1
|
Andreano KJ, Baker JG, Park S, Safi R, Artham S, Oesterreich S, Jeselsohn R, Brown M, Sammons S, Wardell SE, Chang CY, Norris JD, McDonnell DP. The Dysregulated Pharmacology of Clinically Relevant ESR1 Mutants is Normalized by Ligand-activated WT Receptor. Mol Cancer Ther 2020; 19:1395-1405. [PMID: 32381587 DOI: 10.1158/1535-7163.mct-19-1148] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/25/2020] [Accepted: 04/29/2020] [Indexed: 01/21/2023]
Abstract
The estrogen receptor (ER/ESR1) is expressed in a majority of breast cancers and drugs that inhibit ER signaling are the cornerstone of breast cancer pharmacotherapy. Currently, aromatase inhibitors are the frontline endocrine interventions of choice although their durability in metastatic disease is limited by activating point mutations within the ligand-binding domain of ESR1 that permit ligand-independent activation of the receptor. It has been suggested that the most commonly occurring ESR1 mutations would likely compromise the clinical activity of selective estrogen receptor downregulators and selective estrogen receptor modulators (SERMs) when used as second-line therapies. It was unclear, however, how these mutations, which are likely coexpressed in cells with ERWT, may impact response to ER ligands in a clinically meaningful manner. To address this issue, we dissected the molecular mechanism(s) underlying ESR1-mutant pharmacology in models relevant to metastatic disease. These studies revealed that the response of ESR1 mutations to ligands was dictated primarily by the relative coexpression of ERWT in cells. Specifically, dysregulated pharmacology was only evident in cells in which the mutants were overexpressed relative to ligand-activated ERWT; a finding that highlights the role of allelism in determining ER-mutant pharmacology. Importantly, we demonstrated that the antagonist activity of the SERM, lasofoxifene, was not impacted by mutant status; a finding that has led to its clinical evaluation as a treatment for patients with advanced ER-positive breast cancer whose tumors harbor ESR1 mutations.
Collapse
Affiliation(s)
- Kaitlyn J Andreano
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Jennifer G Baker
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Sunghee Park
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Rachid Safi
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Sandeep Artham
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Steffi Oesterreich
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania.,Womens Cancer Research Center, University of Pittsburgh Cancer Institute and Magee-Women Research Institute, Pittsburgh, Pennsylvania
| | - Rinath Jeselsohn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Myles Brown
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sarah Sammons
- Department of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina
| | - Suzanne E Wardell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Ching-Yi Chang
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - John D Norris
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina
| | - Donald P McDonnell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina.
| |
Collapse
|
2
|
Andreano KJ, Wardell SE, Baker JG, Desautels TK, Baldi R, Chao CA, Heetderks KA, Bae Y, Xiong R, Tonetti DA, Gutgesell LM, Zhao J, Sorrentino JA, Thompson DA, Bisi JE, Strum JC, Thatcher GRJ, Norris JD. G1T48, an oral selective estrogen receptor degrader, and the CDK4/6 inhibitor lerociclib inhibit tumor growth in animal models of endocrine-resistant breast cancer. Breast Cancer Res Treat 2020; 180:635-646. [PMID: 32130619 PMCID: PMC7103015 DOI: 10.1007/s10549-020-05575-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 02/11/2020] [Indexed: 12/31/2022]
Abstract
