamics. The agents in the ABM are tumor cells having variable PD-L1 expression, and immune cells that secrete IFN-γ. Tumor cells can be randomly seeded or seeded as a cluster of cells. IFN-γ is modeled as either a binary well-mixed pulse (to simulate the in vitro experimental setup), or as a diffusible via a reaction-diffusion process (to simulate the tumor-immune cell interactions in an in-vivo spatial manner). This allows us to investigate the effects of various pulsing strategies of immunotherapy on tumor evolution where each pulse can be a variable dose of immune cells, given at regular or irregular intervals. RESULTS: Our in vitro experimental data and microscopy images confirm that PD-L1 expression continues to increase within the cells after a 48-hour IFN-γ exposure followed by low levels of IFN-γ. Our ABM has been calibrated to capture in vitro data dynamics for different conditions. Our initial results indicate that pulsing immunotherapy may lead to better overall immune efficacy than continuous immunotherapy, by preventing sustained suppression that increases immune cell exhaustion, despite the potential for tumor regrowth between pulses. We also hypothesize that pulsing immunotherapy will have different immunosuppression effects when tumors are clustered or randomly distributed. CONCLUSION: We have quantified the temporal dynamics of PD-L1 expression in NSCLC cells under different conditions of IFN-γ, and built an ABM to study tumor-immune evolution under various pulsing strategies. The results of this work could lead to improved therapy schedules in patients responsive to checkpoint inhibitors that exploit the complex dynamics of immune response and suppression. Citation Format: Sandhya Prabhakaran, Taylor M. Bursell, Kimberly Luddy, Julian Pineiro, Rafael Bravo, Jeffrey West, Megan Johnson, Mark Robertson-Tessi, Amer A. Beg, Jhanelle E. Gray, Scott Antonia, Robert A. Gatenby, Alexander R. A. Anderson. Evolutionary immunotherapy in NSCLC: An integrated approach [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Cancer Evolution and Data Science: The Next Frontier; 2023 Dec 3-6; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_2):Abstract nr A021.

PerSurge (NOA-30) phase II trial of perampanel treatment around surgery in patients with progressive glioblastoma

BackgroundGlioblastoma is the most frequent and a particularly malignant primary brain tumor with no efficacy-proven standard therapy for recurrence. It has recently been discovered that excitatory synapses of the AMPA-receptor subtype form between non-malignant brain neurons and tumor cells. This neuron-tumor network connectivity contributed to glioma progression and could be efficiently targeted with the EMA/FDA approved antiepileptic AMPA receptor inhibitor perampanel in preclinical studies. The PerSurge trial was designed to test the clinical potential of perampanel to reduce tumor cell network connectivity and tumor growth with an extended window-of-opportunity concept.MethodsPerSurge is a phase IIa clinical and translational treatment study around surgical resection of progressive or recurrent glioblastoma. In this multicenter, 2-arm parallel-group, double-blind superiority trial, patients are 1:1 randomized to either receive placebo or perampanel (n = 66 in total). It consists of a treatment and observation period of 60 days per patient, starting 30 days before a planned surgical resection, which itself is not part of the study interventions. Only patients with an expected safe waiting interval are included, and a safety MRI is performed. Tumor cell network connectivity from resected tumor tissue on single cell transcriptome level as well as AI-based assessment of tumor growth dynamics in T2/FLAIR MRI scans before resection will be analyzed as the co-primary endpoints. Secondary endpoints will include further imaging parameters such as pre- and postsurgical contrast enhanced MRI scans, postsurgical T2/FLAIR MRI scans, quality of life, cognitive testing, overall and progression-free survival as well as frequency of epileptic seizures. Further translational research will focus on additional biological aspects of neuron-tumor connectivity.DiscussionThis trial is set up to assess first indications of clinical efficacy and tolerability of perampanel in recurrent glioblastoma, a repurposed drug which inhibits neuron-glioma synapses and thereby glioblastoma growth in preclinical models. If perampanel proved to be successful in the clinical setting, it would provide the first evidence that interference with neuron-cancer interactions may indeed lead to a benefit for patients, which would lay the foundation for a larger confirmatory trial in the future.Trial registrationEU-CT number: 2023-503938-52-00 30.11.2023.

Abstract B015: Toxin-producing bacterial therapy limits tumor growth in autochthonous mouse models of pancreatic ductal adenocarcinoma

