Abstract 1611: The FACT histone chaperone complex is highly expressed in aggressive drug refractory childhood cancers and the anti-FACT compound CBL0137 represents a highly promising therapeutic approach in this setting

Background: Despite the success of chemotherapy in improving the overall survival rate of childhood cancer, a number of types of children's cancers still have dismal outcomes. Included here are high risk neuroblastomas, Diffuse Intrinsic Pontine Gliomas (DIPG), and infant leukemias with MLL translocations. New treatments for these aggressive childhood cancers are urgently needed. Evidence is emerging of the importance of alterations in chromatin modifier genes in pediatric cancers. In this regard, CBL0137 is a carbazole-based anti-cancer agent with a unique mechanism of action. It is an indirect inhibitor of the chromatin remodeling complex FACT (Facilitates Chromatin Transcription). Inhibition of FACT by CBL0137 modulates the activity of several transcription factors involved in cancer: NF-kB and HSF1 are suppressed, while p53 is activated (Science Transl Med, 2011). We have examined FACT expression in neuroblastoma, DIPG and MLL leukemia, as well as the efficacy of CBL0137 in preclinical models of these diseases.

Methods: Expression of the FACT subunits, SSRP1 and SPT16, was examined in neuroblastoma, DIPG and MLL leukemia cells using RT-PCR and Western analysis. The clinical significance of SSRP1 and SPT16 was also analysed using expression array data on 650 primary untreated neuroblastomas. Colony-forming assays were used to study the effect of CBL0137, either alone or combined with chemotherapeutic drugs. Cohorts of neuroblastoma, DIPG and MLL leukemia xenografted mice, as well as neuroblastoma-prone TH-MYCN mice, were treated with CBL0137, alone or combined with chemotherapeutic drugs.

Results: High levels of SSRP1 and SPT16 expression were observed in all three types of child cancer. In addition, in neuroblastoma, the two FACT subunits were associated with MYCN amplification, and were strongly predictive of poor outcome (p<0.0001). As a single agent, CBL0137 administered iv had remarkable in vivo anti-tumor activity against neuroblastoma, DIPG and MLL leukemia xenografted mice. CBL0137 also synergized strongly with a variety of chemotherapeutic agents, including cyclophosphamide. Most dramatic results were observed when CBL0137 was combined with cyclophosphamide/topotecan, a highly active therapy for relapsed neuroblastoma that is currently in clinical trial. Cylophosphamide/topotecan plus CBL0137 resulted in cure of 90% of tumor-bearing MYCN-transgenic mice.

Conclusions: Targeting FACT offers a highly promising novel therapeutic approach for aggressive childhood cancers. The results for CBL0137 are as good or better than any chemotherapy regimens we have tested in our preclinical models, and a Phase I COG trial of this nongenotoxic agent in refractory pediatric cancer patients is currently being planned.

Citation Format: Michelle Haber, Jayne Murray, Laura Gamble, Ashleigh Carnegie-Clark, Hannah Webber, Michelle Ruhle, Michelle J. Henderson, Shiloh Middlemass, Daniel Carter, Maria Tsoli, Anahid Ehteda, Sandy Simon, Andre Oberthuer, Matthias Fischer, Katerina Gurova, Catherine Burkhart, Andrei Purmal, Richard B. Lock, David Ziegler, Glenn M. Marshall, Andrei V. Gudkov, Murray D. Norris. The FACT histone chaperone complex is highly expressed in aggressive drug refractory childhood cancers and the anti-FACT compound CBL0137 represents a highly promising therapeutic approach in this setting. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 1611. doi:10.1158/1538-7445.AM2015-1611

Abstract 2759: Anticancer compound curaxin CBL0137, that simultaneously suppresses NF-κB and activates p53, is highly effective in two independent mouse models of neuroblastoma

Background: We have reported that the anti-malarial drug, quinacrine (QC), has significant in vivo anti-tumor activity (Neznanov et al, Cell Cycle, 2009, 8: 1-11). We have since identified curaxins, a more potent class of compounds with similar mechanism of action, whose anti-cancer activity results from chromatin-trapping of the Facilitates Chromatin Transcription (FACT) complex (Gasparian et al, Science Transl. Med, 2011, 3, 95ra74). These novel nongenotoxic agents, like QC, cause simultaneous p53 activation and NF-kB inhibition and tumor cell death. We have now studied the effects of QC and one of the most active curaxins, CBL0137, in the TH-MYCN mouse model of neuroblastoma as well as a nude mouse xenograft model of the disease.

Methods: Cohorts of homozygous TH-MYCN mice with small palpable tumors or of human MYCN-amplified BE(2)-C neuroblastoma tumor-bearing nude mice (n=10) were treated with QC (TH-MYCN mice only) or CBL0137, alone or combined with chemotherapeutic drugs.

Results: QC alone had no significant effect on tumor progression and did not enhance cisplatin or VP16 activity. However, strong anti-tumor activity was observed when QC was combined with cyclophosphamide (CPM) (4/10 QC/CPM-treated vs 0/10 CPM-treated long-term survivors, P<0.001). The effect of CBL0137 alone, administered either orally or iv, on tumor progression was more dramatic. Oral CBL0137 significantly extended survival (median survival time from start of treatment = 31.0±9.9 days versus controls = 3.0±0.2 days; P<0.0001), and was as effective as cisplatin or CPM single-agent treatment. Remarkably, CBL0137 administered iv resulted in a significant number of long-term tumor free survivors (7/9 alive at Day 120). When oral CBL0137 treatment was combined with CPM, survival was substantially increased (7/10 long-term tumor-free TH-MYCN mice) compared to either CBL0137 (0/10 alive) or CPM (1/10 alive) alone (P<0.005 in each case). Most dramatic results were observed when CBL0137 was combined with the standard neuroblastoma relapse protocol of CPM plus topotecan (TOPO). CPM/TOPO treatment resulted in 0/10 long-term survivors, however when combined with either oral or iv CBL0137, this combination cured 5/8 or 11/12 TH-MYCN mice, respectively. Moreover, the combination of iv CBL0137/CPM/TOPO resulted in more than a doubling of lifespan in BE(2)-C tumor-bearing mice compared to those treated with CPM/TOPO or CBL0137 alone (P<0.0001).

Conclusions: These are the most impressive results that we have ever observed for any therapeutic protocol in either the TH-MYCN homozygous or BE(2)-C xenograft mouse models. The combination of CPM/TOPO with iv CBL0137 appears to be a highly promising new treatment approach for refractory neuroblastoma. Safety and efficacy of CBL0137 is currently being investigated in a Phase I clinical trial in advanced cancer patients.

Citation Format: Michelle Haber, Jayne Murray, Ashleigh Carnegie-Clark, Hannah Webber, Glenn M. Marshall, Katerina V. Gurova, Catherine A. Burkhart, Andrei Purmal, Andrei V. Gudkov, Murray D. Norris. Anticancer compound curaxin CBL0137, that simultaneously suppresses NF-κB and activates p53, is highly effective in two independent mouse models of neuroblastoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2759. doi:10.1158/1538-7445.AM2013-2759