Purpose The combination of targeting the CDK4/6 and estrogen receptor (ER) signaling pathways with palbociclib and fulvestrant is a proven therapeutic strategy for the treatment of ER-positive breast cancer. However, the poor physicochemical properties of fulvestrant require monthly intramuscular injections to patients, which limit the pharmacokinetic and pharmacodynamic activity of the compound. Therefore, an orally available compound that more rapidly reaches steady state may lead to a better clinical response in patients. Here, we report the identification of G1T48, a novel orally bioavailable, non-steroidal small molecule antagonist of ER. Methods The pharmacological effects and the antineoplastic mechanism of action of G1T48 on tumors was evaluated using human breast cancer cells (in vitro) and xenograft efficacy models (in vivo). Results G1T48 is a potent and efficacious inhibitor of estrogen-mediated transcription and proliferation in ER-positive breast cancer cells, similar to the pure antiestrogen fulvestrant. In addition, G1T48 can effectively suppress ER activity in multiple models of endocrine therapy resistance including those harboring ER mutations and growth factor activation. In vivo, G1T48 has robust antitumor activity in a model of estrogen-dependent breast cancer (MCF7) and significantly inhibited the growth of tamoxifen-resistant (TamR), long-term estrogen-deprived (LTED) and patient-derived xenograft tumors with an increased response being observed with the combination of G1T48 and the CDK4/6 inhibitor lerociclib. Conclusions These data show that G1T48 has the potential to be an efficacious oral antineoplastic agent in ER-positive breast cancer. Electronic supplementary material The online version of this article (10.1007/s10549-020-05575-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Kaitlyn J Andreano
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, 308 Research Drive, Durham, NC, 27710, USA
| | - Suzanne E Wardell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, 308 Research Drive, Durham, NC, 27710, USA
| | - Jennifer G Baker
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, 308 Research Drive, Durham, NC, 27710, USA
| | - Taylor K Desautels
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, 308 Research Drive, Durham, NC, 27710, USA
| | - Robert Baldi
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, 308 Research Drive, Durham, NC, 27710, USA
| | - Christina A Chao
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, 308 Research Drive, Durham, NC, 27710, USA
| | - Kendall A Heetderks
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, 308 Research Drive, Durham, NC, 27710, USA
| | - Yeeun Bae
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, 308 Research Drive, Durham, NC, 27710, USA
| | - Rui Xiong
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (M/C 781), Chicago, IL, 60612, USA
| | - Debra A Tonetti
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (M/C 781), Chicago, IL, 60612, USA
| | - Lauren M Gutgesell
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (M/C 781), Chicago, IL, 60612, USA
| | - Jiong Zhao
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (M/C 781), Chicago, IL, 60612, USA
| | - Jessica A Sorrentino
- G1 Therapeutics, Inc, 700 Park Offices Drive, Suite 200, Research Triangle Park, NC, 27709, USA
| | - Delita A Thompson
- G1 Therapeutics, Inc, 700 Park Offices Drive, Suite 200, Research Triangle Park, NC, 27709, USA
| | - John E Bisi
- G1 Therapeutics, Inc, 700 Park Offices Drive, Suite 200, Research Triangle Park, NC, 27709, USA
| | - Jay C Strum
- G1 Therapeutics, Inc, 700 Park Offices Drive, Suite 200, Research Triangle Park, NC, 27709, USA
| | - Gregory R J Thatcher
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, 833 South Wood Street (M/C 781), Chicago, IL, 60612, USA
| | - John D Norris
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, 308 Research Drive, Durham, NC, 27710, USA.
