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Carvalho D, Richardson P, Olaciregui NG, Stankunaite R, Lavarino CE, Molinari V, Corley E, Ruddle R, Donovan A, Pal A, Raynaud FI, Overington JP, Phelan A, Sheppard D, Mackinnon A, Hubank M, Cruz O, Madrid AML, Mueller S, Carcaboso AM, Carceller F, Jones C. EXTH-46. ARTIFICIAL INTELLIGENCE-BASED IDENTIFICATION OF COMBINED VANDETANIB AND EVEROLIMUS IN THE TREATMENT OF ACVR1-MUTANT DIFFUSE INTRINSIC PONTINE GLIOMA. Neuro Oncol 2020. [DOI: 10.1093/neuonc/noaa215.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Somatic mutations in ACVR1, encoding the serine/threonine kinase ALK2 receptor, are found in a quarter of children with the currently incurable brain tumour diffuse intrinsic pontine glioma (DIPG). Treatment of ACVR1-mutant DIPG patient-derived models with multiple inhibitor chemotypes leads to a reduction in cell viability in vitro and extended survival in orthotopic xenografts in vivo, though there are currently no specific ACVR1 inhibitors licensed for DIPG. Using an Artificial Intelligence-based platform to search for approved compounds which could be used to treat ACVR1-mutant DIPG, the combination of vandetanib and everolimus was identified as a possible therapeutic approach. Vandetanib, an approved inhibitor of VEGFR/RET/EGFR, was found to target ACVR1 (Kd=150nM) and reduce DIPG cell viability in vitro, but has been trialed in DIPG patients with limited success, in part due to an inability to cross the blood-brain-barrier. In addition to mTOR, everolimus inhibits both ABCG2 (BCRP) and ABCB1 (P-gp) transporter, and was synergistic in DIPG cells when combined with vandetanib in vitro. This combination is well-tolerated in vivo, and significantly extended survival and reduced tumour burden in an orthotopic ACVR1-mutant patient-derived DIPG xenograft model. Based on these preclinical data, three patients with ACVR1-mutant DIPG were treated with vandetanib and everolimus. These cases may inform on the dosing and the toxicity profile of this combination for future clinical studies. This bench-to-bedside approach represents a rapidly translatable therapeutic strategy in children with ACVR1 mutant DIPG.
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Affiliation(s)
| | | | | | | | | | | | | | - Ruth Ruddle
- Institute of Cancer Research, London, United Kingdom
| | - Adam Donovan
- Institute of Cancer Research, London, United Kingdom
| | - Akos Pal
- Institute of Cancer Research, London, United Kingdom
| | | | | | | | | | | | - Michael Hubank
- Royal Marsden Hospital NHS Trust, London, United Kingdom
| | | | | | - Sabine Mueller
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Chris Jones
- The Institute of Cancer Research, London, United Kingdom
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