Abstract B008: Therapy-protective peristromal niches mediate positive ecological interaction between therapy-sensitive and therapy-resistant cells, altering the evolutionary dynamics of acquired targeted therapy resistance in lung cancers
Authors: Robertson-Tessi Mark , Desai Bina , Miti Tatiana , Kumar Pragya , Yarlagadda Sagnik , Shah Rishi , Velde Robert Vander , Miroshnychenko Daria , Basanta David , Anderson Alexander , Marusyk Andriy 
Published: November 2024

Abstract
Pharmacological inhibitors of oncogenic signaling, such as drugs that target ALK kinase (ALKi) in ALK+ lung cancers, can induce strong and durable clinical responses. However, targeted therapies are not curative in advanced cancers and even strong responders eventually develop resistance. While therapy resistance is typically attributed to cell-intrinsic (epi)mutational characteristics of tumor cells, it can also result from interactions of tumor cells with the tumor microenvironment (TME). In contrast to the detailed elucidation of the molecular mediators of therapy resistance, our knowledge of the evolutionary dynamics underlying the resistance emergence, including the impact of TME, remains poorly defined. A key open question in understanding the evolutionary dynamics of therapy resistance is whether relapse results from an expansion of pre-existing therapy-resistant subpopulations or from a bona fide gradual evolutionary process. To elucidate this question, we integrated experimental mouse studies with mathematical modeling, interrogating therapeutic responses of therapy-naïve experimental xenograft ALK+ tumors, spiked-in with differentially labeled resistant cells. We found that ALKi treatment induced a rapid expansion of resistant cells, which drastically reduced the magnitude and duration of remissions. Surprisingly, our in silico analyses pointed to the existence of a strong positive ecological interaction between therapy-resistant and therapy-sensitive competitors. Using a combination of spatial analyses, experimental studies, and mathematical modeling, we found that this interaction was mediated by peristromal niches that protected therapy-sensitive tumor cells. Specifically, by limiting tumor regression, the therapy- induced expansion of resistant cells limited the loss of protective peristromal niches, while the subsequent resumption of tumor growth created new peristromal niches capable of supporting the survival and proliferation of therapy-sensitive cells. While this niche-mediated interaction had only a marginal impact on the transition from remission to relapse, enhanced survival of therapy-sensitive cells potentiated their ability to adapt to ALKi, leading to a higher diversity of resistance phenotypes. In summary, our study has revealed a new type of indirect, niche-mediated ecological interaction between therapy-resistant and therapy-sensitive cells. The rapid expansion of rare pre-existent resistant cells and fast transition to relapse challenge a common assumption of the pre-existence of therapy resistance. Finally, our results highlight the essentiality of TME considerations in understanding the evolutionary dynamic underlying the development of therapy resistance.
Citation Format: Mark Robertson-Tessi, Bina Desai, Tatiana Miti, Pragya Kumar, Sagnik Yarlagadda, Rishi Shah, Robert Vander Velde, Daria Miroshnychenko, David Basanta, Alexander Anderson, Andriy Marusyk. Therapy-protective peristromal niches mediate positive ecological interaction between therapy-sensitive and therapy-resistant cells, altering the evolutionary dynamics of acquired targeted therapy resistance in lung cancers [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr B008.