| |
Collapse
|
3
|
Wardell SE, Yllanes AP, Chao CA, Bae Y, Andreano KJ, Desautels TK, Heetderks KA, Blitzer JT, Norris JD, McDonnell DP. Pharmacokinetic and pharmacodynamic analysis of fulvestrant in preclinical models of breast cancer to assess the importance of its estrogen receptor-α degrader activity in antitumor efficacy. Breast Cancer Res Treat 2019; 179:67-77. [PMID: 31562570 PMCID: PMC6985185 DOI: 10.1007/s10549-019-05454-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
Purpose Fulvestrant is a selective estrogen receptor downregulator (SERD) that is approved for first- or second-line use as a single agent or in combination with cyclin dependent kinase or phosphatidylinositol 3-kinase inhibitors for the treatment of metastatic breast cancer. Fulvestrant exhibits exceptionally effective antitumor activity in preclinical models of breast cancer, a success that has been attributed to its robust SERD activity despite modest receptor downregulation in patient tumors. By modeling human exposures in animal models we probe the absolute need for SERD activity. Methods Three xenograft models of endocrine therapy-resistant breast cancer were used to evaluate the efficacy of fulvestrant administered in doses historically used in preclinical studies in the field or by using a dose regimen intended to model clinical exposure levels. Pharmacokinetic and pharmacodynamic analyses were conducted to evaluate plasma exposure and intratumoral ER downregulation. Results A clinically relevant 25 mg/kg dose of fulvestrant exhibited antitumor efficacy comparable to the historically used 200 mg/kg dose, but at this lower dose it did not result in robust ER downregulation. Further, the antitumor efficacy of the lower dose of fulvestrant was comparable to that observed for other oral SERDs currently in development. Conclusion The use of clinically unachievable exposure levels of fulvestrant as a benchmark in preclinical development of SERDs may negatively impact the selection of those molecules that are advanced for clinical development. Further, these studies suggest that antagonist efficacy, as opposed to SERD activity, is likely to be the primary driver of clinical response. Electronic supplementary material The online version of this article (10.1007/s10549-019-05454-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Suzanne E Wardell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Box 3813, Durham, NC, 27710, USA
| | - Alexander P Yllanes
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Box 3813, Durham, NC, 27710, USA
| | - Christina A Chao
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Box 3813, Durham, NC, 27710, USA
| | - Yeeun Bae
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Box 3813, Durham, NC, 27710, USA
| | - Kaitlyn J Andreano
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Box 3813, Durham, NC, 27710, USA
| | - Taylor K Desautels
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Box 3813, Durham, NC, 27710, USA
| | - Kendall A Heetderks
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Box 3813, Durham, NC, 27710, USA
| | | | - John D Norris
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Box 3813, Durham, NC, 27710, USA
| | - Donald P McDonnell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Box 3813, Durham, NC, 27710, USA.
| |
Collapse
|
4
|
Gaillard SL, Andreano KJ, Gay LM, Steiner M, Jorgensen MS, Davidson BA, Havrilesky LJ, Alvarez Secord A, Valea FA, Colon-Otero G, Zajchowski DA, Chang CY, McDonnell DP, Berchuck A, Elvin JA. Constitutively active ESR1 mutations in gynecologic malignancies and clinical response to estrogen-receptor directed therapies. Gynecol Oncol 2019; 154:199-206. [PMID: 30987772 DOI: 10.1016/j.ygyno.2019.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Endocrine therapy is often considered as a treatment for hormone-responsive gynecologic malignancies. In breast cancer, activating mutations in the estrogen receptor (mutESR1) contribute to therapeutic resistance to endocrine therapy, especially aromatase inhibitors (AIs). The purpose of this study was to evaluate the frequency and clinical relevance of ESR1 genomic alterations in gynecologic malignancies. METHODS DNA from FFPE tumor tissue obtained during routine clinical care for 9645 gynecologic malignancies (ovary, fallopian tube, uterus, cervix, vagina, vulvar, and placenta) was analyzed for all classes of genomic alterations (base substitutions (muts), insertions, deletions, rearrangements, and amplifications) in ESR1 by hybrid capture next generation sequencing. A subset of alterations was characterized in laboratory-based transcription assays for response to endocrine therapies. RESULTS A total of 295 ESR1 genomic alterations were identified in 285 (3.0%) cases. mutESR1 were present in 86 (0.9%) cases and were more common in uterine compared to other cancers (2.0% vs <1%, respectively p < 0.001). mutESR1 were enriched in carcinomas with endometrioid versus serous histology (4.4% vs 0.2% respectively, p < 0.0001 in uterine and 3.5% vs 0.3% respectively, p = 0.0004 in ovarian carcinomas). In three of four patients with serial sampling, mutESR1 emerged under the selective pressure of AI therapy. Despite decreased potency of estrogen receptor (ER) antagonists in transcriptional assays, clinical benefit was observed following treatment with selective ER-targeted therapy, in one case lasting >48 months. CONCLUSIONS While the prevalence of ESR1 mutations in gynecologic malignancies is low, there are significant clinical implications useful in guiding therapeutic approaches for these cancers.
