Rachel M Hurley1, Andrea E Wahner Hendrickson2, Daniel W Visscher3, Peter Ansell4, Maria I Harrell5, Jill M Wagner2, Vivian Negron3, Krista M Goergen6, Matthew J Maurer6, Ann L Oberg6, X Wei Meng1, Karen S Flatten1, Maja J A De Jonge7, Carla D Van Herpen8, Jourik A Gietema9, Rutger H T Koornstra8, Agnes Jager7, Martha W den Hollander8, Matthew Dudley4, Stacie P Shepherd4, Elizabeth M Swisher5, Scott H Kaufmann10. 1. Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States of America. 2. Department of Oncology, Mayo Clinic, Rochester, MN, United States of America. 3. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America. 4. Abbvie, North Chicago, IL, United States of America. 5. Department of Obstetrics and Gynecology, Univ. of Washington, Seattle, WA, United States of America. 6. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States of America. 7. Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands. 8. Radboud University Medical Center, Nijmegen, the Netherlands. 9. University Medical Center, Groningen, the Netherlands. 10. Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, United States of America; Department of Oncology, Mayo Clinic, Rochester, MN, United States of America. Electronic address: Kaufmann.Scott@mayo.edu.
Abstract
OBJECTIVE: Poly(ADP-ribose) polymerase (PARP) inhibitors have shown substantial activity in homologous recombination- (HR-) deficient ovarian cancer and are undergoing testing in other HR-deficient tumors. For reasons that are incompletely understood, not all patients with HR-deficient cancers respond to these agents. Preclinical studies have demonstrated that changes in alternative DNA repair pathways affect PARP inhibitor (PARPi) sensitivity in ovarian cancer models. This has not previously been assessed in the clinical setting. METHODS: Clonogenic and plasmid-based HR repair assays were performed to compare BRCA1-mutant COV362 ovarian cancer cells with or without 53BP1 gene deletion. Archival biopsies from ovarian cancer patients in the phase I, open-label clinical trial of PARPi ABT-767 were stained for PARP1, RAD51, 53BP1 and multiple components of the nonhomologous end-joining (NHEJ) DNA repair pathway. Modified histochemistry- (H-) scores were determined for each repair protein in each sample. HRD score was determined from tumor DNA. RESULTS: 53BP1 deletion increased HR in BRCA1-mutant COV362 cells and decreased PARPi sensitivity in vitro. In 36 women with relapsed ovarian cancer, responses to the PARPi ABT-767 were observed exclusively in cancers with HR deficiency. In this subset, 7 of 18 patients (39%) had objective responses. The actual HRD score did not further correlate with change from baseline tumor volume (r = 0.050; p = 0.87). However, in the HR-deficient subset, decreased 53BP1 H-score was associated with decreased antitumor efficacy of ABT-767 (r = -0.69, p = 0.004). CONCLUSION: Differences in complementary repair pathways, particularly 53BP1, correlate with PARPi response of HR-deficient ovarian cancers.
OBJECTIVE:Poly(ADP-ribose) polymerase (PARP) inhibitors have shown substantial activity in homologous recombination- (HR-) deficient ovarian cancer and are undergoing testing in other HR-deficient tumors. For reasons that are incompletely understood, not all patients with HR-deficient cancers respond to these agents. Preclinical studies have demonstrated that changes in alternative DNA repair pathways affect PARP inhibitor (PARPi) sensitivity in ovarian cancer models. This has not previously been assessed in the clinical setting. METHODS: Clonogenic and plasmid-based HR repair assays were performed to compare BRCA1-mutant COV362 ovarian cancer cells with or without 53BP1 gene deletion. Archival biopsies from ovarian cancerpatients in the phase I, open-label clinical trial of PARPi ABT-767 were stained for PARP1, RAD51, 53BP1 and multiple components of the nonhomologous end-joining (NHEJ) DNA repair pathway. Modified histochemistry- (H-) scores were determined for each repair protein in each sample. HRD score was determined from tumor DNA. RESULTS:53BP1 deletion increased HR in BRCA1-mutant COV362 cells and decreased PARPi sensitivity in vitro. In 36 women with relapsed ovarian cancer, responses to the PARPi ABT-767 were observed exclusively in cancers with HR deficiency. In this subset, 7 of 18 patients (39%) had objective responses. The actual HRD score did not further correlate with change from baseline tumor volume (r = 0.050; p = 0.87). However, in the HR-deficient subset, decreased 53BP1 H-score was associated with decreased antitumor efficacy of ABT-767 (r = -0.69, p = 0.004). CONCLUSION: Differences in complementary repair pathways, particularly 53BP1, correlate with PARPi response of HR-deficient ovarian cancers.
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