Abstract Treating pancreatic ductal adenocarcinoma (PDAC) with systemic chemotherapeutic drugs has remained a challenge, due in part to the hypovascularized and poorly perfused nature of PDAC tumors, impeding the accumulation of systemically delivered drugs. Several clinical trials aimed at improving drug delivery in PDAC, through targeting of ECM components (HALO-301) or stromal angiogenic signaling (IPI-926-03) have unfortunately not been effective. However, the features that have interfered with systemic therapy in PDAC are potential advantages for the use of bacterial therapies, as bacteria can actively migrate through tissues, thrive in hypoxic microenvironments, and benefit from local immune suppression. Recent developments in the field of synthetic biology have made it possible to engineer complex logic circuits into bacteria, enabling the production of anticancer therapies directly within the tumor parenchyma. Furthermore, live bacteria, once colonized within the tumor niche, are capable of providing a stable source of anticancer compounds directly, rather than relying on repeated systemic doses. We have therefore worked to develop novel bacterial strains and demonstrate preclinical efficacy of a novel strain of therapeutic bacteria for targeting PDAC. We began by testing a range of bacteria-produced toxins and identified the pore-forming protein theta toxin as having the greatest effect in both 2D cell culture and PDAC explant (tissue slice) models. We then engineered a non-toxic probiotic bacteria, E. coli Nissle 1917, to produce either theta toxin or GFP. To assess preclinical efficacy, we performed intratumoral injections of live GFP- and theta-expressing bacteria into the “KPC” genetically engineered mouse model (Kras LSL.G12D/+; Tp53 LSL.R172H/+; PdxCre tg/+). While GFP-producing bacteria did not induce a change in tumor growth kinetics, treatment with theta toxin-producing bacteria demonstrated prolonged stabilization of tumor growth, increasing the median survival to 34 days compared to ~12 days for vehicle- or gemcitabine-treated controls and 18.5 days for GFP-producing bacteria without additional therapy. Strikingly, while there was minimal spread of bacteria to non-tumor tissues, we observed translocation of the bacteria to macro- and micro- metastatic lesions and distant papillomas following injection of the primary pancreatic tumor, indicating a mechanism for targeting both known and unknown metastases following local administration. Histological analyses demonstrated that diffuse populations of bacteria co-localized with regions of cell death, but that bacterial presence and evidence of increased cell death was not observed in healthy tissues, such as the lung, liver, intestine, and diaphragm. Additionally, bacterial treatment, independent of the payload, led to a modest influx of anti-tumor immune populations, suggesting potential synergy with immunotherapies. Together these data demonstrate potent preclinical activity of cytotoxic bacterial therapy as a novel strategy to circumvent the challenges of systemic treatment of PDAC. Citation Format: Amanda R. Decker-Farrell, Stephen A. Sastra, Tetsuhiro Harimoto, Marie C. Hasselluhn, Fangda Li, Rosa Vincent, Carmine F. Palermo, Edward R. Ballister, Tal Danino, Kenneth P. Olive. Toxin-producing bacterial therapy limits tumor growth in autochthonous mouse models of pancreatic ductal adenocarcinoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr B015.

Growth kinetics of benign neuroepithelial brain tumors in children with relapse

The problem of treating children with recurrent cerebral tumors cannot be solved without effective prediction of recurrent blastomatous growth. The main question will be, in addition to the possible risks of tumor recurrence, when should regrowth of the neoplasm be expected in time? In our opinion, one of the probable ways to solve this problem is to study the kinetics of tumor growth and create a mathematical model for it. The aim of the study was to analyze the kinetic features of the continued growth of benign neuroepithelial brain tumors in children after surgical treatment. The study included the results of an MRI of a 32 patients under the age of 17 years. All patients underwent brain tumor resection for the first time in the Department for Children Polenov Neurosurgical Institute (Almazov National Medical Research Centre). All patients had a relapse/continued tumor growth, as well as a benign nature of the neoplasm, which was confirmed pathomorphologically. To construct the kinetic curves, volumetric indicators of tumors obtained by virtual 3D-modeling were used. Depending on the histotype, the tumor growth rate was determined by the formula: v = (VT-VO)/T, and a graphical assessment of changes in the volume of the neoplasm was carried out – the construction of kinetic curves. Further, the most typical kinetic curves for each histological type of benign neuroepithelial tumors were identified.

Metastases-directed local therapies (MDT) beyond genuine oligometastatic disease (OMD): Indications, endpoints and the role of imaging

To further personalise treatment in metastatic cancer, the indications for metastases-directed local therapy (MDT) and the biology of oligometastatic disease (OMD) should be kept conceptually apart. Both need to be vigorously investigated. Tumour growth dynamics – growth rate combined with metastatic seeding efficiency – is the single most important biological feature determining the likelihood of success of MDT in an individual patient, which might even be beneficial in slowly developing polymetastatic disease. This can be reasonably well assessed using appropriate clinical imaging. In the context of considering appropriate indications for MDT, detecting metastases at the edge of image resolution should therefore suggest postponing MDT. While three to five lesions are typically used to define OMD, it could be argued that countability throughout the course of metastatic disease, rather than a specific maximum number of lesions, could serve as a better parameter for guiding MDT. Here we argue that the unit of MDT as a treatment option in metastatic cancer might best be defined not as a single procedure at a single point in time, but as a series of treatments that can be delivered in a single or multiple sessions to different lesions over time. Newly emerging lesions that remain amenable to MDT without triggering the start of a new systemic treatment, a change in systemic therapy, or initiation of best supportive care, would thus not constitute a failure of MDT. This would have implications for defining endpoints in clinical trials and registries: Rather than with any disease progression, failure of MDT would only be declared when there is progression to polymetastatic disease, which then precludes further options for MDT.