Collapse
Affiliation(s)
- Stéphanie L Gaillard
- Duke University Medical Center, Durham, NC, United States of America; Johns Hopkins Sidney Kimmel Cancer Center, Baltimore, MD, United States of America.
| | | | - Laurie M Gay
- Foundation Medicine, Inc., Cambridge, MA, United States of America
| | - Meghan Steiner
- Duke University Medical Center, Durham, NC, United States of America
| | | | | | | | | | - Fidel A Valea
- Duke University Medical Center, Durham, NC, United States of America
| | | | | | - Ching-Yi Chang
- Duke University Medical Center, Durham, NC, United States of America
| | | | - Andrew Berchuck
- Duke University Medical Center, Durham, NC, United States of America
| | - Julia A Elvin
- Duke University Medical Center, Durham, NC, United States of America
| |
Collapse
|
5
|
Andreano KJ, Baker JG, Chang C, Norris JD, McDonnell DP. Defining the molecular pharmacology of disease relevant estrogen receptor mutations for effective therapeutic targeting in breast cancer. FASEB J 2019. [DOI: 10.1096/fasebj.2019.33.1_supplement.815.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
6
|
Norris JD, Ellison SJ, Baker JG, Stagg DB, Wardell SE, Park S, Alley HM, Baldi RM, Yllanes A, Andreano KJ, Stice JP, Lawrence SA, Eisner JR, Price DK, Moore WR, Figg WD, McDonnell DP. Androgen receptor antagonism drives cytochrome P450 17A1 inhibitor efficacy in prostate cancer. J Clin Invest 2017; 127:2326-2338. [PMID: 28463227 DOI: 10.1172/jci87328] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/02/2017] [Indexed: 12/19/2022] Open
Abstract
The clinical utility of inhibiting cytochrome P450 17A1 (CYP17), a cytochrome p450 enzyme that is required for the production of androgens, has been exemplified by the approval of abiraterone for the treatment of castration-resistant prostate cancer (CRPC). Recently, however, it has been reported that CYP17 inhibitors can interact directly with the androgen receptor (AR). A phase I study recently reported that seviteronel, a CYP17 lyase-selective inhibitor, ædemonstrated a sustained reduction in prostate-specific antigen in a patient with CRPC, and another study showed seviteronel's direct effects on AR function. This suggested that seviteronel may have therapeutically relevant activities in addition to its ability to inhibit androgen production. Here, we have demonstrated that CYP17 inhibitors, with the exception of orteronel, can function as competitive AR antagonists. Conformational profiling revealed that the CYP17 inhibitor-bound AR adopted a conformation that resembled the unliganded AR (apo-AR), precluding nuclear localization and DNA binding. Further, we observed that seviteronel and abiraterone inhibited the growth of tumor xenografts expressing the clinically relevant mutation AR-F876L and that this activity could be attributed entirely to competitive AR antagonism. The results of this study suggest that the ability of CYP17 inhibitors to directly antagonize the AR may contribute to their clinical efficacy in CRPC.
Collapse
Affiliation(s)
- John D Norris
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Stephanie J Ellison
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jennifer G Baker
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - David B Stagg
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Suzanne E Wardell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sunghee Park
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Holly M Alley
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Robert M Baldi
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexander Yllanes
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kaitlyn J Andreano
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - James P Stice
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Scott A Lawrence
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joel R Eisner
- Innocrin Pharmaceuticals Inc., Durham, North Carolina, USA
| | - Douglas K Price
- Genitourinary Malignancies Branch, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | | | - William D Figg
- Genitourinary Malignancies Branch, National Cancer Institute (NCI), NIH, Bethesda, Maryland, USA
| | - Donald P McDonnell
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| |
Collapse
|